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: 1749909
Sex: F
Age: 50
State: CA

Vax Date: 08/18/2021
Onset Date: 08/18/2021
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: I visited the ER 8/23/2021 (5 days post vaccine) after speaking with my physician for possible stroke or heart/blood clotting. The ER visit tests were all "normal" and the ER doctor told me the vaccine is unpredictable and they would be here to help if I had an actual emergency. Bloodwork was done (normal). My doctor prescribed a 6 day course of steroids (methylprednisone 4mg) that had no effect, and referred to neurologist. Saw neurologist 8/27/2021 for initial evaluation and nerve study of arms. He referred me for additional blood work and will follow up with nerve study of legs next week, then meet again with neurologist

Allergies: seasonal allergies, cats, dust, mold, pollen

Symptom List: Dysphagia, Epiglottitis

Symptoms: Inflammatory immune response to vaccine. Left arm went cold immediately, then sore for 1-1/2 days. Dizzy/lightheaded for about 15 minutes. Significant numbness and tingling in Left arm, Left leg, Head/face/neck, right leg and arm, which has persisted for 7+weeks now. The intensity of the numbness and tingling has lessened over time but is still present and significant itching/skin crawling in face, head, neck arms. Swelling of left arm and leg, which moved to right leg after 6 weeks. difficulty remembering words/names of things for the first few weeks (most significant in the first 2 weeks after shot). Balance issues have persisted 7+ weeks now.

Other Meds: Nuvaring, Levothyroxine 50mg

Current Illness: n/a

ID: 1749910
Sex: F
Age: 54
State: OR

Vax Date: 09/27/2021
Onset Date: 09/27/2021
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: None

Allergies: Seasonal allergies

Symptom List: Anxiety, Dyspnoea

Symptoms: severe ache in left arm x 48 hours with fatigue. nausea, body aches, fever/chills x 72 hours

Other Meds: Metoprolol Succinate ER

Current Illness: Similar side effects with Phizer Covid-19 vaccine #1, 26 days prior

ID: 1749911
Sex: M
Age: 28
State: NY

Vax Date: 09/30/2021
Onset Date: 09/30/2021
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:

Allergies:

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

Symptoms: Client passed out approximately 2 minutes after receiving J&J vaccine, client had no recollection of passing out after, rolling back of eyes and slight right arm muscle twitch upon awakening. On site EMS called to client's side, observation provided . Client stated he did not remember passing out but he does remember feeling dizzy prior to passing out, Pt awoke within less than a minute. Client has no history of fainting.

Other Meds:

Current Illness:

ID: 1749912
Sex: M
Age: 27
State: PR

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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data: N/A

Allergies: N/A

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient indicates that they had been vaccinated with Pfizer and arrived at the center for their second dose. When the vaccination card is asked to write down the second dose, they indicated the vaccination card has been damaged and they want a duplicate. They are asked to verify that they have a photo on their phone and when it shows we realize that your first dose was Moderna not Pfizer, as verified at the beginning.

Other Meds: N/A

Current Illness: N/A

ID: 1749913
Sex: F
Age: 59
State: CO

Vax Date: 09/28/2021
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: Keflex,sulfa drugs,nitrates,MSG,fake lemon,vanillin, poly ethy

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

Symptoms: about 24 hours after the flu shot I have been experiencing nausea, stomach cramping, diarrhea (these side effects usually occur with other things that I am allergic to or a migraine 24 hours later). At this time still experiencing symptoms.

Other Meds: Vit D, probiotic,

Current Illness: none

ID: 1749914
Sex: M
Age: 37
State: SC

Vax Date: 09/07/2021
Onset Date: 09/07/2021
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:

Allergies: N/a

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

Symptoms: Ulcerative Colitis flare up - severe stomach pain, diarrhea, urgency, fatigue, stomach cramps

Other Meds: Tacrolimus Cellcept Magnesium (MgPlus-133mg) Entyvio Ursodiol Men?s Multivitamin Cymbalta

Current Illness: None

ID: 1749915
Sex: F
Age: 42
State: MN

Vax Date: 06/14/2021
Onset Date: 09/28/2021
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: 9/28 SARS/COV-2, NAAT Positive

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Breakthrough COVID

Other Meds:

Current Illness:

ID: 1749916
Sex: F
Age: 83
State:

Vax Date: 04/23/2021
Onset Date: 09/27/2021
Rec V Date: 09/30/2021
Hospital: Y

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

Lab Data: COVID + 9/27/21

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Admission to the hospital for COVID-19 infection symptoms

Other Meds:

Current Illness:

ID: 1749917
Sex: M
Age: 48
State: NY

Vax Date: 05/21/2021
Onset Date: 05/28/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: Nothing yet. I was hoping it would pass, but its getting worse so seeing doctors oct 7th

Allergies: None

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Arm pain, weakness. Pins and needles in arm and moving to hand and wrist. and ringing in my ears. Still. Got shot May 21st still have symptoms. Appointment with doctor October 7th.

