VAERS 2021 Database www.vaers.hhs.gov

Main Page | All 2021 Deaths | Videos
VAERS Updated: 10/01/2021
** VAERS DATABASE Last updated: October 1, 2021**
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Manufacturers

Total Manufacturer
187,133MODERNA
33,878JANSSEN
2,321PFIZER\BIONTECH
1,091GLAXOSMITHKLINE BIOLOGICALS
983UNKNOWN MANUFACTURER
363MERCK & CO. INC.
229SEQIRUS, INC.
45DYNAVAX TECHNOLOGIES CORPORATION
41NOVARTIS VACCINES AND DIAGNOSTICS
29SANOFI PASTEUR
18EMERGENT BIOSOLUTIONS
8PAXVAX
7TEVA PHARMACEUTICALS
4PFIZER\WYETH
3BERNA BIOTECH, LTD.
2SMITHKLINE BEECHAM
2INTERCELL AG
2PROTEIN SCIENCES CORPORATION
1CSL LIMITED

Incidents per State

State Total
77,548
AK1,869
AL5,581
AR3,688
AS47
AZ14,288
CA61,984
CO11,665
CT8,149
DC1,663
DE1,807
FL37,749
FM5
GA15,058
GU120
HI2,453
IA4,625
ID2,692
IL20,334
IN24,007
KS4,615
KY7,696
LA4,887
MA14,654
MD12,514
ME3,129
MH11
MI18,739
MN12,528
MO9,710
MP29
MS2,790
MT2,375
NC16,368
ND1,356
NE2,880
NH3,100
NJ17,634
NM3,916
NV4,239
NY34,355
OH19,081
OK6,195
OR8,636
PA23,083
PR2,370
QM2
RI2,088
SC6,411
SD1,212
TN9,131
TX35,174
UT4,273
VA14,937
VI64
VT1,676
WA14,909
WI11,259
WV2,388
WY861
XB5
XL1
XV2

ID: 1459740
Sex: F
Age: 39
State: CT

Vax Date: 07/06/2021
Onset Date: 07/07/2021
Rec V Date: 07/09/2021
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: Penicillin and sulfa drugs

Symptom List: Dysphagia, Epiglottitis

Symptoms: Previously report metallic taste in mouth/altered sense of taste. Additionally reactions to report: sharp chest pain (resolved after several hours), skin peeling, loss of appetite, drowsiness

Other Meds: None

Current Illness: None

ID: 1459741
Sex: M
Age: 58
State: CA

Vax Date: 07/01/2021
Onset Date: 07/02/2021
Rec V Date: 07/09/2021
Hospital:

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

Lab Data:

Allergies: Shellfish allergy

Symptom List: Anxiety, Dyspnoea

Symptoms: Developed chest pain, shortness of breath, nausea, vomiting within 24 hours of vaccine. Evaluated in the ER- lab work up, CXR, CT PE negative. Symptoms resolved prior to ER discharge.

Other Meds:

Current Illness:

ID: 1459742
Sex: F
Age: 46
State: TX

Vax Date: 03/29/2021
Onset Date: 04/05/2021
Rec V Date: 07/09/2021
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: penicillin, sulfa drugs, hydrocodone

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

Symptoms: On 4/5 I had discharge out of my left ear. On 4/9 I had to see an after hours doctor who said there was an abscess. There was a hole and pus, and blood were coming out. The left side of my neck was swollen. I also had pain in my neck and behind both my ears and inside my ears. On 4/13 I had to go to an after hours care because I had sudden onset nerve pain in my left lower back. It felt like sciatica. My pain level was a 9.5/10. I was given a cortisone shot which helped. On 4/16 I went to an ENT where I did an CT scan on my left side because my neck was still was still swollen. He did say my ear was healing. I was also sent to physical therapy which helped a little. On 4/18, I noticed that my right wrist carpal tunnel flared up. My right wrist became enflamed and my right upper arm began hurting. The lower back pain also became enflamed. The left side of my face hurt and inside my left ear, around the cartilage I had another sore. I also was experiencing a dry mouth.

Other Meds: Magnesium (at night), ondansetron (maybe 1x week), multivitamin (ritual),

Current Illness: No

ID: 1459743
Sex: M
Age: 67
State: VA

Vax Date: 04/24/2021
Onset Date: 04/24/2021
Rec V Date: 07/09/2021
Hospital:

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

Lab Data:

Allergies: None.

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Numbness, cramps in left arm, elevated blood pressure, and muscle aches.

Other Meds: None.

