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: 1708255
Sex: F
Age: 29
State: AR

Vax Date: 09/15/2021
Onset Date: 09/16/2021
Rec V Date: 09/17/2021
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: Lidocaine

Symptom List: Dysphagia, Epiglottitis

Symptoms: Softball sized swelling at vaccine site, left arm Fever of 103.2? at 1530 on 9/16/21, lasting until 0230 9/17/21 Nausea/vomiting

Other Meds: Celexa, hydroxyzine, Armour thyroid

Current Illness: N/A

ID: 1708256
Sex: F
Age: 60
State: GA

Vax Date: 03/03/2021
Onset Date: 07/27/2021
Rec V Date: 09/17/2021
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:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: She started symptoms on July 23rd with shortness of Birth and she still have symptoms. Unknown exposure. She is admitted in Hospital on July 28th and she is still in the hospital. She got Covid Pneumonia and on Oxygen. She is in Covid Care Unit. She has Rheumatoid Arthritis medical condition. She had her Covid Vaccine in March. Patient is fully vaccinated.

Other Meds:

Current Illness:

ID: 1708258
Sex: F
Age: 34
State: NY

Vax Date: 09/09/2021
Onset Date: 09/10/2021
Rec V Date: 09/17/2021
Hospital: Y

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: Anion Gap metabolic acidosis CBC with Diff -9/12/21 BMP-9/12/21 Troponin-9/12/21 Thyroid function-9/12/21 EKG-9/12/21 Urinalysis-9/12/21

Allergies: None

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

Symptoms: 1 day after vaccination, heart rate increased to 152 bpm, both arms went numb, and contracted thereafter, numbness became generalized throughout the body with muscle jerks in extremities. Unable to stand and walk without assistance with tachycardia. Went to ED 3 days post-vaccine regained the ability to walk without assistance and no further muscle numbness or jerks, tachycardia subsided. The onset of persistent diarrhea 3 days post-vaccine.

Other Meds: None

Current Illness: None

ID: 1708259
Sex: F
Age: 36
State: ME

Vax Date: 08/27/2021
Onset Date: 08/28/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data:

Allergies: Zyprexa, Codeine

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient developed palpitations and shortness of breath the day after receiving 1st dose of Moderna vaccine. EKG and 48 hour holter monitor showing sinus tachycardia. Kidney and liver function, electrolytes, TSH, Ddimer and Troponin normal. Intermittent tachycardia has continued since 8/28/21 with minimal exertion. Referral to cardiology has been placed, Echocardiogram, chest xray, and Thyroid nuclear radiouptake scan ordered.

Other Meds: Vitamin D3 2000 IU Qday, Ferrous sulfate 325 mg Qday, Vitamin C 500 mg Qday

Current Illness: None

ID: 1708260
Sex: F
Age: 65
State: GA

Vax Date: 02/18/2021
Onset Date: 07/22/2021
Rec V Date: 09/17/2021
Hospital: Y

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

Lab Data: 07/24/2021 PCR+ COVID-19 test at Hospital

Allergies:

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

Symptoms: Breakthrough COVID-19 case with symptom onset 7/22/2021: Fever >100.4, Muscle or body aches, Cough (new onset or worsening of chronic cough), Fatigue or tiredness, Diarrhea (>/=3 loose/looser stools in 24 hr period), a lot of phlegm. Hospitalized for COVID-19 pneumonia and low blood oxygen levels. Hospitalized for at least 4 days starting 7/24/2021

Other Meds:

Current Illness:

ID: 1708261
Sex: F
Age: 77
State: IL

Vax Date: 04/01/2021
Onset Date: 09/08/2021
Rec V Date: 09/17/2021
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: Emergency Department recorded pt's O2 at 91% on room air

Allergies: Diphtheria toxoid, morphine, tetanus toxoid

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

Symptoms: diagnosed with COVID, LOW OXYGEN AT HOME 88%, minimal dry cough, MD Dx COVID pneumonia

Other Meds: UNKNOWN

Current Illness:

ID: 1708262
Sex: F
Age: 47
State: IN

Vax Date: 09/14/2021
Onset Date: 09/15/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: This was a flu vaccine but they did not give me any paperwork with the brand/dose/lot. Symptoms began within 15 hrs, headache, high fever (102), severe muscle aches and fatigue. Persisted and continuing through today, Friday,48 hours and counting.

