VAERS 2021 Database www.vaers.hhs.gov

Main Page | All 2021 Deaths | Videos
VAERS Updated: 11/12/2021
** VAERS DATABASE Last updated: November 12, 2021**
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Manufacturers

Total Manufacturer
199,106MODERNA
36,710JANSSEN
5,381PFIZER\BIONTECH
2,555GLAXOSMITHKLINE BIOLOGICALS
1,469UNKNOWN MANUFACTURER
897MERCK & CO. INC.
627SEQIRUS, INC.
112DYNAVAX TECHNOLOGIES CORPORATION
91SANOFI PASTEUR
75NOVARTIS VACCINES AND DIAGNOSTICS
40EMERGENT BIOSOLUTIONS
14PAXVAX
12TEVA PHARMACEUTICALS
12PROTEIN SCIENCES CORPORATION
9PFIZER\WYETH
4BERNA BIOTECH, LTD.
4SMITHKLINE BEECHAM
3INTERCELL AG
1MEDIMMUNE VACCINES, INC.
1CSL LIMITED

COVID19 Lot Number

VAX LOT Total
2S9CL7,949
7,473
2,547
1,506
1,187
1,051
1,049
s0294561,043
866
IMM209861
816
UT7065MA766
657
579
U62828AA563
557
538
U6737AA516
515
S034636506
4F472471
458
P100253275449
444
276563436
429
418
4BH32414
MENVEO404
PP9L5362
UJ446AA337
319
306
290
271
49TM3270
R1B252M253
4F472179
933622147
C5763AA144
CW3116134
3Y7NL126
UNK114
113
ARBA141A105
104
103
96
300057A90
79
1F4EB73
R1B743M62
56
UJ090AA55
51
UH894AB46
45
UNK44
UNK42
42
EJ168638
Unknown36
35
34
32
32
26
el128424
24
A115A22
22
EN620222
21
UNK20
20
19
Z127A19
19
17
JEV18K95E15
12
111798PI12
10
A739088
No batch number8
3333324181078
6
6
TAR356
5
5
U6935AA5
UNK5
4
unknown4
3
2
55RB72
2
2
2
2
2
U7124AA2
JEV18A68E2
2
ABYB05BA1
1
1
1
1
AMVA436A1
1
1
TJ3521
A130A; VIS give1
1
U7140BB1
1
1
SP UP016AA1
1
1808P08802/ESV01
037K20A300,947
EL1284288,578
57,766
1,432

Incidents per State

State Total
82,750
CA62,821
FL38,209
TX36,512
NY34,921
PA23,646
IN23,622
IL20,597
MI19,590
OH19,426
NJ18,413
NC16,769
GA15,932
WA15,351
VA15,234
MA14,876
AZ14,206
MN12,940
MD12,656
CO11,908
WI11,425
MO10,240
TN9,685
OR8,768
KY8,437
CT8,300
SC6,700
OK6,293
AL5,692
LA5,025
IA4,825
KS4,821
UT4,637
NV4,374
NM3,967
AR3,807
ME3,161
NH3,096
NE2,918
MS2,859
ID2,785
WV2,469
HI2,459
PR2,417
MT2,414
RI2,076
DE1,868
AK1,830
VT1,734
DC1,715
ND1,388
SD1,269
WY866
GU118
VI69
AS47
MP29
MH8
XB6
FM4
QM3
XV2
XL1

ID: 1515307
Sex: F
Age: 22
State:

Vax Date: 07/22/2021
Onset Date: 07/27/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: stuffy nose, congestion, cough and tightness in chest

Other Meds:

Current Illness:

ID: 1515308
Sex: F
Age: 41
State: IA

Vax Date: 01/04/2021
Onset Date: 07/14/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: AST 101 on 7/22/2021; repeated at 104 on 7/28/2021 ALT 162 on 7/22/2021; repeated at 196 on 7/28/2021; Liver ultrasound on 7/27/2021 normal. Started taking vitamin supplements one month prior to event. No other known causes of liver dysfunction.

Allergies: sulfa, avocado; gluten and dairy intolerance

Symptom List: Anxiety, Dyspnoea

Symptoms: Abnormal liver function as noted during routine annual physical.

