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: 1466877
Sex: F
Age: 18
State: CA

Vax Date: 07/10/2021
Onset Date: 07/11/2021
Rec V Date: 07/13/2021
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: Hives covering left arm chest and torso. Numbness of entire left side of body lasting days.

Other Meds: amoxicillin

Current Illness:

ID: 1466878
Sex: M
Age: 50
State: CA

Vax Date: 05/03/2021
Onset Date: 07/02/2021
Rec V Date: 07/13/2021
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: none

Symptom List: Anxiety, Dyspnoea

Symptoms: Pt came back today 7/13/2021 and mentioned that he was having some kind of steady tingling sensation on the vaccinated arm (left) that started around July 2nd. He heard about the recently reported side effect Guillain Barre Syndrome on the news so he tried to seek out how he can report this and came back to our pharmacy. Told him we need to report thru VAERS and will reach out to him if more info is needed. He was also advised to sign up thru Vsafe for monitoring.

Other Meds: pharmacy don't have data

Current Illness: pharmacy don't have data

ID: 1466879
Sex: F
Age: 76
State: KS

Vax Date: 07/09/2021
Onset Date: 07/09/2021
Rec V Date: 07/13/2021
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:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1466880
Sex: F
Age: 30
State: CA

Vax Date: 04/01/2021
Onset Date: 04/16/2021
Rec V Date: 07/13/2021
Hospital:

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

Lab Data:

Allergies: Fentanyl (rash)

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Alright so in late afternoon/evening on April 16th 2021, I went on a long walk which is normal for me. I noticed my yoga pants feeling tight and I felt bloated. When I got back, I had a lighter dinner. The next day I wasn't feeling well still and it was my Mother's birthday. I was feeling really weird and I just kind of ignored it. By the end of the day, after dinner, I started feeling really not great. I felt sick to my stomach, I wasn't getting sick/vomiting but then the next day I tried to go out to see my friends at brunch and just talked - I did not eat because it hurts to eat anything. I went to the store and got yogurt because it is all I could stomach. The following day I finally went to the ER because I was just really in pain, I said to my mom can you just cut out my stomach it hurts so bad. The pain was on my left side though, I'm not even sure if that's stomach pain. The DRS at the ER they did exams and they gave me medications for my pain but they weren't really sure what to diagnose it as. I got a stool softener, a nausea tablet and pain medicine. Most of that week I was still eating just yogurt. Also, mind you, I had started my period around this time and that made it confusing as well. I drove out to Iowa and saw my GI DR on May 11th 2021 in CA and he said well if it is all gone, that's great. So when my period came back, I began having the pains again. I was in pain so much that it hurt to even turn my body. That pain has continued to be repeated every time after the second dose of the vaccine. I saw my OBGYN on Friday July 2nd 2021.

Other Meds: Omeprazol 40 mg 1x daily, Adderall XR 30mg 1x daily, Birth Control pill, Centrum vitamin, cetirizine 10 mg, Ritalin 10mg as needed, Xanax 0.5MG as needed, Flonase, CBD and marijuana maybe 1x week, Tylenol

Current Illness: n/a

ID: 1466881
Sex: F
Age: 39
State: FL

Vax Date: 03/30/2021
Onset Date: 04/12/2021
Rec V Date: 07/13/2021
Hospital:

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

Lab Data:

Allergies: Peanuts

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

Symptoms: Significant flare up of psoriasis and psoriatic arthritis initially, followed by extreme fatigue, hair loss, oral sores, blurry vision, overal malaise. Dr visit on May 14, 2021- Topical steroid prescribed, blood work for autoimmune work up. Prescribed Colchicine for possible Bechet?s Disease. Blood work returned showing high fasting glucose level of over 240 on May 26,2021. No history of high glucose levels prior, no family history of diabetes.

Other Meds: Multi-vitamin

Current Illness: None

ID: 1466882
Sex: F
Age: 40
State: SC

Vax Date: 07/06/2021
Onset Date: 07/07/2021
Rec V Date: 07/13/2021
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: NA

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

Symptoms: Patient had vaccine Tuesday 7/6 around 6pm. Rash present on arm, neck and face Wednesday night. Patient visited emergency room Friday 7/9 because rash was still present. Emergency room diagnosis was Hypersensitivity Reaction. Was prescribed Benadryl 50mg and Prednisone 50mg.

