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: 1519015
Sex: M
Age: 67
State: AZ

Vax Date: 07/08/2021
Onset Date: 07/08/2021
Rec V Date: 08/01/2021
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: Bactrim, Siladine cream

Symptom List: Dysphagia, Epiglottitis

Symptoms: First symptoms were immediate. My left forearm ached for several days. The next day my right calf felt like I was kicked. 20 days after the second shot I had a syncope vasa vagal event when I got up in the middle of the night to urinate. That was preceded by a rapid heart beat that night while laying in bed. I have palpitations so I am accustomed to irregular beats. But this was different from a palpitation.

Other Meds: Losarton, Metoprolol, lovistatin, pantoprozole, amlodipine, ranididine, loratitine, Zinc, magnesium, D3, B-12, B-6, tylenol

Current Illness: none

ID: 1519016
Sex: M
Age: 55
State: FL

Vax Date: 07/28/2021
Onset Date: 07/30/2021
Rec V Date: 08/01/2021
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: On Friday morning, I was feeling fatigued and my nose started running severely, with post nasal drip. As the day went on, the fatigue got worse, I started getting muscle aches all over and a headache. These continued through Saturday and I started getting chills. These still continued today (Sunday) along with diarrhea.

Other Meds: Fexofenadine 180mg, Famotidine 20mg, One-A-Day Men's Silver Multi-vitamin gel tab, Red Yeast Rice, CoQ10

Current Illness: none

ID: 1519017
Sex: M
Age: 41
State: WI

Vax Date: 05/25/2021
Onset Date: 05/31/2021
Rec V Date: 08/01/2021
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: none

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

Symptoms: demyelinating illness started 5 days after second vaccine started with numbness and tingling of legs, progressed to lower extremity weakness, developed facial numbness, hand incoordination mri showing enhancing lesions in brain, cervical, thoracic spine lp abnormal, lymphocytosis oligoclonal bands got high dose steroids for 5 days no improvement getting plasmaphersis hospitalized since 7/22 to present

Other Meds: escitalopram

Current Illness: none

ID: 1519018
Sex: M
Age: 47
State: CT

Vax Date: 07/30/2021
Onset Date: 08/01/2021
Rec V Date: 08/01/2021
Hospital:

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

Lab Data:

Allergies: NKDA NKFA

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Joint ache, muscle fatigue, feeling close to fainting, louder tinnitus than usual.

Other Meds: Metoprolol 100mg QD Amlodipine 10mg QD Creator 20mg qd

Current Illness: None

ID: 1519019
Sex: F
Age: 29
State: TX

Vax Date: 03/12/2021
Onset Date: 03/26/2021
Rec V Date: 08/01/2021
Hospital:

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

Lab Data:

Allergies: Reglan

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

Symptoms: 2 weeks following the vaccination, I started to develop a prominent burning at the tip of my tongue In the first week of April 2021, I started noticing that the taste buds on my tongue were inflamed and I started developing red lesions along the top of my mouth along the soft palate I have not had any reprieve from these symptoms and now my tongue constantly feels like I burned it on a hot drink and the oil glands in my eyes have reduced significantly

Other Meds: Women's 1 a day multivitamin Lo Loestrin Fe

Current Illness: N/A

ID: 1519020
Sex: U
Age: 50
State: CA

Vax Date: 04/02/2021
Onset Date: 04/30/2021
Rec V Date: 08/01/2021
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:

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

Symptoms: Nothing

Other Meds:

Current Illness:

ID: 1519021
Sex: F
Age: 55
State: VA

Vax Date: 03/27/2021
Onset Date: 03/27/2021
Rec V Date: 08/01/2021
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: Bactrian- Sulfur/ Sulfur products- Polysorbate products- Pfizer vaccine

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Tounge and throat swelling, unable to swallow - Anaphylaxis Within 3 minutes of vaccination Given epinephrine injection left arm - ER for 6 hours prescribed Famotidine 40mg, Prednisone 20mg for 4 days

Other Meds: Dicyclomine 20mg, Bupropion, 150mg, Omeprazole DR 40mg, Celecoxib 100mg, Gabapentin 300mg, ProAir 90 inhaler , Dulcolax, Nasacort, Eye drops

Current Illness: None

ID: 1519022
Sex: F
Age: 16
State: SC

Vax Date: 07/31/2021
Onset Date: 07/31/2021
Rec V Date: 08/01/2021
Hospital:

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

Lab Data:

Allergies: norco

Symptom List: Pharyngeal swelling

Symptoms: Idiopathic vasovagal reaction, lasted about 30 seconds. emergency response activated. Evaluated by EMS after and released with mother.

