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: 1758996
Sex: F
Age: 15
State: NJ

Vax Date: 09/15/2021
Onset Date: 09/15/2021
Rec V Date: 10/04/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

Date Died: 07/31/2021

ID: 1758997
Sex: M
Age: 67
State: GA

Vax Date: 02/01/2021
Onset Date: 07/31/2021
Rec V Date: 10/04/2021
Hospital:

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

Lab Data: Report of Examination, Office of the Medical Examiner, Department of Health, 30 Aug 2021

Allergies: None

Symptom List: Anxiety, Dyspnoea

Symptoms: Death.

Other Meds:

Current Illness: None

ID: 1758998
Sex: M
Age: 34
State: NE

Vax Date: 09/20/2021
Onset Date: 09/23/2021
Rec V Date: 10/04/2021
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: Bloodwork. Visited with Neurologist. Follow up appointment on 12th. Waiting on phone call explaining bloodwork.

Allergies: C-Clore and Vantin

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

Symptoms: Numbness started in Right big toe. Numbness spread to other toes and into hands and right side of face. Felt like extremities were asleep. Most numbness has went away, but some numbness still exists in the right big toe.

Other Meds: N/A

Current Illness: None

ID: 1758999
Sex: M
Age: 26
State: CA

Vax Date: 09/21/2021
Onset Date: 09/21/2021
Rec V Date: 10/04/2021
Hospital:

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

Lab Data: none

Allergies: none

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: The night of vaccination I had a fever of 100 degrees, chills, body aches, and headaches that lasted for 2 days. I was also vomiting. I wasn't able to eat. I was feeling nauseas and dizzy. I was also experiencing a faster heart rate at night, but by the next day it stopped. I called the Student Health Center, and they prescribed me with ibuprofen 400mg, Tylenol 650mg, Pantoprazole 20mg, and Domperidone 10mg. I was fine 2 days later.

Other Meds: Told to take Tylenol after vaccine was given, if needed.

Current Illness: none

ID: 1759000
Sex: M
Age: 81
State: MO

Vax Date: 03/02/2021
Onset Date: 07/22/2021
Rec V Date: 10/04/2021
Hospital: Y

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

Lab Data: Case disclosed that he did have x-rays during his hospitalization.

Allergies: none

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

Symptoms: Case felt weak and fatigued. Went to hospital and tested positive for Covid-19. Hospitalization at Medical Center was 7/22/21 through 8/2/21. Case did not know if Covid-19 was primary reason for hospitalization. His diabetes was stabilized, and he was treated for low blood pressure.

Other Meds: treatment for insulin-dependent diabetes

Current Illness: none

ID: 1759001
Sex: F
Age: 55
State:

Vax Date: 03/03/2021
Onset Date: 03/24/2021
Rec V Date: 10/04/2021
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:

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

Symptoms: 3 weeks later unable to walk

Other Meds: blood pressure meds

Current Illness:

ID: 1759002
Sex: F
Age: 52
State: MA

Vax Date: 02/17/2021
Onset Date: 05/22/2021
Rec V Date: 10/04/2021
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: covid positive test on 5/22/21 chest x ray on 5/22 showed bibasialr mild opacities, may represent atelectasis though would correlate for pneumonia.

Allergies: no known allergies

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient presented to BWH ED on 5/22/21 with 10 days of malaise in the setting of known covid 19 infection. Patient was fully vaccinated. Patient was treated for covid 19 and got discharged on 5/27/21.

Other Meds: calcium carbonate, trikafta, prednisone

Current Illness: Not applicable

ID: 1759003
Sex: F
Age: 71
State: MA

Vax Date: 09/29/2021
Onset Date: 09/30/2021
Rec V Date: 10/04/2021
Hospital:

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

Lab Data: None

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: I received the first shot March 6, 2021. I was sick the whole next day. I received my second shot on April 3, 2021. I was sick for 3 days after that one. I had swollen glands that lasted for 2-3 weeks. I got my third shot on September 29, 2021 and I was sick for just over 3 days. I had severe muscle aches starting in early morning after the shot that lasted about 2 days. I had swollen glands on the collarbone on the injection side. I had chills , fevers and weakness for almost 4 days during that time I slept in my winter coat under my bedcovers. When I got out of bed I felt dizzy. I couldn?t eat for the first 3 days. I had severe headaches for the first 2 days after the shot.

