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: 1682617
Sex: M
Age: 25
State: CA

Vax Date: 08/28/2021
Onset Date: 08/31/2021
Rec V Date: 09/08/2021
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: Allergy to Whey

Symptom List: Dysphagia, Epiglottitis

Symptoms: Burning pain and throbbing in legs. Low circulation in legs. Chest tightness. Rash across mid-section. Chest pain and rash improved after several days, pain and throbbing in legs persists after 7 days but starting to improve after running and walking daily.

Other Meds: Garden of Life Raw Vitamin C Ancient Nutrition Vitamin D3+K

Current Illness: None

ID: 1682618
Sex: F
Age: 63
State: TX

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

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

Lab Data: Blood work normal

Allergies: None

Symptom List: Anxiety, Dyspnoea

Symptoms: Mainly I noticed it at night, because it would wake me up 45 minutes I would try to go to sleep. It was like someone was tearing the muscles of my bone. I could not sleep. It was so bad. That would be form my thigh all the way to my ankle. If I got up and move around it lessen but would not go away. It was a huge discomfort. I went to my general practitioner, and he diagnosed it as restless leg and gave me a medication that I did not like because it did not take the pain away and would make me really high so he gave me another one. They did not do any tests they just assume it was restless leg. I went to my husband's doctor and he said it was restless leg as well. So, I went to a specialist and he prescribed me Neupro. I take that at night. It does not make the pain away it just makes it tolerable. That only lasted for about 6 weeks. Into the 4th week I noticed it was not working as well so I contacted my doctor and asked if he would increase it. That was on 08/30/2021. For whatever reason he was so slow getting back to me. He also prescribed gabapentin. I started taking the gabapentin because I could not get the Neupro. But it is not working. They are just trying to figure out what it is. I only had blood work done and everything was normal. I am going to a vein specialist on 09/14/2021. I do have a stabbing pain on my chin and so I am hoping this is just a vein issue.

Other Meds: Lipitor; Synthroid

Current Illness: None

ID: 1682619
Sex: M
Age: 77
State:

Vax Date: 03/01/2021
Onset Date: 09/06/2021
Rec V Date: 09/08/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Patient developed COVID-19 requiring hospitalization post-vaccine.

Other Meds:

Current Illness:

ID: 1682620
Sex: F
Age: 45
State: OK

Vax Date: 09/07/2021
Onset Date: 09/07/2021
Rec V Date: 09/08/2021
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 called 9/8/21 stating that she had pain in her arm and is unable to use it. She is concerned that her vaccine was given to high and possibly in the bursa. She was contacting her primary care as well.

Other Meds:

Current Illness:

ID: 1682621
Sex: F
Age: 27
State: OH

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

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

Lab Data: Was precribed Valacyclovir three times a day!

Allergies: NONE

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

Symptoms: Broken out in rash - all over body including inside mouth and under the tongue. It's a red, small, blistery rash - extremely itchy and sore!

Other Meds: Birth Control

Current Illness: NONE

ID: 1682622
Sex: F
Age: 31
State: PA

Vax Date: 03/03/2021
Onset Date: 03/07/2021
Rec V Date: 09/08/2021
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: Blood work

Allergies: None

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

Symptoms: Heart palpitations, weakness, elevated tsh of 63.5

Other Meds: None

Current Illness: None

ID: 1682623
Sex: M
Age: 84
State:

Vax Date: 01/29/2021
Onset Date: 09/04/2021
Rec V Date: 09/08/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient developed COVID-19 requiring hospitalization post-vaccine.

Other Meds:

Current Illness:

