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: 1779894
Sex: M
Age: 72
State: WA

Vax Date: 03/31/2021
Onset Date: 09/14/2021
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: Antibodies

Allergies: N/A

Symptom List: Dysphagia, Epiglottitis

Symptoms: My family members had tested Positive for Covid-19 and so I went and got tested. I notified my Pulmonologist that I had tested Positive for Covid-19. I got an antibody treatment that evening. I recently had been treated for Pneumonia and my breathing was bad anyway, so I did not notice it getting worse. I quarantined and I did not notice that my symptoms were worse. My lower back pain was a little worse than normal. I ruptured a tendon in my right hand about a week after the antibody treatment.

Other Meds: Lisinopril; rosuvastatin; montelukast; prednisone; levofloxacin; Stiolto Respimat; Flovent; Travatan eye drops; coQ10; vitamin C; vitamin D; probiotic; multivitamin

Current Illness: N/A

ID: 1779896
Sex: F
Age: 57
State: CA

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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: Could not be determined at ER.

Allergies: Compazine, Reglan, traMADol

Symptom List: Anxiety, Dyspnoea

Symptoms: Rapid heartbeat, chest pain, shortness of breath, swollen and painful lymph nodes, extreme fatigue

Other Meds:

Current Illness:

ID: 1779897
Sex: F
Age: 47
State: CA

Vax Date: 09/21/2021
Onset Date: 10/08/2021
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: None

Allergies: Cypro

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

Symptoms: Very heavy bleeding with clots after not having period for month and being on hormone replacement therapy! Comes in waves following abdomen pain and cramping!

Other Meds: Metoprolol 50 mg Setraline 100 mg Estrogen 1.5 Progesterone

Current Illness: Fibromyalgia,ebv

ID: 1779898
Sex: F
Age: 61
State: CA

Vax Date: 04/27/2021
Onset Date: 05/02/2021
Rec V Date: 10/12/2021
Hospital: Y

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

Lab Data: Blood work was done

Allergies: no Food allergies, Allergey to Medications, Xanax , Zyprexa, Traiminolin 0.1, Nystatin,100,000 units ,Cephalexin 500mg, Fluconazole 150mg, Acyclovir 200mg

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: symptoms, where depression, aniexty, moden swing, mental illness,

Other Meds: Bystolic, Depokote, Effexor XR, Vitman D

Current Illness: yes i was having alot of Aniexty, gastric, and modem system

ID: 1779899
Sex: F
Age: 26
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:
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:

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

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: 1779900
Sex: F
Age: 68
State: CA

Vax Date: 08/27/2021
Onset Date: 08/28/2021
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: Haven't had any tests run at this point. If things don't improve significantly, I will contact my GI or family doctor to see about running blood work or stool tests.

Allergies: Many allergies and sensitivities to medications - Can be available to upload.

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

Symptoms: I had a sore arm. The initial day after - very, very cold, sore arm; body aches - couldn't get settled down because of it; dull headache. At the end of the day, I went to get my mail outside and I became dizzy and nauseated. I went back in the house, and talked myself into not throwing up. I didn't have any nausea with previous COVID shots. I had night sweats but no fever. The next day, I had fatigue and a little dizziness, but not bad. And then night sweats that night. My arm was still sore. The next day, I found that I had developed an infection in left lower nostril - in the opening. Acyclovir ointment - it responded to that and to Acyclovir capsules that I eventually took. It took a month to get rid of it. I had something similar many, many years ago that showed up under stress. But this was different and lasted an extra week or two. I developed severe abdominal pain, cramps, bloating queasiness and extreme slowdown in bowels. My whole digestion system changed. Similar to IBS but nothing to that degree. Once my husband wanted to take me to ER but I took a walk and it subsided some. It's been six weeks since it started. I developed red - from the shot area to just above my elbow. It was warm too but not infected. It itched. That lasted a couple of weeks. I had some dizziness that comes back in a waves and then goes away. I have been seeing alternative medical people for the intestinal issues - one did visceral manipulation - and she worked on vagal nerve and kinds of things that can help with that kind of thing. I now see an acupuncturist - and I have seen him three times. I have two days that I can string together that I have felt better. I was able to have lunch today. I hover around 99 and 100. Last time was 96 lbs.

Other Meds: Synthroid 50 mcg - 1 time a day; Pulmicort 180 inhaler; Singulair 1 quarter of a 10 mg tablet once a day; Vit D; Vit E; B and Vit B12; Black Elderberry Syrup and Probiotic once a day

Current Illness: no

ID: 1779901
Sex: F
Age: 46
State: NY

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

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

Lab Data: Not sure what test were but I did had a lot of blood testing, Still haven't received any copies but I'm assuming everything was okay.

