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: 1641434
Sex: M
Age: 55
State: MN

Vax Date: 02/02/2021
Onset Date: 02/25/2021
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: none

Allergies: not known

Symptom List: Dysphagia, Epiglottitis

Symptoms: Second dose of the moderna covid vaccine was given too early for the dosing interval recommended by the FDA. Records indicate first dose was given on February 2nd 2021, and the second given on February 25th 2021.

Other Meds: not known

Current Illness: not known

ID: 1641435
Sex: F
Age: 26
State:

Vax Date: 03/15/2021
Onset Date: 07/22/2021
Rec V Date: 08/27/2021
Hospital: Y

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

Lab Data: Covid positive on admission

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: admitted to hospital with resp failure and abd pain. Discharged 48 hrs later.

Other Meds:

Current Illness:

ID: 1641436
Sex: M
Age: 18
State: IN

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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: EKG, Ultra Sound on heart, blood test.

Allergies: None

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

Symptoms: Chest Pains and shortness of breath.

Other Meds: None

Current Illness: None/None

ID: 1641437
Sex: F
Age: 30
State: CA

Vax Date: 05/07/2021
Onset Date: 05/29/2021
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: Headaches, dizziness, brain fog, fatigue, shortness of breath

Other Meds:

Current Illness:

ID: 1641438
Sex: F
Age: 49
State: CA

Vax Date: 08/16/2021
Onset Date: 08/18/2021
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: ER doctor (Sunday, August 22nd) performed an EKG, various blood tests, blood pressure checks as well as a urine sample.

Allergies: Penicillin

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

Symptoms: Beginning on the third day I experienced slightly blurred vision and chest tightness as well as rapid heart rate while lying down. By the 5th day I had more rapid heart rate episodes (very short; about 30-40 seconds) but this time it was followed by intense dizziness and darkened vision and almost passing out. I almost wen to urgent care, but decided to take it easy and see a doctor on Monday. Unfortunately, the same thing happened the next day but even longer (on and off for 15 minutes) and it was a Sunday so I had to go to the Emergency room.

Other Meds: Vitamin D3 B12

Current Illness: n/a

ID: 1641439
Sex: F
Age: 59
State: VA

Vax Date: 02/23/2021
Onset Date: 02/26/2021
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: Blood work to include Metabolic profile, Thyroid, Ck, Mg, Lipid Profile, CBC (3/19/2021) MRI of brain due to a referral to neurology (6/29/2021) Needle EMG ( 6/29/2021) Nerve Conduction Study (6/29/2021)

Allergies: none

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

Symptoms: Three days following first dose I had a rash on upper right buttock that lasted three weeks, and muscle twitching began 3 days after first dose, continues daily still. I informed the School Nurse at the school I am employed with, she told me to contact my PCP, he looked at rash, he noticed the muscles twitching, he did extensive blood work.

Other Meds: Vitamins B6, B12, C, Cal Mag,

Current Illness: none

ID: 1641440
Sex: M
Age: 21
State: TX

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: LA

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Said he felt sick after vaccination and vomited. BP 124/82, HR 87, O2 97

Other Meds:

Current Illness:

ID: 1641441
Sex: F
Age: 25
State: PA

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: no

Symptom List: Pharyngeal swelling

Symptoms: Patient reported dizziness five min after getting shot. She turned white and lost conscience for a couple seconds. Response team was called and patient was taken to the ER

Other Meds: multi vitamin

Current Illness: no

ID: 1641442
Sex: F
Age: 36
State: WA

Vax Date: 07/23/2021
Onset Date: 07/23/2021
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: Lactose intolerant, Hydrocodone