Other Meds: lexapro birth control pill OTC Calcium OTC Vitamin D OTC Vitamin B12

Current Illness:

ID: 1515309
Sex: F
Age: 42
State: AL

Vax Date: 07/24/2021
Onset Date: 07/24/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: n/a

Symptom List: Chest discomfort, Dysphagia, Pain in extremity, Visual impairment

Symptoms: slight pain at injection site severe headache low grade temp body aches chills upset stomach

Other Meds: n/a

Current Illness: n/a

ID: 1515310
Sex: F
Age: 41
State: NC

Vax Date: 04/30/2021
Onset Date: 07/23/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data: Walgreens covid test july 26 9:45am rapid result positive

Allergies: Ampicillin

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Vomiting nausea chest congestion cough. MdLive dr called 3rd day of symptoms. Prescribed ondansetron for nausea methylprednisolone dospac and azithromycin 250mg tablets 6 pak. Said suspected breakthrough covid & to test. Tested positive for covid 4th symptom day and continued isolation. Today is 1 week from symptom start and feeling much better.

Other Meds: Women's multivitamins, St John's Wart

Current Illness:

ID: 1515311
Sex: F
Age: 58
State: CA

Vax Date: 04/13/2021
Onset Date: 05/01/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: X-ray on 9 July 2021

Allergies: none

Symptom List: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Muscle pain that worsens with use of arm

Other Meds: Vitamin D, Vitamin B complex

Current Illness: none

ID: 1515312
Sex: M
Age: 27
State: CA

Vax Date: 07/09/2021
Onset Date: 07/18/2021
Rec V Date: 07/30/2021
Hospital: Y

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: -7/27/21: Enteric Campylobacter PCR positive

Allergies: No Known Drug Allergies

Symptom List: Chills, Confusional state, Eye inflammation, Headache, Laboratory test

Symptoms: Received Moderna Vaccine (1st dose) on 7/9/21. On 7/15/21, patient experienced GI symptoms including nausea, vomiting, diarrhea for 3 days. He also developed URI symptoms around this time. He was seen in urgent care clinic and diagnoseed with URI/gastroenteritis. On 7/18/21, he developed weakness which started in his feet and began to ascend. He went to hospital and was admitted. By 7/20/21, his weakness progressed and he needed intubation. On 7/23/21, he was transferred to Hospital and diagnosed with Guillain-Barre syndrome and plasmapheresis was initiated. He was diagnosed with Campylobacter based on enteric PCR result from 7/27/21. Infectious Diseases and Neurology were consulted and Guillian-Barre thought to be secondary to Campylobacter (secondary to autoimmune response in setting of molecular mimicry in setting of a Campylobacter infection)

Other Meds: Unknown

Current Illness: None

ID: 1515313
Sex: M
Age: 79
State:

Vax Date: 06/15/2021
Onset Date: 07/15/2021
Rec V Date: 07/30/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: SARS CoV 2 PCR COVID19 positive on 7/22/21

Allergies: nkda

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: 7/22/2021: previously vaccinated with COVID-19 Pfizer vaccine on 5/25/2021 and 6/15/2021. Presents to ED with cough and shortness of breath, fevers. and tested positive for COVID-19. Diagnosed with acute hypoxic respiratory failure, COVID-19 positive, COVID pneumonia 7/28/21: discharged.

Other Meds: simvastatin, ondansetron, omeprazole, Sudafed, fluticasone

Current Illness:

ID: 1515314
Sex: M
Age: 21
State:

Vax Date: 05/01/2021
Onset Date: 07/26/2021
Rec V Date: 07/30/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data: troponin 4000 now up to 15000 most recently

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Pt here with body aches, fever, chills, chest pain, treating for suspected pericarditis,

Other Meds:

Current Illness:

ID: 1515315
Sex: F
Age:
State: WA

Vax Date: 04/13/2021
Onset Date: 04/13/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: pain in joints and a rash on chest

Other Meds: vyvance

Current Illness:

ID: 1515316
Sex: M
Age: 42
State: MI

Vax Date: 07/18/2021
Onset Date: 07/23/2021
Rec V Date: 07/30/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: WBC count - 16,800 7/26/21 0336 COVID PCR negative 7/25/21 0145 CSF 7/25/21 05:13 - Glucose 62, Protein 115, RBC 5, WBC 20, VDRL negative, Cryptococcus antigen negative, Gram stain few WBC, no organisms, HSV 1/2 PCR negative, VZV PCR negative, CMV PCR negative, CSF culture no growth Blood culture No growth 7/25/21 05:24 Vitamin B12 7/27/21 16:40 - 197 pg/mL ANA 7/27/21 19:44 - negative TSH 07/27/21 16:40 - 2.18 Ammonia 7/27/21 16:40 - 57

