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: 1779674
Sex: F
Age: 21
State: NC

Vax Date: 10/12/2021
Onset Date: 10/12/2021
Rec V Date: 10/12/2021
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: Ranitidine, protonix, amoxicillin

Symptom List: Dysphagia, Epiglottitis

Symptoms: Pain in my heart that keeps coming and going. Possibly Myocarditis.

Other Meds:

Current Illness:

ID: 1779675
Sex: F
Age: 43
State: MI

Vax Date: 10/11/2021
Onset Date: 10/12/2021
Rec V Date: 10/12/2021
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: Shellfish Flu shot

Symptom List: Anxiety, Dyspnoea

Symptoms: Fever over 103, chills, bodyaches, crippling headache, extreme exhaustion , pain at injection site, tingling skin, blurred vision

Other Meds: Vitamin c,d,b,a Aspirin

Current Illness: None

ID: 1779676
Sex: M
Age: 63
State: NY

Vax Date: 03/01/2021
Onset Date: 04/01/2021
Rec V Date: 10/12/2021
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: 8/21 thyroid work up. Allergist blood work

Allergies: Sulfa drugs

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

Symptoms: Chronic hives. Prednisone. Benadryl.

Other Meds: Flomax Simvastatin

Current Illness:

ID: 1779677
Sex: F
Age: 75
State: AZ

Vax Date: 04/20/2021
Onset Date: 04/21/2021
Rec V Date: 10/12/2021
Hospital:

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

Lab Data: None. Have been unable to see a doctor but have reported this to all my doctors and see Dr. the end of this month and we are discussing new allergy tests. It was a recommendation on the asdshs Covid19 website that anyone who experienced hives after the first dose of vaccine should not receive the second dose. I was doing great with my retina surgery recovery, even getting a 20/20 vision report from my retina doctor just prior to getting the vaccine. I believe the vaccine hit the weak part of my body (left eye) and I have had a setback as a result.

Allergies: mold, penicillin, opioids, cholesterol medications, diclofenac sodium, tramadol, percoset, lambs ear, juniper, ragweed, cottonwood, cedar, Brimonidine eye drops, raddicio, turnip, dried beans, SOY, honey, rye, MSG, lamb,

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: shortness of breath, fast heartbeat, small hives from neck to hips that lasted for several weeks, headache, dizzy spells. Most symptoms lasted close to a month and some longer.

Other Meds: Omeprazole, Metoprolol Succinate, Cetirizine, Ezetimibe, Prednisolone Acetate Ophthalmic Suspension, Refresh Tears eye drops, Probiotic Complex, Vitamin B, Vitamin D 1000, Tumeric capsules 425 2 x per day, Multiple Vitamin. Also receive s

Current Illness: Doctoring for a severely torn retina since Labor Day 1029. Double tear, double twist that required surgery and a buckle repair. Been on steroid eye drops for most of that time. Cataract surgery as a result of gas used in surgery, lazer to remove a film that developed on new lens, and just last week had to have the buckle removed due to swelling, pain, etc.

ID: 1779678
Sex: M
Age: 86
State:

Vax Date: 08/11/2021
Onset Date: 09/22/2021
Rec V Date: 10/12/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series

Other Meds:

Current Illness:

ID: 1779679
Sex: F
Age: 71
State: NY

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 10/12/2021
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: no

Allergies: lisinopril I don't drink alcohol, it causes me problems codeine thermasil preservative they put in eye drops

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

Symptoms: On 04/02/2021, 30 minutes after the vaccine I got a severe headache and it lasted for 3 months. I would wake up with a headache, and it was constant. 2 hours later my heart started going crazy, I did not feel well and went to sleep. The next day I just felt like my heart was not feeling right. I took my blood pressure and it was 250/100, pulse150. I have high blood pressure, but this was not normal for me. 3 days after the vaccination, I lost my taste, but I noticed it more with sugar. I waited till Monday and called my doctor. My BP was not that high but my heart did not feel right. I could actually see my heart beating in my throat, it was irregular. Something was not right. I could not get an appointment with any doctors. I had a phone visit with my kidney doctor, and said my kidneys were good but my BP was very high. He increased the dosage of Norvase from 5mg to 7.5 mg. Around May, I went to urgent care because I broke out in rash. They diagnosed me with shingles. They wanted me to go to the ER because my BP was very high. I did not want to got to the ER. They prescribed acyclovir 800 mg antiviral. 2 rounds of that, Took it for 7 days, and it did not go away. So the prescribed another round of acyclovir in addition cephalexin 500 mg for 7 days. After that 2nd round of the medications, it calmed the shingles down, and my heart down, and it calmed my headache. I was also going to an acupuncture. Since the end of June, everyday I am starting to feel like myself again. I have an appointment to get an echocardiogram. I don't have all my energy back, my sense of taste is getting better. I am being monitored by doctors for my joints and headache. My joints are getting better.

