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: 1715330
Sex: F
Age: 66
State: FL

Vax Date: 02/11/2021
Onset Date: 09/17/2021
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: Norvasc

Symptom List: Dysphagia, Epiglottitis

Symptoms: 9/14/21: Patient arrived at the ER due to shortness of breath and cough. The patient tested positive for COVID-19 on 08/23/202. At that time she was managed with symptomatic therapy including albuterol inhaler. After testing COVID negative on 09/08/2021, she was getting symptomatically better. But since last 4 days she has worsening of cough and SOB. Shortness of breath is present even at rest, previously orthopnea/ PND absent. She complains of productive cough, associated with loss of appetite and pedal edema. Per patient, her nurse noted that her bp was 152/93 and oxygen saturation of 79%. She had televisit where she complained of home BP 170s-190s and oxygen sat was 79-85 % at room air. Patient received first dose Moderna vaccine on 1/08/2021 Lot # 011J20A and the second dose on 2/11/2021 Lot # 029K20A

Other Meds:

Current Illness:

ID: 1715331
Sex: F
Age: 43
State: NY

Vax Date: 09/10/2021
Onset Date: 09/10/2021
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: Cat Scan09/12/21

Allergies: Sulfa Amoxicillin

Symptom List: Anxiety, Dyspnoea

Symptoms: Received Vax 9.10.21 at 4:30pm. Immediately I felt pain/heaviness in my arm. Slight nauseous Within an hour, the forehead started tingling and gradually moved across the entire face and into the neck. Started flushing with water and started walking and moving my face and lips constantly. a cooling sensation began on both sides of my kidney area- from middle of back down to hips. shortly after my ears started plugging. Had a video dr visit around 7:00pm- was told as long as its on both sides of body, that she thought it was an inflammatory response to the vaccine. Told me to take ibuprofen and tylenol at the same time, then alternate them through the weekend, to eat a healthy meal and drink lots of water. face tingling subsided later that evening. Had extreme hot and cold flashes along with extreme body aches in joints and muscles. Eating and drinking were no problem. Saturday late afternoon to late evening was the worst for body aches. Very difficult to move or do anything. My left arm was extremely sore to the point that I couldn't touch or move it. Sunday morning I woke up and my entire left arm was tingling. Extremely tired and body aches were pretty high. Hot and cold flashes were slightly better. Around 3:00 in the afternoon, the whole left side of my face started going numb. Took my blood pressure which was 170s-/high 80/low 90. After 30-45 minutes, I decided to get checked out at ED as the tingling was severe only on my left arm and left face. A Cat scan confirmed no sign of stroke. Tingling lasted until Monday late morning and afternoon. Monday-Deep chest/back pain only on the left side. Extreme exhaustion and body aches. Hard to do much of anything. Tuesday aches were mostly gone along - had some mild hot and cold flashes, extremely fatigued, and slight headache all day. No relief from ibuprofen or nurtec. Wednesday tried walking with patient- Very difficult, extreme hot flashes and very exhausted. Mild headache persisted all of wednesday. Thursday- pain in both hips, low energy, arm still feels heavy, but pain is gone to touch and can move without pain.all other symptoms gone. Friday- woke up feeling normal again

Other Meds: Junel Fe Vit D Vit C

Current Illness: none

ID: 1715332
Sex: M
Age: 44
State: MA

Vax Date: 03/19/2021
Onset Date: 07/01/2021
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: None

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

Symptoms: Pain in left thigh, treated with pain killers and stretching, also stopping astorvastatin to see if it was a side effect. Pain lessened but not removed by stopping drug. Waiting to see how cholesterol does without drug.

Other Meds: Acyclovir, gabapentin, lisinopril, venlafaxine, hydrochlorothiazide, Aripiprazole, Astorvastain

Current Illness: obesity, sleep apnea, hypertention, hyperlipidemia

ID: 1715333
Sex: M
Age: 38
State: FL

Vax Date: 01/12/2021
Onset Date: 01/28/2021
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: EMG/NCS, Serologic Work-up, MRI Imaging of the total spine

Allergies: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: PT reports the onset of his symptoms, which includes painful muscle cramps, muscle twitches, and painful paresethesias, approximately 2-3 weeks after his receiving his first Moderna COVID-19 vaccination on January 12th 2021. Because of his symptoms, Pt declined the second vaccine. Based on his clinical exam and EMG, he has a diagnosed of acquired neuromyotonia. Although it is unclear if the COVID-19 vaccine is causal for this condition, acquired neuromyotonia is thought to be autoimmune in orgin and prior associations of this condition with other vaccines have been described.

Other Meds: None

Current Illness: None

ID: 1715334
Sex: F
Age: 40
State: CA

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

Lab Data: Treated in ER for anaphylactic shock to the janssen vaccine.

