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: 1640744
Sex: F
Age: 58
State: CA

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

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-

Other Meds:

Current Illness:

ID: 1640745
Sex: M
Age: 18
State: NY

Vax Date: 08/26/2021
Onset Date: 08/26/2021
Rec V Date: 08/27/2021
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:

Symptom List: Anxiety, Dyspnoea

Symptoms: Systemic: Chest Tightness / Heaviness / Pain-Mild

Other Meds:

Current Illness:

ID: 1640746
Sex: F
Age: 65
State: FL

Vax Date: 02/05/2021
Onset Date: 02/19/2021
Rec V Date: 08/27/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Seasonal

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

Symptoms: Ringing/buzzing in ears

Other Meds: Simvastatain Lisinopril Hydroxychloroquine Hydrocodone

Current Illness: Lupus

ID: 1640747
Sex: F
Age: 28
State: IL

Vax Date: 08/26/2021
Onset Date: 08/26/2021
Rec V Date: 08/27/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Site: Pain at Injection Site-Mild, Systemic: Confusion-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Severe, Systemic: Hyperventilation-Medium, Systemic: Hypotension-Mild, Systemic: Shakiness-Severe, Systemic: Visual Changes/Disturbances-Severe, Systemic: Weakness-Severe, Additional Details: RPh was alerted by seatedpatient 10min after injection that she was lightheaded, then patient's head fell back, her arms strongly shook two times Rph went to her but she was unconscious. Rph place her hand on the back of her head for support patients eyes were opn Rph asked if she was ok she then "woke up" a bit dazed gave her apple juice and fan- episode 10 sec

Other Meds:

Current Illness:

Date Died: 02/25/2021

ID: 1640748
Sex: F
Age: 83
State:

Vax Date: 02/15/2021
Onset Date: 02/24/2021
Rec V Date: 08/27/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Death

Other Meds:

Current Illness:

ID: 1640749
Sex: M
Age: 21
State: MA

Vax Date: 08/20/2021
Onset Date: 08/21/2021
Rec V Date: 08/27/2021
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: Systemic: Dizziness / Lightheadness-Severe, Systemic: vertigo exacerbated by positional changes-Severe, Additional Details: Pt did not have this reaction to the prior two doses. Instructed mom to bring pt to be evaluated to r/o inner ear issues, cardiac issues, etc. Pt had a rheumatologist appointment a few days after the vaccine and issue was not directly addressed by provider. Problem still persists even almost a week later. Pt unable to perform a fair amount of ADLs.

Other Meds:

Current Illness:

ID: 1640750
Sex: F
Age: 82
State: SC

Vax Date: 08/20/2021
Onset Date: 08/20/2021
Rec V Date: 08/27/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: Weakness-Severe, Additional Details: Pt said after recieving vaccine and returning home they became very weak, lethargic and dizzy. family members had to take them to the emergency room. Pt said ER doctors told her she had a reaction to the vaccine.

Other Meds:

Current Illness:

ID: 1640751
Sex: M
Age: 76
State: MI

Vax Date: 03/11/2021
Onset Date: 08/11/2021
Rec V Date: 08/27/2021
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: No known allergies

Symptom List: Pharyngeal swelling

Symptoms: Groin pain, lethargy, fever and hospitalized.

Other Meds: Unknown

Current Illness:

ID: 1640752
Sex: F
Age: 46
State: NV

Vax Date: 08/17/2021
Onset Date: 08/17/2021
Rec V Date: 08/27/2021
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: Systemic: Allergic: Difficulty Breathing-Medium, Systemic: Allergic: Rash (specify: facial area, extremeties)-Medium, Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Mild, Systemic: Body Aches Generalized-Severe, Systemic: Chest Tightness / Heaviness / Pain-Mild, Systemic: Chills-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Mild, Systemic: Fever-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Joint Pain-Medium

Other Meds:

Current Illness:

ID: 1640753
Sex: M
Age: 57
State: KS

Vax Date: 08/20/2021
Onset Date: 08/20/2021
Rec V Date: 08/27/2021
Hospital: Y

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: Systemic: Body Aches Generalized-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: Joint Pain-Severe, Additional Details: Was given monoclonal antibody infusion 3 days post vaccination at healthcare center

Other Meds:

Current Illness:

ID: 1640754
Sex: F
Age: 65
State: CA

Vax Date: 08/26/2021
Onset Date: 08/26/2021
Rec V Date: 08/27/2021
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: Systemic: Dizziness / Lightheadness-Mild, Additional Details: pt was feeling a little dizzy, but she informed me that she didn't eat.

Other Meds:

Current Illness:

ID: 1640755
Sex: F
Age: 37
State: CT

Vax Date: 08/26/2021
Onset Date: 08/26/2021
Rec V Date: 08/27/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Nausea-Medium, Systemic: Shakiness-Severe, Systemic: Vomiting-Medium, Systemic: Weakness-Medium, Additional Details: Patient waited the 15 minutes after injection in the store and was on the wat back to the pharmacy to ask questions since they were not feeling well and the patient fainted. 911 was called and pt was still unconscious when taken to the hospital.

Other Meds:

Current Illness:

ID: 1640940
Sex: F
Age:
State: MO

Vax Date: 05/17/2021
Onset Date: 06/01/2021
Rec V Date: 08/27/2021
Hospital:

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

Lab Data: Stomach ultrasound and nuclear medicine stomach test for gallbladder bile blood work and stomach gas/bacteria lab work

Allergies: Mold allergic

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

Symptoms: Stomach won't digest food Swollen abdomen Pain after eating naucious when hungry

Other Meds: Omeprazole Diclofenac

Current Illness: None

ID: 1640941
Sex: M
Age: 63
State: PA

Vax Date: 02/15/2021
Onset Date: 08/16/2021
Rec V Date: 08/27/2021
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: 08/16/21 2051 Respiratory virus detection panel Collected: 08/16/21 1922 | Final result | Specimen: Swab from Nasopharynx Adenovirus Not Detected Mycoplasma pneumoniae Not Detected Chlamydophila pneumoniae Not Detected Parainfluenza Not Detected COVID-19 SARS-CoV-2 Overall Result DetectedCritical Enterovirus/Rhinovirus Not Detected Coronavirus Not Detected Respiratory Syncytial Virus Not Detected Influenza A Not Detected Bordetella pertussis Not Detected Influenza B Not Detected Bordetella parapertussis Not Detected Metapneumovirus Not Detected Procedure Component Value Ref Range Date/Time X-ray chest 1 view [3298075521] Resulted: 08/17/21 1236 Order Status: Completed Updated: 08/16/21 2013 Narrative: XR CHEST 1 VW INDICATION: chest pain today, congestion yesterday, chronic cough Chest pain. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 4/13/2021 FINDINGS: The heart size is normal. The vascular distribution is normal. The hilar and mediastinal silhouettes appear unremarkable. The lungs are clear. No pleural effusion is identified. There is no evidence of pneumothorax. There are no significant bony findings. Vagal nerve stimulator is suggested overlying right chest. IMPRESSION: No acute pulmonary findings. END OF IMPRESSION:

Allergies: LevofloxacinOther (document details in comments) LisinoprilCoughing

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

Symptoms: ED Discharged 8/16/2021 (2 hours) Hospital ER Last attending ? Treatment team COVID-19 Clinical impression Shortness of Breath ? Chest Pain Chief complaint ED Provider Notes MD (Physician) ? ? Emergency Medicine Expand AllCollapse All ED PROVIDER NOTE MRN: 008001133 Medical Decision Making HPI as documented, differential diagnosis includes but not limited to COVID-19, pneumonia, COPD exacerbation 64-year-old male presenting today with shortness of breath, history of chronic bronchitis and COPD, vaccinated for Covid, presenting with upper respiratory symptoms, cough and congestion. EKG is without acute ischemic change, troponin is negative, x-ray unremarkable, he is positive for COVID-19.He is not tachycardic, does not appear consistent with PE at this time. He was given albuterol, steroids, feels safe for outpatient at this time as he is not hypoxic, will discharge History of Present Illness Client is a 64 y.o. yo male presenting to the ED with cough, URI, chest pain and arm numbness. Very pleasant 64 year old male presenting with URI symptoms, congestion, cough productive of an occassional sputum, chest tightness starting today with pain into his neck and left arm. No pain /numbness to left arm currently. Did have some associated diarrhea today. No sick contacts. Did receive covid vaccine. States has COPD but no problems in recent years. H/o CAD s/p stenting

Other Meds: acetaminophen (TYLENOL) 500 mg tablet ADVAIR HFA 230-21 mcg/actuation inhaler albuterol 2.5 mg /3 mL (0.083 %) nebulizer solution ascorbic acid, vitamin C, (VITAMIN C) 500 mg tablet aspirin 81 mg tablet atorvastatin (LIPITOR) 40 mg tab

Current Illness:

Date Died: 05/05/2021

ID: 1640942
Sex: M
Age: 64
State: FL

Vax Date: 03/15/2021
Onset Date: 04/24/2021
Rec V Date: 08/27/2021
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: CXR, covid test

Allergies: NKA

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

Symptoms: Confusion

Other Meds:

Current Illness:

ID: 1640943
Sex: F
Age: 28
State: MI

Vax Date: 08/26/2021
Onset Date: 08/26/2021
Rec V Date: 08/27/2021
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: The vaccine should have been discarded at 2:07pm since was put at room temp at 8:07am but this vaccine was given at 6pm. She has no issues as a result but we are having her come back in to repeat the dose.

Other Meds:

Current Illness:

ID: 1640944
Sex: M
Age: 35
State: OK

Vax Date: 08/01/2021
Onset Date: 08/01/2021
Rec V Date: 08/27/2021
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: Patient describes feeling like he has a "heavy chest and shortness of breath" three days after his first vaccine. Patient describes that is has continued on and off. Seen by provider, unremarkable exam, EKG ordered, patient encouraged to continue with vaccination series.

Other Meds:

Current Illness:

ID: 1640945
Sex: F
Age: 82
State: PA

Vax Date: 04/03/2021
Onset Date: 08/11/2021
Rec V Date: 08/27/2021
Hospital:

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

Lab Data: COVID-19 PCR

Allergies: LisinoprilCoughing

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Cough Fatigue and Congestion or runny nose

Other Meds: calcium carbonate (TUMS) 500 mg (200 mg calcium) chewable tablet doxycycline (VIBRAMYCIN) 100 mg capsule metoprolol tartrate (LOPRESSOR) 50 mg tablet olmesartan-hydroCHLOROthiazide (BENICAR HCT) 40-12.5 mg per tablet warfarin (COUMADIN)

Current Illness:

ID: 1640946
Sex: M
Age: 56
State: KY

Vax Date: 05/03/2021
Onset Date: 08/11/2021
Rec V Date: 08/27/2021
Hospital:

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

Lab Data: COVID positive 1/21 and Covid vaccine 5/21

Allergies: NKDA

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: on August 11, 2021 pt was cleaning out a horse stall and began having pain to his back and stabbing pain in his right side with breathing. Pt unable to lay down due to difficulty breathing. Pt was seen in the clinic on 8/14/21 and prescribed Flexeril 10mg prn, Toradol 60mg IM and Depomedrol 80mg IM. Pt was instructed on risk of PNA and PE and instrcuted to go to ER with worseing symptoms. Pt presented to my office on 8/20/21 with continued symptoms as above. I ordered a CXR which was negative adn a D-Dimer which was elevated at 1.5. Pt was instructed to go to the ER for further eval for a CTA chest to r/o PE and was found to have RLL PE and PNA. Pt was started on Eliquis 5mg BID, Norco 5/325mg QID prn pain, Mucinex DM 1 BID prn cough, Decadron 4mg daily for 10 days, Levaquin 500mg daily for 10 days and to f/u with PCP. I saw the pt in the office on 8/23/21 and ordered at BLE venous doppler and hematology referral

Other Meds: HCTZ 25mg daily Diovan 80mg daly Ventolin inh 2 puffs Q4hrs prn SOA/wheezing

Current Illness: none

ID: 1640947
Sex: F
Age: 43
State: CA

Vax Date: 08/23/2021
Onset Date: 08/24/2021
Rec V Date: 08/27/2021
Hospital:

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

Lab Data:

Allergies: Eggs

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

Symptoms: Pain, redness and swelling at injection site >15cm. Full body rash. Facial swelling. Low-grade fever 100*F. Chills and headache.

Other Meds: Multivitamin, ibuprofen, Benadryl, iron supplements

Current Illness:

ID: 1640948
Sex: F
Age: 50
State: FL

Vax Date: 08/13/2021
Onset Date: 08/13/2021
Rec V Date: 08/27/2021
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: Blood clinic, swabbed the sores on my mouth

Allergies: Penicillin; vancomycin; cephalexin; lidocaine; latex; IV tape; nuts; alcohol

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

Symptoms: I felt like a bolt shooting up, and I felt like my throat was closing and top of my mouth was painful and 3 days later I got a sore on my mouth. I started having fever and chills. I had a rash on my stomach my husband took pictures it would come and go. I was having hard time breathing, and strong palpitations, I couldn't take my heart medication because it would give me a strong headache and it would lower my BP. I went to clinic, they gave me antibiotic, they tested my sore in my mouth it was positive for herpes. I have had dizziness and vertigo. I still difficulty breathing and taking my heart medication. My concern still about my heart palpitations and vertigo.

Other Meds: Bisoprolol; soft gel saw palmetto; progesterone; CLA; Slim Vance

Current Illness: UTI; in hospital gave me medicine I'm allergic to cephalexin on July 1.

ID: 1640949
Sex: F
Age: 32
State: PA

Vax Date: 02/15/2021
Onset Date: 08/19/2021
Rec V Date: 08/27/2021
Hospital:

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

Lab Data: 08/21/21 0305 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 08/19/21 1427 | Final result | Specimen: Swab from Nares COVID-19 SARS-CoV-2 Overall Result DetectedCritical 08/19/21 1415 COVID-19 (SARS CoV-2 RNA, RT-PCR) Collected: 08/19/21 1415 | In process | Specimen: Swab from Nasopharynx

Allergies: PenicillinAnaphylaxis, Dermatitis PenicillinsAnaphylaxis, Dermatitis, Nausea and Vomiting Strawberry Sulfamethoxazole Trimethoprim LatexDermatitis Potassium ClavulanateNausea and Vomiting

Symptom List: Unevaluable event

Symptoms: Congestion of nasal sinus Contact with and (suspected) exposure to covid-19 nausea, vomiting, and diarrhea

Other Meds: albuterol HFA (PROVENTIL;VENTOLIN) 90 mcg/actuation inhaler buPROPion SR (WELLBUTRIN SR) 100 mg 12 hr tablet butalbital-acetaminophen-caff (FIORICET) 50-325-40 mg per tablet clonazePAM (KlonoPIN) 0.5 mg tablet DULoxetine (CYMBALTA) 20 m

Current Illness:

ID: 1640950
Sex: F
Age: 46
State: GA

Vax Date: 08/20/2021
Onset Date: 08/20/2021
Rec V Date: 08/27/2021
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: Penicillin

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

Symptoms: Pain in injection site Tiredness Headache Muscle pain Chills Fever

Other Meds:

Current Illness:

ID: 1640951
Sex: F
Age: 71
State: SC

Vax Date: 01/22/2021
Onset Date: 01/22/2021
Rec V Date: 08/27/2021
Hospital:

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

Lab Data: Had a small Polyp in my sinuses that grew very large all the way down the back of my throat.It was blocking and inpaired my breathing. Had to have surgery to remove it. ENT said it was the largesthe had seen.

Allergies: Codeine ; Morphine ; Watermelon and ALL the Melon families ; Pineapple ; Have a dairy Sensitivity

Symptom List: Injection site pain, Pain

Symptoms: Within 15 minutes My throat started to feel funny and then mt throat began to close . They hit me eith the epic pen and called an ambulance . Then taken to the hospital. was Administered ,by IV Pepcid and Benadryl. They keep me there about four hours and sent home .

Other Meds: pantoprazole Na 40mg ; Diphen/Atro 2.5/.025 tab MYL ; Losartan 50mg Tab ; B12; over counter Cardio Regain

Current Illness: no

ID: 1640952
Sex: F
Age: 36
State: FL

Vax Date: 12/27/2020
Onset Date: 06/30/2021
Rec V Date: 08/27/2021
Hospital: Y

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

Lab Data: multiple CTA, MRA, cerebral angiogram, holter monitor, clot disorder testing

Allergies: n/a

Symptom List: Injection site pain, Menorrhagia

Symptoms: Embolic stroke 2 clots found, 1 in right MCA, 1 in right vertebral artery which also had dissection

Other Meds: Topiramate Magnesium Riboflavin Hemaplex Lactobacillius Vit D Cholecalciferol Low dose estrogen containing birth control

Current Illness: Migraines

ID: 1640953
Sex: F
Age: 17
State: MI

Vax Date: 08/26/2021
Onset Date: 08/26/2021
Rec V Date: 08/27/2021
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: The vaccine should have been discarded at 2:07pm since was opened at 8:07am but this vaccine was given at 4:14pm. She has had no adverse reactions and we are having her come back for revaccination.

Other Meds:

Current Illness:

ID: 1640954
Sex: F
Age: 51
State: TX

Vax Date: 08/24/2021
Onset Date: 08/25/2021
Rec V Date: 08/27/2021
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: Patient began experiencing severe adverse symtpoms on 8/25/2021 at 2am. She went to the ER and they gave her some IVs, Benedryl, pain meds, chest X-ray, ekg. Side effects reported: Fever SOB/Trouble breathing Chest Pain Sore Throat Headache Body Aches Joint pain Vomiting Nausea Dehydration Allergic Reaction/Swollen Face Feelings of having a fast-beating, fluttering, or pounding heart Chills Dizziness Weakness

Other Meds:

Current Illness:

ID: 1640955
Sex: M
Age: 39
State: FL

Vax Date: 08/20/2021
Onset Date: 08/20/2021
Rec V Date: 08/27/2021
Hospital:

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

Lab Data: EKG - 8/23/21 scheduled to have an echocardiogram on Tues 8/31 for further diagnosis.

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: My heart is now having irregular heart beats, is fast beating, & feels like its going to pop out of my chest, in addition to mild chest pressure. These symptoms all started after I received the first vaccine and were not pre-existing as I'm an extremely healthy, young male. I received the vaccine on 8/20/21 at approximately 7:50pm. The heart racing began around 9:30pm and has not gone away from the date of this submission. It is now 8/27/21 and has been one week since my first shot of Pfizer vaccine. This is a daily occurrence that has resulted in multiple doctors visits and a trip to the emergency room. Further testing is being pursued to discover why I am now having these symptoms from the vaccine. I can barely sleep at night as my heart is beating very fast and is not normal for my body.

Other Meds: None

Current Illness: None

ID: 1640956
Sex: F
Age: 40
State: PA

Vax Date: 04/02/2021
Onset Date: 08/14/2021
Rec V Date: 08/27/2021
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: POCT COVID-19 PCR

Allergies: Cat DanderHeadaches, Sneezing, Throat Swelling Dog DanderHeadaches, Sneezing, Throat Swelling Flagyl [Metronidazole]Anaphylaxis Grass PollenHeadaches, Coughing, Sneezing LanolinRash Molds ExtractHeadaches, Coughing, Sneezing OtherRash, Other (document details in comments) Pollen ExtractsHeadaches, Coughing, Sneezing

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

Symptoms: Cough Nasal Congestion

Other Meds: albuterol HFA (PROVENTIL;VENTOLIN) 90 mcg/actuation inhaler benzonatate (TESSALON) 200 mg capsule cetirizine (ZyrTEC) 10 mg tablet multivitamin 400 mcg tablet SUMAtriptan (IMITREX) 25 mg tablet triamcinolone (NASACORT) 55 mcg nasal inh

Current Illness:

ID: 1640957
Sex: M
Age: 65
State: NC

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

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

Lab Data:

Allergies: yellow jackets

Symptom List: Nausea

Symptoms: 2nd dose Moderna was given at day 21

Other Meds:

Current Illness:

ID: 1640958
Sex: M
Age: 32
State: FL

Vax Date: 08/27/2021
Onset Date: 08/27/2021
Rec V Date: 08/27/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Administered early at day 15 rather than day 21 or later.

Other Meds:

Current Illness:

ID: 1640959
Sex: M
Age: 45
State: PA

Vax Date: 02/16/2021
Onset Date: 08/18/2021
Rec V Date: 08/27/2021
Hospital: Y

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

Lab Data: 08/23/21 0711 Respiratory virus detection panel Collected: 08/23/21 0518 | Final result | Specimen: Swab from Nasopharynx Adenovirus Not Detected Mycoplasma pneumoniae Not Detected Chlamydophila pneumoniae Not Detected Parainfluenza Not Detected COVID-19 SARS-CoV-2 Overall Result DetectedCritical Enterovirus/Rhinovirus Not Detected Coronavirus Not Detected Respiratory Syncytial Virus Not Detected Influenza A Not Detected Bordetella pertussis Not Detected Influenza B Not Detected Bordetella parapertussis Not Detected Metapneumovirus Not Detected 08/19/21 1043 Respiratory virus detection panel Collected: 08/19/21 0946 | Final result | Specimen: Swab from Nasopharynx Adenovirus Not Detected Mycoplasma pneumoniae Not Detected Chlamydophila pneumoniae Not Detected Parainfluenza Not Detected COVID-19 SARS-CoV-2 Overall Result DetectedCritical Enterovirus/Rhinovirus Not Detected Coronavirus Not Detected Respiratory Syncytial Virus Not Detected Influenza A Not Detected Bordetella pertussis Not Detected Influenza B Not Detected Bordetella parapertussis Not Detected Metapneumovirus Not Detected Procedure Component Value Ref Range Date/Time X-ray chest 2 views [3225507848] Resulted: 08/19/21 1057 Order Status: Completed Updated: 08/19/21 1058 Narrative: XR CHEST 2 VW IMPRESSION: Lungs are clear without evidence of acute process noted. END OF IMPRESSION: INDICATION: Chest tightness/congestion, diaphoresis, and cough. TECHNIQUE: PA and lateral examination of the chest. COMPARISON: Prior examination January 3, 2017. FINDINGS: The heart size is within normal limits. Bilateral lung zones are clear. There is no evidence of pleural effusion. No evidence of pneumothorax is identified. The osseous skeleton is grossly intact. Patient is an 46 y.o. male who presented to the ED with chief complaint of decreased urination, having abdominal bloating and pain. Patient diagnosed with Covid positive on Thursday. He also reported that he is drinking a lot of water and initially producing a lot of urine but urine flow reduced last 2 days. He also reported shortness of breath cough. His saturations are below 94. But he also reported that he thinks he uses CPAP machine during the night. Patient found to have fever of 100.9 in the ER. WBC with differential is within normal limits. Blood cultures ordered elevated for the results Patient denied headache visual disturbance, denied nausea vomiting, denied chest pain palpitations. Patient is on Metformin I withheld patient metformin and Januvia.

Allergies: PenicillinsSwelling LisinoprilCoughing Polymyxin B Sulf-trimethoprimOther (document details in comments)

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

Symptoms: COUGH, DIFFICULTY BREATHING ED Discharged 8/19/2021 (3 hours) Hospital ED COVID-19 Clinical impression Cough Chief complaint Chief Complaint Patient presents with ? Cough History of Present Illness Patient is a 46 y.o. male presenting to the ED with chief complaint of cough that started last night. Patient reports that he developed some chest tightness throughout the night. Reports he feels it more when he is coughing. Reports mild shortness of breath when coughing. No one else with similar symptoms. Denies any fevers or chills. Reports a slight headache, reports it is starting to get better which is normal for him to have in the morning. He had a difficult time sleeping last night. ED to Hosp-Admission Current 8/23/2021 - present (4 days) Hospital Type 2 diabetes mellitus (CMS/HCC) COVID-19 Diabetic ketoacidosis associated with type 2 diabetes mellitus (CMS/HCC) Acute respiratory insufficiency

Other Meds: allopurinoL (ZYLOPRIM) 300 mg tablet aspirin 81 mg tablet cetirizine (ZyrTEC) 10 mg tablet colchicine (MITIGARE) 0.6 mg capsule colchicine (MITIGARE) 0.6 mg capsule cyclobenzaprine (FLEXERIL) 10 mg tablet fenofibrate (TRIGLIDE) 160 mg

Current Illness:

ID: 1640960
Sex: F
Age: 56
State: VA

Vax Date: 08/27/2021
Onset Date: 08/27/2021
Rec V Date: 08/27/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Metallic taste in mouth within one hour after the shot

Other Meds:

Current Illness: Lyme disease suspected

ID: 1640961
Sex: F
Age: 37
State: GA

Vax Date: 08/14/2021
Onset Date: 08/16/2021
Rec V Date: 08/27/2021
Hospital:

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

Lab Data: CT scan 8/15 MRI 8/24 Blood Work 8/15 8/19 8/23

Allergies: cats seasonal allergies

Symptom List: Tremor

Symptoms: I received the first dose of the Moderna vaccine in my left arm Saturday morning around 8:30, I felt fine through out the day... a little tired but nothing unusual. By the next day body aches were building and I had a slight headache... and I took Ibuprofen to combat these symptoms. As Sunday continued the body aches became worse and by Sunday night the body aches became what I would describe as bone pain especially in arms. A little after 12:00 I went to the kitchen with my daughter who had a headache and asked for medicine (I was also going to take more ibuprofen) and as I was walking down our hallway I could feel this pain building to an unbearable level in my arms, upper torso and head... I managed to pour my daughter some medicine and as soon as I sat it on the counter and turned to get the ibuprofen from a small cabinet by the stove my upper body was filled with this metallic electrical energy. I began convulsing slamming on the counter and partway on the stove. My daughter screamed I turned the stove on and I was semi conscious and could see the red burner I was able to move my hand a little and turn it off and then lost consciousness again. She ran and got my husband and he carried me in out living room where he said I was "talking gibberish" and still shaking. Once came to my brain was wiped clean, I could not talk for a minute or two... we went to the ER. I have since had a CT scan, blood work, and MRI, I have had issues with certain tasks, headaches, and short term memory .

Other Meds: topamax birth control zyrtec pepcid

Current Illness: none

ID: 1640962
Sex: F
Age: 42
State: TX

Vax Date: 08/19/2021
Onset Date: 08/26/2021
Rec V Date: 08/27/2021
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: Erythema, Pruritus

Symptoms: Exactly 7 days after my first dose my left arm began to itch, has hives, very red, has fever in it. Also felt like my skin was crawling all night long. I tried benadryl cream with no luck. Im trying liquid benadryl orally today to see if that helps.

Other Meds: none

Current Illness: none

ID: 1640963
Sex: F
Age: 28
State: TX

Vax Date: 07/31/2021
Onset Date: 08/01/2021
Rec V Date: 08/27/2021
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:

Allergies: None

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

Symptoms: Swelling on opposite side, resulted in spreading of infection. Had to get the expander removed.

Other Meds: Fluoxetine

Current Illness: Recovering from bilateral mastectomy.

ID: 1640964
Sex: M
Age: 54
State: PA

Vax Date: 02/19/2021
Onset Date: 08/19/2021
Rec V Date: 08/27/2021
Hospital:

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

Lab Data: 08/22/21 1316 POCT COVID-19 PCR Collected: 08/22/21 1315 | Final result | Specimen: Swab from Nares POC COVID-19 PCR DetectedAbnormal Lot # 1000277892 Point of Care COVID-19 PCR Testing Method Cepheid Lot Expiration Date 7/24/2022

Allergies: NKA

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

Symptoms: URI symptoms fatigue and a cough

Other Meds: aspirin (ASPIR-81) 81 mg tablet azaTHIOprine (IMURAN) 50 mg tablet glimepiride (AMARYL) 2 mg tablet lansoprazole (PREVACID) 30 mg capsule multiple vitamins (DAILY VITAMIN) tablet tablet PHOSPHA 250 NEUTRAL 250 mg tablet pravastatin (P

Current Illness:

ID: 1640965
Sex: M
Age: 26
State: OK

Vax Date: 07/20/2021
Onset Date: 07/23/2021
Rec V Date: 08/27/2021
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: When patient presented for second vaccine he complianed of some shortness of breath starting a few days after his first Moderna vaccine.

Other Meds:

Current Illness:

ID: 1640966
Sex: F
Age: 49
State: CA

Vax Date: 08/21/2021
Onset Date: 08/26/2021
Rec V Date: 08/27/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Loss of balance, nausea, and vomiting starting 5 days after shot.

Other Meds: None

Current Illness: Surgery on 7/29

ID: 1640967
Sex: F
Age: 43
State: PA

Vax Date: 03/13/2021
Onset Date: 03/13/2021
Rec V Date: 08/27/2021
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: None

Allergies: None known

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

Symptoms: Headache, Muscle aches, and Fatigue for about 24 hours. I also had pain at the injection site for a week. I self treated at home with Tylenol.

Other Meds: Birth Control Pill-Daily

Current Illness: None

ID: 1640968
Sex: M
Age: 18
State: TX

Vax Date: 07/01/2021
Onset Date: 07/01/2021
Rec V Date: 08/27/2021
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: Pain in extremity

Symptoms: -COVID vaccine (manufacturer unknown) -Pt reports having some chest tightness the day after his shot and a couple of times the following week he ?felt like my heart was tearing in two and it lasted about 5 seconds? Again this was reported to us at the time of his second shot, we declined and he is scheduled with a pcp for evaluation and recommendation as to getting second dose.

Other Meds:

Current Illness:

ID: 1640969
Sex: F
Age: 60
State: FL

Vax Date: 04/08/2021
Onset Date: 07/15/2021
Rec V Date: 08/27/2021
Hospital: Y

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

Lab Data: Covid test, chest xray.

Allergies:

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

Symptoms: Recovering from surgery spiked a fever whil inpatient.

Other Meds:

Current Illness:

ID: 1640970
Sex: M
Age: 54
State: OH

Vax Date: 04/01/2021
Onset Date: 04/01/2021
Rec V Date: 08/27/2021
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: hayfever, seasonal, cats, arithromycin

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

Symptoms: I told the doctor (he identified himself as a doctor) inserting the shot that it hurt a whole lot as he was removing needle. He said it was an "advanced vaccine," and dismissed it.

Other Meds: Atorvastatin, Benadryl (OTC), Albuterol

Current Illness: none

ID: 1640971
Sex: F
Age: 49
State: FL

Vax Date: 08/07/2021
Onset Date: 08/18/2021
Rec V Date: 08/27/2021
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: Aspirin Ibruprofen

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

Symptoms: Menstrual changes - period is very regular and came 1 week early, then have been spotting ever since General body aches, sore throat and sinus symptoms on and off

Other Meds: Synthroid 137mcg

Current Illness: None

ID: 1640972
Sex: F
Age: 37
State: FL

Vax Date: 07/30/2021
Onset Date: 07/30/2021
Rec V Date: 08/27/2021
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: 8/5/21: Ultrasound showing the baby was measuring 17w2d but should have been at 18w1d, low amniotic fluid around the baby 8/7/21: Ultrasound showed the baby no longer had a heartbeat; followup ultrasound at hospital confirmed fetal demise 8/8/21: Delivered baby; autopsy showed no abnormal structural issues

Allergies: None

Symptom List: Vomiting

Symptoms: I was 17 weeks and 2 days pregnant (from an IVF cycle with a donor egg) the day I received the vaccine. My baby stopped growing the same day I received the vaccine - (subsequent ultrasounds showed no growth beyond 17 weeks and 2 days. The baby's heartbeat stopped sometime around one week after the vaccine. I had to get induced on Saturday August 7th and delivered the baby on Sunday August 8th. The reason listed on the autopsy is fetal demise.

Other Meds: Prenatal, DHA/omega, Vitamin D, zinc

Current Illness: None

ID: 1640973
Sex: F
Age: 37
State: KS

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

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

Lab Data: CT Scan Blood Work Chest X ray Doppler Scan of my heart

Allergies: Rocephin; Vancomycin; Grain Intolerance

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: I have a history of PVC's. I have not had them since 2019 they have picked up since receiving the vaccine. On the morning of the 8th my heart was pumping super hard. It felt like it was skipping a beat and I had to catch my breath. I would experience these beats up to few within a 10 minute timeframe. I also experienced a constant headache.

Other Meds: Vitamin B-1xdaily; Biotin-1xdaily; Vitamin D3 -1xdaily; Zinc-1xdaily

Current Illness: none

ID: 1640974
Sex: F
Age: 74
State: FL

Vax Date: 03/11/2021
Onset Date: 04/24/2021
Rec V Date: 08/27/2021
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: Ultra sound was negative, Lymphocintography found blockage. I was told this condition would stay with me for life.

Allergies: no known allergies

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

Symptoms: On 04/16/21 had Mammogram on Right breast, on 04/24/21 the right hand and arm swelled. Went to primary care physician who sent to local hospital for ultra sound as he suspected blood clots. Ultra sound was negative for any blood clots. On -5/6/21 again doctor suspected blood clots and ordered another ultra sound which was negative again. Then was sent to Lymphedema Therapy at Hospital. Physical therapy eight (8) times beginning on 05/24/2021 to 06/17/2021. Then was sent to other Hospital to a Lymphedema Specialist on 07/01/2021. The NP there sent me to their Lymphedema Therapist nine (9) times beginning 07/13/2021 to 08/18/2021. On 08/11/2021 I was sent for a Lymphocintography and that test showed blockage and I will need a procedure (out patient) to re-route Lymph Fluid. The therapist recommended a System for at home therapy. This machine cost approximately 5500.00 and I am having to pay out of pocket 1300.00 plus 20.00 for each PT session (17 visits)

Other Meds: Diclofenac, Atorvastatin, Simvastatin, Low dose asprin, Centrum Silver daily vitamin

Current Illness: No illness

ID: 1640975
Sex: F
Age: 48
State: PA

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 08/27/2021
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: COVID test- Negative

Allergies: Aspirin; ibuprofen

Symptom List: Injection site swelling, Limb discomfort

Symptoms: First day I had hives and start taking Benadryl. Next day I had swollen in arm. I was hurting everywhere. I had trouble hearing and could not walk. It felt as if I was stab in my ear. The pain in my ear I was not able to sleep. That following Saturday I visit urgent care. I was dizzy, coughing, and sneezing. Doctor stated I had upper respiratory infection. Sunday I had diarrhea. Also I was told I had fluid behind the ears.

Other Meds: Topiramate; Bupropion; Buspirone; Ferrous Gluc; Allergy medication

Current Illness: None

ID: 1640976
Sex: F
Age:
State: FL

Vax Date:
Onset Date:
Rec V Date: 08/27/2021
Hospital:

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

Lab Data: doctors appointment, recommended a breast doctor, mammogram

Allergies: Penicillin, contrast iodine, Doxycline, Gadolinum

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

Symptoms: both breast became flaming red, red bridge between, smooth rash 3 1/2 days

Other Meds: Tirosint 25mcg each day, Alendronate sodium 70mg 1 time each week, Mirolax daily dose, stool softener decussate daily,

Current Illness:

ID: 1640977
Sex: F
Age: 76
State: OH

Vax Date: 02/24/2021
Onset Date: 04/01/2021
Rec V Date: 08/27/2021
Hospital:

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

Lab Data: 1nd Chest X-ray-bronchial wall thickening ECHO Stress test 2nd Chest X-ray-normal CBC

Allergies: NSAIDS; some seafood

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

Symptoms: A little over a month after receiving the vaccine I developed SOB with activity resulting in me visiting my PCP. On 4/5 a chest X-ray was performed resulting in her noticing bronchial wall thickening and prescribed prednisone. An ECHO and stress test was ordered. On 5/17 a repeat chest x-ray was performed which was normal. The SOB continued for several months. I still suffer from it from time to time but it has gotten much better when I do.

Other Meds: Lisinopril 10mg; Magnesium 400mg; Vit D 1000U; Fish Oil 500mg

Current Illness: no

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am