Other Meds: Methotrexate, Celebrex, folic acid, hydrochlorothiazide, atorvastatin, multi-vitamin, vitamin D, Calcium

Current Illness:

ID: 1759004
Sex: M
Age: 45
State: NJ

Vax Date: 09/15/2021
Onset Date: 09/15/2021
Rec V Date: 10/04/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1759005
Sex: M
Age: 80
State: MO

Vax Date: 02/10/2021
Onset Date: 07/17/2021
Rec V Date: 10/04/2021
Hospital: Y

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

Lab Data: unknown

Allergies: unknown

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Developed symptoms associated with Covid-19 on 7/17/21, including fever, cough, runny nose, congestion, poor appetite, fatigue, chills. He was hospitalized at Medical Center from 7/27/21 to 7/30/21.

Other Meds: unknown

Current Illness: unknown

ID: 1759006
Sex: M
Age: 62
State: WA

Vax Date: 08/20/2021
Onset Date: 09/20/2021
Rec V Date: 10/04/2021
Hospital:

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

Lab Data: None

Allergies: None

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

Symptoms: Skin rash on back, stomach, and arms.

Other Meds: Zinc, Vitamin C, Vitamin D, & Multivitamin

Current Illness: None

ID: 1759007
Sex: F
Age: 76
State: PA

Vax Date: 02/12/2021
Onset Date: 09/06/2021
Rec V Date: 10/04/2021
Hospital: Y

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

Lab Data: Updated Procedure 09/13/21 0725 Respiratory virus detection panel Collected: 09/13/21 0544 | Final result | Specimen: Swab from Nasopharynx Adenovirus Not Detected Mycoplasma pneumoniae Not Detected Chlamydophila pneumoniae Not Detected Parainfluenza Not Detected COVID-19 SARS-CoV-2 Overall Result Detected Critical Enterovirus/Rhinovirus Not Detected Coronavirus Not Detected Respiratory Syncytial Virus Not Detected Influenza A Not Detected Bordetella pertussis Not Detected Influenza B Not Detected Bordetella parapertussis Not Detected Metapneumovirus Not Detected Procedure Component Value Ref Range Date/Time X-ray chest 1 view, Portable Resulted: 09/13/21 0842 Order Status: Completed Updated: 09/13/21 0842 Narrative: XR CHEST 1 VW PORT IMPRESSION: Peripheral right upper lobe mildly consolidated infiltrate. Somewhat rounded mildly consolidated right lower lung infiltrate. Patchy infiltrates at the left base. Nonspecific but could reflect COVID-19 infection. END OF IMPRESSION: INDICATION: Shortness of breath. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 6/29/2021. FINDINGS: There is no acute widening or shift of the mediastinum and the heart size is top normal. Pacemaker leads are present in the area of the right atrium and right ventricle and there is a defibrillator lead. There is a mild area of consolidation in the right upper outer lung bordering the fissure. There is another rounded infiltrate in the right lower lung measuring about 4 cm. There are patchy increased markings along the left heart border. There is no effusion. Since the patient is COVID positive it is likely these are related to COVID areas of infection/pneumonia but the appearance is nonspecific and may reflect infectious etiology of another atypical source. Follow-up to resolution recommended.

Allergies: LisinoprilOther (document details in comments) PenicillinsRash, Other (document details in comments) TramadolItching

