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: 1749597
Sex: M
Age: 29
State: NY

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 09/30/2021
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: Patient was not on scheduled list today. Approached this writer and staff asking for his second vaccine. He stated he received his first dose of Pfizer in July at Pharmacy. Staff screened patient, and asked him again if he received a first dose of Pfizer. Patient stated he had received Pfizer. Second dose was given. After returning to office and entering dose in system it was discovered patient had actually received Moderna vaccine in July. Staff of jail advised.

Other Meds:

Current Illness:

ID: 1749598
Sex: M
Age: 83
State:

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 09/30/2021
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: 1749599
Sex: F
Age: 24
State: WI

Vax Date: 09/15/2021
Onset Date: 09/15/2021
Rec V Date: 09/30/2021
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: Pharmacy sent the vial to Moderna lab to test for efficacy, and it maintained it's activity aganist Covid-19. Based on that, Pharmacy does not recommend a repeat dose to "replace" the 2nd dose received on 09.15.2021. Pharmacy is filling out a report. If more information is needed please reach out to the Pharmacy director.

Allergies: N/A

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

Symptoms: No adverse event, but per page 6 of Moderna EUA Providers Fact Sheet there is a need to report when "vaccine administration errors whether of not associated with an adverse event". Pharmacy gave Employee Health a vial of Moderna to administer vaccines with a manufacturer's expiration date of 09.25.2021. The second covid vaccination was administered to patient in her left deltoid at 10:25am on 09.15.2021. After the vaccination was administered Pharmacy informed Employee Health that the 30 day expiration date was 09.03.2021, which Employee Health had no knowledge of prior to vaccination. No more doses were administered from this vial, it was returned to pharmacy. Writer informed patient of this information, and she had no adverse reactions.

Other Meds: N/A

Current Illness: N/A

ID: 1749600
Sex: F
Age: 38
State: NY

Vax Date: 09/29/2021
Onset Date: 09/30/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data:

Allergies: Oranges; none others known

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: 9/29/2021 10:23pm shot done 10:33pm pain right side of chest Tongue numb. 10:43pm arm pain and numbness 11:00pm blurred vision 11:26pm chills 9/30 8:30am woke up. Arm numb. Can?t lift to chest 10:20am entire body tingling Face numb

Other Meds: Dovato

Current Illness:

ID: 1749601
Sex: F
Age: 86
State: WV

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

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

Lab Data: na

Allergies: no

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

Symptoms: pt given 3rd dose Pfizer after having a primary series of Moderna. No issues post vaccination

Other Meds: na

Current Illness: no

ID: 1749602
Sex: M
Age: 31
State: RI

Vax Date: 03/10/2021
Onset Date: 03/21/2021
Rec V Date: 09/30/2021
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: On April 7 2021 patient had normal Anticardiolipin IgG and IgGM levels, normal Beta 2 Glycoprotein 1 IgG/IgM levels, normal Anti-Thrombombin III Functional levels, normal Lupus Anticoagulant Ratio, normal Protein C levels, and normal Protein S Free Level.

Allergies: None

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

Symptoms: Patient presented to clinic on 24 March 2021 with 4 days of leg pain and swelling. He had no injury or recent travel. An ultrasound was performed that day and patient was placed on a course of Eliquis for three months. Patient then had a second, unprovoked clot while off of Eliquis in August 2021. In April 2021 patient had a normal lab work up for predisposition to clotting. This has prompted his hematologist to place him on anticoagulation therapy indefinitely moving forward. Patient essentially has developed a predisposition to clotting approximately 10 days after his second dose of the Moderna Vaccine. He will remain under the care of hematology.

Other Meds: None

Current Illness: None

ID: 1749603
Sex: M
Age: 15
State: TX

Vax Date: 09/29/2021
Onset Date: 09/30/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: N/A

Allergies: NKDA NKFA

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Swollen injection site-9/30 Painful injection site-9/30 nausea-9/30 dizzy-9/30

Other Meds: N/A

Current Illness: None

ID: 1749604
Sex: F
Age: 44
State: PR

Vax Date: 09/02/2021
Onset Date: 09/02/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: Patient saw her Rheumatologist who recommended second dose

Allergies: SEAFOOD, PENICILLIN, ASPIRIN

Symptom List: Pharyngeal swelling

Symptoms: 44 year old patient had a lot of vaginal bleeding, red, bright color for approximately 3-5 minutes after getting the vaccine. Patient reports bleeding for 2 days and went away. Patient refers not having pain or visiting her doctor. Patient refers visiting her Rheumatologist who recommended second dose.