Allergies: shellfish allergiey, sulfamethizole, erythromycin, cephalosporins, cefaclor

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

Symptoms: Felt fine the first ten min. I have food allergies so I waited the full 20 min. Got up and felt al ittle light headed. By the time I walked to my car I could feel my throat instantly swell. I drove my self straight to the emergamcy room. Emergancy room instanly treat me for anaphylactic shock. I recieved two EPI and was observed there after for the rest of the evening. Was also giving benadyl as well. I was dishcharged with EPI and benadryl to take home. Since I have been home I have had to throat swell everyday and have to take bendrly. I am not experiencing, muscle weakness all over my body and I'm making an apt. with my main doctor.

Other Meds: none

Current Illness: none

ID: 1715335
Sex: M
Age: 63
State: FL

Vax Date: 03/24/2021
Onset Date: 09/19/2021
Rec V Date: 09/20/2021
Hospital: Y

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: No Known Allergies

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

Symptoms: 9/19/21: Patient arrived at the ER due to complaints of shortness of breath and cough which has been worsening over the last 4 days. EMR reported he has had symptoms since 09/07 but came to the ED on 09/14 after his wife testing positive on 09/13. He tested positive on 09/14 and initially was complaining of body aches and diarrhea and was sent home with O2 monitoring kit. Apparently, patient has noted hypoxia at home with O2 saturations dropping as low as 88% so he decided to come back to the ED. Reported associated symptoms include shortness of breath/dyspnea on exertion, diarrhea, fatigue, body ache and cough. Bedside RN reports patient started complaining of chest/rib pain from coughing.

Other Meds:

Current Illness:

ID: 1715336
Sex: F
Age: 74
State: FL

Vax Date: 03/09/2021
Onset Date: 09/16/2021
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: Aspirin, Latex, Morphine

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: 9/16/21: Patient arrived to ER due to shortness of breath. Patient was discharged from our service on 09/09/2021 after being managed for COVID-19 infection and UTI. Patient was discharged on Keflex. Patient states that she was improving but then yesterday she started having acute shortness of breath that started at rest. She checked her O2 sat levels and it was 82%. Shortness of breath is worsened with movement, improved after administering supplemental oxygen in the ED. shortness of breath is associated with a generalized weakness, dry cough and chills.

Other Meds:

Current Illness:

ID: 1715337
Sex: M
Age:
State: MD

Vax Date: 12/17/2020
Onset Date: 01/13/2021
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: MRI with and without Contrast; CT Head with/without Contrast; LP w/CSF evaluation; IVIG Treatment 10days; 10 days Inpatient Treatment; 7days Outpatient Treatment; Continued Followup w/Neurology Specialist;

Allergies: eggplant; demerol; phenergan; dilaudid; opioids; erythromycin; penicillin; keflex;

Symptom List: Pharyngeal swelling

Symptoms: seizure

Other Meds:

Current Illness: none

ID: 1715338
Sex: F
Age: 91
State: FL

Vax Date: 01/12/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Codeine, Sulfadiazine

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: 9/19/21: Patient arrived to ER due to increased O2 requirement being on 4 L. Assessment on admission is viral pneumonia POA, acute on chronic respiratory failure, plan for patient is to monitor O2 saturation keep greater than 92% and monitor and trend inflammatory markers and CMP. Please note: Patient received first dose Pfizer vaccine on 12/21/2020 Lot # EL0140 and the second dose on 1/12/2021 Lot # EL3302

Other Meds:

Current Illness:

ID: 1715339
Sex: M
Age: 47
State: CA

Vax Date: 04/15/2021
Onset Date: 07/13/2021
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: Still waiting, i have a panel that was taken in February 2021 to compair with a new panel taken this week 9/13/21