Other Meds: unknown

Current Illness: no

ID: 1519023
Sex: M
Age: 50
State: IN

Vax Date: 08/01/2021
Onset Date: 08/01/2021
Rec V Date: 08/01/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Minor headache with accompanying fatigue of equal intensity. Very minor muscle soreness in the area directly below the injection site, not the site itself. Headache and fatigue began roughly three hours after injection. These subsided with one over the counter headache pill and an hour nap. They returned a short time later, but we slightly less intense. As of 6 hours after the injection, no other side effects have been noted.

Other Meds:

Current Illness:

ID: 1519024
Sex: F
Age: 12
State:

Vax Date: 08/01/2021
Onset Date: 08/01/2021
Rec V Date: 08/01/2021
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:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient became severely disoriented, lost hearing, pale, after vaccine administration. Called 911 but after evaluation, patient did not go to the hospital with 911 team.

Other Meds:

Current Illness:

ID: 1519025
Sex: F
Age: 54
State: NV

Vax Date: 06/20/2021
Onset Date: 06/20/2021
Rec V Date: 08/01/2021
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: Joint pain all over my body (hand, shoulder, knees)

Other Meds: None

Current Illness: None

ID: 1519026
Sex: F
Age: 23
State: CA

Vax Date: 07/29/2021
Onset Date: 07/29/2021
Rec V Date: 08/01/2021
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: She was feeling lightheaded at 6:15PM. The client ambulated and sat in the anti-gravity chair. Vitals obtained at 6:21PM were as follows: HR 55, O2 99%, and automatic BP 108/64. The client was provided water at 6:24 PM and began drinking it. The client denied any other s/s of anaphylaxis. At 6:28PM the client stated the lightheadedness was improving. Client was moved to a reclining position in the anti-gravity chair. Repeat vitals obtained at 6:31PM were as follows: HR 53, O2 99%, automatic BP 110/72. Educated the client and her family on s/s of anaphylaxis, when to seek EMS, and V-safe. Client and her family voiced understanding of this education. Client denied any current medications. No known allergies. Repeat vitals obtained at 6:41 PM were as follows: HR 58, O2 99%, and automatic BP 109/68. The client denied feeling lightheaded at the time. The client left the vaccination site at 6:44PM. The client ambulated unassisted with a steady gait.

Other Meds: None

Current Illness:

ID: 1519027
Sex: M
Age: 25
State: PR

Vax Date: 08/01/2021
Onset Date: 08/01/2021
Rec V Date: 08/01/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Localized allergic reaction on neck and chest.

Other Meds: n/a

Current Illness: n/a

ID: 1519028
Sex: F
Age: 23
State: GA

Vax Date: 08/01/2021
Onset Date: 08/01/2021
Rec V Date: 08/01/2021
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 known allergies.

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

Symptoms: Patient became light headed shortly after receiving the vaccine. She briefly fainted, but quickly became responsive. She was sweating profusely, but had no chest tightness, shortness of breath, or swelling of the throat. She laid down for 20-30 minutes while we called 911. When the ambulance was slow to arrive, she made the decision to have her friend drive her to the emergency room. She was able to walk out of the store with her friend's assistance.

Other Meds:

Current Illness:

ID: 1519029
Sex: F
Age: 53
State: CA

Vax Date: 07/28/2021
Onset Date: 08/01/2021
Rec V Date: 08/01/2021
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: Patient presented with half of her left eye red in color. It appears as though a blood vessel ruptured. She states there is no pain associated with the eye. She had been suffering with a migraine the day prior.

Other Meds: None

Current Illness: Migraines

ID: 1519030
Sex: F
Age: 42
State: FL

Vax Date: 04/29/2021
Onset Date: 04/29/2021
Rec V Date: 08/01/2021
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

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

Symptoms: Continuous diarrhea ever since the day of the injection so three months so far. I have never had this issue prior. Tennis elbow in injected arm. Never had condition prior

Other Meds: Losartan 50mg, hctz 12.5mg, valacyclovir 500mg, Allegra, multi vitamin, b complex, d3

Current Illness: None

ID: 1519031
Sex: M
Age: 20
State: KS

Vax Date: 08/01/2021
Onset Date: 08/01/2021
Rec V Date: 08/01/2021
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: nka

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

Symptoms: Patient passed out immediately after shot given, patient came to within 10 to 15 seconds, pale in color and incoherent at first. Cold compress applied to neck and forehead. patient passed out second time after 1 to 2 minutes and EMS contacted. Patient came to within 10 to 15 seconds and still very incoherent. patient was laid down flat on back with cold compress. EMS arrived , pulse no other vitals taken EMS determined patient was ok to leave after approximately 30 minutes. Patient refused any further treatment.

