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: 1704263
Sex: F
Age: 68
State: CA

Vax Date: 09/08/2021
Onset Date: 09/08/2021
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:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient came for booster (3rd shot) and received Moderna. Previous vaccine series was Pfizer.

Other Meds:

Current Illness:

ID: 1704264
Sex: F
Age: 69
State: PA

Vax Date: 03/17/2021
Onset Date: 03/17/2021
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: Blood work, CT scan.

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: I was not able to sleep. I felt like I had the flu. I was dizzy and tired. I had headache. I had brain fog and really dizzy. My doctor a brain scan. It show that I had a hematoma in my brain.

Other Meds: Multivitamin; vitamin D; Synthroid

Current Illness:

ID: 1704265
Sex: M
Age: 56
State: MI

Vax Date: 09/14/2021
Onset Date: 09/14/2021
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:

Allergies: NONE

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

Symptoms: dose administered to patient was prepared from a vial that had been stored in freezer -25 C to -15 C for a total of 19 days. maximum allowed time per pfizer temperature excursion table is 17 days.

Other Meds: NONE

Current Illness: NONE

ID: 1704266
Sex: F
Age: 40
State: OH

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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies: NA

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: "Covid Arm" Pain, swelling, redness, itching, hot to the touch - all in the site of the injection

Other Meds: Celexa, 20 mg Prilosec, 20 mg

Current Illness: NA

ID: 1704267
Sex: F
Age: 62
State:

Vax Date: 03/31/2021
Onset Date: 05/04/2021
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: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Reason for call: Patient calls stating that she started to not feel well around 5/4/21, she was tested yesterday for COVID and it came back positive. She had a fever for 1 day, experiences cough, diarrhea, and increased fatigue. She states that it "hasn't been real bad" but she did sound not well. She did get both doses of her COVID vaccine in March.

Other Meds:

Current Illness:

ID: 1704268
Sex: F
Age: 65
State: WI

Vax Date: 09/06/2021
Onset Date: 09/11/2021
Rec V Date: 09/16/2021
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: influenza vaccine

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

Symptoms: Pain in both thighs, altered sensation both lower legs, and slight numbness/tingling both feet lasting 2 days

Other Meds:

Current Illness: none

ID: 1704269
Sex: F
Age: 36
State: CA

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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: none

Allergies: Doxycycline Hyclate- Nausea/Vomiting Paroxetine- Altered Mental Status

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Pt was vaccinated at approximately 840am and per pt "8 minutes after my injection I started to feel burning in the back of my throat" and notified RN. Pt stated "it feels like I ate a bag of spicy chips and it is irritating the back of my throat really bad". Pt denied any redness, swelling or sensations of tightening. She was able to swallow her own saliva without incident, -stridor/wheezing. Vital Signs stable and after drinking water, pt reported the "burning sensation" became worse and ED provider notified. Verbal orders for Benadryl 50mg po obtained and pt tolerated medication well at 0920. At 0930 pt reported that the burning sensation was subsiding. She continued to remain conversive and had no acute respiratory distress. Lung sounds clear to auscultation. After monitoring for 45 minutes and follow up with ER MD. Pt discharged home with wife to drive her home. Vaccine instruction sheet and educational tools provided and reviewed with pt who verbalized understanding. Also advised pt to seek medical attention in the ED should her symptoms not improve, changes or becomes worse, pt verbalized understanding and ambulated with steady gait out of Vaccine clinic.

Other Meds: unknown

Current Illness: pt denied

ID: 1704270
Sex: F
Age: 68
State: NC

Vax Date: 03/12/2021
Onset Date: 05/14/2021
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: None at this time. Discussion with primary care physician.

Allergies: Sulfa

Symptom List: Pharyngeal swelling

Symptoms: Six to eight weeks after the second vaccine was administered, I experienced an inflammatory response. I've was diagnosed with Psoriasis at age 38, but the disease has been in remission for several years. In May, 2021, I had a flare in psoriasis with new plaques on elbows and lower legs developing. I have experienced mild osteoarthritis in my hands but never in knees. Starting in the Spring, I developed bilateral swelling and stiffness in knees, affecting my ability to walk and move around. Also, experienced swelling in both thumb and wrist joints. This inflammation cycles, appearing at random for a week or more, then disappearing and returning. Not related to any changes in diet or exercise levels.

