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: 1750015
Sex: F
Age: 71
State: GA

Vax Date: 09/22/2021
Onset Date: 09/22/2021
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: Penicillin, Allergy medications.

Symptom List: Dysphagia, Epiglottitis

Symptoms: Extreme fatigue, muscle pain, joint pain, congestion, coughing, dizziness.

Other Meds: Synthroid.

Current Illness:

ID: 1750016
Sex: F
Age: 40
State: UT

Vax Date: 08/16/2021
Onset Date: 09/19/2021
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: 9/14/2021 CT Scan, bloodwork, chest xray, covid test all good. 9/23/2021 MRI came back good as well

Allergies: none

Symptom List: Anxiety, Dyspnoea

Symptoms: I started feeling a pressure from my shoulders up into my head. My ears had so much pressure like I was on a plane but they wouldn't pop. I had zero congestion though. Went to Dr the 8/20/2021 and had a fever of 99.7 & was told I was having inflammation from the vaccination & to take some muscle relaxers for 7-10 days. The pressure in my head and ears was so bad I went to Dr a week later & she said she has also been seeing this and I am having inflammtion from the vaccination. No fluid in my ears & externely everything looked fine. She said my eustachian tubes were inflammed. She suggested nasacort, sudafed, & 600 mg of ibuprphen daily for the next week.Also had a slight case of TMJ from the imflammation so told to try soft foods for the week as well. Went back to Dr. & she decied we try Predniose for 10 days. 40 mg for 5 days and 20 mg for 5 days. I made it without any releif to day 6 and ended up going to the ER for chest pains & the headache. They took a CT Scan, chest xray, blood work, & covid test. Everything came back looking good so said they also believed I was having an adverse reaction to the vaccination. They then put me on Lorazpam for 5 days to try to sleep because the back of my head is so paingul and they pressure in my head gets worse as the time goes on. They also suggested ibuprophen & acetaminophen as well. MRI was done a few days later & everything came back looking good with that too. I am still having pressure in my head, shooting pains in neck, muscle pain in my shoulders & some pain in my right arm. I am trying to get into more doctors but everyone is backed up.

Other Meds: mganesium, fish oil, D3, and Calcium

Current Illness: none

ID: 1750017
Sex: M
Age: 35
State:

Vax Date: 09/08/2021
Onset Date: 09/08/2021
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: Pt felt dizzy post vaccine, Vital signs were BP 117/66, Po2 98%, Pulse 106and finger stick 101. Patient was observed by medical staff as per protocol.

Other Meds:

Current Illness:

ID: 1750018
Sex: F
Age: 55
State: TX

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

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

Lab Data: N/A

Allergies: Demerol, clonidine, hydrocodone, Victoza

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Given COVID Vaccine on 08/13/21, on 08/14/21 started having a hard time breathing, and a elevated heart rate, was taken to hospital on 08/14/21, pt recently moved to rehabilitation facility for continued care on 09/29/21

Other Meds: Celecoxib 100 MG prn, NovoLIN N 100 units qhs, Lisinopril 20 MG 1 tab BID, metFORMIN HCl ER 500 MG 3 tabs daily, Metoprolol Tartrate 100 MG 1 tab BID, Pravastatin Sodium 20 MG 1 tab daily

Current Illness: N/A

ID: 1750019
Sex: M
Age: 83
State: AL

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: N/A

Allergies: NKDA

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

Symptoms: Patient received the Moderna brand of the COVID19 vaccination (instead of the Pfizer, which is the brand the patient initially received in Jan/Feb 2021). No adverse events or other symptoms were reported.

Other Meds: Metformin 500mg, Atorvastatin 20mg, Lomotil, Donepezil 10mg, Tamsulosin 0.4mg

Current Illness:

ID: 1750020
Sex: F
Age: 46
State: CA

Vax Date: 04/21/2021
Onset Date: 04/26/2021
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: N/A

Allergies: Sulfa

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

Symptoms: Heavy bleeding while menstruation.. both times Pain on left side ovary

Other Meds: BYSTOLIC VITAMIN D Multi women's vitamins

Current Illness: None

ID: 1750021
Sex: F
Age: 70
State: CA

Vax Date: 02/11/2021
Onset Date: 03/13/2021
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:

Allergies: oxaprozin

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Skin rash around injection site.

Other Meds: I developed a skin rash after the first Moderna vaccine. It lasted about 6 days.

