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: 1722996
Sex: M
Age: 47
State: MO

Vax Date: 09/06/2021
Onset Date: 09/06/2021
Rec V Date: 09/22/2021
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: NKDA

Symptom List: Dysphagia, Epiglottitis

Symptoms: 2nd Dose of Moderna Vaccine administered on 9/6/21 from Lot #011A21A expired 8/16/21. *Site leadership consulted with the Moderna Medical Safety Department and received the below confirmation: * If the dose given in error is the first dose, a second dose should be administered 28 days later. If this dose is the second dose, the series is complete and no additional doses are needed.

Other Meds: N/A

Current Illness: No

ID: 1722997
Sex: F
Age: 33
State: NY

Vax Date: 06/09/2021
Onset Date: 09/06/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Anxiety, Dyspnoea

Symptoms: Sudden allergy to mosquito bites. Mosquito bites sites became swollen, bigger than a quarter.

Other Meds: Multivitamin, calcium, omega 3

Current Illness: none

ID: 1722998
Sex: M
Age: 23
State: NC

Vax Date: 09/16/2021
Onset Date: 09/17/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data:

Allergies: NKDA

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

Symptoms: Headache, Chills, Nausea , Fatigue, muscle pain, Pain in injection site. 24 hours SIQ

Other Meds: Pt reports not taking any medications at this time. Upon review of records, no active medications.

Current Illness: Pt reports no illnesses at the time of vaccination.

ID: 1722999
Sex: F
Age: 96
State:

Vax Date: 03/15/2021
Onset Date: 09/02/2021
Rec V Date: 09/22/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Presented to ED with shortness of breath and low oxygen level. Diagnosed with COVID-19 4 days prior to going to the ED.SpOt was 76% on room air and was given oxygen. Was given regeneraron the day before She was given steroids. Patient was elderly with delirum and confusion so recovering at home with family would be better. Patient was discharged

Other Meds:

Current Illness:

ID: 1723000
Sex: F
Age: 81
State: NC

Vax Date: 02/26/2021
Onset Date: 09/01/2021
Rec V Date: 09/22/2021
Hospital: Y

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

Lab Data: 9/1/21 COVID-19 rapid test detected the virus.

Allergies: codeine, meperidine, erythromycin, penicillin

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

Symptoms: Patient fully vaccinated with 2 dose series of Pfizer vaccine (2/5/21 and 2/26/21). The patient was diagnosed with COVID-19 pneumonia and had a positive COVID-19 test on 9/1/21. The patient was admitted to hospital for treatment on 9/1/21 and again on 9/14/21.

Other Meds: ergocalciferol, folic acid, omeprazole, torsemide, KCL, paroxetine, metoprolol, folid acid, albuterol

Current Illness:

Date Died: 09/21/2021

ID: 1723001
Sex: F
Age: 61
State:

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

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

Lab Data:

Allergies:

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

Symptoms: Presented to the ED with shortness of breath and respiratory failure and hypoxia, coughing Was put on BiPAP. Started on decadron, remdesivir, zinc, vitamin D, melatonin, albuterol, pulmicort, and was sedated to put on a ventilator Developed sepsis cefepime and vancomycin. Vasopressors were given. Vancomycin was later stopped because she was MRSA negative Patient not getting better and patient's spouse thought that it was time to give up and stop all agressive treatments Patient transferred to comfort care and died

Other Meds:

Current Illness:

Date Died: 09/06/2021

ID: 1723002
Sex: F
Age: 39
State:

Vax Date: 07/30/2021
Onset Date: 08/19/2021
Rec V Date: 09/22/2021
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: Presented to the ED with shortness of breath with 77% O2 saturation on room air Patient was given oxygen Received monoclonal antibodies, dexamethasone, remdesivir, singulair Used BIPAP then intubated Patient went into circulatory shock and given IV vancomycin for bacteremia and levophed Patient was extubated and pressors discontinued Passed away on September 6, 2021 at 1220pm.

