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: 1788520
Sex: F
Age: 57
State: NY

Vax Date: 05/22/2021
Onset Date: 05/23/2021
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: Saw a doctor on May 25, 2021 but no tests were taken

Allergies: Penicillin Sulfa drugs

Symptom List: Dysphagia, Epiglottitis

Symptoms: Extremely red swollen arm fever chills bodyaches. Couldn?t get out of bed for four days Slight cough and discomfort in chest Extreme fatigue

Other Meds: Pravastatin Biotin Calcium + D Black seed oil Probiotic

Current Illness: None

ID: 1788521
Sex: F
Age: 91
State: FL

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

Lab Data:

Allergies: Tegretol

Symptom List: Anxiety, Dyspnoea

Symptoms: Had the booster vaccine 10/13/21 began feeling not well on 10/14/21 contacted wellness nurses on 10/15/21 assessed with 28 apical heartrate and sent 911 to the hospital emergency room.

Other Meds: Cranberry pill Lovastatin 10mg Lisinopril/Hydrocholorthizide 10/12.5mg

Current Illness: HTN Pulmonary HTN

ID: 1788522
Sex: F
Age: 65
State: WI

Vax Date: 10/08/2021
Onset Date: 10/09/2021
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:

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

Symptoms: Aches, pains, fatigue for several hours, fever for 4 hours

Other Meds:

Current Illness:

ID: 1788524
Sex: M
Age: 71
State: IA

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:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient called on 10/11/2021 to report he had experienced parkinson -like symptoms, loss of strength, and hallucinations. Progressed to barely being able to move. Pt states he went to medical facility where they ran labs. He reports his potassium and magnesium were low and he was given medication to replenish the values.

Other Meds:

Current Illness:

ID: 1788526
Sex: F
Age: 32
State: TX

Vax Date: 09/13/2021
Onset Date: 09/20/2021
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: N/A

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

Symptoms: Very fatigued, chills, fever for 4 days following vaccine. A week after receiving the vaccine I developed white itchy bumps on my legs. Three weeks later I still have incredibly itchy legs and lots of bruising. Doctor diagnosed today as a virus reaction to the covid vaccine.

Other Meds: Loryna, claritin

Current Illness: N/A

ID: 1788527
Sex: M
Age: 44
State: MT

Vax Date: 08/18/2021
Onset Date: 08/19/2021
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: KNDA Kiwi and some melons

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

Symptoms: Janssen COVID-19 Vaccine EUA Rib and abdominal pain for the first 2 weeks Periodic numbness and tingling to extremities x1 month Mild headache everyday since vaccination I experienced right posterior mid thigh pain as well as numbness and tingling to my right foot 4 days after getting the vaccine. I went to the walk-in clinic and had blood work done including D Dimer test which showed no abnormalities. No further treatment.

Other Meds: Omeprazole, vitamins C, D, Zinc

Current Illness: None

ID: 1788528
Sex: M
Age: 55
State: VA

Vax Date: 02/02/2021
Onset Date: 02/04/2021
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: none

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Pt. experienced facial droop next day or night after first COVID shot. Pt. Had right face weakness, could not close right ee or wrinkle right side of forehead. Pt. was treated with prednisone 20 mg bid for 7 days, and tylenol 325 mg bid for 5 days; was wearing eye patch. Had same symptoms when was seen by this writer on 5/21 Pt. was transferred to another facility on 6/30/21.

Other Meds: none

Current Illness: none

Date Died: 10/14/2021

ID: 1788529
Sex: M
Age: 90
State: WI

Vax Date: 03/31/2021
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: UNK
Vax Route: IM
Vax Site: LA

Lab Data: Admit date: 10/7/2021 Death/Discharge Date: 10/14/2021 Time of Death: 1845 Pronouncing Physician: M.D. Admitting Physician: D.O. Discharge Physician: D.O. Discharge Diagnoses: Active Problems: DM (diabetes mellitus) Chronic diastolic congestive heart failure Pneumonia due to COVID-19 virus COVID-19 vaccine series completed Essential hypertension GERD (gastroesophageal reflux disease) Atrial fibrillation Hypothyroidism Hospital Course: The following is a summary of the admission history and physical that was conducted by me: 90-year-old male with a PMH significant for atrial fibrillation, on chronic anticoagulation with warfarin, GERD, essential hypertension, and other comorbidities, presented to the ED with a chief complaint of increased leg swelling and shortness of breath. Patient noted that over the past couple of days, he has become progressively more short of breath. He also notices it more when he lays flat at night. The patient did remark that he has not been consistently taking his Bumex as well. Patient was also diagnosed with a breakthrough COVID-19 infection. Patient's daughter and POA did provide additional details indicating that the patient has been confused over the last couple of days as well. He also seemed to be above his dry weight at the time of admission. Pneumonia due to COVID-19 virus/COVID-19 vaccine series completed/chronic diastolic congestive heart failure with suspected exacerbation due to poor medication compliance/acute kidney injury/atrial fibrillation/comfort cares o Initially, was thought that the patient was displaying more of a presentation consistent with a CHF exacerbation, but as his hospitalization progressed, it was noticeable that his COVID-19 pneumonia was worsening. o Patient did achieve adequate diuresis, but unfortunately his respiratory status continued to worsen. Patient did receive Decadron and eventually received remdesivir when his renal function allowed this to happen. o Patient was covered for a possible community-acquired pneumonia as well with Rocephin and doxycycline. o Patient was temporally placed on BiPAP due to increased confusion and respiratory distress. Overall condition and COVID-19 deteriorated further. Patient's daughter and POA did arrive and a discussion was had regarding a plan of care. The patient was transitioned to comfort cares and hospice was consulted. This transition was agreed upon by all of the patient's children. o Patient was made comfortable, children were present with him throughout his process of dying, and the patient died in peace with some of his children present. o Patient's care matched his wishes of not wanting to be in a nursing home, not desiring intubation, and stating that he was fine with "going to be with his wife." Consults: None Procedures: None. Significant Diagnostic Studies: XR CHEST 1V PORTABLE CLINICAL INDICATION: dyspnea COMPARISON: Chest radiographs 6/4/2021, 11/5/2020, 10/28/2020, 12/17/2009. TECHNIQUE: One view of the chest. FINDINGS: The

