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: 1753293
Sex: F
Age: 36
State: NY

Vax Date: 09/13/2021
Onset Date: 09/17/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: Blood work , CTA brain , EKG

Allergies: Tdap, doxycycline , cipro, MRI contrast , levaquin , hydrocodone , morphine

Symptom List: Dysphagia, Epiglottitis

Symptoms: Intractable headache , nausea/vomiting , palpations, blurry vision , jaw pain , nasal bone pain , tachycardia , photosensitivity . Treatment IVF, IV pain medication

Other Meds: Metoprolol , Benadryl

Current Illness:

ID: 1753294
Sex: F
Age: 31
State: VA

Vax Date: 08/25/2021
Onset Date: 08/26/2021
Rec V Date: 10/01/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: EKG, xray of my lungs and bloodwork. And they said it was a reaction to the first shot and if I got another one it could get worse or better or stay the same.

Allergies: NO

Symptom List: Anxiety, Dyspnoea

Symptoms: Sat. Sept 18 I ended up back in the Emergency room. So I was having chest pains again - they did a EKG, xray of my lungs and bloodwork. And they said it was a reaction to the first shot and if I got another one it could get worse or better or stay the same. And then Sept 22nd I went to get the 2nd dose and the Pharmacist did not feel comfortable giving it to me because of the reaction from the first shot. To her it sounded like inflammation of the heart and advised I go see a Cardiologist. I'm still taking the naproxen that they gave me. She said I should come back in 6 months to try again- when I'm off the medications and not currently having chest pains. This past Mon Sept 27th I was diagnosed with COVID.

Other Meds: Elderberry and Citracell fiber - but not the day of the vaccination.

Current Illness: No

ID: 1753295
Sex: F
Age: 73
State: SC

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 10/01/2021
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: None.

Allergies: None

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

Symptoms: Pfizer LOT FF2589, EXP: 03/31/2021, Date Given 09/30/2021, Given 6 months after expiration. Is this dose still effective.

Other Meds: ATORVASTATIN; ZOLPIDEM; LOW DOSE ASPIRIN

Current Illness: None

ID: 1753296
Sex: F
Age: 63
State:

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Extreme body aches and fatigue. Headache, leg and low back pain. Nausea.

Other Meds:

Current Illness:

ID: 1753297
Sex: F
Age: 66
State: PA

Vax Date: 09/29/2021
Onset Date: 09/30/2021
Rec V Date: 10/01/2021
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 erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: fever, chills, and headache

Other Meds: warfarin, simvistatin, metpropol, vitamin D, calcium, Bayer 81mg

Current Illness:

ID: 1753298
Sex: M
Age: 55
State: MI

Vax Date: 05/14/2021
Onset Date: 09/30/2021
Rec V Date: 10/01/2021
Hospital: Y

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:

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

Symptoms: positive covid test 09/30/21 in vaccinated pt w/symptoms

Other Meds:

Current Illness:

ID: 1753299
Sex: F
Age: 48
State: TX

Vax Date: 03/27/2021
Onset Date: 03/31/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: MRI-09/30/2021

Allergies: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: As soon as I received the shot I begin to start shaking, I have been diagnosed with internal tremors. Also I developed shingles, had a rash on my face, and high blood pressure. Numbness in my hand and feet. I was diagnose with muscle deterioration. I have extreme headaches.

Other Meds: Multivitamin

Current Illness: None

ID: 1753300
Sex: M
Age: 58
State: MI

Vax Date: 04/27/2021
Onset Date: 09/28/2021
Rec V Date: 10/01/2021
Hospital: Y

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

Lab Data: rapid test

Allergies: aspirin

Symptom List: Pharyngeal swelling

Symptoms: Positive for COVID

Other Meds: Insulin

Current Illness: Diabetes, lymphoma, melanoma

ID: 1753301
Sex: F
Age: 25
State: MI

Vax Date: 01/25/2021
Onset Date: 01/25/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: none

Allergies: none

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: lump in throat , difficulty swallowing's. Treated with EPi and obsevation.

Other Meds: none

Current Illness: none

ID: 1753302
Sex: M
Age: 59
State: KS

Vax Date: 03/05/2021
Onset Date: 03/07/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: I obtained a consult and full battery of hearing tests from a local ENT. The result of the exam/test revealed a 3% loss if hearing since my last visit. Doctor said he'd been seeing several folks with the same sort of issues following this vaccination.

Allergies: none

Symptom List: Diarrhoea, Nasal congestion

Symptoms: I had a loud buzzing start in my left ear two days following the immunization.