Other Meds: aspirin 81 mg od hctz 25 mg od norvase 5 mg od liquid vit B- complex echinacea elderberry

Current Illness: no

ID: 1779680
Sex: M
Age: 43
State: PA

Vax Date: 10/11/2021
Onset Date: 10/11/2021
Rec V Date: 10/12/2021
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: Pyrexia, White blood cell count decreased

Symptoms: Dizziness Flush Difficulty breathing (heavy lungs) Occurred about 5 minutes after injection

Other Meds: Finestaride hair growth

Current Illness: No

ID: 1779681
Sex: F
Age: 26
State: IL

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

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

Lab Data:

Allergies: No known allergies

Symptom List: Pharyngeal swelling

Symptoms: Within a minute of receiving the vaccine, the patient stated she was having blurred vision and feeling clammy. Patient was diaphoretic and stating her field of vision was black and she was unable to see anything. Blood pressure was 66/40. EMS was called. Left pupil was four times larger than the right with neither responsive to light. She was able to answer questions completely. She had no chest pain or shortness of breath. She was assisted into a wheelchair and transported to a room where she could lay flat. Five minutes later, blood pressure had increased to 106/58. Patient stated she was starting to regain some of her vision. She was assessed by EMS upon their arrival. This was her second dose, and she denied any issues with the first dose.

Other Meds:

Current Illness:

ID: 1779682
Sex: F
Age: 26
State: WA

Vax Date: 04/11/2021
Onset Date: 06/14/2021
Rec V Date: 10/12/2021
Hospital:

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

Lab Data: Ultrasound of abdomen with focus on gallbladder - no inflammation, 2.1cm gallstone

Allergies: none

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: pain on right side of mid-abdomen and nausea - led to ultrasound and discovery of large gallstone - gallbladder removed 10/13/2021

Other Meds: fluoxetine, lamotrigine, vitamin D, vitamin C, iron, vitamin B12

Current Illness:

ID: 1779683
Sex: F
Age: 30
State: OH

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

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

Lab Data: none known

Allergies: Amoxicillin listed in profile, None listed on administration form

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient describes sporadic tingling in left arm and numbness in left hand since time of injection at around 12:00pm today.

Other Meds: unknown

Current Illness: unknown

ID: 1779684
Sex: F
Age: 90
State: NC

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

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

Lab Data: None

Allergies: Sulfa (rash), statins (muscle cramps)

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

Symptoms: Patient given 0.3mL injection of Pfizer COVID-19 booster diluted with 0.8mL sodium chloride instead of the correct amount of 1.8mL diluent.

Other Meds: amlodipine 5 mg once daily,coreg 3.125 mg once daily,pepcid 40 mg once daily,protonix 40 mg once daily, valsartan 160 mg once daily

Current Illness: None.

ID: 1779685
Sex: F
Age: 37
State: PR

Vax Date: 09/11/2021
Onset Date: 09/11/2021
Rec V Date: 10/12/2021
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:

Allergies: Latex, Neomycin and Polymyxin

Symptom List: Rash, Urticaria

Symptoms: Patient has swelling and pain in her arm the same day. She then got chest pain in which she to the hospital and had stress test done by cardiologist.

Other Meds: unknown

Current Illness: Asthma, Anemia, lung metabolic disease, blood disorder, heart

ID: 1779686
Sex: M
Age: 69
State:

Vax Date: 04/07/2021
Onset Date: 09/22/2021
Rec V Date: 10/12/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series

Other Meds:

Current Illness:

ID: 1779687
Sex: F
Age: 88
State: CO

Vax Date: 10/11/2021
Onset Date: 10/11/2021
Rec V Date: 10/12/2021
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: n/a

Allergies: No allergies to vaccine components

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

Symptoms: Healthcare was performing an onsite vaccine clinic at an Assisted Living Community. The staff who escorted the patient to the vaccine clinic identified the patient incorrectly. She received a Pfizer vaccine. When the error was noted, it was revealed that this patient had Moderna dose #1 on 1/21/2021 and #2 on 2/23/2021. No adverse symptoms noted.

Other Meds: Unknown

Current Illness: Unknown

ID: 1779688
Sex: F
Age: 27
State: IL

Vax Date: 04/10/2021
Onset Date: 10/04/2021
Rec V Date: 10/12/2021
Hospital:

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

Lab Data: EKG Normal. Chest X-Ray. Normal.

Allergies: No

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

Symptoms: I experienced intense chest pain and shortness of breath and had to go to the ER. The doctors checked to see if there were any issues with my heart and lungs (tests came back negative). I was given an Albuterol inhaler for the shortness of breath for a few days and to follow up with my PCP. I have an appointment with my PCP scheduled for. 10/18/2021 as a follow up for the shortness of breath.

