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: 1704791
Sex: F
Age: 88
State: AZ

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

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

Lab Data:

Allergies: penicillin, grass, dust, perfumes

Symptom List: Dysphagia, Epiglottitis

Symptoms: left arm turn red a streak down front of her arm

Other Meds: no

Current Illness: no

ID: 1704792
Sex: M
Age:
State: IL

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

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

Lab Data: COVID Tests: 9/2/21 COVID 19 NAAT - Negative 9/7/21 COVID 19 PCR - Not Detected 9/13/21 COVID 19 PCR - Detected

Allergies: No known allergies

Symptom List: Anxiety, Dyspnoea

Symptoms: Admitted to the hospital for infected sacral decubitus, tested twice during admission and results were negative. Tested a 3rd time per routine prior to surgery and results were positive for Covid on the 14th day of admission. Remdesivir started on 9/15/21. It is unknown when the patient received his vaccinations.

Other Meds: Unknown

Current Illness: Dementia Infected Decubitus Hypertension CAD Obesity

ID: 1704793
Sex: F
Age: 40
State: CA

Vax Date: 08/23/2021
Onset Date: 08/25/2021
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: MRI and appt with neurologist

Allergies: benadryl

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

Symptoms: facial tingling and numbness on bottom half of face, numbness and tingling of left hand

Other Meds: Vit C, Vit D, Vitamin B complex, Prenatal, iron

Current Illness: none

ID: 1704794
Sex: F
Age: 72
State: IL

Vax Date: 02/13/2021
Onset Date: 08/21/2021
Rec V Date: 09/16/2021
Hospital: Y

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

Lab Data: 8/21/21 COVID19: Positive 8/29/21 US: neg for DVT 8/30/21 chest xray: Severe bilateral consolidative pneumonias 9/1/21 chest xray: Findings compatible with COVID pneumonia unchanged 9/6/21 Chest xray: Stable patchy peripheral opacities, compatible with COVID pneumonia. CT angiogram of chest- no evidence of pulmonary embolism

Allergies: aspirin, ciprofloxacin, codeine, phosphate, latex, levofloxacin, pravastatin

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: She was given Regeneron infusion on 8/24/21 and in that evening she developed SOB and desaturation. Transferred to Hospital from outside hospital on 8/26/21. Tested COVID19 positive on 8/21/21 and transferred due to acute on chronic hypoxic respiratory failure and COVID 19 pneumonia. On admission she was on 6L NC. At baseline she is on 3L. Patient received remdesivir, dexamethasone, albuterol, doxycycline and ceftriaxone. Patient was having some palpitation on 9/5/21 evening and EKG troponin unremarkable. Increase Propanol dose to 20 mg. Repeat x-ray not change compared to previous X-ray, Physical therapy evaluate recommend skilled nursing facility, O2 req improving to baseline . Patient completed 10 days of Remdesivir, Decadron, Rocephin and doxycycline. Transfer to swing bed. Discharged on 9/16/21

Other Meds: Vitamin D3, diltiazem, apixaban, esomeprazole, hydroxychloroquine, isosorbide mononitrate, ofev, prednisone, trazodone

Current Illness:

ID: 1704795
Sex: F
Age: 65
State: FL

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: ekg-borderline

Allergies: penicillin, sulfur

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

Symptoms: chills, fever, heart palpitations

Other Meds:

Current Illness:

ID: 1704796
Sex: M
Age: 61
State: AZ

Vax Date: 03/10/2021
Onset Date: 07/28/2021
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: I tested positive for Covid-19 on 08/03/2021.

Allergies: None

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

Symptoms: Breakthrough case: On 07/31/2021, I started feeling these symptoms: Muscle ache Loss of taste and smell Severely cold and hot Terrible headache Fatigue

Other Meds: None

Current Illness: None

ID: 1704797
Sex: M
Age: 73
State: NV

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: n/a

Allergies: Penicillin, Iodine

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Pts. came in to the clinic to get his 3rd dose for Covid 19 vaccine, check his electronics medical records pts. received Moderna Covid 19 vaccine 1st dose on 1/21/2021 and 2nd dose on 2/18/2021 with our clinic . Pts. qualified for the 3rd dose with our company policy due to medical Dx so 3rd dose was given. When auditing we found out that pts. received Moderna Covid 19 on 3/26/2021 and 4/23/2021. Pts. received a total of 5 doses,

Other Meds: Amlodipine, Furosemide, Niaspan, Pravastatin, Tekturna, Xarelto

Current Illness: N/A

ID: 1704798
Sex: M
Age: 58
State: GA

Vax Date: 09/15/2021
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: UNK
Vax Route: IM
Vax Site: LA

Lab Data: None, this is only day 1 after the shot. The Pharmacist told me because I had Covid recently that I could experience moderate to severe Covid type symptoms over the next 3-7 days. She was right.

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Whole left side was in pain this morning, hip and knee especially. body aches, Chills, extremely weak, neck and Shoulder pain, headaches, slight dizziness, chest tightness and heavy lung irritation along with coughing fits.