Other Meds: Tylenol, advil, one a day vitamin.

Current Illness: None

ID: 1749918
Sex: F
Age: 15
State: LA

Vax Date: 09/08/2021
Onset Date: 09/08/2021
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: none

Allergies: NKA

Symptom List: Diarrhoea, Nasal congestion

Symptoms: About 30-40 minutes later after the vaccine, she was feeling tingling and nerve stimulation in her left arm. Later, her knee began hurting and swelling but we thought it was unrelated since she had hurt her knee in gymnastics the day before. I gave her Tylenol and Claritin just in case. She started having some joint pain a few hours later and then some hives/redness formed around the knee. I gave her 25 mg Benadryl. Around 7pm, all of her joints starting swelling, including wrists, ankles, and her ring finger which was odd to us. Later on, her wrists, hands, fingers, ankles, and knees increased in swelling and pain. I gave her more Benadryl, Pepcid AC, and some Aleve. The next day she broke out in hives all over her body except for her face. She had some hives on her right ear and neck also. She missed school. The joint swelling lasted throughout the day and finally subsided late that night along with the pain. The hives for the most part disappeared and reappeared in the next day briefly, then were gone. She did completely recover.

Other Meds: none

Current Illness: UTI the month before but had cleared up and no meds at the time

ID: 1749919
Sex: F
Age: 52
State: MA

Vax Date: 09/28/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies: Amoxicillin

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

Symptoms: Stomach pains, diarrhea, arm pain

Other Meds: None

Current Illness: Frozen shoulder

ID: 1749920
Sex: M
Age: 12
State: NC

Vax Date: 09/18/2021
Onset Date: 09/24/2021
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: Negative Strep Test Negative Covid Test

Allergies: None

Symptom List: Rash, Urticaria

Symptoms: Covid symptoms, sore throat, runny nose, congestion, shortness of breath, coughing, worsening asthma symptoms 7 days after the shot, ongoing Oral Prednisone Albuterol Rescue Inhaler

Other Meds: ProAir HFA Inhaler, Zyrtec, Multi-vitamin

Current Illness: None

ID: 1749921
Sex: F
Age: 60
State: KS

Vax Date: 08/03/2021
Onset Date: 08/09/2021
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: strawberrys. pataday ??

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

Symptoms: intially soreness and knot on arm, after a week tired and lathargic, then had eye symptoms (pain and swelling) and facial swelling been to eye Dr. 3 times so far tried allergy eye drops with no improvement. gets feeling of electrical pulses thru body. PCP sent to urgent care when talk of lupus. has blood work and allergy test coming up.

Other Meds:

Current Illness:

ID: 1749922
Sex: M
Age: 50
State: FL

Vax Date: 08/24/2021
Onset Date: 09/01/2021
Rec V Date: 09/30/2021
Hospital: Y

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

Lab Data: September 30, 2021 admitted . Heart cath was done . wearing heart monitor now

Allergies: no

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

Symptoms: Heart palpitations started . was admitted to hospital for a week

Other Meds: Vitamin C, Omega, Prosolin

Current Illness: no

ID: 1749923
Sex: F
Age: 48
State: PA

Vax Date: 08/18/2021
Onset Date: 09/11/2021
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: 09/20/2021 - US upper extremity arteries right - peripheral artery disease 09/30/2021 - CTA upper extremity right with and without contrast - No significant flow is visualized to

Allergies: Codeine, Duloxetine

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

Symptoms: 4 weeks after receiving Janssen vaccine, patient's thumb and pointer fingers on her right hand became necrotic. She has no feeling, they are turning black and they are cold. Ultrasound and Cat Scan were done. Patient had blood clot in in her right arm that the doctors told her had broken apart and ended up in her fingers, causing them to lose circulation. Patient was recently told by hand surgeon that fingers will need to be amputated.

