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: 1641584
Sex: F
Age: 54
State: MO

Vax Date: 08/09/2021
Onset Date: 08/27/2021
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: none

Symptom List: Dysphagia, Epiglottitis

Symptoms: Today I woke up with awful ringing in my left ear only. It hasn't stopped ringing. Right ear isn't giving any problems.

Other Meds: none

Current Illness: none

ID: 1641585
Sex: F
Age: 82
State: IL

Vax Date: 08/20/2021
Onset Date: 08/21/2021
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: None. I saw my nurse practioner yesterday for routine blood tests related to my maintenance medications and chemo to keep my leukemia from returning but nothing for the Covid diarrhea which I told her about.

Allergies: penicillin, sulfa drugs, sulfites in food, oranges, cashew nuts

Symptom List: Anxiety, Dyspnoea

Symptoms: Diarrhea and stomach pain and bloating after first Pfizer shot 7/30 which went away but diarrhea came back 8/21 the day after second Pfizer shot and I still have it. My oncologist said it couldn't be from the vaccine. I'm not weak or tired but had to stop taking Immodium because it made me dizzy. I still have loose stools as of today and was told by my nurse practioner yesterday to eat more potassium rich foods which is difficult with diarrhea.

Other Meds: senior multivitamin and calcium supplement from walgreens

Current Illness: in remission from ALL from 10/20 but on maintenance meds and chemo

Date Died: 08/11/2021

ID: 1641586
Sex: F
Age: 87
State: KY

Vax Date: 07/28/2021
Onset Date: 08/08/2021
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:

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

Symptoms: COVID infection. Specimen collected 8/8/21. Patient died on 8/11/21.

Other Meds:

Current Illness:

ID: 1641587
Sex: M
Age: 34
State: CA

Vax Date: 08/15/2021
Onset Date: 08/20/2021
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: U/S performed at local ER 8/26/2021

Allergies: NKDA

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Superficial vein thrombosis right leg extending from calf to thigh

Other Meds: Vitamin C 1,000mg daily OTC, lidocaine 5% patch 1 patch daily prn pain, ibuprofen 600mg i PO bid prn pain, elderberry supplement OTC

Current Illness: None

ID: 1641588
Sex: F
Age: 55
State: KY

Vax Date: 12/28/2020
Onset Date: 08/24/2021
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: NKA

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

Symptoms: POSITIVE COVID

Other Meds: METOPROLOL FOR MITRAL PROLAPSE

Current Illness: DENIES

ID: 1641589
Sex: M
Age: 25
State: TX

Vax Date: 06/01/2021
Onset Date: 06/01/2021
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: none

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

Symptoms: patient had this reaction at a pharmacy while getting 1st dose of Pfizer vaccine in June. He is unsure of exact date. He had nausea, dizziness, presyncope. all symptoms resolved

Other Meds:

Current Illness: none

ID: 1641590
Sex: F
Age: 32
State: TX

Vax Date: 08/20/2021
Onset Date: 08/21/2021
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: Negative Covid test, patient told by ER that it was likely just a severe adverse reaction 08/25/2021

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Muscle pain, Shortness of Breath, sore throat, loss of smell, low fever starting the day following vaccination leading to ER visit on 08/25/2021

Other Meds:

Current Illness:

ID: 1641591
Sex: M
Age: 68
State: FL

Vax Date: 03/19/2021
Onset Date: 08/24/2021
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: Smoke

Symptom List: Pharyngeal swelling

Symptoms: Patient admitted 8/24/21 for nausea, diarrhea, and shortness of breath. History of non-Hodgkin's lymphoma and chemotherapy given 8/9. Resulted positive for COVID on 8/24. Diagnosed with COVID 19, bilateral viral pneumonia and acute hypoxi respiratory failure. Patient received Pfizer vaccination on 3/19/21 and 4/10/2021. Patient is still hospitalized. Hospital Name City State

Other Meds: simvastatin, Eliquis, allopurinol, ondansetron, calcium

Current Illness: Unknown

ID: 1641592
Sex: M
Age: 61
State: MI

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

Lab Data: NONE

Allergies: unknown

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Fever, Chills, Weak, Extreme Fatigue, Dizziness Resolved on own after 24 hours

Other Meds: unknown

Current Illness: unknown

ID: 1641593
Sex: M
Age: 12
State: MN

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

Lab Data:

Allergies: none

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Vaccine was given to the patient and within 15 seconds of receiving the vaccine a seizure like episode happened to the patient, he laid back and shook briefly and was briefly not responding, he was very pale then he woke up and then we chatted with him. He was initially very tired but never had any confusion or any other problems. We had him laying down, gave him some juice and animal crackers and slowly had him raise up on the exam table and then eventually standing up. He was evaluated by the physician again as well.

Other Meds: none

Current Illness: none

ID: 1641594
Sex: F
Age: 36
State: NY

Vax Date: 02/01/2021
Onset Date: 08/06/2021
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: Sulfa meds, bees, strawberries, wine, seasonal

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

Symptoms: Developed Shingles and now have nerve pain at site of Shingles.

Other Meds: Ceterizine, vitamin D, multi vitamin

Current Illness:

ID: 1641595
Sex: F
Age: 63
State: FL

Vax Date: 05/04/2021
Onset Date: 08/20/2021
Rec V Date: 08/27/2021
Hospital: Y

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

Lab Data:

Allergies: contrast

Symptom List: Rash, Urticaria

Symptoms: Admitted 8/20 for GI bleed, dizziness and fatigue. Resulted positive for COVID on 8/21. Patient still hospitalized.

Other Meds: lantus, protonix, amlodipine

Current Illness: Unknown,

ID: 1641596
Sex: M
Age: 63
State: FL

Vax Date: 04/07/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data: SARS-COV-2, NAA, Detected: 08/10/21

Allergies: NKA

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

Symptoms: Patient required hospitalization due to breakthrough infection. He received Pfizer vaccine (2nd dose in series) on 04/07/2021. Hospitalized from 08/10/21 - 08/14/21. Below is copied from discharge summary: Pt responded quickly to supportive care, breathing comfortably on RA, tolerating PO route, hemodynamically stable and asking to go home. Answers all orientation/capacity questions appropriately. 65 y/o AAM with PMH of HTN, DM, and "heart surgery" BIB EMS for AMS. Found to be hypoglycemic in the field in the 30's and was given dextrose. Per EMS run sheet call was placed by patients girlfriend and it was initially thought to be cardiac arrest but patient never lost pulses. Patient seems to be confused on exam but is A&Ox3. Says hasn't been feeling well over the past few days and his abdomen has been hurting him. Denying any HA, Cp, sob, cough, N/V, dysuria, hematuria, hematochezia, melena. Denies tobacco, ETOH or illicit substance use.

Other Meds: Amlodipine 10mg QD Clonidine 0.3mg TID Metoprolol Tartrate 50mg BID Hydralazine 50mg QID Finasteride 5mg QD Terazosin 1mg QHS Aspirin 81mg QD "Statin" QD Metformin 1000mg BID Glyburide 5mg QD (all medications are historical)

Current Illness:

ID: 1641598
Sex: F
Age: 0
State: GA

Vax Date: 06/18/1983
Onset Date: 08/27/2021
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: Exam- pulse ox, vitals patient was given Benadryl 25mg IM , She became jittery and teeth chattering , decreased O2 saturation, monitored and all vitals returned to normal. Only abnormal vital was o2 sat and could have been from positioning was the cause of the drop.

Allergies: amoxil zoloft

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

Symptoms: Patient felt as if her it was difficult to swallow.

Other Meds: Possibly on BUspar, claritin and flonase

Current Illness: anxiety - new med buspar insect bites,- keflex

ID: 1641599
Sex: F
Age: 50
State: FL

Vax Date: 05/11/2021
Onset Date: 05/15/2021
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: I did not seek medical help.

Allergies: latex adhesive irritates skin and sometimes pull the skin off (post C-Section bandaids, heat patches, etc.)

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

Symptoms: The first few days I had injection site pain, aches, and some stomach issues, and the general ill feeling most people have. It was not nearly as bad as I expected from hearing the stories of other peoples 2 dose effects. However, after all that went away, on day 4 I was startled with not being able to do very simple math that I had been able to do with ease leading up to this date (simple math multiplication questions that I quiz my young daughters on like 6x7). This wasn't general brain fog, this scared me like I was having full blown dementia. I also had heart palpitations at night. Note: My family and I wondered if we had Covid in January of 2019 caught during a trip. This was before testing was available and by the time the antibody testing came out it was too late to tell. However, I had experienced extreme tiredness after having seemingly recovered from that illness, heart palpitations, and brain fog. I always wondered if this was long Covid symptoms. However, I had recovered and had eerily the same symptoms after the second shot but the brain fog was more prevalent. I don't know if it is tied to it. but I also developed bumps on my right arm that burned and itched (not the vaccine arm) that lasted a few months.

Other Meds: levothyroxine 50mcg, multivitamin

Current Illness:

ID: 1641600
Sex: F
Age: 42
State: WI

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: n/a

Allergies: Amox PCN

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

Symptoms: Moderna vaccine given that had been thawed, frozen and thawed again

Other Meds: Ferrous Sulfate Dulcolax

Current Illness: none

ID: 1641601
Sex: M
Age: 72
State: MI

Vax Date: 04/28/2021
Onset Date: 05/01/2021
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: None

Allergies: Penicillin

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

Symptoms: Extreme diarrhea for 10 days.

Other Meds: Vitamin D3 Iodoral Vitamin C L-Tyrosine

Current Illness: None

ID: 1641602
Sex: M
Age: 53
State: MI

Vax Date: 03/08/2021
Onset Date: 03/18/2021
Rec V Date: 08/27/2021
Hospital: Y

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

Lab Data: Medical tests and laboratory results performed 6/27/21 - 6/30/21; and again 7/14/21 - 7/18/21.

Allergies: none

Symptom List: Ear pain, Hypoaesthesia

Symptoms: In March 2021 within about 5-10 days of 1st dose of Pfizer vaccine began to experience metallic/bad taste with food and beverages. This is still ongoing and he has lost 35 pounds. June 27th, 2021 experienced major heart attack with 100% blockage due to blood clot that originated in the heart. July 14th, 2021 experienced a second major heart attack with 100% blockage due to blood clot that originated in the heart.

Other Meds: metformin, metoprolol, protonix, plavix, pravachol, cymbalta, vistaril, lisinopril, 81 mg aspirin, lantus, ozempic, advair, vitamin c, vitamin d, vitamin b, omega 3

Current Illness: none

ID: 1641603
Sex: F
Age: 41
State:

Vax Date: 01/15/2021
Onset Date: 08/20/2021
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:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: COVID-19 positive.

Other Meds:

Current Illness:

ID: 1641604
Sex: M
Age: 45
State: CA

Vax Date: 04/09/2021
Onset Date: 05/19/2021
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: none

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

Symptoms: Persistent chest pain. The chest pain is felt throughout the day and tends to increase during the evening. It continues today, 4 months after receiving the vaccine. Additionally, 3 days after receiving the vaccine I lost hearing in my left ear. Hearing returned on day 4.

Other Meds: none

Current Illness: none

ID: 1641605
Sex: F
Age: 60
State: CO

Vax Date: 07/21/2021
Onset Date: 07/22/2021
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: ct scan

Allergies: sulfa

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

Symptoms: woke up next morning with a migraine had it for 5 days went to the ER , ringing in ears, eyeballs having shooting pain and vision is all blurry, vertigo problems

Other Meds: candesartan, levothyroxine, botox injections for migraine

Current Illness: no

ID: 1641606
Sex: M
Age: 53
State: TX

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

Lab Data: N/A

Allergies: None

Symptom List: Unevaluable event

Symptoms: Pain at injection site, headache, fatigue, muscle pain x2 days

Other Meds: Beconase AQ 80 mcg

Current Illness: None

Date Died: 08/26/2021

ID: 1641607
Sex: M
Age: 80
State: FL

Vax Date: 02/18/2021
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: LA

Lab Data:

Allergies:

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

Symptoms: Pt mortality from COVID 19 post vaccination.

Other Meds:

Current Illness:

ID: 1641608
Sex: F
Age: 46
State:

Vax Date: 08/12/2021
Onset Date: 08/14/2021
Rec V Date: 08/27/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Guillain Barre Syndrome diagnosed 2 days after Covid vaccine given. Required hospitalization.

Other Meds:

Current Illness:

ID: 1641609
Sex: F
Age: 14
State: WI

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: Injection site pain, Menorrhagia

Symptoms: Adult dose of Recombivax HB vaccine given too soon. It was given at 4 weeks, rather than waiting the appropriate schedule of 4-6 months from the last Hepatitis B Recombivax HB adult dose.

Other Meds:

Current Illness:

ID: 1641610
Sex: F
Age: 55
State: PR

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

Lab Data:

Allergies:

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

Symptoms: patient indicates that at 4:00 am in the morning he had a paralysis in the whole body. At 6:00 am the ambulance went to pick her up steroids by vein every 4 hours. They sent her home at 7:00 pm at night and the treatment they gave her was methrylprednisoloned for 5 days

Other Meds: orencia IV EVERY 4 WEEKS

Current Illness:

ID: 1641611
Sex: M
Age: 79
State: CO

Vax Date: 02/16/2021
Onset Date: 02/20/2021
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: Echo cardiogram, Heart monitor, Cardiac stress test, Sleep apnea study

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: On the 20th, I noticed skipped heartbeats and PVCs much more frequent than I've noticed in the past. It turned out 15% of the heart beats were contractions. I went through a number of cardiac evaluations related to that, including a heart monitor. I did a sleep apnea study. I also did a cardiac stress test. That came out okay. I also had an echo cardiogram. The pulmonary doctor did my apnea study. I went to see my doctor on 02/24. He put on an Epact monitor for 7 days at home. I am still having PVC's.

Other Meds: Lisinopril, Lipitor, Vitamin D2, Fish oil, Centrum Silver multivitamin, Calcium, Preserve Visiont, Vitamin C.

Current Illness:

ID: 1641612
Sex: M
Age: 70
State: CO

Vax Date: 01/31/2021
Onset Date: 03/01/2021
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:

Allergies: polyester suture

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Initially developed extreme fatigue, malaise and sense of taste/smell became ranacid continuing to current date. States he just felt sick. On May 7th developed seizure x2, brain swelling and multiple lesions on brain MRI. Work up noted normal carotid, normal cerebral arteries and veins. Stroke work up negative. Follow up MRI June 9th appeared with additional lesions. Seen by neurology, neurosurgery and oncology. Most recent MRI August 19th showed marked improvement in lesions. Neurology visit 8/27/21 reported he has sustained encephalitis as an autoimmune response to COVID vaccine.

Other Meds: Metformin, fenofibrate, simvastatin, omeprazole, baby aspirin, levothyroxine, multivit

Current Illness: right shoulder pain

ID: 1641613
Sex: F
Age: 48
State: VA

Vax Date: 07/30/2021
Onset Date: 08/03/2021
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: mild increase in LFTs, Calcium; PET/CT subsequently ordered and notable for mild R axillary adenopathy; RUQ US showing mild hepatic steatosis

Allergies: Augmentin - rash; oxycodone - rash

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

Symptoms: symptoms noted after her 1st Pfizer COVID shot on 30 July 2020. On 3 Aug 2021, she developed R sided abdominal/flank/back pain in addition to pain of her R arm that involved not just the site of the injection but her whole R upper arm and R axilla. She also noted nausea and chills but no fevers and no rashes. Follow up with heme/onc had noted mild increase in LFTs, Calcium. PET/CT subsequently ordered and notable for mild R axillary adenopathy. Symptoms worsened and went to the ER at FBCH on 14 Aug 2021 with RUQ US showing mild hepatic steatosis. Has referral and appointment pending in October to the GI liver clinic.

Other Meds: Zyrtec, Calcium, Vitamin D, Flonase, Exemestane

Current Illness: Breast cancer

ID: 1641614
Sex: F
Age: 87
State: IL

Vax Date: 03/15/2021
Onset Date: 08/05/2021
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: 8/5/21 COVID-19 PCR - Positive (detected)

Allergies:

Symptom List: Nausea

Symptoms: Patient received 1st COVID Vaccine 3/15/21, then 2nd dose on 4/5/21. Patient tested positive for COVID on 8/5/21.

Other Meds: APAP, Amlodipine, ASA, Atorvastatin, flecainide, Imdur, lisinopril, Mag Oxide, metoprolol, pantoprazole, Vit D

Current Illness:

ID: 1641615
Sex: M
Age: 52
State: MI

Vax Date: 04/26/2021
Onset Date: 04/26/2021
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: PCN

Symptom List: Injection site pain

Symptoms: First, shortness of breath which was unreported while happening, resolved in 30 minutes. Second: Over the 24 hour period following vaccine, all symptoms of Lyme disease appeared in a cycle: extreme fatigue, muscle aches, joint aches, cardiac pain, head ache, "brain fog", neurological pain. All symptoms resolved abruptly 24 hours after vaccine.

Other Meds: Lisinopril, Desloratadine, Famotodine

Current Illness: Lyme Disease, Hypertension, GERD

ID: 1641616
Sex: M
Age: 40
State:

Vax Date: 12/30/2020
Onset Date: 08/21/2021
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: None stated.

Other Meds:

Current Illness:

ID: 1641617
Sex: M
Age: 30
State: CA

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: RA

Lab Data:

Allergies: CLINDAMIACIN AND SULFA

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

Symptoms: ONE HOUR AFTER VACCINATION, VISION BECAME DIFFICULT TO FOCUS, WITH TUNNEL VISION, WEAKNESS AND STRAIN IN EYE MUSCLES. AS WELL AS WEAKNESS AND SLIGHT PAIN IN EXTREMETIES. SYMPTOMS HAVE NOT RESOLVED IN 7 DAYS AND LITTLE TO NO IMPROVMENT HAS OCCURED.

Other Meds:

Current Illness:

ID: 1641618
Sex: F
Age: 74
State: MI

Vax Date: 02/25/2021
Onset Date: 02/25/2021
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: Ultrasound EKG- good Chest x-ray- good

Allergies: Naproxen

Symptom List: Tremor

Symptoms: As soon as I received the vaccine I started itching at the site. When I came home to cook I started to feel poorly. I told myself I was just imagining it, but I actually wasn't. After 2 hours went by my temperature went up over 103 and stayed there for about 3 days. I had chills, aches, shooting pains in my legs, and my hands were stiff. I was freezing and so cold. I slept off and on. On the third day, the fever broke and I felt drenched. I felt sick with fatigue and achiness. At the injection shot my arm was so red, hot, inflamed, and swollen. I laid low and took care of myself. I started to get a UTI so I immediately went to urgent care and they prescribed me with an antibiotic. I took it and then I developed an allergy from that. A few days after using the antibiotic, I broke out in hives. My foot started hurting. I had to limp around. I went to the doctor and he checked me out. He said he doesn't think I would need another vaccine shot. He said I am allergic to Moderna Vaccine. I got a cold sore on my nose. I had a gallbladder attack. I had surgery for gallbladder removal and I was ok. I received a bacteria infection from the breathing tube that was used in surgery. Since then I have improved, but I have stiff joints and muscle stiffness. Sometimes in the night my joints hurt terribly but in the morning when I get up and start my day I am fine. If I sit in a chair for a long time, I get stiffness. I rarely take medications for it but I may take a Tylenol or ibuprofen for stiffness rarely though. I may take a ibuprofen 1 or 2 every 3 days and a Tylenol once every 3 days. I am concerned for my health when getting the booster because of what I have already experienced with the COVID vaccine. Since I had the vaccine I have started to feel stiffness in my hands, elbows, and knees from my osteoporosis.

Other Meds: Vitamins D3; Magnesium Citrate; Prolia injection every months

Current Illness:

ID: 1641619
Sex: F
Age: 49
State: FL

Vax Date: 08/04/2021
Onset Date: 08/04/2021
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: PNC

Symptom List: Erythema, Pruritus

Symptoms: POST TIME: 2hrs - 2"x3" hot raised rash at injection site 6hrs - fever <100', chills sweating; headache, joint pain 8hrs - rash now extremely itchy 30hrs - feel fine, clear runny nose Rash remained for 3-4 days

Other Meds: none

Current Illness: none

ID: 1641620
Sex: M
Age: 31
State:

Vax Date: 08/26/2021
Onset Date: 08/26/2021
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: none

Allergies: unsure

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

Symptoms: PAtient was given Moderna vaccine that was thawed then frozen and then given

Other Meds: unsure

Current Illness: n/a

ID: 1641621
Sex: F
Age: 55
State: CA

Vax Date: 04/28/2021
Onset Date: 05/07/2021
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: skin biopsy demonstrating allergic reaction 5/27/21 skin allergy testing completed 7/30/21 failed to demonstrate an alternative etiology

Allergies: Erythromycin and Pseudoephedrine

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

Symptoms: Diffuse itchy red rash developed about a week after second covid vaccination. Was not fleeting and persisted after first prednisone course. She underwent skin biopsy, allergy testing and several office visits for the rash which was severe and debilitating for her. No systemic symptoms. Received a second course of po prednisone end of June into July after which the rash finally resolved.

Other Meds:

Current Illness: None

Date Died: 07/26/2021

ID: 1641622
Sex: F
Age: 57
State: KY

Vax Date: 03/31/2021
Onset Date: 07/21/2021
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: COVID Test 7/21/2021 (positive)

Allergies: NKDA

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient admitted 7/21/2021 for presents as transfer for acute hypoxic respiratory failure and covid pneumonia. Vaccinated for COVID 3/31/2021, tested positive 7/21/2021 Patient discharged, DEATH, 7/26/2021 Date of Vaccination:3/31/2021 & 3/10/2021 Dose: 2 doses total Vaccine Manufacturer: Pfizer Lot #: EN6202/EN6207 Clinic Administering Vaccine: unknown Injection site: R deltoid both times Description of event/reaction: patient died from severe ARDS from COVID-19 Patient initially presented on 06/29 with dyspnea, productive cough and wheezing. She reported having difficulty breathing for the last month, however, her symptoms progressively worsened after 6/26/21. Patient was found to be hypoxic on her home oxygen requirement of 3L to SpO2 52% upon arrival to ER. Of note, patient was discharged from a hospitalization on 6/22/21 (unknown reason for hospitalization, duration, and location). Patient is reportedly fully vaccinated for COVID prior to her current admission and received her last vaccine in February 2021. She tested positive for COVID on 6/29 upon admission, and stated that her daughter had been sick recently and tested negative for COVID. Patient was started on Remdesivir, Decadron, Albuterol, Thiamine, Zinc, Quercetin complex, and Vitamin D. Patient was also started on Vapotherm for supplemental oxygen which was alternated with BiPAP, as well as empiric Vancomycin (6/29-7/10 and 7/15-7/21) and Zosyn (6/29-7/8). Patient was ultimately intubated on 07/15 and her antibiotics were escalated to Vanc and Meropenem (7/13-7/21) for presumed pneumonia. She continued to require high ventilator settings (100%, PEEP 16). Her hospitalization was complicated by shock requiring vasopressors. On 7/17, patient was increasingly acidotic with pH 6.99 and PCO2 78 and was subsequently proned and paralyzed. Her infectious work-up was positive for VRE bacteremia on 7/17 and candida in urine culture. On 7/21 she was transferred to MICU for hypoxic respiratory failure and COVID pneumonia. On arrival, she is sedated on mechanical ventilation...Acute Hypoxic Hypercapneic Respiratory Failure requiring Mechanical Ventilation (POA) COVID PNA (POA) History of COPD (POA) - Etiology: COVID PNA - COVID positive 6/29 - Fully vaccinated with Moderna vaccine prior to admission - s/p Remdesivir, convalescent plasma, dexamethasone - 7/15 Intubated at outside hospital - 7/17 Paralyzed and proned - CXR: bilateral diffuse patchy airspace disease - ABG on arrival: 7.43/53/65/35 on 80%, PEEP 10, PF 81 PLAN: - PAL, comp resp panel, Strep and Legionella urine Ag pending - Continue mechanical ventilation to optimize ventilation and oxygenation, maintain SpO2 >/= 92% - DuoNebs q4hr - Empiric broad spectrum antibiotics as outlined below: Linezolid and cefepime - Propofol and Dilaudid drips to facilitate tolerance of mechanical ventilation - Start DEXARDS protocol - Repeat ABG at 2000; prone if PF ratio not improved - Consider CT chest when clinically stable VRE Bacteremia (POA) Sepsis (POA) Leukocytosis (POA) - Has received dexamethasone - Received the following courses abx: Vanc 6/29-7/10, 7/15- 7/21 Zosyn 6/29 - 7/8 Merrem 7/13-7/21 - BCx from 7/17 resulted for +VRE; transitioned to Linezolid prior to transfer - On vasopressors on 7/18 - WBC 26k, lactate here 1.2 - CXR: bilateral diffuse patchy airspace disease Plan: - PAN cultures: Bcx, UA, PAL, strep/legionella urinary Ag pending - Follow cultures; determine insertion date of PICC line - Empiric antibiotics with : Linezolid (start 7/21) and cefepime - ECHO pending AKI (POA) - Scr on admission 0.96, up to 1.96 on 7/17 - Multifactorial AKI is likely related to sepsis PLAN: - BMP here pending - Renal lytes pending - Renally dose medications, avoid contrast medications - Consult the renal team when appropriate T2DM (POA) - HgbA1C pending - FSBG with correction SSI q6hr per ICU protocol

Other Meds: ariprazole, atorvastatin, certirizine, chlecalciferol, dapagliflozin, fluoxetine, Trelegy Elipta, furosemide, gabapentin, glipizine, hydrocodone-acetaminophen, glycopyrrolate-fomoterol, insulin detemir, linsiinopril, meloxicam, metoprolol t

Current Illness:

ID: 1641623
Sex: F
Age: 57
State: CO

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

Lab Data:

Allergies: Yes, but patient doesn't know what she is allergic to.

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

Symptoms: Client waited 20 minutes after administration of the vaccines due to "previous reactions" to medications. Left office feeling fine, but short time later started to have an "itchy nose and throat." Pulled over on the side of the road for an unknown amount of time and administered Histaminum 30C (natural antihistamine) to herself. Client states that she then developed a hive-like rash on her face and neck. She had severe abdominal cramps and "they have lessened but are still present." She also states that she had a metallic taste. Client did not seek medical attention and is doing "better."

Other Meds: Histaminum 30C

Current Illness: unknown

ID: 1641624
Sex: M
Age: 43
State: VA

Vax Date: 02/20/2021
Onset Date: 07/19/2021
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: xray, blood work, CT scan, EKG, chest xrays

Allergies: No

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

Symptoms: Right side chest pain and trouble breathing.

Other Meds: No

Current Illness: No

ID: 1641625
Sex: F
Age: 22
State: NE

Vax Date: 08/18/2021
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: Influenza A and B, and COVID PCR negative.

Allergies: peanuts; raspberries

Symptom List: Pain in extremity

Symptoms: 2nd Moderna Vaccine 8/18, presented to ED with complaints of headache, lower extremity weakness, numbness, and muscle spasms. Also reports right arm pain - same side as injection. Administered 1L normal saline, 60mg IV Norflex, 15mg IV Toradol, and 1000mg oral Tylenol which helped resolve symptoms. Patient discharged from the ED in stable condition.

Other Meds: Depo-Provera

Current Illness: 1st dose of Moderna vaccine 7/15 and had body aches, lower extremity weakness and numbness, left arm pain - same side as injection site, and supraclavicular mass

Date Died: 07/02/2021

ID: 1641626
Sex: F
Age: 56
State: WA

Vax Date: 10/31/2019
Onset Date: 11/14/2019
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: Multiple MRIs, Visual Field testing, Blood Work, EEGs, CT Angiography, Lumbar Puncture, PET Scan.

Allergies: none

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

Symptoms: 2 weeks after shot complaining of vision issues that worsened over the following months. Eventually called Posterior Cortical Atrophy that spread throughout the brain, leading to full incapacity and death.

Other Meds: multi-vitamin

Current Illness: none

ID: 1641627
Sex: M
Age: 23
State:

Vax Date: 08/26/2021
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:

Allergies: None.

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

Symptoms: Itchy blister at the injection site.

Other Meds:

Current Illness:

ID: 1641628
Sex: F
Age: 43
State:

Vax Date: 01/18/2021
Onset Date: 08/22/2021
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:

Allergies:

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

Symptoms: CVOID-19 positive.

Other Meds:

Current Illness:

ID: 1641629
Sex: M
Age: 57
State:

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: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: none

Allergies: cough syrup PCN

Symptom List: Vomiting

Symptoms: Moderna vaccine given that had been frozen, thawed and then given

Other Meds: Atorvastatin Mirtazapine Amlodipine Pantoprazole

Current Illness: Hep C Hypertension Ulcer

ID: 1641630
Sex: M
Age: 26
State: FL

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

Lab Data: Trip to ER on 8/27

Allergies: None

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: After giving patient vaccine and I handed him his vaccine card he fainted and fell out of chair face first and started convulsing. I told technician to call 911 I proceeded to turn him over to check for pulse and breathing to see if CPR was needed. He came to and sat up and I asked him questions if he had had any reaction to his first dose of Pfizer vaccine. He said no. As I was talking to him he fell backwards and passed out again. He regained consciousness after a few minutes. EMS arrived on site shortly there after and administered aid. Since his blood pressure was very low and pulse was high he was transferred to hospital

Other Meds: None

Current Illness: None

ID: 1641631
Sex: F
Age: 86
State: IL

Vax Date: 02/05/2021
Onset Date: 07/26/2021
Rec V Date: 08/27/2021
Hospital: Y

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

Lab Data: 7/26/21 COVID-19 PCR detected (positive)

Allergies: PCN, Bactrim, Shellfish

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

Symptoms: Vaccinated patient tested positive for COVID -19 on 7/26/2021

Other Meds: APAP, amlodipine, atorvastatin, Buspar, B12 injection, Lexapro, Trelegy Ellipta, Xalatan, Xopenex HHN, Mag Oxide, Reglan, metoprolol. montelukast, MVI, Protonix, Miralax, NaCl 3% HHN, Tradjenta, Vit D

Current Illness:

ID: 1641632
Sex: M
Age: 45
State:

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: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: No known allergies

Symptom List: Injection site swelling, Limb discomfort

Symptoms: "10mins post vaccination, pt c/o dizziness and the pt had a near syncopal event. Vitals: BP 92/66, HR 63, RR 16, SpO2 96% -- > 145/65, 73, 16, 99% -- > 110/72, 80, 16, 100%. Pt stable and released from vaccination site. No known allergies or medications. PMH significant for Gallbladder Surgery in 2012 and a positive PPD s/p treatment in 2015. More recent PMH unavailable to this writer."

Other Meds: No known medications

Current Illness:

ID: 1641633
Sex: M
Age: 54
State:

Vax Date: 08/19/2021
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:

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

Symptoms: Patient came in for a visit, 8 days post vaccine administration, with a chief complaint of a rash. No rash noted but right lower leg swelling noted. Out of abundance of caution, patient advised to go to emergency room to rule out DVT.

Other Meds:

Current Illness:

Date Died: 08/21/2021

ID: 1641634
Sex: M
Age: 92
State: NY

Vax Date: 03/16/2021
Onset Date: 08/08/2021
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: Breakthrough COVID infection resulting in hospitalization and death

Other Meds:

Current Illness: Hemodialysis

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am