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: 1512670
Sex: F
Age: 32
State: NC

Vax Date: 07/24/2021
Onset Date: 07/27/2021
Rec V Date: 07/29/2021
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: Latex Toradol Prednisone (extensive time)

Symptom List: Dysphagia, Epiglottitis

Symptoms: Chest Pain/Tightness started at around 1am on Tuesday 7/27. Went on throughout the day, got worse with deep breaths. Went to an Urgent Care at 6pm on 7/27, EKG was normal, BP was high after 4 rechecks went to a normal number. Was diagnosed with chest pain as a side effect from the vaccine.

Other Meds: Camreese( Birth Control)

Current Illness: N/A

ID: 1512671
Sex: M
Age: 50
State: VA

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 07/29/2021
Hospital: Y

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: Immediately after receiving the injection, I felt pain/sore that traveled from the injection site, went through and across my left pectoral and ended at center of my chest/heart area. I waited 15 minutes in the observation area to see if symptoms would get worse, but they did not; and so I left the facility and drove home. On my way home, about 45 minutes after receiving the shot, I felt my throat tightening up a bit, and my left hand and eyelids began to cramp up. I stopped at a pharmacy and bought some Benadryl. After 30 minutes, the pain in my chest began to feel better, and the cramping had disappeared. At about 6 pm that same day, my chest pain returned; and so I took one more Benadryl. The pain/soreness began to disappear after about 30 minutes. I felt fine for exactly two weeks. On Thursday, April 1st, I woke up with severe abdominal pain, diarrhea, and constant vomiting for about 12 hours. Went to urgent care and received an anti-nausea shot. The vomiting stopped, but the abdominal pain continued until the next morning. The weekend of April 10th, I experienced the chest pain again. This time it was very concerning because I felt very lightheaded, short of breath and faint. I checked myself into ER two days after.

Other Meds: fenofibrate, pravastatin, Nexium, meclizine, multivitamins

Current Illness: persistent, recurring vertigo since Aug 2020

ID: 1512672
Sex: M
Age: 77
State: NC

Vax Date: 02/10/2021
Onset Date: 07/20/2021
Rec V Date: 07/29/2021
Hospital: Y

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: short of breath, cough, nausea, weakness, diarrhea, fatigure

Other Meds:

Current Illness:

ID: 1512673
Sex: M
Age: 18
State: NY

Vax Date: 07/28/2021
Onset Date: 07/29/2021
Rec V Date: 07/29/2021
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: UPON WAKING UP, PATIENT HAD A 100.3 FEVER. HALF HOUR LATER, PATIENT FAINTED.

Other Meds: NONE

Current Illness: NONE

ID: 1512674
Sex: F
Age: 24
State: MI

Vax Date: 07/19/2021
Onset Date: 07/19/2021
Rec V Date: 07/29/2021
Hospital:

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

Lab Data:

Allergies: NA

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

Symptoms: Patient become sweaty, weak, had a loss of hearing and passed out. Happened within 2 minutes of receiving vaccine.

Other Meds: NA

Current Illness: NA

ID: 1512675
Sex: F
Age: 11
State: MN

Vax Date: 07/25/2021
Onset Date: 07/25/2021
Rec V Date: 07/29/2021
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: n/a

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

Symptoms: Patient reported being 12 years old and uninsured and received 1 dose of Pfizer at age of 11.

Other Meds: n/a

Current Illness:

ID: 1512676
Sex: M
Age: 55
State: TN

Vax Date: 07/23/2021
Onset Date: 07/24/2021
Rec V Date: 07/29/2021
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: Pennicillin

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Sniffles, body aches and pains, nausea, diarrhea, light headed, profuse sweating, headache and increased BP for 7+ days

Other Meds: Prozac, Carvedilol, Losartan, Warfarin, Plavix, Crestor, Humira, Tylenol

Current Illness:

ID: 1512677
Sex: F
Age: 74
State: FL

Vax Date: 03/20/2021
Onset Date: 07/15/2021
Rec V Date: 07/29/2021
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: Ampicillin (not specified)

Symptom List: Pharyngeal swelling

Symptoms: Patient hospitalized for breakthrough infection from 7/15-7/19/21. She completed Moderna series: vaccine #1 on 2/20/21 and dose #2 on 3/20/21. Below is copied from discharge summary: "This is a 74-year-old female who presents to the hospital with fever chills sore throat diarrhea and loss of appetite. COVID-19 virus infection Patient has already been vaccinated for COVID-19 (Moderna). No need to continue dexamethasone No need for abx at this moment Sepsis-fever, tachycardia in setting of COVID-19 virus infection- obtain blood cultures, no antibiotics for now. Acute hypoxic respiratory failure secondary to COVID-19 virus infection albuterol MDI as needed Breathing RA Essential hypertension- resume outpatient blood pressure medications Patient is discharged in stable condition with stable vital signs. All questions regarding hospital course and plan of care after discharge have been answered to satisfaction."