Other Meds: Vitamin D3, Nexium 40mg, Hydroxyzine 25mg, Phentermine, cont..

Current Illness: None

ID: 1749924
Sex: F
Age: 52
State: FL

Vax Date: 08/01/2021
Onset Date: 08/01/2021
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: No

Allergies: No

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

Symptoms: Later that night after the vaccine I developed severe chest pains that lasted about 4 or 5 hours and subsided on it on with no additional symptoms.

Other Meds: No

Current Illness: No

ID: 1749925
Sex: F
Age: 62
State:

Vax Date: 03/10/2021
Onset Date: 03/10/2021
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:

Allergies:

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

Symptoms: scar/mark from injection wont leave

Other Meds:

Current Illness:

ID: 1749927
Sex: F
Age: 23
State: CA

Vax Date: 09/16/2021
Onset Date: 09/17/2021
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:

Allergies: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Itchy rash on upper and lower extremities bilaterally, relieved with benadryl

Other Meds: None

Current Illness: None

ID: 1749928
Sex: F
Age: 66
State: OR

Vax Date: 09/27/2021
Onset Date: 09/29/2021
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: No

Allergies: Sulfur

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Rash pain fever chills

Other Meds: Aspirin

Current Illness: No

ID: 1749930
Sex: F
Age: 52
State: MN

Vax Date: 04/01/2021
Onset Date: 04/02/2021
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: NONE

Allergies: AMOXICILLAN

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

Symptoms: I HAD TYPICAL SIDE EFFECTS FROM THE VACCINE THE DAY FOLLOWING THE VACCINE: ARM SORENESS, SLIGHT FEVER, FATIGUE. HOWEVER, AT 11:49AM MY HEART RATE SHOT UP TO 161 BEATS PER MINUTE. I WAS JUST STANDING IN MY KITCHEN NOT DOING ANYTHING, NO EXERTION. IT IMMEDIATELY WENT BACK DOWN. IT WAS VERY STRANGE. IT HAS SEEMED FINE SINCE THEN AND I DID NOT GO IN TO THE DOCTOR.

Other Meds: NONE

Current Illness: NONE

ID: 1749931
Sex: M
Age: 48
State: WI

Vax Date: 09/29/2021
Onset Date: 09/30/2021
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: None

Allergies: Unknown

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

Symptoms: Patient reported having the following symptoms: body aches, nausea, severe chills, then fever. The symptoms began at midnight and appeared to resolve at 3:30 AM. Upon awakening this morning, he reported that felt a little sore and a little weak.

Other Meds: Unknown

Current Illness: Unknown

ID: 1749932
Sex: F
Age: 62
State: NV

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:

Allergies:

Symptom List: Unevaluable event

Symptoms: over 42 days. 1st dose 08/15/2021, 2nd dose 09/20/21

Other Meds:

Current Illness:

ID: 1749933
Sex: F
Age: 28
State: MN

Vax Date: 01/27/2021
Onset Date: 08/27/2021
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: ID NOW COVID-19 test 8/27 with positive results

Allergies:

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

Symptoms: Children exposed at daycare and had Positive test results 8/25; Pt. developed sniffles and was COVID positive on 8/27/21 becoming a covid break through case.

Other Meds:

Current Illness:

ID: 1749934
Sex: M
Age: 60
State: TX

Vax Date: 09/10/2021
Onset Date: 09/15/2021
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:

Allergies: Sulfa

Symptom List: Injection site pain, Pain

Symptoms: Severe pain in pelvic area and between shoulder blades, neck and shoulder pain as well..

Other Meds: Buprenorphine, Celecoxib, Duloxetine? Vitamin D. , Zinc

Current Illness: None

ID: 1749935
Sex: F
Age: 19
State: MI

Vax Date: 08/26/2021
Onset Date: 09/18/2021
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: CBC, mono screen, ferritin, sed rate, CMP, west nile virus antibody, EBV IgG, EBV IgM, lyme disease serology , CMV IgG, CMV IgM, group A strep, HPV PCR HSV-1 Positive and EBV IgG Positive

Allergies: Sulfa, aspartame, clindamycin, omnicef, peanuts, penicillin, chlorpheniramine

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient complained of fever, fatigue, swollen lymph nodes in her neck, groin and armpits, aphthous ulcers

