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: 1771510
Sex: F
Age: 49
State: MN

Vax Date: 09/25/2021
Onset Date: 09/28/2021
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: EKG - elevated heart beat; recommended to see cardiologist

Allergies: No

Symptom List: Dysphagia, Epiglottitis

Symptoms: 28Sep2021 started at 1230PM. I had an elevated heartbeat for 8 hours. Called 911, paramedics and confirmed that. I had a pace maker. On 28 Sep2021 did a virtual visit with cardiologist. Saw that elevated heartbeat for 8 hours and shared the results for EKG with cardiologist.

Other Meds: NORVASC; probiotic

Current Illness: No

ID: 1771511
Sex: M
Age: 26
State: CA

Vax Date: 10/06/2021
Onset Date: 10/06/2021
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:

Allergies: NKA

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient was anxious, felt very warm, and said he did not feel well and could not see approximately 5-10 seconds after the injection. Patient did not improve at which time I administered epinephrine 0.3mg IM approximately 5 minutes after the start of the reaction. During this time I placed ice packs on his chest and rotated the ice pack placement to his upper back. Technicians had a small fan on him, cooling measures helped him much. Patient responded well after receiving the epinephrine, was able to see and his body temperature returned to normal. We had called EMS and they arrived to take vitals. By this time patient had markedly improved. Patients father was called and arrived approximately 10 minutes after the start of the reaction. EMS recommended that he be driven to the local hospital for observation but he refused. I spoke with the patients father and recommend the same but I do not know whether he went to the hospital ER or not. I jotted down some notes for the father to show the ER stating that I had administered epinephrine. The father and his son the patient walked out of the pharmacy in no apparent distress. Sincerely, RPh

Other Meds: No prescription medications listed on his profile except for the Moderna vaccine.

Current Illness: None stated on his vaccine form.

ID: 1771512
Sex: F
Age: 32
State: DC

Vax Date: 08/27/2021
Onset Date: 08/28/2021
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: EKG- normal

Allergies: No

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

Symptoms: I had chest and back pains around my heart area. They were mild but noticeable. It would come and go. I would also have a little bit of shallow breath sometimes. It stopped about 2 ? weeks after. It was on and off for that time. I went to my doctor regarding this and all tests were normal.

Other Meds: Multivitamin

Current Illness: No

ID: 1771513
Sex: F
Age: 58
State:

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

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Headache, Retinal bleed, Injection site pain

Other Meds:

Current Illness:

ID: 1771514
Sex: F
Age: 35
State: TX

Vax Date: 10/06/2021
Onset Date: 10/08/2021
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: Allergies to outdoor pollen and cats

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

Symptoms: My tongue is white with sores. I have an odd metallic taste and the tip of my tongue is sore.

Other Meds: Zyrtec, Benadryl, Tylenol, pristique, pro air, symbicort, and spiriva

Current Illness: Asthma

ID: 1771515
Sex: M
Age: 79
State: KS

Vax Date: 04/28/2021
Onset Date: 10/07/2021
Rec V Date: 10/08/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: History of Present Illness 80 year old male patient who presented to the ER this morning after sustaining a fall at home. Patient was in the living room in his recliner this morning. He stood up and felt dizzy. He lowered himself to the ground, denying loss of consciousness. He sustained a small posterior scalp laceration that required two staples in ER. He denies ongoing dizziness at time of encounter, just after arrival to the inpatient ward. It is unclear if the laceration was sustained during this episode or another fall. At baseline patient is independently ambulatory without need for assist device. He denies headache, vision changes, fever, chills, chest pain, shortness of breath, diarrhea/ constipation. He reports one episode of nausea/vomiting without hematemesis around the time of the near-syncope. He reports occasional constipation, if he does not have an am bowel movement he will take a stool softener at lunchtime. He drinks alcohol daily, 4 ounces of liquor and then 4-5 beers each evening. He never misses a day. No history of withdrawal symptoms. Incidental COVID-19 positive in ER. He had cold symptoms a few days ago and his wife continues to have cold symptoms. He no longer has the cough or runny nose. He has no idea where he may have come into contact with COVID-19. He was vaccinated with Pfizer x 2 doses this summer. He wears a mask in public. He will contact his wife about quarantine and testing.