Other Meds: Multivitamin

Current Illness: No

ID: 1779689
Sex: M
Age: 60
State: MA

Vax Date: 03/30/2021
Onset Date: 04/09/2021
Rec V Date: 10/12/2021
Hospital:

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

Lab Data: Apart from office exams, I have had a brain MRI on 4/16/21 followed by multiple audiology exams.

Allergies: None

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

Symptoms: On April 5, 2021, I had a sudden loss of hearing in my right ear which resolved within about 20 minutes. On April 7, 2021, it happened again with resolution. On April 9, 2021, it happened again but this time without resolution. That evening around 9:00 p.m., I went to the emergency room at the hospital and was started on high dose prednisone. I followed up with my ENT the following week on April 13, 2021 and was tested and placed on a high dose prednisone taper and followed by dexamethasone injections in my right ear. I was fitted for hearing aids in late June of 2021 due to the sensorineural hearing loss which I suffered. I had a second episode after my booster on August 2, 2021 which I will describe in another report.

Other Meds: Lexapro and mesalamine

Current Illness: none

ID: 1779690
Sex: F
Age: 4
State: WA

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/12/2021
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: NKA

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

Symptoms: The patient had a localized reaction on left deltoid.

Other Meds: Albuterol Nebulizer, Pulmicort inhaler, Cetirizine childrens

Current Illness: Nasal congestion

ID: 1779691
Sex: M
Age: 18
State: PA

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

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: No Adverse Effect, but given 2nd dose at 13 days as opposed to 21 days.

Other Meds:

Current Illness:

ID: 1779692
Sex: F
Age: 66
State: VT

Vax Date: 04/12/2021
Onset Date: 05/30/2021
Rec V Date: 10/12/2021
Hospital:

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

Lab Data: 06/07/2021 ER Hospital. Multiple Testing, CT Scan, Blood Work.

Allergies: Levaquin; multiple medication sensitivities; Topical allergies; bees; wasps; shrimp

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: About six weeks after getting the second dose of the vaccine I was experiencing dizziness. I had these symptoms for about five days and one night I fainted and also vomited for no reason. I was very nauseous and sweating. I think I had Vertigo. I felt a little better after vomiting but I was still dizzy. I was very dizzy for three days and I couldn't even walk. I went to the ER four days later and all tests were negative. I got Meclizine and I took it for a while. I could not drive and on 06/08/2021 I saw a Physical Therapist. I was still dizzy and it improved. I could not turn my head. I got more used to feeling like that and I was more able to deal with it. I was fatigued and I saw an optometrist and was diagnosed with a Cataract. On 06/30/2021 It has been four months and I am still dizzy when I move quickly.

Other Meds: Levothyroxine; supplements

Current Illness: N/A

ID: 1779693
Sex: M
Age: 60
State: NJ

Vax Date: 10/11/2021
Onset Date: 10/12/2021
Rec V Date: 10/12/2021
Hospital:

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

Lab Data:

Allergies: NKA.

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

Symptoms: Chills, HA, Pain @ injection site, fatigue, runny nose.

Other Meds: Vit B; Vit D.

Current Illness: Hyperlipemia (controlled), HTN (Controlled), Hypothyroid (Controlled).

ID: 1779694
Sex: M
Age: 46
State: AZ

Vax Date: 10/05/2021
Onset Date: 10/06/2021
Rec V Date: 10/12/2021
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: Bacterium (medication)

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

Symptoms: I got a headache, a slight increase in temperature, and fatigue for the first two days. These symptoms subsided, but I have had lingering muscle and joint pain. I got the J&J COVID-19 vaccine.

Other Meds: Multi-vitamin and vitamin D

Current Illness: None.

ID: 1779695
Sex: M
Age: 76
State: NY

Vax Date: 10/05/2021
Onset Date: 10/09/2021
Rec V Date: 10/12/2021
Hospital:

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

Lab Data: none

Allergies: none

Symptom List: Unevaluable event

Symptoms: aches and pains, perspiration at night, headache, some coughing, probably fever but never measured all for about 3 days

Other Meds: crestor, prozac, naltrexone, singulair, prolia, flonase, calcium/vitamin D

Current Illness: none

ID: 1779696
Sex: F
Age: 62
State: KY

Vax Date: 04/15/2021
Onset Date: 10/12/2021
Rec V Date: 10/12/2021
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: 1. COVID-19 virus infection XR Chest 2Vw azithromycin (ZITHROMAX) 250 MG tablet methylPREDNISolone (MEDROL DOSPACK) 4 MG tablet 2. Cough IPOC SARS-CoV-2 Antigen IPOC SARS-CoV-2 Antigen XR Chest 2Vw albuterol HFA inhaler 2 puff benzonatate (TESSALON) 200 MG capsule 3. Right otitis media, unspecified otitis media type azithromycin (ZITHROMAX) 250 MG tablet 4. COVID-19 COVID+ Referral for EUA Covid Antibody Treatment

