VAERS 2021 Database www.vaers.hhs.gov

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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: 1719020
Sex: M
Age: 32
State: MO

Vax Date: 05/24/2021
Onset Date: 05/26/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data: June 29: Nerve Conduction test showed no sign of carpal tunnel or similar condition August 6: X-ray of the spine showed no abnormalities August 13: Blood test for thyroid issues showed normal levels (Dr said that some thyroid issues could mimic wrist problems like I am experiencing) August 13: X-ray of both wrists and hands, right hand/wrist showed ulnar negative variance

Allergies: N/A

Symptom List: Dysphagia, Epiglottitis

Symptoms: Severe numbness, pain, and weakness in both arms, primarily the right arm, from fingertips to shoulders. Pain was a white hot burning pain, fingers had limited mobility (I could barely hold a pen), and treatments since the end of May with wrist braces and medications including Tylenol, ibuprofen, and Lyrica have been ineffective. Finger mobility has improved but the pain is still present to this day.

Other Meds: Ritalin

Current Illness: N/A

ID: 1719022
Sex: F
Age: 57
State: TN

Vax Date: 09/15/2021
Onset Date: 09/16/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data: None

Allergies: Statins

Symptom List: Anxiety, Dyspnoea

Symptoms: Nausea, vertigo, weakness, swollen left arm at site of injection with large red circle around it, headache

Other Meds: Venlataxine .88 mg Effexor XR 75 Estradiol 2mg Aspirin 81 mg Fish oil Hylands leg cramp Vitamin D3 50 mg

Current Illness: None

ID: 1719023
Sex: M
Age: 50
State: FL

Vax Date: 07/23/2021
Onset Date: 08/03/2021
Rec V Date: 09/21/2021
Hospital: Y

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

Lab Data: Lab work, covid test, cxr.

Allergies: ACE inhibitors

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

Symptoms: Patient came to ER c/o difficulty breathing onset was 1 week ago.

Other Meds:

Current Illness:

ID: 1719024
Sex: F
Age: 56
State: TX

Vax Date: 03/17/2021
Onset Date: 07/16/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data: CT Scan- Normal Covid Test- Positive

Allergies: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: So July 16th I went to the clinic because I had allergy symptoms that were not responding to typical remedies for 4 days I was also experiencing a low grade fever. As I was pulling up to the building I suddenly noticed I lost my sense of smell. Felt like it went off like a light switch. I went in and they tested me for COVID-19 they did rapid and the longer one and both came back positive. Later I realized later I also lost my sense if taste. From then until July 28th my symptoms were low grade fever, hot and cold chills, fatigue, and missing a lot of work (working from home), I needed to take a lot of naps. Loss of taste and smell gradually started coming back beginning July 26th. July 27th I started to feel and then that night, I woke up in the middle of the night with a severe headache. I took Tylenol and waited 4hrs and took ibuprofen and nothing helped. When I woke up I woke up with a migraine. So, I called the clinic and made an appt. He prescribed some medication for me that helped. The medication was Fioricet 50-325-40mg (combo of 3 drugs) . I had migraines for for a week and then headaches for a week. I woke up with headaches for the entire month of August. On the 29th I had another telehealth appt with Doctor because they were still really intense. He said the only way to make sure nothing was going on was to go to the ER and get a brain scan. So after you spoke with him I went to the ER. At the ER they did a CT scan and gave me a headache/migraine cocktail. The cocktail only worked for that night. They said to follow up with my primary doctor. I followed up with Dr. and let her know I was still having headaches even after the pain medication and the migraine cocktail so she prescribed me something else. She prescribed Mobic 15mg daily for 15 days. I took the medication as prescribed and now I am fine.

Other Meds: Claritin; Progesterone; Diindolylmethane; Melatonin; Testosterone; EHEA; Vitamin D3; Thyroid; Estradiol; ORACEA

Current Illness: no

ID: 1719025
Sex: F
Age: 73
State: NC

Vax Date: 01/20/2021
Onset Date: 01/22/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data:

Allergies: Advil

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

Symptoms: After 1st shot had ache and pains. Had 2nd shot feb 11, 2021. 3 days later went in the hospital with a fib

Other Meds: Dexilant, vitamin d

Current Illness: N/A

ID: 1719026
Sex: F
Age: 36
State: VT

Vax Date: 12/28/2020
Onset Date: 02/16/2021
Rec V Date: 09/21/2021
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: None

Allergies: None

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

Symptoms: Adverse event - since receiving the vaccine monthly periods have been extremely painful with a very heavy flow and multiple large clots. Previously periods were uncomfortable but not painful, flow was normal to light and there were occasional small blood clots. Treatment - tylenol, aleeve, etc. These only dull the pain a little. Outcome - 1-2 days of period are extremely painful and it is very hard to work - laying down is the most comfortable position, sitting for an extended period of time is near impossible, the cramps are unbearable and I have to get up and move around, or lay down.