Current Illness:

ID: 1459744
Sex: F
Age: 51
State: DE

Vax Date: 06/18/2021
Onset Date: 06/19/2021
Rec V Date: 07/09/2021
Hospital:

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

Lab Data:

Allergies: Sulfa

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

Symptoms: 6/19/21 - 6/27/21: fatigue, muscle and joint aches 6/25/21 - 6/27/21: slight intermittent pain in upper left abdomen. 6/27/21: very short chest pain 6/27/21 - 7/4/21: swollen lymph node in left thigh 7/4/21: sudden pain in center of upper abdomen that radiated to my back along with vomiting. Diagnosed with acute pancreatitis with a blood lipase level greater than 30,000. After testing and assessment, the medical team could not find a cause and advised me to report my case.

Other Meds: Lexapro 20 mg Omeprazole 40 mg Clarinex Singulair

Current Illness: None

ID: 1459745
Sex: F
Age: 45
State: OR

Vax Date: 07/06/2021
Onset Date: 07/09/2021
Rec V Date: 07/09/2021
Hospital:

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:

Allergies: Cucumber, strawberries, blackberries, watermelon, cantaloupe, peaches, avocados, almonds, plums, latex and bleach

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

Symptoms: I woke up with tingling on my fingers and legs. Light pressure on my left chest. I went back to sleep and chest pressure was gone but I still have tingling on my arm and also a little numb on my cheeks.

Other Meds:

Current Illness:

ID: 1459747
Sex: M
Age: 70
State: MI

Vax Date: 06/23/2021
Onset Date: 06/24/2021
Rec V Date: 07/09/2021
Hospital:

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

Lab Data:

Allergies: NKA

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: fever on day 1 and 2 after vaccine 99.5 and 102.5

Other Meds: GuaiFENesin Liquid 100 MG/5ML Give 10 ml via PEG-Tube Famotidine Tablet 20 MG aspirin 81 mg 1 x day

Current Illness: n/a

ID: 1459748
Sex: F
Age: 42
State: GA

Vax Date: 01/16/2021
Onset Date: 04/22/2021
Rec V Date: 07/09/2021
Hospital:

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

Lab Data:

Allergies: ALLERGIES: Codeine-guaifenesin

Symptom List: Pharyngeal swelling

Symptoms: Patient was diagnosed on 4/22/21 SARS-COV-19 after completing the series of vaccinations.

Other Meds: Albuterol 2.5 mg /3 mL (0.083 %) Neb Soln 2.5 mg (PROVENTIL/VENTOLIN) Medication Sig Dispense Refill ? Labetalol (NORMODYNE/TRANDATE) 100 mg Oral Tab Take 1 tablet by mouth 2 times a day for high blood pressure 180 tablet 0 ? Albuterol (PRO

Current Illness: Diagnosis Resolved RENAL CALCULUS Create Overview Change Dx Resolve PREDIABETES Create Overview Change Dx Resolve HX OF ANEMIA Create Overview Change Dx Resolve ADENOMA, LEFT ADRENAL GLAND

ID: 1459749
Sex: F
Age: 61
State: AR

Vax Date: 07/07/2021
Onset Date: 07/08/2021
Rec V Date: 07/09/2021
Hospital:

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

Lab Data:

Allergies: latex, codeine, iodides, penicillin, zestoretic

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: The patient reports swelling , redness, and pain in the injection arm. I observed the patients arm and she has swelling above the elbow to the shoulder with redness. The patient reports having taken Tylenol, Benadryl, and applying cool compresses.

Other Meds: amlodipine, escitalopram, losartan, topiramate, hydrochlorothiazide, aspirin 81mg, pantoprazole, Tylenol, vitamin c, flaxseed oil, apple cider vinegar, symbicort, albuterol hfa

Current Illness: n/a

ID: 1459750
Sex: F
Age: 25
State: CA

Vax Date: 04/26/2021
Onset Date: 05/10/2021
Rec V Date: 07/09/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Diarrhoea, Nasal congestion

Symptoms: I developed a small lesion on my neck, which was noticed about a week after my second dose. After 15 days of tracking the lesion, I noticed it tripled in size and it strongly resembled ringworm. I treated it with anti-fungal cream, but the lesion seemed to get bigger and significantly worse. I noticed more lesions on my right breast after about 5 weeks. Everyday, I would discover more lesions on my body, ranging from my stomach, chest, face, neck, back, and butt. I stopped using the anti-fungal cream at this time. A dermatologist diagnosed me with pityriasis rosea. I was vaccinated with my second dose in late April, the first lesion was discovered in early May and now it is early July. None of the lesions have healed and I still notice new lesions everyday.

Other Meds: None

Current Illness: None

ID: 1459751
Sex: M
Age: 74
State: NH

Vax Date: 04/07/2021
Onset Date: 04/10/2021
Rec V Date: 07/09/2021
Hospital:

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

Lab Data:

Allergies: dust, mold

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

Symptoms: left arm extremely sore and stiff, generally unable to raise the arm higher than 45 degrees. Constant pain, numbness down the back of the arm thru the hand and fingers. The shoulder has been treated with prednisone and a steroid injection, neither worked. I am presently in physical therapy with very lim9ited success.

