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: 1785113
Sex: F
Age: 58
State: MD

Vax Date: 09/02/2021
Onset Date: 09/02/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data: X-Ray 10/05/2021 Ultrasound 10/05/2021

Allergies: N/A

Symptom List: Dysphagia, Epiglottitis

Symptoms: Pt. states that after receiving the 1st dose of Phizer 09/02/2021, burning during injection, pain in the left arm *continuous, Emergency Room visit 10/05/2021, X-Ray preformed (Normal), * diagnosed with Muscle Spasms treated with Muscle Relaxers. Cramping throughout the *both legs, still continuing to experience symptoms.

Other Meds: N/A

Current Illness: N/A

ID: 1785114
Sex: F
Age: 32
State: WA

Vax Date: 03/03/2021
Onset Date: 03/03/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data: Went to Doctors though it was thresh from minor swelling in mouth

Allergies: Benadryl; Claritin

Symptom List: Anxiety, Dyspnoea

Symptoms: Pain in mouth, allergic reaction. Swelling gone after 48 hours without any form of medication.

Other Meds: Perpramana; Daily Vitamins

Current Illness: None

ID: 1785115
Sex: F
Age: 38
State: CA

Vax Date: 02/23/2021
Onset Date: 02/23/2021
Rec V Date: 10/14/2021
Hospital: Y

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: CT scan to make sure there was not an aditional cause of the pain, MRI prior to ketamine infusions,

Allergies: MCAS, Peaches, local anathesia

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

Symptoms: Triggered previous dormate nerve pain from trigeminal neurlgia. Causing intense facial pain. Which has resulted in weeks of missed work, inability to wear a mask, increased pain with covid testing. Seeked treatment from primary care dr, a facial pain specialist, and pain management anathesiologist. Treatments include, pain medication, botox, ketamine infusions, neurologiacal medications. Currently had to fill for leave from work and took the max of COVID leave.

Other Meds: Bachlofen,

Current Illness: Trigeninal Neuarlgia, allergies MCAS

ID: 1785116
Sex: F
Age: 54
State: VA

Vax Date: 10/13/2021
Onset Date: 10/13/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data: N/A

Allergies: allergic reaction to Thimerasol, antihistamines

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: All stages of symptoms that can occur from the vaccine throughout a person's entire body, only occurred in my left arm. About an hour after the shot, the site felt like a wasp sting, and around 1630 EDT a hard lump appeared at the injection site, that grew to about the size of a lemon, then I experienced swelling of the upper arm, pain in the whole arm, heat all over the arm, then chills in the arm, then inability to raise my arm - by evening my arm felt like I had severely injured a rotator cuff or other shoulder muscle, and it felt like it was made of lead (very heavy). These symptoms continued throughout the night, especially the chills, and I couldn't raise my elbow above waist high. This morning, all the symptoms have receded and I only feel moderate ache in my upper arm, but still have some difficulty lifting it. I tried to find information on the internet about anyone else having experienced a range of symptoms only in the arm of the vaccination, and I haven't found any evidence of that, so I thought it was worth reporting.

Other Meds: none

Current Illness: none

Date Died: 10/13/2021

ID: 1785118
Sex: F
Age: 85
State: AK

Vax Date: 09/29/2021
Onset Date: 10/13/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data: N/A

Allergies: NKA

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

Symptoms: Had Pfizer COVID on 12-18-20, 1-7-21. Have Pfizer COVID Booster on 9-29-21

Other Meds: Morphine, Budesonide, Lorazepam, Trazadone, ASA, Spiriva, Ventolin, Ipratropium, Combivent,

Current Illness: Lung Cancer, CVA, Anxiety, COPD, GERD, Insomnia, Chronic Bronchitis,

ID: 1785119
Sex: F
Age: 40
State: SD

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 10/14/2021
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: Bloodwork - Normal

Allergies: nuts, citrus, diary, greasy food

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

Symptoms: 5PM that night, I had horrible leg cramps , left hip and leg were sore. Bones hurts really bad. Overnight was the worst. I started vomit, the next day, 2days later like someone threw hot water on my shins. Tingling and weird, left leg stiff. Happening a lot and vertigo ( I had before) now its severe. Change in vision (had bad vision before but now I am wearing glasses). Tingling on my arms and legs. Could not work straight. The bottom of my feet burns in bed. Diaphragm will be tight. I had anxiety in the past and brain fog. I saw the doctor in 12 May2021. Food allergies had changed and now I cant have diary. Loss 10 pounds.

