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: 1658631
Sex: F
Age: 33
State: WI

Vax Date: 08/24/2021
Onset Date: 08/26/2021
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: Test: XR Spine Lumbar 2-3 views for Dorsalgia - Results: No acute fracture or malalighment. No soft tissue abnormality. No paravertebral soft issue abnormality. - Date: 8/26/21

Allergies: Amoxcillin, Penicillin, Pertussis, seasonal allergies

Symptom List: Dysphagia, Epiglottitis

Symptoms: 2 days after the 1st COVID-19 dose my right foot and leg started to tingle and feel slightly numb in the early afternoon. About 10 minutes later I had a intense stabbing pain in the lower spine with uncontrollable spasms. It felt as though needles were being injected into my spine repeatedly causing intense spasms. I went to Urgent Care that evening due to it not getting any better. An x-ray was done of my lower spine and it did not show any issues. The doctor advised me to take a muscle relaxer and Ibuprofen. As of today I still have some spasms and spinal pain. It is not as intense, but it's still very much there.

Other Meds: Omeprazole, Women's Multi-Vitamin, Low Dose Aspirin

Current Illness: N/A

ID: 1658632
Sex: F
Age: 41
State: CA

Vax Date: 08/26/2021
Onset Date: 08/27/2021
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: None..

Allergies: Amoxicillin

Symptom List: Anxiety, Dyspnoea

Symptoms: Approximately a day and a half after the first dose I started to experience severe swelling in my neck and chest on the left side of my body (vaccine site side). The swelling reduced a little 3 days later and then returned on day 5 after the vaccine. The swelling in my neck and chest have extended to my left armpit/breast. It is sore to touch.

Other Meds: None

Current Illness: None

ID: 1658633
Sex: F
Age: 35
State: CA

Vax Date: 08/31/2021
Onset Date: 08/31/2021
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: Pulmacort, Qvar, Advair, Beta Blockers, white fish, apples, bananas, latex, carrots

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

Symptoms: Burning and itching down right arm, then up right side of neck, difficulty breathing, wheezing.

Other Meds: Claritin, albuterol

Current Illness: None

ID: 1658634
Sex: F
Age: 46
State: GA

Vax Date: 08/04/2021
Onset Date: 08/09/2021
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: has not been seen yet for this. could not get an appt. until 9/14

Allergies: none aware

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: lump around elbow. feels like tissue or rubbery.

Other Meds: omezapralole

Current Illness: IBS infection after colonoscopy july 15, 2021

ID: 1658635
Sex: M
Age: 67
State: VT

Vax Date: 02/24/2021
Onset Date: 05/15/2021
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: No PCR test April 19th, 2021 negative result before the exposure. I didn't have one after I got COVID toes.

Allergies: Levaquin; Hay fever

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

Symptoms: COVID/related - COVID toes - peritonitis - caused by many different causes - an immune response - it only appeared on my toes. On my left foot first with a rash and prominent blood vessels appearing purple. It then went to my right foot which my big toe and my next three toes next to it turned glowing bright red and swelled up and hurt a lot. And it was itching. And then that eventually turned purple. I immediately started searching what it might be. I contacted Medical Clinic and told me doctor and they said I did not need to come in unless it got worse. I talked to Dr. during the course of it all. I talked to a Dermatologist on June 15. She confirmed the diagnosis. And told me to keep using the cream. OTC - Hydrocortisone cream - 1% and that took away the itching as I kept using it. It was generic brand. The initial pain receded after a a couple or three days. The discomfort (from the swelling) and the itching lasted a long time. My time for ultimate resolution was 62 days that it took. Over production of Interferon 1 and Adam 17 - that is what they are saying that causes it. I had no COVID positive test. I had a negative PCR test (April 19th, 2021). I only had the "COVID toes" and no other symptoms. Note: Exposed to a virus on May 12th. I was sitting in place was coughing and sneezing and refusing to wear a mask.

Other Meds: Atorvastatin; Chlorthalidone; Losartan; Metoprolol XL; Pantoprazole; Flomax; Potassium Citrate SR; Chromium Sodium; nasal cram; Multi Vitamin; Colace; Aspirin; Psyllium (Metamucil): Probiotic

Current Illness: None

ID: 1658636
Sex: F
Age: 58
State: GA

Vax Date: 02/01/2021
Onset Date: 08/19/2021
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: Nka

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

Symptoms: Slight headache & bodyaches

Other Meds: Biotin, Simvistatin, D3, Flinstones Vitaminsx2, B12

Current Illness: Na

ID: 1658637
Sex: F
Age: 34
State: TX

Vax Date: 05/07/2021
Onset Date: 05/21/2021
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: ER,labs and office visit

Allergies: NKDA

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: pevlic pain started a couple of weeks after the 2nd dose of Moderna, so she wonders if this was related. Pt went to ER on 8/8/21 for chest pain; CTA chest negative; ws dx with a viral infection -States she was "feeling drained" from the right pelvic pain- had f/u u/s with Dr. and the previously noted thrombosis had resolved; was tx with flagyl and doxycycline as well due to concern for possible infection (endometritis0

Other Meds: Amphetamine-Dextroamphetamine 15 MG Tablet Refill LORazepam 0.5 MG Tablet Refill Sertraline HCl 50 MG Tablet Continue Eliquis 5 MG Tablet Start Fluticasone Propionate 50 MCG/ACT Suspension

Current Illness: NA

ID: 1658638
Sex: M
Age: 43
State:

Vax Date: 08/01/2021
Onset Date: 08/01/2021
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: No

Symptom List: Pharyngeal swelling

Symptoms: Fatiugue, pain in legs (calves/thighs), back pain, shoulder pain, fatigue, shaking, cold, warm, lethargic, overall feel worse than when I had Covid.

Other Meds: None

Current Illness: Covid

ID: 1658639
Sex: M
Age: 32
State: MN

Vax Date: 04/21/2021
Onset Date: 08/25/2021
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: PMC molecular COVID-19 Rapid test

Allergies: unknown

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: sinus congestion

Other Meds: unknown

Current Illness: unknown

ID: 1658640
Sex: M
Age: 43
State: VT

Vax Date: 08/30/2021
Onset Date:
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: n/a

Allergies: n/a

Symptom List: Diarrhoea, Nasal congestion

Symptoms: On 08/30/2021, at approximately at 1630, a 43-year-old non-immunocompromised male entered the Covid-19 vaccination clinic. Patient had scheduled an appointment to receive the Covid-19 Pfizer vaccine. Once he arrived at the clinic he went to check in and stated he was "here for his second Pfizer shot". Check-in personnel interpreted this as he had previously received a Pfizer shot as part of the normal two-shot Covid-19 vaccination series and was there for the second vaccination. He then filled out and read over the Pre-vaccination checklist, Emergency Use Authorization sheet, Covid-19 Vaccine Patient Information sheet, V-Safe After Vaccination Health Check sheet and Pfizer Vaccine Information Fact Sheet. Once finished filling out and reading over the vaccination paperwork, he was seated at vaccine station where employee signed off on the completed paperwork and entered patient's number into the database and confirmed information listed. (Note that no previous vaccination had been documented into the database) employee then administered the Pfizer vaccine to patient. Once administered, patient removed his vaccination card from his pocket to which employee noticed that he had previously received one (1) dose of the Janssen Covid-19 vaccine; not the Pfizer Covid-19 vaccine. Employee wrote the vaccination lot number (EWO180) and expiration (08/2021) of the Pfizer dose given onto patient's vaccination card, and then reported to clinic supervisors of the error in vaccine given. Patient then waited the recommended 15 minutes after the vaccine was administered and went to the check out station. At check out, he attempted to schedule an additional dose of the Pfizer vaccine. Patient was denied his request to do so. Senior staff educated patient on adverse reactions and potential side effects of Pfizer vaccination and that the potential side effects are listed on the informational sheets. Patient was informed to contact his primary care provider or go to his local emergency department if he experienced any adverse reactions and/or side effects. The patient acknowledged the information provided by Senior Staff. Patient then questioned "so if I had went to a different clinic without my vaccine card I could get an additional dose?" Senior staff and check-out personnel explained why there was no need to do so as he was considered fully vaccinated at this time. Patient left the clinic. Upper management were informed about the situation. Patient's pertinent information including name, DOB, and address were acquired and documented appropriately. Summary: Pt received Pfizer vaccine after previous Janssen dose. NO ADVERSE REACTION REPORTED

Other Meds: n/a

Current Illness: n/a

ID: 1658641
Sex: M
Age: 79
State: FL

Vax Date: 12/31/2020
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: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Admitted for COVID/sepsis 8/25/21, discharged 8/26/21. Treated with dexamethasone IV daily.

Other Meds:

Current Illness:

ID: 1658642
Sex: F
Age: 68
State: NY

Vax Date: 02/26/2021
Onset Date: 02/28/2021
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: SYR
Vax Site: RA

Lab Data: chest x ray blood test covid test

Allergies: statin drugs

Symptom List: Rash, Urticaria

Symptoms: I woke up with fever, fatigue, sore throat, chills, headaches, body aches, and loss of appetite. I could not get up and walk, I was too exhausted. My symptoms continued to worsen and I pass out from shortness of breath and my daughter took me to the ER. They took a chest x-ray, ran some tests, covid test, blood work and I was admitted to the hospital. I stayed in the hospital for 4 days. I was diagnosed with pneumonia and given IV antibiotics. I was to follow up with PCP, pulmonologist, and given oral antibiotics for another 2 weeks. I have not gotten the 2nd shot since I had such a severe reaction to the 1st dose. It is now 6 months post vaccine, I am still having symptoms that have not resolve. I am constantly fatigue, no energy, and shortness of breath. I have not recovered from the adverse event from the vaccine.

Other Meds: Humira; Prednisone; Levothyroxine; supplemental oxygen; Albuterol inhaler;Symbicort;montelukast; oxycodone

Current Illness: none

ID: 1658643
Sex: F
Age: 36
State: TX

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

Lab Data:

Allergies: None

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

Symptoms: Fever, headache, dizzy, nausea, ear and jaw pain on left side

Other Meds: Adderall , buspirone

Current Illness: None

ID: 1658644
Sex: F
Age: 11
State: WI

Vax Date: 05/17/2021
Onset Date: 05/17/2021
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:

Allergies:

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

Symptoms: The patient presented to our clinic with a Date of Birth of 7/30/2008. The patient was new in our system. The patient presented with the parent and did not provide insurance card. Received a call from our state registry that the patient was too young to be vaccinated. These vaccines were interfaced over into the patients chart in WIR, however the Date of Birth listed was 7/30/2009 (in WIR). From our knowledge the patient did not have any adverse outcomes. It appears the parent provided the incorrect DOB when they registered for a MyChart account to set up an appointment for the vaccine. So according to the information provided, the patient was at the approved age, but information is pointing toward the patient was actually 11.

Other Meds:

Current Illness:

ID: 1658645
Sex: F
Age: 58
State: CO

Vax Date: 01/21/2021
Onset Date: 07/22/2021
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:

Allergies: sulfacetamide eye drops Arava Galifloxacin Augmentin Doxycycline erythromycin

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

Symptoms: Breakthrough COVID infection in a fully vaccinated patient resulting in ICU hospitalization. Patient was COVID positive on 7/22/21 and initially admitted to hospital from 7/23/21 to 8/6/21. Discharged to home at at time, however, patient presented to the ED on 8/14/21 with worsening symptoms. She was flown from this location to another hospital at that time. She remains at this other facility in the ICU at this time.

Other Meds: Prednisone 10mg po qd folic acid 1mg po qd methotrexate 15mg SQ weekly albuterol inhaler q4h prn albuterol neb solution 0.83% via nebulizer q4h prn ergocalciferol 1.250mcg po once a week fluoxetine 20mg po qd acetylcystene 20% inhalation so

Current Illness:

ID: 1658646
Sex: M
Age: 79
State: MD

Vax Date: 12/28/2020
Onset Date: 01/13/2021
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: 5/20/21 skin biopsy: Grover's disease

Allergies: No

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

Symptoms: First Moderna dose 12/28/2020. Reaction #1: 01/13/2021; 6 cm patch of dry, erythematous, red, scaly, itchy on right knee; subsequently diagnosed as eczema. Second Moderna dose 1/26/21. Reaction: Third/fourth week March; second patch developed 6 x 8 cm right knee. Second week of April: Third patch developed right lower leg 10 x 16 cm. Several smaller patches developed in the right thigh and distal left lower leg. Reaction #2: End of March: Generalized rash with numerous small red, intensely itchy spots over chest and back. Eventually diagnosed by biopsy as Grover's disease in May 2021. Treatment: 4/6/2021 steroid dose pack; improved and recurred. 5/20/2021: Dermatology evaluation; biopsy-proven Grover's disease. Treatment: Triamcinolone cream; improved with treatment August 2021; all lesions improved with treatment. No lesions completely healed. Follow-up dermatology, 8/13/2021. Patchy lesions diagnosed as eczema. Continued follow-up treatment Grover's disease.

Other Meds: Losartan 25mg, Lovastatin 20mg

Current Illness: none

ID: 1658647
Sex: M
Age: 32
State: GA

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

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

Lab Data: N/A

Allergies: None

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

Symptoms: Patient came into the clinic today for a COVID Vaccine. He filled out his form. He stated on the form and verbally that he had not had a COVID Vaccine. He requested Pfizer. After vaccine was administered, it was noted that he already had a Moderna vaccine on 06/08/2021. As of the time of filling out this form, he had no reaction or adverse event related to receiving the Pfizer.

Other Meds: N/A

Current Illness: None

ID: 1658648
Sex: F
Age: 43
State: VA

Vax Date: 03/13/2021
Onset Date: 03/14/2021
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:

Allergies: Aspartame

Symptom List: Ear pain, Hypoaesthesia

Symptoms: On 03-14-2021; I was heavily medicated and did a lot of preventative treatment at the time I received my second vaccine. This time my symptoms were mild although I still had itchiness to my skin, had a rash and hives. Since I was already on mediation my symptoms only lasted for one day or two then my symptoms went away.

Other Meds: Benadryl; Pepcid; OTC Allegra; Jardiance

Current Illness:

ID: 1658649
Sex: M
Age: 38
State: MN

Vax Date: 05/01/2021
Onset Date: 08/30/2021
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: SARS COVID-19 MOLECULAR 8/31/21: POSITIVE

Allergies: NONE

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: SNIFFLES, HEADACHE, COUGH, CHILLS- STARTED 8/30/21. NO CONTACT WITH OR EXPOSED TO COVID

Other Meds: MULTIVITAMIN DAILY

Current Illness: NONE

ID: 1658650
Sex: F
Age: 66
State: NY

Vax Date: 03/20/2021
Onset Date: 05/01/2021
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: CT scans Coloscopy Blood work other test

Allergies: Antibiotic Tequlin

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

Symptoms: Patient stated that she had aching joints. She received a tense headache and high fever. Patient also stated that she is experiencing extreme weight lost. Patient stated that she has lost 37 lbs. in 4 weeks or less.

Other Meds:

Current Illness:

ID: 1658651
Sex: F
Age: 45
State:

Vax Date: 01/21/2021
Onset Date: 01/23/2021
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: Extremely heavy menstrual cycle beginning a few days after first vaccine. Menstrual period after 2nd dose also much heavier than usual. Extremely heavy meant heavy flow, larger clots than normal (smal avocado sized clots).

Other Meds:

Current Illness:

ID: 1658652
Sex: F
Age: 93
State: FL

Vax Date: 04/21/2021
Onset Date: 08/15/2021
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: nka

Symptom List: Unevaluable event

Symptoms: 8/15/21: Presenting today for evaluation of shortness of breath and constipation. According to EMS report patient oxygen saturation was 90% on room air and was placed on 4 L oxygen with brought patient oxygen saturation up to 97%.. She reported her last bowel movement was 3 days ago, she has been experiencing decreased appetite for the past 7-10 days. Note: patient previously received the COVID-19 Moderna Vaccine: First dose: 03/24/21 Lot Number 0474A21A; Second dose: 04/21/21 Lot Number 039B21A Diagnosed with acute hypoxic resp failure due to COVID, pneumonia 8/18/21: patient discharged

Other Meds: amlodipine, bisoprolol, levothyroxine, rosuvastatin, spironolactone

Current Illness:

ID: 1658653
Sex: F
Age: 33
State: KS

Vax Date: 07/23/2021
Onset Date: 08/27/2021
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: EUA monoclonal antibody infusion education given to patient. V/U noted.

Other Meds:

Current Illness:

ID: 1658654
Sex: F
Age: 74
State: FL

Vax Date: 04/05/2021
Onset Date: 08/25/2021
Rec V Date: 08/31/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Hospitalization for AFIB/Rule-out COVID PNEUMONIA. Treated with dexamethasone 6 mg IV daily

Other Meds:

Current Illness:

ID: 1658655
Sex: F
Age: 75
State: NY

Vax Date: 02/09/2021
Onset Date: 04/25/2021
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: Illusion? Far on, diflucan, iodine, Tripura toon monomacro

Symptom List: Injection site pain, Menorrhagia

Symptoms: Shingles - Had already received 2 Shringrex vaccine

Other Meds: Ibersartan, levvothroxine, mycophenolate, hydrochloroquine, gabapenton,mybertriq, bit d3, calcium, biotin, flovent

Current Illness: Asthma, dermatocytis (auto immune), high blood pressure, hypothyroidism, allergies

ID: 1658657
Sex: F
Age: 48
State: FL

Vax Date: 05/08/2021
Onset Date: 07/14/2021
Rec V Date: 08/31/2021
Hospital: Y

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

Lab Data: CXR, 7/27/21 covid test positive.

Allergies: Benadryl, erythromycin, keflex

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

Symptoms: Pt came to ER with syncope, diagnosed with covid 19 2 days ago.

Other Meds:

Current Illness:

ID: 1658658
Sex: M
Age: 27
State: MA

Vax Date: 06/14/2021
Onset Date: 06/15/2021
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: None administered.

Allergies: N/A

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Acute side effects started 12 hours after second injection: Severe headache, nausea, and dizziness combined with a fever of 103F. Extreme body aches and joint pain in arms, legs, back, and neck. Tylenol was taken to control fever. Acute side effects lasted total of 24hrs but some lingered for one week. Lingering side effects: Extreme dizziness and lightheadedness that persisted for 5 days following second injection. Blood rushing to head and heart flutters when getting up/sitting down too quickly. Primary care physician was notified after 3 days of side effects and patient was monitored for two more days. Extreme dizziness and lightheadedness subsided on 5th day following second injection. Patient will undergo follow-up during yearly physical in October or earlier if needed as minor episodes of dizziness/lightheadedness have sporadically occurred since second injection.

Other Meds: Vitamin D 1000 iu

Current Illness: None.

ID: 1658659
Sex: F
Age: 70
State: KS

Vax Date: 02/03/2021
Onset Date: 08/27/2021
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:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Chief Complaint: patient with COVID s/s that started yesterday, staff at Healthcare did rapid +COVID today. received tylenol supp @ 0645, were unable to manage O2 sat at facility. 83% on RA, up to 92% now on 2L. History of Present Illness : Patient is a 70 year old of Doctor K. who recently moved Care Ct due to increased support needs physically with advancing DJD and arthritis of the hips, shoulders, and knees. She is chronically been on alternating doses of daily prednisone for this. She was given Pfizer COVID vaccination in February and had booster dose 2 weeks ago due to her chronically immunocompromised state. Her sister is at the bedside today and states that there was a recent employee at care center that tested positive for Covid. All residents were tested 2 days ago, Patient was negative but then yesterday began having a nonproductive cough with shortness of breath. Today she began having fevers with hypoxemia and was transferred to emergency room for further evaluation. She has tested positive for Covid today.

Other Meds:

Current Illness:

ID: 1658660
Sex: F
Age: 35
State: KS

Vax Date: 05/21/2021
Onset Date: 08/30/2021
Rec V Date: 08/31/2021
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:

Allergies:

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

Symptoms: Admitted for Acute calculus cholecystitis, subsequently found to be COVID-19 positive with routine admission testing.

Other Meds:

Current Illness:

ID: 1658661
Sex: F
Age: 58
State: GA

Vax Date: 08/09/2021
Onset Date: 08/16/2021
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: n/a

Allergies: n/a

Symptom List: Nausea

Symptoms: Pt got her Vaccine on her right arm after a week she got her left arm swelling and pain.

Other Meds: n/a

Current Illness: she is no

ID: 1658662
Sex: F
Age: 71
State: FL

Vax Date: 03/13/2021
Onset Date: 08/30/2021
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: LA

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Patient is a 72-year-old white male who has been having cough and shortness of breath for the last 2 weeks. He was treated as an outpatient for possible pneumonia. He has been vaccinated with the Johnson Johnson COVID vaccine. Tested positive for COVID-19 yesterday. He was having some loss of taste or smell. Denies any diarrhea. Denies any current cough or congestion. Denies any current fevers or chills. Denies any nausea vomiting. Denies any burning, pain, increased frequency urination. He is a nonsmoker. He is not on any home oxygen. No other active complaints at this time.

Other Meds:

Current Illness:

Date Died: 08/10/2021

ID: 1658663
Sex: M
Age: 75
State: GA

Vax Date: 02/03/2021
Onset Date: 07/25/2021
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: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: fully vaccinated 75-year-old male with past medical history significant for HTN, HLD, obesity, tobacco use, and prior DVTs admitted to Hospital on 07/27/2021 for shortness of breath. Patient was seen at urgent care on 07/25/2021 and found to be COVID-19 positive. CT angiogram performed to assess for pulmonary embolism. Imaging was equivocal but demonstrated bilateral patchy ground-glass opacities suggestive of bilateral pneumonia. Patient was administered and completed azithromycin, ceftriaxone, dexamethasone. Initially on 6L of oxygen by nasal cannula on admission. During his admission, patient's respiratory status worsened and he was placed on humidified high-flow nasal cannula at 60 L and 100% O2. Despite being on high-flow nasal cannula patient desaturated to the 70s and a rapid response was called. Patient was placed on BiPAP with some improvement in his respiratory status and was admitted to the hospital on 08/01/2021. On 8/7, his respiratory status progressively worsened and he was sedated and intubated. On 8/8, code status was changed to DNR. He developed progressively worsening renal failure and increased vasopressor requirements to maintain his blood pressure. 08/01 Rapid response called for patient desaturating in the 70s while on 60L. Transferred to Hospital. 8/07 Intubated and sedated due to worsening respiratory failure. 08/08 Worsening hypoxemia, renal failure, Code status changed to DNR. 08/10 Family elects palliative extubation, withdrawal of care with comfort measures. On 8/10/21 following adequate time to say their goodbyes. Palliative extubation performed by RT at 1823 with Nurse and family at bedside. Loss of palpable pulses appreciated by Nurse.

Other Meds:

Current Illness:

ID: 1658664
Sex: F
Age: 48
State: CO

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

Lab Data: Ekg and x-ray . X-ray showed mass . CT scan was done Found 3 liters of Fluid and blood clots

Allergies: sulfa

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

Symptoms: * hours after vaccine patient had trouble breathing . lasted 3 days. went to the ER on April 9 and was admitted for 5 days and dianosed with Lung cancer

Other Meds: Cymbalta

Current Illness: no

ID: 1658665
Sex: M
Age: 29
State:

Vax Date: 08/31/2021
Onset Date: 08/31/2021
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: Tremor

Symptoms: PATIENT PRESENTED TO CLINIC FOR PFIZER COVID VACCINE DOSE 2 (LOT FF2587, EXP 12/31/21). AFTER RECIEVING DOSE 2 OF COVID VACCINE, PATIENT BEGAN TO HAVE SYSTEMIC ITCHING. PATIENT ALSO HAD RASH ON TORSO. PATIENT STATED HE FELT SLIGHTLY LIGHTHEADED. PATIENT WAS ESCORTED TO EMERGENCY DEPARTMENT. PATIENT DECLINED WHEELCHAIR AND STATED HE WAS ABLE TO WALK. ESCORT STILL BROUGHT WHEELCHAIR WITH PATIENT IN THE EVENT SYMPTOMS WORSENED. PATIENT STATED AFTER FIRST DOSE OF COVID VACCINE, HE HAD A SMALL RASH PRESENT ON TORSO AND WAS SEEN BY PROVIDER. PATIENT STATED HE WAS CLEARED BY HIS PROVIDER TO RECIEVE DOSE 2.

Other Meds:

Current Illness:

ID: 1658666
Sex: F
Age: 69
State: CA

Vax Date: 02/19/2021
Onset Date: 02/19/2021
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: echocardiogram- doctor has all those results

Allergies: flagel; cheese mold

Symptom List: Erythema, Pruritus

Symptoms: On the day of the vaccination, 02/19/2021 my arm was sore and I had a fever. The next day I was very very tired and the arm had a large, red swollen area (4 inches) around the injection site. The next day I went to urgent care, they were going to give me antibiotic and they decided to wait 1 more day and it went down the next day on its own. The provider that was at the urgent site thought it might have been a poorly applied injection. The very next week, I have psoriasis, It's an autoimmune condition, but overnight it appeared very aggressively. It never comes on that fast. I went to dermatology, they treated it with a steroid shot, Kenalog and it took care of it. I have Alopecia and it suddenly got worse fast. It became noticeable in May. The doctor gave me the same steroid shot and asked me to use Rogaine. Till this day, there is no hair coming back and there is still some hair loss. The adverse event, I'm still working on, is I'm having irregular blood pressure. I have never been aware of having irregular blood pressure and I am currently working with my doctor on it. My blood pressure seems to drop when I stand or bend over.

Other Meds: Proair 4 x day; Advair hfa 2 x day; atorvastatin 40 mg od; eliquis 5 mg bd; uloric 40 mg od; metoprolol succ er 50 mg bd; indapamide 1.5 mg od; low dose aspirin 81 mg od; gabapentin 100 mg am /200 mg pm; montelukast sod 10 mg od; allergy sp

Current Illness: no

ID: 1658667
Sex: F
Age: 66
State: CA

Vax Date: 08/14/2020
Onset Date: 08/14/2020
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: none

Allergies: nka

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

Symptoms: fainted twice within the first hour.... shaking first, clammy, 2nd time on the bathroom, felt it coming so laid down on the tile... diarhhea for an hour afterwards. tired, scared. alone. confused.

Other Meds: none

Current Illness: none

ID: 1658668
Sex: F
Age: 70
State: MI

Vax Date: 05/03/2021
Onset Date: 08/23/2021
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: 8/31/21 D-dimer: 0.96 Lymphocytes: 14 Chest X-ray: moderate focal ground glass opacity in lateral mid-left lung CRP: 125.5 CT chest PE: no evidence of PE; moderate ground-glass opacities

Allergies: No known allergies

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

Symptoms: On 8/23/21 the patient began experiencing symptoms of COVID-19 including sore throat, myalgias, congestion, shortness of breath, and cough. Patient presented to ED to receive a scheduled Regeneron COVID-19 monoclonal antibody therapy, but the patient was found to have an O2 sat of 88% with exertion, improving to 90% with exertion. Patient was no longer a candidate for antibody therapy and signed in to ED for evaluation. Patient was placed on 2L O2 via nasal cannula and had improvements of shortness of breath and O2 sat increased to 97%. Patient was started on 6 mg dexamethasone. The patient will be admitted to the hospital.

Other Meds: buspirone, glimepiride, gabapentin, hydrochlorothiazide, levothyroxine, metformin, metoprolol tartrate, potassium chloride ER tablets

Current Illness:

ID: 1658669
Sex: F
Age: 82
State: GA

Vax Date: 03/01/2021
Onset Date: 07/28/2021
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: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient is fully vaccinated. A retired Octogenarian, whose symptoms started on 07/28/21. In addition to the symptoms checked off, she also experienced chest congestion and weakness. Symptoms resolved on 08/09/21. She was hospitalized for 5 days.

Other Meds:

Current Illness:

ID: 1658670
Sex: M
Age: 73
State: PA

Vax Date: 03/23/2021
Onset Date: 04/10/2021
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: Troponin <0.10 (normal) 06/17/2021 Cardiac MRI. Only abnormal finding was acute myocarditis

Allergies: None

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

Symptoms: Tachycardia and chest pain lasting for about 5 minutes. Admitted to emergency room (04/10/2021) and hospital ward Hospital, to 04/12/2021. 04/10/2021 to 04/12/2021: All clinical and laboratory tests, including stress test and echocardiogram were normal except low HDL (45) and high glucose (105). Has remained symptom and sign free since single episode.

Other Meds: Prevacid, Lisinopril, Ursodiol, Metformin, Proscar, Flowmax,

Current Illness: None

ID: 1658671
Sex: F
Age: 59
State: FL

Vax Date: 02/11/2021
Onset Date: 08/25/2021
Rec V Date: 08/31/2021
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:

Allergies:

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

Symptoms: Hospitalization for COVID Pneumonia 8/25-8/29/2021. Treated with dexamethasone IV daily and Remdesivir

Other Meds:

Current Illness:

ID: 1658672
Sex: F
Age: 19
State:

Vax Date: 08/31/2021
Onset Date: 08/31/2021
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: Pain in extremity

Symptoms: Patient requested 2nd dose of Pfizer. When entering into NDiis it was caught that patient received Moderna as her first dose. Patient received 2 different mrna vaccines

Other Meds:

Current Illness:

ID: 1658673
Sex: F
Age: 41
State: FL

Vax Date: 04/22/2021
Onset Date: 04/24/2021
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: Wheat Grass

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

Symptoms: Arthritis in both hands where the Proximal Phalanx and Metacarpal of the pointer finger meet.

Other Meds: zyrtec, Birth Control Loestrin

Current Illness: none

ID: 1658674
Sex: F
Age: 69
State: SC

Vax Date: 03/24/2021
Onset Date: 07/01/2021
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: CHEST CT Angiography w/contrast July 06, 2021 showed multiple pulmonary embolisms Hospitalization July 06-08, 2021 at Hospital

Allergies: Codeine; Latex; Tetracycline

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

Symptoms: I had laparoscopic cholecystectomy 6/28/2021 and presented to my PCP with shortness of breath and dyspnea. On July 6, 2021, I was diagnosed with findings on CT scan revealing extensive embolic material in the subseqmental and segmental branches of all 5 lobes as well at the bifurcation of the right main pulmonary artery. There was a small infiltrate in the left lower lobe which may likely be developing pulmonary infarct. There was also embolus present in the left lower lobe pulmonary artery with extension into multiple seqmental and subsegmental branches. Since starting blood thinner I have not had any breathing issues. Will need to take blood thinner for remainder of my lifetime.

Other Meds: Montelukast Sodium 10mg; Cetirizine 10mg; Nasacort Nasal Spray

Current Illness: None

ID: 1658675
Sex: M
Age: 77
State: FL

Vax Date: 03/09/2021
Onset Date: 07/27/2021
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: 7/28/21: covid test positive, CXR- bilat covid pneumonia.

Allergies: NKA

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

Symptoms: Pt came to ER with SOB since Saturday and feeling tired.

Other Meds:

Current Illness:

ID: 1658676
Sex: F
Age: 77
State:

Vax Date: 12/30/2020
Onset Date: 08/28/2021
Rec V Date: 08/31/2021
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:

Symptom List: Vomiting

Symptoms: PATIENT RECEIVED Dose 1 date: Hospital 12-30-20, Dose 2 date: Hospital 1-20-21 AND TESTED POSITIVE TO COVID-19 8/28/21

Other Meds:

Current Illness:

ID: 1658677
Sex: M
Age: 29
State: MI

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

Lab Data:

Allergies: PENICILLIN

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: PATIENT AWAKENED TO SHORTNESS OF BREATH AND A RASH/HIVES ALL OVER CHEST AND ARMS. SELF TREATED WITH A DOSE OF BENADRYL. SHORTNESS OF BREATH WENT AWAY BUT HIVES REMAINED

Other Meds: NA

Current Illness: NA

ID: 1658678
Sex: F
Age: 20
State: NY

Vax Date: 08/02/2021
Onset Date: 08/21/2021
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: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: Central Retinal Vein Occlusion with Cystoid Macular Edema

Other Meds:

Current Illness:

ID: 1658679
Sex: M
Age: 38
State: MN

Vax Date: 01/19/2021
Onset Date: 08/27/2021
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: Covid-19 test- 08/26/2021

Allergies: No known allergies

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient received 2nd dose of Pfizer vaccine on 01/19/2021. Symptoms of cough, sore throat, and runny nose started on 08/26/2021. Positive for Covid-19 on 08/26/202.

Other Meds: Losartan

Current Illness:

ID: 1658680
Sex: F
Age: 58
State: NY

Vax Date: 03/11/2021
Onset Date: 08/24/2021
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: bloodwork - no antibodies

Allergies:

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

Symptoms: blood showed no antibodies

Other Meds:

Current Illness:

ID: 1658681
Sex: F
Age: 75
State: TX

Vax Date: 01/08/2021
Onset Date: 03/15/2021
Rec V Date: 08/31/2021
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: Chest x-rays, blood work, echo, more chest x-rays and surgery. This all happened from the 15th of March to present. An under the care of a cardiologist and oncologist. Medical tests and lab work always showed inconsistent results.

Allergies: no

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

Symptoms: Several severe AFib attacks and had to have a pacemaker put in after my heart stopped. Then dealt with cardiac tamponade a month later and then as an ablation and watchman put in. AFib unlike previously always was fairly infrequent and easily controlled. Also nodules on my lungs from renal cancer have been stable since 2017 and my cat scan after the above events showed they had started to grow

Other Meds: Eliquis, Tylenol, Clonazepam

Current Illness: no

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am