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: 1771399
Sex: U
Age: 62
State: GA

Vax Date: 09/08/2021
Onset Date: 09/08/2021
Rec V Date: 10/08/2021
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: 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: 1771400
Sex: F
Age: 34
State: MO

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

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

Lab Data: N/A

Allergies: NKDA

Symptom List: Anxiety, Dyspnoea

Symptoms: Right upper arm started to become warm, itch, and swell 5 minutes after injection occurred. Took Tylenol and placed cold pack on site. Site remains painful, red, warm, and has formed a knot measuring 6.5 cm x 4.5 cm greater than 24 hours later.

Other Meds:

Current Illness: None

ID: 1771401
Sex: F
Age: 32
State: GA

Vax Date: 09/16/2021
Onset Date: 09/16/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: 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: 1771402
Sex: F
Age: 29
State: IL

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

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

Lab Data: n/a

Allergies: N/A

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient received 1st dose Moderna vaccine on 09.10.2021. Was given Pfizer vaccine for 2nd dose.

Other Meds: N/A

Current Illness: N/A

ID: 1771403
Sex: F
Age: 37
State: AZ

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: pt developed throat tightness post vaccine, no tongue swelling or difficulty breathing about 10 minutes post vaccine, patient remained for 45 additional minutes after administration of 25mg PO diphenhydramine which immediately resolved her symptoms. Pt experienced these symptoms after doses 1 and 2 and was recommended to finish the series as well as receive a booster by her allergist.

Other Meds:

Current Illness: history of anaphylaxis and allergies and severe asthma, followed by an allergist who recommends vaccination + booster

ID: 1771404
Sex: F
Age: 22
State: AZ

Vax Date: 05/05/2021
Onset Date: 08/19/2021
Rec V Date: 10/08/2021
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: Positive Covid-19 PCR test

Allergies:

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

Symptoms: C/O chills, fever, sore/scratchy throat, headache, runny nose and/or congestion, myalgia, malaise, diarrhea, nausea and/or vomiting.

Other Meds:

Current Illness:

ID: 1771405
Sex: F
Age: 85
State: CA

Vax Date: 02/24/2021
Onset Date: 02/25/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: X-ray; US; COVID Test; Blood pressure check; Bloodwork

Allergies: Sulfa; MACROBID; MACRODANTIN; Tape; KEFLEX

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: I had body aches, sore arm, headache, nauseated, flu like symptoms. That lasted February 24th, 25th, 26th and when I woke up the 4th day, I had nothing all symptoms were gone. I had gone to the doctor on 7/26/21 because I was extremely weak, shortness of breath, and coughing. I had a chest X-ray and everything was normal. I followed up with my cardiologist and he put me in the ER. They did blood pressure check, ultrasound with contrast, COVID test, it came back negative. They did bloodwork. They could not find anything wrong. The ER MD gave me albuterol because he couldn't find anything wrong but thought I was at the start of a bronchial infection, but he didn't think I needed antibiotics. All the symptoms and sickness eventually cleared up. I was at hospital for about 3 hours or so and then was discharged.

Other Meds: Lisinopril; atorvastatin; amlodipine; baby aspirin; vitamin D3; probiotic; magnesium; cranberry; fish oil; calcium citrate/magnesium/zinc

Current Illness: N/A

ID: 1771406
Sex: M
Age: 93
State: CT

Vax Date: 09/27/2021
Onset Date: 09/29/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data:

Allergies: Cephalexin

Symptom List: Pharyngeal swelling

Symptoms: Fatigue, Myalgia, Diarrhea

Other Meds: Atenolol, Xarelto, Vitamin D3, Tylenol, FeSO4, Flomax, Pravastatin

Current Illness: Diverticulitis with abscess, Wound abdomen

ID: 1771407
Sex: F
Age: 59
State: NC

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: Ultrasound 09/2021

Allergies: Augmentin

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Pt. states that after receiving the 1st dose of Phizer 08/31/2021, started experiencing symptoms of high heart rate, headache, left arm swollen, underarm swollen. Primary visit 09/2021 Ultrasound preformed. Recommendation for Observation and delay of 2nd dose. Still continuing to experience symptoms. Primary visit scheduled for 10/11/2021.