Other Meds: NA

Current Illness: NA

Date Died: 04/26/2021

ID: 1466883
Sex: M
Age: 58
State: MD

Vax Date: 03/06/2021
Onset Date: 04/26/2021
Rec V Date: 07/13/2021
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:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: "Chills and aches" the day and evening of the shot. After a couple of weeks, Pt began to experience various pains at different points of his body. He developed severe indigestion resulting in him visiting his physician on April 19th where he was put on a 7-day steroid regimen. One week later, early on Monday morning, April 26, 2021, Pt collapsed in his bathroom at home, was unresponsive, and pronounced dead by the paramedics who responded.

Other Meds:

Current Illness:

ID: 1466884
Sex: F
Age: 11
State: TX

Vax Date: 06/07/2021
Onset Date: 06/07/2021
Rec V Date: 07/13/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Error: Patient Too Young for Vaccine Administered-

Other Meds:

Current Illness:

ID: 1466885
Sex: M
Age: 17
State: MI

Vax Date: 07/06/2021
Onset Date: 07/06/2021
Rec V Date: 07/13/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: pt is was given a injection on 07/06/2021 that was un-refrigerated at drawn up since 07/02/2021. pt did not report any symptoms.

Other Meds: Vyvanse, Amphetamine-Dextroamphetamine, Melatonin

Current Illness: none

ID: 1466886
Sex: F
Age: 75
State: CA

Vax Date: 03/30/2021
Onset Date: 04/01/2021
Rec V Date: 07/13/2021
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: sulfur and penicillin

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Blood tests showing elevated ANA and high titers and rheumatoid factor and excessive inflammation that has not been present for over 20 years

Other Meds: Levo and Lio thyroxine, atorvastin, latanaprost

Current Illness: none

ID: 1466887
Sex: F
Age: 17
State: MI

Vax Date: 04/25/2021
Onset Date: 04/25/2021
Rec V Date: 07/13/2021
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: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: Error: Patient Too Young for Vaccine Administered-

Other Meds:

Current Illness:

ID: 1466888
Sex: M
Age: 55
State: CA

Vax Date: 10/01/2018
Onset Date: 10/01/2018
Rec V Date: 07/13/2021
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:

Symptom List: Rash, Urticaria

Symptoms: After the second dose arm was sore for about 2months. In July 5th 2019 started losing eye sight. Doctors started running test such as MRI and CT scan. In 2020 was Diagnosed with MS.

Other Meds: Cyclavir

Current Illness:

ID: 1466889
Sex: F
Age: 60
State: NY

Vax Date: 03/28/2021
Onset Date: 05/21/2021
Rec V Date: 07/13/2021
Hospital:

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

Lab Data:

Allergies: Biaxin

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

Symptoms: I had a severe headache like a migraine the night before and then in the morning it was really severe. I couldn't stop throwing up. The night before I took the butalb-acetamin-caff. I went to an urgent care facility, and they sent me directly to the emergency room.

Other Meds: Amphetamine Salts; Butalbal; Bupropion; Magnesium; B-Complex Vitamin; Biotin; Gabapentin

Current Illness: Migraines

ID: 1466890
Sex: M
Age: 69
State: NV

Vax Date: 03/29/2021
Onset Date: 03/31/2021
Rec V Date: 07/13/2021
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: No

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

Symptoms: Random severe muscle joint tendon pain. Extreme fatigue. Brain fog. Episodes of serious chills despite ambient temp in the 90s. Fine one day, next day can barely walk. Attempt to exercise beyond easiest levels will result in the 1 or more of above 1-2 days later. Depression. No problem with lungs, breathing. Times of elevated heart rate and / or low oxymeter readings (89-90 where 92-94 is expected) I want to think I'm getting better, but then this morning another chills and fatigue episode motivated this report. Ps as a longtime serious cyclist, I know how to suffer all kinds of setbacks. I know how my body responds to various exercise loads.