Other Meds: Ramipril, hydochlothiazide, metformin, simvastatin, lantus solostar, aspirin, magnesium, fexofenadine, vitamin c, multivitamin, dilacor, vitamin b-12

Current Illness: none

ID: 1459752
Sex: M
Age: 55
State: CA

Vax Date: 04/23/2021
Onset Date: 04/24/2021
Rec V Date: 07/09/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Rash, Urticaria

Symptoms: Woke up morning after receiving vaccine (about 20 hours after vaccination) with my head feeling dense and heavy. Not a painful headache, but a strange fullness as if my head was solid. I took 2 Advil and went about my morning - yard work, cleaning, etc. The symptoms went away on their own approximately 4 hours later.

Other Meds: None

Current Illness: None

ID: 1459753
Sex: F
Age: 58
State:

Vax Date: 07/09/2021
Onset Date: 07/09/2021
Rec V Date: 07/09/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Immediately after administration of the Pfizer vaccine, patient complained of rapid heart rate, pulse was rapid. Skin was warm and dry. Nurse initiated after five minutes patient report improved breathing, BP 150/100. Nurse team recommended continued observation and if condition changes, report to ER. Patient elected to remain at the Covid Clinic. After twenty minutes of continued observation, patient elected to go to ER for assessment and continued observation. Patient transported to ER by RN via wheel chair and report given to Triage Nurse.

Other Meds:

Current Illness:

ID: 1459754
Sex: M
Age: 87
State: PA

Vax Date: 06/29/2021
Onset Date: 06/29/2021
Rec V Date: 07/09/2021
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:

Allergies:

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

Symptoms: Patient received an inadvertent third dose of the Pfizer COVID Vaccine. Second dose was received on 1/16/2021. No adverse events noted after the third dose administration.

Other Meds:

Current Illness:

ID: 1459755
Sex: M
Age: 48
State: VA

Vax Date: 04/16/2021
Onset Date: 06/15/2021
Rec V Date: 07/09/2021
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:

Allergies: Amoxicillin

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

Symptoms: Two months after receiving my second dose of the Pfizer COVID19 vaccine, I suffered a stroke. Symptoms included vision loss, complete left-side paralysis, loss of cognition, and loss of consciousness. Within ~15 minutes of the event, I was transported by ambulance to the nearest hospital and provided care. Within 3 hours of the event, I received tPA (Tissue Plasminogen Activator), and recovered fully.

Other Meds: Olmesartan (40mg)

Current Illness: None

Date Died: 05/02/2021

ID: 1459756
Sex: F
Age: 55
State: MO

Vax Date: 04/10/2021
Onset Date: 04/21/2021
Rec V Date: 07/09/2021
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: Unknown

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

Symptoms: Pericarditis, large vessel vasculitis, death

Other Meds: Unknown

Current Illness:

ID: 1459757
Sex: M
Age: 54
State: NY

Vax Date: 06/11/2021
Onset Date: 06/14/2021
Rec V Date: 07/09/2021
Hospital:

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

Lab Data:

Allergies: No

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

Symptoms: I had some dull pain immediately following the vaccination that lasted three days. One the fourth day, I woke up with serious arm pain. By day five, I could barely move my arm. Raising my left arm above my waist would cause excruciating pain and I had to walk around with my arm at my side for over a week. Putting on or taking off a shirt was nearly impossible. I am not the type of person to complain about a little pain. I have undergone foot surgery with no anesthesia and don't need any local anesthetic when I get a cavity filled at the dentist, but this was really bad. I had some pain relievers left over from nose surgery years before and I had to take those just to get to sleep. It is now almost a month later, and my arm still hurts around the crease of my shoulder during physical activity. If I had a job that involved the muscle in my left shoulder, I would not have been able to do my work.

Other Meds: Just multi-vitamins

Current Illness: None

ID: 1459758
Sex: F
Age: 43
State: GA

Vax Date: 01/16/2021
Onset Date: 04/15/2021
Rec V Date: 07/09/2021
Hospital:

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

Lab Data:

Allergies: ? Iodine [Ivp Dye, Iodine Containing] Asthma and/or Shortness of Breath ? Shrimp Agent Asthma and/or Shortness of Breath ? Amoxicillin Nausea and/or Vomiting ? Gluten

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Member diagnosed with SARS-COV-19 on 4/15/2021 after being fully vaccinated.