Other Meds: Birth control, Imitrex as needed and Albuterol as needed

Current Illness: 8/3/21 seen at specialist for joint pain - polyneuropathy, arthralgia, myalgia and poor sleep 8/12/21 seen at urgent care - abdominal pain 8/12/21 seen in ER - left side abdominal pain 8/13/21 seen in PCP office - LUQ pain, hematochezia, organomegaly 8/14/21 seen in ER - Gastritis

ID: 1749936
Sex: M
Age: 38
State: CA

Vax Date: 03/30/2021
Onset Date: 03/30/2021
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: N/A

Allergies: N/A

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

Symptoms: Crippling fatigue for 5 days Sore arm Unable to stand up or lift my head Shooting & sharp pain on both sides of my body Cold sweats and chills Headache Full body twitches Neurological symptoms worsened: brain fog, short term memory loss, and attentiveness decreased

Other Meds: Bupropion 300 mg Adderall 40 mg

Current Illness: N/A

ID: 1749937
Sex: F
Age: 41
State: WV

Vax Date: 09/28/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data: None.

Allergies: Latex- contact dermatitis Griseofulvin- hives

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Left axillary tenderness noted the next morning. Took Tylenol and alternated with Ibuprofen. Left axillary swelling and severe tenderness without redness noted the second morning. Alternating Tylenol and Ibuprofen.

Other Meds: Lexapro 20mg PO Daily Ativan 0.5mg PO BID PRN Multi-Vitamin

Current Illness: None.

ID: 1749938
Sex: F
Age: 62
State:

Vax Date: 01/07/2021
Onset Date: 09/25/2021
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:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: PATIENT HAD COVID-19 VACCINE PFIZER Dose 1 date: 01/07/2021, Dose 2 date: 01/28/2021, AND TESTED POSITIVE TO COVID.

Other Meds:

Current Illness:

ID: 1749939
Sex: F
Age: 52
State: FL

Vax Date: 08/22/2021
Onset Date: 08/22/2021
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: No.

Allergies: No.

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

Symptoms: Later that night after the vaccine my heart began to flutter off and on for about 3-4 hrs. Then it seems as my body just got bogged down as if I had a low-grade infection in my body. I developed a stuffy nose, headache and various sinus related symptoms. I had a sore throat that would come and go and I was severely fatigued and it's as if the fatigue just wouldn't let up and I was feeling so bad and grogged down that on 9/21 I reached out to my PCP and was given a prescription for Cefdinir to help with the symptoms, but it actually made the symptoms worse for about 3 days then finally I began feeling a little better and I took the last pill today and so far the symptoms has resolved.

Other Meds: No.

Current Illness: No.

ID: 1749940
Sex: F
Age: 62
State: MD

Vax Date: 04/30/2021
Onset Date: 05/04/2021
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: Brain MRI orders by Dr.......negative for stroke or infarct U/S of thyroid ordered ..... normal Video Swallow: ordered by Dr; unremarkable.....but Dysarthria continues ???? Have upcoming appt 10/28 withENT.

Allergies: Med Allergies: PCN, Elavil, Rocephin, Flagyl, Lamictal, Latuda

Symptom List: Nausea

Symptoms: Noticed 3 days after second injection; low grade temp...then followed by sore throat.....And 2-3 weeks later change in speech pattern. Initially attributed to seasonal allergies; but have seen PCP, Endocrinologist, and Neurologist with DX: Dysarthria. The s/s have precipitated for 4 months..

Other Meds: 2 meds: Lithium Carbonate & Crestor 10 mg. Supplents: Fish Oil, Zinc, Selenium, D3

Current Illness: None

ID: 1749941
Sex: F
Age: 42
State: MN

Vax Date: 01/28/2021
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: 9/30 SARS/COV-2, NAAT, Positive

Allergies:

Symptom List: Injection site pain

Symptoms: Breakthrough COVID

Other Meds:

Current Illness:

ID: 1749942
Sex: M
Age: 62
State: ID

Vax Date: 03/18/2021
Onset Date: 04/21/2021
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: Dermatologist visit for physical exam

Allergies: Azithromycin, Clindamycin, Compazine, Codeine, Latex, Lactose,

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

Symptoms: Severe Rash/Dermatitis: groin area, penis, underarms, forearms

Other Meds: Valsartan 80mg/daily

Current Illness: None

ID: 1749943
Sex: F
Age: 72
State: MI

Vax Date: 03/23/2021
Onset Date: 09/20/2021
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:

Allergies: NKDA

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

Symptoms: Hospitalized (9.27.21-present); COVID-19 positive (9.20.21); fully vaccinated HISTORY OF PRESENT ILLNESS: a 72 y.o. female hx malignant hepatoma s/p liver tansplant on chronic immunosuppression with tacrolimus and prednisone, SLE, SCC of left upper lobe of lung, CKD3, DM2 who presents today with crampy epigastric non-radiating abdominal pain associated with nausea, vomiting and diarrhea. She has had this pain for some time but It has been acutely worse the past 24 hours. Daughter estimates >20 episodes of vomiting and loose watery non-bloody stools. Unable to manage symptoms at home with Zosyn so came to the ED. She was recently admitted to CRS 8/23-8/29 with perforated sigmoid diverticulitis. She was managed without surgery on IV Zosyn transitioned to Augmentin at discharge. She was having persistent symptoms of nausea and left sided abdominal pain so CT abdomen and pelvis completed on 9/20 showing residual distal descending colon diverticulitis with partial improvement and no abscess. She was placed back on Augmentin for another week. She also had COVID 19 testing completed on 9/20 which was positive and she had monoclonal antibody infusion on 9/24/2021. She had received both COVID19 vaccinations and does not know how or exact time frame as to when she contracted this virus. On arrival she had rectal temp 37.8, HR 103, RR 28, with O2 saturations mid to upper 90's. Her significant lab findings include bicarb 17, BUN 21, creat 2.2, lactic acid 3.9, WBC 9.33. CT abdomen and pelvis was repeated today with continued findings of localized perforated diverticulitis mildly improved from 9/20/21 and questionable mild superimposed colitis. In ED given IV morphine, IV zofran, 2Liter IVF. ASSESSMENT / PLAN: Acute kidney injury Lactic acidosis -creat today 2.2; baseline 1.2-1.4 -lactic acid 3.9 to 2.2 with IVF -continue IV fluid resuscitation NS 0.9% at 100ml/hr -trend CMP, lactic acid until normalizes Acute on chronic abdominal pain Nausea, vomiting and diarrhea -CT abdomin/pelvis with findngs of localized perforated diverticulitis mildly improved from 9/20/21 and questionable mild superimposed colitis -check stool studies including c diff -may be related to COVID 19 vs antibiotic use vs diverticulitis/colitis -completed prolonged course of augmentin -TIGAN for nausea given prolonged QTc -hold further antibiotic treatment pending stool studies; consult Infectious disease for recommendations of continuing antibiotics Positive COVID-19 testing on 9/20/21 -status post monoclonal antibody infusion on 09/24 -trend CMP, CRP, CBC

Other Meds: Outpatient Medications Bacillus Coagulans-Inulin (PROBIOTIC FORMULA PO) CYCLOSPORINE OPTH fluconazole (DIFLUCAN) 200 MG tablet lansoprazole (PREVACID) 30 MG delayed release capsule LORazepam (ATIVAN) 0.5 MG tablet losartan (COZAAR) 50 MG ta

Current Illness: 8.23.21 - hospitalization - perforated diverticulum / diverticulitis (DC'd 8.29.21) Hiatal hernia diagnosis - seen in office 9.2.21 (general surgery consult) yeast infection - + antifungal treatment (9.23.21) COVID positive 9.20.21 Monoclonal antibody infusion 9.24.21.

ID: 1749944
Sex: M
Age: 81
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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Tremor

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

Other Meds:

Current Illness:

ID: 1749945
Sex: M
Age: 35
State: CA

Vax Date: 08/15/2021
Onset Date: 08/15/2021
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: Not applicable.

Allergies: No allergies

Symptom List: Erythema, Pruritus

Symptoms: Patient fainted post administration of Janssen vaccine patient sitting in chair in observation area leaned over to right side fainted for about 5 seconds, patient did not fall or sustain any injury. Nurse observed patient leaning to right side, immediately assessed patient. Nurse assessed alertness, patient able to speak, and sit up 90 degrees in chair without difficulty, respiration even, and unlabored no respiratory distress noted. Patient assisted to yoga mat on the floor, minimal assistance provided, elevated patient legs on chair. Patient forehead cold to touch, and clammy. Vital signs at 1852, temp 96.4, BP 111/71, HR 63, RR 18, O2 95%. Patient stated he ate today, but had not eating anything for the prior 7 days due to inability to obtain food. Patient awake, alert, and oriented, able to verbalize. Patient remained laying down on mat for 20 minutes. Patient stated he is feeling better, reassessed vital signs at 1920, temp 96.8, BP 124/86, HR 81 RR 16, O2 95%. Assisted patient chair observed patient ambulate to chair with no assistance, observed steady gait and sat upright in chair for another 10 minutes. Patient given water to drink, patient able to drink, and swallow water without difficulty. Instructed and educated patient on possible side effects post vaccine administration, and instructed reinforced education on when to seek medical attention, go to nearest hospital, or call 911, patient verbalized understanding of instructions. Patient went back to hotel room, patient able to ambulate with no assistance with steady gait, and balance. Outcome is that patient self recovered and vital signs stable, no respiration distress, or dizziness, denies any chest pain.