Other Meds: none known

Current Illness: none listed

ID: 1519032
Sex: F
Age: 38
State: FL

Vax Date: 07/28/2021
Onset Date: 07/29/2021
Rec V Date: 08/01/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Shoulder Pain and sever neck pain on left side up the cervical and thoracic spine into head and skull, feels nerve intense plus muscular. Some numbness down left arm.

Other Meds: none

Current Illness: none

ID: 1519033
Sex: F
Age: 26
State: OK

Vax Date: 07/15/2021
Onset Date: 07/15/2021
Rec V Date: 08/01/2021
Hospital:

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

Lab Data:

Allergies: Iodine, shellfish

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: After being taken back to room the shot was administered. I stood up to wait in the lobby for the required 15 minutes. Immediately upon standing a wave of lightheaded/dizziness hit with nausea and dry heaving. All fingers and toes went numb and excessive sweating started. After 2-3 minutes breathing became labored and pharmacist staff reported that I was turning blue. Both hands and both feet were numb and hands began cramping at first knuckle, unable to straighten fingers without assistance from an object and applied pressure. The pharmacist immediately rushed to get an epipen while manager called EMS, but did not administer as they were afraid of making reaction worse. After approximately 15 minutes the symptoms subsided and breathing returned to normal. EMS did provide on assessment on site, but agreed that medical transport was not needed but would remain under supervision from family to ensure no further reaction. Pain from cramping in hands lasted for approx. 4 days.

Other Meds: Oral Hydrocortisone 35mg per day

Current Illness: N/A

ID: 1519035
Sex: M
Age: 17
State: PR

Vax Date: 06/30/2021
Onset Date: 07/25/2021
Rec V Date: 08/01/2021
Hospital:

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

Lab Data:

Allergies: bakers yeast

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

Symptoms: Patient with a history of bakers yeast allergy dignosis as a kid ten years ago (2011) that later stopped in a couple of months of that same year with treatment and diet. In a couple of months (2011) returned to normal diet and without treatment. Not any recurrence of any symptoms in 10 years, until June 25th, 2021 (26 days after the first dose of Covid 19 Vaccine) that the same allergy appeared with the same symptoms as in 2011 consisting of: Sections of irritated red, rised and swollen skin (from less than 1 inch to 5,6 or 7 inch diameter) in head, face, back of ears, arms, torso, pelvis and legs. On and off episodes, still ocurring as this moment (July 30th).

Other Meds: no

Current Illness: no

ID: 1519038
Sex: F
Age: 30
State: IL

Vax Date: 06/30/2021
Onset Date: 07/03/2021
Rec V Date: 08/01/2021
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: Augmentin

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

Symptoms: Constant pain head, neck, back , limbs, hands and feet go numb, Uncontrolled Body tremor, uncontrollable neck tic, difficulty walking, tripping, loss of grip, loss of muscle, difficulty with speech, memory issues, loss of bladder, stuttering, difficulty making out words

Other Meds: Lisinopril Jardiance Trajenta Lantus Humilog Metoprolol Sertaline Abilify Vitamin D

Current Illness: Diabetes, hypertension, depression, ptsd, anxiety

ID: 1519039
Sex: M
Age: 24
State: FL

Vax Date: 08/01/2021
Onset Date: 08/01/2021
Rec V Date: 08/01/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Unevaluable event

Symptoms: patient received a vaccine and was informed to wait 15 minutes. While I was administering the vaccine to someone else, we heard a crash, when I jumped up, I see him on the floor. I told a tech to call 911 and the manager. A customer called 911 for me on her cell phone. The patient asked for a bottle of water which we quickly got for him. He was delirious and sweating for a while but after drinking the water appeared to recover. Rescue came but I think the patient was ok by the time they arrived. He had gotten help up from off of the floor and to the chairs. I asked him where he was going because he was supposed to wait 15 minutes and he replied that he was going to get something to drink

Other Meds: NONE

Current Illness: N/A

ID: 1519040
Sex: M
Age: 26
State: CA

Vax Date: 07/30/2021
Onset Date: 07/30/2021
Rec V Date: 08/01/2021
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: none

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

Symptoms: The patient did not experience any adverse events other than sore arm, but the vaccine was administered a week early.