Other Meds: none

Current Illness: none

ID: 1753303
Sex: F
Age: 31
State: TX

Vax Date: 09/11/2021
Onset Date: 09/12/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: None. On-call provider asked for EKG performed with Apple watch, which demonstrated mild ST elevated but monitoring from home recommended.

Allergies: NSAIDs: anaphylaxis

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

Symptoms: Approximately 15 hours after vaccine administration, patient experienced significant, severe, chest pain. Pain was a heavy, crushing pain without a reflux quality. Pain lasted for approximately 28 hours though decreased in severity after about 10 hours. Uncomplicated, low-risk pregnancy of 30 weeks, 3 days at time of vaccine dose. EDD 11/17/2021. No known complications to pregnancy.

Other Meds: LEVOTHYROXINE 50 mcg daily; PRENATAL VITAMIN

Current Illness: None, 30 weeks pregnant with uncomplicated, low-risk pregnancy. Vaccine did not affect pregnancy

ID: 1753304
Sex: F
Age: 53
State: CT

Vax Date: 04/01/2021
Onset Date: 04/10/2021
Rec V Date: 10/01/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data: Anti SSB (Sjogen's) antibodies and ANA positive 30 days after second dose and again positive 3 months after second dose.

Allergies: Wheat, Soy, Avocado, Silicone, Scallops, Lobster

Symptom List: Rash, Urticaria

Symptoms: Swollen Lymph node under left arm pit 24 hours after vaccine. Inflamed Tibial Tendon with severe pain ten days after second dose. Anti SSB (Sjogen's) antibodies and ANA positive 30 days after second dose and again positive 3 months after second dose.

Other Meds: VITAMIN D; VITAMIN K2; FISH OIL; VITAMIN C; METHYL B12 AND FOLATE; MAGNESIUMK PROBIOTICS

Current Illness: None

ID: 1753305
Sex: F
Age: 81
State: WI

Vax Date: 09/29/2021
Onset Date: 10/01/2021
Rec V Date: 10/01/2021
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: N/A

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

Symptoms: Patient states that after receiving the 3rd dose Booster Pfizer 09/29/2021, started experiencing symptoms 10/01/2021 of rash across the back and abdominal area. Primary communications 10/01/2021 suggested self-treating with Benadryl. No other symptoms noted.

Other Meds: N/A

Current Illness: N/A

ID: 1753306
Sex: F
Age: 36
State: MA

Vax Date: 09/01/2021
Onset Date: 09/22/2021
Rec V Date: 10/01/2021
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: BLOOD TEST

Allergies: none

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

Symptoms: , VOMITING / BLOOD CLOTS / INFLAMMATION / ITCHY / BLOOD VAGINAL / VOICE CHANGE AND OTHERS

Other Meds: none

Current Illness: after finish got the vaccines ,i get sick, Blood ck and inflammation all my body from my face to my toes

Date Died: 09/13/2021

ID: 1753307
Sex: F
Age: 68
State: KY

Vax Date: 03/05/2021
Onset Date: 08/24/2021
Rec V Date: 10/01/2021
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: COVID infection. Specimen collected on 8/24/21 (per ED notes). Patient died on 09/13/21.

Other Meds:

Current Illness:

ID: 1753308
Sex: F
Age: 65
State: CO

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: None.

Allergies: Cherries, Pineapple, Lemons, Limes, Tomatoes, Gluten

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

Symptoms: On 9/28/2021 mild headache at 3:30pm, balance wobbly, extreme headache, muscle aches all over body at 7:30pm;, and fever at 11pm. On 9/29/2021 extreme body aches, 102 fever all night, hot flashes, night sweats then chills, and very cold. Bad headache and balance wobbly. Did not sleep much since my body ached so bad, even my toe nails hurt. On 9/30/2021 morning felt 95% better with just a touch of wobbly balance and light headedness, but continued to improve throughout the day. The night of 9/30 I had a horrible nightmare about losing my grandson. Hardly ever do I have nightmares.

Other Meds: TYLENOL

Current Illness: None

ID: 1753309
Sex: F
Age: 37
State: DE

Vax Date: 09/30/2021
Onset Date: 10/01/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: None at this time, will be calling provider if pain persists.

Allergies: None

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

Symptoms: Severe menstrual like pain. The pain started shortly after the injection, but severe pain this morning (10 days into menstrual cycle).

Other Meds: None

Current Illness: None

ID: 1753310
Sex: F
Age: 31
State: NE

Vax Date: 09/07/2021
Onset Date: 09/11/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data:

Allergies: PENCILLIN and BACTRIM antibiotics

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Itchy eyes, congestion, night sweats, extreme fatigue for 1 week, loss of taste, and smell on 9/18/21.