ID: 1682624
Sex: M
Age: 46
State: PA

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

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

Lab Data: 09/01/21 1530 Respiratory virus detection panel Collected: 09/01/21 1417 | Final result | Specimen: Swab from Nasopharynx Adenovirus Not Detected Mycoplasma pneumoniae Not Detected Chlamydophila pneumoniae Not Detected Parainfluenza Not Detected COVID-19 SARS-CoV-2 Overall Result DetectedCritical Enterovirus/Rhinovirus Not Detected Coronavirus Not Detected Respiratory Syncytial Virus Not Detected Influenza A Not Detected Bordetella pertussis Not Detected Influenza B Not Detected Bordetella parapertussis Not Detected Metapneumovirus Not Detected Procedure Component Value Ref Range Date/Time Transthoracic echo (TTE) limited [3301565795] Resulted: 09/08/21 1102 Order Status: Completed Updated: 09/08/21 1103 MV E/E' septal 7.91 MV E' tissue velocity septal 0.08 m/s LVEF, A2C 60 >50 % LVEF, A4C 58 >50 % LVOT SI 24.80 ml/m2 AoV Vmax (trace/curve) 1.13 m/s LA volume index A2C 28.30 mL/m2 LA volume index A4C 24.30 mL/m2 LVEF, 2D 60 % AoV VTI 21.54 cm AoV peak gradient 5 mmHg AoV mean gradient 3 mmHg LVOT max velocity 0.92 m/s LVOT peak VTI 19.62 cm LVOT peak gradient 3 mmHg LVOT mean gradient 2.0 mmHg FS 31 28 - 44 % IVSd 1 0.6 - 1.1 cm LVIDd 4.50 3.7 - 5.6 cm LVIDs 3.10 2 - 3.8 cm LVEDV 95 mL LVESV 38 mL LVPWd 1 0.6 - 1.1 cm LADs 3.7 1.9 - 4 cm MV deceleration time 201 msec MV peak A velocity 0.54 m/s MV peak E velocity 0.64 m/s MV E/A ratio 1.19 MV E' tissue velocity lateral 0.09 cm/s LA Volume Index 26.3 mL/m2 LV Diastolic Volume Index 3.9 Narrative: ? Left Ventricle: Left ventricle cavity appears normal. Systolic function is normal with an ejection fraction of 55-60%. There is grade I (mild) diastolic dysfunction. ? Left Atrium: Left atrium cavity size is normal. ? Right Ventricle: Right ventricle cavity appears normal. Systolic function is normal. ? Aortic Valve: The aortic valve is tricuspid. The leaflets are not thickened and exhibit normal excursion. ? Mitral Valve: Mitral valve structure is normal. The leaflets are not thickened and exhibit normal excursion. X-ray chest 1 view [3301565784] Resulted: 09/08/21 1007 Order Status: Completed Updated: 09/08/21 1007 Narrative: XR CHEST 1 VW PORT IMPRESSION: No significant interval change from the prior study yesterday. END OF IMPRESSION: INDICATION: while in supine positioning with COVID-19.. Covid positive. Male; 46 years TECHNIQUE: Portable AP upright chest 5:53 AM COMPARISON: September 7, 2021 FINDINGS: Patchy faint bilateral infiltrates are noted in the mid to lower lung zones. The appearance is very similar to the prior study yesterday. Chest appearance otherwise unchanged from yesterday. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. X-ray chest 1 view [3301429459] Resulted: 09/07/21 0746 Order Status: Completed Updated: 09/07/21 0746 Narrative: XR CHEST 1 VW PORT IMPRESSION: Slight improved inflation. Persistent prominence of pulmonary vasculature and patchy bilateral r

Allergies: NKA

Symptom List: Pharyngeal swelling

Symptoms: Telephone 9/1/2021 Family Medicine, Med Asst Conversation Med Asst 9/1/21 2:08 PM Called to check on patient due to the reason for his appt and that he had not shown up. I was unable to reach him. I called his wife and she was very emotional when answering the phone stating that she had found him on the floor and his o2 sat had gone into the 50's. She states that she called emergency services and that she was driving behind his ambulance to the hospital now. She added that he was not doing well and I told her that we all hopes he gets well soon. ED to Hosp-Admission Current 9/1/2021 - present (7 days) Hospital Acute hypoxemic respiratory failure due to COVID-19 Severe sepsis Patient is an 46 y.o. male. With history of granulomatous lung disease who works as a EMT/firefighter who has received his first Covid vaccine 8/19/2021. He had recent travel, and presents to the ED 9/1/2021 with complaint of shortness of breath. He attempted to drive himself to the hospital via private vehicle but in route became more shortness of breath and EMS was activated. On EMS arrival he had pulse ox in the 50s which improved to the 70s on CPAP. On ED arrival he was severely short of breath and hypoxic. He was trialed on BiPAP which was ultimately unsuccessful and he was intubated for respiratory failure. Following intubation he had hypoxia, for which pulmonology was requested to assist prior to admission to the critical care unit. Unable to perform ROS: Intubated Central Line Date/Time: 9/1/2021 7:04 PM Performed by: CRNP Authorized by: CRNP Insert arterial line Date/Time: 9/1/2021 7:04 PM Performed by: CRNP Authorized by: CRNP

Other Meds: albuterol HFA (PROVENTIL;VENTOLIN) 90 mcg/actuation inhaler clomiPHENE (CLOMID) 50 mg tablet montelukast (SINGULAIR) 10 mg tablet predniSONE (DELTASONE) 5 mg tablet

Current Illness:

ID: 1682625
Sex: F
Age: 34
State: TX

Vax Date: 08/16/2021
Onset Date: 09/01/2021
Rec V Date: 09/08/2021
Hospital:

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

Lab Data: Diagnosed with Bell?s palsy

Allergies: None

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Bells Palsy

Other Meds: Tylenol

Current Illness: None

ID: 1682626
Sex: M
Age: 77
State: MI

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

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: Pt arrived at Hospital and was hypoxic and found to be COVID-19 positive.