Allergies: Seasonal Allergies

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Pregnant and had emergency C-section, My blood pleasure dropped and when I woke up I was throwing up. I've had surgeries before and I had never had any reaction like this.

Other Meds: Levofloxacin, Prenatal, Vitamin, Vitamin D, Claritin.

Current Illness: N/A

ID: 1779902
Sex: F
Age: 34
State: OK

Vax Date: 07/29/2021
Onset Date: 08/10/2021
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: Penicillin

Symptom List: Pharyngeal swelling

Symptoms: Chest tightness, hypertension, difficulty breathing, lack of concentration

Other Meds: None

Current Illness: None

Date Died: 04/15/2021

ID: 1779903
Sex: F
Age: 88
State: NJ

Vax Date: 03/25/2021
Onset Date: 03/31/2021
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: trying to retreive medical records from hospital

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Coughing then turned to pneumonia

Other Meds:

Current Illness:

ID: 1779904
Sex: M
Age: 67
State: MO

Vax Date: 09/21/2021
Onset Date: 09/22/2021
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: Pt reported he went to ED on10/7 and had an MRI of head and it was "fine."

Allergies: Denies

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Headache started the day after vaccine and continues daily. Pain as high as 13 on a scale of 1-10. Today, he reports H/A comes and goes now instead of continuous but 4-5x/day. Today around noon he laid down about 15 minutes after it started and it went away. Will schedule appt w/PCP tomorrow.

Other Meds: Unkn

Current Illness: Unkn

ID: 1779905
Sex: F
Age: 57
State: WV

Vax Date: 10/01/2021
Onset Date: 10/02/2021
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: PT; PTT; INR ;Factor5 blood tests

Allergies: Doxycycline

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

Symptoms: Pain and swelling in the Right axilla and right breast with radiating paint o the right elbow, right wrist and thumb from 10/2/2021-10/10/2021. Ecchymosis in the Right axilla and right lateral breast area from 10/3/2021- 10/8/2021.

Other Meds: Synthroid Verapamil Maxide B 100 Complex Vitamins D3 Vitamins

Current Illness:

ID: 1779906
Sex: F
Age: 53
State: FL

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

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

Lab Data:

Allergies: NONE KNOWN

Symptom List: Rash, Urticaria

Symptoms: REDNESS AND ITCHING AT INJECTION SITE. NASAL CONGESTION

Other Meds: NONE KNOWN

Current Illness: NONE

ID: 1779907
Sex: F
Age: 47
State: DC

Vax Date: 08/05/2021
Onset Date: 08/05/2021
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: MRI brain, EMG 8/24/21

Allergies:

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

Symptoms: Pateint said she was feeling perfectly normal before the vaccination in her R lateral deltoid at CVS on 8/5/21 at 11:00 am, and during the injection everything felt fine. She said there was no pain and even told the administering nurse that she was an angel. In the evening, approximately 10 h after the shot she developed tingling tips of her fingers of the RUE, (first in the 4th and 5th digits). The following day she had pain in her R ear with hearing loss and then a generalized headache and b/l neck pain. She may have a had a low grade fever at this time. The following day her entire RUE became completely weak and completely numb (heat, touch, pain) distally from the site of the injection. The hearing has mostly resolved, although intermittently her husband notices that she can't hear things as well as she used to. The headache and neck pain resolved several weeks ago. The weakness and numbness have continued and she cannot move her fingers, wrist, elbow or shoulder at all. No other extremities were effected. No other symptoms.

Other Meds:

Current Illness:

ID: 1779908
Sex: M
Age: 38
State: AZ

Vax Date: 09/17/2021
Onset Date: 09/21/2021
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: Blood draw/labs on 10/1. Increase of medication on 10/7.

Allergies: N/A

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

Symptoms: I saw my endrocrinologist due to feeling tired and not feeling the same level of energy every day starting at 3pm. This was happening before the COVID-19 vaccination but was more intense even after, I completed a blood draw and it was determined that I needed to have my Unithroid Rx increased. I am truly unaware if it is related specifically to the Vaccine, but I do know I was more tired after the vaccine in the afternoons.

Other Meds: Unithroid 100mcg 1x per day; Liothyronine 5mcg 3x per day

Current Illness: N/A

ID: 1779910
Sex: F
Age: 57
State: CA

Vax Date: 09/29/2021
Onset Date: 09/29/2021
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: Not applicable

Allergies: no known allergies on file

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

Symptoms: Patient experienced headaches, seizure in head such as head shaking and involuntary movement. She also experienced leg jerking or shooting movement (involuntary movement). Still has ongoing headache.

