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: 1708988
Sex: M
Age: 61
State: OR

Vax Date: 03/31/2021
Onset Date: 07/06/2021
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: none

Allergies: NKA

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient had previously received the Janssen (J&J) vaccine on 3/31/2021. This violates the guidelines for both vaccine parameters.

Other Meds: coumadin, zyloprim

Current Illness: none

ID: 1708989
Sex: F
Age: 64
State: KS

Vax Date: 04/01/2021
Onset Date: 04/01/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: Vitals taken BP 140/84 P 74 02 98%

Allergies: N/A

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient tripped leaving the facility.

Other Meds: N/A

Current Illness: None listed

ID: 1708990
Sex: M
Age: 51
State: CA

Vax Date: 04/15/2021
Onset Date: 07/05/2021
Rec V Date: 09/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: I've had an MRI and EMG so far, as well as having seen spinal and Neurology Specialists. I don't have the specific dates for all the doctor and hospital visits.

Allergies:

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

Symptoms: Parsonage-Turner Syndrome in right shoulder. Severe pain in shoulder, neck, and upper arm. Nerves in right shoulder not firing - feels paralyzed. Weakness extends into arm and hand. Still determining treatment options. Pain has decreased to a manageable level as of today, but no improvement in nerves.

Other Meds:

Current Illness:

ID: 1708991
Sex: F
Age: 30
State: ID

Vax Date: 08/30/2021
Onset Date: 08/30/2021
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: Apricots, kiwi, peach, most pitted fruits, regular seasonal allergies

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Adverse: Right arm musculoskeletal cold feeling in joints and bones. Lasted about 48 hrs from time of vaccination. Typical: pain at injection site for 2 days, starting 24 hrs after injection.

Other Meds: None

Current Illness: None

ID: 1708992
Sex: F
Age: 53
State: NC

Vax Date: 08/24/2021
Onset Date: 08/24/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient states a few hours after vaccine her eyes began burning and really red and feeling like she had been crying for hours. Her eyes remained red, burning, extremely sensitive to light, and painful for about 18 hours.

Other Meds:

Current Illness:

ID: 1708993
Sex: M
Age: 78
State: ID

Vax Date: 09/15/2021
Onset Date: 09/17/2021
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: no

Allergies: sulfa, ether, lobster, codine, bee stings

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

Symptoms: Teeth ached starting 40 hours after vaccination. Rates pain 6 of 10. Not aching at this moment. Lasted throughout the night. Did not take any pain relief medications. C/O some tightness in chest which is regular for him. Encouraged to see MD and he stated he has had this before and was not concerned.

Other Meds: synthroid, HCTZ, asa, d3 vitamin, vegetable laxative, econasia, statin, tamalosin, nifitapin, MTV

Current Illness: no

ID: 1708994
Sex: F
Age: 59
State: PA

Vax Date: 08/26/2021
Onset Date: 09/10/2021
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: elevated protein on lumbar puncture Given IVIG

Allergies: ibuprofen, meloxicam, atenolol

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: diplopia, lower extremity weakness and numbness, decreased reflexes, urinary retention/hesitancy

Other Meds: calcium, MVI, lisinopril 20mg, carvedilol 6.25mg bid, citalopram 20mg qd

Current Illness: none

ID: 1708995
Sex: M
Age: 33
State: NY

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

Lab Data: None to report.

Allergies: None

Symptom List: Pharyngeal swelling

Symptoms: Patient reported light-headedness, fatigue, and racing heart rate 10 minutes after receiving his first dose of the Pfizer vaccine. Patient was advised to sit on the ground in the event that were to lose consciousness. This reporter attempted to check the patient's heart rate while an ambulance was contacted, but the patient's heart rate was hard to track as it was beating very repidly and seemed irregular. The ambulance arrived with 5 minutes of being contacted, and the patient was monitored and removed from the pharmacy. The patient never lost consciousness and was able to communicate the entire time, but he did state repeatedly that he felt as if he were going to pass out. Vaccine administered at 2:26, Patient reported symptoms to the pharmacy at 2:36. Ambulance arrives at 2:43, then Patient leaves in ambulance at 2:50.

Other Meds: None

Current Illness: None

ID: 1708996
Sex: M
Age: 17
State: WA

Vax Date: 07/07/2021
Onset Date: 07/10/2021
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:

Allergies: None

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: After 3 days of Pfizer-BioNTech, my son started to experience chest pain with every heart beat. He did not want to get this vaccination to begin with but did so in order to cross into the border to see his grandma. He felt like his chest near his heart was constricted and he reported an irregular heartbeat. I asked him if he wanted to go to the hospital but he said no due to his fear of more needles. This pain and restriction lasted for approximately 24 hrs. He is otherwise completely healthy.

