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

Date Died: 09/14/2021

ID: 1715223
Sex: F
Age: 71
State: MO

Vax Date: 03/05/2021
Onset Date: 08/26/2021
Rec V Date: 09/20/2021
Hospital: Y

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

Lab Data:

Allergies: Fluconazole - not specified Morphine - not specified Sulfa - not specified

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient was hospitalized with COVID-19 symptoms on 8/26/2021 with respiratory failure. Patient was subsequently intubated and mechanically ventilated for a total of 17 days before being make compassionate care by family on 9/14/2021.

Other Meds: Albuterol inhaler Arformoterol nebs Biotin Budesonide nebs Bupropion SR 150 mg Cholecalciferol 50,000 unit capsule Clonazepam 0.5 mg tabs Cyanocobalamin 100 mcg tabs Estradiol 1 mg tabs Eszopiclone 1 mg tabs Fluticasone nasal spray Fluticas

Current Illness: COPD and restless leg syndrome

ID: 1715224
Sex: F
Age: 45
State: CA

Vax Date: 09/04/2021
Onset Date: 09/05/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: Received pelvic ultrasound on September 15th after 10 days of intermittent bleeding. Waiting for results.

Allergies: None Known

Symptom List: Anxiety, Dyspnoea

Symptoms: Intermittent vaginal bleeding. Onset 9/5/2021 (morning after receiving vaccine) and is still continuing.

Other Meds: Paroxetine 5 mg (1/2 of 10 mg) daily

Current Illness:

ID: 1715226
Sex: F
Age: 60
State: CA

Vax Date: 07/22/2021
Onset Date: 07/22/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data:

Allergies: nkda

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

Symptoms: Muscle Sore at the injection site that had been lasting for almost 2 months.

Other Meds: fosamax 70mg, calcium 600mg, albuterol hfa 90 mcg, sertraline 25 mg, norco 10/325, hctz 12.5, losartan 100mg, ibuprofen 600mg, omeprazole dr 40mg, montelukast 10 mg

Current Illness:

ID: 1715227
Sex: F
Age: 69
State: MS

Vax Date: 08/04/2021
Onset Date: 08/04/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: None

Allergies: NKA

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Severe all over muscle pain, concentrated mostly in the kidney area. Shooting electrical type pains in head. Sweating. Headache. Ongoing sluggishness.

Other Meds: D3, Zinc, Magnesium, Asprin 81mg, Eliquis 10mg, Potassium Cholride ER 8meq, HCTZ 12.25mg, Simvastatin 20mg, Losartan Potassium tab 100mg, Amlodipine besylate tab 2.5mg, Carvedilol 6.25mg

Current Illness: None

ID: 1715228
Sex: M
Age: 59
State: VA

Vax Date: 06/09/2021
Onset Date: 06/10/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data:

Allergies: Penecilin

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

Symptoms: Very severe insomnia, worsening depression and anxiety. Double the Cerequil. Prescribed a sleep aid. Won't take it because it can cause sleep driving.

Other Meds: Esporanmizol, Symbastatin, Netphormin, Carbamasapine, Mustartin, Custiapine, Cyrilquil, Hyroperdidol, Cremasipan

Current Illness: none

Date Died: 09/17/2021

ID: 1715229
Sex: M
Age:
State: KY

Vax Date:
Onset Date: 09/04/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data:

Allergies: none listed on inpatient chart

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

Symptoms: DEATH-UNKNOWN DATE AND LOCATION OF VACCINATION

Other Meds: unknown-information taken from inpatient chart

Current Illness: UNKNOWN

ID: 1715230
Sex: F
Age: 63
State: IN

Vax Date: 02/23/2021
Onset Date: 02/23/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: N/A

Allergies: Penicillin; IVP dye

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: After 1st Dose: Immediately experienced tight feeling in throat, difficulty breathing, assumed an asthma attack was going to happen, difficulty breathing on first day. The second day, extreme difficulty breathing (assumed it was bad asthma again), extreme tightness in chest and trouble breathing. Took usual medications, then took albuterol inhaler, then nebulizer, neither of them made any difference. Felt more and more sick throughout second day. Third day was having trouble breathing, bedridden the entire day. By Day 4 started to subside and recover. Within a week was totally normal. Now taking prednisone because of asthma, but was not at the time of the vaccine doses. Unsure if that had an effect on recovery, etc. After 2nd Dose: Had tight throat, and difficulty breathing, but was much less severe, occurred in episodes and then would go away. Felt fine by 3rd day.

Other Meds: Effexor; Lasix furosemide; Trulicity Injections; lisinopril; Lipitor; Singulair; trazadone; lamotrigine; Trelegy Inhaler; Flonase nasal spray; Novolog Injections; Tresiba; calcitriol; ventilator and oxygen at night; albuterol nebulizer (as

Current Illness: N/A

ID: 1715231
Sex: M
Age: 80
State: MN

Vax Date: 04/08/2021
Onset Date: 09/17/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data:

Allergies: Patient swabbed at our offsite collection site. Please contact their primary care provider for further questions.

Symptom List: Pharyngeal swelling

Symptoms: Patient vaccinated and then tested positive for COVID-19

Other Meds: Patient swabbed at our offsite collection site. Please contact their primary care provider for further questions.

Current Illness: Patient swabbed at our offsite collection site. Please contact their primary care provider for further questions.

ID: 1715232
Sex: F
Age: 14
State: NJ

Vax Date: 08/29/2021
Onset Date: 08/29/2021
Rec V Date: 09/20/2021
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: Within minutes of the first dose of the Covid Vaccine, my daughter, passed out! Her head fell between her legs! The mother lifted her what seemed to be lifeless body off the ground! As I lifted her I realized she was unconscious, her lips were blue, her skin was grey, she was cold and she was unresponsive, but breathing! After that episode which lasted about 3-5 minutes she came too a little and started to violently throw up and she informed me that she could not see!!! As this was going on no one from the pharmacy came to our aid even though I was screaming call 911! I called 911! When the paramedics came they took her to ER where they ran tests and was monitored!

Other Meds: none

Current Illness: none

ID: 1715233
Sex: F
Age: 44
State: PR

Vax Date: 09/15/2021
Onset Date: 09/15/2021
Rec V Date: 09/20/2021
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: no

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Muscular pain

Other Meds: no

Current Illness: no

ID: 1715234
Sex: M
Age: 68
State: MI

Vax Date: 03/09/2021
Onset Date: 09/13/2021
Rec V Date: 09/20/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: sent in from urgent care for pneumonia and covid 19. Patient states had symptoms for the past few days very short of breath and heart racing; xray shows pneumonia

Other Meds:

Current Illness:

ID: 1715235
Sex: M
Age: 30
State: NY

Vax Date: 09/05/2021
Onset Date: 09/06/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Rash, Urticaria

Symptoms: Severe never pain on both arm, hands and fingers. Feeling dizziness most part of the day. Headaches and stomach problem

Other Meds: none

Current Illness: none

ID: 1715237
Sex: F
Age: 59
State: TX

Vax Date: 02/25/2021
Onset Date: 05/16/2021
Rec V Date: 09/20/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: My legs , neck and head haven been hurting since May 2021.

Other Meds:

Current Illness:

ID: 1715238
Sex: F
Age: 20
State:

Vax Date: 06/16/2021
Onset Date: 08/10/2021
Rec V Date: 09/20/2021
Hospital: Y

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

Lab Data: Immunocompromised respiratory panel- SARS-COV-2 detected (8/10/2021)

Allergies:

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

Symptoms: Pt is 20 yo female s/p Pfizer vaccination: dose 1 on 5/26/2021 and dose 2 on 6/16/2021. She has a history of recurrent germ cell tumor currently cycle 1 weekly taxol. Chemotherapy at time of vaccination: Taxol desensitization, Ifosfamide, Mesna and Cisplatin. Admitted with fevers and COVID+ on 8/11. She presented with reports of fevers, chills, productive cough, and SOB at home. Also complaints of nausea/vomiting, with limited ability to take in PO. CXR with evidence of opacity at the left base concerning for pneumonia. COVID swab was positive on admission. She was started on broad spectrum antibiotics with cefepime and vancomycin. Her MRSA swab was positive. For her COVID, she was started on remdesivir and ID was consulted. She received three days of remdesivir with resolution of symptoms. She was discharged with 30 days of prophylactic eliquis. ID recommended discontinued cefepime and vancomycin as symptoms could be explained by COVID. Remained afebrile off antibiotics for 24 hrs prior to discharge. She had hypokalemia and hypomagnesemia during her hospital stay in the setting of poor PO intake. K and Mg were repleted and she was sent home with a seven day supply. She will have labs re-check on 8/17/21. She also had an AKI up to 1.35, she will have labs re-checked on 8/17. Discharged on 8/13.

Other Meds:

Current Illness:

ID: 1715239
Sex: M
Age: 71
State: MI

Vax Date: 01/21/2021
Onset Date: 09/12/2021
Rec V Date: 09/20/2021
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: cough, loss of taste and smell

Other Meds:

Current Illness:

ID: 1715240
Sex: F
Age: 68
State:

Vax Date: 03/12/2021
Onset Date: 08/11/2021
Rec V Date: 09/20/2021
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: Novel Coronavirus PCR- SARS-COV-2 detected (8/11/2021)

Allergies:

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

Symptoms: Pt is 68 yo female s/p Pfizer COVID vaccination: dose 1 on 2/19 and dose 2 on 3/12. Presented on 8/11 with myalgias, fevers and chills and found to be COVID positive. PMH of ADD, anemia, arthritis, chicken pox, depressive disorder. No immunosuppression. She reports recent symptoms of cough, fevers/chills (temps at home up to 102), headaches, and cough for past 6 days. Started on remdesivir, steroids with improvement in her symptoms. Needed oxygen requirement mostly at night. Discharged on room air on 8/16 but encouraged to follow-up with sleep medicine given concerns for undiagnosed OSA. Did not meet criteria for prophylactic anticoagulation.

Other Meds:

Current Illness:

ID: 1715241
Sex: M
Age: 66
State:

Vax Date: 03/09/2021
Onset Date: 08/12/2021
Rec V Date: 09/20/2021
Hospital: Y

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

Lab Data: Novel Coronavirus PCR- SARS-COV-2 Detected (8/12/2021)

Allergies:

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

Symptoms: Pt is 66 yo male s/p Pfizer vaccination: dose 1 on 2/16/2021 and dose 2 on 3/9/2021. Pt has a history of metastatic prostate cancer to the bone, HCV, alcohol abuse, chronic abdominal pain and lower back pain. During time of vaccination, cancer managed with Eligard every 3 months. Last treatment before vaccination on 1/11. He presents to the hospital with worsening abdominal pain and admitted on 8/12 for pain management. Upon admission, patient tested positive for COVID-19 and was asymptomatic. No therapy for COVID management needed.

Other Meds:

Current Illness:

ID: 1715242
Sex: M
Age: 79
State: GA

Vax Date: 02/23/2021
Onset Date: 08/22/2021
Rec V Date: 09/20/2021
Hospital: Y

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

Lab Data: 09/04/2021 PCR+ COVID-19 test; 09/05/2021 PCR+ COVID-19 test

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Breakthrough COVID-19 case with symptom onset 8/22/2021: Fever >100.4, Cough (new onset or worsening of chronic cough), Shortness of breath or difficulty breathing, Fatigue or tiredness, Diarrhea (>/=3 loose/looser stools in 24 hr period), loss of appetite along . Hospitalized on 9/4/2021 and put on oxygen. Hospitalized for unknown duration.

Other Meds:

Current Illness:

ID: 1715243
Sex: M
Age: 78
State:

Vax Date: 03/12/2021
Onset Date: 09/14/2021
Rec V Date: 09/20/2021
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: Patient is a 79 y.o. male who presents with on 9/14 to an outlying facility with complaints of generalized body aches, nausea, loss of appetite, progressive dyspnea, cough dry nonproductive. Symptom onset was 9/9/2021, date of positive test is 9/14/2021. Fully vaccinated in March. He was started on COVID supplement, IV Decadron, baricitinib and remdesivir with minimal improvement of respiratory status. His oxygen requirement increased and he was placed on BiPAP. He developed new onset A. fib with RVR, started on Cardizem drip. He was transferred to a higher level of care on 9/19/2021.

Other Meds:

Current Illness:

ID: 1715244
Sex: U
Age: 56
State:

Vax Date: 03/26/2021
Onset Date: 08/13/2021
Rec V Date: 09/20/2021
Hospital: Y

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

Lab Data: Novel Coronavirus PCR- SARS-COV-2 Detected (8/13/2021)

Allergies:

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

Symptoms: Pt is 56 yo female s/p COVID Pfizer vaccination: dose 1 on 3/5/2021 and dose 2 on 3/26/2021. Patient with advanced stage follicular lymphoma s/p BR x6 followed by rituxan maintenance that was completed Oct 2020, COVID in 2020 treated with steroids, remdesivir, and convalescent plasma and COVID vaccine in March 2021. Admitted on 8/13/21 with complaints of cough, shortness of breath, fatigue and fever for 3 days and found to have COVID PNA. ID was consulted who recommended for patient to receive casirivimab-imdevimab, which she did this receive prior to being discharged home. She saturated 93-94% on RA. Started on empiric ceftriaxone and azithromycin in the ED. Abx discontinued at discharge.

Other Meds:

Current Illness:

ID: 1715245
Sex: F
Age: 49
State: AL

Vax Date: 09/14/2021
Onset Date: 09/17/2021
Rec V Date: 09/20/2021
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: None

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

Symptoms: I received the 2nd Moderna Covid Vaccine on 9/14/21 and I had the normal symptoms of a low grade temperature starting approximately 24 hours later, then when i woke up Thursday morning (the 2nd day) i had raw open lesions inside my mouth, and the skin inside my mouth and on my lips are peeling off. One open lesion went away approximately 5 days (9/19/21) after receiving the vaccine but then i woke up this morning (the 6th day-9/20/21) and there is another large open raw lesion inside my mouth. It feels like the inside of my mouth is on fire and eating away my skin. it is very painful.

Other Meds: Walmart Sleep Aid

Current Illness: None

ID: 1715246
Sex: F
Age: 47
State: NY

Vax Date: 04/07/2021
Onset Date: 04/26/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data:

Allergies: No

Symptom List: Unevaluable event

Symptoms: I have never had an irregular period in my entire life. It has always been 28 days. Maybe 27 days or 29 days. My first month after the vaccine, my period was one week late. Then several days late, then again several days late, then a week early and now I'm going on two weeks late. It's egregious women's menstruation wasn't studied during the initial trial.

Other Meds: Vitamin D, Co-Q-10, baby aspirin, Claritin, multi-vitamin

Current Illness: None

ID: 1715247
Sex: F
Age: 33
State: VA

Vax Date: 09/03/2021
Onset Date: 09/11/2021
Rec V Date: 09/20/2021
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: Covid test- negative

Allergies: None

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

Symptoms: When I woke up I had a migraine and I took some Tylenol and that did not cut it. I took some ibuprofen and that did not cut it. That stayed until 11 pm. I was getting nauseous. The next day I had a little bit of coughing so I went to get tested for Covid at the pharmacy. It came back negative. I did not know if that was related to the vaccine or just a bug I caught, Since then I have had a lingering cough but nothing too concerning.

Other Meds: Levothyroxine; baby aspirin; prenatal

Current Illness: None

ID: 1715248
Sex: F
Age: 77
State:

Vax Date: 03/22/2021
Onset Date: 08/18/2021
Rec V Date: 09/20/2021
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: SARS-COV-2 RAPID: Detected (8/18/2021)

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Pt is 77 yo female s/p Pfizer COVID vaccination: dose 1 on 3/1/2021 and dose 2 on 3/22/2021. ESRD on HD, DM2, HTN, nonobstructive CAD, and hx R breast cancer 2017 s/p mastectomy and chemotherapy who was admitted on 8/19 for shortness of breath secondary to COVID-19 pneumonia. CTPE confirmed bilateral pneumonia without PE. Completed course Remdesivir. Started on 10 day course Decadron while inpatient of which she will finish at home. Patient meets criteria for extended DVT prophylaxis in COVID-19. She was discharged on Eliquis 2.5 mg BID for 30 days.

Other Meds:

Current Illness:

ID: 1715249
Sex: M
Age: 67
State:

Vax Date: 06/10/2021
Onset Date: 08/20/2021
Rec V Date: 09/20/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Pt is 68 yo male s/p Pfizer COVID vaccination: dose 1 on 4/9/2021 and dose 2 on 6/10/2021. Pt diagnosed with COVID shortly after his first dose and instructed to receive his second dose about 30-60 days after this diagnosis.

Other Meds:

Current Illness:

ID: 1715250
Sex: F
Age: 74
State: MI

Vax Date: 04/05/2021
Onset Date: 09/15/2021
Rec V Date: 09/20/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: admitted 9/15. pt ha had symptoms since 3 weeks prior to admit.Patient presented with symptom(s) noted the chief complaint Patient is being tested today due to having covid-19 symptoms - reports 12 days of feeling ill including symptoms of fatigue, weakness, diarrhea, dry cough and SOB"

Other Meds:

Current Illness:

ID: 1715251
Sex: F
Age: 45
State: FL

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 09/20/2021
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: Tested positive for COVID on 9/15/2021

Allergies: None

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Swelling and pain in the area. That evening had body chills fever, headache, fatigue , diarrhea and dizziness days following

Other Meds: Metformin

Current Illness: Diabetic

ID: 1715252
Sex: F
Age: 61
State:

Vax Date: 04/17/2021
Onset Date: 08/20/2021
Rec V Date: 09/20/2021
Hospital: Y

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

Lab Data: SARS-COV-2 RAPID: Detected (8/20/2021)

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: 61 yo female s/p Pfizer COVID vaccination: dose 1 on 3/27/2021 and dose 2 on 4/17/2021. PMH significant for T2DM, HTN, HLD, GERD, asthma, tobacco use, osteoporosis, obesity, depression. Presented to this institution on 8/20/2021 with COVID-19 pneumonia (symptoms of fatigue, myalgias, insomnia, nasal congestion, loss of taste/smell, loss of appetite, pounding headache, diarrhea. Increasing oxygen requirement during admission to 3L; CXR 8/25 demonstrates increasing bibasilar consolidative airspace opacities greater on L; MRSA/MSSA swab negative. She received 3 doses of remdesivir which was discontinued due to bradycardia. (cont.)

Other Meds:

Current Illness:

ID: 1715253
Sex: F
Age: 20
State: OH

Vax Date: 03/16/2021
Onset Date: 07/11/2021
Rec V Date: 09/20/2021
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: ER and hospital, MRI of lower back; X-ray of both of my hips; CK levels, myoglobin; kidney function and liver function etc. testing

Allergies: No

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

Symptoms: On July 11, jumped down out of a high chair and my legs cramped up and I felt like I broke my hips. My parents, ER HCPs, they said I was in Rhabdomyolysis. They didn't know the cause of it. I hadn't overexerted myself before that. They gave me IV fluids and making sure that my kidneys were functioning normally. No other treatment for it. I was in hospital two days. Legs swelled up when I was in bedrest and stayed swollen for thirty days. They continue to cramp up to this day. I use to waitress and I can't do that anymore and lift everything. Physical therapy two times a week, that isn't really helping; Rheumatologist, I am waiting to get into this doctor. I take a whole bunch of supplements, magnesium, iron (I'm anemic now); B12 and potassium and vit D.

Other Meds: No

Current Illness: No

Date Died: 08/24/2021

ID: 1715254
Sex: F
Age: 44
State:

Vax Date: 03/26/2021
Onset Date: 08/22/2021
Rec V Date: 09/20/2021
Hospital: Y

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

Lab Data: SARS-COV-2 RAPID: Detected (8/22/2021)

Allergies:

Symptom List: Nausea

Symptoms: 45 yo female s/p Pfizer COVID vaccination: dose 1 on 3/5 and dose 2 on 3/26. Past medical history significant for anemia of chronic disease, anxiety, ESRD on PD, depression, T1DM, HTN, GERD, gastroparesis, s/p kidney + pancreas transplant. Presented at the time of admission on 8/22 with shortness of breath and cough. Hospital course described: Septic shock 2/2 MRSA bacteremia: In setting of immunosuppression (cyclosporine). Growth of staph aureus on 8/22 and 8/23 cultures. MecA positive. Treated with vancomycin, meropenem, caspofungin, tobramycin. Clindamycin added 8/24. Respiratory failure thought secondary to COVID ARDS with potential bacterial pneumonia superimposed. Initially satting to 96% on RA, with quick increase in oxygen requirement overnight 8/22-8/23. Intubated and transferred to the MICU. CT PE without PE, but with bilateral pneumonia and findings concerning for necrosis in LLL and some cavitation medially in the right lung, possibly abscess formation. Concerning for development of an aspiration PNE. Treated with Remdesivir and Dexamethasone. CRRT for volume removal. Severe metabolic and respiratory acidosis: Gap (lactate) and non-gap (renal dysfunction) contributions. Thought secondary to septic shock and renal failure in setting of missed dialysis and acute infection. Required concentrated bicarb drip. She was also hypoglycemic as low as 37 treated with Dextrose infusion. She developed atrial fibrillation with rapid ventricular response evening of 8/24 with HR increased to 180s. This was treated with amiodarone bolus + drip as well as fluid resuscitation. HR responded to interventions however she remained hypotensive requiring addition of phenylephrine to her pressors. She required phenylephrine, levophed, and vasopressin for much of the evening as well as albumin, LR, bicarb pushes, and increasing rates of dextrose infusion. Transitioned patient to comfort care evening of 8/24. Palliative extubation performed that evening and all life sustaining medications were withdrawn. Patient was pronounced dead 8/24 at 2339.

Other Meds:

Current Illness:

ID: 1715255
Sex: M
Age: 76
State:

Vax Date: 04/12/2021
Onset Date: 09/19/2021
Rec V Date: 09/20/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: 77-year-old male presents to the emergency department with shortness of breath and fever. He denies any chest pain or palpitations. He denies any syncopal episodes. He states his wife was diagnosed with COVID-19 infection after having similar symptoms a few days ago. He does state that he and his wife both received the Johnson & Johnson vaccination

Other Meds:

Current Illness:

ID: 1715257
Sex: F
Age: 60
State:

Vax Date: 05/03/2021
Onset Date: 08/22/2021
Rec V Date: 09/20/2021
Hospital: Y

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

Lab Data: SARS-COV-2 RAPID: Detected (8/22/2021)

Allergies:

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

Symptoms: 60 yo female pt s/p J&J COVID vaccination on 5/3. PMH significant for COPD, Bipolar, Hepatitis C, HTN, hx osteomyelitis s/p 2nd toe amputation, and polysubstance use disorder coming in with shortness of breath, fever, chills and found to have COVID 19. No evidence of PNA on imaging or exam. However, did have orthopnea and elevated BNP so concern there may have been component of CHF exacerbation on admit. Pt was started on remdesivir given comorbid risk factors. At discharge patient was hemodynamically stable and on room air.