Other Meds: MULTIVITAMIN and VITAMIN D

Current Illness: None

ID: 1753311
Sex: F
Age: 84
State: NE

Vax Date: 09/26/2021
Onset Date: 09/27/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data:

Allergies: None.

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Weak, fever, fatigue.

Other Meds: Lipitor, Vitamins.

Current Illness:

ID: 1753312
Sex: F
Age: 72
State: NY

Vax Date: 09/25/2021
Onset Date: 09/26/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data:

Allergies: MACROBID; PERCOCET; AMBIEN; IVP dye

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

Symptoms: Woke up at 3:00 AM next morning with severe chills, fever of 102, achy, and headache. Chills went away later that morning but fever continued ranging from 102 down to 101, 100.8. Still was very achy with headache, and stayed in bed all day. Similar reaction the following day (day two after injection). Fever not as high ranging from 100.4 - 101.1. Remained in bed again that day. Very little to eat but tried to push water. Took Tylenol both days about every 6 hours for fever. Day 3 fever gone, not very achy or headache, but very weak and had to limit activity most of day.

Other Meds: CRESTOR; FISH OIL; VITAMIN D; PROBIOTIC

Current Illness:

ID: 1753313
Sex: F
Age: 45
State: IN

Vax Date: 09/29/2021
Onset Date: 09/30/2021
Rec V Date: 10/01/2021
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: No allergies

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

Symptoms: Fever up to 102.0, extreme body aches, fatigue, nausea, vomiting---12hrs post injection that persisted for 36 hours.

Other Meds: Effexor Emgality

Current Illness: None

ID: 1753314
Sex: F
Age: 30
State: OH

Vax Date: 09/11/2021
Onset Date: 09/12/2021
Rec V Date: 10/01/2021
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: Heart palpitations, weakness, extreme fatigue, cramping, period messed up, and bleeding.

Other Meds: SYNTHROID; ADDERALL; NIKKI BIRTH CONTROL

Current Illness:

ID: 1753315
Sex: M
Age: 54
State: MA

Vax Date: 09/01/2021
Onset Date: 09/01/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data:

Allergies: NKDA

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

Symptoms: numbness and tingling to left side of face. No facial droop. No tongue swelling or throat closing

Other Meds: omeprazole 40mg

Current Illness: no

ID: 1753316
Sex: M
Age: 13
State: CT

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: No

Allergies: NKA

Symptom List: Injection site pain, Pain

Symptoms: Client received first dose of Pfizer on 8/20/21 Lot # FD8448. Today client received a dose of Moderna Lot # 033C21A. No symptoms observed while waiting the 15 minutes. The patient's father was present with son. The patient's father was informed of incident and was advised to contact us with any changes in symptoms or other concerns.

Other Meds: Unknown

Current Illness: No

ID: 1753317
Sex: M
Age: 60
State: MN

Vax Date: 05/19/2021
Onset Date: 09/25/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Injection site pain, Menorrhagia

Symptoms: Fever, loss of taste, loss of smell, headache, deep cough, and body aches, starting on 9/25/21.

Other Meds: ATORVASTATIN; SERTRALINE; L-ARGININE; OMEPRAZOLE; TRAZODONE

Current Illness: None

ID: 1753318
Sex: F
Age: 40
State: NY

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 10/01/2021
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: I started to feel very weak around 8:30 pm the night of the shot. I went to bed to wake up at 3 am in chills and panic. My body was on fire. My husband got up and took my temperature which was 103.9! He gave me Tylenol which i also took right before going to bed. I woke up again at 7 am with 103.3. With another dose of Tylenol and Advil, the whole day my fever would not break. It remained at 102.8. The following night i woke the same way with 102.9. Today is the third day and still woke up with a fever and severe body aches and headache.

