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: 1768339
Sex: M
Age: 97
State: CO

Vax Date: 02/03/2021
Onset Date: 10/06/2021
Rec V Date: 10/07/2021
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: Patient hospitalized after positive COVID. Patient was fully vaccinated

Other Meds:

Current Illness:

ID: 1768340
Sex: M
Age: 57
State: GA

Vax Date: 03/26/2021
Onset Date: 03/26/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: 28 different blood test ( Dr. has results). Skin Biopsy.

Allergies: Sulfur and nuts.

Symptom List: Anxiety, Dyspnoea

Symptoms: Broke out in hives a few hours later around 8:00 pm. Hand swollen with bruising, left arms started with hives than moved all over body and didn't go away. Took benadryl and zyrtec over the weekend. Contacted my primary physician on the Monday morning following the Friday shot and went in. Perscribed Prednisone and told to take Pepcid. When the hives returned after completing the prednisone, I contacted my Allergist, she prescribed high dose antihistamines and prednisone. When the prednisone stopped the hives came back. More was prescribed and I was told to see a dermatologist for a biopsy to rule out vasculitis, chronic Idiopathic urticaria diagnosed. Given prednisone and chromolyn and to to continue high does antihistamines. No change. Biospy taken as requested, findings Hives. Now taking Xolair shots once a month.

Other Meds: Zyrtec 25 mg, Budesonide and Formoterol Fumarate Dihydrate inhalation 160mcg/4.5, Flonase, Taladafil 5mg.Multivitamin with Iron.

Current Illness: none

ID: 1768341
Sex: F
Age: 15
State: CA

Vax Date: 08/27/2021
Onset Date: 09/09/2021
Rec V Date: 10/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies: None

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

Symptoms: My child missed her menstrual period. She received her 2nd dose of Pfizer Covid-19 vaccination on 8/27/2021. She was expected to start her period on 9/9/21 and did not. I took her to the doctor on 9/20/21. The doctor was unsure why she didn't have a period. She also started her on birth control to help with heavy periods and acne.

Other Meds: Melatonin

Current Illness: None

ID: 1768343
Sex: M
Age: 4
State: CA

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: Basic evaluation from pediatric PA. Referred to optometrist + waiting on neurologist referral.

Allergies: no known

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: About 5 hours after vaccine, we started noticing unusual "tics" in our son. Sudden onset of excessive blinking and movements with his tongue/mouth. Both of these are new for him. The onset was quite obvious as this behavior had not been observed prior to this date. He blinks very frequently and has a lot of hard blinks. With his tongue, he sticks it out a lot almost like a reptile. Lots of repetitive motion. He also randomly suddenly twists his tongue to the side. He doesn't seem too aware and the movements seem involuntary.

Other Meds: multivitamin

Current Illness: none

ID: 1768344
Sex: M
Age: 27
State: OK

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

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

Lab Data:

Allergies: Sulfa

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

Symptoms: headache, body aches fatigues fever

Other Meds: Omeprazole, Lisinopril 5 mg, Sertraline 50 mg, Bupropion 150, Monetelukast, Fexofenadine 180 mg Tumeric Supplement 500 mg

Current Illness:

ID: 1768345
Sex: M
Age: 75
State: MI

Vax Date: 02/16/2021
Onset Date: 09/30/2021
Rec V Date: 10/07/2021
Hospital: Y

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Lisinopril Swelling

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

Symptoms: Hospitalized (9.30.21); COVID-19 positive (9.30.21); fully vaccinated Discharge Provider: DO Primary Care Provider at Discharge: MD Admission Date: 9/30/2021 Discharge Date: 10/02/2021 PRESENTING PROBLEM: Weakness [R53.1] Generalized weakness [R53.1] COVID-19 [U07.1] HOSPITAL COURSE: Patient is a 76 year old male with history of NICM, SSS s/p PPM, A-Fib/Flutter s/p Watchman, prior DVT, HTN, HLD, T2DM with chronic neuropathy, alcohol use with hepatic steatosis, pancreatic insufficiency, COPD, OSA, depression and RLS who presented to the ER with generalized weakness. Patient reported normally performing ADLs with occasional assistance from family, however lately had been so weak he had difficulty standing and ambulating. He denied subjective fevers/chills, however noted to have fever by EMS. In the ER, he was febrile, not hypoxic, and tested positive for COVID 19. CXR was negative for infiltrate. He was admitted under observation for further monitoring. Patient qualified for monoclonal antibody infusion which was given. He did not qualify for Remdesivir or Decadron with negative CXR and no hypoxia. Patient worked with PT/OT who did not identify any needs for him at home. The following day, patient felt much better. He denied shortness of breath, fever. He continued to have fatigue, but overall improved. He was ambulated multiple times by PT and found to not be hypoxic/needing home O2. He was discharged to home in improving condition on 10/3/21.

Other Meds: acetaminophen (TYLENOL) 500 MG tablet aspirin EC 81 MG enteric coated tablet citalopram (CELEXA) 40 MG tablet cycloSPORINE (RESTASIS) 0.05 % ophthalmic emulsion Ferrous Sulfate (IRON) 325 (65 Fe) MG TABS furosemide (LASIX) 20 MG tablet Gluc

Current Illness: NA

ID: 1768346
Sex: F
Age: 37
State: CA

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: NA

Allergies: PCN

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: 0838 Patient received vaccine Pfizer 3rd dose in right arm. Patient waited observation time for 15 minutes, and at approx. 17 mins past, 0901 patient complained throat was abnormally tight, cough was present, and tongue was slightly tingling . Denied itchiness, complained that a abnormal feeling of tightness was accompanied the vaccine. At approx 0903 Benadryl 50mg was given PO. RN stat notified, and patient was wheelchaired over to urgent care for further evaluation.

Other Meds:

Current Illness:

ID: 1768347
Sex: F
Age: 30
State: IL

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

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

Lab Data: Blood pressure was checked 10/4/2021 along with pulse and oxygen levels. Squeeze test on nurses fingers showing hand weakness. No other tests administered.

Allergies: Amoxicillin

Symptom List: Pharyngeal swelling

Symptoms: Arm was still inflamed, swollen and hot at the injection site on 10/4/2021. Fever has been ongoing on and off since 10/2/2021. Injected with higher dose ibuprofen and sent home on 10/4/2021. Pain in arm, hands, feet, head and back. Weakness in hands and legs. Taking OTC ibuprofen since 10/5/2021 with no pain relief.

Other Meds: None

Current Illness: None

ID: 1768348
Sex: F
Age: 24
State: TX

Vax Date: 09/10/2021
Onset Date: 09/13/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data:

Allergies: Mushrooms, cashews

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Delayed hypersensitivity skin reaction - began 3 days after vaccination, resolved 6 days after vaccination. Associated with hot, red rash at vaccination site that spread around the deltoid region. Treated with Benadryl and doxycycline as a precaution against cellulitis, as the rash resembled cellulitis. Fever - began ~10 hours after vaccination, continued until the AM 3 days after vaccination. Greatest temperature ~39C. Treated with Tylenol. Resolved on the third day without Tylenol use. Associated with chills, muscle aches, and anorexia.

Other Meds: Azathioprine, allopurinol, mesalamine, xyzal, Centrum Women's Multivitamin

Current Illness: Ulcerative colitis, polycystic ovary syndrome

ID: 1768349
Sex: F
Age: 49
State: NY

Vax Date: 10/06/2021
Onset Date: 10/06/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: On the way home she started feeling funny. Very tired, vagainal bleeding like a menstral cycle but very heavy.

