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: 1662650
Sex: F
Age: 45
State: FL

Vax Date: 08/28/2021
Onset Date: 08/28/2021
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: N/A

Allergies: PCN, Raw coconut, Pet dander

Symptom List: Dysphagia, Epiglottitis

Symptoms: Aprox 2hrs post injection on Saturday afternoon: mild dysphasia and SOB. This evolved over the next 4hrs into full dysphasia and inability to go beyond shallow breathing, lasting aprox 10hrs. Took Benadryl, which helped to relieve the symptoms. Sunday afternoon: Mild SOB, tachycardia, elevated body temps with movement. Any activity ? walking, standing up hand washing dishes, loading/unloading washer/dryer, sitting and folding laundry - would induce immediate elevated body temps and tachycardia. Only relief was with ice packs placed on back of neck and under armpits to bring down body temp and heart rate. This lasted 24hrs, from Sunday afternoon ? Monday afternoon. Monday evening: Intense LT hemispheric head/face pain. Placing eyeglasses and mask on face felt like razorblades cutting into my skin. Opening mouth, masticating, would cause extreme pain in LT side of jaw. Moving hair and coming in contact with moving air such as a fan or A/C was excruciating pain to LT hemisphere of head/face. This lasted 12hrs until I was able to take Advil and go sleep. Aprox 0400 Tuesday morning: Pain to the injection site, any movement to arm was very painful, very LROM due to pain for the next 24hrs. Tuesday afternoon: Nausea, dizziness, weakness, and lethargy ? difficulty getting up from seated position and heaviness to extremities restricting movement. Wednesday: Appears major negative reactions have subsided with the exception of LT arm injection site still very tender to touch. No ecchymosis noted; however, large tattoo at location may be masking any noticeable signs.

Other Meds: Albuteral inhaler, Calcium, Multi vitamin, Vitamin C, Zinc with Quercetin

Current Illness: N/A

ID: 1662651
Sex: F
Age: 50
State: DE

Vax Date: 04/23/2021
Onset Date: 08/06/2021
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: I had a pelvis ultrasound and another ultrasound with the radiology department to check what was happening since I was having post menopausal bleeding. My results showed no mass or cancerous cells. I have a scheduled appointment with my gyn coming up to discuss my symptoms and test results from radiology

Allergies: None

Symptom List: Anxiety, Dyspnoea

Symptoms: I am in menopause for 2 years and 10 weeks after I received the 2nd vaccine shot I began bleeding on 8/6/21. I started bleeding as if I was having a period cycle. I started off spotting and by the 2nd day I was bleeding as if I was having my period. I was also cramping for a few days and releasing small blood clots. I have not bled or spotted since I began menopause. I bled for 12 days and when I was getting my cycle, it only lasted 5-6 days. This bleeding led me to start thinking that I had cancer!!

Other Meds: Multi Vitamin, vitamin D3, C

Current Illness: None

ID: 1662652
Sex: M
Age: 13
State: FL

Vax Date: 08/29/2021
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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Systemic: Allergic: Itch Generalized-Medium, Additional Details: mother called that said couple hours after vaccine had itching all over; gave benadryl going on for 2 days

Other Meds:

Current Illness:

ID: 1662653
Sex: F
Age: 68
State: MN

Vax Date: 03/26/2021
Onset Date: 08/27/2021
Rec V Date: 09/01/2021
Hospital: Y

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

Lab Data: Labs 9/1: CBC with diff, BMP, INR 8/31 CT abdomen pelvis 8/27 xray abdomen

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Lump in right breast She was notified that with these findings it would necessitate urgent endoscopic evaluation with ERCP to relieve the obstruction along with IV antibiotic therapy to minimize the potential for ascending cholangitis She was instructed to go to the emergency room for initiation of IV fluids, laboratory studies including LFTs, as well as IV antibiotics such as Zosyn as well as to initiate transfer to other medical facility for choledocholithiasis and for GI consultation for ERCP 1. Two new 9 mm rounded lesions within the common bile duct, likely representing choledocholithiasis. Associated increased dilatation of the extrahepatic duct and new intrahepatic duct dilatation. Recommend GI consultation with consideration for ERCP. 2. Occlusion of the upper right superficial femoral artery, new since the prior CT. Cholecystectomy. Since prior CT 2/12/2019, development of intrahepatic duct dilatation and increased dilatation of the extrahepatic duct now measuring up to 21 mm in diameter (previously 17 mm). Two new rounded lesions within the common bile duct each measuring approximately 9 mm. One is in the mid common bile duct and the other is in the distal duct (coronal series 300, images 47-48). These likely represent choledocholithiasis, less likely soft tissue lesions.

