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: 1737463
Sex: F
Age: 20
State: TN

Vax Date: 09/24/2021
Onset Date: 09/27/2021
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: LA

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: There was an opened unlabeled vial of Moderna in the fridge. There had not been any mentions of an open Moderna vial . I grabbed the open vial along with an unopened vial of Moderna and proceeded to the Covid clinic. There were 7 doses of this vaccine given to patients. As of 9/27 we were off on our counts and now realize that the vial that was used on 9/24 to those 7 patients was an expired vial. The vial had originally been opened on 9/23 by RN. These 7 patients have been located and will be contacted once recommendations from CDC are reviewed.

Other Meds:

Current Illness:

ID: 1737464
Sex: F
Age: 46
State: CA

Vax Date: 08/06/2021
Onset Date: 08/06/2021
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: None

Symptom List: Anxiety, Dyspnoea

Symptoms: Sore right shoulder pain that radiates down to fingers; arm is weak. Right side of neck is painfully stiff, pain radiates to top right side of head causing headache. Right ear sounds buffered, depending on head pain.

Other Meds: None

Current Illness: None

ID: 1737465
Sex: M
Age: 74
State:

Vax Date: 09/27/2021
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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: ADMINISTRATION ERROR MIXED SERIES mRNA VACCINE PFIZER AND MODERNA.

Other Meds:

Current Illness:

ID: 1737466
Sex: M
Age: 58
State: MN

Vax Date: 08/13/2021
Onset Date: 08/15/2021
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: Reviewed with Chiropractor and Physician. Had adjustment, no help and Dr scheduled a MRI of back.

Allergies: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: 24 hrs. got dizzy, nausea, tired. After couple days legs and arms felt tired, achy especially legs and arms. Got out of chair and could not stand, felt like I was stepping directly on a nerve in my foot, right side of right foot (smaller toes). Acute pain passed after an hour, was able to walk, but has not gone away. Stopped jogging since. Today, 9/27 acute pain came back to right foot, not going away saw doctor. Pain in back of leg has been regular since first time I felt pain, and again, always feel it, but only sharp pain a couple times.

Other Meds: metoprolol 25 mg, Atorvastatin 40 mg, Vitamin C, D3 & Zinc

Current Illness: None

ID: 1737467
Sex: F
Age: 53
State: MO

Vax Date: 03/29/2021
Onset Date: 04/01/2021
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: Milk

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

Symptoms: I had a lump has my shift site. I was rubbing it and it went away. Then I had a lump under my arm that lasted for about a month and then it went away. I also felt really lightheaded and I had fog head (could not think clearly). I also had a pain in my arm.

Other Meds: Allergic medicine (montelukast); LEXAPRO

Current Illness:

ID: 1737468
Sex: F
Age: 49
State: AL

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 09/27/2021
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: Feathers

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

Symptoms: Facial drooping/slight numbness on left side of face.

Other Meds: No

Current Illness: None

ID: 1737469
Sex: M
Age: 46
State: MN

Vax Date: 04/29/2021
Onset Date: 09/25/2021
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:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Hospitalization chest pain and dyspnea known exposure.

Other Meds:

Current Illness:

ID: 1737470
Sex: F
Age: 55
State: TN

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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: There was an opened unlabeled vial of Moderna in the VFC fridge. There had not been any mentions on the group chat of an open Moderna vial (as when we open each vial we let everyone in the chat know) . I grabbed the open vial along with an unopened vial of Moderna and proceeded to the Covid clinic. There were 7 doses of this vaccine given to patients. As of 9/27 we were off on our counts and now realize that the vial that was used on 9/24 to those 7 patients was an expired vial. The vial had originally been opened on 9/23 by RN. These 7 patients have been located and will be contacted once recommendations from CDC are reviewed.

Other Meds:

Current Illness:

ID: 1737471
Sex: M
Age: 64
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
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:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: ADMINISTRATION ERROR MIXED SERIES mRNA VACCINE PFIZER AND MODERNA.