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Within 4 hours, I was feeling nauseas. I was feeling feverish. My arm started aching and felt really bruised into my shoulder. It was pretty stiff. This lasted for about 5 days. I was feeling feverish and flu-ish. The highest that my temperature got was 101.2. I took ibuprofen and tried to stay hydrated. I also slept to get it to go away. My arm started feeling slightly better. I wasn't able to lift it very high. I had a lot of numbness with pins and needles. I was having pains in my elbow, my shoulder, and into my neck. It was pretty rough. I went to work, but I wasn't able to do a lot of cleaning and scrubbing. About 3 weeks later, I was able to treat my shoulder mostly normal. It did go numb at one point on my left side. Last week at work, my right arm started going number up to my jaw. I felt like I was going to pass out. We had just increased my Gabapentin dosage up so we thought it might have been that. I've been babying it and doing some exercises. It still feels pretty stiff a lot. I woke up with a stiff arm again this morning. It has been kind of an ongoing thing since. When my jaw started going numb I decided I needed to figure out what was going on. I hadn't had these kind of issues with numbing before. My whole body just felt like it was drooping and I've never experienced that before.

Other Meds: Gabapentin, Venlafaxine, Prazosin, B complex, Melatonin, Allegra.

Current Illness:

ID: 1641443
Sex: M
Age: 14
State: UT

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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Difficulty breathing, soar throat, headache, stomach ache, extreme fatigue

Other Meds:

Current Illness:

Date Died: 08/24/2021

ID: 1641444
Sex: F
Age: 74
State: FL

Vax Date: 07/22/2021
Onset Date: 08/22/2021
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: Covid test-positive. Chest xray-bilateral pulmonary infiltrates and small left pleural effusion. CT chest PE with contrast.

Allergies: Morphine, Anoro ellipta, codeine, iodine containing compounds.

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

Symptoms: Pt came to ER with SOB that began morning of. Found to be hypoxic by EMS.

Other Meds:

Current Illness:

ID: 1641445
Sex: M
Age: 57
State: PA

Vax Date: 04/23/2021
Onset Date: 04/23/2021
Rec V Date: 08/27/2021
Hospital:

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

Lab Data: 05/14/2021 A1C test 08/26/2021 Allergy testing 08/27/2021 Bloodwork for immunological testing

Allergies: Doxycycline, Norvasc

Symptom List: Rash, Urticaria

Symptoms: Starting evening of 04/23/2021 accuse pain down left side hip progressing to ankle over next 2 days. Left shin numb and tingling. Never previously had sciatic issue. Not able to sit or lay for more than 30 minutes. Taking Aleve. Thought it was pinched nerve and saw chiropractor 04/26/2021. On evening of 04/27/2021 read post in local group from someone with same symptoms after Pfizer vaccine. Confirmed same day that vision was impaired. Had call with Dr on 04/29/2021. Put on Medrol for extensive body inflammation. Continued with Chiropractor for relief. Saw Optometrist on 05/05/2021. Eye pressures well above normal. Eye ducts inflamed reducing lubrication (possible vision issue cause). Put on medical grade fish oil to assist with eye lubrication. 05/14/2021. Pain mostly gone but excess joint stiffness and soreness. Still seeing chiropractor for relief. 05/21/2021 saw Dr. Discussed what was happening with inflammation and possible causes. Suggested to wait and see if things got better. Make appt if things get worse and see eye Dr if any flashes or changes in eye "floaties". 06/04/2021. Saw Optometrist. Pressures have not increased. Will monitor. Call if any bright flashes or floats get worse. 07/01/2021. Some flashes and new floaties. Called Retina Dr because optometrist limited hrs due to vacation. 07/07/2021. Saw retina specialist Dr. Checked retinas and ok. Eye pressures 22/24. Stated on high end of normal and continue to monitor. 07/10/2021. Started getting weakness sensation throughout body areas at different times. eg pressing in clutch on car, hiking. Neck stiffness/pain at times. 08/09/2021. Started getting heavy chest and upper abdomen. Worried about inflammation of that area and saw Dr (Dr colleague) on 08/18/2021. Ordered bloodwork and referred me to immunologist (Dr.). 08/26/2021. Saw Dr. Tested for allergies including Vaccine suspension compounds. No reaction. Order blood work for immunological testing. Awaiting results. Blood pressure has been raised since second dose reaction. Condition continues.

