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: 1736883
Sex: F
Age: 62
State: MI

Vax Date: 05/17/2021
Onset Date: 09/26/2021
Rec V Date: 09/27/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Pneumonia to both lungs

Other Meds:

Current Illness:

ID: 1736885
Sex: F
Age: 36
State: NY

Vax Date: 05/15/2021
Onset Date: 09/23/2021
Rec V Date: 09/27/2021
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: N/A

Symptom List: Anxiety, Dyspnoea

Symptoms: Full body rash as an immune mediated response to a cold/virus.

Other Meds: Ortho-cyclen

Current Illness: N/A

ID: 1736886
Sex: F
Age: 67
State: OK

Vax Date: 02/26/2021
Onset Date: 09/22/2021
Rec V Date: 09/27/2021
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: 09/22/21: POSITIVE POC SARS COVID RAPID ANTIGEN

Allergies: NKA

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

Symptoms: CHILLS, LOSS OF TASTE/SMELL, MUSCLE PAIN, FATIGUE

Other Meds: GABAPENTIN, HYDROXYZINE, KEOTIFEN, LISOCAINE MOUTH WASH, WARLICK SOLN, AMLODIPINE, BISACODYL, MIRALAX, OFLOXACIN, NYSTATIN POWDER, OMEPRAZOLE, DICLOFENAC GEL, PROPRANOLOL, MULTIVITAMIN, ACETAMINOPHEN, ASPIRIN, IBUPROFEN, CALCIUM CITRATE

Current Illness: LOW BACK PAIN, SACRAL BACK PAIN, NEURALGIA

ID: 1736887
Sex: M
Age: 13
State: TX

Vax Date: 08/10/2021
Onset Date: 08/18/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data: 8/19/21 Chest x-ray - clear 8/20/21 Tested NEGATIVE for Covid-19 8/24/21 Urinalysis results were normal except for transitional high Urobilinogen at 2.0 mg/dL. 8/25/21 Blood panel was mostly within normal range except for high inflammation markers (CRP 88mg/L, ESR 53mm/hr). 9/2/21 Repeat Blood panel showed that inflammation markers had dropped to just above normal (CRP 8mg/L, ESR 17mm/hr).

Allergies: Tamiflu - seizure and hallucination

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: 8/18/21 Intense pain in upper left back near his shoulder blade, which made it hard to breath. The pain continued for 6+ days with soreness for a full week after that. On the first morning after symptoms started (8/19/21), we took him to get a chest x-ray to check his lungs, which were clear and also took him in to the Pediatrician for evaluation. Pediatrician waited a few days to suggest additional testing, which is recorded below. 8/20/21 High fever of 102.7, tested negative for Covid-19 (tested due to fever) 8/24/21 Urinalysis results were normal except for transitional high Urobilinogen at 2.0 mg/dL. 8/25/21 Blood panel was mostly within normal range except for high inflammation markers (CRP 88mg/L, ESR 53mm/hr). 9/2/21 Repeat Blood panel showed that inflammation markers had dropped to just above normal (CRP 8mg/L, ESR 17mm/hr). Because inflammation markers dropped and pain had mostly dissipated by that time (9/2/21), the Pediatrician did not order any further testing. Her conclusion was that the inflammation was most likely due to the vaccine.

Other Meds:

Current Illness:

ID: 1736888
Sex: M
Age: 74
State:

Vax Date: 03/15/2021
Onset Date: 04/29/2021
Rec V Date: 09/27/2021
Hospital: Y

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

Lab Data: 04/29/21 SARS-CoV-2 (COVID-19) - DETECTED

Allergies:

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

Symptoms: Presented to EC via EMS from an ECF for shortness of breath & hypoxia on 04/29/21. Discharged back to facility on 05/07/21.

Other Meds:

Current Illness:

ID: 1736889
Sex: F
Age: 73
State:

Vax Date: 03/30/2021
Onset Date: 09/24/2021
Rec V Date: 09/27/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series

Other Meds:

Current Illness:

ID: 1736891
Sex: F
Age: 57
State: MI

Vax Date: 08/30/2021
Onset Date: 08/31/2021
Rec V Date: 09/27/2021
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: Penicillin, sulfa

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Extreme vomiting for 6 hours, Extreme explosive diarrhea for 6 hours, 103 temp

Other Meds: Levothroid

Current Illness: None

ID: 1736892
Sex: F
Age: 48
State: IL

Vax Date: 09/02/2021
Onset Date: 09/21/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data: Covid test- positive, chest X-ray,

Allergies: Cipro

Symptom List: Pharyngeal swelling

Symptoms: I started off with a bad sore throat running nose, congested, horrible headache, super tired, and cough. I went to doctor was positive for Covid. On the 24th I received the infusion regeneron at hospital .