Other Meds: Bupropion- daily, Fluoxetine-daily, Clonazepam - rarely(as needed)

Current Illness: None

Date Died: 09/14/2021

ID: 1719028
Sex: F
Age: 87
State: MN

Vax Date: 02/16/2021
Onset Date: 09/14/2021
Rec V Date: 09/21/2021
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: Cortisone Environmental Poligrip Super Strong [Denture Care Products] Thimerosal Travoprost Zinc Alprazolam Ampicillin Aspirin Atenolol Brinzolamide Cefaclor Celecoxib Chromium Ciprofloxacin Clindamycin Codeine Dehydrocholic Acid Diagnostic X-ray Materials Erythromycin Ezetimibe Fluconazole Hmg-coa-r Inhibitors Ibuprofen Indomethacin Naproxen Niacin Nifedipine Nitrofurantoin Omeprazole Penicillins Prednisone Propoxyphene Quinine Rofecoxib Sertraline Sulfa Drugs Tetracycline Nicotine

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient passed away on 09/14/2021

Other Meds: Mirapex, Roxanol, Maalox, Zofran, Nizoral

Current Illness:

ID: 1719029
Sex: M
Age: 72
State: WA

Vax Date: 02/10/2021
Onset Date: 03/01/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data: MRI Head WO Contrast on 4-30-21. Results normal Audiogram on 7-15-21.. Results normal, but mild sensory hearing loss in left ear. VNG Testing scheduled for either September or October.

Allergies: Iodine in IV , red cheese and blue wine

Symptom List: Pharyngeal swelling

Symptoms: My second Pfizer vaccine was given on 2-10-21. I did not have any problems until about two weeks later when I started experiencing balance impairment issues and light-headedness. My primary doctor ordered an MRI, which came back normal. I was then sent to an audiologist to determine if this could be an inner ear issue. That test was normal. However, the audiologist recommended that I undergo VNG testing, which I am scheduled to do at an audiology lab at the Hospital on Oct. 20, 2021. I am also undergoing vestibular physical therapy. I am now worried if this problem could be magnified by the booster, which I would be eligible for because of my age, 72..

Other Meds: Levethroid 112 mcg, 1Xd, Zocor 20 mg, 1XD, Liisinopril 10 mg, 1XD: Non Rx: Centrum, Vitamin C, Calcium, FishOil, ICaps Areds, Fiber therapy

Current Illness: None

ID: 1719030
Sex: F
Age: 40
State: WA

Vax Date: 09/17/2021
Onset Date: 09/18/2021
Rec V Date: 09/21/2021
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: Codeine

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Profuse sweating, joint aches (specifically to neck/spine), significant headaches/brain fog for 48 hours. Redness/swelling/pain/itching to injection site that continues to worsen each day. Started as a small red area 24 hours post injection (about a pencil eraser size), now the area is notably more red, painful, swollen and itchy. Size is now larger than my palm (as wide as a coffee mug).

Other Meds: Losartan potassium, sertraline

Current Illness: None

ID: 1719031
Sex: F
Age: 54
State: FL

Vax Date: 09/19/2021
Onset Date: 09/21/2021
Rec V Date: 09/21/2021
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: PCN Sulfa

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Numbness and tingling to bilateral lower extremity. Complete and total loss of bladder control. This has never once happened to me prior to the 2nd COVID-19 vaccine.

Other Meds: Plavix Gabapentin

Current Illness: None

ID: 1719032
Sex: F
Age: 32
State: MD

Vax Date: 08/28/2021
Onset Date: 08/29/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data: Office visit with pcp on 9-17-21, multiple negative covid test, and a series of labs including Lyme.

Allergies: Sulfa

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

Symptoms: Headache the next day after the shot for 4 days, dizzy spells on and of for 3 weeks, almost fainting 3 times, fever 99.9, muscle aches, fatigue for 3 weeks, racing heart for two weeks, nausea on and off and one episode of hand numbness.

Other Meds: Zyrtec, doxycycline

Current Illness: Cold symptoms . COVID negative

ID: 1719033
Sex: M
Age: 68
State: MO

Vax Date: 08/17/2021
Onset Date: 09/11/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data: CT Scan - normal MRI - normal

Allergies: Methotrexate, ragweed.

Symptom List: Rash, Urticaria

Symptoms: Bell's palsy on the right side of the face where injection site is located.

Other Meds: None.