Other Meds: Super EPA, Calcium Citrate, Vitamin D3, CoQ10, Tumeric

Current Illness: None

ID: 1704271
Sex: F
Age: 28
State: MN

Vax Date: 08/04/2021
Onset Date: 08/04/2021
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: N/A

Allergies: None KNDA

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Rash on neck that is persisting. Started right after getting the vaccine.

Other Meds: Valtrex

Current Illness: Cold (sore throat, cough, rash on neck)- tested negative for COVID- symptoms started 9/4/21

ID: 1704272
Sex: M
Age: 66
State: GA

Vax Date: 03/19/2021
Onset Date: 07/14/2021
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: Medical emergency visit for sciatica attack on 7/14/2021 MRI for lumbar spine on 8/29/2021

Allergies: None

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Severe back pain on 7/14/2021 as I woke up and severe sciatica attack on left leg (not able to walk or sit) that required emergency hospital visit. Treated with cortisone injection and ibuprofen. Pain lasted for 2 weeks and it resulted in numbness of the left lower leg and foot (foot drop) which has impaired walking. An MRI on 8/29/2021 revealed inflammation in lumbar spine with an L5/S1 disc causing sciatica. Other long -term side effect - very pronounced alopecia areata (circular spots) on left side of scalp.

Other Meds: None

Current Illness: None

ID: 1704273
Sex: F
Age: 43
State: SC

Vax Date: 03/30/2021
Onset Date: 04/01/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data: E-RAYS

Allergies: N/A

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

Symptoms: EXTREME BACK PAIN! BACK WENT TOTALLY OUT! I was out of work for 2 weeks. It started with the chills. I went to family doctor, emergency care doctor, chiropractor and currently going to a Orthopedic Doctor. Muscle Massage, muscle relaxers and pain meds have all been given and the pain is STILL there! I'm in CONSTANT PAIN DAILY!!!

Other Meds: Losartan Potassium 25 MG

Current Illness: N/A

ID: 1704274
Sex: M
Age: 52
State: TX

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: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data: no

Allergies:

Symptom List: Rash, Urticaria

Symptoms: complete hearing loss in left ear, vertigo, nausea , shakes

Other Meds:

Current Illness:

ID: 1704275
Sex: F
Age: 77
State: MI

Vax Date: 04/16/2021
Onset Date: 09/06/2021
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: LA

Lab Data:

Allergies:

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

Symptoms: breakthrough case, hospitalization

Other Meds:

Current Illness:

ID: 1704276
Sex: F
Age: 37
State: TX

Vax Date: 05/13/2021
Onset Date: 09/11/2021
Rec V Date: 09/16/2021
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: CBC, CMP, rapid COVID

Allergies: NKDA

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

Symptoms: abscess left thigh, cellulitis, given antibiotics

Other Meds:

Current Illness:

ID: 1704277
Sex: F
Age: 56
State: SC

Vax Date: 03/15/2021
Onset Date: 03/16/2021
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: TREE NUTS SHELL FISH PEANUTS IODINE SEFLEALAXI MORPHINE

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

Symptoms: HIGH FEVER BODY ACHE INJECTION SITE SORNESS

Other Meds: WELBUTURIN DIAZAPAN FLOWMAX BUTABITOL MAXALT NORATRIPTIN FINIGRIN METHOCARBINAL ROBAXIN

Current Illness: CHEST PAINS

Date Died: 09/16/2021

ID: 1704279
Sex: F
Age: 71
State: MN

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

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

Lab Data:

Allergies:

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

Symptoms: Covid vaccine dose #1 2/10/2021 Moderna Lot # 024m20A dose #2 3/1/2021, Moderna, lot # n/a pt died on 9/16/2021 in the hospital from cardiac arrest, aspiration, prolonged hospitalizations for chronic illnesses, not a covid related death.