Other Meds:

Current Illness:

ID: 1737472
Sex: F
Age: 22
State: NY

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

Lab Data: 09/26/2021 went to the ER and was given abnormal results... had blood work done and has to have chest exam

Allergies: no

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient reported that she started having tightness in her chest and shortness of breath the next day after getting the vaccine...

Other Meds: no

Current Illness: no

ID: 1737473
Sex: M
Age: 43
State: TX

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: SYR
Vax Site: LA

Lab Data: Unknown

Allergies: None reported

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

Symptoms: Patient received the vacation (2nd dose) around 8:40am on a Friday. By Saturday 4am, patient was throwing up and wife called EMS who diagnosed "non-epileptic seizures". On Sunday he still had some tingling sensation. I received the call from patient on Monday morning and patient was doing find. He had spoke to his PCP also.

Other Meds: Unknown

Current Illness: None reported

ID: 1737474
Sex: M
Age: 36
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
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:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: ADMINISTRATION ERROR MIXED SERIES mRNA VACCINE PFIZER AND MODERNA.

Other Meds:

Current Illness:

ID: 1737475
Sex: F
Age: 37
State: TN

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: LA

Lab Data:

Allergies:

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

Symptoms: There was an opened unlabeled vial of Moderna in the VFC fridge. There had not been any mentions on the group chat of an open Moderna vial (as when we open each vial we let everyone in the chat know) . I grabbed the open vial along with an unopened vial of Moderna and proceeded to the Covid clinic. There were 7 doses of this vaccine given to patients. As of 9/27 we were off on our counts and now realize that the vial that was used on 9/24 to those 7 patients was an expired vial. The vial had originally been opened on 9/23 by RN. These 7 patients have been located and will be contacted once recommendations from CDC are reviewed.

Other Meds:

Current Illness:

ID: 1737476
Sex: F
Age: 39
State: TX

Vax Date: 08/17/2021
Onset Date: 08/25/2021
Rec V Date: 09/27/2021
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: CT Scan 9/20/2021 and Colonoscopy 9/24/2021

Allergies: Amoxicillin

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

Symptoms: One week later, I started experiencing abdominal cramping. The next week I started seeing blood in my stools. My colon is now inflammated.

Other Meds: Multi vitamins

Current Illness: No illnesses

ID: 1737477
Sex: M
Age: 70
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
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:

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

Symptoms: ADMINISTRATION ERROR MIXED SERIES mRNA VACCINE PFIZER AND MODERNA.

Other Meds:

Current Illness:

ID: 1737478
Sex: F
Age: 51
State: OH

Vax Date: 09/18/2021
Onset Date: 09/19/2021
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: none

Allergies: tomatoes, eggs and sea food

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

Symptoms: I had headache and dizziness and still have dizziness. I just contacted the pharmacy and they said I can try Tylenol to have the symptoms reduced.

Other Meds: NONE

Current Illness: NONE

ID: 1737479
Sex: F
Age: 88
State: MN

Vax Date: 05/19/2021
Onset Date: 09/24/2021
Rec V Date: 09/27/2021
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: Hospitalized due to dyspnea, hypoxia, fever, productive cough.

Other Meds:

Current Illness:

ID: 1737480
Sex: F
Age: 40
State: TN

Vax Date: 09/24/2021
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:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: There was an opened unlabeled vial of Moderna in the VFC fridge. There had not been any mentions on the group chat of an open Moderna vial (as when we open each vial we let everyone in the chat know) . I grabbed the open vial along with an unopened vial of Moderna and proceeded to the Covid clinic. There were 7 doses of this vaccine given to patients. As of 9/27 we were off on our counts and now realize that the vial that was used on 9/24 to those 7 patients was an expired vial. The vial had originally been opened on 9/23 by RN. These 7 patients have been located and will be contacted once recommendations from CDC are reviewed.