Other Meds: Diovan HCT, Nisoldipine, Multivitamins, Glucosamine

Current Illness: Swollen finger and cellulitis after first vaccine dose.

ID: 1641446
Sex: F
Age: 72
State: OR

Vax Date: 07/30/2021
Onset Date: 07/30/2021
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: Super sensitive to most medications - no known allergies

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

Symptoms: I experienced hives/swelling/redness with white spots on both hands, the fingers of both hands, both wrists and up both arms below the elbow about 2 hours after injection. I spoke with a triage nurse by phone who advised me to take 2 Benadryl and 2 Ibuprofen immediately to be followed by additional 1-pill doses as needed. My primary physician's nurse practitioner subsequently diagnosed the condition as urticaria after reviewing the record entered by the triage nurse. I was advised to forego the second Moderna vaccine but obtain the Janssen vaccine after four weeks. I continue to experience the symptoms which are aggravated by heat. I met with a colleague of my primary care physician on August 24, 2021, who advised me to wait until the symptoms I am experiencing resolved, i.e., 2-3 months, before obtaining a second vaccine other than Moderna or Pfizer-BioNTech, specifically recommending consideration of the new vaccine to obtain approval for use.

Other Meds: Rosuvastatin Calcium, Vitamins C & D3; Zinc, Melatonin & Gaba Quercetin; occasional Advil and Ibuprofen

Current Illness: None

ID: 1641447
Sex: F
Age: 87
State: KY

Vax Date: 05/01/2021
Onset Date: 07/02/2021
Rec V Date: 08/27/2021
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: tested positive for COVID 7/2/2021, 7/9/2021, 7/13/2021, 7/17/2021 Remdesevir treatment 7/3/2021 - 7/7/2021 Chief Concern, Brief History of Present Illness, and Hospital Course 87 yo female w/ PMHx of HTN presents w/ 3 days complaining of right-sided lower flank/rib pain, low-grade fever and dry cough with weakness and inability to ambulate concerning for new AHRF 2/2 COVID-19 PNA vs CAP. Quickly deescalated initial antibiotics given in ED after COVID-PCR returned positive on 7/2/21. Started on 10 days of dexamethasone and IV remdesivir for 5 day course on 7/3/21. She completed Dexamethasone and remdesivir. She was found to have ESBL UTI while in hospital and treated with 7 days of meropenem. She was found incidentally to have lung abscess and ID recommended treating with Augmentin for 2 weeks (stop date 7/25) and will need follow up for that (follow up appointment is set up with pulmonary on 8/4).

Allergies: sulfeacetamide (intolerance)

