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: 1788150
Sex: M
Age: 55
State: NJ

Vax Date: 10/13/2021
Onset Date: 10/13/2021
Rec V Date: 10/15/2021
Hospital:

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

Lab Data: n/a

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Chills Fever of 101.9 Patient reported feeling cold Headache Body Aches

Other Meds: Levothyroxine

Current Illness:

ID: 1788151
Sex: F
Age: 31
State: LA

Vax Date: 03/13/2021
Onset Date: 03/13/2021
Rec V Date: 10/15/2021
Hospital:

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

Lab Data: No.

Allergies: Codeine

Symptom List: Anxiety, Dyspnoea

Symptoms: Later the day after the vaccine I started to get soreness in the injection site arm. I took Aleve and went to bed. Woke up and it was the arm was really hurting as if the rotor cuff area was hurting real bad when I tried to move the arm. I didn't use the arm and took anti-inflammatories for about 2 days until the symptoms subsided on their on. I was a little tired during this time but otherwise nothing else.

Other Meds: No

Current Illness: No

ID: 1788152
Sex: M
Age: 51
State: VA

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

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

Lab Data:

Allergies: None

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

Symptoms: Lost consciousness. My husband is healthy, fit, exercises daily, and has not been sick in years. He was forced by his employer to receive vaccine or lose his job.

Other Meds: Vitamin C

Current Illness: None

ID: 1788153
Sex: M
Age: 72
State: IA

Vax Date: 03/12/2021
Onset Date: 07/14/2021
Rec V Date: 10/15/2021
Hospital: Y

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

Lab Data: see above

Allergies: NKDA

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Moderna Dose 1 2/12/21 (016M20A) Moderna Dose 2 3/12/21 (029A21A) COVID Positive 7/15/21 7/15/21: 72-year-old male with hypertension, CKD stage 3, hyperlipidemia and type 2 diabetes mellitus presented with fever and nausea. Patient history obtained through a translator with sometimes patient answering. Patient reports he has been sick for the past couple days with dry cough, nausea and fever up to 102. He is also complaining of muscle aches and joint pain, no shortness of breath, dizziness or lightheadedness. He denies any chest pain or abdominal pain, no diarrhea. Denied any urinary symptoms or sick contacts. He received post COVID vaccinations, does not recall if he was vaccinated for influenza. In the ED he had T-max of 101.5? with heart rate of 95 normal blood pressure. Remarkable labs creatinine 3.56 it was 1.9 in 2018, sodium 126, WBC normal at 5.2, urinalysis negative for UTI, influenza a and B negative. Chest x-ray on remarkable for acute abnormalities. CT stone protocol reported no stones. Blood cultures were obtained and patient received 2 g of IV ceftriaxone, COVID-19 pending at the time of admission. 7/30/21: 72-year-old man who presented with complaints of cough, fever, shortness of breath and myalgias. He was found to have acute kidney injury, admitted to the hospital and was subsequently found to be positive for COVID-19 infection. He continued to show worsening respiratory status with increasing oxygen requirements culminating in requirement for intubation mechanical ventilation. Hospital course was complicated by oliguric acute kidney injury which subsequently required renal replacement therapy. He was also noted with fluid volume overload and pulmonary edema for which she required diuresis. Following extubation on 07/24 he has continued to make sustained clinical improvement. Despite improvement in urine output, renal function and laboratories have continued to worsen in between dialysis sessions. He has been recommended for ongoing outpatient hemodialysis for which an outpatient chair has been obtained. He has been discharged today in stable medical condition.

Other Meds: ascorbic acid 250 mg PO QD atorvastatin 40 mg PO QD calcium acetate 667 PO TID carvedilol 25 mg PO BID cholecalciferol 1000 units PO QD furosemide 60 mg PO BID hydralazine 50 mg PO BID insulin glargine 18 units SQ QD insulin lispro aggresiv

Current Illness:

ID: 1788154
Sex: F
Age: 69
State:

Vax Date: 02/11/2021
Onset Date: 10/11/2021
Rec V Date: 10/15/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Pt had positive covid test

Other Meds:

Current Illness:

ID: 1788155
Sex: M
Age: 69
State: WI

Vax Date: 03/22/2021
Onset Date: 06/01/2021
Rec V Date: 10/15/2021
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: Blood clot removed 10/12/2021.