Current Illness: None

ID: 1750022
Sex: M
Age: 33
State: IL

Vax Date: 09/27/2021
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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Pfizer vaccine temperature excursion. The vaccine was placed in the freezer for 3 weeks then removed and placed in the fridge for a week. After that the vaccine was administered,

Other Meds:

Current Illness:

ID: 1750023
Sex: M
Age: 91
State: OH

Vax Date: 01/30/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data: 2019 Novel Coronavirus RNA specimen collected 9/24/2021

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: hospitalized 9/25/21 for covid pneumonia

Other Meds:

Current Illness:

ID: 1750024
Sex: M
Age: 26
State: OH

Vax Date: 09/24/2021
Onset Date: 09/26/2021
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: Heart palpitations and chest tightness. As of now no treatment

Other Meds:

Current Illness:

Date Died: 07/10/2021

ID: 1750025
Sex: F
Age: 81
State:

Vax Date: 03/03/2021
Onset Date: 06/25/2021
Rec V Date: 09/30/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: pt presented to ED with hx of positive COVID test earlier in the week from a dr's office, cough, weakness, fatigue x 1 wk; hypoxic, placed on nonrebreather; in respiratory failure due to COVID pneumonia; pt's condition worsened and she died in the hospital

Other Meds:

Current Illness:

ID: 1750026
Sex: F
Age: 55
State: OH

Vax Date: 08/26/2021
Onset Date: 08/30/2021
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: PAP test done 09/03/2021 - negative result Transvaginal Ultrasound done 09/07/2021 - endometrial lining within normal limits; 2 fibroids seen , one being 1 cm & the other 3 cm. I did already know that I had at least 1 fibroid from a previous ultrasound. My doctor has requested a repeat transvaginal ultrasound in 3 months to make sure the fibroids aren't growing.

Allergies: Lactose intolerant

Symptom List: Rash, Urticaria

Symptoms: Four days after the vaccine, I had a brownish vaginal discharge. It was only as I wiped myself after going to the bathroom. I am postmenopausal (LMP Jan 2019) so I contacted my GYN. It may have nothing to do with the vaccine but I have seen articles related to heavier periods & postmenopausal bleeding after the vaccine so that's why I'm mentioning this. I also had another day w/brownish discharge on 09/25/2021. I did use a vaginal moisturizer the night prior & again may not have anything to do with the vaccine but it was 27 days after the 1st incident.

Other Meds: For RA: Hydroxychloroquine, Sulfasalazine, Celebrex, (Xeljanx normally but was told to NOT take it for 1 week when I got vaccine so I wasn't taking it from 8/26/21-9/1/21). For allergies: Fluticazone Supplements: multivitamin, turmeric, fi

Current Illness: None

ID: 1750027
Sex: M
Age: 47
State: CA

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: IM
Vax Site: LA

Lab Data: EKG NORMAL ON 9/30/2021

Allergies: NONE

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

Symptoms: Costochondritis (MID TO LEFT UPPER LEFT SECTION)

Other Meds: NONE

Current Illness: NONE

ID: 1750028
Sex: F
Age: 42
State: CA

Vax Date: 08/14/2021
Onset Date: 08/24/2021
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: none

Allergies: none

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

Symptoms: Extreme fatigue since first shot. Continued after second shot. Always exhausted and have no energy and can sleep for ten hours and still be tired. This occured after the vaccine. I have never been as tired like I am now. I hoped it would go away but its still there.

Other Meds: none

Current Illness: none

ID: 1750029
Sex: F
Age: 78
State: MO

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

Lab Data:

Allergies: No

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

Symptoms: Fever, extreme muscle pain and skeletal pain, lack of energy

Other Meds: Eliquis HCtZ ceterizine D3 Vitamin C with B

Current Illness: Asthma

ID: 1750030
Sex: F
Age: 54
State: CA

Vax Date: 03/08/2021
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:

Allergies: Dairy and Gluten Some Nuts Remicide Stelara Budesonide Dilaudid Iron infusions Latex

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

Symptoms: So I began having bad muscle aches and joint pain. Both the left and right side and the palms of my hands, wrist, shoulders, knees, ankles, toes and neck. It's really bad joint pain. It feels like the muscles are being pulled from the bone. I also have extreme fatigue. It seems the pain meds I'm taking for it aren't helping it. I'm completely bed ridden at the moment. The anti inflammatory doesn't seem to be helping and I have to be careful on them because I have chromes disease. The treatment is the pain meds that I'm currently taking and the anti inflammatory meds. I was on steroids the day I was hospitalized in April. I had a really bad chromes flair. I was on blood thinners. Because of the blood thinners I had to stay on the steroids longer. After I quit the steroids is when I noticed the joint pain. July 4th is when I quit taking the steroids. The join paint then started to creep up.

