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**
PLEASE CHECK BACK SOON
Download the files above while you wait.







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: 1704159
Sex: F
Age: 39
State: MO

Vax Date: 03/16/2021
Onset Date: 09/16/2021
Rec V Date: 09/16/2021
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: Soy

Symptom List: Dysphagia, Epiglottitis

Symptoms: Lymph nodes swollen with particularly large lump under left arm that made it uncomfortable to relax my arm at my side. Most swelling lasted about a day but the lump under my arm continues although with no discomfort. I've consulted with a primary care physician and my ob/gyn at my annual check-up. They are not concerned with the plan being to monitor and follow up with primary care.

Other Meds: Aurovela, fish oil, flaxseed oil, multivitamin, collagen supplement

Current Illness: None

ID: 1704160
Sex: F
Age: 32
State: NY

Vax Date: 08/13/2021
Onset Date: 08/13/2021
Rec V Date: 09/16/2021
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: NO

Symptom List: Anxiety, Dyspnoea

Symptoms: wrong Diluent used . was diluted with bacteriostatic sodium chloride . not sodium Chloride supplied with vaccine

Other Meds: NO

Current Illness: NO

ID: 1704161
Sex: F
Age: 35
State: MO

Vax Date: 09/09/2021
Onset Date: 09/13/2021
Rec V Date: 09/16/2021
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: Pain in RT upper arm. Upper Extremity Ultrasound on 9/14/2021 shows a "Venous Thrombosis involving the Cephalic Vein Rt Upper Extremity."

Allergies:

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

Symptoms: Pain and redness in RT upper arm. Upper Extremity Ultrasound on 9/14/2021 shows a "Venous Thrombosis involving the Cephalic Vein Rt Upper Extremity."

Other Meds:

Current Illness:

ID: 1704162
Sex: F
Age: 62
State: CA

Vax Date: 08/13/2021
Onset Date: 08/14/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data: 09/15/2021 went to ER and was told it was an allergic reaction and her blood pressure was high...

Allergies: penicillin anything with aspirin gluten preservatives some cleaning products flagyl sulfur

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient reported that she has a feeling in her throat and headache as well.. the headache cleared... throat cleared weeks after... after the second vaccine she had serve headaches and very thirsty had swelling and redness at the injection site.. also had hives on her body and the itching in her throat came back ...

Other Meds: Lamictal morning and night Valium

Current Illness: no

ID: 1704163
Sex: M
Age: 52
State: MO

Vax Date: 09/16/2021
Onset Date: 09/16/2021
Rec V Date: 09/16/2021
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: NKDA

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

Symptoms: shortness of breath and dizziness

Other Meds: States none.

Current Illness: Unknown

ID: 1704164
Sex: F
Age: 73
State: GA

Vax Date: 03/22/2021
Onset Date: 07/12/2021
Rec V Date: 09/16/2021
Hospital: Y

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: 07/15/2021 PCR+ COVID-19 test at pharmacy 4424; 07/19/2021 PCR+ COVID-19 test, 08/10/2021 PCR+ COVID-19 test

Allergies:

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

Symptoms: Breakthrough COVID-19 case with symptom onset 7/12/2021: chills, sore throat, cough, sob/difficulty breathing, headache, diarrhea, loss of smell/taste, tired. Hospitalized 7/19/2021-7/24/2021. ICU Admission.

Other Meds:

Current Illness:

ID: 1704165
Sex: F
Age: 44
State: NJ

Vax Date: 03/14/2021
Onset Date: 06/13/2021
Rec V Date: 09/16/2021
Hospital: Y

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

Lab Data:

Allergies: flonase, bacitracin

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Immediately the next morning I awoke with a 102.7 fever, aches, chills and a sore arm that lasted for about 36 hours. HOWEVER.... it's what happened later on that is what concerns me. I was a very HEALTHY and physically active person up until the morning of 6/13/21, when I awoke at 4am to a sharp pain in my chest upon inhaling. I went to the urgent care clinic where the PA urged me to go to the hospital under strong suspicion of a blood clot. I went to hospital where they did blood work and my D-Dimer was through the roof, indeed indicating a pulmonary embolism- so they started me on Heparin. It turned out I had not one, but three pulmonary embolisms. I could've died. I spent 6 days in the hospital while they tried to get the right dosing of the blood thinners to get my pulmonary embolisms (PEs) under control. Finally, I was discharged. Three weeks later, on 7/9, I got my menstrual cycle, and due to the dosage of blood thinners I was on, I began to hemorrhage. I called my doctor who sent me back to the hospital. They could not control the bleeding, and I wound up needing a blood transfusion along with multiple iron infusions over the next 6 days in the hospital (again). They also needed to stop my blood thinners to control the blood loss. Due to the hemorrhaging, they determined I would need a hysterectomy, and they would need to keep me off blood thinners to perform the operation safely. I began throwing superficial blood clots all over. Any and every time they took a blood sample, or placed an IV, my vein would collapse and I'd get another blood clot. They rushed my surgery as soon as they could. I had my hysterectomy on 8/6/21. They started me on blood thinners that same day, a preventative dose, however it was not good enough. On 8/9/21, I spiked a fever and it turned out I had developed 3 Deep vein thrombosis in my legs (DVTs) despite the blood thinners. So, they upped my blood thinners to the highest possible dosage for my body. I then began to hemorrhage again and was re-admitted back into the hospital (again) for iron infusions and management of my blood thinners. I spent 10 days in the hospital between 8/6/21 and 8/19/21 trying to save my own life. During this time, the doctors and hospital have done ALL genetic marker testing for my condition and ALL have come back NEGATIVE. There is no reason for me to be throwing these blood clots continuously like this. According to my hematologist, the only 'new' factor in my life is the Covid vaccine, which I am now wary of the booster (which I am due for in November).

Other Meds: topiramate, fluvoximine, rexulti, xanax, advair, albuterol, mumultivitamin, calcium citrate, ester C, B12, prebiotics, probiotics

Current Illness: none

ID: 1704166
Sex: F
Age: 39
State: MN

Vax Date: 05/17/2021
Onset Date: 09/15/2021
Rec V Date: 09/16/2021
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: Pharyngeal swelling

Symptoms: Tested PCR positive for COVID 9/15/21 after being fully vaccinated.

Other Meds:

Current Illness:

ID: 1704167
Sex: M
Age: 62
State: WI

Vax Date: 05/28/2021
Onset Date: 06/01/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data: None

Allergies: none

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Received 1st dose of shinles vaccine, then 4 days later while at work, felt a "POP" in left shoulder, went to nurse, told me to take acetaminophen and ibuprofen til Friday June 4. Nurse and PT checked it and verified I had ruptured one of the bicep tendons - put on 6 week no lifting restriction. Aug 18 2021 received 2nd shingles vaccine in left shoulder. Then 6 days later had adverse reaction when I fell onto cement when assistant neglected to help me properly get out of van while confined. Fell onto my right shoulder, but caused rotator cuff damage in LEFT shoulder., and given three weeks off of work. Also had first COVID vaccine in left shoulder. Every night left shoulder goes numb down to my fingers while sleeping. Continuing PT now.

Other Meds: Mesalamine, 1200mg 2/day; folic acid 1mg 1/day: acetaminophen 500mg 1mg 1/day; ibuprofen 600 mg 1/day; psyllium 520 mg 5/day; fish oil 1000mg 1/day; vitamin C 500 mg 1/day; zinc 50 mg 1/day; multivatamin 1/day

Current Illness: none

ID: 1704168
Sex: F
Age: 37
State: IN

Vax Date: 08/28/2021
Onset Date: 09/02/2021
Rec V Date: 09/16/2021
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: Penicillin and nickel

Symptom List: Diarrhoea, Nasal congestion

Symptoms: After receiving the shot, I felt normal flu like symptoms for about 36 hours. Then, in the week following, I started to notice muscle twitching all over my body. It happens every single day, all throughout the day.

Other Meds: Probiotics, vit d, vit c, zinc, celexa 10 mg.

Current Illness:

ID: 1704169
Sex: M
Age: 32
State: NY

Vax Date: 08/13/2021
Onset Date: 08/13/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data: no

Allergies: no

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

Symptoms: wrong Diluent used . was diluted with bacteriostatic sodium chloride . not sodium Chloride supplied with vaccine

Other Meds: no

Current Illness: no

ID: 1704170
Sex: F
Age: 46
State: AL

Vax Date: 03/23/2021
Onset Date: 04/01/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Rash, Urticaria

Symptoms: Skipped periods and experienced hot flashes four months following my first dose. Period resumed August, 2021.

Other Meds: Sertraline 50mg daily, 80 mg aspirin daily, .5 mg ativan at bedtime.

Current Illness: none

ID: 1704171
Sex: F
Age: 76
State: TX

Vax Date: 09/10/2021
Onset Date: 09/11/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data: Physical Therapy started 8/23/2021

Allergies: No

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

Symptoms: It's chronic pain in my left shoulder and it goes down into my elbow. The pain into my elbow started this morning 9/16/2021. The pain has gotten a lot more intense. I can't do anything with it. I alter heat and ice on the area. I started physical therapy in August from the first shot. I didn't connect the symptoms between the two doses until I got the second vaccine. I notice the exact same symptoms.

Other Meds: Synthroid 75 mg and Estrogen-Methyltestosterone Hs

Current Illness: No

ID: 1704172
Sex: M
Age: 68
State: MN

Vax Date: 03/16/2021
Onset Date: 05/06/2021
Rec V Date: 09/16/2021
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: Blood work; MRI x 2

Allergies: Sofia

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

Symptoms: I am 99% blind in my right eye. I get some dizzy spells. I went to the men clinic about my eye. They did all kinds of test on me. Everything came back normal. They said I had a mini stroke.

Other Meds: Marti spine

Current Illness:

ID: 1704173
Sex: M
Age: 80
State: ID

Vax Date: 09/14/2021
Onset Date: 09/14/2021
Rec V Date: 09/16/2021
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: Brilinta-ough

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

Symptoms: He had his first Covid vaccine yesterday. Last night he fell to the floor and was crawling around. When his girlfriend got to him he had a bump and laceration on his right cheek and his mouth was bloody. Today he is shaky and off balance.

Other Meds: Aspirin 81 MG Oral Tablet Chewable Chew and swallow 1 tablet orally daily Metformin HCl 500 MG Oral Tablet Take 1 tablet orally daily with breakfast Metoprolol Tartrate 25 MG Oral Tablet Take 0.5 tablets orally 2 times a day HydroCHLOROthia

Current Illness: N/A

ID: 1704174
Sex: M
Age: 39
State: CA

Vax Date: 05/04/2021
Onset Date: 08/01/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data: Tested for MMR immunity, varicella zoster AB, and Hep A,B, C antibody on 5/1/21.

Allergies: Naproxen causes nightmares Nortriptyline causes nightmares

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

Symptoms: Pt developed shingles on 8/1/21. This was treated with oral medication. Symptoms are resolving.

Other Meds: Tramadol, gabapentin, amitriptyline.

Current Illness: none

ID: 1704175
Sex: F
Age: 52
State: VA

Vax Date: 03/12/2021
Onset Date: 03/13/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data: Blood work - thyroid levels are way off - August 5th 2021 Blood work - thyroid levels are way off - July 19 2021 Blood work - thyroid levels are way off - July 14 2021

Allergies: Raspberries

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

Symptoms: Well in the middle of on the 13th I was diagnosed with Bronchitis. It went on all summer long and continues to this day. I am on inhalers, nebulizers and cannot walk thirty feet without being winded. I am out on long term disability now. My family has to help me get dressed and help me otherwise physically. I sleep about 17 hours a day. I got foggy brain really bad and my thyroid numbers have been really messed up from the shot. I was due for my 6 months check up and my endo DR cannot get my numbers to stabilize. I have hypothyroidism. Also my immune system is shot, I cannot leave my house now. I've also seen an ENT for lesions on the side of my tongue, that was on August 11 2021.

Other Meds: Levothyroxine, Lisinopril

Current Illness: Diverticulitis - was being treated with antibiotics

ID: 1704176
Sex: F
Age: 32
State: KY

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

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

Lab Data:

Allergies: Shellfish

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Right arm down into right arm pit and right breast are swollen red and hot to touch

Other Meds: Multivitamin vitamin C vitamin D

Current Illness: No

ID: 1704177
Sex: F
Age: 65
State: MI

Vax Date: 01/07/2021
Onset Date: 09/07/2021
Rec V Date: 09/16/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: hospitalization

Other Meds:

Current Illness:

ID: 1704178
Sex: M
Age: 70
State: TX

Vax Date: 08/23/2021
Onset Date: 08/24/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data: Unknown date-just about a week after the onset of symptoms EKG-normal Chest x-ray-normal

Allergies: no

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

Symptoms: 08/24/2021 around midnight woke up with high fever, headache, chills and body aches. The fever ended after about 24 hours, the headache and body aches lasted for three days. Still having a lingering pain on the right side below shoulder area.

Other Meds: I take Metformin, Rosatatin,

Current Illness: no

ID: 1704180
Sex: M
Age: 47
State: TX

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

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: No Adverse events, Patient got Moderna first shot on April 02 and didn't mention when getting the Johnson vaccine

Other Meds:

Current Illness:

ID: 1704181
Sex: F
Age: 50
State: OH

Vax Date: 04/15/2021
Onset Date: 04/15/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data:

Allergies: Niacin

Symptom List: Unevaluable event

Symptoms: Increased heart rate by 15-20 beats that started after 2nd dose of Moderna and lasted 3 months. Earlier onset of PMS and painful periods started near the end of April 2021 and still continues.

Other Meds: Wellbutrin Metformin Spirolactin

Current Illness: None

ID: 1704182
Sex: F
Age: 24
State: FL

Vax Date: 09/16/2021
Onset Date: 09/16/2021
Rec V Date: 09/16/2021
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: N/A

Allergies: Mushrooms

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

Symptoms: Vaginal Bleeding

Other Meds: N/A

Current Illness: N/A

ID: 1704183
Sex: M
Age: 64
State: VA

Vax Date: 09/13/2021
Onset Date: 09/14/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Sore arm at vaccination site for one day followed by sneezing that developed into a bad head cold, sore throat and ears, runny nose, and productive cough.

Other Meds: Celecoxib, Advair HFA 115/21, Zyrtec OTC, Carvedilol 3.125 mg, Aspirin 81 mg, Metformin 500 mg, Rosuvastatin 40 mg

Current Illness: NA

ID: 1704184
Sex: M
Age: 32
State:

Vax Date: 08/16/2021
Onset Date: 08/19/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Injection site pain, Menorrhagia

Symptoms: Chest pain and trouble breathing.

Other Meds: None

Current Illness: None

ID: 1704185
Sex: F
Age: 67
State: NC

Vax Date: 03/21/2021
Onset Date: 03/28/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data: ENT evaluation ( negative after had been diagnosed with right serous otitis in May) MRI brain - normal, Allergy specialist ? no allergies, vasomotor rhinitis, videonystagmogram - normal, lab work ( CBC, CMP, B12, Vitamin D, Mg ) normal, Echocardiogram ? normal except mild AI, Tilt table test positive for autonomic dysfunction- POTS

Allergies: None

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

Symptoms: Intermittent dizziness from 3/28/2021 through April. Since early May have had daily symptoms ranging from foggy head, off balance, lightheaded, dizziness with fatigue and orthostatic intolerance.

Other Meds: Levothyroxine, Diclofenac, Cyclobenzaprine, Vitamin D3, Docusate Sodium, Glucosamine Chondroitin Sulfate, Fluticasone nasal spray, Alendronate

Current Illness: None

ID: 1704186
Sex: F
Age: 61
State: ID

Vax Date: 08/16/2021
Onset Date: 08/17/2021
Rec V Date: 09/16/2021
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: Nausea, Pain in extremity, Pyrexia

Symptoms: after the second das my whole body was achy and had a rash on my right foreman and it went up my arm and across my back it was really itchy and had a fever on and off for two weeks. I stopped oral chemo because of this and went to the doctor. I still have the pain in the back and the arm. I am extremely tired and cough more

Other Meds: HYDROCHROLIDE, LYSIC, potassium chloride, exzemestine, subalpine, inahiestmine, aspirin and Tylenol

Current Illness: none

ID: 1704187
Sex: M
Age: 32
State: OR

Vax Date: 09/07/2021
Onset Date: 09/08/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data: chest X-ray, blood panel all on 9/8/21 into the early hours of 9/9/21

Allergies: none

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: chest pain and pressure. Pain radiated to left shoulder and neck. Started at 9pm on 9/8/21 and did not resolve for 2 days.

Other Meds: none

Current Illness: none

ID: 1704188
Sex: F
Age: 33
State: TN

Vax Date: 09/12/2021
Onset Date: 09/13/2021
Rec V Date: 09/16/2021
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

Allergies: Ceftin- antibotic

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

Symptoms: Monday, 9/13- fever began around 10am. severe back aches. fatigue. 1000 mg of Acetaminophen taken every 6 hours. Highest fever 101.5. No fever at night. Tues, 9/14- woke up not fatigued. No fever. No symptoms. Did not take Acetaminophen in afternoon. Returned to work. That night had fever of 102.7 for over 2 hours with intense chills and back ache. 1000 mg of Tylenol taken with cold rags applied to body to cool down. Wed, 9/15- Fever ranging from 100.3-101.5 all day. Alternated Tylenol and Motrin throughout the day to keep fever in check. No chills. Small back ache. Sore throat. Swelling of tonsils. Thurs, 9/16- No fever. Fatigue. Sore throat has gotten worse. Swelling of tonsils continues. Throat very dry.

Other Meds: None

Current Illness: None

ID: 1704189
Sex: F
Age: 31
State: MN

Vax Date: 09/12/2021
Onset Date: 09/13/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data: 9/15/21-Went to doctor and had urine Analysis which showed +1 blood in my urine 9/16/21-Doctor thinks I could have passed a kidney stone or ruptured a cyst in my ovaries. Pelvic ultrasound done

Allergies: Azithromycin

Symptom List: Nausea

Symptoms: Started with fever, headache, and joint pain. Those subsided and I immediately started having severe abdomen pain that started on the left side, went across my abdomen at the naval level, and around my back to the right side. Currently still having pain.

Other Meds: Previfem birth control

Current Illness: None

ID: 1704190
Sex: F
Age: 1
State: TX

Vax Date: 09/14/2001
Onset Date: 09/14/2021
Rec V Date: 09/16/2021
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: Injection site pain

Symptoms: HIVES, SWOLLEN ARM, SWEATING, HOT FLASHES

Other Meds: BENADRYL

Current Illness: NONE

ID: 1704191
Sex: M
Age: 72
State: UT

Vax Date: 02/05/2021
Onset Date: 02/06/2021
Rec V Date: 09/16/2021
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: Codeine Hydrocodone Oxycodone Tamiflu IVP Iodine Allergy shots Keflex

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

Symptoms: Reactive Arthritis. unable to get up , had to crawl. all joints stiff and severely painful.

Other Meds: Levothyroxine Atorvastatin Losartin Aspirin 81mg Acetaminophen Multivitamin C Vitamin Elderberry complex Trospium

Current Illness: Osteoarthritis Heart DIsease Prostate cancer Melanoma

ID: 1704192
Sex: M
Age: 38
State: NC

Vax Date: 02/16/2021
Onset Date: 07/30/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data: CT pulmonary angiogram on July 30, 2021 demonstrated a subsegmental left lower lobe pulmonary embolism with developing lung infarct. Negative COVID-19 test in July 2021. Normal Protein C and S levels in August 2021.

Allergies: None

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

Symptoms: Patient developed a pulmonary embolism on 30 July 2021, 5 months following his 2nd dose of COVID-19 vaccine. He did have mild COVID-19 infection on 12 August 2020.

Other Meds: None

Current Illness: None

ID: 1704194
Sex: F
Age: 40
State: NY

Vax Date: 08/11/2021
Onset Date: 08/11/2021
Rec V Date: 09/16/2021
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: no

Symptom List: Tremor

Symptoms: Wrong Diluent used . was diluted with bacteriostatic sodium chloride . not sodium Chloride supplied with vaccine , Patient was contacted to return for vaccine repeat r/t recommendation of manufacturer .

Other Meds: no

Current Illness: no

ID: 1704195
Sex: F
Age: 52
State:

Vax Date: 01/09/2021
Onset Date: 09/11/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data: PCR Covid-19 positive on 9/11

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Patient is fully vaccinated on 1/09/2021 with Pfizer and contracted COVID, tested positive on 9/11/2021.

Other Meds:

Current Illness:

ID: 1704196
Sex: F
Age: 89
State: MI

Vax Date: 01/23/2021
Onset Date: 08/24/2021
Rec V Date: 09/16/2021
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:

Allergies:

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

Symptoms: hospitalization

Other Meds:

Current Illness:

ID: 1704197
Sex: F
Age: 65
State: NY

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data: N/A

Allergies: Codeine

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

Symptoms: Pt. states that after receiving the 3rd Booster dose of Moderna 09/10/2021, started experiencing symptoms that evening of body aches, extreme fatigue, severe headache, low appetite, and swelling under the left arm. 09/12/2021 presented with 2 new Cold sores. Symptoms have subsided besides the 2 cold sores. No noted Primary visit.

Other Meds: Atenolol, Hydrochlorothiazide, Metaphorim, Tylenol, Advil

Current Illness: N/A

ID: 1704198
Sex: F
Age: 58
State: MD

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 09/16/2021
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 performed. I do not see my Dr. until the 24th , at which time I will report to her my reaction and show her pics of site .

Allergies: Darvocet , stomach slightly with eggs

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Started with a headache about 30 minutes after dose . 24 hours later ( when I awoke ) complete body pain ( especially at fibromyalgia points and where I have sarcoidosis nodules ) malaise , low grade temp , sinus and chest congestion , chills , injection site red and swollen ( 4 inches ) also nearest sarcoidosis nodule ( about 3 inches from injection site . I can still see faint pinkness of these 2 areas at this time .

Other Meds: Metformin , Glipizide, Prednisone , Albuterol , Advair , Cymbalta, Victoza, Turmeric Curcumin , Vitamin D , Zinc , Moringa Powder

Current Illness: Hypothyroidism, Diabetes, Fibromyalgia, Neuropathy, Chronic Sarcoidosis, COPD , asthma

ID: 1704199
Sex: F
Age: 30
State: GA

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data: EKG- SINUS TACARADIA BLOOD PREGANCY TEST CVC CHEST X-RAY METABOLIC PANNEL COVID TEST

Allergies: BROMSED DM

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

Symptoms: FEVER ,CHILLS, BODYACHES, RASH, HEAD ACHE, FATIGUE, IRATTIC HEART BEAT

Other Meds: TYLENOL

Current Illness: NONE

ID: 1704200
Sex: F
Age: 40
State: KY

Vax Date: 09/08/2021
Onset Date: 09/16/2021
Rec V Date: 09/16/2021
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: guaifenesin, PCN, tree nuts, adhesive tape, codeine, cyclobenzaprine, diphenhydramine, fentanyl, gabapentin, garlic, hydrocodone- acetaminophen, live influenza vaccine, ketamine, lidocaine, meperidine, nutmeg oil, onion, shellfish

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

Symptoms: Received 1st dose Pfizer COVID vaccine 9/8/2021. Pt reported sore arm for 2 days post injection and then pain subsided. Awoke on the morning of 9/16/2021 with very swollen right arm at injection site and pain radiating to right neck,.

Other Meds:

Current Illness:

ID: 1704201
Sex: F
Age: 67
State: PA

Vax Date: 02/27/2021
Onset Date: 04/14/2021
Rec V Date: 09/16/2021
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: My palindromic was in remission for 3 years (no flares) - then after 2nd shot it came back, giving me flares every single day and worse than I have EVER had it in the 10 plus years that I have had this disease. Finally, they stopped approximately 5 months after the 2nd injection and now I am once again totally flare free. I think it triggered my already over-active immune system (which causes this disease) and therefore, made the flares come back with great intensity. Also the palindromic group I belong to - many of them say the same thing happened to them.

Other Meds: Quinnipril, thyroid medication, tomixifen

Current Illness:

ID: 1704202
Sex: F
Age: 71
State: NV

Vax Date: 08/24/2021
Onset Date: 08/31/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data: Colonoscopy scheduled for early November.

Allergies: Penicillin - mild rash; Statins - I get a cough; Inexpensive metals

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

Symptoms: I began having severe diarrhea and the doctor diagnosed it with IBS and getting me a diet to follow. And the Doctor gave me the pills to manage the symptoms. I have been utilizing the diet and the med and it's been helping. I still have to follow the diet really strictly that. The meds the doctor has me on now are: Ibgard - for IBS - 2 capsules once a day; Imodium - often times it's about every other day. I think I had been having intermittent symptoms like this for a longer period of time before the vaccines but hadn't had to address it with meds and diet until these severe symptoms at the end of August. I had seen the doctor on July 14th and she had given me an IBS diagnosis, though. This is a a chronic situation and as long as I adhere to a pretty strict diet it won't be as severe.

Other Meds: Losartan Potassium - 75mg 1 1/2 tablets daily; Atorvastatin - 1 10 mg daily; Atenolol - 25 mg daily. Vitamins: Calcium with zinc and D3; D3 on it's own - 50 mg a day; Cod Liver Oil - once a week; B Complex daily; Multiple Vitamin Centrum S

Current Illness: no

ID: 1704203
Sex: F
Age: 63
State: NC

Vax Date: 09/13/2021
Onset Date: 09/01/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data:

Allergies: MORPHINE ER

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

Symptoms: Patient reported to pharmacy to receive shingrix vaccine, but instead was given a Covid-19/Pfizer vaccine. At this time, no adverse events have been reported by the patient.

Other Meds:

Current Illness:

ID: 1704204
Sex: F
Age: 51
State: CA

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data: Day 6 4/19/21 - I believe this is the day I called my doctor's office to see if I could come in. My doctor was out of town so I had to make an appointment with the on-call Dr., which was made for Thursday 4/22/21 and was a phone appointment only. Day 9 4/22/21 - Appointment with Dr. because PCP was not in the office this week. I told him of all my symptoms including the ringing and pressure in my ears that will not stop. I feel like I have earaches in both ears, heaviness in the chest and swelling. He said he doesn?t know why I have ringing in my ears and to follow up with him if I don?t get better. He sent in an order with insurance for me to get approved to see an ENT. Day 11 4/24/2021 - Symptoms remain. The ringing and pressure in my ears seem to escalate in the evenings. I had to sleep with my head elevated or I have feelings of fainting when I lay flat. Day 16 4/29/2021 - I was much worse today so I went to Urgent Care. Dr. injected me with an antibiotic shot on my back side and gave me two Tylenol. Along with all the symptoms I have had the last 16 days stated above, Dr. also diagnosed me with Cellulitis. Dr. documented all my visible symptoms from the reaction to the vaccine as well as the cellulitis. Dr. also outlined the cellulitis on my left arm with a permanent marker so we could watch if it continues to spread. I documented with photos. Dr. prescribed Clindamycin HCL 300 MG to take every six hours. I am scheduled to go to Urgent Care for a follow up appointment in one week. Day 22 5/5/2021 - Upper left arm rash did not appear to grow much larger and the Covid-19 arm pain is better. Some symptoms have gotten better such as I don?t feel constant nausea, sweats and fever. I do still have fatigue, dizziness, swooshing in the back-left side of my head, my face still appears swollen mostly my eyelids, the ringing and pressure is still very strong in my ears and the heaviness in my chest is there. Dr prescribed lab work to be done at Diagnostics. Day 23 5/6/2021 - Gave blood for lab work. Then I stopped by PCP's office as it was right next door to give her an update as to what has been happening the last three weeks and I told her I?d like a MRI to make sure nothing is wrong with my head, as I have not felt normal since I received the Covid-19 vaccine. She said I need to see an ENT first and we would go from there. Day 59 6/11/2021 - Appointment with ENT. Dr. did not visually see any problem inside my ears. She said my eardrums had wax on them. She removed the wax and it was so very painful in my left ear it made me cry. She said next she will order approval for me to get hearing tests. (audiology) And then I can proceed to get an MRI. Day 100 7/22/2021 - Audiology. Comprehensive hearing test, evoked auditory, TST compl, Tympanometry and reflex thr. Day 111 8/2/2021 ? Dr. called me with the results of my audiology. She said we can now proceed to request approval to get the MRA. DAY 148 9/8/2021 - Called to check on the status of the MRA approval. Her assistant said I first need to get blood wo

Allergies: None known.

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

Symptoms: Day 1 4/14/2021 ? About three hours after receiving the Covid-19 vaccine, I began feeling feverish with 101 temp, blurry vision, swollen face, left arm hurt at injection sight and loud ringing and pressure in my ears. Slept and woke up feeling nauseous, sweating, a heavy feeling in my chest and I began hearing a whooshing sound in the back left side of my neck. Day 2 - 5 4/15/2021 - 4/18/2021 - Stayed in bed with a fever, left arm pain at the injection site, loud ringing and pressure in my ears, nauseous, swelling of my face, and heaviness on my chest.

Other Meds: Nothing taken on or near date of vaccine. I have an Alprazolam prescription to take if needed.

Current Illness: None.

ID: 1704205
Sex: F
Age: 52
State: SD

Vax Date: 09/14/2021
Onset Date: 09/15/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data: NA

Allergies:

Symptom List: Vomiting

Symptoms: vaccine administered on 9/14/2021 after expiration date of 9/10/2021. Error identified on 9/15/2021

Other Meds:

Current Illness:

ID: 1704206
Sex: F
Age: 17
State: OK

Vax Date: 08/13/2021
Onset Date:
Rec V Date: 09/16/2021
Hospital:

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

Lab Data: NONE

Allergies: NONE

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: GAVE MODERNA VACCINE ,SHOULD HAVE BEEN PIFER VACINE PER AGE ,FINSHED OFF SERIES WITH MODERNA TODAY LOT#939902

Other Meds: NONE

Current Illness: NONE

ID: 1704207
Sex: F
Age: 12
State: PA

Vax Date: 09/15/2021
Onset Date: 09/15/2021
Rec V Date: 09/16/2021
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

Allergies: none

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

Symptoms: Pt was sitting on edge of exam table. After approximately 5 minutes after getting covid vaccine pt fell backwards on to her back on to exam table and lost consciousness momentarily. Pt opened her eyes after a few seconds and appeared drowsy. After a minute or 2 pt became more alert. Pt stayed laying on exam table for about 15 minutes. Doctor was informed and assessed pt. Nurse got water for pt to drink. After approximately 15 minutes pt stood up. Pt was balanced, no c/o dizziness.

Other Meds: none

Current Illness: none

ID: 1704208
Sex: F
Age: 79
State: TX

Vax Date: 04/01/2021
Onset Date: 04/08/2021
Rec V Date: 09/16/2021
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: Medical swab for poison ivy sent to lab negative

Allergies: Cephalosporin; Hydralazine Analogues; Bactrim; Ciprofloxacin; Lisinopril; Meperidine; Methylprednisolone; Nitrofurantoin; Ranolazine; Iodine containing products; Latex; Morphine; Niacin; Penicillin; Ultram; Tetracycline; Tramadol; Valsartan

Symptom List: Injection site swelling, Limb discomfort

Symptoms: I have itching, burning, swelling, and fever. On the back of my leg, it was hot to the touch. I tried Neosporin and Cortisone 10 and nothing I tried made it go away. I went in to see my doctor until 08/24/2021. It got to the point where I was still running fever and not sleeping at night. It felt like knives stabbing into the back of my leg. My foot was swollen. My ankle was swollen. She said it was oozing a yellow watery looking thing. I was covered in blisters. She touched it with a cotton swab and sent it to the lab. It came back negative for any kind of plant reaction (poison ivy). I still have stuff on the bottom of my foot and the bottom of my leg on my right side. The spot on my shoulder is still kind of broke out, but it is getting better. It feels like a rash under the skin. I have felt bad and my blood pressure has been through the roof. I'm running 155-160 in my blood pressure. That's way high for me especially since I take blood pressure medication.

Other Meds: Alendronate; Anastrozole; Aspirin; Diltiazem; Furosemide; Levothyroxine; Nitrostat; Omeprazole; Simvastatin; Spironolactone; Warfarin; Vitamin B12; Multivitamin

Current Illness:

Date Died: 08/29/2021

ID: 1704209
Sex: F
Age: 54
State:

Vax Date: 04/13/2021
Onset Date: 08/27/2021
Rec V Date: 09/16/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: presented to ED with hx of positive COVID test earlier in the week; mild SOB, cough, diarrhea; pneumonia COVID related; end-stage renal disease (hemodialysis 3xwk); fld overload

Other Meds:

Current Illness:

ID: 1704210
Sex: F
Age: 37
State:

Vax Date: 12/30/2020
Onset Date: 09/14/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am