Allergies: Bactrim, levaquin

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

Symptoms: complaining of a mild headache, cough, nasal congestion and sinus pressure since Sunday morning. Also states that her ears hurt. She did watch her grandchild who is 13 years old and had the same signs and symptoms that she has and her grandchild's Covid test was negative. Patient's Covid test today is positive. Review of Symptoms: Review of Systems Constitutional: Negative for chills and fever. HENT: Positive for congestion, ear pain and sinus pressure. Negative for ear discharge, hearing loss and sore throat. Respiratory: Positive for cough. Negative for shortness of breath and wheezing. Cardiovascular: Negative for chest pain and palpitations. Gastrointestinal: Negative for abdominal pain, blood in stool, diarrhea, nausea and vomiting. Genitourinary: Negative for dysuria and urgency. Skin: Negative for rash. Neurological: Positive for headaches. Head: Normocephalic. Right Ear: Hearing normal. Tympanic membrane is injected. Left Ear: Hearing and tympanic membrane normal. Nose: Congestion and rhinorrhea present. No mucosal edema. Right Sinus: Maxillary sinus tenderness and frontal sinus tenderness present. Left Sinus: Maxillary sinus tenderness and frontal sinus tenderness present. Lungs clear and equal bilaterally, no respiratory distress, does have a cough

Other Meds: ? albuterol HFA (PROAIR HFA) 108 (90 Base) MCG/ACT inhaler Inhale 2 puffs into the lungs every 6 (six) hours as needed for Wheezing. 1 Inhaler 3 ? Biotin 300 MCG TABS Take by mouth. ? Calcium-Magnesium-Vitamin D 300-150-400 MG-MG-UNIT T

Current Illness:

ID: 1779697
Sex: F
Age: 58
State: VA

Vax Date: 02/10/2021
Onset Date: 02/12/2021
Rec V Date: 10/12/2021
Hospital:

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

Lab Data: clinic did a full blood panel that was all normal. PROTEIN ELECTROPHORESIS AND TOTAL PROTEIN. Apr 23, 2021 ANTINUCLEAR ANTIBODY Apr 23, 2021 RHEUMATOID FACTOR TITER Apr 23, 2021 BORRELIA BURGDORFERI ANTIBODY Apr 23, 2021 BLOOD HEAVY METAL PANEL Apr 23, 2021 PLASMA VITAMIN B1 (THIAMINE) Apr 23, 2021 ERYTHROCYTE SEDIMENTATION RATE (ESR)

Allergies: peanuts

Symptom List: Injection site pain, Pain

Symptoms: Nerve pain, that felt like pins and needles sensation all over the body. The pin pricking would turn into an itching sensation over time. It started a few days after the second dose of the vaccine. I talked to my doctor, who referred me to a neurologist. They did a full work up and found nothing. After about 2 more months the pin pricking dissipated. I asked my doctor if it could have been from the vaccine and she said: "no one knows." A few days ago, I got the booster shot, and then pins and needles sensations has started up again, so I thought this was more definitive proof that it was as a result of the vaccine.

Other Meds: metroprolol succinate ER 25 mg NP Thyroid 15 mg norethindrone acetate 5 mg Dotti .0375 mg patch

Current Illness: none

ID: 1779698
Sex: M
Age: 58
State: TX

Vax Date: 04/08/2021
Onset Date: 06/01/2021
Rec V Date: 10/12/2021
Hospital:

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

Lab Data: Bloodwork - all came back negative (July 2021)

Allergies: Barium

Symptom List: Injection site pain, Menorrhagia

Symptoms: On 07/06/2021, I was given an allergy shot and I had an allergy reaction. I coughed uncontrollably about 45 minutes after the shot. I had to pull over as I was driving and took a Benadryl and an aspirin immediately .

Other Meds: RX: Metformin 500 mg 2 tablets twice/day, Farxiga 10 mg/daily, atorvastatin (Lipitor) 20mg/daily, Glyburide 2.5mg once/daily, Levbid 0.375 mg/one tablet 2x/daily. Levothyroxine 125mcg- 1/daily , Trulicity 0.75 one shot weekly , Xyzal 7on

Current Illness: Persistent hacking cough in January

ID: 1779699
Sex: F
Age: 25
State: MI

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

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

Lab Data: N/A

Allergies: No known Food or drug allergies noted

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

Symptoms: 1725-began complaint of swelling, tingling and numbness in Left cheek, 1730- Bendryl administered, 1730 Vital Signs- Blood Pressure 205/105, Pulse 105, Pulse Ox 95%, Respirations 22/min, Auscultated lungs, no audible wheezing, lung sounds clear. 1741-began complaining of tongue tingling, numb and swelling. 1743- Epinephrine 0.3 mg IM Right quadricep administered. Refused further vital signs and didn't want to take ambulance to hospital. 1802- Stat-EMS, ambulance arrived and offered treatment , patient refused. Stated she was going to get a ride from family and spending the night with family. Instructed patient that going to seek treatment in Emergency facility was best option, continued to refuse and ultimately stated she was staying with her mother.

