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: 1719281
Sex: M
Age: 31
State: CA

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: LA

Lab Data: n/a

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: 31 year old M received first dose of Pfizer vaccine to left deltoid at 1622. About 5 minutes later after sitting down in a chair for observation pt c/o dizziness, pt stated he "started to loose sense of hearing and sight, and started to loose consciousness" but did NOT have syncopal episode. Pt also c/o "weird sensation in chest" but when inquired about chest statement pt denied CP, any radiating pain, pt denied like an elephant was sitting on his chest. Pt did state "weird sensation in chest" could of been related to anxiety but was not too sure. Upon nurse assessment pt had pallor look skin, very noticeable on the lips. Pt was immediately brought ice water, vital signs (VS) taken, fan was applied towards patient, ice pack applied on back of patient's neck, legs were propped up on a second chair for venous return. VS taken at 1628 were as followed 141/120. SpO2 100 RA, HR 61, VS at 1635 95/35 (61), SpO2 100% RA, HR 65. Pt stated he did not have a good source of nutrition/meal the day of the vaccine. He reported he are two hours prior to the vaccine and he stated he only ate "a smallpiece of bread, hard candy, pumpkin butter, and cereal for breakfast". Pt educated and adviced on importance of having a nutritious meal on the day of the vaccine. Pt was taken down to nurse treatment room via wheelchair and report was given to charge RN in nurse treatment room. Pt reported symptoms were improving and he felt better as well. Pt's skin color and lip color was improving and pallor was resolved.

Other Meds:

Current Illness:

ID: 1719282
Sex: F
Age: 44
State: TX

Vax Date: 03/19/2021
Onset Date: 03/19/2021
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: Blood work, I had immune disorder

Allergies: keflex, mold

Symptom List: Anxiety, Dyspnoea

Symptoms: I have headache for 16 days, I had no energy, my whole-body aches like flu, after 17 days I was fine. I still have residual brain fogs; my short memory has been affected. I got COVID on 7/20/2021. Doctor said I now have COVID Lung. I am taking Zing 15 mg/day., Vitamin B3 6000 IU/day., K290mc a day., B12 Methylcobalamin (nasal spray). I have been referred to Neurologist.

Other Meds:

Current Illness:

ID: 1719283
Sex: F
Age: 35
State: TN

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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: N/A

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

Symptoms: Diagnosed shingles on upper left back, prescribed Valtrex and as of 09/21 rash is still present, fatigue is still present.

Other Meds: N/A

Current Illness: N?A

ID: 1719285
Sex: F
Age: 87
State: KY

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

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

Lab Data: COVID-19 Result: Detected

Allergies: NKA

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: 88 yr/o female with pmh for stroke (no residual) hld, htn, ckd, chf, atrial fib on Eliquis and osteoporosis who presented to the ed with left leg weakness and diarrhea. Over the last few days she reports lle weakness/numbness her symptoms were reported to be intermittent until this am and says they were worse/constant. She was unable to bear weight on the leg d/t the weakness. There has been no known trauma or injuries. No arm weakness, visual disturbances, dizziness or difficulty with speech. Additionally she reports several episodes of black watery stools and intermittent non-productive cough for the last 4 days. No recent abx, no fevers/chills or abd pain. She is on Eliquis.-denies any bright red blood, or urinary complications. She has been vaccinated for COVID. No other complaints at this time

Other Meds: acetaminophen (TYLENOL) 325 MG tablet atorvastatin (LIPITOR) 40 MG tablet(Expired) Calcium Carbonate-Vitamin D (CALCIUM 600+D) 600-400 MG-UNIT per tablet diclofenac (VOLTAREN) 1 % gel dilTIAZem ER coated beads (CARDIZEM CD) 120 MG 24 hr cap

Current Illness:

ID: 1719286
Sex: M
Age: 27
State: WA

Vax Date: 09/16/2021
Onset Date: 09/19/2021
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: NONE