Allergies:

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

Symptoms: Blood clot removed 10/12/2021, started as a small lump. Initial doctor appointment 8/30/2021. Mass left side of leg.

Other Meds:

Current Illness:

ID: 1788156
Sex: F
Age: 44
State: TN

Vax Date: 10/07/2021
Onset Date: 10/08/2021
Rec V Date: 10/15/2021
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: Codeine, amoxicillin, augmentin, erythromycin, bactrim, macrobid, ciproflaxin

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Quarter size red hard flat lump day after vaccine. 48 hours after appearance it was softer, but 3 times the size and hot to the touch. The lump never grew, only the redness grew.

Other Meds: Bystolic, diazepam, fenofibrate, esomeprazole, MagOx, vitamin d3, pepcid ac, baby aspirin, colace, multi vitamin, caltrate

Current Illness:

ID: 1788157
Sex: F
Age: 31
State: GA

Vax Date: 10/06/2021
Onset Date: 10/07/2021
Rec V Date: 10/15/2021
Hospital:

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

Lab Data: none

Allergies: Diary, gluten, latex, Bactrim, levoquin

Symptom List: Pharyngeal swelling

Symptoms: Sever body aches and joint pain, swelling of the left arm, not just at injection site. Patient was bedridden for 5 days with fever, chills, night sweats, lethargy, shortness of breath, headache, nausea, and loss of appetite. little relief was provided by alternating NSAIDs and Acetaminophen. 9 Days post vaccination patient is still lethargic, and has painful injection site reaction and swelling.

Other Meds: Synthroid, Escitalopram, xyzol, multivitamin

Current Illness: none

ID: 1788158
Sex: M
Age: 69
State:

Vax Date: 03/24/2021
Onset Date: 10/10/2021
Rec V Date: 10/15/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Pt had a positive covid test

Other Meds:

Current Illness:

ID: 1788159
Sex: F
Age: 11
State: PR

Vax Date: 10/15/2021
Onset Date: 10/15/2021
Rec V Date: 10/15/2021
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: NO ALLERGIES

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient present allergy in both hands and legs.

Other Meds: NONE

Current Illness: NO

ID: 1788160
Sex: F
Age: 65
State: VA

Vax Date: 04/06/2021
Onset Date: 04/29/2021
Rec V Date: 10/15/2021
Hospital:

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

Lab Data: Yes, Dr did. The dermatologist did testing, all testing negative for both doctors.

Allergies: Intolerance to gluten, mushrooms, hair permanent and color, flu shot, Premarin cream, Multaq, Rythmol, Clarithromycin, Penicillin, Tylenol, Vitamin D, adhesive bandages, Doxycycline.

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

Symptoms: She got her vaccine, approximately on 8/29/21 she got red bumps with a blister center. The skin around it was red and intensely itchy and was very painful. She went to the doctor on 5/6/21 and she treated her for possible insect bites. Then later on she treated for possible bacterial infection and she did a test as she was getting large boils the size of a nickel and she a culture from the boil. She had her on antibiotics, then she did a culture of a boil and was informed that she did not have a bacterial infection. She then went to a dermatologist who did a biopsy for bolus pemphygoid and it was negative x2 from the boils, but large blisters and he thought it was insect bites. However, no one in the else was getting bites, and she was wearing full protective closing and not even going outside thus not exposed to any insects. She continued to get the large blisters to approximately 9/20/21. She has not had any since 9/20/21. She did have Doxycycline and found out that she was allergic to it. She had been taking all sorts of antibiotics for this reaction, but was still getting the blisters up until September. She did not inform them that she had gotten the vaccine, but indicated that she could possibly have had a reaction. They did call her back and they told her to fill out the report online, which she tried to do and was unsuccessful as it kept timing out on her.

