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: 1741862
Sex: F
Age: 75
State:

Vax Date: 05/27/2021
Onset Date: 09/24/2021
Rec V Date: 09/28/2021
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: 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: 1741863
Sex: F
Age: 82
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
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:

Symptom List: Anxiety, Dyspnoea

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1741864
Sex: M
Age: 44
State: FL

Vax Date: 09/15/2021
Onset Date: 09/18/2021
Rec V Date: 09/28/2021
Hospital: Y

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

Lab Data: While hospitalized, numerous diagnostic tests were conducted to include CT scans, MRI's, echocardiogram as well as heart catheterization. The heart catheterization revealed no blockages in my heart. The echocardiogram revealed the wall thickness of my heart was slightly increased and the left ventricle was mildly dilated. All the diagnostic testing did not identify any plausible cause for the increase in my troponin levels. ***Doctor told me today (Sept 28, 2021) that what I experienced was probably caused by the COVID vaccine.***

Allergies: None

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

Symptoms: On September 18, I woke up at 7am and found my left arm was extremely cold (like ice cold), my left arm was numb, I realized I had been sweating while asleep and I felt "off" - the most strangest "off" feeling I've ever felt. I called 911 and at my request, I was transported to the emergency room. Initial blood work showed my troponin levels were 1.2. I was admitted and the following three blood tests showed my troponin levels as follows: 3.2 at 2pm on Sept. 18, 1.8 at 8pm on Sept. 18 and 1.0 at 2am on Sept. 19. I remained in the hospital until the afternoon of Sept. 20. Please see item 19 for additional information.

Other Meds: Ibuprofen

Current Illness: COVID infection diagnosed on 7/10/2021

ID: 1741865
Sex: F
Age: 32
State: TX

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data: Full inflammatory panel - results all normal except rheumatoid factor of 16. Referral to rheumatologist and neurologist for potential back/nerve issues.

Allergies: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Muscle stiffness in left arm (could not raise arm without support from right arm) within first 3 days after vaccination, moved to carpel tunnel type symptoms in both wrists and hand joints, shoulder stiffness in both shoulders, knee stiffness in both knees. Progressed for 1.5 weeks until symptoms subsided after 2 weeks.

Other Meds: Levothyroxine 112mcg

Current Illness: None

ID: 1741866
Sex: M
Age: 18
State: NE

Vax Date: 09/02/2021
Onset Date: 09/02/2021
Rec V Date: 09/28/2021
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 known.

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

Symptoms: On our drive home (less than 5 minutes after receiving vaccine), pt. began complaining about feeling sick. He leaned forward in the car and I asked him if he felt like he was going to vomit. (He said no.) Within a minute, he started to panic and said that he couldn't SEE anything. Within 10 seconds after that, he appeared to have a seizure (eyes looked funny and head started to spasm). He was unresponsive/lost consciousness for about 8-10 seconds and then seemed to be OK.

Other Meds: None.

Current Illness: None.

ID: 1741867
Sex: F
Age: 11
State: FL

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

Allergies: Unknown

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

Symptoms: Client 11 year of age receive vaccine recommended for age 12 years and above. Weighted 130 lbs., Monitored for 30 minutes, No signs symptoms of distress. Left from clinic with mother to home at 11:00am

Other Meds: Unknown

Current Illness: UnKnown

ID: 1741868
Sex: F
Age: 65
State: MA

Vax Date: 03/27/2021
Onset Date: 05/21/2021
Rec V Date: 09/28/2021
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: CAT scan and blood test - that was at a hospital (blood test) and CAT scan was at another hospital

Allergies: no

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Diagnosis - Ovarian Cancer - there were no screening test and very few symptoms. It was a CAT scan and a blood test and it was fairly obvious what it was from the CAT scan. Could see the tumors and there was blood chemical that was elevated. There was a lump in my abdomen before both vaccines and I hadn't done anything about it. I hadn't had it tested yet. I had surgery - at a hospital and chemo - the surgery was June 1st and I had chemo and I'm in the middle of those treatments. Chemo treatments will be six all together. ER - and then admitted: Complications after the surgery - had a fever the first time I was hospitalized and I had a desensitizing chemo - different reactions the first two chemo cycles.