Other Meds: Megace 40 mg, Losartan 25 mg

Current Illness: high blood pressure, post menopausal bleeding

ID: 1779911
Sex: F
Age: 47
State: PR

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

Allergies: No

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

Symptoms: Severe Cellulitis on left arm, 40 degree fever for 3 days. Body muscular pain, nausea, diarrhea, head pain, tiredness, difficult respiration. I started with Antibiotics, Levaquin 750mg ever 12 hours, Flovent HFA 110mcg twice per day, Albuterol 90mcg twice per day, Symbicort once per day. Severe Cellulites left arm, fever, muscular pain, head pain, nausea, diarrhea, difficult respiration, cough. 47 year female patient receives MODERNA 3rd dose October 10 2021.

Other Meds: Cabergoline 5mg, Synthroid 137mg

Current Illness: prolactinoma

ID: 1779912
Sex: M
Age: 12
State: CO

Vax Date: 08/20/2021
Onset Date: 10/11/2021
Rec V Date: 10/12/2021
Hospital: Y

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: Stroke with right sided MCA narrowing

Other Meds:

Current Illness:

ID: 1779913
Sex: M
Age: 39
State: AL

Vax Date: 03/16/2021
Onset Date: 04/06/2021
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: COVID-19 PCR test (09/09/2021)

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Breakthrough COVID-19 case. Symptoms: pharyngitis, nasal congestion, fatigue, fever > 101?F, chills, cough, difficulty breathing, bronchospasm. Most symptoms resolved after 2 weeks, with lingering cough and fatigue remaining to 4 weeks. Treated symptomatically at day 8 for bronchospasm with albuterol HFA inhaler.

Other Meds: losartan; amlodipine; testosterone cypionate; human chorionic gonadotrophin (hCG); anastrozole; tadalafil; Descovy; vitamin D3; zinc

Current Illness: adenoviral infection

ID: 1779914
Sex: F
Age: 92
State:

Vax Date: 03/17/2021
Onset Date: 09/23/2021
Rec V Date: 10/12/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: 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: 1779915
Sex: M
Age: 25
State: IL

Vax Date: 10/12/2021
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: Penicillin

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

Symptoms: Complained of tinkling an numbness of the fingers and arm.

Other Meds: Taking low dose aspirin

Current Illness:

ID: 1779916
Sex: M
Age: 52
State: TX

Vax Date: 08/25/2021
Onset Date: 08/27/2021
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 so far

Allergies: NKDA

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

Symptoms: fatigue, insomnia, sob, chest pressure

Other Meds: Losartan Fenofibrate Atorvastatin

Current Illness: NONE

ID: 1779917
Sex: M
Age: 24
State: LA

Vax Date: 04/04/2021
Onset Date: 05/01/2021
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: LA

Lab Data: Eye examination performed on 28 SEP 2021.

Allergies: NKDA

Symptom List: Unevaluable event

Symptoms: 1. Squiggly lines or floaters when looking upward; onset in May 2021. 2. reports multiple joint aches; bilateral knee aches with associated "locking and giving out." 3. Trouble trouble sleeping, 4. Frequent headaches with associated nausea, dizziness, and light/noise sensitivity 5. reports NEW ONSET decreased penile erection; onset in JUN 2021. states that erection "isn't full" and also notice "no morning erections" that he normally gets. states that symptoms are still ongoing. states that he didn't have this issue prior to deployment. denies pain with urination or abnormal penile discharge.

Other Meds: None

Current Illness: None

ID: 1779918
Sex: M
Age: 11
State: CA

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

Allergies: NKA

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

Symptoms: No adverse event. Pt. <12yrs of age and received Pfizer Covid vaccine. Parent's consent given and was at chairside at time of incident.