Other Meds:

Current Illness:

ID: 1723003
Sex: M
Age: 71
State: IN

Vax Date: 09/09/2021
Onset Date: 09/09/2021
Rec V Date: 09/22/2021
Hospital: Y

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

Lab Data: Results for Patient (MRN private) as of 9/22/2021 12:47 9/14/2021 03:36 WBC: 0.68 (LC) RBC: 2.45 (L) HGB: 7.3 (L) HCT: 21.1 (L) MCV: 86.1 MCH: 29.8 MCHC: 34.6 RDW-SD: 48.8 RDW-CV: 15.6 (H) NRBCS % AUTOMATED: 0.0 NRBCS # AUTOMATED: <0.01 PLT: 84 (L) MPV: 9.6 Neutrophil #: 0.01 (L) Lymphocyte #: 0.17 (L) Monocytes #: 0.50 Immature Granulocyte #: 0.00 Neutrophils %: 1.0 Lymphocytes %: 25.0 Monocytes %: 74.0 Polychromasia: 1+ Morphology Comment: PRESENT CBC Path Review: SEE BELOW 9/15/2021 06:19 WBC: 0.85 (LC) RBC: 2.48 (L) HGB: 7.4 (L) HCT: 21.8 (L) MCV: 87.9 MCH: 29.8 MCHC: 33.9 RDW-SD: 49.0 RDW-CV: 15.3 (H) NRBCS % AUTOMATED: 0.0 NRBCS # AUTOMATED: <0.01 PLT: 98 (L) MPV: 9.7 9/16/2021 05:49 WBC: 1.43 (L) RBC: 2.72 (L) HGB: 8.1 (L) HCT: 24.8 (L) MCV: 91.2 MCH: 29.8 MCHC: 32.7 RDW-SD: 51.8 (H) RDW-CV: 15.9 (H) NRBCS % AUTOMATED: 0.0 NRBCS # AUTOMATED: <0.01 PLT: 183 MPV: 9.9 Neutrophil #: 0.03 (L) Lymphocyte #: 0.71 (L) Monocytes #: 0.61 Eosinophil #: 0.07 Immature Granulocyte #: 0.01 Neutrophils %: 2.0 Lymphocytes %: 49.5 Monocytes %: 42.6 Eosinophils %: 4.9 Myelocytes %: 1.0 (A) Polychromasia: 1+ Morphology Comment: PRESENT 9/17/2021 06:28 WBC: 1.41 (L) RBC: 2.35 (L) HGB: 7.0 (LC) HCT: 21.1 (L) MCV: 89.8 MCH: 29.8 MCHC: 33.2 RDW-SD: 49.8 RDW-CV: 15.3 (H) NRBCS % AUTOMATED: 2.1 NRBCS # AUTOMATED: 0.03 PLT: 149 MPV: 9.6 Neutrophil #: 0.19 (L) Lymphocyte #: 0.59 (L) Monocytes #: 0.45 Eosinophil #: 0.12 Basophil #: 0.03 Immature Granulocyte #: 0.04 Neutrophils %: 13.3 Lymphocytes %: 41.8 Monocytes %: 31.6 Eosinophils %: 8.2 Basophils %: 2.1 Metamyelocytes %: 1.0 (A) Myelocytes %: 2.0 (A) Polychromasia: 1+ Morphology Comment: PRESENT 9/18/2021 09:01 WBC: 2.29 (L) RBC: 3.09 (L) HGB: 9.1 (L) HCT: 27.8 (L) MCV: 90.0 MCH: 29.4 MCHC: 32.7 RDW-SD: 47.8 RDW-CV: 14.9 (H) NRBCS % AUTOMATED: 0.0 NRBCS # AUTOMATED: <0.01 PLT: 173 MPV: 9.2

Allergies: morphine - shaking atorvastatin - muscle spasms penicillin- swelling hydrocodone - nausea