Other Meds: none

Current Illness: none

ID: 1519041
Sex: F
Age: 48
State: NC

Vax Date: 04/03/2021
Onset Date: 06/01/2021
Rec V Date: 08/01/2021
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: I had heart palpitations(PVC?s) from June 4th until July 15th. I?ve also had daily spotting and a little more than spitting at times from July 2nd until today August 1st. I have reported the heart palpitations and abnormal spotting to my dr.

Other Meds: None

Current Illness: None

ID: 1519043
Sex: F
Age: 56
State: AR

Vax Date: 07/20/2021
Onset Date: 07/24/2021
Rec V Date: 08/01/2021
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

Symptom List: Injection site pain, Menorrhagia

Symptoms: Left ear and tongue, throat covered with whitish puss material and ear feels so full and the ringing in ear is about to drive me crazy. Heart palpitations after years of not having any. Burning I'm chest. Dizziness. Horrible taste in mouth

Other Meds: No

Current Illness: No

ID: 1519044
Sex: F
Age: 36
State: CA

Vax Date: 07/31/2021
Onset Date: 07/31/2021
Rec V Date: 08/01/2021
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: Iodine Reglan Shellfish

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

Symptoms: Patient had tingling in the mount and felt like her tongue was swelling about two hours after vaccination. Paramedics were called who took her to the ER

Other Meds: Lyrica Pantoprazole Linzess Gabapentin Topiramate Motegrity Baclofen Enoxeparin Clonidine Cyproheptadine Benadryl Ondansetron

Current Illness: Not known

ID: 1519045
Sex: F
Age: 48
State: MO

Vax Date: 07/24/2021
Onset Date: 07/25/2021
Rec V Date: 08/01/2021
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: Lamactil

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: I have experienced Vertigo Since receiving the Vaccination, I have not been able to leave my home or go to work, because my Vertigo is so bad.

Other Meds: Vitamin D, Vitamin K, CBD oil, Multi vitamin

Current Illness: idiopathic intracranial hypertension

ID: 1519046
Sex: F
Age: 19
State: IN

Vax Date: 07/20/2021
Onset Date: 07/21/2021
Rec V Date: 08/01/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Fever, body aches, congested, sore throat, asthma, migraine, no appetite, weak

Other Meds: None

Current Illness: None

ID: 1519047
Sex: F
Age: 38
State: WI

Vax Date: 07/31/2021
Onset Date: 07/31/2021
Rec V Date: 08/01/2021
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: Had adverse reaction to supplement PS 150.

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

Symptoms: After I received the shot, I walked out to the store to browse. Within 1-2 minutes I began to feel lightheaded and my heart began to pound rapidly. I went back to vaccination area and sat down with pharmacist. My heart continued to pound rapidly for about another 4-5 minutes. Once my heart slowed down, I continued sitting about another 5min, as I still felt lightheaded. I then left the store to walk outside in fresh air. I had to sit down outside because I felt weak (about 15 min post shot) As I was resting, my heart began to beat rapidly again for about 30sec-1min. It took about 45m for my lightheadedness to fully subside.

Other Meds:

Current Illness:

ID: 1519048
Sex: M
Age: 74
State: FL

Vax Date: 02/04/2021
Onset Date: 02/11/2021
Rec V Date: 08/01/2021
Hospital: Y

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

Lab Data:

Allergies: Penicillin - Cipro - Lisinopril-Feathers-Wool- Horse Hair, Pollen-Some detergents.

Symptom List: Nausea

Symptoms: Received 1st Vaccination on 2/4/21. Started to get severe back pain on left about a week after 1st injection about 2/11/21. Received 2nd Pfizer Covid-19 injection on 2/25/21. On 3/3/21 was sent to ER by my PCP based upon abnormal Blood Work on 8/26/21. Found to have Staph infection in lower back and Sepsis. Had fver for several days after admission, don' know temperature. Treated with antibiotics and had drain inserted into my back. Release from hospital on 3/11/21. Was treated with injection of Cefazolin 3 times per day for 6 weeks until 4/23/21. Drain was removed on 3/23/21 at hospital.