Other Meds: Entyvo Biologic Infusion Valtrex Oxy Condone/Acetametphin 5mg/325 Gabapentin 100mg Two times a day Diazepam 2.5mg as needed Diflucan 25mg a day Pantoprazole 40mg once a day

Current Illness:

ID: 1750031
Sex: F
Age: 64
State: OH

Vax Date: 03/04/2021
Onset Date: 05/22/2021
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: No medical tests. My primary care doctor, recommended a have a CBC, which I did twice: on June 5, 2021 and again on August 18 (prior to my second ED visit but AFTER several nosebleeds that I was able to bring under control myself). The lab work was normal in both instances. The dates of cauterization: July 20 and August 26.

Allergies: No food allergies. No product allergies. Allergic to some amoxicillin and morphine. Seasonal allergies only.

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

Symptoms: On the morning of May 22, 2021, I awoke with a severe nosebleed?the first of many that I would have this past summer?and all involving my left nasal passage. Two subsequent nosebleeds, on July 17 on August 22, required trips to the Emergency Department followed by visits to an ENT doctor. On the first ED visit, they had to pack my nose with a rhino-pack because the bleeding would not stop. On the second visit (I was there for several hours), the bleeding eventually stopped using the nasal clamp I was given. In both instances I was advised to follow up with an ENT doctor. After the first ED visit, the ENT doctor that I saw performed cauterization, which seemed to work at first but clearly it was not enough, given my need to go to the ED the following month. After that second ED visit I followed up with an ENT Specialistwho performed more cauterization. He indicated that several of my blood vessels were "prominent." This was in August, and I've not had a problem since. I am not suggesting that the COVID vaccine had anything to do with these bouts of epistaxis; however, when I responded to the last "Be Safe" text that I received from the CDC indicating these issues, I was advised to report them to VAERS.

Other Meds: Levothyroxine, Bupropion, Fluoxetine, Pravastatin, Vitamin C, Calcium/Magnesium/Zinc, Vitamin D, CoQ10, Refresh Tears

Current Illness: None.

ID: 1750032
Sex: F
Age: 32
State:

Vax Date: 09/30/2021
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:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient said that a few hours after receiving the vaccine, her right lower leg began burning. The pain was on/off and got worse when she would stand. She reported no swelling, redness, or excruciating pain. She will follow up with a physician or a hospital.

Other Meds:

Current Illness:

ID: 1750033
Sex: F
Age: 26
State: AZ

Vax Date: 09/16/2021
Onset Date: 09/17/2021
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: NONE

Allergies: NONE

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Symptoms: Sensitivity to light, nausea, extreme fatigue and migraine that lasted for 4 days. Treatment: OTC Tylenol, BC powder. ( no medications helped. )

Other Meds: Doxycycline 100 mg- For acne

Current Illness: NONE

ID: 1750034
Sex: M
Age: 64
State: KS

Vax Date: 09/18/2021
Onset Date: 09/18/2021
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:

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

Symptoms: Patient said that he received the high dose flu shot in the previous year at his doctor's office and said that this year (as a 64 year old) his doctor recommended he receive the high dose flu shot again. I was unaware that the pharmacist immunization protocol did not allow for vaccinating people under 65 years with the high dose flu shot, even if their doctor recommended they receive it. Patient otherwise had no adverse events from the shot.

Other Meds:

Current Illness:

ID: 1750035
Sex: F
Age: 35
State: AZ

Vax Date: 03/06/2021
Onset Date: 03/12/2021
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: None.

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

Symptoms: I take birth control continuously and don't have to go off of it for five months but on 03/12/2021, I woke up with horrible cramping and heavy bleeding and I had taken my medication every day. I had my last period on 12/18/20. It was so bad that I thought I needed to take another break from medication, and I was cramping really badly. I took a week off of my medication and then went back on it and then on 04/05/2021 I was still taking the medication and had another episode of cramping, heavy bleeding, and clots. At that point I was considering seeing my gynecologist but had an annual visit coming up in June and I also wanted to wait and see if it happened again. It happened again on 05/06/2021 and I saw my Doctor on 06/26/2021 and she asked if it happened in June and it didn't, and she said several patients told her the same thing. I haven't experienced anything weird like that since then. I had weird periods in March, April, and May, and I've been fine since then. My continuous birth control was working just fine and I stopped in August and switched treatments.

Other Meds: Rosuvastatin, Xyzol, Synthroid, liothyronine sodium, Calcium, 1/20 Loestrin, Iron Supplements, B12 Supplement.

Current Illness: None.

ID: 1750036
Sex: M
Age: 51
State: IL

Vax Date: 03/30/2021
Onset Date: 04/01/2021
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: MRI BLOOD WORK

Allergies: NONE

Symptom List: Unevaluable event

Symptoms: FIRST DAY WAS FINE THE NEXT COUPLE OF DAYS I HAD HEADACHES FEVER AND DIZINESS. i WENT TO THE ER AND THEY RAN A COUPLE OF TESTS AND GAVE ME A COUPLE OF MEDICINES. AFTER THAT I MADE A NEUROLOGIST APPOINTMENT AND THEY DID MRI AND EVERYTHING IS FINE BUT I STILL HAVE HEADACHES

Other Meds: ASPRIN, PHEMODIL, ATORVASTAIN

Current Illness: NONE

ID: 1750037
Sex: F
Age: 55
State: AZ

Vax Date: 07/27/2021
Onset Date: 09/23/2021
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: Angiogram Echocardiogram

Allergies: codeine versd iodine

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

Symptoms: Heart attack

Other Meds:

Current Illness: none

ID: 1750038
Sex: M
Age: 59
State: WA

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

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

Lab Data: 9/29-9/30, 2021: Endovascular Thrombectomy (removal of blood clots). One large clot in his brain, and several small clots. High amount of cholesterol in the arteries. Two CAT Scans show small brain bleed at clot site. MRI showed brain tissue death, affecting left side and speech. Ultrasound Heart Scan awaiting results. Blood thickness test continue.

Allergies: List of allergies with hospital and physician

Symptom List: Injection site pain, Pain

Symptoms: Day of vaccine (9/21) tiredness / lack of apatite. Day 2 (9/22) fatigue / weakness. Day 3 (9/23) increased fatigue and nausea - called off work. Day 4 (9/24) continued fatigue - called off work. Day 7 (9/27) numbness in right leg. Day 8 (9/28) weakness. Day 9 (9/29) Stroke symptoms, no feeling entire right side, unable to speak words, collapsed. Taken to Medical Center via ambulance.

Other Meds: List of medications with hospital and physician.

Current Illness: None

ID: 1750039
Sex: F
Age: 39
State:

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: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Pt had a hx of tingling in the tongue, lips ,chest pain and difficulty breathing , given Benadryl & Epipen after 1st dose & sent to ER. Pt .cleared to take the vaccine dose 2 today , Pre-medicated with Benadryl 25 mg & observe for 30 minutes . Pt. was given Benadryl 25 x2.,after feeling tingling of lips , numbness of lips , itchy throat that was relived by 2 dose of benadryl will continue to observe. Continue to feel light itchy all over her body. Pt observed for 15 minutes , D/c home cleared by provider

Other Meds:

Current Illness:

ID: 1750040
Sex: M
Age: 72
State: GA

Vax Date: 09/22/2021
Onset Date: 09/22/2021
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: None.

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

Symptoms: Congestion, muscle pain, joint pain, coughing, dizziness, exhaustion, currently recovering from a stroke.

Other Meds: Synthroid.

Current Illness:

ID: 1750041
Sex: M
Age: 30
State:

Vax Date: 05/26/2021
Onset Date: 09/29/2021
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:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

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: 1750042
Sex: F
Age: 28
State: AL

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: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Latex

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: 13 hours post shot, chills, 102.6 degree fever, throbbing headache, fatigue, injection site pain, and feeling very "heavy". This continued for 12 hours, and throbbing headache continued past other symptoms another 8 hours.

Other Meds: Levothyroxine, Prenatal vitamin, prenatal iron, ashwagandha, sunflower lecithin, prenatal probiotics

Current Illness: None

ID: 1750043
Sex: F
Age: 53
State: CA

Vax Date: 03/20/2021
Onset Date: 03/20/2021
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: NA

Allergies: Trazodone Aspirin Penicillin Erythromycin Hydrocodone QVAR Symbicort Sulera Flonase Minocycline Seafood

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

Symptoms: Pt reports worsening of psoriasis (reports was clear prior to vaccine) and GI upset including emesis

Other Meds: Humira Methotrexate Mirtazapine Alendronate Folic Acid Zolpidem Diclofenac Fluticasone INH Tretinoin topical Vitamin D Sulindac Albuterol INH Clindamycin topical Spironolactone Zyrtec

Current Illness:

ID: 1750044
Sex: F
Age: 39
State:

Vax Date: 03/27/2021
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:

Allergies:

Symptom List: Nausea

Symptoms: PATIENT HAD J&J VACCINE ON 03/27/2021, AND TESTED POSITIVE TO COVID

Other Meds:

Current Illness:

ID: 1750045
Sex: F
Age: 30
State: MN

Vax Date: 06/28/2021
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 COVID-19 Positive

Allergies:

Symptom List: Injection site pain

Symptoms: Breakthrough COVID

Other Meds:

Current Illness:

ID: 1750046
Sex: M
Age: 6
State: NY

Vax Date: 09/16/2021
Onset Date: 09/17/2021
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: NONE

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

Symptoms: Upper right arm became red, painful and swollen to the elbow within the first 24 hours.

Other Meds: NONE

Current Illness: NONE

ID: 1750048
Sex: F
Age: 70
State: MD

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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Background: About two years ago I felt like my heart was pounding. It lasted about 6 weeks. I did see a cardiologist who said I had extra heart beats. This past March 4 , 2021 I had my 2nd Covid shot. About 1-2 weeks later my heart started pounding again. I didn't associate it with the vaccine. I went to cardiologist again who did testing and again said extra heart beats but I am fine. It all lasted about 4-.5 months (hadn't felt it since about end of July or beginning of August). Now, Sept 26 I had Pfizer booster. Three days later after dinner I felt heart pounding. It lasted a few hours but gradually got so it wasn't pounding badly. Woke up fine. After lunch it started again for about an hour.

Other Meds:

Current Illness:

ID: 1750049
Sex: M
Age: 30
State: FL

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

Lab Data: None

Allergies: None known

Symptom List: Tremor

Symptoms: Tingling in left arm moving up to neck area. Throat felt funny. Pale appearing.

Other Meds: Zyrtec

Current Illness:

ID: 1750050
Sex: F
Age: 29
State: NY

Vax Date: 09/27/2021
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: Avelox

Symptom List: Erythema, Pruritus

Symptoms: Within 24 hours of vaccine suffered shortness of breath then next day numbness tingling in injection site shooting down arm, area got extremely red, hot, inflamed and spread through the shoulder region on 9/29/21. Went to an urgent care once it began to spread on 9/30/21 where I was diagnosed with adverse reaction to vaccine product and cellulitis. Was prescribed betamethasone DP AUG 0.05% Cream and Cefadroxil 500 MG capsule for 7 days 2x a day.

Other Meds: None

Current Illness: None

ID: 1750051
Sex: F
Age: 32
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: nka

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

Symptoms: Patient received dose 1 of the Pfizer COVID vaccine (lot FD0809) on 9/8/2021. Patient felt blurry vision and brain fog immediately after injection that resolved in 5min. Patient did not report symptoms to medical staff. Upon return to vaccine POD for 2nd dose, patient reported symptoms to Pharmacist vaccinator who relayed information to PHN. Patient reported no allergies, no medications, no medical conditions. Patient did not follow up with provider after 1st dose. Patient reported eating and drinking fluids prior to vaccination and feeling anxious about COVID vaccine. No previous similar reaction. History of ateriovenous malformation with open brain surgery in 2016 and Cesarean section in 2015. At 1730, vital signs: respirations 16, O2 97%, pulse 84, blood pressure 136/94. PHN texted medical consult to medical team at 1733. PHN received approval for Pfizer 2nd dose with 30min wait at 1737. Patient received dose 2 of the Pfizer COVID vaccine (lot FF8893) at approximately 1750. At 1801, patient reported feeling dizzy and brain fog to Pharmacist. PHN and Paramedic approached to assess. Vital signs: blood pressure 136/92, pulse 84, 99% O2, respirations 18. Patient transferred unassisted to zero-gravity chair and laid supine. Patient reported eating and drinking fluids prior to 2nd dose vaccination. PHN offered Benadryl but patient declined. PHN encouraged patient to stay for 30min monitoring period after report of symptoms, to follow up with provider, and when to call 911. Patient drank water, offered applesauce but patient declined. At 1816, vital signs: blood pressure 126/78, pulse 68, O2 100%, respirations 16. Patient reported symptoms had resolved. Patient sat up, continuing to report no symptoms. At 1810, patient stood up closely monitored by PHN, patient continued to report no symptoms. Patient left walking with steady gait at 1827, patient left against medical advice.

