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: 1696764
Sex: M
Age: 16
State:

Vax Date: 09/04/2021
Onset Date: 09/04/2021
Rec V Date: 09/14/2021
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: none

Symptom List: Dysphagia, Epiglottitis

Symptoms: The night after second vaccine (9/4/2021) patient developed hives with itching on chest, abdomen, back, neck, and bilateral arms. Seen at clinic 10 days post vaccine, with the same symptoms.

Other Meds: none

Current Illness:

ID: 1696765
Sex: F
Age: 33
State: CA

Vax Date: 01/08/2021
Onset Date: 01/30/2021
Rec V Date: 09/14/2021
Hospital:

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

Lab Data: Bloodwork, MRI (on 2/3/21), Chest Xray, eye exams (happy to sign a release of records)- I dont remember all info.

Allergies: NA

Symptom List: Anxiety, Dyspnoea

Symptoms: Scleritis of left eye (first ever flare). Severe pain, redness, swelling. Started 1/30/21. Began Oral Steroids from 2/6/21 until June 2021. Saw Dr. in Eye Institute for treatment.

Other Meds: Levothyroxine .137mcg

Current Illness: NA

ID: 1696766
Sex: F
Age: 45
State: OR

Vax Date: 08/26/2021
Onset Date: 09/06/2021
Rec V Date: 09/14/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Mild case of varicella zoster reactivation (Shingles) accompanied by lymphadenopathy.

Other Meds: none

Current Illness: none

ID: 1696767
Sex: M
Age: 35
State: CO

Vax Date: 07/31/2021
Onset Date: 07/31/2021
Rec V Date: 09/14/2021
Hospital:

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

Lab Data: mri lumbar spine, FINDINGS: There is normal alignment and marrow signal of the lumbar spine. Paraspinal musculature and visualized retroperitoneum and upper sacroiliac joints are unremarkable. Levels not mentioned below appear unremarkable. L4-L5: Disc desiccation with posterior disc bulge which produces moderate to severe canal stenosis. There is mild to moderate left foraminal narrowing. Right foramen is patent. L5-S1: Disc desiccation with posterior disc bulge abutting and potentially compressing the traversing S1 nerve roots. This produces moderate canal stenosis. Moderate to severe left foraminal narrowing. Mild right foraminal stenosis.

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: within an hour of getting the shot I experienced muscular dystrophy and and a flare up of an old back injury that causes me severe sciatic pain.

Other Meds:

Current Illness:

ID: 1696768
Sex: F
Age: 21
State: MI

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

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

Lab Data:

Allergies: None

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

Symptoms: Throat burning, lips tingly, sweaty and shaky, tunnel vision, lightheaded, super fast heart rate. All within 5 minutes of the injection.

Other Meds: None

Current Illness:

ID: 1696769
Sex: F
Age: 50
State: UT

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 09/14/2021
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: I wasn't tested anywhere other than watching out for myself. I wore a Fitbit that monitored my heart rate. My resting heart rate can be in the 70-80's where it used to be in the low 60's.

Allergies: none

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

Symptoms: My heart rate was elevated. My resting heart rate was high 90's- low 100's.

Other Meds: vitamin B-12 vitamin D-3 Thyroid Estradiol Progesterone

Current Illness: none

ID: 1696770
Sex: F
Age: 38
State: FL

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 09/14/2021
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: I noticed after I got out of the shower around 10 pm the day of my 2nd dose I had a rash on the top of my right shoulder across my chest and collarbone and up the sides of my neck. The rash did not itch or hurt and was gone the next day. I also started my menstrual cycle the day after my shot and have been bleeding very heavily for 3 days (Sunday, Monday and Tuesday 9/12-9/14. not showing signs of letting up.

Other Meds: multivitamin

Current Illness:

ID: 1696771
Sex: F
Age: 37
State: OH

Vax Date: 03/01/2021
Onset Date: 03/01/2021
Rec V Date: 09/14/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Pharyngeal swelling

Symptoms: None stated.

Other Meds: Insulin Metformin Lisynipryl

Current Illness: None

ID: 1696772
Sex: F
Age: 77
State: TX

Vax Date: 07/22/2021
Onset Date: 09/05/2021
Rec V Date: 09/14/2021
Hospital: Y

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

Lab Data: ABGs, CBC, Metabolic panel, Covid test, UA, blood transfusion, CXR

Allergies: codeine

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Altered mental status, acute respiratory distress, COVID 19 positive, sepsis, anemia

Other Meds: albuterol, apixaban, buspirone, fluticasone, lasix,insulin, levemir,isosorbide, metoprolol, nitroglycerine, omeprazole, potassium, prevastatin, sertaline, tamulosin

Current Illness:

ID: 1696773
Sex: F
Age: 14
State: WA

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

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

Lab Data: N/A

Allergies: Peanuts, tree nuts, fish, hydrocodone, azithromycin

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Waves of hot/fire/acid burning throughout the whole body. Skin flushing and hot to the touch with waves of burning pain.

Other Meds: melatonin

Current Illness: Complex Regional Pain Syndrome

ID: 1696774
Sex: M
Age: 43
State: CA

Vax Date: 08/17/2021
Onset Date: 08/17/2021
Rec V Date: 09/14/2021
Hospital:

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

Lab Data: VITALS Q 6 HOURS ORDERED BY ON CALL MD VITALS WITHIN NORMAL RANGE

Allergies: NKDA

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

Symptoms: PT HAD RECIEVED THE PFIZER VACCINE ON 6/29/21 BEFORE BEING ARRESTED.PT IN ERROR WAS GIVEN MODERNA AS THE SENCOND DOSE ON 8/17/21

Other Meds: REMERON

Current Illness: ANXIETY

ID: 1696775
Sex: F
Age: 50
State: KS

Vax Date: 02/14/2021
Onset Date: 09/07/2021
Rec V Date: 09/14/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Chief Complaint Increased SOA x3 days, COVID positive today. Reports low spO2 on clinic monitor. 92% on RA on arrival to the ED. History of Present Illness 50-year-old female with past medical history significant for asthma, type 2 diabetes, and obesity (BMI 86.6), presented to LMH with 3-day history of shortness of breath and recent Covid positive test. Patient reports being in her baseline state of health until 6 days prior to admission. She received Covid vaccination series in February 2021. On September 4, patient went out with friends to a bar, fell and injured her left leg while climbing up on the stage. Since that time, she has felt more weak, has had pain in her left leg, and some increase

Other Meds:

Current Illness:

ID: 1696776
Sex: M
Age: 51
State: CA

Vax Date: 03/24/2021
Onset Date: 05/01/2021
Rec V Date: 09/14/2021
Hospital:

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

Lab Data: N/A

Allergies: NONE - until AFTER the Pfizer mRNA shots (EN6189 3/3/2021 and ER 8727 3/24/2021)

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

Symptoms: I've received the two Pfizer mRNA shots at the clinic location on the days of 3/3/21 and 3/24/21 respectively, and as someone who NEVER had ANY allergic reactions to ANYTHING (including shellfish/seafood, pollen, hair dyes, metals, soy, etc, etc ). But I suddenly began experiencing, probably about a month or so after the Pfizer shots, an intense itching in my hands about 10-15 minutes after applying hair dye, which I've been using without any issues at all for a few years; the deep under-skin itching lasts only about 3-5 minutes, but I find this new experience exactly the same with another acquaintance who also suddenly began having allergic reactions AFTER receiving his Pfizer mRNA shots.

Other Meds: None

Current Illness: None

ID: 1696777
Sex: F
Age: 67
State: GA

Vax Date: 03/06/2021
Onset Date: 09/05/2021
Rec V Date: 09/14/2021
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: 09/06/2021 PCR+ COVID-19 test at Medical Center

Allergies:

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

Symptoms: Breakthrough COVID-19 case with symptom onset 9/5/2021: New loss of taste or smell, Runny nose/Congestion, Cough (new onset or worsening of chronic cough), Shortness of breath or difficulty breathing, Fatigue or tiredness. Hospitalized for 1 day 9/5/2021-9/6/2021

Other Meds:

Current Illness:

ID: 1696778
Sex: F
Age: 64
State: MD

Vax Date: 07/01/2021
Onset Date: 07/29/2021
Rec V Date: 09/14/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Breakthrough flare of psoriasis after receiving vaccines, was 100% clear and in remission. Started 8/01/21

Other Meds: Skyrizi

Current Illness: Psoriasis

ID: 1696779
Sex: F
Age: 14
State: AL

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

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

Lab Data: NA

Allergies: NA

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

Symptoms: Approximately 2 to 3 minutes after the vaccine was given the patient's body, head, arms, hands, legs and feet begin to bow and draw. Eyes were rolled back and body felt clammy. Two RNs gently began to lower patient to the floor. Approximately 10 to 15 seconds after lowering patient to the floor she sit straight up and ask what happened. Crash crat had been retrieved and vitals checked, patient's O2 was 99, pulse was 56 and BP was 99/62. Patient was alert, aware of where she was and why. Patient stated she only felt dizzy before the incident and at this time was just shaky. She stated she had not eaten or drank anything all morning prior to the visit and vaccine administration. Patient was given something to drink and was sipping slowly. She stated she felt better. Patient was monitored for approximately 40 minutes. Patient's brother and stepmother was with her. Advised stepmother to take the patient to a doctor for further evaluation for precaution. Stepmother stated she was informed by family member to take the patient to Hospital ER, she was going to do so. Patient walked out of the building without any assistants or further incident.

Other Meds: NA

Current Illness: NA

ID: 1696781
Sex: M
Age: 52
State: KS

Vax Date: 07/27/2021
Onset Date: 09/08/2021
Rec V Date: 09/14/2021
Hospital: Y

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: Chief Complaint Difficulty breathing, cough, n/v/d x 3 days. Has received one covid vaccine. C/o generalized body aches. Zofran PO en route. History of Present Illness 52-year-old gentleman presents to the emergency room with acute shortness of breath cough nausea vomiting. He has been sick for 2 days. His symptoms are progressed to the point that it is worse and had a come in to get checked out. He has had associated nausea vomiting 2-3 times over the past 24 hours nonbloody nonbilious, and a couple episodes of diarrhea as well. He is having some low back flank pain without sciatica and also a headache that is moderate in nature. Is feeling quite fatigued rundown and has had one Covid shot about a mont

Other Meds:

Current Illness:

ID: 1696782
Sex: F
Age: 95
State: KS

Vax Date: 03/03/2021
Onset Date: 09/12/2021
Rec V Date: 09/14/2021
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: Chief Complaint SOB after fall. Also reports "strange" feeling in stomach; 6 BMs today, denies diarrhea. Placed on 3L by EMS; RA sat 88% upon arrival. History of Present Illness 86-year-old female with past medical history significant for atrial fibrillation, hypertension, hyperlipidemia, who presented with 2 day history of cough and abdominal discomfort, frequent bowel movements, and hypoxia. Patient reports feeling more short of breath and tired for last 2 days. She complained of having an upset stomach with multiple bowel movements (reports six bowel movements in last 24 hours, but denies diarrhea). Patient had an unwitnessed fall on the evening of September 13, an

Other Meds:

Current Illness:

Date Died: 09/11/2021

ID: 1696783
Sex: M
Age: 91
State: FL

Vax Date: 01/17/2021
Onset Date: 09/04/2021
Rec V Date: 09/14/2021
Hospital: Y

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

Lab Data: 09/04/2021 SARS COV2 COVID 19 PCR (POSITIVE)

Allergies: Cephalosporins, PCN

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: 09/04/2021 The patient presents with 1 week hx of of worsening shortness of breath. Per EMS, pt was evaluated at his PCP at onset due to viral symptoms. Pt was diagnosed with an URI and prescribed with antibiotics, ceased administration of at home medication. Pt was evaluated today by nurse at Assisted Living and was noticed to be experiencing increased shortness of breath. At arrival, EMS found pt on 82% room air. At ED bedside, pt has been experiencing shortness of breath with cough, nausea, and abdominal pain. Pt denies vomiting, fevers, chills, chest pain, diarrhea, and all other symptoms. Pt has recieved the COVID vax

Other Meds: Ambien, ASA, Betapace, Budesonide-Formoterol, Duo-neb, Betamethasone, topical, Doxycycline, Eliquis, Iron, Glucophage, Mybertrig, Nitrostat, Prinivil, Verapamil

Current Illness: Unknown

ID: 1696784
Sex: F
Age: 39
State: KY

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 09/14/2021
Hospital:

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

Lab Data: thermometer reading of 102.4

Allergies: Penicillin, Amoxicillin, Sucralfate liquid

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

Symptoms: Fever(102.4)(101 with medication), shaking/chills for 48 hours, nausea and vomiting; dizziness, confusion for 48 hours; loss of appetite on 2nd day; fatigue; pt used tylenol and ibuprofen for 48 hours; lingering fatigue since shot

Other Meds: Claritin, Nasonex, CBD oil, elderberry with zinc, Women's One a Day Vitamin, probiotic

Current Illness: None

ID: 1696785
Sex: M
Age: 29
State: CO

Vax Date: 06/22/2021
Onset Date: 06/24/2021
Rec V Date: 09/14/2021
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: STD screening with all negative results

Allergies: amoxicillin

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

Symptoms: Genetalia has been sore and somewhat painfully itchy ever since the first shot. It has been three months and this has not subsided. I have been tested for all STDs and all tests came back negative. No visible bumps or irregularities besides for pink skin on scrotum.

Other Meds:

Current Illness:

ID: 1696786
Sex: M
Age: 65
State: KS

Vax Date: 03/19/2021
Onset Date: 09/13/2021
Rec V Date: 09/14/2021
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: Unevaluable event

Symptoms: Chief Complaint Pt via EMS found by wife in car after being in there for uknown length of time with windows fogged over and patient unconscious. Febrile en route and in triage. BG 215 en route. Diaphoretic . GCS 14. 500 ml fluids en route. History of Present Illness 65-year-old fully COVID-vaccinated (Pfizer in June) male who has presented to the ER this evening via EMS for altered mental status, fever, sepsis and COVID-19 illness. History is somewhat limited. Most of the history is obtained from EMS and the patient's wife over the phone by the ER provider this evening. Patient has not been home very much over the last 4 to 5 days. Apparently the husband has been trying to avoid her due to her illness whi

Other Meds:

Current Illness:

ID: 1696787
Sex: F
Age: 69
State: MD

Vax Date: 08/27/2021
Onset Date: 08/29/2021
Rec V Date: 09/14/2021
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: None

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

Symptoms: I have a 23 year old hip prosthesis. At the beginning of August, I had mild groin pain which I noted on the calendar wondering if it was the start of this prosthesis going bad. However, after my initial calendar note on August 16, 2021, I did not experience any further groin pain. Two days following the vaccination on August 29, 2021, I suddenly had groin pain, but only when standing or walking. The pain was so severe, I was not able to stand for more than a minute. The pain went away when I was sitting or lying down. The groin pain while standing or walking continued unabated until I began a Medrol pack of prednisone the following Friday, with a 6 day course of treatment, Within two days, of starting the Medrol Pack the pain was gone, and I have been walking up to 2 miles for the past few days.

Other Meds: Metoprolol; Amlodipine; Triamterene-HCTZ; Pantapazole

Current Illness: None

Date Died: 09/10/2021

ID: 1696788
Sex: M
Age: 78
State: IL

Vax Date: 03/24/2021
Onset Date: 09/02/2021
Rec V Date: 09/14/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: pt presented to the Medical Center on 9/2 in respirator Distress pt placed on bipap, later intubated pt expired on 9/10/21 @ 1432

Other Meds:

Current Illness:

ID: 1696789
Sex: F
Age: 44
State: AZ

Vax Date: 02/11/2021
Onset Date: 06/02/2021
Rec V Date: 09/14/2021
Hospital:

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

Lab Data: Bloodwork completed 06/17/21; 08/09/21 CT Scan completed 06/29/21 Chest xray 09/08/21

Allergies: Sulfa, PCN, latex

Symptom List: Injection site pain, Menorrhagia

Symptoms: March 2021-April 2021, lymph nodes in left arm pit size of small ball (in between tennis and golf ball) June 9th, first occular migraine with loss of vision. CT scan obtained with no findings. Throughout month of June and July 2021, fevers and shakes during the night time 1-2 per week. July 14th, developed week long raised rash that covered the entire torso and legs. Full bloodwork ran, including inflammatory markers, no findings. No apparent cause.

Other Meds: Multi Vitamin, proair, advair, vivelle dot, loratadine

Current Illness: None

ID: 1696792
Sex: M
Age: 11
State: AZ

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

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

Lab Data: none

Allergies: NKA

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

Symptoms: patient was inappropriately given a first dose of Pfizer when he is not yet 12 years of age

Other Meds: unknown

Current Illness: unknown

ID: 1696793
Sex: F
Age: 26
State: TX

Vax Date: 09/02/2021
Onset Date: 09/02/2021
Rec V Date: 09/14/2021
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: NO MEDICAL TEST DONE

Allergies: NONE

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: CLIENT STATED SHE BECAME DIZZY AND FELT VERY FAINT- NPTED CLENT TO SAETING ON FLOOR-INITIAL B/P-94/49-P-58 P.O2-98-17;25- 113/72-P. 72-02 SAT-99--17:30-115/85-78 CLIENT WAS GIVEM WATER AMD GIVEN TIME RECOVERY- CLIEMT DID ADMITT SHE HAD DRUNK 3 CUPS OF COFFEE BEFORE RECEIVING VACCINE--ALSO SHE GETS VERY ANXIOUS WHEN RECEING SHOTS

Other Meds: NONE

Current Illness: NONE

ID: 1696794
Sex: M
Age: 80
State: OH

Vax Date: 02/21/2021
Onset Date: 02/23/2021
Rec V Date: 09/14/2021
Hospital: Y

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

Lab Data: CT Head ? 2/23/2021 CT Angiogram Head ? 2/23/20201 CT Angiogram Neck ? 2/23/2021 Chest XRay ? 2/23/2021 MRI of brain ? 2/23/2021 Study Results ? ?Impressions? from Head MRI : ( Direct quote from medical chart) 2. Mild to moderate brain volume loss with more focal moderate volume loss in the midbrain. The configuration is nonspecific but can be seen with progressive supranuclear palsy as well as other neurodegenerative disorders. No hydrocephalus. BRAIN PARENCHYMA: Focal moderate volume loss in the midbrain with a Hummingbird configuration on the sagittal imaging. The midline structures are otherwise within normal limits. Moderate to large zone of acute to subacute restricted diffusion involving the left cerebellum with additional smaller stones involving the medial left temporal lobe and left occipital lobe as well as the medial left thalamus. Tiny additional focus in the right thalamus. These areas correlate with T2/FLAIR hyperintensity. No acute intracranial hemorrhage or significant mass effect. Mild additional spotty T2/FLAIR hyperintensities in the cerebral white matter and pons. Ultrasound cardiac carotid duplex - 2/24/2021 Echocardiogram ? 2/25/2021 ECG 12-Lead ? 3/31/2021 ECHO 2D COMPLETE W/CONTRAST (TTE) - 4/5/2021 Cardiac Event Monitor ? 5/4/2021 Vision Field Test. Results - Loss of peripheral vision on the right side in both eyes. This occurred from the strokes. - 6/29/2021

Allergies: None.

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: PT had 3 strokes on 2/23/2021, Tuesday, between 8:00-9:00 a.m. This was less than 48 hours after his 2nd Moderna shot on Sunday, 2/21/2021, at 10:00 a.m. On Monday, the next day after his 2nd Moderna shot, he felt unwell, was irritable and took a long nap. On Tuesday, the second morning after his 2nd Moderna shot, his arms and legs started involuntarily shaking and twitching. He complained of having a very bad headache, threw-up and could no longer stand. He used his arms to lower his body. He happened to be in the bathroom? He lowered his body into the bathtub, as he lost control of his legs. I discovered him lying in the bathtub, unresponsive, with his eyes tightly closed. I tried to move him from the bathtub initially, but his legs would not work and were unresponsive. He held the weight of his body up by a bar in the bathtub, as his legs were not working. I called 911. He was taken in an ambulance to the emergency room. The emergency room staff did not know what was wrong with him and initially tried to discharged him, but he was unable to walk out of the hospital. From the emergency room, he was then admitted to the hospital. He stayed in the hospital for 5 days. After receiving a head MRI, he was diagnosed with having 3 strokes. He still was having great difficulty walking and was having balance problems. His legs appeared unresponsive, rigid and stiff. Vision was affected as well. He could not see on his right side; he was unable to see the food tray or silverware when he was eating. His cognition/brain/mental capacity was obviously affected. He did not know his correct age, and could not remember short-term and long-term events. He lost some use of language. He had a lot of trouble using the telephone. After 5 days in the hospital, pt was admitted to a physical rehabilitation center for 16 days. He attended physical therapy, occupational therapy and speech therapy daily. By the time he discharged, he was walking with a walker. He did NOT use a walker pre-stroke. He also still had significant loss of language, memory and cognitive ability. He still could not see well on the right side, and would often walk into visible obstacles / walls on his right side as he could not see them. After the rehabilitation center, pt returned home and had home healthcare services. He had Occupational therapy, physical therapy, speech therapy, 1:1 nurse, as well as a home health aide who helped him to shower. At home, he some Occupational Therapy and Physical Therapy sessions. Due to his new vision and balance problems following the strokes, and being newly on a blood thinner after the adverse reaction, he was in danger of falling and needed the home health aide to assist with bathing ( so that he would NOT fall in the shower). Speech (cognitive) therapy lasted the longest out of all 3 home healthcare therapies. Even at the close of speech therapy, he still presented significant deficits in both short-term and long-term memory, as well as in his cognitive ability. He can no longer budget his finances. On June 29th, a neurological ophthalmologist diagnosed him with loss of peripheral vision on both right sides. He lost right peripheral vision in both eyes. These 3 strokes, following the 2nd Moderna shot, greatly changed pt's quality of life. Prior to the vaccine and strokes, he used to drive, take care of his grandchildren, manage his finances, shop for food, clean and cook daily, as well "care-take" for his wife who has her own physical injuries. He was 100% independent and helped many members of his family regularly. He helped his family with day-to-day practical tasks, offered emotional support, career direction, and shared his wisdom regularly. Today, almost 7 months later, he can no longer drive, manage his finances nor bank accounts. He regularly writes checks for money he does not have. His mental capacity is extremely diminished. He also gets lost easily. When he is dropped off at a doctor?s appointment in a hospital on his own, he easily gets lost and confused. He is also more easily frustrated, confused and irritated. This causes great strain on his relationships with his wife and family, as he used to be the solid foundation of the family. He has still lost all right peripheral vision in both eyes. His vision has not returned. He also still struggles with both his short-term and long-term memory, and general cognitive / brain / mental function. His quality of life is greatly affected and diminished. The quality of life of his family who depended upon him has been very negatively impacted as well.

Other Meds: Amlodipine, Latanoprost, Sertraline, Tamsulosin, Multi-vitamin

Current Illness: left in wall hernia

ID: 1696795
Sex: F
Age: 40
State: TX

Vax Date: 09/10/2021
Onset Date: 09/12/2021
Rec V Date: 09/14/2021
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: Ultrasound to look for blood clots. No clots found.

Allergies: Sulfa drugs

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

Symptoms: Pain in both legs, tingling, joint pain.

Other Meds: Vitamin C, D, Zinc

Current Illness: None

Date Died: 09/03/2021

ID: 1696796
Sex: M
Age: 83
State: FL

Vax Date: 02/27/2021
Onset Date: 08/31/2021
Rec V Date: 09/14/2021
Hospital: Y

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

Lab Data: unknown test site: Pt tested COVID+ 08/29/2021. 08/31/21 (repeated) SARS COV2 COVID 19 PCR (POSITIVE)

Allergies: No known allergies

Symptom List: Nausea

Symptoms: 08/31/2021 The patient presents with SOB, worsening 3 days ago. Pt tested positive 3 days ago for COVID 19 and note symptoms beginning 1 week ago. He arrived to ED in severe respiratory distress respiratory distress.. The onset was just prior to arrival. Patient is an 83 y/o male admitted to hospital on 8/31 after presenting to ED for evaluation of shortness of breath. He was found to have acute hypoxic respiratory failure secondary to COVID-19 pneumonia, quickly failed BiPAP and was intubated and proned in ED. He had SVT x2 episodes in ED requiring electrical cardioversion each time 100J. Started on levophed gtt after CVC placed in ED. Received bicarb IVP x3 + gtt.

Other Meds: ASA, Rosuvastatin, Amlodipine, Metoprolol, Losartan, Insulin, Mycophenolate, Tacrolimus

Current Illness: Unknown

ID: 1696797
Sex: F
Age: 31
State:

Vax Date: 08/24/2021
Onset Date: 08/31/2021
Rec V Date: 09/14/2021
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: Missed period. 3 weeks late.

Other Meds:

Current Illness:

ID: 1696798
Sex: M
Age: 74
State: CA

Vax Date: 03/04/2021
Onset Date: 07/13/2021
Rec V Date: 09/14/2021
Hospital:

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

Lab Data: 07/13/2021 EKG-abnormal in AFIB Cardio scan since then 09/012/22021-still in AFIB and mitrovavle regurgitation 09/02/2021 Cardivert

Allergies: no

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

Symptoms: 07/13/2021 I went in for eye surgery and after being hooked up to the heart monitor the dr told me I was in AFIB

Other Meds: I was taking Mopic.

Current Illness: no

ID: 1696799
Sex: F
Age: 45
State: OK

Vax Date: 07/19/2021
Onset Date: 07/19/2021
Rec V Date: 09/14/2021
Hospital:

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

Lab Data: None known.

Allergies: None.

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

Symptoms: 15 mins after injection of Pfizer covid vaccine dose #1, pt. reported tingling of left hand/wrist up to elbow. No improvement with walking or water intake. Was placed supine; BP 110/70, heart RRR. Vein enlargement of left forearm was noted & ice applied to area with improvement in tingling. After 15 mins pt. left ambulatory w/daughter, who was driving. Advised Advil for sx relief and report to her dr. if worse. Next day pt. stated arm is not tingling but vein remains swollen. She did not take Advil or see her dr. Pt is resp. therapist and works in hospital and states has access to a dr. if needed. Failed attempt to f/u in 60 days; could not reach pt. at either number provided.

Other Meds: Loratidine prn.

Current Illness: Occ. seasonal rhinitis.

ID: 1696800
Sex: F
Age: 59
State: AL

Vax Date: 03/10/2021
Onset Date: 08/08/2021
Rec V Date: 09/14/2021
Hospital:

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

Lab Data: no

Allergies: penicillin

Symptom List: Tremor

Symptoms: none, no pain to arm

Other Meds: Zyrtec everyday

Current Illness: no

ID: 1696801
Sex: F
Age: 53
State: SC

Vax Date: 09/01/2021
Onset Date: 09/14/2021
Rec V Date: 09/14/2021
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: Ceclor, percocet, Darvocet, morphine, eggplant, mango

Symptom List: Erythema, Pruritus

Symptoms: Swollen feet and ankles

Other Meds: Klonipin, ambien, effexor, Lamictal, Magnesium, potassium gluconate, biotin, vitamin c, vitamin d, black cohosh

Current Illness: None

ID: 1696802
Sex: F
Age: 72
State: FL

Vax Date: 09/04/2021
Onset Date: 09/05/2021
Rec V Date: 09/14/2021
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: UNKNOWN

Allergies: NA

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

Symptoms: PATIENT CAME TO GET FLU SHOT AND INSTEAD GOT Covid19(pfizer) . PATIENT CLAIMS TO EXPERIENCES DIFFICULTY IN BREATHING , BODY ACHES , NAUSEA , FEVER FOR 2 DAYS

Other Meds: albuterol hfa, alprazoloam , atorvasatin , cyanocobalamine injection , olanzapine . mirtazpine , montelukast

Current Illness: COPD . CHF

ID: 1696803
Sex: M
Age: 30
State: WI

Vax Date: 08/24/2021
Onset Date: 09/01/2021
Rec V Date: 09/14/2021
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: Splitting headache, nausea, fatigue - all lasting for two weeks

Other Meds: One a day vitamin

Current Illness:

ID: 1696804
Sex: M
Age: 91
State: TX

Vax Date: 03/23/2021
Onset Date: 09/05/2021
Rec V Date: 09/14/2021
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: CBC, CMP, CXR, Cardiac profile, COVID, EKG

Allergies: NKDA

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: SOB, COVID 19 positive

Other Meds: amlodipine, glipizide, pravastatin, flomax, tramadol

Current Illness:

ID: 1696805
Sex: M
Age: 31
State: AZ

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

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

Lab Data: none

Allergies: NKA

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

Symptoms: patient received second dose of Pfizer two weeks after the first (one week early)

Other Meds: unknown

Current Illness: unknown

ID: 1696806
Sex: M
Age: 21
State: CA

Vax Date: 11/11/2020
Onset Date: 11/11/2020
Rec V Date: 09/14/2021
Hospital:

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

Lab Data:

Allergies: wheat

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

Symptoms: hives 30 minutes after vaccine. treated with benadryl

Other Meds: none reported

Current Illness: fungal rash

ID: 1696807
Sex: M
Age: 91
State: CO

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

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

Lab Data: CBC- HGB 12.9, HCT- 38.1, Lytes- Sodium 129 D-Dimer 409 Covid-19 - negative CXR Cardiac ECHO- LV size and sytolic function are normal. Estimated LVEF 60%.

Allergies: Fosinopril

Symptom List: Pain in extremity

Symptoms: Resident was noted to have increase in confusion and lethargy with elevated heart rate and BP. Resident was transferred to hospital where he required an increase in supplemental oxygen. Resident was admitted to the hospital and diagnosed with exacerbation of asthma. Uses oxygen for exertion and CPAP at night.

Other Meds: Cholecalciferol Tablet 50 MCG (2000 UT) every day, Latanoprost Solution 0.005 % every day both eyes, Cyanocobalamin Tablet 1000 MCG every day, ProAir HFA Aerosol Solution 108 (90 Base) MCG/ACT (Albuterol Sulfate HFA) 2 puffs four times a

Current Illness: Resident has a chronic cough and chronic rhinorrhea. He resides in a nursing home d/t chronic conditions. No major health issues in the past month.

ID: 1696808
Sex: M
Age: 60
State: CA

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

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

Lab Data: n/a

Allergies: citrates as a preservative in blood donation tubing

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

Symptoms: 2 hours after injection of Shingrix, I had excoriation of lower lip with some tingling. by morning, I have lightly scabbed over lesion on lower lip. Some swelling and sensitivity/numbness of lower lip.

Other Meds: Advair, ibuprofen, aciphex

Current Illness: n/a

ID: 1696809
Sex: F
Age: 78
State: PA

Vax Date: 03/22/2021
Onset Date: 03/29/2021
Rec V Date: 09/14/2021
Hospital:

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

Lab Data: 4/29/21 - Rheumatoid Arthritis Factor - 84.2 4/29/21 - CCP Antibodies IgG/IgA - >250

Allergies: None

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

Symptoms: Approximately one week after the second shot (March 29 or so) experienced sharp pains in left wrist and difficulty bending wrist. Thought it might have been a bite some kind, but now, in retrospect, with a new rheumatoid arthritis diagnosis on May 7th, I realize it was the same pain I am now experiencing. A few days later I also experienced a stabbing flare of pain the my upper left arm at the site of a Shringix vaccination in 2019. The following morning there was a bright pink spot on the arm that subsequently developed into a shingles-like crusty scab. This appeared to be a flare up of shingles experienced in Jan. 2013.

Other Meds: Vitamin D

Current Illness: None

ID: 1696810
Sex: F
Age: 61
State: CA

Vax Date: 09/13/2021
Onset Date: 09/14/2021
Rec V Date: 09/14/2021
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: none

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

Symptoms: Tiredness, sore back of neck, shoulders, and lower back All occurred about the same time (~18h after vaccination)

Other Meds: Avostatin (lipitor), 80mg aspirin

Current Illness: none

Date Died: 08/22/2021

ID: 1696812
Sex: M
Age: 50
State: FL

Vax Date: 08/10/2021
Onset Date: 08/18/2021
Rec V Date: 09/14/2021
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: SARS COV2 COVID 19 PCR 08/18/21

Allergies: No known allergies

Symptom List: Vomiting

Symptoms: The patient presents with 8 day hx of viral symptoms. Pt reports to have been experiencing fevers, chills, cough, shortness of breath, myalgia, headache, nasal congestion, rhinorrhea, and headache. Recent sick contacts and COVID-19 exposure. Has administered with over the counter cold medicine. Denies all other acute systemic symptoms. The onset was 8 days ago. Associated symptoms: fevers, chills, cough, shortness of breath, myalgia, headache, nasal congestion, rhinorrhea, and headache, denies chest pain, denies abdominal pain, denies nausea, denies vomiting, denies dizziness and denies back pain.

Other Meds: HCTZ, Amlodipine, Sertraline

Current Illness: Unknown

ID: 1696813
Sex: M
Age: 55
State: MA

Vax Date: 02/18/2021
Onset Date: 02/23/2021
Rec V Date: 09/14/2021
Hospital:

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

Lab Data: extensive labs and blood work completed, 2 MRI's, CT scan, 2 spinal taps, eeg , ekg,

Allergies: allergies to garlic

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: started to become confused, not able to complete simple tasks, change in personality, has been unable to return to work since 3/2/2021

Other Meds: Losartan Potassium Hydrochlorothiazide

Current Illness: none

ID: 1696814
Sex: M
Age: 64
State: NC

Vax Date: 03/29/2021
Onset Date: 03/30/2021
Rec V Date: 09/14/2021
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: NKA

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

Symptoms: Petechiae on the arms and feet.

Other Meds: Norvasc 5 MG Oral Tablet, Atorvastatin Calcium 80 MG Oral Tablet, Olmesartan Medoxomil-HCTZ 40-12.5 MG Oral Tablet,

Current Illness: Hypercalcemia

ID: 1696815
Sex: F
Age: 56
State: MO

Vax Date: 03/13/2021
Onset Date: 03/22/2021
Rec V Date: 09/14/2021
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: severe diarrhea, everything tasted salty and metalic, heart skipped beats extreme brain fog, weakness and fatigue

Other Meds: celebrex and vitamins

Current Illness:

ID: 1696816
Sex: M
Age: 43
State: NJ

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

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

Lab Data: September 9,2021 at Urgent care EKG, Chest Xray, Cover-19 rapid test - all were negative.

Allergies: none

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

Symptoms: Woke up in the middle of the night (Thursday going into Friday morning) short of breath Thursday September 9,2021. On Friday throughout the day I felt more short of breath and had chest pain in center of my chest. I felt very fatigued and had chills without a fever. I took tylenol while at work that day and drank a lot of water but still felt the same. I came home and my wife made me an appointment at urgent care. I also took a rapid cover 19 test at home that was negative. That evening I went to my appointment at urgent care. They did a chest X-ray and an EKG that were all normal and also did another cover 19 test that was negative. I still currently have shortness of breath as of today September 14, 2021.

Other Meds: none

Current Illness: none

ID: 1696817
Sex: F
Age: 38
State: PA

Vax Date: 08/19/2021
Onset Date: 09/05/2021
Rec V Date: 09/14/2021
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: 9/9/2021 abdominal CT - acute appendicitis 9/8/2021 CBC with differential - normal; CMP - normal 9/9/20201 CBC with differential - normal; CMP - normal

Allergies: none

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

Symptoms: Developed abdominal pain and vomiting on 9/4/2021; ultimately found to have acute appendicitis by CT scan, underwent laprascopic appendectomy

Other Meds: abemaciclib, aspirin, pantoprazole, tamoxifen

Current Illness: none

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am