Allergies: None

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Following the second dose I had some reaction consistent with what has been reported by others and consistent with side effects described by the CDC. Tired slept for 8 hours, slight fever, chills that started 12 hours after the shot and lasted through another 24hours, i did have a very sore arm unlike a regular flue shot that radiated to and below my arm pit for 6-10 days before going away. What i was not expecting or paying much attention to scuffing it off to various things was a slow but steady loss of energy the days following being vaccinated, continued below I have always been active getting regular exercise combined with a very healthy diet, something was anew with me but wasn't associating it with anything besides getting older or just a lack of drive or motivations currently. I'm very aware and in touch with my physical and mental health and understand that I'm getting older, but things were changing quickly and my energy and especially stamina during bike rides and physical activity was decreasing steadily being much more noticeable end of June and into July August. End of July first of August was when I was starting to feel different things in my chest. I was noticing my ability to do a regular 4 day a week bike ride was diminishing and the uphill parts were becoming impossible and my heart rate was noticeably elevated "flutter/racing" 120-150 plus at times when before the same hills were very manageable. The exercising and bike rides were becoming more difficult and the airy void feeling in my chest was becoming more prevalent. I'm an public safety first aid CPR instructor, during one of my classes students were practicing taking blood pressure. I was letting students use my arm when one of them stated "sir your blood pressure is extremely high 152/90"I thought ayah i have been been moving around a lot. This did stick with me until i got home and took my own reading using an electronic cuff and got 149/89 HR 80 resting. This was August 4th and I called my Primary for and appointment. August 6th i had an appointment and shared my concerns, my BB was 150/90 HR 79 in the office. The on call doctor cribbed me 10mg of Benazepril and recommend me to make an appointment with my physician. The medication lowered my level about 5-10 points on average but i was still loosing energy and my chest feeling as being anxiousness with increasing pressure/void was becoming regular. On 9/5/21 i met with my new Doctor she started a more thorough inquiry. My BB was 138/89 and i shared with her what i have been experiencing the past few months following and shared that these health changes coincide following my second dose of the Maderna Vaccine. She took in my information and then listened to my heart and chest, she asked if i have ever had a heart murmur, and i asked her what was that? she stated i had a significant murmur. Dr ordered blood work, and other test to be taken at the Cardiovascular Center with Dr . I'm waiting for my appointments and blood work results currently. I did have a large blood panel 4 months before the vaccine, this panel was initiated by myself as a "getting older well visit/physical" I though I would document and send this to you in the case you had any considerations or follow up. i would be happy to share my prognosis to support any improvements for others.

Other Meds: None

Current Illness: None

ID: 1715340
Sex: M
Age: 91
State: FL

Vax Date: 04/22/2021
Onset Date: 09/18/2021
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: No Known Allergies

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

Symptoms: 9/18/21: Patient arrived to ER due to complaints of generalized weakness since 4 days prior. Upon initial EMS evaluation, patient was found with a SpO2 of 77% and was placed on a non-rebreather mask at 15 L per minute. He was then placed on heated high-flow nasal cannula with only mild improvement in oxygenation and was therefore upgraded to BiPAP. He underwent CT Angiography evaluation of the chest with incidental findings of a type B dissection with a small intimal flap involving the proximal descending thoracic aorta and intramural hemorrhage/hematoma. There is also mild fusiform aneurysmal dilatation of the ascending thoracic aorta without dissection.

Other Meds:

Current Illness:

ID: 1715341
Sex: F
Age: 65
State: PA

Vax Date: 09/16/2021
Onset Date: 09/16/2021
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: Not known

Allergies: NKDA

Symptom List: Rash, Urticaria

Symptoms: Patient complained of dizziness and fainted

Other Meds: Prozac, Ativan, Zofran, Fiorcet, Wellbutrin

Current Illness: None Known

ID: 1715342
Sex: F
Age: 54
State: SC

Vax Date: 06/13/2021
Onset Date: 09/15/2021
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: BP - High ECG - Borderline Chest Xray -Normal Urinalyses - Metabolic, Glucose level was high at 117. Kidney failure

Allergies: cleocin

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

Symptoms: Numbness in 2 finger on the left hand. BP was high, heartbeat was pounding unusually hard, felt like I was passing out. Went to ER June 23, 2021.

Other Meds: no

Current Illness: no

ID: 1715343
Sex: F
Age: 83
State: FL

Vax Date: 04/05/2021
Onset Date: 09/17/2021
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:

Allergies: Aspirin, contrast dye, heparin

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

Symptoms: 9/17/21: Patient arrived at the ER due to the last couple days she has had persistent nausea with multiple episodes of nonbloody, nonbilious vomit as well as generalized weakness and reports feeling more shaky than usual. She states she spoke with her nephrologist in regards to her symptoms who referred her to the ED for further management. She reports over the last week she has had upper respiratory symptoms of a cough, nasal congestion, chest congestion and states she saw her PCP who prescribed her antibiotics, a Medrol Dosepak and albuterol inhaler and reports her symptoms have actually improved. She states during the visit with her PCP she tested negative for COVID at that time. Please note: Patient received J&J vaccine on 4/05/2021 Lot # 1805025 Blood pressure with borderline hypotension, and O2 saturations ranging between 92 and 94% on room air. At this time will admit patient under inpatient status for continued monitoring and treatment.