Current Illness:

ID: 1719034
Sex: F
Age: 71
State: MO

Vax Date: 03/19/2021
Onset Date: 04/01/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data: EKG- bradycardia Holter monitor

Allergies: Pravastatin; Ibuprofen; Paroxetine HCl; Trazodone; Zetia; Lisinopril; Nortriptyline; Omeprazole

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

Symptoms: On 04/01/2021, I had a doctor's appointment. I had a 40 pulse at that time and the doctor did not talk about it. This is the first time I had my pulse that low. On 07/01/2021, I saw the doctor, he did an EKG and referred me to my cardiologist. The EKG they found bradycardia. Right bundle branch block and left ventricle enlargement. I saw another doctor on 07/13/2021- he did an Holter monitor it him on 08/25/2021- he did an EKG sinus bradycardia, rest PAC, RBB-right bundle block, and LVH- Left Ventricular Hyper. He scheduled me for a pacemaker- on 09/17/2021. Unknown about my AEs because I am still being monitored and still recovering.

Other Meds: Baby Aspirin 81 mg od; Singulair 10 mg od; Magnesium 250 mg od; Lasix 40 mg od; Losartan 50 mg od; Pantoprazole 40 mg od; Amlodipine 5 mg od; Multivitamin od; Symbicort Inhaler 160/.45 bd; Tylenol 500 mg od

Current Illness: no

Date Died: 09/14/2021

ID: 1719035
Sex: F
Age: 82
State: MN

Vax Date: 02/23/2021
Onset Date: 09/14/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data:

Allergies: Penicillins, Percocet, Sulfa drugs, Fosamax, Tolectin, Aspirin, Morphine, Plavix, Tolmetin, Doxycycline

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

Symptoms: Patient passed away on 09/14/2021

Other Meds: Dilaudid, Norco, Mobic, Protonix, Aldactone

Current Illness:

ID: 1719036
Sex: F
Age: 26
State:

Vax Date: 09/20/2021
Onset Date: 09/20/2021
Rec V Date: 09/21/2021
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: Horrible sore shoulder since 1800 on 9/20. Couldn't sleep on it, pain relieveers don't help. Can't even abduct it past 30 degrees or adduct it past zero degrees. Also, left arm was tingly today

Other Meds: none

Current Illness: none

ID: 1719037
Sex: M
Age: 13
State: PA

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

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

Lab Data:

Allergies:

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

Symptoms: Woke this morning with a migraine which he gets regularly. So we gave him Rizatriptan 10mg. He has also taken a Imodium that morning as he had some mild Diarrhea the day before after eating to much clam chowder. He got into the shower around 10am and after being in the shower for a few minutes started to feel like he was passing out. He got out of the shower and felt weak and was disoriented and called us for help. He had a hard time walking to his bedroom with assistance and layed back down in the middle of the hallway. We then got him up and and helped him to bed to rest. He said he felt very weird. We have not taken him to the doctor at this point as we are not sure what to do and are just waiting to see how he progresses today. His shot was last night.

Other Meds: woke with a migraine so he took Rizatriptan 10mg. Also took 1 Imodium as he had some mild diarrheas the last few days.

Current Illness: had some mild Diarrheas two days prior.

ID: 1719038
Sex: M
Age: 15
State: FL

Vax Date: 08/26/2021
Onset Date: 08/28/2021
Rec V Date: 09/21/2021
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: , Lab results 08/30/2021 20:40 BUN 12 mg/dL Creatinine 0.64 mg/dL 08/30/2021 20:34 Troponin iSTAT 0.33 ng/mL HI Lab/diagnostic tests continued: Radiology results: Echocardiogram Non Congenital Complete Event Date: 08/31/2021 09:07:00 LV ejection fraction, A/L (N) 0.63 0.55 - 0.72 -0.2 CONCLUSIONS: - Left ventricle: In apical two chamber view there may be a very small slightly sluggish segment in the distal septal apical wall. Suggest f/u. - Pericardium, extracardiac: There is a tiny epicardial separation seen lateral to the left ventricular posterior wall, likely within normal limits but given underlying history could be related to a minimal pericarditis. - No structural abnormalities seen. Qualitatively normal left ventricular systolic function.