Other Meds: XARELTO 10MG, PLAQUENIL 200MG, NEURONTIN 800MG, KLONOPIN 1MG-2MG, WELLBUTRIN 150MG, RESTORIL 30MG, TRAZODONE 50MG, PREDNISONE 25MG, CHROPAXINE 50MG

Current Illness: ASTHMA, LUPUS, PROBLEMS WITH COAGULATION

ID: 1749605
Sex: M
Age: 23
State: FL

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: Normal CBC. Nasal exam with area of bleeding in anterior nasal cavity.

Allergies: None

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient reports left sided nose bleeds starting the day of vaccine that lasted for week. Intermittent nose bleeding lasting for a few minutes.

Other Meds: None

Current Illness: None

ID: 1749606
Sex: M
Age: 52
State:

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1749607
Sex: F
Age: 46
State: MI

Vax Date: 08/13/2021
Onset Date: 08/13/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: none

Allergies: Sulfa, Strawberries

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

Symptoms: The first shot I immediately received tingling in my hands then within an hour the left side of my lips, tongue and throat became numb, and felt swollen as if I had lidocaine injection at the dentist. But only the left side. The numbness lasted about 36 hours with the first injection. It did not however effect my ability to swallow. With the second shot, my hands did not tingle but within 30m the left side of my lips, throat and tongue went numb and felt swollen as before but this time it also included my left cheek, my left nostril, a small portion of my left lower jaw, all the way over to my left ear, and my left ear. There was a spot on my cheek closest to my nose that went completely dead to the touch. Had a different, more intense numb feeling. The reaction lasted about 6 hours this time. It never effected my ability to swallow.

Other Meds: Vit C, Vit D, Women's Multi Vitamin

Current Illness: none

ID: 1749608
Sex: M
Age: 63
State: MA

Vax Date: 03/01/2021
Onset Date: 03/02/2021
Rec V Date: 09/30/2021
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

Allergies: enviromental allergies .... grass , trees, mold, mildew , fur , feathers etc....

Symptom List: Rash, Urticaria

Symptoms: My left Lymph node under arm was very swollen . Lymph node took a week for the swelling to start to fade. The second effect was the left side of my face felt like the after effects of large amount of novacaine wearing off. left side of my face felt numb and a bit stiff . it made me think off bells palsy but my eye lid was not droopy. It took a few days for the feeling in my left side of my face to return to normal this happened on the first injection . a few weeks later the second injection I was just tired for a few hours later in the day but did not have the same side effect

Other Meds: atorvastatin , hydroclorthiazide, lorsarton, carvedilol, monlukast, advair, loratdine .... vitamin D , multi vitamin

Current Illness: asthama

ID: 1749609
Sex: M
Age: 55
State: IN

Vax Date: 03/23/2021
Onset Date: 09/26/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: Sofia Antigen COVID-19 test with a positive result.

Allergies:

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

Symptoms: Patient was vaccinated on 3/2/21 and 3/23/21, so was fully vaccinated when testing positive for COVID-19 on 9/26/21.

Other Meds:

Current Illness:

ID: 1749610
Sex: M
Age: 13
State: IN

Vax Date: 08/27/2021
Onset Date: 08/28/2021
Rec V Date: 09/30/2021
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: Abdominal ultrasound, Blood work, upper GI

Allergies: PCN

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

Symptoms: Abdominal Pain, Nausea still occuring Swollen Lymph node under left arm- 7 days High fever for 48 hrs low grade fever on and off since vaccine

Other Meds: None

Current Illness: None

ID: 1749611
Sex: F
Age: 24
State: WI

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 09/30/2021
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: Dizziness, lightheadedness within 6 hours after 2nd vaccine. Later developed fever, chills, myalgia, weakness, and tachycardia.

