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: 1788252
Sex: F
Age: 84
State: KY

Vax Date: 03/13/2021
Onset Date: 03/24/2021
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: see above. ANA neg, retics 76,000 / 1.9% 3/30/21 , fell to 1.2 % 4/29/21

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: pt presented with shortness of breath 11 days later, found to have hbg of 6.0 with abnormal RBC morphology sent for transfusion, + direct Ab to her blood type (A+) hbg rose to 9.9 one week later, then eventually to 12

Other Meds: asa 81mg prednisone 25mg bid (for Addison's) metformin

Current Illness: COPD, htn, Addison's no acute illness noted

ID: 1788253
Sex: F
Age: 42
State: LA

Vax Date: 09/29/2021
Onset Date: 09/29/2021
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: yes chest x-ray

Allergies: sulfa drugs

Symptom List: Anxiety, Dyspnoea

Symptoms: Before she took the vaccine she had a sore throat and she informed the pharmacist and they told her it was ok to take the vaccine. After that she has had a continuous and diarrhea. She went to urgent care and they dx her with pneumonia.

Other Meds: keppra, trazodone, lithium, lamotrigine, topiramate, prazosin, buspirone

Current Illness: sore throat at time of getting the vaccine

ID: 1788254
Sex: F
Age: 60
State: MD

Vax Date: 04/14/2021
Onset Date:
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: Dermatologist appointment June 9. No tests or lab.

Allergies:

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

Symptoms: Two weeks after the second shot, we notice I had developed one spot of missing hair on head, diagnosed as Alcecia Areala. Not sure when exactly the alcecia areala started.

Other Meds: albuterol, as needed

Current Illness:

ID: 1788255
Sex: F
Age: 22
State: GA

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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data: None. Patient left before vaccine status was discovered

Allergies: unknown

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient verbally reported that this was her first covid vaccination to the manager and provider. Upon entering the vaccine in to the Registry of Immunization Transactions and Services. Clinic staff found patient received the second dose of her Moderna Covid Panel 4 months prior. Patient did not report any adverse reactions.

Other Meds: unknown

Current Illness: unknown

ID: 1788256
Sex: M
Age: 62
State: MI

Vax Date: 04/09/2021
Onset Date: 07/08/2021
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: Did X-rays and a blood test.

Allergies: Seasonal allergy, Sulfa drugs

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

Symptoms: 07/08/2021 patient in the am when patient woke up he had a aching in the joint where the big toe meets the foot, progressively worst but it did not impact the activities. Awoke with severe pain and server swelling on the right foot, went to the doctor on on early evening , Diagnosis 07/9/2021. No more significate events.

Other Meds: Pantoprazole; Multi- Vitamin; NasalCrom; Cromolyn Sodium

Current Illness: No

ID: 1788257
Sex: F
Age: 54
State: LA

Vax Date: 10/14/2021
Onset Date: 10/15/2021
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:

Allergies: Seasonal allergyies

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

Symptoms: Fever, nausea, aches and pains,Headache

Other Meds: Lisinopeil.Metformin,atorvastatin,Montelukast,D3,COQ10,Magnesium,Fish Oil,Apple Cider Binedar,Cinnamon,Turmeric,Super B Citamin Complex, Vitamine E

Current Illness: No

ID: 1788258
Sex: F
Age: 53
State: NJ

Vax Date: 10/13/2021
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: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Large Red and itchy rash at injection site

Other Meds:

Current Illness:

ID: 1788259
Sex: M
Age: 24
State: AL

Vax Date: 06/01/2010
Onset Date: 06/01/2010
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: jan 2019 test to confirm bechets

Allergies: NA at the time

Symptom List: Pharyngeal swelling

Symptoms: Bechets disease

Other Meds: na

Current Illness: NA

ID: 1788260
Sex: M
Age: 38
State: WA

Vax Date: 09/28/2021
Onset Date: 10/14/2021
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: MRI brain 10/14 Hypercoagulable workup ordered 10/14 Echo with no PFO No atherosclerotic disease on imaging of head and neck and no laboratory equivalent/risk on HbA1c or lipid panel

Allergies: None

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Lacunar stroke of the right hypothalamic region initially with loss of balance, facial droop, tongue deviation, and slurred speech now resolved with only minor residual speech deficits. Signs first observed on 10/14 at 0400 by patient and patient's spouse.