Other Meds:

Current Illness:

ID: 1715258
Sex: F
Age: 36
State: WA

Vax Date: 09/20/2021
Onset Date: 09/20/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data:

Allergies: NO KNOWN

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

Symptoms: On 9/20/2021 I drew up a dose of Janssen Covid-19 vaccination. This was the first dose drawn from the vial. I did not check the expiration date of the vial. I gave the syringe to my coworker, RN, who administered the vaccine to the staff member. Later that morning another coworker came in and told us that the vaccine had expired on 9/19/2021. I then called Janssen for further guidance. I was told to alert VAERS and follow local jurisdiction guidelines.

Other Meds: UNKNOWN

Current Illness:

ID: 1715259
Sex: F
Age: 24
State: IN

Vax Date: 09/19/2021
Onset Date: 09/19/2021
Rec V Date: 09/20/2021
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

Allergies: NKDA

Symptom List: Tremor

Symptoms: Pt c/o mild raised rash to neck chest and upper back and bilateral mild swelling . took one dose of benedryl and tried hydrocortisone cream without relief presented to office today with continuing symptoms given 40 mg kenalog im and 20 mg prednisone bid for 5 days

Other Meds: sprintec spirnolactone minocycline

Current Illness: none

ID: 1715260
Sex: M
Age: 77
State:

Vax Date: 03/11/2021
Onset Date: 08/26/2021
Rec V Date: 09/20/2021
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: SARS-COV-2 RAPID: Detected (8/26/2021)

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: 77 yo male pt s/p Pfizer COVID vaccination: dose 1 on 2/18 and dose 2 on 3/11. Past medical history of CLL on acalabrutinib, atrial fibrillation, type 2 diabetes, and hypothyroidism who presented to the ED on 8/26. His presenting symptoms were cough, weakness, rhinorrhea, clear sputum, and diarrhea. While in the ED he was found to be positive for COVID-19 with fevers of 101.1 He was started on Remdesivir on the evening of 8/26. Sputum cultures were collected and Initial chest X ray was negative for any acute processes. He had new hypoxia on 8/28 requiring supplemental oxygen. Given his new hypoxia and positive COVID test, he was started on a 10 day course of dexamethasone. Repeat Chest Xray on 8/28 showed multifocal hazy airspace opacities consistent with covid pneumonia. He was empirically started on ceftriaxone 8/28. On 8/29 his sputum cultures were positive for Klebsiella Pneumonia that was susceptible to ceftriaxone. His supplemental oxygen was titrated to a maximum of 6L on 9/2 and eventually weaned off until he was back to his baseline of room air on 9/8. Patient completed a total of two courses of Remdesivir on 8/26-8/31 and 9/2-9/5. His Ceftriaxone was completed on 9/4 for a total duration of 8 days. At his time of discharge, patient was maintaining his saturations on room air. Additionally he was started on 2.5mg Eliquis BID for 30 days given his increased risk of hypercoagulability post-covid infection.

Other Meds:

Current Illness:

Date Died: 09/05/2021

ID: 1715261
Sex: F
Age: 81
State: GA

Vax Date: 03/02/2021
Onset Date: 09/04/2021
Rec V Date: 09/20/2021
Hospital: Y

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

Lab Data: 09/04/2021 PCR+ COVID-19 test at Hospital; 09/05/2021 Antigen+ COVID-19 test at MEDICAL CENTER

Allergies:

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

Symptoms: Breakthrough COVID-19 case, hospitalization 9/4/2021-9/5/2021; death 9/5/2021. COD from vital records: LYMPHOMA, IMMUNE THROMBOCYTOPENIC PURPURA, COVID 19. Per vital records, COD ICD Codes include: Not yet coded ; Other Significant Conditions include: None listed. place of death: HOSPITAL-INPATIENT, MEDICAL CENTER; certified by: CERTIFYING PHYSICIAN; occ/ind: SETTER OPERATOR, INDUSTRIAL MANUFACTURING ."Did the patient die?" marked YES; "Is this a COVID-related death?" marked YES.

Other Meds:

Current Illness:

ID: 1715262
Sex: M
Age: 74
State:

Vax Date: 02/20/2021
Onset Date: 08/26/2021
Rec V Date: 09/20/2021
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: SARS-COV-2 RAPID: Detected (8/26/2021)

Allergies:

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

Symptoms: 74 yo male patient s/p Pfizer vaccination: dose 1 on 1/30/21, dose 2 on 2/20/21, and booster dose on 8/17/2021. Past medical history significant for living donor renal transplant on immunosuppression with rapamune and cyclosporine, T2DM, HTN, HLD, primary hypothyroidism, gout, anemia, and obesity who presented on 8/26 with 4 days of nausea, vomiting, diarrhea, and dry cough who was found to be positive for COVID-19, despite being fully vaccinated. On admission Infectious Disease was consulted and he received remdesivir for 7 days and dexamethasone for 10 days. He required up to 15L high flow nasal cannula this admission. He had elevated d-dimer measurements this admission and on 9/2/21 CTPE was ordered...