Other Meds:

Current Illness:

ID: 1749612
Sex: M
Age: 58
State:

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 09/30/2021
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: 1749613
Sex: F
Age: 74
State: AL

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

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

Lab Data: unknown

Allergies: NKDA

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

Symptoms: PATIENT CAME IN MORNING OF 9/30/2021 TO REPORT ADVESE EVENT FROM PFIZER VACCINE. SHE REPORTS THAT SHE IS HAVING PAIN UP AND DOWN HER ARM. SHE IS CONCERNED ABOUT THE BRUISE ON HER ARM. SHE IS ALSO CONCERNED THAT THE SHOT WAS GIVEN TO LOW. SHE WAS ADVISED TO GO THE URGENT CARE NEXT DOOR AND HAVE THEM CHECK HER OUT. SHE DID GO TO THE URGENT CARE NEXT DOOR.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1749614
Sex: F
Age: 31
State: IN

Vax Date: 09/28/2021
Onset Date: 09/30/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: N/A

Allergies: Penicillin

Symptom List: Ear pain, Hypoaesthesia

Symptoms: My left armpit is very tender and sore to touch. Right arm unremarkable.

Other Meds: N/A

Current Illness: N/A

ID: 1749615
Sex: F
Age: 39
State: CA

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/30/2021
Hospital:

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: Pt called hospital call center to report SEs. alert and oriented x4, NKA, calm/pleasant. Pt states received 2nd dose Pfizer vaccine 9/23/21, and since then, a rash developed on Rt side abdomen, warm to touch, pt thinks, "it looks like hives." Pt states she has "never had a rash like this before." T 98.4 per pt at the time of this ph call. Pt reports minor IM site soreness but is still able to perform daily activities, and some throat dryness but possibly from minor dehydration. Pt also reports headache today, pain rating 4.5/10 and took one dose Tylenol at around 1710PM, with some relief, pain rating 2/10 at 1751PM. Pt advised to got to urgentcare/ED

Other Meds:

Current Illness:

ID: 1749616
Sex: M
Age: 22
State: FL

Vax Date: 09/17/2021
Onset Date: 09/19/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: Clinic visit on 30 September with diagnosis of tension type headaches and prescribed Naproxen.

Allergies: None

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

Symptoms: Patient reports intermittent headaches starting 2 days after vaccine and have been every day for a few hours at a time. No neurologic symptoms. No medications.

Other Meds: None

Current Illness: None

ID: 1749617
Sex: M
Age: 44
State: IN

Vax Date: 04/12/2021
Onset Date: 04/13/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data:

Allergies: NKDA

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

Symptoms: shot given 4-12-21 and next day 4-13-21 had nausea and sweats the next shot given 5-6-21 and then the Muscle pain, bruise at site also neck pain and body aches and nausea still has to this day 9-28-21 when came to see us. I filled out paper and faxed on top of form but did not go through.

Other Meds: Sildenefil 50mg PRN & Imiquimod 5% Topical cream

Current Illness: none

ID: 1749618
Sex: M
Age: 67
State:

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 09/30/2021
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: Unevaluable event

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1749619
Sex: F
Age: 49
State: WI

Vax Date: 03/27/2021
Onset Date: 09/06/2021
Rec V Date: 09/30/2021
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: Chest X-rays, EKG, blood work

Allergies: Erythromycin; amoxicillin; penicillin; cats; dogs; trees

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

Symptoms: I was exposed by two unvaccinated adults who live in my house. I woke up felt like I had a sinus infection, massive headache pressure and congested. It was ragweed season so just thinking Sinus infection. I started feeling worse took a rapid test and went to ER got a PCR test. I started having fever and chills. I had rattily feeling in my chest. I stomachache and diarrhea and sore throat at times. I was supposed to be out of isolation but the health department recommended I stay home until I feel better. I have been to Urgent care twice, I have been taking Mucinex DM, Tessalon pearls cough suppressant pill. My lungs showed I had pneumonia in my left lung and bronchitis, The first chest x-ray showed I had ground glass opacity in my lungs. The Dr. prescribed antibiotics and prednisone. My oxygen dipped into 80s so I went to ER they checked for blood clot, EKG, XRAYS. and other test sent me home my oxygen went up to 93. I'm still sick with fevers and in isolation.