Other Meds: 81 mg Asprin Daily, a.m.100 mg Losartan, a.m.25 mg Hydrochorot, 10 mg Glyburide Daily, 5 mg a.m., 5 mg p.m.,1,000 mg Metformin ER Daily, 500 mg a.m., 500 mg p.m.,150 mg Metoprolol ER Tab, 75 mg a.m. and 75 mg. p.m.,7 mg. Prednisone, 12 - 1

Current Illness:

ID: 1519050
Sex: M
Age: 15
State: CA

Vax Date: 07/28/2021
Onset Date: 07/30/2021
Rec V Date: 08/01/2021
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: None

Symptom List: Injection site pain

Symptoms: Peri/myocarditis - chest pain, pending treatment. At this point, just planning on NSAIDs

Other Meds: None

Current Illness: None

ID: 1519051
Sex: F
Age: 50
State: TN

Vax Date: 05/03/2021
Onset Date: 05/04/2021
Rec V Date: 08/01/2021
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:

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

Symptoms: 05/03/2021 - Received 2nd dose of Pfizer Covid-19 vaccine. Experienced mild cold-like symptoms that evening. 05/04/2021 - Awoke to excruciating lower back pain. Tried to walk it out, but passed out from pain. Could not sit, stand, or lie down. Only relief was kneeling with shoulders lower than hips. OTC pain meds, ice, and (very old) muscle relaxers did not help. 05/05/2021 - Went to ER. Was given a steroid shot and morphine. CT Scan came back normal. Sent home with a steroid pack and pain medicine. Intention was to schedule epidural steroid injection with spine specialist. Insurance refused to pay for injection. Pain meds didn't last long. Took 2nd steroid pack. Spent 12 more days on knees. 05/18/2021 - Went to ER for 2nd time. MRI showed existing issues at L4/L5 and L5/S1 and a new disc protrusion at L1/L2 with severe impingement of the L1 nerve root. Admitted to hospital for pain control 05/20/2021 - Received epidural steroid injection. 05/21/2021 - Discharged from hospital with 3rd steroid pack, muscle relaxers, and more pain meds. Over the next 5-7 days, slowly regained the ability to sit and stand. Have experienced relapses but usually recover in 1-3 days.

Other Meds: Kurvelo (28) Multi-vitamin, Calcium, Vit D, Vit C

Current Illness:

ID: 1519052
Sex: M
Age: 72
State: CO

Vax Date: 01/25/2021
Onset Date: 02/08/2021
Rec V Date: 08/01/2021
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

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

Symptoms: On January 25, 2021, My father who was 72 years old at the time, received his first Moderna Covid 19 vaccine at the Clinic. At the time of the vaccine he was a healthy, very active man. He works everyday as a ranch hand and cattle feeder 7 days a week. He does not and never has taken any prescription medications that would give us any suspicions of a reaction with those. He takes vitamin supplements to stay healthy, which is why he does not need or use prescription medications. Upon receiving this Covid-19 vaccine in his left arm, he noticed an immediate muscle soreness, which he thought was to be expected with a shot. This soreness or "achiness" that he describes in his left arm has never went away, even to this very day. He believes that these series of Moderna Covid-19 vaccines has permanently "damaged" the muscle in his arm. His left arm muscle aches every single day, all day long. On February 23, 2021 he received his second Moderna Covid-19 shot again in his left arm. Two weeks after his first Covid-19 vaccine shot, he went to get a haircut. His beautician and also my father noticed that his hair seemed to be getting a little thinner. Around the second week of March, two weeks after his second Moderna Covid-19 vaccine, he began to notice massive amounts of hair falling out. His hair brush was full of hair and he could literally run his hands through his hair and get a handful of hair immediately. This went on for weeks and months until around May 2021 when there was no more hair to fall out. He was completely bald. He looks like a "Chemotherapy patient NOW! He has always been a very excessive hairy man. He always could grow a full beard, mustache and side burns. He has always had massive belly and chest hair where there was no definite line between his chest hair and his beard. Hairy arms and legs, hair in his ears and nostrils. At this point and time (July 29, 2021) as I am filling out this form, My father, has also told me that In the last month he has NOW also lost about 90% of his eye brows and eye lashes. What few eye lashes he does have left, have dried discharge on them (similar to when a person has pink eye). His long, thick chest hair is starting to thin and quite a bit of his arm hair has fallen out also (50 % loss). He has small bald spots on his arms. The hair on his legs fell out probably started falling out about the same time as the hair on his head (95 % loss). He says the skin on his legs are now super smooth and soft just like " babies skin" as he has told me. This condition he has is very similar to "Alopecia" but has not been confirmed by a dermatologist yet. A gentleman who lives in the very same small town as my father, has had the same reaction to the his series of Moderna Covid-19 vaccine, "COMPLETE HAIRLOSS". I would hope that you will ask for photos of my fathers adverse reaction to your vaccine and that these very serious complaints be documented and publicized to the public.

Other Meds: Absolutely None! only dietary supplements: Vitamin E, Vitamin C, Vitamin D-3, Vitamin K-2, Vitamin B Complex, Niacin, Fish Oil, Calcium Magnesium and Zinc

Current Illness: None!!!!