Other Meds: ? tretinoin (RETIN-A) 0.05 % Top Crea ? Doxycycline Monohydrate (AVIDOXY) 100 mg Oral Tab ? Topiramate (TOPAMAX) 50 mg Oral Tab ? Clindamycin Phosphate (CLEOCIN) 1 % Top Soln ? Diclofenac Sodium (VOLTAREN) 1 % Top Gel ? Biotin 300 mcg Oral

Current Illness: ? SUBCLINICAL HYPERTHYROIDISM [E05.90] 10/15/2019 ? MIGRAINE [G43.909] 07/16/2018 ? LEFT PAROTID GLAND MASS [K11.9] 07/16/2018 Repeat CT 1/19 ? MITRAL VALVE REGURGITATION [I34.0] 12/26/2017 ? AORTIC VALVE REGURGITATION [I35.1] 12/26/2017 Not noted on 5/19 echo ? ORAL CONTRACEPTIVE PILL SURVEILLANCE [Z30.41] 12/26/2017

ID: 1459759
Sex: F
Age: 12
State: IN

Vax Date: 06/04/2021
Onset Date: 06/29/2021
Rec V Date: 07/09/2021
Hospital:

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

Lab Data:

Allergies: Walnuts, Pecans, Citrus

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Ruptured Ovarian Cyst, abdominal pain, fever on 6/29/2021

Other Meds: Prednisone, Ibuprofen

Current Illness: None

ID: 1459760
Sex: F
Age: 86
State: MI

Vax Date: 06/23/2021
Onset Date: 06/24/2021
Rec V Date: 07/09/2021
Hospital:

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

Lab Data:

Allergies: ASA

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

Symptoms: temp on 6/24/21 99.9 and on 6/25/21 100.1

Other Meds: metformin, lispro insulin, atorvastatin, metoprolol, plavix

Current Illness: n/a

ID: 1459761
Sex: M
Age: 13
State:

Vax Date: 07/09/2021
Onset Date: 07/09/2021
Rec V Date: 07/09/2021
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: 5-10 minutes following administration of Pfizer Covid vaccine, patient ( 13 year old) complained of light headedness and the inability to hear with ringing in his ears and diaphoretic. Patient did not have any complaints of difficulty breathing. Patient became pale and lowered to floor with feet elevated. Blood pressure taken by RN at that 9:30 was 89/60 with HR at 60. Nurse was initiated and arrived at the clinic for assessment. Observation was continued with the ER team present. Blood pressure at 9:36 was 108/60 and then again at 9/40 was 100/68. Patient did state his symptoms improved and was transported to the ER via the ER team for continued monitoring with mother and his sister. Report given to ER Nurse.

Other Meds:

Current Illness:

ID: 1459762
Sex: M
Age: 36
State: OH

Vax Date: 06/09/2021
Onset Date: 06/16/2021
Rec V Date: 07/09/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Unevaluable event

Symptoms: Bell?s palsy

Other Meds: N/A

Current Illness: Gout Arthritis

ID: 1459763
Sex: F
Age: 74
State: GA

Vax Date: 05/22/2021
Onset Date: 05/22/2021
Rec V Date: 07/09/2021
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: adhesive tape

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

Symptoms: Dizziness

Other Meds: hydroCHLOROthiazide (ESIDRIX/HYDRODIURIL) 25 mg Oral Tab Take 1 tablet by mouth daily for blood pressure 90 2

Current Illness: ? FEMALE BREAST CANCER, UNSPECIFIED SITE OF RIGHT BREAST [C50.911] 01/12/2018 Breast Cancer Treatment Summary Date of Diagnosis: 1/4/18. Site: right breast. How found? Screening mammogram. Tumor Type: Infiltrative/Invasive. Nodes Positive/Total Removed: 0/4 - Largest nodal deposit: not applicable, Extracapsular nodal extension: not applicable. Staging: Completed Pathological Staging: Stage: 1a T1c N0 M0 Grade: 1. Clinical Staging:Stage: 1a T1 N0 M0 Grade: low. ER: 97%, PR: 43%, Her2: +1 FISH: , Ki67 2%, Oncotype. Genetic testing: N/A. Surgery: Completed Date: 2/23/18, Type: Right Lumpectomy w/ image guidance + SLNB. Reconstruction: N/A. Chemotherapy: N/A Consult Date: 4/17/18 Consult Date: 1/24/18 Radiation: Completed Consult Date: 4/23/18 Consult Date: 1/24/18 Type/Area Total Dose Total Days Comment Right Breast 5/3/18-6/2018 Hormonal Therapy: In Progress Medication Start End Comment Armidex 5/2018 ? PREDIABETES [R73.03] 11/28/2016 ? PURE HYPERCHOLESTEROLEMIA [E78.00] 08/30/2013 ? ABDOMINAL PAIN [R10.9] 04/04/2013 ? BILAT CATARACT [H26.9] 03/25/2013 ? BILAT VITREOUS FLASHES [H53.19] 03/25/2013 ? ADJUSTMENT DISORDER [F43.20] 09/13/2012 ? PALPITATIONS [R00.2] 01/04/2011 ? OSTEOARTHRITIS OF BILAT KNEES [M17.0] 10/07/2010 ? ANEMIA [D64.9] 10/07/2010 ? OBESITY, BMI 30-34.9, ADULT [E66.9] 08/25/2010 ? HTN (HYPERTENSION) [I10] 02/02/2006 ? GERD (GASTROESOPHAGEAL REFLUX DISEASE) [K21.9] 02/02/2006 ? ACQUIRED HYPOTHYROIDISM [E03.9] 02/02/2006