Other Meds: centrium Vitamin Multivitamins - just half a pill

Current Illness: no

ID: 1785120
Sex: F
Age: 68
State: IN

Vax Date: 10/12/2021
Onset Date: 10/13/2021
Rec V Date: 10/14/2021
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: Sulfa, mango, costcochroitin

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Temperature 99.7

Other Meds: Levothyroxine, lisinopril/hydrochlothiazide, metoprolol tartrate, amlodipine besylate, potassium chloride, loratadine, omeprazole

Current Illness:

ID: 1785121
Sex: M
Age: 40
State: CA

Vax Date: 10/13/2021
Onset Date: 10/13/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data:

Allergies: BEE STINGS, IBUPROFEN

Symptom List: Pharyngeal swelling

Symptoms: After 30 minutes, pt c/o of being light headed and an itchy face. Denied SOB or chest pain. Temp 36.4C HR 67 RR 17 B/P 172/108 ( pt believes he may have HTN- ) sat 98%. RA. Administered 25 mg of Benadryl PO and water. After 5 min pt reported feeling better, after fifteen min symptoms subsided, bp 153/103 HR 69. Pt advised to follow up with his PCP, maintain adequate hydration, avoid prolong sun-heat exposure, and rest as much as possible. Pt D/C home with co-worker (driver), ambulatory in stable condition.

Other Meds: N/A

Current Illness: REPORTED BEING LIGHT HEADED A FTER 1ST PRIZER VACCINE ADMINISTERED 9/22/21

ID: 1785122
Sex: M
Age: 51
State: ME

Vax Date: 03/15/2021
Onset Date: 03/22/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data:

Allergies: ct dye,ciprofloaxin,

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: daily neck pain

Other Meds: Eliquis. rybelsus

Current Illness:

ID: 1785123
Sex: F
Age: 28
State: IN

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

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

Lab Data:

Allergies: Penicillin, Hydrocodone

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Joint pain in left leg

Other Meds: None

Current Illness:

ID: 1785124
Sex: F
Age: 27
State: OH

Vax Date: 09/30/2021
Onset Date: 10/01/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Extreme muscle aches in pains, extreme back pain to this day, trouble walking, trouble with speech,

Other Meds: None

Current Illness: None

ID: 1785125
Sex: F
Age: 59
State: NY

Vax Date: 03/17/2021
Onset Date: 03/29/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data: Shoulder x ray - showed slight fluid in joint capsule, otherwise normal ECG stress test without provocation of PVCs, no evidence of ischemia CBC and chemistry - normal Complement level - just above the normal level (5 months after vaccination)

Allergies: Penicillin Cephalosprins Latex Gluten Avocado, bananas, mango, kiwi

Symptom List: Rash, Urticaria

Symptoms: Extreme fatigue sarting about 5 days after vaccination - requiring mid day naps (during work) and 2 hour earlier bedtime. Lasted approximately 2 weeks. Bilateral large axillary lymph nodes (2 cm, started about 10 days after vaccine, lasted about 2 weeks, interfered with resting arms at side),. Slight pain/discomfort in bilateral forearms (not sure if swollen) which interfered with ability to hold heavy items or do activity like pour coffee from a full pot hold laundry basket, sometimes had trouble using door handles (felt like a compartment syndrome); Started about 2 weeks after vaccination and lasted about 3 weeks) . Slight pain in left shoulder with reaching (ie rotation of shoulder capsule) . started about 3 weeks after vaccination, maintained at that level for 4 months and then very quickly progressed to a confirmed diagnosis of frozen shoulder. Pain and significant reduction in range of motion of left shoulder - including inability to put bra on and difficulty dressing. Two months later still receiving physical therapy 3x weekly with significant improvement in range of motion, but still having difficulty putting bra on and still have pain interfering with sleep. Feeling of irregular heart beat, confirmed as frequent PVCs on monitor. Started 2 months after vaccination, ongoing. Not related to caffeine, alcohol, stress, time of day.

