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: 1656106
Sex: F
Age: 67
State: MI

Vax Date: 03/25/2021
Onset Date: 08/25/2021
Rec V Date: 08/30/2021
Hospital: Y

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

Lab Data: Covid positive on admission 8/25/2021

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Small bowel obstruction

Other Meds: Albuterol, norvasc, vitamin D, flexeril, banophen, pepcid, neurontin, multivitamin, renegel, zanaflex,

Current Illness:

ID: 1656107
Sex: M
Age: 20
State: NC

Vax Date: 08/22/2021
Onset Date: 08/22/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient administered PFIZER first dose, Moderna second dose in error. CVMS down, unable to verify first dose information.

Other Meds: N/A

Current Illness: N/A

ID: 1656108
Sex: F
Age: 74
State: VA

Vax Date: 03/15/2021
Onset Date: 03/18/2021
Rec V Date: 08/30/2021
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: has had the whole work up for chronic idiopathic urticaria. unable to find underlying cause. normal cbc, cmp, tsh, esr, autoimmune disease work up with ana, rf, crp, esr

Allergies:

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

Symptoms: developed hives 3 days later consistent with chronic urticaria

Other Meds:

Current Illness:

ID: 1656109
Sex: M
Age: 27
State: TX

Vax Date: 08/30/2021
Onset Date: 08/30/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data: None

Allergies: Nuts and sulfa drugs

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Approximately 10 mins after the administration of the first dose of the Moderna COVID vaccine, the patient fainted in the waiting room chair. I rendered first aid by calling out to him to rouse him. I provided him with water and apple slices as he complained of not having eaten for an extended period of time and being thirsty. He stated that he had no history of seizures, but had terrible anxiety. He also stated that he was still nervous about the vaccine even after administration. He sat in the pharmacy for almost an hour afterwards. In that time he finished off the apple slices and water bottle. He did not complain of any further symptoms and was able to leave the pharmacy under his own power.

Other Meds: None

Current Illness: Anxiety

ID: 1656110
Sex: F
Age: 24
State: AL

Vax Date: 08/26/2021
Onset Date: 08/27/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: It's been four days now since I got the vaccine and I still have a throbbing headache and feel a bit weak. I feel malaise and have brain fog that makes it hard to focus and concentrate. My neck feels stiff and I'm having upper back pain. I have an uncomfortable feeling in my chest like a fluttering feeling.

Other Meds: Trazadone 150MG tab (once at night). D-Amphetamine Salt Combo 30MG tab (twice a day). Hydroxyzine HCL 50MG tab (four times daily as needed).

Current Illness:

ID: 1656111
Sex: F
Age: 52
State: CT

Vax Date: 08/24/2021
Onset Date: 08/27/2021
Rec V Date: 08/30/2021
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: Adverse reaction to codeine

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

Symptoms: Swelling of lymph nodes under left armpit, very painful.

Other Meds: None

Current Illness: None

ID: 1656112
Sex: F
Age: 52
State: TX

Vax Date: 08/27/2021
Onset Date: 08/27/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data: na

Allergies: na

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient was vaccinated with Moderna that expired on 8/11 from Refrigerator. Moderna was place in the refrigerator on July 12th from freezer stock

Other Meds: na

Current Illness: na

ID: 1656113
Sex: F
Age: 17
State: UT

Vax Date: 08/27/2021
Onset Date: 08/27/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data: NA

Allergies: NKDA

Symptom List: Pharyngeal swelling

Symptoms: Received request for Moderna vaccines for family member of an employee. They filled out the required forms. Employee family member filled out the form with wrong birthday. Administered shot in right deltoid. No concerns. Monitored for 15 minutes after dose. No concerns.

Other Meds: NA

Current Illness: NA

Date Died: 08/26/2021

ID: 1656114
Sex: F
Age: 50
State: CA

Vax Date: 08/25/2021
Onset Date: 08/26/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data:

Allergies: Lisinopril, PCN, Vancomycin

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: DEATH

Other Meds: Pt was going to dialysis 3x weekly

Current Illness: Chronic kidney disease, Diabetes, Heart Disease

ID: 1656115
Sex: F
Age: 17
State: CO

Vax Date: 06/23/2021
Onset Date: 06/23/2021
Rec V Date: 08/30/2021
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: Pt. did not have any adverse events. Pt. made appointment for covid vaccine first dose and was given Moderna for 1st dose instead of Pfizer. On 07/21/2021 pt. needed second dose of Covid and she got her second Moderna dose intramuscularly in L deltoid. Pt. did not report any adverse events or reaction. Pt. had a Well Child Check on 08/10/2021 with PCP and pt. did not report any side effects or problems.

