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

Date Died: 05/07/2021

ID: 1759458
Sex: M
Age: 84
State: GA

Vax Date: 03/28/2021
Onset Date: 05/06/2021
Rec V Date: 10/04/2021
Hospital: Y

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

Lab Data: 05/06/2021 PCR+ COVID-19 test at Hospital

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Breakthrough COVID-19 case. Hospitalized on unknown date for unknown duration. Death 5/7/2021. From Records COD = SEPTIC SHOCK, MULTISYSTEM ORGAN FAILURE, BOWEL PERFORATION. place of death: HOSPITAL-INPATIENT; certified by: PRONOUNCING AND CERTIFYING PHYSICIAN; occupation: MAINTENANCE, HEAT AND AIR CONDITION

Other Meds:

Current Illness:

ID: 1759459
Sex: F
Age: 67
State: IL

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

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: PATIENT HAD 2 MODERNA SHOTS AND WAS GIVEN A PFIZER VACCINE AS A THIRD DOSE

Other Meds:

Current Illness:

ID: 1759460
Sex: M
Age: 50
State: CA

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

Allergies:

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

Symptoms: The expiration date was incorrectly noted when the last extension was granted by FDA. Vaccine expiration was noted as 9/28 when correct date should have been 9/21

Other Meds:

Current Illness:

ID: 1759461
Sex: F
Age: 55
State: TX

Vax Date: 10/02/2021
Onset Date: 10/02/2021
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:

Allergies: none

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Began with extreme weakness (had to go to bed in the early evening on the day of the shot), pain at injection site, headache, nerve pain, sharp nerve zaps, involuntary muscle movements (jerking), tingling , burning feeling in both feet with some numbness, general feeling of nerves abnormally firing all around my body, preventing sleep. Headache and tinging/burning feeling along with jerking continues today (2 days after shot). Stayed in bed all day on the day after shot due to weakness, headache, tiredness and general ill feeling. I do not know if this will get better over time or if these neurological symptoms will continue - they are ongoing at this time.

Other Meds: none - did receive a flu shot at the same time

Current Illness: none

ID: 1759462
Sex: F
Age: 42
State: NJ

Vax Date: 09/30/2021
Onset Date: 10/01/2021
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: LA

Lab Data:

Allergies: Adhesive, contrast dye

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

Symptoms: Facility clinic thru Specialty Rx pharmacy provider gave the HCW a booster Pfizer vaccine in the right arm 5.5 inches below the acromion process, which is below the deltoid muscle. The injection went into the tissue below the deltoid resulting in pain, discomfort, itchiness, redness, and warmth to area from site of injection. The area of redness measures 4.5 inches X 2.5 inches.

Other Meds:

Current Illness:

ID: 1759463
Sex: F
Age: 50
State: MD

Vax Date: 09/20/2021
Onset Date: 09/20/2021
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: Penecillin, Sulpha, Gluten

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

Symptoms: It seems that when the vaccine was administered, it hit a blood vessel and perhaps a nerve. The site of the injection bled and I had a burning pain with a circular red spot below the injection site. I have a bruise that is still there. It has been two weeks and I still have pain, burning and a heavy, somewhat numb feeling in my left upper arm. I experienced a headache for one week and nausea for a few days.

Other Meds: Multi-vitamin

Current Illness: None

ID: 1759464
Sex: F
Age: 38
State: NY

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

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1759465
Sex: M
Age: 61
State: CA

Vax Date: 09/26/2021
Onset Date: 09/01/2021
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:

Symptom List: Pharyngeal swelling

Symptoms: The expiration date was incorrectly noted when the last extension was granted by FDA. Vaccine expiration was noted as 9/28 when correct date should have been 9/21

Other Meds:

Current Illness:

ID: 1759466
Sex: F
Age: 29
State: TX

Vax Date: 10/01/2021
Onset Date: 10/01/2021
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: LA

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Period still going on from last injection. it stopped for 4 days and started again. Jaw pain is less but still painful. Headaches, and dizziness/ vertigo body is off when it come to temperature easy to overheat or chill last for a short while but often comes and goes. very tired

Other Meds: Birth control, Daily vitamin, B12 and Iron

Current Illness:

ID: 1759467
Sex: F
Age: 40
State: MI

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

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

Lab Data: None to date. I am monitoring how I feel and watching for signs of myocarditis and/or pericarditis that may develop.