Other Meds: Levothyroid 200mcg Arnuity 100 mg Zyrtec 10 mg

Current Illness: dental work about 3 weeks prior

ID: 1785126
Sex: F
Age: 86
State: NM

Vax Date: 10/01/2021
Onset Date: 10/02/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data: Have not visited doctor yet.

Allergies: no

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

Symptoms: Constant pain in left arm from site of injection to wrist. Used cold pack for several days and then when pain persisted, heating pad. To date, pain is constant.

Other Meds: Eliquis Gabapentin (night) 50 mg. zoloft

Current Illness: none

ID: 1785127
Sex: M
Age: 36
State: AR

Vax Date: 06/03/2021
Onset Date: 07/13/2021
Rec V Date: 10/14/2021
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: EKG, blood work

Allergies: Demerol

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

Symptoms: Palpations below left peck by sternum, Chest pain below left peck and moves around up towards left clavicle, Tired feels like I am carrying a heavy bag on my back. Just started Indomethacin on 10/13/2021.

Other Meds: Nothing

Current Illness: None

ID: 1785128
Sex: F
Age: 42
State: MN

Vax Date: 03/02/2021
Onset Date: 10/13/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data: 10/13 SARS/COV-2, NAAT Positive

Allergies:

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

Symptoms: Breakthrough COVID

Other Meds:

Current Illness:

ID: 1785129
Sex: F
Age: 77
State: CA

Vax Date: 10/13/2021
Onset Date: 10/14/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data: None

Allergies: no

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

Symptoms: Pt received booster dose of Pfizer. First 2 doses were Moderna. No adverse reaction or outcome.

Other Meds: unknown

Current Illness: no

ID: 1785131
Sex: F
Age: 64
State: MI

Vax Date: 10/01/2021
Onset Date: 10/07/2021
Rec V Date: 10/14/2021
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: Unknown

Allergies: No Known Allergies

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

Symptoms: Fever, chills, sweats, loss of taste and smell as well as cough. Received her booster. Patient was not around anyone that has been sick and has not traveled.

Other Meds: Unknown

Current Illness: Unknown

ID: 1785132
Sex: F
Age: 38
State:

Vax Date: 10/08/2021
Onset Date: 10/09/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Ear pain, Hypoaesthesia

Symptoms: both hands swelling, small blisters on wrists, both ears swelling starting the morning after vaccine and lasted for 24 hours

Other Meds:

Current Illness: recovering from cold symptoms

ID: 1785133
Sex: M
Age: 59
State: WA

Vax Date: 10/13/2021
Onset Date: 10/13/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data: None

Allergies: Bee sting/venom (anaphylaxis)

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: 59 year old patient inadvertently administered high dose quadrivalent influenza vaccine, intended for patients 65 years and older, instead of adult quadrivalent influenza vaccine. Pt was informed and was instructed to contact clinic RN if any adverse effects.

Other Meds: Atorvastatin 20 mg daily

Current Illness: None

ID: 1785134
Sex: F
Age: 11
State: OH

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient was given the Pfizer Covid vaccine when the patient was 11 years and 10 months old. No adverse effects reported. Patient will receive second dose after her 12th birthday.

