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: 1769025
Sex: F
Age: 47
State: PA

Vax Date: 02/10/2021
Onset Date: 03/01/2021
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: None

Allergies: Morphine

Symptom List: Dysphagia, Epiglottitis

Symptoms: Red swollen bumps on first joints of all fingers on both hands, difficulty bending fingers, painful and achy. First occurred several weeks after second shot and is ongoing.

Other Meds: Amphetamine salt ER, Pepcid

Current Illness: None

ID: 1769026
Sex: M
Age: 67
State: GA

Vax Date: 09/09/2021
Onset Date: 09/28/2021
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:

Allergies:

Symptom List: Anxiety, Dyspnoea

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: 1769027
Sex: F
Age: 74
State: CO

Vax Date: 10/05/2021
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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Penicillin

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

Symptoms: PATIENT PRESENTED WITH A swollen deltoid, warm to the touch and red for about 6 inches on her upper arm, she also said it feels very sore still.

Other Meds:

Current Illness:

Date Died:

ID: 1769028
Sex: F
Age: 83
State: WI

Vax Date: 09/25/2021
Onset Date: 10/05/2021
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:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Client had 1 dose of covid 19 vaccine, client died-due to complications of covid-19

Other Meds:

Current Illness:

ID: 1769029
Sex: F
Age: 50
State: OR

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

Lab Data: 10/1/2021: T3 FREE, HEMOGLOBIN A1C, SEDIMENTATION RATE, C-REATIVE PROTEIN, D-DIMER, QUANTITATIVE 9/29/2021: T4 FREE

Allergies: IODINE, PENICILLIN, AMOXICILLIN

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

Symptoms: HEAVINESS IN LEGS; UNABLE TO USE RIGHT LEG TO WALK; NUMBNESS IN HANDS, FINGERS, FEET, & TOES; CHEST PAIN; SHAKING/TREMBLING INSIDE; DIZZINESS; WEAK FEELING. UNABLE TO DRIVE. UNABLE TO WALK STEADILY.

Other Meds: LEVOTHYROXINE .088MG, LIOTHYRONINE 5MCG MAGNESIUM 250MG, PRESERVISION AREDS 2, SUPER B-COMPLEX, SELENIUM 200MCG,

Current Illness:

ID: 1769030
Sex: M
Age: 73
State: NY

Vax Date: 09/02/2021
Onset Date: 09/01/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: N/A

Allergies: Meat Fish Eggs Penicillin

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

Symptoms: Joint pain throughout my body, especially in my shoulders, knees, hips, and ankles Muscle weakness throughout my body, especially in the legs, feet, hips, and chest Chest pain I am planning to go to the doctor soon.

Other Meds: Vitamins D, E, C, and F Ferrous Sulfate

Current Illness: None

ID: 1769031
Sex: F
Age: 70
State: PA

Vax Date: 02/24/2021
Onset Date: 08/15/2021
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: None

Allergies: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Blepharitis- antibiotic cream and warm compresses - itching and scaling returned a little after treatment concluded - advised dermatologist on regular visit and she prescribed a steroid cream which cleared up, but condition comes back.

Other Meds: Losartan HCTZ Rosuvastatin Metoprolol Allegra Flonase Baby Aspirin Vitamin D3

Current Illness: None

ID: 1769032
Sex: M
Age: 81
State: SC

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:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Patient received Pfizer Covid vaccination, then his wife came back and told us he has already gotten the 2 dose series of Moderna Covid vaccine. This would be considered a booster, but with a different manufacturer.

Other Meds:

Current Illness:

ID: 1769033
Sex: F
Age: 40
State: NY

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

Lab Data: Steroid Intramuscular injection left arm, ordered a 6K allergy panel with immunology. Prescribed 20mg of Famotidine every 12 hours, 4mg of Methylpredinsolone use as directed for 5 days & Over the Counter Benadryl twice a day.

Allergies: None

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Allergic reaction: wheezing, presented with wheezing rash & swelling of throat/face (lips, cheeks, eye lids, ears, neck)

Other Meds: As per Pharmacy - to use Over the counter Baby Aspirin 81 grams

Current Illness: Currently treating : Ovarian cyst , Unknown large Cystial Mass, Bilateral carpal tunnel syndrome, Posterior Tibal tendinitis, Right Lower Extremity Plantar Fasciitis, & Baker?s Cyst behind Right Knee.