Other Meds:

Current Illness:

ID: 1771516
Sex: F
Age: 63
State: WA

Vax Date: 09/28/2021
Onset Date: 10/01/2021
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: Ultra sound 10/01/2021

Allergies: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Pain and swelling left lower leg. US shows blood clots left thigh. Put on a blood thinner. Pain and swelling currently continues. Will be on blood thinner for at least 6 months.

Other Meds: Paparazzo (IV chemo) Carboplatin (IV chemo)

Current Illness:

ID: 1771517
Sex: M
Age: 68
State: KS

Vax Date: 03/04/2021
Onset Date: 10/05/2021
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: Pharyngeal swelling

Symptoms: Chief Complaint pt in ENDO to get MAB- sudden onset of not feeling well, diaphoretic and almost passed out per endo staff. Denies pain or any other symptoms. hx of chronic afib- per ENDO pt had a run of 16 PVC's while on monitor History of Present Illness Very pleasant 69-year-old gentleman presents to the emergency room upon referral from outpatient infusion. He became ill with some body aches headache cough and hiccups starting on Monday. He got tested for and was diagnosed with Covid on Wednesday at orchard drug, and had been referred to get monoclonal antibody infusion. As he was preparing for that, he was being monitored on telemetry and was noted to have some nausea and lightheadedness that corresponded with 16 beats of a wide-complex tachycardia. He was mildly symptomatic with this, it self resolved. Because of this the process stopped and he was referred to the emergency room for further evaluation. I have been informed that Dr, has seen him and recommended admission for observation close monitoring. He does have a history of paroxysmal atrial fibrillation and follows with electrophysiology Dr.. With known recent diagnosis of Covid on Wednesday, administering Regeneron here today Not repeating test today

Other Meds:

Current Illness:

ID: 1771518
Sex: F
Age: 59
State: SC

Vax Date: 09/23/2021
Onset Date: 09/23/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: nausea, vomiting, headache

Other Meds:

Current Illness:

Date Died: 09/05/2021

ID: 1771519
Sex: F
Age: 73
State: TN

Vax Date: 02/10/2021
Onset Date: 09/05/2021
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: Positive COVID-19 test

Allergies: Codeine, erythromycin

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient expired due to COVID-19 after having been vaccinated.

Other Meds: Ativan Levoxyl Norvasc Ecotrin Toprol Lexapro Aricept Privinil Lopressor

Current Illness:

ID: 1771520
Sex: F
Age: 71
State: MN

Vax Date: 01/25/2021
Onset Date: 09/29/2021
Rec V Date: 10/08/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: received Pfizer vaccines on 1/4/21, 1/25/21 Tested positive for COVID by PCR on 9/29/21 Admitted to hospital on 10/8/21 with SOB, DOE, weakness. Received Monoclonal antibodies on 9/30/21. underlying rheumatoid arthritis

Other Meds:

Current Illness:

ID: 1771521
Sex: M
Age: 93
State: OH

Vax Date: 03/18/2021
Onset Date: 09/29/2021
Rec V Date: 10/08/2021
Hospital: Y

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

Lab Data: 10/8/21 Chest X-ray: faint airspace opacities of the mid lungs bilaterally HGB: 13.4 SCr: 1.22; BUN: 31; Sodium: 134; CO2: 18; ALT: 86; AST: 59; albumin: 3.3 Pro-BNP: 586 High sensitivity troponin (1231): 71; (1355): 62 Rapid COVID-19: Positive

Allergies: NKA

Symptom List: Rash, Urticaria

Symptoms: The patient has had worsening fatigue and weakness for approximately 10 days. He also complains of nausea and diarrhea. Patient found to have COVID-19 in ED. Patient will be admitted to hospital. Patient has received a fluid bolus in ED.