Other Meds:

Current Illness:

ID: 1715344
Sex: F
Age: 62
State: TX

Vax Date: 08/27/2021
Onset Date: 08/30/2021
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:

Allergies:

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

Symptoms: Breaking out in hives/rash, itching and fatigue,

Other Meds: Sertaline

Current Illness:

ID: 1715345
Sex: F
Age: 47
State: FL

Vax Date: 08/25/2021
Onset Date: 08/25/2021
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: Doctor - tested to see if I was totally numb and I could feel it.

Allergies: Tramadol; Codeine; onion and garlic - give me migraines; MSG - give me migraines; Dairy intolerance

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

Symptoms: I did have an influenza vaccine at the same right arm and I had it right after the 1st COVID vaccine. Lot#P100348416. Afluria Quad 2021 - 2Q. Seqirus - Manufacturer. After the shots, probably about an hour afterwards, I started having a sore throat and sneezing. And feeling really fatigue. I continued through the night to feel bad/malaise and flu-like symptoms with muscles aches, sore throat and I went to bed. The next morning, I felt the same. I stayed home from work. I took OTC cold medicine and Dayquil. The night before I took Benadryl. I went to back to work the day after that day - but felt rundown and had a lot of fatigue. I have been feeling very exhausted - don't have any energy. Starting the 1st of September, I started having numb-like tingling sensations in my feet and in my calves and my lower legs - aching super bad. It's really odd. Aching has subsided but the tingling in my fingertips - not arms - having tingling in numbness that hasn't stopped. At night, it has been waking me up with my feet and lower legs (the tingling and numbness). I went to the doctor on the 15th because it hadn't stopped. I do have restless leg syndrome - one of my medications causes it - but it's not bad as it used to be. Doctor said it could be related. I am having really bad, slow digestion problems. I didn't think much of at time of doctor because I have had a history of it before. But I am feeling it again and whatever I take (like mag citrate) - it isn't working and x-lax isn't working either. Doctor said to continue to let her know. I did email her over the weekend - the tingling and numbness was so bad it was waking me up. I am concerned of Guillain-Barre syndrome and concerned with getting my 2nd shot. I recovered from the cold-like symptoms.

Other Meds: Wellbutrin; Lamotrigine; Clonazepam; Robaxin; OTC Vitamins: Emer-gen C powder drink; Vitamin D3; CoQ10; Albuterol inhaler

Current Illness: No

ID: 1715346
Sex: M
Age: 28
State: CA

Vax Date: 09/18/2021
Onset Date: 09/20/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient was given a mixed series of the COVID vaccine. He did not experience any signs or symptoms of adverse reactions from the mixed series aside from a sore arm of the injection site.

Other Meds:

Current Illness:

ID: 1715347
Sex: M
Age: 47
State: SD

Vax Date: 04/16/2021
Onset Date: 05/14/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: physical examination, urinalysis normal, blood work taken two different dates, all results normal, two ekgs, 3 day heart monitor, 1 ecg & chest x-ray,

Allergies: none

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Evening of May 18, strange sensation over entire body, kept coming in waves, really hot, nervous, anxious, lasted 5-10 minutess, was then sick with flu like symptoms for a few days. For the next two month I didn't feel right, something was amiss. Evening of July 22, strange sensation over entire body again, kept coming in waves, this time more intense, nervous, anxious, thought I was going to die, really hot with profuse sweating, heart palpations, ringing in my ears became maddening, my body was shaking and trembling, dizzy and was nauseous. Smaller bad episodes for the following 4-6 weeks all the while have body aches and feeling spaced out, both arms and both legs are wanting to tremble and shake. At one point there was deep bruising deep in my right arm all the way into my hand. My eyes were blood shot for several days. Now my entire body feels constantly sick and my arms and legs just want shake and tremble.

Other Meds: amlpine/benazepril 5/40mg x 1 daily

Current Illness: none

ID: 1715348
Sex: F
Age: 74
State: FL

Vax Date: 01/30/2021
Onset Date: 05/19/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: In formation at Dr's office.

Allergies: Penicillin, Ibuprofen, Sulphur, aspirin, latex, Foods with yellow dye,

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Facial Swelling including top and lower lips , right and left cheeks. Tenderness in the inner cheeks.

Other Meds: none

Current Illness: Asthma, B/P.

ID: 1715349
Sex: M
Age: 63
State: FL

Vax Date: 09/16/2021
Onset Date: 09/18/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: None yet

Allergies: None

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

Symptoms: Just have a dry cough all the time. Drink water and other liquids but it does not seem to help.

Other Meds: multi vitamin, calcium

Current Illness: none

ID: 1715350
Sex: F
Age: 73
State: MN

Vax Date: 02/01/2021
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:

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

Symptoms: pt positive after being fully vaccinated for covid

Other Meds:

Current Illness:

ID: 1715351
Sex: F
Age: 41
State: WA

Vax Date: 09/01/2021
Onset Date: 09/05/2021
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: None

Allergies: None

Symptom List: Unevaluable event

Symptoms: I felt dizzy for a few hours after the vaccine and felt like I might pass out. Shaking for about an hour. Anxiety for a few days. Nausea off and on for two days. Trouble sleeping the night of vaccine. Sore throat for two days. Sore arm for 3 days.

Other Meds: Seroquel, Paxil, mirtazipine, ezetimibe, Ativan, budesonide and formetoterol fumarate dihydrate inhaler. Vit d, b vitamins, vitamin c.

Current Illness: None

Date Died: 09/18/2021

ID: 1715352
Sex: F
Age: 69
State: AZ

Vax Date: 09/16/2021
Onset Date: 09/18/2021
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: None at this time; being reported to Office of Medical Examiner

Allergies: no known allergies

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

Symptoms: Patient was on hospice for senile degeneration of the brain. She had been having abnormal vaginal bleeding in the months leading up to her death, and in mid July, she had increased facial drooping. The vaccine was administered on 9/16 and on 9/18 at 0540, her sister/ primary caregiver called to report that she was breathing "differently" and her "eyes were glassy". She died at 2239 on 9/18. It is unclear if the vaccine is related to her death; however, we are reporting to VAERS per CDC guidance. She is also being reported to the Office of the Medical Examiner.

Other Meds: Levothyroxine 88mcg PO daily Senna 8.6mg 1-2 tablets PO daily Tylenol 650mg PO 3 times daily Haloperidol 1mg PO 3 times daily as needed for agitation/restlessness Lorazepam 0.5-1mg PO every 2 hours as needed for anxiety/agitation Morphine 2

Current Illness: abnormal vaginal bleeding difficulty breathing

ID: 1715353
Sex: M
Age: 53
State: NJ

Vax Date: 03/19/2021
Onset Date: 08/01/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: Many tests, I do not have the results.

Allergies: Penicillin.

Symptom List: Injection site pain, Pain

Symptoms: I did not have any adverse events to the vaccine but was diagnosed with something else months after. I had an appointment with a surgeon on August, and I am going through all the tests. I have an appointment in 2 weeks to get a another test. They did not prescribe any medications because they want to know what is going on first. They do not know what is going on yet. I had a dizzy spell and I do not know where it came from but I had to go to the emergency room.

Other Meds: Vitamin D.

Current Illness: None.

ID: 1715354
Sex: M
Age: 19
State: MN

Vax Date: 09/11/2021
Onset Date: 09/11/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: On Day 4 he contacted the Dr at school and she immediately requested an X-ray of Chest, EKG and blood tests, and Covid Test. All came back normal and the Covid test was negative. She has now referred him to a Cardiologist. On this day As of this day, Day 9, since the injection he has no improvement - still dealing with chest pain, difficulty breathing, headache and dizzy.

Allergies: Penicillin

Symptom List: Injection site pain, Menorrhagia

Symptoms: Nine hours after injection, pt began having abdominal pain, chest pain, trouble breathing and coughing. Hands , feet and legs became cold and turning bluish. He was trembling and shivering, and complaining he was cold. Jawline was numb, headache and dizzy, tingling in hands and feet. It was like his body went into shock. We rushed him to the ER where they administered ibuprofen and antihistamine. At the ER, his vitals were normal and no temp. After 3 hours his hands and feet were warm again and he was released. The next day he had a slight temp and a red bullseye on his arm where he received the injection. He felt worse as the week went on experiencing chest pain and trouble breathing. The bullseye on his arm turned into a bruise and spread down his arm. Sore throat and trouble swallowing from all fo the coughing on the day of the reaction.

Other Meds: None

Current Illness: None

ID: 1715355
Sex: M
Age: 49
State: SD

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

Lab Data:

Allergies:

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

Symptoms: Pt recvd vaccine that expired on 9/19 on AM of 9/20. No adverse reaction noted. This was a third dose in an immunocompromised pt.

Other Meds:

Current Illness:

ID: 1715356
Sex: F
Age: 50
State: NY

Vax Date: 09/12/2021
Onset Date: 09/14/2021
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: Friday 9/17 Covid 19- negative Negative for Stretp I've never had the flu so no test No fever

Allergies: Iodine, indoor and outdoor allergies

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: After receiving the Pfizer vaccine on Sunday 9/12 I had a headache for two days. Tues 9/14 I felt my throat hurt a little but I thought it was my allergies. By Wednesday 9/15 my right side glands were swollen. I was unable to get an appointment with my Dr or City MD. By Friday I was unable to swallow. My lymphnodes were so swollen when I swallowed it was like knives in my throat. I went to City MD where they diagnosed me with lymhonitis. I had a rapid covid test and negative for strep plus no fever. They prescribed antibiotics. Later on that Friday I was able to get an appointment with my Dr who agreed that my symptoms was a reaction to the vaccine and it was common but at that time I felt so horrible. I slept the rest of the weekend. Today Monday 9/20 I feel 80% better. My glands still hurt and my neck is tender.