Other Meds: None

Current Illness: COVID-19 PCR positive 8/1, negative and recovered at the time of receiving vaccine

ID: 1788261
Sex: F
Age: 72
State: FL

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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: N/A

Allergies: erythromycin, sulfa

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Sore arm that evening of 10/12/2021; the next morning (10/13/2021), I had a fever, body aches, eye ache, headache, upset stomach and fatigue. I thought that maybe the ibuprofen caused the stomach upset so I held off taking another 200 mg until about 2-3 pm at which time, I got relief soon after. Then a couple of hours later, took another 200 mg of ibuprofen through the rest of that evening. At about 5 pm, I had some soup and drank water and powerade throughout the day to hydrate myself. My sore arm continues to today (10/15/2021).and I noticed on 10/14/2021 that it felt sore and hot to the touch. This morning (10/15/2021), I noticed a 4x6" red rash and it is hot to the touch. My energy level has not completely returned but I am feeling no other symptoms at this time except the sore arm/and rash.

Other Meds: Vitamin C, probiotic

Current Illness: None

ID: 1788262
Sex: F
Age: 91
State: PR

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

Lab Data:

Allergies: NKDA

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

Symptoms: At the moment during the event at the church on 10/13/2021 patient received, PT of 92 years old. Patient's family member completes the consent indicating that PFIZER was administered and the nurse proceeds. At the office and nurse proceeds to the verification in vaccine page but the page was disabled to check information. When the vaccine page worked, I was able to confirm the patient's information and indeed her first two doses were MODERNA. During the observation period the patient did not present adverse or secondary effects. The immediate action I took to avoid future incidents was to check the information on the vaccination cards before they proceed to the vaccination. The procedure was carried out when receiving patients is to request their identification, medical plan and vaccination card, they proceed to make a copy (this was stapled on the back of the consent) and they are vaccinated.

Other Meds:

Current Illness:

ID: 1788263
Sex: M
Age: 49
State: FL

Vax Date: 07/24/2021
Onset Date: 08/04/2021
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: SYR
Vax Site: RA

Lab Data: CXR, covid test.

Allergies: NKA

Symptom List: Rash, Urticaria

Symptoms: Pt came to ER c/o cough, body aches, fever, chills, nasal congestion, sore throat x 5 days.

Other Meds:

Current Illness:

ID: 1788264
Sex: M
Age: 49
State: VA

Vax Date: 04/08/2021
Onset Date: 05/01/2021
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: None

Allergies: None

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

Symptoms: About a month after getting the vaccine I started getting some weird headaches and brain fog. I took some over the counter medications for the headaches and the brain fog just went away. The brain fog lasted for about a month. About 2 weeks ago I had an allergy reaction. I have never had allergies like this before. I have been using Flonase. I also saw an allergist to see what is going on. They do not know what might have caused the allergies but they think the headaches and brain fog are correlated to the vaccine.

Other Meds: None

Current Illness: None

ID: 1788265
Sex: F
Age: 67
State: MA

Vax Date: 10/02/2021
Onset Date: 10/03/2021
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: Blood test scheduled for 10-18-21

Allergies: Alupent

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

Symptoms: Fatigue- ongoing Light headness- ongoing Muscle aches- first 5 days Pain at injection site- first 3 days Nausea- intermittent, ongoing

Other Meds: Zoloft Singulair Pravastatin Losartan Citracal Loratadine Detoxosode

Current Illness: None

ID: 1788266
Sex: F
Age: 46
State: IL

Vax Date: 09/27/2021
Onset Date: 09/28/2021
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: initial labs done 3 days post vax, follow up scheduled for around 6 weeks - have not completed yet

Allergies: levofloxacin, benzalkromium chloride (BAK), polymyxin

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

Symptoms: sore arm started immediately, extreme fatigue started the day after. Headaches started intermittently, but by the 2nd week were occurring daily, and would wake up with abd pain/nausea feeling. difficulty focusing, thinking straight. saw doctor 10/7/21: BP 80/50. increased salt / protein / fluids in diet. 10/8/21: BP 77/45, 84/50, 10/10: 76/45 10/11: 77/51, 10/12: 75/43. 10/13: 81/48, 10/14/21: 72/46, 80/45. starting electrolyte replacement per MD, re-checked - 95/52. later 104 systolic when in office lying down at MD 10/14/21 (do not recall diastolic reading). 10/15/21 83/49 (have not taken electrolyte replacement yet today). persistent fatigue, low BP, difficulty focusing / thinking clearly, headaches daily.