Other Meds: amLODIPine (NORVASC) 10 MG Tablet Take 1 tablet by mouth daily. aspirin 81 MG Tablet Chewable Chew 1 tablet daily. butalbital-acetaminophen-caffeine (FIORICET, ESGIC) 50-325-40 MG Tablet Take 1 tablet by mouth every 4 hours PRN headaches.

Current Illness:

ID: 1512678
Sex: M
Age: 25
State: TX

Vax Date: 04/23/2019
Onset Date: 05/02/2019
Rec V Date: 07/29/2021
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: NKDA. Denies allergies to food, latex, and insect stings.

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: On 2 May 2019 (9 days post-receipt of SPV), onset of fever and chills - felt "like burning up". He also felt fatigued and achy, and had a headache. Also, onset of constant, nonradiating, substernal chest pain (CP). Pain intensity rated as 7-8/10. Pain was worse with lying supine and deep breaths. Pain decreased slightly with leaning forward. Describes sensation of heart pounding hard and racing (HR 118). Also, felt "like I couldn't get enough air". He denied nausea, vomiting, diaphoresis, and lightheadedness. Sought evaluation for chest pain - Emergency Dept (ED), 2 May 2019: Vital signs: BP 135/77, HR 118, RR 20, Temp 101. Physical exam was within normal limits. Dx'd with Acute Viral Syndrome and prescribed Z-pack, Tylenol, and Motrin. That night, patient reports taking Tylenol and Motrin as prescribed. However, he was unable to sleep due to pain. On 3 May 2019, patient's symptoms continued (CP 8-9/10), and that evening, he returned to the ED (3 May 2019): Patient denied sore throat, cough, pedal edema, dizziness, headache, or rashes. His CP was treated with Toradol w/o symptom relief. In the ED, patient had ECG changes and an elevated Troponin-I. He was diagnosed w/ myopericarditis and was transferred and admitted to Hospital. During phone consultation on 9 May 2019, while patient still hospitalized, he reported he continued to experience ongoing CP, but less severe. He reported his CP was treated with Fentanyl. High dose ASA and colchicine were initiated while hospitalized. On 10 May 2019, Patient was evaluated in his Primary Care Clinic. He reported feeling "much better". He denied chest pain, shortness of breath, dizziness, feelings of heart racing, and headache. He was instructed to take Colchicine 0.6 mg 2x/day (x 3 months), Ibuprofen 600 mg 3x/day, and Zantac 150 mg 2x/day. He was placed on a limited duty profile for 2 weeks, with an activity restriction for 3 months. === Follow-up in May 2020: still symptomatic and awaiting Cardiology and Pulmonology evaluations, but due to COVID-19 restrictions, he is not sure when he will be evaluated. Has profile to "exercise at his own pace"; he can jog at a slow pace for about 1 mile, but then becomes short of breath and will experience sharp, substernal chest pain (7/10) that lasts less than 1 minute. He also reports these brief episodes of chest pain at rest. He sometimes notes his heart is racing, but denies irregular heart beat or pedal edema. Patient's last Cardiology evaluation was in Jul 2019. He failed his health test in Oct 2019. He is not taking any routine medications. He denies any significant changes in his health history - denies new diagnoses or conditions requiring evaluation; no recent surgeries === Per Cardiology, Aug 2020: IMPRESSION/PROBLEM LIST: 1. Prior history of myopericarditis. a. During 2019. b. Believed to be secondary to the smallpox vaccination. c. Echocardiography, cardiac MR imaging, exercise stress testing, and cardiac CT coronary angiography have been unremarkable. d. The patient has been followed and managed by Cardiology. 2. Chronic chest pain. 3. Dyspnea. 4. Hyperlipidemia. 5. Past tobacco use (cigarettes). 6. A medical evaluation has been initiated. PLAN: ----At this time, no further cardiovascular evaluations, tests, studies, or investigations are required. ----At this time, from a cardiovascular perspective, the patient has no physical or duty limitations/restrictions. ----Aggressive risk factor modification. ----Continued smoking cessation. ----Heart healthy diet. The patient will be referred to Nutrition. Fasting bloodwork should be checked after at least 4 months of following strict dietary changes and therapeutic lifestyle modifications. ----The patient should never again receive the smallpox vaccination. ----The patient should be evaluated for non-cardiac etiologies for his symptoms. This evaluation is deferred to the patient's PCM.