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

Symptoms: patient admitted 7/2/2021 for weakness, fever, dry cough , vaccinated for COVID 5/1/2021, tested positive for COVID 7/2/2021, 7/9/2021, 7/13/2021, 7/17/2021 Discharged 7/23/2021 to Nursing Facility Allergies (drug/food and reaction):sulfacetamide Date of Vaccination:5/1/2021 Dose: 2 Vaccine Manufacturer: Moderna Lot #: Not obtained- pt unsure of clinic site Clinic Administering Vaccine: Store Injection site:R delt Description of event/reaction: + Covid test Date of Clinic Visit or Hospitalization: 7/2/2021 Reason for clinic visit or hospitalization: Flank pain w/o pulmonary consolidation COVID-19 positive test result: Yes ; if Yes, date 7/2/2021 Plans to monitor (include medications if prescribed):s/p dexamethasone/remdesivir History Of Present Illness Patient is a 87 y.o. female presenting with weakness, fever. Has not been feeling well for the last 3 days complaining of weakness unable to ambulate. And also had a low-grade fever and dry cough which has been persistent. complaining of right-sided lower flank/rib pain. No chest pain palpitations.c/o difficulty in breathing, no orthopnea or PND. No h/o CHF. No leg edema. She has chronic back pain for which she takes Tylenol twice a day. As her symptoms were not improving she came into the ER for evaluation. She has had a history of UTI in the past. No recent contact with anyone who has been ill. She lives with her husband , patient is accompanied by her daughter-in-law. No abdominal pain nausea vomiting. Denies any dysuria hematuria. Has not been drinking enough water and the family had noticed patient is not urinating that much. Underlying history of dementia. On evaluation in the emergency room patient was hypoxic and not been on home oxygen in the past. Requiring 2-3 L oxygen nasal cannula and also hypotensive started 5 cc fluid bolus. His systolic Bp 87. Patient also was given a dose of Zosyn and vancomycin in the emergency room Hospital Medicine consulted for admission. Review of Systems Constitutional: Positive for fever. Negative for appetite change, chills and unexpected weight change. HENT: Negative. Eyes: Negative. Respiratory: Positive for cough and shortness of breath. Negative for chest tightness. Gastrointestinal: Negative for diarrhea and vomiting. Endocrine: Negative. Genitourinary: Negative. Negative for dysuria and frequency. Musculoskeletal: Positive for back pain and myalgias. Skin: Negative. Neurological: Positive for weakness. Psychiatric/Behavioral: The patient is nervous/anxious. Assessment/Plan Principal Problem: Pneumonia 87-year-old female with a past medical history of hypertension hypothyroidism admitted for hypoxemia probable pneumonia and hypotension. 1. Left lower lobe pneumonia with hypoxemia Requiring oxygen 3 L nasal cannula. white count is normal she has a prior history of neutropenia. Continue to trend. Empiric antibiotic coverage for pneumonia recommend doing ceftriaxone and Zithromax. Will add cough suppressant as needed. 2. Hypotension Probably secondary to decreased oral intake. 500 cc fluid bolus followed by maintenance at 80 an hour for 1 L. Continue to monitor I's and O's. 3. Hypothyroidism resume levothyroxine. 4. Dementia stable continue donepezil. 5. Anxiety patient on sertraline and lorazepam 1 mg at night. 6. Hypokalemia - replace potassium 7. Thrombocytopenia - new No s/s of liver disease. H/o Hydatid cyst.

Other Meds: acetaminophen, aspirin, cranberry PO, donepazil, levothyroxine, melatonins, memantine, lorazepam, nystatin, sertraline, quetiapine

Current Illness:

ID: 1641448
Sex: M
Age: 51
State: TN

Vax Date: 06/05/2021
Onset Date: 08/27/2021
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: 8/26/2021 CT of head indeterminant infarcts; 6404 for suicidal ideation. Has been on room air

Allergies: NKA

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

Symptoms: Ongoing hospitalization. Found by EMS unresponsive in hotel room when quarantining in hotel for COVID. Stated he was trying to kill himself. Intentional overdose. Altered mental status, intoxicated.

Other Meds: Unknown

Current Illness: Unknown

ID: 1641449
Sex: M
Age: 85
State:

Vax Date: 04/05/2021
Onset Date: 08/02/2021
Rec V Date: 08/27/2021
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: no known allergies

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

Symptoms: Admission date 8/2/21. Had both doses Pfizer vaccine, last dose 4/5/21. Presented with generalized weakness, dehydration and AMS due to UTI. COVID test positive on 8/2 and 8/7/21. No treatment for COVID because pt had no SOB or hypoxia. Did receive IV fluids and antibiotics for UTI. Discharged 8/6/21.

Other Meds: Eliquis, Namenda, Cardizem, Aricept, Cozaar, Pravachol

Current Illness:

ID: 1641450
Sex: F
Age: 56
State:

Vax Date: 08/23/2021
Onset Date: 08/26/2021
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: PCN, Sulfa

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

Symptoms: Client called on 8/26/21 and stated that her shoulder was hurting, and her upper arm was swollen. Recommended to rest it and put ice pack on it and call her PCP if no improvement. She voiced understanding.

Other Meds:

Current Illness:

ID: 1641451
Sex: F
Age: 5
State: OH

Vax Date: 08/26/2021
Onset Date: 08/27/2021
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: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: She woke up with her other leg (right leg) hurting her and complained walking on it.

Other Meds: None

Current Illness: None

ID: 1641452
Sex: F
Age: 47
State: OR

Vax Date: 08/06/2021
Onset Date: 08/16/2021
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: Mammogram-08/20/2021-normal but because the liquid out of the breast became bloody. I am to have an MRI with and without contrast on my breast soon.

Allergies: no

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: 08/16/2021-I was having a lot of pain in my breast, my right breast on this morning has a lot of discharge, and it turned to blood. Also, back part of my eye it hurts a lot and a lot of headaches. All these things have continued as of today.

Other Meds: Armour Thyroid; Metformin; Bisoprolol

Current Illness: no

ID: 1641453
Sex: M
Age: 27
State: AL

Vax Date: 08/26/2021
Onset Date: 08/26/2021
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: PCN, SULFA DRUGS

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

Symptoms: -UNIT REPORTED LIPS SWOLLEN & EYES SWOLLEN TO MDG -SM DROVE TO URGENT CARE- GIVEN STERIOD SHOTS TOLD TO RETURN IN 1 HR IF SYMPTOMS CONTINUE CALLED SERVICE MEMBER AT 1214 TO CONFIRM IF HE WAS HAVING ADDITIONAL SYMPTOMS. URGENT CARE GAVE HIM FAST ACTING STERIOD AND INSTRUCTED HIM TO TAKE ZYRTEC THEN BENEDRYL EVERY 6 HRS

Other Meds: WORKOUT SUPPLEMENTS

Current Illness: N/A

ID: 1641454
Sex: F
Age: 38
State: MD

Vax Date: 01/25/2021
Onset Date: 01/26/2021
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: EKG 1-26/2021

Allergies: Sulfa Emycin Cleocin

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

Symptoms: Chest pain; x3-4 weeks; in hindsight I had mild chest pain after dose number one but it was less severe and did not last as long; I thought it was stress then. After dose number two is was crushing and lasted for a long time.

Other Meds: Womens Multivitamin

Current Illness: None

ID: 1641455
Sex: F
Age: 61
State: NE

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:

Allergies:

Symptom List: Unevaluable event

Symptoms: Pfizer vaccine was diluted with 0.9mls of 0.9% of Sodium Chloride instead of1.8mls

Other Meds:

Current Illness:

ID: 1641456
Sex: M
Age: 66
State: WI

Vax Date: 02/12/2021
Onset Date: 04/22/2021
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: unknown

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

Symptoms: Patient was able to receive all 3 series of COVID-19 vaccinations. The first series was provided by MCHS (incident discovered during a NURSELINE call when the patient called reporting symptoms requiring triage). Reporter contacted pharmacy - administrator of Pfizer Series and was informed that at the time of the 2nd series vaccination, they were not checking the Immunization Registry for vaccination history. They have since changed their practice. At the time of the report, still awaiting response from Public Health to understand their vaccination process.

Other Meds: unknown

Current Illness: Unknown

ID: 1641457
Sex: F
Age: 24
State: TN

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

Allergies: Erythromycin

Symptom List: Injection site pain, Pain

Symptoms: The area is red and swollen. Hard to touch. Warm to touch. Running low grade fever (99.0) soreness to site. Went to a walk in clinic this morning. Antihistamines, Advil, cold compresses prescribed. States some better this afternoon.

Other Meds: Spironolactone, Birth control ,

Current Illness: Just seasonal allergies

ID: 1641458
Sex: F
Age: 18
State: WI

Vax Date: 08/23/2021
Onset Date: 08/23/2021
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: None

Allergies: No known allergies

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient was hot, sweaty and shaky. Her face was extremely pale. I had her lay down on the ground with an ice pack and some gatorade.

Other Meds: Minocycline 100mg capsules, Depo Provera IM injection. Cindagel topcial ,

Current Illness: None

ID: 1641459
Sex: F
Age: 52
State: TN

Vax Date: 08/10/2021
Onset Date: 08/10/2021
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: patient visited her pcp about 2 weeks post vaccine administration and her pcp diagnosed her with middle ear effusion and possible loose crystal(s) in her inner ear. Her PCP injected her with 4mg of dexamethasone to help with the effusion. When they told me about the possible loose crystal(s) in her inner ear I suggested she might have benign paroxysmal positional vertigo or BPPV. Based on this I suggest she see a Physical Therapist who could help her with this. She saw a PT within 2 days and he diagnosed her with upper horizontal peripheral vestibular dysfunction.

Allergies: Sulfa, Codeine, Celebrex

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

Symptoms: approximately 15 minutes post vaccine administration patient started feeling dizzy. The dizziness has persisted through the time of this report.

Other Meds: 1200mg Calcium QD; 1000IU Vit D; 25mg Amitryptiline QHS; 10mg diazepam per vagina prn travel or intercourse; 81mg ASA QD

Current Illness:

ID: 1641460
Sex: F
Age: 40
State: FL

Vax Date: 08/06/2021
Onset Date: 08/10/2021
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: Provider ordered IBUPROFEN for inflammation and Gabapentin for nerve pain.

Allergies: no allergies

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Left arm tingles and goes numb. for 10-20 minutes different times during the day. sharp pain from injection site down to hand. Hurts like pin needles , sometimes a burning feeling.

Other Meds: eletriptan for migraines

Current Illness: no other illnesses

ID: 1641461
Sex: M
Age: 73
State:

Vax Date: 03/05/2021
Onset Date: 08/10/2021
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: RA

Lab Data: SARS COV2 COVID19 PCR 08/10/2021 Positive result.

Allergies: no known allergies

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Admitted on 8/10/21. Had both doses Pfizer vaccine, the last on 3/5/21. Had positive COVID test 2 weeks prior at his PCP's office. Presents now with fever, sob, cough and diarrhea. COVID test positive on 8/10/21. Diagnosed with pneumonia and hypoxia due to COVID virus. Started on antibiotics and Remdesivir. 8/20/21: discharged

Other Meds: None

Current Illness:

ID: 1641462
Sex: M
Age: 75
State: MD

Vax Date: 01/22/2021
Onset Date: 01/23/2021
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: Covid-19 test on January 23 was negative.

Allergies: none

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

Symptoms: The afternoon of my first vaccination, I had four hours of nausea, followed by vomiting. For the next few days, I had headaches, fatigue, and a low-grade fever (101 degrees max). I also had constipation that lasted five or six days. I did not see a doctor in person, but got his email advice for the constipation. In August, I had virtually identical symptoms unrelated to any vaccination (nausea, headache, fatigue, low-grade fever, and constipation). This time I went to an urgent care facility, where I was tested for covid-19 (negative) and the doctor there diagnosed my problem as a gastrointestinal virus. My hypothesis is that what I thought was a vaccine reaction in January was instead a gastrointestinal virus that I contracted around the same time as the vaccination.

Other Meds: Tamulosin, Rosavustatin, Vitamin D3, Lutein

Current Illness: none

ID: 1641463
Sex: M
Age: 51
State: NC

Vax Date: 08/01/2021
Onset Date: 08/01/2021
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: RA

Lab Data:

Allergies: None

Symptom List: Nausea

Symptoms: 1) Strong metal taste in mouth for several days. 2) Sore/Tired. 3) My heart was pounding so hard it made me light headed. This lasted for a few days.

Other Meds: None

Current Illness: None

ID: 1641464
Sex: F
Age: 57
State: TX

Vax Date: 03/31/2021
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: UNK
Vax Route: IM
Vax Site: LA

Lab Data: none

Allergies: none known

Symptom List: Injection site pain

Symptoms: I woke up Friday, April 2, with a bad headache and crushing fatigue. Spent the day in bed. The next day, the headache was gone, but the fatigue continued and my back started hurting. The day after that, Sunday, I will still very tired until about 7:00 p.m., when I turned a corner and felt better. On Monday, I felt well upon waking, but lagged in the afternoon and went back to bed. On Tuesday, I was much better. I continued with occasional bouts of fatigue (2-4 hours each) for two weeks following the injection. I have been well since.

Other Meds: zoloft, xanax, tylenol, advil

Current Illness: none

ID: 1641465
Sex: F
Age: 15
State: MO

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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Augmentin

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

Symptoms: Patient feel down ( passed out ?) probably hit her head on the wall. Looked like she had a seizure, but lasted 30 seconds (?) then she was aware. Complained of being cold, but hot to the touch. Did not feel well. EMT was called.

Other Meds: NONE reported

Current Illness: None reported

ID: 1641466
Sex: F
Age: 24
State: NH

Vax Date: 08/22/2021
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: RA

Lab Data: Elevated troponin Normal EKG and echocardiogram

Allergies: Vicodin

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

Symptoms: Myocarditis

Other Meds: Oral contraceptives

Current Illness: None

ID: 1641467
Sex: F
Age: 42
State: NV

Vax Date: 08/24/2021
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:

Allergies:

Symptom List: Tremor

Symptoms: Rash, dizziness, lightheaded, tired. Patient currently using topical hydrocortisone cream (otc) for rash.

Other Meds:

Current Illness:

ID: 1641468
Sex: M
Age: 41
State: NE

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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Pfizer vial diluted with 0.9mls of 0.9 sodium chloride instead of 1.8mls

Other Meds:

Current Illness:

ID: 1641469
Sex: F
Age: 55
State: AZ

Vax Date: 08/06/2021
Onset Date: 08/06/2021
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: N/A

Allergies: N/A

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

Symptoms: Shortly after underarms began to swell. In the last few weeks I have experienced headaches, migraines, achey calves, tired , foggy, chills, nausea, upset stomach, and fatigue. 8/28 I woke up with swollen eyes and face(red and itchy) my blood pressure was 177/117. I have never had that issue. My left breast where I had Cancer and radiation is swollen and uncomfortable. 8/13 had to leave due to diarrhea.

Other Meds: N/A

Current Illness: N/A

ID: 1641470
Sex: F
Age: 79
State: FL

Vax Date: 03/15/2021
Onset Date: 08/24/2021
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: Covid test-positive.

Allergies: Contrast dye

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

Symptoms: Pt came to ED to be covid tested b/c her grandson recently tested positive. C/O of some nasal congestion.

Other Meds:

Current Illness:

ID: 1641471
Sex: F
Age: 39
State:

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

Lab Data:

Allergies: NKA

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: "23mins post vaccination, pt c/o dizziness with 1 episode of vomiting. C/o mild right sided chest pain. Pt denies other pain, tearful. Vitals: @14:15 BP 160/112, HR 83, O2Sat 100% -- > @14:20 137/89, 76, 98% -- > @14:25 118/85, 72, 99% -- > @14:30 117/82, 70, 99% Pt symptoms improved. Pt stable and released from the vaccination site 55mins post vaccination. Pt verbalied understanding to call 911 or seek immediate assistance if symptoms persist or worsen. Pt has no known allergies PMH significant for long standing urinary incontinence w/ urgency, anemia, and TRANSUMBILICAL AUGMENTATION MAMMAPLASTY in 2013. Known medications include a multivitamin PO Daily."

Other Meds: Known medications include a multivitamin PO Daily.

Current Illness:

ID: 1641472
Sex: F
Age: 29
State: TX

Vax Date: 08/19/2021
Onset Date: 08/23/2021
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: None

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

Symptoms: Metallic Taste Mouth

Other Meds: None

Current Illness: None

ID: 1641473
Sex: F
Age: 65
State: KY

Vax Date: 04/05/2021
Onset Date: 08/18/2021
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:

Allergies:

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

Symptoms: PT WAS FULLY VACCINATED. DOSE 1 - 3/8/2021 LOT 048A21A; DOSE 2 - 4/5/2021 LOT 021B21A. S/O 8/18/2021. TESTED + 8/19/2021

Other Meds:

Current Illness:

ID: 1641474
Sex: F
Age: 47
State: CA

Vax Date: 08/18/2021
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:

Allergies: Fruit (except melons and citrus and bananas), latex, moxifloxacin

Symptom List: Pain in extremity

Symptoms: about 20 hours after receiving vaccine I started getting a bad headache and then became diaphoretic, shortly after I started feeling dizzy and had to leave work. Around 6:30pm I had the chills and my body was aching, had a 103.0 temperature. Bundled up with blankets and sweatshirts and fell asleep woke up a couple hours later dripping sweat and had nausea. Not feeling well through the night and had a temp of 102.5 the next morning - stayed home from work and started feeling better by late afternoon. Injection site was swollen, mild redness, feels like a knot is there and is it tender to the touch - still has some mild swelling and tender to touch even today (9 days later).

Other Meds: None

Current Illness: None

ID: 1641475
Sex: F
Age: 23
State: TX

Vax Date: 08/27/2021
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:

Allergies: PCN

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

Symptoms: Pt feeling lightheaded post vaccine administration. BP 88/60,HR 57, O2 99%

Other Meds:

Current Illness:

ID: 1641476
Sex: F
Age: 41
State: SC

Vax Date: 08/19/2021
Onset Date: 08/24/2021
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: No

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

Symptoms: Red halo on left arm, swallow, warm and itchy

Other Meds: Tylenol, ibuprofen, Benadryl and hydrocortisone

Current Illness: Headache some days

ID: 1641477
Sex: F
Age: 22
State: NY

Vax Date: 08/17/2021
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: Latex

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

Symptoms: I started having pains in the center of my back. Even when touching the center of my back it starts to hurt a lot more. I?ve never had pains in the center of my back before and it?s started since the second dat of me having getting the vaccine

Other Meds: Tylenol

Current Illness: No illnesses

ID: 1641478
Sex: M
Age: 62
State: MO

Vax Date: 08/09/2021
Onset Date: 08/09/2021
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:

Allergies: None

Symptom List: Vomiting

Symptoms: Extreme lower back pain starting early the evening of the shot. I was bedridden for Three days. The pain was too severe to sit or stand. As of today I still have discomfort in my lower back right side. Prior to the shot I had NO health issues.

Other Meds: None

Current Illness: None

ID: 1641479
Sex: M
Age: 58
State: NE

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: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Pfizer vial diluted with 0.9mls of 0.9% sodium chloride instead of 1.8mls

Other Meds:

Current Illness:

ID: 1641480
Sex: M
Age: 65
State: OK

Vax Date: 03/30/2021
Onset Date: 04/05/2021
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:

Allergies: tetanus toxoid

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

Symptoms: smells gasoline

Other Meds: alogliptin, Crestor, ergocalciferol, aspirin, glipizide XL, lisinopril, metoprolol, eszopiclone, jardiance

Current Illness: n/a

ID: 1641481
Sex: F
Age: 35
State: NY

Vax Date: 08/24/2021
Onset Date: 08/24/2021
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: n/a

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Shortness of Breath, Extreme Fatigue

Other Meds: vitamin c multi vitamin vitamin d

Current Illness: none

ID: 1641482
Sex: F
Age: 68
State: TN

Vax Date: 07/30/2021
Onset Date: 08/19/2021
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: RA

Lab Data: 8/24/2021 CTA showing patchy opacities common for COVID pneumonia

Allergies: Penicillins, Sulfa (Sufonamide Antibiotics), lisinopril, codeine, oxycodone, methotrexate, azathioprine, fentanyl, paroxetine, risperidone, trazodone, bupropion, meridine, hydromorphone, oxymorphone, citralopram, mirtazapine, celecoxib, duloxetine, pregabalin

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

Symptoms: Ongoing hospitalization, transitioned to hospice, BiPAP dependent, cannot come off, desats to 40s even with Vapotherm 100%, viral PNA, acute hypoxic respiratory failure.

Other Meds: Unknown

Current Illness: Unkown

ID: 1641483
Sex: M
Age: 80
State:

Vax Date: 01/26/2021
Onset Date: 07/19/2021
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: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: admitted to hospital with covid pneumonia. treated and discharged on day 4

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am