Other Meds: N/A

Current Illness: N/A

ID: 1771408
Sex: F
Age: 59
State: NY

Vax Date: 09/03/2021
Onset Date: 09/30/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: Physical exam, Bloodwork and CT scan

Allergies: None

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Multiple side effects such as headache, tiredness, muscle pain, rapid heartbeat, and swollen lymph nodes throughout. On evening of the third week after second shot, severe abdominal pain in lower right. Next morning went to urgent care, and was tested for appenditicitis.

Other Meds: Synthroid, Cholesterol Medication, Vitimans C, D, E & Zinc, Selenium

Current Illness: None

ID: 1771410
Sex: F
Age: 73
State: OH

Vax Date: 09/30/2021
Onset Date: 10/01/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: None

Allergies: None known

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

Symptoms: Fever: up to 103.6 for three days Nausea, vomiting, diarrhea for three days Severe headache for two days Muscle aches and extreme fatigue for five days Mild aches and fatigue for additional two days General malaise and feeling yucky for total of six days

Other Meds: Lumigan Prednisolone Acetate Ketorolac Thera Tears

Current Illness: None known

ID: 1771411
Sex: M
Age: 0
State: WA

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

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

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: The child inadvertently was given Pediarix and Pentacel when Pediarix and HIB were intended therefore the child received a double dose of Dtap and IPV. At the time of this filing the child has not experienced any signs or symptoms related to this error.

Other Meds:

Current Illness:

ID: 1771412
Sex: F
Age: 50
State: TX

Vax Date: 12/22/2020
Onset Date: 12/22/2020
Rec V Date: 10/08/2021
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: Penicillin and NSAIDS (can't take because I have bleeding disorder)

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

Symptoms: I barely started to feel it about 5 PM. I didn't feel that terrible. I had a very mild temperature elevation, body aches that were mild. I didn't miss work after the first dose. The cold sores started that afternoon, I felt the tingling sensation in the afternoon around 4:00 PM. I had a pretty low grade temperature and I was little tired and little sore but nothing unexpected or extravagant. Muscle aches and body aches. This lasted several days. Body aches lasted about a few days. No medical care seeked.

Other Meds: Losartan; hydrochlorothiazide; metoprolol

Current Illness: None

ID: 1771413
Sex: U
Age: 52
State: GA

Vax Date: 09/08/2021
Onset Date: 09/08/2021
Rec V Date: 10/08/2021
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: 1771414
Sex: F
Age: 78
State: GA

Vax Date: 03/30/2021
Onset Date: 09/16/2021
Rec V Date: 10/08/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Spoke with PUI who has been feeling fatigued for a couple weeks now. On 9/16 PUIs symptoms intensified to the point where she went to hospital where she was admitted and released 9/20. She is still symptomatic with cough, aches, congestion, sore throat, and headaches. PUI is fully vaccinated, tried to get the vaccine booster but was ineligible. PUI has COPD, no other preexisting medical conditions.

Other Meds:

Current Illness:

ID: 1771415
Sex: F
Age: 63
State: UT

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

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

Lab Data: No tests

Allergies: Anesthetics

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

Symptoms: Severe itching and not just at the injection site the itching was particularly bad in hands and feet but arms and legs as well. I scratch so hard I tore open skin. I was seen in urgent care on 929 and had oral dexamethasone and I also had another 10 mg of oral prednisone on 9-28-2021 (30 mg daily for three days was prescribed but the OT hing had improved somewhat and I didn?t want to rusk additional side effects from prednisone) and I started on Zyrtec twice a day for a week and triamcinolone cream. The itching is getting better.

Other Meds: Flecainide Diltiazem Vitamin d Calcium Biotin Multivitamin

Current Illness: None

ID: 1771416
Sex: F
Age: 30
State: WI

Vax Date: 10/06/2021
Onset Date: 10/06/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: None

Allergies: Seasonal

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

Symptoms: 50min after vaccine was administered she became tachycardiac, dizzy, numbness face and hands, hands became cold, throat felt like it was swollen, Benadryl given but s/s did not improve, was taken to Hospital ED, said it was a mild reaction to the flu vaccine

Other Meds: None

Current Illness: No

ID: 1771417
Sex: F
Age: 42
State: AZ

Vax Date: 02/04/2021
Onset Date: 08/23/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: Positive Covid-19 PCR test

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: C/O cough, chills, fever, sore or scratchy throat, headache, runny nose or congestion, myalgia, malaise, and diarrhea

Other Meds:

Current Illness:

ID: 1771418
Sex: F
Age: 57
State: NJ

Vax Date: 09/15/2021
Onset Date: 09/16/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: I developed an uncontrollable itch, pain and swelling on both ankles, feet and lower legs after receiving the second dose of the Pfizer COVID-19 vaccine. The swelling was so severe that I had to wrap them with ice. I had hoped that this would alleviate some of the swelling but it did not. I also used an over the counter anti-itch medication. On September 27, I met with my doctor and got a prescription for steroids. The swelling has gone down but I still have an unusual itch that was not there before the shot.

