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: 1658884
Sex: M
Age: 34
State: CA

Vax Date: 05/17/2021
Onset Date: 05/18/2021
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: none

Allergies: no known allergies

Symptom List: Dysphagia, Epiglottitis

Symptoms: tinnitus bilaterally ~24 hours from 2nd Pfizer COVID vaccine. persisting and does not appear to be waning at this time. has tried flonase with no benefit, referral placed to ENT

Other Meds: none to our knowledge

Current Illness: none

ID: 1658885
Sex: F
Age: 31
State: OR

Vax Date: 08/19/2021
Onset Date: 08/20/2021
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: clindamycin

Symptom List: Anxiety, Dyspnoea

Symptoms: sore arm 4 hours later , sweats at night, vomiting , left chest pain still happening

Other Meds: Wellbutrin Advair singular Zyrtec Spiriva

Current Illness: none

ID: 1658886
Sex: F
Age: 83
State: MI

Vax Date: 03/16/2021
Onset Date: 08/21/2021
Rec V Date: 08/31/2021
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:

Allergies: Gabapentin

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

Symptoms: Brief history and medical decision making: Volume over loaf, secondary to missed HD on Monday 08/23. Break through Covid -19 infection, continue isolation per infection control. Hold off Steroids ( anticipating HD will help with breathing) Elevated troponin mostly due to ESRD and volume overload. Asymptomatic. History CVA with expressive aphasia: Cognitive impairment: Patient have guardian. HD per Nephrology. Shortness of breath Volume overload ESRD MWF In setting of missed dialysis on Monday and patient being 5 kg above dry weight. Chest x-ray with evidence of congestion and small bilateral pleural effusions. Differentials also include breakthrough COVID-19 infection and possibility of flash pulmonary edema. History defers from patient shortness of breath worsening over last week worse in last 3 days compared to facility awareness of acutely short of breath last evening. Plan: -consult nephrology discussed with Doctor regarding dialysis today -assess SOB hypoxia with activity after -Lasix if delayed planned to start round 1pm Hypertensive urgency In setting of volume overload with no antihypertensives given on day of dialysis even though missed dialysis and without blood pressure medications today. -Continue amlodipine, imdur, coreg initial dose now and continue on none dialysis days Breakthrough COVID-19 infection Symptomatic with positive test in November 2020, vaccinated Johnson Johnson vaccine 3/2021, negative testing previously now positive test 8/24. No COVID outbreak at facility. Patient has been afebrile. Does have cough, headache. -discussed with infection control will place in isolation 10 days -Received 6 mg dexamethasone in ED. Currently not hypoxic on RA. Will hold on additional treatment currently. -With ESRD would not be candidate for remdesivir. -With current volume overload will avoid convalescent plasma unclear utility with past infection and COVID vaccination. Elevated troponin Myocardial injury In setting of ESRD with volume overload with elevated blood pressure without EKG changes remains atrial paced with right bundle-branch block previously seen. Denies chest pain. Troponin 224 -- > 224. Previous admissions 150 to 250s. Diastolic heart failure Status post permanent pacemaker Afib not on anticoagulation due to GI bleed. Last echo 3/2021. EF 57% mild LVH. Atrial paced. Dementia Prior CVA with expressive aphasia General debility Frequent falls Currently AOx3/4 name, place, president not to date. Has court-appointed guardian. -PT/OT Chronic pain -Continue fentanyl patch q 72 hr Code Status: full unknown. Call out to guardian DVT PPX: SQH Diet: Renal fluid and sodium resricted Dispo: Obs assess after HD. Discussed with Doctor, please see their addendum. Internal Medicine Resident PGY-3

Other Meds: albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler allopurinol (ZYLOPRIM) 100 MG tablet amLODIPine (NORVASC) 5 MG tablet atorvastatin (LIPITOR) 20 MG tablet B Complex-C-Folic Acid (DIALYVITE TABLET) TABS c

Current Illness: Weakness; UTI; fall; seizure; ESRD; loss of consciousness; nose bleed; headaches

ID: 1658887
Sex: F
Age: 21
State: MN

Vax Date: 01/12/2021
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:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Tested positive for COVID 8/30/21 after being fully vaccinated.

Other Meds:

Current Illness:

ID: 1658888
Sex: M
Age: 63
State: MI

Vax Date: 03/30/2021
Onset Date: 08/22/2021
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: LA

Lab Data:

Allergies:

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

Symptoms: Patient came in with cough, hyper -tension, dry mouth and shortness of breath and Covid positive. Patient discharged home

Other Meds:

Current Illness:

ID: 1658889
Sex: M
Age: 60
State: NY

Vax Date: 08/14/2021
Onset Date: 08/28/2021
Rec V Date: 08/31/2021
Hospital: Y

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: Patient suffered a heart attack within 2 weeks of receiving vaccine. Patient had 99% blood clotting in his artery.

Other Meds:

Current Illness:

ID: 1658890
Sex: F
Age: 78
State: CA

Vax Date: 03/18/2021
Onset Date: 05/03/2021
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: using Triamcinolone -- not much help -- Dr. has pictures --

Allergies: Almonds -- weeds --

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Red spots -- raised and enlarging -- started on left leg -- now has spread to right arm with swelling -- also left brest and Right leg and Right sholder -- continue symptoms --

Other Meds: Atorvastatin Losartan --Montelukast --Q Var -- womens vitamins --

Current Illness:

Date Died: 08/21/2021

ID: 1658891
Sex: M
Age: 83
State: MN

Vax Date: 03/03/2021
Onset Date: 08/21/2021
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: Cephalosporins, levofloxacin, environmental and seasonal

Symptom List: Pharyngeal swelling

Symptoms: Patient passed away on 08/21/2021.

Other Meds: Percocet, Coreg, Aspirin, Plavix, Dulcolax, Zyloprim, Cymbalta, Crestor, Tylenol, Prinivil, Kenalog, Desyrel

Current Illness:

ID: 1658892
Sex: M
Age: 70
State: FL

Vax Date: 03/13/2021
Onset Date: 07/28/2021
Rec V Date: 08/31/2021
Hospital: Y

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

Lab Data: Covid test-posititve, CXR.

Allergies: NKA

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Pt came to ER c/o wheezing.

Other Meds:

Current Illness:

ID: 1658893
Sex: U
Age:
State:

Vax Date:
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: MRI 07/12/2021

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Sore shoulder became frozen shoulder

Other Meds:

Current Illness:

ID: 1658894
Sex: F
Age: 38
State: CA

Vax Date: 02/10/2021
Onset Date: 08/05/2021
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: None

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

Symptoms: bladder infection, treated with antibiotics and cleared up within a couple of days.

Other Meds: None

Current Illness: None

ID: 1658895
Sex: M
Age: 72
State: FL

Vax Date: 02/23/2021
Onset Date: 04/15/2021
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: kidneys were going into renal failure.

Allergies: no

Symptom List: Rash, Urticaria

Symptoms: In April, the issue was he had not checked his blood glucose in years. He went to see his internist, for a check up. The doctor called in and said his blood sugars were very high. It took 3 weeks, for the doctor to call to say his blood sugar was so high he needed to be hospitalized. and they started him on a lot of insulins. He was hospitalized. They started pumping insulin through an IV and he spent the night there. And they gave him 3 prescriptions for 3 different types of insulins, Ozempic, Tresiba, Insulin lispro injection. He took all 3 insulins until 06/02/2021, and he went down from 20 units to 0 , from April to June 2, 2021. His endocrinologist is watching him because his kidneys were going into renal failure and they are observing his numbers to make sure he is okay. When this whole deal happened, the COVID-19 , our life style did not change, his diet never changed, I tried to call the Health Dept and CDC did not help. This is the first time someone has contacted us and I would like to say Thank you. It is a concern in the back of my mind for him to get the 3rd booster-COVID . But we have all these insulins just in case something happens.

Other Meds: enalapril 10 mg od Crestor 30 mg od metformin 500 mg bd glimepiride 2 mg od baby aspirin 81 mg od amlodipine 5 mg od

Current Illness: no

ID: 1658896
Sex: M
Age: 77
State: RI

Vax Date: 03/01/2021
Onset Date: 04/01/2021
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: Biopsy proven Chronic Urticaria.

Allergies: Sulfa

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

Symptoms: Chronic Urticaria that is not responding to conventional treatments.

Other Meds:

Current Illness: N/A

ID: 1658897
Sex: M
Age: 38
State: AL

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

Lab Data: N/A

Allergies: None

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

Symptoms: Sharp pain in left leg in the quadricep area. Coming and going throughout the day, did not have these pains before the vaccine.

Other Meds: None

Current Illness: None

ID: 1658898
Sex: F
Age: 37
State: CA

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

Lab Data: Epi pen administered on site (0.3mg) and patient transported to hospital

Allergies: Contrast iodinated diagnostic agents, sulfa antibiotics, sulfanilamide

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

Symptoms: within five minutes, patient felt her throat was closing and that it was hard to breathe. She also had abdominal pain.

Other Meds: temazepam (RESTORIL) 30mg Cap amitriptyline (ELAVIL) 25mg Tab buPROPion 24Hr-XL (WELLBUTRIN XL) 150mg Tab SYMBICORT 160-4.5 MCG/ACT Oral Inhaler topiramate (TOPAMAX) 50mg Tab famotidine (PEPCID) 20mg Tab rizatriptan (MAXALT) 10mg Tab DULoxe

Current Illness: n/a

Date Died: 08/20/2021

ID: 1658899
Sex: M
Age: 84
State: MN

Vax Date: 02/17/2021
Onset Date: 08/20/2021
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: No known allergies

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

Symptoms: Patient passed away on 08/20/2021

Other Meds: Tylenol, Milk of Mag, Maalox, Dulcolax, Roxanol, Lorazepam, Synthroid, Proscar

Current Illness:

ID: 1658900
Sex: F
Age: 5
State:

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

Allergies: None reported

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

Symptoms: Itching, redness, and swelling at the injection sites. 30 mL of liquid diphenhydramine given (error, Poison Control consulted, situation cleared as not requiring medical attention). Client's mother advised to continue monitoring and report incident to pediatrician. Also encouraged to call EMS is symptoms return/worsen. Client and family discharged to home (ambulatory, A&O) with no itching and significantly reduced redness and swelling.

Other Meds: None reported

Current Illness: None reported

ID: 1658901
Sex: M
Age: 91
State: CA

Vax Date: 03/18/2021
Onset Date: 08/11/2021
Rec V Date: 08/31/2021
Hospital: Y

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

Lab Data: All the tests for - heart attack

Allergies: no

Symptom List: Ear pain, Hypoaesthesia

Symptoms: 11th - I started having chest pains - classic symptoms - difficulty breathing; radiating down the left arm; hot and cold at the same time. Call -9-1-1 and they took me to the hospital. I went into Ventricular afibulation and they transferred me to another hospital and I went into Cardiac arrest. Angioplasty - implanted three stents in the main vessels of the heart itself- as far as I understand. I was in the hospital until the 16th.

Other Meds: Corguard - 80 mg; HCTZ - 12.5 mg once a day; Omeprazole - 40 ml once a day; Aspirin - low dose 81 mg; Vit C - 500 mg; Vit D - 400 Units a day.

Current Illness: no

ID: 1658902
Sex: M
Age: 86
State: MI

Vax Date: 04/30/2021
Onset Date: 08/27/2021
Rec V Date: 08/31/2021
Hospital: Y

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

Lab Data:

Allergies: HydrocodoneOther Statins [Hmg-coa-r Inhibitors]Myalgia Sulfa DrugsMyalgia, Other Vicodin [Hydrocodone-acetaminophen]Other Zetia [Ezetimibe]Myalgia Aricept [Donepezil]

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Admitted to the hospital; COVID-19 positive. 8.24.21 CHIEF COMPLAINT: Fall Assessment/Plan ASSESSMENT/PLAN: 1. Acute resp failure with hypoxia- now on HFNC 2. Acute on chronic diastolic heart failure with hemoptysis 3. CAD 4. Elevated ddimer with sudden SOB/hypoxia and tachycardia 5. CKD3 6. DM2-insulin dependent 7. Fall/weakness 8. Anemia- hx iron deficient and chronic disease- 9. Afib 10. HTN 11. HLD 12. GERD 13. Prostate ca-metastatic with right rib lesion Plan: Admit to ICU-he refused transfer FULL code Oxygen keep sat >88% Lasix 40mg IV bid, first dose now VQ scan in am- >DDimer with covid and clinical status suspect PE Trend Hgb- transfuse <8 Telemetry, frequent VS CM for placement/dc planning- will need placement PT/OT Diabetic diet, and continue basal insulin PPI/heparin sq if hgb stable (hemoptysis) Subjective HISTORY OF PRESENT ILLNESS: Patient is a 87 y.o. male who presents today after a fall-though he denies falling. He was recently here and treated for COVID, hypoxia and CHF- refused SNF and went home. He has been difficult to care for per his son and needs help with placement. The patient begrudgingly agrees. In the ER he was completing his workup when he suddenly dropped his 02 satus- thus requiring eventually HFNC- he also had reports of scant blood in his sputum. With family at bedside and help of the ER doctor- advance care planning was discussed. The patient is guarded and very critically ill- family was in agreement for DNR/comfort care however the patient wishes for FULL code and does not want transfer. This was discussed in depth with ER doctor, myself, and patient.

Other Meds: acetaminophen (TYLENOL) 500 MG tablet albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler alendronate (FOSAMAX) 70 MG tablet ALPRAZolam (XANAX) 0.25 MG tablet aspirin (ASPIRIN) 81 MG enteric coated tablet B

Current Illness: Physical deconditioning AKI (acute kidney injury) COVID-19 virus infection COVID-19 Pulmonary edema cardiac cause Hospitalization 8.24.21

Date Died: 08/07/2021

ID: 1658903
Sex: M
Age: 81
State: FL

Vax Date: 01/06/2021
Onset Date: 07/27/2021
Rec V Date: 08/31/2021
Hospital: Y

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

Lab Data: CXR, covid test.

Allergies: Oxycontin

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

Symptoms: Pt came to ER 7/27 with CP and 7/28 with difficulty breathing.

Other Meds:

Current Illness:

ID: 1658904
Sex: M
Age: 19
State: NY

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: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Patient presented for 2nd dose, Vax team of LPN and staff administered Pfizer vaccine, Lot # EW0196 exp 09/2021. Further review of patient medical records show patient received his first dose, MODERNA on 2 Jun 2021. The LPN who documented encounter on today?s date recognized her mistake and will be inputting report for event. Patient was monitored for 15 minutes for reaction, I consulted supervisor for further guidance, patient instructed not to receive any additional COVID Vaccine at this time. Patient contact information was collected should follow up be needed.

Other Meds: None

Current Illness: None

ID: 1658905
Sex: F
Age: 51
State: CA

Vax Date: 08/27/2021
Onset Date: 08/29/2021
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: Unevaluable event

Symptoms: Body aches, headache , itchy throat and chills

Other Meds: None

Current Illness: None

ID: 1658906
Sex: F
Age: 75
State: NC

Vax Date: 03/01/2021
Onset Date: 03/27/2021
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: LA

Lab Data: CT Head scan w/o contrast (3/27/2021) CT Head scan w/o contrast (3/28/2021) XR Abdomen (1 view) CT Angiogram of Neck and Head with Contrast, CTV of the head with contrast

Allergies: Macrodantin Sulfa drugs

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

Symptoms: After my second shot on March 1, I suffered a brain bleed on March 27 on both sides of my brain and was hospitalized in the Surgical Neurological ICU for 5 days and in a step-down neurology room for 1 day. The medical professionals have been unable to determine the cause of the brain bleed except for the fact that my blood pressure (which was always low to normal) was over 200. While hospitalized and since hospitalization I have had to take blood pressure medicine to control the numbers. I have made great strides in overcoming the results of the stroke in the last 5 months. I see a question below that says have I recovered. My answer is not yes, no, or unknown. My answer is mostly. I will, however check yes below.

Other Meds: Metformin Levothyroxine Tylenol

Current Illness: None

ID: 1658907
Sex: F
Age: 39
State: WI

Vax Date: 08/28/2021
Onset Date: 08/29/2021
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: none done, patient went home ill from work recommended seeing primary provider

Allergies: shellfish, azithromycin

Symptom List: Injection site pain, Pain

Symptoms: arm swelling, low grade fever, lymph edema. painful movement and swelling from arm to trunk area

Other Meds: none

Current Illness: none

ID: 1658908
Sex: F
Age: 37
State: IL

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: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: 0927 Patient c/o itching on trunk area. No redness or rash observed. Benadryl 50mg po given. 0937 Patient states itching improved. 0945 Patient states itching has stopped. Informed to continue Benadryl 25mg po at home as needed. Verbalized understanding

Other Meds:

Current Illness:

ID: 1658909
Sex: M
Age: 88
State: IL

Vax Date: 03/06/2021
Onset Date: 08/26/2021
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:

Allergies:

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

Symptoms: Patient started experiencing upper respiratory symptoms (cough, shortness of breath) and weakness on ~ 8/22/21. His son brought him to the ER on 8/26/21 since patient started to wheeze and his symptoms were not improving with OTC medications. He was noted to be confused in the ER as well as hypoxic, and heated high flow oxygen was started due to respiratory failure. Pt was admitted to the hospital and was started on COVID treatment with remdesivir and dexamethasone since he tested positive for COVID in the ER on 8/26. He is also receiving Eliquis 5 mg BID for suspected PE on CT (patient was on Eliquis 2.5 mg BID prior to admission for Afib). Pt is currently on day 5 of hospitalization (on 8/31) and is now on room air with good O2 saturation. Hospital discharge is anticipated to be soon.

Other Meds:

Current Illness:

ID: 1658910
Sex: M
Age: 35
State: IL

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

Lab Data:

Allergies: None

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Fever (100.2), swelling, redness, warm to touch at injection site, vomiting, nausea, diarrhea, and weakness.

Other Meds: None

Current Illness: None

Date Died: 07/25/2021

ID: 1658911
Sex: M
Age: 63
State: MN

Vax Date: 05/25/2021
Onset Date: 07/25/2021
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: RA

Lab Data:

Allergies: Penicillin

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient passed away on 07/25/2021.

Other Meds: Zyloprim, Tenoretic, Viagra, Valtrex, albuterol, Symbicort, Vit D, Prilosec

Current Illness:

ID: 1658912
Sex: F
Age: 75
State: PR

Vax Date: 07/24/2021
Onset Date: 07/24/2021
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: Female patient 75 years old, 15 minutes after immunization reports feeling chest pain. She reports taking medications daily for high pressure condition. We take her vital signs BP 140/50, pulse 65, saturation 98%. Doctor R. recommends transferring her to a hospital to be evaluated by medical and patient refused transportation. Patient call her Dr. by phone and tells her to go home.

Other Meds:

Current Illness:

ID: 1658913
Sex: F
Age: 68
State: VA

Vax Date: 02/27/2021
Onset Date: 03/01/2021
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: They did blood culture, urinalysis, CBC. They did a CAT scan from the neck down to the hip. I was testes for C reactive protein, different blood culture, HIV, cretin, basic metabolism, QuantiFERON goal tb plus, chem8 istate, FSH. HGBA1C, IEP, LH, All of these came back with no abnormalities

Allergies: Penicillin; Petroleum jelly; Azithromycin; Sulfamethoxazole-trimethoprim; Bactrim; Aloe Vera; Latex; Cortisone; Lemon; Chocolate; Surgical Tape; Garlic

Symptom List: Nausea

Symptoms: They day after, I had extreme fatigue and body aches. From the first dose, I had sweats also but then I had extremely heavy sweating following the second dose. It got extremely worse. I would have to wake up and change my clothes because it would be soaked. I was sent to the urgent care where I was sent for a diabetes and thyroid check. Those tests came back fine. I also developed a kidney stone. They were still not able to give a solid diagnosis for the sweats I was experiencing.

Other Meds: Multivitamin; Calcium; cardiac xt; Lisinopril; Estradiol; Statin

Current Illness: No

ID: 1658914
Sex: F
Age: 50
State: CA

Vax Date: 07/19/2021
Onset Date: 07/19/2021
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: Allergic to penecillan

Symptom List: Injection site pain

Symptoms: 5-6 hours after I got the 1st shot, I felt a pulling sensation on the inside of my legs, just under the knee area. Because I have a history of varicose veins, the sensation of rubber bands pulling felt familiar to me. It felt like there was pulling/constriction/swelling deep in my legs in that area. This sensation was felt intermittently every day for 3 weeks. Then, over the next couple weeks, the intensity and frequency faded. At about week 5 it stopped completely. Additionally, since I got the shot, it feels more difficult to get a full deep breath. Now, 6 weeks later, I still notice it, especially when doing exercise. Additionally, exactly one week after the shot, I got "covid arm." My right arm, where I got the

Other Meds: None

Current Illness: None

ID: 1658915
Sex: M
Age: 90
State: FL

Vax Date: 01/07/2021
Onset Date: 07/28/2021
Rec V Date: 08/31/2021
Hospital: Y

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

Lab Data: CXR, covid test.

Allergies: NKA

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

Symptoms: Pt came to ER d/t fall.

Other Meds:

Current Illness:

ID: 1658916
Sex: F
Age: 57
State: AZ

Vax Date: 08/13/2021
Onset Date: 08/16/2021
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: I have not seen the doctor yet. I am calling him today.

Allergies: NKDA, Gluten intolerant

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

Symptoms: I had my 2nd vaccine over two-weeks ago. I have had significant malaise and deep muscle aches with weakness since then. I also have issues with no appetite, and getting nausea with eating more than a little bit. I have been minimizing my symptoms to my family and have not told extended family/friends because they would use it as an excuse to not be vaccinated. When should I be concerned about my symptoms?

Other Meds: Adderall, HCTZ, D3, Magnesium, Amour Thyroid

Current Illness: None

ID: 1658917
Sex: F
Age: 44
State: VA

Vax Date: 08/24/2021
Onset Date: 08/24/2021
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: N/A

Allergies: IVP dye, shellfish, morphine, zithromax (IV medication cause hives), chicken, eggs, bell peppers, garlic, oregano, and Milk

Symptom List: Tremor

Symptoms: Daily very severe headache since receiving 2nd dose of the Moderna vaccine.

Other Meds: Levothyroine, IH (intracranial hypertension), Sjogren?s Syndrome, Obesity, Chornic headaches due to IH.

Current Illness: See item #9

ID: 1658918
Sex: F
Age: 65
State: FL

Vax Date: 08/24/2021
Onset Date: 08/24/2021
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: Patient went to doctor and given medrol dose pack and benadryl

Allergies: aspirin and naproxen

Symptom List: Erythema, Pruritus

Symptoms: Patient's arms is red at injection site and she has rash on her neck occurring at night post vaccine.

Other Meds: none reported

Current Illness: none reported

Date Died: 07/24/2021

ID: 1658919
Sex: M
Age: 59
State: MO

Vax Date: 04/05/2021
Onset Date: 05/21/2021
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: N/A

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

Symptoms: Death- 7-24-2021 Myocarditis

Other Meds: High blood pressure meds

Current Illness: None

ID: 1658920
Sex: M
Age: 18
State: IL

Vax Date: 08/21/2021
Onset Date: 08/26/2021
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: Called doctor's office on Monday, 8/30/21 AM to report symptoms. Dr. recommended same treatment with the Benedryl and Zyrtec. Dr. advised against getting a Booster vaccine. (nurse) stated they DO NOT report these symptoms to VAERS.

Allergies: NONE

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

Symptoms: Sat, 8/21/21 PM - body aches Sun, 8/22/21 AM - body aches, chills, low grade fever, fatigue Sun, 8/22/21 PM - body aches, chills, low grade fever, fatigue Mon, 8/23/21 AM - body aches, chills, fatigue Mon, 8/23/21 PM - body aches, chills fatigue Tue, 8/24/21 AM - fatigue Tue, 8/24/21 PM - fatigue Wed, 8/25/21 AM - fatigue Wed, 8/25/21 PM - fatigue Thu, 8/26/21 AM - fatigue Thu, 8/26/21 PM - hives on arms and legs Fri, 8/27/21 AM - hives on arms, legs, chest and back Fri, 8/27/21 PM - hives on arms, legs, chest and back Sat, 8/28/21 AM - severe hives on arms, legs, hands, feet, back, chest, scalp (symptoms subsided after Diphenhydramine HCI 25mg) Sat, 8/28/21 PM - no symptoms Sun, 8/29/21 AM - severe hives on arms, legs, hands, feet, back, chest, scalp (symptoms subsided after Diphenhydramine HCI 25mg) Sun, 8/29/21 PM - hives lessened to feet only and subsided on own (no medication taken) Mon, 8/30/21 AM - no symptoms Mon, 8/30/21 PM - no symptoms

Other Meds: NONE

Current Illness: NONE

ID: 1658921
Sex: F
Age: 42
State: AR

Vax Date: 08/23/2021
Onset Date: 08/23/2021
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: No known drug allergies

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Diarrhea, emesis, body aches, fatigue

Other Meds: melatonin, Flonase, Temazepam, Trazodone, paxil, buspirone, naproxen

Current Illness: scratchy throat,

ID: 1658922
Sex: F
Age: 13
State: AZ

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

Lab Data: None

Allergies: None

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

Symptoms: At about 5-10 minutes after patient received the injection, she slouched over in her chair and her sisters and mom called for help. They told me she had passed out. When I came over she was foaming in her month and making a quiet groaning sound. Her sisters said her legs muscles had contracted and bent curled under her seat. She was stiff to move. I put her in the recovery position on her side on the ground. Her eyes were fluttering slightly and she was not able to respond to questions. EMS was on scene, had in She slowly started to come to consciousness again. By the time the paramedics arrived, she was able to answer questions. Mom to patient home. She says everything was fine last night. Patient will follow up with a neurologist.

Other Meds: Naproxen OCT for Migraines as needed for headaches, couple times a week.

Current Illness: None

ID: 1658923
Sex: F
Age: 81
State: MI

Vax Date: 04/02/2021
Onset Date: 08/24/2021
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: NA

Allergies: Advair - SOB Azithromycin - SOB

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

Symptoms: Patient Hospitalized; COVID-19 positive 8.24.21. Admitted for COVID pneumonia. DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Respiratory insufficiency COVID-19 Pneumonia due to COVID-19 virus HOSPITAL COURSE: Patient is a 81 y.o. female who presented with COVID pneumonia. Doing much better at this time. Continued remdesivir and Decadron. Continued supplemental oxygen. Patient finished 3 days total of remdesivir and 3 days of IV Decadron. She has weaned down to 2 L and states she is feeling much better. States her breathing is ?normal for her? at this time. Discharge home on her normal 2 L of oxygen. Will finish an additional 7 days of orally Decadron as an outpatient. Advised her to follow-up in 1-2 weeks with her primary care physician. Active Issues Requiring Follow-up Acute hypoxemic respiratory failure Assessment & Plan Continue on 5 L of oxygen at this time. August 25th: Much improved at this time. On 3 liters oxygen COPD (chronic obstructive pulmonary disease) with chronic bronchitis Assessment & Plan Continue on room meter dose inhaler for chronic obstructive pulmonary disease. August 20th: Patient on 3 liters today. Continue pulmonary regimen. * Pneumonia due to COVID-19 virus Assessment & Plan Patient placed on COVID protocol at this time. Started on remdesivir at this time. Started on IV Decadron at this time. Continue oxygen. She normally is on 2 L of oxygen. Currently on 5 L at this time. Continue to watch closely. August 25th: Continue remdesivir and IV Decadron at this time. August 26th: Finish 3 days of remdesivir and 3 days of IV Decadron. Patient is on her baseline 2 L of oxygen at this time. Placed on orally Decadron 6 mg orally q.day for an additional 7 days. Discharge home at this time.

Other Meds: albuterol (PROVENTIL) (2.5 MG/3ML) 0.083% nebulization albuterol sulfate 108 (90 Base) MCG/ACT cholecalciferol (VITAMIN D3) 50 MCG (2000 UT) capsule dexamethasone (DECADRON) 6 MG tablet diltiazem (CARDIZEM ER) 120 MG 12 hr capsule escitalop

Current Illness: NA

ID: 1658924
Sex: F
Age: 31
State: SC

Vax Date: 04/01/2021
Onset Date: 04/26/2021
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: No

Symptom List: Pain in extremity

Symptoms: Mentsrual cycle came seven days early after the first dose

Other Meds: Citalopram, Sudafed

Current Illness: No

ID: 1658925
Sex: M
Age: 66
State: FL

Vax Date: 06/26/2021
Onset Date: 07/25/2021
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: CXR, covid test-positive.

Allergies: NKA

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

Symptoms: Pt came to ER c/o difficulty breathing, cough, sore throat onset 1 day ago.

Other Meds:

Current Illness:

ID: 1658926
Sex: F
Age: 32
State: UT

Vax Date: 07/24/2021
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: Checked for hormone imbalance. Not there.

Allergies: Cephalosporins

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

Symptoms: Heart Palpitations, no treatment. Excessive, continuous treatment. Excessive menstrual cramping

Other Meds: None

Current Illness:

ID: 1658927
Sex: M
Age: 76
State: OH

Vax Date: 02/02/2021
Onset Date: 07/13/2021
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:

Allergies: None

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

Symptoms: None

Other Meds: Klor-Con Me I, Atenolol/Chlorthalidone, Alfuzosun, Finasteride 5 MG, Rosuvastatin Calcium, 20 MG, Prostate 2.4, Prostate Maintain 600 Plus, Omega Fish Oil 1360 MG, DAILY Aspirin, 81MG.penn

Current Illness: None

ID: 1658928
Sex: M
Age: 75
State: OH

Vax Date: 02/18/2021
Onset Date: 02/20/2021
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: eone

Allergies: Amoxicillin, Codeine, Clarithromycin, Ciprofloxacin, Keflex, Meloxicam

Symptom List: Vomiting

Symptoms: Rash, Pityrisasis Rosea, Treated with Clobetasol mixed in Cerave Cream

Other Meds: Pantoprazole sodium, Enzymes (bile salts), Flonase, B complex, Probiotic, Multivitamin, Metoprolol, Loratadine, Low dose aspirin, Loratadine, Xarelto, Simvastatin

Current Illness: A-Fib, Gerds

Date Died: 07/25/2021

ID: 1658929
Sex: M
Age: 74
State: MN

Vax Date: 02/13/2021
Onset Date: 07/25/2021
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: Codeine, Statins, Sulfa drugs

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient passed away on 07/25/2021.

Other Meds: Roxanol, Zofran, Lasix, Hibiclens, Tylenol, Milk of Mag, Maalox, Celexa, Benadryl, Coreg, Methotrexate, Eliquis, Dulcolax, Plavix, Mycostatin, Glycolax, Senokot, Klor-Con, Zetia, Neurontin, Plaquenil, Folic acid, Loperamide, Multi vit

Current Illness:

ID: 1658930
Sex: M
Age: 65
State: MO

Vax Date: 02/01/2021
Onset Date: 02/28/2021
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: 3/31/2021 ultrasound right axilla measured4.1cm with mildly thickened cortex 4/27/2021 ultrasound right axilla measured3.9cm with mildly thickened cortex advised to return in 6 months

Allergies: none

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

Symptoms: swelling lymph nodes for at least 6 months. Started with right underarm, then to left. Neck and throat have recently stated to hurt. I go for an ultrasound (3rd time) in October. Result show swelling several months after vaccine

Other Meds: Allegra, atorstatin, metformin, Tresiba

Current Illness: none

ID: 1658931
Sex: M
Age: 32
State: IL

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

Lab Data:

Allergies: Seasonal allergies

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Fever (100.9), swelling and redness, warm to touch at injection site, couldn't move arm (now resolved), vomiting, nausea, diarrhea, weakness

Other Meds: None

Current Illness: None

ID: 1658932
Sex: F
Age: 42
State:

Vax Date: 01/15/2021
Onset Date: 01/15/2021
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: RA

Lab Data:

Allergies: penicillin; sulphas; demurral

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

Symptoms: Within a few minutes, I got an intense migraine. I was really lightheaded. I had shooting pains in my head and in my eye. I had to take both my migraine meds and an injection. No matter what I took, the symptoms did not ease for five days.

Other Meds: Lyrica; hydrochloride; migraine med; injection for migraine; narco as needed for nerve pain

Current Illness: none

ID: 1658933
Sex: M
Age: 50
State: TX

Vax Date: 08/27/2021
Onset Date: 08/27/2021
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: Patient stated that about 5 hours after receiving the vaccine the injection site swollen up to the size of a soft ball. He also developed a rash right under the injection site. He stated that the site also had a fever. His lympnodes under arm was hurting. His joints were aching to the point he could barely move. He has a high fever of 102.1. He also has headaches.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am