ID: 1459764
Sex: M
Age: 16
State: TX

Vax Date: 07/08/2021
Onset Date: 07/09/2021
Rec V Date: 07/09/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Injection site pain, Pain

Symptoms: Low grade fever

Other Meds: None

Current Illness: None

ID: 1459765
Sex: F
Age: 62
State: TN

Vax Date: 04/30/2021
Onset Date: 05/01/2021
Rec V Date: 07/09/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: I have tried to report this several times to this site, doctor, vaccine provider etc without success. Last time i tried to fill out here, i finihed and it would not let me submit. I emailsed to ask if they recieved my report, but ? Primary concerns have been fluttering, irregular, rapid heart beat; chest pain; shortness of breath. Additionally, mainly mild headaches and pressure behind eyes. These symtoms were not noticed hours after the vaccine, rather intermittently for weeks following. As far as symptoms within days of the vaccine: diarrhea, severe depression, and a few near faint spells - as very sudden onset whoosiness-as perhaps a rapid loss of blood pressure or something, but they resolved within a minute of breathing /rest. regretfully, i did not go to the ER for heart rate, chest pressure, and breathing issues, as I felt was likely called for , but i hoped to make it to a cardiologist or to my primary. I dod see P.A. at my primary, but she did nto think it was related to the vaccine. I feel certain that it is.

Other Meds:

Current Illness:

ID: 1459766
Sex: F
Age: 35
State: IN

Vax Date: 05/24/2021
Onset Date: 05/25/2021
Rec V Date: 07/09/2021
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: Ceptra, Ceclor, Keflex, Augmentin, erythromycin

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

Symptoms: The morning following I had intense neck stiffness and neck muscle pain. I was unable to turn my neck without intense pain for two weeks. Chiropractic care and massage therapy did not help. Although the pain has lessened and most movement has returned, the stiff, sore, tight neck muscles are still there 46 days later.

Other Meds: N/A

Current Illness: NA

ID: 1459767
Sex: F
Age: 44
State: FL

Vax Date: 07/09/2021
Onset Date: 07/09/2021
Rec V Date: 07/09/2021
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: N/A

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: On 7/9/2021, the patient received her dose of Janssen COVID-19 vaccine a little after 0900AM. A couple of minutes after receiving the shot, the patient began to complain about dizziness. The patient was given some water which alleviate some of her symptoms but she remained dizzy. Then the patient was given a lollipop after she stated she had not eaten breakfast and did not have any food allergies. Meanwhile, her vitals were taken: Blood pressure 143/90, respiratory rate 16 breaths/min, heart rate 68, and oxygen saturation 100% on room air. The site lead contacted emergency medical services - her symptoms progressively worsened - she was experiencing worse dizziness, chills, palpitations, and she felt tired. A second set of vitals were taken and her heart rate was 76 and oxygen saturation 100%. The emergency medical services arrived at the site and the patient was taken to the hospital.

Other Meds: Levothyroxine

Current Illness: Thyroid problems, Fainted at the yacht club last week and went to the hospital - she was given fluids nd said she was told it was due to dehydration

ID: 1459768
Sex: U
Age: 81
State: NY

Vax Date: 06/01/2021
Onset Date: 06/30/2021
Rec V Date: 07/09/2021
Hospital: Y

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

Lab Data:

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Heart attack

Other Meds: Afib kidney failure congestive heart failure

Current Illness:

ID: 1459769
Sex: F
Age: 28
State: SD

Vax Date: 07/07/2021
Onset Date: 07/08/2021
Rec V Date: 07/09/2021
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:

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

Symptoms: Fever of 105 started during the night and could not stand or walk without assistance. Extreme dizziness. In the morning started suffering from tinnitus and her hearing became very muffled.