Other Meds: No Prescriptions, over-the-counter medications, dietary supplements, or herbal remedies being taken at the time of vaccination.

Current Illness: No known illnesses or prior illness at the time of vaccination

ID: 1749946
Sex: M
Age: 36
State: FL

Vax Date: 09/14/2021
Onset Date: 09/15/2021
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: None

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

Symptoms: Pt developed blistering rash in groin approximately 24-48 hrs after vaccination

Other Meds: None

Current Illness: None

ID: 1749948
Sex: F
Age: 54
State: FL

Vax Date: 03/30/2021
Onset Date: 05/12/2021
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: Lab work 10/1/2021

Allergies: Pine nuts, color red dye

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

Symptoms: Have been losing weight (25 Lbs) without trying and always feel lethargic.

Other Meds: Ativan 1 mg 3x daily Tizandine 4 mg 2x daily

Current Illness: None

ID: 1749949
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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

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

Other Meds:

Current Illness:

ID: 1749951
Sex: F
Age: 28
State: TX

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: 011J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: none

Allergies: None

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

Symptoms: 1 hour after taking vaccine, noticed blood vessel in left eye burst, BP systolic 180, swelling at left arm and pain, and nausea. BP came back to normal 3rd day. Nausea lasted for 2 days. Swelling came down the night of 2nd day.

Other Meds: Amlodipine, elderberry

Current Illness: None

ID: 1749952
Sex: M
Age: 84
State: CO

Vax Date: 09/03/2021
Onset Date: 09/10/2021
Rec V Date: 09/30/2021
Hospital: Y

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: Penicillin, Hydrocodone, Iodine, Iodide, Sulfa.

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

Symptoms: Uncontrollable diarrhea for 15+ days, turns into constipation.

Other Meds: None.

Current Illness:

ID: 1749953
Sex: F
Age: 56
State: GA

Vax Date: 02/23/2021
Onset Date: 04/01/2021
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: LA

Lab Data: Blood work, Heart X-rays, MKGs, Heart Ultrasound, and Heart Cather from July 31, 2021 through August 3, 2021.

Allergies: None

Symptom List: Pain in extremity

Symptoms: I received the Pizer Covid-19 Vaccine on February 23, 2021 and March 23, 2021. Shortly thereafter, in April of 2021, I started experiencing fatigue, chest tightness, breathing issues and sleeplessness. I thought these symptoms were indications of acid reflux and stress, and took Tylenol and over-the-counter acid reflux medication, Omeprazole. On July 31, 2021, I went to Hospital due to shortness of breath and chest pain. I was then transferred to another hospital, where they ran blood work and tests. I stayed in the hospital until August 3, 2021 and was told that I had inflammation around my heart. Later, I followed-up with Dr., a Cardiologist, on August 18, 2021 and was told that I had in fact, suffered a Heart Attack! Hence, I have been on seven (7) different medications (Omeprazole 20 mg, Aspirin 81 mg, Colchicine 0.6 mg, Isosorbide Mononitrate 30 mg, Atorvastatin 80 mg, Lisinopril 2.5 mg, and Metoprolol ER Succinate 25 mg) for my conditions in order for the inflammation to subside and have a stent placed in a blocked artery. On September 27, 2021, I was informed by Dr. that a stent would be too risky to perform, since the artery is blocked 100%. Therefore, I will have to live with this "permanent injury" for the rest of my life. Consequently, I have been told I have a rare case of inflammation. Therefore, I certainly believe it is Covid-19 vaccine related, and have filed a VAERS report (Vaccine Adverse Event Reporting System) with the CDC. Thus, I do not have a family history of Heart Disease and never have been on ANY prescription medications other than for very brief illnesses. These are some of the symptoms and/or side effects that I have experienced from my medications, since August 5, 2021 to date: 1.) Sore throat/cold 2.) Headaches/migraines 3.) Diarrhea 4.) Chills/hot and cold 5.) Stomach aches 6.) Light-headedness 7.) Low energy 8.) Unstable on feet; fell on September 15, 2021 around 12:30 p.m. 9.) Sleeplessness 10.) Loss of appetite 11.) Tightness in left calf area 12.) Cramping in both legs 13.) Fever 14,) Feeling depressed 15.) Woozy and dizzy 16.) Constipation 17.) Excessive coughing 18.) Body aches, specifically, back, arms and legs 19.) Nausea