Other Meds: None

Current Illness: None

ID: 1708263
Sex: F
Age: 55
State: MA

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: none -no point

Allergies: none

Symptom List: Pharyngeal swelling

Symptoms: heart palpitations and fluttering --heart racing for weeks-it continues

Other Meds: none

Current Illness: none

ID: 1708265
Sex: F
Age: 42
State: MD

Vax Date: 08/04/2021
Onset Date: 08/05/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: I was seen by Dr at the end of August. She ran various test which confirmed partial loss of vision and a pallor over optic nerve. I was referred to retina center on September 7th. I had an mri done on 9/15/21 by peninsula imaging of my brain and orbital sockets. Results are pending. Since that time my vision has been restored to normal.

Allergies: Nickel allergy

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: I received the first vaccine on 8/4/21. My eyes began to water uncontrollably the next day and continued for several days. I began having headaches and heart palpation that continued for over a week. I woke up on a Saturday 10 days after the first dose and could not see out of part of my left eye. After the second dose on 8/25/21 my eyes began the same watering in the right but my vision did not change in that eye.

Other Meds: None

Current Illness: None

ID: 1708266
Sex: M
Age: 69
State: KS

Vax Date: 09/02/2021
Onset Date: 09/02/2021
Rec V Date: 09/17/2021
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: squab (pigeon), penicillin as a child

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient said his arm was red after the shot on 9/14/21. He pulled up his sleeve and the redness appeared to be mild if there at all. Let patient know I am a pharmacist and not a physician, so I didn't feel comfortable diagnosing his arm if the patient was concerned about it. (I did not see anything unusual, but again I am not a physician. It looked like his shirt was just a little tight as he could not pull it up very far... but this also meant I could not see the area very well)none Recommended patient follow-up with his dr. Called 9/17/21 to see if patient had followed-up and he had not.

Other Meds: unknown

Current Illness: none reported

ID: 1708267
Sex: M
Age: 51
State: FL

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

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

Lab Data:

Allergies: none

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

Symptoms: We had to call 911 due to pt experiencing extreme fatigue, sweating, palpitations, and dizziness. Pt's head kept falling back as if he couldnt hold it up on his own and we had to continue to tell him to stay awake and until paramedics arrived. I constantly fanned the pt to ensure he remained cool and did not fall asleep. 911 came about 14 minutes later and took over the situation. Im unaware if they took him or if he walked out on his own

Other Meds: none

Current Illness: none

ID: 1708268
Sex: F
Age: 52
State: TX

Vax Date: 03/15/2021
Onset Date: 07/28/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: Thyroid, and blood test were fine.

Allergies: codeine, aphetamine

Symptom List: Rash, Urticaria

Symptoms: Four months after I was very tired, body ache, could smell or test anything, had fever and it lasted over a week. I went to the doctor and I wasn't test for COVID. They tested the thyroid and test was fine.

Other Meds: Synthroid /Levothyroxine 1/daily

Current Illness:

ID: 1708269
Sex: M
Age: 84
State: GA

Vax Date: 03/16/2021
Onset Date: 07/22/2021
Rec V Date: 09/17/2021
Hospital: Y

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

Lab Data: 07/25/2021 PCR+ COVID-19 test

Allergies:

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

Symptoms: Breakthrough COVID-19 case with symptom onset 7/22/2021: Fever >100.4, Runny nose/Congestion, Sore throat, Cough (new onset or worsening of chronic cough), Shortness of breath or difficulty breathing, Chest pain, Fatigue or tiredness, Headache, Diarrhea (>/=3 loose/looser stools in 24 hr period). Hospitalized from 7/25/2021-7/28/2021

Other Meds:

Current Illness:

ID: 1708270
Sex: F
Age:
State: FL

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

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

Lab Data:

Allergies: None

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

Symptoms: Allergy shot, antibiotic shot

Other Meds: Birth control

Current Illness: Bronchitis

ID: 1708271
Sex: F
Age: 67
State: KY

Vax Date: 04/07/2021
Onset Date: 09/16/2021
Rec V Date: 09/17/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: hospitalization (non-ICU)

Other Meds:

Current Illness:

ID: 1708272
Sex: F
Age: 57
State: TN

Vax Date: 01/10/2021
Onset Date: 09/14/2021
Rec V Date: 09/17/2021
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: 9/14/21 COVID -19 MOLECULAR TEST = POSITIVE