Other Meds: simvastatin, Preservision, latanoprost ophthalmic drops, benazepril, amlodipine

Current Illness:

ID: 1771522
Sex: F
Age: 81
State: TX

Vax Date: 10/06/2021
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: LA

Lab Data:

Allergies:

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

Symptoms: Painful site of shot

Other Meds:

Current Illness:

ID: 1771523
Sex: F
Age: 37
State: WI

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: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: None.

Allergies: Codeine and bees.

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

Symptoms: She got her vaccine, about 12 hours later initially started with soreness in the left arm, heavy feeling. Throbbing headache, fatigue and then throughout the night she could not sleep at all, shaking from not being at all. Her DKA blood sugars around 411, checked every 45 minutes, checked her ketones every couple of hours and they were large, and was drained from energy. Had highest blood sugar was 411. Kept monitoring this and if she cannot resolve the issue on her own then she has to seek medical help. She kept increasing her doses of insulin until it started to decrease. On Friday around 7:00 PM is when she got it down to normal parameters, and checked it every 45 minutes to make sure that it did not go up. The ketones were at the highest level that they could go. Her blood sugars were under good control prior to the vaccine with normal being 90-130.

Other Meds: Metoprolol, Gabapentin, baby aspirin, Plavix, magnesium OTC, Zolpidem, insulin 23 1/2 units, Tylenol. Allegra D.

Current Illness: None.

ID: 1771524
Sex: F
Age: 27
State: WA

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

Lab Data: None

Allergies: No allergies

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

Symptoms: Patient was given mistakenly given her second Moderna 0.5ml COVID vaccine 11 days before her due date to get the repeat dose. She is a young woman with no allergies, recent illnesses, or health problems. She stayed for approximately 20 minutes after and had no immediate side effects. She was directed to contact a clinic if she had any adverse reactions. Once the error was realized the next morning, this RN called her abd the number has been disconnected. Our supervisor emailed her in her native language to contact the clinic as soon as she received the message. Our staff at the clinic made some clerical errors and will streamline administrative processes to ensure the safety of our patients moving forward.

Other Meds: None

Current Illness: No recent illnesses or COVID infection

ID: 1771525
Sex: F
Age: 32
State: DC

Vax Date: 09/20/2021
Onset Date: 10/04/2021
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

Allergies: No

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

Symptoms: I am a breastfeeding mom. I woke up with pain in my left breast and symptoms of a fever. I realized I had a clogged duct. I notified my doctor. I have been breastfeeding for 13 months and never had a clogged duct before. I used natural remedies and was better within 48 hours.

Other Meds: Multivitamin

Current Illness: No

ID: 1771526
Sex: F
Age: 31
State:

Vax Date: 09/16/2021
Onset Date: 10/01/2021
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:

Allergies:

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

Symptoms: The weekend post 2nd dose I felt fatigue, runny nose and cough from Saturday to Monday. However, Friday October 1st, I began having sore throat, nasal congestion and runny nose. These progressed Saturday and Sunday. On Monday I also felt fatigue and chills, no fever. On Tuesday and Wednesday I began to develop a productive cough in addition to all previously mentioned symptoms. On Thursday I began to feel a slight improvement in my energy but cough continued. Today is Friday and I still have cough and congestion headaches. It seems as though these must be related to a delayed response to my 2nd vaccine because I tested negative for Covid-19 and none of my immediate family members have "caught" anything from me.

Other Meds:

Current Illness:

ID: 1771527
Sex: F
Age: 26
State: MD

Vax Date: 06/23/2021
Onset Date: 09/06/2021
Rec V Date: 10/08/2021
Hospital: Y

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

Lab Data: "...underwent a kidney biopsy on 10/6 with preliminary read concerning for class IV and V lupus nephritis. ANA still pending, but found to have low complements" Workup still in process but being treated for lupus nephritis.

Allergies: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Per HCP on 10/5, "Female with no significant past medical history who presents with one month history of shortness of breath and lower extremity swelling. The patient reports feeling well until one month ago when she started to notice progressive shortness of breath initially with exertion then progressed to being present at rest. At baseline, she can walk 2-3 blocks without limitation but can currently walk less than one block before feeling dyspneic. Also reports associated orthopnea, PND and LE swelling, swelling initially involved feet only but now have extended up to the knees. During this time, she also noticed darkening of the urine and decreased urine output. Denied any dysuria, frequency, urgency, hesitancy. Denies any hx of oral ulcers, skin rashes, light sensitivity, joint pain/swelling. "

Other Meds: None

Current Illness: None

ID: 1771528
Sex: F
Age: 19
State: KY

Vax Date: 10/08/2021
Onset Date: 10/08/2021
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: Shellfish

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Patient was given vaccine after expiration.

Other Meds:

Current Illness:

ID: 1771529
Sex: F
Age: 82
State: MN

Vax Date: 06/02/2021
Onset Date: 10/07/2021
Rec V Date: 10/08/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Previously COVID positive 12/15/2020 received Moderna vaccines on 5/29/21, 6/2/21 (Dates probably entered wrong, but this is what is listed in chart) tested positive for COVID by PCR on 10/7/21 admitted to local Hospital on 10/8/21 with COVID pneumonia.

Other Meds:

Current Illness:

ID: 1771530
Sex: M
Age: 66
State: SC

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

Allergies: None

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

Symptoms: The left under arm lymph node swelled causing me concern so I visited the Nurse Practioner.

Other Meds: Tedafil, Crestor, 81 mg aspirin and Vitamin

Current Illness: None

ID: 1771531
Sex: F
Age: 21
State: CA

Vax Date: 08/05/2021
Onset Date: 08/08/2021
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: Blood work - normal; MRI - normal; X-ray - normal; I have to wait to get an EEG done.

Allergies: None

Symptom List: Unevaluable event

Symptoms: For a few days after my first dose, I felt dizzy and nauseous. I had a headache and I was fatigued. On August 8, 2021, I was at work and I walked into the bathroom. My head hurt really badly. I fainted on the floor. I went to the ER and had some tests done. I am still experiencing headaches.

Other Meds: None

Current Illness: None

ID: 1771532
Sex: F
Age: 65
State: CA

Vax Date: 02/26/2021
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: LA

Lab Data: See Above

Allergies: Erythromycin, Flagyl, Amoxicillian

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

Symptoms: Chest pain (felt like heart attack) Hospitalized 9/5/2021-9/7/2021. Did thorough heart work up and labs; Chest XR, NM myocardial perfusion w Adenosine, US venous duplex venous extremity, EKG, unexplained Lipase levels elevated for possible pancreatitis (do not drink, eat plant-based). Except for Lipase all heart tests normal. Continue to have chronic chest pains. No explanation for it. Pain keeps me up at night. Take 1200 mg Advil a day for pain. On 9/14 also had a heart calcification score and several visits to the cardiologist and EKG done. Since vaccine other health issues: May 26-30 hospitalized for diverticulitis, contracted CDiff. On Vancomycin for 16 days in June and again August 15-current. Tapered to 1 every other day will complete the Vancomycin on 10/15/2021. Have been to ER 5x for colon pain usually had CTs done. On 9/24 ER for kidney stone. Before the vaccine was healthy and active. I would go to yearly check-ups. Since the middle of May started having health issues (diverticulitis), June-September (CDiff), September (chest pain & kidney stone) and feeling like I'm in survival mode each day/night with health issues. My main concern is the chest pain won't go away and doctors aren't able to find out the cause. The first dose of Moderna was 2/26/2021 and second dose of Moderna was 3/26/2021. Both times sore arm at injection site. (Have had my flu vaccine on 9/11/2021.) Doctors I have been to since May 2021

Other Meds: Multi-vitamins

Current Illness: None

ID: 1771533
Sex: F
Age: 48
State: CA

Vax Date: 07/02/2021
Onset Date: 08/29/2021
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: Test on the 30th - COVID positive result on August 31st.

Allergies: Medications - penicillin

Symptom List: Injection site pain, Pain

Symptoms: August 29th - It started with a tickle in my throat and I got a runny nose. I had a headache. And then I would be exhausted but would wake up in the middle of the night and be wide awake. Sore throat, runny nose and headache first three days. Somehow I got dehydrated and then I got a bladder infection. That happened. After that, I seemed to be more tired and dizzy; headache, nausea, too. I did have a cough, too. And the cough I still seem to have a little bit of. I did a telemed visit with doctor - I did get an antibiotic which I didn't take and they gave me something for nausea (pills that dissolve under the tongue) - don't remember the name - but I did take that for the dizziness and nausea. That helped with those symptoms.