Other Meds:

Current Illness:

ID: 1785135
Sex: M
Age: 32
State: TX

Vax Date: 07/28/2021
Onset Date: 07/28/2021
Rec V Date: 10/14/2021
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: NKA

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

Symptoms: THREE MONTH GAP BETWEEN 1ST AND SECOND DOSE

Other Meds: NONE REPORTED

Current Illness: NOT REPORTED

ID: 1785136
Sex: F
Age: 62
State: OR

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

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

Lab Data: Blood work MRI Eye Specialist

Allergies: None

Symptom List: Unevaluable event

Symptoms: Loss of sight Dizzy Double vision

Other Meds: Nortriptyline Folic Acid Bupropion Trazodone Lexapro Pantoprazole Atorvastatin diphenhydramine Gabapentin Methocarbamol Acetaminophen extended pain relief tablet

Current Illness: Severe Migraines Serotonin Syndrome disc degenerative disease

ID: 1785137
Sex: F
Age: 74
State: MN

Vax Date: 02/23/2021
Onset Date: 10/12/2021
Rec V Date: 10/14/2021
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: SARS-CoV-2 RNA by PCR Detected Abnormal 10/12/2021

Allergies:

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

Symptoms: Briefly, this is a 75-year-old female with COVID-19 who is requiring high-flow nasal cannula oxygen to maintain her oxygen saturations above 92%. She otherwise appears comfortable and is doing well. Today in the emergency department, she had a CT of her chest which is negative for acute pulmonary embolism. Pulmonary opacities are compatible with COVID-19 pneumonia. I have spoken with the CCOD and a reviewed the patient's care and current clinical status with him. At this time, there is no vacancy in the ICU. The patient has been deemed too high risk to go to the general medical floor. We will continue to care for her here in the emergency department, wean her FiO2 as allowed. Will continue to plan for critica Briefly, this is a 75-year-old female with COVID-19 who is requiring high-flow nasal cannula oxygen to maintain her oxygen saturations above 92%. She otherwise appears comfortable and is doing well. Today in the emergency department, she had a CT of her chest which is negative for acute pulmonary embolism. Pulmonary opacities are compatible with COVID-19 pneumonia. I have spoken with the CCOD and a reviewed the patient's care and current clinical status with him. At this time, there is no vacancy in the ICU. The patient has been deemed too high risk to go to the general medical floor. We will continue to care for her here in the emergency department, wean her FiO2 as allowed. Will continue to plan for critical care admission once an appropriate bed becomes available.

Other Meds:

Current Illness:

ID: 1785138
Sex: F
Age: 29
State: AR

Vax Date: 10/08/2021
Onset Date: 10/13/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data: N/A

Allergies: N/A

Symptom List: Injection site pain, Pain

Symptoms: Patient came into clinic complaining of right sided facial weakness that started on 10/13/21.

Other Meds: N/A

Current Illness: N/A

ID: 1785139
Sex: F
Age: 24
State: MS

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Almost immediately I felt light headed and dizzy. I was sitting down and my legs felt weak under me and I felt as though I was going to pass out. My eyes were burning on and off.

Other Meds:

Current Illness:

ID: 1785140
Sex: M
Age: 80
State: IL

Vax Date: 04/03/2021
Onset Date: 10/03/2021
Rec V Date: 10/14/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Fell at home, admitted with Rhabdomyolysis, no Covid

Other Meds:

Current Illness:

ID: 1785141
Sex: M
Age: 16
State: TX

Vax Date: 05/24/2021
Onset Date: 10/09/2021
Rec V Date: 10/14/2021
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: Respiratory Panel with Covid PCR

Allergies: NKDA

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient tested positive for Covid-19 on 10-12-2021.

Other Meds:

Current Illness: Asthma

ID: 1785142
Sex: M
Age: 59
State: MN

Vax Date: 02/05/2021
Onset Date: 10/12/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data: 10/13/21 SARS/COV2, naat Positive

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Breakthrough COVID

Other Meds:

Current Illness:

ID: 1785143
Sex: F
Age: 91
State: MN

Vax Date: 10/14/2021
Onset Date: 10/14/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient received Pfizer booster shot as 3rd dose, upon later investigation the patient had received Moderna as the first 2 shots. No adverse effects reported at this time. Will follow up with patient in the next couple days.