Other Meds: None reported

Current Illness: sinus infection the week prior. Tested negative for weekly covid tests.

ID: 1779700
Sex: M
Age: 61
State: IA

Vax Date: 10/01/2021
Onset Date: 10/08/2021
Rec V Date: 10/12/2021
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: Blood tests - full blood panel; key information: Elevated Troponin and elevated d-Dimeler. I was admitted to hospital and was no longer an ER patient. And they continued to measure my Troponin levels. They continued to rise over the next 24 hours. I was given an angio-gram and the cardiologist interpreting that saw that my left side of my heart was significantly underperforming. And she had me transported to another hospital where she thought I could get some Emergency operation if necessary. Hospital. I will get operated on - open heart surgery bypass - any day now. We're in one of the situations where staffing and bed are limited and I'm waiting for my number to be called. Definitely, going to have the surgery though. From the 8th - today - have been at hospitals for 5 days

Allergies: Lyrica; Anything in 'cillin family of antibiotics

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: At 07:30 am, Friday, October 8th, I was heading to work. I walk to school. As I was exiting my door, I noticed my chest and back were hurting. And I am 61 and it had been a long week and I was sort of attributing it to normal work fatigue. As the morning progressed, I continued to have some low level chest and back pain. At about 10:30, with students, I was getting a bit sweaty. The attention in my brain - as to whether this was serious or trivial event was beginning to dominate over being able to talk to students. I went to school nurse. 9-1-1 was called. I was transported by ambulance to Hospital. Elevated Troponin - indicative of heart damage. At this point, with the additional information I now I have, I know that that event was a heart attack. I will have open heart surgery soon - will move a couple of arteries around. So there is permanent issues surrounding it. Treatment at this time: Nitroglycerin patches and sublingual. Heparin drip IV also. There is another medicine - a blood pressure med that I wasn't on before. I think it's one of the beta blockers. I am on oxygen right now. Bedrest and time at the hospital while waiting for surgery.

Other Meds: Cymbalta; Nortriptyline; Lovastatin; Ambien; Alprazolam; Dronabinol

Current Illness: no

ID: 1779701
Sex: F
Age: 70
State: NC

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

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

Lab Data: none

Allergies: NKDA

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient given 0.3 ml of vaccine diluted with 0.8 ml sodium chloride instead of correct amount of 1.8 ml sodium chloride.

Other Meds: albuterol,calcium carbonate with vit D3,flonase,claritin

Current Illness: none

ID: 1779702
Sex: F
Age: 51
State: AZ

Vax Date: 04/11/2021
Onset Date: 04/14/2021
Rec V Date: 10/12/2021
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: Range of Motion was tested by Medical Providers Blood work soon by the dermatologist

Allergies: cephalosporins, penicillin, hazel nuts, walnuts, environmental allergies

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

Symptoms: 1st shot of Pfizer EP7534 Given on 3/20/2021 ? After that dose I had an eye rash appear the next day. I took pictures of it because it was alarming to me. I had had a facial rash and neck and chest rashes from COVID, but now it was on my eye lid. There was some raised bumps. I was concerned about it so I got a provider phone call to discuss it. I had a sore arm after the first vaccine in the right arm. I didn?t feel good for a few days, but I never went to bed. I just took a couple extra naps. The problem was the rash on my eyes and on my face. I got an appointment the day after my second vaccine. The second vaccine was the bigger problem. (3 weeks later). April 11, on Sunday I got my second vaccine at 1:30pm. I had a tele-visit Monday April 12 to talk about the eye rash with Medical Provider at 9:30am. I was in bed M, T, W through April 14th with extreme fatigue, muscle aches, facial rash. On the third day, the 14th, I couldn?t lift my arm. I had to physically lift it to lift it up. Then it would go away and I had functionality of my arm, and about every 5-7 days my arm would stop functioning again. I had a chiropractic appointment April 21. He said why did you get the vaccine. Tues, April 17, I went to see Medical Provider and she examined me and said she was gonna refer me to physical therapy. I have had PT off and on since for my shoulder. I go to the same person for neck PT. May 19th was when Medical Provider referred me to PT. I think it was early June to get a shoulder eval. I don?t remember the date when I started PT for my arm. Medical Provider did a formal eval on the shoulder and started incorporating the works of the neck because it?s all connected. Honestly, my challenge is managing my Malformation. It?s hard to manage that and PT. I was there this morning and they worked on my shoulder and neck too. My problems are bad and I?m scared to get the third booster but I need it because of the asthma. PCPs don?t know what to tell me, and I don?t know if I should even have another booster. Dr. said I shouldn?t get another vaccine until there?s a different form. After the second vaccine, I had for like 10 weeks, I had visible lumps on my neck and on my neck where my lymph nodes were. Very painful to the touch.