Other Meds: No

Current Illness: None

ID: 1771534
Sex: M
Age: 59
State: CA

Vax Date: 10/08/2021
Onset Date: 10/08/2021
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: n/a

Allergies: sensitive to amoxicillin

Symptom List: Injection site pain, Menorrhagia

Symptoms: Client received the 1st COVID vaccine (Janssen Lot # 1822809 and expiration date 03/07/2022) at 10:47am. Client reported dizziness and feeling sweaty. PHN and Nurse responded to incident. Client was sitting in chair when he commented "feeling dizzy and sweaty" at 11:00am. Client stated a health history of hypertension with a "baseline of 120s/76)" and took Losartan/Hydrochlorothiazide this morning. Client reports no allergies to medication but sensitive to amoxicillin, "causes upset stomach". At 11:03 vital signs were taken, blood pressure 140/98, heart rate: 44, respirations: 16, and oxygen saturation 98%. Heart rate was retaken reading at 70 beats per minute. Client stated "my baseline heart rate is in the 70's". Client is alert and oriented to place, person, and date. Client was given Gatorade, pretzels, water, and laid down on gravity chair. At 11:06am client began to shake, stating "dizziness and sweating has subside, just cold." Client denies, shortness of breath, chest pain, itchiness, difficulty swallowing or numbness. At 11:10am vital sign were taken, blood pressure 146/90, heart rate: 70 and oxygen saturation 96% and client stays denies any other symptom only reports shakiness. EMS services were provide to client at 11:10am, client refused EMS to be activated. At 11:15am vital sign were taken, blood pressure 137/85, heart rate: 72 and oxygen saturation 96%. Client's wife came in to facility to be with client at 11:20am, vital signs were taken again at that time, blood pressure: 140/83, heart rate: 66, respirations: 16, and oxygen saturation 96%. At 11:35am, PHN and Nurse sat client up on gravity chair, client reported "shakiness is gone" at 11:42am. Last set of vital signs were taken at 11:55am, blood pressure: 144/98, heart rate: 78, respirations: 16, and oxygen saturation 96%. Client left facility at 12:00pm accompanied by wife, client physically left facility with a steady gait and stated "I am okay to drive", wife of client stated "I will follow him home". Emergency Room precautions were provided to client and wife, such as; shortness of breath, chest pain, numbness or tinging or loss of consciousness, follow up with MD, and educated on the use of V-Safe.

Other Meds: Losartan/hydrochlorothiazide

Current Illness: None

ID: 1771535
Sex: F
Age: 75
State: SC

Vax Date: 09/08/2021
Onset Date: 10/08/2021
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:

Allergies:

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

Symptoms: pt said he felt bad. could not touch his skin with out it hurting him. could not get out of the bed if the house was on fire

Other Meds:

Current Illness:

ID: 1771536
Sex: F
Age: 38
State: NY

Vax Date: 09/01/2021
Onset Date: 10/06/2021
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:

Allergies: Keflex

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: At 8 weeks gestation baby had a heartbeat and was healthy. Got the vaccine two days later. Next sonogram visit at 9.5 weeks, no heartbeat detected.

Other Meds: Prenatal vitamins

Current Illness: None

ID: 1771537
Sex: M
Age: 44
State: CA

Vax Date: 03/02/2021
Onset Date: 03/02/2021
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: RA

Lab Data:

Allergies: Walnut allergies

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: For the first 3 to 4 weeks my arm hurt so bad I couldn?t sleep at night. It?s been eight months since my last shot and it feels as though there?s damage to the muscle in my shoulder at the exact spot of injections.

Other Meds: None

Current Illness: None

ID: 1771538
Sex: M
Age: 81
State: DE

Vax Date: 08/16/2021
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:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: Lab work; other numerous tests

Allergies: Niacin

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

Symptoms: I had symptoms the day after I got my shot, my left arm was sore. The next day I had other symptoms. I had low grade fever, difficulty breathing, lung congestion, headache. I had lab work performed and numerous tests. I went to the ER of the Hospital on 08-30-2021. I still have these symptoms today, but slowly recovering it. When they treated me in the hospital, treated me for the infection, thought I had pneumonia. The decided I had no pneumonia, and I still have to take oxygen at this time. The physicians do not know what caused this. The onset of symptoms were two days after my booster shot. The doctors are not sure what caused my symptoms, one doctor said I had a flare up of RA.

Other Meds: Omeprazole; fimbriate acid DR; pioglitazone; rosuvastatin; prednisone; levothyroxine; INVOKANA; baby aspirin; vitamin D; insulin glargine injection; Riolipta; SPIRIVA; vitamin B-12; vitamin; vitamin B complex; losartan Hctz

Current Illness: I still have osteoarthritis; rheumatoid arthritis; kidney disease; interstitial lung disease; emphysema; type II diabetes

ID: 1771540
Sex: F
Age: 51
State: KS

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

Symptom List: Nausea

Symptoms: Fever 102.1; lymph node swelling with pain on left side under arm, breast, neck. Fever lasted for 2 days, swelling for at least 5 days. Still note a 'lump' in left arm pit / side breast area. Called provider's office next day after shot but no one returned call.

Other Meds:

Current Illness:

ID: 1771541
Sex: F
Age: 38
State: AZ

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

Lab Data: none

Allergies: None

Symptom List: Injection site pain

Symptoms: This was the Pfizer booster. First two injections were in December 2020 and January 2021 respectively. The patient is a healthcare provider with frequent exposure to COVID-19 inpatients, thus qualifying for the booster. Event was hives within 5 minutes of booster injection. Three hives: medial left elbow, right lower leg, right 4 toe. All resolved within two hours with Benadryl, taken immediately after first hive developed. Only prior reaction was significant left axillary lymphadenopathy following Pfizer #2 in January.

Other Meds: Junel OCP, one tab daily

Current Illness: Fractured ankle 2 weeks prior

Date Died: 09/15/2021

ID: 1771542
Sex: M
Age: 66
State: TN

Vax Date: 02/12/2021
Onset Date: 09/15/2021
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: Positive COVID-19 test

Allergies: NKDA

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

Symptoms: Patient expired due to COVID-19

Other Meds: Loratidine Azithromycin Atorvastatin Diltiazem ER Fenofibrate Valsartan Aspirin Celecoxib Escitalopram L. acidophilus Dapagliflozin Metformin Pioglitazone Multivitamin Exenatide Imbruvica

Current Illness:

ID: 1771543
Sex: M
Age: 78
State: UT

Vax Date: 10/01/2021
Onset Date: 10/06/2021
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: None

Allergies: None

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

Symptoms: 3 episodes of weakness and involuntary muscle spasms of seizure-like symptoms but patient awake during and able to talk.

Other Meds:

Current Illness: None

ID: 1771544
Sex: F
Age: 29
State: GA

Vax Date: 10/06/2021
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: I have not seen a doctor about it yet.

Allergies: Penicillin and cepaclor

Symptom List: Tremor

Symptoms: After my first dose on September 6th, my period came two weeks early. I got my second dose two days ago, on October 6th, and started bleeding the next day. It was light, so I thought it was just spotting, but now I'm bleeding heavily and my period has indeed started. It should not be starting for at least 10 more days. I have very regular periods and nothing in my diet/ medication/ vitamin routine has changed. The only new variable is the vaccine.