Other Meds: Multivitamin

Current Illness: no

ID: 1741869
Sex: M
Age: 15
State: NC

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 09/28/2021
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, per pt. report

Symptom List: Pharyngeal swelling

Symptoms: Patient received a dose of our Moderna COVID-19 vaccine at the age of 15 years and zero months. The patients age was realized during the patients return to our clinic for his second dose. At such time, the guardians, clinics physician and Medical Director was informed. We then proceeded to call the CDC general questions about COVID-19 or the COVID-19 vaccine helpline at for further guidance. Additionally, reviewing of the literature had revealed that MOderna could be administered to n ages 11-17 as off label use. This was then supported by the guidance given by the CDC during our call. We inquired with the patient his tolerance of his first administration. Pateint reported no post vaccination side -effects and stated he "was fine".

Other Meds: None, per pt. report

Current Illness: None, per pt. report

ID: 1741870
Sex: F
Age: 58
State: PA

Vax Date: 02/25/2021
Onset Date: 07/18/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data: Skin biopsy 8/17/2021 : Negative for direct Immunoflorescence and Mild epidermal Spongiosis and mixed dermal inflammation

Allergies: Bee stings, Scallops and Calamari

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: I had my second Moderna Covid Immunization 2/25/2021. 4months later 7/18/2021 I developed a raised red rash on my right forearm. The rash in that area started to resolve when I noticed it spreading to both my lower legs. The rash was red, raised and very itchy. That area resolved then it started on my back and left flank area where the red rash turned to a bruise., while that area resolved, it spread to my upper arms and posterior neck. iI did not have a fever, I went to a dermatologist several times and my primary care MD, I had a skin biopsy. As of today, I continue to have this traveling red very itchy raised rash that turn into a bruise. I do not have a diagnosis. I believe it is a side effect of the Moderna Vaccine for COVID.

Other Meds: Mometasone Furoate Nasal spray Centrum Vitamin VitaminD 2,000 md

Current Illness:

ID: 1741871
Sex: M
Age: 38
State: VA

Vax Date: 09/13/2021
Onset Date: 09/25/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data: 9/28. Trop: - Chest xray Echocardiogram

Allergies: Opiates

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Chest pain and tightness starting 9/24. Exercised 9/25 could not catch breath and Sob. Went to Er on 9/28 with sob and elevated bp. 133/101. They said could not rule out paricarditis,

Other Meds:

Current Illness: None

ID: 1741872
Sex: M
Age: 61
State:

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

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

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1741873
Sex: M
Age: 60
State:

Vax Date: 04/29/2021
Onset Date: 09/25/2021
Rec V Date: 09/28/2021
Hospital: Y

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: 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:

Date Died: 09/27/2021

ID: 1741874
Sex: M
Age: 38
State: UT

Vax Date: 09/23/2021
Onset Date: 09/24/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data: Intervention given at local Hospital

Allergies: None

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

Symptoms: [Directed to enter VAERS report due to close proximity of vaccine administration] Member received first dose of Pfizer COVID-19 vaccine on 23 September 2021. On 24 September 2021, member complained to co-workers of abdominal pain with nausea/vomiting, treating symptomatically over the weekend. On 26 September 2021, member's co-worker contacted him and member was coherent and alert, On 27 September 2021, after member did not respond to co-workers' attempts to contact him, co-workers and first responders went to member's residence, where member was found somewhat disoriented. Member was subsequently transferred to local Hospital ED (arrived at approximately 09:15), where member was found to have confusion and hyperglycemia (GCS of 14 and blood sugar reading, measuring as 'high".). During treatment and monitoring process, member was found to have labored breathing (at approximately 11:00) and a CODE was called at 11:05. Member subsequently expired at 11:30.

Other Meds: Aspirin 81mg (delay release, 1 tab daily), Atorvastatin 80mg (1 tab daily), Cetirizine 10mg (1 tab daily), Flonase (2 sprays daily), Losartan 50mg (1 tab daily)

Current Illness: None

ID: 1741875
Sex: F
Age: 49
State: WA

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 09/28/2021
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: None

Allergies:

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

Symptoms: After 15 minutes of receiving injection, I had a panic attack. I felt as if I was going to pass out. So Informed the pharmacist she had me put my legs up, wasn?t helping. So i laid on the floor and put my legs on a chair. My body felt extremely hot, my husband said I lost coloring in my face. After about 30 minutes, I was able to get up and walk to my car with assistance. I had chills for 2 days. I am still having issues with anxiety attacks and consulted with my nurse practitioner. We are monitoring at home and if I feel I can?t manage, she will call in a prescription for me.

Other Meds:

Current Illness:

ID: 1741876
Sex: F
Age: 26
State: TX

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 09/28/2021
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: Patient seemed pale and diaphoretic.

Other Meds:

Current Illness:

ID: 1741877
Sex: F
Age: 88
State:

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

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

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1741878
Sex: F
Age: 36
State: MN

Vax Date: 01/27/2021
Onset Date: 09/19/2021
Rec V Date: 09/28/2021
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:

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

Symptoms: Breakthrough covid positive

Other Meds:

Current Illness:

ID: 1741879
Sex: F
Age: 58
State: MI

Vax Date: 05/18/2021
Onset Date: 08/21/2021
Rec V Date: 09/28/2021
Hospital: Y

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

Lab Data: SARS-CoV-2 (COVID-19) and Influenza AB Antigens, POC: SARS CoV 2 DETECTED (8/21/2021)

Allergies: Penicillins

Symptom List: Ear pain, Hypoaesthesia

Symptoms: 59-year-old female presented complaining of shortness of breath. Patient stated that she was recently in the hospital for urinary tract infection. She stated that the day prior to arrival she began having worsening shortness of breath and sputum production. She admitted to fever and chills. She normally wears 4 L nasal cannula at home and today was requiring 6LNC. Pt smokes 4 ppd and has not been wearing her oxygen per husband.

Other Meds: Acid reducer, albuterol, Lipitor, Symbicort, Sinemet, Flexeril, Cardizem, Tricor, Vistaril, Motrin, Isordil, Remeron, Ocuflox, Zofran, Protonix, Lyrica, propranolol, Seroquel, Requip, Zoloft, Carafate, Spiriva, Desyrel, Ambien

Current Illness:

ID: 1741880
Sex: F
Age: 28
State: NY

Vax Date: 09/20/2021
Onset Date: 09/21/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Headaches, missed period, fatigue

Other Meds: Citalopram

Current Illness: None

ID: 1741881
Sex: M
Age: 68
State:

Vax Date: 09/25/2021
Onset Date: 09/26/2021
Rec V Date: 09/28/2021
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: patient complained of back pain unlike he's ever had before. Started about 30 hours after he got the flu shot. He had the typically sore arm for a day which went away, then he started having the back pain

Other Meds:

Current Illness:

ID: 1741882
Sex: M
Age: 11
State: AZ

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 09/28/2021
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: blood pressure blood sugar- 85

Allergies:

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

Symptoms: after administering a flu shot to the patient he passed out for about 30 seconds then he woke up. His face was paled and he felt dizzy. The ambulance was called and they arrived within 7 minutes or less. They took the patient's vitals, blood pressure and blood sugars. His blood sugar was at 85. They monitored the patient for about 15 minutes and spoke with the patient's mom. they took the patient out of the immunization room and had him walk outside to walk around and get some fresh air. They were then going to release patient to his mom.

Other Meds:

Current Illness:

ID: 1741883
Sex: F
Age: 40
State: AK

Vax Date: 09/22/2021
Onset Date: 09/23/2021
Rec V Date: 09/28/2021
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: PENICILLIAN AND AMOXICILLIAN AND GLUTEN

Symptom List: Unevaluable event

Symptoms: ANXIETY, RAPID HEART RATE, MUSCLE TENDERNESS, JOINT TENDERNESS IN SAME ARM AS VACCINE, HEADACHE

Other Meds: VITAMINS C, D, B COMPLEX AND MAGNESIUM

Current Illness: CELIAC DISEASE

ID: 1741884
Sex: M
Age: 75
State: CA

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

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

Lab Data: none

Allergies: combigan

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

Symptoms: Patient was accidentally given a Pfizer COVID booster after initial Moderna COVID vaccinations

Other Meds: simvastatin, vitamin c, multivitamins, magnesium sulfate, latanoprost, lisinopril-hctz, glucosamine-chondroitin, systane balance

Current Illness: none

ID: 1741885
Sex: F
Age: 53
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1741886
Sex: F
Age: 33
State: NJ

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

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

Lab Data:

Allergies: FLORIDE

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient said she had rapid heart beats, pain near heart, fever, excessive swatting, dehydration, stomach ache for two days after taking the vaccine

Other Meds: MONE

Current Illness: NA

ID: 1741887
Sex: F
Age: 62
State: MI

Vax Date: 02/06/2021
Onset Date: 02/24/2021
Rec V Date: 09/28/2021
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: Ekg, echocardiogram, MRI, neurological exam

Allergies: Iodine

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

Symptoms: muscle weakness, shakiness, some tingling occasional heart racing Hospital stay February 28-March 2 for heart tests- found no heart issue. Saw neurologist on May 13th, no findings other than vaccine reaction. Symptoms worsened after second dose.

Other Meds: Daily vitamin

Current Illness: none

ID: 1741888
Sex: F
Age: 69
State: NY

Vax Date: 04/08/2021
Onset Date: 06/25/2021
Rec V Date: 09/28/2021
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: Positive for carcinoma y biopsy 7/27/21

Allergies: None

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: About 3 months after shot, I developed warts from lichen sclerosis that became a squamous cell carcinoma. I had a Condition for 10 hrs, never had a wart, but after the vaccine this occurred. I just had surgery to removed the carcinoma.

Other Meds: Valsartan..320 mg; Amlodopine ..10mg; Sertraline?100 mgr; Latanoprost .005%; Atorvastatin 10 mg; Clobetesol cream - when needed...lichen-sclerosis; Vitamins Daily; 1 celebrate multi vitamin; 3 citracal tablets; Vitamin D3 - 4000 IU (1); Ir

Current Illness: Osteoporosis; HBP; Glaucoma; Overweight

ID: 1741889
Sex: M
Age: 69
State:

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

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

Date Died: 09/26/2021

ID: 1741890
Sex: M
Age: 66
State: IL

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 09/28/2021
Hospital: Y

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

Lab Data: Unknown

Allergies:

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

Symptoms: Ill since June when he received COVID-19 vaccination and developed peeling rash with blisters of the face, arms and body. Tested positive for Covid on 9/24/2021 as part of a pre-operative work-up Expired 9/26/2021

Other Meds:

Current Illness:

ID: 1741891
Sex: F
Age: 43
State: WA

Vax Date: 09/15/2021
Onset Date: 09/15/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data: na

Allergies: None reported

Symptom List: Nausea

Symptoms: Pt reports to have received pfizer previouly. Pt reports persistent diffuse right arm pain following injection, from right clavicle to elbow. Resolves with nsaid then pain returns. Denies any pain currently. No tenderness on palpation. Full range of motion and use of arm. Denies any numbness or loss of sensation. Denies any signs or symptoms of anaphylaxis or allergic reaction following last dose. Pt did not seek medical care for arm as it has not been bothersome enough. This RN consulted with colleague, RN, we agreed pt is safe to receive second dose and to follow up with medical provider if arm discomfort does not resolve. Pt agreed. This rn strongly advised pt receive this shot in alternate, left arm, pt refused and adamantly selected right arm despite this rn?s education around reactogenicity. This rn educated pt on low threshold to seek medical care for any urgent/emergent s/s. Pt verbalized understanding. Pt had immediate localized reaction with marked swelling. Pt quickly Left and declined observation -Pt left against medical advice. Asa rn

Other Meds: Unknown

Current Illness: None reported

ID: 1741892
Sex: F
Age: 12
State: GA

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 09/28/2021
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: Injection site pain

Symptoms: At 12:26 PM, the patient's parent alerted the nurses station that the patient was "not feeling well," and complaining of nausea. Initial blood pressure at 12:26 PM was 85/50, pulse 81. Patient alert, oriented, and responsive. Patient was immediately positioned supine on the exam table and patient's feet were elevated. Patient was given a granola bar and a cup of water. At 12:28 PM, blood pressure was 85/59, patient complained of nausea. At 12:30 PM, blood pressure was 104/70, pulse 79. At 12:32 patient's blood pressure was 100/63. Patient was monitored for several minutes. Patient stated she "felt better." At 12:40 blood pressure was 93/63. At 12:56, blood pressure was 97/62. Patient denied complaints of nausea, dizziness, numbness, shortness of breath. Patient discharged. Follow up call placed at 6:00PM, no answer.

Other Meds:

Current Illness:

ID: 1741893
Sex: M
Age: 48
State: HI

Vax Date: 01/11/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
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: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: fully vaccinated and tested positive for covid 19 on 9/27/21

Other Meds:

Current Illness:

ID: 1741894
Sex: M
Age: 67
State: WV

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data: none

Allergies: none

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

Symptoms: have ramsey hunt sydrome since 2015 and have taken two shingle shots in 2016. Have not had any syptoms of shingles or sydrome since. Received covid-19 booster shot at 11:00 am and at 10:00 pm same evening starting having symptoms of sydrome. Have had symptoms every day beginning around 6:00pm and continuing as of today(9/27/21) ---Pain on left check, drawn muscles, sharp pain in left ear, dizziness, unstable balance, nausea, high fever.

Other Meds: none

Current Illness: none

ID: 1741895
Sex: M
Age: 35
State: MN

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

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

Lab Data: none

Allergies: KNDA

Symptom List: Tremor

Symptoms: light headed and dizzy. Prolonged lasted <30 minutes so called EMS. EMS looked over patient and was okay and released pt and did not take with. Followed up with patient next day and fine no other adverse effects. Vasovagal event. Patient had not eaten before vaccine and was very nervous.

Other Meds: unknown

Current Illness: none

ID: 1741896
Sex: F
Age: 43
State: PA

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
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: Pt stated allergy to all antibiotics, but said that her reaction was stomach upset...pt said allergy to vanilla and beef, but said that her reactions to these were that they made her feel funny...When I told her that the reactions were more side effects and not allergies, she stated that she sometimes gets a rash when she takes these...Pt said severe reaction to immunoglobulin

Symptom List: Erythema, Pruritus

Symptoms: 1020a - Pt initially felt faint - we gave her water and ice packs for her wrists and neck...1030a - Pt looked white and chest was blotchy/lips looked white and a little swollen...Gave the pt 10 ml (25 mg) diphenhydramine liquid x 1 dose...Pt also took Apap 500 mg x 2...We had the pt remove her mask inside the booth so she could breath better...She also said that wearing a mask gives her anxiety...1040 a - she still looked a little red...1050a - Looked a lot better - color back in her face and lips not swollen and rash on chest better and she said she felt less dizzy...1110 a - went to bathroom and returned and feeling better...1120 am - pt felt she was ok to leave...No worsening of reactions.

Other Meds: None according to patient

Current Illness: None - pt said she had a cut on her ankle in July 2021 where she needed a tetanus shot and had no issues with the tetanus shot.

ID: 1741897
Sex: F
Age: 12
State: OH

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
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: None

Allergies: NA

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

Symptoms: No adverse reaction was reported after 15 min monitoring. Pt was not within the age range for JnJ vaccine.

Other Meds: NA

Current Illness: NA

ID: 1741898
Sex: F
Age: 77
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1741899
Sex: F
Age: 65
State:

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data:

Allergies: none reported

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: During 15 minute observation after administration of vaccine, patient complained of lightheadedness, dizziness and throat tightness. Patient states that she is a diabetic and has not eaten all day. Rapid response was called and notified. Rapid response nurse check vital: BP : 121/67, HR:70, Resp: 20, O2 sats 98% on RA. Unable to check blood sugar due to the fact she is not inpatient and declines to go to the ER for blood draw. Family medicine aware and notified by rapid response nurse. Family medicine advised patient to go to ER for immediate care. Patient states she feels better after staying in clinic for ~75 minutes and declines need for emergency room visit. Patient was educated on signs and symptoms to monitor in case of an emergency and to call 911 and/or go to the ER if needed

Other Meds: N/A

Current Illness: none reported

ID: 1741900
Sex: M
Age: 29
State: OR

Vax Date: 06/07/2021
Onset Date: 09/13/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data: Resident Specialty: Student Progress Notes Signed Encounter Date: 9/16/2021 Signed Hide copied text Hover for details NURSING BP CHECK PARAMETERS This patient is scheduled for a nursing/pharmacy blood pressure check for elevated blood pressure and to confirm accuracy of home BP cuff. Pt does not have labs to be performed on the day of the blood pressure check. If BP (<140 SBP AND <90 DBP): >No changes to home meds. >Patient may follow up as previously scheduled or 3-4 months. If BP (SBP =>140 OR =>90 DBP): Review adherence with home meds. >If adherent, Schedule follow up. >If non-adherent, review prescribed meds with patient and schedule follow up. Follow up time frame by blood pressures. Use closest follow up. BP Measures Time Frame With Who =>180 SBP or =>110 DBP or symptoms of high BP Discuss with provider Provider, possibly ED 160-179 SBP or 100-109 DBP 1-2 weeks Provider 140-159 BP or 90-99 DBP 2-4 weeks Provider or Nursing For patients that are scheduled for BP visit, please advise them to 1)Take their medication as usual on the day of the appointment. 2)Bring their medication bottles 3)If the patient checks their blood pressure at home then advise them to? a)bring their blood pressure machine to confirm its measurements b)a log of their most recent blood pressures measures 4)Call for new or worsening symptoms of high or low blood pressure. NURSING BP CHECK PARAMETERS

Allergies: NKA

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

Symptoms: Patient had previously received the Pfizer vaccine on 6/7/2021. This violates the EUA for both vaccine parameters.

Other Meds: Effexor 150 mg q am Zofran 4 mg disintegrating tablet q8h as needed Cozaar 100 mg qd

Current Illness: #HTN Now on 50 mg losartan daily. Checks his BP at home. systolics 146-170. Diastolic around 100. Denies EtOH, other drug use. #Knee pain Started 3 days ago. Bilateral Dislocated right patella laterally in 2009 while walking. No precipitating event. Since then it periodically partially shifts laterally. Painful when it displaces. He had xrays in 2009 without fracture. He's had similar symptoms in the left patella for 2-3 years but never dislocated it. Lateral displacement 5-6 times just in the past few months. He get's right knee pain walking up stairs. Left knee pain if he twists his knee. Pain resolves within 10-15 minutes of activity. Hasn't tried NSAIDS.

ID: 1741901
Sex: M
Age: 50
State: AZ

Vax Date: 09/17/2021
Onset Date: 09/24/2021
Rec V Date: 09/28/2021
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: EKG test

Allergies: None

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

Symptoms: I had my annual work physical and failed my EKG test. I have been getting the same physical for work for 27 years and have never failed my EKG test.

Other Meds: Allegra

Current Illness: None

ID: 1741902
Sex: F
Age: 55
State: FL

Vax Date: 09/13/2021
Onset Date: 09/13/2021
Rec V Date: 09/28/2021
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: estrogen and coreg

Symptom List: Pain in extremity

Symptoms: Got vaccine in R arm. Within the hour had tremor/shaking of R arm for several minutes. Within one day had swelling and pain in supraclavicular lymph node . Couldn't move arm /shoulder due to exquisite pain. No rash or fever. Still with pain palpable swelling, tenderness, warmth and pain with ROM of neck.

Other Meds: protonix, benzapril, amlodipine, montelukast

Current Illness: hidradenitis; severe; on several antibiotics

ID: 1741903
Sex: M
Age: 61
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1741904
Sex: M
Age: 42
State: MN

Vax Date: 09/14/2021
Onset Date: 09/17/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data: 9/20/21 in ER: SARS-COV-2, INFLUENZA A+B, AND/OR RSV NUCLEIC ACID TESTING PANEL Negative for all. 9/20/21 Portable chest x ray done in ER Procedure: XRAY CHEST PORTABLE Date/Time of Service: 09/20/2021 14:43 INDICATION: shortness of breath TECHNIQUE: Chest 1 view. COMPARISON: None. FINDINGS: Cardiovascular and mediastinum: Heart size and vasculature are normal in caliber and appearance. Mediastinum is within normal limits. Lungs and pleural space: Lungs are clear. No sign of infiltrate or mass. No sign of pleural effusion. No pneumothorax. Bones and soft tissues: No significant findings. IMPRESSION: Unremarkable chest. 9/28/21 XRAY CHEST PA AND LATERAL Collected: 09/28/21 1126 Order Status: Completed Updated: 09/28/21 1201 Narrative: Procedure: XRAY CHEST PA AND LATERAL Date/Time of Service: 09/28/2021 11:26 Indication: Cough and fever Comparison: Single view chest September 20, 2021 Technique: PA and Lateral views chest Findings: There is hyperinflation and chronic interstitial change without evidence of dense consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is within normal limits. The bony thorax is grossly intact. Impression: Hyperinflation and chronic interstitial changes without definite acute cardiopulmonary abnormality. Dictated @ 9/28/2021 11:59:46 AM EKG results from 9/28/21: EKG WAVEFORM Sinus tachycardia ST elev, probable normal early repol pattern No previous tracing available Ventricular Rate: 104 BPM Atrial Rate: 103 BPM P-R Interval: 136 ms QRS Duration: 98 ms Q-T Interval: 321 ms QTc Calculation(Bazett): 423 ms Calculated P Axis: 73 degrees Calculated R Axis: 105 degrees Calculated T Axis: 56 degrees

Allergies: Codeine

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

Symptoms: This is from the ER on 9/20/2021: This is a new problem. The current episode started more than 2 days ago. The problem occurs daily. The problem has been gradually worsening. Associated symptoms include shortness of breath. Pertinent negatives include no abdominal pain. Associated symptoms comments: Generalized body aches , Chest congestion , cough after a recent second Covid shot a week ago . . The symptoms are aggravated by walking and exertion. Nothing relieves the symptoms. He has tried rest for the symptoms. The treatment provided no relief He was treated with: ZPak, Medro Dose Pack, Albuterol HFA Chest x ray done, along with negative Covid swab 9/23/2021 Patient was seen in clinic for no change in symptoms, he was treated with Zithromax 500 mg and put on Symbicort inhaler. 9/28/21 patient was again seen in clinic, symptoms slowly improving. chest x-ray redone along with EKG. no medication changes at that time, he was kept off of work for 2 more weeks

Other Meds: buPROPion (WELLBUTRIN XL) 300, One tab daily, Tylenol Ibuprofen

Current Illness: No illnesses prior

ID: 1741905
Sex: F
Age: 73
State: CT

Vax Date: 03/12/2021
Onset Date: 03/20/2021
Rec V Date: 09/28/2021
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: Ultrasound-Lower GI Blood Work

Allergies: Multiple Medications Food, Gluten Dairy, Oats Barley Lotions, toothpaste, Shampoo Seasonal Allergies

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

Symptoms: Within ten days of getting the second dose of the vaccine in March I had problems with extreme stomach acid. I was having a lot of intestinal gas and pain below my ribs. I was given a prescription for Extra Strength Pepcid which helped the problem but when I stopped taking it for two weeks the gas returned. I had a reaction to the Pepcid after getting back on it a few times. The fourth time I took it and I woke up in the morning feeling disoriented. Three days later I was also getting chills so I stopped taking. I am no longer able to take the Pepcid . After that I started to have problems with diarrhea which ended up causing me to be hospitalized on 08/20/2021. I had been called by my doctor because my Sodium levels were dangerously low. I have never had any intestinal problems before. My sodium levels are better now after five months. I still have some gas problems and pain below my ribs. I am careful about my diet and that seems to help.

Other Meds: Norvasc Vitamins

Current Illness: N/A

ID: 1741906
Sex: M
Age: 61
State:

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

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

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1741907
Sex: M
Age: 86
State:

Vax Date: 02/25/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: 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: 1741908
Sex: F
Age: 22
State: MN

Vax Date: 02/04/2021
Onset Date: 09/19/2021
Rec V Date: 09/28/2021
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: Covid-19 Test

Allergies:

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

Symptoms: Employee tested positive for Covid-19 after being fully vaccinated

Other Meds:

Current Illness:

ID: 1741909
Sex: M
Age: 53
State: NY

Vax Date: 08/07/2021
Onset Date: 08/20/2021
Rec V Date: 09/28/2021
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: Went to Emergency room. Ultrasound confirmed blood clots.

Allergies: N/A

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Blood Clots in my left leg. I?m taking blood thinners. Eliquis 5mg. Still healing.

Other Meds: Rosuvastatin 5mg Losartan/Hctz 100/25

Current Illness: N/A

ID: 1741910
Sex: M
Age: 31
State: DE

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data: BP, pulse, oxygen saturation remained stable. Patient recovered and approximately one hour.

Allergies:

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

Symptoms: Dizziness, almost fell out of the chair, had to be laid down on the ground. Known history of anxiety with needles.

Other Meds:

Current Illness:

ID: 1741911
Sex: F
Age: 58
State: TX

Vax Date: 08/24/2021
Onset Date: 08/27/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data: Some labs taken following week.

Allergies: keflex, penicillin, quinolones, sulfa, gpl-1, ace inhibitors, iodine contrast

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

Symptoms: Weakness, tiredness and shortness of breath on day 2 and 3 after vaccine. Extreme amount of Swelling in both legs on day 4 of vaccine. . (thighs, calves and ankles) Swelling lasted 5 days. Very uncomfortable.

Other Meds: n/a

Current Illness: lupus, hbp, type 2 diabetes, cholesterol, g6pdd, arthritis

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am