Allergies: LEVAQUIN

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

Symptoms: 9/14/21 SEEN AT URGENT CARE. COVID TESTED. REFERRED TO MEDICAL CENTER ER: PATIENT PRESENTED WITH DIFFICULTY BREATHING AND COUGH. ONSET 10 DAYS PRIOR. ALSO NOTED WITH FEVER, CHILLS, NAUSEA. PATIENT REPORTS SHE IS A PULMONARY MD WORKS CITY. REPORTS SHORTNESS OF BREATH X 4 DAYS. HS BILAT PNEUMONIA BUT NO EFFUSION. HER EKG SHOWS ST ELEVATION IN MULTIPLE LEADS. TROPONIN IS NEGATIVE. ADMITTED TO HOSPITAL. hYPOXIA WITH O2 SATS = 83% ON ROOM AIR IMPROVED TO 99% ON 2 LO2. DECLINED REMDESIVIR AT THIS TIME, STARTED ON DEXAMETHASONE, ROCEPHIN AND IV FLUIDS. . 9/16/21 DISHCARGED FROM HOSPITAL TO HOME. DISCHARGE DIAGNOSIS: PNEUMONIA DUE TO COVID 19, ACUTE PARICARDITIS

Other Meds: UNKNOWN

Current Illness: UNKOWN

ID: 1708273
Sex: F
Age: 39
State: NJ

Vax Date: 04/02/2021
Onset Date: 05/13/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: 5/24/21: rushed to ER for potential blood clot. Blood clot negative; found mass in neck. 5/28/21: CAT scans of neck and chest with contrast conducted. Impression: Lymph nodes enlarged-bigger on left side than right hand slide and concerning for malignancy. 6/2/21: Bloodwork done 6/2/21: Consult with doctor 6/11/21: Surgical thoracic biopsy conducted. Pathology positive for Hodgkins lymphoma 6/12/21: Rushed to ER with scare for blood clot in leg post-surgery (negative) 6/16/21: PET scan @ Hospital-confirmed early Stage 3 Hodgkins lymphoma, not in organs 6/17/21: Dr. conducted outpatient bone marrow biopsy to rule out spread to bones (negative) 6/23/21: Pulmonary Function test & Echocardiagram for baselines conducted at Hospital (Normal) 6/29/21: Port Surgery @ Hospital 7/6/21: Chemotherapy began. Standard of Treatment for Hodgkins recommended: ABVD for 4 bi-weekly treatments and AVD for 8 additional bi-weekly treatments. Total: 12x treatments over 6 months. 8/26/21: additional PET scan done @ Hospital for progress to confirm standard of treatment was ok to move forward with.

Allergies: n/a

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

Symptoms: Enlarged lymph nodes on left side pushed enlarged lymph nodes on right side sitting on a nerve, causing pain in jaw and collar bone area. Sent to ER for potential blood clot. Doppler came back negative for blood clot but came back with a mass in left side of neck which prompted two CT scans with contrast that were concern for malignancy. Surgical thoracic biopsy was scheduled confirming HODGKINS LYMPHOMA. Pet scan followed for staging followed by Bone Marrow biopsy. Three opinions led to treatment for surgical port insertion and currently in chemotherapy.

Other Meds: Relpax for Migraines

Current Illness: n/a

ID: 1708275
Sex: F
Age: 38
State:

Vax Date: 12/29/2020
Onset Date: 09/13/2021
Rec V Date: 09/17/2021
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: PATIENT HAD COVID-19 VACCINE PFIZER Dose 1 date: 12/29/2020, Dose 2 date: 01/19/2021, AND TESTED POSITIVE TO COVID

Other Meds:

Current Illness:

ID: 1708276
Sex: F
Age: 42
State: KY

Vax Date: 01/12/2021
Onset Date: 09/15/2021
Rec V Date: 09/17/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: hospitalized (non-ICU)

Other Meds:

Current Illness:

ID: 1708277
Sex: M
Age: 54
State: KY

Vax Date: 02/02/2021
Onset Date: 09/16/2021
Rec V Date: 09/17/2021
Hospital: Y

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: hospitalization (non-ICU)

Other Meds:

Current Illness:

ID: 1708278
Sex: F
Age: 70
State:

Vax Date: 07/31/2021
Onset Date: 08/17/2021
Rec V Date: 09/17/2021
Hospital: Y

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: Rapid Covid test (8/15/2021) = positive Covid IgG antibody (8/17/2021) = negative

Allergies:

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

Symptoms: The patient for started to develop symptoms approximately 7 days prior to admission. Symptoms started on Tuesday, August 10, 2021 and she was admitted to the hospital on 8/17/2021. The patient did not particularly perceive any shortness of breath., but she had been coughing frequently and overall felt very weak. The patient received the first dose of the Covid vaccine on 8/7/2021 and notes the next day she developed fever, body aches. She did visit the ED on 8/15/2021 and tested positive for Covid, but was discharged to home. Upon this admission, the patient was found to have COVID-19 pneumonia with some mild hypoxia. The patient was requiring 2 L/min via nasal cannula to maintain sats greater than 88%. The patient underwent CTA of the chest which was negative for any PE. Throughout the hospitalization the patient required slightly increased oxygen needs. The patient ultimately required a heated high flow nasal cannula at 8 L/min max. This was ultimately weaned down to room air at the time of discharge. The patient did have a home oxygen study that showed she required oxygen with any ambulation. During the hospitalization, the patient was treated with remdesivir, dexamethasone, CCP the patient felt well on the day of discharge.

Other Meds:

Current Illness: None

Date Died: 09/17/2021

ID: 1708279
Sex: F
Age: 94
State: MN

Vax Date: 02/09/2021
Onset Date: 09/15/2021
Rec V Date: 09/17/2021
Hospital: Y

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

Lab Data: COMPREHENSIVE METABOLIC PANEL GLUCOSE BY METER, POCT LAB ONLY-COMPLETE BLOOD COUNT WITH DIFFERENTIAL TROPONIN I Icon Imaging Orders Placed Today Imaging Tests CT HEAD WITHOUT CONTRAST CT SPINE CERVICAL WITHOUT CONTRAST EKG XRAY CHEST PORTABLE -

Allergies:

Symptom List: Unevaluable event

Symptoms: DEATH! FINDING: Posterior right scalp hematoma. Additional right frontal/periorbital scalp hematoma. Mild scattered mucosal thickening in the paranasal sinuses. Air-fluid level in the right maxillary sinus. Mastoids aerated. Motion artifact limits evaluation of the globes and orbits, within this limitation the appear unremarkable. Calvarium intact. Low-density change involving nearly the entire left frontal lobe, left basal ganglia, left insula, anterior left parietal lobe, and superior left temporal lobe. There is associated loss of gray-white differentiation and is consistent with an acute to subacute subacute infarct. Measurements are approximately 4.7 x 11.0 cm. Foci of hyperdensity noted centrally within the tissue measuring up to 1.4 x 1.5 cm likely represents small amount of hemorrhage/hemorrhagic conversion. This involves both the left ACA and left MCA territories. Question hyperdensity within the left MCA. There is mass effect with sulcal effacement, compression of the left frontal horn/left lateral ventricle, and 2.5 mm rightward midline shift. IMPRESSION: 1. Large acute to subacute infarct measuring up to 4.7 x 11.0 cm involving nearly the entire left frontal lobe, left basal ganglia, left insula, superior left temporal lobe, and anterior left parietal lobe. This involves both the left anterior cerebral artery and left middle cerebral artery territories. 2. Foci of hyperdensity centrally within the infarcted tissue is consistent with hemorrhage/hemorrhagic conversion. Largest focus of hemorrhage measures up to 1.5 cm. 3. Together these findings contribute to mass effect with sulcal effacement, compression left lateral ventricle, and 2.5 mm rightward midline shift. 4. Question hyperdense left MCA, presents potentially representing vascular occlusion or intravascular thrombus. CTA or MRA could provide further characterization. 5. Posterior right and right frontal/periorbital scalp hematomas.

Other Meds:

Current Illness:

ID: 1708280
Sex: F
Age: 45
State: DE

Vax Date: 02/25/2021
Onset Date: 02/25/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: None

Allergies: penicillin, avelox, clindamycin, azithromycin, amoxicillin, ceftin

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

Symptoms: Within 2 minutes of getting my first dose of the Pfizer vaccine, my tongue became itchy and swollen, and my eyes became itchy. I did not have trouble breathing . The symptoms lasted most of the day and were gone by the next morning. I did not experience similar symptoms after the second dose but got a bad headache within 12 hours after the second dose.

Other Meds: None

Current Illness: None

ID: 1708281
Sex: F
Age: 50
State:

Vax Date: 09/07/2021
Onset Date: 09/17/2021
Rec V Date: 09/17/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Patient hospitalized 7 days after developing symptoms of COVID-19 - tested positive prior to admission.

Other Meds:

Current Illness:

ID: 1708282
Sex: M
Age: 11
State: PR

Vax Date: 06/24/2021
Onset Date: 06/24/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: UNKNOWN

Allergies: UNKNOWN

Symptom List: Injection site pain, Menorrhagia

Symptoms: INADVERTENTLY VACCINATED BEFORE 12 YRS OF AGE.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1708283
Sex: F
Age: 35
State: NH

Vax Date: 06/24/2021
Onset Date: 06/25/2021
Rec V Date: 09/17/2021
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: None known

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

Symptoms: Very sudden feeling of dizziness, nausea, and weakness all at once, followed quickly by a numb feeling in both legs (barely able to stand) and feeling faint (seeing white spots and close to blacking out). Profuse sweating and clammy skin accompanied this. As these specific symptoms slowly subsided after about 15 minutes, a severe headache and extreme exhaustion set in. After about 6-7 hours, I finally felt normal again.

Other Meds: Adderall XR 20 mg taken at 7am on 6/24/21. Did not take the medication on 6/25/21.

Current Illness: None

ID: 1708284
Sex: F
Age: 39
State: NJ

Vax Date: 08/24/2021
Onset Date: 08/24/2021
Rec V Date: 09/17/2021
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: Blood work EKG

Allergies: n/a

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Immediately after the injection I had a metal taste in my mouth however no other symptoms. I was told I may have a sore arm and have flu like symptoms the following day. I waited 15 minutes after the injection at the pharmacy to ensure I didn't have any life threatening effects which I did not. On my ride home, I started having a shooting acute pain in my right leg with pressure. The pain persisted for 20 minutes or so then subsided. Later that evening, I started having more shooting acute pains all over my body like the one I had in my leg and they would subside as well like the first instance. The next day I felt ok except for the metal taste in my mouth and the pains but felt ok enough to engage in physical activity (swimming). By that afternoon the pains increased in frequency coupled with migraines. That evening, I was awoken by my heart racing in addition to pains all over my body. The next day 8/26/21 I had a telemedicine appointment with my doctor's office. The pain and racing would subside so I did not feel it was appropriate for a ER visit. The office requested I have blood work done to confirm I did not have any blood clots. The results came back negative (everything was ok from the tests). The next few days the pain, racing heart and metal tastes continued but were slowly decreasing in frequency however I started feeling mentally foggy (difficulty recalling words/speaking). 8/31/21 I had a follow-up telemedicine appointment and was told I should have an in-office EKG done to confirm my heart was ok. 9/1/21 I went to my doctor's office and had the EKG done. My results were normal. My doctor advised me to reduce my activity level and ease back into my prior routine (running, swimming, biking, walking - daily) and I should report what happened to the CDC as I had an adverse event. Over the next few days the pains were decreasing in frequency, the metal taste went away and my heart was not racing as often. My last episode of my heart racing with a concurrent migraine was 9/14/21 and occurred only once that day. As of today, 9/17/21 I feel ok and plan on trying to workout again (at a moderate pace, though).

Other Meds: n/a

Current Illness: n/a

ID: 1708285
Sex: F
Age: 40
State: FL

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

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

Lab Data: CTA Head and cervical, MRI/MRA head and spine.

Allergies: Pineapple seeds

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: On Tuesday 9/14/21, She started complaining of weakness in the lower extremities progressed to difficulty ambulating and heavy feeling in the legs and poor balance. Around 4pm began to have numbness in the bilateral lower extremities, dizziness, headache on the right side of head, and nausea. Disorientated around 5pm with difficulty finding words. 5:30pm drove to valent of the hospital because could not find the ED and asked them to call the emergency room because I could not feel the gas pedal or brakes to drive home and my legs did not function. Once triaged in the ED, struggled to go the bathroom ambulating, then to urinated it was difficult to start the urine stream and inability to empty the bladder. Once brought back to ED room around 7pm where MD evaluate for stroke. Findings were bilateral upper extremity weakness with tremors and LLE weakness was worse than RLE extremity with difficulty. She had to be ambulated with assistance to prevent falls because right was shaking and left leg drag on floor. Admitted to the hospital where a CTA was order and labs. admitted for full neuro work up and PT.