Allergies: Amoxicillin, Cipro, Welchol, Zocor, Crestor, Glipizide

Symptom List: Diarrhoea, Nasal congestion

Symptoms: I developed a headache almost immediately. Thirty minutes after receiving dose 1 of the Moderna Covid 19 vaccine my face, ears, neck, and chest turned bright red. My neck, face and ears swelled up. The skin was hot to touch and painful; it felt like pins and needles. I took one 200 mg Ibuprofen and held cool compresses to my skin. The swelling and redness subsided within 20-30 minutes. Four hours later, I was fatigued. The next day (Saturday, October 2, 2021), I was dizzy, had full body aches, joint pain, a headache, nausea, a fast heart beat (higher than normal for my resting heart rate; it was in the 120s). My arm hurt terribly at the site of injection it swelled up with a big lump, its very tender, and the skin turned red around the injection and itches. After 48 hours, the general side effects subsided. The injection site reactions have shown little to no improvement.

Other Meds: Metformin 1000 mg twice a day, Lisinopril 5 mg once a day, Januvia 100 mg once a day, Farxiga 5 mg once a day, Gemfibrozil 600 mg twice a day, Meloxicam 15 mg once a day

Current Illness: None

ID: 1759468
Sex: F
Age: 47
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: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1759469
Sex: F
Age: 26
State: NC

Vax Date: 09/18/2021
Onset Date: 09/21/2021
Rec V Date: 10/04/2021
Hospital:

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

Lab Data: All 5 Pregnancy tests were all negative

Allergies: Penicillin

Symptom List: Rash, Urticaria

Symptoms: Vaginal spotting and delayed period since the vaccine. Constant pelvic and lower back pain since the vaccine.

Other Meds: None

Current Illness: Covid 19 diagnosed on August 16, 2021

ID: 1759470
Sex: M
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1759471
Sex: M
Age: 69
State: LA

Vax Date: 03/11/2021
Onset Date: 04/17/2021
Rec V Date: 10/04/2021
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: Ultrasound on liver

Allergies: None

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

Symptoms: Liver lesions

Other Meds: Amlodipine

Current Illness:

ID: 1759472
Sex: F
Age: 54
State: NY

Vax Date: 09/29/2021
Onset Date: 10/01/2021
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: FULL EYE EXAM WITH OCULAR SCAN AND FOLLOW UP WITH A RETINA SPECIALIST 10/2/2021

Allergies: levaquin ; penicillin

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

Symptoms: WENT TO OPTHALMOLOGIST I WAS DIAGNOSED WITH A POSTERIOR VITREAL DETACHMENT

Other Meds: synthroid 200 MCG QD

Current Illness: None

ID: 1759473
Sex: F
Age: 66
State: MT

Vax Date: 09/02/2021
Onset Date: 09/03/2021
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: Fever and Chills

Other Meds:

Current Illness:

ID: 1759474
Sex: F
Age: 29
State: TN

Vax Date: 09/30/2021
Onset Date: 09/30/2021
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: While administering the vaccination, the syringe separated from the needle. It appears less than half of the dose went into the arm. Pt reported no effects. We will administer the second dose per CDC guidelines since it appears it was less than half the dose.

Other Meds:

Current Illness:

ID: 1759475
Sex: F
Age: 15
State: NJ

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

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1759476
Sex: M
Age: 1
State: VA

Vax Date: 09/24/2019
Onset Date: 10/14/2019
Rec V Date: 10/04/2021
Hospital: Y

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

Lab Data: MRI and EEG times since 10/14/2019, every and any lab test you can think of at Hospital, other Hospital, and another Hospital. 10-14-2019 to present.

Allergies: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: ER visit 10/14/2019 via ambulance with respiratory distress, followed by diarrhea, hospitalized one day in ICU, and one day on the other floor. Discharged on 10/16/19 around 4:00 P.M. Returned to the ER via ambulance on 10/16/19 around 8:00 P.M. with seizures, was later intubated for three weeks, remained in the hospital for five weeks, followed by a week and 1/2 of rehabilitation in a different hospital. Has required PT, OT, Speech, Special Education, seizure meds, MRI and numerous of other medical issues.