Other Meds: None

Current Illness: None

ID: 1708997
Sex: F
Age: 34
State: AZ

Vax Date: 08/13/2021
Onset Date: 08/16/2021
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: 8/23: blood work, urine test and CT scan - clear 8/24: blood work & urine test - clear 8/30: urine test - blood found 9/1: CT scan - clear 9/3: ultrasound - awaiting results 9/13: MRI - awaiting results

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: 8/16: Mild pain began in lower left abdomen. 8/23: pain increased to a pain scale 9, went to the ER. Blood test, urine test and CT scan, nothing showed up of concern. Given pain medication and sent home. 8/24: visited primary care doctor, he didn't know what it was either so treated it as diverticulitis and given antibiotics. 8/30: pain continues - doctor now thinks it's a kidney stone - ordered a second CT scan - found nothing - ordered an ultrasound - left ovary seems larger and uterus appears bulky - refereed to OBGYN. 8/31: menstrual cycle begins, very heavy flow but pain finally goes away - OBGYN believes I had a ruptured ovarian cyst, hydrosalpinx in my fallopian tube and possibly have endometriosis - given antibiotics and instructed to begin birth control during next menstrual cycle. 9/16: light menstrual bleeding

Other Meds:

Current Illness:

ID: 1708998
Sex: F
Age: 28
State: PA

Vax Date: 08/18/2021
Onset Date: 09/08/2021
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: NA

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

Symptoms: Extreme cramps, tingling in feet + hands, cold sweats, clammy, spots in vision, nearly fainted

Other Meds: Acidophilus, vitamin D, astragalus, biotin

Current Illness: NA

ID: 1708999
Sex: F
Age: 45
State: MS

Vax Date: 08/13/2021
Onset Date: 08/13/2021
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: None

Allergies: Eggs, Sulfa drugs, Cipro, Codiene,

Symptom List: Rash, Urticaria

Symptoms: 20 minutes after receiving vaccine broke out in hives all over body. Had shortness of breath took 2 Benadryl and used Albuterol inhaler. Hives went away a couple hours later. Approximately 28 hours later began having another allergic reaction. Hives, shortness of breath, swelling of lips and throat. Used Benadryl, Zyrtec, Flonase, Pepcid, and Albuterol inhalor. Did not use my epi pen so did not go to the ER. After about 30 minutes swelling went down and breathing became easier.

Other Meds: Benadryl Zyrtec

Current Illness:

ID: 1709000
Sex: M
Age: 30
State: NC

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

Allergies: None on file

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

Symptoms: Moderna was received from deep freezer on 8/6/21. Was placed in Student Health refrigerator on 8/6/21. 30 day expiration date was 9/5/21. Moderna was left in Student Health refrigerator and used until 9/13/21. On 9/14/21 we realized we were beyond the 30 days and immediately notified the Pharmacy for direction. The Pharmacists are in communication with Moderna to see if the doses are considered valid or invalid. Risk Management is involved to decide on the best course of action and if we notify the patient before we hear back from Moderna.

Other Meds: None on file

Current Illness: None on file

ID: 1709001
Sex: F
Age: 49
State: OH

Vax Date: 08/17/2021
Onset Date: 08/17/2021
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: PCN, Keflex, Bactrim, Sulfa

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

Symptoms: My Left arm has been hurting ever since, I can Not reach my arm up very high with out EXTREME PAIN and can NOT reach behind me . ITS HORRIBLE PAIN , ever since i got my 3rd MODERNA shot.

Other Meds: Klonopin, Adipex, Ozempic, Stelara, Trazadone, Atenelol, Headache Med, Depression Med

Current Illness:

ID: 1709002
Sex: F
Age: 24
State: KS

Vax Date: 04/06/2021
Onset Date: 04/06/2021
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: BP 130/70 HR 63 O2 99% BS 109 follow up vitals BP 109/64 O2 97%

Allergies: NKDA

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

Symptoms: Pt received Covid vaccine and immediately felt light headed. Was immediately rigid in chair. Pt was lowered to the ground by staff. Pt was breathing regularly by this time. Pt transferred to wheelchair and wheeled to EMS room. Pt stiffened and had a second seizure-like episode. Pt was transferred to bed in EMS room and placed in recovery position on left side. Pt was able to verbalize and was alert and oriented x3. EMT arrived and took blood sugar 109. Vitals continued to be stable. Report given to EMS and pt transferred to Hospital via EMS

Other Meds: none

Current Illness: None

ID: 1709003
Sex: F
Age: 22
State: OH

Vax Date: 09/12/2021
Onset Date: 09/13/2021
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:

Allergies: N/A

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

Symptoms: On 13Sep I started having troubles breathing- getting winded doing simple tasks. I am still having this symptom today 17Sep. Also on 13Sep I started having itchiness on and around the injection sight. This symptom is still ongoing. On 17Sep I woke up with a rash around the injection sight. The rash started at quarter size and is now about the size of a softball. Treatment has been a cold compress for five minutes to try and alleviate the itch and rash from spreading. Results of the treatment has lessened the irritation of the rash.