Other Meds: Losartan 50mg, Amphetamine Salts 10 mg

Current Illness: Covid 19 July 30th; Covid Pneumonia just finished 15th Sept 2021

ID: 1704799
Sex: F
Age: 76
State: NV

Vax Date: 05/14/2021
Onset Date: 07/08/2021
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: LA

Lab Data:

Allergies: Lisinopril

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Hives, urticaria, itching

Other Meds:

Current Illness:

ID: 1704800
Sex: F
Age: 57
State: CA

Vax Date: 08/24/2021
Onset Date: 08/24/2021
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: nuts ,eggs , zinc magnums all elements

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Blood pressure immediately went up to almost 200 . was keep at the site until is came down . whole left side was numb had to have someone drive her home . Numbness lasted 2 weeks . headaches have not stopped and pressure is still elevated

Other Meds: colchicine

Current Illness:

ID: 1704801
Sex: F
Age: 65
State: UT

Vax Date: 09/13/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies: Coumadin (blood thinner)

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

Symptoms: Within about 5 minutes of receiving vaccine patient felt pins and needles sensation in legs. She said it felt like a sharp needle prick and the feeling spread randomly throughout body (arm, forehead, elbow). This sensation has continued for the few days since receiving the vaccine but has become a little less frequent. Patient also experienced headache and low grade fever/chills and body aches.

Other Meds:

Current Illness:

ID: 1704802
Sex: F
Age: 17
State: TX

Vax Date: 05/21/2021
Onset Date: 05/21/2021
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: None

Allergies: None

Symptom List: Rash, Urticaria

Symptoms: Patient received inappropriate vaccine based on her age.

Other Meds: None

Current Illness: None

ID: 1704803
Sex: F
Age: 49
State: AR

Vax Date: 09/01/2021
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: EKG CHEST XRAY LABS (BH, RA MARKERS) HEART HOLTER MONITER

Allergies: NONE

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

Symptoms: EXTREME NIGHT SWEATS (OCCURRED DURING DAY ALSO) HEART PALPITATIONS

Other Meds: Armour Thyroid 60mg Lisinopril 25mg/12.5mg Venlafaxine 150mg

Current Illness: NONE

ID: 1704804
Sex: F
Age: 35
State: IN

Vax Date: 04/01/2021
Onset Date: 05/23/2021
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: none

Allergies: Sensitivity to penicillin

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

Symptoms: Lots of hair coming off my head during and after showers starting in late April through the summer. I could tell by how thick my hair felt in a pony tail that it was thinner. I could tell by how long it takes to get wet and how I didn't get overheated as easily in the summer by my hair. By August, I estimate 25-30% hair lost. No treatment. Outcome is the hair on my head is significantly thinner.

Other Meds: Vitamins D, B, C

Current Illness: none

ID: 1704806
Sex: F
Age: 23
State: CA

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: N/A

Allergies: None noted

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

Symptoms: Patient experienced vasovagal syncope approximately 3 minutes after vaccination completed. Appeared to have seizure-like dystonia reaction, then slumped over in chair. Pharmacist moved her to the floor to prevent her from falling. Upon awakening she vomited multiple times. Patient BP recorded at 87/50, HR 42, SpO2 97% on room air. Patient noted on pre-vaccination checklist that she has fainted after previous vaccinations. Mother was present with her and was not concerned as she explained "this happens every time". Patient recovered and was transported out of pharmacy by her mother.

Other Meds: Unknown

Current Illness: None noted

ID: 1704807
Sex: M
Age: 22
State: CA

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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: We contacted Moderna on 9/15/21 and we have case# MOD21-144021. Medical affairs will determine the safety and efficacy, and whether the patient should be revaccinated.

Allergies: none

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

Symptoms: Patient did not have any reaction, however an expired vaccine was administered. Moderna Vial was punctured on 9/13/21 a little after 1:13 PM. Dose was given a little after 12:30 PM on 9/14/21

Other Meds: none

Current Illness: none

ID: 1704808
Sex: M
Age: 52
State: MN

Vax Date: 03/17/2021
Onset Date: 03/30/2021
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: Troponin I (05/07/2021) Comprehensive Metabolic Panel (05/07/2021) CBC with Platelets & Differential (05/07/2021) EKG 12-Lead (05/07/2021) Leadless EKG Monitor 8-14 Day (05/07/2021) Ankle-Arm Index 1-2 Level Bilateral (05/13/2021) EKG 12-Lead (05/13/2021) Lipid Panel to Direct LDL Panel (05/13/2021) CRP Cardiac Risk (05/13/2021) Glucose (05/13/2021) N-Terminal Pro BNP Outpatient (05/13/2021) Albumin Random Urine Quantitative (05/13/2021) Ferritin (06/11/2021) Iron & Iron Binding Capacity (06/11/2021) CBC with Platelets (06/11/2021) ISTAT Creatinine POCT (06/17/2021) Radiologist Consult for Cardiology (06/17/2021) CTA Angiogram Coronary Artery (06/17/2021) US LWR EXT Venous Duplex Limited Bilateral (07/15/2021)

Allergies: Penicillin, Atorvastatin, and Seasonal Allergies

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

Symptoms: Tested positive for COVID 19 08/21/2020. About 2 weeks after 2nd dose, I began to experience dizziness, nausea, tunnel vision, and post exertional malaise. My symptoms steadily declined throughout the summer including muscle weakness, discoordination of lower extremities, and loss of ability to walk. I developed Post Viral Fatigue Syndrome and Long COVID.

