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: 1656563
Sex: F
Age: 54
State: NY

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: LA

Lab Data: Patient was taken to hospital by ems

Allergies: Nka

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient arrived at observation area around 12:15 pm. Complained of nausea and vomited about 25 ml. Patient later complained of chest pain. Vital signs was initiated by RN in observation area. HR 130, R: 18, BP: 200/120, O2: 99%

Other Meds: Amlodipine 5 mg

Current Illness: Hypertension; ?heart disease?

ID: 1656564
Sex: M
Age: 42
State: WA

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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: NA

Allergies: NKDA

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient scheduled early for his HPV 2nd dose. No adverse effects just administered early and will need to be repeated. I reviewed the next minimum date he can received the vaccine 9/27/2021 and gave him a print out of the forecast with minimum dates.

Other Meds: patient scheduled for 2nd dose of HPV vaccine and after administering it, I see that he received his first dose only 2 weeks ago on 8/17/2021.

Current Illness: none

Date Died: 08/24/2021

ID: 1656565
Sex: F
Age: 82
State: TX

Vax Date: 02/09/2021
Onset Date: 08/16/2021
Rec V Date: 08/30/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: COVID positive (8/14/21)

Allergies: Amlodipine, Codeine, Amiodarone, Fentanyl, Allopurinol cont. Benadryl, Levofloxacin

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

Symptoms: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccine on 01/14/2021 and 02/09/2021. Pt presented to ED on 8/16/21 with c/o rectal bleeding, hematochezia, onset of the previous night. States she had 5-6 episodes last night of bright red rectal bleeding which has continued into today, including diarrhea. She had an episode of BRBPR in the ED. Patient was diagnosed with Covid on 8/13 but is largely asymptomatic. Patient was on 2L NC in the ED which is the same amount of O2 at home. Diagnostic colonoscopy was attempted twice, however, due to tortuous colon with acute angulations in the sigmoid, scope could not traverse area. IR was consulted, however cont., both CTA abdomen and angiogram were negative for any active bleeds. Surgery was consulted but determined that patient was too high risk for surgery. It was discussed with both IR and GI that if pt has significant bleed again, will consider potential repeat angiogram. Patient's cough worsened throughout the course of hospitalization and CXR showed worsening opacities and dexamethasone and remdesivir were started. Patient also received vancomycin. Patient also began to display worsening mental status, became minimally responsive with agonal breathing, and difficulty swallowing. Pt status was changed to DNAR/COT and eventually patient's son decided to make patient comfort care. Patient expired on 8/24/21.

Other Meds: acetaminophen 325mg 2 tab q4; albuterol nebulizer cont. 1.25 mg/3mL 1 vial Q6H prn; albuterol HFA inhaler 90 mcg/actuation 1 puff Q6H; calcium acetate, phosphate 667 mg capsule 1 cap TID, cephalexin 500mg 1cap qd; cetirizine 10mg ? tab qd;

Current Illness: UTI (8/14/21)

ID: 1656566
Sex: F
Age: 42
State: PA

Vax Date: 08/29/2021
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:

Allergies: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Arm pain, increased seizure activity day after, tired, aches, wheezing, headache, feverish

Other Meds: None

Current Illness: None

ID: 1656567
Sex: F
Age: 32
State: WA

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: 1
Vax Route: IM
Vax Site: LA

Lab Data: unknown Medics checked vital signs

Allergies:

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

Symptoms: 8:20 before pt had vaccine reported having a migraine earlier in the day, but not feeling sick 97.4 temp 8:22 received vaccine 8:32 reported pressure on chest, harder to breath, but able to walk and talk. Monitored condition of pt 8:40 reported feeling clammy temp 98.6 temp drank 1 ounce of water, seemed to help 8:50 signs of light red rash about size of 1.5 quarters on right side of neck, later a dime size patch on left side. Reported breathing still a little harder than normal, but not worsening. Temp in the 96s (forget decimal point, mid 96s I believe) 8:58 pt and her mother decided that they would drive to an ER and sit outside to make sure pt didn't escalate to anaphylaxis. Pt had crewable benadryl, but didn't want to take yet. 9:03 pt had only made it halfway through the store before feeling much worse. Dizzy, nauseous. 9:06 pt began throwing up. Medics were called. Medics arrived shortly thereafter. Their thermometer recorded temp of 99, elevated BP Medics drove pt to hospital Called pt today to check condition and get more details, reached voicemail

Other Meds: zolmitriptan Very small, and not daily CBD for pain control

Current Illness: Had a migraine evening of vaccination, but had recovered at time of vaccintion

ID: 1656568
Sex: F
Age: 54
State: OR

Vax Date: 08/27/2021
Onset Date: 08/29/2021
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: no

Allergies: ibuprofen, aspirin, latex, hydrochloric acid, erythromycin

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

Symptoms: about an hour after the shot it swale up very bad, had a bad allergic reaction, had a red mark across her neck

Other Meds: metformin, synthroid, fish oil, metoprolol

Current Illness: no

ID: 1656569
Sex: F
Age: 38
State: OK

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

Allergies: N/A

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: soreness at site, chills, headache, tiredness, swollen node in armpit, swollen vein/node in left breast. swollen vein/node in breast active currently 8.30.21

Other Meds: ATORVASTATIN, AMLODIPINE, 80MG ASPIRIN

Current Illness: N/A

ID: 1656570
Sex: M
Age: 74
State: WA

Vax Date: 02/15/2021
Onset Date: 08/10/2021
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: positive COVID test on 08/10/2021

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: muscle aches, slight fever, scratchy throat, sniffles, cough on 08/10/2021.

Other Meds:

Current Illness:

ID: 1656571
Sex: F
Age: 66
State: NV

Vax Date: 08/12/2021
Onset Date: 08/29/2021
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: NONE

Allergies: NONE

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Pt developed a rash which lead to shingles reaction from what the prescriber stated to the patient

Other Meds: NONE

Current Illness: NONE

ID: 1656572
Sex: F
Age: 27
State: ID

Vax Date: 02/05/2021
Onset Date: 08/29/2021
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: Positive COVID test 08/29/2021

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Positive COVID test on 08/29/2021

Other Meds: Vyvanse, isibloom, fluoxetine

Current Illness:

ID: 1656573
Sex: F
Age: 21
State: FL

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

Lab Data:

Allergies: penicillin

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

Symptoms: patient began sweating profusely, shaking, vomiting and eventually fainted. She was only out a few moments then recovered fully.

Other Meds:

Current Illness:

ID: 1656574
Sex: F
Age: 54
State: TX

Vax Date: 08/25/2021
Onset Date: 08/25/2021
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: NKDA

Symptom List: Rash, Urticaria

Symptoms: Pfizer BioNTech COVID-19 Vaccine EUA: Administration Error - Diluted Incorrectly Patient received Pfizer Vaccine on 8/25/2021 that was inadvertently, serially diluted. Per CDC's interim clinical considerations, advised to be revaccinated ASAP in opposite arm.

Other Meds:

Current Illness:

ID: 1656575
Sex: F
Age: 50
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:
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: She complained of red and warm arm from her left deltoid down to her elbow, more on the lateral side which lasted for days. She never had a reaction like this from the first two doses in the series. The pharmacist counseled her to take some oral ibuprofen and if it does not help to come to the pharmacy for an anti inflammatory gel. She continue to monitor and take ibuprofen as needed.

Other Meds: triamcinolone cream, clobetasol solution

Current Illness:

ID: 1656576
Sex: M
Age: 66
State: TX

Vax Date: 08/25/2021
Onset Date: 08/25/2021
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: NKDA

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

Symptoms: Pfizer BioNTech COVID-19 Vaccine EUA: Administration Error - Diluted Incorrectly Patient received Pfizer Vaccine on 8/25/2021 that was inadvertently, serially diluted. Per CDC's interim clinical considerations, advised to be revaccinated ASAP in opposite arm.

Other Meds:

Current Illness:

ID: 1656577
Sex: F
Age: 24
State: MO

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

Lab Data: none

Allergies: eggs

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

Symptoms: Pt had vaccine, was monitored x30 minutes, about 1 hour after vaccine pt lost her ability to speak, brain became foggy and she developed a severe H/A. Pt could initially make sounds, then wasn't able to make any sounds. Could still move jaw, mouth, lips, and tongue. Speech returned after 2 hours, brain still somewhat foggy, had to initially concentrate to speak and say words. Can now speak spontaneously. Felt extremely tired and fatigued x2 days. H/A unrseloved by ibuprofen. Still has H/A 2 days later, sensitive to sound. Still feels a little foggy.

Other Meds: none

Current Illness: none

ID: 1656578
Sex: F
Age: 59
State:

Vax Date: 03/25/2021
Onset Date: 08/02/2021
Rec V Date: 08/30/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: 59 Y/O female, BMI 34.75, with PMHx of Asthma, CAD, GERD, HTN, inflammatory arthritis, tendonitis, admitted with increasing SOB on 8/5/21 and hypoxic at 86% room air. Pt received Regeneron earlier in the day. Pt was started on IV Decadron, inhaled budesonide, remdesivir, and Olumiant, while continuing home medication of Brilinta and ASA. Chest x-ray shows bilateral atypical pneumonia. Pt was discharged home with oxygen on 8/10/21. Pt was then seen in ER several times before transitioning to hospice within 3 days of discharge.

Other Meds:

Current Illness:

ID: 1656579
Sex: F
Age: 36
State: TX

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

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

Symptoms: Pfizer BioNTech COVID-19 Vaccine EUA: Administration Error NOT Diluted Patient received Pfizer Vaccine on 8/23/2021 that was not diluted prior to administration. Patient did not experience any untoward effects.

Other Meds:

Current Illness:

ID: 1656580
Sex: M
Age: 61
State:

Vax Date: 03/26/2021
Onset Date: 07/16/2021
Rec V Date: 08/30/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: 51 y/o male, BMI 37.7, PMHx of HTN and hypolipidemia, admitted for diarrhea, fever, and generalized weakness on 7/19/21. Pt just returned from 4 weeks stay from traveling and symptoms began the day after he got back. Pt presented with AKI. Pt treated with IV antibiotics and IV fluids. Pt was discharged to home on 7/21/21.

Other Meds:

Current Illness:

ID: 1656581
Sex: M
Age: 18
State: MN

Vax Date: 08/25/2021
Onset Date: 08/30/2021
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: D dimer 3222; troponin 0.24, Creatine 1.68

Allergies: KNA

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Pt was out running at clinic this AM when he had a syncopal episode, EMS reported pt had a 104.1; tympanic temp on scene, RLE sharp pain and noted LOC for 30 seconds. Team members were able to facilitate pt to the ground w/o any other injuries.

Other Meds: N/A

Current Illness: None

ID: 1656582
Sex: F
Age: 92
State:

Vax Date: 02/06/2021
Onset Date: 07/08/2021
Rec V Date: 08/30/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: 93 y/o female, PMHx of HTN, hypothyroidism, and hyperlipidemia is admitted for hypoxia, weakness, diarrhea, and cough due to Covid-19 pneumonia on 7/16/21. Pt was started on Decadron and prophylactic Lovenox. Chest x-ray demonstrates multifocal interstitial and minimal groundglass opacity throughout both lungs. Pt discharged to home on 7/19/21.

Other Meds:

Current Illness:

ID: 1656583
Sex: F
Age: 49
State: NJ

Vax Date: 08/12/2021
Onset Date: 08/16/2021
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: Blood Work... identified Iron Deficiency

Allergies: Penicillin

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

Symptoms: Dizziness, Imbalance, slight nausea, Much hair loss

Other Meds: N/A

Current Illness: None

ID: 1656584
Sex: M
Age: 66
State:

Vax Date: 02/06/2021
Onset Date: 08/03/2021
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: 66 y/o male with PMHx of DM, gout, Hyperlipidemia, HTN, and kidney stone admitted for SOB due to Covid-19 on 8/7/21 Symptoms also include nonproductive cough, HA, and myalgias. Chest x-ray demonstrates multifocal patchy ground glass and airspace nodular opacities. Treated with supportive care. Pt discharged home on 8/9/21.

Other Meds:

Current Illness:

ID: 1656585
Sex: M
Age: 23
State: MA

Vax Date: 06/26/2021
Onset Date: 06/27/2021
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: none, we didn't think anything could be done about it

Allergies: chicken, turkey, penicillin

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

Symptoms: Within 24 hrs of his first Moderna injection, Andersen developed severe nausea/vomiting with diarrhea which lasted about 6 hrs, fever (almost 102 F), chills, headache, and fatigue. The vomiting and diarrhea subsided by the next day, but the other symptoms lasted 1 and 1/2 weeks. He said he didn't feel "normal" for about 2 weeks. His arm was sore for a few days. He had little appetite.

Other Meds: Novolog insulin via insulin pump multivitamin celexa

Current Illness: none

ID: 1656586
Sex: M
Age: 72
State: MS

Vax Date: 03/26/2021
Onset Date: 04/06/2021
Rec V Date: 08/30/2021
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: Patient was taken to the Hospital via ambulance on April 6, 2021. He was too weak to let to go by and requested an ambulance. Later that night they took him to facility where there is a Cardio Lab. While there he had a myocardial infarction and was intubated for a week. He was also diagnosed with pneumonia. They inserted stents within the week while intubated. After he came to, they had him sent back to Hospital..

Other Meds:

Current Illness:

ID: 1656587
Sex: F
Age: 36
State: FL

Vax Date: 08/29/2021
Onset Date: 08/29/2021
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:

Allergies: No

Symptom List: Injection site pain, Menorrhagia

Symptoms: Moderna COVID-19 Vaccine EUA

Other Meds: None

Current Illness: None

ID: 1656588
Sex: F
Age: 60
State: CA

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

Lab Data:

Allergies: shell fish, iodine, avocadoes, morphine, pennecillin, codeine, most animals, pollen, dust

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

Symptoms: rash, hives. popping up every day since 2 days after shot. Its been 8 days and i'm still getting these hives popping up and itching each day.

Other Meds: Metformin, Atorvastatin, Ozempic, Vitamin C, D3, Zinc

Current Illness: none

ID: 1656589
Sex: M
Age: 42
State: OK

Vax Date: 08/06/2021
Onset Date: 08/06/2021
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: 8-30-21 Saw nurse practitioner. X-rays of back done. Potential MRI to be done after 2 weeks of physical therapy.

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: The evening of the first shot- mild to moderate lower back and sciatic nerve pain. The evening of the second shot- severe lower back and sciatic pain with numbness wrapping around left leg.

Other Meds:

Current Illness:

ID: 1656590
Sex: F
Age: 49
State: MD

Vax Date: 03/03/2021
Onset Date: 03/05/2021
Rec V Date: 08/30/2021
Hospital: Y

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

Lab Data: Lab results showing kidney dysfunction 4/9 CAT scan 4/10

Allergies: Sulfa, Zithromax, Penicillin

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Multiple large bilateral kidney stones requiring surgical removal; pain began on date reported (on 2nd day after 2nd vaccine)

Other Meds: Metformin, Ozempic, Levothyroxin

Current Illness: N/A

ID: 1656591
Sex: F
Age: 27
State: CA

Vax Date: 08/07/2021
Onset Date: 08/07/2021
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: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: PATIENT CAME IN TO RECEIVE HER 2ND DOSE OF COVID 19 VACCINE PFIZER. SHE HAD RECEIVED HER FIRST PFIZER DOSE AT THIS LOCATION ON 8/7/2021. UPON PROCESSING THE VAR FORM WE DISCOVERED THAT THE PATIENT ALREADY RECEIVED THE COVID 19 VACCINE JANSSEN ON 4/12/2021. WE INFORMED THE PATIENT THAT WE WOULD NOT BE ABLE TO PROVIDE HER A 2ND DOSE OF PFIZER AT THIS TIME BECAUSE SHE HAD COMPLETED THE JANSSEN SERIES AND RECEIVED 1 DOSE OF THE PFIZER VACCINE ALREADY. NO ADVERSE EVENT REPORTED

Other Meds:

Current Illness:

ID: 1656592
Sex: M
Age: 77
State: OR

Vax Date: 08/20/2021
Onset Date: 08/23/2021
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: RA

Lab Data: Spinal tap, blood work. Patient states between 20 and 30 tests, abdominal x-ray, tested for infection

Allergies: none

Symptom List: Nausea

Symptoms: Patient describes experiencing intense hallucinations and confusion to the severity that he was hospitalized. Incoherent speech, and repetitious speech. Muscle coordination difficulty (could not button a shirt or tie shoe laces). Got lost while tring to get home at night. Patient states he felt that he was temporally insane.

Other Meds: vitamin b, c d, zinc, co-q10

Current Illness: none

ID: 1656593
Sex: F
Age: 63
State: FL

Vax Date: 07/20/2021
Onset Date: 07/20/2021
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:

Allergies: NKA

Symptom List: Injection site pain

Symptoms: Large raised, red area at site of injection. Area had fever and was very sore

Other Meds: unknown

Current Illness:

ID: 1656594
Sex: F
Age: 65
State: ID

Vax Date: 08/06/2021
Onset Date: 08/06/2021
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: In office testing by doctor on 08/20/2021

Allergies: Erythromycin causes rash

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

Symptoms: Experience numbness in left lower lip 2 hours after shot received. Numbness was transient and lasted about 2 minutes. Event recurred 4 times on 8/6/21 and increased episodes to total of 12 times per day. AS of 08/09/21 left thumb and fingers also going numb as well as lips, still transient. After 14 days events ceased for 4 days then numbness in mouth area and left hand recurred, is still transient and occurrences have not ceased since. Occurrences number 6 to 8 times per day, sometimes accompanied by slight dizziness. Primary Physician saw and tested in office for neurological problems, found none and agreed that events were probably vaccine related. I have not taken 2nd shoot and probably will not do so at this time.

Other Meds: multivitamin; calcium; vitamin D3; fish oil; COQ10; zyrtec; vitamin C; HTCZ; synthetic thyroid meds; trazodone.

Current Illness: none

ID: 1656595
Sex: F
Age: 28
State: GA

Vax Date: 01/15/2021
Onset Date: 02/09/2021
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: Had cysts burst in my ovaries and free floating fluid in my abdomen. TSH levels were extremely high and my sugar levels were very high on bloodwork. I do not have hypothyroidism and I?m not diabetic.

Allergies:

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

Symptoms: Unbearable stomach pain Uncontrollable sweating Throwing up Went to ER two days in a row, continued to get worse, was admitted for a week.

Other Meds:

Current Illness:

ID: 1656596
Sex: F
Age: 34
State: PA

Vax Date: 08/20/2021
Onset Date: 08/29/2021
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: Site of shot was red raised and itchy right after shot then for 3 days. That part went away then came back yesterday. Along with fever, chills, nausea, diarrhea, headache, neck pain, dizziness, and fatigue.

Other Meds: Tecfidara, Oxybutynin, Xyzal

Current Illness:

ID: 1656597
Sex: F
Age: 57
State: ME

Vax Date: 08/28/2021
Onset Date: 08/29/2021
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: sulfa

Symptom List: Erythema, Pruritus

Symptoms: The next day I came down with a fever. I had aches and chills, I had a headache as well

Other Meds: vitamin d

Current Illness: bronchitis

ID: 1656598
Sex: F
Age: 57
State: IL

Vax Date: 08/13/2021
Onset Date: 08/14/2021
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: Visited emergency room on 08/18/2021

Allergies: None

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

Symptoms: Patient had vaccine on 08/13/2021. Upon arriving home patient felt feverish and dizzy. Patient went to sleep. When patient awoke on 08/14/2021 patient felt a big bump and arm was swollen. Patient used ice pack to try and relieve swelling. On 08/15/2021 patient contacted PCP but was not seen. on 08/18 patient visited emergency room. Patient was prescribed Cephalexin and Bactrim DS.

Other Meds: Levothyroxine Hydroxyzine Clopidogrel Alprazolam Metoprolol LEVETIRACETAM

Current Illness: None

ID: 1656599
Sex: F
Age: 36
State: MN

Vax Date: 08/13/2021
Onset Date: 08/13/2021
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: no

Allergies: Antibiotics - 3 of them: Amoxicillin - Bad rash on butt when a baby; Metronidazole - I got really itchy palms and feet for about a half hour and a little rash the last time I took it; Bactrim - I got rashes - cyst on groin area from shaving and I took the Bactrim and it took care of it three years ago and the cyst came back in March of this year and took Bactrim again but this time within 10 minutes -I got hives stomach and arm and red in face and a little swollen; and itchy, too.

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

Symptoms: 09:00 pm - I realized I was getting itchy in some spots. I ended up finding out I had bumps popping out (like bug bites sort of) - like sores. They were in the most random spots: 12 spots appeared that night - one on my right back shoulder; one on right arm pit; one underneath my right breast on my chest; one on either side of my groin (right and left side); on left thigh; and one on inner right thigh; there were three about three inches apart or so on my left butt cheek and then on my right butt cheek; and two behind my left knee and then one on my left front ankle. They all itched. They popped out that night and I got two more appeared on Saturday morning after waking and then no more were popping out. Most showed up Friday night and Saturday night after that first 24 hours after the vaccine. I took one Benadryl at night both of those nights. They were like little open sores and they did ooze clear pus/liquid. I was trying not to itch these a lot but they did look like open sores when they popped out. They were small like a mosquito bite - maybe 2 mm. They started to scab up within 5 days for sure. But the thing is, they finally just started to disappear about two days ago. They were there for a solid 2 weeks. The most they were doing were that they were red and oozing the first few days and then they scabbed up. But even after they scabbed up they were still itchy. They are slowly fading away. I'm not sure if they are leaving scars - they seem to be fading away. I was also tired after the a vaccine right away that Friday but I did go on a hike on Saturday so I was better then. I called my doctor on that Sunday night after the vaccine and talked to a nurse on the phone. Virtual appt on Monday, 16th at 07:00 pm. Showed him virtually the spots - most of them that I could show over the computer. He said he was pretty sure it was caused by the vaccine. His reason for that is because when your body creates antibodies - and a few of them tries to create them - but no body is perfect and it kind of created a few defective antibodies. So my body noticed those defective or whatever they're called antibodies and then they created a barrier around those and that came out on to my skin. He did say that I was fine and that I should get second vaccine but I am. The first three mornings after the first vaccine: Saturday, Sunday and Monday - feeling like something foreign was taking over my body. I could tell something was going on. The doctor said that was very normal and that it would make sense because the first 72 hours is when the antibody production is happening. No treatment was given. He thought it looked like they were starting to scab and take care of themselves. It took a full two weeks for the sores themselves to go away and I do still have some that are itchy - on my butt. They are still there a little bit. I did have some bit of bad depression - depressive, negative thoughts - and tiredness (feeling drained) last week (the second week from the 23-28th) . Last Thursday and Friday were really bad. I took a nap for 2-3 hours on Thursday night and Friday night. I made sure to be around people I care about during the weekend (I stayed with my parents one night and went to a friend's house)- I'm doing better now with my mood and energy level - today I am feeling better - not out of the water with those symptoms but not nearly as bad as I was last week. I went to my an Appt on Sunday at 04:00pm - activates the higher brain - and after that session I felt better.

Other Meds: Velivet; B12 spray - daily - once spray in mouth; Didn't take Valacyclovir more than a week before the vaccine) - take it as needed

Current Illness: No

ID: 1656600
Sex: M
Age:
State:

Vax Date: 12/30/2020
Onset Date:
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: Asthenia, Chills, Headache, Myalgia

Symptoms: None stated.

Other Meds:

Current Illness:

ID: 1656601
Sex: F
Age: 22
State: NY

Vax Date: 03/24/2021
Onset Date: 05/10/2021
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: CT scan, blood test, and urine test July 3-4th. MRI, CT scan MRV July 8-15th

Allergies: Keflex

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

Symptoms: Started to feel not like myself in May around the 10th, very tired and weak. Around June 15th I started having bad pressure in my head and ears, a June 26th I woke up with neck/shoulder pain that went down my right arm.. I was checked out at a urgent care June 28th around 11am. I was given muscle relaxers and a steroid for the neck/shoulder pain. The head pressure and ?swishing? noise that went with my heart beat in my ears, got very intense and I had horrible painful headaches. July 3rd I was seeing double vision, I went to a Mac center that night and was checked out there. They said all my testing came back normal and sent me home, and told me to follow up with my primary if my vision didn?t get better. July 5th I went to my primary since my vision wasn?t normal. I was ordered to get an MRI and see an ophthalmologist. I saw an ophthalmologist a few days later who told me my optic nerves were very swollen and that meant I had inner cranial pressure.. I got in with a neurologist July 8th who wanted more tests done before he diagnosed me?. Later on July 8th my symptoms got worse, I Brain. I am diagnosed with CVST

Other Meds: Birth control - lo loestrin fe

Current Illness: N/A

ID: 1656602
Sex: M
Age: 15
State: CA

Vax Date: 08/18/2021
Onset Date: 08/20/2021
Rec V Date: 08/30/2021
Hospital: Y

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: Multiple inpatient and outpatient Labs and tests, Echos and Ekgs, many many Troponin levels, cbc chem 7 Crp Esr.

Allergies: None

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

Symptoms: Pt recieved vaccine on 8/18/21 then on 08/20/21 had chest pain we then went to the ER. his Troponin levels kept climbing he was then admitted to hospital his chest pain was severe his troponins kept climbing he was not responding to typical treatment for pericarditis and started to have some ventricular beats that sent him to ICU he then was diagnosed with MYOPERICARDITIS and recieved Immunoglobulin.l He was in Hospital for 5 days. He has to wear a heart monitor for 1 month and can not have activity for 3 months. his troponins are still not at normal level as of 8/20/21 but he does not have chest pain. He just was able to return to school on 8/30/21 with no activity. he is on Motrin 600mg tid. when he walks his heart rate is still elevated in the 110-120's just brisk walking. but he is not in pain.

Other Meds: None

Current Illness: None

ID: 1656603
Sex: F
Age: 67
State: NV

Vax Date: 01/25/2021
Onset Date: 08/30/2021
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: Bactrim, morphine, propranolol, ciprofloxacin

Symptom List: Pain in extremity

Symptoms: COVID-19, hypoxia, hospitalization

Other Meds: trazodone, nortyptyline, lisinopril, atrovastatin, montelukast, gabapentin, Percoset

Current Illness:

ID: 1656604
Sex: F
Age: 5
State: TX

Vax Date: 08/30/2021
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: 2
Vax Route:
Vax Site:

Lab Data: none at this time.

Allergies: NKDA - Patient does have Provider Exemption from Immunization completed for DTAP/TDAP vaccines due to history of mother having potentional hearing loss or seizure after receiving this particular vaccine. However, Child received the DTAP vaccine in the past, but has never had any reaction to it per mother's report. This Exemption for is taking out of precaution for the child due to the mother's experience.

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

Symptoms: 15 min post Hepatitis A vaccination, Mother reported to Nurse that her daughter was feeling nauseas and vomited in the bathroom. Nurse further assessed patient who appeared alert and oriented, but looked pale in the face, weak, and felt nauseas. Nurse had patient lie down with feet elevated. Blood pressure, pulse, and respirations taken every 5 min -10 min until client was stable and began to feel better. Patient never fainted and was able to respond to all questions asked by nurse. 20 min post incident, client was able to sit up and reported feeling much better. Denied being short of breath, nauseas, or weak. Client complexion looked much better and patient was able to stand/walk without feeling light headed or dizzy. Nurse educated parent on vasovagal symptoms as well as adverse reaction signs/symptoms to report. Parent was instructed to dial EMS if any adverse reactions symptoms (itching, rash/hives, swelling of lips/face/throat, shortness of breath, light headed/fainting, nausea/vomiting/abdominal cramping, etc.) was to occur at home. Nurse advised parent to inform healthcare provider of incident as well. Parent (mom), verbalized understanding to all the above and denied further questions at this time. Client was able to leave clinic setting with no further concerns or acute reaction symptoms noted.

Other Meds: None

Current Illness: None noted by parent.

ID: 1656605
Sex: M
Age: 58
State: OR

Vax Date: 04/08/2021
Onset Date: 04/09/2021
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: April 10th MRI imaging and blood work done

Allergies: chloroquine

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

Symptoms: Extreme lower back pain, not able to lie down or walk very well, couldn't sleep, ended up in the ER and received a MRI and blood work, Pain was gone in 2-3 days.

Other Meds: Buspirone 7.5 mg, Metoprolol Tart 50mg, Atorvastatin Calcium 40mg, Metformin 500mg,Vitamin D-3 125mcg

Current Illness: vitiligo, ulcerated proctitis

ID: 1656606
Sex: M
Age: 16
State: WA

Vax Date: 01/23/2021
Onset Date: 01/23/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: During a community vaccination Clinic he came through the screeners - the paperwork checked but didn't catch his birthdate- sent to the vaccinator who didn't catch the birthdate either

Other Meds:

Current Illness:

ID: 1656607
Sex: F
Age: 56
State: FL

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

Lab Data:

Allergies: Sulfa Zithromax Levroquin cicro Latex eggs Citrus Dezmethrozone

Symptom List: Vomiting

Symptoms: Patient stated that After receiving the second vaccine the left side of her face went numb. She also felt that her body was heated from the inside out. She didn't think much of it. That lasted about three days. After receiving the booster she felt like her body was burning on the inside and that her nerves was being hit with a ciggeratte. Her bones and muscles were aching. She could not turn her neck very good. Her legs and face were tingling. The legs are still tingling. Her face is bright red and her arm has a big red rash. She a headache. Extreme fatigue and her eyes felt like sandpaper.

Other Meds: Magnisum D3 Iron Vitamin C Embrel 50mg injectable Sunwell 40mg 2x daily Eliquis 5mg 2x daily Amlodipine 5mg 2x daily Amethlozol 2omg 1x daily Advair 115/21 Cingular 10mg

Current Illness:

ID: 1656608
Sex: F
Age: 60
State: FL

Vax Date: 04/17/2021
Onset Date: 05/01/2021
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: Biopsy of knee blister, came back as contact dermatitis, 6/4/21 Patch testing, mildly allergic to propylene glycol, 8/14 through 8/17/21

Allergies: Sulfa

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: From first vaccine: Blisters inside corner of upper nose under eye and on forehead, lasted about three weeks. Itchy and crusted over. Second vaccine: Blisters all over face, one large one on knee, and other blisters on various parts of body. Sores lasted approximately three weeks to heal. Still occasionally get small ones. Medrol Dosepak times two. Acyclovir (it was misdiagnosed as shingles after first incident) Cephalexin Triamcinolone cream Mupriocin ointment Discontinued products with fragrance and propylene. Have scar on left knee

Other Meds: Allegra, Soma, clonazepam, Flonase, calcium, Fosamax, Celexa, Tramadol, Naproxen

Current Illness: none

ID: 1656609
Sex: F
Age: 32
State: MO

Vax Date: 01/25/2021
Onset Date: 08/11/2021
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: 08/11/21 covid test was positive

Allergies: Cod, shellfish

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

Symptoms: I caught covid. I tested positive on August 11, 2021. I am mostly getting back to normal now, but my smell is still off a bit. The lady who called me from VAERS said to fill this out but most of this seems to be for immediate reactions rather than for reporting breakthrough cases.

Other Meds: Breo Ellipta, escitalopram

Current Illness:

ID: 1656610
Sex: F
Age: 81
State: AL

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

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: PFIZER-BIONTECH COVID-19 VACCINE EUA. ADMINISTRATION ERROR- MIXED DOSE SERIES. Patient received Moderna series for 1st and 2nd dose on 3/10/21 and 4/7/21 respectively. Nursing facility and/or patient attests is immunocompromised and needs an additional dose. Due to exceptional circumstances, patient cannot leave nursing facility to obtain Moderna for 3rd dose. Patient was vaccinated on 8/26/21 with Pfizer for additional dose for immunocompromised.

Other Meds:

Current Illness:

ID: 1656611
Sex: F
Age: 68
State: IN

Vax Date: 05/20/2021
Onset Date: 05/23/2021
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: Ultra sounds . EMG . X-Rays. MTI.. Blood draws

Allergies: statin drugs any sprays

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

Symptoms: swelling in both feet and leg pain muscle. Pain meds Muscle cramps. Pain meds ,muscle relaxers.

Other Meds: lisinopril 20mg; hydrochlorothiazide 25; levothyroxine 112mcg; aspirin 81 mg; albuterol sulfate 90 mcg

Current Illness: none

ID: 1656612
Sex: M
Age: 66
State: MT

Vax Date: 04/21/2021
Onset Date: 08/26/2021
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: RA

Lab Data: SARS-CoV-2 RNA Resp Ql NAA+probe POSITIVE Ordered Test: SARS-CoV-2 RNA Resp Ql NAA+probe Ordered Test Codes: 94500-6 (LN LOINC)/ Status: Final Accession Number: 697736084 Specimen Source: SOFT TISSUE SAMPLE Specimen Site: Nares(Nares) Specimen Collection Date/Time: 2021-08-20 09:41:00.0

Allergies: ? Bactrim [Sulfamethoxazole-Trimethoprim] Hives ? Tamiflu [Oseltamivir] Hives

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

Symptoms: Case completed Pfizer Covid vaccine series on 4/21/21, then was admitted to hospital for Covid treatment on 8/26/2021.

Other Meds: amLODIPine (NORVASC) 10 MG tablet TAKE ONE TABLET BY MOUTH ONCE DAILY (DOSE INCREASE) 6/1/21 atorvaSTATin (LIPITOR) 10 mg tablet Take 1 tablet by mouth nightly. 8/19/20 Cholecalciferol (VITAMIN D3) 5000 units TBDP Take 1 tablet by

Current Illness: ? Arthritis ? Essential hypertension 2/2/2018 ? Hypogonadism 7/22/2012 ? Pure hypercholesterolemia 3/2/2018

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am