Other Meds:

Current Illness:

ID: 1736893
Sex: F
Age: 33
State: CO

Vax Date: 09/24/2021
Onset Date: 09/25/2021
Rec V Date: 09/27/2021
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: Pineapple

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Pt developed an enlarged axillary lymph node 24 hrs after flu shot injection to the left deltoid. No pain or erythema at the injection site. Lymph nodes >3 cm and very tender. Range of motion to the left arm limited by the pain experienced in the lymph nodes. Pt sought care on 9/27/21. No fevers. Endorsed fatigue

Other Meds: None

Current Illness: None

ID: 1736894
Sex: M
Age: 72
State: GA

Vax Date: 08/02/2021
Onset Date: 08/05/2021
Rec V Date: 09/27/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Blood work and ultrasounds on legs and chest

Allergies: Aspirin Zofran Dilaudid Pneumonia vaccine Influenza vaccine Lortab (Blue dye) -Mycin antibiotics

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Received vaccine on Aug. 2. First noticed right lower chest pain two days later. Went to Urgent Care for worsening pain evaluated with chest XRAY and told it was inflammation, sent home with antibiotics. No improvement in symptom, worsening pain over time. Started having leg pain last week 9/21/2021. Went to emergency room that day, was diagnosed with deep vein thrombosis and pulmonary embolism. Started on blood thinners but not admitted.

Other Meds: Tizanidine 4mg Oxycodone Hydrochlor 30mg Vitamin D3 Vitamin C B12 injection Azelastine

Current Illness: Chronic pain Degenerative disc disease Osteoarthritis Hx. Deep Vein Thrombosis Hx. Peripheral Vascular Disease Polyneuropathy

ID: 1736895
Sex: F
Age: 49
State: NC

Vax Date: 08/13/2021
Onset Date: 08/20/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data: 3 hearing tests with audiologist, high dose oral steroid for 3 weeks, 2 steroid injections into eardrum twice, mri. Hearing loss will more than likely be permanent.

Allergies: Adhesive

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

Symptoms: Sudden onset sensorineural hearing loss with vertigo and tinnitus. No sense of balance

Other Meds: Multi vitamin, calcium, biotin

Current Illness: None

ID: 1736896
Sex: M
Age: 68
State: AZ

Vax Date: 07/08/2021
Onset Date: 07/15/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data: None other than inspection by Dr

Allergies: None

Symptom List: Rash, Urticaria

Symptoms: Rash on fingers of both hands developed and remain to the date of this report.

Other Meds: Atenolol - 25mg Losartan- 25mg Aspirin - 81mg

Current Illness: None

ID: 1736897
Sex: M
Age: 43
State: NJ

Vax Date: 09/15/2021
Onset Date: 09/16/2021
Rec V Date: 09/27/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: 1. I lost hearing in my Right Ear next day 2. My head was fill with fluid and pocket air 3. My ears is not stop ringing 4. My balance is bad, cant stand up 5. fatigue 6. Dizziness 7.Cant walk. 8. equilibrium is bad- seeking therapy

Other Meds: N/A

Current Illness: Tinnitus

ID: 1736898
Sex: M
Age: 68
State: MI

Vax Date: 02/09/2021
Onset Date: 09/15/2021
Rec V Date: 09/27/2021
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: fever/cough/chills/shortness of breath, positive covid test

Other Meds:

Current Illness:

ID: 1736899
Sex: M
Age: 83
State: FL

Vax Date: 04/23/2021
Onset Date: 09/24/2021
Rec V Date: 09/27/2021
Hospital: Y

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

Lab Data: The patient presents following fall. The onset was 2 hours ago. 83-YEAR-OLD MALE PAST MEDICAL HISTORY OF DEMENTIA, DEFIBRILLATOR ON XARELTO, FREQUENT KIDNEY STONES, CURRENT URINARY TRACT INFECTION ON DOXYCYCLINE (SEES DR.) PRESENTS WITH RIGHT FLANK PAIN STATUS POST FALL. PATIENT'S WIFE STATES THAT HE NORMALLY HAS A GET AROUND WITH A WALKER HOWEVER TODAY HE REFUSED USES WALKER AND HAD A MECHANICAL FALL IS NOW COMPLAINING OF RIGHT HIP AND RIGHT FLANK PAIN. PATIENT DENIES ANY COUGHS, FEVERS, CHILLS, CHEST PAIN SHORTNESS OF BREATH NAUSEA VOMITING DIARRHEA.

Allergies:

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

Symptoms: he patient presents with PATIENT PRESENTS EMERGENCY DEPARTMENT AFTER HAVING A FALL A COUPLE DAYS AGO WAS EVALUATED IN THE ED WITH NEGATIVE IMAGING. HAD WENT HOME AND FOLLOWED UP WITH HIS PRIMARY TODAY. HE WAS HAVING SOME PAIN ON HIS RIGHT POSTERIOR HIP AND BACK STILL AND HAVING DIFFICULTY WITH AMBULATION SO THE PRIMARY USED A WHEELCHAIR AND WHEELED HIM OVER HERE FOR ADDITIONAL IMAGING AND FURTHER EVALUATION. PATIENT DENIES ANY NAUSEA OR VOMITING. NO HEMATURIA DYSURIA. OF NOTE HE IS BEING TREATED WITH DOXYCYCLINE FOR UTI BY HIS UROLOGIST BECAUSE OF FREQUENT KIDNEY STONES. DENIES ANY CHEST PAIN. NO DIZZINESS. WAS MECHANICAL TRIP AND FALL. HE IS ON XARELTO.. The onset was 2 days ago. The course/duration of symptoms is fluctuating in intensity. The degree at present is minimal. Risk factors consist of age. Prior episodes: occasional. Therapy today: doctor's office visit. Associated symptoms: none.

Other Meds:

Current Illness:

ID: 1736900
Sex: F
Age: 79
State: TX

Vax Date: 04/01/2021
Onset Date: 09/17/2021
Rec V Date: 09/27/2021
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: Bactrim;

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

Symptoms: 79-year-old female with history of COPD presents the emergency department in mild distress secondary to dyspnea by EMS from home. She is been sick for the past 5 days and states is gotten worse. Her daughter states she called EMS when her oxygen dropped to 80% and her temperature was 102 degrees. She has had Covid exposures. She does not complain of chest pain. She states she does feel very weak. She is fully vaccinated against Covid. She states she has not lost her sense of taste or smell. Patient is Covid positive. She does fit criteria for Sirs and sepsis and will be given IV fluid. She was started on Rocephin and azithromycin. Now that her Covid is positive she will be given 10 mg of Decadron as well. She is on high flow oxygen and her O2 saturation is 96 to 97%. She does not appear to be in any acute distress. She will be admitted hospital. Labs are pending. The patient is receiving IV fluids and per her ideal body weight should receive 1700 cc. She will be given 2 L. She has been having diarrhea as well. 0150 patient is on 13 L high flow oxygen. Saturation is 94 to 95%. Her heart rate has improved and her IV fluid bolus is in progress. Her sodium is 128. Remaining labs are nonconcerning with negative cardiac enzymes. Chest x-ray does show patchy bilateral infiltrates. She will be admitted to the ICU.

Other Meds: Current Home Medications 1. Advair HFA : 1 inhaler(s) inhaled 2 times a day 2. alendronate 70 mg oral tablet : 1 tab(s) orally once a week 3. allopurinol 300 mg oral tablet : 1 tab(s) orally once a day 4. Bystolic 5 mg oral tablet : 1 tab(s

Current Illness:

ID: 1736901
Sex: F
Age: 51
State: TX

Vax Date: 08/20/2021
Onset Date: 08/20/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data:

Allergies: Perfumes and flowers

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

Symptoms: Numb lips, metal taste, headache, itchy throat, tongue swollen, sores in my mouth, sick to my stomach both nausea and diarrhea.