Other Meds: aspirin,

Current Illness:

ID: 1768350
Sex: F
Age: 33
State: NJ

Vax Date: 03/08/2021
Onset Date: 08/27/2021
Rec V Date: 10/07/2021
Hospital: Y

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

Lab Data: Anatomy scan 8/27/2021 Fetal MRI and EKG on 9/3/2021 Dilation (laminaria) on 9/7/2021 D&E on 9/8/2021

Allergies: NSAIDs

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

Symptoms: Bilateral renal agenesis of fetus detected at routine 20-week anatomy scan on 8/27/2021. Determined to be fatal for fetus. No treatment available. Dilation began using laminaria on 9/7/21, followed by D&E on 9/8/21.

Other Meds: Cholestyramine 4mg, prenatal vitamins, iron, vitamin C

Current Illness:

ID: 1768351
Sex: M
Age: 77
State: IL

Vax Date: 02/26/2021
Onset Date: 02/27/2021
Rec V Date: 10/07/2021
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: Pacemaker, Cardiac Ablation

Allergies: None.

Symptom List: Rash, Urticaria

Symptoms: About 3:00 AM on 02/27/21 I got up to go to the bathroom and I got about halfway to the bathroom and the next thing I couldn't see the floor. I woke up a little bit later and I had broken my nose, cut my lip, blackened my eyes, and we called an ambulance and they got me over to the hospital to the ER and they were trying to send me home because they were saying they didn't have hospital beds but they did have me on a monitor and they noticed I had a 9 second stop in my heart rhythm and that negated them sending me home. Later, on Monday morning around 8 AM I had a pacemaker put in and a month and a half ago they had an ablation of my heart and right now I seem to be pretty functional. I was hospitalized shortly after the second dose and had an outpatient ablation done. I've had no prior issues or family history of heart related illnesses.

Other Meds: Blood pressure medicine, vitamins, a few other prescriptions, lisinopril 5 mg tablet.

Current Illness: None.

ID: 1768352
Sex: F
Age: 68
State: TN

Vax Date: 09/20/2021
Onset Date: 09/21/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: I had 3 shot in my bottom-a breathing treatment and was given an inhaler

Allergies: None

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

Symptoms: tightness in chest-very difficult to breath- very bad wheezing in chest-extreme tiredness-extreme headache

Other Meds: None

Current Illness: None

ID: 1768353
Sex: F
Age: 53
State: VA

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

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

Lab Data: None

Allergies: Gluten, dairy, all decongestants, most daily asthma meds, Steroids, sulfa drugs, adhesives, dust, pollen, mold, mildew and smoke. Least allergic to horses and highly allergic to everything else.

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

Symptoms: Became very tired evening of 2 October, on 3-4 October had low grade fever 101, severe body/joint aches, migraine and fatigue, 5 October moderate migraine, normal temperature, started getting congested, coughing/wheezing and sneezing. On 6 October had sever runny nose, nausea from drainage going into stomach, diarrhea, fatigue, bad headache, 101 temperature and followed up with Physician. They thought it was sinus infection or bacterial infection and told me to use OTC meds and put me on Azithromycin 250mg. On 7 October mild headache, tired, mild cough and very nauseous. Feeling a little bit better.

Other Meds: Armour Thyroid Vitamin D Vitamin C Drops Albuterol ProAir inhaler Claritin Benadryl

Current Illness: Allergies Asthma Underactive Thyroid

ID: 1768354
Sex: M
Age: 20
State: CA

Vax Date: 09/21/2021
Onset Date: 10/04/2021
Rec V Date: 10/07/2021
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: On 10/4/21 in the afternoon patient reported sharp pains when breathing and tightness/heaviness/burning in upper left chest area. On 10/5/21 patient went to urgent care where they informed him reaction may due to vaccine. Patient prescribed prednisone 20mg twice daily for 5 days and instructed to go to emergency room if symptoms worsened. That night patient checked into emergency room due to severe pain. Labs, X-ray and EKG performed. Patient discharged with acute chest pain and inflammation in the chest (or chest wall? patient unsure) and asked to follow-up with primary doctor.