Other Meds: None

Current Illness: None

ID: 1779919
Sex: F
Age: 46
State: KY

Vax Date: 06/02/2021
Onset Date: 09/13/2021
Rec V Date: 10/12/2021
Hospital: Y

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

Lab Data: Meds given: dexamethasone (DECADRON) injection 8 mg (has no administration in time range) azithromycin (ZITHROMAX) tablet 500 mg COVID-19 RESULT Detected

Allergies: Lisinopril

Symptom List: Injection site pain, Pain

Symptoms: Pt is a 47 yr/o female with a hx of Crohn's disease, COPD, CHF, and sarcoidosis who presents with myalgias that began a few days ago. She has also felt feverish and has had a cough. Her cough is productive of yellow sputum. She has chronic nausea due to her hx of crohn's disease, but has not had relief recently with her Zofran. She is on Mesalamine for her crohn's disease. She is fully vaccinated for Covid19. Review of Systems. Positive for fever. Negative for activity change and unexpected weight change. HENT: Negative for congestion, sore throat and neck pain. Eyes: Negative for visual disturbance. Respiratory: Positive for cough. Negative for shortness of breath. Cardiovascular: Negative for chest pain. Gastrointestinal: Positive for nausea. Negative for diarrhea and vomiting. Genitourinary: Negative for difficulty urinating and flank pain. Musculoskeletal: Positive for myalgias and back pain. Negative for joint swelling. Skin: Negative for rash. Neurological: Negative for seizures and headaches. Hematological: Negative for adenopathy. Psychiatric/Behavioral: The patient is not nervous/anxious.

Other Meds: albuterol (ACCUNEB) 0.63 MG/3ML nebulizer solution Take 1 ampule by nebulization every 6 (six) hours as needed for Wheezing. 30 ampule 1 ? albuterol (PROVENTIL) (2.5 MG/3ML) 0.083% nebulizer solution Take 1 ampule by nebulization every 4 (f

Current Illness:

ID: 1779920
Sex: M
Age: 65
State: CA

Vax Date: 02/26/2021
Onset Date: 02/27/2021
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: None known

Symptom List: Injection site pain, Menorrhagia

Symptoms: I arose on Saturday morning following the second COVID Moderna injection around 7:00 and was very cold in my legs and arms. By 9:00 I developed a headache, which I rarely experience. About 11:00 a.m. I began to run a slight fever. At 1:00 p.m. my fever was 104.9 degrees and remained this high throughout the afternoon, evening and night. I experienced chills, sweats and body ache throughout the 18 hour fever. Around 7:00 a.m. the fever broke and by 9:00 a.m. my temperature was just above normal. I slept the remainder of Saturday and did not feel fully well again until Tuesday. this is sicker than I have been from anything in over 30 years.

Other Meds: Amlodipine

Current Illness: None

ID: 1779921
Sex: F
Age: 37
State: MT

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

Lab Data: None

Allergies: None

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

Symptoms: Very sore arm. Extreme chills , body aches, headache, foggy brain.

Other Meds: Emergency c, natural calm magnesium

Current Illness: None- on monthly period during vaccination

ID: 1779923
Sex: F
Age: 44
State: NJ

Vax Date: 03/17/2021
Onset Date: 10/07/2021
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: PCR + for Covid on 10/8/2021

Allergies: none known

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Client vaccinated with Pfizer vaccine for Covid on March 17 (approx.) and April 17 (exact) 2021. Developed Covid symptoms on 10/7/2021 - nasal congestion, cough, sore throat, mild SOB. Tested + for Covid on 10/8 with PCR test.

Other Meds: none known

Current Illness: none known

ID: 1779924
Sex: M
Age: 75
State:

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: patient received Moderna on 06/17/2021. No adverse effects from receiving this dose

Other Meds:

Current Illness:

ID: 1779925
Sex: M
Age: 12
State:

Vax Date: 10/12/2021
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: RA

Lab Data: None

Allergies: Fish oil; Aspirin

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

Symptoms: Patients mother indicates redness on area of injection.

Other Meds: Unknown

Current Illness: Mother indicates patient not having any.

ID: 1779926
Sex: M
Age: 74
State: AR

Vax Date: 09/30/2021
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: 1
Vax Route: IM
Vax Site: RA

Lab Data: none

Allergies: Tobacco smoke

Symptom List: Nausea

Symptoms: Arm pain starting within hour. Extreme dizziness staring at 6 hours. Falling down, Falling into walls and furniture. Inability to walk more than 50 feet without stopping to let head spinning stop. Unable to walk without holding walls, rails, etc. No pain or any adverse effects with does one and two.

Other Meds: nifedipine, lisinopril, clopidogrel, multivitamin, Ca, Mg, Zn, E, A, B12.