Other Meds: Lexapro, Quetiopine ER, Hydroxychloriquine, Levothyroxine, Rosuvastin, vitamin D, Trazodone.

Current Illness: No

ID: 1715357
Sex: F
Age: 30
State: CT

Vax Date: 06/05/2021
Onset Date: 08/14/2021
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: Autopsy (fetal), Placenta pathology, Various blood work for different viruses, etc. All results of tests were normal, unremarkable.

Allergies: No

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Estimated delivery Nov. 10, 2021. Intrauterine fetal death was diagnosed August 13, stillbirth delivered August 14th. As of now there is no known cause despite the tests that have been run.

Other Meds: Prenatal

Current Illness: No

ID: 1715358
Sex: F
Age: 71
State: GA

Vax Date: 02/18/2021
Onset Date: 02/18/2021
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: none

Allergies: no

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

Symptoms: Arm started swelling and was very sore for 3 weeks before easing up . Still swells up on and off . Muscle is still sore and tight . Looked like a bar code was on her arm .

Other Meds: avtorvastin, Multi vitamin , vitamin C , vitamin d fish oil glucosamine

Current Illness: no

ID: 1715359
Sex: F
Age: 55
State: CT

Vax Date: 03/21/2021
Onset Date: 03/21/2021
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: Yes 2 MRI, 2 ct-scans, brian scan, biopsy

Allergies: Aspirin; penicillin; steroids

Symptom List: Nausea

Symptoms: 1st day of vaccine had a high temp of 110 took Tylenol to break it and the following month she had bad stomach issues, migraines for 3 days, weakness in both legs, pain in left leg.

Other Meds: Hydrocodone; antenatal; simvastatin

Current Illness: No

ID: 1715360
Sex: M
Age: 69
State: PR

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

Allergies: UNKNOWN

Symptom List: Injection site pain

Symptoms: INADVERTENTLY VACCINATED WITH A DIFFERENT VACCINE MANUFACTURER FOR HER 2ND DOSE.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1715361
Sex: F
Age: 55
State: CT

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:
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: 0.3 ml administered

Other Meds: Unknown

Current Illness: None

ID: 1715362
Sex: F
Age: 55
State: MI

Vax Date: 09/08/2021
Onset Date: 09/09/2021
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: ssing a nuerologist. CT of head normal

Allergies: gabapentin, nortriptyine, propranolol, topiramate.

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

Symptoms: 9-9-2021 upperbody aches headache and chills. 9-10 blurry vision and upperbody aches as of today headache is gone upper body ache persisst and vision is improving.

Other Meds: zyrtec, vit D3,flexeril, magnesium, maxalt, immitrex,

Current Illness: none

ID: 1715363
Sex: M
Age: 63
State: TX

Vax Date: 03/14/2021
Onset Date: 08/24/2021
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: COVID-19 test

Allergies:

Symptom List: Tremor

Symptoms: I had headache, server coughing, fatigue, lost of apatite. I had a fever of 102. I went to see the doctor. He sent me to get antibodies. I did a COVID-19 test, positive.

Other Meds:

Current Illness:

ID: 1715364
Sex: M
Age: 58
State: NY

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

Lab Data: unknown

Allergies: na

Symptom List: Erythema, Pruritus

Symptoms: Wife called stating husband had a "small seizure" in the car on the way home from receiving the first shingles vaccine. Vaccine given at 12:40pm 09/20/2021 and she contacted pharmacy at 1:22pm 9/20/2021. Wife said he seems ok and is in bed resting. I suggested to call his doctor as well as er/urgent care to see if they feel he should be evaluated.

Other Meds: unknown

Current Illness: unknown

ID: 1715365
Sex: M
Age: 17
State: OR

Vax Date: 09/15/2021
Onset Date: 09/17/2021
Rec V Date: 09/20/2021
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: 9/19/21 negative COVID test

Allergies: None known

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

Symptoms: Angiderma to head, lips, eyes, throat and hives on torso and extremities.

Other Meds: Joint supplements Glucosamine, Chondritine, CoQ10,

Current Illness: None.