Other Meds: Effexor XR, Lamictal, klonopin, vitamin e, vitamin a, vitamin d, St. John's Wort

Current Illness: None

ID: 1771545
Sex: M
Age: 41
State: MS

Vax Date: 10/06/2021
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: None

Allergies: NKDA

Symptom List: Erythema, Pruritus

Symptoms: Left arm pain Unsure about anything else- have left voicemail for pt to call clinic back

Other Meds: ProAir- as needed Dulera

Current Illness: NA

ID: 1771546
Sex: F
Age: 36
State: OH

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: Patient felt lightheaded about five minutes after her shot and returned to pharmacy counter. We were informed she also often has low blood sugar so we provided water and sugar in the form of candy to help raise her blood sugar. She had no reaction with her first shot. She felt more dizzy after about five minutes of sitting so we had her return to the immunization room and sit down, where she passed out in the chair. She came to a few seconds later and we lowered her to the floor and called 911. She continued to feel dizzy and lightheaded, as well as cold to the touch, until EMTs arrived. On arrival they found her blood sugar to be 60.

Other Meds:

Current Illness:

ID: 1771547
Sex: M
Age: 40
State: WA

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

Lab Data: none

Allergies: none noted by patient

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

Symptoms: The patient requested a Pfizer COVID vaccine and the pharmacist administered the Janssen COVID vaccine.

Other Meds: none noted by patient

Current Illness: none noted by patient

ID: 1771548
Sex: F
Age: 39
State: MN

Vax Date: 01/06/2021
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: Tested NAAT positive for COVID 10/7/21 after being fully vaccinated.

Other Meds:

Current Illness:

ID: 1771550
Sex: F
Age: 41
State: AZ

Vax Date: 09/28/2021
Onset Date: 10/05/2021
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: went to the ER on 10/07/2021 and was given steroids

Allergies: penicillin

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

Symptoms: Patient reported that she having normal symptoms of nausea, headache, and chills no fever... on October she woke with a cough, swollen face, and a fever with running nose

Other Meds: STEROIDS FOR SWELLEN PHENTERMINE

Current Illness: no

ID: 1771552
Sex: F
Age: 51
State: TX

Vax Date: 09/22/2021
Onset Date: 09/22/2021
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: None.

Allergies: Penicillin and NSAIDS (can?t take because I have bleeding disorder)

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

Symptoms: I didn't start to run a fever until 830 at night. The fever was not as intense as the other times from vaccine. I had Muscle aches and body aches. I started to be able to palpate the individual nodes but 48 hours afterwards I had a huge pocket of swelling on axillary where I got the shot. It worked up through my neck over the next few days. The muscle aches cleared up faster and it was only a few days. I still have the cold sores that started that first day in the afternoon. When that one was clearing up the second one started and hasn't cleared up yet.

Other Meds: 100 mg once a day, Hydrochlorothiazide 125 mg once a day; Metoprolol ER 25 mg.

Current Illness: None

ID: 1771553
Sex: F
Age: 84
State: CO

Vax Date: 09/27/2021
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: IM
Vax Site: LA

Lab Data: CT

Allergies: sulfa, pcn

Symptom List: Pain in extremity

Symptoms: PE

Other Meds: timolol, latanoprost, levothyroid, B12

Current Illness: no

ID: 1771554
Sex: M
Age: 61
State: PA

Vax Date: 03/03/2021
Onset Date: 03/03/2021
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: Beta blockers, Losartan.

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

Symptoms: Low grade temp, elevated heart rate 120-130, fatigue, heart rate 268 beats per min.

Other Meds:

Current Illness:

ID: 1771555
Sex: M
Age: 16
State:

Vax Date: 10/04/2021
Onset Date: 10/07/2021
Rec V Date: 10/08/2021
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: Had two ECGs while inpatient which were non concerning. Troponin was followed q6 with a peak to 0.93 on 10/07 which subsequently downtrended.

Allergies: none

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

Symptoms: chest pain, fatigue, tactile fevers

Other Meds: none

Current Illness: none

ID: 1771556
Sex: F
Age: 31
State: PA

Vax Date: 09/16/2021
Onset Date: 09/23/2021
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:

Allergies:

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

Symptoms: Covid arm. Redness, Swelling , itching days after vaccination. Resolving

Other Meds:

Current Illness:

ID: 1771557
Sex: F
Age: 63
State: NJ

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: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: Colonoscopy -6/8/2021 endoscope 6-8-2021 MRI MRE 8/18/2021 Ultrasound lab -blood work and stool studies-6/8/2021 small capsule endo study -8/31/2021

Allergies: N/A

Symptom List: Vomiting

Symptoms: Initial reaction was headache and nausea. By 2/25 not 24 hours later, I experienced explosive diarrhea. This continued consistently for 9 weeks. During this time I lost 30 lbs. My bowels are not the same and it is 7 months later.