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

Symptoms: UNEXPLAINED NUMBNESS IN RIGHT ROOT EXCEEDING 3 DAYS

Other Meds: NONE

Current Illness: NON

ID: 1719287
Sex: M
Age: 64
State: NY

Vax Date: 08/26/2021
Onset Date:
Rec V Date: 09/21/2021
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: 09/13/2021 Bone Marrow Biopsy "Bone marrow, left posterior iliac crest, biopsy and smears: - Marked diffuse histiocytic infiltration with occasional hemophagocytosis. - Background of hypocellular marrow (15-20%). - Mild T-cell lymphocytic infiltration. - Trilineage hematopoiesis with mild megakaryocytic hyperplasia. - Concurrent flow cytometry shows no atypical cell populations. The striking features seen in this marrow is diffuse histiocytic infiltration with occasional forms exhibiting hemophagocytosis. In the setting fever, pancytopenia, and high ferritin, the histologic findings raise the possibility of hemophagocytic lymphohistiocytosis (HLH). Of note, there is no evidence of leukemia, lymphoma, or dysplasia. Clinical correlation is advised. IHC and special stains: CD68 and CD163: extensive histiocytic infiltration. CD3: mild T-cell infiltration CD61: normal megakaryocytes with slight hyperplasia CD34 and CD117: no increase in blasts. FLOW CYTOMETRY IMMUNOPHENOTYPIC STUDIES: SPECIMEN: FL21-4176 ANTIBODIES: CD2,3,4,5,7,8,10,11b,13,14,15,16,19,20,22,25,33,34,38,45,56,58,64, 117,123, GlyP,K,L,DR, cCD79a, MPO, TdT (32 antibodies) VIABILITY: 97% GATING: CD45 versus Side Scatter IMMUNOPHENOTYPIC FINDINGS: Granulocytes are 83% of total Monocytes are 4% of total Lymphocytes are 5% of total Blasts are undetectable by labeling for CD34, with no abnormal myeloid population detected. T cells are 3% of total (51% of cells in lymphocyte gate) with no aberrancies detected, CD4:CD8 = 4.66 B cells are <1% of total (4% of cells in lymphocyte gate) and are polytypic. NK cells are <1% of total (9% of cells in lymphocyte gate) with no aberrancies detected. " Ferritin elevation 9/13/2021 06:08 FERRITIN: 6,251 (H) 9/16/2021 04:53 FERRITIN: 3,888 (H) 9/17/2021 05:19 FERRITIN: 8,074 (H) 9/18/2021 04:15 FERRITIN: 7,810 (H) 9/19/2021 05:46 FERRITIN: 5,218 (H) 9/20/2021 05:23 FERRITIN: 6,614 (H) 9/21/2021 05:24 FERRITIN: 28,096 (H) INTERLEUKIN-2 RECEPTOR is in process Patient following diagnosis of secondary HLH has been started on high-dose steroids and IVIG - Anakinra is planned given lack of response in fevers and encephalopathy Below is brief summary of hospital course - work up thus far unrevealing of cause/trigger of secondary HLH "Following receipt of the first dose of COVID-19 vaccine (Pfizer) on 08/26, presented with persistent fatigue, fever and right sided ribcage pain - was noted pancytopenic, febrile but hemodynamically stable, mild Cr and LFTs elevation Over the course of current hospitalization, has remains persistently febrile, encephalopathic, and pancytopenic - S/P extensive work up of infectious etiology of symptoms which has remained negative - LP not suggestive of infection/encephalitis - CT scan abdomen/pelvis (no contrast study) unremarkable Problem list: - Liver transplantation 5/2021 - Arachnoid cyst in left brain with mild midline shift (not new/known finding) - Recent COVID-19 vaccination (first dose 08/26 - preceding onset

Allergies: No known drug allergies

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

Symptoms: FUO + pancytopenia + acute encephalopathy Workup revealing secondary HLH Symptom onset with fatigue reported day after the COVID-19 vaccine dose

Other Meds: No known OTC or herbal medications Prescription medications as below ? lidocaine 4 % patch 1 patch 1 patch transdermal Once ? lidocaine patch REMOVAL transdermal Q24H ? amlodopine (NORVASC) tablet 10 mg 10 mg oral DAILY AT 5 PM ? aspi

Current Illness: No acute or worsening of chronic illness in the recent 1-2 months prior to onset of current illness

ID: 1719288
Sex: F
Age: 17
State: ND

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: Pyrexia, White blood cell count decreased

Symptoms: Moderna vaccine was administered to a 17 year old. Administration error. Contacted state DOH and also consulted CDC document dealing with this type of error and will follow up with 2nd dose of Moderna after 28 days as directed.

Other Meds:

Current Illness:

ID: 1719289
Sex: F
Age: 35
State: OR

Vax Date: 09/12/2021
Onset Date: 09/12/2021
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: Contrast Dye Orange soap seasonal allergies dust mites