Other Meds: N/A

Current Illness: N/A

ID: 1709004
Sex: F
Age: 57
State: ID

Vax Date: 09/17/2021
Onset Date: 09/17/2021
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: 9/17 at approximately 1300 administered Benadryl 50 mg. IM Right Glute.

Allergies: Eyhrromycin

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

Symptoms: Within 8 mins I got short of breath felt dizzy, tunnel vision, then tongue and throat started feeling full of swollen. HR was 115, respiration?s 28, B/P 169/72 02 sats 99% initially but dropped to 94%.

Other Meds: Methotrexate, trazodone, celebrex, citalopram, folic acid, prampixole, Vit. C, Vit D Zinc, Niacin , magnesium, Omwga 3/Flax/fish oil

Current Illness: No illness

ID: 1709006
Sex: F
Age: 66
State: WV

Vax Date: 03/20/2021
Onset Date: 03/20/2021
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: yes

Allergies: dairy products

Symptom List: Ear pain, Hypoaesthesia

Symptoms: severe fatigue, 2months later had a severe pain and 4 months later pain became worse almost bedridden

Other Meds: remarin, multi vit, fish oil, vit d, vit c, calcium

Current Illness: inflammation/fibromyalgia

ID: 1709007
Sex: M
Age: 30
State: MI

Vax Date: 08/25/2021
Onset Date: 09/13/2021
Rec V Date: 09/17/2021
Hospital:

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: NONE

Other Meds: 1. There were NO REPORTED ADVERSE EVENT. 2. Vaccine was administered at 2 days past the UPDATED EXPIRY of 08/23/21 though still within vaccine PACKAGE EXPIRY date of 08/31/21. 3. Only filing as a VACCINE ADMINISTRATION ERROR report

Current Illness:

ID: 1709008
Sex: M
Age: 54
State: FL

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

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

Lab Data: Blood pressure taken : 178/96 mmHg

Allergies: No known allergies

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

Symptoms: Patient reported a tingling sensation down his left arm approximately 10 minutes after receiving his second Moderna vaccine. He then went on to experience a spike in blood pressure accompanied by headache and blurred vision in his right eye. He took an extra dose of each of his blood pressure medications (Amlodipine 5mg and Valsartan Hctz 160-25mg). Soon after his symptoms began to resolve and he left the store. We advised him to follow up with his doctor regarding the high blood pressure event and blurred vision.

Other Meds: Amlodipine 5mg once daily Valsartan-Hctz 160-25mg once daily Metformin ER 500mg (2 tablets twice daily) Duloxetine 60mg once daily Atorvastatin 10mg once daily Glimepiride 4mg twice daily

Current Illness: None

ID: 1709009
Sex: F
Age: 66
State: PA

Vax Date: 05/19/2021
Onset Date: 05/21/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data:

Allergies: Yes

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

Symptoms: Two days after receiving the vaccine I began to feel physical sick. I had a fever chills my glands under my ears became swollen the size of Jack balls and extremely painful. I developed horrible pains in my stomach with diarrhea. I had a headache with brain fog and confusion. The most frightening was an inability to stay awake. I wasn't fatigue...it was the feeling you'd get from a post op drug or opiate. I couldn't stay woke. My joints aches and I had no appetite. I felt like I was very very sick. I believe if I took the second shot it would kill me. I called my Dr of course and had a virtual visit. He said he thought the side effects would pass ...to take Tylenol for pain...etc etc. These side effect lasted three plus weeks. I feel that I am still not 100% myself. After the third week I physically saw my Dr. Informed him that I was still having problems. And could only treat the symptoms. Im sorry I took the vax and wish I could turn back time.

Other Meds: Pepcid Max Loratodine Amlodopine

Current Illness: Hypertension Diverticulosis Allergies Asthma

ID: 1709010
Sex: F
Age: 41
State: KS

Vax Date: 04/15/2021
Onset Date: 04/15/2021
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: LA

Lab Data:

Allergies: NKA

Symptom List: Unevaluable event

Symptoms: Patient experienced a panic attack, patient is autistic, and it turned into a silent seizure from being overstimulated. Patient was taken to EMS room to lay down and calm. Patient given water and is able to sit back up after 15 minutes and carry on a short conversation with mom at bedside.

Other Meds: None listed

Current Illness: None listed

ID: 1709011
Sex: F
Age: 53
State: GA

Vax Date: 06/15/2021
Onset Date: 06/15/2021
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: Will know on 9/22/21

Allergies: Tramadol, Penicillin

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

Symptoms: I noticed hours later as my left arm was tight? it was swollen from the injection site up to my shoulder and down to my wrist, my left breast was enlarged with a rash under neath, my left leg enlarged down to my calf. My back and entire body was itching. I had hives on my left arm up to my shoulder. I have photos and showed to several nurses who objected to giving me a 2nd dose due to the severe reaction. An Infectious Disease Physician stated I will need to be hospitalized to get a 2nd vaccine. My employer requested medical clearance but it was DENIED. I am still seeking medical attention - covid test and antibody test .

Other Meds: Tylenol

Current Illness: Sinus headaches

ID: 1709012
Sex: F
Age: 45
State: CA

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: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: none. event self resolved.

Allergies: Erythromycin, Milk, Minocycline

Symptom List: Injection site pain, Pain

Symptoms: From her email: " Yesterday, my sons and I had our 2nd dose of the covid vaccine. I had Moderna and expected the sore arm and headache that I got however at some point during the night I got up to use the bathroom and remember feeling like everything was spinning and the next thing I knew, my husband was crouched over me asking what was wrong (he was pretty panicked). I was laying across our bathroom floor and had zero recollection of how I got there. I had serious difficulty getting up and couldn't talk. He later said my blood pressure was normal. I wouldn't imagine this is a normal reaction to a vaccine. "

Other Meds: none

Current Illness: none

ID: 1709013
Sex: F
Age: 54
State: NY

Vax Date: 08/25/2021
Onset Date: 09/04/2021
Rec V Date: 09/17/2021
Hospital: Y

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

Lab Data: left heart catherization, CT angiogram pulmonary artery on 9/7/2021

Allergies: No known drug allergy

Symptom List: Injection site pain, Menorrhagia

Symptoms: Back pain, palpitations and diagnosed with mild myocraditis.

Other Meds: Rosuvastatin

Current Illness: Obesity Hyperlipidemia

ID: 1709014
Sex: F
Age: 29
State:

Vax Date: 08/17/2021
Onset Date: 08/19/2021
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: CBC to check for anemia. ENT visit to check for ear issues. Scheduled for MRI 9/24. Scheduled for neurologist 12/1.

Allergies: Contrast dye; penicillin

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

Symptoms: Dizziness. Unsteadiness, not spinning. Constant whenever on my feet or walking. Not while sitting

Other Meds: Labatelol 50mg, twice daily; daily multivitamin

Current Illness: Pre-eclampsia at the end of pregnancy; hypertension continued & controlled by medications postpartum for 3 months

ID: 1709015
Sex: F
Age: 40
State: KS

Vax Date: 04/06/2021
Onset Date: 04/06/2021
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: 50mg Benadryl given at 1800 by mouth

Allergies: Codeine

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Pt c/o feeling anxious. Clammy and tightening in throat.

Other Meds: Synthroid, PO Benedryl Liothrothylamine

Current Illness:

ID: 1709016
Sex: F
Age: 79
State: MI

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

Allergies: BandaidsRash Sulfa Drugs Tramadol Vicodin [Hydrocodone-acetaminophen]Other

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Hospitalized (9.12.21); COVID-19 positive (9.9.21); fully vaccinated History of Present Illness Patient is a 79 y.o. female with a PMHx of DM2, HTN, who presents to hospital with shortness of breath. The patient states that about a week ago she started having some sore throat and fevers and chills. Patient reports some body aches. About 3-4 days after that she started having some cough and shortness of breath. Patient went to get tested for COVID and her test was positive. It took about 3 days for her test results to come back, and by the time she got her test results she was having significant shortness of breath, continued fevers, and severe cough. Patient denies any sick contacts, does not know where she contracted COVID from. Patient denies any vomiting, but has had some diarrhea. Her appetite has been poor. Patient states she has had fever every single day at home. Patient states that given her positive test and her worsening trouble breathing, she came to the ER for evaluation. Patient is fully vaccinated. In the ER the patient was found to be tachypneic, weak, and hypoxic. Chest x-ray was performed and showed bilateral diffuse infiltrate of disease consistent with COVID-19 pneumonia. Patient was placed on high-flow nasal cannula with improvement in her overall work of breathing. Given her significant hypoxic respiratory failure the patient was admitted the hospital for further treatment. Assessment and Plan Acute hypoxic respiratory failure secondary to COVID-19 pneumonia -on HFNC 50% FiO2 -Symptom started on 9/5, day 7 of illness -Hypoxic -received decadron day 1/10 in the ER -remdesivir day 1/5 -would meet criteria for Tociluzumab, but not available -No MAB therapy -patient did receive Moderna x2 back in March/April -VItamin D 10,000 units now - vitamin C 1.5g TID -zinc -wean O2 as able Notes from 9.17.21: Chief complaint Pneumonia due to COVID-19 virus Subjective 08:30 a.m. Patient seen and examined. Patient states she is feeling a lot better today on the nasal canula. Says her shortness of breath seems to be greatly improving.

Other Meds: Outpatient Medications acetaminophen (TYLENOL) 500 MG tablet acyclovir (ZOVIRAX) 200 MG capsule amlodipine (NORVASC) 2.5 MG tablet ascorbic acid (VITAMIN C) 500 MG tablet aspirin 81 MG tablet Biotin (BIOTIN MAXIMUM STRENGTH) 10 MG TABS Calc

Current Illness: 9.9.21: called office to report symptoms (Patient is calling office to report that she is having a cough, runny nose, and fatigue x 1 week that is not going away. ) COVID-19 positive 9.9.21

ID: 1709017
Sex: F
Age: 30
State: NC

Vax Date: 09/10/2021
Onset Date: 09/13/2021
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: N/A

Allergies: Penicillin

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

Symptoms: I have been experiencing joint pain and stiffness within my fingers and wrists. I have experienced intermittent pains (feels like extreme cramping, stiffness of my fingers and joint fullness) within the majority of my DIP, PIP, MCP joints and wrists BILATERALLY. Most prominently in my left hand in the 2nd digit at the PIP joint as well as the 4th digit at the MCP joint. It's uncomfortable to make fists with my left and right hands (feels stiff and painful). It's been challenging to do my job for the last week; I am an x-ray technologist and use my hands ALL day long. I have NEVER experienced anything like this before. I've never had joint pains or issues with my joints in the past, not anywhere on my body. The only thing that has changed in my life since these symptoms have started is the fact that I got the COVID vaccine.

Other Meds: Pristiq (antidepressant/anti-anxiety)

Current Illness: N/A

ID: 1709018
Sex: F
Age: 41
State: NC

Vax Date: 09/08/2021
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:

Allergies: Aspirin, Bactrim, Penicillin

Symptom List: Nausea

Symptoms: Cellulitis to left upper arm, same location as COVID vaccine arm, left arm swelling and redness

Other Meds: None

Current Illness: None

ID: 1709019
Sex: M
Age: 26
State: NC

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

Allergies: None on file

Symptom List: Injection site pain

Symptoms: Moderna was received from deep freezer on 8/6/21. Was placed in refrigerator on 8/6/21. 30 day expiration date was 9/5/21. Moderna was left in refrigerator and used until 9/13/21. On 9/14/21 we realized we were beyond the 30 days and immediately notified the Pharmacy for direction. The Pharmacists are in communication with Moderna to see if the doses are considered valid or invalid. Risk Management is involved to decide on the best course of action and if we notify the patient before we hear back from Moderna.

Other Meds: None on file

Current Illness: None on file

ID: 1709020
Sex: F
Age: 72
State: IL

Vax Date: 08/05/2021
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: none

Allergies: none

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

Symptoms: patient had immediate right sided back/sciatica pain

Other Meds: fosamax, losartan, norvasc, hctz, metformin

Current Illness: none

ID: 1709021
Sex: F
Age: 73
State: MN

Vax Date: 03/16/2021
Onset Date: 07/29/2021
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: RA

Lab Data: covid test; negative

Allergies: Idapril, Elovil and Advane

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

Symptoms: On 07-29-2021; I had low grade fever but it continued for ten days and at the beginning I felt very tired. I would say ice cream tasted sweeter than normal. I went to see a different doctor on 09-14-2021 and he said it was probably virous. On 08-05-2021; I took a covid test and it was negative. I was also in for a routine physical exam, blood test indicated that my fetal hemoglobin. I went to see a new doctor on 08-26-2021 because my doctor left. I experienced tiredness, no appetite, low energy. I did have a flare up of gout this happened on 08-14-2021 and I was given medication for the gout. My symptoms eventually went away, I have recovered from the virus. I do not know if the virus was caused by the vaccine.

Other Meds: Triamterene/ Hydrochlorothiazide 35.5/25mg, Potassium Chloride 10Q tabs, Simvastatin 40mg, Lisinopril 5mg, Calcium supplements 600mg with vitamin D3, Hair skin and nails OTC 2 tablets a day, stool softener 2 of those a day

Current Illness: None

ID: 1709022
Sex: F
Age: 7
State: MN

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: Tremor

Symptoms: AFTER INJECTING IN PATIENTS RIGHT DELTOID AREA TH FIRST INFLUENZA INJECTION -(NEEDLE FROM LOT#4155460) MALFUNCTIONED & ALL INFLUENZA LIQUID SPIRTED OUT AT THE NEEDLE/SYRINGE HUB. SO PATIENT WAS INJECTED A 2ND TIME WHICH WAS UNEVENTFUL & THE FULL DOSE WAS GIVEN. NO PROBLEMS WITH SKIN INTREGRITY NOTED A BOTH INJECTION SITES.

Other Meds:

Current Illness:

ID: 1709023
Sex: F
Age: 57
State: PA

Vax Date: 09/10/2021
Onset Date: 09/10/2021
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:

Allergies: PENCILLIN; SULFA

Symptom List: Erythema, Pruritus

Symptoms: 1. LEFT ARM NUMB FROM THE SHOULDER TO FINGER TIPS STARTING 9/10/2021 AND STILL CONTINUES. 2. NAUSEA FROM 9/10/2021 UNTIL 9/14/2021. 3. DIARREA FROM 9/11/201 AND STILL CONTINUES. 4. EXTREME TIREDNESS FROM 9/10/2021. SLEPT OVER 20 HOURS EACH DAY FOR 3 DAYS. STILL EXTREMELY TIRED. 5. VERTIGO STARTED 9/17/2021 WHEN I GOT UP IN THE MORNING AND STILL CONTINUES.

Other Meds:

Current Illness: NONE

ID: 1709024
Sex: M
Age: 53
State: FL

Vax Date: 08/30/2021
Onset Date: 08/30/2021
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: Dr. Office visit pending.

Allergies: None known at this time.

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

Symptoms: Approximately 21 minutes after i received the vaccination I began having "adrenaline dumps" my my heart started pounding, and rapid. breathing. I initially thought i was going to die right there in my car. I tried to go to the emergency room but there accident at the the intersection to the hospital and it was closed. They rerouted traffic and i returned to the health department. I asked to speak with the nurse and told them i was having a really bad reaction to the vaccine. They brought me to the back. Checked my blood pressure and pulse. BP was 189/117 and pulse 135 to 140. I continued to have these events for the next 6 days. My pulse finally dropped to 95 and i told them i will try to get home. On the way, i stopped by the pharmacy and told the pharmacist i was having a very bad reaction to the vaccine. He suggested i try some Benadryl and if that didn't work to go to the emergency room. I purchased some Benadryl, made it home and started taking the Benadryl. It seemed stopped the reaction. i was okay through the night until about 3:00 AM when the Benadryl started wearing off and the "adrenal dumps" started. More Benadryl helped to ease this. The following i went to the Urgent Care and explained to them what happened. She prescribed Vistoril which seemed to just knock me out. I continued with the Benadryl until the symptoms finally subsided the following Monday. No terribly bad reactions since. Also, my hands would itch bad and really bother me. The Benadryl helped with that as well. I really wish now i would gone on to the emergency room but i did not want to be around all the folks that have COVIC. I have also reported this even to Moderna.

Other Meds: No prescription. Daily vitamin.

Current Illness: None.

ID: 1709025
Sex: F
Age: 25
State: CA

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

Lab Data:

Allergies: N/A

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

Symptoms: During 15 minute post-vaccine observation, patient reported numbness in the left arm that radiated to the back. After 10 additional minutes, patient described the sensation as a burning, tingling sensation that could be felt in her arm and back. Temperature of affected areas did not differ from remainder of body. Pharmacy staff called 3 hours later. Patient reported that pain/tingling resolved with one dose of Acetaminophen.

Other Meds: N/A

Current Illness:

ID: 1709026
Sex: M
Age: 44
State: CA

Vax Date: 06/03/2021
Onset Date: 06/10/2021
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: Nonw

Allergies: unknown

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: On 9/17/21 client came in to vaccine site and complained that his right arm hurts at the vaccination site intermittently, several times a week, especially at the end of the day when driving. He also states that beginning about a week after the vaccination that he has 4-5 dizzy spells a week. He said that he did not have any of these symptoms before he was vaccinated.

Other Meds: unknown

Current Illness: denies symptoms before the vaccination

ID: 1709027
Sex: F
Age: 50
State: CA

Vax Date: 04/23/2021
Onset Date: 04/27/2021
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: CT scan and was diagnosed with vertigo . Unable to return to work

Allergies: no

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

Symptoms: After 4 days very dizzy . Extreme nausea.