Other Meds: Pro air inhaler; Symbicort; hydrochlorizide; gabapentin; tizanidine; generic Celebrex; fortify pro and prebiotic; vitamin D3; one a day multivitamin; omega 367 gummy; vitamin C; hair and skin gummy with biotin; magnesium plus calcium and tu

Current Illness:

ID: 1749620
Sex: F
Age: 53
State: NY

Vax Date: 04/10/2021
Onset Date: 08/10/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: August: high+ANA (not new) Anti-Jo-1 antibody (new and positive) Complement 3 deficiency (new)

Allergies: Sensitivity to a dye in some medicines and food

Symptom List: Injection site pain, Pain

Symptoms: After vaccination, a recent blood test revealed the presence of anti JO-1 antibodies. I do not have a baseline by which to compare this finding. I have always had a high positive ANA but learned of the anti-Jo-1 antibody only after vaccination. This is the first specific antibody to be found in bloodwork, and I've had dozens of tests throughout the years to track the meaning of the high ANA (so SSA, SSB, Scl, etc. all negative). I did have a vaccine reaction at age 23 to a tetanus booster, so I have avoided vaccines. The risk/benefit profile of the COVID-19 vaccination caused me to opt-in on this one, after consulting with a rheumatologist. The Janssen COVID-19 vaccine is the first vaccine I've received since having the positive ANA and other health issues around the time of the tetanus vaccination. I am definitely concerned about the potential decision for additional doses or boosters.

Other Meds: HRT

Current Illness: None

ID: 1749621
Sex: F
Age: 55
State: NJ

Vax Date: 09/27/2021
Onset Date: 09/28/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data:

Allergies: Clidomyacin, aspirin

Symptom List: Injection site pain, Menorrhagia

Symptoms: Covid arm 24 hours after vaccine. Still have it 3 days later Fatigue 24 hours after vaccine. Still have it 3 days later. Muscle aches 24 hours after vaccine. Still have it 3 days later

Other Meds: Levothyroxine, vyvanse, vitamin d

Current Illness: Fibromyalgia, hashimotos

ID: 1749622
Sex: F
Age: 76
State: TX

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient received Pfizer vaccine after previously receiving J&J vaccine. No adverse events to report.

Other Meds:

Current Illness:

ID: 1749623
Sex: F
Age: 82
State: MI

Vax Date: 03/18/2021
Onset Date: 08/24/2021
Rec V Date: 09/30/2021
Hospital: Y

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

Lab Data: NA

Allergies: Hydrocodone-acetaminophenDiarrhea, Nausea and Vomiting, Swelling Imdur [Isosorbide]Headache Nabumetone Oxaprozin RamiprilCough Spironolactone Tramadol Triamterene Zyrtec [Cetirizine]

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient found to be COVID-19 positive on 8.24.21 - went to ED (not admitted); fully vaccinated Later hospitalized (9.21.21); found to be COVID-19 positive at DC (9.26.21); Fully vaccinated Admission Date: 9/21/2021 Discharge Date: 09/26/2021 Presenting Problem: Unstable angina (HCC) DETAILS OF HOSPITAL STAY: HOSPITAL COURSE: PT is a 82 y.o. female with history of hypertension, dyslipidemia, obstructive sleep apnea, obesity, chronic kidney disease stage 3 and coronary artery disease with previous PCI to her circumflex x2 in 2006 and her LAD in 2010. She presented 9/21 with complaints of posterior left shoulder pain which was reminiscent of prior angina. She ruled out for ACS. She was risk stratified with Lexiscan nuclear stress test that was abnormal with peri-infarct ischemia along with distal inferior lateral wall. LV EF calculated at 52%. Coronary angiography revealed stable CAD, no angiographic culprit to account for presentation symptoms. She was started on amlodipine for additional antianginal therapy. PT/OT evaluated and recommended SAR for ongoing care. Of note she was incidentally COVID-19 + on day of discharge but was not symptomatic.

Other Meds: acetaminophen (TYLENOL) 500 MG tablet amlodipine (NORVASC) 2.5 MG tablet amoxicillin (AMOXIL) 500 MG capsule aspirin 81 MG tablet atorvastatin (LIPITOR) 40 MG tablet Cholecalciferol (EQL VITAMIN D3) 1000 UNITS TABS clopidogrel (PLAVIX) 75 M

Current Illness: COVID positive 8..24.21; COVID positive 9.26.21

ID: 1749625
Sex: F
Age: 46
State: CO

Vax Date: 09/21/2021
Onset Date: 09/23/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: Eye exam and cornea dye test

Allergies: none

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: About 12 hours after shot experienced fever and chills, that subsided after 24 hours after the shot, about 40 hours after the shot had sudden onset of blurred vision in right eye. Received shot on 09/21/2021 at 4:30 pm, blurred vison started on 09/23/2021. Went to eye doctor on 09/27/2021 at 10:00am, Did eye exam and tests and showed atypical spots on the cornea of right eye. Started lubercated eye drops and Doctor sent pics of cornea to a cornea specialist. Had follow up appointment on 09/29/2021, Shows some slight change. Cornea specialist said that it looked like cells in cornea had burst. No change in blurred vision yet but continuing eye drops every two hours and added gel eye drops at night. Unable to drive due to extreme blurred vision in right eye. Have a follow up appointment scheduled for 10/08/2021 with eye doctor

Other Meds: Zolpidem, Wellbutrin, omeprazole and stool softners.

Current Illness: none

ID: 1749626
Sex: M
Age: 11
State: MN

Vax Date: 09/18/2021
Onset Date: 09/18/2021
Rec V Date: 09/30/2021
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: Patient falsified DOB when registering for vaccination, stating a different DOB for the minor. Guardian consented to the vaccination. Department of Health verified with statistical records what the patient's actual DOB was which made the vaccine a contraindication. No known adverse reactions noted.

Other Meds:

Current Illness:

ID: 1749627
Sex: M
Age: 79
State: TX

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 09/30/2021
Hospital: Y

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

Lab Data: None - only visits to doctors and emergency rooms

Allergies: Ciproflaxin

Symptom List: Nausea

Symptoms: Started to develop back pain that spread through out my lower body. Went to emergency clinic and received two shots for pain relief Problem persisted for three plus weeks managed with pain relievers. Ultimately diagnosed as sciatica but that was only to describe location of pain. Meds and physical therapy continued for several weeks. Pain made it difficult to walk, stand . After several weeks, pain stopped and I needed to continue physical therapy to strengthen muscles. FYI, I had a similar reaction during a heart scan with contrast injection. However, the symptoms only lasted about fifteen minutes while the tech had me pant taking deep breathes. Do not know if these reactions are related. I would like to know the recommendation for me to proceed to get vaccinated to develop immunity. I am scared to take a second shot but will do so if recommended although I read the second shot is stronger than the first. Is it possible to take a booster shot or something else that would have less likelihood of a similar reaction. It was terrible although I am pretty much fine now. Thank you

Other Meds: Lisinopril 20mg, Ezetimbe 10mg, Aspirin 81mg, Vitamin D 2500 mcg, Ca/Mg/Zn multiple , Prevagen,

Current Illness: Chest cold

ID: 1749628
Sex: M
Age: 57
State:

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 09/30/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1749629
Sex: F
Age: 11
State: MN

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 09/30/2021
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: Patient falsified DOB when registering for vaccination. Stated the child's DOB was 06/21/2009. Guardian consented to the vaccination. Verified with statistical records the actual DOB is 06/21/2010, which made the vaccine a contraindication. No known adverse reactions noted.

Other Meds:

Current Illness:

ID: 1749630
Sex: M
Age: 66
State: MI

Vax Date: 02/24/2021
Onset Date: 08/25/2021
Rec V Date: 09/30/2021
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: Covid-19, Flu, RSV by NAA: SARS CoV 2 DETECTED (8/26/2021)

Allergies: Codeine, Neo-synephrine (phenylephrine)

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

Symptoms: Patient was one of 8 patients sent from a local nursing facility secondary to COVID-19 outbreak. No reported complaints initially, but was found to be hypoxic on arrival. Improved to 95% on 3L nasal cannula. Febrile on admission at 100.1 degrees F. CT scan of chest showed no evidence for pulmonary embolus, but there was bilateral ground glass opacities, small pericardial effusion, and lytic lesions throughout the bones consistent with metastatic disease. Patient declined, satting at 80%, which led to intubation and PICC line placement. Patient was stabilized and eventually extubated. Discharged in stable condition.

Other Meds: Unknown

Current Illness:

ID: 1749631
Sex: M
Age: 39
State: OH

Vax Date: 09/01/2021
Onset Date: 09/22/2021
Rec V Date: 09/30/2021
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: none

Symptom List: Tremor

Symptoms: has complained of a dull frontal headache intermittently since receiving his first COVID-19 vaccine. BP was 152/90, physical exam was normal.

Other Meds: none

Current Illness: none

ID: 1749632
Sex: F
Age: 69
State: WI

Vax Date: 01/30/2021
Onset Date: 07/01/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: A battery of blood tests were done the end of July and were all within normal ranges. TSH was slightly elevated but again, not deemed high enough to be responsible for hair loss. A1C (for blood glucose average) was 1/10th of a point out of range.

Allergies: Surgi-Lube Erythromycin (Erik)

Symptom List: Erythema, Pruritus

Symptoms: Approximately 1 month after receiving the 1st dose of the Pfizer Covid-19 vaccination, my blood glucose level rose & my thyroid TSH level spiked. Approximately 5 months after receiving both doses of the Pfizer Covid-19 vaccination, my hair started falling out. As of this date, I continue to have hair loss and tender scalp. My thyroid TSH level did spike in my past, but is not high enough to cause hair fall per my endocrinologist. I have never had hair loss in my past even when my TSH level spiked.

Other Meds: Multi-Vitamins + D3 Imipramine Metrogel Probiotic

Current Illness: None

ID: 1749633
Sex: M
Age: 64
State:

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 09/30/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1749634
Sex: F
Age: 73
State: NC

Vax Date: 04/17/2021
Onset Date: 07/02/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: Took an anti-viral on 7/7/2021. Began acupuncture treatments on 8/26/2021. Saw an occupational therapist, had a return visit to my primary physician, and on 9/28/2021 saw an ENT specialist. Have appointments to see a speech therapist and a neurologist.

Allergies:

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

Symptoms: Bell's Palsy symptoms showed up on 7/2/2021. Diagnosed on 7/7/2021 at Urgent Care. Note: Moderna shot #1 was on 3/20/2021 at the same urgent care, and the lot number was 037A21B. The symptoms include a slightly droopy right eyelid, slightly droopy right side of mouth, partly paralyzed tongue causing a speech impediment and difficulty swallowing, an ache in the neck and shoulders, dry eye, and less saliva. The mouth improved quickly. The other symptoms appeared and got worse over the next two months. After three months the ache in the shoulders is less, the tongue and speech is still bad. Have relied on rest, sunglasses and a blindfold, massages, a heatpad, and Biofreeze cream.

Other Meds:

Current Illness:

ID: 1749635
Sex: F
Age: 38
State: IN

Vax Date: 09/03/2021
Onset Date: 09/08/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: I had an ultrasound on 9/10/21 that confirmed my baby was no longer growing.

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: I started cramping and when the ultrasound was done on September 10 2021, I measured 5 weeks 2 days and I should have been 6 weeks 2 days. My baby stopped growing the day I received the second vaccination, which then resulted in a miscarriage.

Other Meds: Prenatal, Compound Thyroid, Vitamin D, Omega 3

Current Illness: N/A

ID: 1749636
Sex: F
Age: 32
State: CA

Vax Date: 04/06/2021
Onset Date: 09/30/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: n/a

Allergies: none

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

Symptoms: Three cycles after my shot (approximately 90 days), my periods began to last 11-12 days, the flow was abnormal, and they began being 30+ days apart. For 5+ years they have been 28 days apart on the dot, exactly 7 days with the same flow. Although I have PCOS, nothing in that condition has changed and have had no significant changes in my diet, exercise or stress levels - nothing that would cause my period to change after being the same for years.

Other Meds: none

Current Illness:

ID: 1749637
Sex: F
Age: 42
State: KY

Vax Date: 03/05/2021
Onset Date: 09/20/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Covid positive household member

Other Meds:

Current Illness:

ID: 1749638
Sex: M
Age: 78
State:

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 09/30/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1749639
Sex: F
Age: 83
State: TX

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 09/30/2021
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: PATIENT RECIEVED PFIZER DOSE AFTER RECIEVING 2 DOSES OF MODERNA

Other Meds:

Current Illness:

ID: 1749640
Sex: F
Age: 58
State: FL

Vax Date: 03/15/2021
Onset Date: 03/19/2021
Rec V Date: 09/30/2021
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: Dupuytrens contracture

Other Meds:

Current Illness:

ID: 1749641
Sex: F
Age: 51
State: NM

Vax Date: 02/22/2021
Onset Date: 09/21/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: Sep 21, 2021@15:10:16 FLU A NEGATIVE, FLU B NEGATIVE, RSV NEGATIVE COVID-19 POSITIVEA*

Allergies: No Known allergies

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

Symptoms: persistent cough, congestion, no SOB, chest pain or fever.