Other Meds: Cymbalta, Gabapentin, Hydroxychloroquine, Leflunomide, Sulfasalazine

Current Illness: Rheumatoid Arthritis, Fibromyalgia, Osteoarthritis, Lichen Sclerosis

ID: 1771558
Sex: M
Age: 48
State: MI

Vax Date: 09/21/2021
Onset Date: 09/23/2021
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:

Allergies: No Known Allergies

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: SEVERE BILATERAL SENSORINEURAL HEARING LOSS THE NEXT DAY AFTER VACCINATION GIVEN

Other Meds: Doxycycline Monohydrate Oral Capsule 100 MG (7/8/2021) Liothyronine Sodium Oral Tablet 50 MCG (3/13/2021) NovoLOG Subcutaneous Solution 100 UNIT/ML (10/16/2020) Spironolactone Oral Tablet 25 MG (3/13/2021) Potassium Chloride ER Oral Tablet

Current Illness: No known Illness at time of vaccination

ID: 1771559
Sex: M
Age: 65
State: WA

Vax Date: 04/03/2021
Onset Date: 09/10/2021
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: 9/15/2021 - ECG - Research Center- Results: LBBB and elevated ST Segment 9/17/2021 - MRI - Medical Center - Results: normal, no evidence of ischemic event 9/20/2021 - ECG - Heart & Vascular -Results: LBBB 10/5/2021 - Echocardiogram and NM cardio stress test - Heart & Vascular - Results: mild septum thickening

Allergies: Prevnar 13 (pneumonia vaccine)

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

Symptoms: Syncope event - I passed out just sitting at my dining table, for approximately 30 to 45 minutes. Upon coming to, I had full-visual-field "aura" like aura migraine, but completely filling my field of vision in both eyes, vs. usual partial aura. I had a continuous moderate headache for one week after fainting, felt generally under the weather, and had a mild temperature (99.6) for about 24 hours after the event.

Other Meds: Oxybutynin 5mg 2x/day Acyclovir 400mg 2x/day Loratadine 10mg 9/2021 1x/day Atorvastatin 20mg Flomax (Tamsulosin) 0.4mg Losartan 50mg Melatonin 3mg Vitamin B complex Vitamin D3 Omeprazole 20mg Iron supplement 27mg every other day Hydroxyzine

Current Illness:

ID: 1771560
Sex: M
Age: 68
State: NJ

Vax Date: 09/28/2021
Onset Date: 09/30/2021
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: the patient went to the clinic and recieved antibiotics for a brusse that she had

Allergies: na

Symptom List: Injection site swelling, Limb discomfort

Symptoms: nurse gave the vaccine sub-q insteast of im

Other Meds: na

Current Illness: na

ID: 1771561
Sex: M
Age: 64
State: NC

Vax Date: 04/22/2021
Onset Date: 04/23/2021
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: Cystoscopy, need for placement of suprapubic tube.

Allergies: Atorvastatin

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

Symptoms: Patient had urinary retention within 24 hours of the first injection. This required emergency room visit. Foley catheter was attempted to be placed but it was found that he had urethral stricture. This could not be dilated. Suprapubic tube had to be placed. Time course: within five hours of injection patient had decreased force of stream after his second dose. He was seen in urgent care facility and catheter could not be placed. Then transferred to another hospital emergency room where catheter could not be placed. Suprapubic tube was then placed in the early morning of 23 April. He was then found to have a urethral stricture which required open surgical repair on June 11, 2021. He is now fully recovered.

Other Meds: Tamsulosin, finasteride, allopurinol

Current Illness: None

ID: 1771562
Sex: F
Age: 41
State: OK

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

Allergies: sulfa antibiotics

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

Symptoms: Pt reports she developed swelling and tenderness underneath left arm 10/7/21 around 8 pm.

Other Meds: None

Current Illness: None

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am