Symptom List: Rash, Urticaria

Symptoms: ED to Hosp-Admission Discharged 9/13/2021 - 9/15/2021 (2 days) Hospital Doctor Last attending ? Treatment team Severe sepsis; Medical Problems Hospital Problems POA * (Principal) Severe sepsis. Yes Essential hypertension Yes Paroxysmal atrial fibrillation Yes Coronary artery disease involving native coronary artery of native heart without angina pectoris Yes History of coronary artery stent placement Not Applicable Restrictive airway disease Yes Overview Addendum 7/14/2021 11:17 AM by (doctors name omitted) 02/08/2019 Pre-BD: FEV1/FVC: 1.25/1.44 (67% / 58%) ratio: 87% Post-BD: FEV1/FVC: 1.20/1.20 (64% / 48%) ratio: 100% DlCO: 31% DlCO/VA: 82% 07/09/2021 Pre-BD: FEV1/FVC: 1.52/1.85 (83% / 77%) ratio: 82% DlCO: 45% DlCO VA: 61% 06/29/2021 1. Findings most consistent with new CHF/volume overload. (Patient was in CHF @ time of CT) 2. No pulmonary emboli are seen. 3. New mild pulmonary edema. 4. New small bilateral pleural effusions. 5. Stable mild cardiomegaly and significant appearing left ventricular dilation. 6. Incidental findings as described. 06/30/2021 Echo Low normal left ventricular systolic function. Left ventricular ejection fraction is estimated at 50%. Abnormal septal motion consistent with pacemaker. Mild to Moderate mitral valve regurgitation. Morbid obesity Yes Pulmonary hypertension Yes OSA (obstructive sleep apnea) Yes Overview Signed 7/12/2020 9:51 AM by (doctors name omitted) Declined treatment Gastroesophageal reflux disease Yes Overview Signed 10/2/2020 11:13 AM by Update, (name omitted) Regulatory Update to replace inactivated diagnosis. Acute respiratory failure with hypoxia Yes Chronic systolic (congestive) heart failure Yes Type 2 diabetes mellitus with complication Yes Diabetic peripheral neuropathy Yes Pneumonia due to COVID-19 virus Yes Acute hypoxemic respiratory failure due to COVID-19 Yes Active Issues Requiring Follow-up Front Page AVS: o Admitted to the hospital with hypoxia secondary to COVID-19 infection. o You were admitted, you were started on Decadron Remdesivir for treatment of the COVID-19 infection. o You respiratory status improved, eventually weaned down to room air, tolerating well. o Continue taking oral Decadron, continue supportive therapy with albuterol nebs, Tessalon Perles. o Please follow-up with your PCP in 1 week, continue COVID-19 precautions/isolation for additional 7 days after discharge per protocol. Please see information below regarding COVID-19 infection and Covid isolation. Presenting Problem/History of Present Illness/Reason for Admission Shortness of breath Third degree AV block Paroxysmal atrial fibrillation Essential hypertension OSA (obstructive sleep apnea) Hypoxia Diabetic peripheral neuropathy Restrictive airway disease Acute respiratory failure with hypoxia Intractable back pain Postsurgical cardiac pacemaker in situ Severe sepsis Type 2 diabetes mellitus with complication Chronic systolic (congestive) heart failure Acute hypoxemic respiratory failure due to COVID-19 Pneumonia due to COVID-19 virus COVID-19 Hospital Course 77-year-old female with a past medical history of congestive heart failure, atrial fibrillation, third-degree heart block status post pacemaker, obstructive sleep apnea on 2 L nightly, type 2 diabetes, diabetic neuropathy, restrictive lung disease, pulmonary hypertension who presented to the emergency department with 1 week history of cough, shortness of breath. Notes that her cough and shortness of breath has been getting worse over the past week, no GI symptoms, denied significant fevers and chills. Reports that she does not wear mask when she goes out in public, she is vaccinated, just got back from vacation. Patient presented with hypoxia emergency department, was admitted to hospital service for treatment of COVID-19 pneumonia. 1. Severe sepsis, COVID-19 pneumonia, hypoxic respiratory failure Presented with severe sepsis with her tachycardia, tachypnea, COVID-19 and source of infection. Hypoxia is source of her organ failure. She was started on Decadron and Remdesivir for her COVID-19 infection, no indication for therapeutic improvement therapy, steroids, Mucinex, and Tessalon Perles. Inflammatory markers trended down, she was weaned down to room air at time of discharge. Patient was medically cleared and stable for discharge, she denied oxygen with activity stating that she has oxygen at home and can use it if she needs. 2. Systolic heart failure, atrial fibrillation History of systolic heart failure, who is euvolemic and without exacerbation during this hospitalization. Does have some mild rales however this is likely from her COVID-19 infection, continued on her home dose of Lasix and Coreg, stable for discharge. She was rate controlled, continue on Coreg and Eliquis 3. OSA, check lung disease, pulmonary hypertension Previous history of OSA, does use oxygen at home occasionally however notes that she is not always compliant. Her respiratory status improved well with Decadron and Remdesivir, she was weaned down to room air at time of discharge. We will continue home medications at discharge, follow-up with PCP in 1 week. On day of discharge, her symptoms significantly improved, she was weaned to room air, notes that her shortness of breath and coughing has improved. Stable for discharge, will be sent home on p.o. Decadron to complete course, instructed to follow-up with PCP in 1 week.

Other Meds: acetaminophen (TYLENOL EXTRA STRENGTH) 500 mg tablet albuterol HFA (PROVENTIL;VENTOLIN) 90 mcg/actuation inhaler apixaban (ELIQUIS) 5 mg tablet ascorbic acid, vitamin C, (ascorbic acid with rose hips) 500 mg tablet aspirin 81 mg tablet

Current Illness:

ID: 1759008
Sex: F
Age: 59
State: NJ

Vax Date: 09/30/2021
Onset Date: 10/02/2021
Rec V Date: 10/04/2021
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: pennycilian

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

Symptoms: Red, swollen, itchy arm started a couple of days after the shot. Better after taking Benadryl.