Other Meds: None

Current Illness: None

ID: 1512679
Sex: F
Age: 42
State: TX

Vax Date: 03/11/2021
Onset Date: 03/15/2021
Rec V Date: 07/29/2021
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: penacillin

Symptom List: Diarrhoea, Nasal congestion

Symptoms: CHRONIC DIZZINESS, NAUSEA, FULLNESS AND PRESSURE IN BOTH EARS BUT LEFT LASTED MUCH LONGER, UNSTABLE BLOOD PRESSURE, SYMPTOMS LASTED JUST OVER TWO MONTHS.

Other Meds: benadryl , topamax, and synthroid

Current Illness: migraines

ID: 1512680
Sex: M
Age: 53
State: WA

Vax Date: 03/01/2021
Onset Date: 03/01/2021
Rec V Date: 07/29/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Very itchy rash on legs and back within 3 days of vaccine. This rash has return twice more since second dose of vaccine. Never had this happen to me before. I can't say that it's related to the vaccine. Seems likely to me.

Other Meds: lisinopril, Zyrtec, Bupropion, Avoristatin, Sertraline. 81mg Aspirin, Previcide, Magnesium 400MG.

Current Illness: None

ID: 1512681
Sex: M
Age: 37
State: UT

Vax Date: 02/23/2021
Onset Date: 02/27/2021
Rec V Date: 07/29/2021
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: N/A

Symptom List: Rash, Urticaria

Symptoms: Neurological problems. Fasciculations, weak muscles, paresthesia, and peripheral neuropathy.

Other Meds: N/A

Current Illness: N/A

ID: 1512682
Sex: M
Age: 64
State: CA

Vax Date: 05/14/2021
Onset Date: 05/15/2021
Rec V Date: 07/29/2021
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: Pt experienced worsening of tinnitus after vaccination. Slowly improving now. Also experienced headaches after vaccination, also improving now.

Other Meds:

Current Illness:

ID: 1512683
Sex: M
Age: 52
State: NY

Vax Date: 03/01/2021
Onset Date: 04/14/2021
Rec V Date: 07/29/2021
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: NONE

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

Symptoms: Blood clot in right calf

Other Meds: NONE

Current Illness: NONE

ID: 1512684
Sex: F
Age: 54
State: IN

Vax Date: 07/23/2021
Onset Date: 07/24/2021
Rec V Date: 07/29/2021
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: Sulfa Based

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

Symptoms: Sore Arm & Fatigue on the 2nd day. Pounding heart beat, shortness of breath and high pulse on 6th day.

Other Meds: Vitamin D, Fish Oil, Sunny Mood (natural anxiety over the counter medication)

Current Illness: None

ID: 1512686
Sex: F
Age: 31
State: ND

Vax Date: 01/11/2021
Onset Date: 01/12/2021
Rec V Date: 07/29/2021
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: None

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

Symptoms: I received my first dose of Pfizer vaccine on 1/11/2021 in my left upper arm. The next day, I developed swollen lymph nodes in my arm pit/neck region. I contacted my provider on 1/14/2021 regarding the swollen lymph nodes. The swollen lymph nodes went away about 7-8 days after the first vaccine but a lump in my neck remained. I continued to monitor. I received the second dose of Pfizer on 2/1/2021 with suggestion from the pharmacist to receive in the right arm due to adverse reactions in the left arm during the first dose. I again had a reaction of swollen lymph nodes however they were not as painful and only lasted approximately 3 days. However, the lump in my neck from the first dose remained and continued to develop symptoms. I had an appointment with my PCP on 2/9/2021, which resulted in an ultrasound of my neck. From this ultrasound, a large nodule (as well as another smaller nodule) was located on my left thyroid and a small nodule noted on the right thyroid. Due to the large size, a fine needle aspiration(FNA) was recommended. The FNA was completed on 2/24/2021 and was determined to be non-cancerous. However, symptoms continued and another ultrasound was ordered. From this ultrasound, growth was noted. I was then referred to ENT for follow up. From this, surgery was an option due to the large size and compressive symptoms that were occurring. Surgery to remove my left thyroid and nodules was completed on 7/7/2021.