Allergies: Allergies: LISINOPRIL - Respiratory Distress,Malaise,Joint Pain

Symptom List: Pharyngeal swelling

Symptoms: FULLY VACCINATED COMPLETED SERIES ON 3/31/21 DIAGNOSED WITH COVID-19 10-07-21. PATIENT HOSPITALIZED 10-7 THROUGH 10-14

Other Meds: Aspirin (Tab) aspirin 81 MG 1 TABLET DAILY Bumetanide (Tab) Bumex 1 MG Take 3 tablets by mouth once daily. Cholecalciferol (Cap) Vitamin D3 125 MCG (5000 UT) Take 1 capsule by mouth once daily Gabapentin (Cap) Neurontin 300 MG Take 1 cap

Current Illness: Date of Admission: 10/7/2021 History of Present Illness Patient, a 90-year-old male, with a PMH significant for atrial fibrillation, on chronic anticoagulation with warfarin, GERD, essential hypertension, hyperlipidemia, and other comorbidities, presented to the ED with a chief complaint of increased leg swelling and shortness of breath. Patient notes that over the past couple of days, he has become progressively more short of breath. He also noticed that when he lays flat at night. Patient did remark that his swelling in his legs have also worsened. Patient did note that he has not been consistently taking his Bumex. He has either not had it available or has forgotten to do so. Patient was not really complaining of any other specific signs/symptoms that would be consistent with a COVID-19 infection. Patient is also fully vaccinated against COVID-19. ED Course: 90-year-old male presented to the ED with a chief complaint of weakness and fatigue. It was noted that patient was hypoxic on room air upon arrival. Labs of note obtained in the ED include a CBC that indicated a low hemoglobin of 10.0 and increased RDW of 16.4, CMP indicated a minimally elevated anion gap of 16, elevated BUN of 58, elevated creatinine of 2.23, decreased GFR of 25, and elevated glucose of 125, initial troponin was elevated at 130, but improved upon recheck to 125 (likely all related to demand ischemia due to the patient's hypoxia and suspected fluid overload), D-dimer was elevated at 0.81, hemoglobin A1c was unremarkable at 6.2%, INR was therapeutic

ID: 1788530
Sex: F
Age: 16
State: IN

Vax Date: 10/09/2021
Onset Date: 10/10/2021
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: In the ED, a full septic work-up was performed due to the concern of meningitis. CBC revealed a total white count of 23.2, with 48% segs, 47% bands, and an absolute lymphopenia of 700. Hemoglobin was 10.7, platelets 241. Procalcitonin was normal at 0.71. CRP was elevated at 30.5. ESR was 17. CMP with LFTs was unremarkable. CSF study showed 2 white blood cell, 74 glucose, with protein Gram stain and culture pending at the time of transfer. Blood culture no growth to date on day 2 CRP (10/14) 119, WBC 8.25 (10/14) 14.59 (10/13) COVID-19 antibody test (10/13) reactive immunology test was negative for EBV, rhinovirus, coronavirus, influenza, RSV, mycoplasma pneumoniae, chlamydophila pneumoniae

Allergies: Cephalexin

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: A 16-year-old female with a history of ulcerative colitis status post total colectomy being admitted for headache, palpitations, neck pain, and rash on 10/13/21. History is provided by patient and her family at the bedside, as well as review of the ER records. Patient first began having a headache on Wednesday (10/6) after which she received a dose of Remicade, technically her second dose, but first dose in the last 4 years. She also received her second Covid vaccine just this last Saturday (10/9). Patient reports that she has had pain in the subclavicular region on the left side, the same side as her vaccine. She is also complained of palpitations, and feeling her heart beating in her throat. The symptoms began Sunday, 24 hours after her vaccine, along with chills and body aches. Over the next few days, she was also noted to have redness around her eyes, pain behind her eyes, blurry vision. Tuesday (10/12), patient developed hives on her chest that then spread to her extremities. She had an episode of presyncope in the bathroom, with her ears ringing and vision darkening, but no loss of consciousness. PCP was unable to see the patient on Tuesday, so she was taken to an urgent care, where they prescribed prednisone 40 mg daily x5 days. She received 1 dose of this, but during that appointment she developed tenderness in the anterior neck, itchiness, and puffiness of her face and neck. Mom reports that she recently had COVID-19 infection approximately 2 weeks ago, but no one else in the family has had symptoms. Patient was doing better during her hospital stay: benadryl helped with the rash, tylenol for pain control, and short course of steroid. She was discharged home on 10/15, much less pain, still achy, able to move head and neck, no fever.

Other Meds: Diphenoxylate-Atropine 2.5-0.025 MG Oral Tablet, Oral, QID Iron Chews, 50 mg, Oral, Daily Tylenol Childrens 160 MG/5ML Oral Suspension, Oral Remicade 250 mg biweekly

Current Illness: None

ID: 1788531
Sex: M
Age: 77
State: FL

Vax Date: 09/27/2021
Onset Date: 10/04/2021
Rec V Date: 10/15/2021
Hospital: Y

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

Lab Data:

Allergies: none

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Dropped platelets to 0. Bleeding in mouth and heavy brusing

Other Meds: none

Current Illness:

ID: 1788532
Sex: F
Age: 19
State: GA

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: SYR
Vax Site: LA

Lab Data: none

Allergies: none reported

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

Symptoms: Patient presented on 10-14-21 as second dose for Pfizer COVID19 vaccine, with documentation of what she reported as first dose received on 9-23-21. She was vaccinnated by us for presumed second dose on 10-14-21. However, upon entering dose record into the system, it was determined that she had received an initial dose of Pfizer COVID19 vaccine on 7-15-21, which she did not disclose to us. So she received a third dose of Pfizer vaccine at day 21 after second dose. This would be considered a dose timing error and an error in that she received an additional/third dose that she did not qualify for. No side effects or other adverse effects were noted.

Other Meds: none reported

Current Illness: none reported

ID: 1788533
Sex: M
Age: 54
State: MI

Vax Date: 02/19/2021
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: SYR
Vax Site: RA

Lab Data:

Allergies: NKDA

Symptom List: Rash, Urticaria

Symptoms: Hospitalized X2 (10.6.21 and 10.12.21); COVID-19 positive (10.6.21); Fully Vaccinated Admission Date: 10/12/2021 Discharge Date: Oct 15, 2021 Diagnosis Pneumonia due to 2019 novel coronavirus PRESENTING PROBLEM: Hypoxia COVID-19 virus infection COVID-19 HOSPITAL COURSE: Patient was admitted 10/6 for acute respiratory failure with hypoxia due to COVID pneumonia, requiring 2L O2 to maintain sats. He did complain on presentation of vague pain in his calves, bilateral duplex were negative for DVT; he was maintained on BID Lovenox. He completed 5 days of remdesivir and 5 days of dexamethasone. He was additionally given 3 days of coverage for CAP given persistent left lower lobe consolidation and slightly positive procalcitonin at 0.33. He was well volume repleted initially and maintained good oral intake the last few days of his hospitalization; as his only symptom was measurable hypoxia with fatigue on exertion, and as he felt comfortable to go home and continue oxygen there, this was arranged for him on 10/10, with advisement to follow up with his PCP in a week. Return instructions given. READMITTED: Admission Date: 10/12/2021 Discharge Date: Oct 15, 2021 Diagnosis Pneumonia due to 2019 novel coronavirus PRESENTING PROBLEM: Hypoxic Pneumonia due to 2019 novel coronavirus Pneumonia due to COVID-19 virus HOSPITAL COURSE: 54 y/o WM married community dwelling patient of Dr. was readmitted to Hospital on 10/12/21 for acute respiratory failure with hypoxia with COVID pneumonia. The patient was previously admitted from 10/6-10/10 for COVID 19 pneumonia with hypoxia and received Remdesivir and Decadron. He was discharged home on Decadron. Unfortunately, the patient became increasingly short of breath and came back of an evaluation. CTA thorax showed no PE, but extensive pneumonia bilaterally from the COVID 19 infection. Patient had a procalcitonin of 0.07. MRSA PCR was negative. Film arraay was positive only for COVID 19. We had 2 sputum cultures that were contaminated specimens. A cardiac etiology was also ruled out. The patient seemed to improve with ongoing steroids and addition of antibiotics to cover community acquired pneumonia. He received MDI's including Dulera and Albuterol, as well as the addition of pulmonary toilet. He improved quickly. His inflammatory markers were monitored and were slowly decreasing. He was medically stable and improved for discharge on 10/15/21. He was sent home on oxygen at 3L nasal cannula. He will follow up with his PCP in a week after discharge. Thank you for the privilege of taking care of Patient.

Other Meds: acetaminophen (TYLENOL) 500 MG tablet albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler amLODIPine (NORVASC) 10 MG tablet ascorbic acid (VITAMIN C) 500 MG tablet aspirin 81 MG enteric coated tablet azithr

Current Illness: 10.5.21: Called PCP - reporting cough, nausea, vomiting, diarrhea, headache 10.6.21: ED to Hospital Admission (DC'd 10.10.21) READMITTED: 10.12.21 (DC'd 10.15.21)

ID: 1788534
Sex: M
Age: 63
State: NY

Vax Date: 06/01/2021
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: LA

Lab Data: PCR positive Oct 7 and 14

Allergies: No

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

Symptoms: dry cough dyspnea on exertion breakthrough infection requiring admission

Other Meds: None

Current Illness: No

ID: 1788535
Sex: M
Age: 16
State: WA

Vax Date: 04/02/2021
Onset Date: 04/02/2021
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: Consent form supplied at time of vaccination gave an incorrect birthday. Patient due to misreported birthdate was vaccinated with Moderna at age 16. No reported adverse events.

Other Meds:

Current Illness:

ID: 1788536
Sex: F
Age: 29
State: VA

Vax Date: 10/05/2021
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: None

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

Symptoms: Unexpected change in menstrual cycle. Breakthrough bleeding beginning 10 days after 2nd covid shot (pfizer)

Other Meds: Vyvanse

Current Illness: None

ID: 1788537
Sex: M
Age: 64
State: MN

Vax Date: 04/08/2021
Onset Date: 10/04/2021
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: none

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

Symptoms: cough, shortness of breath, diarrhea, wheezing. Did have one night where he was unable to sleep flat due to shortness of breath but did sleep in bed flat last night. Symptoms have been persistent since onset, but do feel like they are improving slowly.. starting 10/4/21

Other Meds: Vitamin C 500 MG Capsule; Simvastatin

Current Illness: none

ID: 1788538
Sex: F
Age: 29
State: OR

Vax Date: 09/29/2021
Onset Date: 10/14/2021
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:

Allergies:

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

Symptoms: heavy period severe increase in menstrual pain

Other Meds: care/of prenatal fish oil

Current Illness:

ID: 1788539
Sex: F
Age: 53
State: VA

Vax Date: 09/30/2021
Onset Date: 10/11/2021
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: A COVID 19 Test was given and one bottle of Prednisone and one bottle of Hydroxyzine.

Allergies: Penicillin and all forms of Cillins, Bee Stings, Pollen, Ragweed and COVID 19 Vaccine, but this is all that?s known at this time.

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Monday, 10/11/2021, I noticed a big red rash on both of my legs and my arms, then two days later I noticed a circular red rash on my upper left arm around the injection site. Then, the next day I started with itching all over my body and inside my mouth, upper roof, tongue and throat. I called the pharmacist, and told her what was happening, which I confirmed that Zyrtec would be considered an Antihistamine and I already had a bottle of this in my cabinet, so I took one Zyrtec pill around 2:00 pm. Around 4:00 pm, i realized it wasn?t subsiding and some different symptoms started, like blurred vision, headache, cold chills and light headedness. So, I called my mother to come to my home and pick me up to take me to Urgent Care. While there I started with Chest Pains.

Other Meds: None

Current Illness: None

ID: 1788540
Sex: M
Age: 51
State: OH

Vax Date: 03/23/2021
Onset Date: 05/24/2021
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: Ultrasound confirmed blood clot on 09/08/2021

Allergies: N/A

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: 1. numbness in left arm and hand. 2. Blood clot in left leg.

Other Meds: Vitamin D, Zyrtek, Naproxen

Current Illness: N/A

ID: 1788541
Sex: M
Age: 36
State: FL

Vax Date: 04/06/2021
Onset Date: 04/20/2021
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: MRI of Brain and cervical spine, MRA of brain, stress test, echocardiogram, holter monitor, EKG, blood work

Allergies: None

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

Symptoms: Pain in back of knees, pain in hips, pressure in back of head, dizziness, lightheaded, dry heaving, blurred vision Wide spread symptoms of an auto immune or neurological response started 2 weeks after vaccination

Other Meds: Amlodipine Benazepril

Current Illness: None

ID: 1788542
Sex: F
Age: 67
State: MD

Vax Date: 10/13/2021
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: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Pt's VS-B/P-127/84, HR-102, RR-20, T-97.6 PO, SPO2-96-97%RA with pain 6/10. 12 lead EKG done showing NSR at 92 BPM, non STEMI or ectopy noted.

Allergies: Sulfa-drugs, Compazine

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

Symptoms: Patients arrives with a CC of SOB and left sternal chest pain with onset 24 hours after taking booster for COV-19 procedure. Patient was anxious and arrived to medical facility by her own means and without assistance. Patient was seen by provider and RN along with initiation of SBAR and transported to local ER for further evaluation. cancer.

Other Meds:

Current Illness: No acute conditions informed.

ID: 1788543
Sex: M
Age:
State: MI

Vax Date:
Onset Date: 10/07/2021
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: EKG and it came back negative, bloodwork 3 times - negative, Ddimer -negative, stress test- negative

Allergies: I'm allergic and it's not really an allergy, and I have a history of afibb and the transadone gave me heart palpitations.

Symptom List: Unevaluable event

Symptoms: I was at work and had no issues. My shift ended and got in the car 10 to 3 and was driving less than 4 miles away from my work. About 2.5 miles from work I started having severe chest, should, neck, jaw pain. I had difficulty breathing as well. I was afraid I wasn't going to make it to the hospital less than 1/2 a mile, pain level was 15 out of ten - that's how bad the pain was. So I drove to the ER. When I went in to the ER and they did an EKG and it came back negative, bloodwork 3 times - negative, Ddimer -negative, stress test- negative. The next morning I felt fine with no issues and I was discharged after the stress test and i went home. They put me in the CDU - 24 hr observation.

Other Meds: No

Current Illness: nothing

ID: 1788544
Sex: F
Age: 31
State: CO

Vax Date: 09/10/2021
Onset Date: 10/08/2021
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: LA

Lab Data: Admission to ICU for 4 days

Allergies: Demerol

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

Symptoms: Breastfeeding infant (4 months old) diagnosed and treated for Kawasaki disease within one month of me receiving 3rd dose of vaccine. No previous illness, no household exposure. The third vaccine did make me feel quite ill for about 12 hours.

Other Meds: None

Current Illness: None

ID: 1788545
Sex: F
Age: 66
State: KY

Vax Date: 03/12/2021
Onset Date: 08/29/2021
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:

Symptom List: Injection site pain, Pain

Symptoms: Tested Positive for Covid

Other Meds:

Current Illness:

ID: 1788546
Sex: F
Age: 60
State: IN

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

Lab Data: NA

Allergies: Bactrim

Symptom List: Injection site pain, Menorrhagia

Symptoms: My arm is red and Swollen. It is hard to the touch. I have had a headache and very tired. My legs started hurting at work , they felt very heavy andI barely made it through the rest of the afternoon. Today I've been very fatigued and Nauseous, and as of last night I haven't ate much much. Not very hungry

Other Meds: Lunesta 1mg Benazepril 10mg Amlodipine 5mg Escitalopram 20mg

Current Illness: muscle spasms in back and hip

ID: 1788547
Sex: F
Age: 39
State: GA

Vax Date: 10/03/2021
Onset Date: 10/09/2021
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: Only the last covid vaccine, the booster on 10/3/21.

Allergies:

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

Symptoms: Since the 3rd shot, starting 10/9/21 I have been smelling cigarette smoke. I never had covid-19, only the vaccines. I got the booster on 10/3/21 and on 10/9/21 started smelling cigarette smoke and I am still smelling it.

Other Meds:

Current Illness:

ID: 1788548
Sex: M
Age: 72
State: MI

Vax Date: 05/12/2021
Onset Date: 10/06/2021
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: LA

Lab Data:

Allergies: NKDA

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Hospitalized 9.28 (NOT due to COVID); found to be COVID positive during hospitalization) (10.6); fully vaccinated Admission Date: 9/28/2021 Discharge Date: Oct 11, 2021 PRESENTING PROBLEM: Blood loss anemia [D50.0] Gross hematuria [R31.0] Hematuria, unspecified type [R31.9] HOSPITAL COURSE: Patient is a 72-year-old with past medical history significant for persistent AFib (on Xarelto), coronary artery disease status post PCI, severe aortic stenosis status post TAVR, ischemic cardiomyopathy (EF of 25%), prostate cancer status post radiation therapy who presented to the emergency department on 09/28/2021 for evaluation of hematuria and dysuria. Of note patient has been having ongoing hematuria for about 2 weeks. PT and OT recommended subacute rehab. Prior to discharge to subacute rehab COVID screening test was ordered and positive. As patient was totally asymptomatic he did not meet criteria for monoclonal antibody. As he was not hypoxic no steroids were started

Other Meds: amiodarone (PACERONE) 200 MG tablet amoxicillin (AMOXIL) 500 MG capsule ascorbic acid (VITAMIN C) 250 MG tablet cyanocobalamin (B-12) 1000 MCG/ML injection Cyanocobalamin 1000 MCG CAPS cyclobenzaprine (FLEXERIL) 10 MG tablet ergocalciferol

Current Illness: NA

ID: 1788549
Sex: F
Age: 59
State: TX

Vax Date: 03/19/2021
Onset Date: 03/19/2021
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: Septra, Ciprofloxicin, Cymbalta. Foods such as cow's milk, horseradish, peppermint, sage, thyme, vanilla, pepper, cayenne, curry, cinnamon, cumin, ginger, peanut, cashew, filbert, pineapple, string bean, cod, salmon, tuna, buckwheat, kidney beans, lentils, dill, allspice, watermelon, bean sprouts, flax seed, navy bean, garbonzo beans. Animals such as cats and dogs. Mold, grasses, trees and other pollen. All kinds of products such as make up, lotion, shampoo, conditioner, soap, detergent, cleaning products and so on.

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Within 5 minutes after the injection, my face got hot, I turned red all over, rapid pulse, itchy all over, headache, cognitively altered, it felt odd to walk. Both pharmacists observed me and asked if I could breathe okay. I said yes. They said to get some Benedryl and take it, so I did. My son had to drive me home. During the same day, I had on my left side swollen glands in my neck, armpit, and breast. Breast tissue thickened on left. Muscle and joint pain, loss of appetite, ringing in ears, left ear tight, headache, excess mucus, pain in lungs, shortness of breath (took albuterol inhaler). tiredness, exhaustion. I contacted my GP on patient portal to report. 4/14 diagnosed with Moderna rash/ atopic dermatitis by dermatologist. Rash on left hand and chest. Database quality. Rx Triamcinolone acetpnide cream for rash. 5/5/2021 Telehealth call with doctor follow-up regarding Long Covid and regarding Moderna rash and Moderna reaction. It is decided to follow new CDC guidelines and not take second injection of Moderna due to immediate rxn. 7/6/2021 contacted GP, again due to Delta varient concerns. 8/18 Rash spreads to neck, shoulders, legs, feet and is painful, itchy, and keeps me from sleeping. Doctor Appointment follow up for Moderna rash. 10/13/2021 Doctor's. to follow up Moderna rash. It is improving after taking 2 zyrtec a day, using desoximetasone, Vanicream products, Elidel cream. Disease caused by severe acute respiratory symdrome Coronavirus 2 disorder

Other Meds: Lisinopril, Metformin, Albuterol sulfate, Budesonide, Wellbutrin XL, Estradiol, Thyroid medication, HRT (Estradiol, progesterone, testosterone)

Current Illness: Post-acute sequelae of SARS- CoV-2 infection

ID: 1788550
Sex: M
Age: 36
State: VA

Vax Date: 09/05/2021
Onset Date: 10/08/2021
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: COVID tests, patient at local urgent care, negative results

Allergies: No

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

Symptoms: Fever on the 8th of this month and it went to 100.6. I had headaches. It was more like a migraine. I had a COVID test, PCR and Rapid and both were negative. No treatment other than taking Tylenol. I had these symptoms for a couple of days.

Other Meds: Toprol XL; allopurinol; Lipitor

Current Illness: No

ID: 1788551
Sex: M
Age: 64
State: OK

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: IM
Vax Site: RA

Lab Data:

Allergies: Alopurinol

Symptom List: Nausea

Symptoms: Janssen COVID-19 Vaccine EUA On Oct 13 Vaccinated at 12:45. Swelling and hot skin around injection site beginning late afternoon on first day. Super tired and went to sleep around 7 pm. Increasing body aches through the night. On Oct 14 Discovered a rash had formed a few inches around the injection location at 6 am. Extremely tired, severe muscle aches in torso, arms, & legs. Low grade headache all day, and vision became blurred for several hours in late afternoon. Slept most of the day due to fatigue. Alternating chills and sweating starting late afternoon, and throughout the night. On Oct 15 at 6 am the rash, swelling, headache were gone. Aches subsiding and no chills since 8 am.

Other Meds: NA

Current Illness: NA

ID: 1788552
Sex: F
Age: 67
State: MA

Vax Date: 03/15/2021
Onset Date: 09/19/2021
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: covid positive test on 9/20/21 chest x ray impression on 9/19/21: no focal consolidative process or pulmonary edema

Allergies: ciprofloxacin, erythromycin, gabapentin, macrobid, percocet, bactrim

Symptom List: Injection site pain

Symptoms: Patient presented to BWH ED on 9/19/21 with fever, sore throat, cough and nasal congestion. Patient was fully vaccinated for covid. Covid test came back positive and patient was started on remdesivir. Patient was discharged on 9/21/21 with no chest pain or SOB.