Other Meds:

Current Illness:

ID: 1715263
Sex: M
Age: 67
State:

Vax Date: 05/12/2021
Onset Date: 08/27/2021
Rec V Date: 09/20/2021
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: Novel Coronavirus PCR- Detected (8/27/2021)

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: 67 yo male with renal/pancreas transplant (1997), metastatic prostate CA, PAD s/p fem-tib bypass 2015, R fem-pop bypass 2018 admitted for CABG x3 8/16/21. Immunosuppressed on mycophenolate mofetil, cyclosporine, prednisone. Found to have COVID-19 8/27/21. Negative admission testing. He is fully vaccinated (dose 1 on and dose 2 on . He is unaware of any illnesses in his household or visitors. Denies respiratory symptoms. No SOB, cough. Had a low grade temp 8/25/21. Has had a leukocytosis which seems like prompted the test. Put on cefepime and vancomycin day 3 for empiric coverage. No evidence of PNA. Casirivimab/imdevimab infusion completed 8/28.

Other Meds:

Current Illness:

ID: 1715264
Sex: F
Age: 45
State: ME

Vax Date: 01/01/2021
Onset Date: 02/01/2021
Rec V Date: 09/20/2021
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: Aspirin

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

Symptoms: Dizziness, generalized weakness, muscle aches lasting for months

Other Meds:

Current Illness:

ID: 1715265
Sex: F
Age: 36
State: CA

Vax Date: 05/21/2021
Onset Date: 08/13/2021
Rec V Date: 09/20/2021
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: Ibuprofen

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

Symptoms: I have been feeling horrible for about a month. Made a doctor's appointment only for them to tell me to get another vivid test. However I recently found out that I am pregnant. I have been on birth control for over 2yrs . I was on the Depo shot and I am now pregnant.

Other Meds: N\a

Current Illness:

ID: 1715266
Sex: F
Age: 31
State: WI

Vax Date: 09/02/2021
Onset Date: 09/20/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

Symptom List: Pain in extremity

Symptoms: Migraine headache that lasted four days after vaccination. Dizziness and lightheadedness that lasted one day after vaccination. Chest tightness and discomfort that started two weeks after vaccination and occurred at least once a day for seven days with episodes that lasted an average of one hour.

Other Meds: None

Current Illness: None

Date Died: 09/15/2021

ID: 1715267
Sex: M
Age: 71
State: MI

Vax Date: 01/17/2021
Onset Date: 09/03/2021
Rec V Date: 09/20/2021
Hospital: Y

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: Shortness of breath.

Other Meds:

Current Illness:

ID: 1715268
Sex: M
Age: 80
State: IA

Vax Date: 09/20/2021
Onset Date: 09/20/2021
Rec V Date: 09/20/2021
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: pt was here for his third dose of the vaccination and was given the pfizer instead of the mondera shot

Other Meds:

Current Illness:

ID: 1715269
Sex: F
Age: 74
State: VA

Vax Date: 08/21/2021
Onset Date: 09/01/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: Bloodwork WBC 1.9, neutrophils 0.80.

Allergies: Penicillin; sulfa

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

Symptoms: About 3 1/2 weeks after the booster I began to feel weak tired and a lot of nausea. I called a HCF to let them know and they told me to come in for bloodwork. When I get symptoms of any kind my oncologist has me come in to get checked because of the cancer that I have. I am off for 7 days off of cancer meds right now. I scheduled my booster on August 21, during the time I was on my 7 day off of Revlimid.

Other Meds: Revlimid; metformin; Amaryl; Cymbalta; baby aspirin; levothyroxine; pantoprazole; Fosamax; vitamin B12 injection; Zetia; alopurinol; Zyrtec; Flonase; Imodium; Zofran; magnesium lactate; vitamin D3; krill oil; B complex; multivitamin; calciu

Current Illness: No

ID: 1715270
Sex: M
Age: 36
State: AL

Vax Date: 09/20/2021
Onset Date: 09/20/2021
Rec V Date: 09/20/2021
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: Unknown

Symptom List: Vomiting

Symptoms: Pt indicated no prior covid vaccination. After moderna vaccination, he remembered he got Pfizer previously .