Other Meds: Trazadone, gabapentin, bupropion, Tylenol

Current Illness:

ID: 1708286
Sex: F
Age: 96
State: NY

Vax Date: 09/16/2021
Onset Date: 09/17/2021
Rec V Date: 09/17/2021
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: CMC, BMP

Allergies: no known allergies

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

Symptoms: lethargy, vomiting dark coffee ground emesis with small clots appearing, low grade temps

Other Meds: Namenda 10mg po QD and Donepezil 10mg po at HS, Edoxaban 30mg p QD, Isosorbide mononitrate 15mg po QD, Metoprolol 10mg po QD, Synthroid 125mcg po QD, Senna S one po Q HS

Current Illness: none

ID: 1708287
Sex: F
Age: 58
State: GA

Vax Date: 04/27/2021
Onset Date: 08/22/2021
Rec V Date: 09/17/2021
Hospital: Y

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

Lab Data: 08/23/2021 PCR+ COVID-19 at the hospital.

Allergies:

Symptom List: Nausea

Symptoms: Breakthrough COVID-19 case with symptom onset 8/22/2021: Fever >100.4, Subjective fever (felt feverish), Muscle or body aches, Shortness of breath or difficulty breathing, Fatigue or tiredness, Nausea or vomiting, Diarrhea (>/=3 loose/looser stools in 24 hr period). Hospitalized 8/23/2021-8/25/2021. In the ED patient was noted tachycardia heart rate into 130s and on blood work potassium 3.3, WBC count 15.4 and COVID-19 reported positive. Chest x-ray suggestive of Confluent right upper lobe opacity consistent with pneumonia. A mass cannot be excluded but is considered less likely.

Other Meds:

Current Illness:

ID: 1708288
Sex: F
Age: 21
State: MN

Vax Date: 09/10/2021
Onset Date: 09/14/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: Negative COVID test 9/16/21 Electrolytes and kidney function WNL after rehydration with IV NS

Allergies: Penicillin - anaphylaxis

Symptom List: Injection site pain

Symptoms: nausea & vomiting, fever with chills and night sweats, headache, sore throat, productive cough, stuffy nose, fatigue and loss of appetite. Severe dehydration from inability to keep anything down, including water. I went to the ER after 24hrs of vomiting up any intake, where I received 2L of NS, one dose of Zofran and one dose of Toradol.

Other Meds: Bupropion HCL 150mg QD AM

Current Illness: n/a

ID: 1708289
Sex: M
Age: 39
State: CT

Vax Date: 05/27/2021
Onset Date: 05/29/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: Blood tests, ekg, chest xray

Allergies: None

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

Symptoms: After 2 days from injection I woke with moderate to severe pain began in arms, shoulders, and thighs, as well as a tightness in hands, feet, and chest. The highest point of pain was specifically in the areas of the median cubital vein, having a consistent range of 5/10 to 7/10 pain, and this seems to radiate to shoulders and down to finger tips. Thigh area of pain was in the area of obturator nerve.

Other Meds: None

Current Illness: None

ID: 1708290
Sex: M
Age: 57
State: OH

Vax Date: 05/06/2021
Onset Date: 09/15/2021
Rec V Date: 09/17/2021
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:

Allergies:

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

Symptoms: Patient developed breakthrough COVID-19 requiring hospitalization post-vaccination.

Other Meds:

Current Illness:

ID: 1708291
Sex: F
Age: 37
State: CT

Vax Date: 06/05/2021
Onset Date: 06/06/2021
Rec V Date: 09/17/2021
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 yet

Allergies: Dairy intolerance

Symptom List: Tremor

Symptoms: 1. Have been getting my period every 1.5 weeks since my second dose. Very heavy bleeding and cramping. Has not gotten better. 2. Very bad lower back pain, knee pain, ankle pain, and feet pain and tingling since second dose. Limited range of motion in my legs and constant stiffness and pain. Interferes with daily life. Has not gotten better.

Other Meds: Vitamin B Complex, Birth control pills

Current Illness: NONE

ID: 1708292
Sex: M
Age: 77
State: NC

Vax Date: 02/02/2021
Onset Date: 06/26/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: Throat culture -----Negitive

Allergies: NO

Symptom List: Erythema, Pruritus

Symptoms: Sore Throat and cough, No fever

Other Meds: Hydrochlorthiazide, Metoprolol, Telmisartan, Red Rice Yeast with CoQ10, Allegra, Uloric, Fish OIL, Aspirin`

Current Illness: NO

ID: 1708294
Sex: M
Age: 65
State: KY

Vax Date: 03/04/2021
Onset Date: 09/14/2021
Rec V Date: 09/17/2021
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:

Allergies:

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

Symptoms: Positive COVID Test

Other Meds:

Current Illness:

ID: 1708295
Sex: M
Age: 11
State: PR

Vax Date: 06/28/2021
Onset Date: 06/28/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: UNKNOWN

Allergies: UNKNOWN

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

Symptoms: UNADVERTENTLY VACCINATED BEFORE 12YRS OF AGE.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1708296
Sex: M
Age: 69
State: GA

Vax Date: 02/13/2021
Onset Date: 07/29/2021
Rec V Date: 09/17/2021
Hospital: Y

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

Lab Data: Monoclonal infusion, oxygen, steroids. Sent home with oxygen and steroids.

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: PUI had some pre-existing medical conditions and when tested at hospital he was admitted and given Covid-19 treatment for 5 days. Patient is fully vaccinated.

Other Meds:

Current Illness:

ID: 1708297
Sex: M
Age: 42
State: UT

Vax Date: 08/28/2021
Onset Date: 08/28/2021
Rec V Date: 09/17/2021
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: NA, but several environmental allergies

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

Symptoms: Within the hour of getting the vaccine my throat and lungs began feeling constricted and congested. I feel like i am in a constant asthma attack that advair and albuterol will not help. It has been weeks since the first injection and it has not gotten any better, it hasn't gotten worse either. I have not sought medical attention due to the rise in cases, what i am feeling does seem severe enough to go in, but i feel is directly related.

Other Meds: Levothyroxine, Sumatriptan, Topiramate, Zyrtec

Current Illness:

ID: 1708298
Sex: F
Age: 36
State: NY

Vax Date: 09/13/2021
Onset Date: 09/14/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data:

Allergies: Penicillin allergy

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

Symptoms: Strong menstrual cycle. Hand cramps. Spotting blood after orgasms.

Other Meds: Advil

Current Illness: Na

ID: 1708299
Sex: F
Age: 78
State:

Vax Date: 03/05/2021
Onset Date: 09/16/2021
Rec V Date: 09/17/2021
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: Pain in extremity

Symptoms: hospitalized 9/16 due to ongoing poor oral intake and hyponatremia, SARS-CoV-2 positive 9/16/21 again, originally positive 8/28/21. Had symptoms of COVID weeks to months prior to initial positive test.

Other Meds:

Current Illness:

ID: 1708300
Sex: F
Age: 36
State: OH

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

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

Lab Data: Vitals obtained

Allergies: N/A

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

Symptoms: After ten minutes of monitoring after pfizer dose 1 vaccine patient developed nausea and vomiting. Then several minutes after N/V patient started to get dizzy and tunnel vision. Vitals obtained by this RN and B/P was 158/98 and heart rate was 111. Pt alert and oriented and didn't eat breakfast this morning. Patient reports recent history of high blood pressure and anxiety. Pt continued ongoing s/s and per decision to call EMS. Vitals obtained again before EMS arrival and B/P was 160/101 and heart rate 115. Pt remains alert and oriented during EMS arrival and departure. EMS and patient agreed to go to ER clinic for evaluation. Pt transported to EMS ambulance via wheelchair by EMS staff.

Other Meds: N/A

Current Illness:

ID: 1708301
Sex: F
Age: 16
State: NC

Vax Date: 09/17/2021
Onset Date: 09/17/2021
Rec V Date: 09/17/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: ADMINISTERED MODERNA VACCINE TO A 16 YEAR OLD. THIS SHOULD BE FILED UNDER OFF-LABEL USE PER CDC, IF SOMEONE 16 OR 17 YEARS OLD IS GIVEN MODERNA.