Other Meds:

Current Illness:

Date Died: 09/01/2021

ID: 1737481
Sex: F
Age: 89
State:

Vax Date: 02/23/2021
Onset Date: 08/31/2021
Rec V Date: 09/27/2021
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 ED with c/o worsening SOB x 3days, respiratory distress, collapse of left lower lobe secondary to consolidation versus atelectasis; earlier was diagnosed with bilateral pneumonia; has taken her antibiotics; was diagnosed with COVID a few days after pneumonia diagnosis; pt's condition deteriorated and patient died in the hospital

Other Meds:

Current Illness:

ID: 1737482
Sex: F
Age: 56
State: WA

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

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

Lab Data:

Allergies:

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

Symptoms: Pt was given vaccine beyond 12 hour beyond use date/time after initial vial puncture.

Other Meds:

Current Illness:

ID: 1737483
Sex: M
Age: 52
State: TX

Vax Date: 04/11/2021
Onset Date: 04/22/2021
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: 4/22/2021 suffered a stroke, hospitalized on 4/23/2021 for 3 days! affected right side ,speech was affected. been off work since,Still currently off work disabilty 9/27/2021

Allergies: none

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

Symptoms: 4/22/2021 suffered a stroke, hospitalized on 4/23/2021 for 3 days! affected right side ,speech was affected. been off work since,Still currently off work disabilty 9/27/2021

Other Meds: metformin 500 mg ,simvastatin 20 mg , gabapentin 300 mg ,amlodipine 10 mg ,aspirin 325 mg

Current Illness: high blood pressure,diebeted,

ID: 1737484
Sex: F
Age: 67
State: MO

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: LA

Lab Data: None

Allergies: Ultram, aspirin

Symptom List: Unevaluable event

Symptoms: Rash on my chest, under breasts, arms, and on left shoulder. Slight itching. This lasted till 9/27 , mid day. Saturday (9/26) felt flu like symptoms. None of this was accute, but the if the rash hadn't gone away today, I was going to call my Dr

Other Meds: Lisinopril Dulera inhaler

Current Illness: None

ID: 1737485
Sex: M
Age: 12
State: NV

Vax Date: 08/04/2021
Onset Date: 08/04/2021
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: unknown

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

Symptoms: Client received Pfizer vaccine (1st dose) that had been reconstituted incorrectly by prepper. Saline amount mixed with vaccine was 0.8 ml-the correct diluent of Saline should have been 1.8 ml. Patient was observed for 30 minutes prior to departure with mom and no complaints of side effects noted. No adverse effects. Client alert and oriented. No compliant of headache, dizziness, visual changes, pain at injection site or instability.

Other Meds: unknown

Current Illness: unknown

ID: 1737486
Sex: M
Age: 29
State: WA

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: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Patient received Pfizer vaccine at 12:30. Patient began having chest pain 5 minutes after receiving vaccine, as well as complaining of a tickle in his throat. 50mg of Benadryl was administered. Pain in chest increased to a 7/10 pain. Paramedics were called at 12:49. Patient complained that chest pain was worse with breathing. Paramedics arrived at 13:00, took vital signs, and administered a 12 lead EKG. Paramedics did not feel as though a hospital visit was necessary. Assesment of vaccine site shoed no localized reaction, patient denied pain at injection site. No visible signs of redness or rash on arms or torso. Patient was alert and oriented the entire time. 30 minutes following Benadryl administration, the patient stated he was tired. The patient decided he wanted to go home and was picked up by a family member. He was instructed to rest the remainder of the day and to calll 911 if his symptoms worsened.

Other Meds:

Current Illness:

ID: 1737487
Sex: M
Age: 77
State: AL

Vax Date: 02/12/2021
Onset Date: 02/15/2021
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: I had not indication of a stroke. Both legs got wobbly Monday evening Feb 15, 2021. I rested. The next fay, only my left leg and left arm were afflicted. Various tests (e.g., scans, MRI, Transesophageal Echocardiogram) performed Feb 17-22, 2021 confirmed the stroke. I did not know I had a stroke until the tests confirmed it.

Allergies: None that I am aware of.

Symptom List: Injection site pain, Menorrhagia

Symptoms: Stroke (Ischemic, I think)

Other Meds: Dutasteride 0.5 mg (3X per week); Folic Acid 1 mg; Levothyroxine 88 mcg; Irbesartan 300 mg; MultiGen vitamin caplets; Omeprazole DR 40 mg; Sildenafil 20 mg (3X per day); PreserVision Areds 2; Aspirin 325 mg (2X per day); Vitamin C 500 mg (

Current Illness: Very low "good" Cholesterol, high blood pressure (e.g., 160/80)

ID: 1737488
Sex: F
Age: 63
State: MN

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

Lab Data:

Allergies:

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

Symptoms: Hospitalized pneumonia due to covid

Other Meds:

Current Illness:

ID: 1737489
Sex: F
Age: 40
State: TX

Vax Date: 03/23/2021
Onset Date: 03/23/2021
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: LA

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: that evening I have 100 fevers to 101. My whole-body aches, I had headache all night. I have to change clothes several times I was wet. It last 48 hrs. I had tenderness in my arm. I had fatigue and brain fog. No need to see a doctor. Everything was fine by the next day.

Other Meds:

Current Illness:

ID: 1737490
Sex: F
Age: 48
State: SC

Vax Date: 07/19/2021
Onset Date: 07/20/2021
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: RA

Lab Data:

Allergies: none

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: After the first shot, I had a weird after taste in my mouth. Suddenly it would appear. It eventually went away about 5 weeks later or so. After the second shot, things smell different and I would say disgusting. My perfumes, hand lotion and certain foods don't take good anymore. This has not changed and it has been over 6 weeks since I had the last shot (8/16/21)

Other Meds: None

Current Illness: none

ID: 1737491
Sex: F
Age: 15
State: MN

Vax Date: 09/25/2021
Onset Date: 09/25/2021
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:

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

Symptoms: Reporting that a 15 year old individual received both a Moderna and a Pfizer COVID-19 vaccine. This individual received Pfizer on 8/31/2021 and Moderna on 9/25/2021.

Other Meds:

Current Illness:

ID: 1737492
Sex: M
Age: 31
State: AR

Vax Date: 09/08/2021
Onset Date: 09/08/2021
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: EKG

Allergies: Amlodipine

Symptom List: Nausea

Symptoms: Patient presents to clinic with complaint of fatigue. Pleasant demeanor and ambulates without assistance. Precordial flutters felt 3-4x/day and he is unable to lay flat or on his left/right side without having difficulty breathing. Began after administration of Covid vaccine 2nd week of August. This lasted for 2 weeks and dissipated. 2nd Covid vaccine September 8th and the flutters returned. EKG completed. Orthopnea: Intermittent dyspnea when in the supine and lateral recumbent position. This started 2-3 days after his second Covid vaccination. Currently not in respiratory distress. Neck stiffness started 3 days ago. Limited movement in neck without pain. Pain 5 on pain scale of 0-10. The pain is constant and relieved with standing. Aggravated with lying supine and lateral recumbent. HA: Pain started while lying supine and increased when he changed position for supine to standing. Pain described as throbbing, squeezing, pressure pain. Pain unrelieved lasting 4 hrs. Normally pt takes Excedrin for HA relief. Heart: EKG completed precordial flutters felt 3-4x/day. Began after administration of Covid vaccine 2nd week of August. This lasted for 2 weeks and dissipated. 2nd Covid vaccine September 8th and the flutters returned. Flutters described as light tapping in the precordial region that is not painful. Numbness and tingling: Bilat upper ext numbness and tingling usually starts in the hands and radiates to forearm. Lower ext bilat tingling and numbess. This started days after 1 Covid vaccine.

Other Meds: Olmesartan, escitalopram, atorvastatin, pantoprazole

Current Illness: None

ID: 1737493
Sex: M
Age: 51
State: OR

Vax Date: 08/26/2021
Onset Date: 08/26/2021
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: none

Allergies: none

Symptom List: Injection site pain

Symptoms: Tingling sensation in legs and arms. sometimes slightly painful sometimes itchy.

Other Meds: Adderall

Current Illness: none

ID: 1737494
Sex: F
Age: 30
State: AZ

Vax Date: 09/26/2021
Onset Date: 09/26/2021
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: unknown

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

Symptoms: Tinnitis, called patient today and it did subside after a couple of hours, she still has intense pressure. Advised pt to check with her physician.

Other Meds: unknown

Current Illness:

ID: 1737495
Sex: F
Age: 72
State: WA

Vax Date: 03/23/2021
Onset Date: 09/11/2021
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: RA

Lab Data:

Allergies: Neosporin ointment

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

Symptoms: On Saturday September 11th I had itching and a burning sensation on the left side toward my back around my waist. I though it was a spider bite, but when I felt it I didn't feel anything. At noon I noticed a lot of little red bumps that extended towards my spine on my back. I went to urgent care and they told me I had shingles. I was prescribed an anti viral medication for it which I took immediately. The medication that was prescribed was Valacyclovir 1000mg 3xday for 10 days by mouth. On the 7th day everything started to clear up. The day before I found out I had shingles, I had a venom shot against yellow jackets, wasp, and hornets. I get the venoms shots just incase if I ever get stung the reaction would be milder because of my mast cell activation that I have. I have been getting those venom shots for five months without any issues.

Other Meds: Magnesium Turmeric Vitamin D Macuhealth

Current Illness:

ID: 1737496
Sex: F
Age: 48
State: OH

Vax Date: 05/14/2021
Onset Date: 05/31/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data:

Allergies: cats, dog dander IV contrast dye sulfa drugs

Symptom List: Tremor

Symptoms: I had brain fogginess when I had COVID in November of 2020. I was fine afterwards until I got the vaccine. After the vaccine was administered, I had some blurry vision within an hour of getting it. 2 weeks later, I started experiencing more brain fogginess than I had ever had, even during November when I previously had Covid. There were times in June where I couldn't remember what I had for dinner, the night before and had to go to my dish washer to see what was in it to remind me. There has been times at work when I'm on a mission to get stuff for stocking the rooms or times in procedures where I just go blank and can't remember things. There was also a time in August when I had went away on the Lake for the whole weekend. I woke up and was getting ready for work thinking about what I did on the weekend. I could not even recall going away, let alone what we did while we were there. I had to look at my phone's pictures to recall that. A girl at work even noticed me being more forgetful than ever. I do have some eye issues but seems like my vision has gotten a little worse as well.

Other Meds: adderall 25 mg diclofenac 50 mg as needed

Current Illness: none

ID: 1737497
Sex: F
Age: 44
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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Pt is seeing her md Tuesday 9/28/21 to follow up about the adverse event.

Allergies: cephalosporins, penicillin, hibiclens

Symptom List: Erythema, Pruritus

Symptoms: Pt started the evening after receiving vaccine feeling fever, body aches and chills. The next day her arm where she received the vaccine became red, itchy and swollen. Vaccine was administered on a Friday and by Monday (9/27/21) her arm was not getting any less swollen or red. Pt was told to take benadryl by her md.

Other Meds: levothyroxine, estradiol vaginal, sertraline,

Current Illness: recent stem cell transplant, recent covid-19 vaccine 6 weeks prior

ID: 1737498
Sex: F
Age: 74
State: IL

Vax Date: 03/21/2021
Onset Date: 09/26/2021
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: 9/26/21 PCR COVID 19 test positive

Allergies: NKA

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

Symptoms: Patient tested positive for COVID 9/26/2021, chest pain, shortness of breath, cough and fever x1 week. Troponin elevated (58)

Other Meds: aspirin (aspirin) 81 mg, EC Tablet, PO, Daily atenolol (atenolol) 50 mg, TAB, PO, Daily docusate (docusate sodium) 100 mg, CAP, PO, Q12H (Every 12 hours) gabapentin (gabapentin) 300 mg, CAP, PO, TID levothyroxine (levothyroxine) 50 mcg

Current Illness:

ID: 1737499
Sex: F
Age: 61
State: FL

Vax Date: 03/06/2021
Onset Date: 08/06/2021
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: 18th of August - had a PET Scan (Radiology associates) - and I answered yes that I was feeling sick that day. Results of that said - There is new hyper metabolic ground glass opacity and nodular consolidation in the posterior right upper lobe of lung. It says no hyper metabolic pulmonary mass otherwise. What they said at the end of the review they said it likely could be pneumonia and she said she apologized to me, and she said that she hadn't realized that I was that sick and the PET results look like someone who had COVID. I am having a CT scan on October 11th.

Allergies: no

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

Symptoms: A couple days earlier, I was sensitive to really harsh smells. At first, it was just a tickle in my lungs - an irritation. It started on the Tuesday before the 6th but only occurred once that day and then on Thursday it happened again. On the 6th, after I got my tooth pulled, I was knowing that my chest was bothering me. The next day, I could tell for sure it was my chest. I had been on Hydrocodone with the pulled tooth and so I only got a fever to 99. I never got to 100.4. When I did have a fever, it could have been from the anesthesia. It was never higher than 99. I started coughing and hacking and was worried about irritation from where the tooth was pulled. Wednesday, the 11th, I went to get the Rapid test. They told me I didn't have COVID - but it wasn't a PCR. On the 18th of August I had my PET scan - I told her I was sick when I was there for the scan. I am still coughing - still can feel it in my chest and I can feel pain in one of my lungs (I don't have the coughing fits (like I had before) that I was still having last week). Before Labor day, (1st or 2nd) my Primary physician put me on Erythromycin and a cough medicine pill and it stopped some of the congestion but it didn't stop the cough. Instead of hacking a lot, it reduced it - it was a lot less. Still have a cough but have recovered quite a bit. The CT scan will show if I'm recovered. (October 11th).

Other Meds: Letrozole; Levothyroxine; Ibrance - have been taking them for about three years. Alprazolam - a form of Xanax - but don't take them very often: Melatonin - not a regular basis; Tylenol; Vit D

Current Illness: no

ID: 1737500
Sex: M
Age: 68
State: WI

Vax Date: 08/09/2021
Onset Date: 09/25/2021
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: 9/26/21: D-dimer: 1100 Chest xray: new opacity left lower lobe CT angiogram: Small-moderate number of proximal subsegmental acute pulmonary emboli to the left lower lobe with some distal consolidative atelectasis and trace left effusion.

Allergies: NKA

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Pulmonary emboli 9/26/21

Other Meds: Acetaminophen, acyclovir, aspirin, atorvastatin, calcium-vitamin D, gabapentin, metoprolol, mycophenolate, omeprazole, prednisone, tacrolimus

Current Illness: None

ID: 1737501
Sex: M
Age: 48
State:

Vax Date: 12/23/2020
Onset Date: 09/23/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: PATIENT HAD COVID-19 PFIZER VACCINE 12/23/2020, 01/13/2021, AND TESTED POSITIVE TO COVID.

Other Meds:

Current Illness:

ID: 1737502
Sex: M
Age: 69
State: MI

Vax Date: 01/31/2021
Onset Date: 02/04/2021
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: hearing tests

Allergies: na

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

Symptoms: loud high pitched ringing in both ears. Hearing not affected. treated with prednisone injections. did not change or inprove. Ringing has remained to date

Other Meds: na

Current Illness: na

ID: 1737503
Sex: F
Age: 65
State: WA

Vax Date: 09/21/2021
Onset Date: 09/23/2021
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:

Symptom List: Pain in extremity

Symptoms: Pt was given vaccination beyond 12 hour beyond use date/time after initial vial puncture.

Other Meds:

Current Illness:

ID: 1737504
Sex: F
Age: 87
State: IL

Vax Date: 03/25/2021
Onset Date: 09/19/2021
Rec V Date: 09/27/2021
Hospital: Y

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

Lab Data: 09/09/21 COVID19: positive 9/19/21 chest xray: cardiomegaly

Allergies: Nsaids, cephalexin

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

Symptoms: Patient apparently was at health this morning at her nursing home. Suddenly in the morning she was noted to have difficulty speaking along with weakness hand her left extremity. EMS was called patient reached the ER. Was not found to be eligible for tPA. She recently tested positive for covid and was recovering in her nursing home. Per reporting she was supposed to come out of isolation today. Nursing home has been contacted to fax the reports. Patient is able to comprehend speech having slurring while answering questions. She reports frustration, reports mouth is dry and would like to drink. She reports she had difficulty hearing and now seeing and can not speak and it is frustrating. She is not able to answer much as voice is not clear. CT of the head showing penumbra suspected inferomedially in the left temporal region and subthalamic region. No core infraction demonstrated. CT angio in neck showing 50% to 60% stenosis in the left carotid bulb and 60% to 70% stenosis in the right carotid bulb. No aneurysms. Further imaging also showing a small focus of hyperdensity in the left subinsular region, small vessel ischemic and lacunar change. Patient admitted for cerebrovascular accident, not a candidate for tPA because patient is anticoagulated and there is concern of questionable bleeding on CT. MRI suggestive of left cerebellar stroke, left middle cerebral peduncle. Patient has symptoms. Patient was started on aspirin 325 mg per Neurology consulted. Neurology reviewed images, questionable punctate left cerebral late subacute ischemic stroke. Per Neurology, not able to clearly identify ischemic stroke on the MRI, can be an artifact or late subacute tiny stroke. Patient improved in terms of motor strength. Did have an elevated INR and warfarin was held during admission. Per pharmacy protocol plan to restart warfarin now 1.5 mg tomorrow. Will check INR. No concerns for swallow problems. Patient tolerating pureed nectar thick liquid diet. PT/OT evaluated the patient. Plan to discharge for acute rehab at nursing home. Patient will be discharged on atorvastatin and continued with warfarin on a lower dosage due to elevated INR. Discharged on 9/24/21

Other Meds: Emollient cream, multivitamin, travatan eye drops, allopurinol, atorvastatin, brinzolamide eye drops, calcium with vitamin D, fluocinonide cream, furosemide, glucosamine-chondroitin, levothyroxine, lidocaine cream, metoprolol succinate, mup

Current Illness:

ID: 1737505
Sex: M
Age: 41
State: WA

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Patient stated he has numbness on the ball of his right foot. He stated the same thing happened when he recieved his first shot but he did not tell anyone. Patient's vital signs were taken and within normal range. No other symptoms were expressed. Patient was sent back to work but stated that numbness was still in the same spot. The patient was instructed to call 911 if the numbness progressed to his ankle or leg.

Other Meds:

Current Illness:

ID: 1737507
Sex: M
Age: 75
State: MN

Vax Date: 02/26/2021
Onset Date: 09/27/2021
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:

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

Symptoms: Hospitalized chest pain and headache normal cardiac testing runny nose dry cough exposed to sick child.

Other Meds:

Current Illness:

ID: 1737508
Sex: F
Age: 13
State: WI

Vax Date: 09/23/2021
Onset Date: 09/24/2021
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

Allergies: no known allergies

Symptom List: Vomiting

Symptoms: Noted a rash diffuse papular and itching, nothing that appeared like wheals or hives. Started about 24 hours after vaccine, has been taking diphenhydramine at night only. Rash today, day 4, appears minimal and resolving.

Other Meds: none

Current Illness: had vaginal yeast infection 1 week prior to vaccination, treated with Diflucan single dose 9/20/21

ID: 1737509
Sex: M
Age: 13
State: MD

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: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Rash on arms, legs, face, trunk - consistent with hives- given antihistamines, developed within 24 hours of 2nd dose

Other Meds:

Current Illness:

ID: 1737510
Sex: F
Age: 31
State: IN

Vax Date: 01/22/2021
Onset Date: 04/15/2021
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: 7/26/21 MPO: 39, Panca 7/27/21 cr 1.2. gfr 59 Urine protein to creatinine ratio = 2.2 g/g UA: rbc 11-20. wbc 0-5 8/5/21 covid ag neg 8/13/21 cr up to 1.7 gfr39 8/6/2021 kdineybiopsy : focal crescentic Glomerulonephritis

Allergies: erythromycin ( hives)

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

Symptoms: By april 2021 she started manifesting nonspecific constituinal symptoms of runny nose, sore throat, fever, sneezing, recurrent till by 7/2021 primary physician did test for vasclitis relapse. pt had active urine sediment and P anca levels were very high at 1:640 and MPO was 27. By August 4, 20201, creatinine was up further to 1.2-1.3 gfr 47-59 when her baseline cr was 0.7-0.84 gfr 81. kidney biopsy was done on 8/6/21 sowed focal crescentic GN, pauciimmune type. She relapse 17 years after being in remission. At age 15, she had prior epidose of P anca GN

Other Meds: lisinopril, sertraline

Current Illness: respiratory infection

ID: 1737511
Sex: F
Age: 27
State: CO

Vax Date: 09/12/2021
Onset Date: 09/22/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data: None. ER would not do any testing.

Allergies: daily allergy pill for general allergies

Symptom List: Injection site swelling, Limb discomfort

Symptoms: 2nd vaccine on 9/12/2021. Started with painful red rash on chest 9/22/2021 at 3:30pm which spread to face. Symptoms temporarily relieved with Zyrtec for 4 hours. Rash continued to worsen to spread to under arm area. 9/23/2021 rash had spread to stomach, shoulders, and back. Presented to the ER with the symptoms. Was given steroids, and Benadryl via IV. 9/24/2021 woke up with swollen eyes, face, neck. Rash worsened on chest, shoulders, back, stomach, and legs. Total body swelling, shortness of breath, and muscle pains. Presented to the ER and received no care. Struggled to breath as I drove home to get a dose of Benadryl. Provided temporary relief. Symptoms still a problem as of 9/27/2021.

Other Meds: Daily Zyrtec and birth control

Current Illness: none

ID: 1737512
Sex: M
Age: 52
State: NJ

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

Allergies: Penicillin, erythromycin

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

Symptoms: Fever,chills,muscle aches and stiffness,dizziness over the course of 23 hours so far,also a little swelling of glands in neck,but effects waning.Took Tylenol to break fever about 8 hours in,only 500 mg because Tylenol upsets my stomach.Will return to work within 48 hrs of dose.

Other Meds: Citrulline, arginine

Current Illness: Seasonal allergies

ID: 1737513
Sex: F
Age: 72
State: VA

Vax Date: 07/19/2021
Onset Date: 08/02/2021
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: Eggs, pineapple, eggplant

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

Symptoms: Destruction of memory recall. Specifically, the following happened. In the summer of 2020, I received a stem cell injection. I had a wonderful, positive reaction. My memory recall prior to the injection had been poor, and I struggled to recall information that I knew was committed to memory. After the stem cell injection, all limitations to memory recall were gone, and I could recall all memories I had. No barriers. I was thrilled. But after receiving the second Moderna injection, that ability was wiped out. It is as if I never had the stem cell injection. Now I struggle to recall memories, as I did before the stem cell injection. The second Moderna injection has erased the benefit of the stem cell injection and injured my brain. I am devastated. And this cannot be reversed, as the FDA has halted stem cell injections in this country. I cannot get another one to undo the damage of the COVID vaccine.

Other Meds: Synthroid, ProAir, Lansaprosole, Bumetanide, Niacin

Current Illness: None

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am