Allergies: Nona

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

Symptoms: Pt is a 15-year-old male with past medical history of anxiety who was admitted to our cardiology floor for pericarditis in the setting of recent COVID-19 vaccination. Per mother he received his second dose of the Pfizer COVID-19 vaccine on Thursday. Initially following the vaccine, he had no reaction and was asymptomatic. However on Saturday he began with palpitations and mild chest pain. On Sunday he continued with palpitations and also states that he felt a warm flushed type sensation on occasion. Today (Monday), troponin was relatively asymptomatic, however given his symptoms over the weekend he was seen by his pediatrician who then referred his family to the emergency room. Of note, patient has been without fevers, fever vomiting, diarrhea, or rashes. Mother denies that patient has any other cardiac history. He has never had an echocardiogram or EKG done previously. There is no significant cardiac family history. No history of cardiac medications, only home meds include duloxetine 30mg BID and Buspirone 10mg BID. No congenital heart disease, no heart surgery done in infancy or childhood in the family, no history of pacemakers, no history of arrhythmia, and no history of sudden or on known cause of death, namely before the age of 50. In the ED, vital signs were normal. There troponin was done which resulted at 615 ng/L and a proBNP was done which was 120 pg/mL. CRP was also done which was 22.5 mg/L. EKG was done which demonstrated normal sinus rhythm with mild left axis deviation (likely lead placement related), and no significant ST segment or PR segment changes. Respiratory pathogen panel (PCR) was completed at their ER and was negative including COVID-19. Chest x-ray was obtained which demonstrated normal heart size and mild infiltrate and/or subsegmental atelectatic changes in the right lower lobe. No medication aside from Motrin was given. Dr. was called from the ED and decision was made to transfer patient to our facility for further management in the setting of vaccine related myopericarditis.

Other Meds: buspirone; duloxetine

Current Illness: None

ID: 1719039
Sex: M
Age: 72
State: TX

Vax Date: 04/26/2021
Onset Date: 09/20/2021
Rec V Date: 09/21/2021
Hospital: Y

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

Lab Data: CXR,

Allergies: NKA

Symptom List: Ear pain, Hypoaesthesia

Symptoms: weakness, dyspnea, pleural effusion

Other Meds: lactulose, atorvastatin, furosemide, harvoni, lantus, lisinopril, metformin, metoprolol, pantoprazole, propanalol, spironolactone,xifaxan

Current Illness:

ID: 1719040
Sex: F
Age: 30
State: IN

Vax Date: 09/13/2021
Onset Date: 09/15/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data: n/a

Allergies: n/a

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: On 9/15/21 my menstrual cycle started around its scheduled time, but I had a heavier menstrual flow, along with painful cramps, pelvic pain, and extreme fatigue. The best way I can compare my cramps and pelvic pain are close to pregnancy contractions. I haven't had this sort of menstrual pain before and my usual dose of Tylenol 1,000mg that I take for my normal menstrual cramps did not alleviate the pain. It is now day 7 and I still have spotting and pelvic pain on and off (which are both abnormal for me). My usual cycle ends around the 5th day and cramping usually stops after day 2.

Other Meds: Propanolol 80mg daily Levothyroxine 88mcg daily

Current Illness: none

ID: 1719041
Sex: F
Age: 39
State: OH

Vax Date: 09/03/2021
Onset Date: 09/16/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data:

Allergies: no

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

Symptoms: Menstrual cycle started sooner than expected.

Other Meds: Multi-vitamin

Current Illness: none

ID: 1719042
Sex: F
Age: 39
State: OK

Vax Date: 05/01/2021
Onset Date: 05/28/2021
Rec V Date: 09/21/2021
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: Autoimmune lab panel that is pending results.

Allergies: Wasp venom

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

Symptoms: Three weeks after received the second dose, patient developed a "severe burning" rash on her left cheek. She went to urgent care and was diagnosed with Shingles and was treated with Acyclovir. Treatment did not help and she returned to her PCP who agreed it was Shingles and treated the condition with steroids with little to no effect. The rash spread to her right side and was treated with more steroids -- seven rounds in total. Rash continue to spread down to her neck and chest and has only gotten worse since. She has seen dermatology for the rash. She has been prescribed Lyrica and gabapentin for the pain, however she cannot take it due to side effects. She will be referred to Neurology for suspected neurological pain brought about by the vaccine. It should noted she received the first dose of the Moderna vaccine on 03/03/21 and later was diagnosed with COVID-19 on 03/28/2021.

Other Meds: Ibuprofen 200 mg TID as needed, Mortrin 800 mg TID as needed, Tylenol 325 q6h as needed, Vitamin D 50 mcg one a day, Zyrtec Allergy daily.