Other Meds: acyclovir, alprazolam, vitamin d3, desonide, famotidine, letrozole,

Current Illness: N/A

ID: 1788553
Sex: F
Age: 59
State: FL

Vax Date: 04/13/2021
Onset Date: 04/16/2021
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: Two CT scans Ultrasound or sonogram

Allergies: None

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

Symptoms: Enlarged lymph nodes Lump on my clavicle Two lumps underneath my neck

Other Meds: Xigduo Xr Vitamin D3 Fish oil Zinc Multivitamin Biotin Ginger

Current Illness: None

ID: 1788554
Sex: F
Age: 63
State: MN

Vax Date: 04/15/2021
Onset Date: 05/19/2021
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: RA

Lab Data: Lab Tests Completed in the ED on 10/12, other labs performed upon transfer to another hospital. C-REACTIVE PROTEIN (INFLAMMATION) DIAGNOSTIC OCCULT BLOOD (GUAIAC), SPECIMEN 1 PROTIME/INR PTT SARS-COV-2, INFLUENZA A+B, AND/OR RSV NUCLEIC ACID TESTING PANEL Icon Imaging Orders Placed Today Imaging Tests EKG

Allergies:

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

Symptoms: On the day of admission, she was seeing her PCP for a routine visit where hemoglobin was found to be 6.6. She was otherwise feeling well with no change in her BMs (dark black from iron) and no other symptoms. FOBT was positive. She was admitted to our facility and received 2U PRBC. Her hemoglobin has improved to 8.4. An occult GI bleed is of concern for her ongoing iron-deficiency anemia. She was seen by general surgery and recommended to have an outpatient colonoscopy and EGD next week. She will continue her ASA 81 mg for now (given severe CAD and no brisk bleeding) and also her PO iron supplementation. We have also arranged for a repeat Hb next week to assure ongoing stability. PER ED CHART: Reason for Visit Other Diagnoses Acute GI bleeding Fatigue, unspecified type Blood loss anemia Follow-up Items Upon Discharge: -Continue PO ferrous sulfate and all other meds -EGD / Colonoscopy next week to evaluate for iron-deficiency anemia -Repeat Hb on 10/20/21

Other Meds:

Current Illness:

ID: 1788555
Sex: M
Age: 36
State: GA

Vax Date: 04/13/2021
Onset Date: 04/26/2021
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: I've included a couple of months prior to the vaccine as well in case it is needed. There are more prior to that going back to November. I had lab work at on these dates: 2/17/21 3/2/21 4/14/21 6/2/21 6/7/21 7/21/21 8/23/21 I have heart rate information on my phone shows a resting heart rate graph that covers a period. It shows a low of 50 on 4/12, took the vaccine on 4/13, and the information ever since has been an ever increasing graph. I've reported chest and arm pains to my doctor. Many days my resting heart rate is not below 100 now. I am on disability from my company now (disability insurance).

Allergies:

Symptom List: Tremor

Symptoms: I have been advising my doctor since May that my fevers and muscle pains related to an unknown disease have seemingly come back, but they were not the same as before. I spent months before this second shot working out, losing weight, correcting so many medical issues. My heart rate was one thing I paid special attention to because I was trying to make it better. I was riding miles on my bike. I was walking almost every day. My cholesterol numbers were improving. My weight was dropping. I was still working at it until July when it almost wasn't possible anymore. I suspected it was just my condition again, but it was different. It wasn't quite as bad. The fevers weren't always as high, but I still had some very high fevers. My muscle pain was different, and now it's only in a couple of spots consistently (my left side of my chest and both of my deltoids hurt consistently). I do have other pains that pop up, but that's expected. I was starting a new job at the end of July, although I didn't know when I was going to be starting in April at the time of my shot. I took a physical (4/16/21) at my new employer the Friday following my shot (4/13/21). They actually emailed me that my start date would be delayed. I had concerns in early May that things were returning and I suspected my condition over the vaccine at the time. It continued to get worse. I am now taking (October 2021) 1-2 steroids (prednisone 10 mg) a day to even feel slightly normal. I have been taking steroids regularly since May or early June. Before then I took maybe 4 or 5 in a year. They helped to break my fevers.

Other Meds: Metformin 2 x daily (1000 mg), Trulicity weekly (1.5mg per .5mL), Cetirizine hydrochloride daily (10mg), Loratadine daily (10mg), Armour thyroid daily (120mg & 30 mg - 150 total)

Current Illness: Diabetes mellitus type 2, hyperthyroidism, no thyroid from thyroidectomy

ID: 1788556
Sex: M
Age: 65
State: MI

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

Lab Data:

Allergies: Sulfa and penicillin

Symptom List: Erythema, Pruritus

Symptoms: Patient did not suffer adverse effect however syringe attached to the needle did come apart causing the vaccine dose to spill down his arm. I had to give another dose of vaccine- he did not get any of the vaccine at all the first time. The hub that attached to the needle broke when pressure was applied.