Other Meds: Levothyroxine, Diltiazem, Magnesium, Metoprolol, baby aspirin.

Current Illness: None.

ID: 1788161
Sex: M
Age: 50
State: WA

Vax Date: 09/30/2021
Onset Date: 10/01/2021
Rec V Date: 10/15/2021
Hospital:

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

Lab Data: blood test 10/5/21, chest x-ray 10/5/21.

Allergies: Flu Vaccine, Cipro, NSAIDS, wheat, eggs

Symptom List: Rash, Urticaria

Symptoms: Severe head ache, severe pressure in sinus/ears, severe ringing in the ears, severe body pain/ache, upper abdominal pain/cramping, slight breathing constriction.

Other Meds: SPIRIVA; FLONASE; VIANTEROL; LEVALBUTEROL; XTAMPZA; TRAMADOL; SINGULAIR; VITAMIN D3; ZINC

Current Illness: None

ID: 1788163
Sex: F
Age: 77
State: IA

Vax Date: 04/30/2021
Onset Date: 07/29/2021
Rec V Date: 10/15/2021
Hospital: Y

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

Lab Data: see above

Allergies: amlodipine - nausea

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

Symptoms: aspirin 81 mg PO QD clopidogrel 75 mg PO QD gabapentin 600 mg PO TID glipizide 2.5 mg PO QD levothyroxine 200 mcg PO QD nifedpine ER 30 mg PO QD warfarin 1 mg PO QD

Other Meds: aspirin 81 mg PO QD clopidogrel 75 mg PO QD gabapentin 600 mg PO TID glipizide 2.5 mg PO QD levothyroxine 200 mcg PO QD nifedpine ER 30 mg PO QD warfarin 1 mg PO QD

Current Illness:

ID: 1788164
Sex: F
Age: 72
State:

Vax Date: 03/03/2021
Onset Date: 10/12/2021
Rec V Date: 10/15/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Pt had a positive covid test

Other Meds:

Current Illness:

ID: 1788165
Sex: M
Age: 77
State: MD

Vax Date: 05/13/2021
Onset Date: 09/26/2021
Rec V Date: 10/15/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Patient presented to the ED with increasing shortness of breath, cough, fatigue, nausea, decrease in appetite and bilateral leg swelling. He was found to be COVID positive and admitted for further management of COVID pneumonia. He was discharged 12 days later in stable condition.

Other Meds:

Current Illness:

ID: 1788166
Sex: M
Age: 63
State: WA

Vax Date: 10/14/2021
Onset Date: 10/15/2021
Rec V Date: 10/15/2021
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: None

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

Symptoms: Mild fever, achy, headache.

Other Meds: Metformin, Prilosec, Multivitamin, Loratadine, Lisinopril, HCTZ, CoQ10, Magnesium Oxide, Glucosamine

Current Illness: None

ID: 1788167
Sex: F
Age: 39
State: NV

Vax Date: 02/03/2021
Onset Date: 02/03/2021
Rec V Date: 10/15/2021
Hospital:

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

Lab Data: Allergy test - to cat dander and milk Swab - did not hv bacterial infection

Allergies: small allergy to milk and dander from the cat

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

Symptoms: 1st dose - sore arm,18 Jan2021 rash with lumps in the left armpit. it got worse and I didnt want my 2nd dose. Facility at hospital said the rash was not a severe enough reaction not to hv 2nd dose. after 2nd dose, my insides felt hot but didnt have fever, chills, body ache, sweating profusely and the rash moved to left side of my body and to my waist and back and right armpit, sides and back. Lumps on both armpits . Called doctor - teledoctor 5Feb2021. Lumps and rash was normal to the doctor. 11Feb2021 - I asked her to feel the large lumps but she didnt want to feel it and to follow up with dermatologist two weeks after. Gave me an ointment Triamchinolne cream, Hydroxzine and allegra . The rash never went away. Rash and hyerpigmentation flares ups that come and goes. Had to see allergist -no bacterial infection.