Other Meds:

Current Illness:

ID: 1459770
Sex: F
Age: 26
State: MI

Vax Date: 06/11/2021
Onset Date: 06/11/2021
Rec V Date: 07/09/2021
Hospital:

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

Lab Data:

Allergies: Sensitive to medications for depression, migraines, and anxiety. Sensitive skin. No real allergies besides the weather.

Symptom List: Nausea

Symptoms: First 3 days, heart racing, blood pressure issues (not sure exactly) I couldn't go up the stairs, getting off the couch I'd nearly pass out. Chest pain. On both hands my middle finger to my pinky would tremor on and off for weeks. It was constant the first 3 days. I felt like the inside of my body was on over drive and the outside of my body was lethargic. The symptoms have persisted on and off for a month now. Currently, I have a heart monitor on for a week. I had blood work done, most of it came back normal. My bilirubin is always elevated due to Gilbert's syndrome. But my bilirubin count was double what it was in March of 2021

Other Meds: Vyvanse 20mg, Cymbalta 30mg, propranolol 80mg

Current Illness: Lack of appetite, depression.

ID: 1459771
Sex: M
Age: 53
State: FL

Vax Date: 04/06/2021
Onset Date: 07/01/2021
Rec V Date: 07/09/2021
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: N/A

Symptom List: Injection site pain

Symptoms: Had sudden ?eye? stroke. Neurologist at hospital could not rule out this being an adverse affect from vaccine since there were no underlying health issues or past history of any health issues. Lost 25% vision in right eye due to sudden stroke.

Other Meds: N/A

Current Illness: N/A

ID: 1459772
Sex: F
Age: 27
State: NH

Vax Date: 07/08/2021
Onset Date: 07/08/2021
Rec V Date: 07/09/2021
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: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Symptom onset in evening of 7/8/21. Symptoms included: fever (temp 101), feeling weak/wobbly, tachycardia and chest feeling heavy. Also reports fast heart beat. Advised to seek medical care through her pcp or urgent care

Other Meds:

Current Illness:

ID: 1459773
Sex: F
Age: 46
State: TX

Vax Date: 04/19/2021
Onset Date: 04/20/2021
Rec V Date: 07/09/2021
Hospital:

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

Lab Data:

Allergies: Penicillin; sulfa drugs; hydrocodone

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

Symptoms: On 4/20 I had a very sore arm and left lower buttock pain. I had a sore throat and inside my throat hurt. My left side jaw also hurt. I also had shooting pains up both my arms from carpal tunnel. I had pins and needles in my hands which is something I never experienced on 4/22; I had diarrhea begin. On 4/23, the ear pain came back in both ears. On 4/24, I had sudden nerve pain on the right lower back, and I had to go to an afterhours clinic. I was given a cortisone shot that provided immediate relief. On 4/25, I got a CT scan that was ordered. On 4/27, I saw an ENT. He said my carotid glands were inflamed. He said my blood tests showed I was ANA positive. He said it could indicate an autoimmune disease. Due to the cortisone shot, further workups had to be delayed. He told me to see a rheumatologist. On 4/28, my arms swelled up, more on the left side, and I had left ear pain and the left side of my neck was very inflamed. My IBS was also really bad. On 6/3, I saw the rheumatologist, who said I needed to wait on my blood work. I had continued ear, back and arm pain. On 5/4, I had what I thought was a clogged pore. I wear glasses and it was very tender It got to a point that I had to get contacts because I could not wear glasses. On 5/4, my nose started bleeding in the outside and the inside of my nose hurt. On 5/5, I saw the dermatologist. I had more blood and pus come out that day as well. The dermatologist said it was a boil. He told me to put mupirocin. This was not helpful. I had intermittent hand pain, dry mouth and continued ear pain. On 5/9, I was able to get lab work. On 5/12, after the doctors thought I had Sjogren's, everything came back normal, and I did not have any disorder. On 5/14, I woke up with both sciatic nerves completely on fire. I went to the chiropractor, sports medicine doctor I was referred to. They did a deep muscle massage and 30 mins of active therapy. I was taught some stretching exercises which were helpful and provided relief. On 4/24, the sciatica pain subsided for the weekend but came back. I looked up some exercises which provided relief. The next day, I might have done something wrong because the pain got worse. The boil on my nose finally went away after I used cystic acne medication on it. The arm pain calmed a bit as I was not having constant pain. On the week on 6/21, I started having chest pains. I was not sure what was going on. On 6/25, I realized things were not getting better. I decided to take things easy. Things got worse. It felt like an elephant sitting on my chest. On 7/2, I was remarkably worse. I went to the ER where my vitals were okay. I was in so much pain. The pain reminds me of shingles pain although not as bad. I was told to visit and internal doctor. I was given lidocaine patches and prednisone. The blister on my chest has gotten worse and I have developed a few more. The pain on my chest now wraps around my back. I am seeing a doctor today.