Symptom List: Pharyngeal swelling

Symptoms: 9/22 Per Patient: received the 2nd Pfizer vaccine Thursday, 9/9/21 at 1900. By Friday he was feeling bad and on Monday 9/13/21 he was very SOB and had to come to the ED. 9/14 Per ED: Patient is a 71-year-old gentleman comes in with shortness of breath, fatigue and dyspnea on exertion. Patient states he had COVID back in January of this year. States he spent 6 months in the hospital. His DVT to self hot a walk. He states that since last week and not been feeling well and felt like he was coming down with something. He states he went and had his 2nd COVID vaccination this past Thursday since then has been feeling very bad. The duration is constant. The onset progressive. The intensity moderate. The quality as above. This is single episode. No radiation. Nothing makes it better or worse. No other associated symptoms. Patient arrived with a fever. 9/14 Per ID: 1. Neutropenic fever: Appreciate Dr. note. Neutropenia thought to be due to to vaccine. Per pt, has not received recent chemo. Cbc from 8.9 shows a wbc of 5, ANC of 3800 and plts of 163. D/w Pharmacy. Not a known side effect. Will report this to VAERS For now continue cefepime + doxy. 2. Possible PNA: Chest CT reviewed. Old changes, but possible new infiltrates. Continue cefepime/doxy 3. H/o COVID-19 4. CLL 5. Sacral ulcer: Much improved. Continue local care 9/17 Per ID: 1. Neutropenic fever: Appreciate Dr. note. Neutropenia thought to be due to to vaccine. Per pt, has not received recent chemo. Cbc from 8/9 shows a wbc of 5, ANC of 3800 and plts of 163. D/w Pharmacy. Not a known side effect. Will report this to VAERS For now continue cefepime + doxy- upon discharge can convert to Levaquin 750 mg every 48 hours x 3 doses. WBC improving , hemoglobin low 7.0- to receive transfusion today 2. PNA: Chest CT reviewed. Old changes, but possible new infiltrates. Continue cefepime/doxy-- > po Levaquin upon discharge. procal better today. Initial value may not have reflected the peak. 3. H/o COVID-19 4. CLL 5. Sacral ulcer: Much improved. Continue local care 9/17 Per Oncologist: Pancytopenia/Acute illness - New and acute onset - I suspect secondary to acute reaction to COVID vaccine and inflammatory cascade process but secondary to infectious process also possible - No evidence of lymphocytosis with WBC differential - Will hold off on G-CSF support due to increase theoretical risk of neutrophil activation and lung inflammatory process - No evidence of b12 or folate deficiency - Counts seem to be slowly improving with increase in ANC and PLT count now normalized. Hgb lacking behind somewhat. Patient complaining of marked fatigue. Will transfuse 1 unit of PRBC today CLL - RAI stage II with complex karyotype (trisomy 12, deletion 13q, and 11q deletion) - Diagnosed in July 2019 - Enrolled in Clinical trial at medical. EA9161. Ibrutnib/Venetoclax/Obinotuzumab - Treatment has been on hold since initial admission for critical COVID in end of January 2021 - Imaging studies have indicated partial response to therapy with no indication to resume therapy. Patient was last seen at medical in August 2021 at the time WBC was 5.0/Hgb 10.1/PLT 163 with no absolute lymphocytosis PNA - Covered with cefepime and doxy - Afebrile now Hx of CAD - Has hx of CAD s/p PCI and stent placement in May 2019 Respiratory failure - Now resolved - Tracheostomy has been removed - has required intervention for tracheal stenosis COVID PNA in January 2021 - Prolonged hospital stay with respiratory failure and trach and peg placement and need for renal replacement therapy - Patient is now s/p COVID vaccination

Other Meds: aspirin 81mg po nightly ezetimibe 10mg po daily metoprolol succinate 25mg po daily rivaroxaban 10mg po nightly terazosin 1mg po nightly

Current Illness: This is a 71 yo man.. He was admitted initially back in January due to covid-19. He had a very prolonged course and was on the ventilator and eventually trached and was dcd to a LTACH. He was re-admitted in May for PNA and then in June for tracheitis. During his June admission, noted to have tracheal stenosis and he was transferred to medical for tracheal surgery. He improved and then was transferred to rehab. Finally, he did recently return home. He was recently vaccinated against covid-19 and received a 2nd shot on 9/9. Since this 2nd shot, he has noted high grade fevers and increased sob. He did have a fever of 103.3 in the Er and an O2 sat of 84%. His CT scan was negative for a PE, but did show b/l infiltrates. His wbc was noted to be 0.68.

ID: 1723004
Sex: M
Age: 64
State: IL

Vax Date: 07/27/2021
Onset Date: 09/22/2021
Rec V Date: 09/22/2021
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 had previously received J$J vaccine at the hospital, he came in 07/27/2021 and told us he needed to get his covid vaccine, patient filled up the questionnaire and indicated on it that he had never received a covid vaccine. the pharmacist ended up giving the patient his first dose of pfizer, and on 08/24-2021 patient came in to receive the 2nd dose of pfizer. On 09/21/21, the nurse called from the hospital to inform us about the patient had already received a J$J vaccine in the past. So we ended up documenting and reported the issue to the hospital

Other Meds: N/A

Current Illness: N/A

ID: 1723005
Sex: M
Age: 30
State: OH

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

Symptom List: Diarrhoea, Nasal congestion

Symptoms: lower back pain, bilateral leg pain, fever, vomiting, diarrhea, chills, headache,- started 9-21-21. 9-22-21 no fever but still has back pain, bilateral leg pain and headache.