Other Meds:

Current Illness:

ID: 1788557
Sex: F
Age: 16
State: TX

Vax Date: 05/04/2021
Onset Date: 05/04/2021
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: NONE REPORTED

Allergies: NOT REPORTED

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

Symptoms: VASOVAGAL RESPONSE

Other Meds: NOT REPORTED

Current Illness: NOT REPORTED

ID: 1788558
Sex: M
Age: 90
State: MN

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

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

Lab Data: Facility Outbreak testing

Allergies: Oxycodone

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

Symptoms: N/A

Other Meds: Methotrexate, Folic Acid, levothyroxine, multivit, Remicade

Current Illness: None

ID: 1788559
Sex: F
Age: 73
State: MI

Vax Date: 10/02/2021
Onset Date: 10/07/2021
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: AdhesiveRash LatexHives

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Hospitalized; COVID-19 positive (10.7.21); Fully Vaccinated PLUS booster Discharge Provider: MD Primary Care Provider: MD Admission Date: 10/9/2021 Discharge Date: Oct 11, 2021 PRESENTING PROBLEM: Metabolic acidosis [E87.2] COVID-19 virus infection [U07.1] COVID-19 [U07.1] HOSPITAL COURSE: Patient is a 73 woman with PMH: Significant for diabetes, IgG deficiency, CKD stage 4, peripheral neuropathy, bronchiectasis on azithromycin Q Monday Wednesday Friday sent to emergency department for abnormal labs. Patient husband works in a nursing home, he was tested positive 1st COVID-19. As patient develops symptoms she was tested and positive on 10/07/2021. Labs drawn prior to monoclonal antibodies were abnormal so she was admitted. On admission she completed monoclonal antibodies. Tolerated well. Labs improved. Renal functions returned to baseline. She did not require oxygen supplementation. She still have some cough and soreness in throat. In stable condition patient is discharged home with recommendations to use incentive spirometer and prone positioning as tolerated. Also recommended to monitor vitals and pulse oximetry closely. Recommended to return to emergency department if symptoms are getting worse given chronic lung disease.

Other Meds: ACCU-CHEK SOFTCLIX LANCETS MISC albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler aspirin 81 MG tablet atorvastatin (LIPITOR) 10 MG tablet azithromycin (ZITHROMAX) 250 MG tablet benzocaine-menthol (CEPACO

Current Illness: NA

ID: 1788560
Sex: F
Age: 53
State: GA

Vax Date: 04/10/2021
Onset Date: 06/01/2021
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: Hearing test.

Allergies: Penicillin

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

Symptoms: I have had hissing/ringing in my both of my ears. I went to my PCP and an ENT specialist. I have had a hearing test done and I passed the hearing test. I was also given steroids and a steroid shot, but the hissing and ringing in my ear will not go away.

Other Meds: N/A

Current Illness: N/A

ID: 1788561
Sex: F
Age: 42
State: PA

Vax Date: 10/05/2021
Onset Date: 10/06/2021
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: latex shellfish

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

Symptoms: Axillary lymphadenopathy. Swollen gland under right armpit. went to the Urgent care on the second day of the swelling. went away completely after 4 days

Other Meds: Qsymia Metformin Multivitamin Alegra Zyrtec

Current Illness: none received the HPV vaccine at the same time

ID: 1788562
Sex: M
Age: 11
State: WI

Vax Date: 06/23/2021
Onset Date: 06/23/2021
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: Pain in extremity

Symptoms: Mom came into our office, stating her son need his second dose. First dose was given on 5/25/21. Mom provided documentation of prior dose. Pfizer vaccine was administered. It was noted after administration that patient was under age. No adverse event occurred.

Other Meds: NONE

Current Illness: NONE

ID: 1788563
Sex: F
Age: 45
State: CO

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: 2
Vax Route:
Vax Site:

Lab Data:

Allergies: Coconut, droperidol, penicillin

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

Symptoms: Shortness of breath, facial swelling, rash

Other Meds:

Current Illness: Tooth abscess

ID: 1788564
Sex: F
Age: 45
State: IN

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

Lab Data: N/a

Allergies: NKA

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

Symptoms: within half hour after injection patient contacted triage nurse. Arm is red and warm from the injection site to her fingers. She has a rash on arm. She states her fingers are numb and the numbness is moving up her arm. She denies any shortness of breath, difficulty breathing, or swelling of her airway. Patient was advised to seek emergent medical care a an urgent care or emergency room.

Other Meds: Unknown

Current Illness: Unknown

ID: 1788565
Sex: F
Age: 71
State: IN

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

Lab Data: None

Allergies: None

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

Symptoms: Headache and fever of 100.4. Fever lasted about 36 hours. No fever since then.

Other Meds: None

Current Illness: None

ID: 1788566
Sex: F
Age: 33
State: MN

Vax Date: 04/16/2021
Onset Date: 06/11/2021
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:

Symptom List: Vomiting

Symptoms: 33yr old female who presents for breast concerns. Thursday morning she woke up and her breasts felt engorged and the left was worse than the right and milk was coming out of the left. It was about a teaspoon in amount. She has had a tubal ligation for contraception. She now has pain on the left side of her breast and into her armpit and into her shoulder. She does have a FH of breast cancer. She has a maternal aunt with breast cancer. She does have lupus. She is having troubles emptying her bladder. She does think she empties okay but the stream can be slow to start. She takes provera 30 mg daily to prevent menses. ASSESSMENT: urinary issues Breast tenderness Nipple discharge PLAN: Her breast exam was benign and reassurance given that most likely her tenderness was due to hormonal changes of her breast. I do want to check a tsh and prolactin given the nipple discharge. I do want to order a diagnostic mammogram and u/s to be safe as she is concerned about her tenderness. If this is normal, reassurance given. Will start with a urine culture. If her urinary symptoms aren't improving, will refer to urogyn.