Other Meds: ? Levothyroxine 100mcg daily ? Hydrochlorothiazide 25mg daily ? Losartan 25mg daily ? Citalopram 20mg daily ? Albuterol inhaler ? Vitamin C 500mg daily ? Zyrtec 10mg daily ? Flonase nasal spray once daily ? Magnesium calm powder ? Women ov

Current Illness: N/A

ID: 1779703
Sex: F
Age: 32
State: CA

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

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

Lab Data:

Allergies: nkda

Symptom List: Nausea

Symptoms: None reported

Other Meds: n/a

Current Illness: n/a

ID: 1779704
Sex: F
Age: 19
State: CA

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

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

Lab Data: ekg done 10-12-21 with sinus arrhythmia and HR 82

Allergies: none

Symptom List: Injection site pain

Symptoms: Patient noted numbness in left axilla immediately after getting her flu shot on left arm and noted pain at injection site afterwards. After 15 minutes observation , arm pain resolved and pt states axilla numbness less and improving. Advised to monitor and would follow up with patient on the phone later in the afternoon. Patient returned back to the Clinic location about 1 hour post injection due to noted numbness spreading to left flank area, upper and lower back up to waist level on left side only . Patient then noted numbness in left ankle extending upwards to her left thigh. Patient was transported to Health Services for further evaluation/ monitoring. EKG was done. Patient noted some improvement at discharge but still with numbness and referred to ER for further eval

Other Meds: none

Current Illness: none

ID: 1779705
Sex: M
Age: 70
State: MO

Vax Date: 03/05/2021
Onset Date: 03/06/2021
Rec V Date: 10/12/2021
Hospital:

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

Lab Data: NA

Allergies: NKDA

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

Symptoms: Tinnitus that developed the next day after vaccine was given and has not resolved currently.

Other Meds: Famciclovir, Calcium + Vitamin D3, Probiotic, Vitamin D3, Multi-vitamin, Fish Oil

Current Illness: None per patient

ID: 1779706
Sex: F
Age: 44
State: CA

Vax Date: 10/06/2021
Onset Date: 10/06/2021
Rec V Date: 10/12/2021
Hospital:

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

Lab Data:

Allergies: Codeine, Penicillin, Lactose, Vicodin

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

Symptoms: On 10/07/21, Patient received first dose Pfizer COVID vaccine 0.3mL. Patient stated felt lightheaded, BP elevated 153/105. Unable to obtain manual blood pressure reading. Urgent care was contacted and arrived. Patient was transferred to urgent care and subsequently discharged.,

Other Meds:

Current Illness:

ID: 1779707
Sex: F
Age: 43
State: MA

Vax Date: 10/05/2021
Onset Date: 10/05/2021
Rec V Date: 10/12/2021
Hospital:

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

Lab Data: This was reported to the manufacturer Moderna. Case number CEA0843 Their response: Thank you for your unsolicited inquiry: Pharmacist states that 4 patients received their 3rd doses of the Moderna Covid-19 Vaccine 33 days after the vial was moved to refrigeration. She wants to know how to proceed. Lot number(s): 040C21A. Number of doses/vials: 1 vial/4 doses. Date the vial was initially stored in the refrigerator: 2Sep2021. Date(s) of administration of vaccine: 5Oct2021. Did the vial undergo any temperature excursions? No Our team can conduct an analysis to determine if the vaccine administered past the expiry date provided the necessary protection against a COVID-19 infection. Due to the nature of your event, a LOT assessment will be conducted to determine the activity level of the vaccine. This assessment can take 8 to 10 business days. Your case number is CEA-0843. Following the conclusion of that assessment you will be contacted and provided with a product stability determination and instructions.

Allergies: No known allergies

Symptom List: Tremor

Symptoms: The vaccine was administered 3 days after the beyond use date. The dose was administered on 10/5/2021 when the beyond use date was 10/2/2021. The expiration date of the vial was 10/31/21. The expiration date was used instead of the beyond use date.

Other Meds: unknown

Current Illness:

ID: 1779708
Sex: F
Age: 40
State: CA

Vax Date: 08/12/2021
Onset Date: 08/15/2021
Rec V Date: 10/12/2021
Hospital:

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

Lab Data: blood test-08/24/2021 mri-09/11/2021

Allergies: none

Symptom List: Erythema, Pruritus

Symptoms: vision issues, floaters, inflammation, ear pain, migraines, vertigo

Other Meds: celexa 40mg ambien 5mg

Current Illness: none

ID: 1779709
Sex: F
Age:
State: CA

Vax Date:
Onset Date: 05/01/2021
Rec V Date: 10/12/2021
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: 53 year old female received Pfizer covid-19 immunization april and may 2021. Developed full body pain after the 2nd shot after a few days and stopped menstrating with no further period since.

