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: 1685517
Sex: M
Age: 36
State: NJ

Vax Date: 09/08/2021
Onset Date: 09/08/2021
Rec V Date: 09/09/2021
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: Patient received expired dose of moderna covid vaccine on 9/8/21. No adverse reaction noted or reported.

Other Meds:

Current Illness:

ID: 1685518
Sex: F
Age: 50
State: NY

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

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

Lab Data: MRI & Blood work on 9/7/2021

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Sept 6th, 7:00 p.m. had double vision. Went to Hospital Emergency Room on Sept. 7th, 2:00 pm. and they ran blood work, and MRI. Results showed no stroke, bleeding on the brain or tumor. ER Dr. couldn't diagnose why I was having double vision which is neurological disorder. Referred me to Neuro Ophthamologist.

Other Meds: Progesterone, Estrogen, Vitamin D, Vitamin C, Magnesium

Current Illness:

ID: 1685519
Sex: F
Age: 41
State: TN

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

Allergies: unknown

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

Symptoms: unknown

Other Meds: unknown

Current Illness: unknown

ID: 1685520
Sex: M
Age: 31
State: AL

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

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

Lab Data: Blood in urine was abnormal, blood work came back normal

Allergies: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: The next day after the shot when I woke up I started peeing blood and I now have a body rash

Other Meds: None

Current Illness: None

ID: 1685521
Sex: M
Age: 71
State: IL

Vax Date: 03/20/2021
Onset Date: 09/08/2021
Rec V Date: 09/09/2021
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: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: unknown lot numbers for vaccine. patient hospitalized and diagnosed with Covid breakthrough case

Other Meds:

Current Illness:

ID: 1685522
Sex: F
Age: 55
State: GA

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

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

Symptoms: 90 minutes post injection outside of both eyes felt scratchy. 3 hours after injection intense nausea, salivation, headache, intense grainy eye feeling, dry stuck throat on the right side. 5 hours post injection conjunctivitis in both eyes, heavy sleep in lashes, blurred vision, sensitivity to light, intense thirst, achy eyes, gritty feeling around eyes from discharge, metallic taste and tingling tongue. Following morning I noticed swollen eyes and face. I had continued headache, light sensitivity, brain fog, metallic taste, better but continued blurred vision, occasional eye pain, head pain if bent over, fatigue.

Other Meds: Vyvanse

Current Illness: N/A

ID: 1685523
Sex: M
Age: 36
State: CO

Vax Date: 09/09/2021
Onset Date: 09/09/2021
Rec V Date: 09/09/2021
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: Patient given dose 7 days prior to the 28th day by our clinic nurse. No health reactions or symptoms noted.

Other Meds:

Current Illness:

ID: 1685524
Sex: F
Age: 48
State: OK

Vax Date: 08/18/2021
Onset Date: 08/23/2021
Rec V Date: 09/09/2021
Hospital:

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

Lab Data: Seeing dr on September 22, 2021 to discuss if I should get second shot

Allergies: Unknown

Symptom List: Pharyngeal swelling

Symptoms: Left breast doubled in size, two painful lumps over two inches in size, each directly behind nipple and one on left side, rash all over chest, hot to touch and lasted two weeks followed by skin sloughing off all over chest. Then right arm developed painful rash that felt like I had come into contact with fiberglass insulation which lasted two days. Over all had a feeling of severe anxiety and depression with suicidal idealizations for three weeks. Completely fine and no symptoms now.

Other Meds: Alavert Vitamins C and D

Current Illness: Anemic

ID: 1685525
Sex: M
Age: 18
State: SC

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

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

Lab Data: Hospital admission (9/6/21), EKG with typical pericarditis findings (9/6/21) echocardiogram with preserved ejection fraction (9/6/21), cardiac MRI with results pending at discharge (9/8/21), troponin of 42.02 (9/7/21)

Allergies: NKDA

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: The patient presented with myalgias and chest pain. He was found to have myopericarditis.