Other Meds:

Current Illness:

ID: 1662654
Sex: F
Age: 49
State: VA

Vax Date: 02/01/2021
Onset Date: 02/01/2021
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: EKG

Allergies: sertraline, venlafaxine, meloxicam, latex, Flonase, duloxetine, gabapentin, levetiracetam

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

Symptoms: chest pain, numbness, shortness of breath

Other Meds: trazodone, topiramate, diphenhydramine, tramadol, Xanax, rizatriptan, propranolol, Maxalt, levothyroxine, Latuda, lansoprazole, inositol, dicyclomine, CBD

Current Illness:

ID: 1662655
Sex: F
Age: 28
State: TX

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

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-

Other Meds:

Current Illness:

ID: 1662656
Sex: F
Age: 33
State: PA

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

Lab Data: No medical tests or labs were performed.

Allergies: Previous allergic reaction to flu vaccine in 2017 Sulfa Augmentin

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Symptoms started with mild itching behind the neck at approximately 11 minutes after injection. Itching continued, worsened and moved to arms, thighs, and face. Hives start to show on her face at approximately 20 minutes after injection. Pharmacist, who injected vaccine was notified of patient status. Patient was given 50 mg of Benadryl. Patient was taken to Medical Center - hospital by husband. At approximately 30 minutes post injection patient describes feeling like she has ?frog in her throat?. Hives continue to get worse can be visualized on patient arms. Patient seen in emergency room at Medical Center - Hospital. After being taken into the treatment area patient was promptly seen by PA-C and RN. Medications administered during stay included Sodium Chloride 0.9% intravenous solution 1000 mL, Methylprednisolone 125mg IV push, famotidine 20 mg IV push, and Hydroxyzine 25 mg by mouth. After close observation for 4 hours patient was discharged from emergency room with Epi pen and prescriptions for Benadryl 25mg, Epinephrine 0.3 mg Injectable kit, Pepcid 40mg, and Prednisone 20mg.

Other Meds: None

Current Illness: None

ID: 1662658
Sex: M
Age: 73
State: CA

Vax Date: 08/11/2021
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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: No known allergies

Symptom List: Pharyngeal swelling

Symptoms: Widespread urticaria developed about 5 minutes post vaccine. Patient self-treated with fexofenadine and said he had resolution of symptoms.

Other Meds: Unknown

Current Illness:

ID: 1662659
Sex: M
Age: 61
State: NJ

Vax Date: 02/23/2021
Onset Date: 03/01/2021
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: None

Allergies: Seasonal allergies

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: 1 or 2 weeks after getting the vaccine I developed a lump at the injection site. It does not hurt. The dermatologist looked at it and he had no idea of what it was. He told me to rub some cortisone on it. Nothing happened. I still have it months later. I just have not been to the doctor yet. He said the next step would be to aspirate it.

Other Meds: Multivitamin; Atorvastatin 10 mg

Current Illness: None

ID: 1662661
Sex: M
Age: 32
State: FL

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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Benadryl, latex

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Intense chills, fever, sweating, horrible body aches, bad headache - headache started first a couple hours after the shot then the other symptoms came on and intensified over night - some of the worst chills and body aches I've ever had, still running a fever today (day after) and continuing to sweat and feel weak

Other Meds: Zyrtec, omeprazole, probiotic

Current Illness: None

ID: 1662662
Sex: F
Age: 39
State: FL

Vax Date: 08/20/2021
Onset Date: 08/20/2021
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: bloodwork - hcg it was higher than normal

Allergies: no

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

Symptoms: Some soreness in arm and couldn't lift about 24 hrs and slept most of the time. 29th Aug, possibly had miscarriage. I was bleeding, going through more test with the doctor. Things are still unknown. Ultrasound.

Other Meds: cinvia

Current Illness: no

ID: 1662663
Sex: M
Age: 53
State: WI

Vax Date: 04/06/2021
Onset Date: 08/19/2021
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: covid swab

Allergies: cinnamon, codeine, ketchup

Symptom List: Rash, Urticaria

Symptoms: Developed Covid infection in august 2021

Other Meds: Depakote, Claritin, Mobic, zantac, calan, Cymbalta

Current Illness: none

ID: 1662665
Sex: F
Age: 79
State: MT

Vax Date: 03/29/2021
Onset Date: 08/23/2021
Rec V Date: 09/01/2021
Hospital: Y

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

Lab Data: SARS-CoV-2 RNA Resp Ql NAA+probe DETECTED Ordered Test: SARS-CoV-2 RNA Resp Ql NAA+probe Status: Final Specimen Source: SOFT TISSUE SAMPLE Specimen Site: ENTIRE NASOPHARYNX Specimen Collection Date/Time: 2021-08-23 13:13:00.0

Allergies: ? Lisinopril Caused cough

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

Symptoms: Case completed MOderna Covid vaccine series on 3/29/21, then was admitted to the hospital on 8/23/21 for treatment of Covid pneumonia.

Other Meds: docusate-senna (SENOKOT-S) 50-8.6 mg per tablet Take 1 tablet by mouth 2 times daily . Patient not taking: Reported on 8/23/2021. glucose blood VI test strips (BLOOD GLUCOSE TEST STRIPS) strip One Touch Ultra Blue test strips Test bl

Current Illness: ? Bilateral leg edema 6/11/2021 6/2021?begin compression stockings ? Bladder infection, chronic ? Diabetes mellitus type 2, uncomplicated (HCC) 6/19/2007 A1C: 9/1210.9, 3/13 Lipid Panel: 3/13 Urine microalbumin/cr: 3/13 Eye Exam: Foot Exam:3/13 Creatinine: 3/13 ? Essential hypertension ? Neurogenic bladder 1/20/2021 - refer to abnormal urine ? Paroxysmal atrial fibrillation (HCC) 2/2/2017 1/2017 ? Patellar bursitis of right knee 1/28/2019 2018?Seeley Lake aspiration, treated with antibiotics, right side ? Pyelonephritis 10/25/2019 10/2019?emergency room, trial Ceftin., CT scan 10/2019?grew Candida glabrata. Unhelped by Ceftin so begin fluconazole 200 mg a day for 10 days ? Syncope 10/12/2015 10/15 EKG ? Unspecified hypothyroidism 6/19/2007

ID: 1662666
Sex: M
Age: 38
State: NJ

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

Lab Data:

Allergies:

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

Symptoms: Systemic: Diarrhea-Severe, Systemic: Vomiting-Severe, Systemic: Weakness-Severe

Other Meds:

Current Illness:

ID: 1662667
Sex: M
Age: 38
State: WI

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

Lab Data:

Allergies: None Noted

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

Symptoms: Patient Received Vaccine at approximately 1305. Patient was talking. At approximately 1307 for about 10-15 seconds patient lost consciousness. PHN immediately supported the client, called for help, and assessed patient. Patient was Diaphoretic and Pale. BP taken and noted to be 124/40 upon startling awake. Pulse in the 60?s Respirations 18. Ice pack placed under arm. Patients coloring returned. Soda given to patient and patient stated feeling better. At approximately 1315 patient lost consciousness for a second time. PHN again called for assistance while supporting the patient and the patient was lowered to the floor and feet put up on chair. Patient was unconscious for approximately 15-20 seconds. Once on the floor patient came too. Another BP was taken and noted to be 122/80 with a pulse in the 60?s and Respiration rate at 18. Ice pack placed under patients neck. Patient stated immediate relief and was already feeling better then before the second loss of consciousness. Another PHN called 911 while this was happening. Patient remained conscious until Paramedics arrived. He declined transportation to the hospital and left the clinic.

Other Meds: None noted

Current Illness: None Noted

ID: 1662668
Sex: F
Age: 72
State: OH

Vax Date: 03/14/2021
Onset Date: 08/26/2021
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: Positive COVID-19 PCR on 8/30/21

Allergies: Latex, adhesive tape

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

Symptoms: Patient vaccinated in Feb/Mar and in August 2021, developed suspected upper respiratory tract infection around 8/26/21 manifesting as headache initially progressing to cough and shortness of breath with no fever. On 8/29/21, patient noted loss of taste/smell and reached out to PCP for COVID screening. Positive PCR result from test 8/30/21 and patient reported worsening shortness of breath and cough with no fever, leading to infusion on 9/1/21 of REGEN-COV. This is reported on 9/1/21 and no future information is known at this time.

Other Meds: Lexapro, Coreg, Carafate, Prevacid, ASA, Vit B-12, Docusate,

Current Illness: Depression, acid reflux noted at PCP visit 1/11/21

ID: 1662669
Sex: F
Age: 5
State: MI

Vax Date: 09/01/2021
Onset Date: 09/01/2021
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: none

Allergies: NKDA

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

Symptoms: Administered Kinrix vaccine to 5 year old as second DTap and IPV

Other Meds:

Current Illness: None

ID: 1662670
Sex: F
Age: 53
State: DE

Vax Date: 08/24/2021
Onset Date: 08/25/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data: none

Allergies: Penicillin

Symptom List: Ear pain, Hypoaesthesia

Symptoms: began day after vaccination administration with fever, headache, body aches and generalized itching. Progressed over next 5 days with same symptoms plus rash which is still evolving. The rash is now on b/l arms, right leg, right upper chest and left neck. It looks herpetic with macular erythematous patches with vesicles.

Other Meds: none

Current Illness: None

ID: 1662671
Sex: M
Age: 21
State: IL

Vax Date: 05/12/2021
Onset Date: 05/15/2021
Rec V Date: 09/01/2021
Hospital:

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: Systemic: Neurological Disorder (diagnosed by MD)-Severe, Additional Details: pt says he has bell's palsy as a result of the vaccine

Other Meds:

Current Illness:

ID: 1662672
Sex: F
Age: 18
State: IA

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

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

Lab Data:

Allergies: none

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

Symptoms: patient disclosed that she was afraid of needles. the pharmacist on staff gave her the shot, she appeared to be well. walked out of room with her mom and passed out a few moments later. a paramedic came and evaluated her, she signed a form saying she didn't want to go to the hospital and she left with her family after her 30 min wait time post vaccine

Other Meds: QVAR, Ventolin, Prednisone

Current Illness:

ID: 1662674
Sex: M
Age: 79
State: NY

Vax Date: 02/16/2021
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: 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: Diagnosed with COVID-19 pneumonia on 8/31/21

Other Meds:

Current Illness:

ID: 1662675
Sex: M
Age: 4
State: FL

Vax Date: 08/11/2021
Onset Date: 08/12/2021
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: none

Symptom List: Unevaluable event

Symptoms: the child woke up around 3am that same night with a nosebleed (only had one once his whole life, years ago) and stating that there were bugs on the bedroom walls. I made sure child was fully awake before asking what he was pointing out at the wall for, child stated again, there are bugs like spiders all over the walls. The next night patient also stated the same, and a few more nights since then. That had never happened before the vaccine. 2 weeks later patient had fever for 3 days.

Other Meds: melatonin 2mg; children's multivitamin

Current Illness: none at the time

ID: 1662676
Sex: F
Age: 67
State: FL

Vax Date: 08/27/2021
Onset Date: 08/27/2021
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: LA

Lab Data:

Allergies: Penicillin. Amoxicillin Tetracycline Fish (not shellfish) salmon

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

Symptoms: Headache Leg cramps Fingers tingling Ocean sound in ears/head Fatigue

Other Meds: D3. B12 Biotin Vit C

Current Illness: None

ID: 1662677
Sex: M
Age: 73
State: NC

Vax Date: 03/05/2021
Onset Date: 06/01/2021
Rec V Date: 09/01/2021
Hospital: Y

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

Lab Data: Pulmonary embolism bilateral; Deep vein thrombosis of right lower extremity; Atelectasis; Acute respiratory failure with hypoxia; Elevated troponin level; Hypoxemia

Allergies: sulfa; percocet

Symptom List: Injection site pain, Pain

Symptoms: Difficulty breathing due to large blood clot in each lung and a small clot in right femoral artery

Other Meds: zyrtec 10 mg; Vitamin D3 1000 units; Vitamin B12 1000 mcg; Fluticasone nasal 50 mcg Metamucil 11 g; CoQ 10 100 mg; Tumeric 1000 mg

Current Illness: none

ID: 1662678
Sex: F
Age: 44
State: KY

Vax Date: 07/29/2021
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: SYR
Vax Site: LA

Lab Data: CSR scan- came back negative.

Allergies: Influenza Vaccine; Chickenpox Vaccine

Symptom List: Injection site pain, Menorrhagia

Symptoms: In the morning after the vaccine I was experiencing the regular sweats and chills. I also was experiencing back, neck, and hand pain throughout my upper torso. Three days later the hand pain stayed and it felt very arthritic pain, I could not make a fist with my right hand. I have never experienced pain as such before in my hands. On the same day my left eye felt very heavy and itchy like allergy symptoms. On the 14th of August my vision went completely blurry in my left eye, and has been blurry since that day. My PCP believes that I could possibly have had a CSR flare up that I have already experienced previously before the vaccine. The opthamologist decided to do a CSR scan and it came back negative but there was a possibility that it could have resolved it on its own.

Other Meds:

Current Illness:

ID: 1662679
Sex: F
Age: 54
State: CA

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

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

Lab Data:

Allergies: Penicillin, alcohol

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

Symptoms: Chills and malaise

Other Meds:

Current Illness: None

ID: 1662680
Sex: M
Age: 21
State: RI

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

Lab Data: NONE.

Allergies: NKDA

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: CLINIC ADMINSTERED EXPIRED MODERNA VACCINE TO PATIENT. BATCH #036A21A EXPIRED ON 26AUG2021 PER MODERNA WEBSITE AND VACCINE WAS GIVEN ON 30AUG2021. PATIENT REPORTS THAT IN MINUTES FOLLOWING INJECTION, FELT SLIGHT CHEST DISCOMFORT. NOT DESCRIBED AS PAIN. NO ASSOCIATED SHORTNESS OF BREATH, FACE SWELLING, RASH. SYMPTOMS RESOLVED OVER THE NEXT FEW HOURS, WITHOUT INTERVENTION. THERE WERE NO OTHER REPORTED SYMPTOMS.

Other Meds: tacrolimus, 0.1 %, OINT. (G), TOPICAL minoxidil, 2.5 MG, TABLET, ORAL carboxymethylcellulose sodium, 0.5 %, DROPERETTE, OPHTHALMIC ketotifen fumarate, 0.025 % (0.035 %), DROPS, OPHTHALMIC clindamycin phosphate, 1 %, LOTION, TOPICAL hyd

Current Illness: NONE REPORTED

ID: 1662681
Sex: M
Age: 12
State: CA

Vax Date: 08/27/2021
Onset Date: 08/28/2021
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: RA

Lab Data: CHECKED VITALS. NO TESTS.

Allergies: N/A

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: On 8/27/21, at approximately 9:25am my son had his second Pfizer vaccine. He returned to school and was fine the duration of the day. At approximately 10:30/45pm my son went to bed with no symptoms. At approximately 3:30am 8/28/21, I checked on him and he was under his comforter and very hot and sweating a little. I took the comforter off and covered him with only his sheet. When I did this, he woke groggy and said he had vomited but was ok. I told him to rest more, he went back to bed and at approximately 5:25am I heard an agonizing loud drawn out yelling moan. I ran into my son?s bedroom and he was convulsing in his bed having a seizure. I got in his bed, held his head and assured him I was with him, then called his father and 911 at 5:28am. SEIZURE OBSERVATIONS: His tongue was limply hanging out the left side of his mouth, eyes rolled back, he was gasping for air, his right hand was stretched up and latched onto his light cord, right side of body was rigid and convulsing. I was on hold with 911, the call took a total of 5minutes. Half way through the 911 call, while answering the dispatchers questions about my son ie: is he responsive, does he know his name -while he was seizing and couldn?t talk, my son's convulsions lessened and his eyes came back to a resting state. I asked him his name again and he was responsive but with slurred speech. My son was seizing for approximately 5min from start to finish (appx. 5:25 - 5:30am) . POST SEIZURE: His head laid in my hands, he was limp, weak, exhausted, sweaty, out of breath and disoriented. He didn't know what happened. He said he had a headache and his left leg was aching. He had to use the bathroom but couldn?t get up, and released in the bed (urinated). The whole left side of his face was drooping and speech was slurred for about 20minutes after he started being responsive. The FD (and his father) arrived at approximately 5:45am. They checked his vitals. All vitals were fine except the FD mentioned something about his blood sugar was a little high/low(?) at 127. We drove our son to emergency, where he was checked and all vitals were confirmed to be fine. He was discharged and rested the remainder of the day. We had a follow up appointment with his pediatrician on 8/31/21 scheduled for 10:45am.

Other Meds: N/A

Current Illness: N/A

ID: 1662682
Sex: F
Age: 14
State: MI

Vax Date: 08/27/2021
Onset Date: 08/27/2021
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: no

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

Symptoms: MMRV given to patient when she is 14 years old. Cut off age for MMRV is 12 years old.

Other Meds: no

Current Illness: no

ID: 1662683
Sex: F
Age: 93
State: FL

Vax Date: 01/11/2021
Onset Date: 06/10/2021
Rec V Date: 09/01/2021
Hospital: Y

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

Lab Data: 6/17/21: Covid test-positive, CXR.

Allergies: Demerol, scallops, sulfadiazine.

Symptom List: Nausea

Symptoms: Came to ER from SNF due to fall. Worsening mental status.

Other Meds:

Current Illness:

ID: 1662684
Sex: F
Age: 49
State: AL

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

Lab Data: unknown, patient upon education from nurse on two conversations refused to call 911 or go to hospital as recommended. Patient to contact her primary medical provider.

Allergies: NKDA reported by patient

Symptom List: Injection site pain

Symptoms: Patient contacted the Facility on 8/31/31 in the afternoon reporting that she received the 1st Moderna Vaccine on 8/30/21. She woke up on the 31st and began experiencing arm soreness, chest pain, headache, weakness, temp of 103-104. Nurse returned call promptly and spoke to patient but patient was educated that due to her complaint of chest pain she needed to either call 911 or go to the nearest E.R. 9/1/2021 Nurse contacted patient @ 0815 and phone went straight to voicemail. Patient returned call to Facility at 1:05 and patient once again informed nurse that she was having "weakness, soreness to both arms and across chest and unable to get up off of recliner". When asked, patient stated she did not go to the E.R. as was recommended because "I was too tired". Nurse re-enforced importance of going to the hospital to have her heart checked due to complaints of chest pain and tightness. Patient agreed to contact Dr. to let him know how she was feeling.

Other Meds: unknown

Current Illness: Patient reports none

ID: 1662685
Sex: M
Age: 21
State: TX

Vax Date: 09/01/2021
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 induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: nausea, light-headed, trembling. BP 117/72, HR 69, SpO2@98%, R 16

Other Meds:

Current Illness:

ID: 1662686
Sex: F
Age: 34
State: IL

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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: PCN

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

Symptoms: Nauseous over the night, passed out over night from dizziness, headache took tylenol 500 mg twice yesterday, slight headache 9/1/21 today, swelling all over arm, has a rash on chest and back (raised bumps), shoulders, and arm (redness)

Other Meds: Tylenol

Current Illness: No

ID: 1662687
Sex: M
Age: 18
State: FL

Vax Date: 08/27/2021
Onset Date: 08/28/2021
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: EKG: ST segment changes; troponin and BNP normal.

Allergies: None

Symptom List: Tremor

Symptoms: Patient has chest pain and diagnosed with pericarditis. Pain is ongoing.

Other Meds: None

Current Illness: None

ID: 1662689
Sex: M
Age: 35
State: OR

Vax Date: 09/01/2021
Onset Date: 09/01/2021
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: none

Allergies: none

Symptom List: Erythema, Pruritus

Symptoms: Patient became diaphoretic immediately after vaccination, pulse regular, sweaty, cold; pt lost conciousness, had seizure of short duration (<30 sec) regained conciousness, vomitted; paramedics arrived and assessed pt, pt transported to Hospital via ambulance **pt reported a similar episode at sons appointment roughly 1 month ago, lightheaded/pale had to sit at dr office, reported feeling same at beginning of this incident

Other Meds: unknown

Current Illness: none known

ID: 1662690
Sex: F
Age: 28
State: NJ

Vax Date: 02/24/2021
Onset Date: 04/24/2021
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: Blood work confirmed pregnancy and loss of pregnancy. There is on going testing to determine if there are any other causes for the losses.

Allergies: Bananas, Polymyxin B-Trimethorim, COVID Vaccine

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

Symptoms: I had 2 miscarriages between 5-7wks gestation. 4/24/21 and 7/7/21

Other Meds: None

Current Illness: None

ID: 1662691
Sex: F
Age: 51
State: TX

Vax Date: 02/10/2021
Onset Date: 02/10/2021
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: LA

Lab Data: no

Allergies: pine nut; Demerol; iodine; Vicodin; Levaquin; Avelox; Cipro; z-pack; Rocephin

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

Symptoms: 02/10/2021, at 05:00 PM on the day of the vaccine, I started of with chill and fever, it got up to 101.9, I went to bed and throughout the night I was just shivering, at about 11:00 am the next day I turned the corner. All my symptoms subsided. I had a headache that lingered throughout the day and it went away the next day. My arm, I received the injection on, was hurting, it was red, swollen and itched and it didn't go away for a whole week. A week after the vaccine, 02/27/2021, I felt like I had bugs crawling all over me, on my forehead, head and all over my body and it lasted several days. I took Benadryl for like 3 days. Occasionally I fell like I still have bugs on me. The feeling has dissipated after several months, but occasionally I still feel like bugs are crawling on me, but it's not all the time. My asthma was exasperated by the vaccine within 24 hrs of taking it, but it subsided about a week.

Other Meds: Synthroid .112 mcg od; Singulair 10 mg od; dulera 100/5; ixempra infusion; juice plus; vitamin D; magnesium; turmeric

Current Illness: no

ID: 1662692
Sex: F
Age: 85
State: MO

Vax Date: 02/15/2021
Onset Date: 02/19/2021
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: On 2/21/2021, I was subjected to abdominal and chest X-rays, a heart ultrasound, urinalysis, and blood tests when I went to the hospital. I was diagnosed with pneumonia in both lungs.

Allergies: Clams.

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: On 2/19/2021 at about 5:00PM, I had hard thigh cramps. They were just in my thighs at first, but they then spread to my stomach and the rest of my legs afterwards. I rubbed Icy Hot on them and then went to bed about 7:30PM. The Icy Hot relieved the cramps enough that I was able to get to sleep. On 2/20/2021 at between 2:00-4:00AM, I had severe dry heaves. The dry heaves lasted for over an hour. I was so exhausted that I stayed in bed. I also had bouts of severe diarrhea and my stomach was so inflamed by the dry heaves that it was very painful and I was bloated. On 2/21/2021, my stomach muscles hurt so badly I could hardly get up. I was also very weak. I took ibuprofen and called a nurse, who urged me to go to the nearest hospital. I then went to emergency room, and I was hospitalized until 2/26/2021. I was told that I had pneumonia in both lungs. After I was released, I was on antibiotics for a week, and I was fine afterwards.

Other Meds: Atorvastatin; Omeprazole; Aspirin; Dicyclomine; Glucosamine chondroitin; Calcium/Vitamin D Supplement.

Current Illness: None.

ID: 1662693
Sex: M
Age: 31
State: PR

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

Lab Data:

Allergies:

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

Symptoms: Inflammation of the area under left armpit, sensation of liquid in that pocket. It cause immobilization of the arm.

Other Meds: Panadol

Current Illness:

ID: 1662694
Sex: F
Age: 37
State: OK

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

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

Lab Data:

Allergies: none

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

Symptoms: After second shot I have loss my sense of smell completely it still has not recovered.

Other Meds: none

Current Illness: none

ID: 1662695
Sex: F
Age: 42
State: FL

Vax Date: 07/28/2021
Onset Date: 07/29/2021
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: Shell fish, mango, coconut

Symptom List: Pain in extremity

Symptoms: My tuberculosis vaccine scar became red, swollen and tender to the touch. It lasted 3 days and then went back to normal. I have also been experiencing headaches since 3 days after the first dose.

Other Meds:

Current Illness:

ID: 1662696
Sex: F
Age: 24
State: OR

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: 2
Vax Route:
Vax Site:

Lab Data: none

Allergies: none

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

Symptoms: Pt presented to the clinic for a covid pfizer vaccine, #1. Pt reported that she has a history of "fainting" when receiving injections and blood draws. Pt was placed on the exam table, consent signed and EAU given. Her husband was also present. Pt was given the injection and tolerated well. 2 minutes post injection she became pale and vasovagal response occurred. She was safe on the exam table and awoke within seconds. She did have some mild hand tremor as she was waking. She drank some gatorade and was talking and coherent after event. About 3 minutes later after reporting that she felt embarassed she had a similar event that lasted seconds and she awoke with mild hand tremor. Pt remained safe on the exam table the entire time. She waited for 30 minutes past this, reported she felt good and walked out the clinic on her own accompanied by her husband.

Other Meds: none

Current Illness: unknown

Date Died: 08/31/2021

ID: 1662698
Sex: M
Age: 60
State: WI

Vax Date: 03/08/2021
Onset Date: 08/18/2021
Rec V Date: 09/01/2021
Hospital: Y

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

Lab Data: CORONAVIRUS (COVID 19) RT PCR Status: Final result 0 Result Notes Ref Range & Units 8/22/21 1240 CORONAVIRUS SARS COV 2 PCR (RESP) POSITIVE Panic

Allergies:

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

Symptoms: Admission Date: 8/22/2021 Date of Death: 8/31/2021 actual Time of Death: 9:35 am Autopsy Scheduled/Performed: No Manner of Death: Natural Cause of Death: COVID-19 pneumonia 9 days - interval between onset and death Acute hypoxic respiratory failure Obstructive sleep apnea on respiratory support patient has not been compliant with weight prior to this hospital stay Chronic osteomyelitis Quadriplegia Hospital Course: Patient presented with increased weakness hypoxia and hypotension. Patient has history of chronic osteomyelitis and also he has quadriplegia. Patient was admitted started on broad spectrum antibiotics and shortly after admission he required pressors so he was transferred to the intensivist service. Patient also required significant amount of oxygen and that was providing using BiPAP. Once the patient was off of pressors he was transitioned to hospitalist service. Patient developed A. fib with rapid ventricular response cardiology service was consulted and also he was treated with amiodarone. Patient developed worsening infiltrates with increased opacification of the left lung. Initial testing in the emergency room turned back positive for coronavirus. Patient did have the 2 doses of vaccine given approximately 6 months ago. Pulmonology service was consulted due to opacification of the left lung but patient refused bronchoscopy. To note even prior to this hospital stay patient has been declining regarding ability to function. Minimal activity was causing significant shortness of breath. Patient continued to deteriorate and he became hypoxic despite using BiPAP on a maximum settings with FiO2 of 100%. In view of her rapid deterioration patient was intubated but after discussing with family it became clear that patient does not want to be on prolonged mechanical ventilation and that would have been the best outcome in view of his previous deterioration in pulmonary function on top of his pneumonia and COVID-19 disease. Patient was extubated the same day and he died shortly after being extubated. Discharge Diagnoses: Acute hypoxic respiratory failure secondary to COVID-19 pneumonia and bacterial pneumonia worsened by patient quadriplegia and decreased cough reflex Septic shock likely source multilobar pneumonia other possibilities UTI with chronic enduring catheter and chronic osteomyelitis COVID-19/SARS-CoV-2 viral infection patient treated with remdesivir and dexamethasone Partial quadriplegia from an old accident with neurogenic bladder and also with colostomy Anemia acute on chronic acute component likely related to present illness ICU delirium

Other Meds:

Current Illness:

ID: 1662699
Sex: M
Age: 41
State: WA

Vax Date: 06/24/2021
Onset Date: 06/24/2021
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: NKDA

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

Symptoms: Feeling lack of motivation, increased forgetfulness, less mental acuity

Other Meds: B Complex Oral Capsule, Fish Oil 1200 mg Capsule, Ibuprofen 800mg oral tablet, Lions Man 500 capsules, Probiotic Oral Capsule, Solifenacin 10mg Oral Tablet, Vitamin D3 5000 unit oral capsule

Current Illness: UTI, weight loss, neurogenic bladder, Feeling lack of motivation, increased forgetfulness, less mental acuity

ID: 1662700
Sex: M
Age: 18
State: NY

Vax Date: 06/30/2021
Onset Date: 07/07/2021
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: eco cardio gram ekg heart monitor

Allergies: none

Symptom List: Vomiting

Symptoms: Woke up in the middle of the night with heart racing and shortness of breath 6 days after 2nd shot. Same thing happened after getting the first dose. Exactly 6 days in the middle of the night for first dose.

Other Meds: none

Current Illness: none

ID: 1662701
Sex: F
Age: 58
State: WA

Vax Date: 07/21/2021
Onset Date:
Rec V Date: 09/01/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Breakthrough case: I tested positive for COVID-19 on Saturday August 21, 2021 when I did a rapid test. I also received another confirmation that I had COVID-19 on August 24, 2021 when I did a PCR test. My symptoms: Fever, Chills, Cough, Congestion, Headache, Body aches, and Fatigue.

Other Meds:

Current Illness:

ID: 1662702
Sex: F
Age: 70
State: VA

Vax Date: 02/24/2021
Onset Date: 06/11/2021
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: mammogram ultrasound

Allergies: Penicillin; sulfa drugs

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

Symptoms: I had the typical flu like symptoms which resolved within 24 hours. On 6/24/2021, I went to see my OBGYN for a raised and inflamed bulge on my left breast. I was sent for a mammogram and ultrasound on 7/1/2021 and a biopsy on 7/7/2021. The biopsy was negative for cancer and I was to follow up with PCP for possible autoimmune causes. On 8/10/2021, I went to see my PCP and did blood work. The blood work show positive for double strand DNA, which is a possible indication of lupus. I have an appt with rheumatology in Dec 2021. I have also developed a lot of joint pain especially at night.

Other Meds: Synthroid; Metoprolol; Aspirin; Claritin

Current Illness: none

ID: 1662703
Sex: F
Age: 26
State: TX

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

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient was administered first dose of covid Moderna vaccine . After 5 minutes she said she wanted to lie down and she fell on the chair and fainted . Her eye lid got a laceration . . She regained her consciousness after few minutes . EMT were called . Later she went to urgent care .

Other Meds:

Current Illness:

ID: 1662704
Sex: F
Age: 47
State: MA

Vax Date: 04/23/2021
Onset Date: 05/15/2021
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: none

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

Symptoms: irregular, heavy and extended periods. i have been extremely regular my whole life until i got the vaccine.

Other Meds: none

Current Illness: none

ID: 1662705
Sex: M
Age: 27
State: RI

Vax Date: 08/30/2021
Onset Date: 08/30/2021
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: NKDA

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

Symptoms: PATIENT WAS GIVEN EXPIRED VACCINE, PER MODERNA WEBSITE, BATCH #036A21A EXPIRED ON 26AUG2021 AND VACCINE WAS ADMINISTERED ON 30AUG2021.

Other Meds: NO MEDICATIONS BEING TAKEN AT TIME OF VACCINATION

Current Illness: NONE REPORTED

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am