Other Meds:

Current Illness:

ID: 1785144
Sex: F
Age: 65
State: MI

Vax Date: 09/24/2021
Onset Date: 10/04/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data: EKG - NSR with rate 95, no evidence of myocardial injury. U/A - negative for infection CBC w/diff, TSH, Iron Biding Capacity w/Transferrin - nl Iron Saturation - 19% (low, nl 20-55%) Holter monitor ordered - will begin on 10/20

Allergies: PCN - rash Sulfa - rash

Symptom List: Nausea

Symptoms: On 10/4 around 1200, i began to experience palpitations, not associated with chest pain, SOB, or dizziness. My heart rate ranged from 150-190 bpm. It would slow down and then return to the rapid rate. Around 1400, the palpitations began and lasted for an hour and a half. Carotid sinus massage and the Valsalva Maneuver did not work. Around 1545, I went to UC. While waiting to be seen, my heart rate began to slow down. When I was seen, it was 90-100, NSR. Since my EKG and U/A were normal, I was told to f/u with my PCP. Saw her on 10/7, AR 65,NSR. Holter monitor and labs ordered

Other Meds: MVI 1 tab qd Calcium 600mg qd Cranberry 2 tabs qd Miralax 1 capful qd

Current Illness: None

Date Died: 10/10/2021

ID: 1785145
Sex: F
Age: 45
State: AL

Vax Date: 09/28/2021
Onset Date: 10/09/2021
Rec V Date: 10/14/2021
Hospital: Y

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

Lab Data: cta scan, covid test, echocardiogram, cxr

Allergies: tomato

Symptom List: Injection site pain

Symptoms: Death diagnosed with covid pneumonia, hypoxia, acute respiratory failure, intubation, Death increased sob reported on 10/8/2021, recommended to go to ER. Patient admitted to Hospital. Death on 10/10/2021

Other Meds: Trelegy Ellipta 100/62.5 mg , Spironolactone 25 mg, sildenafil 20 mg, prevacid 15 mg, prednisone 20 mg, lasix 20 mg, Lexapro 20 mg, Eliquis 5 mg, Daliresp 500 mcg, cetirizine 10 mg, albuterol HFA

Current Illness: Pulmonary Hypertension, GERD, Pulmonary edema, diastolic heart failure, left ventricular hypertrophy, asthma, raynaulds syndrome, congestive heart failure

ID: 1785146
Sex: F
Age: 53
State: AZ

Vax Date: 10/12/2021
Onset Date: 10/13/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data:

Allergies: PENICILLIN

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

Symptoms: PATIENT EXPERIENCED HEADACHE, SINUSITIS AND ONE EYE SWOLLEN

Other Meds: UNKNOWN

Current Illness: R/A

ID: 1785147
Sex: M
Age: 47
State: DC

Vax Date: 09/28/2021
Onset Date: 10/01/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data: Please note, unable to provide flu vaccine type. Unable to determine if the flu vaccine type is Fluarix or Seqirus

Allergies: No

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

Symptoms: Severe Headaches, left arm pain, left neck pain, elevated blood pressure. Went to ER on 10/4/2021. Was out of work for 3 days. Prescribed Toradol for severe headache pain

Other Meds: Norvasc, Pro air

Current Illness: No

ID: 1785148
Sex: F
Age: 73
State: MN

Vax Date: 03/04/2021
Onset Date: 10/05/2021
Rec V Date: 10/14/2021
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: 10/5/2021 Coronavirus 2 PCR Detect, V Asymptomatic DETECTED

Allergies:

Symptom List: Tremor

Symptoms: CHIEF COMPLAINT/REASON FOR VISIT Weakness - Generalized HISTORY OF PRESENT ILLNESS Patient is a 74 y.o. female presents with generalized weakness. Patient describes that she has been feeling generally weak for the past week which is been associated with COVID. Patient also describes that for the past 3 weeks she has been having intermittent black stools. Last 1 that was abnormal was last night. She describes that today her stools were almost back to normal. Chronic back and neck pain which are unchanged. No abdominal or chest pain. No difficulty breathing. No pain with urination. No fevers or chills. No nausea or vomiting. EGD 07/17/2019 showed grade 1 varices in the lower 3rd of the Additional information for Item 18: CHIEF COMPLAINT/REASON FOR VISIT Weakness - Generalized HISTORY OF PRESENT ILLNESS Patient is a 74 y.o. female presents with generalized weakness. Patient describes that she has been feeling generally weak for the past week which is been associated with COVID. Patient also describes that for the past 3 weeks she has been having intermittent black stools. Last 1 that was abnormal was last night. She describes that today her stools were almost back to normal. Chronic back and neck pain which are unchanged. No abdominal or chest pain. No difficulty breathing. No pain with urination. No fevers or chills. No nausea or vomiting. EGD 07/17/2019 showed grade 1 varices in the lower 3rd of the esophagus. PMH includes insulin-dependent diabetes, general weakness, CHF, portal hypertension, malnutrition, heart failure, pancreatic cancer with Whipple procedure, cerebral hemorrhage, ascites, cirrhosis, bacteremia, colitis, AFib, PE on Eliquis, gastric ulcer, AFib, IVC filter, soft feel varices, COVID.