Other Meds: no

Current Illness: no

ID: 1709028
Sex: F
Age: 57
State: ID

Vax Date: 03/05/2021
Onset Date: 03/06/2021
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: X-ray: I do not have the results yet Covid test- positive

Allergies: Latex, metal

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

Symptoms: When I got my first shot I felt like I was having Covid all over again. I got the same symptoms I had when I got Covid on December 8th. My taste got better. I could smell from miles away. Everything hurt. Every injury I had before started hurting. It went to my bowels. I have not had hemorrhoids since I had my baby at 40 years old. Now I do. Now it feels like I am on my period every year because it makes me bleed. This time it feels like it is going to my lungs. It is also attacking my heart. It is attacking every old injury it had. My doctor suggested me to take an x-ray because my ribs were hurting on the left side. I don?t know if I had pull a muscle. I got the booster last week but it started hurting before that. I had the x-ray but I do not have the results back yet. I also got a Covid test and influenza test. I got Covid. I am working at a high school and there is no safety guidelines there.

Other Meds: Opioids and vitamins

Current Illness: None

ID: 1709029
Sex: F
Age: 62
State: KS

Vax Date: 04/15/2021
Onset Date: 04/15/2021
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: LA

Lab Data: N/A

Allergies: Sulfa IV Contrast dye

Symptom List: Pain in extremity

Symptoms: Patient was brought to EMS room due to stating history of dizziness with first covid vaccine, as well as shakiness and anxiety. At 1627 c/o shakiness and mild dizziness. 1700 states patient states she feels much better, sat on cot w/o dizziness, stood and tolerated well.

Other Meds: Protonix 40 mg Flonase APAP 500mg bid

Current Illness: None listed

ID: 1709031
Sex: M
Age: 54
State: SC

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:

Allergies:

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

Symptoms: Approximately 15 minutes after my 2nd covid 19 moderne vaccine the right side of my head developed a numb feeling and my right ear began ringing non stop.

Other Meds:

Current Illness:

ID: 1709032
Sex: M
Age: 80
State: IA

Vax Date: 09/07/2021
Onset Date: 09/11/2021
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: 0948 EKG 12-lead 1011 Aspirin 324 mg 1022 Comprehensive metabolic panel Magnesium CBC and differential Whole Blood Lactic Acid Troponin I 1027 CT Head or Brain wo Contrast 1043 Sodium Chloride 70 mL Iohexol 60 mL 1059 XR Chest 1 View 1100 CT Angiography Head Neck w wo Contrast 1101 Urinalysis with Reflex Testing 1136 Clopidogrel Bisulfate 300 mg 1155 Placed in Observation Transferred to MedSurg 1209 Respiratory Filmarray Panel, With SARS-CoV-2 09/16 1013 EKG VIEW RHYTHM STRIP

Allergies: Morphine Sulfate Nausea And Vomiting High Allergy 3/4/2020 Past Updates... Neosporin [Neomycin-bacitracin Zn-polymyx] Hives High Allergy 8/21/2017 Past Updates... Latex Rash Low Allergy 1/30/2015 Past Updates... IF LEFT ON TOO LONG Adverse Reactions/Drug Intolerances Ambien [Zolpidem Tartrate] Nausea Only, Myalgia/Myopathy High Side Effect 3/20/2015 Past Updates... Nausea and leg aching Other Hives High Side Effect 3/20/2015 Past Updates... Imuran [Azathioprine] Nausea And Vomiting Medium Intolerance 8/21/2017 Past Updates... Morphine Nausea And Vomiting Medium Side Effect 9/3/2012 Past Updates... Morphine Sulfate Nausea And Vomiting Medium Intolerance 7/13/2021 Past Updates... Hydrochlorothiazide Other (See Comments) Not Specified Intolerance 9/4/2012 Past Updates... UNSURE Per Dr. Lipitor [Atorvastatin] Other (See Comments) Not Specified Intolerance 2/24/2017 Past Updates... Myalgia's Hytrin [Terazosin] Dizziness Low Intolerance 12/14/2014 Past Updates... Hytrin [Terazosin Hcl] Dizziness Low Side Effect 9/4/2012 Past Updates... Deletion Reason: Erroneus Entry

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

Symptoms: presented to ED on 9/11/2021 with complaints of right upper extremity weakness and discoordination. The patient stated he awoke this morning and noticed paresthesias of his right arm, had a tingling sensation from his right shoulder down into his fourth fingers excluding his thumb and when he attempted to hold his comb he was unable to coordinate his grip and was also unable to hold a fork to eat his breakfast. He denied any headache/dizziness/change in vision, no facial droop or dysarthria. This morning, he noticed paresthesias of his right arm and incoordination. Patient states that he has tingling from his shoulder down into his 4 fingers excluding his thumb and when attempting to hold his comb he could not angle his comb correctly to comb his hair. Similarly he had difficulty with his toothbrush and not being able to "get it to do what I want". No headache. No fever chills. He has not been ill as of late.

Other Meds: Alendronate Sodium 70 mg Oral EVERY 14 DAYS, Takes one every other Saturday. Aspirin 81 mg Oral DAILY Coenzyme Q10 150 mg Oral DAILY Cyclobenzaprine HCl 10 mg Oral 3 TIMES DAILY PRN Eszopiclone 3 MG TAKE 1 TABLET BY MOUTH DAILY AT BEDTI

Current Illness: ? CAD (coronary artery disease) ? Cancer 2003 skin CA - nose ? Chronic anticoagulation 1-30-15 Plavix & baby aspirin for anticoagulation because he has 2 cardiac stents that were placed in 12/2014. ? Diverticulosis of large intestine 08/08/2018 ? H/O idiopathic urticaria ? Hyperlipidemia ? Hypertension ? Immune deficiency disorder ? Lupus ? Myocardial infarction 2013 ? Non-functioning gallbladder 1-30-15 ? Osteoporosis ? Pericardial effusion ? Status post colonoscopy with polypectomy 08/08/2018 ? Thyroid disease

ID: 1709033
Sex: M
Age: 32
State: AZ

Vax Date: 09/12/2021
Onset Date: 09/15/2021
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:

Allergies:

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

Symptoms: Day 1 - Fever above 101 for 4 hours. Strong headache. Day 3 to day 5 - Vertigo, dizziness, motion sickness.

Other Meds:

Current Illness:

ID: 1709034
Sex: F
Age: 15
State: GA

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

Allergies: NKDA

Symptom List: Vomiting

Symptoms: Moderna not indicated for Pt's age. RN administered vaccine. Pt denies any symptoms and will be given 2nd dose per CDC and Manufacturer guidelines for her age.

Other Meds: Adderall XR, Aripiprazole, Hydroxyzine, Lactase

Current Illness: N/A

ID: 1709035
Sex: M
Age: 49
State: MI

Vax Date: 08/27/2021
Onset Date: 09/13/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: 1. There were NO REPORTED ADVERSE EVENT. 2. Vaccine was administered at 4 days past the UPDATED EXPIRY of 08/23/21 though still within vaccine PACKAGE EXPIRY date of 08/31/21. 3. Only filing as a VACCINE ADMINISTRATION ERROR report

Other Meds:

Current Illness:

ID: 1709036
Sex: F
Age: 65
State: MN

Vax Date: 06/23/2021
Onset Date: 07/19/2021
Rec V Date: 09/17/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Patient presented to the ED and was subsequently hospitalized for acute cystitis without hematuria within 6 weeks of receiving COVID vaccination.

Other Meds:

Current Illness:

ID: 1709037
Sex: M
Age: 49
State: CA

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

Lab Data: vitals only at observation patient went to urgent care following observation unable to return to work

Allergies: azithromycin , Lipitor

Symptom List: Injection site swelling, Limb discomfort

Symptoms: 1038 patient in lobby of observation BP: (!) 132/93 (!) 147/93 (!) 153/129 BP Patient Position: SITTING SITTING SITTING BP Location: RA-RIGHT ARM LA-LEFT ARM RA-RIGHT ARM Cuff Size: Standard Adult Large Adult Standard Adult Pulse: 64 74 75 Resp: 18 18 SpO2: 96% 95% Patient awake, alert, clear speech Denies difficulty swallowing Unlabored breathing "never get the flu shot because of a reaction", stated patient Last pfizer shot had fever and chills Patient will remain for further observation Lung sounds clear no wheezing RN,BSN,PHN 9/17/2021 11:02 AM

Other Meds: eye drops

Current Illness: reported since 1st dose difficulty taking a deep breath

ID: 1709038
Sex: F
Age: 73
State: IL

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

Lab Data: None

Allergies: Penicillin, some sulfa drugs, shellfish, latex Duloxiteine,

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

Symptoms: Severe gastrointestinal cramping and diarrhea for more than 24 hours. Malaise.

Other Meds: Wixela Inhub

Current Illness: None

ID: 1709039
Sex: F
Age: 21
State: NC

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

Allergies: None on file

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

Symptoms: Moderna was received from deep freezer on 8/6/21. Was placed in refrigerator on 8/6/21. 30 day expiration date was 9/5/21. Moderna was left in refrigerator and used until 9/13/21. On 9/14/21 we realized we were beyond the 30 days and immediately notified the Pharmacy for direction. The Pharmacists are in communication with Moderna to see if the doses are considered valid or invalid. Risk Management is involved to decide on the best course of action and if we notify the patient before we hear back from Moderna.

Other Meds: None

Current Illness: None on file

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am