Other Meds:

Current Illness:

ID: 1788267
Sex: F
Age: 49
State: MI

Vax Date: 03/17/2021
Onset Date: 03/17/2021
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: Visual exam by physician of nose, throat, and ears. Fluid present in ears. No apparent blockage or infection in nasal passages. Some labored breathing/wheezing in lungs. Prescribed prednisone and steroids. Breathing improved after steroid pack. Sinus, ear, dizziness issues did not change. Physician suggested use of saline nasal spray every 2 hours for 5 days. No improvement. Used Saline nasal rinse. No improvement. Sent to CT scan of facial bones/sinuses. CT results were negative.

Allergies: Penicillin allergy

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

Symptoms: Significant sinus congestion and facial pressure, both ear pain/discomfort, loud ringing in both ears, dizziness, headache, fever within two hours of first Moderna dose. Fever broke overnight. Felt terrible for one week. Sinus, ear, tinnitus, dizziness, headache continued for several weeks. Received second dose of Moderna vaccine and all symptoms returned within hours except fever. No fever ever occurred on second dose. Symptoms continue to the present day with varying headache symptoms. Continuing sinus pain/pressure, ear pain, tinnitus, dizziness.

Other Meds: Omeprazole, Xyzal, Fluticasone propionate 50 MCG, Montelukast sodium 10mg, Symbicort 160, Albuterol sulfate 90 inhaler, multi-vitamin, iron supplement, calcium supplement, Vitamin D3, Vitamin B12, Folic Acid, potassium supplement, magnesium

Current Illness: none

ID: 1788268
Sex: M
Age: 87
State: MI

Vax Date: 04/02/2021
Onset Date: 10/13/2021
Rec V Date: 10/15/2021
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: COVID positive

Allergies: No Known Allergies

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

Symptoms: Patient stated he was sent in by nursing home due to being COVID positive. 88% room air and does not normally use oxygen. cough.

Other Meds: Unknown

Current Illness: Unknown

ID: 1788269
Sex: F
Age: 48
State: TX

Vax Date: 10/13/2021
Onset Date: 10/13/2021
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: Patient mentioned went to the Doctor's office on 10/15/21 morning with the above side effects and Doctor prescribed two AntiBiotics ie.Bactrim DS and Cephalexin 500mg BID for 7 days.

Allergies: none

Symptom List: Ear pain, Hypoaesthesia

Symptoms: starting from 10/13/21 evening at 3 pm, patient felt swollen arm so took a tylenol at that night and 10/15/21 at 2:30 am patient had left arn, left side of the neck and left side of the face swollen. ANd arm felt hard and hot. Felt pain when touch or move the arm.

Other Meds:

Current Illness:

ID: 1788270
Sex: F
Age: 13
State: NY

Vax Date: 09/17/2021
Onset Date: 09/19/2021
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:

Allergies: none

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Small infraclavicular tender node, approximately 1-1.5 cm, 2 days following first COVID -19 vaccine and another node ( 1 cm) following the second COVID-19 vaccine.

Other Meds: none

Current Illness: obesity

ID: 1788271
Sex: M
Age: 39
State: WI

Vax Date: 01/27/2021
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: None Documented

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

Symptoms: Patient contracted COVID after being fully vaccinated fatigue, sore throat, muscle aches, headaches, chills, fever, congestion, shortness of breath, loss of taste, loss of smell

Other Meds: None Documented

Current Illness: None Documented

ID: 1788272
Sex: M
Age: 51
State: FL

Vax Date: 07/06/2021
Onset Date: 08/07/2021
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: Covid test

Allergies: NKA

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

Symptoms: Pt came to ER c/o loss of taste of smell onset day prior.

Other Meds:

Current Illness:

ID: 1788273
Sex: F
Age: 25
State: CA

Vax Date: 04/14/2021
Onset Date: 10/03/2021
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: Pap Smear- abnormal; HPV Test-negative

Allergies: Zucchini; sea urchin

Symptom List: Unevaluable event

Symptoms: During my annual visit to the gynecologist I was informed of developing pre-cancerous cervical cells and my pap smear was abnormal. Experiencing heavier periods which lasted for about 3weeks. The periods lasted for 2 cycles and they reverted back to normal.

Other Meds: DEPAKOTE; LAMICTAL

Current Illness: None

ID: 1788274
Sex: F
Age: 43
State: HI

Vax Date: 10/14/2021
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Codeine, Iodine, Cortisone, Celebrex, Shellfish, Fish, Mushrooms, Gluten

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

Symptoms: Hives, Itching that started at approximately 10pm on day of vaccination and has been getting progressively worse. Advised to take antihistamines. Awaiting for further guidance from MD.