Other Meds: Levothyroxide Rouvastatin Multi-vitamin Fish oil B12

Current Illness: N/A

ID: 1759009
Sex: F
Age: 76
State: MO

Vax Date: 03/31/2021
Onset Date: 07/24/2021
Rec V Date: 10/04/2021
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: unknown

Allergies: unknown

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

Symptoms: Symptoms developed on 7-24-21, including fever, cough, fatigue, myalgia, trouble breathing. Patient was hospitalized for COVID-19 on 8-4-21 at hospital. Release date unknown.

Other Meds: unknown

Current Illness: unknown

ID: 1759010
Sex: M
Age: 83
State: GA

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

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

Lab Data:

Allergies:

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

Symptoms: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1759011
Sex: F
Age: 63
State: NJ

Vax Date: 09/16/2021
Onset Date: 09/16/2021
Rec V Date: 10/04/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1759012
Sex: F
Age: 30
State: MA

Vax Date: 04/05/2021
Onset Date: 08/12/2021
Rec V Date: 10/04/2021
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: I had a miscarriage at 5 weeks pregnancy. Conception on July 18-20, positive pregnancy test August 5, miscarriage August 12-13.

Other Meds:

Current Illness:

ID: 1759013
Sex: F
Age: 25
State: OH

Vax Date: 03/03/2021
Onset Date: 05/01/2021
Rec V Date: 10/04/2021
Hospital:

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

Lab Data: Endoscopy, came out clear

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: I have stared having stomach issues such as pain and bloating, but I don?t think it is due to the vaccine

Other Meds: Birth control

Current Illness:

ID: 1759014
Sex: F
Age: 48
State: CA

Vax Date: 09/17/2021
Onset Date: 09/17/2021
Rec V Date: 10/04/2021
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: Heavy drowsiness for up to 3 weeks after.

Other Meds: none

Current Illness: none

ID: 1759015
Sex: F
Age: 36
State: MS

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

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

Lab Data:

Allergies: none

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

Symptoms: I received my second dose of the Pfizer vaccine at 3:00 p.m. on 10/1/21. By around 7:00 p.m. my left arm (injection site) was extremely sore and a headache. As the night went on I had fever, chills, cold sweats, headache and swollen lymph nodes in neck and under arms. 10/2/21-still all symptoms present as on 10/1/21 and add no taste and barely able to smell. These symptoms lasted until 10/3/21 afternoon around 4:00 p.m. I still cannot fully taste or smell and my lymph nodes are still somewhat swollen or sore.

Other Meds: none

Current Illness: Tested positive for Covid SARS-2 on 8/23/2021. Took first vaccination as instructed by vaccine event on 9/10/2021 and the second vaccine on 10/1/2021.

ID: 1759016
Sex: F
Age: 87
State: MO

Vax Date: 03/17/2021
Onset Date: 07/22/2021
Rec V Date: 10/04/2021
Hospital: Y

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: unknown

Allergies: unknown

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

Symptoms: Symptom onset for Covid-19 was on 7-22-21. Symptoms included fever, cough, runny nose, poor appetite, headache, fatigue. Hospitalized at Hospital from 7-24-21 through 7-26-21.

Other Meds: unknown

Current Illness: unknown

ID: 1759017
Sex: M
Age: 50
State: MI

Vax Date: 08/18/2021
Onset Date: 08/23/2021
Rec V Date: 10/04/2021
Hospital: Y

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

Lab Data: SARS-CoV-2 panel (8/28) - negative CT Head w/o contrast (8/28) - No acute intracranial lesions CBC/Chemistry Panels (8/29) - C-Reactive Protein elevated at 1.05, Sedimentation Rate elevated at 39, Glucose - 180; WBC normal at 8; otherwise unremarkable Contrast Head MRI (8/31) - bilateral facial nerve enhancement; no intracranial abnormalities; mildly prominent cervical/axillary lymph nodes CT Chest/Abdomen/Pelvis with contrast (9/1) - a few nonspecific solid lung nodules <4mm Lumbar Puncture (9/1) - Clear CSF with WBC of 2 and elevated protein at 140.5; Glucose - 100; Negative for Lyme, Cryptococcus, flow cytometry, oligoclonal bands and culture