Other Meds: None

Current Illness: None

ID: 1749954
Sex: F
Age: 51
State:

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: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1749955
Sex: F
Age: 66
State: IA

Vax Date: 03/19/2021
Onset Date: 03/21/2021
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: Ultrasound (09/14/2021), CT-scan. (09/16/2021)

Allergies: Penicillin

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

Symptoms: Two days after receiving my 2nd dose of the Pfizer-BioNTech vaccine I experienced large swelling in my right axillary region. The swelling mostly subsided over the next couple of days, but some swelling and mild pressure has yet remained even after 6 months time. My primary doctor ordered an ultrasound and then a CT-scan of the region to rule out other causes but those procedures found nothing that could be causing this lymphedema and pressure sensation.

Other Meds: Rosuvastain, Lisinopril/HCTZ

Current Illness: None

ID: 1749956
Sex: F
Age: 40
State: PA

Vax Date: 09/26/2021
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: None

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

Symptoms: Hives rash all over body itchiness

Other Meds: None

Current Illness: None

ID: 1749957
Sex: F
Age: 34
State: IL

Vax Date: 09/28/2021
Onset Date: 09/30/2021
Rec V Date: 09/30/2021
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: PFIZER TEMPERATURE EXCURSION. THE VACCINE WAS IN THE FREEZER FOR 3 WEEKS THEN IT WAS MOVED TO THE FRIDGE FOR A WEEK. AFTER THAT IT WAS ADMINSTERED TO THE PATIENT

Other Meds:

Current Illness:

ID: 1749958
Sex: F
Age: 49
State: PR

Vax Date: 09/28/2021
Onset Date: 09/28/2021
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:

Allergies: ASPIRIN, DECADRON

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient refers after arriving home, he lost his voice. He was instructed to visit his doctor for any actions and evaluations.

Other Meds: UNKNOWN

Current Illness: MIGRAINE

ID: 1749959
Sex: M
Age: 43
State: FL

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: 1
Vax Route: IM
Vax Site: RA

Lab Data: none

Allergies:

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

Symptoms: medication error only, patient given wrong dose of vaccine. No adverse outcome

Other Meds:

Current Illness:

ID: 1749961
Sex: F
Age: 39
State: OH

Vax Date: 09/08/2021
Onset Date: 09/09/2021
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: ER visit 9/14 CT scan, labs, given Toradol and Phenergan and D/C'd. Express care visit 9/20 started on steroids and given IV steroid shot. PCP visit 9/23 and MRI ordered, labs ordered, set up with neurologist. 9/27 started on more steroids. 9/30- saw Neurologist who is ordering CT-V, MRI, EEG, starte don Topamax and indomethacin and increased steroids, r/o cerebral venous thrombosis/ microclots, set up eye appt also to check for clots in eye vessels.

Allergies: none

Symptom List: Injection site swelling, Limb discomfort

Symptoms: severe headaches, migraines, tinniuts, ear pressure/pain, eye twitching, insommia, numbness tingling arms at night

Other Meds: none

Current Illness: none

ID: 1749962
Sex: F
Age: 38
State: MN

Vax Date: 02/03/2021
Onset Date: 02/25/2021
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: Subsequent bleeding with found retained products of conception (via MRI and hysteroscopy) and subsequent D&C.

Allergies: Lactose intolerance

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

Symptoms: Previous history of miscarriage in 2017; healthy delivery in 2018. Was 7 weeks at time of miscarriage.

Other Meds: Fluoxetine, lactase

Current Illness: None

ID: 1749963
Sex: F
Age: 78
State: NC

Vax Date: 09/27/2021
Onset Date: 09/27/2021
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: body aches (extreme), extreme fatigue so that I slept about 32 hours, temp of 101.1, diarrhea, headache

Other Meds: Letrozole, lipitor

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am