Other Meds: Tylenol,

Current Illness: Itch and rash from 1st dose

Date Died: 10/03/2021

ID: 1788168
Sex: F
Age: 91
State: AZ

Vax Date: 05/17/2021
Onset Date: 05/19/2021
Rec V Date: 10/15/2021
Hospital:

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

Lab Data: Pt was admitted to the hospital in july as above

Allergies: Levofloxacin, codeine, Loratadine

Symptom List: Ear pain, Hypoaesthesia

Symptoms: within days of vaccine pt experienced increased fatigue, weakness and increased number of falls ( 3 reported by family member) , pt had dementia and family noticed worsening of memory after the vaccine , Pt experienced heart attack July 25, 2021

Other Meds: Amlodipine, Atorvastatin, Lumigan eye drops , Cardizem, levothyroxine, Prninivil, Multivitamins

Current Illness: Hypertension, Uti, Atrial fibrillation, peripheral vascular disease, hypothyroidism

ID: 1788169
Sex: F
Age: 53
State: CO

Vax Date: 04/14/2021
Onset Date: 08/30/2021
Rec V Date: 10/15/2021
Hospital:

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

Lab Data: COVID test

Allergies: Sulfa drugs

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: After vaccine I developed OAS (oral allergy syndrome). I got hives inside mouth, throat and lips. I also contracted COVID after being fully vaccinated.

Other Meds: Yes, Adver 250/50, Allegra, Well bupropion 150mg,

Current Illness: No

ID: 1788170
Sex: F
Age: 50
State:

Vax Date: 03/25/2021
Onset Date: 10/11/2021
Rec V Date: 10/15/2021
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: Pt had a positive covid test

Other Meds:

Current Illness:

ID: 1788171
Sex: F
Age: 59
State: OR

Vax Date: 04/07/2021
Onset Date: 08/05/2021
Rec V Date: 10/15/2021
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: 8/8/2021: EKG- normal MRI- normal Lab work- normal

Allergies: Amoxicillin

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

Symptoms: On August 5, 2021 the left side of my body felt numb that started out with my lips. I had a fuzzy feeling in my head going down the left side of my body including my arm, trunk, legs, and feet. The entire left side of my body felt numb. It lasted for about 30 minutes and then stopped. It happened intermittently about 3 or 4 times a day over the period of a week. I went to the ER at Hospital on August 8th where the doctors observed me. They ran different tests on me, but the tests came back normal so they couldn't find anything wrong. I haven't had the numbness feeling anymore since about August 11th or 12th.

Other Meds: I don't want to add them.

Current Illness: none

ID: 1788172
Sex: M
Age: 41
State: AL

Vax Date: 01/27/2021
Onset Date: 02/03/2021
Rec V Date: 10/15/2021
Hospital: Y

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

Lab Data: During the dates of Feb 4 - 9th 2021 I under went EKG (abnormal) stress test (abnormal) CT scan and then a heart catheter (in my right wrist). No blockage was found. August 2021 woke up with heart attack like symptoms went to the ER via wife drove me. Heart rate upon entry was 166 with high BP as well. I had an EKG and chest CT performed. I have since been put on Ativan three times a day and Cymbalta.

Allergies:

Symptom List: Unevaluable event

Symptoms: First week of February approximately one week after the shot I started having severe chest pain. I went to an urgent care hospital.

Other Meds: baclofen buspirone Lexapro

Current Illness:

ID: 1788173
Sex: F
Age: 73
State: CA

Vax Date: 03/11/2021
Onset Date: 03/11/2021
Rec V Date: 10/15/2021
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: The doctor ordered chest xrays and pulmonary function test in August, 2021.