Other Meds:

Current Illness:

ID: 1785149
Sex: F
Age: 35
State: IL

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/14/2021
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: none

Symptom List: Erythema, Pruritus

Symptoms: Began with tingling in left arm after administration. Developed in to numbness in all four extremities the day after administration.

Other Meds: none

Current Illness:

ID: 1785150
Sex: M
Age: 40
State: NV

Vax Date: 02/04/2021
Onset Date: 06/01/2021
Rec V Date: 10/14/2021
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: Going to schedule an EKG

Allergies: None

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

Symptoms: Since June 2021, I have noticed heart flutters about 7-8 times per day. The sensation feels like the heart skips a beat and a little bit of anxiousness, but it goes away rather quickly. This did not happen in the past. I have no other symptoms at this time.

Other Meds: Fish oil, multi-vitamin, baby aspirin

Current Illness: None

ID: 1785151
Sex: F
Age: 56
State: WV

Vax Date: 07/15/2021
Onset Date: 07/21/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data: Mri, carotid artery scan, ECHO

Allergies: Nka

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

Symptoms: TiA. Aphasia , saying words I didn't mean to say. No treatment. Testing. Started on daily 81 MG Asa. Referred to neurologist

Other Meds: Metropolol, sensipar, Heparin, synthetic, amlodipine, Calcitriol

Current Illness: Esrd

ID: 1785152
Sex: F
Age: 48
State: CA

Vax Date: 04/03/2021
Onset Date: 06/01/2021
Rec V Date: 10/14/2021
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: Please see all of my hospital tests, scans, blood work over the course of the last 3 months.

Allergies: n/a

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Since the vaccine, I have been diagnosed with Lupus SLE and Raynaud's Disease. I have been in the ER for head and neck weakness, tremors, and fatigue. My second visit to the hospital ended up in a 4 day stay. Every day of my life is a struggle now. I am on 4 different medications to treat my day to day lupus. I am unable to be in the sun due to my sensitive skin issues. My life has been turned upside down.

Other Meds: effexor 150 mg, armour thyroid, trazadone for sleep when needed.

Current Illness: n/a

ID: 1785153
Sex: M
Age: 19
State: PR

Vax Date: 07/23/2021
Onset Date: 07/23/2021
Rec V Date: 10/14/2021
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: no

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

Symptoms: Patient reports feeling dizzy, and auditory loss in both ears and chills. Vitals BP 70/50, P79, Sat 98, T36.0, Dxt 100.

Other Meds: n/a

Current Illness: no

ID: 1785154
Sex: M
Age: 59
State: NC

Vax Date: 04/09/2021
Onset Date: 05/14/2021
Rec V Date: 10/14/2021
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: The event is over before I can get into the doctors office! Once there, nothing to see.

Allergies: shell fish, sulfa based anitbiotics

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

Symptoms: testicular swelling after 2nd COVID shot. Adverse Event on: 5/14/2021 , 6/13/2021, 9/16/2021, 10/2/2021. Each event lasted almost exactly 24 hours, start to finish. Zero allergic reactions from other stuff, nothing out of the ordinary noted. I saw on social media men reporting this and it seems the same is happening to me! Testicles swell to avocado size, penis grossly disfigured during the swelling. Dissipates within 24 hours.