Allergies: no known allergies

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient has no known past medical history other than COVID-19 pneumonia few months ago. He was treated with a regimen used in that country (details not available). About a week ago, patient got 1st dose of COVID-19 vaccine. Since then he has been having intermittent fevers, chills and has been progressive confused. No nausea, vomiting, recent travel, rash, joint pain or swelling. Currently not on any medications at home. On arrival, fever of 104.4, tachycardic, normal blood pressure Hospitalized and treated for suspected meningitis. CSF cultures came back negative for infectious process. Mental status, fever, improved over the course of 2-3 days. Infectious disease and Neurology evaluated the patient. Unclear etiology of symptoms, but given the recent dose of Pfizer vaccine, it possibly could be related to vaccine. Patient is now improving, generally weak but otherwise recovered and will be discharged from the hospital to home.

Other Meds: albuterol inhaler, tylenol

Current Illness: COVID pneumonia

ID: 1515317
Sex: F
Age: 53
State: AZ

Vax Date: 07/27/2021
Onset Date: 07/29/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: I did not have any related to this incident.

Allergies: KNA

Symptom List: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: Day 1-2 sore arm to where I could not move it well. Day 3-4 dizziness waking me up at night, also, during day. Day 3-4 Brain Fog( hard to stay focused. Or feels like I?m dreaming.

Other Meds: Xanax .5 2 Tylenol 500 mg

Current Illness: No

ID: 1515318
Sex: F
Age: 46
State: OK

Vax Date: 02/08/2021
Onset Date: 02/11/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data: No tests done. Doctor looked at rash via video conference (ice storm prevented in person visit) and diagnosed shingles.

Allergies: Shellfish, duracef, medrol, flecanaide

Symptom List: Rash, Urticaria

Symptoms: Fever, headache, exceptionally sore arm, rash from shoulder to elbow, and development of shingles rash within 72 hours of administration of the Covid19 vaccine

Other Meds:

Current Illness:

ID: 1515319
Sex: M
Age: 63
State: OH

Vax Date: 03/06/2021
Onset Date: 03/20/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Yes. July 3rd 2021- Ohio health Ear Nose and Throat physicians-

Allergies: Tramadol

Symptom List: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Inflammation of the middle ear, hearing loss described by a doctor as possible tinnitus.

Other Meds: Aspirine and Atorvastatin due to a previous heart surgery.

Current Illness: None.

ID: 1515320
Sex: F
Age: 54
State: IN

Vax Date: 07/28/2021
Onset Date: 07/29/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: None

Allergies: None

Symptom List: Dyspnoea, Fatigue, Feeling abnormal, Head discomfort, Headache

Symptoms: None stated.

Other Meds: Amlodipine, Montuklast, Sudafed, Zyrtec, Vitamin D, IASO Tea

Current Illness: None

ID: 1515321
Sex: F
Age: 47
State: NC

Vax Date: 01/29/2021
Onset Date: 01/29/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: none

Allergies: None

Symptom List: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: Day one: rash on chest and back, left side of face tingling that was transient/intermittent; day 2/about 16 hours after the vaccine: severe abdominal pain and nausea x 17hours with inability to get out of bed or tolerate any po's, not even ice; headache (as expected) x 18hrs, 48hrs later fatigue only with dizziness; day 3 after vaccine: moderate consistent vertigo x next 5 days through Friday February 5th, hypertension with BP 169/92 and range of 160's/90's x 3; right side face tingling, right eye tingling or unlcear vision and right side of mouth/lip tingling with swelling feeling but not visible; day 3 or 72 hours after vaccine I had a sudden onset break out in cold sweats, lightheadedness, nausea and inability to concentrate x 60 minutes or more without any exertion, sitting did not relieve sensation of impending doom or incoherence, slowly improved after 60 minutes to return to vertigo and right upper body numb tingling sensations from eye to finger tips. Full 7 days of feeling "unwell" and not safe.