Other Meds: Multi vitamin, B-12, magnesium citrate, glucosamine+chondritin, CoQ12

Current Illness: No

ID: 1466891
Sex: M
Age: 13
State: MD

Vax Date: 06/11/2021
Onset Date: 06/12/2021
Rec V Date: 07/13/2021
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: no

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

Symptoms: pt received 1st vax which was moderna and was supposed to be pfizer. on July 2, he recieved another shot of moderna instead of pfizer. he has severe headaches, nose bleeds, and weakness.

Other Meds: no

Current Illness: no

ID: 1466892
Sex: M
Age: 72
State: PA

Vax Date: 01/29/2021
Onset Date: 02/17/2021
Rec V Date: 07/13/2021
Hospital: Y

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

Lab Data:

Allergies: penicillin

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

Symptoms: had diarrhea for 52 days, rash, hives an allergic reaction and dx with lymphocytic colitis

Other Meds: metoprolol 25mg, lisinopril 5mg

Current Illness: no

ID: 1466893
Sex: F
Age: 21
State: WV

Vax Date: 07/05/2021
Onset Date: 07/07/2021
Rec V Date: 07/13/2021
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: Allergy to Celexa

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

Symptoms: Red spot with hard lump under surface slightly swollen started itching on 7-12-2021

Other Meds:

Current Illness:

ID: 1466894
Sex: M
Age: 17
State: MD

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

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Error: Patient Too Young for Vaccine Administered-

Other Meds:

Current Illness:

ID: 1466895
Sex: F
Age: 59
State: DE

Vax Date: 06/24/2021
Onset Date: 07/07/2021
Rec V Date: 07/13/2021
Hospital: Y

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

Lab Data:

Allergies: No known allergies

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: new onset of R-sided facial drooping, slurred speech, and confusion. VS: 98.7, 120 (apical), 22, 90/68, pulse ox 85% on room air. She was medicated with routine ASA and PRN Clonazepam. Pulse ox improved to 90%. . New orders received to send to ER via 911 for eval.

Other Meds:

Current Illness:

ID: 1466896
Sex: F
Age: 29
State: OH

Vax Date: 04/07/2021
Onset Date: 05/06/2021
Rec V Date: 07/13/2021
Hospital:

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

Lab Data:

Allergies: Keflex

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

Symptoms: I recieved my second vaccine 4/8/2021. Beginning of May to mid may range, I developed chest pains, palpitations, dyspnea, fatigue on and off. It was never severe enough to go to doctor. It never got better so I saw my PCP. She ordered lab tests and Holter monitor which came back fine. I chalked it up to my zoloft not working and had her increase my dose in case it was anxiety related. I saw that we should report things if they seem odd so just wanted to make you aware

Other Meds: Zoloft 25mg qhs Claritin 10mg qhs

Current Illness: None

ID: 1466897
Sex: F
Age: 62
State: CA

Vax Date: 03/10/2021
Onset Date: 03/17/2021
Rec V Date: 07/13/2021
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: Benadryl - major allergy; Macradatin and sulfa drugs don't work for me; coconut; Homni - mexican vegetable