Symptom List: Pharyngeal swelling

Symptoms: 45 minutes after receiving the vaccine, I developed a rash on my upper chest, left side of my stomach, and my face around the cheeks. The areas was red, warm to the touch, and itchy. It was especially more itchy on my belly. I went back to the site where I got vaccinated. I was triaged by a nurse who confirmed that I was having an allergic reaction. They told me to take Benadryl and Pepcid OTC and follow up with my PCP if needed or go to the ER if symptoms got worse. I took the medication and then the reaction on my skin did not go away completely. It will come and go. I still took the medication. That same day when I got the vaccine, at night i called my doctors office. The nurse told me to follow up with my PCP and I was given an appointment. I saw the doctor on a video visit and she told me to go in person to one of the offices and to take pics of the rash so she could send them to the dermatologist. I went to do that and waited for a call from them and they did not get back to me. So I called them almost everyday. I finally got to talk to someone and they prescribed me with a cream for the rash, but no clear answer was given to me when I asked if it was safe to get the 2nd vaccine. I was told to complete the treatment with cream for 1 to 2 months before they could make a decision. I told them that I couldn't wait because at my job HR was asking for the 2nd vaccine because of them possibly letting people go if they weren't fully vaccinated or have a medical exception. I guess they are really busy so I never got an answer back that I had asked them about. I went to urgent care trying to get an answer and they told me to wait for another appointment with the dermatologist. Someone told me they would call me back from the dermatologist department. I got a message from a dermatologist from my online application from Kaiser and the provider said I needed to continue with the treatment with the cream. She said she was going to refer me to an allergy specialist. On September 20, 2021 I had the appointment with the allergy doctorand he gave me a letter saying that he does not recommended that I get the 2nd vaccine. However, he said to continue with the treatment with the cream and follow up with the dermatologist for 1 to 2 months to reassess the situation. I'm not sure if that means they will give me the okay in the future to take the 2nd dose, and I am afraid that I will get laid off if I don't get the 2nd dose. I do want to get protected but if the doctor is saying that I shouldn't because of the reaction that I had, I am not sure what to do as of now. I sent a message to my PCP yesterday trying to get all of the information all in one place because I had been getting different answers when I was trying to talk to the dermatology department. They would just tell me they don't know if the reaction was significant to the vaccine and that's why they wanted me to finish the treatment for the cream. I'm not sure if they are sure on what is going on with me. I am kind of going in circles with being told to continue to use the cream because the doctors are telling me to go to one specialists to another each time.

Other Meds:

Current Illness:

ID: 1719290
Sex: M
Age: 17
State: OH

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: LA

Lab Data:

Allergies: n/a

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient experienced dizziness right after vaccine and collapsed

Other Meds: n/a

Current Illness: n/a

ID: 1719291
Sex: F
Age: 33
State: OR

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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: As of the time of this report, none.

Allergies: Cephalexin, Paper tape

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Immediately after injection pt vomited once and within 15 minutes began feeling severe burning and tearing sensation throughout R arm (opposite the side that was injected) that spread toward upper back and further spread downward to lower back. Pt rates pain 9/10 now but immediately after injection states pain was 10/10. Pt has sensation of skin being on fire, tingling, and numbness that she describes as being "like when your arm falls asleep". Skin is very sensitive to palpation and clothing is further irritating sx. Pt also has full body fine tremors. Immediately after injection she had blotchy red rash to chest noted by EMS but has resolved upon arrival to emergency room. Per pt, pharmacist at pharmacy where she received the vaccine also noted that her temperature rose from 97.4 to 99.2.

Other Meds: Mirena

Current Illness: No

ID: 1719292
Sex: F
Age: 43
State: MO

Vax Date: 07/29/2021
Onset Date: 08/07/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data: EKG, heart and oxygen monitor, bloodwork, chest x-ray, iodine CT scan performed on 8/9/21; all normal except elevated D-dimer levels EKG & bloodwork performed on 8/16/21; normal Home heart monitor implemented on 8/30/21 for 4 weeks Referred to Neurologist, Upper GI specialist, and Psychiatrist

Allergies:

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

Symptoms: 8/7/21 @5:30am woke with "quivering" of the heart immediately followed by chest pain/tightness, "squeezing", & difficulty breathing. Pain/distress 6 on a scale of 1-10, better when sitting up, worse when lying down. Low risk of cardiovascular disease, no pain in left arm (or any extremities). Symptoms lasted ~1 hour until fell asleep sitting up 8/8/21 ~8pm symptoms occurred again, 3 out of 10. Lasted ~1.5 hours. 8/9/21 @4am symptoms occurred again, 4 out of 10, lasted ~1 hour. @3pm symptoms occurred and worsened; @ 5pm visited urgent care. Attending physician sent to the emergency room. At the ER they performed an EKG, attached heart and oxygen monitors, and performed bloodwork. Elevated D-dimer levels prompted a chest x-ray and iodine CT scan: no clots. All other tests in normal range. Administered aspirin and referred to a cardiologist. Symptoms continued until ~11pm. Aspirin helped. 8/10/21 - 8/12/21 symptoms recurred intermittently, 4 out of 10, usually at night. Stopped Apri. 8/13/21 @7am symptoms worsened and lasted all day, 6 out of 10, causing incapacitation and a migraine. 8/14/21 - 8/15/21 symptoms lessened but continued. GP and cardiologists booked through Nov; depression & anxiety spiked; suicidal thoughts. Took 10mg Escitalopram, an anti-depressant used before with good result. 8/16/21 @330am woke to severe quivering, "a wave of adrenaline", and clenching/shaking/seizing that started in chest, spread to torso, stomach, intestines, legs, eventually arms, locking up the jaw. Spouse called ambulance; taken to another ER. Episode lasted ~45 minutes; disoriented intermittently thereafter. EKG showed normal. Given Ativan, brought on more shaking, lasted ~10 minutes. Referred to GP, upper GI professional, Psychiatrist. Chest discomfort continued 3 out of 10 intermittently. 8/17/21 @4am another seizure episode, lasted 15 minutes, similar severity as first. Discontinued Escitalopram. Seizures brought on a migraine which continued 8/17 - 8/19. Intermittent chest discomfort, 3 out of 10, continued until 8/18. 8/20/21 @3:30am seizure occurred, milder than before, lasted ~ 15 minutes. 8/22/21 @2am another seizure, milder still 8/22, 8/24, 8/25/21 chest tightness for several hours, racing/pounding/quivering heart when waking up, much milder than onset. 8/29/21 saw cardiologist, implemented use of a heart monitor to be worn at home for 4 weeks. 8/30/21 mild heart racing. 9/10/21-9/14/21 mild chest discomfort/pain 9/15/21 saw GP's Nurse Practitioner, referred to neurologist. @8pm chest pain began and worsened through 7am 9/16/21, 6 out of 10; some muscle spasms since.