Other Meds: Zyrtec

Current Illness: None

ID: 1515322
Sex: F
Age: 56
State: MA

Vax Date: 07/27/2021
Onset Date: 07/27/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies: Erythromycin and possibly Bactrim

Symptom List: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Moderna COVID-19 Vaccine EUA

Other Meds: Vitamin D3, Folic Acid and B-12

Current Illness: None

ID: 1515323
Sex: F
Age: 31
State: CA

Vax Date: 12/21/2020
Onset Date: 01/22/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data: TSH results, reference normal range 0.358-3.800: 1/22/21 = 0.1500 low 2/5/21 = 0.034 low 3/10/21 = <0.005 low 4/9/21 = 0.009 low 6/11/21 = 3.040 normal 7/16/21 = 2.770 normal

Allergies:

Symptom List: SARS-CoV-2 antibody test, SARS-CoV-2 test negative

Symptoms: I am a healthcare worker and received my Pfizer COVID vaccines on 12/21/20 and 1/12/21. I had a routine annual primary care visit on 1/22/21 in which I obtained labs. For the past few years, my thyroid panel had always been within normal limits, however, this time my TSH was significantly out of range (low) and T4/T3 normal. We repeated thyroid labs again in two weeks on 2/5/21 to be sure, and my TSH was even lower (T4/T3 normal). I was symptomatic (fatigued more than usual) and was referred to an endocrinologist. At the endocrinologist visit, upon discussion of my history, physical exam, labs, and no recent viral illnesses, it was diagnosed that I had subclinical hyperthyroidism, due to thyroiditis, possibly due to the COVID vaccine. Treatment of thyroiditis is only supportive care to manage symptoms, but I had to let the thyroiditis run its course, in which I would go through a hyperthyroid phase, euthyroid phase, hypothyroid phase, then back to euthyroid. I started obtaining a monthly thyroid panel to monitor labs for the appropriate course of thyroiditis, and remained subclinical hyperthyroid for 4 months (TSH low, T4/T3 normal). My labs are finally back to normal/recovered per my endocrinologist as of 7/16/21, and I will continue with every 3 month monitoring for now. The facility I listed in this report is not the location where I received the vaccine. The listed facility is my endocriniologists' office. I received the vaccine at work.

Other Meds:

Current Illness:

ID: 1515325
Sex: F
Age: 30
State: CA

Vax Date: 07/10/2021
Onset Date: 07/14/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: HIBV
Manufacturer: MERCK & CO. INC.
Vax Name: HIB (PEDVAXHIB)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data: On July 28 I had to go to the emergency room at hospital due to the intense pain and the appearance of the bruises, a Rheumatology Specialist observed me, they indicate that the x-ray results came out fine, general exam did too, and I am still waiting for more results

Allergies: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Third day after the vaccine by 7 at two mid night, Saturation was 88 for about an hour, then my muscles start to ache, stopping making movements as my wrist swelled. I could not close my hands, the pain would move to different parts of my body, when it was on my leg I started to limp. I can't lift my arms, I can't sleep because of the pain. 3 days ago, I noticed bruises all over my body they hurt. I'm not the young woman I was before, I'm totally inefficient, I can't do anything on my own, I wasn't like this before.

Other Meds: None

Current Illness: None

ID: 1515326
Sex: F
Age: 47
State: MN

Vax Date: 07/05/2021
Onset Date: 07/28/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: PNC13
Manufacturer: PFIZER\WYETH
Vax Name: PNEUMO (PREVNAR13)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: EE TESTED POSITIVE TO COVID

Other Meds:

Current Illness:

ID: 1515327
Sex: F
Age: 45
State: NY

Vax Date: 07/30/2021
Onset Date: 07/30/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: RV1
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: ROTAVIRUS (ROTARIX)
Lot:
Dose Series: 1
Vax Route: PO
Vax Site: MO

Lab Data: labs sent, ekg

Allergies: penicillin

Symptom List: Blood pressure increased, Chest discomfort, Heart rate increased

Symptoms: Patient developed nausea, vomiting and headache after vaccine. Patient was given steroids, benadry, pepcid, with improvement of symptoms

Other Meds: none

Current Illness: none

ID: 1515328
Sex: F
Age: 47
State: TX

Vax Date: 07/30/2021
Onset Date: 07/30/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site erythema, Injection site pruritus, Injection site swelling, Lymph node pain, Lymphadenopathy

Symptoms: Patient has a history of syncope; vaccine was administered without incident. Pt was advised to wait 15 minutes in store. After 15 minutes, pt walked to vehicle and became unresponsive. Medical clinical staff responded to scene. Pt stated unable to get out of vehicle and into wheelchair to be evaluated inside. EMS was called.

Other Meds:

Current Illness:

ID: 1515329
Sex: F
Age: 19
State: NV

Vax Date: 07/19/2021
Onset Date: 07/26/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: NONE

Allergies: SULPHUR

Symptom List: Unevaluable event

Symptoms: RED RASH AT INJECTION SITE, INCREASED ITCHINESS, INCREASED SWELLING, INCREASED PAIN AT SITE.

