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: 1662182
Sex: F
Age: 39
State: VA

Vax Date: 02/25/2021
Onset Date: 04/07/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data: 5/18/2021 EKG, Holter Monitor for 2 weeks, blood work Panel 04/08/2021, CT scan of chest 04/22/2021, Complex duplex scan of abdomen and blood flow scan 04/16/2021, CT of brain 04/14/2021, positive tachycardia showed on heart monitor

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: First dizzy spell went away after a few minutes, when it happened a second time at work the school nurse took my BP it was extremely high, she wanted to send me to hospital, I went to see my doctor, they did an EKG she put me on hydrochlorothiazide, my heart rate continued to remain high so the doctor switched my medicine to amlodipine besylate, I'm still on that medication My BP has stayed relatively stable on cusp between normal to stage 1. My heart rate has been normal on medicine.

Other Meds: Daily multivitamin; birth control

Current Illness:

ID: 1662183
Sex: F
Age: 50
State: GA

Vax Date: 01/01/2021
Onset Date: 01/06/2021
Rec V Date: 09/01/2021
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: None

Symptom List: Anxiety, Dyspnoea

Symptoms: left side of facial swelling and swelling of the tongue lasted for a bout 2 days for swelling to go down

Other Meds: None

Current Illness: None

ID: 1662185
Sex: F
Age: 57
State: WI

Vax Date: 07/19/2021
Onset Date: 07/29/2021
Rec V Date: 09/01/2021
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: see above

Allergies: penicillin

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

Symptoms: 10 days after first vaccine, experienced deep thoracic pain with increased in severity over the course of 3 days to pain and numbness in the upper/middle back (T1-9). The symptoms of numbness wrapped around to the chest and abdomen, right triceps, and 4th and 5th digits. I lost abdominal wall, triceps strength. Pain was incredibly intense in the upper/middle back to the point that I was unable to tolerate lying in bed in any position resulted in needing to sit upright in a chair to dose on and off throughout the night. On average, I slept 2-3 hours per night for 3 weeks. I am now able to sleep propped up in bed most nights otherwise I am up and sleep in a chair currently. I have seen a Chiropractor, Physiatrist, and was seen in an Emergency Department (untenable night pain required Morphine to ease the pain for 4 hours). I have had x-rays of the neck and torso. I have had MRI of the c-spine and t-spine - all diagnostic tests were normal and did not explain the incredible nerve pain and numbness. I am currently on Gabapentin every 8 hours and Hydrocodone prn up to every 6 hours.

Other Meds: 5000 IU vitamin D, 1000 IU vitamin C

Current Illness: none

ID: 1662186
Sex: F
Age: 58
State: NC

Vax Date: 02/24/2021
Onset Date: 08/03/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data: COVID PCR test. And it was positive.

Allergies: I have an allergy to cinnamon; corn silk; allergy to antihistamine

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: I had a sore arm. In August I tested COVID. I had a lot of symptoms and got really sick. Fevers for 4 days, sore throat, lingering cough, lost sense of taste. In bed for entire week. I had head congestion in my head.

Other Meds: Lisinopril; Gabapentin; Verapamil; Metformin; Atorvastatin; Omeprazole; Amlodipine; Topiramate; Trazadone

Current Illness: No

Date Died: 09/01/2021

ID: 1662188
Sex: M
Age: 76
State: TN

Vax Date: 02/02/2021
Onset Date: 09/01/2021
Rec V Date: 09/01/2021
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: PT IS A BREAKTHROUGH CASE OF COVID-19 THAT EXPIRED ON 9/1/2021.

Other Meds:

Current Illness:

ID: 1662189
Sex: M
Age: 68
State: KY

Vax Date: 03/02/2021
Onset Date: 08/31/2021
Rec V Date: 09/01/2021
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: Hospitalization (non-ICU)

Other Meds:

Current Illness:

ID: 1662190
Sex: M
Age: 74
State: PA

Vax Date: 02/13/2021
Onset Date: 08/18/2021
Rec V Date: 09/01/2021
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: 08/26/21 0637 Respiratory virus detection panel Collected: 08/26/21 0537 | Final result | Specimen: Swab from Nasopharynx Adenovirus Not Detected Mycoplasma pneumoniae Not Detected Chlamydophila pneumoniae Not Detected Parainfluenza Not Detected COVID-19 SARS-CoV-2 Overall Result DetectedCritical Enterovirus/Rhinovirus Not Detected Coronavirus Not Detected Respiratory Syncytial Virus Not Detected Influenza A Not Detected Bordetella pertussis Not Detected Influenza B Not Detected Bordetella parapertussis Not Detected Metapneumovirus Not Detected X-ray chest 1 view - Portable Result Date: 8/26/2021 XR CHEST 1 VW PORT IMPRESSION: No evidence of acute cardiopulmonary disease. END OF IMPRESSION: INDICATION: COVID plus hypoxic. TECHNIQUE: Portable AP view of the chest is acquired. COMPARISON: 7/10/2018. FINDINGS: The cardiomediastinal silhouette is unremarkable. No consolidation, effusion, nor pneumothorax is identified. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. CT angiogram chest pulmonary embolism with and without contrast Result Date: 8/26/2021 CTA CHEST WITH ATTENTION TO THE PULMONARY ARTERIES WITH IV CONTRAST IMPRESSION: No obvious central pulmonary neoplasm. Suboptimal evaluation of the more peripheral pulmonary arterial branches due to study limitations. Consider repeat imaging or CT scan as clinically indicated. Mild scattered groundglass opacities suspicious for Covid 19 pneumonia. END OF IMPRESSION: INDICATION: Acute shortness of breath. Concern for pulmonary emboli. TECHNIQUE: Enhanced helical CT scan of the chest was performed from the lung apices to below the diaphragm. 2 mm axial reconstruction with MPR reconstructions. 3D shaded surface display, Maximum Curved Intensity Projection (MIP) and multiplanar reconstructions were performed on an independent workstation and permanently recorded. CONTRAST: 80mL of IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION administered INTRAVENOUS. Quality of contrast opacification was suboptimal opacification of pulmonary arterial system limits sensitivity for detection of pulmonary embolism. Other limitations: Respiratory motion artifact grades image quality and contributes to study limitations. COMPARISON: None available. FINDINGS: No obvious central pulmonary embolism. Evaluation of the segmental and subsegmental pulmonary arterial branches is limited due to suboptimal contrast opacification and extensive bilateral respiratory motion artifact. There are mild scattered groundglass opacities in the lungs bilaterally with rounded morphology and predominantly peripheral distribution; findings are nonspecific but typical of Covid 19 pneumonia. There is calcified granuloma in the right lower lobe. Central airways are patent. No pleural nor pericardial effusion. Coronary arterial calcification and atherosclerosis of the aortic arch. Heart and great vessels are otherwise unremarkable. Thyroid gland and thoracic inlet are within normal limits. There are calcified right hilar l

Allergies: NKA

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: COUGH, BODY ACHES, ED to Hosp-Admission Discharged 8/26/2021 - 8/28/2021 (2 days) Hospital COVID-19, Hypoxemia Sepsis HPI: Patient is a 74 y.o. male with past medical history of type 2 diabetes mellitus, hypertension, hyperlipidemia, obesity, BPH who was admitted to the Hospital with acute respiratory insufficiency with hypoxia secondary to COVID-19 pneumonia. The patient began to have symptoms last Thursday difficulty breathing, shortness of breath, cough, and dizziness when sitting up and was found to be positive for COVID-19. Hospital Course: Acute respiratory insufficiency with Hypoxia secondary to COVID-19 Pneumonia. o He was consented for complete COVID-19 Pneumonia treatment and agreed to treatment with Convalescent Plasma, Dexamethasone, Remdesivir o He has improved with COVID-19 pneumonia treatment including 3 days of IV Remdesevir. He did receive 1 unit of convalescent plasma. o His breathing has remained stable off oxygen. o He will not need oxygen on discharge. o No further need to complete IV Remdesevir treatment or dexamethasone treatment.

Other Meds: acetaminophen (TYLENOL EXTRA STRENGTH) 500 mg tablet alogliptin 25 mg tablet aspirin 81 mg tablet atorvastatin (LIPITOR) 40 mg tablet clopidogrel (PLAVIX) 75 mg tablet empagliflozin (JARDIANCE) 25 mg tablet tablet finasteride (PROSCAR

Current Illness:

ID: 1662191
Sex: F
Age: 72
State:

Vax Date: 04/12/2021
Onset Date: 08/25/2021
Rec V Date: 09/01/2021
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: Pharyngeal swelling

Symptoms: Hospital 8/25/21, second covid vaccine (Pfizer) 5/27/21

Other Meds:

Current Illness:

ID: 1662193
Sex: F
Age: 24
State: ND

Vax Date: 03/04/2021
Onset Date: 03/04/2021
Rec V Date: 09/01/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Vaccine deemed expired after vaccine was administered.

Other Meds: unknown

Current Illness: none

ID: 1662194
Sex: F
Age: 79
State: NJ

Vax Date: 08/30/2021
Onset Date: 09/01/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Just a Moderna Arm with slight pink rash and itch.