Current Illness: none

ID: 1779928
Sex: M
Age: 29
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: LA

Lab Data: EKG

Allergies: None

Symptom List: Injection site pain

Symptoms: Body went numb 5min after. Heart rate jumped to 165, had a weird taste, transported to ER, burning chest, chest pressure, stabbing chest pain. Head had pressure, head went numb, felt like I was dying. No history of reaction to vaccines or injections. Heart palpitations. Feet would go numb, very fatigued, extremely dizzy, blurred vision. Only a EKG was done which returned normal. Chills/ very hot as if I have a heating blanket on. Feeing as if I had fiberglass in my throat. Some difficulty breathing. Feeling if an out of body experience as if everything was moving fast but slow at the same time. Pounding heart beat, numbness in stomach. Was discharged after EKG and told it was a anxiety attack.

Other Meds: Lexapro

Current Illness: Diagnosed with panic disorder after being COVID positive in may of 2021

ID: 1779929
Sex: F
Age: 47
State: PA

Vax Date: 10/09/2021
Onset Date: 10/10/2021
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: BACTRIM DS 1TAB BID

Allergies: NO ALLERGIES

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

Symptoms: SYMPTOMS - LOCAL IRRITATION , REDNESS, HOTNESS

Other Meds: ADDERALL XR 30 MG

Current Illness: NOTHING

ID: 1779930
Sex: F
Age: 75
State: NJ

Vax Date: 02/25/2021
Onset Date: 02/26/2021
Rec V Date: 10/12/2021
Hospital: Y

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

Lab Data: On 2/26/2021, I underwent a brain scan, which determined I had a seizure. Every 6 months, I have undergone brain scans at Dr practice, and everything seems fine, so far.

Allergies: None.

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

Symptoms: On 2/26/2021 at around 11:00AM, I wasn't able to formulate a sentence and I had trouble speaking. A few years ago, I had a stroke after undergoing open heart surgery, and my husband thought I was displaying similar symptoms, so he took me to the ER at University Hospital. They ran a brain scan and it was determined that I hadn't had a stroke, but a seizure. I was then put on a ventilator, and I stayed on it until about 9:00PM that night. I spent the night in the ER and was released late in the morning on 2/27/2021. After that, I made an appointment to see my cardiologist, Dr.. Dr. prescribed Keppra, which is an antiseizure medication. Since then, he has been following my progress, and I have undergone brain scans at his practice every 6 months. So far, everything seems to be fine. I am currently concerned, though, as I would like to receive the Moderna booster when it finally comes out. However, I'm afraid it could cause me to have another seizure. One doctor recommends I not get it, whereas another doctor recommends that I do, so I'm confused. In about 2 weeks, I plan to get my antibody levels checked.

Other Meds: Carvedilol (12.5 mg twice a day), levothyroxine (75 mg 6 times a week), Losartan (100 mg once a day), ezetimibe (10 mg once a day), rosuvastatin (20mg once a day), Ecotrin (81mg once a day), multivitamin, Caltrate, Prolia injection for oste

Current Illness: None.

ID: 1779932
Sex: M
Age: 70
State:

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:

Allergies:

Symptom List: Tremor

Symptoms: Patient received Moderna on 07/14/2021& 08/13/20212, then received Pfizer as booster on 10/05/2021. No side effects reported at this time.

Other Meds:

Current Illness:

ID: 1779933
Sex: F
Age: 34
State: CT

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: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Patient's arm immediately began to swell at the injection site. No bleeding but area became hard and puffed straight out. Slight discoloration developed. An ice pack was given and patient monitored for any other signs or symptoms for 30 minutes.

Other Meds:

Current Illness:

ID: 1779934
Sex: F
Age: 69
State: NH

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

Allergies: Super sensitive to medications and side affects. Super sensitive to Eggs, wheat, garlic, chocolate, red kidney beans (none of which eaten or taken day before, of or after vaccine.

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

Symptoms: Extreme pain in left arm radiating throughout entire body, severe trembling, chills, fever, nausea, shortness of breath Beginning at 11:30PM continuing throughout the night - without sleep. Resulting next day (Monday 10/11) in extreme fatigue, continued trembling, fever, chills. Still in wakened state but SLOWLY recovering on third day 10/12/2021. Sense of taste has dwindled. Same reaction at second injection - though not as severe. Was strongly encouraged to receive booster against MY better judgement.

Other Meds: Irbesartan, Hydrochlorothiazide, Carvedilol, Synthroid, Prilisec, 5% sodium Chloride Ophthalmic solution - Eye Drops.