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

Symptoms: I had no symptoms immediately after vaccine except I tired out a little earlier than normal that day. I week later, I noticed the swelling and the pain. It started my entire foot, ankle, calf and knee. Foot was swollen but it did go down. I didn't think about it right off. I think it started in my right foot but it spread to my left foot and ankle, calf and knee. So both swelled and were painful for awhile. It just went down a little - the pain and swelling. It didn't go completely away but it was better. After the second vaccine, on April 7th,Lot # 038B21A - I got really bad about seven or 8 days past the second vaccine (COVID vaccine). I swelled up severely. My knees were so bad you couldn't see them. The pads of the feet were so swollen. I had no wrinkles in my feet because they were so swollen. I was putting them up to elevate them as much as I could. I had a lot of problems with it. Both legs were severely swollen and painful. I was having a lot of pain with it. It scared me. I had a few pains in my chest, too. At the 10 days range after the second vaccine, the hands started swelling and the wrist and up my arm - the injection site didn't swell instead of my arm started swelling. The pain got so bad in my hands. I told me doctor. I couldn't walk around. The pain radiating was really bad - I tried icing and elevating and nothing was working. I even bought a pair of boots (medical support) to keep the blood circulating. As soon as I have the feet down even for an hour the pain and swelling just starts right back up. My hands are hurting, too. I started having numbing in the fingers, whole hand and into my wrist. The doctor put me on generic Lasix 20 twice a day mg but for the last week or two weeks, we had to double it because my feet were so huge. My ankles are starting to discolor it's so bad. The doctor gave 10 mg Potassium tablets extended relief. He increased the Potassium when we increased the Lasix so that I take two Potassium - one in am and one in pm. It did not relieve the symptoms. It took the swelling down a hair but it's still real bad. I'm still having all the same issues - hands are numb and swollen now from talking on the phone.

Other Meds: Calcium pill; Premarin - 0.625mg; Atenolol - 25 mg

Current Illness: no

ID: 1466898
Sex: M
Age: 52
State: MN

Vax Date: 05/06/2021
Onset Date: 05/20/2021
Rec V Date: 07/13/2021
Hospital:

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

Lab Data:

Allergies: No known allergies

Symptom List: Unevaluable event

Symptoms: Started to notice facial droop left side of face about 2 weeks after receiving the Johnson & Johnson (Janssen) Covid 19 vaccine. Started behind the ear and worked to the front of his face. Included eye and nostril. Couldn't chew food on that side of mouth. It has been painful, but the pain and the drooping have gotten better. Did not seek out any medical treatment as he felt nothing could be done.

Other Meds: Metoprolol

Current Illness: No known

ID: 1466899
Sex: F
Age: 42
State: MO

Vax Date: 07/09/2021
Onset Date: 07/09/2021
Rec V Date: 07/13/2021
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: shellfish, erythromycin, injectable benadryl, codeine, HCTZ, injectable Depo-Medrol, injectable Cortisone

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

Symptoms: Approximately 3 hours after receiving vaccination, heart racing and Blood Pressure high. Pulse 120 to 184. Blood Pressure 264/130. Took 2 Nitroglycerin and baby aspirin. Went by ambulance to Emergency Room. Discharged from ER with diagnosis of chest pain per patient. Was in emergency room for approximately 3 hours once blood pressure and heart rate stable.

Other Meds: None

Current Illness: none

ID: 1466900
Sex: F
Age: 40
State: CT

Vax Date: 04/11/2021
Onset Date: 05/26/2021
Rec V Date: 07/13/2021
Hospital: Y

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

Lab Data:

Allergies: No

Symptom List: Injection site pain, Pain

Symptoms: I'm not sure if related still would like to report complications to CDC. On Wed May 26 I had episode of bleeding during night around 2am. I went to the ER me and the baby was monitored for 24 hrs. Since I had no additional bleeding sent home. On Fri June 4 had the same episode went to the ER I was 37 weeks my doctor decided to induce my labor. I delivered, baby was healthy then I started hemorrhaging. I got to a stage 3 hemorrhaging became more got different shots. I lost a couple liters of blood now I'm doing fine now.

Other Meds: Levothyroxine, prenatal vitamin, low dose Bayer aspirin, probiotic, Augmentin

Current Illness: No

ID: 1466901
Sex: M
Age: 21
State: AR

Vax Date: 07/12/2021
Onset Date: 07/12/2021
Rec V Date: 07/13/2021
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: Systemic: Confusion-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Medium, Systemic: Headache-Medium, Systemic: Hypertension-Medium, Systemic: Nausea-Severe, Additional Details: Patient was given the Pfizer Covid-19 Vaccine. About 2-5 minutes after receiving the patient stated he felt a "headache" and immediately lost consciousness. Patient was seated and slowly slid out of chair. When I got to the patient it looked as though patients eyes were fluttering and he was not responsive the first 5-10 seconds of me laying patient on back and elevating feet. Patiend suddenly came to after about 15 seconds total and was responsive to all questions. vitals were taken.