Other Meds: Unkown

Current Illness:

ID: 1715271
Sex: F
Age: 46
State: TN

Vax Date: 03/15/2021
Onset Date: 09/03/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: Bloodwork normal 9/6/21 Chest xray normal 9/6/21 EKG normal 9/6/21, 9/8/21, and 9/17/21 Stress test 9/17/21 - no cause for concerns

Allergies: penicillin

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Tingling in right arm and back of neck, some chest pain over the course of a few days - eventually did a telehealth visit on Monday, Sept 6 and they recommended an EKG to rule out any heart problems. Visited ER at the hospital that evening for EKG, bloodwork, and chest x-ray. All came back normal. Followed up with cardiologist and did stress test as a precaution. Some symptoms continue (primarily numbness in right arm) and mild occasional chest pain, but these are likely stress induced. Everything appears to be good with my heart. No suspicion that the vaccine is related in any way.

Other Meds: Nasacort allergy medication

Current Illness: none

ID: 1715273
Sex: F
Age: 42
State: OK

Vax Date: 09/17/2021
Onset Date: 09/17/2021
Rec V Date: 09/20/2021
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: unknown

Allergies: All Migraine medications, numerous food allergies, ACE inhibitors

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

Symptoms: Onset of cheeks, lips, and throat numbness 20-30 minutes after leaving office (left office at 1007 after 15 minute wait). Seen at dentist at 12:00pm and was having bronchospasms, vomiting mucus and diaphoretic. Advised to go to urgent care. Seen at Urgent care and transported via ambulance to the Emergency Room. Treated and released, no admission for anaphylaxis.

Other Meds: Employee declined to provide medications, reports she submitted her own VAERS report and included them with that submission.

Current Illness: None

ID: 1715274
Sex: F
Age: 20
State: OH

Vax Date: 02/23/2021
Onset Date: 02/25/2021
Rec V Date: 09/20/2021
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: Hospital ER - CT of abdomen; general chemistry of my blood. Cervix exam and whatever the test was for seeing if I was bleeding rectally. I weas. I took my first antibiotic there at the ER and that was it. And then they sent me a prescription for the antibiotic. That helped with the symptoms.

Allergies: no

Symptom List: Injection site swelling, Limb discomfort

Symptoms: On 25th, I noticed that I had re-started my menstrual cycle. 26th , I was bleeding rectally as well. I went to Urgent Care -they tested and confirmed I was bleeding out of both places. My heart rate and blood pressure was too high. My dad took me right to ER as suggested at the Urgent Care. I went to the Hospital and they did a CT of my abdomen - my colon was inflamed and they did a cervical exam and my cervix was inflamed and I got medication for colitis. I followed up with my gynecologist . I had to wait until I was 21 to have my first pap smear. By the time I got it my cervix had returned back to normal and bleeding had stopped. The blood did happen until March 20th, though. I was waiting for that to stop to get my next shot. And I also saw my primary care provider.

Other Meds: no

Current Illness: no

ID: 1715275
Sex: F
Age: 77
State: MN

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: Normal ER monitoring/testing.

Allergies: Zithromax Cefaclor Erythromycin Contrast(iodinated Diagnostic Agents) Drinking Alcohol Seafood Sea salt Gluten Lactose intolerant

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

Symptoms: Almost immediate anaphylactic reaction. Epi-pen administered in clinic, then transported to ER. I received steroids and Benadryl by an IV. After monitoring, I was allowed to go home. After 3 day dosage of steroids ended, reactions increased. My face was numb from eyes to jawline. I felt as if I had a megadose of novacaine. At the same time I would have attacks to my lungs, as if a foreign monster had entered my body. These attacks are a sudden and fast as an anaphylactic reaction. I have been trying to control reactions with Benedryl. Attacks appear to be lessening, but still occurring, without advance notice. After a month of feeling like a zombie from the Benadryl, I requested, from my doctor to go on steroids. I am presently on a 10 day, 20mg dose of prednisone. I also use my Advair and Ventolin inhalers daily to help my lungs survive the attacks. I have also needed a 12mg tablet most days to control help control the attacks. I still have mildnessnumbness in my sinuses and mouth. SCIENCE AND MEDICINE NEEDS TO DO BETTER!!! I am very worried about the damage being cause to my lungs and heart. I have requested scans on both when this (hopefully) subsides.

Other Meds: 12mg Benadryl And air inhaler Ventolin inhaler

Current Illness: None

ID: 1715276
Sex: F
Age: 54
State: MO

Vax Date: 09/11/2021
Onset Date: 09/13/2021
Rec V Date: 09/20/2021
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: latex, methimazole, codeine, penicillins

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

Symptoms: Pt received vaccine on Sat 9/11 . She reports monday not feeling good at all. Tuesday she had burning, Wednesday she had eruption of shingles on side of lower back. Her Dr started valtrex 500mg 1bid for 14 days on Friday 9/17. Pt reports it hurts to have her shirt on. She asked that we report this as an adverse event from moderna vaccine.

Other Meds: unknown

Current Illness: unknown

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am