ID: 1769034
Sex: M
Age: 17
State: GA

Vax Date: 09/09/2021
Onset Date: 09/28/2021
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: 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: 1769035
Sex: F
Age: 48
State: MD

Vax Date: 06/22/2021
Onset Date: 07/19/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: Ear - audio test, MRI GI - bloodwork, ultrasound and stool test

Allergies: Penicillin

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

Symptoms: Tinnitus and hyper acoustics in one ear and hearing loss. Doctor injected steroids into eardrum to help with hearing loss after sending me for an MRI that was clear. Treatment has had no impact so far. Also GI issues. Doctor ran bloodwork, ultrasound and stool test with all normal results. GI issues ongoing and unexplained.

Other Meds: Vitamin D

Current Illness: No

ID: 1769036
Sex: F
Age: 19
State:

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: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data: None.

Allergies: PCN, Amoxicillin, class drugs.

Symptom List: Rash, Urticaria

Symptoms: Pt received 1st dose @1100. waited in clinic for 15 minutes. Pt left. 30 minutes later Pt started to feel per Pt "like my throat was closing". when PT returned to clinic seen by Provider and administered .25 mg of diphenhydramine @ 1155 IM. Vitals signs taken and where as follows. B/P 124/87, HR 82, O2, 100 n RA.

Other Meds: Pt was administered .25 mg diphenhydramine @ 1155.

Current Illness: N/A

Date Died: 10/03/2021

ID: 1769037
Sex: M
Age: 90
State: TX

Vax Date: 01/26/2021
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: 9/27/2021: COVID positive; 9/27/2021: Chest x-ray revealed patchy airspace opacity in the left lower lobe as well as the periphery of the right lower lobe

Allergies: No known allergies

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

Symptoms: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 12/31/2021 and 1/31/2021. Patient recently diagnosed with COVID on 9/20/2021 and hospitalized at a different facility from 9/20/2021 to 9/22/2021. Patient presented to emergency department for shortness of breath and required oxygen supplementation 4-5L nasal cannula. Patient received cholecalciferol, ceftriaxone, and dexamethasone. Patients respiratory status continued to deteriorate and patient declined intubation. Patient expired 10/3/2021 at 0917.

Other Meds: Allopurinol 200 mg daily, aspirin 81 mg daily, bumex 1 mg BID, calcitriol 0.25 mcg daily, coreg 6.25 mg BID, cholecalciferol 400 units daily, vitamin B12 400 mg, finasteride 5 mg daily, tamsulosin 0.4 mg nightly.

Current Illness:

ID: 1769039
Sex: U
Age: 76
State: GA

Vax Date: 09/17/2021
Onset Date: 09/28/2021
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:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1769040
Sex: F
Age: 50
State: FL

Vax Date: 08/05/2021
Onset Date: 08/15/2021
Rec V Date: 10/07/2021
Hospital: Y

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

Lab Data: 8/18/21 Chest xray, CT scan, bloodwork. 2 PE's, 1 in each lung

Allergies:

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

Symptoms: Developed a croupy cough, shortness of breath, and pain with every breath, swelling of legs and feet.

Other Meds: Tamoxifen

Current Illness:

ID: 1769041
Sex: F
Age: 43
State: UT

Vax Date: 10/29/2020
Onset Date: 10/29/2020
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: 10/29/2020 Tdap & blood work. Within 15 minutes felt like I was having a heart attack. Pressure, tightness, pain, palpitations. Coughing, weezing. Bad pain & discomfort went on for 5 days. Couldn?t exercise for 2 months. Can?t lie on left side of body for 11+ months without feeling discomfort. 1/4/2021 Blood work. 1/5/2021 Dr Apt with provider 3/25/2021 Blood work 3/26/2021 Dr Apt with provider to go over blood work 3/26/2021 Cardiology X-ray - Medical Center 4/27/2021 Cardiology Stress Test - Medical Center 5/3/2021 Dr Apt with provider & blood work 5/4/2021 Holter Monitor & EKG Medical Center 5/20/2021 Apt with Cardiologist, Electrocardiogram ***confirmed PERICARDIAL EFFUSION 6/2/2021 Electrocardiogram, Stress test and Blood work. Still shows PERICARDIAL EFFUSION 6/14/2021 Electrocardiogram (still shows PERICARDIAL EFFUSION), blood work 6/25/2021 More blood work 7/26/2021 Dr Apt with provider 8/25/2021 Electrocardiogram. Now classified as ?CHRONIC PERICARDIAL EFFUSION?. 9/6/2021-10/7/2021 30 day Heart monitor 11/1/2021 Apt scheduled with Dr. (head of cardiology)