ID: 1715366
Sex: F
Age: 28
State: IN

Vax Date: 09/17/2021
Onset Date: 09/17/2021
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: NKDA

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

Symptoms: 7:00pm- onset of fatigue 10:00pm- headache, chills, took tylenol 11:00pm- elevated temp, severe chills/shivering, headache, blurred vision; took benadryl 2:00am elevated temp 102F, chills/shivering subsided, blurred vision continued, started with profuse sweating and shortness of breath, nausea, took more benadryl. 4:00am- blurred vision improved, headache and elevated temp continued; took more tylenol nausea lasted through 9/19/21 with intermittent headache and blurred vision.

Other Meds: SYNTHROID 112MCG DAILY

Current Illness: N/A

ID: 1715367
Sex: F
Age: 49
State: NY

Vax Date: 12/28/2020
Onset Date: 04/01/2021
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: Vaginal Ultrasound with 14mm endometrium, biopsy normal 9/2021

Allergies: topical benzyl peroxide

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: 3 mos after the 2nd shot I stopped having a period. 1-2 months later I had excessive vaginal bleeding for 2 months. I had to have a D&C and ablation because of the abnormal uterine bleeding that would not stop.

Other Meds: synthroid, vit c, vit e, co q10, creatine, carnitine, folate, nac, b12, zinc, vit d, calcium, selenium, B6, ASA

Current Illness: no

ID: 1715369
Sex: M
Age: 46
State: FL

Vax Date: 08/26/2021
Onset Date: 09/01/2021
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: None

Allergies: None

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

Symptoms: I broke out in hives. They come and go and are extremely itchy. Initially showed up on hands and arms, but have since spread to my torso and back. None on neck and face as of yet. They "bubble" up throughout the day but seem worst in the AM. They become extremely itchy and once scratched turn into a dry psoriatric like patch. I have had this now, and seems to be getting worse, for almost 2 weeks. I have stopped using detereget on clothes, started antihistamines and topical steroids, but have not seen a decrease in symptoms.

Other Meds: None

Current Illness: None

ID: 1715370
Sex: F
Age: 63
State: GA

Vax Date: 03/23/2021
Onset Date: 09/20/2021
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: none

Allergies: Lorsartin, Lisinopril

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

Symptoms: After receiving the vaccine my wife drove me from the back of the building to the front of the building to wait. During the minute it took to drive around, I felt unwell. I felt a sudden heat go from both sides of my neck, up both sides of my face to the top of my head. Within a few minutes I noticed hives on my neck and face. I did NOT have any trouble breathing. We were concerned, so we walked to the health department front door in case my symptoms worsened. The symptoms did not changes. We went back into the care to search on line for allergic symptoms. We went inside to report the allergic reaction. Two nurses looked at me. By this time 30 minutes has passed and my symptoms were starting to resolve. They said to go to the ED if the symptoms worsended. I sat another 30 minutes for more symptom decrease. We drove to a pharmacy for benadryl. I went home and slept serveral hours. The hives did not completely resolve unti overnight. I informed my physician weeks later. She advised not to get the second shot of Moderna. I am interested in getting the Johnson and Johnson vaccine. Please advise.

Other Meds: Concerta, Sertraline, Amlodipine Besylate, Armour Thyroid, Valacyclovir, Premier 50 Plus multi-vitamin, Omega 3 Plant, Butycaps, B12, D3, glucocare

Current Illness:

ID: 1715371
Sex: F
Age: 21
State: CA

Vax Date: 09/14/2021
Onset Date: 09/15/2021
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: no

Allergies: NKA

Symptom List: Pain in extremity

Symptoms: The injection site of varicella @ left upper arm has redness, swollen, skin is rough , it is warm to touch, size 4.5cm x 5.0 cm, but no fever.

Other Meds: No

Current Illness: No

ID: 1715372
Sex: M
Age: 29
State: WV

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

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

Lab Data: O2 saturation was good, pulse was normal, blood pressure cuff malfunctions.

Allergies: non reported

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

Symptoms: patient was given shot and approximately 5 minutes later experienced a syncope episode without losing consciousness. Patient became pale, had sweating and slight tingling in is vaccine administered arm. patient was responsive through whole episode so 911was called but cancelled as he regained composure. Cold packs were applied and patient stated no breathing distress. Pt remained in pharmacy for approximately another 25-30 minutes until family member arrived for a ride home. Pt stated would not be alonefor the rest of the evening and I verified contact info to call later to check on patient.

Other Meds: none reported

Current Illness: none reported

ID: 1715373
Sex: M
Age: 43
State: NY

Vax Date: 08/24/2021
Onset Date: 08/24/2021
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: no

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

Symptoms: Pfizer vaccine was diluted with NS 0.9% Bacteriostatic which is not recommended for use with this vaccines. Reported to Pfizer and CDC. As per recommendation from CDC, affected dose should be repeated. Pt was notified and all questions answered. Pt repeated dose on 9/15/21.