Current Illness: unknown

ID: 1719043
Sex: F
Age: 58
State: KY

Vax Date: 05/26/2021
Onset Date: 09/17/2021
Rec V Date: 09/21/2021
Hospital:

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 PCR - Detected

Allergies: Nsaids Hydralazine: Nausea And Vomiting, Other (See Comments) Mango: Rash

Symptom List: Unevaluable event

Symptoms: HPI: she reports symptoms mainly started on Wednesday. She has Sarcoid and is on Imuran. She states she usually has a cough but it became a lot worse the last couple days. She has been vaccinated for Covid. F/c/sweats, body aches-has had aches x 2 days, +chills, no fever Cough-dry cough SOA,CP-no Sore throat-no Congestion-slight Headache-yes Earache-no Fatigue-yes N/V/D-no Loss of taste or smell-no Covid exposure-no known Covid exposure but her husband started getting sick with the same symptoms 2 days before she did and he has not been vaccinated Travel in the last 2 weeks- Work or school

Other Meds: amLODIPine (NORVASC) 5 mg tablet azaTHIOprine (IMURAN) 50 MG tablet famotidine (PEPCID) 20 MG tablet famotidine (PEPCID) 40 MG tablet lisinopril (PRINIVIL) 20 MG tablet predniSONE (DELTASONE) 20 MG tablet

Current Illness:

ID: 1719044
Sex: F
Age: 27
State: FL

Vax Date: 09/10/2021
Onset Date: 09/14/2021
Rec V Date: 09/21/2021
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, I do not have Healthcare insurance. This is a major reason I was not wanting to get the vaccine.

Allergies: Penacillian

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

Symptoms: Major sweating, major headaches, stiff neck pain and ear pain (right ear only). Still experiencing symptoms.

Other Meds: None

Current Illness: None

ID: 1719045
Sex: M
Age: 77
State: KY

Vax Date: 04/09/2021
Onset Date: 09/20/2021
Rec V Date: 09/21/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Pfizer on 3/19 and 4/9. Positive on 9/20

Other Meds:

Current Illness:

ID: 1719046
Sex: M
Age: 18
State: IN

Vax Date: 06/04/2021
Onset Date: 07/05/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data:

Allergies: penicillin

Symptom List: Injection site pain, Menorrhagia

Symptoms: pt developed 3" stretch marks under left arm pit. It is very noticeable and still looks the same as it did a couple of months ago.

Other Meds:

Current Illness:

ID: 1719047
Sex: F
Age: 38
State: NY

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

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

Symptoms: Mild intermittent vertigo, tinnitus, paresthesias

Other Meds: Zyrtec, zoloft

Current Illness: None

ID: 1719048
Sex: F
Age: 52
State: MS

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 09/21/2021
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: EKG 05/27/2021 Ultrasound 05/27/2021 Chest X-Ray 05/27/2021

Allergies: Pennicillin, Lavoquin, Sulfa-Drugs, Zanaflex, Steroids, Contrast Dye, Pollen, Dust, Animal Dandruff, Preservatives, Low-Level Milk Allergy

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Pt. states that after receiving the 2nd dose of Moderna 05/27/2021, started experiencing symptoms immediately of dizziness, nausea, both legs with a tingling feeling throughout, shortness of breath, arm swelling, flu-like symptoms, and chest pressure. ER visit 05/27/2021 EKG/Ultrasound, Chest X-Ray preformed (T-Wave abnormal), severe fatigue. 06/22/2021 ER due to severe tingling in both legs, sometimes in different parts of the body. 09/08/2021 Neurologist appt. follow-up in November. Symptoms still continuing to experience symptoms.

Other Meds: Diaxipan, Carvajal, Hydrazine, Lothartin, Zyrtec, Colace

Current Illness: N/A

ID: 1719049
Sex: M
Age: 53
State:

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Within 15-20 minutes of injection; full body rash; red skin; sensation was burning. Light headedness. In three days; ringing in ears.

Other Meds:

Current Illness:

ID: 1719050
Sex: F
Age: 57
State: FL

Vax Date: 09/18/2021
Onset Date: 09/19/2021
Rec V Date: 09/21/2021
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. Just thought you should know had I known I was going to get that sick and go through what I just went through, I probably would have changed my mind about getting the vaccine. I haven't had so much as a sniffle since this whole mess began, until I got vaccinated.

Allergies: None

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

Symptoms: Fever between 101 and 102.6 (highest temp taken before bed Sunday p.m.); severe headache, cough, severe muscle aches, pain in every joint, including my feet. Today is 72 hours since the injection and I am extremely fatigued, although my fever is gone, and the muscle/joint pain is greatly reduced.