Other Meds:

Current Illness:

ID: 1656116
Sex: F
Age: 28
State: WA

Vax Date: 08/12/2021
Onset Date: 08/13/2021
Rec V Date: 08/30/2021
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: Pcn, sulfas, corn

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

Symptoms: Bleeding gums (x3 days). Fever, muscle spasms, body aches (all resolved within 24 hours). Severe weakness (weakness is persistent to this day).

Other Meds: Prenatal vitamins, Allegra

Current Illness: None

ID: 1656117
Sex: F
Age: 58
State: PR

Vax Date: 08/24/2021
Onset Date: 08/24/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Patient female 58 years old is in the observation are and reports to the EMT of feeling dizzy. Approximately 30 min after the administration of the vaccine. Vitals signs are taken BP 120/70, pulse 60min, Sp0 99%, glucose 101. Consultation with Doctor R. is make, and she indicates to keep patient under observation for 15 more mins. Patient's condition is reassessed, vitals are taken 15 minutes later BP 120/70, pulse 60, Sp02 99%, dextrose 105. Patient reports not feeling dizzy. She proceeds to leave the vaccination center accompanied by her husband.

Other Meds:

Current Illness: Asthma, Anxiety, Depression

ID: 1656118
Sex: M
Age: 31
State: NJ

Vax Date: 06/13/2021
Onset Date: 06/17/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data: Mononucleosis 8/04/2021

Allergies: Allergic to dairy

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

Symptoms: Felt off and weak for the first two days after receiving my second shot, and then things began doing down hill with weight loss and body aches, tested positive for mono and have been mostly bed ridden for months and still going and getting tested from my doctor

Other Meds:

Current Illness: 0

ID: 1656119
Sex: M
Age: 30
State: CA

Vax Date: 08/28/2021
Onset Date: 08/28/2021
Rec V Date: 08/30/2021
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:

Allergies: nka

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

Symptoms: Pt fainted

Other Meds: not known

Current Illness: none

ID: 1656120
Sex: F
Age: 40
State: FL

Vax Date: 08/20/2021
Onset Date: 08/27/2021
Rec V Date: 08/30/2021
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: Allergic codeine

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

Symptoms: COVID arm appeared on injection site on day 7. Day 8 rash on thighs which worsened. Day 9 went to ER with full body measles rash painful, red bumpy, and itchy being treated with Prednisolone, Benadryl, and Pepcid

Other Meds: Multi vitamin

Current Illness: No

ID: 1656121
Sex: F
Age: 40
State: KS

Vax Date: 08/26/2021
Onset Date: 08/27/2021
Rec V Date: 08/30/2021
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 - been treating with benadryl, cortisone and ibuprofen

Allergies: NA

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

Symptoms: The day after receiving the vaccine my trunk has broken out in a bumpy/red and swollen rash. It starts mildly at my neck and moves to the breast, stomach area and all over my lower to mid-back.

Other Meds: N/A

Current Illness: N/A

ID: 1656122
Sex: F
Age: 41
State: PR

Vax Date: 05/02/2021
Onset Date: 05/10/2021
Rec V Date: 08/30/2021
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: After about a week and 1/2 started to cough ?? I thought it was asma went to Dr several times even went to the hospital and right now I?m still coughing!! The medicine will only make it a bit easy but the cough will not go away!!

