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: 1700912
Sex: M
Age: 25
State: CO

Vax Date: 09/15/2021
Onset Date: 09/15/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: BP taken at 4:17 pm and was 126/99.

Allergies: UNKNOWN

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient lost consciousness. He began struggling to breathe and turned very red. He was audibly gasping for air. An epi-pen 0.3 mg was administered to the right leg. He resumed breathing and laid down on the ground.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1700913
Sex: M
Age: 27
State: PA

Vax Date: 09/15/2021
Onset Date: 09/15/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data:

Allergies: benadryl

Symptom List: Anxiety, Dyspnoea

Symptoms: syncope, vomiting

Other Meds: unknown

Current Illness: unknown

ID: 1700914
Sex: F
Age: 37
State: NC

Vax Date: 08/20/2021
Onset Date: 08/01/2021
Rec V Date: 09/15/2021
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: I do not have that information

Allergies: Patient did state on vaccine consent form that had, allergic reactions to other medications or vaccines other than the COVID vaccine

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

Symptoms: Patient fainted and was dizzy within a few minutes of getting the vaccine (Janssen), patient was alert. Made the patient comfortable and helped to keep her cool, with an ice pack, as the pharmacist I spoke with her and did not see any signs of swelling. There was no loss of conscienceness and 911 was called with the ambulance coming to escort the patient. A follow up call was made the following day and the patient was doing fine.

Other Meds:

Current Illness:

ID: 1700915
Sex: F
Age: 58
State: TX

Vax Date: 04/01/2021
Onset Date: 04/21/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: None performed. Doctor refused to treat.

Allergies: antibiotics

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Large, bee-sting like swelling and redness around injection site lasting more than a week. Severe pain.

Other Meds: none

Current Illness: none

ID: 1700916
Sex: F
Age: 66
State:

Vax Date: 08/30/2021
Onset Date: 09/01/2021
Rec V Date: 09/15/2021
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: experienced stroke 2 days later

Other Meds:

Current Illness:

ID: 1700917
Sex: F
Age: 44
State: CA

Vax Date: 09/15/2021
Onset Date: 09/15/2021
Rec V Date: 09/15/2021
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: No

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

Symptoms: Shortly after receiving vaccine the patient began feeling healrt racing. Took BP and HR. BP was 137/97 and HR originally was 117 @9:57, then quickly began to drop. @9:59 HR was 85. Received water and a granola bar and was monitored.

Other Meds: No

Current Illness: No

ID: 1700919
Sex: F
Age:
State: KS

Vax Date: 12/16/2020
Onset Date: 12/18/2020
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: Normal echo in July 2021 but have not had an episode sin he June. Abnormal EKG with Kardia monitor during and episode.

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Heart palpitations, tachycardia, hypertension, nausea, lightheadedness and shortness of breath during first episode. These episodes continues for 6 months after my second injection. Officially my vision would also start to go black. Episodes typically lasted for 1-3 hours.

Other Meds: Birth Control

Current Illness:

ID: 1700920
Sex: M
Age: 46
State: WA

Vax Date: 09/08/2021
Onset Date: 09/11/2021
Rec V Date: 09/15/2021
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: N/A

Symptom List: Pharyngeal swelling

Symptoms: Finger tips on both hands present as tingling an swollen. All ten finger and thumb tips are tender to touch. Skin appeared dry and flaking on the first morning. since that day they appear to look blistered and white. the tingling has continued to present time. Finger tips feel as though they were burnt and are now in a healing process. DR. advised the use of Ibuprofen or asperin when contacted.

Other Meds: 81mg asperin as per my PCP

Current Illness: none

ID: 1700921
Sex: M
Age: 70
State: AZ

Vax Date: 03/12/2021
Onset Date: 03/15/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: I did not get medical attention.

Allergies: I do not have any allergies.

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Three days after receiving my 2nd dose, I experienced my body go into shock. I became bedridden and every neurological pathway in my body fired off. With all of my previous diseases I had, I felt like I was experiencing them again. Every morning I wake up, I feel like I am falling down a mountain. I used to go on my treadmill all the time and now I can barely walk 30 minutes a week. My Achilles tendon, in my left foot, became very painful and I had to use a crutch to get around. My spine felt like it was spearing downward into my body. I felt like it was collapsing. I have an inversion chair that I can straighten my back out. I usually put it at a 30 degree angle. I am better now than I was, but I'm easily fatigued still. I also still experience fogginess. I eat better now than I ever had. I have a good diet and have been taking my supplements for 10 plus years. I have been changing medications to get some relief from the joint pains I'm experiencing. I feel like I have aged over 5 years in the past 6 months.

Other Meds: I was taking Xeljanz, Otezla, Cetirizine, Montelukast, Budesonide, body wise multivitamin/minerals, body wise super cell vitamin and Arthritis Tylenol (as needed).

Current Illness: I did not have any illness other than my long standing health conditions.

ID: 1700922
Sex: F
Age: 65
State: OH

Vax Date: 03/25/2021
Onset Date: 08/28/2021
Rec V Date: 09/15/2021
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: no

Symptom List: Diarrhoea, Nasal congestion

Symptoms: had dr appt in Feb her heart was fine and after 2nd dr appt in Aug. her dr told her she had a weakened heart muscle which occured after she took the 2nd vaccine

Other Meds: lisinopril

Current Illness: no

ID: 1700923
Sex: F
Age: 75
State: CA

Vax Date: 06/26/2021
Onset Date: 06/26/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data:

Allergies: Statins, Sulfa drugs, Penicillins

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

Symptoms: Patient states she felt "like she got the virus". She had bad pain, and felt "like she was not doing well" for 3 days. She recovered after 3 days but does not wish to try again.

Other Meds: Aspirin, Lisinopril, Amlodipine, Omeprazole, Symbicort, Trelegy

Current Illness:

ID: 1700924
Sex: F
Age: 65
State: CA

Vax Date: 09/15/2021
Onset Date: 09/15/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: n/a

Allergies: Aspirin, milk, fish-derived, clavulanate acid

Symptom List: Rash, Urticaria

Symptoms: Tingling and numbness of gums and palate after 10 minutes of administration. After 25 minutes she stated that it was diminishing.

Other Meds: none

Current Illness: Previous stroke in past

ID: 1700925
Sex: F
Age: 69
State: IN

Vax Date: 09/13/2021
Onset Date: 09/14/2021
Rec V Date: 09/15/2021
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: Cortisone, Seafood, X-ray dye

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

Symptoms: Pain at injection site and in joints starting the evening of the injection. The next day these symptoms continued and I also experienced headache, fatigue, chills and fever of 100.6 degrees. The following day (today) headache, fatigue and pain at injection site continue, but the other symptoms have subsided.

Other Meds: Olmesartan Medoxomil, Naproxen Sodium, Potassium Cl, Furosemide, Aspirin, Metoprolol Tartrate, Clonidine, Atorvastatin, Montelucast, Hydralazine, multivitamin

Current Illness: none

ID: 1700926
Sex: M
Age: 52
State: MS

Vax Date: 09/15/2021
Onset Date: 09/15/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data:

Allergies: demerol - itching

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

Symptoms: Within 30 minutes after administration of DynaVAX Tech Heplisav-B vaccine patient developed urticaria in bilateral axillae, groin, and neck. Patient then became dyspneic and felt as if his throat were becoming tight. Developed erythematous rash on chest.

Other Meds: budesonide 3 mg 24 hr capsule buproprion 300 mg 24 hr capsule cetirizine 10 mg cholestyramine 4 g melatonin 3 mg testosterone cypionate 100 mg/ml injection triamcinolone acetonide vortioxetine 10 mg tabs

Current Illness: Premature ventricular contactions, rotator cuff impingement syndrome, obstructive sleep apnea, history of graves disease, lymphyocytic colitis

ID: 1700927
Sex: F
Age: 51
State: CA

Vax Date: 06/17/2021
Onset Date: 06/27/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: Waiting for appt with ENT specialist.

Allergies: none

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

Symptoms: Tinnitus in both ears. Started 10 days after second dose. Pretty bad and constant. Never experienced tinnitus before.

Other Meds: none

Current Illness: none

ID: 1700928
Sex: F
Age: 65
State: GA

Vax Date: 09/11/2021
Onset Date: 09/11/2021
Rec V Date: 09/15/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: sore arm, nauseous, diarrhea, fatigue, loss of appetite, lower back pain, upper thigh muscle ache, mild headache, joint pain

Other Meds: yes

Current Illness:

ID: 1700929
Sex: M
Age: 73
State: CA

Vax Date: 03/15/2021
Onset Date: 05/13/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: Chest X-ray; Lab work - electrolytes and Hemoglobin and potassium - ER. 2nd time - Pulmonary CT scan - Lab work and Pulmonary angiogram and EKG ER

Allergies: Provocaine Shellfish - anaphylactic shock -

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

Symptoms: Severely short of breath in the a.m. - I needed to sit up to breathe. I couldn't sleep because I couldn't breathe. Doctor gave me a Lasix - Diuretic but didn't help any. ER. 160 heart rate - several doses of Cartazen injections and gave me Oxygen (which I had been getting at home - the oxygen) and the blood pressure was a bit elevated. They sent me home after his heart rate went down with those injections. Added the Lopressor to his Regimen (CartaZen.) I never really got better. Shortness of breath for about four days and so called regular physician and I sent us back to ER. They did more tests and gave me Lasix and at that point I was having ankle swelling and edema. They diagnosed me with Congestive Health Failure. Gave him Lasix - Put out about 2 liters. They wanted to keep in hospital but I refused. At that point, I was going to see a cardiologist they referred me to. They wanted an echo-cardiogram and was unable to get that done for two months. I also had an abdominal ultrasound. Under the care of cardiologist, ordered further testing. Heart patch to monitor heart rate - wore it for two weeks. They did an echo cardiogram finally and I saw the doctor - 20-25% cardiac output (normal is 50). I had a cardiac angiogram - heart cath to see if there was any heart damage or blockage - and there was not. My arteries were wide open. So now I continue under the cardiologist's care and they have changed the medication multiple times because I remain in Atrial Fibulation. They changed my meds two days ago. The first med - I was slowly getting better and second one, I went backwards and now the third med I've been on for two days and so far it's promising. Echo-Cardiogram - October 13th.

Other Meds: Lopressor - 50 mg twice a day; Lisinopril; aspirin (2 baby aspirin once a day): Met4 - twice a day (Combination Metformin;Glipazidin); Norvec - 5 mg.

Current Illness: no

ID: 1700930
Sex: M
Age: 24
State: MT

Vax Date: 08/30/2021
Onset Date: 09/02/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient advised receiving 1st dose Pfizer vaccine and started feeling extremely sick with fever, headache, body aches, congestion, chills and sweats that lasted for several days from day of vaccine received.

Other Meds: None

Current Illness: None

ID: 1700931
Sex: F
Age: 33
State: TX

Vax Date: 09/03/2021
Onset Date: 09/04/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: While in the ER they ran blood test and they gave me an ultrasound of my liver and gallbladder which came back inconclusive. They told me they wanted me to do a CT scan but that it would be several hours before they could get to me and I had two children that still needed my care. The diagnostic imaging report stated that portions of the aorta, IVC and pancreas are partially obscured by what they thought is bowel gas.

Allergies: No

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: The second day after the shot I experienced muscle aches, fever of 103, chills, nausea and abdominal pain. This went on for 2 to 3 days after the vaccination. The fever and chills went away after a few days but the abdominal pain did not? I kept feeling lots of pressure in my upper abdominal area. I started throwing up stomach acid and bile and had a hard time keeping any food down. I then went to the emergency room at Hospital on 9/8/2021. They started mixing Covid negative patients with Covid positive patients, there were dried blood stains in the waiting area after triage, it was very obvious that the people there were overworked and understaffed and the patients were paying the price for it. I tried to call ER hospital in the same area and they said they were so packed with Covid patients that they could not help me. As was a smaller ER. I couldn?t stop throwing up at the ER but I also didn?t want to be surrounded by Covid positive patients so I left the ER due to the fact that they told me they couldn?t run the CT scan they wanted for another five hours because they were busy and also another nurse told me that they straight up did not have room for me to begin with. The following day I made an appointment with my primary care provider. He gave me a bunch of medication for acid reflux and that was about it. He told me it would probably be best for me to try and follow up with a gastroenterologist for more in-depth help. I am still waiting to see gastro as we speak. My blood pressure has been up and down and I am still sick to my stomach with upper abdominal pain.

Other Meds: Tylenol, Levothyroxine, Vitamin D3 and Viibryd

Current Illness: No

ID: 1700932
Sex: F
Age: 28
State: IN

Vax Date: 08/29/2021
Onset Date: 08/30/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: n/a

Allergies: Bacitracin

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

Symptoms: Patient has a Mirena IUD and has not experienced any menstrual cycles for 2.5 years. One day after receiving the Covid-19 Vaccine, patient started period and has continued to bleed on and off for appox 2.5 weeks (From time of vaccine until present.)

Other Meds: Mirena IUD Zyrtec Women's Multivitamin

Current Illness: None

ID: 1700933
Sex: F
Age: 64
State: IL

Vax Date: 03/31/2021
Onset Date: 05/31/2021
Rec V Date: 09/15/2021
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: Did not go through vaccine people.... Called dermatology office Dr. was told to take over the counter benadryl. Did not realize at the time hives were caused from shot, realized after reading what to look for and instructions to not take the 2nd doze if hives developed. So I did not go back to get 2nd shot, but feel now that I should report hives after 1st doze.

Allergies: None

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

Symptoms: Hives all over body

Other Meds: None

Current Illness: None

ID: 1700934
Sex: M
Age: 48
State: MO

Vax Date: 08/28/2021
Onset Date: 08/29/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: Patient got sick a day after vaccination. He developed further COVID-like symptoms and was diagnosed by PCP with COVID 3 days after vaccination. He is doing well now.

Other Meds:

Current Illness:

ID: 1700935
Sex: F
Age: 52
State: KS

Vax Date: 05/12/2021
Onset Date: 05/26/2021
Rec V Date: 09/15/2021
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: none

Allergies: none

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

Symptoms: Sores in mouth. Mostly on roof of mouth and gums. The sores on the roof of my mouth form blisters that ooze pus and are incredibly painful when eating anything that rubs against the roof of my mouth. The gums are sore when brushing teeth.

Other Meds: none

Current Illness: none

ID: 1700936
Sex: F
Age: 64
State: MN

Vax Date: 03/24/2021
Onset Date: 04/09/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: 04-14-21 MRI & CT; 04-20-21 Labs; 04-23-21 MRI; 05-07-21 MRI; 05-17-21 MRI; 06-03-21 PT; 06-10-21 PT; 06-16-21 Chiropractor; 06-17-21 EMG; 06-17-21 Chiropractor; 06-18-21 Chiropractor; 06-21-21 PT; 09-03-21 Consult at clinic; 09-14-21 Test at clinic; 09-14-21 Meds prescribed

Allergies: Milk-related products; Erythromycin; Fluoxetine

Symptom List: Injection site pain, Pain

Symptoms: 2 weeks or so, after injection. Left leg numbness for 2 hours. Then, left leg tremors when standing and walking. Has continued ever since the onset, when standing and walking. MRIs; CT Scans; EMG; Blood Tests. Nothing shown as the cause. Tried PT. Doesn't do anything to help the tremors. Just began taking Clonazepam .5 mg tablets/day to start. Don't know if it will alleviate the tremors or not.

Other Meds: Multi-Vitamin; Calcium; D3; Zyrtec; Amitriptyline; Gabapentin; Sertraline; Flonase; Advair

Current Illness: N/A

ID: 1700938
Sex: F
Age: 69
State: NE

Vax Date: 03/16/2021
Onset Date: 03/30/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: Blood work, x ray of sinuses, hearing test said no sound was penetrating my L ear.

Allergies: Erythromycin.

Symptom List: Injection site pain, Menorrhagia

Symptoms: Two weeks after vaccine, I woke up in the middle of the night with vertigo. On the 30th I went into see the Dr. and he gave me antibiotics and Z-pak. I went back to them three times altogether. The vertigo seemed to subside but came back in July but after I got the vertigo and it got better, I was left with tiredness and I had the brain fog. On July 13 I went in and saw another Doctor and at that point my sinuses were bothering me really bad and I was very achy so they gave me a round of antibiotics. I went back on July 16 and then again on July 22. On July 22 they said there was nothing else they could do so they just kept ordering me antibiotics. They told me I needed to see ENT, so on August 23 I went to see the ENT and at that point on the 23rd my ear was plugged and I had no energy and was just laying around and it didn't take much for me to sweat. On the September 9th I went to ENT and she said it looked like swelling in Eustachian tubes and I went back and seen her and they gave me more antibiotics and I went back because I had a reaction to antibiotics and steroids I was given. I ended up having a reaction and my doctor thought it was one because my glands were swollen. She gave me a steroid and that cleared up the swelling and that went down and so I went back on August 23 and she said that she didn't understand what was going on with me and she said that I needed to go back to my PCP because she didn't know what to tell me. To this day, my hearing is not very good in my left ear anymore, my left shoulder hurts and feels like my joints are stiff and Dr. thought it might be something because it was to do with allergies and when I got the vaccine my immune system went into overdrive. As of now, I've just given up and stopped taking my sinus medicine and the last couple days I've been trying myself to get up. No-one knows what's going. In between these times I did go to ER for kidney stones which was around July at the hospital and they gave me antibiotics and steroids. I've also had inflammation in my joints. Also, my ear drum had fluid inside left ear and my sinuses were swollen as well as my soft and hard palate in mouth. I also had lumps under my chin. They did a hearing test which concluded that no sound was penetrating my left ear.

Other Meds: Nasonex; Loratadine.

Current Illness: None.

ID: 1700939
Sex: F
Age: 43
State: IL

Vax Date: 04/13/2021
Onset Date: 08/14/2021
Rec V Date: 09/15/2021
Hospital: Y

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

Lab Data: 8/24/21 covid19: positive 8/24/21 chest xray: 1. Near complete opacification of the left hemithorax. There may be mild right basilar airspace disease as well. 8/25/21 chest CT: Small to moderate left pleural effusion with consolidation throughout the left lung likely representing a combination of pneumonia and atelectasis.

Allergies: Aspirin, NSAIDS, iodine, cephalexin, shellfish, iron, augmentin, tape

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

Symptoms: History of recent admission at Hospital from 08/14/2021 to 08/24/2021 because of a COVID-19 infection leading to respiratory failure and bilateral pneumonia. Discharged on Augmentin and Flagyl. After reaching home, she called 911 again because of worsening shortness of breath and EMS found her to be only saturating 60% on room air. They put her on a non-rebreather where she was saturating around 85% to 86%. In the ER, she was put on the BiPAP. ABG done on the non-rebreather showed a pH of 7.328, pCO2 67.6, and a pO2 of 59.6. Repeat ABG on the BiPAP is still pending as we speak. CT angio of the chest was done in the ER, the preliminary results of which is showing no PE but showing bilateral pneumonia, especially in the left upper lobe and left lower lobes. Patient was started on Zosyn and vancomycin and the hospitalist service was called for admission. Admitted on 8/24/21 due to being very symptomatic with occasional chest pain when she coughs. Placed also on dexamethasone. discharged on 9/14/21.

Other Meds: Acetaminophen, albuterol, amlodipine, atorvastatin, bisacodyl suppository, budesonide, cyclobenzaprine, famotidine, breo ellipta, insulin 70/30, levothyroxine, lisinopril, metformin, nystatin cream, ondansetrone, oxycodone PRN, pantoprazole

Current Illness:

ID: 1700940
Sex: M
Age: 43
State: IL

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 09/15/2021
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: Fevers, chills, shortness of breath, hyperventilating.

Other Meds:

Current Illness:

ID: 1700941
Sex: F
Age: 24
State: TX

Vax Date: 09/14/2021
Onset Date: 09/14/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data:

Allergies: Sulfa Penicillin Zyvox Vancomycin Mushrooms

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Nausea Severe Fatigue Joint pain Muscle pain

Other Meds: Dapakote Zyprexa Hydroxyzine Prazosin

Current Illness:

ID: 1700942
Sex: F
Age: 36
State: NY

Vax Date: 09/14/2021
Onset Date: 09/14/2021
Rec V Date: 09/15/2021
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: None were done

Allergies: Grass, Bleach, Dogs/Cats, Eggs, Latex, Perfumes

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

Symptoms: Patient reported feeling very warm, like she was experiencing hot flashes. Soon after, developed rashes on arm and over other areas, such as groin, legs, neck and chest. Patient also reported feeling very anxious, experiencing "air hunger", and feeling like it was difficult to breathe. Patient reported taking Benadryl to help with reaction. Called today at 6:15pm to report this to us, stating that she felt better. Instructed patient to reach out to her doctor and seek medical treatment for rash since it was still bothering her.

Other Meds: None reported

Current Illness: None reported

ID: 1700943
Sex: M
Age: 46
State: CA

Vax Date: 01/08/2021
Onset Date: 08/21/2021
Rec V Date: 09/15/2021
Hospital: Y

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

Lab Data: CT, MRI, blood work, ECHO

Allergies: NKDA, none

Symptom List: Nausea

Symptoms: CVA

Other Meds: Amlodipine, Adarbyclor

Current Illness: None

ID: 1700944
Sex: F
Age: 39
State: OK

Vax Date: 09/12/2021
Onset Date: 09/12/2021
Rec V Date: 09/15/2021
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: none

Symptom List: Injection site pain

Symptoms: Severe headache, severe abdominal pain, nausea, tiredness, lack of energy, generalized body aches (2.5 days) vomiting (1 episode the morning after injection was received) lack of appetite (1 day) chills (0.5 day) left arm pain, redness, swelling, and warmth (3 days and persists but has improved) Mild headache and body aches persist Symptoms treated with self care at home and OTC medications - Naproxen, Headache/Migraine Relief, Acetaminophen Symptoms have improved significantly but some persist as stated above

Other Meds: none

Current Illness: none

ID: 1700945
Sex: F
Age: 34
State: NY

Vax Date: 08/06/2021
Onset Date: 09/10/2021
Rec V Date: 09/15/2021
Hospital: Y

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

Lab Data: CT done in ER 9/10 confirming acute appendicitis

Allergies: Penicillin

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

Symptoms: Developed acute appendicitis approx. 5 weeks after vaccine

Other Meds: Keppra XR, Seasonique, Vitamin D, Vitamin B 12, Magnesium, Elderberry sambuccus,

Current Illness: None

ID: 1700946
Sex: F
Age: 58
State: CO

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

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

Lab Data: CareNow Urgent Care 09/07/2021-720-449-8060

Allergies: Cymbalta-Vertigo

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

Symptoms: The day after the vaccine when I got home, I noticed two little itchy spots on my breast. Then within an hour my whole torso was covered in hives. I tried taking Benadryl at home but the hives were still spreading and getting worse. I went to Urgent care on 09/07/2021 and they prescribed some Prednisone. I was told to take Benadryl. It was getting worse and was very itchy and I visited the ER on 09/09/2021 because I was covered in hives from the neck down. I was given Epinephrine and I am finished with the Prednisone. It has been almost two weeks and the hives are still present especially on my hands today. They are consistently on my torso and legs, but they are coming and going on my arms. The ones on my arms are new and I have two on my eye. They are big spots that become large and raised patches. They get worse in the evening and become raised and itchy.

Other Meds: Omeprazole, Levothyroxine

Current Illness: N/A

ID: 1700947
Sex: M
Age: 41
State: NC

Vax Date: 08/14/2021
Onset Date: 08/17/2021
Rec V Date: 09/15/2021
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 tests were taken.

Allergies: None

Symptom List: Tremor

Symptoms: Multiple cold sores in mouth for about 3 weeks. Did not seek treatment. Symptoms resolved over time.

Other Meds: Xerelto, ibuprofen

Current Illness: None

ID: 1700948
Sex: M
Age: 25
State: IA

Vax Date: 09/14/2021
Onset Date: 09/14/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Received a dose of Moderna when already had received a dose of JNJ months ago.

Other Meds:

Current Illness:

ID: 1700949
Sex: F
Age: 18
State: CA

Vax Date: 08/23/2021
Onset Date: 09/07/2021
Rec V Date: 09/15/2021
Hospital: Y

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: Went to hospital from chest pains.

Allergies: None

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

Symptoms: Bad chest pain all over, next day pain continued to get worse, diarrhea, headaches, sore throat, slight cough.

Other Meds: None

Current Illness: None

ID: 1700950
Sex: M
Age: 56
State: MI

Vax Date: 06/02/2021
Onset Date: 06/15/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: Only a doctor office visit. No diagnosis.

Allergies:

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

Symptoms: Two weeks after the first Pfizer injection, a rash formed. It was very similar to shingles experienced in the past, intense itching, blistering, and weeping for weeks. At the same time a high increase in hair loss began and continues. Additional symptoms continued to appear. Eye styes became frequent for e few weeks. Chalazia formed on both eye lids, one still exists. Lower leg cramps occurred for weeks and have lessened, but leg swelling, cold extremities, and bright red toes can still occur. Brain fog, fatigue, and a general feeling of poor health have all been experienced since the first vaccination. With the hair loss and circulatory issues, a micro thrombosis is being researched.

Other Meds:

Current Illness:

ID: 1700951
Sex: F
Age: 54
State: MD

Vax Date: 06/11/2021
Onset Date: 06/15/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: Aug 9 for X-ray, EKG, Blood panel, ECG

Allergies: Nickle, sensitive to alot of medications causing nausea and/or dizziness

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Pain all over body like when one exercises whole body. Continuous pain throughout body constantly moving, Cymbalta was first prescribed and caused other issues, Sabella was then issued for treatment. Testing for fibromyalgia. In Aug. had a new issue with a tingling (like pins and needles) feeling in left leg, felt cold, numbness on shin. Also, had a panic attack because thought it was a heart attack.

Other Meds: None

Current Illness: None

ID: 1700952
Sex: F
Age: 52
State: NJ

Vax Date: 09/15/2021
Onset Date: 09/15/2021
Rec V Date: 09/15/2021
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: Zithromax - itching and rash

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

Symptoms: 1707 patient sat down in monitoring area after vaccination. 1737 patient left after 30 minutes of monitoring (was being monitored for half an hour due to Zithromax allergy that results in itching and rash) 1750 patient came back to monitoring area reporting tingling in left face, left arm, and left leg. Vital signs taken by LPN. BP 171/91. O2 sat 100% on Room Air. Pulse 70. Respirations 19. 1753 Ate 2 graham crackers and drank 711 ml of water. 1754 Vaccine Clinic Team Lead RN made aware of patient reporting symptoms. 1756 patient reported worsening tingling to bilateral arms, legs, and back of head. 1757 Code called. 1800 patient taken to ER in wheelchair by Emergency Room RN. Nursing Supervisor present.

Other Meds:

Current Illness:

ID: 1700953
Sex: F
Age: 55
State: AR

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 09/15/2021
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: Spoke with my plastic surgeon and my oncologist, Dr. on 9/13/2021. I sent Dr. a picture of one of my rashes. He advised I start taking Benadryl every day for the next week and to contact him again if the rashes return.

Allergies: No

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

Symptoms: Day 1 (9/3/2021) - arm became really hot and was extremely painful Day 2 (9/4/2021)- hot, splotchy rash on injection arm; lasted 12 hours painful arm, difficult to move Day 3 (9/5/2021) - multiple hot, splotchy rashes on other arm; 3 rashes in different spots; each lasted about 4 hours painful arm, difficult to move Day 6-11 (9/8/2021- 9/13/2021)- pain and tightness in breast implant on right side; this is my cancer and radiation side Day 9 (9/11/2021) large red welt and rash showed up on vaccine side around injection site Day 11 (9/13/2021)- rash and itchiness around my breast implant on my right side at the top of the impant Day 12 (9/14/2021) - flashing lines of light in my left eye, started about 6:00pm and continued until around 9:30pm

Other Meds: Lisinopril 20 mg Anastrozole 1 mg Desvenlafaxine ER Succinate 100mg

Current Illness: No

ID: 1700954
Sex: F
Age: 69
State: OH

Vax Date: 08/23/2021
Onset Date: 08/23/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: Patient was administered fluzone HD on 8/23/21, but reported to the pharmacy on 9/15/21. Patient said arm was swollen and had rash all over her arm. Patient did state that she did go to her physician when she had the reaction.

Other Meds:

Current Illness:

ID: 1700955
Sex: F
Age: 52
State: TX

Vax Date: 03/31/2021
Onset Date: 03/31/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: All of my medical care was given at the hospital shortly after having received the shot.

Allergies: Eggs Contrast

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

Symptoms: Shortly after taking the 2nd Pfizer shot I became really dizzy and nauseous. After being unable to recover within a few minutes and becoming increasingly unwell, I checked into the emergency room.

Other Meds: Medications varied from hospital.

Current Illness: Asthma Fibromyalgia Migraines Mental Chronic pain

ID: 1700956
Sex: F
Age: 73
State:

Vax Date: 02/23/2021
Onset Date: 03/16/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: Skin biopsy April 19, 2021 X-ray August 13, wpwq

Allergies: Ace Inhibitors

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

Symptoms: Squamous Cell carcinoma diagnosed April 19, 2021 Moderate arthritis diagnosed by X-ray August 13, 2021

Other Meds: Irbesartan

Current Illness: None

ID: 1700957
Sex: M
Age: 70
State: MI

Vax Date: 09/12/2021
Onset Date: 09/12/2021
Rec V Date: 09/15/2021
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: PATIENT COMPLETED TWO SHOT SERIES OF MODERNA COVID SHOTS 7 MONTHS BEFORE AND WAS GIVEN PFIZER COVID SHOT AS A BOOSTER. NO ADVERSE EFFECTS REPORTED TILL TODAY

Other Meds:

Current Illness:

ID: 1700958
Sex: F
Age: 65
State: AL

Vax Date: 04/08/2021
Onset Date: 04/12/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: I have not reported this condition to my primary care provider yet. Will discuss during my annual physical in Feb. 2022.

Allergies: None

Symptom List: Vomiting

Symptoms: tinnitis (high pitched)

Other Meds: None prescription meds. OTC multi-vitamin and vitamin D3

Current Illness: None

ID: 1700959
Sex: M
Age: 51
State: CA

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

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

Lab Data: Patient declined to present to emergency room. Offered sooner appointment with Primary Care Provider, patient declined. Preferred to speak and follow up with doctor on 9/17/21.

Allergies: Bactrim, Doxycycline, olive, Chlorhexidine topical, Penicillin

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Per patient, after he received 1st dose of Covid Vaccine on 9/2 he started experiencing pain on left shoulder to fingers tips 5/10, difficulty breathing, chest pressure, and chest pain 4/10 same day. Denied any trauma to chest. C/O lightheadedness, dizziness, and headache. Patient declined to present to emergency room.

Other Meds: insulin glargine, lisinopril, pantoprazole (per patient, took the day prior to vaccination).

Current Illness:

ID: 1701095
Sex: M
Age: 59
State: WA

Vax Date: 04/22/2021
Onset Date: 09/01/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Bell's palsy

Other Meds: insulin (70/30), glipizide, metformin, metoprolol, atorvastatin

Current Illness:

ID: 1701096
Sex: M
Age: 62
State: CA

Vax Date: 08/25/2021
Onset Date: 08/25/2021
Rec V Date: 09/15/2021
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: None

Allergies: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Client reported that he developed pain over the left side of his chest the night after receiving the vaccine. The client described the pain as "I feel like I got hit." The client also reported some shortness of breath. The client stated the symptoms lasted about 1 week. After one week the client stated his symptoms started to "go down." The client reported mild persistent chest pain. The client also reported that two weeks after the 1st COVID vaccine Pfizer, he developed a "red rash on my arms." The client described the rash as "big red spots that were itchy." The client stated that the rash resolved after one day. The client did not take any medication for the symptoms. The client did not follow up with PCP or allergist. The client denies any chronic conditions. The client takes Omeprazole daily for heartburn. The client has no known allergies.

Other Meds: Omeprazole

Current Illness: Unknown

ID: 1701097
Sex: M
Age: 56
State: CA

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: none know

Allergies: NKA

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

Symptoms: Patient called 9/15 to cancel second dose at md advice. States md dx pericarditis after first dose

Other Meds: none known

Current Illness: none know

ID: 1701098
Sex: F
Age: 22
State: FL

Vax Date: 09/13/2021
Onset Date: 09/15/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: steroids and EpiPen was given at ER

Allergies: no

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

Symptoms: Rash all over body

Other Meds: no

Current Illness: no

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am