Other Meds: Nortriptyline (50 mg) Bupropion XL (150 mg) Fenofibrate (54 mg) Trulicity (1.5 mg/0.5 ml) Lisinopril (40 mg) Buspirone (15 mg) Simvastatin (40 mg) Sildenafil (25 mg) Metformin 24 hr (2,250 mg) Polyethylene Glycol (34 g) Clindamycin 1% Exter

Current Illness:

ID: 1704809
Sex: F
Age: 75
State: CA

Vax Date: 01/13/2021
Onset Date: 01/14/2021
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:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: 2nd dose- H/A, felt all over sick 2nd day.. approx 5-7 days strong issue with muscles & nerves- felt like not connecting- difficulty with standing from sitting & body strength... progressively got worse. Utilized trainer.... kept getting worse... problem with getting up from toilet. Muscles not connecting as if I had a stroke. Upper body affected heavily... no strength. Continue with trainer which was like rehab.. Noticed multiple red splotches/ uneven redness across knuckles, side of hand & wrist & little finger, left lower leg and foot. Seemed to be inflammation on areas in which I had prior injuries. Diabetes & hypertension returned with heavy intensity. Went on insulin & B/P meds. Was off work 7 wks, RTW on 8/9/21. Prior to receiving vaccine was heavy with exercise/fitness training (for 11 yrs). Training turned into rehab; improving in baby steps, but still not to original condition.

Other Meds:

Current Illness:

ID: 1704810
Sex: F
Age: 71
State: IL

Vax Date: 03/18/2021
Onset Date: 08/21/2021
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: 8/21/21 chest xray: New consolidation right lower lung most consistent with pneumonia. 8/21/21 CT chest: Bilateral lower lobe and right middle lobe ground-glass infiltrates which may represent COVID-19 pneumonia. 8/21/21 US: No DVT 8/21/21 Lung perfusion: Negative for PE

Allergies: atorvastatin, morphine, penicillins

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Arrived to ER on 8/21/21 and was admitted for COVId19 pneumonia. At baseline she is on 5L. Patient presented to the ED today with multiple complaints including worsening shortness of breath, cough, sore throat etc. She denies nausea vomiting or diarrhea but appetite is very poor. Chest x-ray did show right lobe infiltrate but CT chest without contrast shows bilateral lower lobe and right middle lobe ground-glass infiltrates consistent with COVID-19 pneumonia. Patient is fully vaccinated with Moderna 3 months ago. Blood pressure is borderline low initially 86/52 but upto 96/53, oxygen saturation in the mid 80s on 5-6 L. ABG with pH of 7.38, pCO2 30, PO2 67. Labs significant for acute kidney injury with BUN 84, creatinine 3.4, baseline usually around 1.5. Bicarb 17. She has been started on IV Rocephin and azithromycin for 5 days. She required up to 10L of high-flow oxygen during her stay. Her AKI resolved and cultures remained negative. Oxygen was titrated to baseline. Discharged on 8/27/21.

Other Meds: Aspirin, dulaglutide, garlic oil, multiple vitamin, acetaminophen, allopurinol, amlodipine, carvedilol, doxazosin, fenofibrate, fish oil, gabapentin, insulin regular, levothyroxine, lisinopril-hydrochlorothiazide, rosuvastatin, sertraline

Current Illness:

ID: 1704811
Sex: F
Age: 76
State: NY

Vax Date: 09/13/2021
Onset Date: 09/13/2021
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:

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

Symptoms: Patient reports full body hives from second covid shot

Other Meds:

Current Illness:

ID: 1704812
Sex: M
Age: 67
State: NY

Vax Date: 08/30/2021
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: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies: None

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

Symptoms: Swollen lymph node underarm left side same side as vaccine. Mildly painful for about 10 days.

Other Meds: None

Current Illness: None

ID: 1704813
Sex: M
Age: 58
State: NV

Vax Date: 03/23/2021
Onset Date: 03/24/2021
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: NEED TO GET MY INR RECHECKED AGAIN.

Allergies: INTRAVENEOUS IODINE

Symptom List: Unevaluable event

Symptoms: CHECKED MY INR VALUE (BECAUSE I TAKE COUMADIN) IT WAS OVER AN 8. I LET MY INR TEAM KNOW THAT I GOT THE COVID VACCINE. I WAS GETTING RED SPLOTCHES ON MY SKIN. BRUISING VERY EASILY. CAPILLARIES WERE RUPTURING. I ACCIDENTALLY CUT MY SELF SHAVING. TOOK 3 DAYS TO STOP BLEEDING. IN THE INTERIM, I STARTED TO EAT LEAFY GREENS AND TAKING VITAMIN K. THAT HELPED.

Other Meds: Spiriva Respimat 2.5 mcg/Act Aers, albuterol 108 (90 Base) MCG/ACT Aero Soln inhalation aerosol, atorvastatin 40 MG Tabs, losartan 100 MG Tabs, warfarin 2.5 MG Tabs, acetaminophen 500 MG Tabs.

Current Illness: NONE

ID: 1704814
Sex: F
Age: 52
State: FL

Vax Date: 04/16/2021
Onset Date: 05/07/2021
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: CTScan, Needle Biopsy, Bloodwork

Allergies: Vicodin

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

Symptoms: Prolonged swollen lymph nodes (all lymph nodes) causing pain and swelling in neck and armpits which persists to present date.

Other Meds: None

Current Illness: None

ID: 1704815
Sex: F
Age: 47
State: FL

Vax Date: 05/03/2021
Onset Date: 05/07/2021
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: Penecillin

Symptom List: Injection site pain, Pain

Symptoms: Extreme Tinnitius. I self treated with ringing in the ear, ear drops and OTC ringing in the ear supplements. I discussed it with a TelaDoc Doctor who referred to see a physician in person. May 25th, I saw an ENT Specialist who said their was no fluid in my ear, nor any issue with my vestibular organ. I had a hearing test that showed moderate loss of hearing and he recommended hearing aids. I also had disequilibrium issues and started seeing a chiropractor who helped with that. The tinnitus has continued and is at times piercing and painful. 09/09/21 I saw a PCP who prescribed Methlpred 4mg therapy pak. Finished yesterday, tinnitus still strong and varies.

Other Meds:

Current Illness:

ID: 1704817
Sex: M
Age: 80
State: CA

Vax Date: 08/17/2021
Onset Date: 08/17/2021
Rec V Date: 09/16/2021
Hospital: Y

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

Lab Data: At hospital he was diagnosed with aspiration pnueumonia. Did the third booster exacerbate this condition. I don't believe in coincidence. He has been very ill for three weeks after 3rd booster.

Allergies: none

Symptom List: Injection site pain, Menorrhagia

Symptoms: Pt. started with chills that night. I (his wife) was out of town but spoke to him twice a day. He had body aches, loss of appetite, fatigue, running temperature and eventually health went down hill that a neighbor found him on floor of bathroom. He had fallen and could not get up.I had called Sunday morning, Aug. 22, 2021, and when he did not answer I called my neighbor to check on him. He had to carry him to chair and paramedics were called. I returned home the next day and could see the remnants of his downhill health with water bottles and granola bars strewn all over house. Clothes were in hallway, bathtub, office and family room. It was quite obvious of what I found he had been suffering from the evening he received his booster.

Other Meds: iron, multivitamine, b12, carvedilol, xarelto trelegy, atorvastatin, losartan,cymbalta

Current Illness: copd

ID: 1704818
Sex: M
Age: 25
State: FL

Vax Date: 09/11/2021
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: none

Allergies: NONE

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

Symptoms: right eye conjunctivits

Other Meds: NONE

Current Illness: NA

ID: 1704819
Sex: M
Age: 12
State: TX

Vax Date: 06/14/2021
Onset Date: 06/30/2021
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: His doctor checked his skin and the rash. Had said the vaccine did something to his immune system. Anything that touches skin becomes irritated. Prescribed Montelukast x10mg/1daily also Levocetirizine 5mg/2xdaily (morning/night), informed not to take Zyrtec, received blood work.

Allergies: None

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Little mosquito bites, different shape bumps, become very red, left arm will get really swollen. Back, lower back, legs, arms, chest. Did not develop fever, but very warm to the touch. Participant also became itchy.

Other Meds: None

Current Illness: None

ID: 1704820
Sex: M
Age: 42
State: CA

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: UNK
Vax Route: IM
Vax Site: RA

Lab Data: We contacted Moderna on 9/15/21 and we have case# MOD21-144021. Medical affairs will determine the safety and efficacy, and whether the patient should be revaccinated.

Allergies: NONE

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient did not have any reaction, however an expired vaccine was administered. Moderna Vial was punctured on 9/13/21 a little after 1:13 PM. Dose was given a little after 12:04 PM on 9/14/21

Other Meds: NONE

Current Illness: NONE

ID: 1704821
Sex: F
Age: 57
State: CA

Vax Date: 08/12/2021
Onset Date: 08/26/2021
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:

Allergies: Septra - rash

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

Symptoms: 8/26/21: Bilateral sandpaper rash around knees at night. 8/27: Rash on entire legs, below buttocks; 8/28 Rash included buttocks and swollen, painful lymph nodes in inguinal area. Skin felt inflamed, but not itchy. Started Zyrtec 10mg daily. That night rash started on hands. 8/29 AM, rash was on arms up to the shoulder. 8/29 Rash started on lower trunk area, itching started. Singulair 10 mg nightly started. 8/30 Rash covered trunk area from below the chest in front and below the shoulder blades in back. 8/31 Top of breasts. 9/2, rash started to wane, inguinal pain started to diminish. By 9/5 pain in the inguinal area was gone. 9/10 small patchy areas behind the knee and at elbows. 9/13 rash completely resolved.

Other Meds: Metformin 500mg ER tab

Current Illness: none

ID: 1704822
Sex: M
Age: 54
State: NY

Vax Date: 05/07/2021
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: RA

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: covid symptoms

Other Meds:

Current Illness:

ID: 1704823
Sex: F
Age: 71
State: WA

Vax Date: 03/27/2021
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: UNK
Vax Route: IM
Vax Site: LA

Lab Data: My doctor has run just about every test available and there is no physical reason for this weakness. I had not changed my Thyroid medicine for years and years and all my tests have been normal, however after my vaccine my thyroid level was almost non existent. Also my B12 went from normal to almost non existent. Both have finally been corrected by my doctor.

Allergies: None

Symptom List: Injection site pain

Symptoms: Immediate extreme muscle weakness and fatigue. Has not improved and possibly worse 6 months later. So weak went from an active person painting my deck to not being able to climb ladder. Extreme difficult to climb stairs. Strength is just gone overnight. Second issue is that I am having mensural bleeding which hasn't occurred in 23 years.

Other Meds: Trazadone - Levothyroxine - Omeprazole = Naproxen - Metoprolol - Hydrochlorothiazide

Current Illness: None

ID: 1704824
Sex: F
Age: 71
State: MS

Vax Date: 02/04/2021
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: IM
Vax Site: LA

Lab Data: Bowel samples which found the Colitis. Blood work that found the Chronic Anemia and low sodium. CAT scan of chest area which noticed something about the heart, appointment in Oct. with heart specialist.

Allergies: none

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

Symptoms: I have developed acute anemia, colitis, kidney problems, am to see heart specialist in Oct. and and internal specialist in Oct. Have had bowel specimens done which found the colitis. Low sodium. Still in process of seeing multiple doctors. Saw kidney specialist today. Everything started happening in April sometime. Not sure exactly when because have been busy with 100% disable husband. Wasn't paying much attention to me, just noticed all these symptoms coming on.

Other Meds: Pantoprazole, multi vitamin, vitamin C, vitamin D, vitamin E, magnesium, calcium

Current Illness: Barrett's Esophagus and hiatal hernia-under control at the time.

ID: 1704825
Sex: F
Age: 70
State: IL

Vax Date: 03/18/2021
Onset Date: 08/23/2021
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: 8/25/21 COVID19: positive 8/27/21 Chest xray: Significant enlargement of the cardiac silhouette. Associated pulmonary vascular congestion is seen. Airspace disease is likely at least partially to CHF. Superimposed changes of COVID-19 pneumonia not excluded. Further evaluation as clinically indicated. 8/27/21 CTA chest: congestive failure and COVID-19 pneumonia. No PE

Allergies: lisinopril, prednisone, pregabalin, ceftaroline, morphine

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

Symptoms: presented to the ED on 8/27/21 for evaluation of weakness, cough and SOB since 8/22/21. Pt tested positive for COVID 19 on 8/25/21. Pt has received both doses of Moderna vaccine. While in the ED, pt with SpO2 of 93-94% on RA. ABG showed a pO2 of 74.2. D-dimer elevated at 1.63. CT angio chest done showed no PE, but changes consistent with combination of CHF and COVID-19 pneumonia. Pt had crackles and rhonchi on exam. She was started on IV Lasix. Pt admitted for CHF exacerbation. She was started on Azithromycin as well. She had been started on 2 L oxygen because of slightly low PO2 on ABG. Pt with Fever of 101.9 on 8/28. No fever for the last 48 hours. Ordered Urinalysis, Sputum and blood cultures. Blood cultures without growth so far. U/A not suggestive of UTI. No report of sputum culture. IV Azithromycin switched to PO on 8/29. Will discharge with PO Azithromycin; per nurse she has been off of oxygen for over 24 hours and doing well. Cardiology was consulted on admission given elevated troponin. Troponin initially trended up from 0.048 to 0.076, but went down to 0.066. Pt denies any chest pain. Elevation of troponin thought to be likely related to CHF and COVID infection. Troponin has been elevated since March. ECHO showed EF of 30-35% and pseudonormal pattern of LV diastolic filling; no changes from ECHO in June. Nurse reported that pt had new onset Afib on 8/28, so Cardiology has started Xarelto. Discharged 8/30/21

Other Meds: Albuterol, allopurinol, atorvastatin, carvedilol, diclofenac gel, aspirin, exemestane, gabapentin, glipizide, levothyroxine, losartan, metformin, omega-3 acid and metolazone

Current Illness:

ID: 1704826
Sex: M
Age: 53
State: TX

Vax Date: 08/01/2021
Onset Date: 08/13/2021
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: LABS on 09-13-2021. 09-14-2021.09-15-2021 and I was admitted in the hospital where more labs were collected to figure out the cause of the problem. I was then treated with steroids. As I am writing I am still admitted in the hospital.

Allergies: None

Symptom List: Tremor

Symptoms: Routine blood test shows extreme low blood platelets. Admitted to hospital and was treated with some steroid and a lot of lab work.

Other Meds: Amlodepine,allopurinol,lisinopril,creator,labetalol,potassium and magnesium.

Current Illness: High blood pressure

ID: 1704828
Sex: M
Age: 87
State: CA

Vax Date: 02/23/2021
Onset Date: 02/24/2021
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: no

Symptom List: Erythema, Pruritus

Symptoms: almost immediately could not swallow eat nor drink

Other Meds: probenecid, statin, losartan

Current Illness: no

ID: 1704829
Sex: F
Age: 36
State: NY

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

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data: N/A

Allergies: UNKOWN

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

Symptoms: PATIENT REPORTED ON 9/16/21 THAT SHE EXPERIENCED SPOUTS OF DIZZINESS LASTING 4-1O SECONDS AT A TIME INTERMITTENTLY. AND WAS STILL ONGOING AT 12PM

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1704830
Sex: F
Age: 46
State: GA

Vax Date: 04/09/2021
Onset Date: 04/09/2021
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: Xray & ultrasound - 8/5/2021; MRI - 8/28; (ongoing physical therapy too)

Allergies: None

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

Symptoms: muscle soreness, difficulty using arm, limited range of motion, pain

Other Meds: Multivitamins

Current Illness: None

ID: 1704831
Sex: F
Age: 32
State: WA

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:

Allergies: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Fever, chills, uncontrollable shaking. Migraine, extreme body aches, lasting over 24 hours. Loss of appetite.

Other Meds: Vitamin D daily supplement

Current Illness: Covid positive 30 days prior to vaccination

ID: 1704832
Sex: M
Age: 25
State:

Vax Date: 09/08/2021
Onset Date: 09/11/2021
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:

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

Symptoms: Pericarditis which resulted in urgent care, ER, and cardiologist visits. Treating with NSAIDs. No change in outcome yet.

Other Meds:

Current Illness:

ID: 1704833
Sex: F
Age: 65
State: OK

Vax Date: 02/24/2021
Onset Date: 02/26/2021
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: Blood work (unsure what kind).

Allergies: Amoxicillin, Probably allergic to the MODERNA, a lot of antibiotics ? I only have a few I can take.

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

Symptoms: It started out normal at night and my arm got sore and I ran a low grade fever. I took some Tylenol and I was tired and I took a nap and I woke up and felt just fine. The next day was fine, but on the 3rd day (possibly in the evening) I started getting blisters on roof of my mouth and into throat. I called my Doctor and he was out of state so I had to see someone else and at first he didn't think it had anything to do with vaccine but my best friend had blisters on her tongue after vaccine. My doctor called me in 2 bottles of nystatin 100,000 units mL suspension 4x a day, liquid antacid over the counter CVS brand 3-4 times a day. He told me to gargle with salt water 5-6 times a day. I did that for about two weeks and it went away. I also had chronic diarrhea since vaccine.

Other Meds: Atenolol- Chlorthalidone;Vitamin D3; Extra strength Tylenol; Vitamin C;, Claritin;

Current Illness: None.

ID: 1704834
Sex: M
Age: 31
State: PA

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:

Allergies:

Symptom List: Pain in extremity

Symptoms: patient passed out for 30 seconds and came back , he was sweating , pale and said he felt cold. his pulse was 52/min. gave patient sugary drink and he felt better in about 2-3 minutes

Other Meds:

Current Illness:

ID: 1704835
Sex: F
Age: 61
State: MD

Vax Date: 03/01/2021
Onset Date: 04/01/2021
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: Per primary care physician, Was taken of Cholesterol medication 18 August 2021

Allergies: No

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

Symptoms: Sour Arm, light headache. Vision issues.

Other Meds: 1 regular Tylenol

Current Illness: Sour Arm, Mild Headache, Sleepless nights, Muscle pain in legs/ spasms

ID: 1704836
Sex: F
Age: 49
State:

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: IM
Vax Site: LA

Lab Data:

Allergies: Multiple medication and food intolerance, noticed in past year.

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

Symptoms: 1740 client vaccinated with Moderna, per vaccinator, client anxious about vaccination after visit with allergy doctor who "said I should get Moderna." Approx 5 minutes after vaccination, Safety Officer notified by Observation staff that client felt numbness and shortness of breath. Client observed taken to lay supine in special observation. Complained of Shortness of breath, cough (not present before vaccination), numbness in hands, feet, lips, and head with slight headache +pain in upper left abdominal region. Denies chest pain or trouble breathing. No wheezing noted on auscultation, heart sounds normal. Hx high cholesterol, 2 heart attacks in 2017 and 2020. Allowed to lay down until feeling better. Client states "I'm feeling a bit better" and verbalized feeling safe to leave ~1830. Ambulated off facility independently. Client made aware to call 911 if symptoms worsen and to follow up with PCP. Vitals: 1755: BP 122/75, HR 57 -- 1815: BP 121/82. HR 57.

Other Meds: Statins

Current Illness: High cholesterol, 2 heart attacks in 2017 and 2020

ID: 1704837
Sex: M
Age: 21
State: TN

Vax Date: 08/31/2021
Onset Date: 09/03/2021
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: Penicillin

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

Symptoms: Myocarditis and Pericarditis. Going to have to miss my D1 college senior season and have serious heart issues. Hospitalized for 5 days.

Other Meds: None

Current Illness: None

ID: 1704838
Sex: F
Age: 67
State: KS

Vax Date: 09/09/2021
Onset Date: 09/09/2021
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: Sulfa, HCTZ, singular, spinach, corn, trees/weeds

Symptom List: Vomiting

Symptoms: Chills, joint pain, back ache, red injection site and pain down right arm, headache; all of above lasted 48 hours. Right arm pain lasted for 7 days. Slept for 2 days sporadically. Continued prescribed meds. Drank water and did not eat.

Other Meds: Methotrexate, folic acid, Claritin, synthroid, metoprolol, citalopram, vitamin D, vitamin B, symbicort

Current Illness: Asthma issue

ID: 1704839
Sex: M
Age: 86
State: IL

Vax Date: 03/25/2021
Onset Date: 08/22/2021
Rec V Date: 09/16/2021
Hospital: Y

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

Lab Data: 8/30/21 COVID19- positive 8/29/21 Chest xray: COVID 19 pneumonia

Allergies: bactrim, doxycycline, cephalexin, clindamycin, iodine, statins

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Presented to the hospital on 8/29/21 with chronic/moderate/constant weakness that had worsened throughout the week with associated shortness of breath early that morning. Patient was brought to hospital by ambulance from an assisted living facility. Nurse at the nursing home stated that the patient was not looking well. Patient stated that he could not get up from bed. Denied chest pain or shortness of breath. Patient required 2L of oxygen to elevate oxygen saturation. He received PTA via saline and demonstrating atrial fibrillation with RVR. The patient has a past medical history of LBBB and CAD. Patient wasn't sure of his current medications since it is provided to him by the assisted living facility. The patient is fully vaccinated for COVID-19 with moderna in April and May. In the ED, the patient was febrile with a temperature of 100.7, tachycardiac at 125, BP 141/66 with a WBC of 18.8. The patient met SIRS criteria and placed on 2L of O2, CRP 122, BNP 1350, creatinine wnl, BUN 25. EKG demonstrated atrial fibrillation with RVR and the patient was given cardizem 20 mg IV for rate control. The patient was also started on Vanc + Zosyn due to the suspicion of possible secondary pneumonia. Respiratory cultures, culture for Legionella and S. Pneumoniae antigen, MRS PCR, blood gases, ferritin, fibrinogen, lactic acid, lactate dehydrogenase, PT, CBC, and electrolyte studies were obtained. During hospital course the patient was started on Remdesivir 200 mg qhs then switched the second day to 100 mg for a total of 4 days. He was started on Decadron 6 mg for 10 days. He received Mucinex 600 bid prn and albuterol 4 puffs q6h prn. For the patiens history of atrial fibrillation with RVR he received a single dose of cardizem 20 mg IV and then was started on metoprolol tartrate 2.5 mg IV q6h and xarelto 15 mg qd was restarted. For his chronic diastolic he was given lasix 40 mg IV and then daily dosed. Patients' hypokalemia was managed by started him on Klor-Con 20 meq bid to raise the level above 4. For his history of CAD s/p cath/HLD/HTN he continued his home medication of fenofibrate 160 mg, lisinopril HCTZ 10-12.5. Also received his nightly BIPAP treatment. Throughout his continuation of the hospital course he began to have difficulty swallowing and choking on food. Speech therapy performed an evaluation and recommended that the patient to be put on a cardiac diet with thin liquids. Due to the patient being on vancomycin since admission it was discontinued due to elevated levels and was switched to Levaquin 750 mg received on 9/1 then a second dose to be given on 9/3, due to being renally dosed. Patients potassium began to elevated and Klor-Con 20 meq was put on hold. Patient was discharged on a second dose of Levaquin 750 mg to be on Friday, 9/3/2021, Decadron 6 mg qd for 5 more days, Mucinex bid, albuterol q4h.

Other Meds: benzonatate, famotidine, fenofibrate, finasteride, furosemide, isosobide mononitrate, levothyroxine, lisinopril-hydrochlorothiazide, metoprolol succinate, mirtazapine, mucinex, nitroglycerin, rosuvastatin, xarelto

Current Illness:

ID: 1704841
Sex: F
Age: 23
State: LA

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

Lab Data: Respiratory panel, x-ray, comprehensive metabolism panel, inflammation 9/14/2021

Allergies: Latex

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

Symptoms: Severe cheat pain, shortness of breath, back pain, arm swelling

Other Meds: Fludrocortisone acetate, vyvanse, elinest

Current Illness: No

ID: 1704842
Sex: M
Age: 34
State: VA

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: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: D Dimer and CBC sent. EKG - Sinus tachycardia. S1; Not clear whether he has Q3; T3. ? PE workup in progress.

Allergies: Carrots

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Drenched in sweat; Rigors; chest pain; Shortness of breath; myalgias; muscle spasm.

Other Meds: Robitussin, Tylenol

Current Illness: URI 5 days earlier

ID: 1704843
Sex: F
Age: 65
State: WI

Vax Date: 03/08/2021
Onset Date: 04/12/2021
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: Cardiac panels, Echo, Cardiac stress test. COVID tests. Chest xray, CT chest

Allergies: Heparin High Other (See Comments) HIT Allergy Not Specified VOMITING Narcotic analgesics - lethargy Betadine [povidone Iodine] Not Specified Codeine Not Specified Iodine (environmental Or Med) Not Specified Latex (environmental) Not Specified Miralax [polyethylene Glycol] Not Specified RASH Penicillins Not Specified PRURITUS Throat swelling Percocet [oxycodone-acetaminophen] Not Specified Phenergan [promethazine Hcl] Not Specified Statins Not Specified RASH Tape [adhesive (environmental)] Not Specified RASH Topamax Not Specified DIZZINESS Near syncope Valium [diazepam] Not Specified Vicodin [hydrocodone-acetaminophen]

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

Symptoms: 3-8-21 Moderna Vaccine #1 a 3-18-21 phone call States after vaccine had fever 101 couple days-resolved. Was also very nauseated, decreased appetite. Could bearly eat anything. Had decreased urine output-improving. Now having increased shortness of breath Admitted 3-19-21 to hospital for Afib. Also ear drum ruptured. 3-24-21 Seen, continued with night sweats, chills, fatiue, shortness of breath. 4-2-21 Had abnormal Nuc Med stress test. symptomatic decompensated heart failure. TTE showed EF 65%. Transferred to another hospital. 4-3-21 discharged from Hospital 4-6-21 in ED c/o SOB at night and with activity. Pt denies N/V/cough. Pt states she feels a little bit of CP when having PVC-Admitted-Dyspnea,Tachycardia,heart failure with preserved ejection fraction,Orthostatic hypotension. Discharged 4-10-21.

Other Meds: Dosage traMADol (ULTRAM) 50 MG tablet Take 2 tablets by mouth 2 times daily as needed for Pain. cetirizine-pseudoephedrine (ZyrTEC-D Allergy & Congestion) 5-120 MG per tablet Take 1 tablet by mouth 2 times daily. naLOXone (NARCAN) 4 MG/0.1M

Current Illness: Left thigh pain Shortness of breath Chest pain Leg edema Other specified hypothyroidism Lymphedema of both lower extremities Chronic constipation OSA (obstructive sleep apnea) Overview Signed 8/19/2016 8:15 AM Intolerant of CPAP Previous Version Obesity (BMI 30-39.9) Knee joint replacement status Knee osteoarthritis Fibromyalgia History of poliomyelitis Knee contusion Benign neoplasm of colon

ID: 1704844
Sex: F
Age: 57
State: NH

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

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

Lab Data: The dates are unknown, blood work was done that showed high lipase levels, which indicated acute pancreatitis. An abdominal ultrasound was done, and sludge was found in the gall bladder and that stones had already passed; it was then decided I needed to have my gall bladder removed.

Allergies: Penicillin, bactrim, Augmentin, amoxicillin, various other antibiotics.

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

Symptoms: I got my Pfizer vaccinations on 2/12/2021 and 3/12/2021. Both times, I developed an itch and a rash in the evening after receiving the vaccines, but the second time was far worse than the first. After the second vaccination, a rash covered by body from my scalp to my feet. The only part of my body that was left unscathed was my buttocks. I consulted by PCP, who prescribed me prednisone, because I had already been taking Benadryl, which proved ineffective. The prednisone successfully treated the rash. Right after I finished the prednisone, though, I then began experiencing severe abdominal pain. Dr. ordered blood work, and the results showed high lipase levels, which are a sign of acute pancreatitis. Not long after that, I ended up going to the ER for severe abdominal pains; I was admitted for a couple of days, and I was treated for pain and the cause of my pain was investigated. Not long afterwards, I was referred to a surgeon, who removed my gall bladder. During the gall bladder removal, it was discovered I had an obstructed common bile duct. I was then referred to hospital where I had a stent placed in the bile duct. The stent eventually passed, and I am now symptom-free.

Other Meds: Flonase, Zyrtec, Effexor, cyproheptadine, levothyroxine, melatonin, vitamin D, amitriptyline, simvastatin, gabapentin.

Current Illness: None.

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am