Other Meds:

Current Illness:

ID: 1466902
Sex: M
Age: 52
State: NC

Vax Date: 04/06/2021
Onset Date: 05/12/2021
Rec V Date: 07/13/2021
Hospital: Y

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: Patient is a 53 year old male who presented to Medical Center Emergency Department on 5/12/2021 with the chief complaint of fever. He is not under the care of a primary care provider and does not take any regular medications. On May 4th patient received his second Moderna COVID vaccine. Several hours later he developed a subjective fever with chills, body aches and a headache. These symptoms have been ongoing since onset. Since this time he has also developed a dry cough, generalized weakness and burning with urination. Denies any shortness of breath, chest pain, nausea, vomiting, or diarrhea. No bloody/dark stools. Wife is at the bedside who states that patient has recently developed "little red bumps" all over his body.

Other Meds:

Current Illness:

ID: 1466903
Sex: F
Age: 22
State: OH

Vax Date: 12/22/2020
Onset Date: 03/15/2021
Rec V Date: 07/13/2021
Hospital: Y

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: NKDA

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: 3/15/21: began feeling short of breath with any exertion as well as having tachycardia. Went to get covid tested and was negative, vitals were heart rate 169 at and they sent me to an ER to be evaluated for possible . While at Hospital my heart rate continued to be 150-160 while resting and elevated with movement. D dimer was elevated at 1.67. CT angiogram of Pulmonary arteries was negative. Troponin was negative x3. Wbc were 3.08. EKG showed sinus tachycardia with possible left atrial enlargement. Tested again for covid and was negative. Hospitalized for 1 night for observation. Discharged 3/16/21 with a 1 month heart monitor. Had follow up visit with PCP on 3/19/21. Heart rate in office was 120s. EKG was performed, lying down my heart rate dropped to 70s. Orthostatic vitals were obtained. Heart rate increased with sitting and standing and blood pressure continued to decrease. Magnesium level and echocardiogram were then obtained and both came back normal. I had to be off of work for over a month due to heart rate and symptoms with it. 3/28/21: covid test performed, negative for 3rd time. 4/1/21: tilt table exam performed. Heart rate laying was 100, tilted up went well over 170 with almost passing out and shaking uncontrollably in the first 7 minutes of the test. Cardiologist ruled it as inappropriate sinus tachycardia. 4/20/21: office visit with cardiologist. Cardiologist notes, "Impression inappropriate sinus tachycardia with hypersensitivity of sinus node. Post viral syndrome without evidence of flu or Covid with negative testing. History of being previously vaccinated." Cardiologist stated to me it was most likely vaccination related since he has seen cases like this recently. Had to be put on beta blocker atenolol 12.5 mg and still taking it to this day. Heart rate still occasionally increases to 140s while on medication but is overall controlled.

Other Meds: Effexor 75mg Topamax 25mg 2x daily Velivet birth control

Current Illness: N/a

ID: 1466904
Sex: F
Age: 39
State: NE

Vax Date: 06/13/2021
Onset Date: 06/19/2021
Rec V Date: 07/13/2021
Hospital:

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

Lab Data:

Allergies: NKA

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: 6/21/21 Patient was at home this past Saturday afternoon when she first noticed some change with her ability to drink from a bottle on the left side of her face. Her husband then noticed her inability to close the left eye during her blinking. She contacted the on-call provider who recommended presenting to the emergency department for initiation of corticosteroids and antiviral medication for suspected Bell's palsy. She was placed on 40 milligrams of prednisone as well as 1000 milligram tablets of valacyclovir. Since initiating those medications, she is noted slight progression in the paralysis of the muscles of the face on the left side. The eye is now not able to be closed without assistance. She is noticing some dryness and irritation of the left eye. She has not had any left upper or lower extremity numbness or weakness. With her noticing some slight worsening of symptoms here in the past 24 hours, I will up her corticosteroid dose to 60 milligrams for 3 days and then taper her on down with 40 milligrams for 3 days, 20 milligrams for 3 days followed by 10 milligrams for 5 days. She will complete the valacyclovir as prescribed. I discussed the importance of eye care to prevent corneal injury while she is unable to close her eyelids. Recommended eye patch at night as well as aggressive hydration using drops or gels. She does have an optometrist and could contact them for any further recommendations or supplies if she does not find appropriate products at her pharmacy.

