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: 1670768
Sex: F
Age: 75
State:

Vax Date: 01/27/2021
Onset Date: 08/29/2021
Rec V Date: 09/03/2021
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: Tested positive for COVID-19

Other Meds:

Current Illness:

ID: 1670769
Sex: F
Age: 18
State: FL

Vax Date: 08/11/2021
Onset Date: 08/12/2021
Rec V Date: 09/03/2021
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: I have had spasms in my upper left arm, where i got the vaccine, ever since the first shot. It looks like a heartbeat and is very uncomfortable to have. It has not been every day, but very apparent the past 72 hours.

Other Meds: None

Current Illness: None

ID: 1670770
Sex: F
Age: 60
State: WA

Vax Date: 01/23/2021
Onset Date: 01/30/2021
Rec V Date: 09/03/2021
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: Have not gone to doctor but have an appointment in December and will report it then if still having the problem.

Allergies:

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

Symptoms: One week after vaccine my upper arm muscle started twitching strongly every 4-12 seconds for a week. There has been random twitching since then but not often. The muscle is still swollen, sensitive and very sore. Arm movements hurt and to touch the site hurts. It has been 7 months since the vaccine. Although I had the pain and twitching after the first vaccine, I still took the second vaccine per requirements.

Other Meds:

Current Illness:

ID: 1670771
Sex: F
Age: 51
State: TX

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 09/03/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient mentioned that she felt "itchy." Patient also mentioned that she had a history of "itchiness" with vaccines.

Other Meds:

Current Illness:

ID: 1670772
Sex: F
Age: 13
State: MD

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 09/03/2021
Hospital:

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

Lab Data: NOT APPLICABLE.

Allergies: NKDA.

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

Symptoms: PATIENT PASSED OUT FOR FEW SECONDS FOLLOWING THE ADMINISTRATION OF VACCINE. PATIENT'S BP AND HEART RATE WERE NORMAL. PATIENT HAS HAD HEADACHE FOR FEW HOURS FOLLOWING THE INCIDENT.

Other Meds: UNKNOWN.

Current Illness: UNKNOWN.

ID: 1670773
Sex: F
Age: 73
State: CA

Vax Date: 03/03/2021
Onset Date: 05/12/2021
Rec V Date: 09/03/2021
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: Stress Test Holter Monitor Echo Cardiogram

Allergies: N/A

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

Symptoms: I started to have trouble breathing and I had very little stamina when I was walking. I experienced panic attacks after there was no diagnosis. I had some heart testing in November of 2020. I wore a monitor and I had a stress test which were negative. My symptoms and shortness of breath got worse. At the end of July I ended up in the hospital and I was diagnosed with Atrial Fibrillation and Congestive Heart Failure.

Other Meds: Levothyroxine, Multivitamin

Current Illness: N/A

ID: 1670774
Sex: F
Age: 72
State:

Vax Date: 02/22/2021
Onset Date: 08/24/2021
Rec V Date: 09/03/2021
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: Tested positive for COVID 19.

Other Meds:

Current Illness:

ID: 1670775
Sex: F
Age: 31
State: IL

Vax Date: 02/19/2021
Onset Date: 07/30/2021
Rec V Date: 09/03/2021
Hospital: Y

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

Lab Data: Unknown tests - all yielded normal results

Allergies: Bactrim (sulfa)

Symptom List: Pharyngeal swelling

Symptoms: Pregnancy loss at 16 weeks 3 days.

Other Meds: Advair, Zyrtec

Current Illness: none

ID: 1670776
Sex: M
Age: 57
State: CA

Vax Date: 08/27/2021
Onset Date: 08/27/2021
Rec V Date: 09/03/2021
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: None

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Swelling and soreness in deltoid lasting three days; minor redness at site lasting two days.

Other Meds: Lamotrigine, 200 mg/day; Voltaren topical analgesic

Current Illness: None

ID: 1670777
Sex: M
Age: 73
State: NJ

Vax Date: 02/07/2021
Onset Date: 03/02/2021
Rec V Date: 09/03/2021
Hospital:

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

Lab Data: MRI, Cortisone Shots

Allergies: shell fish

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Received your second shot and started filling shoulder pain within 4-5 hours in left shoulder. Went to the Orthopedic 4 months latter and doctor prescribed an MRI and cortisone shots for the pain. After the shots, pain was still lingering and has not gone away.