Allergies: Latex, penicillin, valium iv, prednisone injection,

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

Symptoms: I felt fine when I left the facility. I drove for 20 minutes to go to a store. When I got out of the car, I had difficulty breathing. It felt as though I had run a marathon. I got back in my car and went home. The next morning when the symptoms did not decrease, I called my doctors office and they told me to go to the Emergency room. I went to emergency and after diagnosing me, they told me that I ?had a bad reaction to the vaccine. They told me to call my doctor which I did. She prescribed some breathing medications (Symbicort, Albuterol) and added more drugs as the symptoms did not decrease over time. It is now October and my shortness of breath is worse.

Other Meds: Quercitin with bromelain, allegra, famotidine, metoprolol, omeprazole,colon health probiotic,calcium

Current Illness: Flu in February, 2021

ID: 1788174
Sex: M
Age: 69
State: CO

Vax Date: 04/26/2021
Onset Date: 05/17/2021
Rec V Date: 10/15/2021
Hospital:

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

Lab Data: Syphilis test at a medical clinic, which test came back negative and accompanied by the clinic's written statement that the Blood Center positive reaction was a false positive.

Allergies: None known

Symptom List: Injection site pain, Pain

Symptoms: My donation at the Blood Center 3 weeks after receiving the vaccination produced a positive reaction to their syphilis screening test, resulting in them discarding my donation. This was the first time in over 55 years of donations that my donation was discarded. I was advised by the Blood Center that a second positive reaction will result in my being barred forever from donating again. Under the advice of the Blood Center, and of the Medical Clinic (described in item #19), I am refraining from attempting another donation for six months, in the hope that whatever chemistry the Moderna vaccine introduced into my body will dissipate, and that I will be able to continue making blood / platelet donations.

Other Meds: No prescriptions; daily OTC multi-vitamin for the past 15 yrs

Current Illness: None

ID: 1788175
Sex: F
Age: 12
State: PR

Vax Date: 07/27/2021
Onset Date: 07/27/2021
Rec V Date: 10/15/2021
Hospital:

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

Lab Data: N/A

Allergies: No

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient is oriented to person time and place next to her mother, vaccine is administered patient is tearful and anxious when vaccine is administered patient collapses. Feet are elevated and vitals are taken P76 ox 93. Jackets were on patient to keep her warm at all times, giving her alcohol to smell. Pressure was 110/50, after a few minutes patient reacts, she is given 2 snacks to eat and water. When is time to leave P120/90, sat 98, pulse 85 patient is oriented to person, time and place.

Other Meds: N/A

Current Illness: No

ID: 1788176
Sex: M
Age: 33
State: NJ

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 10/15/2021
Hospital:

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

Lab Data:

Allergies: Allergy to oak pollen

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

Symptoms: 7 minutes after the vaccine was administered, the patient (my son) passed out (lost his consciousness). The pharmacist Dr. performed chest compression to bring him back to consciousness. It was successful, and by the time the Emergency team arrived, my son was already in a conscious state.

Other Meds: N/A

Current Illness: No

ID: 1788177
Sex: M
Age: 68
State: CA

Vax Date: 10/01/2021
Onset Date: 10/04/2021
Rec V Date: 10/15/2021
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: None.

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Nothing other than some minor arm pain but on the 3rd day, I developed a very runny nose and watery eyes. Reminded me of spring allergies and lasted 3 days. I used an antihistamine for the symptoms that helped. Back to normal after 3 days.

Other Meds: Armour Thyroid, Simvastatin, Chromium, Green Tea Fat Burner, multi-vitamin, and vitamin D.

Current Illness: None.

ID: 1788178
Sex: F
Age: 28
State: MN

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

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

Lab Data: none

Allergies: No known allergies

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Flu Mist was given and patient is currently 14 weeks 4 days pregnant EDD 04/11/2022

Other Meds: Tylenol, Fluoxetine, Magnesium, Metoclopramide, Prenatal Vitamins

Current Illness:

ID: 1788179
Sex: F
Age: 83
State: FL

Vax Date: 10/15/2021
Onset Date: 10/15/2021
Rec V Date: 10/15/2021
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 an second and unnecessary dose of the flu (Fluad) on 10/15/21 -- previous dose was 9/10/21 -- when they were meant to get their Pfizer booster dose (3rd dose). Patient did receive their requested immunization of Pfizer the same day (10/15/21) on the opposite arm. Upon recognition that the wrong vaccine was administer patient was informed and received the correct vaccination, informed patient that there should be no additional risk of adverse effect to receiving two flu shots in one flu season.

Other Meds:

Current Illness:

ID: 1788180
Sex: F
Age: 29
State: NY

Vax Date: 10/15/2021
Onset Date: 10/15/2021
Rec V Date: 10/15/2021
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: Mushrooms; latex

Symptom List: Nausea

Symptoms: Left side pain/tingling in arm shoulder to fingers, stiffness in spine, cold feeling

Other Meds: None

Current Illness: None

ID: 1788181
Sex: F
Age: 41
State: MN

Vax Date: 04/14/2021
Onset Date: 09/03/2021
Rec V Date: 10/15/2021
Hospital: Y

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

Lab Data: CT scan, EEG, Spinal Tap, Blood work

Allergies: Lexapro,Mental medications(common), Niacin

Symptom List: Injection site pain

Symptoms: This is a continuation of worsening symptoms since last report. Due to my symptoms I have had to move to seek better doctor health. I've gotten to the point I sleep frequently while eating(don't even realized it when I awake that it ever happened). I have developed Cataplexy. I had to go to the Clinic September 2021 due to me falling down the stairs broke my left toe was hospitalized overnight. They did a Spinal Tap, lots of blood work, CT scan.I kept falling asleep during the EEG even with the lights on therefore a sleep study was ordered. Since I have hallucinations and sleep paralysis.

Other Meds: Vit D 50,000 units week,Pantoprazole,Prazosin 2 capsules bedtime, Tarmipefolle, Acedomiphine as needed,Tizanidine 4 mg 3 times a day,Trazodone 150 1 tablet at bedtime, Advair inhaler once daily, Nabumetone 3 times daily, Buproprone, Atorva

Current Illness: No

ID: 1788182
Sex: M
Age: 92
State:

Vax Date: 01/29/2021
Onset Date: 10/12/2021
Rec V Date: 10/15/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Pt had a positive covid test

Other Meds:

Current Illness:

ID: 1788183
Sex: F
Age: 20
State:

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

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

Lab Data:

Allergies:

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

Symptoms: Patient received COVID-19 vaccine approx 8.5 hours after the defined beyond use date. Discussed with Pfizer, and determined no need to redose patient based on data provided.

Other Meds:

Current Illness:

ID: 1788184
Sex: F
Age: 49
State: MD

Vax Date: 06/14/2021
Onset Date: 09/25/2021
Rec V Date: 10/15/2021
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:

Allergies:

Symptom List: Tremor

Symptoms: Patient presented to the ED with nausea, vomiting, diarrhea and cough for 3 days. She tested positive for COVID-19. She was found to have acute on chronic renal failure secondary to vomiting and diarrhea. She was admitted for rehydration. She was discharge 2 days later in stable condition.

Other Meds:

Current Illness:

ID: 1788185
Sex: M
Age: 72
State:

Vax Date: 02/10/2021
Onset Date: 10/13/2021
Rec V Date: 10/15/2021
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: Pt had a positive covid test

Other Meds:

Current Illness:

ID: 1788186
Sex: F
Age: 45
State: NV

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

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

Lab Data:

Allergies:

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

Symptoms: Patient thought they received Moderna previously, documented that on pre-vaccine checklist, and scheduled today for second dose Moderna, Denied having vaccine card, received Moderna vaccine, then returned with vaccine card after visit, nurse noted patient previously received Pfizer not Moderna. Nursing administrator notified, NA notified clinical director for guidance. Although, mixed-series doses is not considered approved per the EUA and the CDC has specific guidance for exceptional circumstances to interchange them, it is still an error; however, per the CDC "Do not repeat dose". Patient notified of error, encouraged to report any unexpected side effects / adverse effects ASAP to clinic and follow up with provider if needed, if emergent sx arise notify 911/EMS. Patient verbalized understanding and agreement. No s/sx adverse effects noted thus far.

Other Meds:

Current Illness:

ID: 1788187
Sex: F
Age: 51
State: WI

Vax Date: 08/18/2021
Onset Date: 08/23/2021
Rec V Date: 10/15/2021
Hospital:

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

Lab Data: none, an appointment will be scheduled for evaluation.

Allergies: NONE

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

Symptoms: First set of symptoms: within 4-6 hours, I developed flu-like symptoms- headache, body aches, fatigue, malaise. This lasted almost 48 hours and missed 2 days of work. Symptoms gradually resolved and I did not seek treatment. Second set of symptoms: Although being in peri-menopause and not having a period for almost one year, within 4 days of the vaccine I experienced a very severe period. Heavy cramping, heavy flow, lasting 7 full days. Also started experiencing hot flashes, headaches, restless sleep. Period came again 3 weeks later, still heavy, cramping, and lasting 7 days.

Other Meds: NONE

Current Illness: NONE

ID: 1788188
Sex: F
Age: 23
State: WI

Vax Date: 10/12/2021
Onset Date: 10/14/2021
Rec V Date: 10/15/2021
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: no known allergies

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Employee reported fever of 101.4, arm swelling/redness/itchiness, vomiting and diarrhea starting on 10/14/21.

Other Meds: unknown

Current Illness: unknown

ID: 1788189
Sex: M
Age: 81
State: WI

Vax Date: 10/15/2021
Onset Date: 10/15/2021
Rec V Date: 10/15/2021
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: aspirin

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

Symptoms: Patient scheduled for 3 dose of Moderna vaccine which was given by nursing staff. Patient did not present proof of first 2 doses. After administration of Moderna vaccine, it was discovered that first 2 doses were Pfizer

Other Meds: albuterol inhaler, arformoterol, benadryl, gabapentin, glipizide XL, duoneb, metformin, triamcinolone cream

Current Illness: none

ID: 1788190
Sex: M
Age: 65
State:

Vax Date: 02/11/2021
Onset Date: 10/14/2021
Rec V Date: 10/15/2021
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:

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

Symptoms: Pt had a positive covid test

Other Meds:

Current Illness:

ID: 1788191
Sex: M
Age: 23
State: VA

Vax Date: 03/24/2021
Onset Date: 03/26/2021
Rec V Date: 10/15/2021
Hospital:

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

Lab Data:

Allergies: No

Symptom List: Pain in extremity

Symptoms: I have experienced very high levels of anxiety, difficulty concentrating and remembering things, brain fog, occasional fast heart rate. I had one experience where I almost passed out after moderate exercise which has never happened to me before. I have racing thoughts as well and irritability. I also am experiencing very poor sleep quality. The new and worsening symptom I have experienced has been fatigue. It has gotten pretty bad in the past month. It has gotten to a point where yesterday I felt out of breath after waking around the neighborhood. I have not received any treatments for this but I am seeing a doctor tomorrow. These doctors specialize in long haul COVID. The only thing I have been prescribed is hydroxyzine by my psychiatrist. At first, I was being treated for a mental health condition but she has come to the conclusion that it doesn't seem to be a mental health condition for me. This has caused me to investigate more into the symptoms of long haul COVID. I did go to the ER early on but because the herbs I was taking had SSRI properties, I was treated for serotonin syndrome which turned out to not be the case.

Other Meds: Yes, herbal supplements: Ashwagandha; St John Wort; Rhodiola rosea

Current Illness: No

ID: 1788192
Sex: F
Age: 70
State: MI

Vax Date: 03/05/2021
Onset Date: 10/10/2021
Rec V Date: 10/15/2021
Hospital: Y

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

Lab Data: COVID positive

Allergies: No Known Allergies

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

Symptoms: Jaundice, generalized weakness, lethargy over the past couple weeks. yellowing of her urine and diarrhea, abdominal pain.

Other Meds: Unknown

Current Illness: Unknown

ID: 1788193
Sex: M
Age: 62
State: FL

Vax Date: 03/20/2021
Onset Date: 05/02/2021
Rec V Date: 10/15/2021
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:

Allergies: No known allergies

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

Symptoms: Admission to critical care hospital with COVID-19 diagnosis on admission

Other Meds:

Current Illness:

ID: 1788194
Sex: F
Age: 45
State: CA

Vax Date: 04/11/2021
Onset Date: 05/11/2021
Rec V Date: 10/15/2021
Hospital:

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

Lab Data: Does not issue provide details

Allergies: None

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

Symptoms: High Blood Pressure.

Other Meds: None

Current Illness: None

ID: 1788195
Sex: F
Age: 37
State: GA

Vax Date: 10/12/2021
Onset Date: 10/12/2021
Rec V Date: 10/15/2021
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: Neosporin

Symptom List: Vomiting

Symptoms: Muscle and joint pain, skin pain for 2 days. Massive headache around head, sinus pain, jaw-clenching, nausea for 3 days. Heightened anxiety, shortness of breath on day 2.

Other Meds: Ortho Tri Cyclen Lo, Rosuvastatin

Current Illness: None

ID: 1788196
Sex: F
Age: 27
State: GA

Vax Date: 10/13/2021
Onset Date: 10/13/2021
Rec V Date: 10/15/2021
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: yeast

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Situation: Moderna COVID-19 Vaccine Dose 2 administered too soon Background/Risk Factors: Patient scheduled for dose 1 of COVID Vaccine on 09/22/21. Unclear how patient had second dose appointment scheduled on 10/13/21. For unknown reason (not documented in chart) patient received dose 7 days after first dose. Assessment: Vaccinator must look at vaccine record card or database to ensure appropriate timeframe between first and second dose. Response/interventions: Patient notified that dose administered too soon. Per CDC guidance, doses inadvertently administered earlier than the grace period should not be repeated.

Other Meds: sertraline, trazodone

Current Illness: none

ID: 1788197
Sex: F
Age: 36
State: IN

Vax Date: 10/13/2021
Onset Date: 10/13/2021
Rec V Date: 10/15/2021
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: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: High fever 1 day Chills Nausea Fatigue Diarrea

Other Meds: Lamictal

Current Illness:

ID: 1788198
Sex: M
Age: 53
State: NY

Vax Date: 01/14/2020
Onset Date: 01/14/2020
Rec V Date: 10/15/2021
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:

Allergies: no known

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient reported at 1/18/20 appointment constant left upper arm pain aggravated by bending and lifting, swelling, warmth and redness. Prednisone prescribed, education given and follow-up recommended within 5 days with primary care. AT Primary Care Appointment on 2/10/20 patient reported pain was improving but achy. Aggravated by movement, alleviated by rest. Patient has decreased mobility. Prednisone prescribed earlier relieved swelling but patient reported continuing with pain and limited joint mobility. Patient was referred to Physical Therapy.

Other Meds: Dramamine 50mg - 1 oral every 6 hours as needed

Current Illness: none known

ID: 1788199
Sex: F
Age: 44
State: NE

Vax Date: 03/15/2021
Onset Date: 08/21/2021
Rec V Date: 10/15/2021
Hospital:

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

Lab Data: 9/7/21 - Rapid Covid-19 Test is negative, Covid-19 antibody test is positive 9/9/21 - no medical tests or labs specific to adverse event, PA said it was a GI bug.

Allergies: Sulfa

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

Symptoms: Occasional stomach cramps, diarrhea, dizziness/nausea, and exhaustion for 3 weeks.

Other Meds: Bupropion HCL XL 300 MG, Sertraline HCL 100 MG

Current Illness: None

ID: 1788200
Sex: F
Age:
State: SC

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

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

Lab Data: none

Allergies: NKA

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

Symptoms: none

Other Meds: tylenol Motrin

Current Illness: none

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am