Other Meds:

Current Illness:

ID: 1753319
Sex: M
Age: 29
State: CA

Vax Date: 03/24/2021
Onset Date: 03/28/2021
Rec V Date: 10/01/2021
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: All tests coming back mostly normal

Allergies: None

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: 05/2020 - Umbilical hernia repair (no mesh) and appendectomy. Smooth surgery, smooth recovery, no issues at all except hernia recurring 6 weeks later. 12/2020 - Covid. I had fever, cough, horrible headache, loss of taste/smell, etc. Negative covid test, wife tested positive. I?m 100% sure I had it and I had a false negative. Recovered fully from what I could tell in about 2-4 wks. Mid 03/2021 - 2nd Pfizer vaccination. A few days later - playing tennis with a friend. Not overly warm out (maybe 80-85 degrees no humidity). Had to stop mid game because i felt like I absolutely could not catch my breath and i felt like a slight pain in my chest. Had an EKG done a week later and it was fine. Early 04/2021 - Step-father inlaw passed away pretty unexpectedly. 04/13/2021 - Hernia repair (mesh used). I was totally fine, not concerned at all before the surgery. Woke up in the recovery room in a panic, couldn?t breathe. I remember gasping for air. They were able to stabilize me I guess? Sent me home that day and I only really remember a couple things the rest of that day, and I think I was fairly normal. 04/14/2021 - When everything really went to shit. Every 6 hours after the 10am surgery the previous day I was taking 5mg of oxycodone. On the 5th and final dose that I took at around 4:30p, I went into a serious panic attack with horrible like air hunger/shortness of breath. Went to the ER said all my vitals and stuff were fine and sent me home. Had another panic attack I think later that night. I remember like my head just feeling like immense pressure, and my mind doing/seeing things it never had before. Like I was just seeing stars and I for sure felt like I was going to die. Eventually I was able to fall asleep around 3am. Had continued air hunger/shortness of breath every day around the clock for the next two months. Constantly felt like I wasn?t getting enough air. I think the lowest my O2 went to was 90 or 91. Another panic attack early May. Which was when I stopped working. Late 05/2021 - Went to a psychiatrist and was given Zoloft. Took for 4 or 5 days. Didn?t sleep for 4 days straight. Early 06/2021 - Between the insomnia and suicidal thoughts I asked my family to get me some help. I was tired and delirious and having some intense frequent thoughts about hurting myself. I?ve never had thoughts like these ever before. Discontinued Zoloft while I was in the ER. Early 06/2021 - ER sent me to a mental hospital for a 72 hour hold. This was hands down the worst experience and time of my life. I received no help at all while I was there and it felt like I was in prison. They tried giving me a few different pills and none helped. I got about 12 hours combined of sleep while I was there. 06/10/2021 - Went to this mental health outpatient treatment facility. Was absolutely reeling at the time. Most of the people there were nice but had radically different backgrounds I had (abusive or completely dysfunctional home), and it was obvious that all of their problems were rooted in their families. Now my family isn?t perfect, but I?ve always had 100% loving parents. Didn?t find the program very helpful. 6/15/2021 - Started on Prozac 10mg, went up to 20mg. At this time I absolutely couldn?t do anything (most days for the previous 2 weeks prior to this I sat in one spot and had no desire to do anything, it was the worst feeling ever). Late 06/2021 - Psych told me to go up to 40mg of Prozac. Nearly got serotonin syndrome, went to urgent care and went back down to 20mg. Mid 07/2021 - Went back to home with my mom and wife. Late 07/2021 - titrated up to 30mg because 20mg didn?t seem to be doing much. Early 08/2021 - Stumbled upon a r/covidlonghaulers sub-Reddit and discovered that all this shit seems to be covid related. The only differences between my surgery last year and this year from a biological standpoint was the mesh and having gotten covid in 12/2020. Early 08/2021 - moved to the mountains with my wife and her mom. A week later - evacuated from our house for 3 weeks because of wildfires. Mid 09/2021 - evac lifted went back to our house. Late 09/2021 - family decided I should come back home for a little while. List of symptoms throughout all of this (bolded are the ones still lingering to this day): Constant headaches. Sleep problems / chronic insomnia (never had a problem with sleeping in my life prior to all of this). Earlier on in April, May, June I?d get either brain zap feelings or a shot of adrenaline that would jolt me awake when I was trying to fall asleep. For a long time it was hard to get to sleep and stay asleep. Thankfully now it?s easier to fall asleep, but I usually wake up 3-6x per night. Difficulty Breathing (this mostly went away in June). Dissociation/Derealization/Depersonalization; Dizziness; Hand Tremors (I have a video I can text if you?d like); Anhedonia; General brain fog; Difficulty thinking; reading; concentrating; forgetfulness; nausea and appetite loss; Acid Reflux; Chest pain/tightness/discomfort (few EKG?s, a CT of my chest and an echo done. All show my heart/lungs are fine) Palpitations every so often Orthostatic / Tachycardia problems (BP drops 20-30 systolic when I go from laying down to standing and 10-15 diastolic). Heart rate usually goes up by 25+, (usually from 70 ish to 100ish); Disorientation (especially after sleep) Low energy most of the time, but I can do almost all tasks without any physical inabilities; Difficulty exercising and honestly maybe PEM; Exercising makes me feel shitty. I recently (late september) did a kind of test where I cycled for 30 mins one day. The next day I felt horrible. A little over 24 hours later I was absolutely balling for about 20-30 mins. Muscle twitches; Anxiety/PTSD/Depression/Intrusive thoughts; Body aches; Muscle soreness or stiffness with minimal activity; No pre-existing physical or mental health issues.

Other Meds: None

Current Illness: None

ID: 1753320
Sex: F
Age: 71
State: VT

Vax Date: 03/31/2021
Onset Date: 04/07/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: pulmonary test, oxygen prescribed, pulmonary rehab

Allergies: none

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Ability to breath diminished almost 50% from where it was prior to vaccination.

Other Meds: metoprolol er succinate 50 mg pravastatin 20mg omeprazole 20mg trelogy 100 multi-vitamin

Current Illness: none

ID: 1753321
Sex: M
Age: 47
State: MO

Vax Date: 08/18/2021
Onset Date: 08/18/2021
Rec V Date: 10/01/2021
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: None

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

Symptoms: After receiving shot I returned to car with wife to wait 15 minutes before leaving. After being in the car for 10 minutes I became very sweaty and my extremities started to tingle. At that point, my wife observed me going ridged. My wife tried to communicate to me since my eyes were open but I was non-responsive. She ran inside and brought medical works to the car. When workers arrived I became responsive and went inside with the works. The works diagnosed the event as a seizure, held me for observation and took vitals. All vitals were normal. I have not reported it till now, because I have passed out giving blood before and it seem very similar. However, multiple medical personnel encouraged me to report since passing out giving blood is immediate and not correlated with a seizure.

Other Meds: MULTIVITAMIN; STATIN

Current Illness: None

ID: 1753322
Sex: M
Age: 58
State: CA

Vax Date: 03/19/2021
Onset Date: 04/04/2021
Rec V Date: 10/01/2021
Hospital: Y

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

Lab Data:

Allergies: Cephalosporins

Symptom List: Nausea

Symptoms: A flutter

Other Meds:

Current Illness:

ID: 1753323
Sex: M
Age: 34
State: OH

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: N/A.

Allergies: SULFA and PENCILLIN

Symptom List: Injection site pain

Symptoms: Within 2 minutes of administering Pfizer covid vaccination patient expressed that his throat felt very dry and he feels like his throat is closing a little. Patient was given Allegra 60 mg 1 tablet per standing orders. Patient was talking to nursing staff the entire time. After administration of Allegra patient expressed that he felt better. He was talking the entire time of his observation with nursing staff.

Other Meds: ZYRTEC; CIPRO; and ALLEGRA

Current Illness: N/a

Date Died: 09/28/2021

ID: 1753324
Sex: M
Age: 56
State: MI

Vax Date: 04/08/2021
Onset Date: 09/09/2021
Rec V Date: 10/01/2021
Hospital: Y

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

Lab Data:

Allergies: CatsAsthma/Shortness of Breath DogsAsthma/Shortness of Breath PenicillinsNausea Only, Rash

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

Symptoms: Patient has expired / died (9.28.21); Hospitalized (9.15.21); COVID positive (9.9.21); fully vaccinated Discharge Provider: Admission Date: 9/15/2021 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: COVID-19 virus infection [U07.1] COVID-19 [U07.1] Acute respiratory failure with hypoxia [J96.01] Acute respiratory failure due to COVID-19 [U07.1, J96.00] HOSPITAL COURSE: Patient is a 57 year old with asthma, MS (ocrelizumab q 6 months), tobacco abuse (30pkyr), and congenitally absent left kidney. He was COVID (+) 9/9 (was vaccinated in the spring). He presented 9/15 with 10 days cough/SOB/fevers. In the ED, he was hypoxemic and would desaturate with activity. CXR showed patchy bilateral opacities. He was admitted and treated with Decadron, remdesivir, and empiric antibiotics. On 9/18, he was transferred requiring HFNC/NRB. On 9/19, he required intubation, NMB (until 9/22), and proning (until 9/21). Doppler US 9/20 showed acute right IJ and right SC DVTs. He was extubated 9/26 and initially tolerated low-flow NC oxygen but was profoundly weak. He decompensated requiring BiPAP. He had been made DNR by family then comfort measures. He passed away on 9/28 while this attending was off service and at home Date of Death: 9/28/21 Time of Death: 8:07 PM Preliminary Cause of Death: Acute respiratory failure due to COVID-19

Other Meds: acetaminophen (TYLENOL) 500 MG tablet albuterol (PROAIR HFA) 108 (90 BASE) MCG/ACT inhaler ALPRAZolam (XANAX) 0.5 MG tablet aspirin 81 MG chewable tablet CALCIUM PO CANNABIDIOL PO Cholecalciferol (VITAMIN D-3 PO) CRANBERRY PO Dalfampridine

Current Illness: 9.2.21 - office visit - annual physical - MS, HTN, asthma, polyps, knee pain, difficulty walking / cold legs Symptoms started 9.5.21. COVID-19 positive 9.9.21 (weak, coughing, difficulty walking)

ID: 1753325
Sex: M
Age: 70
State: VA

Vax Date: 03/18/2021
Onset Date: 03/25/2021
Rec V Date: 10/01/2021
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:

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

Symptoms: Pt states he had COVID in January and was in the hospital for 2 weeks. He also stated that a week after receiving the vaccine, he had a mental break. He was taken to Medical facility. He spent another 2 weeks in the hospital.

Other Meds:

Current Illness: Pt stated he had COVID in January. Was hospitalized for 2 weeks

ID: 1753326
Sex: M
Age: 58
State: GA

Vax Date: 08/17/2021
Onset Date: 08/18/2021
Rec V Date: 10/01/2021
Hospital: Y

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

Lab Data: unknown

Allergies: sulfa

Symptom List: Tremor

Symptoms: CVA/Stroke: patient noticed loss of speech during conversation alerting the need for medical attention. Patient was treated inpatient at the local medical center. Patient has partially recovered has difficulty with speech in stressful situations and paralysis on left side of his face.

Other Meds:

Current Illness:

ID: 1753327
Sex: F
Age: 44
State: NY

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 10/01/2021
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: At time of vaccination patient declined any allergies or history of reaction to vaccines, After the patient received her dose and stared to develop redness/itching of her chest, she stated that she might have gotten slightly itchy with her second dose of pfizer vaccine. Later she said she also sometimes gets itchy after eating eggs.

Symptom List: Erythema, Pruritus

Symptoms: Patient got her pfizer vaccine and developed redness and itching on her chest 15 minutes after. She said her face felt slightly itchy as well. She was given 2 tablets of diphendydramine 25 mg. Her symptoms did not progress. She was monitored for a half hour then returned home. No addition medical intervention was given.

Other Meds:

Current Illness: na

ID: 1753328
Sex: F
Age: 72
State:

Vax Date: 03/12/2021
Onset Date: 04/20/2021
Rec V Date: 10/01/2021
Hospital: Y

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: 04/20/21 CoVID-19 by NAA DETECTED 05/01/21 CoVID-19 by NAA NOT DETECTED

Allergies:

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

Symptoms: Unsure why pt. was tested on 04/20; on 05/01/21 tested for surgical procedure; pt. admitted for a scheduled transfemoral aortic valve replacement.

Other Meds:

Current Illness:

ID: 1753329
Sex: F
Age: 41
State: WA

Vax Date: 09/12/2021
Onset Date: 09/16/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: Medical appointment with Internal Medicine Physician 9/20, MRI of neck 9/20, Medical appointment with Primary Care Physician, Future appointments scheduled with Neurologist 10/26, and EMG appointment 12/15.

Allergies: Allergies to wheat, soy, dairy, corn, tomatoes, eggs, citrus; Allergies to nearly all animals (rabbit, horse, dog, cat, guinea pig)

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

Symptoms: On Thursday 9/16 started experiencing left eye twitch, tremor, right and left arm numbness, lower leg and feet numbness, and feeling of numbness down neck wrapping into diaphragm area.

Other Meds: HYDROCHLOROTHIAZIDE; VITAMIN D3; ZINC; MAGNESIUM; PROBIOTIC; and MULTIVITAMIN.

Current Illness: NONE

ID: 1753330
Sex: M
Age: 76
State: MI

Vax Date: 05/13/2021
Onset Date: 09/27/2021
Rec V Date: 10/01/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Hospitalized Breakthrough case

Other Meds:

Current Illness:

ID: 1753331
Sex: M
Age: 31
State:

Vax Date: 09/29/2021
Onset Date: 09/30/2021
Rec V Date: 10/01/2021
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: None

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

Symptoms: Fever, chills, headache, sleeplessness Noticed symtoms the morning following vaccine and they subsided around 36-48 hours after

Other Meds: None

Current Illness: None

ID: 1753332
Sex: F
Age: 91
State: WI

Vax Date: 09/29/2021
Onset Date: 09/30/2021
Rec V Date: 10/01/2021
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: Fever began on 9/30/2021 at 0426 of 99.4. Throughout the day of 9/30/2021 continually increased to 103.0 at 2120. Given tylenol and fever has subsided. 10/1/2021 at 0823 98.1.