Other Meds:

Current Illness:

ID: 1779880
Sex: M
Age: 91
State: NC

Vax Date: 10/12/2021
Onset Date: 10/12/2021
Rec V Date: 10/12/2021
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: statins-swelling

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

Symptoms: Vaccine was incorrectly diluted with 0.8 ml of sodium chloride instead of the correct 1.8 ml amount.

Other Meds: coreg 12.5 mg,lisinopril 20 mg,prilosec 20 mg,flomax 0.4 mg

Current Illness: none

ID: 1779881
Sex: M
Age: 33
State: AZ

Vax Date: 09/13/2021
Onset Date: 09/13/2021
Rec V Date: 10/12/2021
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: Pfizer booster dose given before it was approved.

Other Meds:

Current Illness:

ID: 1779882
Sex: F
Age: 47
State: CA

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

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

Lab Data:

Allergies: Iron Dextran

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

Symptoms: Patient received 1st dose of Pfizer vaccine at about 15:15 and after about 15 minutes, she started complaining of tingling and numbness in her throat. Patient denied shortness of breath or trouble breathing. No rash, hives, dizziness or other symptoms. After 30 minutes patient continued to have symptoms and was clearing her throat. Patient brought to ED for evaluation.

Other Meds:

Current Illness:

ID: 1779883
Sex: F
Age: 25
State: NY

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 10/12/2021
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: penicillin

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

Symptoms: Within 20 mins of vaccination she developed chest tightness which she thought might be her usual asthma symptoms and treated with symbicort and albuterol subsequently noticed that she had hives on wrists and swelling of her hands. Took benadryl for it. resolved. did not go to ER. felt dizzy and dehydrated despite having had plenty of fluids prior to the vaccination. Other symptoms such as headache were present and continued for a few days

Other Meds: psyllium polycarbophil albuterol budesonide-formoterol

Current Illness: none

ID: 1779884
Sex: F
Age: 27
State: TX

Vax Date: 10/08/2021
Onset Date: 10/08/2021
Rec V Date: 10/12/2021
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: Pain in extremity

Symptoms: I first had diffuse myalgias, chills and a fever of 102. That lasted for 12 hours. Then, I had an enlarged, tender axillary lymph node in my left axilla. That lasted for 2 days. Then, I had a scintillating scotoma that obscured all of my vision. It lasted for 30 minutes and finally resolved without sequellae. I took 2 tablets of Aleve prophylactically in the event that the scotoma was an aura for a migraine.

Other Meds: Women?s multivitamin

Current Illness: None

ID: 1779885
Sex: F
Age: 32
State: NY

Vax Date: 09/27/2021
Onset Date: 09/28/2021
Rec V Date: 10/12/2021
Hospital:

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

Lab Data:

Allergies: Labetalol

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

Symptoms: Syncope episode. Several burns on arm where injection was given. Arm still swollen almost 2 weeks later.

Other Meds:

Current Illness:

ID: 1779886
Sex: F
Age: 70
State: IN

Vax Date: 10/05/2021
Onset Date: 10/06/2021
Rec V Date: 10/12/2021
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: penicillins (Swelling) Losartan Potassium (unknown) lisinopril (unknown) Social History

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

Symptoms: Proximal weakness that started the next evening, difficult to get off the couch. Improving daily but still not feeling back to normal.

Other Meds: aspirin 81 mg oral tablet, delayed release 81 mg = 1 Tablet, Orally, Daily atorvastatin 10 mg oral tablet 10 mg = 1 Tablet, Orally, QPM cyanocobalamin 1000 mCg sublingual lozenge 1,000 mCg = 1 Lozenge, Sublingually, Daily Ditropan XL 5 mg/2

Current Illness: None, but had kidney stones and pulmonary embolism in July

ID: 1779887
Sex: M
Age: 83
State: MA

Vax Date: 10/05/2021
Onset Date: 10/05/2021
Rec V Date: 10/12/2021
Hospital:

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

Lab Data: This was reported to the manufacturer Moderna for a recommendation if the dose should be repeated. Moderna case #CEA0843 There response: Thank you for your unsolicited inquiry: Pharmacist states that 4 patients received their 3rd doses of the Moderna Covid-19 Vaccine 33 days after the vial was moved to refrigeration. She wants to know how to proceed. Lot number(s): 040C21A. Number of doses/vials: 1 vial/4 doses. Date the vial was initially stored in the refrigerator: 2Sep2021. Date(s) of administration of vaccine: 5Oct2021. Did the vial undergo any temperature excursions? No Our team can conduct an analysis to determine if the vaccine administered past the expiry date provided the necessary protection against a COVID-19 infection. Due to the nature of your event, a LOT assessment will be conducted to determine the activity level of the vaccine. This assessment can take 8 to 10 business days. Your case number is CEA-0843. Following the conclusion of that assessment you will be contacted and provided with a product stability determination and instructions.

Allergies: Allergy-Morphine.