Other Meds: None

Current Illness: None

ID: 1771419
Sex: F
Age: 40
State: CA

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

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

Lab Data: Vitals only: racing pulse, high BP that then plummeted and ECG showed PVCs and runs off Vtach

Allergies: Amoxicillin, Citalopram, Levetiracetam, Lamotrigine, Seroquel, Carbamazepine, Topiramate, Oxcarbazepine, Zonisamide, Latex, polysorbate-80

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

Symptoms: <15 minutes after shot my throat felt constricted, I had difficulty swallowing, was wheezing and had trouble speaking. Staff checked my vitals - BP was 165/118 (my normal is 100/60) and my pulse was 129. The doctor gave me 50 mg of Benadryl. They rechecked my vitals to find my BP had plummeted to what they deemed ?dangerously low.? Their EpiPen malfunctioned so the paramedics were called. I was transported to the ED via ambulance. The doctor I saw was trying to avoid having to use an EpiPen so started with 40 mg Pepcid, high dose IV Prednisone and 8 puffs of albuterol. I showed no signs of improvement, so she ordered the EpiPen. Within 5-10 minutes of administering the EpiPen, my breathing was back to normal, I could swallow normally and was able to speak. I was discharged a couple hours later and sent home with 2 EpiPens in case it happened again.

Other Meds: Gabapentin, Protonix, Lovenox, dilaudid (prn), MS Contin, magnesium, Baclofen, Remeron, daily vitamin, clobazam, tizanidine (prn), Claritin, colace, Montelukast, Fluocinonide 0.05 % Topical Cream (prn)

Current Illness: None

ID: 1771420
Sex: F
Age: 39
State: NY

Vax Date: 07/22/2021
Onset Date: 08/17/2021
Rec V Date: 10/08/2021
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: Penicillin, aspirin

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

Symptoms: Serious vertigo, started as Positional Vertigo, evolved into general dizziness and nausea, currently less violent but still present

Other Meds:

Current Illness:

ID: 1771421
Sex: F
Age: 47
State: OH

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: N/a

Allergies: Asa, pcn

Symptom List: Unevaluable event

Symptoms: Abnormal movements of torso- back and forth when at rest

Other Meds: Amlodipine, duloxetine, fenofibate, gabapentin, levothyroxine, Mobic , trazodobe

Current Illness: None

ID: 1771422
Sex: F
Age: 59
State: WA

Vax Date: 08/19/2021
Onset Date: 08/22/2021
Rec V Date: 10/08/2021
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: Chest x-ray - Normal CAT scan - normal ultra sound of hear - normal Breathing test - normal stress test - normal Blood tests - mostly normal

Allergies: Penicillin, Septra, Sulfa, Azithromycin, Clindamycin

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

Symptoms: Had vaccine on 8/19/21. On the 22nd and 23rd I had very, very bad muscle, joint, body aches. On 8/22 I started to have a hard time breathing whenever I was active, not sitting. I was given an Albuterol inhaler which had no effect after 1 week of use. On 8/27 I was given a 5 day dose of prednisone. This was helpful on day 3 but all help went away and my chest started to hurt after each breathing episode. On 10/01/21 I was started on an Alvesco inhaler and on Omeprozal. From 8/31 to 10/08 my symptoms have been; shortness of breath whenever active (walking, standing, sitting at a computer), and whenever I have a breathing episode I also have chest pain that can last up to 3 hours. The only changes I have had during this time is that now I can be active a bit longer ? 3 to 15 minutes- before breathing is difficult and chest pain starts at all times not just after a breathing episode.