Other Meds: none

Current Illness:

ID: 1750053
Sex: F
Age: 50
State: OH

Vax Date: 06/04/2021
Onset Date: 09/21/2021
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: 2019 Novel Coronavirus RNA specimen collected 9/22/2021

Allergies:

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

Symptoms: hospitalized 9/22/2021. Symptoms include shortness of breath, nausea, fatigue, and abdominal pain.

Other Meds:

Current Illness:

ID: 1750054
Sex: F
Age: 11
State: FL

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: PATIENT HAS NOT HAD ANY SIDE EFFECTS AS OF TODAY.

Allergies: DOG DANDER, CAT DANDER, POLLEN, DUST MITES NO KNOWN DRUG ALLERGIES

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: PATIENT WAS GIVEN PFIZER COVID VACCINE AND IS UNDER 12 YEARS OF AGE

Other Meds: FLUTICASONE-NASAL SPRAY CETIRIZINE

Current Illness: ABNORMAL WEIGHT GAIN 22 POUNDS IN ONE YEAR

ID: 1750055
Sex: F
Age: 65
State: MI

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

Allergies:

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

Symptoms: COMPLAINED OF SWELLING WHERE INJECTED AND ARMPIT THAT ALSO WENT TO RIBS AND BREAST (STARTED MONDAY 9/27/21) - RIBS SWELLING DECREASED ON OWN - HOWEVER SWELLING DID NOT GO DOWN IN ARM OR ARMPIT, NO TREATMENT AS OF YET

Other Meds:

Current Illness:

ID: 1750056
Sex: F
Age: 54
State:

Vax Date: 01/16/2021
Onset Date: 09/29/2021
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:

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

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: 1750057
Sex: F
Age: 41
State: AZ

Vax Date: 03/30/2021
Onset Date: 09/08/2021
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: COVID test - CVS urgent department - walk in - Sept 9th. I think I went to that on Monday and the PCP on Tuesday. COVID test 14th - positive result

Allergies: food allergies - dairy and nuts

Symptom List: Pain in extremity

Symptoms: I had a really severe sore throat and a lot of sinus pressure. I had a super low fever for only a day or two. I lost my sense of smell. I had really, really bad back pain. A little bit nauseous, cough and some shortness of breath. I had a lot of fatigue and still feel really fatigued. I initially tested negative for COVID - I had gotten an antibiotic thinking a strep throat and a sinus infection. But I wasn't getting better, so 3 or 4 days after that, I went to doctor my PCP - because of my cough - I couldn't sleep at night because of it. He retested me for COVID and I tested positive for COVID. He gave me a cough syrup to address the cough. He said I wasn't eligible for the infusion. I still have some symptoms but I'm definitely better. I still have a cough and shortness of breath. I am just starting to get sense of smell back and I feel very fatigued still.

Other Meds: no

Current Illness: no

ID: 1750058
Sex: F
Age: 25
State: ND

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:
Dose Series: 2
Vax Route:
Vax Site:

Lab Data: none

Allergies: NKA

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

Symptoms: approximately 10 minutes after injection reported fullness in head and below eyes, as well as feeling heaviness in her chest. Response was called and as taken to Urgent Care for evaluation by MD.

Other Meds: No meds listed

Current Illness: None listed

ID: 1750059
Sex: F
Age: 48
State:

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

Lab Data:

Allergies:

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

Symptoms: Pt with a PMHx of previous allergic reaction to COVID-19 vaccine on 8/4/21, where pt reported right side throat tightness following vaccine administration and was given benadryl PO which relieved her sx. Pt saw her allergist today, and was given a letter by her allergist clearing her to receive the second dose of the vaccine but rec that the pt be monitored for 30 min following the vaccine. Pt received the second dose of the vaccine at approx 13:20, and was monitored until 13:50. At approx 13:50, pt reported sx of mild right sided throat irritation and requested PO benadryl. Pt was given benadryl 25mg PO. Pt was observed until 2:50pm, at which time she reported "feeling much better" and denied any chest pain, throat pain, throat tightness. Pt was determined to be safe for discharge home