Other Meds: None

Current Illness: None

ID: 1512687
Sex: F
Age: 43
State: NY

Vax Date: 03/12/2021
Onset Date: 03/13/2021
Rec V Date: 07/29/2021
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:

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

Symptoms: The date after my second dose of Pfizer, I developed a migraine that lasted for 6 days. I've never had a migraine like this before--it didn't respond to any meds. After the migraine subsided, I was left with a dull background headache that never goes away and from time to time blooms into a migraine. On day 4 after the vaccine shot, I also developed neuropathy in the lesser occipital nerve and on top/left side of my head. These also are still present. It's been debilitating. I am being treated at the with propranolol, gabapentin, and nerve injections, but the condition persists.

Other Meds: Nortriptylene 40 mg, Magnesium 750 mg

Current Illness:

Date Died: 05/05/2021

ID: 1512688
Sex: M
Age: 94
State: ME

Vax Date: 01/13/2021
Onset Date: 04/22/2021
Rec V Date: 07/29/2021
Hospital:

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

Lab Data:

Allergies: No Known Allergies

Symptom List: Ear pain, Hypoaesthesia

Symptoms: 4/22/2021 Tested positive for Covid-19 discovered during Universal Swabbing on Specific Unit. Resident was asymptomatic. COVID-19 screening were completed every 4 hours. 5/3/2021 COVID-19 screening revealed runny nose, declining meds and combative. Urine tea colored and foul smelling, Poor PO Intake. 5/4/2021 resident appeared uncomfortable and distressed with increased respiratory rate. Morphine and Ativan given for comfort measures. 5/5/2021 Deceased.

Other Meds: Aspirin, Finesteride, Miralax, Tamsulosin, Lorazepam, Colace,Metoprolol, Levothyroxine, Tylenol ES

Current Illness: None

ID: 1512689
Sex: F
Age: 63
State: DC

Vax Date: 04/01/2021
Onset Date: 05/01/2021
Rec V Date: 07/29/2021
Hospital:

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

Lab Data:

Allergies: all nuts, all fish (fin and shell)

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: One afternoon in May 2021, erratic heart beat for approximately 25 minutes. I was home and working, not engaged in any physical activity. Also in mid-May, I began to experience pain in lower right pelvic area which increased in severity over several weeks. I had pelvic ultra sound to rule out anything. Nothing was detected and the pain resolved within a few weeks. My doctor stated that he had other female patients who experienced similar symptoms after the COVID-19 vaccine.

Other Meds: n/a

Current Illness: n/a

ID: 1512690
Sex: M
Age: 41
State: MN

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

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

Lab Data:

Allergies: none

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

Symptoms: Severe ringing in ears, partial loss of hearing, dizziness, loss of balance

Other Meds: none

Current Illness: none

ID: 1512692
Sex: M
Age: 15
State: PA

Vax Date: 07/01/2021
Onset Date: 07/02/2021
Rec V Date: 07/29/2021
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: No

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

Symptoms: Muscle aches and hot sweats

Other Meds: None

Current Illness: NO

ID: 1512693
Sex: F
Age: 56
State:

Vax Date: 07/21/2021
Onset Date: 07/28/2021
Rec V Date: 07/29/2021
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: Unevaluable event

Symptoms: Left eye doesn't hurt or burn, but cannot see out of the eye suddenly. Can only see black, white, and grey.

Other Meds: None.

Current Illness: None.