Other Meds: Apri (Birth Control), Gabapentin, Sumatriptan, Ibuprofen, Tizanidine, 5 HTP (rarely), Multi-vitamin with CoQ10, Vitamin D3, Fish Oil, Magnesium

Current Illness: Migraines

ID: 1719293
Sex: M
Age: 74
State: CA

Vax Date: 02/21/2021
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:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: weakness, fever 100.5, cough, headache, started yesterday, denies sob or cp, was walking to restroom and had fall landing on carpet, no injury from fall, able to get him self up, usually uses walker to walk around but not when he fell,

Other Meds:

Current Illness:

ID: 1719294
Sex: M
Age: 49
State: OK

Vax Date: 02/23/2021
Onset Date: 09/01/2021
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: Covid-19 Rapid test @ Beggs Pharmacy Pryor OK

Allergies: Morphine Codeine

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

Symptoms: Tested positive for Covid-19 Runny Nose Headache Sneezing Congestion Shortness of Breath

Other Meds: Losartan 100mg Duloxetine DR 20 mg Bupropion SR 100mg Metoprolol Tartrate 50mg

Current Illness:

ID: 1719295
Sex: F
Age: 29
State:

Vax Date: 08/30/2021
Onset Date: 08/31/2021
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:

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

Symptoms: migraines, constant headaches, shortness of breath

Other Meds:

Current Illness:

ID: 1719296
Sex: F
Age: 12
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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: none. Mother was notified immediately and instructed to monitor the patient and take her directly to and ED if issues arise. I checked on the patient an hour later and she was doing well. I will continue to call the mom/patient over the next couple of days to see how she is doing.

Allergies: none

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

Symptoms: pfizer vaccine was mixed with sterile water instead of 9% normal saline. dose give was 0.5ml instead of 0.3ml as well.

Other Meds: none

Current Illness: none

ID: 1719297
Sex: F
Age: 40
State: MN

Vax Date: 01/25/2021
Onset Date: 09/19/2021
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: Breakthrough COVID case. Tested positive on PCR test 9/20/21

Other Meds:

Current Illness:

ID: 1719299
Sex: F
Age: 66
State: CT

Vax Date: 03/27/2021
Onset Date: 03/29/2021
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: Hospitalized for 1 week and transferred to SNF. She was home for 2 days and went back into the hospital for an additional week. CXR showed pulmonary edema and opacity. Diagnosed with pneumonia and COPD exacerbation. CT scan showed bilateral lower lobe atelectasis.

Allergies: Penicillin and sulfa. No food allergies. No other allergies.

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

Symptoms: 2 days after receiving the second dose of the moderna COVID vaccine, patient developed total body weakness, syncopal episodes, legs felt like jelly when she was standing. She was unable to eat. Nauseous. Unable to swallow without aspirating. Hospitalized for 1 week. Transferred to SNF. Rehospitalized after discharge from SNF. She is now in a scooter due to the continued weakness since receiving the second vaccine.

Other Meds: Albuterol inhaler alprazolam Aripiprazole bupropion escitalopram furosemide hydroxyzine lamotrigine liothyronine metformin motoprolol montelukast pantoprazole potassium chloride quetiapine rosuvastatin synthroid tramadol trazodone

Current Illness: None

ID: 1719300
Sex: M
Age: 79
State: CA

Vax Date: 03/09/2021
Onset Date: 03/14/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data: None

Allergies: Vicodin

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Headaches, Dizziness, Itchiness, Pins and needles sensation all over body.

Other Meds: N/A

Current Illness: None

ID: 1719301
Sex: F
Age: 35
State: MD

Vax Date: 03/18/2021
Onset Date: 07/13/2021
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:

Allergies: Dairy

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: I wake up that morning, my right jaw at the joint had pain and tightness. I got in my clinic; he was unsure what was causing this. He gave me pain medicine, and a muscle relaxer. I also having pain in my left arm that started on Sept 2nd. I got an appointment for this issue soon.

Other Meds:

Current Illness:

ID: 1719302
Sex: F
Age: 26
State: SD

Vax Date: 08/29/2021
Onset Date: 08/29/2021
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: No tests done

Allergies: green beans, peas

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

Symptoms: Patient received one dose of Jansen COVID vaccine on 8/29/2021; patient had indicated that they had not ever received COVID vaccination in the past. When updating the SDIIS system, it appears the patient received Pfizer COVID vaccinations on 5/5/2021 and 5/26/2021. Patient has not complained of any adverse reactions. The DOH recommended we turn this into the Agency site.

Other Meds: No medications

Current Illness: NA

ID: 1719303
Sex: F
Age: 45
State: KS

Vax Date: 02/25/2021
Onset Date: 07/12/2021
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: None for me. Our 7 year old had two chest X-rays, our 11 year old had one chest X-ray.

Allergies: Environmental allergies, ie ragweed, cedar, mold. I am in maintenance allergy shots for this.

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

Symptoms: 7/12/21 breakthrough covid case. I did become ill with headache, bronchitis like cough, asthma exacerbation and extreme fatigue. I got ahead of the worst of the cough and headache after about 6 days. I treated at home with Sudafed, Mucinex, ibuprofen, and iprotropium bromide Albuterol Sulfate nebulizer. I was on prednisone and augmentin for a sinus infection I saw my ENT for on 7/7. I had a negative at home covid test 7/6 with that sinus infection. I felt completely different in 7/12 as my covid symptoms set in. My primary care physician extended the prednisone upon my covid dx. The fatigue and asthma tightness remained an issue for a couple of weeks as did off and on slight headaches. On 8/16 I saw my dr to check in on my asthma. My lungs sounded clear, we added a steroid inhaler twice a day and I stayed on my nebulizer. Of note, our 7 year old showed first signs cough and 101 temp and tested 7/11 positive. Our 11 year old was tested same time out of caution and was positive also. He had a 100.4 temp at the urgent care as we took her in. My husband and I PCR tested positive the morning of 7/12, initially just some throat clearing for him, we both became symptomatic sick the evening of the 12th.

Other Meds: Allegra, metformin, birth control pills, ozempic. I?m not diabetic, off label use for PCOS. I keep an albuterol inhaler and duoneb nebulizer on hand in case of upper respiratory illness triggering my otherwise asymptomatic asthma.

Current Illness: None

ID: 1719304
Sex: F
Age: 46
State: MN

Vax Date: 06/03/2021
Onset Date: 06/24/2021
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: Positive RT-PCR Covid-19 Test

Allergies: NKA

Symptom List: Unevaluable event

Symptoms: Tested positive for COVID-19 when fully vaccinated.

Other Meds: Melatonin, Probiotic, Magnesium

Current Illness: N/A

ID: 1719305
Sex: F
Age: 29
State: IN

Vax Date: 09/20/2021
Onset Date: 09/20/2021
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:

Allergies: NKA

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

Symptoms: Patient under the age of 65 was mistakenly administered Fluad. Patient monitored in pharmacy and via follow up phone call. No adverse effect reported.

Other Meds: Fluoxetine 20mg tablet, Timolol 0.5% drops

Current Illness:

ID: 1719306
Sex: F
Age: 65
State: CA

Vax Date: 03/07/2021
Onset Date: 04/01/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data: Estrogen level test

Allergies: Corn

Symptom List: Injection site pain, Pain

Symptoms: thyroid event high levels of estrogen major change in hormones

Other Meds: Biothyroid, estrogen cream

Current Illness: No

ID: 1719307
Sex: F
Age: 46
State: MA

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

Lab Data: None

Allergies: Dogs, Tuna, Horses, Roaches

Symptom List: Injection site pain, Menorrhagia

Symptoms: The patient reported tingling in throat, slight headache, and numbness in upper lip. No SOB noted. Pt drank water and her symptoms subsided.

Other Meds: Zyrtec, Atenolol, MVI, Vit D

Current Illness: No

ID: 1719308
Sex: M
Age: 25
State: KS

Vax Date: 08/17/2021
Onset Date: 08/17/2021
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:

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

Symptoms: Patient did not have symptoms. He was given two doses of Moderna after having already received Janssen.

Other Meds:

Current Illness:

ID: 1719309
Sex: F
Age: 80
State: CA

Vax Date: 03/11/2021
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:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Positive for leg swelling Positive for shortness of breath

Other Meds:

Current Illness:

ID: 1719310
Sex: M
Age: 17
State: ME

Vax Date: 09/14/2021
Onset Date: 09/14/2021
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: NKA

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient under the age of 18 when he received the Moderna COVID vaccine. Patient had no adverse side effects or symptoms.

Other Meds: Fluoxetine

Current Illness:

ID: 1719311
Sex: F
Age: 67
State: NY

Vax Date: 03/19/2021
Onset Date: 08/31/2021
Rec V Date: 09/21/2021
Hospital: Y

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

Lab Data: X-rays Blood clots CT Scan- Blood Clots Blood work- Blood Clots

Allergies: any medications with Sulfur, shrimp,

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

Symptoms: A few months after receiving my vaccine I had to use a can to walk around because I was having leg pain. As well as heel pain. I thought ti was a bone spur. I used a cane to alleviate some of the pressure. Around August 31st is when I noticed my symptoms. I was walking down 5 flights of stairs and I was fine, and as we got closer to the car I was having trouble catching my breath. The car was 3 blocks away and I could not make it it without stopping. We had to stop at a bus stop so I could stop and sit down. I thought I might be having an asthma attack so we hooped on the bus and went to the pharmacy to get pick up an inhaler since I did not have mine on me. It did not help me out at all. We went home. A few days later September 4th we went to visit my daughters friend in the hospital , and I was having issues again and my daughter said she thought I was having heart issues and she made me go to ER. I went to the ER because I thought I was having an asthma attack. They did not think that was the case because I was not wheezing. They drew blood and found it I may have a blood clot. X-rays, CAT SCAN legs and chest. Then they put me in the ICU in the ER because they found blood clots in my legs and chest. They admitted me September 5th to the hospital in the step down unit from ICU. I was in the hospital until September 16th. While in the hospital they started you Eloquist but took me off because there is not enough studies down for women of my size. So they switched me to Heparin and Warfarin. After 3 days they moved me to regular unit and took me off of Lorsartan because my blood pressure returned to normal. Heparin was increased a few times. I am still being monitored being closely.

Other Meds: Albuterol 8.5gm inhaler prn, Vitamin C 500mg daily, Vitamin D3 50mcg 2000IU 2 tabs daily, Losartan/HCTZ 25mg tabs PM daily, Simvastin 5mg tab daily PM, Foot medication- cream, Nystatin cream

Current Illness: no

ID: 1719312
Sex: M
Age: 0
State: AZ

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: none needed

Allergies: none listed

Symptom List: Nausea

Symptoms: client requested the vaccine in his gluteus and was already upset about being forced to get it at all- wife was very concerned . discussed the fact this was not approved site and the risks of pain and unknown absorption at that site was discussed but he insisted. and I assessed the risk vs benefits as well and gave him the vaccine in the right gluteus like he requested. Observed for 15-20min no reaction education given verbally was competent cognitively to understand and was able to read literature use computer assessed.

Other Meds: unknown

Current Illness: none listed

ID: 1719313
Sex: F
Age: 45
State: MO

Vax Date: 08/13/2021
Onset Date: 08/18/2021
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: X-ray Chest Bloodwork EKG

Allergies: NA

Symptom List: Injection site pain

Symptoms: I went to the doctor because I kept sneezing and it kept getting worse. I went to the doctor I was told I had a sinus infection and was prescribed medication. I ended up going to ER and I had an x-ray of my chest, bloodwork, and was prescribed steroid medicines, steroid shot, and an inhaler. I felt like I just couldn't breathe. I am still out of work and don't know if I can go back. I had an EKG and they also ordered an echo.

Other Meds: Sertraline HCL ( 50mg 1xday ) Hydroxyzine HCL ( 25mg 3xday )

Current Illness: NA

ID: 1719314
Sex: M
Age: 26
State: TX

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: LA

Lab Data: none

Allergies: none recored

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

Symptoms: Pt reported apprehension to vaccines/ needle sticks. Right after giving vaccine. pt with eyes open , was quiet then stiffened and extended limps , head then went back.. the event lasted for about 5 seconds. he does not remember the event. Pt refused 911 help in front of me and store manager; said he was fine.. He was instructed to remain for at least 30 min. He complied. His wife drove over and then he was helped into car. I instructed that he seek medical attention that his event did not appear to be a "fainting" episode.

Other Meds: unknown

Current Illness: none

ID: 1719315
Sex: M
Age: 18
State:

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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

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

Symptoms: "Pt w/ no significant PMH. 2mins post vaccination, pt c/o dizziness. Denies any other symptoms. Vitals: @12:15 BP 100/60, HR 59, RR 18, O2 Sat 98% -- > @12:20 101/57, 65. Pt given fluids and moved to observation room to lay down. Pt reports improvement in dizziness. Denies any other symptoms. Returned to general observation for remainder of observation time. Pt ambulates independently, gait steady. Pt stable and released form vaccination site."

Other Meds: None

Current Illness:

ID: 1719316
Sex: M
Age: 58
State: AZ

Vax Date: 09/18/2021
Onset Date: 09/19/2021
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:

Allergies:

Symptom List: Tremor

Symptoms: Lymphadenopathy ipsilateral axilla

Other Meds:

Current Illness:

ID: 1719317
Sex: M
Age: 65
State: CA

Vax Date: 08/14/2021
Onset Date: 08/16/2021
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: went to the ER 3x until finally was given Steroids for treatment

Allergies: no

Symptom List: Erythema, Pruritus

Symptoms: Patient report that he had burning blusters all over his left leg...

Other Meds: steroids

Current Illness: no

ID: 1719318
Sex: F
Age: 44
State: KY

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

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

Lab Data:

Allergies:

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

Symptoms: On 9/18/21, the patient came to pharmacy for the first Pfizer COVID 19 vaccine. She was asked to wait 15mins afterwards for any immediate reactions and then had left the store. Hospital called in the morning on 9/21/21 to inform us that the patient's throat swelled up , she was nauseated and had tingling all over her body. This started about 45 mins after receiving the vaccine.

Other Meds:

Current Illness:

ID: 1719319
Sex: F
Age: 56
State: WA

Vax Date: 09/16/2021
Onset Date: 09/17/2021
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: N/A

Allergies: sulfa, pencillin,erythromin, clindamin,codine,onions, pesticides,

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

Symptoms: moderna covid-19 vaccine EUA

Other Meds: zertec,chantix,buspar,coreg.lisinapil,asprin,metformin,gabapentin,nexium,mucinex

Current Illness: ms, arthitis, diabetic,hyper tension, chf, hyperaldosteronism,

ID: 1719320
Sex: F
Age: 37
State: MA

Vax Date: 03/07/2021
Onset Date: 03/08/2021
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: Rapid Strep, Regular Strep, Labs, Neck CT, Mono, WBC

Allergies: Red Wine, Adhesives (bandaids)

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: After my second dose within 12 hours, I felt like I was dying. I?ve never felt that sick in my life, I was freezing cold and sweating. I told my mother I needed to go to ER. I felt like this for four days and it felt like the flu. I've been hospitalized a lot too in my past and have never been sick like this. My glands swelled up on a Tuesday night and throat started hurting and I thought I was getting strep. The next morning 8-10 hours later the glands in throat were so swollen it looked like golf balls on side of my neck. You could see them very clear. I went to urgent care that night and they did rapid strep and regular strep that were negative. They thought it was viral but I do have history of ear infections and history of sore throat so she gave me 7 day course Augmentin just incase it was bacterial. I completed that and went to ER on a Saturday because it wasn't getting better and glands weren't going down in size. I had labs, neck ct (clear), and glands looked normal size on ct but were clearly sticking out that prompted my Doctor to take a picture. I will be following up with an ENT and completing my Augmentin. They tested for mono and few other things that came back negative, WBC was fine, and my glands are still swollen but not as bad.

Other Meds: None.

Current Illness: None.

ID: 1719321
Sex: F
Age: 80
State: CA

Vax Date: 02/16/2021
Onset Date: 09/11/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: positive for fever, positive for chills and malaise / fatigue

Other Meds:

Current Illness:

ID: 1719322
Sex: M
Age: 65
State: IL

Vax Date: 07/24/2021
Onset Date: 07/27/2021
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: none

Allergies: codeine (all derivatives), iodine dye, sodium pentothal, oxycontin, dilaudid, morphine, almost all narcotic pain meds, darvocet, latex and adhesive, zyban

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

Symptoms: SEVERE pain starting in latissimus dorsi muscle, moving to shoulder/blade, down arm, severely in joints. Then as that healed moved to right side in same fashion. Then, back to left side (MOST SEVERE PAIN event) following same pattern, now in right side again. Went to primary care physician (9-8), recommended rheumatologist (saw 9-20). Determined it was a gout flare-up and recommended reporting

Other Meds: Humalog, Novalog, Metformin HCL, Ezetimibe, Methotrexate, Folic Acid, Allopurinol, D3, B12, Gabapentin, Fluticasone, Symbacort, Quinapril HCTZ, Omega 3, Potassium CLER, Furosemide, Low Dose Aspirin, CoQ10, Echinacea

Current Illness: none

ID: 1719323
Sex: M
Age: 85
State:

Vax Date: 02/15/2021
Onset Date: 09/20/2021
Rec V Date: 09/21/2021
Hospital: Y

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

Lab Data: Reported COVID positive 7 days before admission, not confirmed. Cycle threshold on admission was 17.5.

Allergies:

Symptom List: Pain in extremity

Symptoms: Hospitalization due to COVID 19. Reported per Moderna COVID vaccine EUA.

Other Meds:

Current Illness:

ID: 1719324
Sex: M
Age: 37
State: OR

Vax Date: 09/07/2021
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: 2
Vax Route:
Vax Site:

Lab Data:

Allergies: propylene glycol

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

Symptoms: Pt experienced vesicular rash with burning/tingling on right lower back and right thigh consistent with shingles 1 week after he received his first COVID vaccine. Symptoms are improving 1 week following the onset of the rash, but symptoms have not resolved yet.

Other Meds:

Current Illness: no

ID: 1719326
Sex: F
Age: 48
State: MO

Vax Date: 07/15/2021
Onset Date: 09/17/2021
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:

Allergies: none

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

Symptoms: Extremely heavy mestrual cycle that was 2 weeks late. This was the heaviest period I have ever had in my life.

Other Meds: none

Current Illness: none

ID: 1719327
Sex: F
Age: 50
State: MN

Vax Date: 09/15/2021
Onset Date: 09/19/2021
Rec V Date: 09/21/2021
Hospital: Y

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

Lab Data:

Allergies: lupron and latex

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

Symptoms: on 9/19/ 2021 was hospitalized and diagnosed with non epileptic seizures .Discharged on the 20th . had a seizure on the parking lot and was admitted to hospital for 1 day

Other Meds: concerta Zoloft

Current Illness: none

ID: 1719328
Sex: M
Age: 32
State: OR

Vax Date: 08/06/2021
Onset Date: 08/09/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Vomiting

Symptoms: Patient got his initial Moderna vaccine on 8/6/21 and three days later both legs became swollen and painful. They continue to be painful and swell daily. He felt swollen all over and started having muscle spasms in most muscle groups. Bilateral joint pain in his knees. Due to the muscle spasms he is unable to sleep. This continues to this day. Labs and Ultrasound done to r/o thrombosis.

Other Meds: Centrum Multi Vitamin

Current Illness: N/A

ID: 1719329
Sex: F
Age: 36
State: MD

Vax Date: 09/11/2021
Onset Date: 09/12/2021
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: 9/17: CBC, CMP, d-dimer, troponin, EKG, covid PCR

Allergies: sulfa

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Shortness of breath/inability to take a complete breath. Started 1 day after vaccine-present

Other Meds: multivitamin

Current Illness: none

ID: 1719330
Sex: F
Age: 48
State: MD

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

Allergies: NKDA

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

Symptoms: Severe migraine with photo sensitivity and sound sensitivity that lasted 6 days Severe fatigue that lasted >12hrs

Other Meds: Amlodipine, Wellbutrin, Lexapro, Claritin

Current Illness: none

ID: 1719331
Sex: M
Age: 51
State: IL

Vax Date: 07/27/2021
Onset Date: 08/23/2021
Rec V Date: 09/21/2021
Hospital: Y

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

Lab Data: You'd have to ask the hospital. I do not know.

Allergies: STADOL, Tide Laundry soap, and Downy Fabric Softener

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Shortness of breath/Congestive Heart Failure Hospital Stay over night,

Other Meds: Tylenol 4, Pioglitazone 30mg,Low dose asprin, Ropinrole 3mg,Astrovastatin 80mg, Metoprol 25mg

Current Illness: N/A

ID: 1719332
Sex: F
Age: 67
State: KS

Vax Date: 03/26/2021
Onset Date: 03/01/2021
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: LP: elevated protein 110 and normal WBC MRI thoracic spine: mild multilevel degenerative foraminal stenosis at T8-T12, No central spinal stenosis or thoracic cord lesion MMAL 0.08, Ceruloplasmin 14.7 Heavy metals: normal, A1c: 7.3 Autoimmune labs: ANA, Anti SSA, Anti SSB, RF and CCP Ab Myopathy Labs: All WNLs

Allergies: Stadol (hallucinations)

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

Symptoms: Guillain-Barr? syndrome - chronic progressive weakness and numbness since March after receiving J&J vaccine Complete loss of vibration lower extremities bilaterally, pinprick sensation diminished up to mid calf level Loss of reflexes in lower extremities and painful dysesthesia Differential included axonal variant of CIDP, or subacute inflammatory demyelinating polyneuropathy

Other Meds: Acetaminophen, Aspirin 81 mg, Atorvastatin, Copper Gluconate, Cyanocobalamin, Ferrous Sulfate, Gabapentin, Glimepiride, Levothyroxine, Lisinopril, Magnesium, Metformin, Pantoprazole, Potassium Chloride, Multivitamin

Current Illness: DM, HTN

ID: 1719333
Sex: M
Age: 20
State: CA

Vax Date: 08/27/2021
Onset Date: 09/17/2021
Rec V Date: 09/21/2021
Hospital: Y

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: 20yo male with Duchenne's Muscular Dystrophy. On 9/17/21 patient began experiencing palpitations and a sensation that his heart. He also noted some substernal chest pain. patient has previous suffered from medical anxiety related to the prognosis of his condition and notes worsening over the last month. He saw a psychiatrist who prescribed alprazolam 0.25mg nightly, which patient states has helped. Patient was taking Pfizer brand, "Tafil" until 9/12/21 when he switched brands to "Alzam" due to shortage. Patient also had a troponin elevation on admission of 0.09 however his baseline troponin is already mildly elevated due to his underlying heart disease. Patient has since recovered and was discharged.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am