Other Meds:

Current Illness:

ID: 1750060
Sex: F
Age: 68
State:

Vax Date: 12/23/2020
Onset Date: 09/26/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

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

Other Meds:

Current Illness:

ID: 1750061
Sex: M
Age: 50
State: OR

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: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: Na

Allergies: C-Lor, lamictal

Symptom List: Vomiting

Symptoms: I was suppose to receive a flu vaccine and instead received a COVID shot: I already had my two COVID Moderna vaccines and did not require additional COVID shot I had rapid heart rate, fatigue, muscle pain and emotional distress, sleeplessness and anxiety: I have mood swings and depression

Other Meds: Amlodipine 10 mg . Losarten 100 mg , hydrocodone 5/325

Current Illness: None

ID: 1750062
Sex: F
Age: 11
State: CA

Vax Date: 09/24/2021
Onset Date: 09/26/2021
Rec V Date: 09/30/2021
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: 9/26/21 flu test positive, also positive for Rhinovirus, CSF - 141 WBC, glucose 68, protein - 68, CSF culture - neg

Allergies: No

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Encephalitis, started with numbness legs and arms, slurred speech, admitted to hospital recovered in 24 hours back to baseline in 36 hours

Other Meds: No

Current Illness: Abdominal migraines

ID: 1750063
Sex: F
Age: 50
State: MO

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

Lab Data: MRI, scan, labs,

Allergies: Compazine; Codeine

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

Symptoms: Approximately 25 minutes after my second Moderna dose, I was driving home and had to pull over and call 911 due to difficulty breathing and tingling/numbness in my left leg and left arm. An ambulance arrived and gave me BENADRYL on the way to the ER and the redness surrounding the injection site and, on my neck, and chest started to subside. In the ER, I received 125 mg Prednisone and 1 mg ATIVAN to help with the anxiety caused by shortness of breath and dizziness. Within about 20 minutes, my throat felt like it opened up and I could breathe normally. I was released from the ER at around 3pm. I had a follow up appt with PCP. BP and pulse were very high and I was sent to ER. I was given Benadryl, steroids and famotidine. At that point, the whole left side of my face was numb and feeling of pins and needles. I also had dystonic muscle movement. On 3/29/2021 I had a telehealth visit and based on my vitals, I had to go back to the ER. I was admitted and stayed 2 days. They ordered imaging tests, MRI, scan of throat and chest and I was to continue Benadryl and steroids. The MRI showed bulging disc in my neck. The doctor said it could have been from the vaccine. I was released from hospital 3/31/2021. I was instructed to follow up with neurologist and have neurologist look at mri results. I did follow up with neurologist and who said it could be an inflammation reaction from the vaccine. I started physical therapy 3 times a week. I am still having left side neck/ear/arm/hand tingling sensations or it feels hot to the touch. The symptoms are improving but have not resolved.

Other Meds: none

Current Illness: none

ID: 1750065
Sex: F
Age: 88
State: LA

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: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: none

Allergies: amoxicillin, sulfa, nubain, prednisone

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient thought she was getting her third dose of the vaccine, presented to our office without her covid vaccination card, when asked if she was immunicompromised, said yes and she wanted the Moderna shot. We gave her the shot. In inputting the information into the system, we realized her first two shots were Pfizer shots.

Other Meds: Eliquis, Cordorane, levothyroxine, montelukast, Norco

Current Illness: diabetes, htn, hyperlipidemia, arthralgias, constipation

ID: 1750066
Sex: M
Age: 30
State: MN

Vax Date: 04/09/2021
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: RA

Lab Data: SARS CoV-2 RNA Rapid NAA-Positive

Allergies:

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

Symptoms: 9/23/21 Pt developed productive cough, chills, diarrhea, chest discomfort with coughing, nausea, some shortness of breath and bilateral ear aches. Presented to emergency department for evaluation.

Other Meds:

Current Illness:

ID: 1750067
Sex: F
Age: 34
State: IN

Vax Date: 09/24/2021
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: IM
Vax Site: RA

Lab Data:

Allergies: Codeine

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

Symptoms: Intense blood clots and cramping during next menstrual period (3 days later).

Other Meds: Multivitamin

Current Illness: None

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am