ID: 1519053
Sex: F
Age: 41
State: CA

Vax Date: 07/07/2021
Onset Date: 07/11/2021
Rec V Date: 08/01/2021
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: Client reported that 5 days after receiving the 1st dose COVID vaccine Pfizer she developed a headache which lasted 4 days. The client also stated she developed "trouble breathing and throbbing in her chest" 5 days after the vaccine. The client reports intermittent episodes of trouble breathing since receiving the first dose of COVID vaccine Pfizer. The last episode of shortness of breath was on 07/25/21. The client states the shortness of breath sometimes triggers an anxiety attack where she has to take deep breaths to calm down. The client stated she did seek care at a doctors office where she was prescribed some sort of pain medication that did not provide relief of her symptoms. The client did not know which specific medication she was prescribed. The client returned to the doctors where she was given some sort of medication in an injection which resulted in improvement of her symptoms. The client does not know which type of medication she was given via injection. The client reports that she "feels weird" ever since she received the first dose COVID vaccine Pfizer. The client denies any chronic conditions. She does not take any medications regularly. The client denies any known allergies. The client denies any history of shortness of breath prior to receiving the first dose COVID vaccine Pfizer. Current vitals obtained were as follows: automatic BP 122/90, HR 75 BPM.

Other Meds: None

Current Illness:

ID: 1519054
Sex: M
Age: 16
State: NY

Vax Date: 07/22/2021
Onset Date: 07/24/2021
Rec V Date: 08/01/2021
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: Erythema, Pruritus

Symptoms: Had high fever, chest pain, body aches

Other Meds: None

Current Illness:

ID: 1519055
Sex: F
Age: 70
State: CA

Vax Date: 07/06/2021
Onset Date: 07/07/2021
Rec V Date: 08/01/2021
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: wheat, gluten (celiac) certain drugs: avelox, antibiotics

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

Symptoms: Extreme alertness, inability to sleep at night, for 2 weeks solid, and now intermittently, for another week. Waking in middle of night with extreme anxiety running through my body (never experienced in my life before, i calmed it down myself, 4 nights this week); Extreme fatigue.

Other Meds: dessicated thyroid, tryptophan

Current Illness: COPD for 52 years bronchiectasis or chronic lung inflammation

ID: 1519056
Sex: M
Age: 78
State: NY

Vax Date: 02/02/2021
Onset Date: 06/23/2021
Rec V Date: 08/01/2021
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: NONE

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

Symptoms: ON JUNE 23, 2021 I WOKE UP WITH TERRIBLE PAIN IN MY LEFT LEG FROM BEHIND MY KNEE ALL THE WAY DOWN MY LEG. I WENT TO AN URGENT CARE FACILITY AND THEY LOOKED AT MY LEG AND SAID THEY THOUGHT IT WAS A BLOOD CLOT. THEY CALLED AN AMBULANCE THAT TOOK ME TO EMERGENCY ROOM. THEY TOOK A CAT SCAN AND ULTRA SOUND AND TOLD ME I HAD A DVT. THEY PUT ME ON HEPARIN AND ADMITTED ME TO THE HOSPITAL FOR 2 DAYS AND PUT ME ON HEPARIN FOR TWO DAYS AND RELEASED ME ON JUNE 28, 2021. I WAS GIVEN A PRESCRIPTION FOR ELOQUIS,

Other Meds: AMLODOPINE, ATOROVASTIN,TAMSOLUSIN,GABAPENTINE,CLONAZAPAM, SERTRALINE,

Current Illness: NONE

ID: 1519058
Sex: F
Age: 51
State: NY

Vax Date: 08/01/2021
Onset Date: 08/01/2021
Rec V Date: 08/01/2021
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 came in for her first dose of the pfizer vaccine. At vaccination,showed that the pt received a first dose of moderna on 7/27/21. When asked, the pt stated that she had not received any covid vaccine. Pt was informed that having mixed covid vaccines is not approved by CDC, and her immunization record would not be accurate, resulting in her not being able to receive further doses (given that there are two records of separate vaccines present on her ). Pt reiterated not having taken any covid vaccine. AP Nurse Hotline was called to ask how to proceed at 2:19 PM. After calling the hotline, we reviewed the latest AP update from 7/28/21 that stated to escalate the issue if a pt discloses having received another covid vaccine. Due to this, we proceeded with the Pfizer vaccine at approximately 3:30 PM and noted in pts EMR record (pt denies having received another covid vaccine) as we were previously instructed to do so, being that the EMR CIR is not 100% accurate. At 3:46 PM the hotline called back and informed that reflected that there was a Moderna dose from 7/27/21 and a Pfizer dose from 8/1/21. Pt was still in observation, and when questioned again, she continued to attest to not receiving the moderna vaccine. Pt denied having received any Covid vaccine throughout the entire process. Pt left at 3:55 PM.

Other Meds:

Current Illness:

ID: 1519059
Sex: M
Age: 14
State: TN

Vax Date: 08/01/2021
Onset Date: 08/01/2021
Rec V Date: 08/01/2021
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: unknown

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

Symptoms: Seconds after receiving Pfizer covid 19, pt had a vasovagal episode with stiffening and jerking movements of extremities. Few second duration. Father stated upon arrival that Pt's mother had a "Bad reaction to Moderna" (seizure). She also has these reactions frequently and with botox injections. Pt "ate very little for breakfast. He was given water to drink. He drank 2 bottles. Vital signs x2 and walked in clinic without difficulty.

Other Meds: unknown

Current Illness: none

ID: 1519060
Sex: F
Age: 15
State: CA

Vax Date: 08/01/2021
Onset Date: 08/01/2021
Rec V Date: 08/01/2021
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: none

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

Symptoms: At 1457 client alerted EMT she was dizzy and hearing ringing on both ears. PHN and RN arrived at 1459, client sitting upright on chair, alert and oriented x4, pale, mild diaphoresis. First vitals at 1459: blood pressure 69/54, pulse 56, oxygen sat 99%. At 1500 client transferred to anti-gravity chair with help from EMT. Grandmother present with client, stated no medical history, no medications and no known allergies. Client stated she had ate and hydrated prior to vaccine. Per client felt dizzy from the moment she stood after vaccine administration and still walked to observation room without alerting staff. At 1504: pulse 78, oxygen sat 96%. Vitals at 1505: blood pressure 114/71, pulses 89, oxygen sat 97%. Skin normal for ethnicity, client reported ringing of ears and dizziness improving. Client denied blurry vision, headache, nausea, or shortness of breath. RN gave client Capri-Sun juice, client began drinking in small sips. Vitals at 1513: blood pressure 100/68, pulse 78, oxygen sat 98%. Client reported dizziness and ringing of ears resolved. EMT placed anti-gravity chair on 45 degree angle, client tolerated well, no complaints. Vitals at 1522: blood pressure 105/61, pulse 72, oxygen sat 98%. Client stated no symptoms at this time. EMT placed anti-gravity chair at 90 degrees, client reported no changes. Last vitals at 1533: blood pressure 107/70, pulse 75, oxygen sat 98%. PHN gave client and client's Grandmother ER precautions and advised to follow up with primary medical provider. PHN asked client to stand up and walk a few steps at 1534. Client walked with no complaints.

Other Meds: none

Current Illness:

ID: 1519061
Sex: M
Age: 19
State: ID

Vax Date: 08/01/2021
Onset Date: 08/01/2021
Rec V Date: 08/01/2021
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: Pain in extremity

Symptoms: Syncope occurred immediately after injection. Patient was seated and physically supported with no injury sustained. Patient was non-responsive for 10-15 seconds. Patient became alert shortly thereafter and was given water and sugar. After 15 to 20 minutes, the patient was able to move and recovered appropriately.

Other Meds: unknown

Current Illness: unknown

ID: 1519062
Sex: M
Age: 27
State: WI

Vax Date: 07/31/2021
Onset Date: 07/31/2021
Rec V Date: 08/01/2021
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 fainted after the vaccination while sitting in the chair just outside the pharmacy. patient soon became responsive and was assessed. No allergic reaction was present, and it was deemed vasovagal syncope.

Other Meds:

Current Illness:

ID: 1519063
Sex: M
Age: 51
State: NV

Vax Date: 07/27/2021
Onset Date: 07/27/2021
Rec V Date: 08/01/2021
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: PCN, gadolinium

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

Symptoms: Dizziness immediately post-vaccination. Resolved with IV hydration. Awakened by spouse in the middle of the night on 8/1/2021 because upper and lower extremities were so cold that he felt like he was dead. He reported moderate chills and difficulty getting warm. He required bed warming and layers of clothes rather than normal bed cooling. The chills have persisted into the late afternoon.

Other Meds: modafinil, atorvastatin, melatonin, krill oil, multivitamin, turmeric, Amino Activ

Current Illness: None

ID: 1519064
Sex: M
Age: 42
State: CO

Vax Date: 06/02/2021
Onset Date: 06/02/2021
Rec V Date: 08/01/2021
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: n/a

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

Symptoms: 06/02/2021; received the 2nd shot in my right arm after the first hour of the shot, my arm became tight to the feel and numbness was present. Two weeks later the symptoms, were still present as well as the pain that would radiate down my arm from my neck through my arm to my thumb which continued to become numb. On 06/18/2021, I had a visit with my physician for examination and x-rays were taken. Possibly mild-to-moderate degenerative disk disease at C5-6 and C6-7. No prevertebral soft tissue swelling. No acute osseous abnormality. Normal alignment. On 07/29/2021, I went to a physical therapist. Cervical AROM:rotation 72 R, 62 L. Grip strength: R55# avg , L100# avg On 08/01/2021, Had an MRI regarding the numbness

Other Meds: n/a

Current Illness: n/a

ID: 1519065
Sex: M
Age: 52
State: CA

Vax Date: 07/16/2021
Onset Date: 08/01/2021
Rec V Date: 08/01/2021
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: No

Symptom List: Vomiting

Symptoms: This Morning (Sunday 8/1/2021) at around 9:30 am, I felt tightening in the left side of my chest and my airways were closing. My wife rushed me to the emergency room at . During the ride I was very dizzy and started having blurred vision. I measured my oxygen using an oximeter, it was 77 SPO2. My oxygen is usually between 96 and 100 SPO2. I started to hyperventilate as fast as possible until we reached the hospital.

Other Meds: Theophylline 100 mg/day Prilosec 20 mg/day Ventolin Losartin 25 mg/day

Current Illness: None

ID: 1519066
Sex: F
Age: 15
State: PA

Vax Date: 07/28/2021
Onset Date: 07/28/2021
Rec V Date: 08/01/2021
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: Pain at injection site, general malaise. Due to an incorrectly diluted vial of vaccine. Dose administered was 4X concentrated

Other Meds: None

Current Illness: None

Date Died: 05/11/2021

ID: 1519067
Sex: F
Age: 83
State: PA

Vax Date: 04/06/2021
Onset Date: 04/30/2021
Rec V Date: 08/01/2021
Hospital: Y

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

Symptoms: Patient received the 2nd Pfizer Covid-19 Injection on 4/27/2021. She began having severe stomach pain the following day that did not resolve. She went to the hospital and was admitted on 4/30/2019. She underwent CTs, Ultrasounds. Found that she had 1 blood clot in a mesenteric artery. A second CT performed 2 days later showed that she had a 2nd blood clot that formed in a mesenteric vein. She has a condition ITP where she does not clot very well, however, it was stable at this time. She was started on heparin drips which made no improvement to the clots. Lysis catheter inserted with a TPA drip. This resulted in hemorrhagic stroke. She was placed on palliative care and passed away on 05/11/2021.

Other Meds:

Current Illness:

ID: 1519068
Sex: F
Age: 17
State: IN

Vax Date: 02/13/2021
Onset Date: 03/13/2021
Rec V Date: 08/01/2021
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: Peanuts, peas, latex

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Extreme fatigue, dizziness, sore throat, light sensitivity, worsened vision deficiency. Fatigue lasted for 6 weeks. Donated blood after 6 weeks due to assumption that it was over already. Symptoms worsened significantly in the following 48 hours, then cleared up entirely. Doctor disagreed that the vaccine was the cause, but timeline makes no sense otherwise. Has also felt disoriented quite often since symptoms started, and this has continued despite other symptoms stopping.

Other Meds: Escitalopram, Flonase, and betamethazone

Current Illness: N/A

ID: 1519069
Sex: F
Age: 54
State: OK

Vax Date: 07/31/2021
Onset Date: 07/31/2021
Rec V Date: 08/01/2021
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 known allergies

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

Symptoms: Body tingling, light headedness, nausea, vomiting

Other Meds: Fluoxetine 20 mg/daily

Current Illness: None

ID: 1519070
Sex: M
Age: 53
State: MN

Vax Date: 07/18/2021
Onset Date: 07/23/2021
Rec V Date: 08/01/2021
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: NA

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

Symptoms: Patient states that he is experiencing persistent upper leg cramping since 07/23/2021. Patient describes feeling uncontrollable spasms in his legs for approximately two weeks. Treatment has been predominantly self care by the patient which have included ibuprofen and oral hydration.

Other Meds: Patient is not taking over the counter medications, dietary supplements, or herbal remedies at the time of the vaccination.

Current Illness: NA

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm