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: 1658530
Sex: F
Age: 42
State: NC

Vax Date: 01/19/2021
Onset Date: 01/21/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: Eye Exam within one week of the shot, unknown exact date ulcers in eye

Allergies: Oranges; Bleach; Silver; Adhesive

Symptom List: Dysphagia, Epiglottitis

Symptoms: Within a couple days after the shot my right eye was very irritated, I knew it wasn't pink eye though. I called the eye Dr. on the Friday after my shot, and I got in there and he said I developed corneal ulcers in my right eye. They gave me a couple different eye drops and a gel. Then I had to start buying single packet eye drops and get that every month. They put plugs in my eye, and they said they didn't know how I had lasted those few days without help. Then I was sent to an eye specialist, and they said my immune system was attacking itself. Then it finally starting correctly (get better) with more treatment. My vision is still not completely back, and I will have to continue to do the gel drops and the eye drop packets every month.

Other Meds: Singulair; Brio; Tiotropium bromide; Flonase; Patanol; Metformin; Zipsor; Zofran; Furosemide; Armour Thyroid; Amitriptyline; Cetirizine; B12 injections; Vitamin D; Aldosterone; Glucosamine; Ozempic; procerin; Flaxseed oil; Vitamin C; Pepcid

Current Illness: N/A

ID: 1658531
Sex: M
Age: 62
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 08/31/2021
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:

Symptom List: Anxiety, Dyspnoea

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1658532
Sex: M
Age: 45
State: ME

Vax Date: 08/25/2021
Onset Date:
Rec V Date: 08/31/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Headache, Dizziness, Sore Throat, Runny Nose

Other Meds:

Current Illness:

ID: 1658533
Sex: F
Age: 55
State: IN

Vax Date: 08/30/2021
Onset Date: 08/30/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data:

Allergies: NA

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Pt is experiencing hives and itching to bilateral lower extremities and taking Benadryl

Other Meds:

Current Illness:

ID: 1658534
Sex: M
Age: 18
State:

Vax Date: 05/29/2021
Onset Date: 08/28/2021
Rec V Date: 08/31/2021
Hospital: Y

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

Lab Data: Urine drug screen was negative, Alcohol level = 29 mg/dl, COVID PCR negative

Allergies: NKDA

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

Symptoms: Patient presented to the emergency department on 08/28/2021 for evaluation of post cardiac arrest state that started prior to arrival. Friends report patient was drinking a beer; he suddenly collapsed and then hit his head as he went down. CPR was initiated by nursing students present; EMTs arrived on the scene very quickly and ACLS was initiated. Patient was intubated/ventilated and sent to ED via ambulance.

Other Meds: None

Current Illness: None

ID: 1658535
Sex: M
Age: 63
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 08/31/2021
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:

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

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1658536
Sex: M
Age: 24
State: AZ

Vax Date: 06/04/2021
Onset Date: 06/27/2021
Rec V Date: 08/31/2021
Hospital: Y

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

Lab Data: Multiple ECGs (June 27, 2021 to August 17, 2021); nothing significant found Echocardiogram (June 28, 2021); nothing significant found Blood draws to test blood cell counts, thyroid activity, and general health (June 28, 2021); nothing significant found

Allergies: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Shortness of breath, heart palpitations, feeling of overwhelming anxiety, panic attacks These events started on June 19, 2021 and reached a peak on June 27, 2021 when I was hospitalized following a panic attack that caused me to faint.

Other Meds: None

Current Illness: None

ID: 1658537
Sex: F
Age: 0
State: MN

Vax Date: 05/13/2021
Onset Date: 05/14/2021
Rec V Date: 08/31/2021
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: Swelling and redness at injection site described by mom as the size of an orange. No signs of fever or irritability. Medical provider advised that mother continue to monitor site and report any further symptoms. Advised that mom can apply ice to injection site or administer ibuprofen to help reduce swelling or discomfort.

Other Meds:

Current Illness:

ID: 1658538
Sex: F
Age: 36
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 08/31/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1658539
Sex: F
Age: 25
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 08/31/2021
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: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1658540
Sex: M
Age: 65
State: FL

Vax Date: 02/12/2021
Onset Date: 07/14/2021
Rec V Date: 08/31/2021
Hospital: Y

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

Lab Data: Chest xray: airspace opacities in the lungs demonstrating a perihilar predilection. 7/15/21: Covid test-positive.

Allergies: NKA

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

Symptoms: Pt came to ER with SOB, cough, and covid positive, onset 1 week prior. Fever and chills since 7/4/21. Covid positive on 7/9/21.

Other Meds:

Current Illness:

ID: 1658541
Sex: F
Age: 51
State: SC

Vax Date: 08/29/2021
Onset Date: 08/29/2021
Rec V Date: 08/31/2021
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: pears, peaches, plums, apples, and cherries

Symptom List: Rash, Urticaria

Symptoms: arm pain when received shot, arm pain afterward, red about two inches all around site

Other Meds: take Vitamin D, C, and Zinc regularly

Current Illness:

ID: 1658542
Sex: M
Age: 83
State: KY

Vax Date: 03/26/2021
Onset Date: 08/29/2021
Rec V Date: 08/31/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Moderna on 2/26 and 3/26. Positive on 8/29 admitted 8/29 to current

Other Meds:

Current Illness:

ID: 1658543
Sex: F
Age: 43
State: KS

Vax Date: 08/20/2021
Onset Date: 08/23/2021
Rec V Date: 08/31/2021
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: Will be visiting my primary care physician on 9/1/21.

Allergies: Lavender oil

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

Symptoms: Right shoulder, Right Bicep and neck became stiff 3 days (8/23/21) post 2nd COVID vaccine. I notified my physician a week after symptoms started (8/30/21) as I was not sure if this was just a side effect of immunity building but she does not feel it should be this severe. My pain level is 7/10 and I am unable to move my neck, I can not lay down as this makes the pain a 10/10. As of 8/30/21, the pain continues to be right shoulder, right bicep area, neck and is now is starting to travel down my right arm past my elbow and is radiating into the right side of my jaw.

Other Meds: Vitamin C Atenolol Losartan Simvastatin Medroxyprogestrone Jardiance Metformin Wegovy Toujeo Max Pregabalin Trazodone Lorazepam Asprin Hair/Skin/Nails vitamin

Current Illness: n/a

ID: 1658544
Sex: M
Age: 83
State: TX

Vax Date: 01/26/2021
Onset Date: 08/23/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: Prednisone and Acclovir 8/23/21

Allergies: None

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

Symptoms: August 23. 2021. Woke up with right side of face feeling weird. Went to emergency room at hospital. diagnosed as Bell's Palsy.

Other Meds: Xeralto, Famotidine, Atovastatin, Oxicodone pain, Multivitamins

Current Illness: None

ID: 1658545
Sex: M
Age: 21
State: TN

Vax Date: 08/30/2021
Onset Date: 08/31/2021
Rec V Date: 08/31/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Arm soreness, fever, chills, headache, soreness of entire body, nasal congestion, and sore throat.

Other Meds:

Current Illness:

ID: 1658546
Sex: F
Age: 75
State: KY

Vax Date: 04/08/2021
Onset Date: 08/29/2021
Rec V Date: 08/31/2021
Hospital: Y

Vax Type: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies:

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

Symptoms: Janssen on 4/8. Positive on 8/29 admitted on 8/29-current

Other Meds:

Current Illness:

ID: 1658547
Sex: F
Age: 51
State: NC

Vax Date: 02/27/2021
Onset Date: 02/27/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: EKG Blood work Echocardiogram

Allergies: shellfish; contrast media; Paxil; Lipitor; sulfa drugs

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Right after the vaccine, I felt very hot around my torso which radiated out. My heart was beating very fast, and I flagged the nurse down and my BP reading was 214/155. I had difficulty swallowing and I felt my tongue was large. I was given a dose of Benadryl. I stayed onsite for about 2.5 hours. My BP was still elevated and my husband had to come to drive me home. At home, I did not feel well. I still had high blood pressure, heaviness in my chest and accelerated heart rate even at resting. I tried doing breathing exercises to calm my symptoms down. I did go see my doctor and my doctor wanted to monitor me for the next few days in hopes the symptoms will resolve on its own. I was not prescribed any medications at that time. I started to feel better over the next few days, but I continued to have fatigue. I had episodes of feeling unwell, fatigue, accelerated heart rate, visual disturbances, lightheadedness, feeling very hot, nausea and high blood pressure. I decided to go back to my PCP. I was prescribed a new blood pressure medication (amlodipine) and I was referred to a cardiologist. The amlodipine was able to bring my bp to normal range. However, I am still not feeling back to normal. I am still feeling very fatigue, no energy, and I still have intermittent episodes once or twice a week of accelerated heart rate, visual disturbances, feeling hot, lightheadedness and nausea. I recently had an echocardiogram, and I am waiting results. I also have a stress test scheduled.

Other Meds: Pravastatin; Aspirin; Vitamin C; Women's multivitamin

Current Illness: none

ID: 1658548
Sex: F
Age: 56
State: MA

Vax Date: 08/01/2021
Onset Date: 08/27/2021
Rec V Date: 08/31/2021
Hospital:

Vax Type: PNC13
Manufacturer: PFIZER\WYETH
Vax Name: PNEUMO (PREVNAR13)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data: None

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Migraine Throbbing headache since day after vax Ringing in ears sporadic Very sore breasts nonstop since the day following vax including painful nipples Diarrhea intermittent seems to have resolved

Other Meds: Daily Vitamins including D, C, and zinc

Current Illness: None

ID: 1658549
Sex: F
Age: 47
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1658550
Sex: M
Age: 30
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 08/31/2021
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 expired in fridge

Other Meds:

Current Illness:

ID: 1658551
Sex: M
Age: 64
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1658552
Sex: F
Age: 62
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 08/31/2021
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: vaccine expired in fridge

Other Meds:

Current Illness:

Date Died: 08/31/2021

ID: 1658553
Sex: M
Age: 54
State: KY

Vax Date: 08/17/2021
Onset Date: 08/31/2021
Rec V Date: 08/31/2021
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: Janssen on 8/17. Positive 8/29. death at end hospital stay

Other Meds:

Current Illness:

ID: 1658554
Sex: F
Age: 61
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1658555
Sex: M
Age: 64
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

Date Died: 08/30/2021

ID: 1658556
Sex: F
Age: 83
State: KY

Vax Date: 03/12/2021
Onset Date: 08/30/2021
Rec V Date: 08/31/2021
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: Nausea, Pain in extremity, Pyrexia

Symptoms: Moderna on 2/12 and 3/12. Positive on 8/27 hospital stay ended with death

Other Meds:

Current Illness:

ID: 1658557
Sex: M
Age: 82
State: MI

Vax Date: 03/31/2021
Onset Date: 08/25/2021
Rec V Date: 08/31/2021
Hospital: Y

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

Lab Data: 1. COVID19 positive- negative PCR 8/13, positive PCR 8/24- pt is asymptomatic. Pt immunized on 3/10 and 3/31 with Pfizer COVID19 vaccine. Repeat PCR ordered. 2. Low B12 with negative PA workup- continue PO B12 3. Hypothyroidism 4. Dementia with behavioral disturbance 5. HLD 6. Macrocytic anemia- Hgb stable 7. H/o GAD 8. H/o IBS 9. Await COVID antibodies 10. Await repeat PCR, if negative, pt can return to facility. 11. Patient unable to go to facility until 10 day quarantine is completed if repeat test is positive 12. DC planning- SAR vs. facility

Allergies: Medication Administration Record Allergies reviewed. Klonopin [clonazepam

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: This is a 83y.o. male with a PMH as below who was admitted to 4N due to sexually inappropriate behavior. Pt was being prepared for discharge and subsequent COVID19 PCR testing was positive. Pt is asymptomatic. Spoke with daughter and she confirmed patient was vaccinated for COVID19 on 3/10 and 3/31. Pt received the Pfizer vaccine. Pt was evaluated this morning. Pt denies any symptoms. Pt denies any CP/sob. No n/v/d. No fever or chills.

Other Meds: Current Facility-Administered Medications Medication Dose Route Frequency Last Rate ? fluticasone (FLONASE) nasal spray SUSP 1 Spray 1 Spray Both Nares DAILY ? QUEtiapine (SEROquel) tablet 50 mg 50 mg Oral DAILY ? QUEtiapine (SEROquel

Current Illness: Past Medical History: Diagnosis Date ? Alzheimer disease (CMS/HCC) ? Anemia ? Anxiety ? Dementia (CMS/HCC) ? GERD (gastroesophageal reflux disease) ? Herpes simplex type 1 infection ? Hyperlipidemia ? Hypothyroidism ? IBS (irritable bowel syndrome)

ID: 1658558
Sex: F
Age: 64
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 08/31/2021
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: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1658559
Sex: M
Age: 89
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 08/31/2021
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: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1658560
Sex: F
Age: 19
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 08/31/2021
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: Injection site pain

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1658561
Sex: F
Age: 55
State: WA

Vax Date: 02/12/2021
Onset Date: 03/11/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: 3/4/2021 - EBV Early Antigen AB, IgG 139.0 (High) and EBV ab VCA IgG 201.0 (High) 6/10/2021 - EBV Early Antigen Ab, EgG 129.0 (High) and EBV Ab VCA IgG 203.0 (High)

Allergies: General Anesthesia

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

Symptoms: I had seen my primary doctor on Feb. 11th and felt fine. On Friday, Feb. 12, I received my 1st dose of vaccine and by Monday I had a really bad sore throat and was very fatigued and tired. I had just started working so was not sure what it was. I went in for a COVID test on Feb. 23rd and that was negative. I saw my doctor on March 3rd and we discussed that my symptoms could be Ebstein Barr Virus re-activation. My doctor took blood to confirm positive EBV which it was. She told me to get as much rest as I could. In June I was still not well. My doctor took more lab work and confirmed EBV was still positive. Now I'm considered to have Chronic EBV and still suffering. I'm taking Valacyclovir medication.

Other Meds: Estradiol,Progesterone, Levothyroxine, Liothyronine,Meloxicam

Current Illness: SIBO

ID: 1658562
Sex: F
Age: 51
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1658563
Sex: M
Age: 62
State: MT

Vax Date: 03/04/2021
Onset Date: 08/29/2021
Rec V Date: 08/31/2021
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:

Allergies:

Symptom List: Tremor

Symptoms: Patient presented to ED with a 5 day history of cough, rhinorrhea, muscle aches, and chills. Patient was hypoxic and initially required 2 L of oxygen by nasal cannula.

Other Meds:

Current Illness:

ID: 1658564
Sex: F
Age: 45
State: FL

Vax Date: 03/31/2021
Onset Date: 07/15/2021
Rec V Date: 08/31/2021
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: 7/15/21: covid test: positive.

Allergies: NKA

Symptom List: Erythema, Pruritus

Symptoms: Pt came to ER c/o upper abdominal pain with nausea and vomitingx3 days.

Other Meds:

Current Illness:

ID: 1658565
Sex: M
Age: 49
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 08/31/2021
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:

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

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1658566
Sex: F
Age: 42
State: NC

Vax Date: 02/17/2021
Onset Date: 02/20/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: Biopsy unknown date, Feb 2021 precancerous

Allergies: Oranges; Bleach; Silver; Adhesive; Canfor; Neosporin

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

Symptoms: Well I am guessing that within a week or two I went to a regular annual exam with my DR and I ended up having precancerous lesions. I had to have CRYO therapy in March 2021 and then had to be checked a few extra times, I just did my six month exam now because they have to keep an eye on me now. I have never had cancerous anything before. We are waiting on results from that. That is extremely scary and honestly painful because of the CRYO therapy.

Other Meds: Singulair; Brio; Tiotropium bromide; Flonase; Pentanol; Metformin; Zipsor; Zofran; Furosemide; Armour Thyroid; Amitriptyline; Cetirizine; B12 injections; Vitamin D; Aldosterone; Glucosamine; Ozempic; procerin; Flaxseed oil; Vitamin C; Pepci

Current Illness: Covid EYE from first vaccine - eye ulcers

ID: 1658567
Sex: M
Age: 29
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 08/31/2021
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: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1658568
Sex: M
Age: 58
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 08/31/2021
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:

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

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1658569
Sex: M
Age: 16
State: IL

Vax Date: 08/27/2021
Onset Date: 08/29/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Headache, body aches, fatigue, really bad coughing, sore throat.

Other Meds:

Current Illness:

ID: 1658570
Sex: M
Age: 24
State: AZ

Vax Date: 07/02/2021
Onset Date: 07/11/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: - ECG conducted in follow up with cardiologist after hospital stay on June 27, 2021, nothing significant found; August 19-23, 2021

Allergies: None

Symptom List: Pain in extremity

Symptoms: - Overwhelming levels of anxiety that can not be controlled, being treated with 10mg Paxil daily and therapy, issues are still on going; June 19, 2021 to Today - Pain in the thoracic and lumbar spine as well as surrounding muscle, being treated with physical therapy, pain is still on going along the spine; July 27, 2021 to Today - Muscle spasms and Myoclonus, therapy being done to relieve anxiety, issue is still on going but has improved slightly; July 30, 2021 to Today - Digestive issues, nothing done at this time, changes in stool color and consistency; August 11, 2021

Other Meds: Generic Multivitamin

Current Illness: None

ID: 1658571
Sex: M
Age: 18
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1658572
Sex: F
Age: 21
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 08/31/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1658573
Sex: M
Age: 41
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 08/31/2021
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: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1658574
Sex: F
Age: 74
State: MI

Vax Date: 03/25/2021
Onset Date: 08/25/2021
Rec V Date: 08/31/2021
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:

Allergies: Allergies Allergen Reactions ? Cephalexin Acute renal failure and GI Distress ? Decadron [Dexamethasone] Rash/Itching ? Erythromycin Hives "it tears my insides up" ? Gentamicin Swelling, generalized Toe swelling and redness ? Lamisil [Terbinafine] Rash/Itching ? Levofloxacin Swelling, lips/throat/tongue ? Methylprednisolone Rash/Itching ? Prednisone Rash/Itching ? Toviaz [Fesoterodine Fumarate Er] Hives ? Cleocin [Clindamycin] GI Distress ? Codeine Anxiety Hyper/restless ? Lamotrigine Other Can not recall

Symptom List: Vomiting

Symptoms: Patient is a 75-year-old female with history of asthma and hypertension who presents with a chief complaint of nausea and diarrhea. Patient states for the past week she has felt "lousy." She describes nasal congestion, productive cough, nausea, and diarrhea. She states she had a couple episodes of emesis which has since resolved. She is most bothered by diarrhea which she states has been "pouring out of her"for the past several days. She has been able to drink water but has not had much of an appetite. Denies fevers. Denies shortness of breath or chest pain. She went to her PCP who prescribed for azithromycin for an unspecified infection per patient. Patient denies sick contacts. She lives in a senior community. She was fully vaccinated for COVID with last dose in March.

Other Meds: Patient's Medications New Prescriptions No medications on file Previous Medications ACETAMINOPHEN (TYLENOL) 325 MG PO TAB take 2 Tabs by mouth every 6 hours. ALBUTEROL (PROVENTIL, VENTOLIN, PROAIR) HFA 108 (90 BASE) MCG/ACT INHAL

Current Illness: Arthritis ? Asthma ? Chronic back pain ? Dyslipidemia ? GERD (gastroesophageal reflux disease) ? Hepatitis 20 yrs. + A ? Hyperlipidemia ? Hypertension ? Neuropathy back/scapula area. ? Obstructive sleep apnea Uses Cpap machine. ? Primary osteoarthritis of left hip ? Stroke shown in MRI. ? TIA (transient ischemic attack)

ID: 1658575
Sex: M
Age: 50
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1658576
Sex: F
Age: 59
State: MI

Vax Date: 08/13/2021
Onset Date: 08/16/2021
Rec V Date: 08/31/2021
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: Lisinopril.

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

Symptoms: Dizzy spells, referred to a cardiologist, short of breath, nauseous, fatigue.

Other Meds: None.

Current Illness: None.

ID: 1658577
Sex: F
Age: 63
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 08/31/2021
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: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1658578
Sex: F
Age: 50
State: GA

Vax Date: 01/19/2021
Onset Date: 01/22/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: I did not go to the hospital.

Allergies: Shrimp

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

Symptoms: Within 5 min my mouth tingled and felt my tounge felt bigger. Metallic taste in my mouth. Happens when I eat shrimp. Did not report after 1st vax. But did notify staff after the 2nd vax. Because it was very predominant. They watched me for over an hour. 3-4 days after the 1st and 2nd vac I developed severe epigastric pain and severe N/V. I?m a CRNA. I now believe I had an inflammatory response to the vaccine and I had pancreatitis. Lasted about 5 days each time.

Other Meds: Vit c. Vit d. Zinc. Occasionally nexium

Current Illness: None

ID: 1658579
Sex: F
Age: 81
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 08/31/2021
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: vaccine expired in fridge

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am