Other Meds:

Current Illness:

ID: 1682627
Sex: M
Age: 50
State: GA

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

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

Lab Data: 08/18/2021 Antigen + COVID-19 test at medical Practice; 08/23/2021 PCR+ COVID-19 test at Hospital

Allergies:

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

Symptoms: Fever >100.4, Subjective fever (felt feverish), Chills, Muscle or body aches, New loss of taste or smell, Runny nose/Congestion, Cough (new onset or worsening of chronic cough), Shortness of breath or difficulty breathing, Chest pain, Fatigue or tiredness, Headache, Diarrhea (>/=3 loose/looser stools in 24 hr period), eye pain, nostril burning, ear ringing. Bilateral Pneumonia. 9/1/2021 BiPAP machine at hospital. Scheduled to move to ICU

Other Meds:

Current Illness:

ID: 1682628
Sex: F
Age: 23
State: VA

Vax Date: 09/04/2021
Onset Date: 09/04/2021
Rec V Date: 09/08/2021
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: Shot received 9/4/21 at 3:00pm, approx. 8:30 pm malaise & fever began, along with headache. By 9/5/21 fever increased to 102? and sustained for most of the day despite Tylenol 1000 mg every 4 hours, fever maxed at 102.8?. On 9/6/21 increased swelling of the arm with the injection site was noted and a red rash, as of today 9/8/21, the rash is still spreading with tightness and pain but no itching. Malaise, chills and fever have subsided but return in waves, usually in the evening. Some chest pressure has occurred. Recovery is on-going.

Other Meds: None

Current Illness: None

ID: 1682629
Sex: F
Age: 42
State: MT

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

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

Lab Data: NA- see above

Allergies: Patient states allergies to 5 different medication classes but didn't have information available to provide

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

Symptoms: No problems with 1st 2 shots in series other than fever/fatigue side effects. Candidate for 3rd dose due to immusuppression with Symzia. No problems during injection, 24 hours later reported itching around throat, trouble breathing, and hoarsness in throat. Due to her history of allergic reactions she took a benadryl 25 mg which resolved side effects after 3 doses. Stated she was traveling and not able to go see a Dr or ER when symptoms occurred. Reported this side effect to pharmacy on 9/8/21 and back in normal state with just a slight hoarse throat.

Other Meds: Patient fills rxs at another pharmacy so no data available, but stated she currently is on Symzia

Current Illness: None noted

ID: 1682630
Sex: M
Age: 71
State: PA

Vax Date: 08/25/2021
Onset Date: 08/26/2021
Rec V Date: 09/08/2021
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: Inflammation elevated. Rheumatoid arthritis and PMR ruled out as diagnoses. No other apparent cause.

Allergies: none

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

Symptoms: Sever pain and stiffness in shoulders and hips every morning. Eases during the day with medication and movement.

Other Meds: levothyroxine. Turmeric, vitamin D, zinc, aspirin

Current Illness: none

ID: 1682631
Sex: F
Age: 86
State: MN

Vax Date: 01/12/2021
Onset Date: 09/01/2021
Rec V Date: 09/08/2021
Hospital:

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

Lab Data: COVID PCR positive on 09/01/2021

Allergies: Atrovastin, erythromycin, metoprolol, prednisone

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

Symptoms: Patient tested positive for COVID on 09/01/2021. Did have increased oxygen needs. She was started on dexamethazone 6mg PO x10 days on 09/04/2021.

Other Meds: decadron, tramadol, miralax, tylenol, preparation H, cozaar, hygroton, prilosec, advair, celexa, colace

Current Illness: NA

ID: 1682632
Sex: F
Age: 30
State: NY

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

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

Lab Data: CMP, CBC with diff pending

Allergies: none

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

Symptoms: Urticaria - diffuse, Persistent, saw her on 9/8/2021 and she still had urticaria, added 2 week course of prednisone

Other Meds: Methylprednisolone, Cetirizine, Allegra, Famotidine,

Current Illness: none

ID: 1682633
Sex: F
Age: 73
State: TN

Vax Date: 09/03/2021
Onset Date: 09/04/2021
Rec V Date: 09/08/2021
Hospital:

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

Lab Data: NA

Allergies: Osteoporosis medication- medication is unknown, causes swelling of the tongue

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

Symptoms: Redness and swelling on the left upper arm area that extended to the bend of her elbow and started the night of 9/4/21. Patient stated she was taking Aleve 1x in the morning and applying cold packs to the area though out the day. Discussed with patient to take Aleve 2x a day and to apply cold pack for 10-15 minutes and then remove it for at least 30 minutes and repeat if needed. Patient stated she was feeling better when contacted on 9/7/21. Instructed patient to contact Health Department if she was not feeling better by Friday 9/10/21.

Other Meds: Albuterol, Aspirin 81mg, Symbicort, Clopidogrel 75mg, Cyclobenzaprine 5mg, Daliresp 500mcg, Gabapentin 300mg, Duo-neb, Loratadine 10mg, Montelukast 10mg, Multivital oral, Pembrolizumab 25mg/mL, Rosuvastatin 20mg

Current Illness: Lung Cancer

ID: 1682634
Sex: M
Age: 50
State: NY

Vax Date: 05/29/2021
Onset Date: 06/11/2021
Rec V Date: 09/08/2021
Hospital:

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

Lab Data: They performed an EKG, chest x-ray and took blood samples. I stayed for 8 hours. All results came back negative for a heart attack.

Allergies: none

Symptom List: Ear pain, Hypoaesthesia

Symptoms: While at home watching TV, I began to have pains in my shoulders. The pain started to move towards the center of my chest. Pain then started in my left shoulder and moved down my arm to my elbow and then in my wrist. I tried to rub the pain in my chest but it was a deep, not in the upper muscle area. Fearing signs of a heart attack, I went to NYU Langone Long Island hospital. They performed an EKG, chest x-ray and took blood samples. I stayed for 8 hours. All results came back negative for a heart attack. I followed-up with my primary care physician and he recommend to hold off on the second Covid shot and to see a cardiologist. I have a stress test and follow-up later this month. Since the first Covid shot, the area of the shot in my left arm has been sore on a regular basis.

Other Meds: None

Current Illness: None

ID: 1682635
Sex: M
Age: 58
State: MI

Vax Date: 08/17/2021
Onset Date: 08/17/2021
Rec V Date: 09/08/2021
Hospital:

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

Lab Data: none

Allergies: none

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Hives on abdomin . next dat sores in mouth

Other Meds: zyrtec, synthroid, neurontin.

Current Illness: none

ID: 1682636
Sex: M
Age: 62
State: IL

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

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

Lab Data:

Allergies: coumadin, heparin, morphine

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

Symptoms: hospitalization 9/3 - 9/6/2021

Other Meds:

Current Illness:

ID: 1682637
Sex: F
Age: 67
State: OH

Vax Date: 07/23/2021
Onset Date: 09/07/2021
Rec V Date: 09/08/2021
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: covid + 9/7/2021, symptom onset 8/31/2021, CXR clear

Allergies: iodine, bee sting, sufa, polyester, diatrizoate, percocet

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

Symptoms: breakthrough case, mild symptoms, admission for acute pyelonephritis w/ sepsis

Other Meds: albuterol, ASA, biotin, vitamin D, estradiol, fluoxetine, meclizine, rosuvastatin, spironolactone, tolterodine, trazodone

Current Illness: no

ID: 1682638
Sex: M
Age: 17
State: AL

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

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

Lab Data: EKG and VS 9/8/2021

Allergies: Bee stings

Symptom List: Unevaluable event

Symptoms: reports feeling real tired post vaccination

Other Meds: none

Current Illness: 14-15 days post covid

ID: 1682639
Sex: F
Age: 29
State: AR

Vax Date: 08/24/2021
Onset Date: 09/03/2021
Rec V Date: 09/08/2021
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: 09/05/21- COVID PCR: Negative 09/05/21- UA: Normal

Allergies: None

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

Symptoms: Low-grade fever 99.1-99.6 F, nausea, headache beginning day 10 after injection. Symptoms lasted 3 days. Visited urgent care center, missed 1 day of work due to illness symptoms.

Other Meds: Prozac, Klonopin, Vit D + Calcium, iron, prenatal vitamin, AZO Cranberry

Current Illness: None

ID: 1682640
Sex: M
Age: 81
State: NY

Vax Date: 02/26/2021
Onset Date: 09/06/2021
Rec V Date: 09/08/2021
Hospital:

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

Lab Data: COVID-19 positive

Allergies: no known allergies

Symptom List: Injection site pain, Pain

Symptoms: Patient admitted to hospital with positive COVID-19 diagnosis

Other Meds: unknown

Current Illness: unknown

ID: 1682641
Sex: F
Age: 74
State: GA

Vax Date: 03/24/2021
Onset Date: 08/20/2021
Rec V Date: 09/08/2021
Hospital: Y

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

Lab Data: 08/20/2021 PCR+ COVID-19 test at Hospital

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Fever >100.4, Subjective fever (felt feverish), Chills, Cough (new onset or worsening of chronic cough), Shortness of breath or difficulty breathing, Fatigue or tiredness, Nausea or vomiting, Headache, Hospitalization, ICU admission. Patient states on 8/20/2021 she was cold in the house and went outside on her deck and fell asleep, in the heat, Patient husband thought she had had a heat stroke and called 911. Patient was taken to the hospital, she was tested for Covid was positive and was admitted and stayed in the hospital until 8/26/2021 and returned home with home oxygen but states her SATS are at 100% and she is not using the oxygen. Patient said she started to go into organ failure and had Covid pneumonia and possible PE's.

Other Meds:

Current Illness:

ID: 1682642
Sex: F
Age: 45
State: MI

Vax Date: 04/24/2021
Onset Date: 04/26/2021
Rec V Date: 09/08/2021
Hospital:

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

Lab Data: Scheduled ultrasound. Urine tests for infection normal.

Allergies: Cephalexin Lisinopril. Pregabalin Ezetimibe. Gabapentin. Metoclopramide Sim a statin. Lamotrigine. Nitrofurantoinmono/Mcryst Atorvastatin. Mematine. Phenazopyridine Meloxicam. Topiramate. Cefaclor

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

Symptoms: Heavy menstrual cycle after second dose in April & again in May 2021. June 2021 was normal. July cycle was very short. Have not menstruated since July.

Other Meds: Novolog Domperidone Levothyroxine Lasix Pravastatin Vitamin D3 daily multivitamin

Current Illness:

ID: 1682643
Sex: F
Age: 56
State: UT

Vax Date: 09/01/2021
Onset Date: 09/01/2021
Rec V Date: 09/08/2021
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: 9/1/21 - Glucose wnl

Allergies: Sulfa antibiotics

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: After receiving COVID-19 vaccine, patient experienced lightheadedness, dizziness, extreme fatigue, blood pressure was labile, throat swelling and shortness of breath. RRT called, patient was monitored, vitals taken, glucose monitored, O2 administered at 2 L/min. Pt reported feeling dizzy and fatigued, but other symptoms improved. No medication interventions noted. patient discharged and scheduled for 2nd COVID vaccine 9/20.

Other Meds:

Current Illness:

ID: 1682644
Sex: F
Age: 47
State: MA

Vax Date: 02/16/2021
Onset Date: 05/23/2021
Rec V Date: 09/08/2021
Hospital: Y

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

Lab Data: Many medical tests, cardiologist exams, labs and test work throughout my hospital stay from June 6th - 11th. If needed, will grant permission to have access to these files through my medical portal or doctor.

Allergies: Penicillin Vicodan

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: My adverse reaction did not come for a few months, I ended up contracting Shingles and then as soon as the Shingles (May9th-22nd) ended, I ended up in Acute Afib and was sent to the hospital on June 6th, 2021

Other Meds: Omeprazole 20mg probiotic Loratadine Flonase

Current Illness: May 9th through May 21st - Shingles over left orthamic nerve

ID: 1682645
Sex: F
Age: 32
State: FL

Vax Date: 06/08/2021
Onset Date: 06/15/2021
Rec V Date: 09/08/2021
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: EKG, troponin, chest xray, basic labs including CMP and CBC were WNL. However, these were obtained over 1 month after presentation of symptoms. Tested for covid 19 x 2 during symptoms and negative both times.

Allergies: None

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

Symptoms: Approximately 1 week after vaccination developed burning chest pain, bilateral however greatest on L side. Albeit the pain has improved, it has been 3 months since vaccination and continues with chest pain. Unable to exercise as pain worsens with activity. History of covid + (mild illness without chest pain/SOB) approx 1 year with antibody production prior to vaccination. Treatment includes NSAIDs with some relief. Please investigate adverse events related to covid survivors with high antibody production prior to vaccine.

Other Meds: None

Current Illness: None

ID: 1682646
Sex: F
Age: 41
State: CO

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

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

Lab Data: Nothing as of yet

Allergies: Augmentin

Symptom List: Nausea

Symptoms: Left shoulder blade pain, throat and tongue fuzzy feeling, tingle, vision blurred, head pressure and slight pain. Left arm numbing. Dizzy. POST COVID syndrome symptoms worsened and regressed from recovery.

Other Meds: B12, Vitamin C

Current Illness: POST COVID syndrome. ie:Heart palpitations, fatigue, lightheadedness, dizziness, elevated heart rate.

ID: 1682647
Sex: F
Age: 67
State: OH

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

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

Lab Data: PCR + 9.7.2021, CXR: clear

Allergies: nkda

Symptom List: Injection site pain

Symptoms: breakthrough case Covid + 9.7.2021, symptoms, SOB, cough, weakness, CXR: clear

Other Meds: amlodipine, ASA, atorvastatin, calcium w/ vit D, coreg, vit D, dulaglutide, fluoxetine, gabapentin, hydrocodone/APAP, humalog, senne-docusate, trazodone

Current Illness: no

ID: 1682648
Sex: F
Age: 38
State: MO

Vax Date: 03/30/2021
Onset Date: 03/30/2021
Rec V Date: 09/08/2021
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: allergy to pertussis

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

Symptoms: An hour I left the vaccination event, my neck became immediately sore and I couldn't turn it. I had an intense headache. Several hours later I did have minor chills and tiredness. I started having intense pain in my neck and it was extremely stiff and I couldn't turn it. Intense stiffness in my right arm even though I received the vaccine in my left arm. I was in so much pain I was taking 1000 mg of Tylenol every 4 hours to help manage the pain. On the third or 4th night I was in so much pain at 2am, I thought I needed to go to the ER. I started listening to a guided meditation and that helped me get through the pain. I was trying to mentally preparing myself for this pain to be my new normal. It was very scary. By the 7th day the pain subsided, but it was very scary that whole week and did not receive the 2nd dose of the vaccine because the pain.

Other Meds: none

Current Illness: no

ID: 1682649
Sex: F
Age: 76
State: MA

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

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

Lab Data: ER visit July 20 MRI CAT scan ENT august 9 PT 9/2 and continues

Allergies: Codene

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

Symptoms: Vertigo lasting 3 days returning in June 2021 and continues to present date

Other Meds: Amlodapine 5 mg..calcium

Current Illness: Cold

ID: 1682650
Sex: F
Age: 30
State:

Vax Date: 12/30/2020
Onset Date: 09/05/2021
Rec V Date: 09/08/2021
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: Tremor

Symptoms: patient HAD PFIZER COVID-19 VACCINE ON Dose 1 date: 12/30/2020, Dose 2 date: 01/20/2021, AND TESTED POSITIVE TO COVID.

Other Meds:

Current Illness:

ID: 1682651
Sex: M
Age: 40
State: OR

Vax Date: 09/03/2021
Onset Date: 09/04/2021
Rec V Date: 09/08/2021
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: Fever, fatigue, upset stomach, sensitivity to touch, sore muscles

Other Meds: NONE

Current Illness: NONE

ID: 1682652
Sex: M
Age: 12
State: CA

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

Allergies: KNA

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

Symptoms: Pt was given an expired Pfizer vaccine for second dose. Vaccine expired on 8/30/21 at 9:59pm, vaccine was given on 8/31/2021 at 9:35am. Pt was stable and was monitored for over 45 min in the clinic, no adverse reaction noted. Dr was notified as well.

Other Meds: Unknown

Current Illness: Unknown

ID: 1682653
Sex: F
Age: 48
State: NY

Vax Date: 04/25/2021
Onset Date: 06/07/2021
Rec V Date: 09/08/2021
Hospital:

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

Lab Data: I met with an allergist (thinking that I was having an allergic reaction to something). She ordered blood work to check my thyroid antibodies and to check some common allergens. The allergens were negative. Based on my antibody levels, she noted that she believes my hives are autoimmune-related, especially since I was diagnosed with thyroid issues a long time ago - so this diagnosis makes sense to me. The only question is: what triggered the chronic hives? This is the answer I don't have.

Allergies: None

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

Symptoms: I have developed chronic idiopathic urticaria (hives) and dermatographia. I can't be entirely sure that this condition has stemmed from the vaccine. I only know that I'd never had chronic hives before I got the vaccine, so I figure it was worth reporting. I manage this through Zyrtec (antihistamine) on a daily basis - I can't function without it.

Other Meds: Levothyroxine, Levonest (birth control)

Current Illness: None

ID: 1682654
Sex: F
Age: 26
State: IL

Vax Date: 09/07/2021
Onset Date: 09/07/2021
Rec V Date: 09/08/2021
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: Shellfish, Sulfa

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Face and arms became red and blotchy. Chest became red. Neck felt heavy

Other Meds: Effexor, Singulair, Claritin, Dupixent, birth control

Current Illness:

ID: 1682655
Sex: M
Age: 11
State: WI

Vax Date: 08/03/2021
Onset Date: 08/03/2021
Rec V Date: 09/08/2021
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: N/A

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

Symptoms: Client came to one of our public vaccination clinics. The age written on the administrative form was not the child's actual birthday(the year was changed to 2008 rather than 2009). This error was not noticed until after the vaccine had been administered. No adverse reactions occurred at the clinic and when the child came back for his second dose, they did not report any adverse reactions to the first dose.

Other Meds: N/A

Current Illness: N/A

ID: 1682656
Sex: F
Age: 37
State: NJ

Vax Date: 08/25/2021
Onset Date: 09/08/2021
Rec V Date: 09/08/2021
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: Sonogram confirmed no heartbeat and dated pregnancy one week behind.

Allergies:

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

Symptoms: Miscarriage confirmed 9/8/21 at routine appointment Due : 4/2022 Pregnancy history- 3 pregnancies 1 termination 1 full term birth 1 miscarriage

Other Meds: Prenatal vitamin, zyrtec

Current Illness:

ID: 1682657
Sex: F
Age: 31
State: VA

Vax Date: 08/25/2021
Onset Date: 08/26/2021
Rec V Date: 09/08/2021
Hospital:

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

Lab Data: The took all my vital signs and then they did the EKG, urine, blood work panel. EKG showed that my heart was jumping.

Allergies: No

Symptom List: Pain in extremity

Symptoms: It started the next day I woke up with a Margarine around 5am and then about 2pm I started getting tired and then 6pm is when the chest pain started. The 8/27/2021 I still was having all the same symptoms and then at 6pm I went to the ER. They hook me up to fluids with anti inflammatory. The doctor stated it was a reaction to the vaccine. He also stated to go home and take Ibuprofen 600 mg every 6 hours. So I did that and the pain didn't go away. A week later I went to see my Doctor. He really do anything but chest vital and between my breast and stated that I had Costochondritis. he stay it was information of the rib cage and he prescribe Naproxen 500 mg twice a day for a month. I started the meds and the pain started to subside 9/6/2021. Every once in a while I will have a dry cough and it will hurt but not as bad.

Other Meds: No

Current Illness: No

ID: 1682658
Sex: M
Age: 46
State: NC

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

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

Lab Data: ON SITE BLOOD GLUCOSE-103

Allergies: UNKNOWN

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

Symptoms: PT RECEIVED 1ST DOSE OF PFIZER VACCINE, APPROXIMATELY 5 MINUTES AFTER RECEIVING VACCINE, PT WAS HAVING SEIZURE LIKE ACTIVITY. EMS WAS CALLED IMMEDIATELY. PT REMAINED IN A TONIC/CLONIC STATE FOR APPROXIAMTELY 45 SECONDS. PT REGAINED CONSCIOUSNESS AND WAS ADVISED OF WHAT HAPPENED. BP WAS 150/80, PULSE 68, RR-16, SPO2%-98%. PT WAS ALERT TO NAME, DATE, MONTH AND YEAR ONCE HE CAME TO. PT STATED THAT HE HAD NO MEDICATION HX OR HX OF GOING TO THE DOCOR IN OVER 18 YEARS. PT WAS TRANSPORTED VIA EMS TO LOCAL HOSPITAL.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1682659
Sex: F
Age: 50
State: MO

Vax Date: 09/01/2021
Onset Date: 09/02/2021
Rec V Date: 09/08/2021
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 and General Chemistry panel on 9/3/2021 magnesium low at 1.7 Calcium low 7.5 Total protein 6.3 Albumin 2.9

Allergies: Dilaudid egg containing compound morphine

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

Symptoms: SEVERE involuntary muscle movements

Other Meds: propranolol 20mg every day duloxetine 60mg every day gabapentin 600mg twice a day rosuvastatin 10mg every day Vitamin D 3 50mcg every day omeprazole 20mg every day zyrtec 10mg every day vitamin B complex every day magnesium 400mg ever

Current Illness:

ID: 1682660
Sex: M
Age: 17
State: WV

Vax Date: 09/07/2021
Onset Date: 09/07/2021
Rec V Date: 09/08/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: Vaccine administration error, unauthorized age group

Other Meds:

Current Illness:

ID: 1682661
Sex: F
Age: 38
State: MA

Vax Date: 08/19/2021
Onset Date: 08/29/2021
Rec V Date: 09/08/2021
Hospital: Y

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

Lab Data: COVID test; blood test; chest x-ray; CT scan - it wasn't a full collapsed lung - (I had to have surgery done previously to prevent it from collapsing completely anymore)

Allergies: Latex; Ceclor; Morphine; and Aleve

Symptom List: Vomiting

Symptoms: I started having shortness of breath and pain in my chest- it was another collapsed lung - I have been getting it fairly often with my immune disease. I went to ER and I was hospitalized for two days. Treatment: pain meds and oxygen therapy. I have to see my doctor today for a follow up.

Other Meds: Amovig; Amitriptyline; Buspar; Dicyclomine; Duloxetine; Duoneb; Eliquis; Gabapentin; Methyltrexate; Midodrine; Plaquenil; Protonix; Tizanidine; Topamax; Medrol; Zofran; Nurtec; Vit B12 and Vit D

Current Illness: Cold - I thought I was over it though at time of vaccine

ID: 1682662
Sex: F
Age: 66
State: CA

Vax Date: 08/27/2021
Onset Date: 08/28/2021
Rec V Date: 09/08/2021
Hospital:

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

Lab Data: I have to be dying to get tested and I wasn't dying but the reaction was sudden onset, overwhelming and disconcerting.

Allergies: doxyclycoline, versed, hydrocodon

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: After the first dose, I had extreme pain in my left arm, had foggy brain and fatigue. Nothing major although I did notice the onset of irregular heartbeat which is why I added Aspirin to my supplements before the 2nd dose. The 2nd dose was a nightmare. I am NEVER sick. Nausea/vomiting, chills, fever, memory loss, increased tinnitus, hearing a radio that wasn't playing for 3 days mostly in the middle of the night; major fatigue, depression, and general malaise for days.

Other Meds: 324 mg aspirin; 6 grams chlorella; 6 grams spirulina; 500 mg Quercetin; 5,000 mg Vit C; NAC-1200 mg; Zinc 44mg; Selenium 300mcg; B-complex 100mg; Homeopathic remedies: Traumeel, Biocell Salts, Arnica.

Current Illness: None whatsoever.

ID: 1682663
Sex: F
Age: 47
State: NC

Vax Date: 08/31/2021
Onset Date: 09/01/2021
Rec V Date: 09/08/2021
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: No test. Bought Benadryl pill and cream.

Allergies: Vicodin

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

Symptoms: body ache, hives/whips all over my body.

Other Meds: None

Current Illness: none

ID: 1682664
Sex: F
Age: 33
State: MO

Vax Date: 12/20/2020
Onset Date: 03/27/2021
Rec V Date: 09/08/2021
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: CT scan on 4/1/2021 shows paracadial effusion. Ultra sound to the thyroid 7/21/21 shows proof of the hypothyroidism(Hashimotos Disease). Placed on thyroid and cholesteral medication therefore having Continues blood work over this course of time to gage what levels of medication needs to be.

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: End of January into Febuary developed shortness of breath, neck and back pains, cardiac palpitations. Marsh 27 2021. Went to the emergency room for chest pressure and shortness of breath. syptoms have worsened greatly. Diagnosed with paracardial effusion, & hypothyroidism. Refered to cardiac Dr. who informed me that this could be a side effect of the vaccine. Continued to have thyroid issues incuding weight gain and throat complications. Endocrinologist now has Diagnosed myself with Hashimotos Disease 9/8/2021. Said this was also a side effect to recieving the vaccination and to report.

Other Meds: Tremfya 100mL/8weeks

Current Illness:

ID: 1682665
Sex: F
Age: 61
State: MN

Vax Date: 03/17/2021
Onset Date: 08/31/2021
Rec V Date: 09/08/2021
Hospital: Y

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

Lab Data:

Allergies: Amoxicillin Amoxicillin-Pot Clavulanate Aspirin Dihydroxyaluminum Aminoacetate Duloxetine Insulin Regular Metal (Nic) Morphine (Pf) Naproxen Nsaids (Non-Steroidal Anti-Inflammatory Drug) Pramlintide Pregabalin Tolmetin Unidentified Metoprolol

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

Symptoms: POSITIVE COVID TEST 8/31/21

Other Meds: acetaminophen (TYLENOL) 325 mg oral tablet albuterol HFA (PROVENTIL;VENTOLIN HFA) 90 mcg/actuation Inhl inhaler albuterol, conc: 2.5mg/3mL, (PROVENTIL, VENTOLIN) 2.5 mg /3 mL (0.083 %) Inhl nebulizer solution aspir

Current Illness:

ID: 1682666
Sex: M
Age: 78
State: OH

Vax Date: 03/05/2021
Onset Date: 09/04/2021
Rec V Date: 09/08/2021
Hospital: Y

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

Lab Data: PCR + 9.4.2021 CXR: 1. Atelectasis versus early infiltrate in the left lower lobe. 2. Minimal atelectasis in the right lower lobe.

Allergies: nkda

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

Symptoms: breakthrough case- w/ diarrhea and fatigue/weakness

Other Meds: amlodipine, vit D, flonase, mirabegron, tacrolimus

Current Illness: no

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am