Current Illness: NONE

ID: 1779935
Sex: F
Age: 26
State: NC

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

Lab Data:

Allergies: Benzoyl peroxide

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

Symptoms: Inflammation, development of a knot, pain, mild cellulitis

Other Meds: Labetalol, zoloft

Current Illness: None

ID: 1779936
Sex: F
Age: 54
State: TX

Vax Date: 04/06/2021
Onset Date: 05/10/2021
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: US HEART W CONTRAST AND 3D ANALYSIS - normal 7/16/21 Stress test - normal 7/16/21 CT ANGIOGRAM CHEST W WO CONTRAST - No aneurysm of your aorta 9/3/21

Allergies: Sulfa drugs

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Increased heart rate

Other Meds: multi-vitamin, vitamin c, zinc, vitamin d and elderberry

Current Illness: None

ID: 1779937
Sex: F
Age: 54
State: WA

Vax Date: 03/10/2021
Onset Date: 04/23/2021
Rec V Date: 10/12/2021
Hospital: Y

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

Lab Data: 8/1 CAT scan 8/5 MRI 8/5 Lumbar puncture 10/5 Electromyography 8/5 EEG

Allergies: None

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

Symptoms: 4/23/21 started to feel small inner thigh pain that slowly progressed until mid June when my right foot started to move involuntarily (IMM) 7/21/21 involuntary movement from my foot and started to affect my full right leg 7/28/21 involuntary movement starts to affect my upper right arm and into my neck - pressured speech starts to happen. 7/29/21 Went to Medical Center for a flair up of shingles on my lower back and talk about the pain and (IMM) on my right side. Medication was prescribed for shingles, but Dr. unsure what the pain down the leg is (could be sciatic and shingles affect the nerves). Referral to physical therapy. Continue below Continuation of symptoms: 8/1/21 (IMM) is now very painful and continues on only the right side of my body mostly inner thigh, outer thigh, arch of my foot, lower back and back of neck. We went to Lynden urgent care; attending Dr. told us to go to the ER at Hospital. CAT scan revealed nothing that would cause involuntary muscle movement. 8/5/21 - Pain continues to intensify (IMM) same areas all on the right side. I was admitted to the hospital were I had an EEG, MRI, and Lumbar puncture. No signs of lesions or anything else that would show why I was having (IMM). Released on the Aug. 8th - and referred to my primary caregiver Dr. for results. I met with his colleague around Aug 10 or so - results read to me by Dr. and referred back to Neurology. 9/14/21 - Neurologist- prescribes Carbidopa-Levodopa, (IMM stops in my leg, arm, neck but continues in my foot without pain) still intense pain in inner thigh out thigh lower back and foot. refers me to Dr for Electromyography, and Neurology for a movement consultation. 10/4/21 - physical therapy 10/5/21 Electromyogpahy - reveal no results of "stiff person syndrome" or Dystonia 10/13 appointment with Neurology. Not sure of results yet

Other Meds: Citelapram, Phentermine, levothyroxine, loratadine,minocycline, Other medicaiton taken Calcium 600, Minocycline

Current Illness: None

ID: 1779938
Sex: F
Age: 21
State: FL

Vax Date: 10/12/2021
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: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none known

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

Symptoms: Patient given Pfizer vaccine around 6:28 pm , within one minute of vaccination patient fainted and lost consciousness while sitting in vaccination chair. Pharmacist arrived back to patient's side within one minute and patient regained consciousness almost immediately. 911 was called and EMS arrived, BP assessed, taken to ambulance for assessment where BP recorded 80/33 and HR 40 bpm. Patient taken to Hospital

Other Meds: none known

Current Illness: none known

ID: 1780104
Sex: M
Age: 56
State: WA

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: LA

Lab Data: NA

Allergies: None noted by patient

Symptom List: Pain in extremity

Symptoms: PT here for 1st dose of Pfizer, received at 1324. At 1328, PT stood from chair in observation area and then collapsed. PT presented with pallor, diaphoresis. VS at 1331 were: BP laying 98/62, HR 56, SPO2 95% RA. It is unclear whether PT lost consciousness completely; PT reports that he had felt anxious, SOB, and over-heated and that he had stood up to get the attention of nurses. He said that he knew he was going to pass out and tried to grab a chair, but missed it and fell to ground. PT reported that he doesn?t believe he hit his head or injured himself. PT was assisted to elevate legs, remained laying. At 1333, PT?s color had already begun to improve. PT accepted and consumed offered juice and water, ate a small snack. VS at this time: BP 116/68 laying, HR 58, SPO2 97%. Pulse at 1336 was 70. PT reported that he was anxious about the vaccination and had not had anything to eat all day aside from some nuts. At 1340, PT reported that he felt ?okay?. At 1341, PT was able to sit up on floor without assistance, reported that he was a little dizzy but ?not like before.? VS at this time: BP sitting 112/70, HR 69, SPO2 97% RA. PT?s head was assessed for any signs of injury, none noted. PT educated on vasovagal responses, safety, what to expect throughout day, and to report this incident when he presents for 2nd dose. PT continued with slight s/s, reporting at 1343 that he felt okay, but things were a ?little echo-y?. PT was sitting while drinking water and declined to lie back down. At 1346, PT reported that s/s and improved and was able to stand up from the floor without assistance in order to sit on chair. PT?s pallor and diaphoresis were resolved; although PT reports that he was feeling cold. PT put coats back on and reported that feeling was better. By 1349, PT stated ?I feel okay, maybe a little bit distant.? At 1403, PT was able to stand without difficulty, reported that he felt no changes from sitting position, denied dizziness, vision changes, hearing changes. VS at 1403: BP 116/70 standing, HR 78, SPO2 97%. PT reports that this is in line with his normal BP. PT walked short distance in facility, moved without difficulty or pain, full ROM and steady gait noted. PT reported that he felt ready to leave facility, that he will be monitored by family at home. PT exited facility at 1410.