Other Meds:

Current Illness:

ID: 1768355
Sex: F
Age: 36
State: MA

Vax Date: 04/03/2021
Onset Date: 05/01/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: See above already listed

Allergies: Codeine / morphine Diamox Copaxone Almonds

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

Symptoms: Began having Frequent UTI?s and a constant bladder spasm yet to be relieved by various medication trials along with vaginal pain and discomfort as well as bowel pain; constipation; and difficult passing bowels ?- it has been 7months and have seen various health providers to assist in looking into the matter (urology, colorectal) Have had ultrasounds, xrays, ruled out kidney stones, have tried 3 trials of medications to assist with symptoms in addition to 4 rounds of antibiotics (1 the first infection) and (3 for the last infection); relieves UTI but not the symptoms. Am now scheduled for additional colorectal consult and colonoscopy. Have had increased heart rate and low blood pressure - now am wearing an EKG holter to further monitor and determine appropriate course to assist with symptoms. Migraines have returned. It does not appear I am having a relapse of MS due to no enhanced or new lesions, but these issues can be a natural course of MS and related to nerve issues; while I had POTS already from a previous massive bilateral pulmonary embolism ? it is not clear if these heart related/blood pressure related symptoms are increasing for any other reason, or just the natural course I do not and did not automatically assume these issues were related to the vaccine, and no one has told me it was or mentioned this beyond asking if I have had it (everyone asks automatically to enter a dr?s office). I was asked by CDC to fill out this report based on my report on the text sent to me if I had recent medical issues which I said ?yes? but I did NOT answer ?yes? to beLieving it was related to vaccine.

Other Meds: Tysabri infusion Baclofen Tramadol Carbamezapine Gabapentin Lorazepam Topamax Vitamin d/vitamin b12 Amitryptiline

Current Illness: Relapse Remit Multiple Sclerosis Postural Orthostatic Tachycardic Syndrome Chronic UTI (was stablefor over 1 year) Migraine (was stable) Pulmonary embolism 3 years prior Trigeminal Neuralgia

ID: 1768356
Sex: M
Age: 77
State: CO

Vax Date: 02/08/2021
Onset Date: 10/01/2021
Rec V Date: 10/07/2021
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: Patient admitted to hospital with COVID. Patient is fully vaccinated.

Other Meds:

Current Illness:

ID: 1768357
Sex: M
Age: 62
State: MO

Vax Date: 06/14/2021
Onset Date: 06/14/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient may have potentially received an expired dose of vaccine after the 6 hours after being reconstituted.

Other Meds:

Current Illness:

ID: 1768358
Sex: F
Age: 45
State: NC

Vax Date: 10/06/2021
Onset Date: 10/06/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: vaccinator gave employee pfizer instead of moderna for 2nd vaccine. Employee was monitored and no adverse reactios noted.

Other Meds:

Current Illness:

ID: 1768359
Sex: M
Age: 43
State: GA

Vax Date: 04/06/2021
Onset Date: 07/01/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient reports left-sided numbness/tingling starting approximately 2-3 months ago from today (10/07/2021). He has since went to several doctors to find a cause for these symptoms but has yet to find a cause/treatment, leading him to believe this is from the vaccine. Patient reports that he feels the numbness/tingling all the time, though his symptoms differ in severity depending on the day. He reports that he sometimes feels the tingling in his chest, but this symptom was not present during the encounter. His symptoms are localized to the left side, with mainly his face, lower arm, and thigh being affected. Patient denied any trouble walking due to these side effects.

Other Meds:

Current Illness:

ID: 1768360
Sex: F
Age: 27
State: PR

Vax Date: 08/31/2021
Onset Date: 09/01/2021
Rec V Date: 10/07/2021
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: Patient does not have any allergies to medication, food or other products

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

Symptoms: Patient reports that the next day after the PFIZER vaccine, she starts her period for 5 days and it was not supposed to have it by that time. Bleeding stops and comes back for 7 days again for additional 5 days. Stops for another 7 days and comes back for 5 more days. Patient reports that the bleeding was so profuse that she noticed it the entire area where she was sitting bled. Patient reports bleeding still, and the blood is very dark with solid clots. Patient reports heat sensation at night which is not usual. Patient communicates with her gynecologist/OBG who tells her to go to the hospital. Patient refers that she does not want to visit the hospital since she does not present any additional symptoms to bleeding. The patient is recommended to visit her specialist.