Other Meds: None

Current Illness: None

ID: 1736902
Sex: M
Age: 62
State: NE

Vax Date: 09/23/2021
Onset Date: 09/24/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data: a lot

Allergies: penicillan

Symptom List: Ear pain, Hypoaesthesia

Symptoms: confussion, fever

Other Meds: HYDROCORTISONE 1% CREAM ,LEVOTHYROXINE SODIUM 50 MCG,ATORVASTATIN CALCIUM 40 MG , ASPIRIN LOW DOSE 81 MG , VALPROIC ACID 250 MG/5 ML SYRUP BID and 10ml at HS, VITAMIN D 2000 IU TABLET , NATURE`S BLEND FOLIC ACID 1 MG , KETOCONAZOLE 2% SHAMP

Current Illness: no

ID: 1736903
Sex: F
Age: 41
State: KS

Vax Date: 09/16/2021
Onset Date: 09/16/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data: Mri, ekg, labs

Allergies: Metformin

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Shot given at 8:30 am. Tingling tongue, roof of mouth and back of lips by 8:40 am. Tingling throat by 9am. Tingling down left arm by 10 am. Feeling of warm goo running down left leg and puddling in shoe at heel by 11 am. Right arm and hand tingling by 4;30 pm. Speech affected and speech pattern by 7 pm. To Er for diagnosis of parasthesia. Have had varying areas tingling or having that deadened feeling since. Mostly focused in tongue, arms and legs.

Other Meds: Gabapentin Vitamin D Lisinopril Atorvastatin Jardiance

Current Illness: None

ID: 1736904
Sex: M
Age: 64
State:

Vax Date: 04/05/2021
Onset Date: 04/29/2021
Rec V Date: 09/27/2021
Hospital: Y

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

Lab Data: 04/29/21 SARS-CoV-2 (COVID-19) by NAA - DETECTED

Allergies:

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

Symptoms: 04/29/21 in ED "with PMHx most significant for CHF, COPD on 4L, GERD, HTN, HLD,, IDDM presenting for dyspnea"; discharged home on 05/06/21.

Other Meds:

Current Illness:

Date Died: 09/21/2021

ID: 1736905
Sex: M
Age: 80
State: TN

Vax Date: 04/09/2021
Onset Date: 08/27/2021
Rec V Date: 09/27/2021
Hospital: Y

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: NKA

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

Symptoms: Breakthrough COVID infection admitted with acute hypoxic respiratory failure secondary to SARS-CoV-2

Other Meds: Allopurinol 300mg; aspirin 81mg; Cardura 4mg; ibuprofen 200mg; zyrtec 10mg

Current Illness:

ID: 1736907
Sex: F
Age: 53
State: IL

Vax Date: 04/20/2021
Onset Date: 04/21/2021
Rec V Date: 09/27/2021
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: Unevaluable event

Symptoms: patient develop hives the day after receiving the vaccine, less than 24 hours

Other Meds: Vitamin D, Vitamin B

Current Illness: none

ID: 1736908
Sex: M
Age: 10
State: TX

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/27/2021
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: parent states pt is allergic to all meat. Parent sttates he eats eggs regularly and denies egg allergy.

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

Symptoms: 1503: Patient returns to clinic area, mom lifts atient?s shirt to reveal hives on back and front of trunk, neck, and on upper arms. Pt also noted to be scratching. Patient AAO, respirations even/unlabored at 20/min, child is calm with no s/s of distress. 1505: clinic area cleared, Vital signs taken, initiated close monitoring and observation for safety. 1508: Administered Benadryl 25mg chewable tablet PO 1511: Language line called, explained to mother that hives are an allergic reaction, that the children are not in immediate danger or distress, and explained the medication administered and how it should help 1517: Vital signs taken and pt reassessed. Hives still visible, but no s/s of distress or increase in severity. Close monitoring continued. 1520: Notified Dr. of situation via phone, MD orders taken: 1. Follow SDO for moderate allergic reaction 2. Continue monitoring for 30 minutes, then evaluate ensure reaction is not progressing in severity. 1524: Onsite provider NP, comes to clinic area, evaluates patient. NP reinforces that patient is experiencing a mild reaction, and that it is safe for patient to leave clinic as reaction is not progressing in severity. 1529: Vital signs taken, and patient reassessed. Fewer hives visible, and those seen are noted to be smaller and less raised. 1530: Administered second Benadryl 25mg chewable tablet PO, continued close monitoring. 1537: Program manager contacted via phone and briefed on situation. 1545: Spoke with parent again via language line interpreter. Educated parent on hives as an allergic reaction, medication given as treatment, s/s of anaphylaxis, and instructed to seek emergency medical care if symptoms worsen. Parent verbalized understanding. 1550: Reinforced instructions to parent to seek emergency care if condition worsens. Assessment reveals hives visibly reduced, no s/s of discomfort or distress. 1551: Patient left clinic in stable condition.

Other Meds: denies

Current Illness: denies

ID: 1736909
Sex: M
Age: 78
State: FL

Vax Date: 09/26/2021
Onset Date: 09/27/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data: N/A

Allergies: N/A

Symptom List: Injection site pain, Pain

Symptoms: Pt. states that after receiving the 3rd dose Booster of Phizer 09/16/2021, started experiencing symptoms 09/27/2021 of Vertigo when getting up for the day. Lasting 1 minute. No noted Primary visit.

Other Meds: Atenolol, Wellbutrin, Crestor, Metaphorim, Aspirin, Multi-Vitamins, Magnesium

Current Illness: N/A

ID: 1736910
Sex: F
Age: 44
State: CA

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data:

Allergies: None known

Symptom List: Injection site pain, Menorrhagia

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds: Aranesp Calcitriol Carvedilol Clonidine HCl Covid-19 Pfizer-BioNTech Addl dose Furosemide Heparin bolus LiquaCel SUPPORT Losartan Potassium Renavite Renvela Venofer Venofer Zofran

Current Illness:

ID: 1736911
Sex: M
Age: 35
State: TN

Vax Date: 08/31/2021
Onset Date: 09/24/2021
Rec V Date: 09/27/2021
Hospital: Y

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

Lab Data: Echo reduced LV function. Interstitial and alveolar opacities in the midlungs bilaterally

Allergies: NKA

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

Symptoms: Hospitalized with CHF likely due to cocaine use, potentially long-standing hypertension. Could be myocarditis. IV Lasix. Did not require oxygen.

Other Meds: Unknown

Current Illness: Unknown

ID: 1736912
Sex: F
Age: 56
State: MN

Vax Date: 01/15/2021
Onset Date: 09/22/2021
Rec V Date: 09/27/2021
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: states became ill on 9/21/21 with headache; achiness; feeling feverish; congestion and sneezing.

Other Meds: Remicade; Tizanidine; Cetirizine; Citalopram; Bupropion; Fluticasone

Current Illness: none

ID: 1736913
Sex: M
Age: 57
State:

Vax Date: 04/03/2021
Onset Date: 09/26/2021
Rec V Date: 09/27/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: per ED note: 58-year-old male presents emergency room with complaints of cough and shortness of breath that has had over the past 3 days. Cough is productive of yellow phlegm. Patient states he has had previous episodes of pneumonia. Patient is normally on home O2 of 3 L and was found to be a 9% on his home O2 of 3 L. Patient states he developed a fever today. Patient admits to central chest pain with coughing. Patient states he has occasional wheezing. No abdominal pain nausea vomiting or diarrhea. Patient does complain of bilateral lumbar back pain and right side pain. This is also been present over the past 3 days. Patient admits to having urinary urgency to the point that he cannot make it to the bathroom in time before he urinates on himself.

Other Meds:

Current Illness:

ID: 1736914
Sex: F
Age: 22
State: NY

Vax Date: 08/28/2021
Onset Date: 08/28/2021
Rec V Date: 09/27/2021
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: N/A

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

Symptoms: Ever since receiving the first dose of the vaccine on August 28, 2021, I have been experiencing a long-term side effect. Initially, I had the normal reported side effects such as a sore arm, headache and generalized weakness. The same day of the initial shot, I began experiencing vagina bleeding within 8 hours. The blood was bright red and very heavy. I have been filling pads within one hour and this is very abnormal even with my prior condition of pcos. I have never in my life experienced such bleeding even on menstrual cycle. This has been going on since the first dose and has worsened after my second dose. I am very concerned for my health.

Other Meds: N/A

Current Illness: N/A

ID: 1736915
Sex: M
Age: 17
State: NC

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

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

Lab Data: N/A

Allergies: N/A

Symptom List: Nausea

Symptoms: Patient received 0.3 mL of undiluted dose of Pfizer vaccine on 9/21/2021. This was his first dose of the series which equated to ~4 doses. Patient stayed in the pharmacy for 15 minutes for observation and appeared fine with no reactions. Contacted patient's mother and father and informed them of the situation. Followed up with call over the next 2 days to monitor any symptoms. Mother has stated that he had not experienced any symptoms of headache, chills, fever, or fatigue on 9/22 or 9/23. Also contacted patient's PCP and left a message about the situation as well.

Other Meds: N/A

Current Illness: N/A

ID: 1736916
Sex: M
Age: 58
State: ID

Vax Date: 04/10/2021
Onset Date: 04/11/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data: D dimmer..... elevated CT heart .... normal Ultrasound of legs normal

Allergies: none

Symptom List: Injection site pain

Symptoms: the day following the injection. I was standing at the counter and suddenly felt very heavy. I began to drop to the floor and couldnt move my arms to catch myself. My torso landed on the counter in front of me and I began to loose black out. I began sliding to the floor when I suddenly had control again. The total time I'm guessing was 10 seconds. I was tired, disoriented for a short time.

Other Meds: Ibuprofen and ducolax

Current Illness: none

Date Died: 09/27/2021

ID: 1736918
Sex: F
Age: 57
State: GA

Vax Date: 07/25/2021
Onset Date: 08/29/2021
Rec V Date: 09/27/2021
Hospital: Y

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

Lab Data: troponin on admit 0.34 (09/04/2021)

Allergies: NKDA

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

Symptoms: Shortness of breath

Other Meds:

Current Illness: DM

ID: 1736919
Sex: M
Age: 18
State: OH

Vax Date: 05/01/2021
Onset Date: 08/13/2021
Rec V Date: 09/27/2021
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: MRI (8/14/21), CT Scan (8/13/21), Blood work (8/13/21)

Allergies: n/a

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

Symptoms: Stroke on August 13th, left cerebral cortex, right side paralysis. Unable to speak and move his entire right side.

Other Meds: n/a

Current Illness: n/a

ID: 1736920
Sex: M
Age: 54
State: MI

Vax Date: 03/31/2021
Onset Date: 09/26/2021
Rec V Date: 09/27/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: Per ED note: The patient is a 55-year-old male with past medical history of diabetes mellitus and end-stage renal disease on hemodialysis who presents to emergency department for complaint of nausea, vomiting, and hiccups. The patient states that he has been having hiccups intermittently for the last week and over the last 2 to 3 days he has had vomiting. He also admits that he has been having chills that have been going on for the last several days. He denies any shortness of breath, chest pain, or abdominal discomfort. The patient was febrile upon arrival in the emergency department with a temperature of 102.2 ?F. He states that he is fully vaccinated for COVID-19. He is currently being treated for a left foot ulceration and follows with the wound clinic.

Other Meds:

Current Illness:

ID: 1736921
Sex: F
Age: 71
State: OR

Vax Date: 04/09/2021
Onset Date: 04/10/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Fever, aches and pains and flu-like symptoms.

Other Meds: Venlafaxine

Current Illness:

ID: 1736923
Sex: F
Age: 17
State: GA

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/27/2021
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:

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

Symptoms: Patient began feeling "unwell" about 30 minutes after administration. She admits to being nervous, but complained of new onset dizziness versus lightheadedness. The patient was placed in a seated position, but she continued to complain of dizziness and very mild nausea so she was laid supine. She eventually was able to sit upright, sit in a chair, and then stand following PO fluids. Her BP, HR, spO2 were normal throughout. She confirmed improved symptoms and was ambulated without issue. Patient reported resolution of symptoms about 25minutes after first onset and was released to home.

Other Meds:

Current Illness: None

ID: 1736924
Sex: F
Age: 47
State: PA

Vax Date: 09/01/2021
Onset Date: 09/09/2021
Rec V Date: 09/27/2021
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: Tahini allergy

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

Symptoms: Menstrual Cycle, which is ALWAYS extremely regular and fluctuates at most by 1 day in either direction, arrived 11 days early - which was 8 days post 1st vaccine shot. It proceeded to last 8 days, although it was more mild and less flow than a normal period.

Other Meds: Vitamin D3, Milk Thistle, Berberine, Magnesium, Lysine

Current Illness: None

ID: 1736925
Sex: F
Age: 93
State:

Vax Date: 04/12/2021
Onset Date: 04/29/2021
Rec V Date: 09/27/2021
Hospital: Y

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

Lab Data: 4/29/2021 SARS-CoV-2 (COVID-19) PCR Detected

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: On 04/29/21 pt. was in inpatient rehab and tested routinely for COVID for SAR placement; tested positive; PMH AAA, HTN, CAD, pacemaker, previous TIA with left CEA 2005, CKD III; discharged to HCF on 05/05/21.

Other Meds:

Current Illness:

ID: 1736926
Sex: F
Age: 86
State: NJ

Vax Date: 02/28/2021
Onset Date: 09/26/2021
Rec V Date: 09/27/2021
Hospital: Y

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

Lab Data: SARS-CoV-2 Antigen (+) on 9/26/2021

Allergies: Latex, erythromycin

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

Symptoms: This is an 86 year old female, , with past medical history significant for Atrial fibrillation, s/p PPM, Hypertension, Hypothyroidism, DM type 2, non-insulin dependent, Dementia, Anxiety, who initially presented to the Emergency Room this AM for monclonal antibodies post exposure. The patient is a resident where there is currently a covid outbreak. She received her MABs and was transported back to the facility. On arrival to the facility, the patient vomited and 02 sats were 76% on room air therefor she was sent back. A CXR was negative for an infiltrate and showed possible Cardiomegaly.

Other Meds: apixaban (Eliquis) 5 mg Tablet Directions: 1 tablet oral twice a day (Active) cholecalciferol (vitamin D3) 50 mcg (2,000 unit) Tablet Directions: 1 tablet oral daily (Active) digoxin 125 mcg (0.125 mg) Tablet Directions: 1 tablet oral

Current Illness:

ID: 1736927
Sex: M
Age: 46
State: CA

Vax Date: 09/27/2021
Onset Date:
Rec V Date: 09/27/2021
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: Metformin

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds: Aranesp (Billable) Aspirin Atorvastatin Calcium Calcitriol Calcitriol Clonidine HCl Covid-19 Pfizer-BioNTech Addl dose Emla Cream Engerix-B (Hepatitis B Vaccine) Engerix-B (Hepatitis B Vaccine) Furosemide Glucometer Elite Classic Heparin bo

Current Illness:

ID: 1736928
Sex: F
Age: 51
State: TX

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

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

Lab Data:

Allergies: Perfume & flowers

Symptom List: Pain in extremity

Symptoms: Numb lips, itchy throat , fever, chills, sick to stomach, cough, difficulty breathing, headache, metal taste. sick and out of work for 1 week.

Other Meds: Mucinex, Ibuprofen, Acetaminophen

Current Illness: 5 days after receiving my first vaccine I got Covid and was still trying to recover when I had to get the second shot.

ID: 1736929
Sex: F
Age: 30
State: GA

Vax Date: 09/26/2021
Onset Date: 09/27/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data:

Allergies: SULFA

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

Symptoms: Pt called store & reported pain and swelling under armpit of left arm, with mild warmth and redness. Pt received 1st dose on 09-26 in LD and reported symptoms the following day. Told pt the location of localized swelling/irritation is abnormal and that she should have it evaluated at her local walk-in clinic. If unable to be seen immediately and it worsens, take benadryl.

Other Meds: Blisovi FE 21 1-20

Current Illness: Unknown

ID: 1736930
Sex: M
Age: 31
State: TN

Vax Date: 06/16/2021
Onset Date: 09/10/2021
Rec V Date: 09/27/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Breakthrough COVID case admitted for hospitalization for SARS-CoV-2 pneumonia

Other Meds: Amlodipine 5mg; atenolol 25mg; depo-testosterone 100mg; ergocalciferol 50,000 units; levothyroxine 75mcg

Current Illness: Hypothyroidism; hypertension

ID: 1736931
Sex: F
Age: 83
State: MD

Vax Date: 05/24/2021
Onset Date: 05/31/2021
Rec V Date: 09/27/2021
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: n/a

Allergies: codeine

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

Symptoms: pt believes in retrospect that her COVID vaccines precipitated fluid overload/CHF exacerbations within a week after each dose

Other Meds: numerous

Current Illness: has chronic CHF and pt believes each dose of the vaccine precipitated fluid retention

ID: 1736933
Sex: M
Age: 42
State: IL

Vax Date: 09/20/2021
Onset Date: 09/20/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data: None to date but I have been in contact with my doctor about my condition.

Allergies: Penicillin

Symptom List: Vomiting

Symptoms: Day 1 - Extreme Lethargy Day 2 - Sore arm, weakness, dizziness, lethargy, and unknown pressure in top left side of brain. Day 3 - Headache, Sore arm, weakness, dizziness, lethargy, and unknown pressure in my head. Day 4 - 101 degree fever, headache, sore arm, weakness, dizziness, lethargy and unknown pressure in my head. Day 5-7 - Headache, dizziness, weakness, lethargy and unknown pressure in my head.

Other Meds: Daily Multivitamin and zinc supplement Morning Coffee

Current Illness: None

ID: 1736934
Sex: F
Age: 78
State: OH

Vax Date: 02/09/2021
Onset Date: 02/10/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data: None.

Allergies: Penicillin, Morphine, Steroids like Decadron, ragweed, pollens of different kinds.

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: After the vaccine I started coming down with fever and I don't remember the exact temperature but it was low grade (100-101) and I had that fever for six weeks and I had a terrific headache to accompany the fever for six weeks, The fever would vary each day and it would drop down and come back. The headache was continuous and all the glands in my neck were swollen so greatly that it actually pushed my jaw forward and so I lost my bite, it pushed my teeth and they didn't align so I had trouble eating and chewing and that lasted for a good six weeks. Gradually after that period of time my glands started going down --took more than six weeks for it to go down but the headaches and the fever did decrease shortly after six weeks but the gland thing was going on for several more weeks but it was milder. I contacted my Doctor's office about this, and they just listened to my list of complaints and said they couldn't do anything and that was it. Swelling in my neck felt like I had lumps. I did have arm soreness and redness the night after the vaccine.

Other Meds: Levothyroxine, Magnesium, Vitamin D

Current Illness: None.

ID: 1736935
Sex: F
Age: 74
State: VT

Vax Date: 09/21/2021
Onset Date: 09/23/2021
Rec V Date: 09/27/2021
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: Penicillin

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

Symptoms: Herpes Zoster, right upper chest, axilla and right upper back.

Other Meds: Prilosec, Prednisone, Synthroid, Methadone, Tylenol, Sinemet,

Current Illness: Parkinsons, chronic degenerative arthritis

ID: 1736936
Sex: F
Age: 75
State: MN

Vax Date: 03/06/2021
Onset Date: 09/24/2021
Rec V Date: 09/27/2021
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:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient admitted for COVID on 9/24/21 - 9/26/21. Fully vaccinated for COVID. Dose one COVID Pfizer vaccine 2/13/21, dose 2, 3/6/21

Other Meds:

Current Illness:

ID: 1736937
Sex: M
Age: 8
State: TX

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data: N/A

Allergies: parent states pt is allergic to all meat. Parent states he eats eggs regularly and denies egg allergy.

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

Symptoms: 1503: Patient returns to area, mom lifts atient?s shirt to reveal hives on back and front of trunk, neck, and on upper arms. Pt also noted to be scratching. Patient AAO, respirations even/unlabored at 20/min, patient is calm with no s/s of distress. 1505: Area cleared, Vital signs taken, initiated close monitoring and observation for safety. 1508: Administered Benadryl 25mg chewable tablet PO 1511: Language line called, explained to mother that hives are an allergic reaction, that the patient is not in immediate danger or distress, and explained the medication administered and how it should help 1517: Vital signs taken and pt reassessed. Hives still visible, but no s/s of distress or increase in severity. Close monitoring continued. 1520: Notified Dr. of situation via phone, MD orders taken: 1. Follow procedures for moderate allergic reaction 2. Continue monitoring for 30 minutes, then evaluate ensure reaction is not progressing in severity. 1524: Onsite provider NP comes to area, evaluates patient. NP reinforces that patient is experiencing a mild reaction, and that it is safe for patient to leave clinic as reaction is not progressing in severity. 1529: Patient reassessed. Fewer hives visible, and those seen are noted to be smaller and less raised. Close monitoring continued. 1537: Program manager contacted via phone and briefed on situation. 1545: Spoke with parent again via language line iinterpreter.Educated parent on hives as an allergic reaction, medication given as treatment, s/s of anaphylaxis, and instructed to seek emergency medical care if symptoms worsen. Parent verbalized understanding. 1550: Reinforced instructions to parent to seek emergency care if condition worsens. Assessment reveals hives visibly reduced, no s/s of discomfort or distress. 1551: Patient left clinic in stable condition.

Other Meds: denies

Current Illness: denies

ID: 1736938
Sex: F
Age: 66
State: NV

Vax Date: 03/24/2021
Onset Date: 04/01/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data:

Allergies: Sulfa; Penicillin; Tartaglia; Matutine; Valium; Advani; Subalpine; Formamide

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

Symptoms: I had a horrible tease in my month. I felt nausea. In the middle of the night, I wake up with server pain in all my joints. Every where I had surgery, it swollen at the sites. They have given me proton zone for the pain but it has not helped. I went to the doctor and to my pain doctor about this. They said it was due to the vaccine. My knees and my toes are very swollen and are painful.

Other Meds: Oxybutynin; Tram trine; Delaine; Seteria; Zirconia; Prolactin; Vitamin D3; Calcium; Tamarac; Margate; Oxycodone

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am