Other Meds: Advair 250mcg twice a day

Current Illness: None

ID: 1788275
Sex: F
Age: 27
State: VA

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: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKDA

Symptom List: Injection site pain, Pain

Symptoms: Patient. Oct, 15, 2021: 27 year old female patient received her second COVID 19 vaccine. Patient stated before the vaccine was administered that she tends to feel become anxious with needles but had no previous history of vasovagal responses. After the vaccine was administered the vaccinator asked the patient how she was feeling and the patient stated she was "fine". Patient was given discharge instructions and told to sit in the observation area. It was there that the patient stated "she was feeling nauseous and hot" approx. 5 minutes after receiving the vaccine. Patient. Patient stated that she had had no food intake since dinner the previous night. Vital signs were B/P :141/83, RR: 12, HR: 79, Spo2: 100 and A&O x3. Patient taken to the Emergency Room based off hospital protocol.

Other Meds: none reported

Current Illness: none reported

ID: 1788276
Sex: F
Age: 73
State: OH

Vax Date: 10/07/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies: Codine, red and blue dye, lots of foods / chemicals have MCS

Symptom List: Injection site pain, Menorrhagia

Symptoms: Oct 10 Began getting large red bumpy welts on my ankles that moved up my legs and turned into full blown hives. It was very red, swollen and very itchy. It however was just below the waist on this day. Took 1/2 benedryl to help with the itching. Oct 11 Hives now on both lower and upper body and some on face. All very red, hot, itchy. Took 1/2 a benadryl to help with the itching. Oct 12 Continued to have smaller blotches of hives, but left foot was all swollen and red and hot. had to put ice on it, 1/2 benedryl Oct 13 Most hives on body quit, but today right foot was all swollen and red and hot, had to put on ice. Oct 14 No more hives on body a little red if it got warm. Feet still a bit red but no swellin Oct 15 no visible hives on body, feet are better but still get red if they get warm. Finally slept thru night last nite. Taking one full benedryl a couple of times a day

Other Meds: Premerine, vitamin, E, D, Cod liver oil, Cranberry

Current Illness: none

ID: 1788278
Sex: F
Age: 67
State: IN

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

Lab Data: Not applicable.

Allergies: Penicillin

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

Symptoms: ADVERSE EVENT: Approximately 6 hours after the shot, I began feeling feverish, although my temperature remained at its usual level of 97.6 degrees. I also began experiencing joint and muscular pain. The following morning, (10/14/21) the joint and muscle pain was intense and my temperature was beginning to go up. My first check was around 9 a.m. and it was 99.8. At approximately 7 p.m. it reached it peak level of 101.2 and began to slowly decrease. At 10 p.m. it was 100.6; at 11 p.m. it was 100; at midnight it was 99.2. The next day, Friday, Oct. 15, I felt much better; the joint and muscle pain was almost completely gone, I didn't feel feverish anymore, and at 9 a.m., my temp was 99.3. it continued to decline and by 1 p.m. it was back at my normal level of 97.6. TREATMENT: I treated the fever, aches, and pain with 650 mg acetaminophen every 6 hours, beginning at 9 a.m. 10/14/21. OUTCOME: Recovered after=effects of booster shot in approximately 36 hours.

Other Meds: Acetaminophen Anastrozole Atorvastatin Calcium (Lipitor) Cetirizine (Zyrtec) Famotidine Indapamide Levothyroxine (Synthroid or Levothroid) Omeprazole DR 40 Venlafaxine (Effexor)

Current Illness: None

ID: 1788279
Sex: F
Age: 34
State: CA

Vax Date: 04/24/2021
Onset Date: 04/24/2021
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: EKG, Panel 7, LFTs, Hemogram w/ diff, Ca, Lipid panel, folate, vitamin B12, H&H, ANA, Sed rate, and Echo all WNL.

Allergies: Nitrofurantoin (fatigue, hives muscle spasm, SOB, sleep disorder, swelling), PCN (anaphylaxis, hives, Rash, SOB, swelling)

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: 4/24 After vaccination, pt had extreme dizziness, needed to call 911 thinking she was going to faint. Had muscle twisting. Had rash on face and chest. Also had some tightness in chest. Had rapid heart rate. 5/10 Most side effects are going away except still has random palpitations. 5/14 Pt w/ no hx of HTN reports to ED w/ BP wrist cuff measurements SBP >200, reports recurrent HTN w/ HA/ head pressure/dizziness and facial spasms episodes since vaccination. SBP 140'S in the ED. Denies numbness/weakness, double vision,CP, SOB,head injury. Denies t/e/d. 5/25 Pt is still very bothered by dizziness. Describe baseline sensation of rocking on a boat but denies spinning of room sensation. Have intermittent significantly worsening of dizziness sensation when she describe sensation as if she is going to pass out. Not associated with dyspnea, palpitations. 6/4 In the past few days, developed burning/tingling sensation in various parts of body. Palpitation now much better but still continue feel chest pressure. Describe dizziness as both of a lack of balance sensation (like on a boat) and near syncope. Had MRI, echo, holter ordered but still pending insurance approval. Developed burning pain recently, mostly around left upper extremity but also lessen extent various other part of body including feet/hand b/l and trunk/back area. Did notice redness of skin developing mostly around left upper extremity. BP in clinic is normal 120/75 Also feel some right ear discomfort and pressure sensation. Bilateral ear wash completed. Pt reports hearing better after ear lavage. 7/15 Continue to have dizziness, head fullness and hearing issue. Got a lot better when she took one week off from work. Would like to try to take a longer time off work to help with recovery. Insurance not in network provider, will need to go to outside facility for MRI IAC. Also had not gone for vestibular rehab. PT place referred before do not do vestibular rehab. Also has issue with intermittent numbness on upper arms and feeling of bug crawling under skin. Concern that she may have some autoimmune issue from getting COVID vaccine that causes all her symptoms. 10/8 Here for follow up on dizziness. Describe as room movement or tilting. Not as bad as before but still severe at times. Would like to extend disability to maximum date allowed of Oct 25th. Has upcoming appt with Hospital ENT in December. Also continues to have burning sensation intermittently that travels down both upper extremities. Trying alternative medication treatment. Not too interested in trying out other medications. Report that dizziness symptoms often happens when she uses her eyes too much. Physical therapy had not been the most helpful. Neuro referral.

Other Meds: None

Current Illness: None

ID: 1788280
Sex: F
Age: 27
State:

Vax Date: 09/21/2021
Onset Date: 09/27/2021
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:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: PCP visit on 10/01/2021: Patient received the first dose of her COVID-19 vaccine series on 9/21/2021 and within a few minutes of receiving the vaccine she started to develop a left-sided frontal headache. She did not have a headache prior to this and does not have headaches on a regular basis. Her left frontal headache migrated toward the other side of her forehead, and then started to involve her occipital area and posterior neck muscles. Neck pain was described as a tender spasm, and when she pressed on her neck muscles it would make her headache worse. Since that time her headache has persisted at about the same severity, and she has been using Ibuprofen intermittently which does dull the pain but does not completely resolve it. She has also tried taking caffeine, along with hot showers and massaging her neck with some improvement. Additional symptoms include intermittent vertigo with moving her head or positional changes, mild ear fullness, visual sensitivity to screens or bright lights, and nausea. Denies fevers, chills, nasal congestion, runny nose, recent illnesses, hearing loss, ear ringing, pre-syncope, loss of consciousness, vision loss, facial droop, slurred speech, or focal areas of weakness. Administered ketorolac 30mg injection in pt left deltoid. Pt tolerated well. Administered ondansetron ODT 4mg tablet to pt. Pt tolerated well. Prescribed cyclobenzaprine HCI 10mg and ondansetron 4mg.

Other Meds:

Current Illness:

ID: 1788281
Sex: F
Age: 76
State: MA

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

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

Lab Data: covid positive on 9/14/21 chest x ray on 9/14/21 impression: bilateral patchy opacities may represent multifocal pneumonia or viral pneumonia such as covid 19.

Allergies: lisinopril, losartan

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

Symptoms: Patient is fully vaccinated with Janssen vaccine back in March. Patient presented to emergency department on 9/14/21 with SOB, couth with scant blood, and subjective fever. Patient was covid positive with consistent symptoms and recent household contact. Patient completed 5 days of steroids and remdesivir and was discharged on 9/23/21.

Other Meds: calcium carbonate, isosorbide mononitrate, pioglitazone, potassium chloride, simvastatin, warfarin

Current Illness: N/A

ID: 1788283
Sex: M
Age: 43
State: IL

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: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Unknown

Symptom List: Nausea

Symptoms: Patient previously completed Pfizer series. Patient then requested Moderna but did not show his completed vaccine card with the previous Pfizer doses. Patient came in for his second dose of Moderna. Patient presented a vaccine card with the initial dose of Moderna. Again, he did not show his vaccine card with the completed Pfizer series.

Other Meds: Unknown

Current Illness: Immunosuppressed

ID: 1788284
Sex: F
Age: 65
State: NC

Vax Date: 03/10/2021
Onset Date: 03/10/2021
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: No

Allergies: shellfish, sulfa, oxycodone, oxycontin

Symptom List: Injection site pain

Symptoms: I had a mild headache, body aches, slight chills and cramping in my leg. I did not run a temperature. It felt like someone had hit me with a truck. I let things run its course. I took some Tylenol and Advil and stated in bed. This lasted 24 hours and I was back to normal.

Other Meds: diltiazem ,aciphex, aspirin, ecotrin, tylenol

Current Illness: No

ID: 1788285
Sex: M
Age: 85
State: FL

Vax Date: 01/13/2021
Onset Date: 08/07/2021
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: Covid test, cxr.

Allergies: Augmentin

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

Symptoms: Pt came to ER c/o worsening SOB.

Other Meds:

Current Illness:

ID: 1788286
Sex: F
Age: 64
State: MN

Vax Date: 04/09/2021
Onset Date: 04/09/2021
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: Chest x-ray- found pneumonia nose swab Covid test- positive

Allergies: Antibiotics Mushrooms

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

Symptoms: Probably about a couple days after receiving the vaccine I got a sore arm. It felt like it hit a nerve and went up to my neck. I was fine for awhile and then I developed covid in September on the 14th. I ended up having pneumonia with it. I had a runny nose, ear infection, night sweats with high fever, and then the bacterial pneumonia with a cough.

Other Meds: Vitamins Levothyroxine

Current Illness: none

ID: 1788287
Sex: F
Age: 40
State: FL

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Latex

Symptom List: Tremor

Symptoms: Large baseball size swelling at injection site, hot to touch, chills, headache, dizziness

Other Meds: Xanax

Current Illness: Covid on 9/8/21

ID: 1788288
Sex: F
Age:
State: AK

Vax Date:
Onset Date:
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: Migraine

Other Meds:

Current Illness:

ID: 1788289
Sex: F
Age: 55
State: FL

Vax Date: 01/27/2021
Onset Date: 10/01/2021
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: COVID test 10/1/21

Allergies: No Known Allergies

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

Symptoms: tested positive for COVID-19 on 10/1/21. Symptoms included: cough, fever, body aches, runny nose, scratchy throat. Received Regeneron monoclonal antibody treatment on 10/1/21 at approximately 3 pm. Symptoms improved within 24-36 hours.

Other Meds: Valsartan-HCTZ, Ibuprofen (PRN), Vitamin Gummies, Norco 7.25-325 (PRN)

Current Illness: N/A

ID: 1788290
Sex: F
Age: 62
State: GA

Vax Date: 04/14/2021
Onset Date: 08/25/2021
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: Covid 19 Testing was positive

Allergies: Ceclor, penicillan

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

Symptoms: Congestion, cough, fatigue for about 7-10 days. Took Vitamin D3, Vitamin C, Zinc and Tessalon Perles for cough

Other Meds: Osphena 60 mg, Zinc, Vitamin D3, Vitamin C

Current Illness: None

ID: 1788291
Sex: F
Age: 64
State: PA

Vax Date: 10/03/2021
Onset Date: 10/11/2021
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: N/A

Allergies: N/A

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Pt. states that after receiving the 1st dose of Moderna 10/03/2021, started experiencing symptoms 10/11/2021 of blotchy and itchy area at injection site continuing to swell throughout the left arm up to the shoulder. Pharmacist communications recommendation of Reporting and Follow-Up with Primary.

Other Meds: N/A

Current Illness: N/A

ID: 1788292
Sex: M
Age: 39
State: TN

Vax Date: 10/08/2021
Onset Date: 10/12/2021
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: SYR
Vax Site: LA

Lab Data: EKG -- > STEMI Troponin = 7.2, 10.5, 10.5 ECHO = Normal L. ventricle size and function; mildly dilated right ventricle with normal systolic function; normal valvular function CTA Chest-- no PE

Allergies: Sulfa drugs

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

Symptoms: On 10/12, patient had chest pain described as tightness that radiated to teeth. He became nauseated and diaphoretic. He presented to the ER. Patient treated with nitroglycerin sublingual, acetaminophen, aspirin and diphenhydramine. Patient has cardiac catherization and is admitted to the hospital post procedure. Patient is to follow up with cardiology as outpatient.