Other Meds: Magnesium; ondansetron; multivitamin; ibuprofen

Current Illness: No

ID: 1459774
Sex: F
Age: 58
State: MA

Vax Date: 01/17/2021
Onset Date: 01/19/2021
Rec V Date: 07/09/2021
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:

Allergies: None

Symptom List: Tremor

Symptoms: On Tues the 19th I began to not be able to type on a computer or text on my phone. On Thurs the 21st I drove myself to the hospital. I had a horrible headache and was immediately checked in to the Emergency department at the hospital and an MRI was completed which discovered swelling on my brain. I was then admitted to the hospital and stayed there for 3 days until I was transferred to another hospital. I stayed there for 7 days and was given high doses of steroids to try and decrease the swelling in my brain. I was released and stayed out of work for 2 months. I still have swelling on my brain and I am still being monitored by the neurology department at the hospital.

Other Meds: Metformin; Prilosec

Current Illness: None

ID: 1459775
Sex: M
Age: 59
State: CA

Vax Date: 04/12/2021
Onset Date: 04/24/2021
Rec V Date: 07/09/2021
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: Erythema, Pruritus

Symptoms: Muscle pain in both shoulders. The pain in the opposite shoulder (RT) of the injection has worsened significantly over the past month. Some arm weakness in both arms has been experienced as well.

Other Meds: Pantapropazole, Testosterone

Current Illness:

ID: 1459776
Sex: M
Age: 54
State: GA

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 07/09/2021
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: nka

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

Symptoms: Noticeable Hair Loss after 1st dose resulting in member shaving his head. Significant Hair Loss following 2nd dose resulting in loss of most of Member's hair on face and body.

Other Meds: lisinopril 10mg latisse tacrolimus symfi 600-300-300 zyrtec

Current Illness: ? HX OF SMOKING ? CIRCADIAN RHYTHM SLEEP DISORDER ? ASYMPTOMATIC HIV INFECTION

ID: 1459777
Sex: F
Age: 68
State: WA

Vax Date: 02/28/2021
Onset Date: 03/15/2021
Rec V Date: 07/09/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: DVT

Other Meds: Sumatriptan, prn

Current Illness: Migraines

ID: 1459778
Sex: M
Age: 57
State: MN

Vax Date: 02/25/2021
Onset Date: 02/25/2021
Rec V Date: 07/09/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: pt states he came down with a 102 temp and was extremely week. He had severe pain in ankles, knees and hips. He ended up into the ER. He had an US of legs, chest X-ray, and lab work. They could not find anything wrong with him and was told it was a reaction to the vax. He had a negative Covid Test. He has neuropathy in his feet and the vax seemed to aggravate this condition. This pain lasted at least 10 days. He has started doing neuropathy therapy to help with his pain. He still has pain in his shoulders to this day.

Other Meds: pravastatin 40mg, fish oil, baby aspirin

Current Illness:

ID: 1459779
Sex: F
Age: 43
State:

Vax Date: 03/09/2021
Onset Date: 04/01/2021
Rec V Date: 07/09/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: For the first time in my adult life, I missed a whole period the month after the vaccine - the month of April.

Other Meds: None

Current Illness: None

ID: 1459780
Sex: F
Age: 30
State: ME

Vax Date: 04/07/2021
Onset Date: 04/07/2021
Rec V Date: 07/09/2021
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: N/a

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

Symptoms: So, my headaches have been sporadic, but frequent. Mostly headaches. Shortly after I got my vaccine, within a couple days it occurred. It was enough to be noticeable since I don't normally get them. Then in June I started to get really severe headaches behind my right eye it seemed. I am sensitive to light when it happens. It has been happening now for 3-4 weeks sporadically; the more intense headache pains, that is. The headache from the beginning was different. So, I contacted my doctor's office and had an appointment in May 2021 sometime and they are still investigating my symptoms. I am also seeing my PCP at the end of this month as well. Every once in a while, I still get one of those new painful headaches randomly but it's hard to pinpoint when it happens.

Other Meds: Ibuprofen; acetaminophen; Generic of Nuvaring; Albuterol inhaler; cortisone

Current Illness: N/a

ID: 1459781
Sex: M
Age: 58
State: VA

Vax Date: 05/22/2021
Onset Date: 05/24/2021
Rec V Date: 07/09/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Pain in extremity

Symptoms: Salivary Gland disfunction, and Oral Inflammation in lower mouth and Lymph Glands. Headache. Blood bruise weeping down left arm. Headache resolved after two days and was treatable with Ibuprofin. Salivary disfunction alternated between steady flowing salivation causing coughing at night, to Zero Salivation causing dry burning and oral pain. It was possible to force salivation once awake. This continued for four days and then stopped. Throat Lymph swelling and mouth pain continued for two weeks, and reoccurred after 4 weeks. Lymph Swelling resolved after July 4th, but a lump remained on the left side of the throat but seems to decreasing.