Other Meds: none

Current Illness: none

ID: 1685526
Sex: F
Age: 33
State: PA

Vax Date: 08/25/2021
Onset Date: 09/03/2021
Rec V Date: 09/09/2021
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: Over a week since getting my first shot of Moderna COVID19 vaccine, I started getting a rash at the injection site and other little skin irritations. The rash was red, had some raised bumps and was warm to the touch. It itched sometimes. Lasted around 3-4 days. It seemed to be gone but today it started itching a little and just a little red again. I have also felt fatigued since getting the shot.

Other Meds:

Current Illness: none

ID: 1685527
Sex: F
Age: 30
State: MN

Vax Date: 06/18/2021
Onset Date: 06/29/2021
Rec V Date: 09/09/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Patient hospitalized for two hours for pelvic pressure on 6/29/2021. patient hospitalized for supervision of vaginal delivery. These visits are within 6 weeks of receiving COVID vaccination. Per doctor notes she delivered a healthy baby boy.

Other Meds:

Current Illness:

ID: 1685528
Sex: F
Age: 44
State: MO

Vax Date: 07/10/2021
Onset Date: 07/11/2021
Rec V Date: 09/09/2021
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 Known

Allergies: None Known

Symptom List: Rash, Urticaria

Symptoms: Pt reports symptoms similar to facial palsy starting approx 1 day after administration and still occurring during first report to clinic on 9/9/21. Clinic had attempted to contact patient about completing series and patient reported palsy symptoms occurring soon after admin of first dose. Pt asked if she should see a neurologist and clinic agreed that seeing a neurologist as soon as possible would be in the best interest of the patient.

Other Meds: Unknown

Current Illness: None Known

ID: 1685529
Sex: M
Age: 49
State: NJ

Vax Date: 09/08/2021
Onset Date: 09/08/2021
Rec V Date: 09/09/2021
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: Patient received expired dose of moderna covid vaccine on 9/8/21. No adverse reaction noted or reported

Other Meds:

Current Illness:

ID: 1685530
Sex: M
Age: 43
State: FL

Vax Date: 01/11/2021
Onset Date: 08/14/2021
Rec V Date: 09/09/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: tested positive for Covid on 8/14/21.

Allergies: seafood

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

Symptoms: 8/14/21: presented to ED complaining of nausea vomiting diarrhea and shortness of breath patient is fully vaccinated against COVID with (Pfizer) 2nd dose was in January, he recently been traveling , has been experiencing nausea vomiting diarrhea that he contributed probably to food poisoning but and then he continue to have some shortness of breath last night he presented to ED and found to be hypotensive, given 2 L IV fluid with still no response so central venous catheter was placed the same time COVID- PCR test came back positive, patient was started on norepinephrine and will be admitted to ICU . Note: previously vaccinated with Covid-19 Pfizer vaccine on 12/22/20 & 1/11/21.Diagnosed and treated for acute distributive septic shock with multifocal viral PNA, acute colitis, and viral syndrome secondary to COVID-19 infection. Improved and was discharged 8/20/21

Other Meds: amlodipine, aspirin, lisinopril, pantoprazole, rosuvastatin, trazodone

Current Illness:

ID: 1685531
Sex: F
Age: 60
State: MO

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

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

Lab Data: None

Allergies: Allergic to, PCN, Sulfa, Codeine, Latex, Restasis, Cefdinir, Prognose

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

Symptoms: So, 20 mins after the injection, driving home I had severe Vertigo and ambulance assistance came but I didn't go because I took two Meclizine 25 mgs which helps with the dizziness and Vertigo attach. I hadn't had one of those Vertigo attacks for about a year. There after I had a headache for about 6 weeks straight after that. I had to see a neurologists after which he put me on other meds after that.

Other Meds: Am taken, Levothyroxine 50mcg, Claritin 10 mg, Kaitlid, Vitamin B2, Magnesium Calm 166 mg, Meclizine 25 mg, Xiidra and Fluorometholone. These are PRN meds: Air Borne, Pantoprazole, Dicyclomine and Maxalt. I take a Mortine as needed.

Current Illness: Sinus infection and Migraine

ID: 1685532
Sex: F
Age: 45
State: MI

Vax Date: 07/12/2021
Onset Date: 09/06/2021
Rec V Date: 09/09/2021
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: Echocardiogram 9/7/21 and ekg 9/6/21

Allergies: Benadryl and eryremicn

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

Symptoms: Developed AFIB never had before

Other Meds: Metformin 500 mg bid, metoprolol 25mg bid

Current Illness: None

ID: 1685533
Sex: F
Age: 66
State: WA

Vax Date: 03/04/2021
Onset Date: 06/08/2021
Rec V Date: 09/09/2021
Hospital:

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

Lab Data: EKG - 10/29/2021; Stress Test - 10/01/2021

Allergies: Codeine

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

Symptoms: I experienced an achy arm, fatigue, and am scheduled to see a Cardiologist to have a Stress Test on 10/01/2021 and an EKG 10/29/2021 performed for the symptoms I'm experiencing with my heart.

Other Meds: I took my normal medications: Humulin N Quick Pen (30 units nightly/14unit every morning), Metformin 1000mg (twice per day), Gabapentin 300mg (twice per day), Lisinopril 20mg (daily), Citalopram 20mg (daily), Simvastatin 80mg (daily), Jardi

Current Illness: No

ID: 1685534
Sex: F
Age: 34
State: KY

Vax Date: 07/27/2021
Onset Date: 09/07/2021
Rec V Date: 09/09/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Did not have a reaction to vaccine but did test positive for COVID on 09/07/2021.

Other Meds:

Current Illness:

ID: 1685535
Sex: F
Age: 61
State: NY

Vax Date: 04/01/2021
Onset Date: 04/28/2021
Rec V Date: 09/09/2021
Hospital:

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

Lab Data: Blood drawn only for the MAC & thyroid cond. which included CBC etc. [3/12/21; 4/16; 4/27; 5/26] N/A for the adverse events

Allergies: Doxycycline, Niacin supp., Lactose intolerant

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: 4/28/ 21- Vertigo (1st event) -EMTs dispatched/BP-slightly elevated 130; took 24 hours to fully recover; was rechecked at Dr.'s 4/30/21-by that time only Left ear distress; 5/19/21 HBP noted at Infectious Disease, but at that time attributed to possible HIGH stress events. June two separate panic attacks. Again thinking stress. 6/30/21 & 7/9/21 spoke to a mental health counselor; completed antibiotic treatments for MAC infection end of June/off probiotics as well by end of July. Early August one full week of severe joint pain in BOTH hands; Left EAR shooting pain, sore throat, head ache on 8/11; by 8/12 less EAR issues and more facial SINUS pressure, head ache by now constant; Red rash, and blistering, and continuing headache 8/14/21-Diagnosis in Urgent Care -Shingles of the face LEFT SIDE, LEFT EYE lateral movements difficult; Seen Eye Doctor 8/17/21; and will see same doctor end of September. In the meantime: August 26 blood work results came back showing TSH increasing and kidney function not so good; need to repeat blood work later; [Whether Valacyclovir & Prednisone prescribed for shingles is the issue will be determined]. September 4, 2021 Severe Vertigo returned / this time no EMT called, but Dr. -- Meclizine 12.5 mg prescribed; (previous vertigo event was simply with nausea ...this event had vomiting as well; similar to previous event 24 hour duration; initially unable to be upright at all (even sitting);

Other Meds: Azithromycin, Myambutol, Amikacin, Levothyroxine

Current Illness: MAC infection

ID: 1685536
Sex: F
Age: 40
State: NC

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

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

Lab Data: None

Allergies: None

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

Symptoms: Injection at 8am. At 4:45pm came an onsite of mild chills and general sluggish feeling At 5:38pm, body aches, muscle aches, joint pain at 6:30 pm, worsening feeling and with fever 7pm, profuse sweating with chills, body aches, fever 11:35pm-began to come out of it 10am next day, mostly finished and able to remain working.

Other Meds: Yaz

Current Illness: None

ID: 1685537
Sex: F
Age: 59
State: GA

Vax Date: 09/05/2021
Onset Date: 09/06/2021
Rec V Date: 09/09/2021
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: EKG

Allergies: Tylenol

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

Symptoms: I waited for fifteen minutes and I was a little dizzy, I had had a strange taste in my mouth within a few minutes of the shot. When I got the next morning and I was still dizzy and my blood pressure was very high. I went to the ER and I was advised to take Ibuprofen 800 mg. I took the medication as advised the next day I noticed that the area around where I got the shot was very hard and sore. It is swollen and red with a ring around the site of the shot. On the third day my arm was itchy and I tried some Benadryl. My arm was warmer and warmer and I went to the doctor. It has been five days and my arm is still very warm so the doctor advised to take some Benadryl and he gave me Prednisone.

Other Meds: Low dose Aspirin, Rabeprazole; Carvedilol, Lisinopril; Carafate, Calcium, Probiotics

Current Illness: N/A

ID: 1685538
Sex: F
Age: 58
State: MO

Vax Date: 09/06/2021
Onset Date: 09/07/2021
Rec V Date: 09/09/2021
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: Unevaluable event

Symptoms: Patient is experiencing a low grade headache since receiving the vaccine. In addition, she feels tired and flu-like. She reports that her left arm is red and slightly swollen.

Other Meds: metoprolol 100mg, eliquis 5mg,

Current Illness: acute respiratory virus

ID: 1685539
Sex: F
Age: 63
State: MO

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

Allergies: unknown

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

Symptoms: fever, cough , poor appetite, nausea, diarrhea, headache, muscle aches, fatigue and chills.

Other Meds: unknown

Current Illness:

ID: 1685540
Sex: M
Age: 27
State: TX

Vax Date: 09/08/2021
Onset Date: 09/08/2021
Rec V Date: 09/09/2021
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: Pfizer BioNTech COVID-19 Vaccine EUA, Moderna COVID-19 Vaccine EUA: Mixed Series Patient received Pfizer vaccine on 8/7/2021 for the first doe, and received Moderna vaccine on 9/8/2021 for the second dose.

Other Meds:

Current Illness:

ID: 1685541
Sex: M
Age: 80
State:

Vax Date: 02/24/2021
Onset Date: 07/03/2021
Rec V Date: 09/09/2021
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: Pt fully vaccinated as of 2/24/21, COVID+ on 7/3/21 seen in ED

Other Meds:

Current Illness:

ID: 1685542
Sex: F
Age: 68
State: FL

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

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

Lab Data: Covid 19 test on 8/6 - results were negative

Allergies: sulfa, penicillin, flex

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

Symptoms: I returned from a trip to help family. Arrived via plane on Sunday August 1, 2021. On August 2 I had a sore throat and by the following day I had a fever of 99.9 and requested a COVID test to be sure I did not have COVID. The test was provided by pharmacy on August 6, 2021 and I had a negative result. For 7-10 days I had slight congestion but fever disappeared by August 4. I was asked to provide this information to the CDC.

Other Meds: estradiol .5mg and prometrium 100mg - each 1 x daily iron tablets (1 daily) .375 Vitamin D - 1000 1 x daily

Current Illness: None

ID: 1685543
Sex: M
Age: 24
State: OK

Vax Date: 09/09/2021
Onset Date: 09/09/2021
Rec V Date: 09/09/2021
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: Fainted and vomited.

Other Meds:

Current Illness:

ID: 1685544
Sex: U
Age:
State: NY

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

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

Lab Data: 5/24 - Treatment for allergic reactions; 6/1 - Cat scan, bloodwork, treatment for allergic reaction - inconclusive

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Started with head aches, flu like symptoms and progressed into allergic reaction (swelling, hives, anaphalaxis), numbness in limbs and face. Poor hand eye coordination and fogginess.

Other Meds:

Current Illness:

ID: 1685545
Sex: M
Age: 55
State: NJ

Vax Date: 09/08/2021
Onset Date: 09/08/2021
Rec V Date: 09/09/2021
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: Patient received expired dose of moderna covid vaccine on 9/8/21. No adverse reaction noted or reported

Other Meds:

Current Illness:

Date Died: 08/22/2021

ID: 1685546
Sex: F
Age: 79
State: FL

Vax Date: 05/07/2021
Onset Date: 08/14/2021
Rec V Date: 09/09/2021
Hospital: Y

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

Lab Data: Tested positive for covid 8/14/21.

Allergies: morphine

Symptom List: Nausea

Symptoms: 8/14/21: patient brought to ED as she was found unresponsive by family last time was seen was 8:00 p.m. on arrival to ED patient has to be intubated for low GCS round 3 stroke alert team was activated head CT is negative chest x-ray significant for right upper lobe mass patient required norepinephrine as she was hypotensive. COVID test PCR came back positive. admitted to COVID unit Note: patient previously vaccinated with Pfizer Covid-19 vaccine on 4/26/21 & 5/17/21. Diagnosed with hypoxic respiratory failure secondary to covid pneumonia. 8/22/21: patient died.

Other Meds: acetaminophen, amlodipine, amoxicillin-clavulanate, aspirin, baclofen, gabapentin, metoprolol tartrate, pantoprazole, sulfamethoxazole-trimethoprim

Current Illness:

ID: 1685547
Sex: F
Age: 70
State: PA

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

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

Lab Data: NONE

Allergies: CIPRO, DOXYCYCLINE, NOVOLOG, SHELLFISH

Symptom List: Injection site pain

Symptoms: IMMUNOCOMPROMIZED BOOSTER, MIXED MRNA 3RD DOSE

Other Meds: FLUTICASONE NS, DEBEROX, LANTUS, CITALOPRAM , TYLENOL, CRANBERRY, GABAPENTIN, LEVOTHYROXINE, LOSARTAN, ALLOPURINOL, BACLOFEN, ATORVASTATIN, VIT d3-50K

Current Illness: NO

ID: 1685548
Sex: F
Age: 40
State: CA

Vax Date: 04/27/2021
Onset Date: 04/28/2021
Rec V Date: 09/09/2021
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: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: My left arm has not stopped throbbing since I have gotten the Janssen J & J shot. This is an all day every day occurrence.

Other Meds: None.

Current Illness: none

ID: 1685549
Sex: M
Age: 58
State:

Vax Date: 04/01/2021
Onset Date: 04/03/2021
Rec V Date: 09/09/2021
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: Penicillin, shrimp

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

Symptoms: Rash on both arms, chest and neck. Chills, headache and muscle aches.

Other Meds:

Current Illness:

ID: 1685550
Sex: F
Age: 62
State: GA

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

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

Lab Data: Unknown

Allergies: None

Symptom List: Tremor

Symptoms: Rash developed the day after vaccination. Rash is erythematous and pruritic. Rash began in left axilla and flexor surface of left elbow and has spread to include parts of the left chest, back, and abdomen. Benadryl has helped some but rash continues to progress. Patient was seen at Hospital ER and by her PCP.

Other Meds: None

Current Illness: None

ID: 1685551
Sex: M
Age: 21
State: CO

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

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

Lab Data: 7/8/21 ECG NSR; 7/20/21 echo without effusion; CBC, BMP, trop 7/8/21 negative; CRP, ESR 7/16/21 negative; ANA, RF, D dimer, trop, CBC, BMP negative; 8/17/21 TSH, CBC, ESR, CRP, trop negative

Allergies: none

Symptom List: Erythema, Pruritus

Symptoms: symptomatic pericarditis starting day after vaccine. Symptoms have lasted for a month but improved on tapering Indomethacin. Also on colchicine.

Other Meds: none

Current Illness: none

ID: 1685552
Sex: F
Age: 53
State: IN

Vax Date: 06/14/2021
Onset Date: 06/16/2021
Rec V Date: 09/09/2021
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: 06/22/2021 ? EKG ? normal, Chest x-ray ? normal 06/24/2021 ? Covid test ? Negative CONTINUED BELOW

Allergies: Penicillin, bee stings

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

Symptoms: Adverse event includes: Starting 06/16/2021 - extreme shortness of breath, irregular & pounding heartbeat that can be felt throughout the body, loss of voice, headaches, nausea, stomach pain and abdominal pressure and pain with excessive bloating. Treatment: 06/18/2021 ? PCP ? Suggests this is anxiety. Take meds, buspirion, which I took for 4 weeks with no relief from symptoms, although not able to sleep and felt strange and distanced during the day 06/22/2021 ? Urgent care. Diagnosis: inflamed trachea and laryngotracheitis. Prescribed Prednisone and Zithromax. CONTINUED BELOW

Other Meds: Pantoprazole SOD DR 40mg

Current Illness: None

ID: 1685553
Sex: M
Age: 35
State: GA

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

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

Lab Data: 9/2/2021; EKG; Chest X-Ray; Chest to waist CT scan; Blood panels.

Allergies: None known

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

Symptoms: Symptoms: Day 0 - 8/28/2021 Extremely mild injection site pain; Day 1 - 8/29/2021~36 hours post-injection: Acute extreme abdominal distension (bloating), shortness of breath, dizziness, pre-syncope, confusion, lack of concentration, sweating. Took 20mg Diphenhydramine and laid supine followed by nap. Symptoms subsided. Day 2-4 -3-4 daily bouts of dizziness, bloating, shortness of breath, lack of concentration. Eating food worsened bloating. Assumed possible constipation and dosed with Magnesium Citrate. Diarrhea followed, along with assumed dehydration/malnutrition. Began mostly liquid diet (meat broths) along with occasional crackers, grilled chicken, and vegetables like bell peppers, green beans, and potatoes. Day 5 - 9/2/2021***ER visit at 6:30PM 9/2/2021.*** Roughly the same symptoms as Day 1: Acute extreme abdominal distension (bloating), shortness of breath, dizziness, pre-syncope, confusion, lack of concentration, sweating. Tests included: EKG, Chest X-ray, shoulders-to-waist CT scan. Full blood work. All came back normal. IV administered for hydration, vital signs were monitored for 2-3 hours. All normal. Doctor prescribed ondansetron for nausea, which was not present; Day 6 and onward Switched to diet of oatmeal, cereal, bananas, grilled/baked chicken, lightly seasoned ground beef, green beans, yogurt. Symptoms show improvement.

Other Meds: None

Current Illness: None

ID: 1685554
Sex: M
Age: 65
State: MI

Vax Date: 03/04/2021
Onset Date: 08/20/2021
Rec V Date: 09/09/2021
Hospital:

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

Lab Data: See above

Allergies: None that I am aware of

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: On August 18, 2021, my adult son (who lives with me) tested positive for Covid-19. I was tested later that day, and my results were negative. On August 20, 2021, which was five and a half months after my second dose, I started getting Covid-19 symptoms. These included fever, chills, headaches, body aches, brain fog, and congestion. On August 21, 2021, I tested positive for Covid-19.

Other Meds: Tamsulosin 0.4 g capsules

Current Illness: None

ID: 1685555
Sex: M
Age: 65
State: MI

Vax Date: 02/25/2021
Onset Date: 03/15/2021
Rec V Date: 09/09/2021
Hospital:

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

Lab Data: Virtual visit with my primary doctor. Blood testing will take place at my upcoming visit.

Allergies: Strawberries

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

Symptoms: Following the second shot, I've experienced lethargy, headaches, and weakness and pain in my legs. It's still on-going

Other Meds: Lipitor, Dulera, Vitamin D3

Current Illness: None

ID: 1685556
Sex: F
Age: 60
State: WI

Vax Date: 02/26/2021
Onset Date: 02/27/2021
Rec V Date: 09/09/2021
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: All of the following tests were conducted on 2/28/2021: B-type natriuretic peptide test CBC autodifferential test comprehensive metabolic panel lipase blood test troponin test (twice) EKG 12-lead (twice) X-ray for chest PA and lateral

Allergies: Morphine.

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

Symptoms: On the morning of 2/27/2021, I began having chest pains. I also had body aches, but the most prominent pain was on the left side of my chest. The pain also covered the left side of my neck and the left side of my back with movement. The pain continued into the following day, and my husband took me to the ER at Hospital at around noon on 2/28/2021. I was subjected to a B-type natriuretic peptide test, a CBC autodifferential test, a comprehensive metabolic panel, a lipase blood test, a troponin test (twice), an EKG 12-lead (twice), and an X-ray for chest PA and lateral. I was ultimately diagnosed with stress and told to go home and rest. The chest pains resolved themselves on 3/1/2021.

Other Meds: Vitamin D, aspirin, ibuprofen, oxybutynin, omeprazole DR, sertraline HCl, hydrochlorothiazide.

Current Illness: None.

ID: 1685557
Sex: F
Age: 37
State: CA

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

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

Lab Data: Not at this time

Allergies: Peanuts, Walnuts, Pecans, Gluten pseudoephedrine and Morphine

Symptom List: Pain in extremity

Symptoms: Body aches, Intense Migraine that lasted over a week (included aura and nausea), upper respiratory tightness and cough. I continue to have fatigue, body aches, and an upper respiratory cough that seems to be worsening. I am going to the urgent care 9/9 as I cannot get into my primary care physician until 9/24. I have continued to test weekly for covid and continue to come up negative.

Other Meds: 180 Mg Armor Thyroid

Current Illness: No other illness

ID: 1685558
Sex: F
Age: 76
State: LA

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

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

Lab Data: COBAS SARS COV2 PCR

Allergies: Amoxil, Bactrim, Cipro, tylenol

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

Symptoms: Breakthrough COVID19 infection

Other Meds: Aldactone, Carafate, Cardizem, Miralax, ASA, B12

Current Illness:

ID: 1685559
Sex: M
Age: 30
State: NJ

Vax Date: 09/08/2021
Onset Date: 09/08/2021
Rec V Date: 09/09/2021
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: Patient received expired dose of moderna covid vaccine on 9/8/21. No adverse reaction noted or reported

Other Meds:

Current Illness:

ID: 1685560
Sex: F
Age: 51
State: IN

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

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

Lab Data: 8/7/21: ECG, EGRF, CBC, MG, CK, Troponin, CMP, CXR 8/9/21: ECG, BNP, Troponin, CBC, BMP, EGRF, Covid, U/A, CXR 8/13: Covid PCR 8/30: ECG, EGRF, CXR, Troponin, MG, CMP, CBC 9/2: Sed Rate, CRP, Covid anti-spike Protein 9/14: to have Holter Monitor placement

Allergies: avocado, banana, gluten, caffeine., pork, cashew, pistachio, Dilauded, Eliquis, Pradaxa, Coumadin, Xarelto, Spiriva, Breo Ellipta, Symbicort, Tamiflu, Keppra, Augmentin, Omnicef, Pylara, Pepcid, Prilosec, Protonix, Lovenox, Bactrim

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

Symptoms: 8/7/21: weakness, shortness of breath, chest pain, headache, muscle pain, headache, nausea, chills- sent to the ED by PCP, ECG and labs completed, discharged to home 8/9/21: weakness, feeling faint, short of breath, chest pain, diaphoresis, nerve pain, headache-sent to the ED by PCP, ECG/labs/IV Fluid, discharged to home 8/10: muscle pain, tingling through body, weakness, fatigue 8/17: headaches, muscle pain, nerve pain, weakness, nausea, feeling faint 8/21: tachycardia, feeling faint, not sweating in the heat, nausea 8/30: tingling, nerve pain, headache, nerve pain in neck, chest and arms- ED visit, EKG and Mg, CBC, CMP, Troponin, CXR, EGRF, 9/2: seen by cardiology for feeling faint, tachycardia at times, chest pain, fatigue, CRP/SED Rate, increase sodium, apply compression socks out of work 8-10-8/16 and 8/23-9/7

Other Meds: Arixtra, Singulair, Zyrtec, Tylenol, Calcium, D3, Iron, Magnesium Glycinate, Vitamin C

Current Illness: None

Date Died: 09/06/2021

ID: 1685561
Sex: M
Age: 79
State: IL

Vax Date: 03/11/2021
Onset Date: 08/12/2021
Rec V Date: 09/09/2021
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 Anti-Spike IgG Positive, COVID Anti-Spike Nucleocapsid IgG Negative, COVID Rapid Molecular Positive,

Allergies: Penicillin

Symptom List: Vomiting

Symptoms: Presented to the ED with chief complain of fever, myalgia and noted low oxygen saturation. He was possibly exposed to the coronavirus at his bar during a hosted festival from 8/6-8/8 where one attendant called to inform him he tested positive to the coronavirus. His symptoms started with fever, myalgia, chills about 1-2 weeks prior to his admit on 8/24/21, In the ED, he was desaturating to the 50s and placed on a HFNC. His code status is DNR/DNI. He has received remdesivir, decadron, 2 doses of barticinib and therapeutic anticoagulation for being at high thrombotic risk from the coronavirus infection. Patient was managed in the ICU from the time of admission. On the night of 9/5/21 patient became hypotensive and not responding adequately to IV fluids. Patient was found to have asystole at 3:06 AM on 9/6/21. Pronounced dead at 3:06 AM.

Other Meds: Lisinopril, Amiodipine,quin

Current Illness: UTI

ID: 1685562
Sex: M
Age: 34
State: RI

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

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

Lab Data: Went to urgent care to get it checked out. They advised to put in a report. No testes done.

Allergies: None

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: When I come in contact with cold water my hands will swell and have a rash. Once my skin warms back up the rash goes away. Has been happening since the shot.

Other Meds: Adderall 20xr

Current Illness: None

Date Died: 09/04/2021

ID: 1685563
Sex: M
Age: 75
State: WI

Vax Date: 08/23/2021
Onset Date: 09/04/2021
Rec V Date: 09/09/2021
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: iodine, tamsulosin, atorvastatin, doxycycline monohydrate

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

Symptoms: Decedent on hospice for acute respiratory failure due to chronic obstructive pulmonary disease.

Other Meds: albuterol, vitamin C, aspirin, zebeta, fibercon, calcium, vitamin D, plavix, tricor, proscar, lasix, gabapentin, glucosamine, guafenesin, novolog, ketoconazole, lisinopril, loratadine, magnesium oxide, metformin, multivitamin, nitro, ropini

Current Illness:

ID: 1685564
Sex: M
Age: 69
State: CO

Vax Date: 03/23/2021
Onset Date: 06/30/2021
Rec V Date: 09/09/2021
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: Received 2nd dose of COVID vaccine on 3/23/21. Pt with symptoms on 6/30/21 presenting to provider on 7/2/21. Pt found to be COVID+ and received Regeneron on 7/2/21.

Other Meds:

Current Illness:

ID: 1685565
Sex: F
Age: 70
State: FL

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

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

Lab Data: SARS COV2 COVID19 PCR POSITIVE

Allergies: N/A

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

Symptoms: FULLY VACCINATED, SEVERE COVID-19 CASE. DIAHHREA, SHORTNESS OF BREATH.

Other Meds: Atorvastatin 10 mg, Aspirin 81mg, Plaquenil 400mg, Vitamin C 500mg, Omega -3 4,000mg, Synthroid 125mg,

Current Illness:

ID: 1685566
Sex: F
Age: 26
State: MT

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

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

Lab Data: Was referred to an allergist by my primary care physician and will have the 2nd dose administered by my PCP on 10/1 and monitored.

Allergies: Shellfish, tree nuts, Hydroxychloroquine, Sulfa drugs, contrast iodine, bees, cats, dogs, pollen, grass, noxious weeds, strawberries, hay, dairy & some egg products.

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

Symptoms: Within 5 minutes of receiving the vaccine and being asked to wait by the pharmacy I began getting hives on my eyebrows, back of arms by my armpits, chest, jawline and neck. Within 10 minutes I had a full blown rash, hives, sore/swollen tongue, itchy/watery eyes and throat tightening. I was given 50mg of diphenhydramine and was monitored by a pharmacist for 50 minutes post vaccine. I was told to call 911 if chest pain/shortness of breath occurred. I monitored my symptoms on my own after 1hr of being monitored by the pharmacist. The allergic reaction continued for 48hrs. Chest tightness occurred 9-10hrs after injection but was reduced with another 50mg dose of diphenhydramine. The injection site became swollen, red, irritated and incredibly itchy 7 days after the injection.

Other Meds: Oral birth control tablet (once daily)

Current Illness: Cold (possible Delta variant; non confirmed) beginning 8/16 - 8/28. Symptoms included severe headache, sore throat, watery/itchy eyes, nasal congestion, runny nose, body ache, fever at highest 101.4?, cough, chest congestion, nausea, diarrhea.

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am