Other Meds: Patient reports not taking any daily medications

Current Illness: No illness at time of vaccination

ID: 1768361
Sex: F
Age: 63
State: NE

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

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

Lab Data: none

Allergies: none

Symptom List: Unevaluable event

Symptoms: After receiving the vaccine on the first evening I got very tired and felt like I needed to lay down. I was dizzy, nauseas, and had a headache. That lasted for 7 days. I also had received the first dose of the Shingrix vaccine on July 6, 2021. After receiving that vaccine I had a fever, headache, body aches, itching in both of my forearms, swelling under my right arm, and my lypmh nodes were swelling under my right arm as well. I had received the Shingrix shot in my right arm.

Other Meds: Janumet XR Tabs 50-1000, 2xday Exemestane Tabs 25mg, 1xday Farxiga Tabs 5mg, 1xday OTC Multivitamin

Current Illness: none

ID: 1768362
Sex: M
Age: 55
State: MA

Vax Date: 02/17/2021
Onset Date: 08/29/2021
Rec V Date: 10/07/2021
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: COVID PCR + 5 days prior to admission.

Allergies: cortisone, diltiazem, oxycodone,

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

Symptoms: Recently diagnosed (5 days prior to admission) but now presented feeling worse with dyspnea on exertion, cough and fever and now with oxygen requirement as welll, believes he got sick at work (no specific sick contact however). Patient vaccinated x2 against covid (Pfizer). He was scheduled to receive MAb however due to sickness was held off and rechecked spike protein Ab 8/30 and positive.On admission started Remdesivir on admission 8/29 (5 day course- 200 mg x 1, 100 mg x 4). Discussed with ID given renal function but felt benefit outweighs risk given symptoms. Dexamethasone was added 8/30. Pt had poor po intake so received 1l of LR 8/31 with some improvement of his Cr. Also started Albuterol inhaler ATC. Due to slow improvement and persistent 02 requirement discussion had with ID and Pulm started on Baricitibib (9/1).

Other Meds: acetaminophen, allopurinol, amlodipine, apixiban, dulaglutide, D2, famotidine, hydralizine, Tesibia, Humalog, labetolol, metolprolol, prednisone, rosuvastatin, sodium bicarb, tacrolimus, torsemide, tramadol, t

Current Illness: unknown.

ID: 1768363
Sex: F
Age: 23
State: FL

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: BP. 153/105

Allergies: None Known

Symptom List: Injection site pain, Pain

Symptoms: Dizziness, High Blood Pressure

Other Meds: None

Current Illness: None

ID: 1768364
Sex: F
Age: 41
State: CA

Vax Date: 09/21/2021
Onset Date: 09/23/2021
Rec V Date: 10/07/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Hepatitis, jaundice over 2 weeks

Other Meds:

Current Illness:

ID: 1768365
Sex: F
Age: 43
State: WV

Vax Date: 09/28/2021
Onset Date: 09/30/2021
Rec V Date: 10/07/2021
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: Not reported. No history of allergy event with any vaccine.

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

Symptoms: Dose received on 9/28/21. On 9/30/21, patient reported a "golf ball size" swelling and redness. On 10/1/21, patient reported swelling resolved, but redness had increased to the size of a "silver dollar." Patient took Tylenol and Benadryl. Patient was instructed to mark redness with a pen/marker and monitor for changes in size (increase or decrease). Patient reported redness resolved.

Other Meds: Not reported.

Current Illness: Not reported.

ID: 1768366
Sex: F
Age: 53
State: VA

Vax Date: 10/06/2021
Onset Date: 10/06/2021
Rec V Date: 10/07/2021
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:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: vaccinator gave employee pfizer 3rd dose/booster when employee previously had completed dose of moderna.

Other Meds:

Current Illness:

ID: 1768367
Sex: M
Age: 21
State: AR

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

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient was given one dose of Janssen COVID 19 vaccine on 10/5/2021 that had expired on 10/02/2021

Other Meds:

Current Illness:

ID: 1768368
Sex: M
Age: 14
State: MI

Vax Date: 10/07/2021
Onset Date:
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: NONE PT RECEIVED THE VACCINE EARLIER THEN INTENDED

Allergies: NKDA

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

Symptoms: NONE

Other Meds: NONE

Current Illness: NONE

ID: 1768369
Sex: F
Age: 54
State: PR

Vax Date: 12/01/2020
Onset Date: 01/01/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: TSH, CBC, CMP,

Allergies: NKDA

Symptom List: Nausea

Symptoms: One week after second dose: intense fatigue and mental fog, leg weakness, generalized muscle pain and weakness, mood alteration (intermittent and recurrent) Then 3 months after 2nd dose severe photodermatosis and hyperparesthesia with sensation of burning skin, unable to stand sunlight without immediate development of painful rash, tiredness,

Other Meds: Synthroid

Current Illness: Hypothyroidism

ID: 1768370
Sex: M
Age: 13
State: MO

Vax Date: 06/14/2021
Onset Date: 06/14/2021
Rec V Date: 10/07/2021
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: Patient may have potentially received an expired dose of vaccine after the 6 hours after being reconstituted.

Other Meds:

Current Illness:

ID: 1768371
Sex: F
Age: 25
State: PR

Vax Date: 05/28/2021
Onset Date: 05/28/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data:

Allergies: n/a

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

Symptoms: Female patient without chronic conditions. Does not use medication. Within 10 minutes of MODERNA vaccination refers to paramedic feels dizzy. He proceeds to take the patient to the area of the stretcher where she says that she has a heater in her body. Vital signs were taken, BP 140/70m, 99 SAT, temp 36.0, dextrose 110. She was kept under observation and at 30 minutes she indicated that she had chills and proceeded to call 911 so the patient was transferred to the hospital.

Other Meds: n/a

Current Illness: n/a

ID: 1768372
Sex: F
Age: 70
State: MI

Vax Date: 04/01/2021
Onset Date: 10/06/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: SARS-COV-2 (COVID-19, Micro 10/6/2021 Detected

Allergies:

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

Symptoms: tested positive routinely when presented to hospital after a fall

Other Meds:

Current Illness:

ID: 1768373
Sex: M
Age: 48
State: FL

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

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

Lab Data: None

Allergies: None

Symptom List: Tremor

Symptoms: Feelings of numbness to the right side of my body. Feelings of Bells Palsy.

Other Meds: None

Current Illness: None

ID: 1768374
Sex: F
Age: 51
State: AR

Vax Date: 10/05/2021
Onset Date: 10/05/2021
Rec V Date: 10/07/2021
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: Patient was given one dose of Janssen COVID 19 vaccine on 10/5/2021 that had expired on 10/02/2021

Other Meds:

Current Illness:

ID: 1768375
Sex: F
Age: 34
State: CA

Vax Date: 09/29/2021
Onset Date: 10/05/2021
Rec V Date: 10/07/2021
Hospital:

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data:

Allergies: None

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

Symptoms: Currently breastfeeding and had first period after vaginal delivery being heavier than usual, prior to vaccine the period lasted 1 day heavy, this time is going on for 3 days of heavy bleeding non-stop. Haven?t visited doctor yet.

Other Meds: Prenatal vitamins, vitamin D 2,000. Vitamin C., vitamin B complex.

Current Illness: Breastfeeding

ID: 1768376
Sex: F
Age: 52
State: KS

Vax Date: 01/22/2021
Onset Date: 01/29/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: 1/29/21 - reduced white blood cell count and low neutrophils

Allergies:

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

Symptoms: S&S: reduced white blood cell count, low neutrophils, increased fatigue, short on air. WBC have recovered. Increased Fatigue continues and fluctuates day to day without any correlation.

Other Meds: Xeljanz, Requip, Hysingla ER

Current Illness:

ID: 1768377
Sex: M
Age: 84
State: MI

Vax Date: 03/19/2021
Onset Date: 10/02/2021
Rec V Date: 10/07/2021
Hospital: Y

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

Lab Data:

Allergies: NKDA

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Hospitalized (9.29.21); COVID-19 positive (10.2.21); fully vaccinated Discharge Provider: DO Primary Care Provider: MD Admission Date: 9/29/2021 Discharge Date: Oct 3, 2021 HOSPITAL COURSE 84-year-old gentleman presented with one week of weakness, nausea, feeling like he could not breathe. Fever over 100?. Some chest pain that would come and go. See H&P for full details. EMS was called and he was found to be hypoxic on room air in the low 80s and in respiratory distress (is supposed to be on 2 L oxygen at home.) Chest x-ray showed bilateral airspace disease. COVID testing positive. Admitted for treatment. Received five days Remdesivir in five days Decadron. Symptoms markedly improved. One day before discharge she had increased lower extremity edema and received one dose Lasix 40 mg IV. By the day of discharge he felt well enough to return home. Lower extremity edema significantly improved. He will complete another five days of Decadron (which will be 10 days total.) He is on his home oxygen at discharge. The patient had some hyperglycemia due to steroids which was treated appropriately with insulin. The rest of the patient's chronic medical issues were stable while here. PROCEDURES 9/29 BC x1: Staph epi 9/29 BC x1: Negative 9/29 CXR: Bilateral airspace disease Exam at discharge 36.3, 60, 20, 156/73, 93% 3 L Heart regular rate and rhythm Lungs clear to auscultation Abdomen nondistended nontender Extremities trace edema DISCHARGE RECOMMENDATIONS 1. Follow up with PCP in one week 2. Complete five additional days Decadron 3. Diabetic diet 4. Activity as tolerated Patient discharged home in improved and stable condition.

Other Meds: acetaminophen (TYLENOL) 500 MG tablet albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler amLODIPine (NORVASC) 10 MG tablet apixaban (ELIQUIS) 5 MG tablet atorvastatin (LIPITOR) 80 MG tablet B Complex Vitam

Current Illness: 9.26.21: ED - diarrhea

ID: 1768378
Sex: M
Age: 50
State: CA

Vax Date: 10/05/2021
Onset Date: 10/06/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: Na

Allergies: None

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

Symptoms: Headache mild fever body ache

Other Meds: Tylenol

Current Illness:

ID: 1768379
Sex: F
Age: 40
State: OH

Vax Date: 09/10/2021
Onset Date: 09/15/2021
Rec V Date: 10/07/2021
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: Pepto Bismol

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

Symptoms: Allergic reaction. Itchy eye lids, swollen eyes, itchy scalp. Rash on opposite arm, inside right elbow lasting at least a week. Hive-like rash on same side (left) hip lasting two weeks.

Other Meds: n/a

Current Illness:

ID: 1768380
Sex: M
Age: 48
State: WV

Vax Date: 09/25/2021
Onset Date: 09/27/2021
Rec V Date: 10/07/2021
Hospital: Y

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

Lab Data: CT scan with contrast; Ultrasound of the liver, pancreas, gallbladder, and kidneys; Blood work.

Allergies: Phenobarbital.

Symptom List: Pain in extremity

Symptoms: A couple days later, I started feeling stomach pain. It went away. 6 days after the initial shot, I woke up in excruciating pain. I went to the ER. They performed all kinds of tests while at the ER. I was diagnosed acute pancreatitis. I should still be at the hospital, but we had a death in the family so I came home. I was in the hospital for 2 days.

Other Meds: Losartan; Cymbalta; Flomax; Xanax XR.

Current Illness: COVID-19 one month prior.

ID: 1768381
Sex: F
Age: 76
State: FL

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: none

Allergies: none

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

Symptoms: fever, nausea, tiredness, headache, chills, diarrhea, loss of appetite, stiff and sore I felt like this for 2-3 days, but didn't feel better until day 5.