Other Meds: Lisinopril 20MG Amlodipine 5MG

Current Illness: none

ID: 1785155
Sex: F
Age: 35
State: MN

Vax Date: 03/15/2021
Onset Date: 03/15/2021
Rec V Date: 10/14/2021
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: Fever, extreme drowsiness, upset stomach, headache, chills. This went on for 3-4 days

Other Meds: Vitiamins

Current Illness: none

ID: 1785156
Sex: F
Age: 72
State: NV

Vax Date: 09/20/2021
Onset Date: 09/24/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data: Four vision exams. The last with neuro opthamologist. All eye structures appear normal. Blood work scheduled.

Allergies: Latex

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

Symptoms: Persistent usual disturbances both eyes. Gray, cloudy vision, many tiny dots, impaired depth perception. All vision tests ( 4 so far) show normal, healthy eyes.

Other Meds: Flecanide Pradaxa Synthroid

Current Illness: No

Date Died: 10/12/2021

ID: 1785157
Sex: M
Age: 67
State:

Vax Date: 10/09/2021
Onset Date: 10/12/2021
Rec V Date: 10/14/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: Patient was unexpectedly found deceased at home on 10/12/21

Other Meds:

Current Illness: treated for head and neck cancer with concurrent chemotherapy and radiation

ID: 1785158
Sex: F
Age: 38
State: IL

Vax Date: 10/11/2021
Onset Date: 10/11/2021
Rec V Date: 10/14/2021
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: N/A

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

Symptoms: **THIS IS AN ERROR, NOT AN ADVERSE EVENT** Patient received multiple doses of the Pfizer vaccine. The vial was not diluted with 1.8mL of normal saline and 0.3mL of the undiluted vaccine was accidentally sent up the floor and administered to the patient. No adverse effects have occurred to the patient since administration.

Other Meds: Esomeprazole 40mg by mouth daily Norco 7.5/325mg 1 tablet every 6 hours as needed for pain Bisacodyl 10mg suppository Gabapentin 300mg capsule take 2 capsules by mouth daily Vancomycin 1500mg IV every 12 hours Meropenem 1000mg IVevery 8 ho

Current Illness: Surgical site infection/pelvic abscess

ID: 1785159
Sex: F
Age: 38
State: PA

Vax Date: 10/08/2021
Onset Date: 10/10/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data: I only had an EKG done and that came back negative for any irregularities. No chest x-ray, no blood work, no COVID test

Allergies: N/A

Symptom List: Vomiting

Symptoms: On my third booster of Pfizer, I got sharp, stabbing chest pain that radiated to my right shoulder blade. I was diagnosed with costochondritis and put on an anti inflammatory. About 4 days after my shot I have been being short of breath with activity and mild dull stabbing chest pain. I have also had a slight chest kind of cough, dry cough.

Other Meds: cymbalta lamictal pantoprazole zofran celebrex compazine buspar vitamin D3 probiotic

Current Illness: N/A

ID: 1785160
Sex: M
Age: 46
State: MN

Vax Date: 04/08/2021
Onset Date: 09/25/2021
Rec V Date: 10/14/2021
Hospital: Y

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

Lab Data: SARS CoV-2, PCR, Rapid, V Detected Abnormal 9/25/2021

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: HISTORY OF PRESENT ILLNESS Patient is a 47 y.o. male with past medical history significant for morbid obesity, hypertension, type 2 diabetes, peripheral neuropathy, peripheral venous insufficiency, history of DVT and pulmonary embolism (5/2019) who presented with acute worsening of right great toe pain, swelling and tenderness. He states that he has had pain and mild swelling in his right great toe since he fractured it in 06/2021. On Monday 10/11 he noticed worsening pain and swelling and yesterday 10/12 he noticed redness on his great toe and foot. This morning 10/13 his great toe opened and began to have serosanguinous drainage which prompted him to present to the ED. He does states that he has had pain and mild swelling in his right great toe since he fractured it in 06/2021. On Monday 10/11 he noticed worsening pain and swelling and yesterday 10/12 he noticed redness on his great toe and foot. This morning 10/13 his great toe opened and began to have serosanguinous drainage which prompted him to present to the ED. He does states that he has had chills and increased fatigue over the last few days. Notably, he was diagnosed with COVID 09/25/2021 and has had dyspnea on exertion, fatigue and dry cough since. He also endorses right sided chest wall pain that is reproducible with palpation. He denies SOB, abdominal pain, nausea, vomiting, or diarrhea. He does not use tobacco, alcohol (since starting Wellbutrin several months ago) or illicit substance. In the Emergency Department, he was tachycardic and tachypneic. There were concerns regarding necrotizing fasciitis or osteomyelitis so he was started on vancomycin and zosyn for broad spectrum coverage. Orthopedic surgery was consulted in the emergency department. They believe this is a subcutaneous abscess with surrounding cellulitis and made a small incision for abscess drainage. At this time they do not recommend surgical debridement but recommend close follow up and IV antibiotics. He was subsequently transferred to the clinic for management of acute cellulitis.

Other Meds:

Current Illness:

ID: 1785161
Sex: F
Age: 63
State: NC

Vax Date: 10/13/2021
Onset Date: 10/14/2021
Rec V Date: 10/14/2021
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: n/a

Allergies: n/a

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

Symptoms: fever, injection site pain, swelling- advised to take tylenol

Other Meds: n/a

Current Illness: n/a

ID: 1785162
Sex: F
Age: 21
State: NJ

Vax Date: 10/09/2021
Onset Date: 10/10/2021
Rec V Date: 10/14/2021
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: n/a

Allergies: peanuts, tree nuts, fish, shellfish, latex, thimerosal

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Swelling and itchiness of upper and lower lip, hydroxyzine 1 tab taken and repeated 6 hrs later. Swelling subsided after 1 day and a half

Other Meds: n/a

Current Illness: n/a

ID: 1785163
Sex: M
Age: 26
State: WI

Vax Date: 10/14/2021
Onset Date: 10/14/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data:

Allergies: Erythromycin

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

Symptoms: The vaccine was administered to the patient. The patient was a few minutes into his 15 minute observation period. He grabbed the attention of the technician who was observing and said he was feeling faint. She called me over and the patient started going down from his chair. He fell onto the floor from the the chair (bracing himself onto the floor) and was on the floor about 3 seconds. He got off of the floor really fast and stood up and I assisted him back to the chair. He was a aware that he just passed out. We got him some water and a medical emergency was called. He said he felt a little better after the water but was sweating a lot. Patient said he does not eat in the morning and fast. He said me sitting there talking to him was very helpful for him. He said he has fainted in the past but never from a vaccine. He hasn't received a vaccine in over 10 years and was being mandated from his job. The emergency team evaluated him asked him did he wanted to be evaluated in the emergency room, patient declined. Patient was sweating a lot and the emergency team got him some juice and crackers for possible low blood sugar with fasting.

Other Meds:

Current Illness: -Patient has been fasting in the morning

ID: 1785164
Sex: F
Age: 76
State: OR

Vax Date: 04/07/2021
Onset Date: 08/20/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data: Echocardiogram- showed a fast pulse and an irregular heart beat. Bloodwork- unknown results

Allergies: none

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

Symptoms: I had dizziness. nauseas, no pain but pressure on my upper chest. I called the ambulance and was sent to the ER. The doctor examined me and hooked me up to an echocardiogram that showed a fast pulse and an irregular heart beat. The doctor said the upper chamber of my heart was not connecting electrically with the lower chamber. I did not have a heart attack, but they diagnosed me with atrial fibrillation. They increased my dosage of aspirin so now I am taking 162mg of aspirin. I have not seen a heart specialist yet only my general practitioner who said to make an appointment with a cardiologist.

Other Meds: Aspirin 81mg 1xday Daily Multi Vitamin Cholest Off Plus 900mg of plant steroids Boron 3mg daily D3 1000units 1xday Calcium Carbonate 1000mg 1xday Ginseng 500mg 1xday Hair, skin, and nails soft gels 5000mcg 1xday Loratadine 10mg 1 or 2 a wee

Current Illness: none

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am