Other Meds: Fexofenadine HCl 180 mg Periodic Cialis 20 mg Fluticasone Spray

Current Illness: None

ID: 1459782
Sex: F
Age: 53
State: CT

Vax Date: 04/01/2021
Onset Date: 06/29/2021
Rec V Date: 07/09/2021
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: Heavy arms; jaw pain; chest pain.

Other Meds: Retin-A 0.05%

Current Illness: None

ID: 1459783
Sex: F
Age: 45
State: GA

Vax Date: 05/22/2021
Onset Date: 05/22/2021
Rec V Date: 07/09/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: generalized Weakness and SOB right after receiving the COVID VACCINE TODAY. She admits to eating and drinking earlier today. She states that her mouth is very dry despite drinking water. She denies any dizziness, chest pain or palpitations. No rash.

Other Meds: Ciclesonide (ALVESCO) 80 mcg/actuation Inhl HFAA Inhale 1 puff by mouth 2 times a day for Asthma control 6.1 12 ? Albuterol (VENTOLIN HFA) 90 mcg/actuation Inhl HFAA Inhale 2 puffs by mouth every 4 hours as needed for wheezing or coughing 1

Current Illness: asthma

ID: 1459784
Sex: M
Age: 24
State: PA

Vax Date: 04/21/2021
Onset Date: 04/21/2021
Rec V Date: 07/09/2021
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: Felt lightheaded and diaphoretic. Given juice and crackers. No juice or crackers...no difficulty breathing. Patient felt better. VS WNL> Lightheadedness resolved. Only had 1 egg for breakfast - counseled patient on eating meal.

Other Meds:

Current Illness:

ID: 1459785
Sex: M
Age: 72
State: OR

Vax Date: 04/17/2021
Onset Date: 04/18/2021
Rec V Date: 07/09/2021
Hospital: Y

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

Lab Data:

Allergies: Isoproil, fish sauce

Symptom List: Vomiting

Symptoms: Shortness of breath , I was treated at the emergency with Atrial Fibrllation, SYSTOLIC HEART FAILURE, CHRONIC

Other Meds:

Current Illness:

ID: 1459786
Sex: F
Age: 53
State: TX

Vax Date: 07/05/2021
Onset Date: 07/05/2021
Rec V Date: 07/09/2021
Hospital:

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

Lab Data:

Allergies: pennicilian

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: body aches, chills, fever, dry cough, loss of taste and smell.

Other Meds: estrodile

Current Illness: none

ID: 1459787
Sex: F
Age: 48
State: LA

Vax Date: 12/16/2020
Onset Date: 07/08/2021
Rec V Date: 07/09/2021
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: latex

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

Symptoms: tested positive for Covid 19 after being fully vaccinated. body aches, fever no more fever now, I just have terrible body aches, headaches and very congested and very tired.

Other Meds: Humara 40mg every 2 weeks, Adderall, Klonopin, trazadone

Current Illness:

ID: 1459788
Sex: F
Age: 38
State: FL

Vax Date: 04/19/2021
Onset Date: 04/21/2021
Rec V Date: 07/09/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Injection site swelling, Limb discomfort

Symptoms: large Lump at the base of neck by between clavicle and shoulder. Constant pain in shoulder still occuring as if todays date. Lump went away 2 weeks later. But pain in shoulder and feeling of constant tightness has not left infact has gotten worst over time

Other Meds: none

Current Illness: none

ID: 1459789
Sex: M
Age: 71
State: MI

Vax Date: 06/23/2021
Onset Date: 06/25/2021
Rec V Date: 07/09/2021
Hospital:

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

Lab Data:

Allergies: n/a

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

Symptoms: second day after vaccine on 6/25/21 100.3

Other Meds: Atorvastatin Calcium Tablet 80 MG, , Ferrous sulfate(65 Fe) MG , Ergocalciferol Capsule 50 MCG (2000 UT) Tablet 325 ,Multivitamin Tablet (Multiple Vitamin) ,Aspirin Tablet Chewable 81 MG ,Omeprazole Capsule Delayed Release 20 MG

Current Illness: n/a

ID: 1459790
Sex: F
Age: 51
State: NJ

Vax Date: 05/25/2021
Onset Date: 06/30/2021
Rec V Date: 07/09/2021
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: N/A

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

Symptoms: After the shot got extremely light headed and ended up falling down a flight of stairs which ended in a broken bone that will need surgery to fix. Surgery was May, 27th and had to go in for a second surgery on June 28th.

Other Meds: N/A

Current Illness: N/A

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm