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: 1641081
Sex: F
Age: 48
State: VA

Vax Date: 06/25/2021
Onset Date: 08/17/2021
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: Pending: I have been advised to visit MD if menses does return by late September.

Allergies: None

Symptom List: Dysphagia, Epiglottitis

Symptoms: Abnormal menstrual cycle: After the 1st dose the menstrual cycle was delayed by 1 week (onset July 17, 2021), was heavier than usual. It lasted 3 days, however, two days later I experienced spotting which lasted 4 days. After 2nd dose the menses has been missing. Historically my menstrual cycle has been exactly 29 days.

Other Meds: None

Current Illness: None

ID: 1641082
Sex: M
Age: 88
State: CA

Vax Date: 02/17/2021
Onset Date: 08/27/2021
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: sonagram of lungs and then CT scan of lungs showing small nodules in lower lungs

Allergies: None

Symptom List: Anxiety, Dyspnoea

Symptoms: developed dry cough and then developed cough with very viscus material-- subsequent CT scan of lungs indicated small nodules in lower lungs.

Other Meds: Simvastatin, Furosemide, Tamsulosin, Metoprolol ER, Eliquis

Current Illness: None

ID: 1641083
Sex: F
Age: 44
State: CA

Vax Date: 02/19/2021
Onset Date: 03/09/2021
Rec V Date: 08/27/2021
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: Brain MRI with and without contrast multiple lab tests holter monitor test

Allergies:

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

Symptoms: Cognitive Impairment (Confusion, Brain Fog, Aphasia, memory deficits, tripping and tipping sideways while walking) Severe Vertigo Occipital Headache Severe Insomnia Mental Health Distress bi-lateral jaw pain tailbone pain Full Body Tremors Chills and inability to regulate body temperature Endocrine (Thyroid Failure) Swelling on the Oronasal passages. Panic Attacks (Frequent and Severe) Photophobia (Severe) Altered Auditory/Sensory abilities Encephalitis Myocarditis/Tachycardia lasting approximately 7-8 weeks Gastroparesis (also included nausea, vomiting and frequent diarrhea) Irregular Menstrual Cycle Bladder Function Abnormalities Multiple Providers/Specialties are investigating and testing currently

Other Meds: levothyroxin, multivitamin

Current Illness: none

ID: 1641084
Sex: M
Age: 49
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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data: none

Allergies: nkda per sister

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: After i gave the pfizer vaccine at 10.26am, within approx 15 min the sister knocked on the door saying he is not feeling well. When i saw him, his eyes were open but he was not responding. My tech , his sister and another person were there. I, immediately, called 911 and my tech and fellow rph went by the patient, and were letting me know the situation about the patient so i could tell the 911 team. He was about to vomit, but he did not. Cold sweating alot. Confused. Eyes open. Breathing less than normal, but not gasping for air. When 911 checked him, his blood pressure was low and then it was trending back up. But when they took the standing blood pressure, it started dropping, so they took him to the hospital.

Other Meds: unknown. only took vaccine from us. spanish speaker. sister was with her but she did not know.

Current Illness: unknown

ID: 1641085
Sex: F
Age: 40
State: CA

Vax Date: 03/18/2021
Onset Date: 04/01/2021
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: hbg given progestogen and provera shot

Allergies: none

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

Symptoms: vaginal bleeding x 4 months, joint pain

Other Meds: multivitamin vitamin c

Current Illness: none

ID: 1641086
Sex: F
Age: 14
State:

Vax Date: 07/27/2021
Onset Date: 07/27/2021
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: No negative side effects to report. Only reporting that dose was administered to a child under the approved age limit.

Other Meds:

Current Illness:

ID: 1641087
Sex: F
Age: 59
State: MT

Vax Date: 02/22/2021
Onset Date: 08/25/2021
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: Covid infection despite vaccination

Other Meds:

Current Illness: pre-DM, obesity

ID: 1641089
Sex: F
Age: 76
State: PA

Vax Date: 02/26/2021
Onset Date: 08/17/2021
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: On 08/17/21 1525 Respiratory virus detection panel Collected on 08/17/21 1431 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 Detected Critical, 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, X-ray chest 1 view [3298219392] Resulted on 08/17/21 1354. Completed Updated: 08/17/21 1354. Narrative: AP upright portable chest radiograph at 1:40 PM. IMPRESSION: Heart size normal. No evidence for acute cardiopulmonary disease. Compared to 1/5/2021 and earlier. INDICATION: Altered mental status. Heart size normal. Lungs clear. Pulmonary vascular do not congested. No pleural fluid. No focal consolidation.

Allergies: Ramipril: Dermatitis, Welts, Itching Solifenacin: Itching Atorvastatin: Myalgia, Muscle Pain Bee Sting: Swelling Amoxicillin: Rash Cortisone: Itching Penicillin: Rash Prednisone: Other

Symptom List: Pharyngeal swelling

Symptoms: ED to Hospital Admission, Discharged 8/17/2021 to 8/20/2021 (3 days) Hospital COVID-19 virus infection, weakness. Patient was admitted secondary COVID-19 pneumonia picture after presenting with shortness of breath. Patient had fatigue and tiredness with however had no loss of taste or smell. He also did have COVID-19 vaccination. Patient was placed on Decadron and supportive care and IV fluids. Patient did well and was taken off of oxygen. PT and OT evaluation was done secondary to her weakness at presentation and felt the patient would benefit from placement to ECF.

Other Meds: Tylenol NORVASC Asprin Tessalon CALCIUM WITH D Celexa Vitamin B12 DECADRON ARICEPT ROBITUSSIN Melatonin Memantine MULTIVITAMIN PriLOSEC FLORASTOR ZOCOR EFFEXOR

Current Illness:

ID: 1641090
Sex: M
Age: 15
State:

Vax Date: 04/24/2021
Onset Date: 04/24/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: ? 1st Pfizer dose on 04/24/21, 2nd on 05/15/21. Patient turned 16 on between doses. Patient was under 16 at the time of the first dose. No adverse affects to report. Just underage at the time.

Other Meds:

Current Illness:

ID: 1641091
Sex: F
Age: 51
State: FL

Vax Date: 06/01/2021
Onset Date: 08/20/2021
Rec V Date: 08/27/2021
Hospital:

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

Lab Data: CXR, covid test.

Allergies: Ampicillin, paxil, prolixin, vistaril

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Came to ER c/o diffuse abdominal pain. Dx with UTI three days prior.

Other Meds:

Current Illness:

ID: 1641092
Sex: M
Age: 59
State: IL

Vax Date: 08/14/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies: none

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

Symptoms: Elevated liver function tests

Other Meds:

Current Illness: #Intracranial hemorrhage 2/2 uncontrolled HTN #HTN #HLD #Suspected OSA, obesity:

ID: 1641093
Sex: F
Age: 36
State: NC

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: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data: pending

Allergies: Betadine, Iodinated contrast media, honeydew, cantaloupe, kiwi, oranges, walnuts, peanuts, pertussis vaccine, shellfish

Symptom List: Rash, Urticaria

Symptoms: Called to room 15 minutes after Pfizer 2nd dose. Patient c/o globus feeling and itching around mouth and inside mouth. Hx of vaccine reactions to various things. Had some itching after 1st shot, but did fine after monitoring. Had premedicated with 2 Zyrtec tabs. VSS, O2 sat 100% RA Gen: 36-year-old female appearing concerned, but in NAD Skin: warm and dry, no visible rashes HEENT: no rashes, no edema or erythema on face or in mouth/throat, Mallampatti 1 Heart: RRR Lungs: CTAB Approximately 5 min later, patient c/o dizziness described as spinning. Hx of vertigo. Laid head of exam table back with some relief. Other sx unchanged. VSS, O2sat 100% RA Gen: 36-year-old female appearing concerned, but in NAD Skin: warm and dry, no visible rashes HEENT: no rashes, no edema or erythema on face or in mouth/throat, Mallampatti 1 Heart: RRR Lungs: CTAB Five minutes later, patient c/o feeling that she was going to pass out and tongue feeling swollen. Also c/o decreased sensation in B hands and shaking. Wanting to call coworker, but unable. VSS, O2 sat 100% RA Gen: 36-year-old female, diaphoretic, rigors Skin: diaphoretic, pink rash R neck HEENT: no rashes on face, no erythema in mouth/throat, edema noted at the base of the tongue, Mallampatti 3 Heart: RRR Lungs: CTAB, breathing more shallow than before Neuro: decreased mentation, unable to tell RN how to unlock her phone to call the coworker she wanted, slow responses, decreased sensation to light touch on BUE compared to BLE, grip strength 4/5, unable to flex B elbows Code Medic activated Epipen 0.3 mg IM given in R lateral thigh at 0940. Mentation improved. Asking for coworker. Still c/o dizziness and sensation in tongue/throat. Reporting decreased sensation "from neck down" VS: HR 112, BP 161/81, O2 sat 100% RA Gen: 36-year-old female, diaphoretic, color improved Skin: diaphoretic, pink rash R neck HEENT: no rashes on face, no erythema in mouth/throat, edema noted at the base of the tongue, Mallampatti 3 Heart: RRR Lungs: CTAB, breathing remained Neuro: mentation improved, rigors resolved, moving all limbs, decreased sensation to light touch throughout House supervisor and transport arrived. Report given. Patient transferred to stretcher. Patient lost consciousness. Pulse and shallow breathing remained. Code blue activated. Patient regained consciousness spontaneously after ~1 min. 2nd Epipen 0.3 mg IM given in L lateral thigh at 0955. Patient's color and breathing improved. Attached to Zole and non-rebreather at 100%. Code team arrived. Gave report. Patient lost consciousness again. Pulse strong, but no breathing for ~30 sec. Patient spontaneously began breathing again and regained consciousness. Code team transferred patient to ER with 3 additional Epipens in hand. Electronically signed by PA at 08/27/21 1056

Other Meds: Zyrtec

Current Illness: unknown

ID: 1641094
Sex: F
Age: 66
State: NJ

Vax Date: 02/23/2021
Onset Date: 02/24/2021
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: Standard tests in ER. Stress test. CT Scan- Discovered Pneumonia. EKG.

Allergies: Latex; Gluten; Doxycycline; Narcotic Drugs; Adhesive

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

Symptoms: I was getting heart palpitations then my heart would race 144 beats a minute. This happened while sitting in the car to pick my grandson up from school. I went to hospital as a result. They observed me. My heart went back into a normal rhythm, and they let me go home. This also happened several times after. I have bouts of crazy high blood pressure. There was one day where I was not breathing right and that passed by the following day. My left leg got weaker, and my hearing has been affected. I also was advised by my doctor I had "weird pneumonia" which I am still struggling with. I have received 3 heart monitors since being vaccinated. Two of which are external, and one was implanted internally. My protons were high I was bruising very easily. I was taken off baby aspirin and prescribed Vitamin K for 5 days. I was hospitalized at the hospital for 4 days during the time my stress test was completed. On a separate occasion I was also hospitalized at the hospital or for observation which lasted for two nights.

Other Meds:

Current Illness: None

ID: 1641095
Sex: F
Age: 55
State: OH

Vax Date: 06/22/2021
Onset Date: 06/25/2021
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: July 13th, Ultrasound, July 14th Biopsy & Ultrasound, July 20th, Ultrasound Breast Edema, Erythema of Breast, July 21st Abnormal finding in imaging, 21st Consult/Inflammatory Breast Cancer Diagnosis, July 21st Mammogram, July 26th Hospital Visit, Port Cathedar Surgery Placement (for upcoming chemo), July 30th, Chemo, 8/2 CT Scan, Echocardiogram, bone scan, abdominal scan, 8/21 Chemo, 4 chemo treatments left, then surgery, then radiation

Allergies: none

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

Symptoms: Shortly after my shot, my left breast started to enlarge as if infected, so I made a doctor appointment for July 8th. I was referred to an ultrasound, then biopsy which turned out positive for inflammatory breast cancer. A mammography in March of 2021 was clear. I have started chemotherapy and will need surgery and radiation then reconstructive surgery

Other Meds: Estroven

Current Illness: none

ID: 1641096
Sex: F
Age: 30
State:

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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Grass, Sulfa Drugs

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

Symptoms: Red, itchy, hot rash developing on injection site. The rash is also swollen

Other Meds: Prenatal Vitamins, Adderal, Antihistamine

Current Illness: None

ID: 1641097
Sex: F
Age: 51
State: MA

Vax Date: 04/22/2021
Onset Date: 04/22/2021
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: was given fluids, benadryl, zofran

Allergies: Penicillin, Codeine, Morphine,

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

Symptoms: Immediately dizzy, vomiting, blood pressure went up. Still to this day I have Vertigo

Other Meds: Trazodone, Clonozepam, Bupropion, Lyrica, Lexapro

Current Illness: No

ID: 1641098
Sex: F
Age: 53
State: IL

Vax Date: 07/31/2021
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: N/A

Allergies: N/A

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

Symptoms: Pt. states that after receiving the 1st dose of Phizer 07/31/2021, started experiencing symptoms 08/01/2021 of dizziness, fatigued, pain in the left hip, difficulty moving left leg, and joint pain. Pains have increased since having the 1st dose, back pain consistent. No noted Primary visit. Still continuing to experience symptoms.

Other Meds: N/A

Current Illness: N/A

ID: 1641099
Sex: M
Age: 15
State:

Vax Date: 04/24/2021
Onset Date: 04/24/2021
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:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: ? 1st dose Pfizer was on 04/24/21, 2nd 05/15/21, patient was only 15yrs old at the time. No adverse affects, just reporting age at time of first dose.

Other Meds:

Current Illness:

ID: 1641100
Sex: F
Age: 72
State: PA

Vax Date: 02/26/2021
Onset Date: 08/14/2021
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: 08/16/21 2159 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 08/16/21 0947 | Final result | Specimen: Swab from Nares COVID-19 SARS-CoV-2 Overall Result DetectedCritical 08/16/21 2159 COVID-19 PCR Collected: 08/16/21 0947 | Final result | Specimen: Swab from

Allergies: CefazolinRash ClarithromycinRash, Other (document details in comments) NickelOther (document details in comments) TriamcinoloneRash, Other (document details in comments) Triamcinolone AcetonideRash

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: COVID EXPOSURE, FEVER, FATIGUE, BODY ACHES, HEADACHE, CONGESTION/RUNNY NOSE

Other Meds: ascorbic acid, vitamin C, (VITAMIN C) 500 mg tablet bisoprolol (ZEBETA) 5 mg tablet cetirizine (ZyrTEC) 10 mg tablet cholecalciferol, vitamin D3, 2,000 unit capsule clindamycin (CLEOCIN HCL) 300 mg capsule fluticasone (FLONASE) 50 mcg/

Current Illness:

ID: 1641101
Sex: M
Age: 66
State: NC

Vax Date: 03/08/2021
Onset Date: 03/08/2021
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: Ibuprofen causes itching.

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

Symptoms: The patient reports that since vaccination he hasn't been able to use his hand as well as before in the right hand. He attributes it to vaccination. He said that he isn't able to grip things the same way, and that it "feels funny." He reports being able to feel with his hand, and denies numbness.

Other Meds: Gabapentin 400mg at bedtime; Lisinopril/HCTZ 20/12.5mg daily; Omeprazole 20mg daily; Montelukast 10mg daily; Aspirin 81mg daily; Levemir 100u/ml 65 units twice daily; Niacin ER 500mg at bedtime; Rosuvastatin 40mg daily; Novolog 100u/ml 55 u

Current Illness: None known.

ID: 1641102
Sex: M
Age: 40
State:

Vax Date: 08/21/2021
Onset Date: 08/23/2021
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:

Allergies:

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

Symptoms: Patient with new diagnosis SCC of right tonsil, presenting to emergency center 2 days following vaccination for dehydration and uncontrolled pain. Recent radiation to neck. Patient discharged from emergency center.

Other Meds:

Current Illness:

ID: 1641103
Sex: F
Age: 67
State: OR

Vax Date: 08/25/2021
Onset Date: 08/25/2021
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: none

Symptom List: Unevaluable event

Symptoms: very swollen and sore glands in left armpit

Other Meds: estradiol 1.5mg medroxyprogesterone 2.5mg

Current Illness: none

ID: 1641104
Sex: F
Age: 58
State: KY

Vax Date: 01/11/2021
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: Antigen test

Allergies: N/A

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

Symptoms: 08/25/2021

Other Meds: N/A

Current Illness: N/A

ID: 1641105
Sex: F
Age: 70
State: FL

Vax Date: 01/28/2021
Onset Date: 08/20/2021
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: Covid test.

Allergies: NKA

Symptom List: Injection site pain, Pain

Symptoms: Pt came to ER with nasal congestion, fever, headache, muscle aches, dry non productive cough x 2 days.

Other Meds:

Current Illness:

ID: 1641106
Sex: F
Age: 34
State: WI

Vax Date: 05/13/2021
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: SYR
Vax Site: LA

Lab Data: INR 0.9 5/20/21

Allergies: Peanut, hazelnut, monistat

Symptom List: Injection site pain, Menorrhagia

Symptoms: Change in menstruation, significantly heavier flow. Hypercoagulable state?INR 0.9 on no blood thinner

Other Meds: Zyrtec, lansoprazole, , Claritin, Zoloft, singulair, Flonase, Astelin, prenatal vitamin

Current Illness: None

ID: 1641107
Sex: F
Age: 15
State:

Vax Date: 04/28/2021
Onset Date: 04/28/2021
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:

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

Symptoms: ? 1st does Pfizer was on 04/28/21, 2nd 05/19/21, patient was only 15yrs old at the time. No adverse affects. Just reporting age at time of their shot.

Other Meds:

Current Illness:

ID: 1641108
Sex: F
Age: 29
State: FL

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: EKG on 8/26/21

Allergies: none

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: On 8/25/21 started having migraines. On 8/26/21 had swollen right sided clavicle lymph node, tingling down right arm, pressure on chest, continued migraines.

Other Meds: none

Current Illness: none

ID: 1641109
Sex: M
Age: 15
State:

Vax Date: 07/27/2021
Onset Date: 07/27/2021
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: RA

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: NO ADVERSE EVENTS TO REPORT. REPORTING THAT DOSE WAS GIVEN TO CHILD UNDER THE APPORVED AGE LIMIT

Other Meds:

Current Illness:

ID: 1641110
Sex: F
Age: 72
State: FL

Vax Date: 08/25/2021
Onset Date: 08/26/2021
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: None

Allergies: None

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

Symptoms: I woke up early the next morning after the Moderna vaccination unable to use my muscles to stand or walk. I slowly slipped to the floor, and it took me about an hour to crawl to the bathroom even with my husband helping me. I felt like none of my muscles were working. By late afternoon, I was better and able to stand and walk.

Other Meds: multivitamin calcium plus D alendronate pregabalin ibuprofen as needed Excedrin as needed

Current Illness: None

ID: 1641111
Sex: M
Age: 57
State: PA

Vax Date: 02/27/2021
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: RA

Lab Data: 08/20/21 1854 COVID-19 (SARS CoV-2, Molecular Amplification) Collected: 08/19/21 1138 | Final result | Specimen: Swab COVID-19 SARS-CoV-2 Overall Result DetectedCritical 08/20/21 1854 COVID-19 PCR Collected: 08/19/21 1138 | Final result | Specimen: Swab

Allergies: EGG

Symptom List: Nausea

Symptoms: COUGH, SINUSITIS, CONGESTION, FEVER

Other Meds: azithromycin (ZITHROMAX) 250 mg tablet

Current Illness:

ID: 1641112
Sex: F
Age: 51
State: MA

Vax Date: 05/24/2021
Onset Date: 05/24/2021
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: Was given fluids, zofran,

Allergies: PENICILLIN, Codeine, Morphine

Symptom List: Injection site pain

Symptoms: Vomiting, dizzy, fever

Other Meds: Trazodone, Clonozepam, Bupropion, Lyrica, Lexapro

Current Illness: NO

ID: 1641113
Sex: M
Age: 58
State: NC

Vax Date: 04/01/2021
Onset Date: 04/02/2021
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 induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: no reactin to first dose 2nd dose made him sick for 5 days, had loss of balance until july, trouble breath until june pulmonologist said it wasnt his COPD

Other Meds: naproxen vitamin d

Current Illness:

ID: 1641114
Sex: F
Age: 55
State: CA

Vax Date: 07/31/2021
Onset Date: 08/03/2021
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: penicilin

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

Symptoms: 2 days after shot kidney inflammation, worsened three weeks later, spasms

Other Meds:

Current Illness:

ID: 1641115
Sex: F
Age: 24
State: OH

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: IM
Vax Site: LA

Lab Data: Patient reported that she was evaluated at ER and was treated with epinephrine and steroids.

Allergies: Amoxicillin codeine hydrocodone IVP Dye Zyrtec

Symptom List: Tremor

Symptoms: Immunization given at 9:05 pm, at 9:20 pm patient husband alerted staff that patient had passed out. Nurse entered room, patient was sitting on floor awake. Patient then vomited x2. Patient complained of feeling "dizzy, hot flashes, and room spinning". Nurse observed hives/red rash starting above right breast up to right ear. EMS called at 09:20pm while nurse took vital signs. SPO2 98, pulse 95, glucose 98, BP 132/88. Patient also reported itching and was observed scratching rash. EMS arrived at 09:30pm, evaluated patient. Patient refused treatment due to insurance not covering. This nurse urged patient and husband to go to the ER. Patient left facility at 09:45pm. in personal vehicle.

Other Meds: Unknown

Current Illness: Unknown

ID: 1641116
Sex: F
Age: 35
State: FL

Vax Date: 08/27/2021
Onset Date: 08/01/2021
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: None

Allergies: None

Symptom List: Erythema, Pruritus

Symptoms: Swollen Lump in neck the size of 1/2 golf ball.

Other Meds: None

Current Illness: None

ID: 1641117
Sex: F
Age: 24
State: FL

Vax Date: 08/18/2021
Onset Date: 08/18/2021
Rec V Date: 08/27/2021
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: Vaginal ultrasound and blood work 8/20/2021

Allergies: None

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

Symptoms: I started having very dark and heavy vaginal bleeding that lasted for 3 days. I bled through 5 super tampons within 4 hours. I wasn?t due for my period for 2 1/2 more weeks. My period never comes early and is never that heavy. There were dark blood clots in the vaginal bleeding. I bled through several pairs of pants at work. I also was having very bad abdominal pain. It got to the point (on the second day) where i had to leave my work unit (I work in a hospital) and go to my hospital?s ER. They ran blood work and did a vaginal ultrasound.

Other Meds: Vitamin C Vitamin b 12

Current Illness: None

ID: 1641118
Sex: F
Age: 31
State: MA

Vax Date: 08/12/2021
Onset Date: 08/12/2021
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: None

Allergies: None

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

Symptoms: Chronic fatigue syndrome

Other Meds: None

Current Illness: None

ID: 1641119
Sex: F
Age: 55
State: MD

Vax Date: 04/06/2021
Onset Date: 04/06/2021
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: None. I have seen a doctor but he doesn't know what to do.

Allergies: NKA

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Vaccine shot at 8am. muscle stiffness and trouble walking around 5:30 pm getting progressively worse throughout the evening. Very difficult to walk by 8 pm. Exhausted and painful to move. Laid down. Tried to get up to use bathroom. Very painful and difficult. Walked a couple of steps and had heart palpitations and shortness of breath. Laid back down. Next day: muscle stiffness. Hard to move and painful when I tried, Migraine in morning. Rested in bed the entire day. Better the next day- but still stiff and exhausted. Muscle stiffness lasted about 3 days During the week after the shot I did not have a bowel movement (I usually have several a day) I had a migraine headache every day for a week after getting the shot. Everything gradually got better after 6 weeks. But since then, about every 3-4 weeks, I have had bouts of debilitating exhaustion that lasts 1-2 weeks, accompanied by memory loss/cognitive degradation that lasts 2-4 days. I have had 3 episodes so far. The last episode was accompanied by red itchy welts, abdominal, hip, and lower back stiffness. 3-4 weeks after the shot I experienced muscle weakness. Hard to lift and exercise.

Other Meds: none

Current Illness: no

ID: 1641120
Sex: F
Age: 36
State: TX

Vax Date: 08/24/2021
Onset Date: 08/25/2021
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: none

Allergies: NO known allergies.

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

Symptoms: The next morning patient woke up with dry mouth, pain all over her body with rash on her neck, chest and her back (the whole back). Patient denied any rash on extremities or legs. Patient advised to take Benadryl and call primary care provider. not outcome has been reported.

Other Meds: Unknown

Current Illness: no illnesses, no chronic diseases, no vaccines in the past 4 weeks prior to this event.

ID: 1641121
Sex: F
Age: 60
State: MI

Vax Date: 08/04/2021
Onset Date: 08/05/2021
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: EKG - heart attack

Allergies: Sucralfate, tiotropium, codeine, iodine contrast, zofran, penicillin.

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

Symptoms: Terrible pain in left thigh, shoulder, and chest. (Opposite side of injection site), severe headache for over 12 days. panic attacks, anxiety attacks, visited ER on 08/14.

Other Meds:

Current Illness:

ID: 1641122
Sex: F
Age: 42
State: GA

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: IM
Vax Site: LA

Lab Data: BP (R) arm 121/79, P 78, R 16, 02 sat RA 99% @ 1650. BP (R) arm 138/81 P 80 R 16 , 02 sat RA 99% @ 1655.

Allergies: None reported.

Symptom List: Pain in extremity

Symptoms: After 2nd Pfizer vaccine, Pt. noticed (R) sided arm discomfort @ injection site. Completed 15 minute observation period & departed vaccine site to her car. Returned for eval due to persistent discomfort. Discomfort had migrated to (R) upper chest over about 5-10 mins after vaccine receipt. Discomfort reported 3/10. VSS. Pt. denied dyspnea, urticaria, facial edema, or substernal chest discomfort. No signs of rash, erythema at injection site. Pt. appeared in NAD. . Due to c/o chest discomfort, ER eval recommended w/ambulance transport. Pt. declined. Pt. alone. Signed out AMA. Appeared NAD on departure. Advised to seek med attn if sxs persist or 911 if worse.

Other Meds: None offered.

Current Illness: None reported.

ID: 1641123
Sex: M
Age: 28
State: MS

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

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

Lab Data: None

Allergies: codeine

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

Symptoms: received vaccine 8/26/2021 - unknown time - unknown location but IM injection - started having nausea and vomiting 8/27/2021 AM and high fever of 103.2F orally

Other Meds: Lipitor 40mg, Cozaar 100mg, Nexium 40mg

Current Illness: covid19 diagnosed positive 8/9/2021

ID: 1641124
Sex: M
Age: 26
State: NY

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: low blood pressure of systolic 64 per emt

Allergies: none

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

Symptoms: patient fainted ( syncope) after standing up post vaccination about 7-10 minutes after the vaccine. we then had him lie down while calling 911. Emt came around 5 minutes later stating he was mostly dehydrated. They gave him an iv of saline and took him to the hospital.

Other Meds: none

Current Illness: none

ID: 1641125
Sex: F
Age: 33
State: NC

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: EKG 8/26/21

Allergies: red dye

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

Symptoms: Called to room for throat complaint after Pfizer vaccine. Pfizer vaccine had been given at 8:01. Patient immediately c/o heart racing, metallic taste, and feeling that something's in her throat. History of feeling poorly after flu vaccine and rash after TB skin test. History of allergy to tomatoes and red dye. VS: HR 86, BP 145/83, O2 sat 100% RA Gen: 33-year-old female appearing concerned Skin: warm and dry, no rashes HEENT: no rashes, no edema or erythema of face, mouth, or throat, Mallampati 1 Cardiac: RRR Resp: CTAB 8:06 Patient reports feeling the same in throat. Starting to feel nauseous and "clammy" in left hand. VS: HR 71, BP 118/78, O2 sat 98% RA Gen: 33-year-old female appearing concerned Skin: warm and dry, no rashes HEENT: no rashes, no edema or erythema of face, mouth, or throat, Mallampati 1 Cardiac: RRR Resp: CTAB Motor: B grip strength 5/5 Continued to monitor. Patient's symptoms remained the same and HR remained in low 70s and O2 sats remained 98-100% RA 8:20 Patient began coughing and vomited a small amount. VS: HR 90, BP 136/84, O2 sat 100% RA Gen: 33-year-old female appearing concerned Skin: warm and dry, no rashes HEENT: no rashes, no edema or erythema of face, mouth, or throat, Mallampati 1 Cardiac: RRR Resp: Wheezing in LLL Code medic activated. NP arrived to assist. Patient assisted to exam table. 8:27 VS HR 90, BP 136/84, O2 sat 100% RA 8:28 Epipen 0.3 mg IM Left lateral thigh given 8:29 VS HR 81, BP 127/84, O2 sat 100% RA 8:31 Patient c/o throat tightness, chest tightness, sensation of cervical lymph node swelling VS HR 78, O2 sat 100% RA Gen: 33-year-old female appearing concerned Skin: warm and dry, no rashes HEENT: no rashes, no edema or erythema of face, mouth, or throat, Mallampati 1 Cardiac: RRR Resp: Wheezing throughout 8:32 VS HR 75, BP 134/70, O2 sat 97% RA 8:33 VS HR 75, BP 134/7, O2 sat 99% House Supervisor and two nurses from the ER arrived. Report given. Patient transported to the ER for further monitoring and treatment. Report completed by LPN. VAERS completed. Work note sent. Treated in ER with prednisone, Benadryl, and Zyrtec. Discharged home after 3.5 hours.

Other Meds: unknown

Current Illness: none

ID: 1641126
Sex: M
Age: 37
State: PA

Vax Date: 03/02/2021
Onset Date: 08/19/2021
Rec V Date: 08/27/2021
Hospital:

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

Lab Data: 08/21/21 0003 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 08/20/21 1157 | Final result | Specimen: Swab COVID-19 SARS-CoV-2 Overall Result DetectedCritical 08/21/21 0003 COVID-19 PCR Collected: 08/20/21 1157 | Final result | Specimen: Swab

Allergies: NKA

Symptom List: Vomiting

Symptoms: cough Fatigue and Muscle or body aches

Other Meds: FLUoxetine (PROzac) 40 mg capsule methylphenidate HCl (RITALIN) 20 mg tablet rosuvastatin (CRESTOR) 40 mg tablet

Current Illness:

Date Died: 08/12/2021

ID: 1641127
Sex: F
Age: 80
State: GA

Vax Date: 03/09/2021
Onset Date: 08/04/2021
Rec V Date: 08/27/2021
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:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient was hospitalized due to COVID-19 and died. Patient is fully vaccinated.

Other Meds:

Current Illness:

ID: 1641128
Sex: M
Age: 93
State: FL

Vax Date: 03/23/2021
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: RA

Lab Data: Cxr, covid test.

Allergies: NKA

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

Symptoms: Pt came to ER with altered mental status. BS in the 30's. Mental status did not improve with improved blood sugar. Tested positive for covid earlier in the month.

Other Meds:

Current Illness:

ID: 1641129
Sex: F
Age: 48
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: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: EKG and bloodwork performed on Monday 8/23/2021. All WNL

Allergies: none

Symptom List: Injection site swelling, Limb discomfort

Symptoms: felt tingling in nose (sinus area), side of face and lip area

Other Meds: Prozac, Immune Booster with Vitamin C,D and Zinc, Klonopin, Iron and Red Yeast Rice

Current Illness: none

ID: 1641130
Sex: F
Age: 21
State: AR

Vax Date: 08/12/2021
Onset Date: 08/15/2021
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: None

Allergies: None

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

Symptoms: I began having period symptoms and started my period a couple days before I was expected to. I've always had extremely regular periods so this was uncommon. This period was also unusually heavy and my period symptoms were much worse than normal.

Other Meds: None

Current Illness: None

ID: 1641131
Sex: F
Age: 61
State: OK

Vax Date: 07/19/2021
Onset Date: 07/19/2021
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:

Allergies: None.

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

Symptoms: This patient was inadvertently given a 3rd Shingrix injection, 6 days after she had received her 2nd Shingrix shot. Patient was followed up within one hour of receiving shot, 24 hours later, 4 days later and one week later. Patient responded that she had not experienced any adverse sign or symptoms.

Other Meds: Albuterol inh., amlodipine 5mg, ASA 81mg, atorvastatin 20mg, calcium acetate 667mg, ciclopirox 8% top soln., clopidogrel 75mg, diclofenac 1% topical gel, Vit D2, escitalopram 10mg, ferrous gluconate 324mg, gabapentin 300mg, hydrophilic topi

Current Illness: NONE.

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am