Other Meds:

Current Illness:

ID: 1788567
Sex: F
Age: 83
State: NY

Vax Date: 10/14/2021
Onset Date: 10/15/2021
Rec V Date: 10/15/2021
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: XR- Pulmonary Congestion + Cardiomegaly - unchanged from baseline EKG- new RBBB and VTach Tropenimia Elevated Lactic Acid INR/PTT - elevated Low Creatinine Low MG AST elevated

Allergies: Shellfish Fish Containing Products

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient presented with similar symptoms after receiving the 2nd dose of the vaccine in 03/21. Her illness then was self limited and she had a short 2 day hospitalization stay where she received supportive therapy. Following the booster, she woke up extremely nauseous, severely SOB, and then vomited 2-3 times prior to her hospitalizations. She felt extreme full body fatigue and weakness, and cannot ambulate which is not her baseline.

Other Meds: bulbabital-acetaminophem-caff Calcium with Vit D Carvedilol Furosemide Hydrocodone-Acetaminophin Methylprednisolone Multivitamin Mycophenolate Omeprazole Potassium Chloride Prolia Sertraline

Current Illness: Dermatomyosits Polymyositis Non-ischemic Cardiomyopathy CHF GERD Depression

ID: 1788568
Sex: F
Age: 73
State: MI

Vax Date: 10/02/2021
Onset Date: 10/07/2021
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:

Allergies: NKDA

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

Symptoms: Hospitalized; COVID-19 positive; Fully vaccinated plus booster Discharge Provider: Primary Care Provider: MD Admission Date: 10/9/2021 Discharge Date: Oct 11, 2021 PRESENTING PROBLEM: Metabolic acidosis [E87.2] COVID-19 virus infection [U07.1] COVID-19 [U07.1] HOSPITAL COURSE: Patient is a 73 woman with PMH: Significant for diabetes, IgG deficiency, CKD stage 4, peripheral neuropathy, bronchiectasis on azithromycin Q Monday Wednesday Friday sent to emergency department for abnormal labs. Patient husband works in a nursing home as a CNA he was tested positive 1st COVID-19. As patient develops symptoms she was tested and positive on 10/07/2021. Labs drawn prior to monoclonal antibodies were abnormal so she was admitted. On admission she completed monoclonal antibodies. Tolerated well. Labs improved. Renal functions returned to baseline. She did not require oxygen supplementation. She still have some cough and soreness in throat. In stable condition patient is discharged home with recommendations to use incentive spirometer and prone positioning as tolerated. Also recommended to monitor vitals and pulse oximetry closely. Recommended to return to emergency department if symptoms are getting worse given chronic lung disease.

Other Meds: ACCU-CHEK SOFTCLIX LANCETS MISC albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler aspirin 81 MG tablet atorvastatin (LIPITOR) 10 MG tablet azithromycin (ZITHROMAX) 250 MG tablet benzocaine-menthol (CEPACO

Current Illness: NA

ID: 1788569
Sex: F
Age: 44
State:

Vax Date: 08/16/2021
Onset Date: 09/06/2021
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: No medical tests or laboratory results directly related to the adverse event.

Allergies: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Outbreak of herpes simplex virus around the lips. Still ongoing. Treating with Abreva. I haven't had an outbreak of herpes simplex virus in over 10 years. I feel that this outbreak is directly related to receiving the COVID vaccine as I have a strong immune system, no sickness, and no excessive stress. I am a very healthy adult. Medical workup for wellness was conducted 9/9/21 and blood work showed that Vitamin D level had dropped to 14. I'm not sure if this is related to the vaccine, but thought it was worth mentioning since it happened after receiving the vaccine and it dropped to such a low level. Doctor prescribed a high dose vitamin D supplement. Calcium levels dropped below normal levels. This was odd as well as calcium levels have always been in the normal range. Doctor suggested taking an over the counter calcium supplement to get levels back to normal. I thought it was worth mentioning since this occurred shortly after the vaccine as well. I experienced no serious side effects. The only other side effects were the described side affects of injection site pain, fatigue and muscle aches. I also had a headache that was reoccurring over a few days.

Other Meds: Drospirenone and ethinylestradiol tablets

Current Illness: None

ID: 1788570
Sex: F
Age: 40
State: VA

Vax Date: 04/10/2021
Onset Date: 04/10/2021
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: RA

Lab Data: Biopsy and Ultrasound- not cancer

Allergies: red dye for Pepto-Bismol tablet

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

Symptoms: A few hours, I was shivering, very cold and tired through the day. I didn't notice my neck but in July the dentist indicated the lump and in September got Ultrasound for the lumps on both side. The right was bigger. Went to ENT. Not cancer. Lump right before both vaccinations, biopsy. In July2021, in Ultrasound the left was new and the right grew bigger and it's not cancer. Chronic Lump.

Other Meds: no

Current Illness: no

ID: 1788571
Sex: F
Age: 86
State: TN

Vax Date: 09/09/2021
Onset Date: 08/24/2021
Rec V Date: 10/15/2021
Hospital: Y

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

Lab Data: tropinin was slightly elevated, heart rate decreased with HCT low needing 2 units blood- follow by platelet count low required a hematology consult prior to discharge

Allergies: feldene, influenza virus vaccine, iodine and iodine containing products, lincocin, morphine, sulfa and now COVID 19 vaccine Mrna, BNT 162b2, Lnp-s Pfizer

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

Symptoms: first dose given 7/19/21 and on 7/28/21 unable to read eye chart for eye exam that she had been able to do so last year. I was not made aware that vaccine had been given at that time. informed of 2nd injection after the fact - notice mother unable to walk without help, not eating and seen weak and loosing weight. taken to PCP on 8/24/21 where she vomited in office- referred to ER where she was admitted to hospital.

Other Meds: Elderberry 200 mg w/ Zinc, Vitamin D, Vitamin C and Vitamin E daily. chlorthalidone 12.5 mg daily- check BP before given if below 100 hold daily aspirin 81 mg daily atorvastatin 20 mg at bedtime Levocetirizine 10 mg at bedtime

Current Illness: none

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am