Other Meds: None

Current Illness: No

ID: 1656123
Sex: M
Age: 23
State: TX

Vax Date: 08/27/2021
Onset Date: 08/30/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data: na

Allergies: na

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient was vaccinated with Moderna that expired on 8/11 from Refrigerator. Moderna was place in the refrigerator on July 12th from freezer stock

Other Meds: na

Current Illness: na

Date Died: 08/15/2021

ID: 1656124
Sex: M
Age: 80
State: CA

Vax Date: 03/04/2021
Onset Date: 08/09/2021
Rec V Date: 08/30/2021
Hospital: Y

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: Breakthrough infection 8/10/2021; patient died 8/15/2021 - hypoxia

Other Meds:

Current Illness:

ID: 1656125
Sex: F
Age: 64
State: NJ

Vax Date: 01/26/2021
Onset Date: 01/26/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data: Ultrasound, HIDA, Blood work

Allergies: Cipro, Levaquin; quinolone drugs

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

Symptoms: Immediately after the vaccine, I had difficulty breathing, feeling a little numbness, heart racing, nausea, dizziness, headache, nausea. I was waiting in the holding area until I felt better. That evening, I felt tired, chills, felt cold, blurry vision, chest discomfort, difficulty breathing, and stomach pains, body aches and joint pains. Most of these symptoms did resolve by day 3. Then in February, I started having chest discomfort, chest heaviness, flutters, vision changes, headaches, stomach pains, back pain and I made an appointment with my doctor. I was sent to get an ultrasound of my gall bladder; I did blood work and a HIDA scan. Everything came back normal. I was prescribed a medication (which I cannot remember) to help with my stomach issues. The doctor also prescribed a new medication called Rosuvastatin for my cholesterol, which I took but could not tolerate so I stopped taking it. In March 2021, I started noticing more chest discomfort and flutter and made an appointment with my doctor for Oct 2021. In July 2021, I noticed my arthritis pain is increasing. I am currently just waiting to get an appointment to see my doctor.

Other Meds: Multivitamin, Vitamin D

Current Illness: none

ID: 1656126
Sex: M
Age: 34
State: AL

Vax Date: 08/18/2021
Onset Date: 08/18/2021
Rec V Date: 08/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Vaccine left out of temperature for an extended amount of time.

Other Meds:

Current Illness:

Date Died: 08/25/2021

ID: 1656127
Sex: F
Age: 74
State: FL

Vax Date: 04/05/2021
Onset Date: 08/14/2021
Rec V Date: 08/30/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: Result Type: History and Physical Date: August 14, 2021 2:17 Result Status: Auth (Verified) Result Title: Admission H & P Performed By: MD on August 14, 2021 2:21 Verified By: MD on August 14, 2021 2:21 Encounter info: Inpatient, 08/14/2021 - 08/25/2021 * Final Report * Date of Admission 08/14/2021 Chief Complaint for resp distress, COVID+, intubated by EMS and given 4mg versed, 20mg etomidate, 100mg ketamine, 125mg solumedrol History of Present Illness 75-year-old female sent from secondary to respiratory distress. Patient is intubated in the ER therefore history is taken from ER records and chart. Patient had recent admission at hospital rib patient had been initially admitted with symptomatic anemia and abnormal vaginal bleeding. At that time patient was found to have brainstem mass likely metastatic cancer secondary endometrial cancer. Patient required blood transfusion. Patient presents today with acute worsening of shortness of breath at 11:30 a.m. this evening. patient has known covid-19. Per EMS patient's initial O2 sats were in the 70s. Patient started on CPAP with no improvement. Patient intubated in the field. Course of symptoms constant degree at onset severe degree of present severe. No known exacerbating alleviating factors. No known other associated symptoms. Patient by emergency department patient started IV pressors given IV antibiotics. Pneumonia due to COVID-19 virus U07.1 Acute hypoxemic respiratory failure Respiratory failure J96.90 Severe sepsis R65.20 Recent diagnosis metastatic CA likely endometrial History of Abnormal vaginal bleeding CM Ongoing Assessment AH NEW Patient: Age: 75 years Sex: Female DOB: Associated Diagnoses: None Author: Professional Services CM Contact Information: Discharge Planner . Discharge Planner Phone . Assessment Ongoing Assessment Situation: was advised that pt expired this morning 8/25/21. contacted (ex-spouse) to inform him of this information. Pt was not under hospice services as ex-spouse only returned part of the paperwork..

Other Meds:

Current Illness:

ID: 1656128
Sex: F
Age: 58
State:

Vax Date: 03/06/2021
Onset Date: 08/30/2021
Rec V Date: 08/30/2021
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: Breakthrough case. PCR test was positive for Covid on 8/30/2021

Other Meds:

Current Illness:

ID: 1656129
Sex: M
Age: 36
State: KY

Vax Date: 04/21/2021
Onset Date: 08/30/2021
Rec V Date: 08/30/2021
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:

Symptom List: Injection site pain, Pain

Symptoms: None stated.

Other Meds:

Current Illness:

ID: 1656130
Sex: M
Age: 55
State: WA

Vax Date: 07/14/2021
Onset Date: 07/16/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data: 7/17/2021, urgent care visit urinalysis showed gross hematuria and 30ml/dl UA protein in urine. 7/17 XR Abdomen AP SUP and Upright (Normal) 7/27 urinalysis, gross hematuria, no protein. Basic Metabolic panel, BUN 39 and Creatinine 2.48, eGFR 27. 7/29 CT KUB, (Normal), Referred to Nephrologist . 8/2 Dr ordered Cytology, Urine (Normal) US Renal Kidney, (Kidney's showed up bright on US.) All other results looked to be normal. 8/4 INR ordered (Elevated INR at 3.6) Reduced INR to 2.3 on 8/9 Urinalysis still showing blood in urine and elevated BUN and Creatinine , 2.4 on 8/19, 8/23 Urinalysis still showing blood in urine and elevated BUN and Creatinine. 2.0 INR on 8/26.

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: on 7/16/2021 I had blood in my urine.

Other Meds: Coumadin (Due to heart valve) Sodium ascorbate, kirkland signature multi vitimins, Kirkland signature Calcium, vitamin D and Zinc.

Current Illness:

ID: 1656131
Sex: M
Age: 61
State: TX

Vax Date: 11/08/2019
Onset Date: 11/12/2019
Rec V Date: 08/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: COMPLETED BLOOD, URINE. TEST FOR ANA POSITIVE 01/08/2020,

Allergies: unknown

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

Symptoms: FATIGUE, JOINT PAIN IN SHOULDERS, NECK, LUMBAR. NUMBNESS IN ARMS, HANDS, LEGS, HEADACHE, NIGHT SWEATS., BLOOD IN URINE DIAGNOSED WITH AUTOIMMUNE, SERUM SICKNESS RELATED TO SHRINGRIX VAC. 2ND DOSE NOT ADMINISTERED. STERIOD AND HYDROCODINE PERSCRIBED. SYMPTOMS SUBSIDED 8 MONTHS.

Other Meds: Multi vitamin, Omega 3,

Current Illness: none

ID: 1656133
Sex: M
Age: 76
State: MI

Vax Date: 02/23/2021
Onset Date: 07/30/2021
Rec V Date: 08/30/2021
Hospital: Y

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

Lab Data: SARS-COV-2 (COVID19), POINT OF CARE, ANTIGEN - OFFICE: Positive (7/30/2021) SARS-COV-2 (COVID-19) by NAA, Micro: Detected (8/1/2021)

Allergies: Cephalexin, ciprofloxacin, tetanus toxoid

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient presents to the ED secondary to cough, shortness of breath, generalized malaise and fatigue. Patient was recently diagnosed with COVID - 19. Patient reports a one-week history of worsening symptoms, tested positive 2 days prior to admission. Patient denies any nausea or vomiting. No abdominal pain. No changes in urination or bowel habitus. ID and pulmonology were consulted for COVID pneumonia. Remdesivir and steroids were given. Patient also received antibiotics for bacterial pneumonia. Oxygen supplement via nasal cannula. Symptoms improved and patient felt better, no longer required oxygen supplement. Upon discharge, he had 3 more days of doxycycline for bacterial pneumonia and follow up as outpatient with PCP.

Other Meds: Tylenol, albuterol, amlodipine, aspirin, Lipitor, Vitamin D3, Plavix, CoQ10, Benadryl, ferrous sulfate, Neurontin, Norco, insulin glargine, metformin, metoprolol, multivitamin, Prilosec, prednisone, probiotic, Ranexa, Januvia, Ambien

Current Illness:

ID: 1656134
Sex: F
Age: 73
State: OK

Vax Date: 08/23/2021
Onset Date: 08/25/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data: Troponin I 0.071, EKG, D Dimer501, SARS COV2 negative

Allergies: NKMA

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Chest pain, hypertension, Elevated Troponin

Other Meds: amiodarone (Pacerone) 200 MG tablet aspirin, antiplatelet dose, 81 MG chewable tablet atorvastatin (Lipitor) 80 MG tablet clopidogrel (Plavix) 75 MG tablet ferrous sulfate 325 mg 325 (65 FE) MG tablet furosemide (Lasix) 40 MG tablet metopro

Current Illness: Acute on chronic combined systolic and diastolic congestive heart failure Acute systolic heart failure Atherosclerosis of coronary artery Ischemic dilated cardiomyopathy HTN (hypertension)

ID: 1656135
Sex: F
Age: 57
State: GA

Vax Date: 08/10/2021
Onset Date: 08/24/2021
Rec V Date: 08/30/2021
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: HOSPITAL ADMISSION WITH EKG, CTA, XR CHEST AND ICR VASUCLAR TRANSCATHER INFUSION 8/29/21 CURRENTLY INHOUSE AND UNDER TREATMENT

Allergies: NKDA

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

Symptoms: PT ADMITTED TO MEDICAL CENTER FOR PE

Other Meds: ALLPURINOL, ASPIRIN, ATORVASTATIN, COREG CR, LASIX, LOSARTIN, NITROGLYCERIN PRN, OMEGA 3S, KCL10MeQ, TRILIPIX, B12, VIT D

Current Illness: HYPERTENSION, HYPERLIPIDEMA, PERIPHERAL NEUROPATHY,

ID: 1656136
Sex: F
Age: 31
State: PR

Vax Date: 08/24/2021
Onset Date: 08/24/2021
Rec V Date: 08/30/2021
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: Nausea

Symptoms: 31 year old walking patient stands in observation area. Reports to the paramedic of feeling nauseous after the vaccine administration. We proceed on taking her vital signs BP 130/80, pulse 76min, Spo2 99%, glucose 71mg/dl. Patient reports not having eaten anything all day. 4oz of juice is given to her. Vitals are re-evaluated BP 130/80, pulse 87, Spo2 99%, DEXTROSE 113. Patient reports not having any nausea and feeling good and proceeds to leave the vaccination center.

Other Meds:

Current Illness: Asthma; Diabetes

ID: 1656137
Sex: F
Age: 64
State: TX

Vax Date: 08/24/2021
Onset Date: 08/24/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data: na

Allergies: morphine, codeine, seroquel, penicillin

Symptom List: Injection site pain

Symptoms: patient vaccinated with Moderna that expired on 8/11/2021. Moderna vials were moved from Freezer to fridge on 7/12/2021

Other Meds: doxepin, ibuprofen, vitamin d3, levothyroxine, trazadone, sertraline,

Current Illness: na

ID: 1656138
Sex: F
Age: 66
State: AL

Vax Date: 08/18/2021
Onset Date: 08/18/2021
Rec V Date: 08/30/2021
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: Vaccine was left out of temperature for an extended amount of time

Other Meds:

Current Illness:

ID: 1656139
Sex: F
Age: 17
State: NJ

Vax Date: 08/27/2021
Onset Date: 08/27/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data: None

Allergies: None noted on consent form

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

Symptoms: Patient saw down in the chair and was very nervous to get vaccinated. Father was present. Vaccine was given and nurse had patient stay in the chair for a few minutes. School cafeteria where the clinic was held was very hot; did not have air condition but fans were blowing. Cold water was given to patient. After approx 3 minutes patient stated she was feeling better and wanted to go to the waiting area. Nurse walked patient to seating area and on the way she stated she was going to vomit and then she dropped slowly to the floor and asked to lay down. Cold compress and ice pack provided. Patient never lost consciousness. EMS was called due to both siblings incident/ After approx 10 minutes school principal came with wheelchair and patient was moved to nurse office that had air conditioning. EMS checked patient and cleared to go home. Patient walked out with father and 2 siblings. Father and patient stated that she passed out after flu shot last fall as well.

Other Meds: None noted

Current Illness: None noted

ID: 1656140
Sex: F
Age: 29
State: SD

Vax Date: 12/18/2020
Onset Date: 08/30/2021
Rec V Date: 08/30/2021
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: Breakthrough case of Covid confirmed positive test on 8/30/2021 by PCR

Other Meds:

Current Illness:

ID: 1656141
Sex: F
Age: 16
State: MI

Vax Date: 08/30/2021
Onset Date: 08/30/2021
Rec V Date: 08/30/2021
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: patient was 16 years old

Other Meds:

Current Illness:

ID: 1656142
Sex: F
Age: 55
State: TX

Vax Date: 08/17/2021
Onset Date: 08/19/2021
Rec V Date: 08/30/2021
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:

Allergies: Iodine, mastisol, dermabond

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

Symptoms: Paresthesia in left arm about 36 hours after injection. Starting at level of injection and goes down to fingers. Painful pins and needles feeling, like hitting the "funny bone". Not helped by NSAIDs, ice, or elevation. This has continued to present, affecting work and sleep. I'll go to the doctor if this does not subside soon.

Other Meds: Wellbutrin, Actos, Crestor, Prempro, Armour thyroid, metformin, omeprazole

Current Illness: tick bite

ID: 1656143
Sex: M
Age: 52
State: TX

Vax Date: 08/25/2021
Onset Date: 08/26/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data: My Primary Care Manager diagnosed me with shingles during my 1130 appointment today. I have been prescribed acyclovir (ZOVIRAX) 800MG tablets; 5 times daily for 10 days.

Allergies: None

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

Symptoms: Within 24-48 hours of 1st Shingrix shot, started having sharp, piercing, hyper-sensitive pain in my rib cage starting in the back left upper part of rib cage moving all the way around to my left breast. Ultra-sensitive to touch, burning, pulsating pain at times -- felt like someone kicked me in the ribs or had a collapsed lung. To-date, still have the pain precluding me from sleeping well at night. Today, woke up with painful itchy red raised bumps mid range on side of left ribs.

Other Meds: Fenofibrate, Ketoconazole 2% cream, Hydrocortisone 2.5% cream, Adult one a day vitamins

Current Illness: None

ID: 1656144
Sex: F
Age: 65
State: NV

Vax Date: 03/19/2021
Onset Date: 04/01/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data: The results from the biopsy was hypersensitive reaction

Allergies: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: On April 1, 2021, I started developing a rash on the upper areas of my body. It was was itchy. small red bumps. On April 2, I went to my primary doctor and he prescribed Hydroxyzine Hcl 50/mg. The next morning, the rash was all over my body, from my head to my toes, in my ears, in my hair. So I went to UMC Urgent Care to see a Dr. The Dr. stated that is was mostly from the vaccine. The Dr. took a Covid test and it came back negative. On April 5,2021, I went to my Dermatologist, they they took a biopsy. My Dermatologist has indicated that I should not take the second shot. I was given Prednisone 10/mg and Triamcinolone 0.1% 15/mg.

Other Meds: Losartan, Centrum Silver 50+, Magnesium Citrate, Nhan Sam Tuyet Lien Truly Phong, Hoan

Current Illness: None

ID: 1656145
Sex: M
Age: 65
State: MO

Vax Date: 05/24/2021
Onset Date: 08/25/2021
Rec V Date: 08/30/2021
Hospital: Y

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

Lab Data: Diagnostic Results Diagnostic Results (08/25/2021 23:23 CDT XR Chest Portable) INDICATION: cough, fever, hypoxia; COVID 19 infection VIEWS: 1 view of the chest COMPARISON: May 26, 2021 chest radiograph and multiple priors FINDINGS: ACDF hardware. Partially visualized leads terminate overlying the mid thoracic spine. Normal cardiomediastinal silhouette. Diffuse bilateral airspace opacities left greater than right. No pleural effusions. No pneumothorax. No acute osseous abnormalities. IMPRESSION: Diffuse bilateral airspace opacities left greater than right consistent with COVID-19 pneumonia.

Allergies: NKA

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

Symptoms: Chief Complaint short of breath, fever History of Present Illness 65yo male with obesity, CAD s/p 5 stents (last stented in 2016), HTN, HLD, depression, neuropathy 2/2 cervical injury in 1990's, b/l glaucoma, h/o cornea transplant, BPH, presenting to the ER with 3-days history of headache, persistent cough, and malaise. Patient oxygenation worsened on 8/27 and was thus transferred to MICU on 60% FiO2 at 50 L/min. Patient reported that his grandson was visiting for a week 3 weeks ago. His grandson was sick at that time and found out he had Covid later. Patient then began to have persistent cough 3 days ago and had trouble breathing. He had Covid vaccine back in April-May 2021. Initial labs were notable for leukocytosis 19k, Cr 1.43 (Cr 1.3 baseline), elevated D-dimer 0.79, CRP 19.53. CXR showed bilateral airspace opacities. CTPE was negative for PE but showed multifocal opacities. Patient was started on remdesivir, dexamethasone, and barictinib.

Other Meds: unknown

Current Illness: unknown

ID: 1656146
Sex: F
Age: 33
State: OR

Vax Date: 08/21/2021
Onset Date: 08/21/2021
Rec V Date: 08/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: none

Allergies: none

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

Symptoms: Tinnitus began about 11pm. Next day feelings of vertigo, dizziness. Flu like symptoms for a couple days. Dizziness comes and goes, tinnitus has been constant

Other Meds: none

Current Illness: none

ID: 1656147
Sex: F
Age: 19
State:

Vax Date: 04/29/2021
Onset Date: 08/28/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data: 8/29/2021 PCR COVID POSITIVE test @ clinic

Allergies:

Symptom List: Pain in extremity

Symptoms: Patient received 2 doses of the pfizer vaccine on 4/08/2021 and 4/29/2021. Patient became ill on 8/28 and tested PCR positive for COVID on 8/29

Other Meds:

Current Illness:

ID: 1656148
Sex: M
Age: 13
State: MI

Vax Date: 06/28/2021
Onset Date: 08/04/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data: 08/09/2021 Ht 1.785 m (5' 10.28") | Wt 63.5 kg (140 lb) | BMI 19.93 kg/m? Gen: well appearing HEENT: moist mucus membranes, left eye tearing, TMs clear, no conjunctival injection Neuro: Left side: unable to puff out cheeks, unable to raise forehead, unable to fully close eyelid. EOMI, PERRLA. A/P: Bells Palsy 1) Will obtain Lyme serologies 2) Will do oral steroids 60mg for 5d, then 40mg for 2d, then 20mg for 3d 3) Referral to neurology for evaluation 08/18/2021 saw Neurologist MD Patient is a 14 year old male here today for evaluation of Bell's Palsy. Onset was the evening of 8/4/2021. It started with his left eye watering more, and mom and patient attributed it to allergies. The next morning, mom noted mild puffiness of that eye, not severe. 4 days after the onset was the peak of symptoms (8/8/21), where it was most obvious he could not move the left side of his face. Patient reports this may have actually been noticeable at least to him about 2 days in, because at night for example, he would feel the wind from the fan on his left eye more than the right when trying to close his eyes. He also noted the left side of his mouth felt like it was moving less, and felt like his left eyelids were not moving as well as the right. Since onset, sxs have not improved. He is completing a course of steroids prescribed by his PCP. He denies any other symptoms (no headache, no movement disorder, no rash), but does feel a "blind spot" out of the periphery of his left eye. Negative Lyme serologies. No known tick exposure. Had not been ill in the few weeks leading up to the onset, however, he did have the 2nd dose of his Pfizer COVID vaccine on 6/28/2021 (5.5 weeks prior to sx onset). Lyme antibody test, 8/12/2021: negative No prior history of Bell's Palsy 08/20/2021 saw pediatric opthalmology Facial paralysis/Bells palsy, left side o Left side, stable from onset two weeks ago by history o See #2 o Discussed potential spontaneous resolution with time o Normal intraocular exam 2. Paralytic lagophthalmos of left upper eyelid o Secondary to #1 o 1mm lag with lid closure, no improvement with forceful closure. o No pain or redness noted, but epiphora OS noted. o Trace PEE seen in clinic, discussed excess tearing a sign of dry eyes o Begin ATs TID with gel lubrication or tape for lid closure at bedtime. o Will continue to monitor. 3. Visual disturbance, left eye o Patient complaining of blurred vision in far periphery of upper temporal quadrant of left eye (1 year duration). Never diagnosed with concussions, but plays hockey and has been hit on the head before. No progression from one year ago. o No retinopathy seen. o Will do HVF next visit. o Will continue to monitor. 4. Hyperopia, both eyes o Not amblyogenic o No need for glasses at this time

Allergies: none

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

Symptoms: Facial paralysis/Bells palsy, left side o Left side, stable from onset two weeks ago by history o See #2 o Discussed potential spontaneous resolution with time o Normal intraocular exam 2. Paralytic lagophthalmos of left upper eyelid o Secondary to #1 o 1mm lag with lid closure, no improvement with forceful closure. o No pain or redness noted, but epiphora OS noted. o Trace PEE seen in clinic, discussed excess tearing a sign of dry eyes o Begin ATs TID with gel lubrication or tape for lid closure at bedtime. o Will continue to monitor. 3. Visual disturbance, left eye o Patient complaining of blurred vision in far periphery of upper temporal quadrant of left eye (1 year duration). Never diagnosed with concussions, but plays hockey and has been hit on the head before. No progression from one year ago. o No retinopathy seen. o Will do HVF next visit. o Will continue to monitor. 4. Hyperopia, both eyes o Not amblyogenic o No need for glasses at this time

Other Meds: none

Current Illness: none

ID: 1656149
Sex: M
Age: 71
State: IL

Vax Date: 04/28/2021
Onset Date: 05/01/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data: stool pcr negative, colonoscopy negative

Allergies:

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

Symptoms: intractable diarrhea, abd pain, incontinence x 5 months

Other Meds: gabapentum, Cymbalta, glimepride

Current Illness:

ID: 1656150
Sex: F
Age: 46
State: NV

Vax Date: 08/24/2021
Onset Date: 08/24/2021
Rec V Date: 08/30/2021
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 yet. Going to urgent care today.

Allergies: Penicillin, sulfa based rx, imitrex

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

Symptoms: Fatigue, malaise, body aches, muscle aches, joint pain, nausea, diarrhea for first two days, decreased appetite, headaches, inability to sleep for more than an hour due to being so uncomfortable, occasional chills/hot flashes but no fever, told that I look very pale compared to my normal paleness. It has been 6 days since I got my second covid shot.

Other Meds: Prednisone, Zoloft, topiramate ER, Claritin, Colestid

Current Illness: None

ID: 1656151
Sex: F
Age: 56
State: OH

Vax Date: 08/30/2021
Onset Date: 08/30/2021
Rec V Date: 08/30/2021
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: none

Symptom List: Vomiting

Symptoms: patient did get a 3rd vaccine, we did not check Impact prior to giving her the 3rd. vaccine, she had no adverse reaction, just one shot too many. she got her first 2 shots.

Other Meds: not known

Current Illness: none

ID: 1656152
Sex: F
Age: 72
State: MI

Vax Date: 08/20/2021
Onset Date: 08/21/2021
Rec V Date: 08/30/2021
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: Penecilin, Sulfa, Copazine, Tigan

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Rash all over body, itching eyes, pockets of fluid under both eyes, swelling on left and right sides of face, swelling worse on left side, left eye swollen 3/4 shut, swelling in neck. Called doctor, went into ER.

Other Meds:

Current Illness: None

ID: 1656153
Sex: F
Age: 29
State: MN

Vax Date: 01/26/2021
Onset Date: 08/28/2021
Rec V Date: 08/30/2021
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: Tested NAAT positive for COVID 8/28/21 after being fully vaccinated.

Other Meds:

Current Illness:

ID: 1656154
Sex: M
Age: 69
State: SD

Vax Date: 03/15/2021
Onset Date: 03/20/2021
Rec V Date: 08/30/2021
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: None

Allergies: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Mild to severe muscle pain at injection site for the last 5 months. Certain arm movements result in severe pain and weakness. No pain from touching the arm?pain starts with arm movements.

Other Meds: Lipitor, Alsace, plavix, ramipril, nexium,

Current Illness: None

ID: 1656155
Sex: F
Age: 70
State: FL

Vax Date: 08/26/2021
Onset Date: 08/26/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data:

Allergies: Pen, asp,codeine

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

Symptoms: 103.5 for 4 hours. Then 104 for 8 hrs. Shortness of breathe & rash on neck. Husband had to submerse into ice cold tub to break fever. Tylenol did NOT work. Only happened with Booster

Other Meds: B/P med & thyroid med

Current Illness: N/A

ID: 1656156
Sex: F
Age: 63
State: CA

Vax Date: 08/30/2021
Onset Date: 08/30/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: 1030 pt reported dizziness, pt passed out and vomitted, bp 96/66. Team Alert initiated. Pt alert and awake when ER staff present., Declined ER visit, Husband called to drive home. AT 1100, Bp 149/81, pt home in stable condition.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am