Other Meds:

Current Illness: multiple hospitalizations for chronic diseases

ID: 1704280
Sex: M
Age: 56
State: GA

Vax Date: 09/01/2021
Onset Date: 09/02/2021
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: Covid 19 tests negative Antigen tests negative

Allergies: NKA

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

Symptoms: Elevated Blood Pressure and Headaches. Headaches remain constant . Blood pressure fluctuations systolic 140-160 and diastolic 80-100

Other Meds: Atorvastin Aspirin 81mg Humira SQ Vit D Vit C

Current Illness: Vaccine 1st dose: 02/11/2021 Moderna Vaccine 2nd dose: 03/11/2021 Moderna Vaccine Booster Dose: 09/01/2021 Pfizer Cough intermittent since previous dose of vaccine and sinus congestion along with elevated blood pressures.

ID: 1704281
Sex: F
Age: 43
State: NC

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: unknown

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: The patient misrepresented her vaccine status to the pharmacist completing her request for a covid-19 vaccine. The pharmacist asked her if she had ever received a covid-19 vaccine before in which she replied "no, this is my first dose". Later on that evening, the pharmacist realized what happened when she tried to log the dose in the state-wide database. She had already received pfizer dose 1 and 2 on 6/17/21 and 7/8/21, respectively by a different pharmacy.

Other Meds:

Current Illness:

ID: 1704282
Sex: F
Age: 41
State: IL

Vax Date: 02/25/2021
Onset Date: 03/25/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data: Per Pt. she followed up with her PCP and lab tests of CBC, CMP were completed. Pt reported she was referred to an ENT and an Oral surgeon.

Allergies: Penicillan and Bactrim

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Pt stated having body aches, lost of taste and smell, cough, fever, fatigue 1 week after vaccine. Two weeks after vaccine, pt reports sore throat and weird taste. Pt later explained having these symptoms after 1 month of receiving vaccine of increased salivation and jaw/tooth pain.

Other Meds: Unknown

Current Illness: Per records is taking Levothyroxine 25mcg/daily. Pt reports her PCP is with a different facility.

ID: 1704283
Sex: F
Age: 84
State: IN

Vax Date: 09/14/2021
Onset Date: 09/15/2021
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:

Allergies: Pennicillin

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

Symptoms: Extreme weakness, headache, slept 36 hours

Other Meds: Eliquis, Metopropol, Lyothyrine, Lasix, Potassium

Current Illness:

ID: 1704284
Sex: F
Age: 52
State: IN

Vax Date: 09/13/2021
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: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies: Penicillin, iv contrast dye, seasonal

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

Symptoms: Received injection on 9/13/2021 at approximately 13:00. Approximately 3-4 hours after injection, headache that got worse through the night. Approximately 6 hours after injection, severe body aches and pain, freezing chills, sweating, with worsening headache. Took advil and excedrin for the pain. Symptoms peaked about 3 or 4am on 9/14/2021, then gradually went away. Symptoms were completely gone by 11am on 9/14/2021.

Other Meds: Omeperazole, venlafaxine, Cozaar, Norvasc, synthroid, liothyronine, vit D3, zyrtec, singulair, magnesium, tumeric

Current Illness: None

ID: 1704285
Sex: M
Age: 42
State: MI

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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: vaccine dose was prepared from vial that has been stored in freezer at -25c to -15c for a total of 19 days which is 2 days over allowed time frame of temperature excursion of pfizer ( 17 days)

Other Meds:

Current Illness:

ID: 1704286
Sex: F
Age: 80
State: NJ

Vax Date: 07/19/2021
Onset Date: 09/14/2021
Rec V Date: 09/16/2021
Hospital: Y

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

Lab Data: COVID-19 Antigen (+) on 9/14/2021

Allergies: Azulfadine, celecoxib, sulfa medications.

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

Symptoms: 80 year old woman with PMHx of DM, HTN, hypothyroid, Breast CA, OA, osteoporosis, venous stasis, fatty liver, reflux, hiatal hernia, B/L mastectomy presented to the ED by BLS for evaluation of back pain. Reported 1 day of sharp pain on L side of back that is worsening associated nausea. in the ED underwent CT A/P and CXR with findings concerning for B/L pneumonia suspicious for COVID. She is COVID vaccinated Pfizer 7/19/2021 2nd dose. COVID Ag positive in the ED, inflammatory markers elevated. Consulted for further recommendations.

Other Meds: Aspirin 81 mg po daily Coenzyme Q10 100 mg po daily Valsartan 320 mg po daily Edecrin 25 mg po daily Ester-c 500 mg po BID Metoprolol 100 mg po daily Myrbetriq 50 mg po daily Metformin 1000 mg BID Pravastatin 40 mg po daily Esomperazole 40

Current Illness:

ID: 1704287
Sex: F
Age: 51
State: NJ

Vax Date: 09/11/2021
Onset Date: 09/12/2021
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: Refused ambulance. Going to urgent care

Allergies: Sulphur

Symptom List: Injection site pain, Pain

Symptoms: Confusion, brain fog, cold sweat on face and neck. Unable to formulate sentence or to figure out how to anything such as figure out exits, not sure of whereabouts.

Other Meds: None

Current Illness: None

ID: 1704288
Sex: F
Age: 53
State: VA

Vax Date: 09/07/2021
Onset Date: 09/07/2021
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: None

Allergies: Penicillins

Symptom List: Injection site pain, Menorrhagia

Symptoms: HA, fever/chills, throat pain/swelling, periorbital edema/irritation

Other Meds: None

Current Illness: None

Date Died: 09/15/2021

ID: 1704289
Sex: M
Age: 59
State: IN

Vax Date: 09/02/2021
Onset Date: 09/15/2021
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:

Allergies: penicillin

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

Symptoms: sudden death

Other Meds: Lisinopril, metoprolol, rosuvastatin, amlodipine, hydrochlorothiazide, gapapentin, cyclobenzaprine, omega 3 fatty acid

Current Illness:

ID: 1704290
Sex: F
Age: 48
State: RI

Vax Date: 09/03/2021
Onset Date: 09/03/2021
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: 9/4/21: ECG, Chest PA and Lateral. Given Toradol.

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Vaccine administered, and report of dizziness and lightheadedness occured immediately. Temperature elevated over the next 3 hours. Rash noted on upper aspect of legs and reported swelling of tongue. Evaluated at the Emergency Room and anaphalaxis ruled out. Discharged home from ER. Returned to ER on 9/4/21 for continued complaints. Evaluated and discharged.

Other Meds:

Current Illness:

ID: 1704291
Sex: M
Age: 58
State: NC

Vax Date: 04/08/2021
Onset Date: 04/10/2021
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: Positive ANA Positive antinuclear antibodies

Allergies: NKA

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: After receiving the vaccine I have experienced chronic pain, fatigue, shortness of breath, tingling in my fingers and toes, and generally feeling ?off?.

Other Meds: Lasix-Wellbutrin-Latrell-Rosuvastatin-Omeprazole-Prazosin-Klonipin-Seroquil-Fortesa-Cymbalta-Voltarin Gel-Aspirin-Multivitamin

Current Illness:

ID: 1704292
Sex: F
Age: 44
State: WA

Vax Date: 04/12/2021
Onset Date: 04/19/2021
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: Test Ordered By Date VAS VENOUS REFLUX BILATERAL MD Sep 14, 2021 CBC W/DIFFERENTIAL MD Sep 8, 2021 VITAMIN D, 25 HYDROXY MD Sep 8, 2021 VAS UPPER EXTREMITY VENOUS BIL? MD Aug 17, 2021 VAS ARTERIAL BILATERAL UPPER EX? MD Aug 17, 2021 LABS - EXTERNAL SCAN Onbase Scan Wamt Aug 7, 2021 CBC W/AUTO DIFFERENTIAL MD Aug 4, 2021 COMPREHENSIVE METABOLIC PANEL MD Aug 4, 2021 LIPID PANEL W/ LDL DIRECT MD Aug 4, 2021 US, EXTREMITY, NONVASCULAR, REA? Aug 4, 2021 MYOMARKER 3 (RESULTS ONLY) Jul 22, 2021 ANTIPHOSPHOLIPID SYNDROME Jul 22, 2021 HYPERCOAG CONSULT, EXTENDED P? Jul 22, 2021 ELECTROPHORESIS, SERUM, REFLEX? Jul 22, 2021 Hepatitis B Core Total Antibodies Jul 22, 2021 HEPATITIS B SURFACE ANTIBODY Jul 22, 2021 HEPATITIS B SURFACE ANTIGEN Jul 22, 2021 HEPATITIS C ANTIBODY,SERUM Jul 22, 2021 CMV ANTIBODIES IGG-IGM Jul 22, 2021 RPR RFX QN RPR, CONFIRM TP Jul 22, 2021 SPECIAL COAGULATION INTERPRETA? Jul 22, 2021 INFLUENZA A,B,COVID-19,NAAT Jul 21, 2021 XR CHEST AP PORTABLE Jul 21, 2021 POC GROUP CHEM 8+ (HGB,HCT,BM? Jul 21, 2021 POC TROPONIN I (RESULTS ONLY) Jul 21, 2021 CBC W/DIFFERENTIAL Jul 21, 2021 Liver Panel Jul 21, 2021 Thyroid Stimulating Hormone Jul 21, 2021 ECG 12 LEAD MD Jul 21, 2021 CONTINUOUS AMB MONITOR 8 TO 1? MD Jul 20, 2021 XR FOOT RIGHT 3 + VW MD Jul 15, 2021 XR FOOT LEFT 3 + VW MD Jul 15, 2021 DDimer Quant MD Jul 15, 2021 CBC W/DIFFERENTIAL MD Jul 15, 2021 APTT MD Jul 15, 2021 PROTIME W/INR MD Jul 15, 2021 GLUCOSE, FASTING Jul 15, 2021 PROLACTIN Jul 15, 2021 VAS RENAL ARTERY COMPLETE MD Jul 15, 2021 VAS CAROTID DUPLEX BILATERAL MD Jul 15, 2021 ECHO STRESS TEST EXERCISE MD Jul 14, 2021 VAS BILATERAL VENOUS DOPPLER E? PA Jul 13, 2021 CORONAVIRUS (COVID-19) NAAT MD Jul 11, 2021 US BREAST LIMITED LEFT MD Jul 9, 2021 FECAL IMMUNOCHEMICAL TEST (FIT? MD Jul 9, 2021 Free T4 Jul 8, 2021 T3, FREE Jul 8, 2021 Thyroid Stimulating Hormone Jul 8, 2021 PROLACTIN Jul 8, 2021 Cortisol Jul 8, 2021 ACTH Jul 8, 2021 Misc Referral Jul 8, 2021 LH - LUTEINIZING HORMONE Jul 8, 2021 FSH - FOLLICLE STIMULATING HORM? Jul 8, 2021 ESTRADIOL Jul 8, 2021 COMPREHENSIVE METABOLIC PANEL Jul 8, 2021 POC TROPONIN I (RESULTS ONLY) MD Jul 5, 2021 ECG 12 LEAD MD Jul 5, 2021 ECG 12 LEAD MD Jul 5, 2021 POC TROPONIN I (RESULTS ONLY) MD Jul 5, 2021 CT SOFT TISSUE NECK W CONTRAST Jul 3, 2021 CBC W/DIFFERENTIAL Jul 3, 2021 BASIC METABOLIC PANEL Jul 3, 2021 EPSTEIN BARR VIRUS EARLY ANTIGE? MD Jun 30, 2021 Epstein-Barr Virus Antibody Profile MD Jun 30, 2021 Glyco Hgb MD Jun 23, 2021 SEDIMENTATION RATE Jun 23, 2021 C-REACTIVE PROTEIN Jun 23, 2021 CK,TOTAL Jun 23, 2021 ANTINUCLEAR AB, TITER + PATTERN Jun 23, 2021 C3 AND C4 Jun 23, 2021 UA W/MICROSCOPIC W/CULTURE IF I? Jun 23, 2021 UA, MICROSCOPIC, REFLEX Jun 23, 2021 CULTURE, URINE, REFLEXIVE Jun 23, 2021 THYROID PEROXIDASE (TPO) ANTIB? MD Jun 23, 2021 Thyroid-Stimulating Immunoglobulin MD Jun 23, 2021 THYROTROPIN RECEPTOR ANTIBODY MD Jun 23, 2021 RNA POLYMERASE III AB IGG MD Jun 23, 2021 5 HIAA, QUANTITATIVE, URINE, 24 H? MD Jun 23, 2021 MICROALBUMIN/CREATININE RATIO,? MD Jun 21, 2021 TSH, R

Allergies: Sulfa antibiotics, nitrofurtoin

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

Symptoms: On April 12 I received the J&J vaccine, 2 days later I began having bruising on my arms and legs and pernio in my left index finger which resolved. From April 20 ? present, my symptoms are flushing in face/chest/arms, high blood pressure, fast heart rate, back pain, upper body muscular pain, headaches, nerve pain in limbs, bruising on legs and torso, body tremors, swollen lymph nodes, diarrhea, Raynaud's syndrome in toes, petechiae, paresthesia, neuropathy (burning, electric shocks in legs and groin). Post vaccine, I have been diagnosed with labile hypertension, deep vein insufficiency in the left CFV, connective tissue disorder unspecified, mast cell activation syndrome, depression, and Post traumatic stress disorder. Currently schedule to be tested for dysautonomia on October. There is no medical history in my family for autoimmune, disautonomia or mast cell issues. Treatment is ongoing and includes blood pressure medication, Naltrexone for autoimmune, prednisone in past, anti inflammatory supplements, physical therapy, cognitive therapy, antihistamine diet, allergy medication, SSRIs.

Other Meds: Levothyroxine

Current Illness: Hyperthyroid, anxiety

ID: 1704293
Sex: M
Age: 34
State: CO

Vax Date: 02/23/2021
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: 1
Vax Route: IM
Vax Site: RA

Lab Data: 9/9 - A1C = 9.7 and Glucose (random) = 381 mg/dL

Allergies: Cashews, latex, nickel

Symptom List: Nausea

Symptoms: Type 2 Diabetes diagnosis

Other Meds: Bupropion and lamotrigine

Current Illness: N/A

ID: 1704294
Sex: M
Age: 86
State: MI

Vax Date: 03/03/2021
Onset Date: 09/11/2021
Rec V Date: 09/16/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: breakthrough case, hospitalization

Other Meds:

Current Illness:

ID: 1704295
Sex: F
Age: 48
State: RI

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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: 9/4/21: ECG, Chest PA and Lateral. Given Toradol.

Allergies:

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

Symptoms: Vaccine administered, and report of dizziness and lightheadedness occured immediately. Temperature elevated over the next 3 hours. Rash noted on upper aspect of legs and reported swelling of tongue. Evaluated at the Emergency Room and anaphalaxis ruled out. Discharged home from ER. Returned to ER on 9/4/21 for continued complaints. Evaluated and discharged.

Other Meds:

Current Illness:

ID: 1704296
Sex: M
Age: 89
State: MO

Vax Date: 02/24/2021
Onset Date: 09/15/2021
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: RA

Lab Data: 9/15/21: SARS-CoV-2 RNA-Positive and 9/15/21: SARS-CoV2 Rapid Antigen-Positive

Allergies:

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

Symptoms: Per ED chart, family reported coughing, shortness of breath, chills and nausea/vomiting started about 4 days ago. Patient was confused with date and time. At ER, patient was found to have hypoxemia, Covid test: positive. Chest x-ray showed signs of pneumonia.

Other Meds:

Current Illness:

ID: 1704297
Sex: M
Age: 45
State: MI

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: dose administered to patient was prepared from vial that was stored in freezer at -25 to -15 celsius for a total of 19 days which exceeds the allowed duration by pfizer of 14 days plus 3 days of temperature excursion.

Other Meds:

Current Illness:

ID: 1704298
Sex: F
Age: 39
State: TN

Vax Date: 01/14/2021
Onset Date: 05/01/2021
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:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Severe menstral symptoms: Monthly menstral cycle has become more painful and bleeding has increased. Cramps are more severe as well as breast extreme tenderness.

Other Meds:

Current Illness:

ID: 1704299
Sex: M
Age: 53
State: TX

Vax Date: 01/23/2021
Onset Date: 09/11/2021
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: CBC, CMP, CXR, rapid COVID, CT abdomen

Allergies: haldol, penicillin

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

Symptoms: fever, dysuria

Other Meds: amitiza, amlodipine, aripiprazole, benztropine,cerovite, chlorpromazine,eucerine,ferrous sulfate, fluticasone, furosemide,loratadine,potassium prednisone, singulair

Current Illness:

ID: 1704300
Sex: F
Age: 49
State: CT

Vax Date: 03/16/2021
Onset Date: 03/16/2021
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: Bloodwork blood pressure (high)

Allergies:

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

Symptoms: Within an hour of receiving the vaccine I had a fever, chills, and my bottom lip went numb. I had memory fog, and I couldn't think straight. This has been an ongoing issue. My immunologist tells me not to get a 2nd vaccine. After doing my bloodwork my hematologist explains that I am high risk because of blood clots and a potential stroke. I had to get injected with Lovenox. For 15 days after I had to inject myself with Lovenox. I will be on warfarin 10mg-12.5mg for the rest of my life now. I am also on hydroxychloroquine now indefinitely. I'm going to clinic to be monitored. I was in the hospital last Thursday because of memory loss, memory fog, and because I couldn't see straight. My doctor said he thought it could be a ocular migraine. He recommended me not to drive. The hospital report said I had a TIA. I had 2 TIAs in 2019, but not since then until receiving the vaccine. I have blurry eyes. My doctor said I am too young to be experiencing this with my eyes. I have posterior Vitreous detachment and hemorrhagic PVD in my right eye. My doctor said it could go into the left eye. He also said that the vaccine trigged my autoimmune disease. I have resigned from my position and job had agreed to allow me to work remotely. I had high blood pressure and chest pains.

Other Meds:

Current Illness:

ID: 1704301
Sex: F
Age: 57
State: CA

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: no

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: chilling. and body ache

Other Meds: tylenol 500mg

Current Illness: none

ID: 1704302
Sex: F
Age: 40
State: IN

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: 011J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Rash over whole body. Looks like chicken pox. Keeps spreading and itching. Seems to be only itching on wrist tattoo today which previously was not itching at all. Rash looks similar to chicken pox rash. Started the next day. Still going as of 9/16/21. Very itchy.

Other Meds: None

Current Illness: None

ID: 1704303
Sex: F
Age: 99
State:

Vax Date: 01/20/2021
Onset Date: 09/12/2021
Rec V Date: 09/16/2021
Hospital: Y

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: COVID Symptomatic + 9/13/2021

Allergies: no known

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

Symptoms: Day 3 of hospitalization first dose 12/30/2020 100-year-old female sent from nursing home to ED due to AMS x1 day, and elevated creatinine, patient is a poor historian, and history was mainly taken from ED physician/ ED records, apparently, patient was found by nursing home staff, lethargic, sleepy, confused, and disoriented at approximately 9:00 a.m. this morning, with shortness of breath, and occasional cough, with mild sputum production, there has been no, fever, chills, vomiting, diarrhea, patient was in no pain, and in no apparent distress.

Other Meds:

Current Illness:

ID: 1704304
Sex: F
Age: 52
State: NJ

Vax Date: 05/28/2021
Onset Date: 08/21/2021
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 at this time. Will scheduled visit with Rheumatologist.

Allergies: Penicillin

Symptom List: Pain in extremity

Symptoms: Extreme pain in both hips and right shoulder for approximately 1 month now. No previous injuries or pain ever experienced in these affected areas.

Other Meds: NA

Current Illness: NA

ID: 1704305
Sex: F
Age: 33
State: MI

Vax Date: 09/14/2021
Onset Date: 09/14/2021
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:

Allergies:

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

Symptoms: dose was prepared from vial that was stored in freezer at -25C to -15 C for a total of 19 days which exceeds the allowable time at this temperature ( per manufacturer website, 17 days)

Other Meds:

Current Illness:

ID: 1704306
Sex: F
Age: 40
State: CA

Vax Date: 09/15/2021
Onset Date: 09/15/2021
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: None as of now.

Allergies: cephalosporin antibiotics

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

Symptoms: An expired dose was unintentionally given to the pt. This event was discovered at around 5:30pm when staff was salvaging vaccines as part of store-closing tasks, a few hours after the pt received 1st dose. Pt showed no adverse effects/symptoms during the 15+ min interval after vaccine administration, before leaving pharmacy for home. Unknown if something happened afterwards to pt. Pt will be notified of situation once upper management finalizes reviewing clinical Pfizer Covid vaccine data stability; revaccination is a possibility. Pharmacy workflow changes were immediately made to decrease the risk of expired-dose administration reoccurrences such as ordering template expiration labels and incorporating the date of vaccine reconstitution as part of the label. Staff were all made aware of incident.

Other Meds: Per Pharmacy fill hx of recent 3 months, only lidocaine pain relief 4% patches were dispensed on 9/15/21.

Current Illness: Breast cancer

ID: 1704307
Sex: F
Age: 39
State: CA

Vax Date: 08/27/2021
Onset Date: 08/28/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data: 09/15/2021 Covid Test Negative. 09/15/2021 X-ray has been ordered.

Allergies: I am allergic ibuprofen

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

Symptoms: 08/28/2021 Dizziness, nausea, fatigue, sharp pain from shoulder to my elbow and in lungs. 08/29/2021 Sharp pain both legs. 09/15/2021 Migraine headache, short of breath, wheezing. 09/13/2021 Tachycardia.

Other Meds: I was not taking anything at the time of the vaccination.

Current Illness: I have a colonoscopy done and results came back at polyps one was cancerous and the other was not 2 were removed.

ID: 1704308
Sex: F
Age: 18
State: CA

Vax Date: 09/02/2021
Onset Date: 09/04/2021
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: None

Allergies:

Symptom List: Vomiting

Symptoms: Per patient she broke out in whelpts all over her body 2 days after the injection. Currently there is a reddish rash and scattered whelpts all over her body. Patient has pictures of diffused irritations and whelpts from when it first started. Denies wheezing, SOB, or taking any medications. Benadryl 25mg 1-2 caps Q 6hrs ordered for patient, if needed.

Other Meds:

Current Illness:

ID: 1704309
Sex: F
Age: 18
State: NJ

Vax Date: 08/31/2021
Onset Date: 09/01/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data: none

Allergies: none

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Chills and vomiting only during first day after 2nd vaccine administration Lymph swelling in throat, laryngitis, headache, sinus swelling - lasted for 8 days Fatigue - lasted for 12 days

Other Meds: none

Current Illness: none

ID: 1704310
Sex: M
Age: 67
State: MI

Vax Date: 04/08/2021
Onset Date: 09/14/2021
Rec V Date: 09/16/2021
Hospital: Y

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: breakthrough case, hospitalization

Other Meds:

Current Illness:

ID: 1704311
Sex: F
Age: 26
State: WI

Vax Date: 03/01/2021
Onset Date: 09/14/2021
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:

Allergies: No known allergies

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient contracted COVID after being fully vaccinated asymptomatic with an exposure

Other Meds: Mirena Multivitamin

Current Illness: None documented

ID: 1704312
Sex: F
Age: 40
State: OR

Vax Date: 05/08/2021
Onset Date: 05/08/2021
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: n/a

Allergies: NKDA

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

Symptoms: Pt received 2nd dose of Pfizer 5/5/21 at her pharmacy. Pt sent email to PCP on 6/2/21 stating ongoing left arm pain and arm weakness since receiving 2nd dose of Pfizer. Pt called PCP clinic on 6/7/21 stating left arm pain, swollen lymph node in axilla and neck (intermittent), ongoing small bruise at injection site. Stated for 1 week after second dose had fever, chills, headache, body ache. 6/8/21PCP recommended Tylenol. Pt evaluated 6/9/21: "She had both in the left arm, is right handed. It hurts to lift a coffee cup initially, now just with heavier things, or when tuning the hand inward. The had feels asleep from time to time. Wonders if she had a blood clot. She had bilateral carpal tunnel surgery in 2013, but this feels different, just numb not tingling. She had some swelling in the left armpit initially, mostly resolved now. She feels tired. She takes CBD for headaches, tried 2-3 ibuprofen without relief." Recommended tylenol and diclofenac if no relief with tylenol. Pt sent email 7/12/21 reporting ongoing symptoms despite tylenol. Pt sent email 9/15/21 stating arm continues the same, "I feel something strange in my muscle when I make any effort with it".

Other Meds: None.

Current Illness: None.

ID: 1704313
Sex: F
Age: 81
State: VA

Vax Date: 04/15/2021
Onset Date: 05/10/2021
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: Unknown

Allergies: Unknown

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

Symptoms: Received Phone call and client states that a month after receiving second dose of Moderna was unable to walk, and began breaking out with blisters. She has seen her PCP, dermatology, and ortho.

Other Meds: Unknown

Current Illness: Unknown

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am