Allergies: None

Symptom List: Unevaluable event

Symptoms: Five days after receiving a 3rd dose of Pfizer?s COVID vaccine, patient experienced painful bilateral musculoskeletal back spasms that progressively ascended from the lumbar to cervical region over the course of 4 days. Previously, he was in his usual state of health with no recent history of infection, rash, travel abroad, exposure to tick bites or trauma. Patient is a non-smoker and does not consume alcohol/illicit drugs. First Pfizer Vaccine Dose on 16 Feb 2021 and Second Pfizer Dose on 9 March 2021 with minimal side effects for 36 hours. By Day 4, various back regions began losing sensation in thoracic dermatomes, with onset of bilateral finger tip tingling (median nerve distribution - 1st thru 3rd digits), altered taste sensation, bilateral facial pain and bilateral dorsal foot and toe numbness. On Day 5, there was onset of prominent fatigue, oral/buccal numbness, complete loss of taste and rapidly progressive right facial paresis to paralysis within 12 hours. This prompted an ER visit, with a negative head CT. By Day 6, there was severe right facial paralysis with left facial paresis and loss of ability to hold water or food in mouth with impaired speech. Admitted to inpatient neurology on Day 7 of symptom onset (Day 11 after vaccine administration) with bilateral reduced patellar and absent ankle reflexes, lower extremity muscle weakness progression, episodic vertigo with nausea/vomiting and diffuse extremity/back paresthesia or numbness. On Day 8, there was bilateral complete loss of patellar and ankle reflexes and R > L 4/5 proximal leg weakness. Preserved upper extremity reflexes and afebrile throughout hospitalization. Loss of pinprick to mid-calf bilaterally. Mastication fatigue without dysphagia. Pulmonary function assessments were within normal limits. No bladder or bowel involvement at any point. Lumbar puncture with albumin-cytological dissocation. Diagnosed with Acute Inflammatory Demyelinating Polyneuropathy (Guillain-Barre Syndrome) due to COVID vaccination. Treated with IVIG over a 5 day period with hypertension elevations. Symptom plateau half-way through treatment. Discharge home on hospital day #8 with ability to ambulate short-distance without assistive devices, but with easy muscular fatigue.

Other Meds: Escitalopram, Bupropion, Omeprazole, Losartan, Amlodipine, Dolutegravir, Emtricitabine & Tenofovir Alafenamide, Glimepiride, Centrum Multi-Vitamin

Current Illness: None

ID: 1759018
Sex: F
Age: 25
State: NY

Vax Date: 10/01/2021
Onset Date: 10/03/2021
Rec V Date: 10/04/2021
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: Macrobid

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

Symptoms: Swollen axillary lymph nodes ipsilateral to injection site, experienced 2 days following injection, improving Migraine with aura (visual disturbance) evening following injection, resolved without sequalae

Other Meds: Spironolactone

Current Illness: None

ID: 1759019
Sex: M
Age: 27
State: NJ

Vax Date: 09/16/2021
Onset Date: 09/16/2021
Rec V Date: 10/04/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1759020
Sex: M
Age: 14
State: KY

Vax Date: 06/28/2021
Onset Date: 09/13/2021
Rec V Date: 10/04/2021
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: Tested Positive for Covid

Other Meds:

Current Illness:

ID: 1759021
Sex: F
Age: 75
State: MI

Vax Date: 01/22/2021
Onset Date: 02/05/2021
Rec V Date: 10/04/2021
Hospital:

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

Lab Data: None.

Allergies: Codeine, Penicillin, latex.

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

Symptoms: She got her vaccine, and about 2 weeks later started noticing raised rash/bumps in a semi-circle ring pattern under both of her arms. She was diagnosed after a biopsy as having granuloma annulare, and given Clobetasol ointment for that reaction. The name of the dermatologic clinic was (clinic name). Doctor did the biopsy. She then followed up with another doctor whom she saw today. They discussed that it may be due to the vaccine, he stated that there has been reactions like hers due to the vaccine. He was a pathologist at one point, and now practices dermatology. The clinic was in state. Her 2nd vaccine was on 2/12/21, Pfizer, lot #EL9269. She received the booster on 9/21/21, lot #FF2588

Other Meds: Metoprolol, Valsartan, Atorvastatin, Xanax as needed. Vitamin D, Biotin.

Current Illness: None.