Other Meds: Metformin Cymbalta

Current Illness: None

ID: 1719051
Sex: F
Age: 64
State: MI

Vax Date: 03/25/2021
Onset Date: 09/13/2021
Rec V Date: 09/21/2021
Hospital: Y

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

Lab Data: 9/7/21: ED visit for Cellulitis of left lower extremity. discharged home on antibiotic 9/13/21: returned to ED with worsening abscess of her left lower extremity. admitted for abscess, lymphedema and COVID 19+ 9/14/21 USV: There is no deep venous thrombosis in the visualized deep veins of the right or left lower extremity. 9/15/21 CXR: There is scattered bilateral mixed interstitial and airspace opacity most prominent in the left mid to lower lung. This is nonspecific and could relate to the patient's known COVID 19 although can also be seen with pulmonary edema given the associated pulmonary vascular congestion. 9/15/21 Right upper quadrant US: Right upper quadrant ultrasound with complete duplex Doppler liver 1. Cirrhotic liver without definite mass or cyst. 2. Sonographic findings suggesting portal hypertension. 3. The splenic vein and superior mesenteric veins were not seen on this exam. 4. Exam indeterminate for acute cholecystitis is the gallbladder is mostly contracted. 5. Small amount of ascites scattered throughout the abdomen. 9/18/21 CXR: There are persistent subtle bilateral interstitial opacities. However, the appearance has significantly improved from prior. 9/20/21: Patient was hypotensive overnight. Was started on stress dose steroids. Will discontinue stress dose steroids and administer IV fluids. Patient's blood pressure responded well to fluids. Will continue to monitor vitals overnight. If blood pressure remains stable anticipate discharge tomorrow. If patient continues to be hypotensive will plan to start midodrine.

Allergies: none

Symptom List: Nausea

Symptoms: Hospitalized 9/13/21; COVID-19 positive on 9/13/21; fully vaccinated. Admitted for Abscess , Lymphedema and COVID-19

Other Meds: Tylenol, Unasyn, Tessalon, TUMS, lovenox,Pepcid, Lasix, Motrin, Synthroid, Midodrine, Norepinephrine infusion, Zofran, Oxycodone, senna, Aldactone, constulose

Current Illness: 9/7/21 went to ED for leg swelling. Dx with cellulitis of left lower extremity and d/c home on Keflex. 9/13/21 returned to ED for skin problem of left leg again. CT left lower extremity US: A fluid collection, right lower leg is consistent with a subcutaneous abscess. No muscle involvement. No osteomyelitis. COVID + with no symptoms per patient admitted to hospital.

ID: 1719052
Sex: F
Age: 35
State: KY

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

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

Lab Data:

Allergies: NKDA

Symptom List: Injection site pain

Symptoms: Patient received their 1st Moderna Covid vaccine on 8/30/2021. Patient received their second Moderna Covid vaccine on 9/20/2021. The vaccine was given out of interval. It was administered 21 days apart rather than 28 days apart. No adverse reactions were noted. Patient was informed of event.

Other Meds:

Current Illness:

ID: 1719053
Sex: F
Age: 23
State: KY

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

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

Lab Data: n/a

Allergies: pcn

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

Symptoms: Patient has a rash that is on her neck, that is on the side she had the vaccine and it is going towards the center. The area does not itch, but it is hot to touch. The area is raised and red.

Other Meds: birth control

Current Illness: n/a

ID: 1719054
Sex: F
Age: 61
State: VA

Vax Date: 09/18/2021
Onset Date: 09/18/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data: Dr. checked my vitals on September 18, 2021 and everything came back normal. Dr. advised me to keep taking the Benadryl as needed.

Allergies: Animals; plants; my allergy shot.

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

Symptoms: A hour hour after receiving my 3 shot I started to feel fullness in my head and then I felt a tingling in my throat and my voice became foggy. 12:30PM I took a Benadryl tablet myself, 25mg; and then I waited to see if it would fix it. So around 1:00pm, I went to the ER. They checked my vitals and everything was normal. Dr. told me to wait a while to see if my symptoms would go away. I waited about an hour and I was discharged and the Dr. told me to continue to take the Benadryl as needed.

Other Meds: Omeprazole; Keppra; Buspirone

Current Illness: I have Cancer

ID: 1719055
Sex: F
Age: 76
State: KY

Vax Date: 03/23/2021
Onset Date: 08/26/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data: SARS-CoV-2 PCR - : Detected

Allergies:

Symptom List: Tremor

Symptoms: 77 yo female presents with cough, fatigue, body aches, and vomiting. She reports that the cough started on Tuesday and has worsened. She denies soa or wheezing. She is vaccinated for COVID-19. She has had 2 episodes of nb emesis today. She thinks this was caused from taking mucinex for the cough. Fever tmax at home was 100.9.

Other Meds: acetaminophen (TYLENOL) 500 MG tablet Ascorbic Acid (VITAMIN C) 500 MG CAPS aspirin 81 MG EC tablet Cholecalciferol (VITAMIN D3) 50 MCG (2000 UT) capsule hydroCHLOROthiazide (HYDRODIURIL) 12.5 MG tablet losartan (COZAAR) 50 MG tablet pravas

Current Illness: NKA

ID: 1719056
Sex: M
Age: 16
State: IN

Vax Date: 06/04/2021
Onset Date: 07/05/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: pt developed 2 x 1 stretch mark on the center of the back. It is very noticeable and still looks the same as it did a couple of months ago.