Other Meds: lisinopril, ferrous Sulfate

Current Illness: none

ID: 1749642
Sex: F
Age: 65
State: MI

Vax Date: 02/01/2021
Onset Date: 09/25/2021
Rec V Date: 09/30/2021
Hospital: Y

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

Lab Data:

Allergies: NKDA

Symptom List: Vomiting

Symptoms: Hospitalized (9.23.21); COVID-19 positive (9.25.21); Fully vaccinated Discharge Provider: MD Primary Care Provider: MD Admission Date: 9/23/2021 Discharge Date: Sep 26, 2021 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute cholecystitis [K81.0] Fever and chills [R50.9] Nausea and vomiting, intractability of vomiting not specified, unspecified vomiting type [R11.2] Left lower quadrant abdominal pain [R10.32] COVID-19 virus infection [U07.1] HOSPITAL COURSE: Patient is a 65 yo female with a PMH of HTN admitted for abdominal pain secondary to acute cholecystitis and COVID pneumonia. She presented with a 2 day history of acute abdominal pain radiating to her back associated with food intake. In the emergency department, a right upper quadrant ultrasound was obtained and concerning for cholelithiasis/CBD dilation/acute cholecystitis. General surgery was consulted and HIDA scan was obtained which confirmed acute cholecystitis. Patient was also noted to be febrile on admission for which she was started on Zosyn. She also tested positive for COVID, and other than fevers, she had no other COVID symptoms. Due to her COVID positive status, general surgery recommended IR consult for cholecystostomy tube placement with plans for cholecystectomy in 6 weeks. Cholecystostomy tube was placed successfully on 09/25. Patient was started on a diet and able to tolerate oral intake with no problems. She was discharged home stable condition on Augmentin to complete a 5 day course of antibiotics. She will follow-up with Interventional Radiology for drain management as well as General surgery for cholecystectomy. Of note, patient also was noted to have hypokalemia during admission, and was discharged on 5 days of supplementation with instructions to follow-up with PCP for repeat check. Discharge Disposition: home or self care Active Issues Requiring Follow-up: 1. Acute cholecystitis: Follow up with IR and General surgery to discuss plans for cholecystostomy tube removal and cholecystectomy plans 2. Hypokalemia: Follow-up with PCP for repeat potassium check

Other Meds: acetaminophen (TYLENOL) 500 MG tablet amLODIPine (NORVASC) 10 MG tablet omeprazole (PRILOSEC) 20 MG delayed release capsule potassium chloride SA (K-DUR, KLOR-CON M) 20 MEQ controlled release tablet sodium chloride flush 0.9 % syringe

Current Illness: ED 9.22.21 - for left flank pain and low serum potassium

ID: 1749643
Sex: F
Age: 62
State: WI

Vax Date: 09/17/2021
Onset Date: 09/24/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: I have not contacted my doctor.

Allergies: non

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: One week after receiving the vaccine my left knee became painful and swollen. I had the same thing happen one week after the first dose only it mostly effected my right knee. The pain and swelling lasts about 2 weeks plus. When it happened to my right knee I thought it was because of previous surgery (ACL) 25 years ago. I have pain in my right knee from time to time, but I have not had a problem with my left knee and no history of injury.

Other Meds: euthyrox 100mcg, lisinopril/HCTZ 10-12.5mg, vitamin D3 25mcg, vision formula 50+, magnesium 250mg

Current Illness: non

ID: 1749644
Sex: F
Age: 45
State:

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/30/2021
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: eggs, pork, tomatoes, sudafed, aspirin, and hazelnut

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

Symptoms: Dizziness starting a few hours after shot, but gone a few hours later, mild; same for upset stomach and mild nausea, diarrhea around midnight after the shot and again the following morning, general tiredness for next two days or so, some mild confusion, and some general muscle soreness for the day following the shot.

Other Meds: Fish oil, niacin, calcium, D3, B12, daily fiber supplement, melatonin, alavert

Current Illness:

ID: 1749645
Sex: F
Age: 74
State:

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 09/30/2021
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:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1749646
Sex: M
Age: 18
State: IN

Vax Date: 04/25/2021
Onset Date: 09/26/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: Antigen COVID-19 test with a positive result.

Allergies:

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

Symptoms: Patient was vaccinated on 4/1/21 and 4/25/21, so was fully vaccinated when testing positive for COVID-19 on 9/26/21.

Other Meds:

Current Illness:

ID: 1749647
Sex: M
Age: 45
State:

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 09/30/2021
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:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am