Other Meds: Levoxyl Omeprazole Tolterodine Atorvastatin Metroprolol CoQ10 Vitamin D3 Multi-vitamin (iron free) Levocetirizine (as needed for hives)

Current Illness:

ID: 1768384
Sex: F
Age: 61
State: MN

Vax Date: 08/26/2021
Onset Date: 09/13/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: BMP and hemogram CT Head Sinus x-rays

Allergies: none

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

Symptoms: Headache began 9/13/21, dull and continuous, then fever started 9/17/21 (still had headache). On 9/22/21 my head started to "buzz" and will not stop. Fever stopped around the same time as buzzing started. Headaches now come and go. Other symptoms currently experiencing are brain fog, unable to focus/concentrate, poor sleep waking up often and unable to get back to sleep. Unable to work at my job. Applied for short term disability for now.

Other Meds: Daily multi mineral and vitamin, vitamin c, zinc, vitamin d, magnesium oxide

Current Illness: none

ID: 1768385
Sex: F
Age: 57
State:

Vax Date: 10/05/2021
Onset Date: 10/06/2021
Rec V Date: 10/07/2021
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:

Allergies:

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

Symptoms: got shingles

Other Meds:

Current Illness:

ID: 1768386
Sex: F
Age: 54
State: MN

Vax Date: 10/04/2021
Onset Date: 10/05/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: N/A

Allergies: Sulfa, Amoxicillin

Symptom List: Vomiting

Symptoms: Chills, febrile (101.3), headache, body aches, enlarged lymph nodes on left side.

Other Meds: Tylenol taken after vaccine, upon being symptomatic.

Current Illness: none

ID: 1768387
Sex: M
Age: 76
State: OH

Vax Date: 10/06/2021
Onset Date: 10/06/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: N/A

Allergies: unknown

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Jand J was erroneously administered instead of Pfizer.

Other Meds: unknown

Current Illness:

ID: 1768388
Sex: F
Age: 89
State: MN

Vax Date: 01/20/2021
Onset Date: 10/04/2021
Rec V Date: 10/07/2021
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: Covid 19 PCR test completed 10/5/21- tested positive

Allergies: Contrast Dye, Cephalexin, Oxybutyin

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

Symptoms: Cough, runny nose, lethargy, loss of taste and smell

Other Meds: Calcium Carbonate, Plavix, Claritan, Zocor, losartan, Trusopt, Xalatan, metoprolol succinate, Fish oil, Probiotic, Timoptic, Vit D

Current Illness: None known

ID: 1768390
Sex: F
Age: 68
State: MO

Vax Date: 07/15/2021
Onset Date: 07/16/2021
Rec V Date: 10/07/2021
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: Hospital has medical records.

Allergies: Sulfates Benzoates

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Weakness, fatigue and unable to breathe requiring hospitalization. Still in hospital.

Other Meds: Fluoxitine Low dose aspirin

Current Illness: None

ID: 1768391
Sex: F
Age: 22
State: MO

Vax Date: 06/20/2021
Onset Date: 06/20/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient may have potentially received an expired dose of vaccine after the 6 hours after being reconstituted.

Other Meds:

Current Illness:

ID: 1768392
Sex: F
Age: 33
State: TX

Vax Date: 10/04/2021
Onset Date: 10/05/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: N/A

Allergies: Molds, animal dander, grass, trees, environmental allergens

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

Symptoms: Parosmia, everything smells like rotten meat. Anything savory (salty, rich) tastes of the same rotten or putrid smell. Sugary tastes remain unaffected but taste has greatly diminished. Phantosmia, or smelling things that aren?t present, is also present. The smells are always of a foul odor and are transient throughout the day. Began occurring roughly 24 hours after vaccine, remain ongoing.

Other Meds: Mirena IUD, valacyclovir, vitamin D3, Adderall XR, biotin

Current Illness: N/A

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am