Other Meds: Lisinopril- once daily (5mg) Simvastaein- once daily (20mg) Carvebilol- twice a day (6.25mg)

Current Illness: bored line diabetic

ID: 1670778
Sex: M
Age: 71
State: WA

Vax Date: 02/25/2021
Onset Date: 08/16/2021
Rec V Date: 09/03/2021
Hospital:

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

Lab Data: No

Allergies: Augmentin - ankle rash

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

Symptoms: Immediately after vaccine, no significant ones other than I reported on v-safe permanent a fib - my heart rate/vitals changed dramatically; usually I'm stable 115/75 BP normal to 100-110 - Pulse rate; dropped to as low as 39 pulse rates. Average heart rate was 78 and BP 124/74. The lowest being as low as 39 for heart rate. I had a little shortness of breath and my O2 saturation dropped to 90 a nd that happened over a couple of day period. Normally I can't even force it down to 94. I had general fatigue. Persistent headache - slight pulse rate is coming back up. At the beginning of the episode periodic discomfort at my left pec and shoulder. Increased anxiety levels with this - didn't trust me to go out to get the mail. Spoke with a doctor - did not see a doctor - the facility is two hours away; did it via message service. They decreased the Metoprolol to 50 mg, and they are monitoring it now. And then we'll examine it again. I am free to message them at any time. I have confirmed that I am feeling better as I am compliant with the decrease, and I will be getting back to them on Tuesday of next week. So, it's an ongoing monitoring process. The average on the Pulse rate is 64 now. Anxiety has come down - but I do still have some recognized fatigue - I'm easily fatigued. We're still maintaining self-quarantining - over this last year and a half. Not being very social at this time.

Other Meds: Eliquis (Apixaban); Omeprazole; Atorvastatin; Diltiazem; Alopurinol; Metoprolol Succinate; Hydrocodone; Supplements: Iron; Vitamin D3; Daily Multi-Vitamin; Chromium; Ubiquinol; Glucosamine/Chondroitin; Tart cherry extract - natural anti-inf

Current Illness: No

ID: 1670779
Sex: F
Age: 17
State: FL

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

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

Lab Data: none

Allergies: none

Symptom List: Rash, Urticaria

Symptoms: Given a Moderna vaccine at 17 years, when 18 years is required age. This is a vaccine administration error, not an adverse event. Patient did not report any side effects other than sore arm at injection site.

Other Meds: none

Current Illness: none

ID: 1670780
Sex: F
Age: 24
State: MN

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 09/03/2021
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: None

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

Symptoms: Patient after about 6 minutes felt very light headed/dizzy and felt like fainting. She was sitting the entire time. Gave her water and crackers which steadily made her feel better. She sat there for 30 minutes drinking water and eating, then she felt fine. Dizziness and all other symptoms were gone.

Other Meds: None

Current Illness: None

ID: 1670781
Sex: M
Age: 37
State: SC

Vax Date: 08/16/2021
Onset Date: 08/20/2021
Rec V Date: 09/03/2021
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: Pain in shoulder area that radiates in neck and head. Said very painfull and cannot eat or sleep on it. Started 5 days after actual injection. Absense of rash.

Other Meds:

Current Illness:

ID: 1670782
Sex: M
Age: 38
State: PA

Vax Date: 08/28/2021
Onset Date: 08/29/2021
Rec V Date: 09/03/2021
Hospital:

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

Lab Data: N/A

Allergies: Arathamicin

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

Symptoms: Pt. states that after receiving the 2nd dose of Phizer 08/28/2021, started experiencing symptoms 08/29/2021 of jaw pain, numbness in the jaw, cheek, and left Nostril. Still continuing with previous Prednisone treatment from 1st dose 08/07/2021, symptoms subsiding slowly. No noted Primary visit.

Other Meds: N/A

Current Illness: N/A

ID: 1670783
Sex: F
Age: 83
State:

Vax Date: 08/28/2021
Onset Date: 08/31/2021
Rec V Date: 09/03/2021
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:

Allergies:

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

Symptoms: Admit from emergency center for fatigues, diarrhea for 2 days, bloating, nausea w/o vomited 2-3 days after vaccination. discharged in stable condition on 9/3

Other Meds:

Current Illness:

ID: 1670784
Sex: F
Age: 55
State: KS

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 09/03/2021
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: Patient complained right away of being nauseated, light headed, and chest pains. She kept trying to throw up. When asked if she was having trouble breathing she nodded her head. Dose of epinephrine 0.3mg was administered to left thigh. Patient sat with water. Complained of same symptoms and dosed a second dose of epinephrine 0.3mg exactly 15 minutes later. Patient was taken to ER by ambulance shortly after.

Other Meds:

Current Illness:

ID: 1670785
Sex: M
Age: 1
State: MN

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

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

Lab Data: NA

Allergies: blueberries

Symptom List: Ear pain, Hypoaesthesia

Symptoms: RAISED RED LUMP GOLF BALL SIZE TENDER MOM STATED EXTRA FUSSY SINCE THE VACCINE

Other Meds:

Current Illness:

ID: 1670786
Sex: F
Age: 71
State: TX

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

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

Lab Data:

Allergies: Severe sulfa allergy; Celebrex

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: The next morning after receiving the 3rd dose I woke up with sizable swelling on the underarm lymph node on the side of my body which caused pain. Throughout the day I pressed on it to help disperse the fluids because the swelling wasn't hard. It just felt like it was filled with fluid. It got painful enough for me to take Tylenol to help ease the pain throughout the day. It did disperse a bit by the next day but continued until today. I'm calling my doctor to see if they have any suggestion or remedies for the swelling because I'm a little concerned with how my body reacted. I had no injection site reaction at all.

Other Meds: Levothyroxine 75mcg, 1xday; Losartan 100mg and50mg 1xday; Restasis 2xday; Atorvastatin 20mg, 1xday; Montelukast 10mg, 1xday; Calcium

Current Illness:

ID: 1670787
Sex: F
Age: 54
State: AZ

Vax Date: 02/21/2021
Onset Date: 02/21/2021
Rec V Date: 09/03/2021
Hospital:

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

Lab Data: Hearing test

Allergies:

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

Symptoms: I had ringing in my ears. I was very lethargic. I had chills and low grade fever. I have hearing lost in my right ear.

Other Meds: Lisinopril; sulfasalazine; Nasacort; multi vitamin

Current Illness:

ID: 1670788
Sex: F
Age: 17
State: WI

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 09/03/2021
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: Received her first Pfizer COVID vaccine today around 11:25am. She was very reserved and quiet and seemed nervous but pleasant during the vaccine. Immediately after administering the vaccine, I asked her how she was doing, and she claimed to be fine. She left the consultation room. I went to administer a vaccine to the next patient in line. While I was doing the next vaccine, apparently the patient was attempting to walk to a chair and started to tip over (around 11:27am), on the verge of passing out. Her mother and sisters were there to catch her. She claimed her vision was blurry. When I came out of the consultation room, my other RPh, was on the phone with 911 per the mother's request. I went out to check on the patient. She claimed to be dizzy and have blurry vision. She was sipping on water and taking deep breaths. I asked if she was having any trouble breathing, and she denied that. Her face was very pale, and her lips were purplish/bluish. My technician brought out a cool cloth for her mother to put on the back of her neck. I asked her a few more times over the next 5-10 minutes if she was having any trouble breathing, and she denied it every time. When the EMTs arrived, they checked the patient's blood pressure sitting and standing and determined that her reaction/low blood pressure was most likely temporary, related to the vaccine and/or her anxiety about the vaccine. Havilah was not transported to the hospital, and her mother opted to take her home as she was feeling much better about 20 minutes after the initial reaction started.

Other Meds:

Current Illness:

ID: 1670789
Sex: M
Age: 74
State:

Vax Date: 02/22/2021
Onset Date: 08/25/2021
Rec V Date: 09/03/2021
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: Unevaluable event

Symptoms: Tested positive for COVID 19

Other Meds:

Current Illness:

ID: 1670790
Sex: F
Age: 43
State:

Vax Date: 02/13/2021
Onset Date: 09/03/2021
Rec V Date: 09/03/2021
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: Patient is Covid Positive now and receiving monoclonal antibody as outpatient infusion

Other Meds:

Current Illness:

ID: 1670791
Sex: M
Age: 29
State: WA

Vax Date: 08/13/2021
Onset Date: 08/14/2021
Rec V Date: 09/03/2021
Hospital:

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

Lab Data: none

Allergies: gluten

Symptom List: Injection site pain, Pain

Symptoms: The day after the vaccination patient started having chest pain and dizziness/vertigo. The pain did not radiate down his arm or up his neck and he experienced no shortness of breath. At times he would have to hold onto something while walking due to the vertigo. This lasted from Saturday until Wednesday. He did contact his doctor but did not go in to be seen in person. Patient stated that he has not had any cardiac problems in the past nor has he experienced this with any other vaccines. He also had a bumpy itchy rash that formed on his left leg, it was quite itchy for a few days.

Other Meds: unknown

Current Illness: none

ID: 1670792
Sex: F
Age: 20
State: TN

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 09/03/2021
Hospital:

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

Lab Data: Not known.

Allergies: NKDA

Symptom List: Injection site pain, Menorrhagia

Symptoms: Became extremely hot, sweaty, shaky, nauseous, and had ringing in her ears. She did not lose conscious at all but EMS was called since she has active history of passing out. They came and checked her vitals when she asked them to, she left on her own and declined to be taken to the hospital by EMS.

Other Meds: Not known.

Current Illness: Not known.

ID: 1670793
Sex: F
Age: 41
State: WI

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

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

Lab Data: CBC with platelets and diff normal INR normal

Allergies: NKMA

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

Symptoms: rash on arms - one red spot on the left arm and bruising on the right forearm and right knee

Other Meds:

Current Illness:

ID: 1670794
Sex: F
Age: 47
State: NJ

Vax Date: 04/14/2021
Onset Date: 04/21/2021
Rec V Date: 09/03/2021
Hospital: Y

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

Lab Data: CT Scan Head No Contrast 4/21/21 No stroke normal; CT Scan Without Contrast 5/26/21 normal; CT Scan Chest with contrast 4/22/21 normal; CT Scan Cervical Spine without contrast 4/21/21 normal; MRI Lumbar spine without contrast 4/22/21 degenerative changes; MRI Cervical Spine without contrast 4/22/21 moderate stenosis; MRI Brain with and without contrast 4/22/21 white matter lesions on brain; MRI Brain with contrast 5/26/21 white matter lesions; MRI Mid Thoracic Spine 8/2/21 Normal no cord lesions; MRI of Brain with contrast 5/26/21 white matter lesions on brain; Lumbar Puncture 5/28/21 Normal (no MS/Lyme); EKG 4/21/22 normal; EKG 5/25/21 normal; EEG 72 hour 6/14/21-6/18/21 Normal; EMG 7/15/21 CIDP diagnosis; Multiple blood panels Various from hospital stays Normal; Rheumatology Bloodwork 4/26/21 Normal No Auto Immune Disease; Ultra Sound on legs 4/22/21 Normal; Pulmonary Function testing 6/28/21 Normal; Chest X Rays 4/21/21 Normal; Chest X Ray 5/25/21 normal.

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: On April 21st, 2021, 7 days after receiving the 1st dose of the Moderna vaccine, I was hospitalized with severe muscle weakness/stiffness, joint pain and loss of fine motor skills. There was also Myoclonus episodes that started at the same time. I was hospitalized for 3 days and when released I started PT to try to regain some of the mobility that was lost through this occurrence and continued up through the 2nd dose. On May 21st, 9 days after receiving the 2nd dose of the Moderna vaccine I started encountering more severe and debilitating symptoms. I was again hospitalized, via ambulance from my home on Tuesday May 25th from complete leg failure and a severe Myoclonus episode and remained there until Saturday May 29th when I was transferred via ambulance to Inpatient Rehabilitation Center where I stayed until June 9th. While there I received intensive PT/OT and Speech Therapy. As mentioned, the symptoms were much more severe that I was wheelchair bound with very limited ability to use a walker. Upon release, I have continued at our local Outpatient facility where I am still receiving PT/OT and Speech. Speech has since completed on August 2nd, 2021. I am currently using a walker, cane and sometimes a wheelchair and I am NOT cleared to resume driving. There is NO timetable currently on when I will be cleared to drive. Through the intensive testing performed and described in section 19 of this form, I have been diagnosed with Demyelinating Polyneuropathy or CIDP. I have commenced IVIG infusion treatments, on August 9th, 2021, to hopefully reverse the damage caused by the vaccine and to get my life back!!

Other Meds: Wellbutrin XL 300mg; Lorazepam 1mg; Albuterrol inhaler; Asthmanex inhaler

Current Illness: none

ID: 1670795
Sex: M
Age: 76
State: AZ

Vax Date: 01/28/2021
Onset Date: 06/18/2021
Rec V Date: 09/03/2021
Hospital: Y

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

Lab Data: CAT scan, echocardiogram, blood tests, ultrasound of legs. Again, no known cause of the clot was determined.

Allergies: none

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Developed a severe left thigh ache sometime in April although I?m not sure of the date. Consequently had a pulmonary embolism event on June 18, 2021. I didn?t realize the thigh ache was a DVT. Went to emergency room with shortness of breath and was diagnosed with multiple PE in all 5 lung lobes. I was given heparin and scheduled for clot removal but turned out clots were small and no surgical invention was necessary. I was discharged from hospital the next day and placed on a blood thinner (Eliquis). Follow up appointment with hematologist resulted in no known cause of the clot. Subsequently I?m on blood thinners for the rest of my life.

Other Meds: Allopurinol, Amlodipine, Losartin, Rosuvastatin, Fish oil, multi vitamin, CO Q-10, D2, milkweed

Current Illness: none

ID: 1670796
Sex: M
Age: 37
State: CA

Vax Date: 03/25/2021
Onset Date: 03/25/2021
Rec V Date: 09/03/2021
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: I've had all type of blood work done, xrays, ct scans and seen a cardiologist, endocrinologist, hearing specialist, physical therapist, now I'm waiting to see a neurologist.

Allergies: none

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

Symptoms: Immediately after getting my first dose, i felt a hot flush in my chest and my heart rate shot up along with my blood pressure. For the next month i experienced extreme dizziness, HBP, elevated heart rate, and anxiety-like symptoms. I ended up at the ER several times all test keep coming back ok/normal. I got my second dose a month after i decided to take Ativan a few minutes before the shot to help with the heart rate incase i have the same result as the first and sure enough my heart rate was a bit elevated along with my blood pressure and now 5 months after i have been to the ER more times because I'm still having episodes of heart palpitations/anxiety/HBP/fatigue/dizzines and Groggy feeling.

Other Meds: none

Current Illness: none

ID: 1670798
Sex: F
Age: 25
State: ND

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

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

Lab Data: none

Allergies: diazepam. latex

Symptom List: Nausea

Symptoms: Tachycardia, redness to chest. Tachycardia lasted approx 8 minutes 224pm-232pm, redness to chest started approx 230pm, was flat blotchy area from bilateral lateral neck starting at lateral jaw line down over clavicle and meeting approx 4 inches into chest from base of neck. Appeared like a collar. did not extend to behind neck, back of arms or further down chest. No redness to abdomen or legs. Blotchy patches did move together and faded to a very light pink by 330pm. pt was monitored, assisted with deep breaths and due to the symptoms residing, no other medical intervention performed.

Other Meds:

Current Illness:

ID: 1670799
Sex: F
Age: 29
State: PA

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 09/03/2021
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: The patient received her first dose of the Moderna Covid-19 vaccine. She was asked to wait for 15 minutes seated in her chair. A few minutes after the vaccine, the patient passed out in the chair and fell to the floor. She woke up as soon as the pharmacist spoke to her. She stayed on the floor until she was no longer dizzy. Then she sat back up in the chair and was given water and orange juice. She stated that she had hit her head. We offered to call an ambulance, but she refused. She refused ice. We offered to call someone to pick her up, but she refused. Once she was feeling better, she stayed another 15 minutes before leaving.

Other Meds:

Current Illness:

ID: 1670800
Sex: F
Age: 33
State: MI

Vax Date: 04/30/2021
Onset Date: 04/30/2021
Rec V Date: 09/03/2021
Hospital:

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

Lab Data:

Allergies: imatrex, ultram

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

Symptoms: Since my second dose i have had 7 different episode where I get flu like symptoms. I can not regualte my tempature even with tylenol and motrin. I have flu like symptoms. My tempature will go from hot to cold in seconds. Im sick and I can not eat. After 24-30 hours of that I spend the next 3 days still feeling sick. I have zero energy. I cant really eat. Nothing I do fixes it except just going through it

Other Meds: noroc, adderall, bafclfin, lantus, lyrica, lexapro

Current Illness: no

ID: 1670801
Sex: F
Age: 11
State: WY

Vax Date: 08/12/2021
Onset Date: 08/12/2021
Rec V Date: 09/03/2021
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: Patient presented to an offsite clinic on 08/12/2021. On this day Pfizer was given to the patient. This patient is out of age range for this specific vaccine. Then on 09/02/2021 The patient present to site to get the second dose of the Pfizer vaccine and the dose was given on 09/02/2021, the patient was also out of age range for the second dose as well. On 09/03/2021 the out of age range was noticed and this nurse called the patient and spoke to the parent/guardian. The parent/guardian was inform of the dose being given even though the patient was too young for the vaccine. The parent also stated that the patient has no underlying health condintions.

Other Meds:

Current Illness:

ID: 1670802
Sex: F
Age: 73
State: NJ

Vax Date: 02/07/2021
Onset Date: 03/02/2021
Rec V Date: 09/03/2021
Hospital:

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

Lab Data: MRI and Cortisone Shot Given by doctor.

Allergies: None

Symptom List: Tremor

Symptoms: After the second dose, within hours (4-5) left shoulder was in pain. 4 Months later, patient went to see orthopedic and was told to take a Cortisone shot and do an MRI. To this day pain I still within the left shoulder, nothing has helped.

Other Meds: None

Current Illness: None

ID: 1670803
Sex: U
Age: 39
State:

Vax Date: 12/21/2020
Onset Date: 09/03/2021
Rec V Date: 09/03/2021
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: PATIENT HAD COVID-19 VACCINE ON Dose 1 date: 12/21/2020, Dose 2 date: 01/11/2021 AND TESTED POSITIVE TO COVID ON 9/3/21

Other Meds:

Current Illness:

ID: 1670804
Sex: F
Age: 53
State: MA

Vax Date: 08/23/2021
Onset Date: 08/23/2021
Rec V Date: 09/03/2021
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: None to this date. A teledoc appointment for allergist is scheduled through my work because vaccines was given at the medical facility I work at .

Allergies: Sulfur antibiotics

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

Symptoms: Right arm pain ad could only lift right arm 45degrees. Extreme abdominal pain and cramping. Nauseous . Diarrhea for 5 days. Abdominal and back muscle cramping 5 days post vaccine. 7 days post vaccine blood in stool. Abdominal pain ceased 12 days post vaccine.

Other Meds: None

Current Illness: None

ID: 1670805
Sex: F
Age: 45
State: NY

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 09/03/2021
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: The Patient presented to our pharmacy after making an appointment for a booster dose of her Moderna vaccine. The patient stated they had a compromised immune system and their last dose was administered on 2/8/21. Consistent with the law we administered a booster for the patient. Within several minutes the patient's face became red and they stated they had difficulty breathing. it was at this moment I as the pharmacist made used my clinical judgement to administer an Epipen dose to the patient. I asked my staff call emergency services. within moments their face came back to normal coloring and they were able to breath better. they did state their heartbeat was racing consistent with administration of the Epipen. I remained with the patient and counseled to focus on breathing. emergency services arrived several minutes later and took the patient in the ambulance with them. they then went to the hospital.

Other Meds:

Current Illness: Patient has a "compromised immune system". she was unable to verify which one.

ID: 1670806
Sex: M
Age: 65
State: FL

Vax Date: 02/08/2021
Onset Date: 04/26/2021
Rec V Date: 09/03/2021
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: MRI of the brain with and without contrast; CT Scan of head brain without contrast ; MRI Thoracic Spine with and without contrast; MRI cervical spine with and without contrast; MRI of lumbar spine with and without contrast ;CT myolegram;

Allergies: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Spontaneous Intracranial Hypotension,; Subdural hematoma; spontaneous cranial spinal fluid leak;

Other Meds: Amlodipine, Prevastatin and Omega 3 Fish Oil

Current Illness: None

ID: 1670807
Sex: M
Age: 50
State: NC

Vax Date: 08/18/2021
Onset Date: 08/21/2021
Rec V Date: 09/03/2021
Hospital: Y

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

Lab Data: Heart catheterization

Allergies: None

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

Symptoms: Patient vaccinated 8/18/21, came in with STEMI 8/21/21. Thrombus to mid LAD, received stent. All others angiographically normal, no CAD history. Did have risk factors of HTN, HLD (reports these were controlled) and smoking. Timiline concerning, as this occurred within 72 hours of the first Pfizer Covid-19 vaccine.

Other Meds: Atorvastatin, lisinopril.

Current Illness: None

ID: 1670808
Sex: F
Age: 56
State: PA

Vax Date: 04/03/2021
Onset Date: 04/03/2021
Rec V Date: 09/03/2021
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: physical exam of arm, with primary care physician: Friday, July 1st; xRay: Friday, July 1st; MRI: Monday, August 9th ultrasound: Friday, August 13th

Allergies:

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

Symptoms: Strong increased pain in the arm where injection was received, with loss of mobility. Stiffness and sharp pain, even during sleep. The pain has subsided a little, but it remains. I have sought medical care, and am currently receiving physical therapy.

Other Meds: Losartan

Current Illness:

Date Died: 07/15/2021

ID: 1670809
Sex: M
Age: 71
State: TN

Vax Date: 02/08/2021
Onset Date: 07/03/2021
Rec V Date: 09/03/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: Positive COVID test, dementia, CVA, CKD3, seizure disorder

Other Meds:

Current Illness:

ID: 1670810
Sex: F
Age: 45
State: AL

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

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

Lab Data:

Allergies: shellfish

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

Symptoms: immediate light headed feeling and nausea. She sat down and then went to bathroom about 15 minutes later and said felt much better. She stayed for 30 minutes until we were comfortable with her leaving. I put wet rag on head and neck. She went home and laid down and took zoran. I checked on her 4 times that day and she was fine later. The next day she was still fine.

Other Meds:

Current Illness:

ID: 1670811
Sex: F
Age: 39
State: FL

Vax Date: 08/23/2021
Onset Date: 08/24/2021
Rec V Date: 09/03/2021
Hospital:

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

Lab Data: CBC, CMP, TSH on 8/31/21. All results were within normal ranges.

Allergies: Sulfa

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

Symptoms: Hives on bilateral feet, top of feet, now having nerve symptoms of numbness and tingling, burning in soles of feet.

Other Meds: Escitalopram

Current Illness: Sinus infection prior. Competed antibiotic on 8/20/21

Date Died: 08/22/2021

ID: 1670812
Sex: F
Age: 58
State: NY

Vax Date: 08/19/2021
Onset Date: 08/22/2021
Rec V Date: 09/03/2021
Hospital:

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

Lab Data: 8/22/21 CAPILLARY GLUCOSE = 159 INFLUENZA-A&B = NOT DETECTED SARS-CoV-2 PCR = NOT DETECTED

Allergies: NKDA

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

Symptoms: ACCORDING TO DAUGHTER & SISTER: THE DECEASED HAD NO RECENT COMPLAINTS. THEY HAD A HISTORY OF HTN FOR, WHICH THEY WERE TAKING MEDICATION, BUT NO KNOWN CARDIAC ISSUES. THEY WERE AT WORK WHEN THEY HAD "SEIZURE-LIKE" ACTIVITY & COLLAPSED TO THE GROUND. EMS WAS CALLED. SHE WAS NOTED BY EMS TO BE IN ASYSTOLE AND ACLS BEGAN. EMS ADMINISTERED 3MG OF EPINEPHRINE AND CONTINUED COMPRESSIONS UNTIL THEIR ARRIVAL TO ED AT 11:38AM ON 8/22/21. WHILE IN THE ED, SHE RECEIVED MAGNESIUM SULFATE, AMIODARONE, CALCIUM CHLORIDE, SODIUM BICARBONATE, AND ADDITIONAL DOSES OF EPINEPHRINE. BEDSIDE CARDIAC US REVEALED NO CARDIAC WALL MOTION. A CENTRAL VENOUS CATHETER WAS PLACED AND tPA WAS ADMINISTERED. CPR WAS CONTINUED. DESPITE ALL EFFORTS, SHE REMAINED IN ASYSTOLE. REPEAT BEDSIDE CARDIAC US AGAIN REVEALED NO CARDIAC WALL MOTION. SHE WAS PRONOUNCED AT 12:11PM.

Other Meds: AMLODIPINE 10MG DAILY, OLMESARTAN 40MG DAILY ROSUVASTATIN 5MG DAILY, PANTOPRAZOLE 40MG DAILY & LEVOCETIRIZINE 5MG DAILY (30 DAY SUPPLIES LAST FILLED IN MAY 2021, COMPLIANCE?) OTC & HERBALS UNKNOWN

Current Illness:

ID: 1670813
Sex: M
Age: 14
State: MS

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 09/03/2021
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: none

Symptom List: Vomiting

Symptoms: Patient received a Moderna vaccine for his 2nd shot instead of a Pfizer. Patient had no type of adverse reaction and required no treatment of any kind.

Other Meds: none

Current Illness: none

ID: 1670814
Sex: F
Age: 38
State: ME

Vax Date: 08/26/2021
Onset Date: 08/27/2021
Rec V Date: 09/03/2021
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 performed

Allergies: Lactose

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: The next day she had axillary pain and myalgias Two days after the vaccine she developed fatigue and headaches.

Other Meds: Wellbutrin, Tylenol, Eucalyptus Tea, Green Tea, Ginger

Current Illness: None

ID: 1670815
Sex: F
Age: 73
State: OH

Vax Date: 03/19/2021
Onset Date: 04/01/2021
Rec V Date: 09/03/2021
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: normal CBC, CMP c/w CKD, other items WNL , CK normal, Mg normal, TSH normal

Allergies: NKDA

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

Symptoms: complains of diffuse muscle weakness, worse in the hip girdle and thighs, has persisted since early April and is no better or worse now.

Other Meds: apple cinder vinegar, olmesartan, magnesium,

Current Illness: none

ID: 1670816
Sex: M
Age: 51
State: VA

Vax Date: 08/12/2021
Onset Date: 08/19/2021
Rec V Date: 09/03/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Venous Duplex Lower Left Extremity- Interval recanalization of previously occluded left popliteal vein with residual nonocclusive thrombus in the distal femoral vein and popliteal vein. Persistent occlusion of the left peroneal trunk and posterior tibial vein. No sonographic evidence of deep venous thrombosis of the right lower extremity above the calf. CT/CTA Chest for PE w/wo IV CON- The pulmonary arteries are well opacified. Thre are filling defects in the proximal aspects of the primary branches of the right lower lobe pulmonary artery. There are no other visible filling defects. The lungs are clear. There is no evidence of mediastinal or hilar adenopathy. Pleural surfaces are unremarkable. The thoracic aorta is normal. RV/LV ratio is 0.8.

Allergies: Metoprolol succinate

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient had Moderna vaccine on 8/12/2021 by Pharmacy. Patient had an appointment with our facility on 8/20/2021 for left leg pain that started the night before. He states it felt like a slight twinge that was more severe by his appointment. Was sent to the Emergency Room on 8/20/2021 and was diagnosed with left popliteal DVT. He was prescribed Eliquis and told to follow up with our facility 3 days later. Patient called on 8/25/2021 stating he felt worn out after moving around for a few minutes and needed to take breaks to catch his breath. Patient's doctor at our facility recommended him go the Emergency Room due to concern of pulmonary embolism. CTA on 8/25/2021 was positive for pulmonary emboli in the right lower lobe. The patient has no personal or family history of DVT.

Other Meds: Lamotrigine, Metformin, Tresiba FlexTouch 200 unit/mil solution pen injector, Novolog FlexPen solution pen injector, Lisinopril, Rosuvastatin calcium, Aspirin, Fexofenadine, Fluticasone Propionate suspension spray, Armodafinil, Fluocinolone

Current Illness: None

ID: 1670817
Sex: F
Age: 33
State: CA

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

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

Lab Data: none

Allergies: none

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

Symptoms: systemic body rash on arms, legs, back, trunk started 8PM night of vaccine administration, unresponsive to zyrtec, hydrocortisone cream - went to urgent care and received a medrol dose pak which resolved the rash

Other Meds: prenatal vitamin, vitamin c, vitamin d, coq10

Current Illness: none

ID: 1670818
Sex: F
Age: 17
State: IN

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 09/03/2021
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: COVID Vaccine - Pfizer was given by mistake

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am