Other Meds: unk

Current Illness: unk

ID: 1715374
Sex: F
Age: 56
State: TX

Vax Date: 02/18/2021
Onset Date: 08/30/2021
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: Positive COVID Test 8/30/2021 Regen-COV monoclonal antibody infusion 09/02/2021 Negative COVID Test 9/10/2021

Allergies: None

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

Symptoms: 8/30/2021 at approximately 3:30 pm I started sneezing and began having extreme sinus pressure and ear pressure. My nasal passages became inflamed. I was extremely fatigued. I was not running a fever. I performed an OTC COVID test and it was positive. I then went to and had a Sofia SARS Antigen test performed at 8:56 pm. The results were positive. On 8/31/2021 I list my sense of smell and taste.. My symptoms were that of an upper respiratory infection. My oxygen level stayed between 96 to 99. I never developed a cough and never had a fever. My highest temperature was 99.7. I was prescribed the following: 325 mg aspirin 4000 IU Vitamin D3 1000 mg Vitamin C twice a Day 100 mg Zinc 500 mg Qucertin 10 mg melatonin ZPac Ivermectin for 5 days Monoclonal Antibody infusion

Other Meds: Valsartsn/HCTZ 160mg/ 25mg Omeprazole 20 mg Fluticasone Propionate Nasal Spray 50 mcg Loratadine 10 mg

Current Illness: None

ID: 1715375
Sex: M
Age: 45
State: MA

Vax Date: 09/17/2021
Onset Date: 09/17/2021
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: Sensitive to mussel relaxers and medications that effect blood pressure.

Symptom List: Vomiting

Symptoms: 9 hour delay then onset of severe flu like symptoms lasting approximately 24-36 hours, tapering off to no side effects 12-18 hours later.

Other Meds: DayQuil and NyQuil as needed.

Current Illness: URI: unknown variant- effected whole family two toddler age children were placed on amoxicillin and eye drops for conjunctivitis.

ID: 1715376
Sex: M
Age: 16
State: PR

Vax Date: 04/21/2021
Onset Date: 04/21/2021
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: UNKNOWN

Allergies: UNKNOWN

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: INADVERTENTLY VACCINATE WITH MODERNA INSTEAD OF USING PFIZER, AS RECOMENDED.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1715377
Sex: M
Age: 64
State: HI

Vax Date: 05/21/2021
Onset Date: 05/21/2021
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: NA

Allergies: NA

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

Symptoms: Within a few minutes I could feel the drug move across and in my body. Very strange feeling. Then I felt short of breath. I knew I was taking a breath but it felt as if my lungs were not getting air in the same volume as I'm used to feeling. I told my self to stay calm and keep breathing. Within a minute or two the feeling went away and breathing returned to the normal feeling. I did not feel light headed or pass out it was just that my lungs did not feel as if it was getting air in the normal way. When I returned to the facility for the second shot my body was going through a panic feeling. High heart rate and anxiety. I decided not to get the second shot

Other Meds: hydrochlorothiazide, carvedilol, metformin, glipizide, lisinopril, clopidogrel, rosuvastatin, Humira.

Current Illness: NA

ID: 1715378
Sex: M
Age: 56
State: NY

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

Lab Data: None

Allergies: unknown

Symptom List: Injection site swelling, Limb discomfort

Symptoms: 0.3 ml administered

Other Meds: unknown

Current Illness: unknown

ID: 1715379
Sex: M
Age: 47
State: OH

Vax Date: 05/19/2021
Onset Date: 09/15/2021
Rec V Date: 09/20/2021
Hospital: Y

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

Lab Data: 9/15/21 Sars-CoV-2 antigen test positive

Allergies: adhesive tape, latex

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

Symptoms: Patient was admitted with primary diagnosis of COVID-19 pneumonia on 9/15/21 after presenting to the ED with stable symptoms given his history of renal transplant (2017). At the time of this report, patient is still admitted receiving remdesivir, dexamethasone, and 3L oxygen through nasal cannula.

Other Meds: Amlodipine, low-dose aspirin, vit D3, fenofibrate, lovastatin, magnesium oxide, metoprolol tartrate, mycophenolate, omega 3-dha-epa fish oil, prednisone, probiotic, pysillium husk, K-Phos neutral, tacrolimus, vit B and C complex

Current Illness:

ID: 1715380
Sex: F
Age: 60
State: IN

Vax Date: 03/16/2021
Onset Date: 06/01/2021
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: Dye test, Echo and stress test

Allergies: Statin

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

Symptoms: Went to the doctor scope for acid reflux, that was when the EKG something of wrong. Went to specialist EKG, should left bundle lock and rapid heartbeat, dye test, echo and stress test, beta blocker.

Other Meds: Thyroid medications

Current Illness: No

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am