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

Symptoms: The vaccine was administered 3 days after the beyond use date. The dose was administered on 10/5/2021 when the beyond use date was 10/2/2021. The expiration date of the vial was 10/31/21. The expiration date was used instead of the beyond use date. No outcome or adverse event occurred at this time

Other Meds: Unknown.

Current Illness:

ID: 1779888
Sex: U
Age:
State: NY

Vax Date: 10/10/2021
Onset Date: 10/11/2021
Rec V Date: 10/12/2021
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 yet

Allergies: Ammox, Wellbutrin, azithromycin, contrast,

Symptom List: Vomiting

Symptoms: Period came early and pain (cramps) is debilitating

Other Meds: None

Current Illness: None

ID: 1779889
Sex: F
Age: 59
State: CO

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

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

Lab Data: N/A

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient came in on 10/07/21 to get Pfizer booster. The patient was do for booster dose on the 9th of October. Patient reported having slight body aches for about 2 days. Patient did not report any other symptoms.

Other Meds:

Current Illness:

ID: 1779890
Sex: F
Age: 79
State: MA

Vax Date: 10/05/2021
Onset Date: 10/05/2021
Rec V Date: 10/12/2021
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: This was reported to the manufacturer Moderna for a recommendation if the dose should be repeated. Moderna case #CEA0843 There response: Thank you for your unsolicited inquiry: Pharmacist states that 4 patients received their 3rd doses of the Moderna Covid-19 Vaccine 33 days after the vial was moved to refrigeration. She wants to know how to proceed. Lot number(s): 040C21A. Number of doses/vials: 1 vial/4 doses. Date the vial was initially stored in the refrigerator: 2Sep2021. Date(s) of administration of vaccine: 5Oct2021. Did the vial undergo any temperature excursions? No Our team can conduct an analysis to determine if the vaccine administered past the expiry date provided the necessary protection against a COVID-19 infection. Due to the nature of your event, a LOT assessment will be conducted to determine the activity level of the vaccine. This assessment can take 8 to 10 business days. Your case number is CEA-0843. Following the conclusion of that assessment you will be contacted and provided with a product stability determination and instructions.

Allergies:

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

Symptoms: The vaccine was administered 3 days after the beyond use date. The dose was administered on 10/5/2021 when the beyond use date was 10/2/2021. The expiration date of the vial was 10/31/21. The expiration date was used instead of the beyond use date. No outcome or adverse event occurred at this time

Other Meds: unknown

Current Illness:

ID: 1779891
Sex: F
Age: 76
State: CA

Vax Date: 09/10/2021
Onset Date: 09/12/2021
Rec V Date: 10/12/2021
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: Chest X-ray 10/10/2021 normal, lab work 10/11/2021 A1C elevated

Allergies: Aspirin; ibuprofen

Symptom List: Injection site swelling, Limb discomfort

Symptoms: I had chills and a fever and felt tired/fatigued about 2 days after the vaccine. I had swelling on the back of my head that was painful. Then gradually my temperature went down but I have continued to feel fatigued throughout the day. I think I have had something going on with my intestines. I have been very thirsty and after the swelling in the back of my head went down, I started to swell on my right temple. It is very painful. My doctor today 10/12/2021 said there is a swollen gland on the side of my head. My throat has also been hurting a little bit. I was unable to finish my exercise class this morning which is unusual for me. My doctor had suggested a few weeks ago to take zinc and vitamin D to help with energy levels but I am still fatigued. This last saturday I called the advice nurse and I went to urgent care 10/10/2021.

Other Meds: Multivitamin; fish oil; calcium; Bone up

Current Illness: No

Date Died: 04/01/2021

ID: 1779892
Sex: M
Age: 83
State: NJ

Vax Date: 03/25/2021
Onset Date: 04/01/2021
Rec V Date: 10/12/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: DEATH

Other Meds:

Current Illness:

ID: 1779893
Sex: M
Age: 60
State: MA

Vax Date: 08/22/2021
Onset Date: 09/02/2021
Rec V Date: 10/12/2021
Hospital:

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

Lab Data: Further audiology evaluations and clinical exams.

Allergies: None

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

Symptoms: This is in addition to the episode I described and submitted in my prior report of VAERS E-Report No: 678040. Received my booster vaccination on August 22, 2021. On 9/2/2021, I had increased tinnitus in my right ear with sudden loss of hearing and tinnitus. I was evaluated that day and by the time I reached my ENT's office, my hearing returned. However, the increase in tinnitus followed by complete hearing loss happened three more times but resolved each time. Finally, it occurred again without resolution and I contacted my ENT's office for full hearing loss in my right ear. I was tested on September 16, 2021 which demonstrated further significant hearing loss in my right ear. I was then put on high dose prednisone again. Upon completion, I was tested again on October 12, 2021 and told there was little change from the prior testing and the loss is permanent (moderate to severe loss) in my right ear.

Other Meds: Lexapro and mesalamine

Current Illness: None

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am