Other Meds: Vitamin D & B12

Current Illness: C-Diff earlier that month

ID: 1771423
Sex: F
Age: 71
State: GA

Vax Date: 09/12/2021
Onset Date: 09/12/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

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

Other Meds:

Current Illness:

ID: 1771424
Sex: F
Age: 62
State: SC

Vax Date: 03/12/2021
Onset Date: 08/30/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: Bloodwork on September 28, 2021 and October 8, 2022

Allergies: Aspartame and Gabapentin

Symptom List: Injection site pain, Menorrhagia

Symptoms: Drastically elevated liver enzymes (AST and ALT) as of September 28, 2021. Trying to determine the cause.

Other Meds: Fexofenadine and hormone cream

Current Illness: None

ID: 1771425
Sex: F
Age: 43
State: CA

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

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

Lab Data: 9/13/2021 - PCR test - positive result

Allergies: None

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

Symptoms: Horrible headache that lasted several days that wouldn't go away - worst in my life. Nausea - I wanted to throw up. That was for a few days and I had a slight cough, too. I do still have a lingering deep cough. I used Advil or Tylenol for headache; drank water; taking zinc and Vit C.

Other Meds: No

Current Illness: None

ID: 1771426
Sex: F
Age: 67
State: ME

Vax Date: 04/16/2021
Onset Date: 04/18/2021
Rec V Date: 10/08/2021
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: Has had blood work done and everything was fine.

Allergies: Cipro.

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: She received her vaccine, just felt very very tired, and achy. She is a walker and found it hard to lift her legs up to walk. She had a headache and shortness of breath. It's now feeling like she is having the same reaction that she had after the 2nd vaccine. She had the same reaction with the first one as well. She has notified her doctor her symptoms, and they did not give her any recommendations.

Other Meds: Amlodipine 25 mg; Pantoprazole 40 mg; Buproprion 300 mg; Alprazolam 1 mg; Sertraline 50 mg; Atenolol 25 mg; Atorvastatin 20 mg; Telmisartan 40 mg.; one a day vitamins, Allergy medicine. Amoxillin for a tick bite.

Current Illness: Tick bite on antibiotics.

ID: 1771427
Sex: F
Age: 84
State: IL

Vax Date: 01/28/2021
Onset Date: 09/17/2021
Rec V Date: 10/08/2021
Hospital: Y

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 fully vaccinated with Pfizer vaccine 1/28/21 and 2/17/21. Patient developed COVID infection 9/17/21 and received antibody infusion 9/20/21 -- this all through urgent care center. On 9/28/21 patient had follow up appointment with MD and noted to have rapid heart rate and was sent to the ED. Patient admitted with AF with RVR and underwent a TEE/CV and ultimately required a pacemaker insertion. The atrial fibrillation with rapid ventricular response possibly related to recent COVID breakthrough infection.

Other Meds:

Current Illness:

ID: 1771428
Sex: M
Age: 62
State: GA

Vax Date: 09/17/2021
Onset Date: 09/17/2021
Rec V Date: 10/08/2021
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: 1771429
Sex: F
Age: 94
State: MN

Vax Date: 10/05/2021
Onset Date: 10/06/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: Lab Tests Completed C-REACTIVE PROTEIN (INFLAMMATION) COMPREHENSIVE METABOLIC PANEL ESR LAB ONLY-COMPLETE BLOOD COUNT WITH DIFFERENTIAL LAB ONLY-URINE MICROSCOPIC REFLEX LACTIC ACID SARS-COV-2, INFLUENZA A+B, AND/OR RSV NUCLEIC ACID TESTING PANEL TROPONIN I URINE DIP, REFLEX TO MICROSCOPIC, REFLEX TO CULTURE Icon Imaging Orders Placed Today Imaging Tests EKG XRAY CHEST PORTABLE -

Allergies:

Symptom List: Nausea

Symptoms: Weakness Dehydration Chills (without fever)

Other Meds:

Current Illness:

ID: 1771431
Sex: F
Age: 75
State: GA

Vax Date: 03/31/2021
Onset Date: 09/16/2021
Rec V Date: 10/08/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Patient hospitalized due to COVID. Patient is fully vaccinated. Symptoms: fever, fatigue

Other Meds:

Current Illness:

ID: 1771432
Sex: M
Age: 39
State: NJ

Vax Date: 10/05/2021
Onset Date: 10/05/2021
Rec V Date: 10/08/2021
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: Pt said none

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

Symptoms: Pt came to or clinic and said he wanted a Janssen shot. He did not tell us that he had already gotten the Pfizer shot on 4/1/21 and 4/24/21 -- when we processed the shot thru his insurance. it told us to use the same manufacturer as before . That's when we questioned him about the other covid shots he got which was not revealed to us before. He said technically he did not get any shots since it was more than 6 months ago. He then started to say he has an underlying condtion and needed this shot. We told him he could have gotten the Pfizer shot in that case but it seems he came specially to get the Janssen shot and also said it was approved elsewhere.

Other Meds: Pt did not tell us

Current Illness: Pt did not tell us

ID: 1771433
Sex: F
Age: 65
State: NC

Vax Date: 09/28/2021
Onset Date: 09/29/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: Doctor checked it out and asked me to report it...no known issue was found from examination.

Allergies: none

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

Symptoms: After the shot the next morning I had pain in my front jaw area, top and bottom. First thought was tooth ache. Then the next day the pain was in around my eyes and my jaw/cheek area. I looked up the nerves in that area and it seems to be the Trigeminal nerves. The pain would throb, then itch and burn. Now, 10 days later I have some jaw pain but lots of pain around the eyes...burning and itching. You can't see anything which makes me think it is nerves....maybe a sort of bells palsy? I visited the doctor yesterday and said the Trigeminal nerves usually is just one junction of the nerve not all of them. I would say it is 30% better so at least is getting better. The odd thing about it my husband is experiencing the SAME THING!! That is why we think it is from the Covid booster as we got it the same time. His is more around the top of his eye and front of ear. It is only one side of the face.

Other Meds: Synthroid, Vitamin D, Pure Multivitamin

Current Illness: none

ID: 1771435
Sex: M
Age: 62
State: CA

Vax Date: 08/12/2021
Onset Date: 08/12/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: NA

Allergies: Haldol [Haloperidol] Risperidone Zyprexa [Olanzapine]

Symptom List: Tremor

Symptoms: Mixed dose series. Cl. previously vaccinated on 5/6/21 with Janssen.

Other Meds:

Current Illness:

ID: 1771436
Sex: F
Age: 42
State: TN

Vax Date: 10/05/2021
Onset Date: 10/06/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: Physical exam at the walk-in clinic, no tests done at this time

Allergies: Penicillin, Keflex, Sulfa

Symptom List: Erythema, Pruritus

Symptoms: Started having arm pain at site of injection and noticed my arm pit was starting to feel sore the evening of Oct 5th -the first day of receiving the booster vaccine. I started to take 600mg of ibuprofen that first evening and continued to take it at regular intervals and am currently still taking it. I woke up about 3:30am and my arm and armpit we extremely painful to the point I couldn't get back to sleep. I took my temperature at that time and it was 99.8. The morning of Oct 6th I noticed my armpit was a little swollen and really sore and my arm continued to be really sore at the injection site the entire day and maintained a 99.4-99.8 temperature by ear. The night of the 6th, I woke up and my right arm was completely asleep from the pressure in my armpit but resolved once I moved around. When I woke up the next morning on Oct 7th, the pain at the injection site hand subsided a bit, but my armpit and inside of my arm was even more swollen and really painful. I called the Covid hotline and Medical Center (where I work) and they recommended I get it checked out at a walk-in clinic. I went to the Pharmacy Walk-in at lunch time on Oct 7th and the nurse practitioner noted "Swelling and tenderness to R axillary region "Diagnosis was Axillary lymphadenopathy and Vaccine reaction". She recommended warm compress and continued ibuprofen and if it got worse to call back. Then on the morning of the 8th, I woke up and not only is my armpit swollen and really painful, but not the area behind my collarbone to my neck are now also very swollen and I noticed some swelling into my chest from my armpit as well but neither of the newer swelling are painful.

Other Meds: Allegra once a day, multi-vitamin once a day, probiotic once a day

Current Illness: None

ID: 1771437
Sex: F
Age: 57
State: SC

Vax Date: 10/08/2021
Onset Date: 10/08/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: blurred vision, high blood pressure (175/101 p=70)

Other Meds:

Current Illness:

ID: 1771439
Sex: F
Age: 32
State: MD

Vax Date: 10/04/2021
Onset Date: 10/04/2021
Rec V Date: 10/08/2021
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: No

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

Symptoms: Severe arthralgia, myalgias, headache, fatigue, severe pain at injection site diarrhea, nasal congestion, hyaline rhinorrhea, dysphonia, anosmia, ageusia, dry cough 4 day evolution.