Other Meds: Unknown

Current Illness: Unknown

ID: 1780106
Sex: M
Age: 69
State: CO

Vax Date: 09/24/2021
Onset Date: 09/24/2021
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:

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

Symptoms: Patient came in to get a flu shot and he felt pain and burning immediately; after he left, he noticed that the immunizing pharmacist gave it less than 2 finger-widths from his shoulder (he was a paramedic and knows how vaccines should be given); he said it was injected around the ball joint and he believes it may have hit bone; later that night he couldn't sleep from the pain, it radiated down to his elbow and then further affecting his wrists and fingertips (he said he felt pain in his fingertips); he got a 2nd opinion while at the md office and the nurse concurred that it was given too high

Other Meds:

Current Illness:

ID: 1780107
Sex: M
Age: 81
State: KY

Vax Date: 04/12/2021
Onset Date: 10/12/2021
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: IM
Vax Site: LA

Lab Data: CT Head wo contrast: Brain Parenchyma: No acute intracranial hemorrhage, CT evidence of acute territorial infarct, mass, mass effect or midline shift. Patchy areas of white matter hypoattenuation are nonspecific but are most typical of chronic microvascular change. Ventricles/Extra-axial Spaces:No hydrocephalus or extra-axial fluid collection. There is generalized cerebral volume loss. Extracranial Structures:Visualized orbits are unremarkable. Paranasal sinuses and mastoids are clear. Calvarium is unremarkable. IMPRESSION: No acute CT abnormality. XR Chest: IMPRESSION: Mild infrahilar opacities bilaterally likely represent atelectasis. CT Angiogram Chest For PE IMPRESSION: 1. No pulmonary embolism or aortic dissection. 2. Bilateral groundglass infiltrates in a pattern most suggestive of Covid 19 pneumonitis though other forms of pneumonia are also in the differential diagnosis. 3. Cardiomegaly with coronary artery and aortic atherosclerotic calcification. 4. Multinodular enlargement of the thyroid consistent with goiter. Right lobe involved more than left

Allergies: No known allergies

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

Symptoms: He has been feeling bad for about one week. States his shortness of breath has progressively gotten worse. He also complains of difficulty swallowing. He has been unable to eat for about two weeks. He says that water just runs out of his mouth when he takes a sip. General Appearance: Appears thin. Head: Normocephalic, atraumatic Eyes: PERRL, conjunctiva/corneas clear, EOM's intact, sclera anicteric Ears: TMs not observed Nose: Patent without discharge Throat: No erythema or exudate Neck: Supple, without thyromegaly or masses. Trachea is midline. Back: Straight, no CVA tenderness Lungs: Decreased breath sounds Chest wall: No tenderness Heart: Regular rate and rhythm, S1 and S2 normal, no murmur, rub or gallop Abdomen: Soft, non-tender, non-distended, bowel sounds active all four quadrants, no masses, no organomegaly Extremities: Extremities normal, atraumatic, no cyanosis or edema Pulses: 2+ and symmetric all extremities Skin: Warm, dry, no rashes or lesions Lymph nodes: No adenopathy in the neck, axilla, or groin Neurologic: No focal deficits. CNII-XII intact. Speech is fluent. Conversation is coherent. Admitted to hospital, started on nasal O2 at 4lpm. MEDICATIONS GIVEN IN THE ER Medications Ampicillin/Sulbactam 3 gm/100 mL in NS (has no administration in time range) Azithromycin 500 mg/250 mL in D5W (has no administration in time range) fluconazole (DIFLUCAN) tablet 200 mg (has no administration in time range) iohexol (OMNIPAQUE) 300 MG/ML injection 60 mL (60 mLs Intravenous Given 10/12/21 1414)