Allergies: amoxicillin

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

Symptoms: Within 15-20 minutes of receiving the Tdap immunization i started feeling major chest pain, pressure, palpitations (felt like I was having a heart attack) and coughing and wheezing. I immediately call the doctors office and they said I was having a reaction to the shot. The nurse told me to take Benadryl and to go to the ER if I couldn't breathe. I could always breathe and didn?t want to go to the ER because we had brand new insurance with a very high deductible. (My husband lost his job a few month before due to Covid layoffs). I couldn't afford to go to the ER because I got a routine Tdap booster. I spent the next 5 days with extreme heart pain, pressure, palpitations, and discomfort. I was taking Benadryl every 4 hours for 5 days straight. I couldn?t exercise for 2+ months and have had heart discomfort ever since. I have since been diagnosed with a ?Chronic Pericardial Effusion?. I?ve had numerous tests, monitors and blood work done. I haven't been able to lie on my left side at night in almost a year without discomfort. My cardiologist believes that the Tdap is the cause of my chronic pericardial Effusion. I meet with a vaccine induced specialist on November 1st, 2021. I truly feel like I should be reimbursed for financial, physical, and emotional damages by what this immunization has done to me.

Other Meds: Levothyroxine 50 MCG Estrogen, progesterone, and testosterone bio identical hormone replacement cream

Current Illness:

ID: 1769042
Sex: M
Age: 11
State: TX

Vax Date: 10/01/2021
Onset Date: 10/02/2021
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: zoloft

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

Symptoms: marked swelling and redness at site larger than 20 cm, swelling to eyes

Other Meds: Valproic acid, norditropin, guanfacine, buspar, amanatdine, bactrim, ciprofloxacin

Current Illness: skin abscess

ID: 1769043
Sex: F
Age: 35
State: NV

Vax Date: 09/07/2021
Onset Date: 09/07/2021
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: None

Allergies: Egg

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Pt throat started to swell after few hours along with trouble breathing. Pt too liquid benadryl and it went away after a few hours.

Other Meds: Benadryl liquid

Current Illness:

ID: 1769044
Sex: F
Age: 15
State: GA

Vax Date: 09/09/2021
Onset Date: 09/28/2021
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: 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: 1769045
Sex: M
Age: 72
State: TX

Vax Date: 02/04/2021
Onset Date: 02/05/2021
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: Blood work autoimmune panel. Results negative 6/17/2021 Punch biopsy. Results ?Inconclusive? 4/14/2021

Allergies: Moderate reaction to Butrans

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

Symptoms: Mild rash post 1st vaccine. Diffuse red, angry, itching rash with fluid filled blisters post 2nd vaccine. Initially treated with topical corticosteroids. After no improvement, treated with low dose Prednisone for 14 days. No improvement noted, stronger dose topical corticosteroids. No improvement noted, high dose Prednisone tapering over 30 days. Began in February, 2021. The only improvement is the rash is no longer present all over the body but is located on the hands, forearms and shins. Remains red, itchy and has tiny fluid filled blisters.

Other Meds: Latanoprost eye drops, Dorzolomide eye drops, Combigan eye drops, Adderall

Current Illness: None

ID: 1769046
Sex: F
Age: 36
State: NC

Vax Date: 04/07/2021
Onset Date: 04/08/2021
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: None.

Allergies: None

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

Symptoms: I did not have the same sensation with this injection as my last one and I remember I didn't feel the cooling sensation or tingles or numbness and it felt like a normal vaccination. I had the typical upper arm pain as usual. I don't remember but I think the generalized arm pain lasted for maybe about a week. I went to bed as normal and felt fine and the next day I was fatigued, but nothing extraordinary and I would say by lunch time the next day I started feeling rough. I just felt really weak, lethargic, swimmy headed and dizzy, tiredness, and I just couldn't go on and I just wanted to lay down. A little after lunch time the following day I remember just laying down on the floor because I felt so bad. I remember begging my husband to come home early because I just wanted to lay down and I felt pretty miserable the rest of the evening. It felt like flu symptoms with body aches, fatigue, and weakness. I didn't have cold like symptoms like sniffles. I felt like I had been hit by a truck. I didn't want to eat, speak, and my whole body ached and it was hard to sleep. The following night, I went to sleep and the next day I was much improved from the day before and I could walk around and not feel like I was gonna fall over. I still have a pain in left side of body that goes into leg and it's relatively recent and started in July. I seen a doctor about it. It's like a shooting sore pain that goes down the side of leg.

Other Meds: Prenatal Vitamins

Current Illness: None

ID: 1769047
Sex: U
Age: 16
State: GA

Vax Date: 09/09/2021
Onset Date: 09/28/2021
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:

Symptom List: Unevaluable event

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: 1769048
Sex: M
Age: 46
State: GA

Vax Date: 09/17/2021
Onset Date: 09/28/2021
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: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

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: 1769049
Sex: F
Age: 43
State: NY

Vax Date: 03/04/2021
Onset Date: 03/08/2021
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: They did evenutually COVID Test just to be sure. I got like a touch exam under my arms and I stopped wearing deodorant. My period was not coming frequently, it just started being off schedule and I took three pregnacy test to check for pregnancy.

Allergies: I have a epi pen for bee stings. I also have that walnuts. Just allegic to walnuts and also strawberries. The other one is latex. Latex anywhere I breakout in hives and can't breath. I can not have any pitted fruits such as mango aprocots, stone fruits. The other ones are carrots. Oh!, also bananas.

Symptom List: Injection site pain, Pain

Symptoms: I was just very tired and I was sore. The site was sore and red and a raised bumb where the shot was. It didn't go done. Around the second shot it went down. Monday morning after the shot I could not sore and could not raise my arm, the lymph nodes were swollen. I missed my mamogram because my underarm was so swollen. I am still swollen. I had excessive saliva, it was weird I just know it started after and I was super tired and exhausted. I just stopped being tired, I was eating and exercising healthy.

Other Meds: I take adderal 6 days a week. Herbal Turmeric chewable pill every day.

Current Illness: NO.

ID: 1769050
Sex: F
Age: 61
State: FL

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

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

Lab Data: COVID Test- positive (8/24/2021)

Allergies: Sulfa Drugs; Codeine (possibly); Cephalosporin

Symptom List: Injection site pain, Menorrhagia

Symptoms: I got the 2nd dose in April 2021 at 7:30 at night. After that, the arm the shot was given in started to hurt. I was ok until about 18 hours later on Saturday I started to feel very tired. I started to get a headache and muscle aches. I took my temperature and I had a fever over 100 degrees so I just stayed bed that day. I didn't do much or eat much. I took Tylenol. Sometimes if the Tylenol didn't work I would take the Butalbital APAP CAS 50-325-40. I took maybe 1 or 2 doses of that. That lasted Saturday, Sunday, most of the day, and possibly all the way to Wednesday. I didn't have any congestion, but I did have a little bit of scratchy throat too. I was felling better by Tuesday. About 3 weeks later after receiving the 2nd dose I started going out. I was still wearing a mask and not trying to be around many people. I had small gatherings with people who wore a mask and were all vaccinated. I am a school teacher. July 2020-May 2021 I was on a health leave of absence because my doctor didn't want me to be exposed to anything because there was no vaccine available at that time. July 2021 I went back to work. The teachers report back a week before the students. The county changed their protocol and said that teachers need to wear mask while with children but it was voluntary. We had a meeting with the faculty of about 50 people and not many of them were wearing their mask. On the first day of school Tuesday August 10, 2021 I had 18 children between 8-9 years of age. When the kids came to school it was voluntary for them to wear a mask. We have a thing for meet the teacher and allowed a maximum of 4 families at a time for a half an hour. Most of them that came to my room wore a mask. Many of my students had mask on but not all of them. We swap students to where I teach 16 students in the first group and then 16 more students in the second group. That was the second day. I have my students in a room that is fairly small and the AC isn't the best but it works. I have the students grouped in 4 desks. Tuesday night I get a phone call from my secretary that one of my students tested positive for covid. That student isn't in my home room but in my block when we swap the students. I had to tell the secretary who were sitting by the girl who tested positive. The kids that were sitting beside her had wore a mask and so did the girl as well. They told the kids they didn't have to quarantine because they had a mask on. I wasn't close to the girl and neither were the other students so we didn't have to quarantine. Students were in and out of school because of kids testing positive for COVID and having to quarantine. On August 18th it was mandatory for students to have to wear a mask unless they had a doctors note for a good reason to opt out. When the kids wore the mask, the kids mask would fall down their nose and had mask that didn't fit properly. One little boy pulled his mask down to talk, but I told him he didn't need to do that. Some had gator mask, paper mask, and cotton mask. August 23, 2021 I went to school on that Monday and I was really tired when I got home. My throat was scratchy when I went to bed that night. I woke up the next morning and my throat was really sore. I had a slight fever and called my secretory at 4 in the morning. My secretary called the people over the COVID testing and scheduled an appointment for me for a COVID test. I went to the appointment and they did the rapid test on August 24, 2021. I tested positive for COVID. My fever had went up over 100 degrees. I went home and isolated and didn't go out again. My fever went up to 102.8, and I felt exhausted. My muscles and joints were aching. I had chills but it didn't last that long. I went and got a medication called monoclonal antibodies, which is supposed to help the symptoms, at a health department 1hr away from me. Our governor procured these antibodies. There were about 15 people ahead of me when I got there. We stood for about 50 mins in the heat at about 89 degrees. When I finally got in, I sat there and had to wait for an hour. When it was my turn, they gave me 4 shots. One in each arm and then one on each side of the stomach. I had to wait to make sure I didn't have a reaction and I didn't so I drove back home. The fever lasted for about 4 or 5 days. I didn't have breathing issues but I was very congested. I was coughing and had a fever. I lost my taste and smell and that lasted for about 6 days. Once my fever broke I felt really tired. I still had the scratchy throat, fever, and congestion. I missed three weeks of school. The day I went back was September 13th 2021. We wasn't required to get a negative test but only to quarantine for 10 days. My symptoms lasted longer so I didn't go back to work after only 10 days of quarantine. The congestion went away I got my smell and taste back. After my fever broke is when I had lost the taste and smell .On September 13, 2021 I felt exhausted when I went back to school. I still have the cough in the morning and during the evening. When I went back to school I was wearing a mask except when we took kids to recess. The past two weeks my students are back. It seems like the covid spread is leaving the 3rd grade and moved on to another grade level. I'm not fully recovered still.