Other Meds:

Current Illness:

ID: 1708302
Sex: F
Age: 65
State: NY

Vax Date: 03/14/2021
Onset Date: 06/29/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: treated with 2 shots in left eye of Lucentis on July 26 and August 31, 2021, third shot in October Vein in eye went up through lattice and bled

Allergies: Latex, hemorrhoid cream

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

Symptoms: Eye bleed in June, interference with vision, left eye , on-going issue at this time

Other Meds: Levothyroxin, Omeprezol, Travaprost, Combigan, Vitamin D, Vitamin B complex,

Current Illness: None

ID: 1708303
Sex: F
Age: 27
State:

Vax Date: 09/16/2021
Onset Date: 09/17/2021
Rec V Date: 09/17/2021
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: Gluten

Symptom List: Vomiting

Symptoms: Pt with constant tingling and heaviness into the arm she received the injection 12-16 hours post injection and continued symptoms at time of appointment

Other Meds:

Current Illness: None

ID: 1708304
Sex: M
Age: 58
State: GA

Vax Date: 03/30/2021
Onset Date: 08/24/2021
Rec V Date: 09/17/2021
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: 08/25/2021 PCR+ COVID-19 test; 09/02/2021 PCR+ COVID-19 test; 09/09/2021 PCR+ COVID-19 test

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Breakthrough COVID-19 case with symptom onset 8/24/2021: Fever >100.4, Muscle or body aches, New loss of taste or smell, Runny nose/Congestion, Sore throat, Cough (new onset or worsening of chronic cough), Shortness of breath or difficulty breathing, Chest pain, Fatigue or tiredness, Nausea or vomiting, Loss of appetite, extreme chest tightening. Hospitalization. Admitted for dehydration and lack of appetite. Went to hospital on 9/1 but not admitted until 9/2. They did a heart catherization because they thought he had blockages based on an EKG on 9/3.

Other Meds:

Current Illness:

ID: 1708305
Sex: F
Age: 55
State: NY

Vax Date: 08/18/2021
Onset Date: 08/18/2021
Rec V Date: 09/17/2021
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: I went to the doctor the very next day and the nurse practitioner preformed an EKG which showed nothing. I was scheduled to get the second shot this past Wednesday but the pharmacist refused stating I needed clearance from a doctor to get the vaccine after the experience I had. I am going back to the doctor this morning to have another more test as I can't get into see a cardiologist until February of 2022.

Allergies: food allergies and pet allergies. (rabbits). I break out in hives.

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

Symptoms: First, site of injection in my left arm started to twitch, muscle spasm. Then my heart started to have palpitations then it started to feel like it was on fire with pain intensifying through my body to my back. My tongue felt like it had pins and needles in it like when you eat pineapple. A few days later my fingers and toes went numb for a day then exactly two weeks later on 9/01/21 the injection site in my left arm became inflamed and blew up and was hot to the touch resembling an allergic reaction to a bee sting. To this day I still feel pain in my heart with radiating pain to my back. I went to the doctor the very next day and the nurse practitioner preformed an EKG which showed nothing. I was scheduled to get the second shot this past Wednesday but the pharmacist refused stating I needed clearance from a doctor to get the vaccine after the experience I had. The nurse practitioner felt it was just heart burn and prescribed me Nexium which I took for over a month now and has done nothing.

Other Meds: None

Current Illness: None

ID: 1708306
Sex: F
Age: 44
State: UT

Vax Date: 04/15/2021
Onset Date: 04/26/2021
Rec V Date: 09/17/2021
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: Only allergies is animals and seasonal hay

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Shingles on the left side of the abdomen, burning at touch, blister around the bellybutton and side of the abdomen. Burning last for a entire month. Anti-Viral and steroids used as treatment. On June 17th lost sense of smell and taste.

Other Meds: Antihistamine, Magnesium, vitamin B6, E, D3, C, omega 3, Vitex, Cranberry,

Current Illness:

ID: 1708307
Sex: F
Age: 22
State: NM

Vax Date: 09/13/2021
Onset Date: 09/15/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: Vaccine was given at a pharmacy not in the patients primary care providers office.

Allergies: Blueberries

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

Symptoms: Severe rash on the arms, back, upper chest, and feet

Other Meds:

Current Illness:

ID: 1708308
Sex: F
Age: 11
State: PR

Vax Date: 06/17/2021
Onset Date: 06/17/2021
Rec V Date: 09/17/2021
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: Inadvertently vaccinated before 12 yrs of age.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am