Other Meds: ? aspirin EC EC tablet 81 mg, 81 mg, Oral, Daily, ? citalopram (CeleXA) tablet 20 mg, 20 mg, Oral, Daily, ? famotidine (PEPCID) tablet 20 mg, 20 mg, Oral, BID, ? fluconazole (DIFLUCAN) tablet 200 mg, 200 mg, Oral, Q24H,

Current Illness: None

ID: 1780108
Sex: M
Age: 53
State:

Vax Date: 04/04/2021
Onset Date: 09/24/2021
Rec V Date: 10/12/2021
Hospital: Y

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

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1780109
Sex: M
Age: 21
State: LA

Vax Date: 04/04/2021
Onset Date: 05/01/2021
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:

Allergies: NKDA

Symptom List: Vomiting

Symptoms: 1. PT reports numbness in feet and lower legs when running; onset MAY 2021. 2. PT reports multiple painful joints, no history of direct trauma to these areas; onset MAY 2021. Pt reports dull joint ache in bilateral elbow, wrist, knee, shoulder and ankle; dull ache in back; bilateral Achilles tendon ache. 3. PT reports dry, mildly itchy skin rash on bilateral forearms, upset stomach, and diarrhea; onset AUG 2021. PT states that GI issues resolved but continues to have rash. 4. PT reports frequent headaches; onset JUN 2021 with frequent trouble sleeping 5. PT reports NEW ONSET decreased penile erection; onset JUN 2021 with frequent urination and occasional painful urination. PT states that erection "isn't full" and also notice "no morning erections." PT states that he didn't have this issue prior to deployment.

Other Meds: None

Current Illness: None

ID: 1780110
Sex: F
Age: 64
State: NY

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: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: None

Allergies: Bactrim, augmentin, cipro, elidel cream

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Tachycardia , increased blood pressure, dizziness 15 minutes after 3 injection in my right arm. Same symptoms 5 minutes after my 4 th injection in my left arm. When I got home I was itching but no hives.

Other Meds: Lisiniprol 2.5 mg Crestor 10 mg Aspirin 81 mg Probiotic

Current Illness: None

ID: 1780111
Sex: M
Age: 67
State: NY

Vax Date: 09/03/2021
Onset Date: 09/09/2021
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: Elevated white blood cell count, C-reactive protein, and ESR. Negative serologies for lupus, rheumatoid arthritis, gout, and Lyme disease.

Allergies: Allergic to iodine contrast

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

Symptoms: Reactive arthritis, starting with acute monoarticular arthritis of the right knee, then progressing to a migratory polyarthritis, with involvement of both knees, both wrists, both thumbs, jaw, and PIP joints of the left hand

Other Meds: Perindopril, amlodipine, lipitor, famotidine

Current Illness:

ID: 1780112
Sex: F
Age: 31
State: TX

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: IM
Vax Site: LA

Lab Data: None

Allergies: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Can't move my left arm due the extreme sore pain.

Other Meds: Only vitamins

Current Illness: None

ID: 1780113
Sex: F
Age: 45
State: MO

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

Lab Data:

Allergies: Peanuts, Tramadol

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

Symptoms: Numbness and tingling to the right side of the face, the tongue also numb and tingling, right side of neck, the right should, right arm, and right hand to fingers. No facial drooping or difficulty speaking. Symptoms resolved in approximately 15 minutes. My husband was driving me to the hospital but did not seek medical care as symptoms resolved. We contacted our private physician in lieu of seeking medical attention. No visit to doctor's office, consultation only as no permanent symptoms. Physician has recommended not to receive second dose on November 1, 2021, as scheduled.

Other Meds: None

Current Illness: None Known

ID: 1780114
Sex: F
Age: 58
State:

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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: Ultrasound, EKG, and bloodwork found nothing significant.

Allergies:

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

Symptoms: Patient woke up Monday morning complaining of symptoms of body ache, fever, chills, headache, rapid heart rate, and swelling in armpit. The pain in armpit swelling escalated and was visibly swollen. Patient had over 100 degree F fever. Patient went to ER. ER ran EKG, bloodwork, and ultrasound. Provider found patient has swollen lymph nodes and her allergies were escalated in reaction to the vaccine. ER doctor prescribed ibuprofen, zpak, flonase, and allegra. Patient is taking claritin for heightened allergies.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am