Other Meds:

Current Illness:

ID: 1719057
Sex: M
Age: 66
State: WI

Vax Date: 04/22/2021
Onset Date: 05/20/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Significant, on-going pain in the muscles of lower and upper right arm near the elbow (not the shoulder where the shot was given). This pain started about a month after receiving the shot and is not diminishing or going away even now 5 months after receiving the shot. Also had the same side effects in the left arm where the first shot was given but right after the shot was given and not as severe. It has mostly subsided in the left arm over about a 4 week period but occasionally still have some mild pain.

Other Meds: Multivitamin, vitamin D

Current Illness: none

ID: 1719058
Sex: F
Age: 56
State: WA

Vax Date: 03/15/2021
Onset Date: 03/30/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data: Lab and biopsy blood workup done at gym office in August 2021

Allergies: Anaphylactic to food and antibiotics and pain medicat

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

Symptoms: May or may not be related after 1- the year no period right after shot and continued to month of August cycle restarted. Gym did testing rule out other causes no finding as to what prompted the cycle to regenerate. Reported to gun she did not choose to report. I felt it was worth a mention as no other explanation can be concluded.

Other Meds: Allerplex herbal allergy

Current Illness: Anxiety (history of serious reaction to mild )

ID: 1719059
Sex: M
Age: 77
State: NC

Vax Date: 02/11/2021
Onset Date: 02/14/2021
Rec V Date: 09/21/2021
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:

Allergies: n/a

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: 2 days after vaccine, was very sick with sepsis and pneumonia. Stayed in hospital 4 days.

Other Meds: Carbamazepine,metoprolol,simvastatin,potassium,warfarin,omeprazole,indapamide,vitamin b12

Current Illness: N/a

ID: 1719060
Sex: M
Age: 14
State: NC

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

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

Lab Data: CT, MRI, blood work

Allergies: none

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

Symptoms: Student was drooling, and had an altered state. Speech was mumbled, student was able to smile and it was equal. Student's heart rate was in the 50s, Sp02 98-99% , EMS/911 was called, student transported to hospital after monitor showed 3rd degree heartblock. EMS took student to hospital where a code stroke was called. student had a CT and an MRI, student then was taken to surgery to remove clot from brain.

Other Meds: NONE

Current Illness: none

ID: 1719061
Sex: M
Age: 62
State: CA

Vax Date: 03/17/2021
Onset Date: 08/05/2021
Rec V Date: 09/21/2021
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: ER did a lot of testing - Bloodwork - because of my immunosuppressants my white blood count is very low - 2.0 at the time. Red blood count - low - and these numbers for white and red are still low but are in normal ranges due to the immunosuppressants I'm taking currently. Electrolytes - I had low sodium. AST - tested that - and that was low. Did a lot of tests - vitals at the time: 122/65. Pulse was 90. Respiration 18.; 02 - 98% COVID - diagnosis was confirmed as positive

Allergies: sulfa based medications; mulberry tree - gives me asthma as an allergic reaction (pollen)

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

Symptoms: (Immediately after - soreness of the injection site arm and that was it. The next day, it didn't even feel like I had had a shot.) Health Event in August - I felt fatigue for two days or so. I felt like I was out of breath then two days after that. Both of these symptoms continued. And also I had a lack of appetite and a lack of taste right off the bat. I had a cough. My chest - I felt like I couldn't take a full breath but my oxygen level was between 92-96 most of the time. My wife checked my temperature - and it was 99.8. Then my fever started going up- 99.8 and then 101.2 - I took acetaminophen - my fever was going down a little bit with that. A week into it, I got a fever of 104. I had diarrhea, too. My liver transport coordinator told me to go immediately to go to ER and get an infusion of monoclonal antibodies. ER was hot and packed with people. It took almost 40 minutes to get checked in and an hour later and they came out saying that it would a long time before we could be seen. My wife was feeling sick too and she was worried that she wouldn't be able to drive me home if we waited into the night. The next day we went very early in the morning and then I was able to get the infusion (Regeneron). They kept me a little while - an hour or so to make sure the infusion they gave me didn't give me any side effects. I went home and it took a couple of days for me to feel better. Quarantined until about August 28th - until I didn't have a fever for several days.

Other Meds: no

Current Illness: recovering from cancer - but at the time cancer free

ID: 1719062
Sex: F
Age: 43
State: KY

Vax Date: 01/27/2021
Onset Date: 09/07/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data: COVID-19 RESULT:Detected

Allergies: NKA

Symptom List: Pain in extremity

Symptoms: HPI patient is a 43-year-old female who presents for evaluation. Patient is having mild upper respiratory tract type symptoms with cough nonproductive she has lost her taste and smell. Patient been going on for last 3 to 4 days. As noted her husband is quite sick with regard to GI complaints associated possibly with COVID-19 as well. Patient denies any other significant problems at this point. GI or GU complaints no other cardiac or pulmonary complaints medications were reviewed with the patient as were her drug allergies

Other Meds: buPROPion (WELLBUTRIN XL) 300 MG 24 hr tablet clonazePAM (KLONOPIN) 1 MG tablet docusate sodium (COLACE) 100 MG capsule fluticasone (FLONASE) 50 MCG/ACT nasal spray ibuprofen (MOTRIN) 800 MG tablet levothyroxine (SYNTHROID) 75 MCG tablet lo

Current Illness:

ID: 1719063
Sex: M
Age: 0
State:

Vax Date: 05/18/2021
Onset Date: 05/18/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data: UNKNOWN

Allergies: UNKNOWN

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

Symptoms: INFO COULD NOT BE CLARIFIED. SUSPECTED WRONG DATA ENTRY.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1719064
Sex: F
Age: 77
State: VA

Vax Date: 02/17/2021
Onset Date: 02/21/2021
Rec V Date: 09/21/2021
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: Bloodwork was done 2/21/2021 EKG, echocardiogram 2/21/2021

Allergies: Metformin, Sulfa drugs, Bactrim, Scallops

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

Symptoms: I woke up and my heart was racing and went to the ER, my blood pressure was high. They lowered my blood pressure with medications. Eventually my heart rate stabilized. I went in there about 8:30, they admitted me but they did let me go home that same afternoon. They told me I had pulmonary hypertension, and I do not think I've had that before.

Other Meds: Losartan-HCTZ, Escitalopram, Atorvastatin, Diltiazem, Aspirin, Calcium, Magnesium, zinc, D3

Current Illness: none

ID: 1719065
Sex: M
Age: 66
State: NC

Vax Date: 09/13/2021
Onset Date: 09/15/2021
Rec V Date: 09/21/2021
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 treated me for gout

Allergies: None

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

Symptoms: Gout Mild Diarrhea Skin rash Chills but no fever

Other Meds: Amplodipine Brsylate 10mg. Hydrochlorothiazide 25 mg. Tamsulosin HCL 0.4 mg Folic Acid 1000 mg.

Current Illness: Gout

ID: 1719066
Sex: F
Age: 76
State: MI

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: Positive 9.10.2021

Allergies:

Symptom List: Vomiting

Symptoms: Fever, loose stools,

Other Meds: vitamin C, lioresal, biotin, zyrtec, vitamin D3, colace, neurontin, dirtopan, paxil, prednisone

Current Illness:

ID: 1719067
Sex: M
Age: 26
State: IA

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

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

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient is impaired and while institutionalized earlier in the year was administered the J&J vaccine. He later came to our facility and we administer both pfizer doses to this patient. He requested the covid vaccine at initial injections and did not acknowledge that he had received another vaccine. 1st administered 8/13/2021 2nd dose administered 9/8/2021

Other Meds:

Current Illness:

ID: 1719068
Sex: F
Age: 30
State: CA

Vax Date: 09/17/2021
Onset Date: 09/18/2021
Rec V Date: 09/21/2021
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: emailed doctor for bloodwork. waiting to get completed. 9/21/2021

Allergies: codeine

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

Symptoms: bed ridden for 4 days, bruised at injection sight, fuzzy, dizzy, body aches, cramping, nausea, vaginal bleeding (this is the one I was worried and upset about), weak. I am still dizzy 4 days later and weak.

Other Meds: birth control

Current Illness: none

ID: 1719069
Sex: M
Age: 59
State: WI

Vax Date: 07/06/2021
Onset Date: 09/15/2021
Rec V Date: 09/21/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: No known allergies

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient contracted COVID after being fully vaccinated

Other Meds: albuterol fluticasone metformin multivitamin propranolol xarelto simvastatin

Current Illness: None documented

ID: 1719070
Sex: M
Age: 47
State: MI

Vax Date: 09/21/2021
Onset Date: 09/21/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data: na

Allergies: na

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

Symptoms: Patient was administered dose of COVID-19 Janssen vaccine. The lot number administered was expired, it expired on 9/19/21.

Other Meds: na

Current Illness: na

ID: 1719071
Sex: F
Age:
State: FL

Vax Date: 09/16/2021
Onset Date: 09/16/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: pain, asthma, loss of smell and taste, chills, fatigue and cough

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am