Other Meds: Metformin 1000mg, 2xday; Glimepiride 4mg, 2xday; Toujeo 130 units, 1xday in the morning; Trulicity 1.5, 1xweek; Levothyroxine 150 mcg, 1xday; Losartan 100mg, 1xday; Hydrochlorothiazide 25mg, 1xday; Omeprazole 20mg, 2xday; Rosuvastatin 20mg,

Current Illness: none

ID: 1769051
Sex: F
Age: 40
State: IN

Vax Date: 04/20/2021
Onset Date: 04/20/2021
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: Penicillin - Rash Clindamycin - Rash Morphine - Rash

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

Symptoms: Patient was sitting in Observation c/o feeling weakness in bilateral legs. States she has a history of Myasthenia Gravis and pseudo-seizures. Able to take several steps to chair steadily. Sat for a while then states legs feel much better.

Other Meds:

Current Illness:

ID: 1769052
Sex: M
Age: 48
State: AZ

Vax Date: 09/30/2021
Onset Date: 10/01/2021
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: Patient is complaining of swollen injection site, pain, and inability to raise arm above shoulder level.

Other Meds:

Current Illness:

ID: 1769053
Sex: M
Age: 23
State: NY

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:
Dose Series: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Tamiflu medication

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: 1st (before going to bed) fatigue, tiredness, and headache; 2nd (trying to go to bed) cold feeling, extremities cold to the touch, extreme shivering (causing teeth chattering, thighs shaking, louder breathing), shivering causes inability to seep. Duration: about 2 hours; 3rd (waking up in the middle of the night) hot flashes, sweating, thirst, slight muscle pain in right hand. Duration: 2-3 times throughout the night for about 10-15 minutes each 4th (waking up the next day) dizziness, slightly blurry vision, orange foamy urine (my urine is normally pale yellow and not foamy)

Other Meds:

Current Illness:

ID: 1769054
Sex: F
Age: 68
State: GA

Vax Date: 09/09/2021
Onset Date: 09/28/2021
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:

Allergies:

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

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: 1769055
Sex: F
Age: 30
State: ID

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

Lab Data: Primary Health should have both vaccines documented. I went to the same clinic for both.

Allergies: Ceclor

Symptom List: Nausea

Symptoms: I was given the wrong vaccine by a nurse. I verified with the front desk beforehand that I was supposed to get my 2nd Moderna, not Pfizer. The nurse failed to check my record, or my vaccination card, and gave me the Pfizer vaccine instead.

Other Meds: Adderall Aldactone

Current Illness: None

ID: 1769056
Sex: F
Age: 71
State: CO

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:

Allergies: cepholasporins, penicillins, sulfa drugs, sulfonamide derivatives, tetracyclines, epinephrine, cats, dogs, birds

Symptom List: Injection site pain

Symptoms: Woke up following morning with blue spot on top side of tongue. By Sunday morning, the underside of the tongue was a deep red and swollen, with numbness along the front and left side

Other Meds: Montelukast 10 MG, Levocetirizine 5 mg, calcium 600 mg x2, magnesium 500 mg x2, glucosamine chondroitin x2, potassium gluconate 595 mg x2, vitamin D3 125 mag x2, zinc 50 mg x2, Thyroid Action, B Complex with Vitamin C 60 mg, ashwagandha 230

Current Illness:

ID: 1769057
Sex: M
Age: 79
State: MN

Vax Date: 10/03/2021
Onset Date: 10/04/2021
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: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: The day of vaccination just site pain. The next day lack of control of bladder. lack of control of muscles aiding getting out of bed and/ or up from chairs, headache, fever, elevated blood pressure, fatigue. adverse reactions lasted two days with strength, then the third day slight headache persisted, tiredness continued (less than fatigue level). The fourth day after vaccination hunger started to return.

Other Meds: Lisinopril 40Mg, Metoprilol Succinate 25 Mg, Omega -3 900 Mg, Aspirin (enteric) 325 Mg (1 AM 1 PM), Atorvastatin 20 Mg

Current Illness: none

ID: 1769058
Sex: F
Age: 53
State: MD

Vax Date: 09/10/2021
Onset Date: 09/10/2021
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: Repeat CBC after vaccine and adverse reaction showed normal H/H 14.2/43% Plts 301K (prior 328K)

Allergies: None

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

Symptoms: Migraine headache shortly after vaccine administration. D5 after vaccine recurrent migraine. D10 got menstruakl cramping and onset of menses than continued through D13. In addition have had night sweats , headaches, mild cramping and bloating during, and since menstruating. Prior to this experience, my last menses was in December 2020 when I stopped taking the birth control pill. It took about a month after stopping the pill that my migraines (used to get them 3-4x/mo) and night sweats (that mostly occurred during menses) stopped so this experience has been concerning and disconcerting. It feels like this vaccine negatively affected my hormones.

Other Meds: azelastine-fluticasone 137-50 mcg/spray Spry 1 spray by Nasal route 2 (two) times daily. 2/8/21 2/8/22 Yes frovatriptan (FROVA) 2.5 MG tablet TAKE 1 TABLET BY MOUTH AT ONSET OF MIGRAINE. MAY REPEAT AFTER 2 HOURS AS NEEDED. DO NOT EXCEED> 2

Current Illness: None

ID: 1769059
Sex: M
Age: 67
State: CO

Vax Date: 08/29/2021
Onset Date: 09/04/2021
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: Immediate Care - CT Scan - they verified that spot was still there in the right lung; 126 - blood serum; they seemed to think I had definite symptoms of pneumonia; they admitted me to their sister hospital about a mile away.

Allergies: Latex Benadryl - instead of slowing me down, it hypes me up and makes me legs and arms restless - horrible feeling (paroxysmal reactional)

Symptom List: Tremor

Symptoms: Started to feel extremely fatigued. General malaise and when I coughed a lot, I was even throwing up. I did have some nausea but was surprised when I had to throw up because the nausea didn't seem all that bad. It lasted about four days. It seemed to resolved days after 4 or 5 days and then I had a period where I started to feel great. It started to come back in the last week (final) of September. The onset and symptoms were almost identical but this time it didn't let up and so I went for a good 5 days and eventually I went to Immediate Care - Friday, this past week. I did go see Dr. the week before on Wednesday - she ordered x-ray - they found a new area in the lower area in the right lung - she thought it might be pneumonia but she couldn't be sure. I hadn't had anything there before. On Friday before the last week of September, I saw my cardiologist and my medical oncologist (rechecking the cancer and she said I was doing very well). At first, my cardiologist said everything looked good but was concerned about the Olmesartan and so she did say to go off of that and went back to Losartan (less potent) - this was after the first week of the health symptoms in September and before the last week of the adverse symptoms in Sept. when she thought everything was going okay again. So then she said to go back on the Olmesartan but then told me to go off again when I was so sick again - she was a bit concerned with me taking it. I have hypo-natremia and that has been going on for 3-4 months. Not severe but the highish 120's. The final week in September when I was feeling sick it was maybe a bit worse - extreme fatigue, that same nausea and throwing up. I was continuing to take me dog out to walk but I would sometimes have difficulty making back to car - light headed and very, very weak. It wasn't clearing up on it's own. Over the month of September, I lost 14 lbs. When I had those two weeks of feeling so sick - I was eating very little, not drinking enough. I was in the high 150's and dropped to 138. Hospital for 5 days - pnuemonia; Olmesartan; nephremia - could have all been contributors. IV fluids - normal saline and then Sunday - Dr. - she prescribed sodium tablets and high protein diet and high calorie diet. I started to really improve on the diet and salt tablets. They collected a sputum sample - the day after I was hospitalized; was diagnosed on Sunday - I was in isolation then with that Diagnosis; standard treatment for IV - gave me Vancomycin -they were very concerned that it may have been doing more harm than they initially realized. Zyvox - 600 mg tablet twice daily until finished - started that Tuesday and they discontinued the Vancomycin. WHen I came home, they also prescribed 1 mg at least for 3 times day of sodium tablets; that and the protein shakes have made a significant difference for me. I feel much better now. I have improved dramatically - but each evening I do have a downward turn. I see Primary Care physician soon and he'll be doing another blood panel. On the day of the hospital release, they did give me a flu vaccine - October 5th. Had a sore arm after it.

Other Meds: A lot of blood pressure meds; asthma medications - inhaler Morning: Isosorbide Mononitrate - 90 mg daily in the morning; a aspirin 81 mg; Plavix - 75 mg every morning; Carvedilol - 25mg twice a day; Olmesartan - 20 mg once daily; Steroid i

Current Illness: no

ID: 1769060
Sex: M
Age: 74
State: MI

Vax Date: 10/01/2021
Onset Date: 10/03/2021
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: Echocardiogram, blood tests, mri, ct scan, heart monitor

Allergies: None

Symptom List: Erythema, Pruritus

Symptoms: Hospitalization for arrhythmia, chest pain, elevated pulse, blood pressure. Began 2.5 days after injection. Affected heart requiring hospitalization sndctreatment

Other Meds: None

Current Illness: None

ID: 1769061
Sex: F
Age: 56
State: NY

Vax Date: 10/05/2021
Onset Date: 10/07/2021
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: None

Allergies: None

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

Symptoms: Baseball size lump in armpit lymph node of left vaccination arm.

Other Meds:

Current Illness: None

ID: 1769062
Sex: M
Age: 26
State: WA

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: n/a

Allergies: none

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

Symptoms: patient fainted, then regained consciousness, sweaty palms, palms turned bright red then pale white

Other Meds: none

Current Illness: none

ID: 1769063
Sex: U
Age: 12
State: GA

Vax Date: 09/09/2021
Onset Date: 09/28/2021
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:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

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: 1769065
Sex: M
Age: 73
State: WA

Vax Date: 03/02/2021
Onset Date: 08/16/2021
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: EKG to verify AFib

Allergies: none

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

Symptoms: Recurrence of AFib which did not respond to ?Pill in a pocket? chemical cardioversion

Other Meds: Simvastatin, Levothyroxine, amlodipine, chlorthalidone, psylium fiber, docusate sodium, milk of magnesia, glucosamine, aspirin

Current Illness: no acute illnesses

ID: 1769066
Sex: M
Age: 53
State: AZ

Vax Date: 03/16/2021
Onset Date: 04/01/2021
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: n/a

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

Symptoms: Have been extremely tired. Finally went to the doctor and had various bloodwork done. NP said heart is skipping beats. Currently seeing a cardiologist and have various tests scheduled. No results as of today's date.

Other Meds: n/a

Current Illness: n/a

ID: 1769067
Sex: F
Age: 61
State: GA

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

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: A 61-year-old female patient received her 2nd dose of Pfizer COVID-19 vaccine. Within 15 minutes of administration, patient reported severe body weakness, dizziness and experienced uncontrollable tears. Pharmacy called code white and patient refused 911 and asked pharmacy to monitor until her co-worker arrived. Patient requested pharmacy to call her work and inform them about the reaction. Her vitals were normal with BP of 135/80 HR of 85 at the time of the reaction. Normal breathing. No signs or symptoms of allergic reaction. Pharmacy provided food and water. Pharmacy continued to monitor the patient until her co-worker arrived.

Other Meds:

Current Illness:

ID: 1769068
Sex: F
Age: 16
State: GA

Vax Date: 09/10/2021
Onset Date: 09/28/2021
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:

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: 1769069
Sex: F
Age: 46
State: AZ

Vax Date: 09/21/2021
Onset Date: 10/07/2021
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: Positive COVID test 9/30/21

Allergies:

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

Symptoms: I had Numbness in right side of body setting in an hour after inoculation that lasted 24 hrs, headache lasting from inoculation to present, fatigue, pain in lower legs. I contracted COVID-19 with fever of 103.5, 8 days after inoculation and continue to suffer from fatigue/exhaustion, back/body aches,.

Other Meds: Escitalopram 10mg, Adderall 10mg

Current Illness:

ID: 1769070
Sex: M
Age: 13
State: OR

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

Lab Data:

Allergies: Sensitive to Dairy

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

Symptoms: Sore arm that moved up into neck area and down under arm below the arm pit area, feverish, chills, lump in neck area the size of a jelly bean, very tired, headaches. Went into the doctor's office on Monday...starting to feel better but lump was still there. Dr said everything looked okay and to just keep watch that lump didn't grow or move. As of today, still has the lump but no pain

Other Meds: Children's Multi Vitamin, Vitamin D3

Current Illness:

ID: 1769071
Sex: F
Age: 64
State: GA

Vax Date: 09/10/2021
Onset Date: 09/28/2021
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:

Allergies:

Symptom List: Vomiting

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: 1769072
Sex: F
Age: 47
State: CA

Vax Date: 09/13/2021
Onset Date: 09/16/2021
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:

Allergies: Oysters, rash.

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Client reported to Rn that 3 days after receiving the 1st COVID vaccine Pfizer she developed breast tenderness and menstruation for 3 days. The client stated this was abnormal for her as she had experienced her regular menstruation the 3 days prior to receiving the vaccine. The client also developed redness around her right cornea, which she described as a "blood vessel pop." The client stated the redness lasted about 3-4 days. The client denied any pain associated with this. The client also stated she developed fatigue that lasted one week. The client took Tylenol for her symptoms. The client denied an dizziness or shortness of breath. The client did not follow up with her primary care provider or an allergist. The client has a history of a high ANA which she manages with diet and follows up with a rhuematologist regarding her ANA level every 6 months. The client takes vitamin D and Iron supplements regularly. The client has a history of of a rash after consuming oysters.

Other Meds: Vitamin D, Iron

Current Illness: Unknown

ID: 1769073
Sex: M
Age: 59
State: OR

Vax Date: 10/07/2021
Onset Date: 10/07/2021
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: None

Allergies: No known

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

Symptoms: Patient was vaccinated twice in 2 months by accident. He is fine but received 2 doses.

Other Meds: HCTZ 25mg, Metformin 500mg, Flomax 0.4m

Current Illness: None

ID: 1769074
Sex: F
Age: 68
State: WA

Vax Date: 09/30/2021
Onset Date: 09/30/2021
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: IM
Vax Site: LA

Lab Data:

Allergies: levofloxacin (anaphylactic)

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient received her first Pfizer dose on February 2, 2021 and reported an itchy rash that developed shortly after receiving the vaccine. She said she took Benadryl after the rash developed but it did not relieve her symptoms. Patient received her second dose of Pfizer on February 20, 2021 and did not report any reaction after that dose. Within 10 minutes of receiving her third Pfizer vaccine, she reported red itchy areas on her inner arms. As she was describing this, the rash began to develop around her neck and chest and became more red and itchy. She did not report any trouble breathing or swelling of lips or tongue. Patient did not want to take Benadryl because she said it did not work after having similar symptoms after her first dose. Per Pharmacy protocol for vaccines, the emergency service was called because of the generalized reaction. Patient sat in a chair at the pharmacy for approximately 15 minutes until the emergency services came, they monitored her for approximately 15 more minutes, then she left to go home with her husband to drive her home.

Other Meds:

Current Illness:

ID: 1769075
Sex: F
Age: 63
State: AZ

Vax Date: 04/03/2021
Onset Date: 04/03/2021
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: Bloodwork has been done resulting in low thyorid hormone, low white blood count, high red blood count, Iron levels fine, inflammation is fine. Abnormal stress test and nuclear stress test, both came out fine.

Allergies: LACTOSE INTOLLERANT, SURGICAL TAPE, TOPICAL IODINE, SULFUR BASED MEDICATIONS SENSITIVITY [RASH OR METALLIC TASTE, OR HIVES]

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

Symptoms: I have been fatigued and thyroid has been acting up worse than usual, congestion, headaches, muscle aches and pains/spasm. Increased thyroid medications 3 times in last 3 months. Meeting with endocrinologist in December

Other Meds: COMPOUNDING THYOIRD T3 AND T4 , LEVOCARNITINE, B-12 INJECTIONS, VITAMIN D3 PRESCRIPTION, XIIDRA, MARILAX, CITRASEL, MULTI-VITAMIN, CALCIUM, K, PROBIOTIC, PYRROLOQUINOLINE QUINONE, METRA-GEL, TYLENOL

Current Illness: NO

ID: 1769076
Sex: M
Age: 74
State: GA

Vax Date: 10/04/2021
Onset Date: 10/04/2021
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:

Allergies:

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

Symptoms: On 10/4/21 a patient came in and requested to get the Covid Booster. They indicated that they had Pfizer and it had been more than 6 months since their 2nd dose. The patient did not have their immunization card with them. We did not give the previous doses so we attempted to verify the previous series on database and there was no record. We had the patient sign the attestation form and gave the Booster dose of Pfizer. Today on 10/7/21 the patient came back in with his card for us to add the Booster to it and we discovered he had Moderna not Pfizer. I called the patient later in the day to ask if he wanted us to call his primary care doctor and he said he had already contacted them.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am