ID: 1512694
Sex: M
Age: 14
State: CT

Vax Date: 07/23/2021
Onset Date: 07/01/2021
Rec V Date: 07/29/2021
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: n/a

Other Meds:

Current Illness:

Date Died: 07/28/2021

ID: 1512695
Sex: F
Age: 87
State:

Vax Date: 03/03/2021
Onset Date: 07/28/2021
Rec V Date: 07/29/2021
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:

Symptom List: Injection site pain, Pain

Symptoms: death I21.4 - NSTEMI (non-ST elevated myocardial infarction) (CMS/HCC)

Other Meds:

Current Illness:

ID: 1512696
Sex: F
Age: 40
State: LA

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

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

Lab Data:

Allergies: no known allergies

Symptom List: Injection site pain, Menorrhagia

Symptoms: patient reported that left leg was numb for a while immediately after receiving injection. Pharmacist called patient again on Thursday, July 29 at which time reported no more problems that was experienced on 7/28/2021

Other Meds: no medications listed

Current Illness: no illnesses

ID: 1512697
Sex: M
Age: 66
State: CA

Vax Date: 07/23/2021
Onset Date: 07/27/2021
Rec V Date: 07/29/2021
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: NONE

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

Symptoms: On Tuesday night at 11:30PM I experienced sharp pains under my skin on the right side of my torso. (Neuralgia of the right flank (M79.2). The pain steadily increased until I saw a doctor at Urgent Care one July 29 at 8:30AM.

Other Meds: Ibuprofen 800MG Testosterone Topical Solution 3 mL Sidenafil 50MG

Current Illness: NONE

ID: 1512698
Sex: M
Age: 55
State: CT

Vax Date: 07/01/2021
Onset Date: 07/29/2021
Rec V Date: 07/29/2021
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: Nausea, Pain in extremity, Pyrexia

Symptoms: n/a

Other Meds:

Current Illness:

ID: 1512699
Sex: F
Age: 27
State: NY

Vax Date: 07/15/2021
Onset Date: 07/16/2021
Rec V Date: 07/29/2021
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: Localized reaction, approximately 5cm X 5cm raised reddened area. Lasted approximately 8 days,

Other Meds: No medications, no herbal supplements, no alcohol, no illegal drugs.

Current Illness: none

ID: 1512700
Sex: F
Age: 76
State: AR

Vax Date: 07/28/2021
Onset Date: 07/28/2021
Rec V Date: 07/29/2021
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: Minoxidil

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

Symptoms: This nurse was notified by Pharmacy at 12:15pm 7/29/21 that this was elder's 3rd vaccine when they were entering in . On admission, elder notified staff she was not vaccinated. No adverse effects noted at this time. APRN/PCP were notified

Other Meds: Megestrol 40mg BID, Nephro Vitamins 0.8mg daily, Cozaar 100mg daily, Phos Lo 667mg 2 capsules with meals, Norco 5/325mg 1 tablet q 4h PRN, Pantoprazole 40mg BID, Carvedilol 6.25mg BID, Renvela 800mg 2 tablets with meals, Alprazolam 0.5mg 1

Current Illness: Acute MI 7/23/21

ID: 1512701
Sex: F
Age: 41
State: OH

Vax Date: 01/25/2021
Onset Date: 07/14/2021
Rec V Date: 07/29/2021
Hospital:

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

Lab Data:

Allergies: No

Symptom List: Nausea

Symptoms: I started feeling sick on the 14th - tickle in my throat and feeling rundown. And the next day, headache and my head felt cloudy and I was congested. I thought I had a head cold. The next day, I was sweating so profusely - my shirt was wet and I couldn't stop sweating but went from sweating to freezing and back and forth. I did not have a fever. I had awful body aches. It hurt standing up - joints hurt. Not normal for me. The headache and body aches continued and I was nauseous and I had diarrhea. By Sunday, I felt okay. I was alright. I was still really tired but I wasn't like I was like I was the week prior. By Monday, I was doing pretty good and then Tuesday, I had a pre-op appt. I had to get tested before the operation and they tested it and it was positive. I had to cancel my surgery. 10 day quarantine from the 20th. I've been symptom free during quarantine. I just used OTC - ibuprofen and took a sinus medication: a Tylenol, cold and sinus OTC to help during the time of they symptoms. I did contact my primary care doctor on the 20th when I had the positive test because I had seen her on the 12th. So it was remote - email visit.

