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: 1641835
Sex: F
Age: 39
State: CA

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

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: 9:10 AM Patient to Covid Vaccine for second dose of J&J per Dr. post allergic reaction to first dose. Patient states she started experiencing itchy throat, cough and feeling like her throat was tightening, cough and her tongue felt like rubber. Patient states this was after observation period post vaccination with Moderna approximately 45 mins after and had to return to Urgent care for treatment. Patient is here now for second dose to increase dose coverage. Patient aware she may have a reaction and brought her epi pen in case. Patient made aware to notify us of any changes in status. 9:15 AM patient started coughing, complaints of difficulty breathing. Transferred to holding room for assessment. 9:20 AM stat MD called. 9:25 Am Skin prepped with chloraprep swab. Tourniquet applied. 22 guage saline lock started to right AC, on 1st attempt, blood return observed. Saline lock secured with tegaderm. Tourniquet removed. SL flushed with 10 mL 0.9% NaCl without difficulty, no redness, swelling or drainage noted to saline lock insertion site. Two DR's here for evaluation, orders for allergy placed. 9:30 am 50mg Benadryl iv push given per providers orders: diphenhydrAMINE Inj 50 mg (BENADRYL) 50 mg ONE TIME 8/5/2021 8/5/2021 -- Class: Back Office Route: intraVENOUS Order: 957070890 Associated Diagnoses ADVERSE EFFECT OF CORONAVIRUS COVID-19 VACCINE, INIT [T88.1XXA, T50.B95A] 9:35 AM Patient has persistent coughing causing constant retching and dry heaving with very little output on vomitus. Dr. ordered Zogran IV to aid with vomiting. ONDANSETRON (ZOFRAN) given IV push. Dosage: 4mg Volume: 2ml Start time: 9:35 Stop time: 9:36 AM Ondansetron (PF) Inj 4 mg (ZOFRAN) 4 mg ONE TIME 8/5/2021 8/5/2021 -- Class: Back Office Route: intraVENOUS Order: 957070892 Associated Diagnoses ADVERSE EFFECT OF CORONAVIRUS COVID-19 VACCINE, INIT [T88.1XXA, T50.B95A] 9:51 AM patient reports improvement with breathing, still a little tingling on tongue and rubbery feeling to tong 10:49 AM patient evaluated by Dr. and cleared for discharge. IV infusion completed. Flushed with 10ml 0.9% Normal Saline. IV DC'd w/cath intact. Pressure held to site w/ 2X2 gauze X 1 minute:hemostasis acheived: secured w/tape. Pt tolerated well. Pt. DC'd home in stable condition with all belongings.

Other Meds:

Current Illness:

ID: 1641836
Sex: F
Age: 74
State: AR

Vax Date: 08/21/2021
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

Allergies: n/a

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient stated having covid like symptoms with intense swelling /redness in the injection arm. on 8/27 pt presented with red patch of swelling on the arm down to about the elbow. pt stated itching but was improving from the day of injection.

Other Meds: ESTRADIOL, HYDROCHLOROTHIAZIDE

Current Illness: NONE

ID: 1641837
Sex: F
Age: 64
State: MN

Vax Date: 07/29/2021
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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None, Called Clinic, took Advil, stayed home one day

Allergies: Reaction to previous flu shot

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

Symptoms: Woke up 2 am on 8/20/20 with headache , fever 100.4, aches and chills, severe right knee pain and almost unable to pain, pain in left arm and unable to lay on that side of elevate arm overhead. Called in to work with adverse reaction- unable to work

Other Meds: Levothyroxine, Norvasc, Vit D and C, Omega 3, Turmeric, Daily vitamin

Current Illness: None

ID: 1641838
Sex: F
Age: 30
State: NJ

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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data: N/A

Allergies: latex

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: PT SAID SHE HAD ACUTE LEFT CHEST PAIN 30-40 MINUTES AFTER RECEIVING FLUCELVAX VACCINE (FLU SHOT). THE CHEST PAIN WENT AWAY FOR 2 HOURS AND CAME BACK LATER THAT NIGHT AROUND 7:30PM; PT STATES THAT TODAY FRI, 8/27 SHE STILL HAS MILD CHEST PAINS (HAS GOTTEN BETTER OVER TIME) AND NOW HAS A HEADACHE TODAY. I ADVISED THE PT TO SEEK MEDICAL ATTENTION IF THE CHEST PAINS GOT WORSE IN CASE ANYTHING WAS WRONG WITH HER HEART. I TOLD THE PT THAT I WOULD DOCUMENT HER REACTION TO THE FLU SHOT. I LEFT THE PT A VOICEMAIL TO CALL US BACK BC ONE OF THE SEVERE ALLERGIC REACTIONS TO THE FLU SHOT IS CHEST PAIN. I WILL TRY TO SUGGEST TAKING SOME BENADRYL TO COUNTERACT THE REACTION AND AGAIN ADVISE SEEKING MEDICAL ATTENTION IF THE CHEST PAINS GET WORSE. PT STATED THAT SHE IS SEEING HER MD SOON FOR AN ANNUAL PHYSICAL SO I TOLD THE PT TO MENTION TO THE DOCTOR EVERYTHING THAT HAPPENED TO HER AS WELL.

Other Meds: unknown

Current Illness: unknown

ID: 1641839
Sex: F
Age: 21
State: IL

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: N/A

Allergies: NO KNOWN ALLERGIES

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

Symptoms: PATIENT ALMOST PASSED OUT ALMOST 5 MINUTES AFTER RECEIVING THE VACCINE. PATIENT WAS RECOMENDED TO SIT AND SHE WAS OBSERVED BY THE PHARMACIST AND PATIENTS MOTHER SHE REPORTED HAVING SOME VISUAL DISTEBASES AND RINGING IN THE EARS.

Other Meds: UNKNOWN

Current Illness: NO KNOWWN HEALTH CONDITIONS

ID: 1641840
Sex: F
Age: 11
State: MD

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

Allergies: none

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

Symptoms: patient filled out the form saying date of birth was 3/24/2009 and when i called the insurance they said it was 3/24/2010 making the patient under age. no adverse events reported

Other Meds: none

Current Illness: none

ID: 1641841
Sex: M
Age: 17
State: IN

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

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Pt DOB was misread at offsite clinic and pharmacist administered moderna vaccine to patient under the age of 18.

Other Meds:

Current Illness:

ID: 1641842
Sex: F
Age: 25
State:

Vax Date: 01/07/2021
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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: asymptomatic but covid test was positive; fully vaccinated

Other Meds:

Current Illness:

ID: 1641843
Sex: F
Age: 34
State: CA

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

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

Lab Data: Total Tryptase send 8/26/1. results not yet available

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: 34 y.o. female with h/o anaphylaxis, allergic rhinitis and asthma with allergic reaction to second dose of COVID-19 Pfizer vaccine. Patient had anaphylactic reaction to first dose in April requiring 3 day admission to ICU and epinephrine drip (not intubated). Patient tested outpatient by allergy & immunology for components of COVID-19 vaccine which were negative and it was deemed safe for patient to receive 2nd dose of vaccination today in supervised environment. Patient states vaccine appointment was at 10:30AM and about 15 minutes after she developed hives and shortness of breath. Denies difficulty swallowing or facial swelling. She received epi, benadryl and zyrtec which relieved her symptoms. Upon presentation here she endorses some chest tightness but denies difficulty swallowing, breathing, facial swelling. Patient has minimal hives on UEs. Discharged from ED following observation for 4hours. Patient with epi-pen at home and follow-up with immunology clinic next month.

Other Meds:

Current Illness:

ID: 1641844
Sex: F
Age: 11
State: MD

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: none

Allergies: none

Symptom List: Diarrhoea, Nasal congestion

Symptoms: patient wrote date of birth of 3/24/2009 on consent sheet but when i contacted the insurance they say the date of birth is 3/24/2010 which would make the patient 11 years old instead of 12.

Other Meds: none

Current Illness: none

ID: 1641845
Sex: F
Age: 25
State: WA

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: SYR
Vax Site: LA

Lab Data:

Allergies: unknown

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

Symptoms: 3 minutes after vaccination administration, pt went unconscious while sitting down in observation area for approx 30 seconds. Was assisted to supine position on floor by RN, RR was called get additional assistance. Resumed consciousness with inital confusion, mentation improved to baseline shortly after. VSS, monitored q2min for 15 minutes. Given granola bar and Gatorade once condition stabilized. Pt reported having not eaten prior to vaccination, had only consumed coffee that day. Pt observed for 30 minutes, VSS, escorted downstairs without assistance. No medications administered.

Other Meds: unknown

Current Illness: unknown

ID: 1641846
Sex: F
Age: 35
State: IN

Vax Date: 08/18/2021
Onset Date: 08/25/2021
Rec V Date: 08/27/2021
Hospital:

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

Lab Data: 8/26/2021 Ekg Chest X-ray Bloodwork

Allergies: None

Symptom List: Rash, Urticaria

Symptoms: After receiving the vaccine there was an evening that when I laid down for bed I started experiencing what felt like my heart was pounding. I went on to falling asleep and the next day I woke up fine. It wasn?t until Wednesday early morning that I noticed the tightness feeling in my chest, my heart feeling like it was racing, and the feeling I had to continue to take deep breaths. I continued through my day getting my girls ready for school and taking them to the bus stop. I continued feeling this way throughout the day. I begun monitoring my heart rate with my Apple Watch and my heart rate was anywhere between 100-147 bpm when I was standing or walking. When I finished my errands I returned home to rest on the couch hoping these feelings would pass. When I was laying down my heart rate was between 77-85 bpm. After getting my kids off of the school bus is when I decided to call my doctors office. I went into detail on what I was experiencing, what my heart rate was periodically, and that I have had the first dose of the Pfizer vaccine on the evening of 18th. The lady I spoke with was going to send the information off to my dr to see what she recommended. Not even 10 minutes later I received a call from the nurse practitioner from my doctor?s office asking me more questions about the type of vaccine and which one. The nurse then said my Doctor recommended that if my heart rate was 110 bpm or more that I need to go to the ER. I decided to take it easy for the rest of the evening and go to bed, I decided that if I continued to have these symptoms in the morning that then I would go to the immediate care. Thursday morning I woke up still with the symptoms. So I got my kids ready for school and went to the immediate care once they opened. When I went into immediate care they took me right back when they seen what my Watch was showing my heart rate was. I was then given an ekg which came back fine but with my heart rate being 124bpm while I was sitting with the dr she did not feel comfortable allowing me to leave unless someone picked me up and took me to the ER, and even offered to call an ambulance to take me over. I then called my husband who was at work to come get me and take me to the ER. Upon arrival at 10:37am they registered me in and took me back to take another ekg and to draw blood. I told them that when I?m laying down my heart rate is normal but once I stand and start walking it will jump 110 bpm and beyond. The highest it got yesterday was 158 bpm. They did a chest X-ray which came back normal and the ekg came back normal. After being in the ER for 11 hours I finally was taken back to see the On-call dr. He said that the ekg and X-ray looked great but because of the tightness in my chest and the high heart rate that he wanted to do more blood work to make sure I?m not clotting. After the bloodwork came back fine he discharged me but had an outpatient order for me to wear a holter monitor for 72 hours. After being at the ER for 12 1/2 hours I was finally discharged and on my way home. This morning I have called to set up an appointment for me to go back to Hospital to get the holter monitor which will be on September 7th. And today I continue with the same symptoms.

Other Meds: Lamotrigine Prazosin Adderall

Current Illness: None

ID: 1641847
Sex: F
Age: 61
State: NC

Vax Date: 08/13/2021
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:

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

Symptoms: PATIENT RETURNED TO THE PHARMACY ON 08/27/2021 AND PRESENTED WITH A RED RASH AROUND THE INJECTION SITE (APPROXIMATELY 4" X 6"). SHE SAID THAT IT ITCHED, AND THAT IT HAD STARTED OUT AS A SMALL RED CIRCLE AROUND THE INJECTION SITE, AND GRADUALLY SPREAD TO ITS PRESENT SIZE AS DESCRIBED ABOVE. PHARMACIST MARKED THE PERIMETER OF THE RASH WITH A MARKER WITH DATE AND TIME (08/27/21, 5:27PM), AND TOLD THE PATIENT TO ADD ICE, AND TAKE DIPHENHYDRAMINE 25MG AT 1 PO Q4-6H PRN. ALSO TOLD THE PATIENT THAT IF THE RASH SPREAD OUTSIDE OF THE PERIMETER ONCE SHE HAD STARTED THE ICE AND DIPHENHYDRAMINE, TO SEEK MEDICAL ATTENTION FROM HER DOCTOR.

Other Meds:

Current Illness:

ID: 1641848
Sex: M
Age: 60
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: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: Initial vitals: BP: 80/60, Pulse: 62, O2: 95% Repeat vitals @ 12:01p: BP: 104/70, Pulse: 82, O2: 98-99%

Allergies: None

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

Symptoms: Pt received the J&J vaccine. A few minutes after receiving the vaccine the pt became pale, clammy, had blank stare, and rigid jaw. Pt responded to sternal rub. Would not lay down. Pt's wife sated she believes he had worked himself up over getting the vaccine. Pt's wife also stated he did not eat prior to coming. Pt had brief syncopal episode lasting less than 10 sec. Pt somewhat alert and talking/sluggish. EMS/911 called at 11:51a. 911 stayed on the phone with me until ambulance arrived. During phone call the pt became more alert saying he was better and needed to walk around. I did not let pt up; kept him seated. He became less diaphoretic/clammy, but still pale, alert and talking. Vitals at this point were reassessed and had improved. At approx 1205p report was given to paramedic and care transferred.

Other Meds: None

Current Illness: None

ID: 1641849
Sex: F
Age: 62
State: GA

Vax Date: 04/10/2021
Onset Date: 04/15/2021
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: X-ray, June, normal ***Just received insurance approval yesterday for an MRI which is yet to be scheduled but should be soon.

Allergies: None known

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

Symptoms: A few days after the second dose the lymph nodes under my right arm became extremely sore. Then my left (opposite) arm became sore and the pain continued moving down to my hand. It was so painful I couldn?t pick up a cell phone. Many nights my arm woke me up throbbing. Most of the pain is centered in the elbow with throbs and occasional shooting pain above and below the elbow occasionally. My husband got his second one a few days later. He has much milder pain in his opposite elbow. I?ve also read (and have a screenshot) of someone else with an identical reaction. My doctor put me on two months of anti inflammatories and didn?t think it was vaccine related, but I KNOW it is...especially with others having similar experiences.

Other Meds: Atorvastatin, 81 mg aspirin, Losartan, Vascepa

Current Illness: None

ID: 1641850
Sex: F
Age: 0
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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: shrimp

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

Symptoms: When pharmacist went out to check on patient 15 min post vaccination, patient reported she was not feeling great. She reported an itchy throat-similar to when she eats shrimp, feeling really warm, and like her feet were not attached to her body. Pharmacist gave 25mg of Benadryl, a glass of ice water, and an ice pack. Pharmacist then called over a nurse to check her over in clinic. As of time of this report (6:13pm) patient's vitals were stable.

Other Meds: unknown

Current Illness: unknown

ID: 1641851
Sex: M
Age: 17
State: NY

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

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

Symptoms: right after I injected pt with vaccine he jumped out of his chair onto the floor hitting his head on the table, pt was bleeding, stayed with the patient and mother for about 25 minutes made sure patient was feeling ok to leave

Other Meds: none

Current Illness: none

ID: 1642004
Sex: F
Age: 67
State: NY

Vax Date: 08/15/2021
Onset Date: 08/22/2021
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: Patient presented to her primary care who told her that she has cellulitis/ "covid arm"

Allergies: PENICILLIN, PRACTICALLY ALL ANTIBIOTICS THAT START WITH A "C" (SHE COULD NOT NAME THEM)

Symptom List: Ear pain, Hypoaesthesia

Symptoms: ARM SWELLING EITHER SLIGHTLY BELOW THE INJECTION SITE OR AT THE INJECTION SITE. Red and warm to the touch

Other Meds: NONE AT THE TIME OF ADMINISTRATION

Current Illness: NONE

ID: 1642005
Sex: M
Age: 0
State: MI

Vax Date: 08/27/2021
Onset Date: 08/27/2021
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: NA

Allergies: No know allergies

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Patient received first dose of the COVID-19 Pfizer vaccine. I was alerted by the patient's friend that he fainted. I went to check on the patient and he was unconscious. He quickly regained consciousness and asked for water. I proved him with water, moments later he began to vomit. I continued to monitor the patient and after about 10-15 minutes he began to feel a lot better. He call someone to come and pick him up and take him home. I advised the patient to remain seated for another 10-15 minutes, and he did so. He began to feel a lot better and then went home.

Other Meds: NA

Current Illness: No know illnesses

ID: 1642006
Sex: F
Age: 57
State: PA

Vax Date: 05/21/2021
Onset Date: 05/21/2021
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: Went to my pcp's office on 5/28/21 due to these symptoms. ran labs including D dimer. all were normal with the exception of elevated cholesterol (unrelated to symptoms)

Allergies: Eggs, all sulfur drugs including PCN/Bactrim, napryson,

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

Symptoms: hypersensitivity in body/arms/legs, tingling/numbness L arm started a few hours after the 2nd shot and lasted 3 weeks. Within 2 days of the 2nd shot episodic electric shock feeling to my tongue. this lasted 4 weeks. I sought medical care through my pcp's office.

Other Meds: no prescription medications, no over the counter medications, Kelp, Omega 3/6's, multivitamin

Current Illness: None

ID: 1642008
Sex: M
Age: 31
State: CA

Vax Date: 04/02/2021
Onset Date: 05/01/2021
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: NA

Allergies: Pineapple and guava

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

Symptoms: The fist symptoms were unusual bruises in my legs, then some sort of like pimple looking thing start showing on the right of my rightfoot. Then swelling and pain start showing and by today the pain is making me difficult to walk.

Other Meds: Losartan Xanax Duloxetine Hydoxycut Ashagwandha Vitamin c, d and B12 5 HTP PROBIOTICS

Current Illness: NA

ID: 1642009
Sex: F
Age: 13
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Unevaluable event

Symptoms: PT c/o discomfort on left side of chest, felt panic and overwhelmed. Pt was sweating, flush in the car with no AC. Vital BP: 127/75. HR: 88. Nurse practitioner cleared patient.

Other Meds: None

Current Illness: None

ID: 1642010
Sex: F
Age: 19
State:

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

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

Lab Data:

Allergies: Pt w/ hx of allergy to ASA (muscle spasms) and tomato (hives).

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

Symptoms: "Pt w/ hx of allergy to ASA (muscle spasms) and tomato (hives). PMH significant for Palpitations, depression. s/p MVA 10/2019. Current Medications: No active medications 15mins post vaccination, pt c/o rash/itching in her arm. Vitals: BP 116/79, HR 74, RR 16, SpO2 100%. Pt given benadryl 25mg PO @ 16:45 and symptoms resolved. Reviewed ER precautions including SOB, throat swelling, or any other concerning symptoms. Pt stable and released from the vaccination site. Within hours of vaccination, pt developed and numbness/tingling in lower legs, back pain, and intermittent headaches. Pt presented to the ED c/o these symptoms on 8/25. Per ED MD, they did not appreciate swelling on exam but does not tenderness over bilateral calves. VSS, neurological exam WNL, intact reflexes. Pt has 5/5 strength in BLE and BUE with normal gait. ED MD concluded that this is likely myalgia secondary to an immune reaction from the Moderna Vaccine. Pt discharged with APAP."

Other Meds: No active medications

Current Illness:

ID: 1642011
Sex: F
Age: 37
State: NV

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: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NA

Symptom List: Injection site pain, Pain

Symptoms: After 5 min, my fingers swelled. After 45-50 min, my tongue and throat swelled. I treated them with antihistamine medication. It led to following days of abdominal pain/difficulty eating and crushing chest pain. All symptoms are indicative of systemic inflammation. It took about 9 days to mostly resolve with home care and use of anti inflammatory herbs and antihistamines.

Other Meds: Pepcid, Allegra, multivitamin, vitamin C

Current Illness: NA

ID: 1642012
Sex: M
Age: 68
State: CA

Vax Date: 06/28/2021
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: SYR
Vax Site: LA

Lab Data: in person visit with Doctor on August 26, 2021

Allergies: none

Symptom List: Injection site pain, Menorrhagia

Symptoms: outbreak of Bell's Palsy with initial symptoms (drooping mouth) within 3 weeks

Other Meds: 1 - Atenelol 50MG 1 - Pantoprazole 40 mg OTC 1 - Lutein 25mg & Zeaxanthin 5mg 1 - Daily Multi Vitamins & Minerals 1 - Calcium Citrate 500mg, Magnesium 80mg & Zinc 10mg with Vitamin D3 20mcg 1 - Ferrous Gluconate 324 mg EVENING: PRESCRIPTI

Current Illness: none

ID: 1642014
Sex: F
Age: 12
State: NJ

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

Lab Data: Vitals was checked by EMT and everything was normal

Allergies: No Know allergy

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

Symptoms: Today 08/27/21 the patient came in to get her second dose of the Pfizer covid-19 vaccine. The vaccine was administered by pharmacy technician. About 5 minutes after the administration the patient was about to faint and was caught by her mom and was stabilized. Then she started vomiting. 911 was called and her vitals was checked and everything was normal. The patient and mom left the pharmacy around 11:18am. Pharmacist called the mom around 4:30pm to check on patient and the mom stated that she is doing okay.

Other Meds: N/A

Current Illness: None

ID: 1642015
Sex: M
Age: 49
State: PA

Vax Date: 08/20/2021
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: physical examine and blood draw

Allergies: no

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Bell palsy Thursday the whole right side of his face was numb

Other Meds: lisinopril

Current Illness: no

ID: 1642017
Sex: M
Age: 42
State: IA

Vax Date: 06/01/2021
Onset Date: 06/02/2021
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: RA

Lab Data: Myocarditis

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: -Cough -Wheezing -Tight chest -Hypoxia feeling -Breathing difficulties -HRV was off - High /sporadic HR compared to usual -Muscle spasms in chest - Tight/pain left middle upper back - usual fatigue

Other Meds:

Current Illness:

ID: 1642018
Sex: M
Age: 26
State: AR

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: 1
Vax Route: IM
Vax Site: RA

Lab Data: Seen in ER

Allergies: none

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

Symptoms: Patient presented for Pfizer vaccine. Prior to immunization he appeared to be very nervous and reported he was having a lot of anxiety. He was accompanied with his wife who reports he was very nervous. Pt confirmed no allergies, not in quarantine, being sick, and denied any medical problems. Pt tolerated the vaccine while and walked with his wife to the waiting room. After about 5 minutes in waiting room, his wife yelled out "I need help." Nurse was first on scene and instructed the clerk to call 911. Nurse was in unit and assisted in care, checking BP and pulse (90/50 and 64). Pt was diaphoretic and pale, oxygen administered and patient monitored until EMTs arrived. Once arrived patient had started to come around, color returning and not as sweaty. He got up and walked to stretcher and exited with EMTs and wife who followed after.

Other Meds: none

Current Illness: none

ID: 1642019
Sex: M
Age: 44
State: WI

Vax Date: 08/01/2021
Onset Date: 08/02/2021
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: RA

Lab Data:

Allergies: None

Symptom List: Nausea

Symptoms: Next day I woke up to complete body soreness and fatigue. Day 2 had same symptoms as when I had Covid. Consisted of muscle cramping, fatigue, headache, chills, fever of 100 degree. Day 3 symptoms went away. Had positive Covid test December of 2020.

Other Meds: 5mg amlodipine daily

Current Illness: None

ID: 1642020
Sex: F
Age: 27
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:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Sulfa Drugs

Symptom List: Injection site pain

Symptoms: Left Arm Pain, Headache, and Fatigue

Other Meds: No Medications were taken at the time of the vaccine but I am on medications. Propanolol 20mg QD, Potassium 10MEQ BID, Omeprazole 40MG BID, Aspirin 81mg BID

Current Illness: None

ID: 1642021
Sex: F
Age: 37
State: CA

Vax Date: 08/13/2021
Onset Date: 08/13/2021
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, penicillin, cephalexin

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

Symptoms: No treatment need. I am to premediated with Benadryl for my next dose and bring my EpiPen.

Other Meds: Too many to list

Current Illness: Itchy lips and throat felt swollen on right side for about 15 minutes after injection. Diarrhea 4 hours later.

ID: 1642022
Sex: M
Age: 41
State: PR

Vax Date: 08/13/2021
Onset Date: 08/14/2021
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: Laboratories

Allergies: No

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

Symptoms: Urine infection, pain testicular.

Other Meds: Celcep, Tacrolimus 10mg, Prednisone 5mg

Current Illness: No

ID: 1642023
Sex: F
Age: 38
State: CA

Vax Date: 08/19/2021
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: IM
Vax Site: LA

Lab Data: MRI cervical spine without and with contrast showed a 4x13 mm left spinal cord T2 lesion at the cervical level c3. She was diagnosed with an acute transverse myelitis.

Allergies: None

Symptom List: Tremor

Symptoms: One day after receiving the vaccine, the patient developed bilateral leg weakness, palpitations, and also numbness in the lower back region. She was found to have neck flexion as well as bilateral proximal leg weakness. Her gait is unsteady.

Other Meds: Levonorgestrel

Current Illness: None

ID: 1642024
Sex: F
Age: 13
State: CT

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

Lab Data: N/A

Allergies: N/A

Symptom List: Erythema, Pruritus

Symptoms: The patient had a syncope reaction from a seated position. The patient went limp, but did not fall from their chair. The patient quickly regained consciousness and was instructed to remained seated with their head between their legs. The patient was responsive and denied any allergic reaction symptom, like difficulty breathing or itching. After 10 minutes the patient returned to a normal seated position and drank water. After 5 more minutes the patient was able to leave under their own power.

Other Meds: N/A

Current Illness: N/A

ID: 1642025
Sex: F
Age: 15
State: SC

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

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

Symptoms: Patient felt faint approximately ten minutes after receiving the vaccine and had to sit and sip water to regain composure. After approximately 15 minutes of sitting down, she felt fine and was able to leave.

Other Meds: None

Current Illness: None

ID: 1642026
Sex: F
Age: 12
State: FL

Vax Date: 08/22/2021
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: IM
Vax Site: LA

Lab Data: ECHO and EKG performed on 8/25/2021 revealing slight Pericardial Effusion Follow up ECHO and EKG performed on 8/27/2021 showed that condition was subsiding, if not gone. Chest tightness still present, however.

Allergies: none

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

Symptoms: PT complained of chest pain, chest tightness, dizziness, headache, and fever (100.4) approximately 19 hours after receiving the first dose of the Pfizer COVID-19 vaccine. As a result of her symptoms, she was seen by a cardiologist on 8/25 and diagnosed with Pericardial Effusion. PT was given 400 mg ibuprofen twice daily to treat symptoms.

Other Meds: none

Current Illness: none

ID: 1642028
Sex: F
Age: 30
State: CA

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:

Allergies: Patient has allergies to peanuts and seasonal allergies.

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patients states she had lip fillers about two years ago. Patient reported lips feeling warm and swelling. Patient had slight itchy in throat and eyes. Benadryl 50mg ordered by Dr. and given to patient. Patient stayed about 40 minutes and was able to leave clinic. Patient advised any worsening to go to ER or call 911. Patient has epi pen and Benadryl at home.

Other Meds: Patient was given Benadryl 50mg tablet

Current Illness: Patient was diagnosed with COVID on 7/26/21. Patient has botox/fillers.

ID: 1642029
Sex: F
Age: 48
State: NC

Vax Date: 08/25/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Rash on neck and face

Other Meds: None

Current Illness: None

ID: 1642030
Sex: F
Age: 37
State: DC

Vax Date: 02/23/2021
Onset Date: 02/23/2021
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: Blood work in March

Allergies: Wellbutrin

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

Symptoms: My lymph node inside my armpit was tender and swollen for about 13 days. I missed my cycle the month of vaccine. I had a lot of muscle soreness and fatigue at the site of injection. My mobility was very limited. The fatigue lasted for about 12 days and then the next month, I did get my cycle, but it lasted for 14 days. My cycle went back to normal until this month (August) and then I missed my cycle again.

Other Meds: Levothyroxine T4 170mcg; Liothyronine T3 140mcg; Hydrochlorothiazide 12.5mg; Escitalopram 5mg; Hydrocortisone 12.5mg; Iron tablet; Progesterone; Fexofenadine HCl 180mg; Undecylex; Pregnenolone 100mg; Vitamin B3 125 mcg

Current Illness:

ID: 1642031
Sex: F
Age: 45
State: NV

Vax Date: 03/09/2021
Onset Date: 03/10/2021
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: NOT KNOWN

Allergies: NO KNOWN DRUG ALLERGIES

Symptom List: Pain in extremity

Symptoms: PT REPORTED HAVING A SEIZURE EPISODE (LASTING 2 TO 3 MINUTES) AT 1:00 AM THE NEXT DAY. EMT ARRIVED AND ASSESSED AND PT WAS OK. NO HOSPITALIZATIONS AND PT HAVE FOLLOW UP WITH NEUROLOGIST SINCE INCIDENT.

Other Meds: NOT KNOWN

Current Illness: NOT KNOWN

ID: 1642032
Sex: F
Age: 34
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: Unknown

Allergies: Unknown

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

Symptoms: Patient came to get her second dose of Pfizer Covid Vaccine, after receiving the vaccine, patient reports that she had tightness in her throat after the first dose, but her VAR did not reflect reaction to any previous vaccine. While waiting after the second vaccine, she reports having tightness in her throat and this time it is worse than the first incident . We gave her 50 mg benadryl liquid, then epipen then called 911

Other Meds: Unknown

Current Illness: Unknown

ID: 1642033
Sex: F
Age: 38
State: FL

Vax Date: 08/13/2021
Onset Date: 08/23/2021
Rec V Date: 08/27/2021
Hospital:

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

Lab Data: NA

Allergies: NA

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

Symptoms: Swollen and sore arm persistent over the course of a week; red rash on arm and mainly around injection sight

Other Meds: NA

Current Illness: NA

ID: 1642034
Sex: U
Age: 40
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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NA

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

Symptoms: After Patient received second dose of Pfizer vaccine they disclosed to RN that they received Janssen Vaccine on 5/29/21. Patient recieved first dose of pfizer on 8/6/21 from a clinic. Only the Pfizer dose was present in patients vaccination record.Patient has received two complete series of CV19 vaccinations. Pfizer and Janssen

Other Meds: NA

Current Illness: NA

ID: 1642035
Sex: F
Age: 36
State: CA

Vax Date: 04/12/2021
Onset Date: 04/13/2021
Rec V Date: 08/27/2021
Hospital: Y

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

Lab Data: Echo

Allergies: Compazine Reglan

Symptom List: Vomiting

Symptoms: Bleeding gums nose and rectal bleeding. Pericardial effusion and pericarditis. Shortness of breath COPD

Other Meds:

Current Illness:

ID: 1642036
Sex: M
Age: 48
State: CA

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

Lab Data: None

Allergies: no known allergies

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient came into pharmacy and requested his second vaccine (in the series, he said he had Pfizer before, indicated so on his consent form as well. I checked the dates and administered a Pfizer shot. Only when I updated his vaccination record card I saw that he actually received Moderna before. Patient said he wanted Pfizer and thought first one was Pfizer.

Other Meds: Not known

Current Illness: None known

ID: 1642037
Sex: M
Age: 35
State: CA

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: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Pain in arm, arm weakness, pins and needles in fingers within minutes of vaccine. Increasing pain over time. Especially lethargic and sleepy. Dizziness, vertigo-like

Other Meds: 200 mg Lamictal, 10 mg Lexapro, 200 mg Ibuprofen

Current Illness:

ID: 1642038
Sex: M
Age: 39
State: GA

Vax Date: 04/01/2021
Onset Date: 04/23/2021
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: IM
Vax Site: LA

Lab Data: Vng test- for vestibular neuritis Ekg-afib 6/4

Allergies: None at time. Now I do

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Vestibular neuritis- 4/23/2021 first symptoms Atrial Fibrillation- 6/4/2021

Other Meds: Metoprolol twice a day Levocetirizine

Current Illness: None

ID: 1642039
Sex: M
Age: 24
State: RI

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: RA

Lab Data: Basic metabolic panel, CBC with Diff, D Dimer deep vein thromb level, TROPONIN 1 ECG 12 Lead, XR: Chest PA & Lateral All taken on 08/26/2021, all normal

Allergies:

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

Symptoms: Started experiencing shortness of breath, fever with severe/uncontrollable shaking in arms and legs, and confusion and dizziness around 6 hours after receiving the vaccine. Also experienced painful headache around 3 hours after receiving vaccine.

Other Meds: Multivitamin, krill oil, vitamin d, probiotic

Current Illness: Fever 2 weeks beforehand.

ID: 1642040
Sex: F
Age: 18
State: TX

Vax Date: 08/06/2021
Onset Date: 08/22/2021
Rec V Date: 08/27/2021
Hospital: Y

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

Lab Data:

Allergies: Avocado, peanuts

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

Symptoms: Patient presented with acute flaccid myelitis. Progressive weakness and sensory changes starting in the upper extremities bilaterally and then progressing to the lower extremities with the right lower extremity relatively spared comparatively. MRI of the spine shows extensive T2 hyperintensity of the central gray matter of the cord from c2-3 level to T1.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am