Other Meds: none documented

Current Illness: none

ID: 1788293
Sex: F
Age: 65
State: NC

Vax Date: 04/10/2021
Onset Date: 04/10/2021
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: None

Allergies: shellfish, sulfa, oxycodone, oxycontin

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

Symptoms: I had mild headaches, worse than the first. I had neck and back pain. I also had chills. I took Advil and Tylenol. I let things run it?s course. It had resolved within 24 hours.

Other Meds: diltiazem ,aciphex, aspirin, ecotrin, tylenol

Current Illness: NO

ID: 1788294
Sex: F
Age: 63
State: TX

Vax Date: 09/08/2021
Onset Date: 09/08/2021
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: none declined to see a doctor even her own pcp.

Allergies: none

Symptom List: Pain in extremity

Symptoms: Began with a sharp shooting pain that radiated entiriely down the muscle of the left arm. Days later she states it was a constant intermitten shooting pain that at times would make her left hand cramp up and become unusable. This lasted for 5 weeks. At present has resolved.

Other Meds: none

Current Illness: none

ID: 1788295
Sex: F
Age: 43
State: FL

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

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

Lab Data: Went to ER within 15 mins of getting shot no blood was drawn on the day. They gave me steroids sent me home. I returned 3 days later still with symptoms. Blood was drawn but I do not know the results I was told I would be given a antihistamine and sent home. My BP was very high this day I believe it was due to the discomfort I am in.

Allergies: Benadryl Ceftin Phenergan Peanuts - severe anaphylaxis Corn Wheat Soy Pork

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

Symptoms: Within the first 10 mins of getting the shot I started to turn bright red all over it felt like I was on fire from the inside out. Pins and needles feeling all over my body. Itchy feeling all over.

Other Meds: Claritin, 10 MG Pepcid Lisiniprol, 10 MG Estrogel

Current Illness: None

ID: 1788296
Sex: M
Age: 84
State: WI

Vax Date: 02/12/2021
Onset Date: 10/06/2021
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: BMP, Magnesium Level, Troponin, Stool Occult Blood, CMP, TSH, PT, CBC Chest Xray, EKG, Ultrasound

Allergies: No known allergies

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

Symptoms: Patient contracted COVID after being fully vaccinated fatigue, anorexia, muscle aches, chills, shortness of breath, weakness

Other Meds: ascorbic acid daily atorvastatin 40mg daily donepezil 10mg HS Lamotrigine 200mg HS Vitamin D Daily Venlafaxine 150mg BID Warfarin

Current Illness: None documented

ID: 1788298
Sex: F
Age: 12
State: VA

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:

Allergies: NKDA

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

Symptoms: Patient received the 2nd dose of Pfizer covid vaccination on 10/14/21 with no immediate adverse reaction. She was normal last night and this morning, but had a seizure today, 10/15/21, while at school. She was brought to our ER where she had a second seizure. Per mother, patient's last seizure was 6/29/2020, prior to these two seizures today.

Other Meds: Oxcarbazepine Fluoxetine Dextroamphetamine

Current Illness: No illnesses

ID: 1788299
Sex: F
Age: 39
State: WI

Vax Date: 04/08/2021
Onset Date: 04/12/2021
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: Zofran

Symptom List: Vomiting

Symptoms: A couple days later I developed a rash. I went home and changed my clothes thinking that it might have been an allergic reaction to something on my clothes. It stayed around for about 3 days then resolved itself. I got the vaccine on 4/08 and on 04/15 I went to the doctor because I had a rash. It was very miserable and all over my body. It showed up on the 14th. They told me to keep on Benadryl and it went away. I have now come down with Covid-19. My symptoms started 10/05. It was like a very very bad cold. I had a headache, but I did not have a fever. On Sunday the 10th, I got my positive results. It's like a cold. My nose has been burning. On the 12th, I got a rash that was very heated and red. It comes and goes. I started taking Benadryl immediately and it completely made me sleep. I would wake up with severe itching. I called my doctor on 10/12 at 1PM. I told her that my rash woke me up around 2AM. She prescribed me prednisone on the 13th. I started taking it that evening. I have some swelling in my hands and lips. My fingers have been swollen the whole time. The inflammation finally went away. I still have a rash all over my body. It comes and goes, but the itching is non stop. I still take the Benadryl and it helps for a few hours. I take about 2 Benadryl at a time. I keep waking up with severe itching. I am able to work from home. My lower legs are itching, my sides are itching, and my arms are itching. It looks like hives. I sent my doctor another message this morning asking if there was anything else they could do for me since it has not gone away. I am still in quarantine for now.

Other Meds:

Current Illness:

ID: 1788300
Sex: F
Age: 36
State: NJ

Vax Date: 03/17/2021
Onset Date: 10/09/2021
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: PCR for Covid + on 10/13/2021

Allergies: none known

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Client received Moderna vaccines for Covid on 3/17 and 4/17/2021. Symptoms started on 10/9 - nasal congestion, cough, loss of taste and smell. Tested + with PCR on 10/13 (tested neg with rapid on same date.)

Other Meds: none known

Current Illness: none known

ID: 1788301
Sex: F
Age: 72
State: TN

Vax Date: 09/28/2021
Onset Date: 10/05/2021
Rec V Date: 10/15/2021
Hospital: Y

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

Lab Data: all of her cultures were negative and all of her respiratory viral panel and 2 Covid tests were negative sepsis syndrome, delirium, acute kidney injury and transaminitis with an otherwise unimpressive reason for this occurring considering her CT scan which was suggestive of an interstitial process but without the clinical syndrome leading up to that and negative viral panel and blood cultures

Allergies: Darvon: dizziness - Side Effects sulfa drugs: rash - Side Effects Boniva: gi upset - Side Effects

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

Symptoms: Pt was seen in office on 10/5 after husband called stating that pt was a bit off mentally that morning and just not making much sense. She wasn't sure whether she had taken her medications or not and was unsteady on her feet. She had been up until about 3 am watching movies which is not atypical for her and did not use her CPAP so he thought it might be related to that. He had her use her CPAP for an hour or so but it did not improve things. In office pt was somewhat disoriented and confabulating. She was pale appearing and noted to be tachycardic and significantly hypotensive with bp in the 80's/40-50's. Initial 02 sat 88% but improved to 97%. Pt was taken to medical center for urgent eval in the ER. CT chest suggested interstitial infiltrates but negative CT of the abdomen and pelvis, markedly elevated WBC at 27.5, mild AKI with creatinine of 1.36, elevated liver enzymes as well as persistent hypotension and tachycardia with 02 sats in the 93-95% range. Final blood cultures showed no growth. Pt was treated for sepsis syndrome and atypical pneumonia with Ceftriaxone and Azithromycin and clinically responded very well.

Other Meds: ?Vitamin D 2000 UNIT Tablet 3 tablet Orally Once a day ?NexIUM(Esomeprazole Magnesium) 40 mg Capsule Delayed Release 1 tablet Orally q am ?Delestrogen(Estradiol Valerate) 10 MG/ML Oil inject 1ml (10mg) intramuscularly once monthly ?Furosem

Current Illness: none known

ID: 1788302
Sex: F
Age: 34
State: CA

Vax Date: 08/01/2021
Onset Date: 09/03/2021
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: IM
Vax Site: LA

Lab Data: 9/21- lab work for pulmonary embolism

Allergies: Tree nuts, amoxicillin

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Irritated chest/lungs, chest heaviness, shortness of breath, cough

Other Meds: Imitrex as needed for migraines

Current Illness: None

ID: 1788303
Sex: F
Age: 71
State: FL

Vax Date: 04/01/2021
Onset Date: 08/07/2021
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: Covid test

Allergies: Codeine

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

Symptoms: Pt came to ER c/o cough onset 2 days prior.

Other Meds:

Current Illness:

ID: 1788304
Sex: F
Age: 44
State: MA

Vax Date: 10/13/2021
Onset Date: 10/14/2021
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: EKG and Chest XRay 10/14/2021, were fine

Allergies: Sulfa, Penicillin

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

Symptoms: Very strong chest pains 28 hours post injection. Felt like the worst heartburn I've ever had, or that I was being stabbed in the chest and back repeatedly.

Other Meds: Prescriptions: Estrogen patch (.1 mg), Sertraline (12.5 mg), Mirena IUD OTC Supplements: Calcium, Apple cider vinegar, Turmeric, Probiotic

Current Illness: Cold 2 weeks prior + mild sinus infection (no antibiotics).

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am