Other Meds: Lexapro 10mg daily

Current Illness: N/A

ID: 1466905
Sex: F
Age: 26
State: TX

Vax Date: 05/30/2021
Onset Date: 07/12/2021
Rec V Date: 07/13/2021
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: Site: Pain at Injection Site-Severe, Systemic: SWOLLEN LYMPH NODES-Severe, Systemic: Lymph Node Swelling-Severe, Additional Details: PATIENT VISITED HER DR SINCE SHE HAS BEEN EXPERIENCING PAIN IN HER BREAST AND WAS TOLD THAT HER LYMPH NODES ARE SWOLLEN DUE TO COVID VACCINE.

Other Meds:

Current Illness:

ID: 1466906
Sex: M
Age: 56
State:

Vax Date: 06/30/2021
Onset Date: 06/30/2021
Rec V Date: 07/13/2021
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: Moderna Covid-19 Vaccines (Lot#002C21A; expiration date 10/14/21) were sent to our facility from a larger facility within our enterprise. The vials were sent in a bag with a sticker on the bag indicating the expiration date from the removal of the freezer which was 6/24/21. An RN drew up vaccines from these vials without realizing/seeing the expiration date on the bag. The RN labeled the drawn-up syringe with the expiration date/time since puncture of the vial. The vial itself did not have an expiration date on it. This patient was given this dose of the Moderna vaccine on 6/30/21.

Other Meds:

Current Illness:

ID: 1466907
Sex: M
Age: 49
State: TX

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

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

Lab Data:

Allergies: Penicillin

Symptom List: Injection site pain

Symptoms: Severe injection point pain. Continues in a mild manner to this day.

Other Meds: B complex. Antihistamine (Generic Claritin.)

Current Illness: None

ID: 1466908
Sex: F
Age: 71
State: MT

Vax Date: 03/30/2021
Onset Date: 06/05/2021
Rec V Date: 07/13/2021
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: No known allergies

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

Symptoms: Patient presented to Clinic with nausea and vomiting that had been going on since June 5. 30lb wt loss. Work up in the clinic included a CT scan that showed infrarenal abd aortic occlusion and common and iliac artery occlusion with reconstitution at the level of the external iliac arteries. Patient was started on heparin and shipped to a higher level of care.

Other Meds: Takes no home medications

Current Illness: unknown

ID: 1466909
Sex: F
Age: 14
State: TX

Vax Date: 07/07/2021
Onset Date: 07/07/2021
Rec V Date: 07/13/2021
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:

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

Symptoms: Site: Itching at Injection Site-Medium, Site: Pain at Injection Site-Mild, Site: Redness at Injection Site-Medium

Other Meds:

Current Illness:

ID: 1466910
Sex: F
Age: 36
State: NE

Vax Date: 04/10/2021
Onset Date: 06/18/2021
Rec V Date: 07/13/2021
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: Tremor

Symptoms: I was exposed to COVID-19 via infected family member approximately June 7th and was mildly symptomatic by the 9th. I tested positive for COVID-19 on June 15th with worsening symptoms, however, mild respiratory issues. I began having issues with double vision on June 17th and contacted the emergency nurse hotline on June 18th as I had lost the ability to walk/stand, experienced waves of paralysis, numbness in hands and feet, rapid heart rate, and vision and hearing impairment. I was directed to the ER by the on-call Dr to test for possible encephalitis and have an EKG. I was discharged after a few hours. These symptoms align with Guillain-Barre Syndrome, however, I did not receive a spinal tap to confirm.

Other Meds: 20mg Adderall daily

Current Illness: None

ID: 1466911
Sex: M
Age: 15
State: NJ

Vax Date: 04/11/2021
Onset Date: 04/11/2021
Rec V Date: 07/13/2021
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: Error: Patient Too Young for Vaccine Administered-

Other Meds:

Current Illness:

ID: 1466912
Sex: F
Age: 67
State: CA

Vax Date: 04/28/2021
Onset Date: 04/28/2021
Rec V Date: 07/13/2021
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: ALLERGIC TO PENICILLIN, SPICY FOODS, CURRY

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

Symptoms: Immediately upon being injected, my right arm began to bleed. Almost immediately I began to experience extreme pain radiating from the injection sight, down my arm to my elbow, up to my shoulder and across my back, right to left. The pain was not "injection sight"pain. I had very limited range of motion in my right arm. The pain was so severe I had to go to my doctor's office and have him prescribe pain meds. Over the counter pain meds did nothing. Here we are, 2 1/2 months later and I still have limited motion in my right arm and pain. I believe I have developed SIRVA.

Other Meds: INSULIN, JANUVIA, GLIPZIDE,JARDIANCE,IRBESARTIN, ATENOLOL, ATORVASTATIN, LOW DOSE ASPIRIN, MULTI-VITAMINS

Current Illness: NONE

ID: 1466913
Sex: M
Age: 74
State: OK

Vax Date: 04/09/2021
Onset Date: 05/12/2021
Rec V Date: 07/13/2021
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: after about 30 days or so from the date of the shot in my left arm I woke up at 3 in the morning with a terrible aching pain in left arm. I had no injury so I took a pain killer but it didn't help so I went to ER. They did X-Rays then gave me a shot of Morphine for the pain. Two days later the same pain occurred in the left arm and I went back to same ER at 5 am and got another shot. That next week went to my primary doctor who recommended an MRI on my left arm. It was clear so they did an MRI on my neck. Some issues appeared and I was then sent to nerve Doctor who did a nerve test on me. That doctor determined an issue with nerve to my arm. I have since been doing PT for about 3 weeks with some recovery of use of my arm. I recently was told about Builain-barre syndrome and now not sure what caused this problem. No accident and no known injury. My wife also had the shot at the same time and 4 weeks later she had a blood clot in her corated artery. Needless to see something isn't right . Just reporting this for future reference if needed.

Other Meds: Simvastatin

Current Illness: None

ID: 1466914
Sex: F
Age: 49
State: ME

Vax Date: 07/10/2021
Onset Date: 07/11/2021
Rec V Date: 07/13/2021
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: Vaccine was reconstituted incorrectly with only 0.8ml of sodium chloride instead of the required 1.8ml. Patient received more than double the dose on Saturday 07/10/21. I spoke with her on Sunday 07/11/21 at 4:57pm and she stated that she was doing fine though had a slight headache and some fatigue. I told her what happened and explained that she could have a stronger immune response due to the higher dose. I asked if I could call her back later this week and she said Thursday afternoon 07/15/21 would be fine. I will check in with her at that time to determine whether she has had any further effects. Her primary care provider has been notified of the incident.

Other Meds:

Current Illness:

ID: 1466915
Sex: F
Age: 52
State: PA

Vax Date: 04/09/2021
Onset Date: 07/05/2021
Rec V Date: 07/13/2021
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:

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

Symptoms: ASYMPTOMATIC

Other Meds:

Current Illness:

ID: 1466916
Sex: F
Age: 63
State: MS

Vax Date: 01/08/2021
Onset Date: 01/09/2021
Rec V Date: 07/13/2021
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: Sulfur drugs

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

Symptoms: Woke up around midnight ~14 hours after my vaccine with the worst chills I?ve ever had. Never ran fever during the chills. Fever was around 101 right after chills stopped but that only lasted a few minutes. During the time with chills I could not stop shaking. Clenched my teeth so bad. Jaws were sore fur several days afterwards. Chills lasted about 3 hours. When chills were over I was totally wiped out for about 3 days. Mainly slept during that time.

