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: 1666002
Sex: F
Age: 28
State: CA

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1666003
Sex: F
Age: 56
State: OH

Vax Date: 02/11/2021
Onset Date: 07/31/2021
Rec V Date: 09/02/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: Chest xray Covid test

Allergies: none

Symptom List: Anxiety, Dyspnoea

Symptoms: I tested positive for COVID on 8/2/2021 Cough, coughing spasms, thick mucous that I was coughing up- started off as green now is clear, shortness of breath, extreme fatigue, increased sleep, nausea, mild headache at first, decreased appetite, over all feeling of just not feeling right Monoclonal antibody infusion on 8/6/2021 at 1:00PM I was off work for 3 weeks from 8/2/2021 and went back on 8/24/2021 I continue with residual symptoms of cough, shortness of breath and fatigue I was put on Tessalon Perrls which did help some with the coughing, used cough drops, drank lots of water,

Other Meds: yes, numerous Hydroxychloroquine for RA since 2019 Zinc VIT D Selenium Dexilent Lipitor CoQ10 Cinnamon tumeric

Current Illness: none

ID: 1666004
Sex: F
Age: 26
State: CA

Vax Date: 08/16/2021
Onset Date: 08/16/2021
Rec V Date: 09/02/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1666005
Sex: F
Age: 16
State: CA

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1666006
Sex: M
Age: 33
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 09/02/2021
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: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1666007
Sex: M
Age: 28
State: AZ

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 09/02/2021
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: Systemic: Dizziness / Lightheadness-Severe, Systemic: Patient fell and bumped knee-Mild

Other Meds:

Current Illness:

ID: 1666008
Sex: M
Age: 45
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 09/02/2021
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:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1666009
Sex: M
Age: 48
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1666010
Sex: M
Age: 15
State: TX

Vax Date: 09/01/2021
Onset Date: 09/01/2021
Rec V Date: 09/02/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Systemic: Seizure-Mild, Additional Details: Patient had a seizure a few minutes after receiving the vaccine. The patient was sitting down when seizure occur and was place on the ground in a safe position. Parent denied an ambulance or calling 911. Once patient recovered, temperature and blood pressure where checked and normal. Patient and parent left about 30 mins after incident and were recommended to see the provider.

Other Meds:

Current Illness:

ID: 1666011
Sex: F
Age: 41
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 09/02/2021
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:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1666012
Sex: M
Age: 42
State: VA

Vax Date: 02/18/2021
Onset Date: 02/18/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data: COVID-19 Influenza

Allergies: Bees

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

Symptoms: It started out as body aches. I felt really bad, I was nauseous. I had the same symptoms as the flu. I did not have a fever but I did experience chills. This lasted for about 24 hours. About 2 weeks later I ran a fever of 102. I went to the doctor and I tested negative for the COVID-19 virus as well as Influenza. It took 48 hours for me to recover after the second set of symptoms.

Other Meds: Alopurinol 300mg 1xdaily; Amlodipine 1xdaily; Aspirin 81mg 1xdaily

Current Illness: none

ID: 1666013
Sex: F
Age: 65
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 09/02/2021
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:

Symptom List: Rash, Urticaria

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1666014
Sex: M
Age: 25
State: OK

Vax Date: 09/01/2021
Onset Date: 09/01/2021
Rec V Date: 09/02/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Systemic: Dizziness / Lightheadness-Medium, Systemic: Flushed / Sweating-Severe, Systemic: Hypotension-Medium, Systemic: Shakiness-Medium, Additional Details: Patient appeared to have vasovagal type reaction. He felt faint and broke out in a severe full body sweat. He recovered after sitting for about ten minutes and drinking a bottle of water.

Other Meds:

Current Illness:

ID: 1666015
Sex: F
Age: 62
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 09/02/2021
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: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1666016
Sex: F
Age: 58
State: AR

Vax Date: 07/20/2021
Onset Date: 07/20/2021
Rec V Date: 09/02/2021
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:

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

Symptoms: Moderna vaccine used past the 12 hour window of use once vial was punctured. Stored in fridge entire time of use and cleaned between each use with alcohol .Contacted pt and no adverse reaction reported. Spanish interpreter used.

Other Meds:

Current Illness:

ID: 1666017
Sex: F
Age: 62
State: MI

Vax Date: 03/02/2021
Onset Date: 08/22/2021
Rec V Date: 09/02/2021
Hospital: Y

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

Lab Data: COVID19 PCR

Allergies: N/A

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

Symptoms: Positive for COVID19 on 8/22/2021

Other Meds:

Current Illness: Atrial fibrillation ? CKD (chronic kidney disease) stage 3, GFR 30-59 ml/min ? CVA (cerebral vascular accident) ? Gastrostomy tube dependent ? Uterine cancer ? Wernicke encephalopathy

ID: 1666018
Sex: F
Age: 26
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1666019
Sex: F
Age: 50
State: MN

Vax Date: 02/16/2021
Onset Date: 08/28/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data:

Allergies: apixaban

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient fully vaccinated and tested positive for COVID-19

Other Meds: levothyroxine, mesalamine, sertraline, Vit D and MVI

Current Illness:

ID: 1666020
Sex: M
Age: 40
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 09/02/2021
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: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1666021
Sex: M
Age: 79
State: FL

Vax Date: 06/08/2021
Onset Date: 06/08/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1666022
Sex: F
Age: 74
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 09/02/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1666023
Sex: F
Age: 53
State: MI

Vax Date: 07/26/2021
Onset Date: 07/29/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data:

Allergies: Sulfa, CT scan dye

Symptom List: Unevaluable event

Symptoms: Measle like itchy red bumps that turn into hard skin colored bumps.

Other Meds: Oxycodone, lyrica

Current Illness:

ID: 1666024
Sex: M
Age: 38
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1666025
Sex: F
Age: 22
State: FL

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

Symptom List: Injection site pain, Pain

Symptoms: Systemic: Dizziness / Lightheadness-Mild, Additional Details: patient was dizzy post vaccination, gave her orange juice and had her lie down. Felt better after about 20 minutes

Other Meds:

Current Illness:

ID: 1666026
Sex: F
Age: 31
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1666027
Sex: M
Age: 67
State: FL

Vax Date: 04/20/2021
Onset Date: 06/02/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data: CXR, covid test.

Allergies: PCN

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

Symptoms: Pt came to ER c/o chest pain with SOB. Was positive for covid one month prior and was home with O2.

Other Meds:

Current Illness:

ID: 1666028
Sex: M
Age: 26
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1666029
Sex: F
Age: 53
State: TX

Vax Date: 07/24/2021
Onset Date: 07/24/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

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

Other Meds:

Current Illness:

ID: 1666030
Sex: F
Age: 69
State: IL

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Vaccine expired in fridge.

Other Meds:

Current Illness:

ID: 1666031
Sex: M
Age: 13
State: CT

Vax Date: 09/01/2021
Onset Date: 09/01/2021
Rec V Date: 09/02/2021
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: Nausea

Symptoms: Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Numbness (specify: facial area, extremities)-Mild, Additional Details: call 911 emt arrived took vitals all was fine dad spoke with md vasovagal reaction due to nervousness

Other Meds:

Current Illness:

ID: 1666032
Sex: F
Age: 64
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1666033
Sex: F
Age: 53
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 09/02/2021
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: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1666034
Sex: M
Age: 20
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 09/02/2021
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:

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

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1666035
Sex: F
Age: 71
State: KY

Vax Date: 03/05/2021
Onset Date: 08/06/2021
Rec V Date: 09/02/2021
Hospital: Y

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

Lab Data:

Allergies: NKDA

Symptom List: Tremor

Symptoms: Received COVID vaccine on 3/5/21, tested positive for COVID on 8/7/21 8/6/21:Patient is a 72 y.o. female with a history of HTN, COPD, HLD who presents to the Emergency Department for evaluation of bowel perforation. Patient reports she started having lower abdominal pain approx 1 week ago. States her pain went away after a few days. 2 days ago her pain returned, and has progressively worsened. Seen at the hospital today, had CT scan that showed findings concerning for bowel perforation with stool contamination, abscess, and possible malignancy. Patient denies hx of previous abdominal surgeries. States her pain is tolerable as long as she remains still. Denies fever, chills, body aches, chest pain, palpitations, shortness of breath, wheezing, dizziness, lightheaded, syncope, dysuria. 72y female with COPD and no known history of cancer who presents with abdominal pain and CT findings consistent with feculent perforation of the sigmoid colon, sigmoid mass with concern for metastasis, and 2 large pelvic abscesses. Patient is hemodynamically stable, but given that pain is consistent with peritonitis and with the findings of free air within her hiatal hernia, will plan to take patient to OR emergently for lap sigmoid ectomy with end colostomy. Risks, benefits, and alternatives of the procedure were discussed with the patient. Patient elected to proceed to the OR. Code status discussed and patient is full code. Patient will be posted as an A and will be admitted to colorectal surgery following the procedure. #Perforated sigmoid mass #Intra-pelvic feculent abscesses - To OR as A for laparoscopic sigmoidectomy, end colostomy, and all other indicated - NPO - IVF @ 100 - zosyn 3.375 IV - Dilaudid for pain control - Admit to colorectal surgery following procedure - Consent signed and in chart 8/17/21 Discharge Summary: Hospitalization Admit Date/Time: 8/6/2021 5:05 PM Discharge Date: 08/17/21 No address on file Chief Concern, Brief History of Present Illness, and Hospital Course Patient is a 72 y.o. female with COPD who presented to ED with abdominal pain, evidence of bowel perforation. They were evaluated and found to have perforated sigmoid mass and intra-pelvic feculant abscess. They were taken to the operating room on 8/6 for emergent laparoscopic sigmoidectomy and end colostomy. Patient found to have involvement of left ovary and tube as well as small bowel; therefore, left SPO and SBR performed as well. The patient tolerated the procedure well and was subsequently extubated and transferred to the PACU for recovery. After recovery, the patient was transferred to the floor. Patient's COVID test was positive, so she was transferred to COVID unit. She received aggressive respiratory therapy. With her COPD, she was high risk for severe infection; however, her respiratory status has slowly improved. She is now on 1L O2 nc. Of note, she was vaccinated. The patient's hospital course was otherwise uncomplicated and it was felt that the patient had reached maximal benefit from hospitalization. They were deemed appropriate for discharge to acute rehab. On the day of discharge the patient's pain was controlled on oral medications, they were ambulating, voiding appropriately, passing flatus and stool in ostomy bag, and tolerating oral intake. Patient becoming more comfortable with changing ostomy bag herself, but struggles with dexterity. Has some deconditioning. Of note, her pathology returned as likely ovarian cancer. She will follow up outpatient with Dr. The patient was discharged on 08/12/21 to rehab and will return to clinic in 1 month with Dr. Discharge Diagnosis Medical Problems Active and Resolved Hospital Problems Hospital Aspiration pneumonitis (CMS/HCC) Overview Addendum 8/16/2021 7:55 AM by MD -confirmed by CXR -speech consulted- no dysphagia, okay for regular diet and thin liquids -monitor for signs of pneumonia -no concern for pneumonia COPD (chronic obstructive pulmonary disease) (CMS/HCC) Overview Signed 8/14/2021 11:54 AM by MD Complicates all aspects of care Increases risk for severe COVID infection Clear cell carcinoma (CMS/HCC) Overview Signed 8/14/2021 11:55 AM by MD -thought to be gyn primary * (Principal) Bowel perforation (CMS/HCC) Overview Addendum 8/16/2021 7:56 AM by MD -s/p lap colectomy, end colostomy, SBR, and left salpingo-oophorectomy (8/7) -Path: HIGH-GRADE CARCINOMA WITH CLEAR CELL AND SARCOMATOID DIFFERENTIATION, INVOLVING FALLOPIAN TUBE, OVARY, COLON MUSCLE WALL AND MESENTERY. ONE LYMPH NODE NEGATIVE FOR METASTASIS (0/1). Dr. discussed with Dr., will see outpatient. -IS/OOB, Flutter Valve for IS -Regular diet, HLIV -PT/OT: acute recs, appreciate visits - Pending insurance approval to ARF, medically stable for discharge - SW states she will require transportation to rehab facility due to Covid (+) COVID-19 Overview Addendum 8/14/2021 11:53 AM by MD -On 3L O2 at home in past, now on 1L nasal cannula -Duo-nebs PRN for wheezing -formal consult to RT -chest physiotherapy and airway clearance

Other Meds: alendronate, aspirin effervescent, ergocalciferol, ferrous sulfate, pantoprazole, pravastatin, polyethylene glycol

Current Illness:

ID: 1666036
Sex: M
Age: 35
State: ME

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

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Nausea-Medium, Systemic: Shakiness-Medium, Systemic: Weakness-Medium

Other Meds:

Current Illness:

ID: 1666037
Sex: M
Age: 65
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 09/02/2021
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:

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

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1666038
Sex: F
Age: 54
State: IL

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 09/02/2021
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:

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

Symptoms: Vaccine expired in fridge.

Other Meds:

Current Illness:

ID: 1666039
Sex: M
Age: 23
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1666040
Sex: M
Age: 30
State: AL

Vax Date: 09/01/2021
Onset Date: 09/01/2021
Rec V Date: 09/02/2021
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: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild, Additional Details: Patient fainted within 3 minutes of vaccine administration. He never fully lost conciousness and pharmacist was able to get to him promptly. Water was given and 911 was called to assist in checking the patient out to make sure further care and intervention was not needed. Patient returned home after and did not require further evaluation.

Other Meds:

Current Illness:

ID: 1666041
Sex: M
Age: 46
State: FL

Vax Date: 08/31/2021
Onset Date: 09/01/2021
Rec V Date: 09/02/2021
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: Chest Xray - diagnosis CAP ( Community Acquired Pneumonia)

Allergies: Dust Mites

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

Symptoms: Extreme sharp pain right above both sides of ribcage -radiating from fron to back

Other Meds: Ramipril 10 mg (daily) Mens Multi Vitamin Gummies (daily)

Current Illness: Just High Blood pressure (taking Ramipril 10 mg -daily)

ID: 1666042
Sex: U
Age: 42
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1666043
Sex: M
Age: 31
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1666044
Sex: M
Age: 27
State: NV

Vax Date: 09/01/2021
Onset Date: 09/01/2021
Rec V Date: 09/02/2021
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: Systemic: Fainting/Unresponsive-Mild, Systemic: Flushed/Sweating-Mild, Additional Details: Patient fainted for a few seconds and came back conscious. He sweated but no fever (temp 98). He was back to normal after 15 minutes. He was okay to leave after 30 mins.

Other Meds:

Current Illness:

ID: 1666045
Sex: M
Age: 27
State: GA

Vax Date: 08/11/2021
Onset Date: 08/31/2021
Rec V Date: 09/02/2021
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: Codeine Morphine Sulfa Pineapples Magnolia Pollen

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

Symptoms: Cutaneous peeling of skin on bottom of feet mostly on heel. Pt denies callused skin on feet prior to this. Noticed 2-3 days ago. Also. he noticed burning right index finger a few days after receiving injection. It now has flaky peeling skin only to that finger. He states he noticed burning the a bit painful. States it felt better to walk. Now he is having the multi-layer continued skin peeling. Advised keeping the feet moistened, Xyzal, and Tylenol.

Other Meds: Zyrtec Cozaar

Current Illness: none

ID: 1666046
Sex: M
Age: 61
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1666047
Sex: F
Age: 61
State: SC

Vax Date: 08/30/2021
Onset Date: 08/31/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data: None

Allergies: Sulfa

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Heart palpitations for both the first and second shots right after the shot was given and felt up to 8 hours after the shot " Covid Arm" large red area at injection site started 8 hours after injection was hard knot and the knot lessened but the red blotchy area also became itchy and continues. Have had it now 3 days

Other Meds: Vitamin B12 Vitamin C Woman's Multi Vitamin

Current Illness: none

ID: 1666048
Sex: M
Age: 30
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1666049
Sex: M
Age: 61
State: CA

Vax Date: 08/30/2021
Onset Date: 08/30/2021
Rec V Date: 09/02/2021
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: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-

Other Meds:

Current Illness:

ID: 1666050
Sex: M
Age: 76
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 09/02/2021
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: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1666051
Sex: M
Age: 56
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 09/02/2021
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: vaccine expired in fridge

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am