Other Meds: Multi-Vitamin; Levothyroxine; Atorvastatin; Lyrica; Cymbalta; Tanazidine

Current Illness: No

ID: 1512702
Sex: F
Age: 41
State: IN

Vax Date: 07/26/2021
Onset Date: 07/27/2021
Rec V Date: 07/29/2021
Hospital:

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

Lab Data:

Allergies: Doxycycline

Symptom List: Injection site pain

Symptoms: Broke out in hives all over my body

Other Meds: Strattera 80 mg Lexapro 20 mg Lamictal 200 mg Protonic 40 mg Trazodone 100 mg Vitamin D 50000 unit capsules Vyvanse 60 mg

Current Illness:

ID: 1512703
Sex: M
Age: 29
State: KY

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

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

Lab Data:

Allergies: unknown

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

Symptoms: Patient had received vaccine and was in waiting area for observance. After around 10 minutes wife came to counter and said he was feeling dizzy. RPH walked out to check on patient whom had sit back down from standing up briefly. Patient seemed responsive until his head drifted down, unresponsive to voice and touch for one minute or less. Pulse on wrist was faint, but present and no signs of struggled breathing. No swelling or redness near throat present. Patient woke up shortly with pale skin, but responded well and water was given. Ambulance arrived to further assist.

Other Meds: n/a

Current Illness: unknown

ID: 1512704
Sex: M
Age: 36
State: WI

Vax Date: 07/29/2021
Onset Date: 07/29/2021
Rec V Date: 07/29/2021
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: NKDA

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

Symptoms: During the post-vaccine monitoring period , a bout 5-10 minutes after the first dose injection of Moderna Covid Vaccine, pt felt nausea and had seizure episode for about 2-3 minutes. Pharmacist noticed rolling eye balls and body shake with brief unconsciousness. Pt was alerted 2-3 min after with sweats and slight confusion. Meanwhile, 911 was called and paramedics came and checked patient. out . Pt was pale but all vitals were normal and returned to stable condition. Pt was released and his wife accompanied back home. Pharmacist is planning to l follow up with patient .

Other Meds: NA

Current Illness: none

Date Died: 05/24/2021

ID: 1512705
Sex: M
Age: 93
State: KY

Vax Date: 01/28/2021
Onset Date: 04/30/2021
Rec V Date: 07/29/2021
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: Tremor

Symptoms: 93 Male vaccinated Pfizer 1/06/2021 & 1/28/2021. Symptom onset 4/30/2021 - SOA, fatigue. Taken to ER 5/10/2021 for blurry vision. Diagnosed with COVID 4/30/2021. Started dexamethasone. Patient claims left eye problems secondary to dexamethasone. Discharged and final diagnosis at time of death 5/24/2021 - COVID-19 with PNA

Other Meds:

Current Illness:

ID: 1512706
Sex: M
Age: 51
State: TX

Vax Date: 04/23/2021
Onset Date: 04/23/2021
Rec V Date: 07/29/2021
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: Sulfa drugs taken internally

Symptom List: Erythema, Pruritus

Symptoms: Previously reported with lot number - VAERS ref# 539288. High pitch constant sound in both ears (tinnitus) starting evening of shot that occurred on 4/23. Two visits to ENT confirmed no hearing loss. Steroid treatment didn?t affect intensity of sound. Removal of statin for two months and 50% reduction of proton inhibitor did not reduce intensity of sound.

Other Meds: 75 mcg L-Thyroxine reduced to 50% due to racing pulse. 20mg omeprazole. 20 mg simvastatin. Multivitamin.

Current Illness: None

ID: 1512707
Sex: F
Age: 33
State: PA

Vax Date: 04/14/2021
Onset Date: 04/21/2021
Rec V Date: 07/29/2021
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: Zofran Ciprofloxacin Trazodone

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

Symptoms: Continuous Respiratory Issues -Cough -Shortness of Breath -Sore throat -Vomiting -Headaches

Other Meds:

Current Illness: No

ID: 1512708
Sex: F
Age: 82
State: FL

Vax Date: 04/01/2021
Onset Date: 07/02/2021
Rec V Date: 07/29/2021
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: lactose intolerance, IV morphine

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

Symptoms: Internal body vibrations beginning in July 2021, starting in my feet and moving up into my body, arms and hands with stress. My hands lose fine motor control when the vibrations get very bad. They are idiopathic. I can allieviate them for a few hours with sports mineral and electrolyte supplements.