Other Meds:

Current Illness:

ID: 1753333
Sex: F
Age: 33
State: GA

Vax Date: 03/18/2021
Onset Date: 07/18/2021
Rec V Date: 10/01/2021
Hospital: Y

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

Lab Data: Esophageal scope by ENT to confirm laryngomalacia. Sleep study to confirm obstructive and central apnea.

Allergies: Amoxicillin

Symptom List: Pain in extremity

Symptoms: My baby was diagnosed with laryngomalacia and central and obstructive apnea, conditions common for premature babies, but she was born full term at 39 weeks 3 days (by measurement at 6 wk scan and 39 weeks 6 days by what?s actually possible given the date of positive pregnancy test). She weighed 7lbs 8oz at birth. No pregnancy complications . Traumatic birth (left bruising and broken blood vessel in eye) but no recorded birth injury. Baby was seemingly born stunned but had normal APGAR score by 1 minute. Note, I started to fill out the TDap vaccine but the date was after the COVID vaccine and the form doesn?t let me change it to no vaccines within a month of first Pfizer dose. The TDAP was administered to me at 30 weeks pregnant to ensure 2 weeks after second Pfizer dose. I received TDap on 5/14/21, but I put 03/01/2021 on this form as the date just so I could finish and submit the form. It won?t let me delete the entry.

Other Meds: Ritual Prenatal Vitamin, collagen supplement At time of positive pregnancy test: generic of Pristiq Vaccine during pregnancy: TDAP at 30 weeks gestation

Current Illness: None

ID: 1753334
Sex: F
Age: 58
State: KY

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: CBC and Metabolic Panel ED Provider Notes MD at 9/29/2021 11:51 PM Chief Complaint Patient presents with ? Other family said pt was "convulsing" in bed and SOB. Had second COVID and flu shot today The patient is a 58-year-old female who presents by squad for evaluation of shaking. She tells me that she got an influenza immunization in her right arm and the COVID-19 booster shot in her left arm. This is her third COVID-19 vaccine. She has not had COVID-19 infection in the past. She got the shots at 11:00 this morning. She states that she was fine all day with exception of some soreness in her arms from the immunizations. She went to take the dog for a walk this evening and felt like her right leg locked up. She describes that she couldn't flex or extend very well, but nonetheless got back into the house. She states that she started having coarse shaking of both arms and both legs. The paramedics described that she was awake, alert and talking, but having shaking of both her upper and lower extremities. Eventually she stopped shaking. She denies having a fever today, but feels cold. She did not have any previous reactions to her first 2 COVID-19 vaccines. She currently feels much better. She states that she has never had a panic attack before and has not been under a lot of stress today. Patient History No Known Allergies Home Medications: Prior to Admission medications Not on File Past Medical History: Past Medical History: Diagnosis Date ? Renal stones Social History: reports that she has never smoked. She has never used smokeless tobacco. She reports current alcohol use. She reports being sexually active and has had partner(s) who are male. She reports that she does not use drugs. E-Cigarettes (such as Vapes or Juul) Family History: Family History Problem Relation Age of Onset ? Cancer Mother colon ? Cancer Maternal Grandmother lung ? Cancer Maternal Grandfather lung ? Cancer Maternal Aunt breast ? Diabetes Paternal Grandmother Surgical History: Past Surgical History: Procedure Laterality Date ? OTHER SURGICAL HISTORY 6/21/11 No surgeries Review of Systems Review of Systems All other systems reviewed and are negative. Physical Exam There were no vitals taken for this visit. Physical Exam Vitals and nursing note reviewed. Constitutional: General: She is not in acute distress. Appearance: She is well-developed. HENT: Head: Normocephalic and atraumatic. Eyes: Conjunctiva/sclera: Conjunctivae normal. Pupils: Pupils are equal, round, and reactive to light. Cardiovascular: Rate and Rhythm: Normal rate and regular rhythm. Heart sounds: No murmur heard. No friction rub. No gallop. Pulmonary: Effort: Pulmonary effort is normal. Breath sounds: Normal breath sounds. Abdominal: General: There is no distension. Palpations: Abdomen is soft. Tenderness: There is no abdominal tenderness. Musculoskeletal: General: Normal range of motion. Cervical back: Normal range of motion

Allergies: NA

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

Symptoms: At approximately 9:30pm I became chilled and experienced overall body ache. Later when taking my dog out my right leg locked up and once I got into bed I began convulsing, could not breath and was unable to communicate with my husband. Initially the paramedics felt it was a panic attack. Vital signs, CBC and Metabolic panel showed no abnormal results. Medical Center ER doc also initially indicated he also suspected a panic attack, however conceded it was possibly an adverse reaction. I spent 9-31-2021 resting and on 10-1 feel back to normal. I do not believe it was a panic attack. After the first dose of the Pfizer vaccine (EL9269) I was aware of underarm gland swelling. Now after the third dose it is more pronounced.

Other Meds: NA

Current Illness: NA

ID: 1753335
Sex: F
Age: 53
State: MD

Vax Date: 09/09/2021
Onset Date: 09/25/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: I just woke up bruises all over my body. I haven't treated it yet.

Other Meds: None

Current Illness: None

ID: 1753336
Sex: F
Age:
State: CO

Vax Date: 09/30/2021
Onset Date: 10/01/2021
Rec V Date: 10/01/2021
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: Migraine headache in the evening- same day as the shot Bone & joint aches, moderate fatigue, mild muscle weakness - the day after getting the shot

Other Meds: Aderrall CBD topical cream Ibuprofin

Current Illness: None

ID: 1753337
Sex: M
Age: 33
State:

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 10/01/2021
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: Patient had a n episode of syncope approximately 10 minutes after injection. Evaluated and released

Other Meds:

Current Illness:

ID: 1753338
Sex: F
Age: 73
State: IN

Vax Date: 09/29/2021
Onset Date: 09/30/2021
Rec V Date: 10/01/2021
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:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Flu like symptoms. Total fatigue, head felt thick or foggy, aching all over

Other Meds:

Current Illness: None

ID: 1753339
Sex: M
Age: 30
State: OH

Vax Date: 09/29/2021
Onset Date: 09/30/2021
Rec V Date: 10/01/2021
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: Basic Metabolic Panel. Card ENZ CBC with differential. D-Dimer Differential Erythrocyte sedimenation rate ECG DIAG-Portable Chest Doctor confirmed all results were good.

Allergies: None

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

Symptoms: I had trouble all day. In the morning, my shoulder where the shot was administered, I couldn't lift my 19 month old out of her crib. Checked my heart rate, and it was at 130 with O2 at 97%. Shoulder then got better throughout the day, but then my knees felt like they were 87 years old. I had a major headache all day and felt like I was having an asthma attack all day as my chest was tight. After I went to a doctor visit (heart rate at 115 and O2 at 96%), I came home, sat on the couch and picked up my youngest daughter and my heart started racing. I felt cold and was wanting to sleep. I put my daughter down and checked heart rate - 150 and O2 at 96%. I felt like I was working out, but was not moving at the time. This lasted for 20 or so minutes and had to call ambulance. On the way to hospital, heart rate flucuated from 120 to 95. Again, not doing anything except sitting in the ambulance. At the moment, my heart rate has been at a steady 100-110. Before, my resting heart rate was 60.

Other Meds: Vitamins.

Current Illness: Covid on 09/06/2021

ID: 1753340
Sex: F
Age: 70
State: AL

Vax Date: 09/01/2021
Onset Date: 09/29/2021
Rec V Date: 10/01/2021
Hospital: Y

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

Lab Data: 9/29 CTA of chest: Saddle type pulmonary thromboembolism with large burden primary, lobar, and segmental distribution PTE.

Allergies: Chlorothiaxide, Hydrocholorothiazide, lisinopril, valsartan

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Saddle PE

Other Meds: Amlodipine, Vitamin D3, Lexapro, Neurontin, metoprolol succinate

Current Illness: None except for chronic disease states

ID: 1753341
Sex: F
Age: 65
State: VA

Vax Date: 03/11/2021
Onset Date: 03/12/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: none

Allergies: cephalosporin

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

Symptoms: Burning of back, from the neck to the upper hips, took a nap; stayed in bed all day. Felt fine the next day. Felt like my back was burning similar to a burn from hot water. Took anti inflammatory FOODS for the next 28 days to prepare for next injection. Next injection was normal compared to the first. Did not have a Physician to consult, so just toughed it out. Glad I survived !!

Other Meds: none

Current Illness: none

ID: 1753342
Sex: M
Age: 65
State: KY

Vax Date: 04/01/2021
Onset Date: 09/24/2021
Rec V Date: 10/01/2021
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: resembled sinus infection

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am