Other Meds: None

Current Illness: None

ID: 1759477
Sex: M
Age: 77
State: CA

Vax Date: 02/26/2021
Onset Date: 09/25/2021
Rec V Date: 10/04/2021
Hospital: Y

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

Lab Data: Results for patient as of 10/4/2021 12:58 9/25/2021 12:00 NA: 131 (L) K: 4.2 CL: 94 (L) CO2: 27 BUN: 14 CREAT: 0.85 ANION GAP4 SERPL: 10 GLUC: 116 TROPONIN I: 0.02 CK: 209 (H) LDH: 454 (H) BNP: 85 ALT: 334 (H) AST: 219 (H) ALKP: 186 (H) LIPASE: 23 TBILI: 1.5 (H) BILID: 0.5 (H) GFR-AFRAM: >60 GFR NONAFR AMER: >60 COMMENT, GLOMERULAR FILTRATION RATE: SEE NOTE ALB: 3.3 (L) CRP, SER QL: 15.0 (H) FERRITIN: 3,638 (H) LACTATE: 2.9 (AA) TP: 5.6 (L) WBC: 6.6 RBC'S: 3.91 (L) HGB: 12.9 (L) HCT: 36.6 (L) MCV: 94 RDW, RBC: 12.6 PLT: 230 IMMAT GRANULO % AUTO: 1 NRBC: 0 NEUTROPHILS % AUTO: 78 (H) ANC: 5.2 LYMPHS % AUTO: 7 (L) MONOS % AUTO: 10 EOS % AUTO: 4 BASO'S % AUTO: 0 PT: 15.3 (H) INR: 1.3 D-DIMER: 2.55 (H) FIBRINOGEN: 1,074 (H) AB SCR BLD: Negative ABO+ RH GRP: A POS BLD CULT RSLT: Final Report... 9/25/2021 12:00 BLD CULT RSLT: Final Report... 9/25/2021 12:32 XR CHEST: Rpt (A) 9/25/2021 14:13 LACTATE: 1.4 9/25/2021 17:30 HIV 1+2 AB/AG: NON REAC HEP B COREAB: NEGATIVE HEP B S AB: NEGATIVE HEP B S AG: NEGATIVE HEP C AB: NEGATIVE 9/26/2021 06:38 NA: 134 (L) K: 4.7 CL: 99 (L) CO2: 28 BUN: 18 CREAT: 0.78 ANION GAP4 SERPL: 7 CA: 8.4 (L) MG: 2.1 PHOS: 3.7 GLUC: 144 LDH: 336 (H) ALT: 247 (H) AST: 124 (H) ALKP: 148 (H) TBILI: 1.1 COMMENT, GLOMERULAR FILTRATION RATE: SEE NOTE ALB: 2.9 (L) CRP, SER QL: 14.2 (H) FERRITIN: 2,745 (H) WBC: 6.2 RBC'S: 3.68 (L) HGB: 12.3 (L) HCT: 34.6 (L) MCV: 94 RDW, RBC: 12.5 PLT: 252 IMMAT GRANULO % AUTO: 1 NRBC: 0 NEUTROPHILS % AUTO: 86 (H) ANC: 5.4 LYMPHS % AUTO: 7 (L) MONOS % AUTO: 6 EOS % AUTO: 0 BASO'S % AUTO: 0 PT: 15.2 (H) INR: 1.2 D-DIMER: 1.28 (H) FIBRINOGEN: 1,022 (H) 9/26/2021 10:03 US ABDOMEN: Rpt 9/27/2021 06:36 NA: 136 K: 5.2 CL: 100 CO2: 28 BUN: 21 CREAT: 0.79 ANION GAP4 SERPL: 8 GLUC: 128 ALT: 287 (H) AST: 149 (H) ALKP: 163 (H) TBILI: 1.2 COMMENT, GLOMERULAR FILTRATION RATE: SEE NOTE CRP, SER QL: 9.3 (H) D-DIMER: 1.09 (H) 9/28/2021 06:12 NA: 134 (L) K: 5.0 CL: 100 CO2: 25 BUN: 25 CREAT: 0.77 ANION GAP4 SERPL: 9 GLUC: 113 ALT: 318 (H) AST: 162 (H) ALKP: 155 (H) TBILI: 1.2 COMMENT, GLOMERULAR FILTRATION RATE: SEE NOTE CRP, SER QL: 5.2 (H) WBC: 8.5 RBC'S: 3.73 (L) HGB: 12.6 (L) HCT: 35.6 (L) MCV: 95 RDW, RBC: 12.6 PLT: 402 (H) NRBC: 0 D-DIMER: 1.17 (H)

Allergies: Amoxicillin - Body rash

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

Symptoms: 78 Y male with hypertension, gilbert syndrome, prediabetes, diverticulosis of colon, gout, vaccinated w 2 doses of PFIZER for COVID-19 (2/5/21 & 2/26/21) who developed cough, fever, bodyaches ~ 9/14. COVID-19 positive on 9/15 came back positive, yesterday O2 sat was 89% on room air with activity so came to ED COVID Pneumonia, Acute hypoxemic Respiratory failure - symptom onset on 9/14. COVID positive on 9/15. Last fever on 9/25. CXR showed bilateral opacities.Treated with decadron 6mg x 3 days. He was not a candidate for remdesivir due to elevated transaminases. Supplemental O2 at 2 lpm was successfully weaned to room air and he was discharged to home. Elevated LFT's - abdominal US was unremarkable. Likely due to acute covid disease. Can repeat once acute illness resolves. Primary Procedures: None Secondary Procedures: None Reason for Hospital Admission (Admitting Diagnosis): covid pneumonia

Other Meds: Outpatient Medications: confirmed with Patient Prior to Admission Medications Outpatient Home Medications Taking? Allopurinol (ZYLOPRIM) 300 mg Oral Tab Takes Regularly Sig: Take 1 tablet by mouth daily after a meal Calcium Carbonate-Vit D3

Current Illness: None

ID: 1759478
Sex: U
Age: 13
State: GA

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

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

Lab Data:

Allergies:

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

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: 1759479
Sex: M
Age: 67
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1759480
Sex: F
Age: 59
State: CA

Vax Date: 09/29/2021
Onset Date: 09/29/2021
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: EKG and chest x-ray proved normal. Blood work normal. Diagnosed with severe case of paresthesia.

Allergies: Penicillin, cherries, all fruit, dogs, cats, pollen, mold, dust

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

Symptoms: Had shortness of breath and accelerated heart 60 minutes after vaccine. The about two hrs later numbness on left side of face, neck shoulder, arm, hand, hip, leg and foot, which got worse as the day wore on. Excruciating pain in left leg and arm for two days, and numbness in left side for two day but numbness in left side of face is still present. Numbness around the left eye is also present and my eye is cloudy and have trouble focusing on reading material and I've not had this problem before the vaccine.

Other Meds: Tylenol

Current Illness: None

ID: 1759481
Sex: M
Age: 12
State: GA

Vax Date: 09/03/2021
Onset Date: 09/03/2021
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: 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: 1759482
Sex: F
Age: 61
State: OK

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

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

Lab Data: None

Allergies: Sulfa; Statins

Symptom List: Injection site pain, Menorrhagia

Symptoms: The next day on Thursday at about 4 or 5 in the evening I had started to have headaches, a high fever, and dizziness. I still had a fever on Friday morning so I didn't go into work.

Other Meds: I do not want to add them.

Current Illness: none

ID: 1759483
Sex: F
Age: 66
State: KY

Vax Date: 03/16/2021
Onset Date: 09/06/2021
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:

Allergies:

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

Symptoms: Tested Positive for Covid

Other Meds:

Current Illness:

ID: 1759484
Sex: F
Age: 69
State: GA

Vax Date: 08/30/2021
Onset Date: 09/11/2021
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: LA

Lab Data: Hospitalized for 3 days total.

Allergies: None

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient described shortness of breath and stomach pains. Sent to Emergency room via EMS and tested positive for COVID-19 Delta variant 12 days after vaccine. Upon X-ray of chest, small blood clot located into right lower lobe. Admitted into hospital for observation and released 2 days later with blood thinner and antibiotics. No other symptoms reported.

Other Meds: Losartan 50mg Tamsulosin 0.4mg Temazepam 30mg

Current Illness: None

ID: 1759485
Sex: F
Age: 62
State: IN

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

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Muscle aches, headaches, soreness at injection site, fatigue, slight fever all lasting about 24 hours

Other Meds: Atorvastatin 20mg, B12 100mcg, Fenofibrate 160mg, Iron 65mg-325mg Ferrous Sulfate, Metformin 1000mg, Olmesartan Medoxomil 20mg, One a day vitamin, Pioglitazone 30mg, Fish oil 1000mg-300mg Omega 3, 81mg low dose aspirin

Current Illness: None

ID: 1759486
Sex: M
Age: 46
State: MD

Vax Date: 03/11/2021
Onset Date: 03/18/2021
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: Blood Work 10/04/2021

Allergies: N/A

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

Symptoms: Pt. states that after receiving the 1st dose of J&J 03/11/2021, started experiencing symptoms 03/18/2021 of night sweats, leg weakness and shaking, vision loss, leg cramping, fatigue, and muscle aches. Emergency Room visit 10/04/2021, Blood Work and Observation. Pt. continues to experience symptoms.

Other Meds: N/A

Current Illness: N/A

Date Died: 09/30/2021

ID: 1759487
Sex: M
Age: 74
State: PA

Vax Date: 03/30/2021
Onset Date: 09/15/2021
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: Updated Procedure 09/20/21 1526 Respiratory virus detection panel Collected: 09/20/21 1421 | 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 09/15/21 1624 Respiratory virus detection panel Collected: 09/15/21 1428 | 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 X-ray chest 2 views Result Date: 9/15/2021 XR CHEST 2 VW IMPRESSION: 1. Moderate cardiomegaly. No edema or pneumonia. 2. Prior coronary bypass and port catheter placement END OF IMPRESSION: INDICATION: Suspected sepsis, SOB, fever, chills, dry cough Suspected sepsis. TECHNIQUE: AP and lateral projections of the chest are acquired. COMPARISON: 12/15/2020 FINDINGS: Prior coronary bypass. Interval right jugular port catheter with tip in SVC. Lungs clear. Stable moderate thyromegaly. Mediastinal pleural spaces clear. Bones and soft tissues within normal limits. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. Nuclear Medicine lung scan perfusion only Result Date: 9/16/2021 NM LUNG SCAN PERFUSION ONLY IMPRESSION: No definitive pulmonary embolus is identified on perfusion only study. **PIOPED criteria for diagnosis of PE is combination of ventilation and perfusion, plus x-ray. Without ventilation scan, the specificity for diagnosis of PE is lower. MODIFIED PIOPED CRITERIA FOR THE DIAGNOSIS OF PE (2008) LOW PROBABILITY: Non segmental perfusion defect. Any perfusion defect with a substantially larger CXR abnormality. Matched V/Q defects with a normal CXR. Small subsegmental perfusion defect. HIGH PROBABILITY: Two or more large mismatch segmental defects or equivalent mod/large defects with normal CXR. INTERMEDIATE PROBABILITY: Any V/Q scan abnormality between low and high probability. Significance: Low probability < 20% of probability of PE; intermediate probability: 20-80% probability of PE; High probability >80% of probability of PE. END OF IMPRESSION: INDICATION: High d-dimer. Hypoxemia. TECHNIQUE: Following intravenous administration of 4.3 mCi of Tc-99m MAA using a sterile technique. Lung perfusion images were obtained in 8 projections: anterior, posterior, LPO, LAO, RPO, RAO, left lateral and right lateral.

Allergies: Shellfish DerivedSwelling Mushroom Spironolactone CodeineOther (document details in comments) Fish Containing ProductsOther (document details in comments) MetforminOther (document details in comments) PravastatinOther (document details in comments) Statins-hmg-coa Reductase Inhibitors

Symptom List: Nausea

Symptoms: ED to Hosp-Admission Discharged 9/15/2021 - 9/18/2021 (3 days). Last attending ? Treatment team Anemia requiring transfusions Principal problem Details of Hospital Stay Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9] Hospital Course 1. Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis. Patient has been started on cefepime and doxycycline, Decadron. Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was not a candidate for convalescent plasma and remdesivir due to transaminits 2. Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3. Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5. Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6. Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8. Diabetes mellitus 2: On glipizide 9. Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ?C (97.7 ?F) Weight: 96.8 kg (213 lb 6.5 oz) Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged 9/20/2021 - 9/27/2021 (7 days) Last attending ? Treatment team COVID-19 Principal problem Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN Hospital Course Patient was recently hospitalized for Covid infection. He tested positive on 9/15/2021. He was discharged on 9/18. He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness. He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions. He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021. He was transferred to the ICU. He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s. He was presumed to be in cardiogenic versus septic shock. He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis. Initially he was full team. After discussion with patient and his wife, he is now DNR with short-term intubation only. He cannot receive remdesivir because of transaminitis. He cannot receive interleukin-6 because of immunocompromised state. His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine. He has acute renal failure, likely ATN. He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia. He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather. He is essentially requiring a cumulative amount of 75 L of oxygen. Today he was initially agitated when discussing hospice and states "I will not talk to the death squad". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home). In discussion with his wife, the decision was made to transition him to hospice. He is uremic and hypoxemic, and likely cannot make high-level decisions. The patient does agree to go on hospice service. He was initially adamant about not receiving morphine. Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety. He will be discharged, and readmitted under inpatient hospice. It is not feasible at this time for him to go home unfortunately. Operative Procedures Performed Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ?C (97.7 ?F) Weight: 96.5 kg (212 lb 11.9 oz) General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr. Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert. He is oriented to self, place and situation. He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect Condition at Discharge Discharge Condition: poor

Other Meds: amiodarone (PACERONE) 200 mg tablet amLODIPine (NORVASC) 10 mg tablet carvediloL (COREG) 6.25 mg tablet cyanocobalamin (VITAMIN B-12) 500 mcg tablet ezetimibe (ZETIA) 10 mg tablet furosemide (LASIX) 20 mg tablet glimepiride (AMARYL) 2

Current Illness:

ID: 1759488
Sex: U
Age: 22
State: GA

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

Symptom List: Injection site 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: 1759489
Sex: F
Age: 51
State: MD

Vax Date: 04/30/2021
Onset Date: 04/30/2021
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: 9/17/21 Cardiac Enzyme Blood Test (Troponin 1) - Within Normal Limits - 4

Allergies: Allergic to all nuts and adhesive tapes

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

Symptoms: Evening of April 30 after second vaccination, had a rapid continual heart beat along with shortness of breath and an excruciating headache. The headache continued through 2 o'clock on May 1. It resolved finally with some Tylenol. The rapid heart rate and shortness of breath continued with exertion along with some mild chest pain. This all continued for a couple of months until I began acupuncture treatments. I did not seek medical treatment. I had a physical a few months ago and let my doctor know, Dr. He ran a cardiac enzyme blood test on me that came back within normal limits. I am doing better now, but I occasionally do have a strange sensation in my chest after exertion at times since then. Not sure if that could be the mitral valve regurgitation getting worse, but I had not had that sensation ever before my second vaccination.

Other Meds: Megafood One Daily Multivitamin, Megafood Vitamin D 2000 IU, Nordic Naturals Ultimate Omega Fish Oil, Florastor Probiotic

Current Illness: None

ID: 1759490
Sex: F
Age: 52
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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1759491
Sex: F
Age: 68
State: IN

Vax Date: 09/30/2021
Onset Date: 10/01/2021
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: n/a

Allergies: linsopril sulfa shrimp

Symptom List: Tremor

Symptoms: fever, chills, body aches and headache for 24 hours. Sore arm and underarm

Other Meds: atorvastatin 40 mg 2x per week ezetimibe 10 mg 1x per day losartan potassium 1x per day 81 mg aspirin 1x per day multivitamin 1x per day calcium 1x per date vitamin c 1x per day fish oil 1x per day vitamin E 1x per day vitamin D 3x per wee

Current Illness: none

ID: 1759492
Sex: U
Age: 55
State: GA

Vax Date: 09/03/2021
Onset Date: 09/03/2021
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: Erythema, Pruritus

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: 1759493
Sex: M
Age: 61
State: NJ

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

Allergies:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1759494
Sex: U
Age: 14
State: GA

Vax Date: 09/03/2021
Onset Date: 09/03/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

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: 1759495
Sex: M
Age: 88
State: NY

Vax Date: 09/30/2021
Onset Date: 09/30/2021
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: CXR, Echo and EKG were ordered CMP, Blood cx, BNP, Troponin, Urine w/reflex and a CBCD were ordered for today. (EKG resulted today one of the findings was Inferior infarction, probably acute, pt was sent to the ER)

Allergies: Imddur and Statin

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Pt had a syncopal episode that evening of vaccination, the following morning he had 2 episodes of syncope. The last one that happened on Friday morning at 7am the patient was reportedly convulsing, diaphoretic and disoriented- blood pressure was 220/100. Son also reported he was not responsive to sound or voice and his breathing became labored for a short time after the convulsing stopped.

Other Meds: Taking ZyrTEC 10 mg tablet, Sig: 1 tab(s) orally once a day Taking ofloxacin ophthalmic 0.3% solution, Sig: 1 gtt in each affected eye 4 times a day Taking prednisoLONE ophthalmic acetate 1% suspension, Sig: 1 gtt in each affected eye 4

Current Illness:

ID: 1759496
Sex: F
Age: 67
State: CA

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: None

Allergies: Dye (IVP) per pt

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

Symptoms: Patient stated chest tightness and her arm felt numb. started about 10 minutes after patient had vaccine.

Other Meds: None

Current Illness: Unknown

ID: 1759497
Sex: M
Age: 90
State: MN

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

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

Lab Data:

Allergies:

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

Symptoms: None stated.

Other Meds:

Current Illness:

ID: 1759498
Sex: F
Age: 46
State: MI

Vax Date: 09/29/2021
Onset Date: 10/01/2021
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: LA

Lab Data: Seen doctor on 10-4-21

Allergies: Amoxicillin

Symptom List: Pain in extremity

Symptoms: Hives

Other Meds: Acetaminophen, Aspirin 81 mg, metamucil

Current Illness:

ID: 1759499
Sex: U
Age: 75
State: GA

Vax Date: 09/13/2021
Onset Date: 09/13/2021
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: 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: 1759500
Sex: F
Age: 44
State: MN

Vax Date: 10/01/2021
Onset Date: 10/02/2021
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: Guaifenesin Insect Extract

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

Symptoms: Pt states, received the vaccine 10/1/2021, about 9 am, waited 15 minutes following vaccine, felt okay. Awoke the next morning 10/2/2021.about 430 am from symptoms tachycardia, bounding pulse, chest tightness/discomfort. Pt states she doesn't describe as chest pain. No Shortness of breath. Went back to sleep. At about 11am, symptoms felt: no energy, not feeling right. Decided to check blood pressure 238/152. Took PRN medication Clonidine, in addition to relaxed, non-pharmacy interventions to bring blood pressure down. Clonidine and Baby ASA (81 mg). Denies symptoms of chest pain, jaw pain, shortness of breath. Pt reported the hypertension symptoms improved. Did not report actual numbers. Does not believe symptoms were related to anxiety of getting the vaccination. 10/4/2021: symptoms: energy is not back. checked blood pressure today, still slightly elevated but much improved. "doing what I need to do to keep it down. Denies chest pain, shortness of breath. "I manage my blood pressure without medications, my doctor works with me to manage without medication,. I made some lifestyle changes". Pt "does not feel at risk" to go to the ED or be seen at this time, wanted information documented. Taking action at home to bring blood pressure down. Clinic provider notified for review. Recommend office visit for blood pressure check. Per patient, sounds like symptoms are under control.

Other Meds:

Current Illness:

ID: 1759501
Sex: F
Age: 28
State: VA

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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: n/a ongoing

Allergies: Sulfa antibiotics, Cinnamon

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

Symptoms: The night after receiving my COVID booster my left axillary lymph node began to swell and become sore to the touch. % days later the swelling and soreness is still present.

Other Meds: Spironolactone 25MG daily.

Current Illness: none.

ID: 1759502
Sex: F
Age: 43
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: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1759503
Sex: F
Age: 78
State: HI

Vax Date: 03/05/2021
Onset Date: 03/05/2021
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:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Dizziness, headaches, diarreah, fever, ER on 02/08/2021 was given 2 bags of fluid. Ear began swelling, loss of apetite, neck and scalp itchy.

Other Meds: Losartan, Eliquis, Vitamin C.

Current Illness:

Date Died: 09/26/2021

ID: 1759504
Sex: F
Age: 73
State: MI

Vax Date: 08/03/2021
Onset Date: 09/17/2021
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:

Allergies: Latex, sulfa and tape

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

Symptoms: Hospitalized 09/23/2021; COVID-19 positive 09/17/2021; fully vaccinated DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute hypoxemic respiratory failure (HCC) [J96.01] Acute hypoxemic respiratory failure due to COVID-19 (HCC) [U07.1, J96.01] COVID-19 [U07.1] HOSPITAL COURSE: 73-year-old female with history of chronic respiratory failure on 3-4 L of oxygen at baseline, chronic obstructive pulmonary disease, previous colorectal cancer, OSA, and aortic stenosis who presented with worsening dyspnea, hypoxia, hemoptysis, abdominal pain, and diarrhea after being diagnosed with COVID-19 9-17. She had symptoms for 2 weeks prior to admission. The patient required non-rebreather while in the emergency department. CTA was negative for PE, but showed diffuse bilateral peripheral airspace disease. CT of the abdomen and pelvis showed an atrophic pancreas, but no acute process. Steroids were started in the emergency department and the patient was admitted to the hospitalist service for further continuation of care. The patient's oxygen requirement worsened to the point where she was on 100% via high-flow nasal cannula. Her diarrhea and abdominal pain improved without intervention. IV vancomycin was started as her sputum culture grew Staph aureus. IV Lasix was administered. The patient was discussed with pulmonology who reported that prognosis was poor in the setting of her pre-existing lung disease. Goals of care were discussed with the patient by this provider. The patient was clear that she would not want intubation and mechanical ventilation in the case of worsening respiratory failure. The patient desaturated overnight 9-25 the and was hypoxic despite high-flow nasal cannula and non-rebreather. Comfort measures were initiated after discussion with the patient and her son. The patient passed away 09/26/2021 at 11:40 with family at bedside.

Other Meds: albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler famotidine (PEPCID) 40 MG tablet furosemide (LASIX) 40 MG tablet glycerin-hypromellose-PEG 400 (ARTIFICIAL TEARS) 0.2-0.2-1 % SOLN HYDROcodone-acetaminoph

Current Illness: Hospital Admission/observation 09/17/2021-09/18/2021 Admission Diagnoses: Dehydration [E86.0] Confusion [R41.0] Fatigue [R53.83] Fever [R50.9] Headache [R51.9] Sepsis, due to unspecified organism, unspecified whether acute organ dysfunction present (HCC) [A41.9] Discharge Diagnoses: Acute encephalopathy Discharged Condition: stable Indication for Admission: AMS Covid 19 Positive Hospital Course: Hospital (09/17/2021-09/18/2021) The is a 73-year-old female patient with history of COPD on home oxygen, history of chronic pain on narcotic, who was admitted to the hospital with confusion. intermiitent fever And fatigue The patient on admission was slightly confused. The rest of the examination was unremarkable. The labs revealed normal blood gases. Troponin was negative. Labs revealed no evidence for acute kidney injury with sodium 137, potassium 3.7. The patient's proBNP was 365. Ammonia level was 11. CRP 5.1. Lactate normal at 0.9, glucose 157. TSH 2.0. White count 6.7. Urine analysis revealed no infection. Ethanol negative. Urine drug screen was positive for opiates. Serum benzodiazepine screen was negative. Covid test was positive Chest x-ray revealed no acute changes. EKG is normal. CT abdomen and pelvis revealed no acute changes. The patient was admitted for observation. Her acute confusion resolved. We suspect her confusion was possibly due to polypharmacy including narcotic. The patient was given education and was discharged home to follow up with PCP in 1 week.

ID: 1759505
Sex: M
Age: 84
State: MN

Vax Date: 02/01/2021
Onset Date: 09/18/2021
Rec V Date: 10/04/2021
Hospital:

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

Lab Data: Labs and CXR obtained 9/20 ABOTT ID NOW COVID-19 positive.

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Pt started to feel ill on 9/18 was tested for COVID at clinic on 9/20 with positive results and came to BFV ED for evaluation and treatment Pt met the criteria for Monoclonal antibody tx and referral was made

Other Meds:

Current Illness:

ID: 1759506
Sex: F
Age: 26
State: TX

Vax Date: 09/30/2021
Onset Date: 09/30/2021
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: NOTE: Patient had positive COVID-19 test on 7/24/2021 using the Hologic Panther System platform utilizing PCR or equivalent nucleic acid amplififcation technology.

Allergies: Hydrocodone (Itching)

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

Symptoms: Pfizer BioNTech COVID-19 Vaccine EUA: Hospitalization Patient received Pfizer Vaccines on 9/8/2021 and 9/30/2021. Presented to ED on 9/30/2021 with severe crampy abdominal pain, diarrhea, nausea after receiving her second COVID-19 vaccine earlier in the day. On arrival the patient was tachycardic up to 120s (states tachycardic at baseline). Covid test was negative. UA negative. CMP and CBC WNL. US of pelvis and CT A/P were negative. Patient was treated with zofran, morphine x1, LR and atarax. Abdominal pain resolved by the morning of 10/1/2021 and patient was discharged.

Other Meds: Albuterol MDI, Benzonatate 200 mg TID PRN, Bupropion 300 mg QD Cetirizine 10 mg QD, Benzaclin gel BID, Dupilumab 300 mg Q2Weeks, Lidex ointment BID, Wixela Inhub BID, Flonase Nasal QD, Hydroxyzine 10 mg BID PRN Anxiety, DUOneb PRN, Metaxolo

Current Illness:

ID: 1759507
Sex: F
Age: 69
State: WI

Vax Date: 08/24/2021
Onset Date: 09/30/2021
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: None.ddb

Allergies: aspirin azithromycin Cephalosporins choline fenofibrate ciprofloxacin clarithromycin codeine doxycycline ertapenem iodine loratadine montelukast sodium Penicillins tetracycline

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

Symptoms: Blistering lesions at injection site and subsequent redness and swelling spreading from this site and development of pain in shoulder joint adjacent to injection site. Treatment is involving methylprednisolone oral taper and valacyclovir for 7 days.

Other Meds: clonidine, Euthyrox, hydrochlorothiazide, fluticasone nasal spray, losartan, metoprolol, ocuvite, potassium chloride, evolocumab

Current Illness: None

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am