Other Meds: 10 mg Diazapam @ 2AM, Glucosamine chondroitin, multdigestive enzymes, milk thistle, COQ10, B-12, fiber caps, probiotics,

Current Illness: idiopathic chronic diarrhea

ID: 1512709
Sex: F
Age: 53
State: NC

Vax Date: 07/26/2021
Onset Date: 07/27/2021
Rec V Date: 07/29/2021
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: Fever (4 hours) chills (6 hours) extreme fatigue (36 hours) body aches (24 hours) nausea (36 hours) decreased appetite (72 hours) sore arm at site of injection (4 days) fatigue (4 days)

Other Meds: Fish Oil, Biotin, Multi-vitamin, Vitamin C, Synthroid, Liothyronine, Magnesium, Vitamin B12

Current Illness:

ID: 1512710
Sex: F
Age: 60
State: CA

Vax Date: 07/28/2021
Onset Date: 07/28/2021
Rec V Date: 07/29/2021
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: ~20 mins (0852) after receiving the 1st dose of Pfizer vaccine, complained of itchiness on her back, legs. She denied swelling of throat/tongue, difficulty of breathing. BP 190/93, O2 sat=96. 25 mg. Benadryl given x1 at 0853. 20 minutes later, verbalized persistent itchiness on her back and left foot. A second dose of Benadryl 25 mg. given at 0913. 10 minutes later, verbalized she's "feeling good". Patient advised to get clearance from her PCP regarding the second dose of the Pfizer vaccine.

Other Meds:

Current Illness:

ID: 1512711
Sex: M
Age: 21
State: CT

Vax Date: 07/01/2021
Onset Date: 07/01/2021
Rec V Date: 07/29/2021
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: n/a

Other Meds:

Current Illness:

ID: 1512712
Sex: M
Age: 15
State: OR

Vax Date: 07/28/2021
Onset Date: 07/28/2021
Rec V Date: 07/29/2021
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 REPORTED

Symptom List: Pain in extremity

Symptoms: SUBJECTIVE: Pt. is a 15 year old male here vaccinated at our community vaccine event at high school last evening and received the Pfizer vaccine Approx 10 min after receiving the vaccine the patient reported: weakness and lighheadedness At approx 10 min post vaccination he was still sitting in the chair he was vaccinated in. When I came to him he was clamy and pale and felt weak and lightheaded. He also c/o of feeling tremulous This Hx of was obtained by pt and pt's mother who was with pt at the vaccine event. Pt was feeling anxious but well prior to the vaccine. He last ate approx 5 hrs prior to vaccine and had hamburger and root beer. He had no significant activity during the day prior to the event. He did wake up approx 4 hrs earlier then his usual time on day of event because of school orientation he had that day. Pt and mom denied any prior hx of similar reactions after vaccines Pt reported it "feels like just got a shot" No nausea, itching or resp distress No PMHx -Per pt. has been on IEP for adhd No current medications NKDA SocHx: pt denied any recent drug or etoh use Sudden onset of symptoms/signs: yes Rapid progression of symptoms/signs: Rapid progression that quickly improved OBJECTIVE: General appearance: pale and clammy Skin:no rashes Resp: CTA bilat CV: RRR Vitals Vaccine given at 5:58 pm 6:05 pm BP 87/50, P 83, pox 98%- pt was given water 6:08 pm BP 134/84, - coloring in face improved and pt began to feel better- pt was alert and oriented x 3 at this point 6:13pm BP 130/66- pt was given granola bar and 2nd bottle of water BS: 118 DISPOSITION: After sitting in chair for approx 35 min, drinking two bottles of water and two granola bars pt was feeling better, appeared better with normal coloring and not clamy and had normal vitals signs. He and his mom felt comfortable going home to rest. I reviewed warning signs with mom to call or go to ED for I called the next day (7/29) and spoke with his mom and she stated pt was doing better after eating dinner and was feeling well this. She plans to call pt's pediatrician to coordinate his 2nd dose in their office or affiliated clinic.

Other Meds: NONE REPORTED

Current Illness: NONE

ID: 1512713
Sex: M
Age: 57
State: CA

Vax Date: 04/25/2021
Onset Date: 04/30/2021
Rec V Date: 07/29/2021
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: Shingles, maybe eye infection too? I got grit in my eye while working on my car 5 days after my first Pfizer shot. In the following days I began to be bothered by my eye and possible infection. A doctor video call 9 days after my Pfizer shot suggested antibiotics for my eye (Cephalexin). My girlfriend thought possibly shingles and suggested I ask doctor. 2nd doctor video visit, 11 days after Pfizer shot, doctor agreed Shingles likely - began antiviral Valacyclovir that evening for 7 day prescription . Continued with my 7 day prescription of Cephalexin as well. I had a relatively light bout of Shingles but the scaring and nerve tingling is still present two months later. I had face breakouts for about a month.

Other Meds: occasional multi-vitamin or vitamin c.

Current Illness:

ID: 1512714
Sex: M
Age: 63
State: NY

Vax Date: 03/04/2021
Onset Date: 03/13/2021
Rec V Date: 07/29/2021
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: Severe gas, abdominal pain, cramping, bloating, nausea, fatigue and dizziness

Other Meds: hydrochlorothiaz 25mg acyclovir 400mg citalopram 40mg

Current Illness: none

ID: 1512715
Sex: F
Age: 30
State: IN

Vax Date: 07/27/2021
Onset Date: 07/28/2021
Rec V Date: 07/29/2021
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: Latex Batadine Iodine

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

Symptoms: Large swollen welt tender to touch but ichy

Other Meds:

Current Illness: Na

ID: 1512716
Sex: F
Age: 36
State: MO

Vax Date: 04/12/2021
Onset Date: 07/20/2021
Rec V Date: 07/29/2021
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: Unknown

Symptom List: Vomiting

Symptoms: Case hospitalized on 7/20/2021 for COVID. Symptoms unknown - have been unable to reach case.

Other Meds: Unknown

Current Illness: Unknown

ID: 1512717
Sex: F
Age: 28
State: IL

Vax Date: 07/29/2021
Onset Date: 07/29/2021
Rec V Date: 07/29/2021
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: CEFZIL

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: PATIENT UPON RECEIVING VACCINE IMMEDIATELY PASSED OUT IN CHAIR; SHE SLID AND BUMPED HEAD SLIGHTLY AGAINST WALL. PATIENT WAS OUT FOR ABOUT 30 SECONDS. UPON COMING TO, PATIENT WAS FINE. EMTS WERE CALLED TO EVALUATE PATIENT AND PATIENT WAS DEEMED OK AND LEFT WITH HER MOTHER WHO WAS WITH HER AT THE TIME. SHE HAD NO OTHER COMPLAINTS AND MOTHER HAD STATED PRIOR THAT THIS HAD HAPPENED IN PAST WITH OTHER VACCINES. PATIENT IS OTHERWISE OK AT THIS TIME AND WENT HOME WITH HER MOTHER; SHE IS TO CONTACT US AND MD IF ANY OTHER CONCERNS ARISE.

Other Meds: TRINTELLIX, GABAPENTIN, WELLBUTRIN, BUSPIRONE, ABILIFY, ZIPRASIDONE

Current Illness:

ID: 1512718
Sex: M
Age: 45
State: NV

Vax Date: 07/28/2021
Onset Date: 07/28/2021
Rec V Date: 07/29/2021
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: na

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

Symptoms: day 49 to complete series

Other Meds: na

Current Illness: na

ID: 1512719
Sex: F
Age: 29
State: NJ

Vax Date: 07/27/2021
Onset Date: 07/27/2021
Rec V Date: 07/29/2021
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: Systemic: Dizziness / Lightheadness-Severe

Other Meds:

Current Illness:

ID: 1512720
Sex: F
Age: 42
State:

Vax Date: 05/02/2021
Onset Date: 05/09/2021
Rec V Date: 07/29/2021
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: SYMPTOMS: SWELLING IN THE LINING OF HEART, NAUSEA, CANT BREATH REALLY BAD FATIGUE FOR A WEEEK, MASSIVE HEADACHE. CURRENTLY TAKING ANTI ANFLAMMATORY FOR PAIN AND SWELLING. PATIENT DIAGNOSED WITH PERICARDITIS AND COSTOCHONDRITIS

Other Meds: VITAMIN SUPPLEMENTSNONE

Current Illness: ASTHMA AND ANAEMIA

ID: 1512721
Sex: F
Age: 54
State: NC

Vax Date: 01/25/2021
Onset Date: 01/29/2021
Rec V Date: 07/29/2021
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: No known allergies.

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

Symptoms: I was having severe jaw pain on the right side of my face. I started having a tingling feeling in my fingers and my toes. I started having memory loss, confusion, migraines and swelling on the right side my face and my eyes was swollen shut. I am also having ringing in the right ear.

Other Meds: I am taking Gabapentin 300mg

Current Illness: No illnesses at the time of vaccination.

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm