VAERS 2021 Database www.vaers.hhs.gov

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

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

COVID19 Lot Number

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

Incidents per State

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

ID: 1632863
Sex: F
Age: 26
State: UT

Vax Date: 03/30/2021
Onset Date: 05/01/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: Testing hormone levels and going to do a pelvic exam in the future. 2021.08.25

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: I didn't get my period for all of March, all of April, and then had a severe and heavy period for 2 weeks in May (I am normally regular with an easy flow and a period of around 4 days. Then in June the period length extended to 3 weeks of the same. July 17th began anoher period which I am now on day 40 of with no end in sight. I consulted with a doctor and we are looking into birth control.

Other Meds: Nexus, propranolol, Adderall

Current Illness:

ID: 1632864
Sex: M
Age: 77
State: WI

Vax Date: 02/19/2021
Onset Date: 05/10/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: blood work - low thyroid levels

Allergies: permethrin

Symptom List: Anxiety, Dyspnoea

Symptoms: I did not have any adverse reaction except a sore arm which resolved after a day or so. About 3 months later, I was feeling tire, feeling listless, not having energy and weight gain. I was gaining about a pound a day. I have been on amiodarone for 10 years without any issues. However, amiodarone does have a warning about thyroid issues. I went to the doctor and they tested my thyroid and my thyroid levels were low. I was prescribed Levothyroxine. I am feeling better and back to my normal weight. I am currently still taking levothyroxine.

Other Meds: Xarelto; Potassium; Furosemide; Amiodarone; Vitamin D

Current Illness: none

ID: 1632865
Sex: M
Age: 36
State: UT

Vax Date: 05/27/2021
Onset Date: 05/28/2021
Rec V Date: 08/25/2021
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: EKG, MRI, TSH & free T4, CMP, CBC done at the ER on 8/19 were all normal

Allergies: cephalosporins

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

Symptoms: severe uncontrolled muscle pain despite medication, loss of muscle control, muscle weakness, loss of appetite and 25 pound weight loss over 3 months, development of a pronounced essential tremor in hands, arms, head, and lower extremities

Other Meds: none

Current Illness: none

ID: 1632866
Sex: F
Age: 54
State: FL

Vax Date: 03/30/2021
Onset Date: 07/16/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: CXR, covid test

Allergies: E-mycin

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Cough, SOB, left lower quadrant abdominal pain.

Other Meds:

Current Illness:

ID: 1632867
Sex: F
Age: 28
State: TX

Vax Date: 08/22/2021
Onset Date: 08/25/2021
Rec V Date: 08/25/2021
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: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Chest pain

Other Meds: None

Current Illness: None

ID: 1632868
Sex: F
Age: 38
State: OK

Vax Date: 08/06/2021
Onset Date: 08/16/2021
Rec V Date: 08/25/2021
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: Covid negative

Allergies:

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

Symptoms: Rash generalized

Other Meds:

Current Illness:

ID: 1632869
Sex: F
Age: 54
State: MI

Vax Date: 08/24/2021
Onset Date: 08/24/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: none

Allergies: penicillin, apples, nuts

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: I started not feeling well, I went to the bathroom and said my stomach hurt and my body felt very heavy, I knew something was wrong but wasn't sure what. I went to go lay down, and began heaving and throwing up for several hours, I eventually fell asleep. when I woke up my body was still very heavy and my face swollen .......I do not have an appetite and am slightly afraid to eat, I have had crackers and sips of water as I still feel nauseas. I went back to sleep this morning and slept till 1pm. I was sitting at the table doing some reading and my left arm began to feel a little throbbing, when I went to rub it I felt the hardness from where I received my injection and that is when it dawned on me I had a reaction to the immunization.

Other Meds: benazepril 20mg; trazadone 50mg

Current Illness: none

ID: 1632870
Sex: F
Age: 24
State: TX

Vax Date: 01/05/2021
Onset Date: 08/23/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: 8/24: CXR: peribronchial cuffing and thickening, WBC: 6, Hgb: 14.2, Plt: 179K, Glucose: 96, HbA1c: 4.9%, BUN: 7, Creat: 0.7, Na: 140, K: 3.5, Cl: 107, CO2: 26, Ca: 9.4, Albumin: 4.1 , Tbili: 0.7, AST: 25, ALT: 17, AlkPhos: 64, CRP: 12, HCG <5

Allergies: PCN, cephalosporins

Symptom List: Pharyngeal swelling

Symptoms: Mild symptoms of fatigue, sore throat and low grade fever of 99F started the evening of 8/22/2021. Tested positive for COVID-19 on 8/23/2021. Symptoms included Severe arthralgia, fever 102F, cough, congestion. Treated with Regeneron antibodies on 8/24. CXR on 8/24 showed early pneumonia and also treated with steroids and inhaler.

Other Meds: Wellbutrin 150 mg/day Sumatriptan 25 mg PRN Annovera

Current Illness: None

ID: 1632871
Sex: F
Age: 17
State: WA

Vax Date: 04/06/2021
Onset Date: 08/25/2021
Rec V Date: 08/25/2021
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: Gave the vaccine to a 17 year old, the vaccine age requirement was 18 years or older

Other Meds:

Current Illness:

ID: 1632872
Sex: F
Age: 39
State: NC

Vax Date: 08/17/2021
Onset Date: 08/17/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: None

Allergies: No known allergies

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Nausea, extreme weakness, cold chills, sweatiness, muscle aches and cramps, headache, fever

Other Meds: Allegra

Current Illness: None to report

ID: 1632873
Sex: F
Age: 43
State:

Vax Date: 05/01/2021
Onset Date: 05/03/2021
Rec V Date: 08/25/2021
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: Started as rashes(small red spots here and there). Went to physician, prescribed steroids. Rashes got worse, referred to dermatologist. Then diagnosed as lichen planus.

Other Meds:

Current Illness:

ID: 1632874
Sex: F
Age: 30
State: NM

Vax Date: 08/21/2021
Onset Date: 08/22/2021
Rec V Date: 08/25/2021
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: Minocycline

Symptom List: Rash, Urticaria

Symptoms: Arm soreness within first day, lasted maybe first three days Arm bruising noticeable at site Pronounced fatigue day 1- current (day 5) Diarrhea pronounced started day 2, worsened day 3-4 GI cramping day 2-5 current Intestinal pain and cramping day 2-5 current

Other Meds: Diamox Milk thistle Motil Pro Vit d and c Cod liver oil Flax seed oil Zinc

Current Illness:

ID: 1632875
Sex: F
Age: 59
State: TX

Vax Date: 08/25/2021
Onset Date: 08/25/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: C-reactive protein, cardiac enzymes, d-Dimer blood count

Allergies: Morphine, flagil, pro air, sulfa, CT Iodine Contrast, all diabetes medication that works through pancreas.

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

Symptoms: Within a few hours I experienced a hard squeeze inside around my heart. Not like an elephant on the chest, but from within. My husband wanted to take me to the ER, but I opted to try and relax; take an aspirin and have him massage my back behind my heart. Within about 10 minutes it passed. My arm was sore and achy the first night. The next morning about 10:00 am I began with chills, diarrhea, low grade fever, slight headache, body aches and fatigue. This lasted about 3 days. The child however lasted 3 more days. During this whole time I had difficulty with tightness in my chest that would not go away I also had edema in my ankles and feet that lingered all day. At night it would get better when I slept, but not go away. The pressure in my chest was not going away, so I went to my primary care doctor. We went over my medications, none of which are new to me and the only thing he could conclude was the vaccine reaction, so he did lab work. I am still waiting on the Cardiac enzymes and D-dimer for blood clots, but the C-reactive protein was very high. He gave me an injection of steroid mixed with an anti inflammatory medication and toroidal. It took about 6 hours but the pain my chest went away and today I am feeling better. He diagnosed me with myocarditis and has since added a short term dose of meloxicam, lasix and potassium to help get the excess fluid off.

Other Meds: Metoprolol, Glipizide, protonix, elavil, baby aspirin & infusion weekly of Hizentra

Current Illness: Bronchitis

ID: 1632876
Sex: M
Age: 66
State: IN

Vax Date: 02/16/2021
Onset Date: 03/13/2021
Rec V Date: 08/25/2021
Hospital: Y

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

Lab Data: Electolytes, calcium, magnesium, basic metabolic profile, urinalysis. EMG All normal

Allergies: latex, statins, Lamictal

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

Symptoms: Awakened by severe cramp medial head of left biceps femoris which lasted 90 minutes. Since that time have experienced random cramps all over the body but more frequent in left leg. Most now last a few seconds to a minute then spontaneously resolve. Can be triggered by use of a muscle group. Have been treated with Flexeril and carbamazepine without benefit. Took a course of prednisone for an asthma flare and no cramps for 5 days. Also frequent fasciculation of muscles, especially legs.

Other Meds: vitaamin D

Current Illness: None

ID: 1632877
Sex: F
Age: 49
State: NM

Vax Date: 04/15/2021
Onset Date: 05/06/2021
Rec V Date: 08/25/2021
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: At time of both shot, numbing cold tingling of tongue that lasted for days. Shot 1: 5/6/21 developed lymphoedema and lymphadenitis. Shot 2: developed lymphoedema and lymphadenitis within 4 days and continues off and on to present date. I am a Natural Therapeutic Specialist that does not do well with Western Medicine and treated myself and continue to do so. Treatment protocols: Vitamin C (2g) daily, Vitamin D (3g) every 2-3 days, Sage and Oregano baths, lymph drainage massages, and sweat lodges.

Other Meds:

Current Illness: none

ID: 1632878
Sex: M
Age: 41
State: WA

Vax Date: 08/24/2021
Onset Date: 08/24/2021
Rec V Date: 08/25/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Everything smell and taste like ash mouth very dry

Other Meds: hydrocodone

Current Illness: no

ID: 1632879
Sex: M
Age: 46
State: IN

Vax Date: 04/16/2021
Onset Date: 05/01/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: MRI

Allergies: None

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

Symptoms: Sciatic nerve pain started appx 2-3 weeks after the shot. Sciatic pain has gotten steadily worse since and pain has propagated to other areas of the lower back.

Other Meds: Vitamin D and B complex.

Current Illness: None.

ID: 1632880
Sex: F
Age: 28
State: CA

Vax Date: 04/08/2021
Onset Date: 04/19/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data:

Allergies: None that I know of besides pollen and pollutants

Symptom List: Ear pain, Hypoaesthesia

Symptoms: I have normally periods due to birth control but have experienced very clotted blood in my period cycle compared to normal since the vaccine as well as heavier bleeding.

Other Meds: Singular and loryna

Current Illness:

ID: 1632881
Sex: F
Age: 44
State:

Vax Date: 02/20/2021
Onset Date: 02/20/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: EKG normal

Allergies: codeine; coconut

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: After 12 hrs, I got stabbing chest pains and center left side of my chest; advil. From the nest day the pain happened once every hr. This lasted two or three days and became less and less painful. By the 24th it was gone. Went to my doctor 21st Feb 2021.

Other Meds: no

Current Illness: no

ID: 1632882
Sex: M
Age: 62
State:

Vax Date: 02/22/2021
Onset Date: 08/13/2021
Rec V Date: 08/25/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Stoke like symptoms per the EUA we have to report when the patient is admitted to hospital after vaccination. The patient was COVID-19 positive

Other Meds:

Current Illness:

ID: 1632883
Sex: M
Age: 76
State: AZ

Vax Date: 02/17/2021
Onset Date: 03/05/2021
Rec V Date: 08/25/2021
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: Various blood tests done by two different doctors.

Allergies: None

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

Symptoms: Extreme joint pain in shoulders, wrists, fingers, hips, buttocks, legs. (Polymyalgia Rheumatica) that began about a week after the second Moderna injection and became worse and worse in intensity over several months, for which I ultimately sought a consultation with a Rheumatologist.

Other Meds: Levothyroxin, Metropolol, Citalopram, Atorvastatin, Tamsulosin, Cyclobenzaprine, 81 mg aspirin, Tylenol, ibuprofen, multivitamin, probiotic, saw palmetto, Famotidine, simethecone, Tums

Current Illness: None

ID: 1632884
Sex: F
Age: 73
State: AZ

Vax Date: 07/27/2021
Onset Date: 08/04/2021
Rec V Date: 08/25/2021
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: Unevaluable event

Symptoms: Patient experienced muscle pain on entire left side of body that resided after 3 days. Patient also experienced vertigo 8 days after vaccination and still persists as of today 8/25/21.

Other Meds:

Current Illness:

ID: 1632885
Sex: F
Age: 40
State:

Vax Date: 04/01/2021
Onset Date: 04/01/2021
Rec V Date: 08/25/2021
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: States she had headache and body aches for 2 days.

Other Meds:

Current Illness:

ID: 1632886
Sex: F
Age: 94
State: TN

Vax Date: 01/13/2021
Onset Date: 08/25/2021
Rec V Date: 08/25/2021
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:

Symptom List: Injection site pain, Pain

Symptoms: Fully vaccinated patient tested positive for COVID 8/25/2021 and hospitialized 8/25/2021

Other Meds:

Current Illness:

ID: 1632887
Sex: M
Age: 46
State: FL

Vax Date: 05/27/2021
Onset Date: 07/16/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: Cxr, covid test

Allergies: NKA

Symptom List: Injection site pain, Menorrhagia

Symptoms: Dizziness, weakness, fatigue.

Other Meds:

Current Illness:

ID: 1632888
Sex: M
Age: 46
State: MI

Vax Date: 10/07/2013
Onset Date: 10/08/2013
Rec V Date: 08/25/2021
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: Meloxicam, Prednisone, and Zithromax

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

Symptoms: Chronic constipation and chronic flu like symptoms including fatigue, weakness, nausea, migraine, malaise

Other Meds: Tramadol

Current Illness: Migraines

ID: 1632889
Sex: M
Age: 82
State: FL

Vax Date: 01/19/2021
Onset Date: 02/24/2021
Rec V Date: 08/25/2021
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: BIOPSY AT DR'S OFFICE (07/07/2021), 2 PELVIC SCANS AND BONE SCAN AT FACILITY (08/03/2021), ALL PSA TEST ARE RECORDED AT LAB FACILITY: PSA TOTAL TEST ON 04/11/2017 WAS 2.7; PSA TOTAL TEST ON 08/04/2020 WAS 4.1; PSA TOTAL TEST ON 11/18/2020 WAS 4.2; PSA TOTAL TEST ON 02/24/2021 WAS 6.1; PSA TOTAL TEST ON 04/19/2020 WAS 6.9. ACCELERATED INCREASE NOTED, HENCE COVID VACCINE MAY BE OF CONCERN.

Allergies: CHOCOLATE, TOMATOES, CASHEWS, BEETS (NASAL DRIP)

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: A PSA TEST INDICATED A CONCERN AS THE LEVEL HAD RISEN TOO HIGH. THE LEVEL OF PSA TOTAL AT THIS TIME IS 6.1. NO ACTION WAS TAKEN AT THIS TIME. HOWEVER, THE NEXT TEST TAKEN ON 04/19/2021 SHOWED A LEVEL FOR PSA FREE OF 6.9. A BIOPSY WAS THEN TAKEN OF THE PROSTATE ON 07/07/2021 (12 SAMPLES ALL INDICATED "HIGH RISK CANCER'). THEN TWO PELVIC SCANS PLUS A BONE SCAN ON 08/03/2021 INDICATE THE CANCER HAS SPREAD WIDELY TO THE BONES. A CONINUOUS SERIES OF SHOTS OF ELIGARD (EVERY 3 MONTHS) WAS INITIATED AT DR. OFFICE ON 08/12/2021 AND A NEW DAILY MEDICATION OF BICALUTIMIDE (50MG) WAS STARTED. A VISIT TO AN ONCOLOGIST WAS RECOMMENDED AND IS SCHEDULED FOR 09/02/21. SEE MORE LAB HISTORY IN ENTRY 19 BELOW.

Other Meds: ATORVASTATIN - 40MG - 1/D, AMLODIPINE BESYLATE - 2.5MG- 1/DAY, EDARBYCLOR - 40/12.5MG - 1/DAY, FINASTERIDE - 5MG - 1/DAY, TAMSULOSIN - 0.4MG - 2/DAT SEPARATELY, TIMOLOL - 0.5% - 1 DRIOP/DAY, TRAZODONE - 100MG - 1/DAY, ASPITIN - 81MG - 1/DAY

Current Illness: NONE

ID: 1632890
Sex: F
Age: 58
State: MA

Vax Date: 08/12/2021
Onset Date: 08/17/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: Creatinine - 0.90 (before shot) / 1.37 (after shot) GFR - 70 (before shot) / 42 (after shot) AST - 22 (before shot) / 35 (after shot) ALT - 23 (before shot) / 50 (after shot)

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Acute renal injury and acute hepatic injury. No treatment, only observation. TBD

Other Meds:

Current Illness:

ID: 1632891
Sex: F
Age: 33
State: MN

Vax Date: 01/12/2021
Onset Date: 08/21/2021
Rec V Date: 08/25/2021
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: Labs COVID antigen test via nasal swab - COVID positive result

Allergies:

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

Symptoms: Patient fully vaccinated with Pfizer, dose 1 received on 12/22/2020 and dose 2 on 1/12/2021. Patient reported COVID symptoms of diarrhea, nausea, cough, shortness of breath, congestion, muscle aches, fatigue, headache, sore throat, chills, loss of taste and loss of smell starting on 8/21/21. Patient tested COVID positive on 8/23/21.

Other Meds:

Current Illness:

ID: 1632892
Sex: F
Age: 74
State: KY

Vax Date: 04/05/2021
Onset Date: 08/24/2021
Rec V Date: 08/25/2021
Hospital: Y

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

Lab Data: COVID (+) 8/24/21

Allergies: Penicillins

Symptom List: Nausea

Symptoms: Admitted 8/24/21 with COVID PNA, remains hospitalized on 8/25/21. Currently receiving remdesivir, requiring 3L O2. Began having symptoms 8/19/21.

Other Meds: Amlodipine, citracal, MVI, prednisone, risedronate, valacyclovir, vitamin C

Current Illness:

ID: 1632893
Sex: M
Age: 76
State:

Vax Date: 03/02/2021
Onset Date: 08/13/2021
Rec V Date: 08/25/2021
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:

Symptom List: Injection site pain

Symptoms: per the EUA we have to report when the patient is admitted to hospital after vaccination. The patient was COVID-19 positive on 7/31/21

Other Meds:

Current Illness:

ID: 1632894
Sex: F
Age: 66
State: WA

Vax Date: 02/19/2021
Onset Date: 02/22/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: After calling my physician to ask about antiviral meds for the herpetic outbreak, she advised me to drive to a COVID-19 testing site. She called in meds for Valtrex 1 gm bid and continue tylenol 500 mgs.

Allergies: Benedryl, Septra and Atarax - disseminated rash and hives

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

Symptoms: Within 10 hours of second dose of Moderna vaccine, I had chills, slight fever (99.5F), fatigue. On the third day post second dose, I began to experience mouth soreness with small intramural blisters, but also two larger blister-like lesions left to the philtrim area of my upper lip. Either the same day or after, I began to notice sensitivity to light and what appeared to be conjunctivitis.

Other Meds: Vitamin D, 5000 mcg, one capsule once a week, 500 mg CA++ twice a day, AREDS 2, one capsule am and pm

Current Illness: None noted.

ID: 1632896
Sex: M
Age: 58
State: TX

Vax Date: 08/08/2021
Onset Date: 08/09/2021
Rec V Date: 08/25/2021
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: none

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

Symptoms: pt states had pain swelling to site for 3-4 days after receiving inj, then seemed to resolve, today 8/25/21 states pain/swelling returned last night, swelling to site noted with redness to area

Other Meds: levothyroxine

Current Illness: none

ID: 1632897
Sex: F
Age: 57
State: TX

Vax Date: 08/22/2021
Onset Date: 08/23/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: none

Allergies: Bactrim

Symptom List: Tremor

Symptoms: achy and feverish the next day only: redness, itchy and slightly swelling around the injection site for at least four days afterward

Other Meds: OTC calcium, multi-vitamin, Vitamin D3

Current Illness: none

ID: 1632898
Sex: F
Age: 78
State: GA

Vax Date: 08/20/2021
Onset Date: 08/21/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: none done for this incident

Allergies: amoxil, tylenol, iodinated dyes prilosec

Symptom List: Erythema, Pruritus

Symptoms: I developed flu symptoms, with a vey bad cough, low grade fever and chills the cough is very bad and unexpected. no problems with previous shot 1 and 2

Other Meds: Plaquenil, allopurinol, atorvastatin, paxil, temazepam, breo, aleve, benadryl, bystolic,

Current Illness: hbp, high cholesterol, asthma, arthritis, lupus

ID: 1632899
Sex: F
Age: 74
State: GA

Vax Date: 02/17/2021
Onset Date: 07/25/2021
Rec V Date: 08/25/2021
Hospital: Y

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: EKG, bloodwork, Coagulation test, urinalysis. chest x-ray, nuclear medicine (lung vent/perf imaging), echo cardiogram

Allergies: morphine, levaquin, vancomycin lactose intolerant

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

Symptoms: I do not know if my condition is related to the vaccine. I experienced weakness/fatigue, light-headedness and heart palpitations for about five days. Ended up going to the ER on July 25, 2021. I was diagnosed with AFib, sent home with prescriptions for Eliquis and Metoprolol, and discharged on July 26, 2021. I was advised to consult with a cardiologist who I saw on August 23, 2021.

Other Meds: Celebrex, Multi-vitamin, calcium, magnesium, vitamin K2, prevagen. omeprazole, hemp oil

Current Illness:

ID: 1632900
Sex: M
Age: 29
State: IL

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

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

Lab Data: none

Allergies: none

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

Symptoms: Fainted within 7 minutes of shot

Other Meds: none

Current Illness: none

ID: 1632901
Sex: F
Age: 45
State: CA

Vax Date: 08/24/2021
Onset Date: 08/24/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: Vital signs taken on 8-24-2020

Allergies: Per patient: allergy to flu vaccine, TDAP vaccine, and TB Test.

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: 0859 Pt received the first dose of Pfizer Lot # ew0168 at approximate 0830. Pt states having "heavy feeling in chest, dizziness, and it's hard to concentrate my vision on things", but denies throat swelling, tongue swelling, itching, and no hives noted. Per pt she has had an allergic reaction in the past to the flu vaccine, TDAP, and TB test. Vital Signs at 0859 BP: 138/91 (108) HR: 80 SPO2: 100% RA RR: 20 Pain:0/10 Temp: 96.3 F 0908 Pt states heaviness in chest lessened after drinking water and states it is no longer difficult to focus her vision. 0910 Spoke with Dr about patients symptoms and he recommended patient be given Cetrizine 10 mg and monitor patient until she returns to baseline. Dr also advised that pt see her PCP and discuss reaction to first dose so that it can be determined if she is safe to receive the second dose of pfizer. 0917 Pt states she no longer has chest heaviness and lip numbness is lessening. Vital Signs at 0925 BP: 120/67 HR: 77 SPO2: 99% RA Pain: 0/10 0929 Administered Cetrizine 10 mg. Advised patient not to drive or return to work after receiving medication. 0940 Pt states no chest pain or heaviness, no lip numbness. Pt stable and not in distress. Pt passed walking test. Reminded patient not to drive or return to work after receiving medication. Advised patient to see her PCP to determine if it is safe for her to receive the second dose of the Pfizer vaccine.

Other Meds: Nothing on file

Current Illness: unknown

ID: 1632902
Sex: F
Age: 52
State: IL

Vax Date: 08/04/2021
Onset Date: 08/08/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: CT scan of head

Allergies: Penicillin mild, had pruritus

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

Symptoms: pain R side of the head shooting down R ear sensitivity

Other Meds: Aspirin 81 mg every other day

Current Illness: Asthma

ID: 1632903
Sex: M
Age: 77
State: KY

Vax Date: 02/22/2021
Onset Date: 08/24/2021
Rec V Date: 08/25/2021
Hospital: Y

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: 8/24/21 1438: COVID + 8/24 labs: CRP 18.61, Lactate 1.7, Procalcitonin 1.45, d-dimer 1.31, ferritin 284

Allergies: no known allergies

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

Symptoms: Pt presented to ED on 8/24/21 with complaints of shortness of breath and falls. Tested positive for COVID-19 on 8/24/21. Progressive respiratory decline in ED requiring intubation . Currently in ICU on mechanical ventilator and receiving remdesivir and dexamethasone

Other Meds:

Current Illness:

Date Died: 08/24/2021

ID: 1632904
Sex: M
Age:
State: KY

Vax Date: 08/24/2021
Onset Date: 08/24/2021
Rec V Date: 08/25/2021
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: Pain in extremity

Symptoms: unknown date of vaccination

Other Meds: unknown

Current Illness: unknown

ID: 1632905
Sex: M
Age: 80
State: MT

Vax Date: 03/29/2021
Onset Date: 08/11/2021
Rec V Date: 08/25/2021
Hospital: Y

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

Lab Data: Ordered Test: SARS-CoV-2 RNA Resp Ql NAA+probe Ordered Test Codes: 94500-6 Status: Final Accession Number: 212230060LP-198922 Specimen Source: SOFT TISSUE SAMPLE Specimen Site: ENTIRE NASOPHARYNX(181200003) Specimen Collection Date/Time: 2021-08-11 11:23:00.0 Patient Status at Specimen Collection: Specimen Details:

Allergies: Latex

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

Symptoms: Case completed 2 dose Covid vaccine series on 3/29/21, then was hospitalized for Covid pneumonia on 8/11/2021.

Other Meds: apalutamide (ERLEADA) 60 mg tablet Take 4 tablets by mouth Daily. 11/17/20 cholecalciferol (VITAMIN D3) 50 mcg (2,000 units) capsule Take 1 capsule by mouth Daily . ELIQUIS 5 MG tablet TAKE 1 TABLET TWICE DAILY Patient taking diff

Current Illness: ? Acute respiratory failure (HCC) 1/2017 mechanically ventilated, pneumonia, influenza, CHF, possibly undiagnosed COPD all involved ? Colon polyps Adenomatous polyps ? Diastolic CHF (HCC) 1/2017 LVEF 60% on echo 1/2017; diastolic CHF while hospitalized ? Duodenal ulcer 1/2017 with GI bleeding while in hospital, treated endoscopically, H pylori negative ? DVT (deep venous thrombosis) (HCC) 11/2016 treated with apixaban ? Elevated troponin 1/2017 to > 4, without EKG changes, symptoms or wall motion abnormalities on echo; low risk nuclear stress test 1/30/17 ? Esophageal dysmotility 1/2017 EGD and barium swallow findings suggestive of achalasia 1/2017 ? History of ITP treated with IVIG and prednisone April-June 2016 ? Hypertension ? Prostate cancer (HCC) ? Sarcoidosis

ID: 1632906
Sex: M
Age: 57
State: WI

Vax Date: 08/25/2021
Onset Date: 08/25/2021
Rec V Date: 08/25/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: Patient presented to the pharmacy to receive her 2nd dose of the COVID-19 vaccine. Patient was unknown to pharmacy staff and did not have a vaccination card from her 1st dose but patient reported receiving the Pfizer vaccine as her 1st dose which she received elsewhere. Upon entering vaccination data into the registry it was discovered that the patient received a Moderna COVID-19 vaccine as her 1st dose. This information was communicated to the patient and patient received a new vaccination card detailing both doses. Patient has reported no adverse events to date.

Other Meds:

Current Illness:

ID: 1632907
Sex: F
Age: 65
State:

Vax Date: 03/17/2021
Onset Date: 08/13/2021
Rec V Date: 08/25/2021
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:

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

Symptoms: per the EUA we have to report when the patient is admitted to hospital after vaccination. The patient was COVID-19 positive ON 8/12/21

Other Meds:

Current Illness:

ID: 1632908
Sex: M
Age: 46
State: GA

Vax Date: 08/25/2021
Onset Date: 08/25/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: Infusion stopped immediately and administered Tylenol 1000 mg orally. Patient tolerated well.

Allergies: None

Symptom List: Vomiting

Symptoms: Patient spiked a fever. Patient was 100.7 orally when we started at 1430 and then at recheck 1438 patient's temp was 103.1 orally.

Other Meds: None

Current Illness: COVID-19

ID: 1632909
Sex: M
Age: 71
State: WA

Vax Date: 05/24/2021
Onset Date: 06/26/2021
Rec V Date: 08/25/2021
Hospital: Y

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

Lab Data: Two passing out episodes. Loop recorded put in on July 9, 2021. Pacemaker put in after episode where heartbeat was down to 25/minute with 23 seconds without a heartbeat. Pacemaker put in July 16, 2021.

Allergies: Ambien

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: First passed out on June 26, 2021, then passed out July 6, 2021. Determined needed to get pacemaker. Pacemaker put in July 16, 2021.

Other Meds: Morning: Aspirin 81 mg Amlodipine 5 mg Lisinopril 40 mg Evening: Atorvastin 40 mg

Current Illness: None

ID: 1632910
Sex: M
Age: 66
State: MI

Vax Date: 07/15/2021
Onset Date: 07/16/2021
Rec V Date: 08/25/2021
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: ACE Inhibitors, Statins-Hmg-Coa Reductase Inhibitors, Zetia

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

Symptoms: Fever of 102 for 2 days, Severe rash covering entire body for 7 days, was put on Prednisone then rash resolved after 12 days

Other Meds: AtenoloL 25 mg tablet; hydroCHLOROthiazide 25 mg tablet; Jardiance 10 mg tablet; levocetirizine 5 mg tablet; levothyroxine 112 mcg tablet; montelukast 10 mg tablet; omeprazole 40 mg capsule,delayed release; predniSONE 20 mg tablet; Repatha

Current Illness:

ID: 1632911
Sex: F
Age: 20
State: CA

Vax Date: 08/24/2021
Onset Date: 08/24/2021
Rec V Date: 08/25/2021
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: Penicillin, Ativan

Symptom List: Injection site swelling, Limb discomfort

Symptoms: During the COVID clinic on 8/24 an employee received the Pfizer Vaccination. Approx. 15min post vaccination the employee's began to exhibit shortness of breath and took her prescribed anti-anxiety medication orally. Within two minutes her pupils dilated and she became verbally unresponsive to my questions. She had a pulse and was breathing, however she began to hyperventilate. She began to convulse so the vaccination team laid her down on the ground from her chair. A rapid response was called overhead and the RR team responded immediately. She was presumed to have a panic attack precipitated by the vaccine administration. She was provided a respirator by RT to support her oxygenation. We obtained IV access as per MD but we did not give any medications due to known allergies to recommended treatments. MD was present. We called 911. She was lifted from the floor to the gurney. EMS arrived quickly (within 10min) and we transferred care to EMS who then transported her to medical facility. She recovered and returned to work the following day.

Other Meds: Atarax

Current Illness:

Date Died: 08/24/2021

ID: 1632912
Sex: F
Age: 83
State: TX

Vax Date: 02/28/2021
Onset Date: 06/04/2021
Rec V Date: 08/25/2021
Hospital: Y

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

Lab Data: CT, XRAY, ECHO, EKG; Multiple labs

Allergies: cephalexin, ciprofloxacin, levofloxacin, meperidine

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

Symptoms: Patient started having SOB in June 2021; in July found to have a large Pulmonary embolism; Was readmitting for SOB 2 more times and ultimately died 08/24/2021;

Other Meds:

Current Illness: Positive for COVID 11/2021 with minimal symptoms

ID: 1632913
Sex: M
Age: 48
State:

Vax Date: 02/12/2021
Onset Date: 08/10/2021
Rec V Date: 08/25/2021
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:

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

Symptoms: per the EUA we have to report when the patient is admitted to hospital after vaccination. The patient was COVID-19 positive and has COVID-19 pneumonia

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am