ID: 1759022
Sex: M
Age: 35
State: CA

Vax Date: 10/04/2021
Onset Date: 10/04/2021
Rec V Date: 10/04/2021
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: None

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Sweating, dizziness

Other Meds:

Current Illness:

ID: 1759023
Sex: F
Age: 48
State: WI

Vax Date: 03/05/2021
Onset Date: 10/04/2021
Rec V Date: 10/04/2021
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: positive for covid 10/4/2021

Other Meds:

Current Illness:

ID: 1759024
Sex: M
Age: 67
State: CA

Vax Date: 04/10/2021
Onset Date: 04/10/2021
Rec V Date: 10/04/2021
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: My PSA, Total, count increased by 3.4 ng/mL after receiving the Moderna vaccine Went from 5.1 pre-shot to 8.5 post dose.

Allergies: None

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

Symptoms: My PSA, Total, count increased by 3.4 ng/mL after receiving the Moderna vaccine Went from 5.1 pre-shot to 8.5 post dose.

Other Meds: Tamsulosin hcl 0.4 mg 1x / day

Current Illness: None

ID: 1759025
Sex: F
Age: 69
State: MD

Vax Date: 02/15/2021
Onset Date: 03/01/2021
Rec V Date: 10/04/2021
Hospital:

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

Lab Data:

Allergies: Macrodantin

Symptom List: Nausea

Symptoms: Following first dose given 02/15/2021 Early March, horizontal double vision upon awakening lasting about five minutes.

Other Meds: Multivitamin, Vitamin C 500 mg, Zinc 50 mg Calcium 600 mg Aspirin 81 mg Fish Oil 1000 mg Glucosamine/Chondroitin Triple Strength Metoprolol suucinate Extended Release 25 mg Zytec 10 mg

Current Illness:

ID: 1759026
Sex: F
Age: 69
State: NY

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

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

Lab Data:

Allergies: No known

Symptom List: Injection site pain

Symptoms: Shingles outbreak 5 days after second dose of vaccine

Other Meds: Azor Synthroid

Current Illness: None

ID: 1759027
Sex: F
Age: 66
State: NJ

Vax Date: 09/17/2021
Onset Date: 09/17/2021
Rec V Date: 10/04/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1759028
Sex: F
Age: 35
State: MN

Vax Date: 02/05/2021
Onset Date: 09/30/2021
Rec V Date: 10/04/2021
Hospital:

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

Lab Data: Covid-19 test

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1759029
Sex: F
Age: 71
State: GA

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/04/2021
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: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1759030
Sex: F
Age: 74
State: PA

Vax Date: 03/04/2021
Onset Date: 09/17/2021
Rec V Date: 10/04/2021
Hospital: Y

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

Lab Data: 09/19/21 2126 Respiratory virus detection panel Collected: 09/19/21 2011 | Final result | Specimen: Swab from Nasopharynx Adenovirus Not Detected Mycoplasma pneumoniae Not Detected Chlamydophila pneumoniae Not Detected Parainfluenza Not Detected COVID-19 SARS-CoV-2 Overall Result Detected Critical Enterovirus/Rhinovirus Not Detected Coronavirus Not Detected Respiratory Syncytial Virus Not Detected Influenza A Not Detected Bordetella pertussis Not Detected Influenza B Not Detected Bordetella parapertussis Not Detected Metapneumovirus Not Detected Procedure Component Value Ref Range Date/Time CT COVID chest without contrast (Abnormal) Resulted: 09/20/21 0038 Order Status: Completed Updated: 09/20/21 0038 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 9/19/2021 11:49 PM Age: 75 years old Clinical indication: Covid 19 infection, hypoxia TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT Chest PE,Abdomen,Pelvis W Contast 3/1/2017 10:32 AM FINDINGS: Lungs: Mild chronic COPD changes are noted. Very minimal patchy airspace disease at left upper lobe. Bilateral mild bronchiectatic changes. Pleural spaces: Right-sided pleural thickening. Heart: Unremarkable. No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes within the aorta. Mild atherosclerotic changes within the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Degenerative changes within the thoracic spine. Soft tissues: Unremarkable. IMPRESSION: Mild chronic COPD changes are noted. Very minimal patchy airspace disease at left upper lobe. Bilateral mild bronchiectatic changes. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD X-ray chest 1 view - Portable Resulted: 09/19/21 2151 Order Status: Completed Updated: 09/19/21 2151 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mild interstitial changes. END OF IMPRESSION: INDICATION: WEAKNESS, +COVID Sepsis. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 3/4/2017 FINDINGS: Heart size appears unremarkable. There is mild bilateral interstitial prominence that represents a change since the prior study. There is no pleural effusion.

Allergies: AzithromycinRash Bupropion HclRash CodeineRash CortisoneRash PrednisoneRash Sulfa (Sulfonamide Antibiotics)Rash

Symptom List: Erythema, Pruritus

Symptoms: ED to Hosp-Admission Discharged 9/19/2021 - 9/23/2021 (4 days) Last attending ? Treatment team Acute respiratory failure with hypoxia Assessment Patient is a 75 y.o. female who presents with with past medical history of COPD, presented with generalized weakness, and shortness of breath x2 days. Plan 1. Acute hypoxic respiratory failure: Presented with generalized weakness, cough and shortness of breath, SPO2 dropped to 77% on room air, likely due to COPD exacerbation, in light of SARS-CoV-2 pneumonia. Supplemental oxygen by nasal cannula, keep SPO2 greater than 90%, start IV dexamethasone, and remdesivir. send and monitor inflammatory markers. 2. COPD with acute exacerbation: Patient use 2 L of oxygen at night, CT chest showed right sided pleural thickening, mild bilateral bronchiectatic changes, with minimal patchy airspace disease. Continue treatment as #1, continue scheduled nebs, resume Breo, 3. SARS-CoV-2 pneumonia: Patient received Pfizer COVID-19 vaccine on 3/21, nasopharyngeal swab positive for SARS-CoV-2, with mild patchy airspace disease. Continue treatment as #1, maintain Covid isolation, 4. Hyponatremia and hypokalemia: Due to decreased p.o. intake, encourage oral hydration, replace potassium 5. Essential hypertension: Resume hydrochlorothiazide 6. GERD: Resume Protonix 7. Generalized anxiety disorder: On sertraline, will continue DVT PPX: low molecular weight heparin Dispo: 3 S., anticipate > 2 midnight inpatient stay DNR (Do Not Resuscitate) CC: Shortness of breath and generalized weakness. HPI Patient is a 75 y.o. female who presents with with past medical history of COPD on 2 L home oxygen at night, presented to the ED with generalized weakness, cough, shortness of breath x3 days. Patient states that her symptoms started last Thursday when she started experiencing body aches, generalized weakness and poor appetite. Since yesterday she has been feeling more out of breath and experienced fever. Patient reports that her cough is dry and about the same. Reports nausea and one episode of diarrhea this morning.

Other Meds: acetaminophen (TYLENOL) 500 mg tablet albuterol HFA (PROVENTIL HFA) 90 mcg/actuation inhaler benzocaine-menthoL 15-3.6 mg lozenge benzonatate (TESSALON) 100 mg capsule esomeprazole (NexIUM) 40 mg capsule fluticasone (FLONASE) 50 mcg/ac

Current Illness:

ID: 1759031
Sex: F
Age: 74
State: CA

Vax Date: 09/29/2021
Onset Date: 09/01/2021
Rec V Date: 10/04/2021
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: no

Allergies: aloe vera, egg plant, lanolin

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

Symptoms: pain at injection site, red, swollen, itchy. Little less each day, but still itchy today, 10/4/21. Called Kaiser advice nurse today. Since itch seems to be less each day I should eventually be okay.

Other Meds: none

Current Illness: none

ID: 1759032
Sex: F
Age: 74
State: WA

Vax Date: 02/20/2021
Onset Date: 02/21/2021
Rec V Date: 10/04/2021
Hospital:

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

Lab Data: None.

Allergies: None.

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

Symptoms: The day I had the injection I had no problem. The next morning I was a little lightheaded and then I realized I was so sleepy so I went to sleep for about twelve hours and when I woke up I was okay besides being dizzy still. Nothing after that. It was around 14 hours that it lasted.

Other Meds: Motrin for pre-diabetes; oxybutynin; omeprazole; multivitamin; probiotic; vitamin C; vitamin D; calcium.

Current Illness: None.

ID: 1759033
Sex: F
Age: 17
State: MO

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

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

Lab Data: Not medically necessary at this time.

Allergies: Ibuprofen

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient came in to receive COVID 19 vaccination. Grandmother asked for patient to receive Moderna, as that was the vaccine she received. After administration of the vaccine, it was realized that patient was not 18 years old.

Other Meds: Flovent HFA, fluticasone propionate, ProAir HFA

Current Illness: none

ID: 1759034
Sex: F
Age: 24
State: MN

Vax Date: 10/04/2021
Onset Date: 10/04/2021
Rec V Date: 10/04/2021
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: Third dose of Pfizer COVID vaccine given earlier than 6 months since second dose.

Other Meds:

Current Illness:

ID: 1759035
Sex: F
Age: 22
State: WI

Vax Date: 03/25/2021
Onset Date: 10/04/2021
Rec V Date: 10/04/2021
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: positive for covid today

Other Meds:

Current Illness:

ID: 1759036
Sex: F
Age: 60
State:

Vax Date: 02/24/2021
Onset Date: 09/28/2021
Rec V Date: 10/04/2021
Hospital:

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

Lab Data: 9/28/2021 @ HCF -tested non -PCR positive for COVID-19

Allergies:

Symptom List: Pain in extremity

Symptoms: tested COVID-19 positive > 14 days after vaccine series

Other Meds:

Current Illness:

ID: 1759037
Sex: F
Age: 30
State: KY

Vax Date: 01/08/2021
Onset Date: 09/02/2021
Rec V Date: 10/04/2021
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: Site: Pain at Injection Site-Medium, Systemic: numbness of left side of face.-Medium, Additional Details: The patient has a tumor that already affects the nerves on the left side of her face. After getting the shot the numbness have noticeably increased causing some droopiness. It has not resolved, gotten better/worse over the past month. Her physician told her it was because of the shot and signed a waiver to prevent the second for her workplace. At which time she called an reported to pharmacy.

Other Meds:

Current Illness:

ID: 1759038
Sex: M
Age: 74
State: GA

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/04/2021
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: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1759039
Sex: M
Age: 44
State: AZ

Vax Date: 09/12/2021
Onset Date: 09/16/2021
Rec V Date: 10/04/2021
Hospital:

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

Lab Data: Emergency room. CT scan. EKG. The follow up at cardiologist. Echo Cardiogram

Allergies: Penecillin

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

Symptoms: Severe chest pain. Peracarditis confirmed. Testing for myocarditis or other issues.

Other Meds: Duloxetine Pregabalin Tumeric Ibuprofen Percocet

Current Illness:

ID: 1759040
Sex: F
Age: 84
State: MI

Vax Date: 02/11/2021
Onset Date: 09/26/2021
Rec V Date: 10/04/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: Pt had a ground level fall at group home and was found to be hypoxic, requiring 2L NC and tested positive for COVID 19.

Other Meds:

Current Illness:

ID: 1759041
Sex: F
Age: 53
State: TN

Vax Date: 09/10/2021
Onset Date: 09/12/2021
Rec V Date: 10/04/2021
Hospital:

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

Lab Data: none

Allergies: NKA

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient received Moderna Covid Vaccine # 1 from pharmacy on 9/12/2021. Reports that 2 days after the injections she started experiencing symptoms of pain at injection site, swelling, redness, itching, fever, developed a large knot at injection site. She notified Pharmacy of symptoms and was advised to continue to monitor, take ibuprofen and benadryl. Symptoms improved minimally. Since injection, symptoms have progressively gotten worse. She now c/o difficulty lifting left arm above her head or gripping, severe itching which is worse at night. Symptoms have now been present for almost four weeks.

Other Meds: vitamin D2, omeprazole, triamterine/hctz, topiramate, carbamazepine, prednisone

Current Illness: none

ID: 1759042
Sex: F
Age: 71
State: MI

Vax Date: 03/21/2021
Onset Date: 10/01/2021
Rec V Date: 10/04/2021
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: rapid covid

Allergies: morphine

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

Symptoms: Covid positive

Other Meds: Hydrochlorothiazide, metronidazole, linagliptin, lisinopril, diclofenac topical

Current Illness: Acute Kidney injury, Hyponatremia, Anemia, HTN, Anemia, HTN, DM 11 Hyperlipidemia, obesity

ID: 1759043
Sex: M
Age: 57
State: CA

Vax Date: 03/05/2021
Onset Date: 09/25/2021
Rec V Date: 10/04/2021
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:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: SHORTNESS OF BREATH pt diagnosed with COVID Thursday 9/23, reports progressive SOB, tonight states that he was coughing and couldn't catch his breath also noted low spo2 when ambulating. per EMS pt spo2 drops to 70's when ambulating

Other Meds:

Current Illness:

ID: 1759044
Sex: M
Age: 79
State:

Vax Date: 03/20/2021
Onset Date: 10/02/2021
Rec V Date: 10/04/2021
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:

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

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: 1759045
Sex: F
Age: 50
State: WI

Vax Date: 02/09/2021
Onset Date: 10/04/2021
Rec V Date: 10/04/2021
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: positive for covid

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am