Other Meds: ELISNET BIRTH CONTROL, LORATADINE, MONTELUKAST SODIUM , DOXYCYCLINE MONOHYDRATE

Current Illness: NONE

ID: 1515330
Sex: M
Age: 53
State:

Vax Date: 07/23/2021
Onset Date: 07/23/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: "Pt c/o severe dizziness at approximately 3:36PM. Received 1st dose MODERNA at 3:25PM. Pt was found laying on the floor, present with his spouse. Pt stated that he wanted to lay flat and brought himself to the floor. Pt was then transferred via W/C to triage area. Pt stated that he was experiencing dizziness, was placed on recliner chair. Offered and provided water. Pt denied experiencing any other abnormal symptoms. Per pt, has hx of vasovagal symptoms. On-site lead notified, NP notified. V/S taken: @3:30PM - BP - 109/66, HR - 65, RR - 18 Np provided further eval. Pt monitored for add'l 15 min, given OK to be released from clinic. V/S taken: @347PM - BP - 114/76, HR - 76 Pt verbalized improvement to sxs, stated OK to leave. ED precautions provided. Pt left, stable gait, accompanied by spouse. "

Other Meds:

Current Illness:

ID: 1515331
Sex: F
Age: 14
State: CA

Vax Date: 07/18/2021
Onset Date: 07/20/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Went to the Dr on 7/27. Suggested Magnesium. Went to the Dr again on 7/29. Suggested Motrin every 6 hours for 72 hours. Going to get bloodwork done 7/30.

Allergies: NONE

Symptom List: Injection site pain, Pain

Symptoms: Was lethargic and slight headache 24 hours after the second vaccine. Two days after developed a headache and felt nauseated. This has persisted and the headache worsened. It is not helped by motrin, tylenol or aleve. Night sweats. Sensitivity to light. Headache is keeping her from doing her normal routines. Mostly wants to lay down and rest. Went to lunch and while walking through the shopping center felt like she was going to faint.

Other Meds: Prozac 30mg ; Childrens multi vitamin

Current Illness: NONE

ID: 1515332
Sex: F
Age: 30
State: VA

Vax Date: 07/30/2021
Onset Date: 07/30/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: n/a

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Pt had a vasovagal syncope after getting COVID shot. pt passed out for a few seconds. Had pt lie down for 30 mins. pt states that she felt better after 30 mins.

Other Meds:

Current Illness:

ID: 1515333
Sex: F
Age: 30
State:

Vax Date: 12/23/2020
Onset Date: 07/26/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Arthralgia, Chills, Headache, Mobility decreased, Myalgia

Symptoms: COVID-19 infection despite being vaccinated 6 months prior

Other Meds:

Current Illness:

ID: 1515334
Sex: F
Age: 62
State: IL

Vax Date: 07/20/2021
Onset Date: 07/20/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: none

Allergies: Penicillin, Sulfa drugs, Ketek

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: 4:30pm tingling to lips. 5:30 pm tingling to cheeks, 5:45pm tingling to tongue. 5:51 Called to have Dr. paged. 6:03pm Dr. returned call and advised me to take 2 Benadryl and she would call in Prednisone 20mg daily for 5 days.. She further stated to go to ER should I begin to have issues breathing. 6:30pm while waiting for pharmacy to fill my prescription I took 2 more Benadryl on my own as it felt like I was breathing in fire.. At 7:58 my prescription was ready and my daughter picked it up. She delivered it to me and I took 1 Prednisone. Around 9:30pm slight red rash noted to my abdomen. 12 midnight tingling was resolved.

Other Meds: Lysine, Vitamin D, Calcium, Magnesium and Zinc Caplet, Align Probiotic

Current Illness: None

ID: 1515335
Sex: M
Age: 16
State: CA

Vax Date: 07/23/2021
Onset Date: 07/23/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Penicillin

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: COVID VACCINE CLINIC- Administered dose to pt with previous reaction to vaccine in general. Pt was laying down for administration. Pt stated he was feeling nauseated and felt as if he was going to pass out immediately after administering the dose, pt started sweating and looking pale. We provided water and juice for pt. Rapid Response team came and assessed pt, took vitals and determined pt was ok. Pt discharged and walked out without assistance accompanied by parent.

Other Meds:

Current Illness:

ID: 1515336
Sex: M
Age: 66
State: NJ

Vax Date: 02/03/2021
Onset Date: 02/06/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: None

Allergies: None

Symptom List: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: Vertigo (Severe Dizziness & Nausea for the better part of 8 days) started 2/06/2021 at 11:00 am

Other Meds: Atorvastin 10mg Losartan.hct 100-25 Finasteride 5mg Fish oil 4000 mg CoQ10 300mg Low Dose Aspirin 81 mg

Current Illness: None

ID: 1515337
Sex: M
Age: 61
State: KY

Vax Date: 03/05/2021
Onset Date: 07/19/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: Lost of taste and smell, Diarrhea

Other Meds:

Current Illness:

Date Died: 07/20/2021

ID: 1515338
Sex: F
Age: 89
State:

Vax Date: 04/05/2021
Onset Date: 07/08/2021
Rec V Date: 07/30/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: nkda

Symptom List: Injection site pain

Symptoms: 7/16/21: patient presented to ED with altered mental status. found to be PCR COVID-19 positive. Patient received J&J COVID-19 vaccine on 4/5/21. Diagnosed with septic shock secondary to bacteremia and UTI, acute hypoxic and hypercapnic resp failure requiring mechanical ventilation, resp metabolic acidosis, COVID-19 infection. 7/20/2021: Patient expired

Other Meds: aspirin, atorvastatin, diclofenac topical, losartan, multivitamin, omega-3 polyunsaturated fatty acids (Fish Oil oral capsule)

Current Illness:

ID: 1515339
Sex: M
Age: 96
State: MD

Vax Date: 03/09/2021
Onset Date: 04/21/2021
Rec V Date: 07/30/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: ended up having a stroke less than 1 month after having the stroke.

Other Meds: None

Current Illness: None

ID: 1515340
Sex: F
Age: 62
State: CO

Vax Date: 03/12/2021
Onset Date: 03/15/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: X-ray April 20, following a clinic visit in May, can't remember the date

Allergies: codeine, erythromycin

Symptom List: Chills, Dizziness, Nausea, Pain, Tachycardia

Symptoms: Within a couple of days (don't recall exactly) my right hand began to cramp in the palm, between 3rd and 4th fingers (counting thumb as #1). Pain was intense and radiated up into those 2 fingers. continued for months, and still happens occasionally. Sought X-ray and Occupational Therapy for it. much diminished after a couple of months, and improved with OT exercises. Also began to experience light headaches in the week after the first vaccine, which increased after the second dose on April 9. Continue to have light headaches 2-3 times a week lasting for several hours. Headaches were rare my entire life up til first vaccine.

Other Meds: Armour thyroid, Escitalopram, vitamin D, magnesium

Current Illness: none

ID: 1515341
Sex: F
Age: 65
State: NC

Vax Date: 07/19/2021
Onset Date: 07/22/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies: Morphine based products, anti seizure meds, NSAIDS, SSRI anti depressants, Soma, flexeril.

Symptom List: Tremor

Symptoms: Rash on neck, both forearms extending to thumb, both, underarms, severe itching and burning. Had video appointment with NP at Neurology the following Monday and she prescribed Benadryl every 4 hours, it got worse for several days and gets worse in sunlight but today is much better so have reduced Benadryl to every 8 hours.

Other Meds: Oxycodone 15 mg 4x daily, OxyCotin ER 15 mg 3x daily, 1 mg alprazolam up to 3x daily, estradiol patch once weekly, Premarin cream vaginally, tizidine muscle relaxant 1/2 pill when needed for back spasms

Current Illness: Trigeminal neuralgia, occipital neuralgia, fibromyalgia, complications from failed brain surgery, degenerative disc disease, TMJ:TMD with arthritis in jaw joints. I have been under care of pain management doctor since failed brain surgery in 2010.

ID: 1515342
Sex: F
Age: 51
State: WV

Vax Date: 07/09/2021
Onset Date: 07/09/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: I had bloodwork done and am going to the doctor today.

Allergies: None that aware of

Symptom List: Erythema, Pruritus

Symptoms: I felt a heaviness/weakness in both of my legs almost immediately. This lasted for about 48 hours then I felt better. Then 10 days later I started feeling shocks and weird pains in my legs off and on for 6 days. I then started feeling weakness in my legs. It has gotten worse now at 21 days out plus I feel a weakness in my arms as well. I also am having trouble sleeping and feel some shaking in my legs at night.

Other Meds: estrovan

Current Illness: None

ID: 1515343
Sex: F
Age: 0
State:

Vax Date: 07/22/2021
Onset Date: 07/22/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data:

Allergies:

Symptom List: Injection site erythema, Injection site induration, Injection site pruritus, Injection site swelling, Myalgia

Symptoms: slight fever

Other Meds:

Current Illness:

ID: 1515344
Sex: F
Age: 48
State: FL

Vax Date: 04/25/2021
Onset Date: 04/26/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies: None

Symptom List: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: Pain and sight of injection, extreme itching underneath the skin, huge rash left almost a complete square

Other Meds: Tylenol

Current Illness: None

ID: 1515345
Sex: F
Age: 66
State: TN

Vax Date: 03/06/2021
Onset Date: 07/22/2021
Rec V Date: 07/30/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: 7/22 HR 124, oxygen saturation 90%, LabsWBC 13.5, ABC pH 7.19, pCOX 66.5, PO2 Bicarb 26, Chest x ray ill-defined opacities in mid to lower lung zones. intubated due to seizure activity, hypercapnia and hypoxia.

Allergies: NKA

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Not aware of adverse event at time of vaccination. Hospitalized later

Other Meds: Unknown

Current Illness: Unknown

ID: 1515346
Sex: F
Age: 50
State: NC

Vax Date: 04/23/2021
Onset Date: 04/23/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: None yet

Allergies: suflfa drugs, constrast used in MRIs

Symptom List: Injection site erythema, Injection site pain, Injection site swelling

Symptoms: 20 minutes after the injection had numbing and mild swelling of lips, similar to my reaction toward sulfa drugs, but more mild. Too, had redness on cheeks, again, lar to my reaction toward sulfa drugs, but more mild. the day of the injection, had extreme pain in right arm, chills, mild fever, tiredness. this lasted for 3 days. the following week, after the injection, severe headaches began (1 to 2 weekly) combined with neck stiffness/pain in the back of my neck lasting several hours each day, sporadic warmth throughout my body, mild burning sensation in my lungs when inhaling strongly, but most severe is my extreme dizziness combined with nausea and brain fog. Dizziness last throughout the day, regardless of sitting, standing, walking, etc. I thought this may be related to my vestibular schwanoma; however, after doing Dr. recommended exercises that fixed dizziness previous, these had no effect. 3 months later (now 7/30), neck pain has decreased drastically but there is still some stiffness, headaches are very infrequent now (1 every other week), burning lung feeling has subsided to almost never (couple of times weekly when breathing deeply), body warmth has intensified however, I've difficulty sleeping throughout the night, dizziness continues but nausea is subsiding, and brain fog also lingers (I've the constant feeling of disconnectedness - I struggle to stay focused since my mind wonders).

Other Meds: Amlodipine (NORVASC) - 5 mg nightly for high blood pressure

Current Illness: None

ID: 1515347
Sex: M
Age: 11
State: TX

Vax Date: 07/26/2021
Onset Date: 07/26/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Chills, Feeling cold, Feeling hot, Myalgia, Pain

Symptoms: Patient received 1st dose of Pfizer Covid-19 dose at age 11 instead of 12 or older. Patient's mother states that patient did just fine with the dose and had no adverse reaction.

Other Meds:

Current Illness:

ID: 1515348
Sex: M
Age: 36
State: IL

Vax Date: 07/23/2021
Onset Date: 07/24/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: High level of fatigue and general body soreness which lasted about 2 days. Extremely sore and swollen throat as well as general congestion which has worsened over the course of 1 week

Other Meds:

Current Illness:

ID: 1515349
Sex: M
Age: 66
State: FL

Vax Date: 07/14/2021
Onset Date: 07/26/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 2
Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List: Abdominal pain upper, Abnormal behaviour, Adverse reaction, Anger, Asthma

Symptoms: Diagnosed with Covid July 29 2021

Other Meds:

Current Illness:

ID: 1515350
Sex: M
Age: 19
State: CT

Vax Date: 07/30/2021
Onset Date: 07/30/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: N/A

Allergies: NKDA

Symptom List: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: Patient received Janssen vaccine at 11:15 am. Patient was waiting for 15 minutes after vaccination when another customer said that he needed help. The patient called me over and said he was feeling nauseous and then vomited into a trash can. He was very pale, sweating and said he felt dizzy and nauseous and lightheaded. No signs of anaphylaxis/difficulty breathing or allergic reaction. I gave the patient some water and after 5-10 minutes he felt much better. Patient said that he "fainted" bus this was not directly observed. He stayed at the pharmacy for an additional 15-20 minutes and left after he felt better. Patient did mention he was very afraid of needles and nervous prior to vaccination.

Other Meds: Unknown

Current Illness: None

ID: 1515351
Sex: F
Age: 9
State: MT

Vax Date: 07/29/2021
Onset Date: 07/29/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: Patient receiving vaccine was 9 years old, only indicated down to 12 years old

Other Meds:

Current Illness:

ID: 1515352
Sex: F
Age: 28
State:

Vax Date: 07/29/2021
Onset Date: 07/29/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: none

Allergies: No known allergies

Symptom List: Vomiting

Symptoms: At approximately 1130, RN assisted patient to anti-gravity chair. RN reported patient started leaning on her when they were walking to the anti-gravity chair. RN and EMT assisted patient into anti-gravity chair. RN assessed patient. Patient was diaphoretic and pale. Patient stated she was "nervous about getting the vaccine". Patient reported previous episodes of fainting due to menstrual cramps. Patient denied itchiness, rashes, hives, difficulty swallowing, and difficulty breathing. At 1133, EMT assessed patient vital signs: blood pressure 105/65 mmHg and pulse 51 beats/minute. Patient reported eating in the morning. RN utilized breathing techniques with patient. At 1138, EMT assessed patient vital signs: blood pressure 124/76 mmHg and pulse 51 beats/minute. Patient stated she was "feeling better". At 1141, EMT reassessed patient vital signs: blood pressure 115/61 mmHg and pulse 55 beats/minute. At 1146, EMT reassessed patient vital signs: blood pressure 98/62 mmHg and pulse 61 beats/minute. Patient stated she felt "normal". Patient offered chips. Patient ate chips. At 1156, EMT reassessed patient vital signs: blood pressure 109/63 mmHg and pulse 63 beats/minute. Patient stated she felt "fine" and "normal". RN educated patient on signs/symptoms of when to seek emergency care, to follow up with primary care provider and to sign up on v-safe. Patient called grandmother to drive patient home. Patient waited for grandmother to arrive at facility. At 1215, patient left facility with unlabored respirations and steady gait.

Other Meds: No medications

Current Illness: none reported

ID: 1515353
Sex: M
Age: 65
State: ID

Vax Date: 03/01/2021
Onset Date: 03/04/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: None

Allergies: None

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Distorted/metallic taste. Food has very different negative taste even though smell is fine.

Other Meds: Atorvastatin, daliresp, brelenta, amalotipine, rinolezine, losartan

Current Illness: Heart and lung disease

ID: 1515354
Sex: F
Age: 57
State: TX

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Dust, mold, animals, and some foods, outdoor allergies

Symptom List: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: Whezzing, coughing and breathing troubles

Other Meds: vitamin D and Claritin

Current Illness:

ID: 1515355
Sex: F
Age: 59
State:

Vax Date: 03/05/2021
Onset Date: 07/12/2021
Rec V Date: 07/30/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: SARS CoV 2 PCR COVID19 positive on 7/19/2021

Allergies: nkda

Symptom List: Injection site swelling, Limb discomfort

Symptoms: 7/19/21: patient presents to ED with complaints of shortness of breath x 8 days, generalized body aches x3 days. tested positive for COVID-19 7 days prior. Reports having previously received the J&J COVID-19 vaccine in March (3/5/2021). Diagnosed with COVID-19 pneumonia and hypoxia. received remdesivir. 7/23/21: discharged

Other Meds: tramadol, Florastor oral cap, rosuvastatin, pantoprazole, onda

Current Illness:

ID: 1515356
Sex: M
Age: 78
State: FL

Vax Date: 07/28/2021
Onset Date: 07/29/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: N/A

Allergies: NO KNOWN

Symptom List: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: PATIENT FELT WEAK AND TIRED. HE SLEPT SEVERAL HOURS LATER THAN NORMAL. HE REPORTS MEMORY LOSS THAT HAS CONTINUED THROUGH 7/30/21

Other Meds: NO KNOWN

Current Illness: NO KNOWN

ID: 1515357
Sex: F
Age: 26
State: MA

Vax Date: 07/29/2021
Onset Date: 07/29/2021
Rec V Date: 07/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: NKA

Symptom List: Hot flush, Myalgia, Nausea, Tension headache

Symptoms: Patient was scheduled for second dose of Pfizer vaccine on 7/29/2021. Second dose of vaccine was given 6 days early. Second dose of vaccine was due to be given on 8/4/2021.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am