Other Meds:

Current Illness:

ID: 1662195
Sex: F
Age: 62
State: GA

Vax Date: 08/18/2021
Onset Date: 08/19/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data: None

Allergies: none

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

Symptoms: I had pain shooting up and down my arm and my hand is numb, and my arm and shoulder is in constant pain.

Other Meds: Tylenol 500 mg, omeprazole 20 mg twice daily, montelukast 10 mg, methylcobalamim 2500 mg, gabapentin 400 mg 4 times daily, calcium, losartan 25 mg twice daily, fluticasonepropionate

Current Illness: None

ID: 1662196
Sex: F
Age: 61
State: OK

Vax Date: 08/25/2021
Onset Date: 08/25/2021
Rec V Date: 09/01/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies: None

Symptom List: Rash, Urticaria

Symptoms: 9:15am 8/25/21-dizziness, lightheaded, hard to focus, loss of balance.10pm 8/25/21 woke up with chills, midnight awoke again with chills & uncontrollable shaking. 8/26/2021 fever of 102.4, aching, sore muscles, large rash on injection site of arm, lump in left lymph node near collarbone, arm is feverish, swollen bright red rash & painful. 9/1/2021. Arm is still somewhat red but lessened quite a bit, lump in lymph node still there but arm is intensely itching.

Other Meds: Gabapentin, synthroid, fusion plus, Wellbutrin, multivitamin

Current Illness: None

ID: 1662198
Sex: F
Age: 39
State: MI

Vax Date: 08/19/2021
Onset Date: 08/21/2021
Rec V Date: 09/01/2021
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: Painful abdominal cramping and headaches starting on Saturday after vaccine. Left arm pain for whole arm and armpit tenderness on Tuesday following vaccine

Other Meds: Prenatal, Allertec

Current Illness: None

ID: 1662199
Sex: F
Age: 11
State: SC

Vax Date: 08/10/2021
Onset Date: 08/10/2021
Rec V Date: 09/01/2021
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: None

Allergies: None

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

Symptoms: Father purposely entered the patient's DOB incorrectly so his daughter could receive the Pfizer vaccine even though she's only 11 years old. Our pharmacy discovered it when we located active insurance coverage before the 2nd shot was received. We did not administer the 2nd shot due to not meeting the required protocol.

Other Meds: None

Current Illness: None

ID: 1662200
Sex: F
Age: 72
State: KY

Vax Date: 04/10/2021
Onset Date: 08/30/2021
Rec V Date: 09/01/2021
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:

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

Symptoms: Pfizer on 3/13 and 4/10. Positive on 8/30. admitted on 8/30 to current

Other Meds:

Current Illness:

ID: 1662201
Sex: M
Age: 45
State: IN

Vax Date: 08/30/2021
Onset Date: 08/31/2021
Rec V Date: 09/01/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Moderate muscle and joint soreness and pain throughout entire body for over 24 hours. Also have more acute pain at the injection site in my left arm. The pain is not debilitating, but it is very uncomfortable and makes it difficult to function in a normal capacity.

Other Meds: None

Current Illness: None

ID: 1662202
Sex: M
Age: 82
State: TX

Vax Date: 08/29/2021
Onset Date: 08/29/2021
Rec V Date: 09/01/2021
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: Oxycodone causes extreme nausea

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

Symptoms: Soreness such that it was painful to move arm, redness about 3.5 inches wide, swelling as of 9/1/2021. Note: I am still experiencing itching and burning of face and eye irritation from shingles that I came down with in the face on July 29, 2020.

Other Meds: Finasteride, Tamsulosin, Allegra, Famotidine, Amitiza, Lumigan, Flonase, Vitamin D

Current Illness:

ID: 1662203
Sex: F
Age: 57
State: NY

Vax Date: 12/23/2020
Onset Date: 08/10/2021
Rec V Date: 09/01/2021
Hospital: Y

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

Lab Data:

Allergies: Ace inhibitors (choking sensation) Atorvastatin (myalgias) Hydralazine (vision changes) Nifedipine (gum swelling Rosuvastatin/simvastatin (myalgias)

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient recently vacationed and presented to the emergency department with mild, non-productive cough, nausea, recurrent vomiting, and mild upper abdominal discomfort x 1 day, and few loose stools. She tested positive for COVID19. She was afebrile, O2 saturation was good on room air, and hypertensive. CXR without pneumonia. She was treated with IV labetalol for hypertension and also received 1 liter of fluids and anti-nausea medications. She was not hypoxic throughout her admission. She received supportive management (acetaminophen, ondansetron) with good effect) and was discharged in asymptomatic condition on 8/13/21.

Other Meds: Amlodipine 10 mg PO daily, sulfasalazine 1000 mg PO BID, famotidine 20 mg PO BID, ibuprofen 800 mg PO TID PRN fever/pain, labetalol 200 mg PO q8h, allopurinol 200 mg PO BID, folic acid 1 mg PO daily, naproxen 500 mg PO BID PRN pain, albuter

Current Illness: Had rectal bleeding warranting ED visit on 11/16/20 in setting of colonoscopy/endoscopy a few months prior with polym (removed) and diverticulosis. Patient was not admitted.

ID: 1662205
Sex: F
Age: 69
State:

Vax Date: 03/31/2021
Onset Date: 08/30/2021
Rec V Date: 09/01/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Hospital 8/30/21. Provider noted second COVID Pfizer vaccination received in April

Other Meds:

Current Illness:

ID: 1662206
Sex: M
Age: 79
State: KY

Vax Date: 02/24/2021
Onset Date: 08/31/2021
Rec V Date: 09/01/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Pfizer on 2/3 and 2/24. Positive on 8/24 admitted on 8/31 to current

Other Meds:

Current Illness:

Date Died: 08/29/2021

ID: 1662207
Sex: F
Age: 95
State: PA

Vax Date: 02/16/2021
Onset Date: 08/29/2021
Rec V Date: 09/01/2021
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: 08/29/21 0423 Respiratory virus detection panel Collected: 08/29/21 0301 | Final result | Specimen: Swab from Nasopharynx Adenovirus Not Detected Mycoplasma pneumoniae Not Detected Chlamydophila pneumoniae Not Detected Parainfluenza Not Detected COVID-19 SARS-CoV-2 Overall Result DetectedCritical Enterovirus/Rhinovirus Not Detected Coronavirus Not Detected Respiratory Syncytial Virus Not Detected Influenza A Not Detected Bordetella pertussis Not Detected Influenza B Not Detected Bordetella parapertussis Not Detected Metapneumovirus Not Detected

Allergies: LevofloxacinShortness of breath / Dyspnea RamiprilCoughing

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

Symptoms: ED to Hosp-Admission Discharged 8/29/2021 (20 hours) Hospital Acute respiratory distress Presenting Problem/History of Present Illness/Reason for Admission Acute respiratory distress [R06.03] Respiratory distress [R06.03] Acute cystitis without hematuria [N30.00] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type [I50.9] Sepsis, due to unspecified organism, unspecified whether acute organ dysfunction present [A41.9] COVID-19 [U07.1] Pneumonia due to COVID-19 virus [U07.1, J12.82] Hospital Course Patient admitted to monitored floor. She was started on non-invasive ventilation, found to have renal failure, and signs of severe sepsis. Upon admission goals of care meeting was held and family opted to withdraw active treatment and transition the patient comfort care. Active Issues Requiring Follow-up Not applicable patient expired

Other Meds: allopurinoL (ZYLOPRIM) 100 mg tablet amiodarone (PACERONE) 200 mg tablet apixaban (ELIQUIS) 2.5 mg tablet aspirin 81 mg tablet B-complex with vitamin C (VITAMIN B COMPLEX WITH C ORAL) esomeprazole (NexIUM) 40 mg capsule ferrous sulfat

Current Illness:

ID: 1662209
Sex: F
Age: 18
State: TX

Vax Date: 08/01/2021
Onset Date: 08/11/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Unevaluable event

Symptoms: Significant changes in my menstrual cycle . I got my period on the 7th of August & a few days into my ovulation cycle , I started to spot brown blood along with some red as well . This went on for about a week to the point where there was so much coming out of me that I had to where tampons . There were no other period side effects other than the bleeding at this time . I normally have a really heavy period and after the week of having a light and brown period, it seems that I started a normal period again! My period is now( 09/21/21) is heavy like it normally is and is the normal color . I also have other symptoms such as bloating , acne , and cramps with this period .

Other Meds: N/A

Current Illness: The month before , everyone in the family got sick . It was a bad cold .

ID: 1662210
Sex: M
Age: 83
State: KY

Vax Date: 04/01/2021
Onset Date: 08/30/2021
Rec V Date: 09/01/2021
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:

Allergies:

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

Symptoms: Moderna on 2/25 and 4/1. Positive on 8/31 admitted on 8/30 to current

Other Meds:

Current Illness:

ID: 1662211
Sex: F
Age: 12
State: UT

Vax Date: 08/31/2021
Onset Date: 09/01/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data:

Allergies: Remedies for the cough

Symptom List: Injection site pain, Pain

Symptoms: Nausea, fever, headache.

Other Meds: None

Current Illness: None

ID: 1662212
Sex: M
Age: 33
State: NE

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data: None

Allergies: NKA

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient. While giving vaccine at the patient requested to receive one, as with any patient I went over the information and patient signed and consented to vaccine. Returning back to it was found that patient had already received a Janssen dose in 5/2021 at another facility.

Other Meds: unknown

Current Illness: NONE

ID: 1662213
Sex: F
Age: 55
State: KY

Vax Date: 05/12/2021
Onset Date: 08/30/2021
Rec V Date: 09/01/2021
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: Pfizer on 4/15 and 5/12. Positive on 8/30 admitted on 8/30 to current

Other Meds:

Current Illness:

ID: 1662215
Sex: M
Age: 90
State: FL

Vax Date: 03/09/2021
Onset Date: 05/28/2021
Rec V Date: 09/01/2021
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: Covid test-positive. Chest xray.

Allergies: NKA

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Pt came to ER d/t coughing spell.

Other Meds:

Current Illness:

ID: 1662216
Sex: F
Age: 67
State:

Vax Date: 03/30/2021
Onset Date: 08/28/2021
Rec V Date: 09/01/2021
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: Hospital 8/28/21. 2nd Pfizer COVID vaccine on 4/18/21 with LOT ER8730

Other Meds:

Current Illness:

ID: 1662217
Sex: M
Age: 98
State: KY

Vax Date: 02/18/2021
Onset Date: 08/31/2021
Rec V Date: 09/01/2021
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: Moderna on 1/25 and 2/18. Positive on 9/1 admitted on 8/31 to current

Other Meds:

Current Illness:

ID: 1662218
Sex: F
Age: 30
State: MO

Vax Date: 07/02/2021
Onset Date: 07/16/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data: Platelets and iron levels - normal

Allergies: Macrolides

Symptom List: Nausea

Symptoms: Deep bruising began 2-3 weeks after both COVID shots

Other Meds: Citalopram, Levothyroxine, Pantoprazole

Current Illness: ITP

ID: 1662219
Sex: M
Age: 26
State: TN

Vax Date: 08/23/2021
Onset Date: 09/01/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Injection site pain

Symptoms: Severe fatigue, muscle pain, cold sweats, diarrhea. Injection site is swollen about 4 inches wide, painful, red and itchy. This began suddenly and is worsening

Other Meds: None

Current Illness: None

ID: 1662221
Sex: M
Age: 50
State: AZ

Vax Date: 04/15/2021
Onset Date: 08/27/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data: I took a rapid test at pharmacy yesterday, 8/31/21, and tested negative. I've taken, I believe, 7 covid tests, both rapid and lab based, since May 2020 and tested negative on all tests.

Allergies: none

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

Symptoms: I keep smelling cigarette smoke. Sometimes it's very strong, like being in a bar standing next to someone smoking, my nostrils burn and I get a headache. It can be just a whiff of smoke or it might last minutes. It seems to be happening more often and for longer periods now.

Other Meds: none

Current Illness: none

ID: 1662222
Sex: F
Age: 56
State: ID

Vax Date: 02/25/2021
Onset Date: 02/25/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data: MRI, bloodwork, hearing test, VNG

Allergies: Tetracycline; Cipro; Codeine; Penicillin; Sulfas; Levaquin

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

Symptoms: After the 2nd vaccine, I had basically the same symptoms, but they were more severe. I had an extremely sore arm, body aches all over, severe chills, headaches, nausea, fatigue and low grade fever. Starting about the 1st week of February, I started feeling off balance and getting low blood pressure 98/68. I did go see my doctor and an ENT specialist. I did an MRI, everything was normal. I also went to chiropractor and my PCP to get checked out. I did blood work, and everything was all normal. I am going to see a neurologist and waiting for my appointment. So far, all my tests have come back normal, and I cannot find the cause of my symptoms.

Other Meds: Levothyroxine; Bupropion; Cephalexin; Progesterone; Testosterone; Cranberry capsule; Turmeric capsule; Calcium tablet; Multivitamin

Current Illness: None

ID: 1662223
Sex: M
Age: 85
State: PA

Vax Date: 02/21/2021
Onset Date: 08/24/2021
Rec V Date: 09/01/2021
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: 08/29/21 2235 Respiratory virus detection panel Collected: 08/29/21 1842 | Final result | Specimen: Swab from Nasopharynx Adenovirus Not Detected Mycoplasma pneumoniae Not Detected Chlamydophila pneumoniae Not Detected Parainfluenza Not Detected COVID-19 SARS-CoV-2 Overall Result DetectedCritical Enterovirus/Rhinovirus Not Detected Coronavirus Not Detected Respiratory Syncytial Virus Not Detected Influenza A Not Detected Bordetella pertussis Not Detected Influenza B Not Detected Bordetella parapertussis Not Detected Metapneumovirus Not Detected 08/27/21 1131 POCT COVID-19 PCR Collected: 08/27/21 1130 | Final result | Specimen: Swab from Nares POC COVID-19 PCR DetectedAbnormal Lot # 1000277892 Point of Care COVID-19 PCR Testing Method Cepheid Lot Expiration Date 07/24/2022

Allergies: NKA

Symptom List: Tremor

Symptoms: Suspected COVID-19 virus infection With cough, shortness of breath, fever, headache sore throat and nasal congestion ED to Hosp-Admission Current 8/29/2021 - present (3 days) Hospital for COVID Chief Complaint Patient presents with ? Fatigue 1. COVID-19 pneumonia with weakness?patient be hospitalized. His ambulatory pulse ox was 90%. Because of that we will start him on dexamethasone along with remdesivir. I also consented him for convalescent plasma. He did receive both doses of Pfizer vaccine the last 1 approximately 6 months ago. Will check inflammatory markers. He does not have a pneumonia on chest x-ray. 2. History of COPD?not in exacerbation, he will continue with his home inhalers. 3. History of atrial fibrillation he status post pacemaker placement. Is currently not anticoagulated, unsure of the reason behind that he will need to follow with cardiology regarding that.

Other Meds: acetaminophen (TYLENOL) 500 mg tablet allopurinol (ZYLOPRIM) 300 mg tablet azithromycin (ZITHROMAX) 250 mg tablet cholecalciferol (VITAMIN D3) 1,250 mcg (50,000 unit) capsule divalproex (DEPAKOTE) 125 mg EC tablet finasteride (PROSCAR)

Current Illness:

ID: 1662224
Sex: F
Age: 73
State: SC

Vax Date: 02/24/2021
Onset Date: 02/28/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data: Stool sample

Allergies: Sulfa; admitten

Symptom List: Erythema, Pruritus

Symptoms: It started with headache, fatigue, fever, diarrhea. I couldn't get the diarrhea under control it kept getting worst. That prompt me to go to urgent care where I was diagnosed with C-DIFF.

Other Meds: Centroid; vitamin C; vitamin D; Ambien

Current Illness: No

ID: 1662225
Sex: F
Age: 53
State:

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 09/01/2021
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: PCN

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

Symptoms: after receiving vaccine, pt developed redness to L side of face and arms. Also c/o shivering.

Other Meds:

Current Illness:

ID: 1662227
Sex: F
Age: 67
State: NC

Vax Date: 03/14/2021
Onset Date: 08/22/2021
Rec V Date: 09/01/2021
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: COVID19 PCR positive with cycle threshold of 22.8 on 8/22/2021

Allergies:

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

Symptoms: Hospitalization due to COVID-19 Reported per Pfizer COVID-19 Vaccine EUA

Other Meds:

Current Illness:

ID: 1662228
Sex: F
Age: 56
State: CA

Vax Date: 08/31/2021
Onset Date: 09/01/2021
Rec V Date: 09/01/2021
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: I get a cough from lemons

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: 1. Chills and shaking starting at 1:30am 2. Nausea 3. Hallucinogenic fitful dreams 4. Didn?t sleep at all. 5. Almost fell over going to the toilet.

Other Meds: Benicar, Valtrex, Metformin, Viibryd, Wellbutrin, Letrozole, Tylenol, Trazedone

Current Illness: None

ID: 1662229
Sex: F
Age: 36
State: TX

Vax Date: 08/06/2021
Onset Date: 08/09/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data: 8/10/21 - Clinic visit. EKG, ECHOCARDIOGRAM, CBC, CMP, D DIMER, CKMB

Allergies: SULFA

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

Symptoms: TACHYCARDIA, CHEST PAIN, SHORTNESS O F BREATH

Other Meds: NONE KNOWN

Current Illness: NONE

ID: 1662230
Sex: M
Age: 20
State: MD

Vax Date: 08/27/2021
Onset Date: 08/27/2021
Rec V Date: 09/01/2021
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: On admission: AST 4,343, ALT 5168, Bilirubin 1.6, Lactic acid 2.5,

Allergies: No known allergies

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

Symptoms: Patient reported intractable vomiting , sensation of pins and needles,

Other Meds: None

Current Illness: None

ID: 1662231
Sex: F
Age: 62
State: FL

Vax Date: 06/07/2021
Onset Date: 06/17/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data: N/A

Allergies: N/A

Symptom List: Pain in extremity

Symptoms: Shortness and heaviness of breath. Unable to participate in cardio activities.

Other Meds: Hormone replacement

Current Illness: N/A

ID: 1662232
Sex: M
Age: 80
State: PA

Vax Date: 03/07/2021
Onset Date: 08/27/2021
Rec V Date: 09/01/2021
Hospital: Y

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

Lab Data: Updated Procedure 08/27/21 2104 Respiratory virus detection panel Collected: 08/27/21 1934 | Final result | Specimen: Swab from Nasopharynx Adenovirus Not Detected Mycoplasma pneumoniae Not Detected Chlamydophila pneumoniae Not Detected Parainfluenza Not Detected COVID-19 SARS-CoV-2 Overall Result DetectedCritical Enterovirus/Rhinovirus Not Detected Coronavirus Not Detected Respiratory Syncytial Virus Not Detected Influenza A Not Detected Bordetella pertussis Not Detected Influenza B Not Detected Bordetella parapertussis Not Detected Metapneumovirus Not Detected Result Date: 8/28/2021 XR CHEST 1 VW PORT IMPRESSION: Worsening bibasilar interstitial opacities. See discussion. Imaging features are atypical for a COVID-19 pneumonia. Alternative diagnoses should be considered. END OF IMPRESSION: INDICATION: Suspected sepsis. Hx of emphysema and pneumonia. Suspected sepsis.Rule out SARS-CoV-2( related to COVID-19) contact, Droplet isolation. TECHNIQUE: Portable AP view of the chest was obtained. COMPARISON: 6/7/2021 FINDINGS: The cardiac silhouette is normal in size. The mediastinal contours are within normal limits accounting for technique. There are worsening bibasilar interstitial opacities suggestive of mild interstitial edema. Correlate clinically. Developing chronic interstitial changes in the differential diagnosis. Previous right pneumothorax has resolved. The pulmonary vascularity is within normal limits. Right pleural space: There is no pleural fluid or pneumothorax. Left pleural space: There is no pleural fluid or pneumothorax. The bone density appears to be within normal limits. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. CT angiogram chest pulmonary embolism with and without contrast Result Date: 8/30/2021 PROCEDURE INFORMATION: Exam: CTA Chest Without And With Contrast Exam date and time: 8/27/2021 8:40 PM Age: 80 years old Clinical indication: Pain; Other: See below; Additional info: Shortness of breath, elevated d-dimer TECHNIQUE: Imaging protocol: Computed tomographic angiography of the chest without and with contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. Contrast material: OMNI 350; Contrast volume: 80 ml; Contrast route: INTRAVENOUS (IV); COMPARISON: CTA CHEST PULMONARY EMBOLISM W WO CONTRAST 7/30/2020 6:46 PM FINDINGS: Pulmonary arteries: No pulmonary emboli. Aorta: Mild aortic atherosclerosis. No aortic aneurysm. No aortic dissection. Lungs: There are benign, calcified pulmonary granulomas. New patchy ground-glass opacities are present in both lower lobes. Moderate pulmonary emphysema, stable. The slightly irregular 7 mm right upper lobe nodule h

Allergies: LevofloxacinMyalgia / Muscle Pain

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

Symptoms: ED to Hosp-Admission Discharged 8/27/2021 - 8/31/2021 (4 days) Hospital (Principal) COVID-19 virus infection Hospital Course HPI: Patient is a 80 y.o. male with known history of chronic hypoxic respiratory failure requiring 2 L of oxygen due to severe COPD and hypertension has presented to emergency room for evaluation of worsening shortness of breath, fevers, diarrhea, nausea & non productive cough for the last 2 days. His wife tested positive for Covid on Monday and has been in quarantine and home. Both him and his wife were vaccinated with Pfizer vaccine. Upon arrival he is noted to be having hypoxia with requirement of 4 L of oxygen to keep saturation above 90% and CT chest showing bibasilar interstitial infiltrates suggestive of atypical pneumonia.d Hospital Course: COVID-19 pneumonia: Breakthrough case as patient was vaccinated with Pfizer back in March. CTA showed bilateral lower lobe infiltrate but negative for PE. Patient received on 5 days of remdesivir and dexamethasone, along with inhaler, schedule albuterol, cough medication. We added azithromycin since procalcitonin is elevated at 0.92. Lung exam shows decreased breath sounds at bases, add ISB, OPEP. Procalcitonin now trending down to 0.35. Overall clinically improved. Oximetry showed that he will require 2 L of O2 at rest and 3 L with activity. Patient received 4 days of azithromycin, will be discharged on 3 more days of azithromycin and 5 more days of Decadron. AKI: Admission creatinine 1.74->1->0.9, resolved with IV fluid, resume lisinopril/hydrochlorothiazide COPD on 2 L home O2 Hypertension Hypomagnesemia: Replaced

Other Meds: ASPIRIN LOW DOSE ORAL azithromycin (ZITHROMAX) 500 mg tablet dexAMETHasone (DECADRON) 6 mg tablet fluticasone HFA (FLOVENT HFA) 110 mcg/actuation inhaler (Expired) glucosamine-chondroitin 250-200 mg tablet hydroCHLOROthiazide (HYDRODIU

Current Illness:

ID: 1662234
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/01/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Vaccine deemed expired after vaccine was administered.

Other Meds:

Current Illness:

ID: 1662235
Sex: F
Age: 58
State: TX

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 09/01/2021
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: N/a

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

Symptoms: Extreme pain at injection site, cannot raise arm more than 1 inch and pain in the shoulder and neck area and do not get any relief from the Tylenol or ice packs.

Other Meds: Tylenol

Current Illness: allergies but not taking medicine for it.

ID: 1662236
Sex: F
Age: 72
State: DE

Vax Date: 02/23/2021
Onset Date: 07/01/2021
Rec V Date: 09/01/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: Lab work on July 27 came back normal

Allergies: sulfa drugs

Symptom List: Vomiting

Symptoms: I started having burning sensations in my right ankle that would come and go and went on for 2.5 weeks. On 7/19, the burning was into my mouth and tongue. It was numbing. It went down my throat and it was burning and numb and hard to swallow. It was like it feels when you go to the dentist. I had body aches that day off and on. The feelings would switch between my arms and my legs. By that weekend, I had no taste (July 23-25) in my mouth and was still having burning sensations. One episode lasted for 4 hours at night and couldn't get to sleep. I had foggy feeling brain. This lasted a good week. After about week my tongue started to feel better, and could start to taste. I still had burning sensations throughout different parts of my body. July 26 I went to my doctor, did blood work which was normal. I called her back the next week to tell her that I started getting itchy spots all over my body. My doctor then gave me a prescription to try to help with the itching ( a tablet) that hasn't helped. As of today's date, the burning sensations still come and go and the itchiness all over different parts of are still here. I feel like I constantly need to scratch all over my body. The achy body symptoms are now few and far between.

Other Meds: Pravastatin; Losartan; Hydroxyzine HCL; Alprazolam; Hyoscyamine; Escitalopram; Multi Vitamin; Fish oil; Vitamin D3

Current Illness: none

ID: 1662237
Sex: F
Age: 71
State: NC

Vax Date: 02/20/2021
Onset Date: 08/20/2021
Rec V Date: 09/01/2021
Hospital: Y

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

Lab Data: COVID 19 pcr positive with cycle threshold of 22.6 on 8/20/2021

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Hospitalization due to COVID-19 Reported per Pfizer COVID-19 Vaccine EUA

Other Meds:

Current Illness:

ID: 1662238
Sex: F
Age: 61
State: MN

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 09/01/2021
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: None

Allergies: None

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

Symptoms: Fever to 101.6F, chills, headache, body aches, tachycardia to 140

Other Meds: Potassium, omeprazole, seroquel,asa, plavix,cymbalta,simvastatin,Wellbutrin,

Current Illness: None

ID: 1662239
Sex: M
Age: 73
State: PA

Vax Date: 02/24/2021
Onset Date: 08/15/2021
Rec V Date: 09/01/2021
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 PCR test 8/17/2021 positive

Allergies: N/a

Symptom List: Injection site swelling, Limb discomfort

Symptoms: On August 15th I have a temperature elevation and deep in the lung coughing, body weakness and loss of taste and smell. August 17th, 2021, I was positive for Covid 19. No treatment was received, I was home and rested and recovered in eight days. I had maintained 98% O2 saturation throughout the week and that is all the information I have. I had contacted the Dr. on Monday August 16th and that was why I went to get tested.

Other Meds: Atorvastatin; Lisinopril; Acetamide; Carbinol; Nasacort; Multivitamin

Current Illness: N/a

ID: 1662240
Sex: F
Age: 61
State: KS

Vax Date: 03/08/2021
Onset Date: 08/25/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Chief Complaint Covid + on 8/25, sent here by PCP for CXR. Not really worse, buy has HX of Pneumonia.Not able to drink due to nausea, did start on Zofran yesterday which has helped some. Pt states O2 sat at home after nap was 83% History of Present Illness 61yo woman with h/o severe obesity, LE edema, hypothyroidism, gout, who was vaccinated for COVID-19 in March 2021 and presents with progressive weakness, nausea, headache and chills. Tested COVID positive on 8/25/2021 and has developed DOE. SpO2 83% on ED arrival with scant nonproductive cough. No chest pain or other pain. No diarrhea. No syncope.

Other Meds:

Current Illness:

ID: 1662241
Sex: M
Age: 21
State: TX

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 09/01/2021
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: Panic attack

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am