Other Meds: Dexketoprofen 25mg 1 every 8 hours

Current Illness: No

ID: 1771440
Sex: M
Age: 17
State: CA

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/08/2021
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: A 17 year old student experienced itchiness and tingly on his arms about 15 minutes after vaccination. The nurses on site evaluated him and spoke to doctor on the phone. He was given 12.5mg of Benadryl orally at 1:15pm. At 1:25pm, he was given an ice pack to cool down itchiness. By this time, the itchiness had spread to his legs.

Other Meds:

Current Illness:

ID: 1771441
Sex: F
Age: 55
State: AZ

Vax Date: 01/05/2021
Onset Date: 08/28/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: Positive home Covid-19 test.

Allergies:

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

Symptoms: C/O cough, headache, runny nose or congestion, loss of taste and/or smell, and myalgia

Other Meds:

Current Illness:

ID: 1771442
Sex: F
Age: 96
State: CT

Vax Date: 10/05/2021
Onset Date: 10/05/2021
Rec V Date: 10/08/2021
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: Imaging 10/6, Labs 10/7

Allergies: Sulfa, Codeine, Gluten, Whey, Lactose

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

Symptoms: Fatigue, Myalgia, Shortness of Breath, Fever, Diarrhea

Other Meds: Metoprolol, Norvasc, Vitamin D3, Melatonin, Omeprazole

Current Illness: Constipation, deconditioning

ID: 1771443
Sex: F
Age: 63
State: NV

Vax Date: 02/11/2021
Onset Date: 03/01/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: ER; Medical Center

Allergies: N/A

Symptom List: Pain in extremity

Symptoms: I had Flu-like symptoms for a day or so. Two weeks after the vaccine I had breakthrough bleeding. The bleeding was very heavy and I noticed it when I urinated. I am menopausal I have not had a menstrual period for 12 years so this was very unusual. I have had many tests and a Pelvic exam as well as a D&C. All tests have been negative. I have had these bleeding episodes six more times during the next couple of months since that time. It stopped but I had another on 09/22/2021. I am not sure if it is done happening.

Other Meds: Metoprolol

Current Illness: N/A

ID: 1771444
Sex: M
Age: 32
State: KY

Vax Date: 06/28/2021
Onset Date: 06/01/2021
Rec V Date: 10/08/2021
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: Pt was given Pfizer as his first Covid vaccine on 5/29/21, and then was given Moderna as his second dose on 6/28/21 in error by NP.

Other Meds:

Current Illness:

ID: 1771445
Sex: F
Age: 39
State: MD

Vax Date: 04/01/2021
Onset Date: 04/30/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: Scanner in my head and anti-inflammatories.

Allergies: No

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

Symptoms: Headache and dizziness and joint paint.

Other Meds: Vitamin Supplements

Current Illness: No

ID: 1771447
Sex: F
Age: 66
State: LA

Vax Date: 02/25/2021
Onset Date: 03/10/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: Stress test- spot on the front of my heart, he could not tell me what it was at that time. The heart catherization showed I had a 40 % heart blockage on the front of my heart.

Allergies: No

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

Symptoms: A couple of week after the 1st Dose Moderna, around 03/10/2021, my boss noticed my face was red. I did not think anything about it. I felt weak. Other people noticed my face was red. I would continue to get very weak. Until I could not function anymore. That is when I went to see my nurse practitioner, she said my pulse rate was 60. She sent me to a cardiologist. The cardiologist gave me a stress test. I ended up with a heart catherization. That's when they found the blocked heart artery. They put me on medication, beta-blocker, toprol 25 mg od, low dose Bear Aspirin od. I have recovered from the AEs with the medication and I am being monitored by my Nurse practioner and my cardiologist . It has slowed me down a little bit, but I'm good. I'm still working. I go back for a check up on 11/08/2021.

Other Meds: Multivitamin; ALLEGRA; DYAZIDE; LEVOXYL; EFFEXOR; ESTRACE

Current Illness: No

ID: 1771448
Sex: F
Age: 64
State: FL

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

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

Lab Data: None

Allergies: None, but a bee sting on my finger about a week and a half before I did get a reaction to, but that also did not become life threatening.

Symptom List: Vomiting

Symptoms: The worst started four hours after the vaccine and lasted ten hours, then I slept awhile, and the next day it was still effecting me but to a lesser degree and by the following day no symptoms. My first dose knocked me out for three days (chills, tired, headaches) the second dose was four days of the same. This booster although over much quicker, it's was a little scary, and touch and go that first night not knowing if my breathing was going to be effected since it was my arm was swollen, and felt it in my neck and in my eye on that side. I feel it's important to be vaccinated being in healthcare, but I'm concerned about the next one. Perhaps an alternative vaccine, or something I can do on my end, or think about retirement.

Other Meds: Multivitamin, d3+k2, loratadine 10mg, preservision areds (eyes).

Current Illness: None

Date Died: 09/04/2021

ID: 1771449
Sex: M
Age: 36
State: TX

Vax Date: 02/09/2021
Onset Date: 06/06/2021
Rec V Date: 10/08/2021
Hospital: Y

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

Lab Data: 9/3 and 9/4 2021.

Allergies: See attached

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Became unresponsive during non emergency transport to dialysis. Rerouted to nearest hospital. Transport company failed to supply hospital with patient info. Was admitted as generic patient around 5pm on Sept 3, 2021. Transport company failed to contact me with patient unresponsive, and emergency location. I couldn't locate my son until after midnight.

Other Meds: See attached

Current Illness: Esrd, high blood pressure, osteogenesis imperfecta, depression, anxiety, chronic pain, insomnia,

ID: 1771451
Sex: M
Age: 69
State: GA

Vax Date: 08/27/2021
Onset Date: 09/01/2021
Rec V Date: 10/08/2021
Hospital: Y

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

Lab Data: Ct, labs, rle ultrasound

Allergies: CDN, celebrex, vioxx

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

Symptoms: On 8/27/21 pt had 3rd covid booster. On 9/2/21 pt began having SOB. Pt went to an urgent care on multiple occasions and tested negative for covid. Pt was experiencing sob with oxygen into the 80s and some tachycardia. On 10/5/21 he was found to have a RLE DVT and pulonary emboli. Resulting in hospitalization. Pt also severaly anemic.

Other Meds: levothyronxine, hydroxycholorquin, methotrexate, sertraline, pantoprazole, terazosin, atorvastatin, lisinopril

Current Illness: none

ID: 1771452
Sex: F
Age: 52
State: NH

Vax Date: 04/11/2021
Onset Date: 06/01/2021
Rec V Date: 10/08/2021
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: Doctor is having me do a blood test.

Allergies: no

Symptom List: Injection site swelling, Limb discomfort

Symptoms: My arms and hands fall asleep and get tingly often. My legs and feet do sometimes.

Other Meds: lisinopril- hydrochlorothiazide 12.5 propranoler capsule 10mg 1 day

Current Illness: no

ID: 1771453
Sex: F
Age: 48
State:

Vax Date: 04/15/2021
Onset Date: 04/01/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data:

Allergies: Procardia - anaphylaxis Severe seasonal allergies

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

Symptoms: In April 2021, soon after the patient's second dose of the COVID-19 (Moderna) vaccine, she started to experience word finding difficulties. She did not report this to the physician until June 2021. She had additionally been on Trikafta since November 2020. Upon report in June 2021, the dose of Trikafta was decreased to exclude the evening dose. The issue has resolved as of October 2021.

Other Meds: Corlanor 5 MG Oral Tablet Creon 24000-76000 UNIT Oral Capsule Delayed Release Particles DULoxetine HCl - 60 MG Oral Capsule Delayed Release Particles Esomeprazole Magnesium 40 MG Oral Capsule Delayed Release Fluticasone Propionate 50 MCG/

Current Illness:

ID: 1771454
Sex: F
Age: 62
State: OK

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

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

Lab Data: unknown. ask physician.

Allergies: honey, codeine

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

Symptoms: According to the patient, she had multiple temporal lobe seizures that rendered her unable to speak or communicate. These were more extreme and for longer duration than she has had before. Prior to this her seizures were controlled with her topiramate and the patient states she has not had a seizure in a "long time". Seizures are still occurring intermittently.

Other Meds: topiramate, warfarin, hydroxyurea, sertraline, cyanocobalamin

Current Illness: none

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am