Other Meds:

Current Illness:

ID: 1723006
Sex: F
Age: 64
State:

Vax Date: 08/04/2021
Onset Date: 08/30/2021
Rec V Date: 09/22/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Presented to the ER with left lower abdomen pain and shortness of breath. Recently diagnosed with COVID-19 Was given mucinex, singulair, flovent, combivent Patient insisted on going home and was discharged

Other Meds:

Current Illness:

ID: 1723007
Sex: M
Age: 33
State: MO

Vax Date: 09/06/2021
Onset Date: 09/06/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data: N/A

Allergies: NKDA

Symptom List: Rash, Urticaria

Symptoms: 2nd Dose of Moderna Vaccine administered on 9/6/21 from Lot #011A21A expired 8/16/21. *Site leadership consulted with the Moderna Medical Safety Department and received the below confirmation: * If the dose given in error is the first dose, a second dose should be administered 28 days later. If this dose is the second dose, the series is complete and no additional doses are needed.

Other Meds: N/A

Current Illness: No

ID: 1723008
Sex: M
Age: 20
State: OK

Vax Date: 09/15/2021
Onset Date: 09/15/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data: NONE

Allergies: NONE

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

Symptoms: Injection was given @4:29PM & immediately broke out in a sweat. Patient was given water & taken to a room to lay down. EMSA was called & arrived at 5:40PM. They assessed him & determined he was fine. His girlfriend took him home. The next day the pharmacist who administered the shot called and he was feeling good.

Other Meds: NONE

Current Illness: NONE

ID: 1723009
Sex: M
Age: 73
State:

Vax Date: 05/20/2021
Onset Date: 08/16/2021
Rec V Date: 09/22/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Presented to the ED for foot ulcers Tested positive during hospitalization Was diagnosed with COVID toes Oxygen saturation dropped down to 88% Was given heparin because of ischemia of right lower extremity Underwent atherectomy Discharged under stable conditions

Other Meds:

Current Illness:

ID: 1723010
Sex: F
Age: 37
State: AZ

Vax Date: 09/18/2021
Onset Date: 09/20/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data: EKG and labs

Allergies: Amoxicillin Contrast iodine Levaquin

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

Symptoms: Chest pain and pressure shortness of breath

Other Meds: Synthroid Aspirin Vitamin C Vitamin D

Current Illness:

ID: 1723011
Sex: F
Age: 78
State: IL

Vax Date: 02/12/2021
Onset Date: 09/08/2021
Rec V Date: 09/22/2021
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: 9/8/21 COVID19: Positive 9/16/21 Chest xray: Patchy bilateral airspace disease most consistent with COVID-19 pneumonia. 9/16/21 CTA chest: Multifocal bilateral consolidation most consistent with COVID-19 pneumonia.

Allergies: bactrim, doxy, statins

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

Symptoms: Since 9/8/2021, she has been having some problems with cough, shortness of breath, and headache. She thought she had a sinus infection. She went to see her primary care physician and was tested positive for COVID-19. She was sent over to ER for Regeneron transfusion on 9/16/21. However, the patient was found to be quite hypoxemic with ABG showing a pO2 of only 54.8 on room air. The patient was then started on Decadron and since the CTA of the chest showed bilateral consolidation, she was started on Rocephin and Zithromax and then the Hospitalist Service was called for admission. When I saw the patient, she was saturating 93% to 94% on 2 L nasal cannula. Her main complaint is her cough right now. She does not feel short of breath at this point of time. No chest pain. Mild nausea, but no vomiting. No diarrhea. No loss of taste or smell. Says she lives alone. Admitted on 9/16/21 as an inpatient. Continued Decadron on her. Started her on remdesivir as well. Put her on oxygen. Started her on vitamin C and vitamin D as well. For the Bilateral pneumonia, gave her Rocephin and Zithromax. Patient says occasionally she is able to bring up a sputum, mostly it is clear, but sometimes slightly yellow ting as well, but no epistaxis, no hemoptysis. On 9/21/21 patient's symptoms resolved. REquires 1L NC with exertion. Discharged on 9/22/21 with 5 more days of azithromycin and cephalexin.

Other Meds: Aspirin, calcium with vitaminD, levothyroxine, lisinopril-hydrochlorothiazide, meclizine, propranolol

Current Illness:

ID: 1723012
Sex: F
Age: 69
State:

Vax Date: 03/30/2021
Onset Date: 09/12/2021
Rec V Date: 09/22/2021
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:

Allergies:

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

Symptoms: Presented to the ED with weakness,cough, and nausea/vomitting. Patient had fever at home but was afebrile at ED. O2 sat dropped down to 61% on room air so was given oxygen Was given decadron, albuterol, pulmicort, vitamin D, zinc, and melatonin. Remdesevir was not given due to renal function Was discharged home with oxygen tank, steroids, and anticoagulation.

Other Meds:

Current Illness:

ID: 1723013
Sex: M
Age: 63
State: VA

Vax Date: 03/21/2021
Onset Date: 08/01/2021
Rec V Date: 09/22/2021
Hospital: Y

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

Lab Data: Yes but I can't remember

Allergies: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: I had a stroke at home working and my wife called 911 and took me to the hospital and Dr did a medical procedure because there was a blockage in my brain I don't have much memory of the event. I'm soon to schedule another surgery.

Other Meds: Anti Cholesterol, Allergy Medication.

Current Illness: None

ID: 1723014
Sex: F
Age: 63
State:

Vax Date: 08/16/2021
Onset Date: 08/20/2021
Rec V Date: 09/22/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Presented to the ED with shortness of breath, diarrhea, urinary symptoms, body aches, O2 is 60% Was given decadron, symbicort, and oxygen Discharged under stable conditions

Other Meds:

Current Illness:

ID: 1723015
Sex: F
Age: 57
State: MN

Vax Date: 01/13/2021
Onset Date: 09/18/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data:

Allergies: Firoicet; Fironil, Paxil, prolia

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

Symptoms: cough, sore throat, headaches, body aches, fever, starting on 9/18/21. Husband tested positive on 9/17/21

Other Meds: Melatonin; Tylenol; Vitamin D; Simponi Aria; Reclast; Calcium; Protonix, Estrace; Venlafaxine; Omeprazole; Methotrexate; Cyclobenzaprine; Tramadol; Folic acid, prednisone

Current Illness: none

Date Died: 09/15/2021

ID: 1723016
Sex: F
Age: 85
State:

Vax Date: 03/11/2021
Onset Date: 08/23/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Presented to the ED with weakness, shortness of breath, cough, fever, diarrhea. Health history of hypertension, COPD, lung cancer Was given oxygen, decadron, zinc, vitamin D, melatonin, albuterol, pulmicort, ceftriaxone, azithromycin Patient was put on BIPAP Developed acute kidney injury on top of chronic kidney disease. COVID-19 movement disorder Later developed sepsis Patient was transferred to comfort care and passed away

Other Meds:

Current Illness:

ID: 1723017
Sex: F
Age: 92
State: ME

Vax Date: 09/16/2021
Onset Date: 09/16/2021
Rec V Date: 09/22/2021
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: Not relevant

Symptom List: Unevaluable event

Symptoms: Patient received the Pfizer vaccine as her second dose 21 days after receiving the Moderna vaccine as her first dose.

Other Meds: Not relevant

Current Illness: Not relevant

ID: 1723018
Sex: M
Age: 29
State: MO

Vax Date: 09/06/2021
Onset Date: 09/06/2021
Rec V Date: 09/22/2021
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: N/A

Allergies: PCN

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

Symptoms: 2nd Dose of Moderna Vaccine administered on 9/6/21 from Lot #011A21A expired 8/16/21. *Site leadership consulted with the Moderna and received the below confirmation: * If the dose given in error is the first dose, a second dose should be administered 28 days later. If this dose is the second dose, the series is complete and no additional doses are needed.

Other Meds: N/A

Current Illness: No

Date Died: 09/11/2021

ID: 1723019
Sex: F
Age: 71
State:

Vax Date: 05/12/2021
Onset Date: 09/06/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Presented to the ED with weakness, shortness of breath, hypoxic Was given decadron, remdesivir, albuterol, combivent, vitamin D3, zinc, melatonin, then BiPAP Patient was put on the ventilator Suspected to have bacteremia so she was started on vancomycin and cefepime Developed shock and was started on levophed and vasopressin. Patient later died

Other Meds:

Current Illness:

ID: 1723020
Sex: M
Age: 91
State:

Vax Date: 02/11/2021
Onset Date: 09/22/2021
Rec V Date: 09/22/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient tested C19 positive and admitted to hospital on date of adverse event

Other Meds:

Current Illness:

ID: 1723021
Sex: M
Age: 38
State: WA

Vax Date: 03/17/2021
Onset Date: 04/01/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data: EKG: 06/03/2021, revealed left bundle branch block n EKG determined that I had a left bundle branch block and cardiomyopathy. Echocardiogram: 07/29/2021 determined my left ventricular ejection fraction was only 30% 08/02/2021: Stress Test confirmed my left ventricular ejection fraction was only 30% 08/13/2021: Cardiac catherization determined there was no cholesterol blockage

Allergies: None

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

Symptoms: I contracted covid-19 in April 2020 and recovered with no lasting symptoms. I received my first moderna vaccination 02/02/2021 with no substantial side effects. I received my second moderna vaccine on 3/17/2021. Within a couple weeks I started to feel palpitations in my chest when conducting physical activity. By the end of May/early June 2021, it had gotten so bad that I went to the emergency room. Hospital staff were shocked to see visibly my chest to rise and fall with each heart beat. I had a resting heart rate of 140 and an EKG discovered a left bundle branch block. Doctors initially suspected there was a cholesterol blockage, but a cardiac catherization revealed no cholesterol blockages. I also conducted an echo cardiogram and a cardiac stress test. My current left ventricular ejection fraction sits at only 30%. The following are my current diagnosis'. CHF: Chronic Systolic Congestive Heart Failure NICM: Non-Ischemic Cardiomyopathy LBBB: Left Bundle Branch Block HTN: Hypertension I have been in the military for 19 years and have maintained a physically active lifestyle. Doctors are unable to officially determine what is causing my heart to fail (Non-Ischemic Cardiomyopathy), but the timing of these symptoms and vaccination date make me believe that there is a relation.

Other Meds: None

Current Illness: None

ID: 1723022
Sex: M
Age: 56
State: OR

Vax Date: 08/26/2021
Onset Date: 08/28/2021
Rec V Date: 09/22/2021
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: none

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: The day after the first injection my right arm shoulder area, biceps and triceps were aching and sore. Left arm where shot was administered no pain. My right shoulder had a joint replacement and tendon repair on May 3rd 2021. Saturday on May 28, 2021 I noticed my lower back having pain from my Sciatic nerve as the next 4 days progressed it got worse affecting both my right leg and left leg. I had been dealing with the pain hoping it would lessen. it did not. I received my 2nd shot on 9-16 The following day my lower back pain amplified. I have a previous back problem so I thought nothing of it. Until I researched on possible side effects of the Vaccine.

Other Meds: bystolic 20mg triamterene 37.5-25 mg meloxicam 15 mg trazodone 150 mg hydrocodone-acetamin 10-325 multi vitamins D C E K Zinc Magnesium Apple cider vinegar

Current Illness: none

ID: 1723023
Sex: F
Age: 52
State: PA

Vax Date: 08/15/2021
Onset Date: 09/17/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data: EKG, halter monitor for two days that showed no irregular heart beats

Allergies: anti spasm medication and high dose steroids

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Three days after the shot i had a fever of 103 and started vomiting and had flu like symptoms for several days and have never recovered and have been sick to my stomach and vomiting ever since and have been dry heaving every day. And my heart rate is over 100 and climbs to over 130 with any motion

Other Meds: Eliquis, lexbutinin, vitamin D

Current Illness:

Date Died: 09/11/2021

ID: 1723024
Sex: F
Age: 67
State:

Vax Date: 04/08/2021
Onset Date: 09/05/2021
Rec V Date: 09/22/2021
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:

Allergies:

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

Symptoms: Presented to ED with shortness of breath, hypoxia, cough, 72% spo2, hypotensive, Started on decadron, singulair, aspirin, remdesivir, zinc, vitamin D, melatonin, albuterol, pulmicort. Developed sepsis and was given antibiotics Placed in comfort care and passed away.

Other Meds:

Current Illness:

Date Died: 09/17/2021

ID: 1723025
Sex: M
Age: 53
State:

Vax Date: 04/07/2021
Onset Date: 08/20/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: Presented with shortness of breathx3 days, productive cough, fever, nausea, and diarrhea. O2 was 70%. Was given oxygen, decadron, pulmicort, combivent, remdesivir, melatonin, vitamin D3, Patient respiratory distress got worse, and he was intubated. Got into septic shock, requiring multiple vasopressors Patient was disconnected from ventilator. Passed away after placing in comfort care

Other Meds:

Current Illness:

ID: 1723027
Sex: M
Age: 36
State: MO

Vax Date: 09/06/2021
Onset Date: 09/06/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data: N/A

Allergies: NKDA

Symptom List: Injection site pain

Symptoms: 2nd Dose of Moderna Vaccine administered on 9/6/21 from Lot #011A21A expired 8/16/21. *Site leadership consulted with the Moderna Medical Safety Department and received the below confirmation: * If the dose given in error is the first dose, a second dose should be administered 28 days later. If this dose is the second dose, the series is complete and no additional doses are needed.

Other Meds: Tum, APAP, Prilosec

Current Illness: No

ID: 1723028
Sex: F
Age: 58
State:

Vax Date: 04/16/2021
Onset Date: 09/13/2021
Rec V Date: 09/22/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Patient came to the ER with shortness of breath with any exertion, slight fever, cough, loss of appetite, diarrhea, fatigue, nausea, vomitting. Tested positive for COVID 11 days ago. Was given vancomycin for suspected sepsis. Also had acute kidney injury and treated with hydration. Cystitis was also present and treated with rocephin. Was given supportive care for COVID. Discharged in stable medical condition.

Other Meds:

Current Illness:

ID: 1723029
Sex: M
Age: 74
State:

Vax Date: 08/18/2021
Onset Date: 09/05/2021
Rec V Date: 09/22/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Presented to ED with shortness of breath, myalgia, non productive cough Received decadron, asprin, singulair, oxygen, out of window for remdesivir Discharged under stable condition.

Other Meds:

Current Illness:

ID: 1723030
Sex: M
Age: 67
State: NJ

Vax Date: 04/03/2021
Onset Date: 06/03/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data: Songram and CT scan verified node.

Allergies: N/A

Symptom List: Tremor

Symptoms: Swollen lymph node in right side of neck

Other Meds: Magnesium orerate (over the counter), naprocin.

Current Illness: N/A

ID: 1723031
Sex: F
Age: 43
State: MD

Vax Date: 08/12/2021
Onset Date: 08/15/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data: None

Allergies: None

Symptom List: Erythema, Pruritus

Symptoms: Achy arm feeling heavy and weak from day 3 after the shot for the next 10 days. Site of injection spot on my arm is hot. For 2 weeks following the shot I was EXHAUSTED daily with a random burst of INTENSE energy lasting 2 to 3 hours daily and usually between 3 and 8 pm. Increased headaches daily. Stomach upset. I called my doctor and was prescribed Prednisone. It helped for 1 week. The same 2 symptoms of a throbbing arm, and being hot at the injection site returned. It has been 6 weeks. I want my arm to stop throbbing in pain.

Other Meds: None

Current Illness: None

ID: 1723032
Sex: M
Age: 32
State: PA

Vax Date: 09/21/2021
Onset Date: 09/22/2021
Rec V Date: 09/22/2021
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: amoxicin,

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

Symptoms: diarrhea, headache, body ache, , soreness at injection site, eyes felt hot, forehead pounding, left hand tingling and numb, couldnt open door, both lips tingling, and tongue/top of mouth

Other Meds:

Current Illness:

ID: 1723033
Sex: F
Age: 23
State: NJ

Vax Date: 05/18/2021
Onset Date: 05/18/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data: Physical examination by PCP two days after vaccination to confirm ulcers. Hospital visit for onset of blue and painful hands.

Allergies: Cipro

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

Symptoms: Unable to move or speak within minutes of vaccination. Completely drenched in perspiration to the point of dripping. Brought back to room to be given immediate care until symptoms resolved within approx. 20 minutes. Next day - internal ulcers in all mucosal membranes. Within Days - Hands blue, swollen and painful on and off. Arthritis symptoms. Vaccine induced both diseases that were in remission and made symptoms more severe.

Other Meds: Adderall Lo_loestrin 24

Current Illness:

ID: 1723034
Sex: M
Age: 27
State: MI

Vax Date: 09/17/2021
Onset Date: 09/17/2021
Rec V Date: 09/22/2021
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: n/a

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: After giving the first dose of Pfizer vaccine , pt fainted after coming out of consultation room. Patient's parent were with him and called out for help. With parent's help , rph was able to lay patient on floor immediately, monitored the blood pressure, gave him water and ice. Rph took another BP reading after few minutes and it was normal. Patient went home with parents after 30 minutes of incident onset.

Other Meds: n/a

Current Illness: n/a

ID: 1723035
Sex: F
Age: 15
State: IA

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 09/22/2021
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: none

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

Symptoms: Patient received the vaccine a week early. She was to return on 9/29/21 and she was vaccinated today on 9/22/21. No adverse event at this time.

Other Meds: N/A

Current Illness: none

ID: 1723036
Sex: F
Age: 11
State: MD

Vax Date: 08/30/2021
Onset Date: 08/30/2021
Rec V Date: 09/22/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: An 11 year old patient was administered a Pfizer COVID-19 on 8/30/21 at pharmacy. No adverse effects were reported. No treatments were provided. Parent was advised that the second dose could be given when the patient turns 12 or the vaccine is approved for younger ages.

Other Meds:

Current Illness:

ID: 1723037
Sex: F
Age: 36
State: FL

Vax Date: 08/21/2021
Onset Date: 08/21/2021
Rec V Date: 09/22/2021
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: Pain in extremity

Symptoms: The night of the second vaccine, there was intense pain at the injection site, to the point I was awakened from my sleep, could not sleep comfortably and had to take ibuprofen. The following day I experienced extreme fatigue/malaise, headache, fever, and chills. I have also had an abnormal menstrual cycle following the vaccine, with break through heavy bleeding and painful cramping.

Other Meds: None

Current Illness: None

ID: 1723038
Sex: F
Age: 25
State: MS

Vax Date: 08/06/2021
Onset Date: 08/19/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: No menstrual cycle since receiving the vaccine. No other health issues going on to cause it. Never missed a cycle before now.

Other Meds: Trintellix

Current Illness:

ID: 1723039
Sex: F
Age: 21
State:

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

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

Lab Data:

Allergies:

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

Symptoms: Patient became dizzy and diaphoretic at 1210 after her vaccination at 1205. Patient legs elevated and ice pack placed behind neck. Vitals BP 100/60 P 72 T 97.4 and R16. Water and crackers given. Patient monitored extra 15 minutes. Patient states feeling better and then released.

Other Meds:

Current Illness:

ID: 1723041
Sex: M
Age: 22
State: MI

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

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

Lab Data: NA

Allergies: NA

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

Symptoms: On 9/21/21 patient administered dose of Janssen vaccine with expiration date of 9/19/21.

Other Meds: NA

Current Illness: NA

ID: 1723042
Sex: F
Age: 67
State: TN

Vax Date: 08/24/2021
Onset Date: 08/26/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data: N/A

Allergies: N/A

Symptom List: Vomiting

Symptoms: 48 hours after the shot, I was extremely fatigued and ended up sleeping for 1 and 1/2 days. 48 hours after that, I got a large rash that severely itched at the shot site. I needed Benadryl and Calamine lotion to stop the itching. That lasted for 2 days.

Other Meds: Amlodipine, Olmesartan Medoxomil, Rosuvastatin, D3, One a day vitamin

Current Illness: N/A

ID: 1723043
Sex: F
Age: 34
State: CA

Vax Date: 09/11/2021
Onset Date: 09/11/2021
Rec V Date: 09/22/2021
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: None

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: I had severe pain on my left side starting from the side of my neck all the way down to the tops of my left foot. The pain started a few hours after the vaccine severe pain lasted 3 days and has now turned into a dull pain all the way day my enitre left side same side i had the injection on. I have yet to see a dr for the side effects

Other Meds: None

Current Illness: None

ID: 1723044
Sex: F
Age: 55
State: IA

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

Allergies: ampicillins codeine

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

Symptoms: violent shaking Thought I would shoot an email to you; because I thought you might want to document the reaction I had to the vax. Dose was administered at 12:45 pm Monday. Felt fine. Went to bed around 10 pm. Woke up less than an hour later shaking violently and couldn?t stop. (Lasted over an hour.) It was so bad, Couldn't hold phone. I couldn?t call out to my husband. When he came to bed, I did have a temp of 101.4. I?ve had kidney infections, so fever with chills is not new to me; but NOTHING like this. It was terrifying.

Other Meds: ibprofen

Current Illness: NA

ID: 1723045
Sex: F
Age: 66
State: TN

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 09/22/2021
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: Ran blood test and forms of other test (unknown)

Allergies: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Fever, swollen lymph nodes under left arm, high blood pressure

Other Meds: High Blood pressure Medicine

Current Illness: None

ID: 1723046
Sex: F
Age: 48
State: MA

Vax Date: 09/13/2021
Onset Date: 09/14/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data:

Allergies: Sulfur Drugs and Pain Killers

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

Symptoms: I can not move my left arm do to the severe pain and inflammation. It has now been 10 days I went to the doctors who gave me a steroid shot to lower the inflammation and taking pain med (hopefully I will not have a reaction to the pain med). I had a fever for four days, migraine for 5 days, nauseous for 3 days, severe shoulder pain, abdominal cramps (have not had cramps in yrs.) and chills for about 5 days.

Other Meds: None

Current Illness: None

ID: 1723047
Sex: F
Age: 32
State: VA

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data: COVID-19 rapid test positive for COVID-19 on 09/16/2021

Allergies: N/A

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

Symptoms: Extreme fatigue, migraine, feeling of burning bones, feeling of burning muscles, diarrhea, extreme pain in shoulder of injection site, fever 102. The diarrhea subsided after 36 hours, all other symptoms eased after 36 hours but remained for 5 days

Other Meds: Adderall, Stress B-Complex plus Zinc, spironolactone

Current Illness: N/A

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am