Other Meds: Premarin, telmisartan, flonase, astelin, calcium + Vitamin D, Claritin

Current Illness: None

ID: 1466917
Sex: F
Age: 56
State: FL

Vax Date: 03/26/2021
Onset Date: 03/29/2021
Rec V Date: 07/13/2021
Hospital:

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

Lab Data:

Allergies: Penicillin, Sulfa

Symptom List: Pain in extremity

Symptoms: Bad headache first couple of days, then the pain started all over my body. Joint pain shoulders, hands, knees and feet. Inflammation and did I say pain? The worst pain I have ever had. This has continued without relief since 3 days after the vaccine. I have arthritis (doctor had me off all meds. had been on biologics in the past. i have developed cysts on the top of my hands (fluid filled under skin) pain travels from joints have no idea what day knees, shoulders, feet hurt, hands hurt all the time.

Other Meds: Synthroid, Lomictal, Zoloft, Vita.D

Current Illness: none

ID: 1466918
Sex: F
Age: 16
State: OH

Vax Date: 07/12/2021
Onset Date: 07/12/2021
Rec V Date: 07/13/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: PATIENT RECEIVED THE MODERNA VACCINE BUT WAS UNDER THE AGE OF 18. PATIENT IS CURRENTLY 16 YEARS OLD

Other Meds:

Current Illness:

ID: 1466919
Sex: F
Age: 33
State: NY

Vax Date: 07/02/2021
Onset Date: 07/03/2021
Rec V Date: 07/13/2021
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: N/A

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

Symptoms: Moderate diarrhea on and off beginning 2 days after 2nd dose of vaccination.

Other Meds: LoEstrin FE

Current Illness: N/A

ID: 1466920
Sex: M
Age: 66
State: CO

Vax Date: 02/23/2021
Onset Date: 02/24/2021
Rec V Date: 07/13/2021
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: None known.

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

Symptoms: Irregular heartbeat noticed approximately 36 hours after first Covid19 Moderna vaccination. Symptoms continued periodically to, and through, the date of the 2nd Covid 19 vaccination. Subsequently confirmed via EKG and 2-week heart event monitor to be AFIB. Echocardiogram shows Tricuspid Valve Regurgitation and dilated right atrium. AFIB episodes are paroxysismal and typically last 8-10 hours each. No previous symptoms or problems prior to the two Covid 19 vaccination doses.

Other Meds: Only daily Multi-Vitamin

Current Illness: None.

ID: 1466921
Sex: F
Age: 55
State: CO

Vax Date: 02/07/2021
Onset Date: 07/09/2021
Rec V Date: 07/13/2021
Hospital:

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

Lab Data:

Allergies: None.

Symptom List: Vomiting

Symptoms: Got covid-19 six months after receiving Pfizer vaccination.

Other Meds:

Current Illness: None.

ID: 1466922
Sex: M
Age: 52
State: KY

Vax Date: 12/14/2020
Onset Date: 03/23/2021
Rec V Date: 07/13/2021
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: none

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: pac,pvc, SVT, shortness of breath may 23 2021

Other Meds: aspirin, fenofibrate, lisinopril vitamin, fish oil

Current Illness: none

ID: 1466923
Sex: F
Age: 38
State: OH

Vax Date: 02/04/2021
Onset Date: 02/04/2021
Rec V Date: 07/13/2021
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: no

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

Symptoms: I was extreamly sick and ended up at my doctor's office. I have not had my period since my shot.

Other Meds: no

Current Illness: no

ID: 1466926
Sex: F
Age: 30
State: GA

Vax Date: 07/08/2021
Onset Date: 07/08/2021
Rec V Date: 07/13/2021
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:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1466927
Sex: F
Age: 63
State: IL

Vax Date: 05/02/2021
Onset Date: 05/21/2021
Rec V Date: 07/13/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: extreme shortness of breathe, irregular heartbeat, fatigue, loss of bladder control, shooting pains, muscle ache, tightness in chest

Other Meds: Wellbutrin, Adderall

Current Illness: COVID 4/3/2021

ID: 1466928
Sex: F
Age: 33
State: NJ

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 07/13/2021
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: None

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

Symptoms: Since about a week after the first dose I have experienced daily nausea, stomach cramps most days. Whenever I do any abdominal workout I get stomach cramps and get my period the next day.

Other Meds: Zoloft. Birth control. Zyrtec.

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm