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: 1659087
Sex: F
Age: 70
State: PA

Vax Date: 03/01/2021
Onset Date: 03/05/2021
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: LA

Lab Data: X-ray shows arthritis in my back. The first available appointment for the nerve test was September 16th. It is scheduled with the doctor.

Allergies: cefuroxime, codeine, iodine, nitrofurantoin, Elmiron, tetracycline, sulfa antibiotics, peanuts, shellfish, soy protein..

Symptom List: Dysphagia, Epiglottitis

Symptoms: 5 days after the shot, the right side of my body felt like it was on fire; it felt like a jolt of electricity was shooting through it. Exactly 4 weeks after the shot, I was admitted to the hospital through the ER with Afib - this was new to me. 21 weeks after the shot, I started feeling 'pins and needles' on my left side (lower back, buttocks, leg and toes. I saw my PCP who ordered a back xray, and nerve test (scheduled for Sept. 16th)

Other Meds: atorvastatin

Current Illness: none

ID: 1659088
Sex: F
Age: 21
State:

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

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient reported discoloration and white patchy areas on tongue. Not painful and not raised. Based on my research the closest thing I could find was "covid tongue".

Other Meds:

Current Illness:

ID: 1659089
Sex: F
Age: 68
State: AR

Vax Date: 08/10/2021
Onset Date: 08/10/2021
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:

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

Symptoms: Patient contacted me stating after she arrived home from receiving her vaccine that her "tongue felt thick and legs were shaking uncontrollably." She called her primary doctor and they sent her to the ER. Patient stated that she didn't receive any treatment at the ER ,but her primary doctor advised her to not receive 2nd vaccine.

Other Meds:

Current Illness:

ID: 1659090
Sex: F
Age: 19
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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient fainted a few minutes after her vaccination. She regained consciousness within a few seconds. Paramedics were called and she was examined. She was okay and declined transport to the hospital.

Other Meds:

Current Illness:

ID: 1659091
Sex: F
Age: 40
State: NC

Vax Date: 08/10/2021
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: LA

Lab Data: Diagnosed Shingles 8/30/21

Allergies: None

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

Symptoms: Developed Shingles - first symptom 8/21 (pain - right side of body), rash appeared (lower right side of back) 8/28, diagnosed 8/30, medication started 8/30

Other Meds: Metoprolol Baby Aspirin

Current Illness: None

ID: 1659092
Sex: M
Age: 20
State: CA

Vax Date: 05/19/2021
Onset Date: 05/22/2021
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: EKG, Troponin, Chemistry Panel, on May 23 All tests were normal and did not show any abnormality

Allergies:

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

Symptoms: 3 days after vaccine, started chest pain which also spread to shoulder. It felt like tightly squeezing the arm.

Other Meds:

Current Illness:

ID: 1659093
Sex: M
Age: 14
State: MO

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: IM
Vax Site: LA

Lab Data: Chest xray, CBC,CMP done 8-31-2021

Allergies: No.

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Fever 101.6 Chest Pain Headache Short of Breath

Other Meds: None.

Current Illness: None.

ID: 1659094
Sex: F
Age: 58
State: NV

Vax Date: 02/24/2021
Onset Date: 07/26/2021
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: No

Allergies: Penicillin - any cillin products; Lyrica and Cymbalta

Symptom List: Pharyngeal swelling

Symptoms: Right afterwards, I had soreness of arm for several days. Like someone punched me in the arm. (Injection site arm.) This lasted for days. I didn't have a fever or anything else. Last week in July - I started getting a rash/eczema condition. It started in hands and it went up my wrist and went up my upper arms and it's scaly and then it started on my legs and going up my legs, too. It gets worse at time and then it gets somewhat better and then gets worse again. It hasn't gone away though since it started. It's itchy and scaly. I am putting an eczema cream (cortisone) on it and I have an ant-itch spray that I spray at night sometimes. Because sometimes my ankles and lower legs start itching really bad and it's hard to sleep. These help a little to relieve that. Dermatologist - waiting on my referral approval that visit. Should get it this week. My doctor has looked at it. Note: About 6 weeks after the second vaccine, I had the first Shingles vaccine and then in the timeframe required after that I had the 2nd Shingles vaccine. My rash/eczema symptoms didn't show up until after those vaccines.

Other Meds: Oxycodone 10 mg three times a day; Oxybutynin - 5 mg 3 times a day; 2 mg twice a day: Requip; Escitalopram 20 mg once a day; Omeprazole - 20 mg once a day.

Current Illness: no

ID: 1659095
Sex: F
Age: 35
State: FL

Vax Date: 08/24/2021
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: None

Allergies: Sulfa

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: I was 20 weeks pregnant when I received the 2nd dose. Day after the shot started feeling a bit of fatigue and shortness of breath.

Other Meds: Baby aspirin, prenatal vitamins, omega 3

Current Illness: None

ID: 1659096
Sex: F
Age: 71
State: AZ

Vax Date: 04/07/2021
Onset Date: 05/21/2021
Rec V Date: 08/31/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: xrays, ct scan echo gram

Allergies: Allergic to pennicillin, teramyacin, erythromycin, medrol, morphine, Percocet, tylenol w/cod#3, carvedilol, Macrobid, paxil and nitrofurantoin. Can not take dalauadid makes me feel weird?, sulfa and levaquin all makes me sick. Prednisone makes sugar levels high I can take Keflex, cefdiner, doxycycline monohydrate, doxycycline 100mg, rocephin, caftan 500mg, bacterium, cefuroxime 500mg, hydrocodone, acetaminophen and oxycodone

Symptom List: Diarrhoea, Nasal congestion

Symptoms: going blind and developed pulmonary hypertension

Other Meds: none

Current Illness: none

ID: 1659097
Sex: M
Age: 27
State: MD

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: NA

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

Symptoms: Patient had a fainting episode after receiving a dose of Janssen Covid-19 Vaccine. Patient walk out of the consultation room, and immediately reported feeling lightheaded and fell backwards landing on his buttocks first and then hitting is head. The pharmacy staff called 911 and they came within about 5 minutes. The patient quickly recovered and was sitting up by the time the medics arrived. The patient refused service, citing feeling much better.

Other Meds: NA

Current Illness: NA

ID: 1659098
Sex: F
Age: 14
State: VA

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: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data: none

Allergies: unknown

Symptom List: Rash, Urticaria

Symptoms: patient felt light headed roughly 5min after shot, pt Mom states patient did not eat since 12pm

Other Meds: unknown

Current Illness: unknown

ID: 1659099
Sex: F
Age: 39
State: CA

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: NKA

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

Symptoms: At 1500 client was sitting in observation area and notified PHN that she was feeling a "heaviness in her chest? and reported a new onset of sinus congestion. Client denied dizziness, denied shortness of breath, difficulty breathing, or swelling in her throat our mouth. No rash observed. Vital signs taken at 1510 (oxygen 98%, heart rate 88 bpm, blood pressure 110/58, respirations 16). At 1515, the client stated that it "feels worse, but it's nothing out of the ordinary." At this time, PHN offered the client 50 mg of PO Benadryl, which the client accepted. Vital signs taken at 1515 (oxygen 98%, respirations 16, heart rate 92, blood pressure 110/80). Client has a history of Crohn's Disease, skin cancer, SVT, low blood pressure and migraines. Client reports a history of ?chest heaviness? after receiving her first dose of Moderna, when she receives IV infusions for her Crohn's Disease, and with other injections. Client has completed evaluations with immunologist, and states has ?no allergy? to anything. PHN elevated the client's situation to PHN before she received the vaccine onsite today. Per CDC guidelines the client was approved to receive the vaccine. Client states she was also cleared by her immunologist as well. PHN offered to call EMS, which the client refused and stated, "this is normal. I was feeling anxious after it started. I get anxious every time it happens." At 1525, client stated, "it's feeling better." At 1540, client stated, "I feel a lot better." Vital signs at 1540 (respiration 16, oxygen 98%, heart rate 77, blood pressure 105/78). Client has no known allergies. Client is currently taking Colestid, Wellbutrin, Lialda, Rizatriptan, vitamins, and has an Antivio infusion once a month. PHN reviewed symptoms of emergency with the client, and when to seek emergency services. PHN also instructed the client to follow up with her primary care provider within 24 hours. Client called her parents to come pick her up. Client reported symptoms resolved as client left the facility at 1602 unassisted and with a steady gait.

Other Meds: Colestid, Wellbutrin, Lialda, Rizatriptan, vitamins, and has an Antivio infusion once a month

Current Illness:

ID: 1659100
Sex: F
Age: 68
State: NE

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: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: N/A

Allergies: Nothing

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

Symptoms: I had zero symptoms with my first two shots (2/20/21 and 3/13/21). After getting my 3rd shot at 10:30 AM on 8/28/21 (Saturday), in the middle of the night, I woke up with a very sore left arm, extreme muscle aches all over my body, the chills, headache, nausea, and extreme fatigue. I slept a total of 29 hours. By Tuesday (8/31/21) I was back to normal. I just found that I experienced all of these symptoms with the third shot after having zero with the first two.

Other Meds: Levothyroxine; Montelukast; Trintellix; Buspirone; Pravastatin; Olmesartan; Latanoprost; Vyzulta; Carteolol; Fluticasone Propionate and Salmeterol inhaler; baby aspirin; Allegra; Mucinex; Vitamin D3; Calcium; Vitamin C.

Current Illness: N/A

ID: 1659101
Sex: F
Age: 40
State: NM

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: N/A

Allergies: NKDA, no food allergies

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

Symptoms: had no reaction day of vaccine I noticed red bumps on my right upper arm and down my arms , morning of 8/31/2021, by lunch time I noticed red bumps on my upper thighs and chest neck and face did not itch or both but was very visible Benadryl, Zyrtec and pepcid taken

Other Meds: paxil, myrbetriq, centrum vitamins, vitamin B complex, Vit B12, caltrate

Current Illness: N/A

ID: 1659102
Sex: F
Age: 42
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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Within 5-10 minutes after administration of the vaccine the patient started experiencing diaphoresis, nausea, headache and slight chest pressure. Pt denied dizziness, SOB, cough, swelling in face/tongue/throat or rapid heart beat. Pt given juice and monitored. Pulse was normal. After waiting an additional 20 minutes patient continued to have same symptoms with extra attention to headache and nausea. Pt did mention she had not eaten normal qty's and was poorly hydrated on day of vaccine. Pt was able to leave clinic/pharmacy on own with no further intervention.

Other Meds:

Current Illness:

ID: 1659103
Sex: M
Age: 32
State: UT

Vax Date: 08/05/2021
Onset Date: 08/23/2021
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:

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

Symptoms: Increased heart rate at irregular time . Mostly felt it during rest hours or while trying to sleep or in mid of sleep. Heart rate goes up for few minutes and then becomes normal. At such times, can feel the heart is pumping and makes body shake automatically.

Other Meds:

Current Illness:

ID: 1659104
Sex: F
Age: 32
State: AL

Vax Date: 01/26/2021
Onset Date: 05/28/2021
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: CBC, TSH, metabolic panel: all results in normal range; lab work performed on 7/22/21. Echocardiogram showed normal results (no structural abnormalities) on 8/12/21.

Allergies: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Heart palpitations: I experienced 3 tachycardia episodes between 5/28/21 and 7/2/21. Each heart episode was ~3 minutes long, and my heart rate was 160-200bpm during each episode. I began tracking my heart rhythm with a smart watch, and I also wore a Holter monitor for 48 hours to confirm diagnosis. I was diagnosed with supraventricular tachycardia by my primary care doctor on 6/4/21, and I was referred to a cardiologist who confirmed diagnosis on 7/22/21. I was prescribed propafenone to use PRN for heart palpitations. My echocardiogram showed normal results, no structural abnormalities of the heart. I am being considered for heart ablation surgery in the near future.

Other Meds: -Medroxyprogesterone injection (every 3 months) -Multivitamin -Calcium + vitamin D

Current Illness: None

ID: 1659105
Sex: F
Age: 16
State: RI

Vax Date: 08/19/2021
Onset Date: 08/20/2021
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: 8/21/21 - CBC, BMP, PT/INR, DDIMER, Troponin, pregnancy urine, CXR, EKG

Allergies: NKA

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Generalized body aches, chills, diaphoresis, fatigue, mild headache, pain in chest with deep breathing and SOB.

Other Meds: ASA 81 mg

Current Illness:

ID: 1659106
Sex: F
Age: 32
State: MO

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

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

Symptoms: Patient reported experiencing arm swelling, redness, warmth, and soreness around the area of injection site after receiving the 2nd dose of Moderna vaccine. Photo showed picture of deltoid area, redness around the deltoid , extending approximately half-way down to elbow. Patient developed a bruise at injection site but reported the bruise is fading, and the swelling has gone down. She experienced fever and fatigue after the injection, but reported not having to seek medical attention. She said fever escalated to over 103 deg. F. She used OTC treatment to help with fever and arm pain. She said she has recovered from all fever/fatigue symptoms as on 8/31/21. Arm swelling has gone down and redness around injection site is decreasing. She added that she experienced a similar local injection site reaction after first dose, but it was smaller and not to the extent of the reaction she experienced after the 2nd dose. She reported having no systemic symptoms after the first dose.

Other Meds: DESVENLAFAXINE ER 25MG, LORAZEPAM 0.5MG

Current Illness: UNKNOWN

ID: 1659107
Sex: F
Age: 77
State: TN

Vax Date: 07/24/2021
Onset Date: 08/01/2021
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: Patient received the Pfizer vaccine series on 2/3/21 and 2/24/21. She asked to receive the Shingles vaccine on 7/24/21 but was administered the Moderna vaccine series on 7/24/21 and 8/28/21. She did not realize until after the series was complete that it was the Moderna vaccine and not the Shingrix. She reports no side effects or adverse events other than a sore arm and a small knot at the injection site that resolved on its own in a few days.

Other Meds:

Current Illness:

ID: 1659108
Sex: F
Age: 52
State: CA

Vax Date: 08/28/2021
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: None

Symptom List: Unevaluable event

Symptoms: I have not had a period in over a year, I am past menopause and exactly three days after getting vaccinated I have started bleeding, and have a period again. I know this is not normal. I also have period cramps and bloating, as I used to when I had regular periods. Being 52 and having a period again after menopause is what I want to report. This should not be happening. This is from getting the Johnson & Johnson vaccine.

Other Meds: None

Current Illness: None

ID: 1659109
Sex: F
Age: 20
State: TN

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: N/A

Allergies: Ibuprofen, aspirin, Mucinex

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

Symptoms: Nausea, vomiting, and feeling hot.

Other Meds: N/A

Current Illness: Pt stated allergies and asthma

ID: 1659110
Sex: F
Age: 62
State: FL

Vax Date: 02/18/2021
Onset Date: 02/18/2021
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: CT scan normal

Allergies: Z-pak

Symptom List: Injection site pain, Pain

Symptoms: On the day of the vaccine at 06:00 pm I was fatigue. On the 02/19/2021, when I woke up I had very heavy legs and dizzy. After that I was in a complete tailspin of being dizzy all the time and blood pressure spikes, but mainly dizzy. Every time I was driving to work, I was dizzy. I had to get help to get out of the car. Once I got out of the car it was activated again. I felt like if I pressed on my pulse points it would feel better. I applied strips of tape on lymph nodes around my neck and on my wrist and it made me feel better. And I had rapid heartbeat the whole time. I was coming home and going straight to bed because I was exhausted. At work I was mean and nasty which is not like my character. I felt like I was drug induced. The only way I would feel better was to try to eat and drink. I drove myself to the Emergency Room in March, and I told them I was having a stroke or heart attack and I was dizzy. My heartbeat was really fast all the time. They took CT scans, and everything was normal. They prescribed meclizine at the ER, it made me feel sleepy, I only took one that they gave me at the hospital. It lasted like this until April 20, 2021, it subsided on its own. Like I woke up from the end of the side effects of the vaccine. The emergency room doctor advised me not to take the Moderna Dose 2.

Other Meds: None

Current Illness: No

ID: 1659111
Sex: M
Age: 12
State: KS

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: SYR
Vax Site: LA

Lab Data: ER visit with lab work and CT head

Allergies: None

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient had a syncopal episode around 5 minutes after vaccines and fell to the ground, striking his head on the floor.

Other Meds: None

Current Illness: None

ID: 1659112
Sex: M
Age: 52
State: WA

Vax Date: 03/10/2021
Onset Date: 03/23/2021
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: ENT appointment scheduled for November 2, 2021

Allergies: None

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

Symptoms: Tinnitus started about 2 weeks after second dose.

Other Meds: None

Current Illness: None

ID: 1659113
Sex: M
Age: 14
State: CA

Vax Date: 08/30/2021
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: None

Allergies: NKDA

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient developed a sudden onset of chest pain that occurs with inspiration and expiration. He has shortness of breath and pain in his left side.

Other Meds: None

Current Illness: Unknown

ID: 1659114
Sex: M
Age: 69
State: MN

Vax Date: 03/30/2021
Onset Date: 04/06/2021
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: none

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Severe Guttate Psoriasis

Other Meds: none

Current Illness: none

ID: 1659115
Sex: F
Age: 15
State: GA

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: RA

Lab Data:

Allergies: PENICILLINS- RASH, SWELLING OF FACE AND LIPS

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

Symptoms: - RASHES AROUND THE INJECTION SITE - RASHES APPEARED AND DISAPPEARED SEVERAL TIMES

Other Meds:

Current Illness:

ID: 1659116
Sex: M
Age: 62
State: MD

Vax Date: 04/27/2021
Onset Date: 04/27/2021
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: none

Allergies: none

Symptom List: Nausea

Symptoms: Patient presented today 8/31/21 and reported that since getting vaccine he had experienced soreness and pain in arm and limited ROM since vaccine. Has seen ortho, had MRI, intraarticular steroid injection and medrol dose pack taper

Other Meds: ascorbic acid (Vitamin C), PO, Daily, 0 Refill(s) 2. aspirin (aspirin 81 mg oral tablet), 81 mg, 1 tab, PO, Daily, 90 tab, 0 Refill(s) 3. cyanocobalamin (Vitamin B12), Daily, 0 Refill(s) 4. ergocalciferol (Vitamin D), PO, Daily, 0 Ref

Current Illness: none

ID: 1659117
Sex: M
Age: 51
State: CA

Vax Date: 04/01/2021
Onset Date: 05/01/2021
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: MRI, LP, EMG

Allergies: Penicillin

Symptom List: Injection site pain

Symptoms: Pt developed severe Guillain Barre syndrome around 3 weeks after vaccine administration

Other Meds: None

Current Illness: None

ID: 1659118
Sex: F
Age: 79
State: AR

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

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

Lab Data: none

Allergies: codeine

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

Symptoms: On same night, my BP was high. Checked BP and it was high 204/89 BP & and daughters went emergency with daughters. Medication to bring down. It took an hour for BP to go down.

Other Meds: Atorvastatin - 10 milligram; Flecainide - 100 milligrams 2 times a day; Eliquis - 5milligram twice a day; Metoprolol - 25miiligram; Coq10 - 100 milligram a day; Vit D; Dorzolamide- 10/1 drop twice a day. Symbicort

Current Illness: no

ID: 1659119
Sex: F
Age: 37
State: TX

Vax Date: 08/29/2021
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: IM
Vax Site: RA

Lab Data: none. Prescribed prednisone

Allergies: none

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

Symptoms: 8/30/21 at 9:30 started having numbness/tinlging to lower lips with swelling. Felt some throat tightness and chest pressure. Took benadryl and reduced. Woke up next morning and swelling present. Took another benadryl and improved with mild swelling remaining.

Other Meds: none

Current Illness: none

ID: 1659120
Sex: M
Age: 84
State: MT

Vax Date: 02/06/2021
Onset Date: 07/31/2021
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: SARS-CoV-2 RNA Resp Ql NAA+probe DETECTED Ordered Test: SARS-CoV-2 RNA Resp Ql NAA+probe Ordered Test Codes: 94500-6 Status: Final Accession Number: 212120014LP-198922 Specimen Source: SOFT TISSUE SAMPLE Specimen Site: ENTIRE NASOPHARYNX(181200003) Specimen Collection Date/Time: 2021-07-31 06:58:00.0 SARS-CoV-2 (COVID-19) RNA [Presence] in Specimen with probe detection (SARS Coronavirus 2 RNA) Detected Ordered Test: SARS-CoV-2 (COVID-19) RNA [Presence] in Specimen with probe detection (SARS Coronavirus 2) Ordered Test Codes: 94309-2 /2019nCoV (L LOCAL) Status: Final Accession Number: 1574472 Specimen Source: Other Specimen Site: Specimen Collection Date/Time: 2021-07-30 00:00:00.0

Allergies: ? Sulfa Antibiotics ? Turkey [Poultry]

Symptom List: Tremor

Symptoms: Case completed the 2 dose Covid vaccine series on 2/6/21, then was admitted to hospital for Covid disease on 7/31/2021.

Other Meds: acetaminophen (TYLENOL) 325 mg tablet Take 650 mg by mouth every 4 hours as needed for Pain. albuterol (VENTOLIN HFA) 90 mcg/puff inhaler Inhale 1 puff into the lungs every 4 hours as needed for Wheezing (coughing fit, anxiety).

Current Illness: ? Autism disorder ? BPH with obstruction/lower urinary tract symptoms required straight cath in hospital multiple times 2/2018 ? CHF (congestive heart failure) (HCC) 11/2016 echo done at CMC. EF 60-65% wtih diastolic dysfunction ? CKD (chronic kidney disease), stage III (HCC) baseline Cr ~ 1.6 as of 3/2018 ? COPD (chronic obstructive pulmonary disease) (HCC) ? Coronary artery disease ? Hypertension ? MSSA bacteremia 09/2014 at CMC treated with iv ancef/rifampin. TEE neg for vegetations. ? Small bowel perforation (HCC) 03/2018 microperforation, unclear etiology, hospitalized, managed with bowel rest and antibiotics

ID: 1659121
Sex: M
Age: 32
State: WA

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Initially, I only had pain at the injection site. About 10 hours later I started to become fatigued and have chills. This is around the time that I went to bed. All through the night I was running a fever of about 101.4 degrees Fahrenheit oh, and my pulse is racing at about 108 beats per minute. I can feel my head pulsating and towards morning a headache came on. I did not take any medication and was just waiting for the fever to pass.

Other Meds:

Current Illness:

ID: 1659122
Sex: F
Age: 51
State: MA

Vax Date: 02/26/2021
Onset Date: 02/26/2021
Rec V Date: 08/31/2021
Hospital: Y

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: blood work X-ray Covid test flu test

Allergies: Penicillin, strawberries

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

Symptoms: About 2 hours after the 2nd dose, I was extremely tired and slept the whole weekend. I had a fever 103, no appetite, diarrhea, arm pain, body aches, and nausea. The symptoms did not go away so I consulted with my doctor who instructed me to keep an eye on it. On day 3, the symptoms increased and I could not eat or drink and I felt very nauseas so I decided to go to the ER. I was given an IV and I was admitted for a total of 7 days. They ran a bunch of tests and labs and everything came back normal. I was discharge with instructions to keep hydrated. I am still suffering from nausea, diarrhea, and body aches. The symptoms have not improved over time and have not resolved.

Other Meds: Topamax; Ramipril; Citalopram, Diltiazem, Multivitamin, Vitamin D, Vitamin B12

Current Illness: none

ID: 1659123
Sex: M
Age: 62
State: AZ

Vax Date: 07/13/2021
Onset Date: 07/14/2021
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:

Allergies: NONE KNOWN

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

Symptoms: FEVER, HEADACHES, BODY ACHES, DIARREAH, SORE LUNGS, SHORTNESS OF BREATH, MORE HEADACHES, MORE FEVER

Other Meds: OLMESARTEN, METOPROLOL, ATVORASTATIN

Current Illness: NONE

ID: 1659125
Sex: F
Age: 28
State: VA

Vax Date: 08/31/2021
Onset Date:
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: Extremely irritable and hot flashes

Other Meds: Non

Current Illness:

ID: 1659126
Sex: F
Age: 13
State: MA

Vax Date: 06/07/2021
Onset Date: 08/07/2021
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: SYR
Vax Site: LA

Lab Data: Nuerologist review on August 12, 2021 as part of Hospital stay. Lyme Disease testing on August 30, 2021.

Allergies: None

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

Symptoms: Trouble breathing starting within 10-days. Saw a Pulmonologist and determined GERD related and prescribed Prilosec. Seizures/loss of motor control started around August 6th and were occurring around 1-2 times per days. ER and transfer to Hospital admission on 8/12/2021. Starting around August 21st, loss of feeling in the lower extremities, loss of motor control below the waist, increased Knee/Joint pain, currently confined to wheelchair with no firm diagnosis to cause.

Other Meds: None

Current Illness: None

ID: 1659127
Sex: F
Age: 39
State: VA

Vax Date: 08/27/2021
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: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Non

Allergies: Non

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

Symptoms: Fever (over 101), headache, muscle aches, nausea, diarrhea, extreme fatigue. Fever and muscle aches lasted for around 32 hours. Nausea and diarrhea is still ongoing. Headache comes and goes, but is still ongoing.

Other Meds: Non

Current Illness: Non

ID: 1659128
Sex: F
Age: 17
State: KY

Vax Date: 08/25/2021
Onset Date: 08/26/2021
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: No tests have been performed since she received the Meningococcal vaccine. I called her doctor on Monday August 30th to report the episodes of illness that occurred over the weekend. They told me to get her tested for Covid-19 even though I'm certain she does not have Covid-19. I don't think it's in her best interest to go back to a doctor's office anytime soon as her immune system is arguably weak right now and I don't want to expose her to any additional ailments.

Allergies: Occasionally apples and pears

Symptom List: Pain in extremity

Symptoms: In the middle of the night of August 26th, following her afternoon vaccine shot on August 25th, pt. developed incredible pain in her elbow, knee, and finger joints. She experienced fatigue and bouts of diarrhea from August 26th through August 30th. She developed a severe headache and swollen neck/jaw glands (Friday, August 27th) along with non-stop sneezing (Saturday, August 28th) that lasted until Monday, August 30th. She still has swollen glands and fatigue, however, the headache, diarrhea, and sneezing are diminishing. On Tuesday, August 31st, she is now starting to develop psoriasis on her scalp (which has been at bay for over a year).

Other Meds: Isotretinoin Xyzal

Current Illness: None

Date Died: 07/29/2021

ID: 1659129
Sex: M
Age: 69
State: WA

Vax Date: 01/28/2021
Onset Date: 07/29/2021
Rec V Date: 08/31/2021
Hospital: Y

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

Lab Data: Positive COVID-19 test on 7/24/2021

Allergies: Unknown

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

Symptoms: Patient died of COVID-19 illness on 07/29/2021

Other Meds: Unknown

Current Illness: Unknown. Patient contract pneumonia as a result of COVID-19 illness.

ID: 1659130
Sex: M
Age: 31
State: TX

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies: None

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

Symptoms: I had muscle pain and felt feverish the night after I received the treatment. My temperature was 99.4 but I am normally in the 97 range, so this is abnormal for me. The next morning I had a splitting headache (one of the worst I've ever had) that made it extremely difficult to walk. When I laid down, the headache would get significantly worse for several minutes. I would estimate a 7/10 on a pain scale for that location. Treated with ibuprofen with symptoms subsiding the next day.

Other Meds: Dexilant, 30mg

Current Illness: None

ID: 1659131
Sex: F
Age: 19
State: KY

Vax Date: 08/07/2021
Onset Date: 08/15/2021
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

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

Symptoms: 2 weeks after shot: extreme pins and needles in arm and legs, fatigue, dizziness, nausea, muscle spasms 3 weeks after shot: pins and needles went away, now having high resting heart rate at 90bpm, goes up to 130 when standing. Gi issues, fatigue/dizziness comes and goes. Muscle spasms still but now occasional.

Other Meds: No

Current Illness: No

ID: 1659132
Sex: F
Age: 77
State: FL

Vax Date: 01/26/2021
Onset Date: 08/21/2021
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: Oxycodone, Tramadol, Levaquin, Lisinopril

Symptom List: Vomiting

Symptoms: Vaccinated patient hospitalized for COVID-19.

Other Meds:

Current Illness:

ID: 1659133
Sex: M
Age: 44
State: MI

Vax Date: 08/16/2021
Onset Date: 08/17/2021
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: N/A

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Shot on Monday. Tuesday night developed body soreness and fever between 100-101. Overnight Tuesday woke up shaking with fever over 102. Wed had a fever over 103 all day/night taking advil every 4 hours. Late Wed night, early Thursday morning, woke up shaking again with fever of 105.2. Could not function enough to go to doctor. Fever finally broke Thursday morning waking up soaking wet. Ran a temp of about 100-101 for the next few days after that but felt much better.

Other Meds: Advil

Current Illness: N/A

Date Died: 08/24/2021

ID: 1659134
Sex: M
Age: 61
State: TX

Vax Date: 04/01/2021
Onset Date: 08/01/2021
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: COVID positive 8/1/2021, 8/20/2021, and 8/24/2021. Clostridium difficile positive 8/14/2021

Allergies: No known allergies

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

Symptoms: Janssen (J&J) COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Janssen Vaccine on 04/01/2021. Patient presented to ED with complaints of shortness of breath x 3 days. On arrival he was placed on high flow nasal cannula. Patient was mechanically ventilated on 8/5/2021 due to worsening hypoxia. Patient received dexamethasone & remdesivir. Patient was transferred to hospital on 8/5/2021. Patient received methylprednisolone, cefepime, meropenem, metronidazole, & vancomycin IV and PO. Hospital course progressed without meaningful recovery of lung function. On 8/24/2021, family decided to move to comfort care. Patient expired on 8/24/2021.

Other Meds: Aripiprazole 10 mg daily, pepto-bismol 262 mg every 6hrs PRN, lisinopril 5 mg daily, omeprazole 20 mg daily, sertraline 25 mg daily, zolpidem 5 mg daily at bedtime, Tylenol #3 1-2 tabs every 6 hours as needed.

Current Illness:

ID: 1659135
Sex: F
Age: 43
State: TX

Vax Date: 03/19/2021
Onset Date: 03/01/2021
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: Latex, iodine, Lyrica, steroids

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Migraine Head aches and Left Arm tingles and hurts from shoulder to finger tips.

Other Meds: Omeprazole, Duloxetine, spironolactone, alprazolam, iron, vitamin D, Women's A-Z vitamins,

Current Illness: Fibromyalgia, Chronic Fatigue Syndrome, Interestrail Cystitis, Myofacial Pain, Spinal Stenios, Endometriosis, Gerd, positive ANA, IBS

ID: 1659136
Sex: M
Age: 34
State: CA

Vax Date: 08/29/2021
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: RA

Lab Data: None

Allergies: NKA

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

Symptoms: Fever, chills, body aches, head aches

Other Meds: None

Current Illness: None

ID: 1659137
Sex: F
Age: 21
State: WI

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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Omeprazole, Cinnamon, and Amoclan

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

Symptoms: I had about 5 minutes left to wait there and at that time I started noticing that my throat was feeling weird, kind of scratchy but also it was harder for me to swallow. The doctor and nurse had come out to keep an eye on me and they gave me some water and it helped the scratchy part, but it was still hard for me to swallow for about 4-5 hours after getting the vaccine and today my throat still doesn't feel normal.

Other Meds: No medications were taken.

Current Illness: No other illnesses

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am