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: 1788733
Sex: M
Age: 18
State: GA

Vax Date: 04/09/2021
Onset Date: 09/30/2021
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: Rapid COVID-19 Test on Friday October 1: Negative PCR COVID-19 Test on Friday October 1: Negative Rapid Strep Test on Saturday October 2: Negative Flu Test on Saturday October 2: Negative PCR COVID-19 Test on Wednesday October 6: Negative

Allergies: Peanuts, tree nuts, Augmentin

Symptom List: Dysphagia, Epiglottitis

Symptoms: I had a very bad sore throat and cough. My clinic sent me home out of concern for COVID to isolate. After getting tested at Urgent Care for COVID-19 and for strep throat and for the flu, it was determined that I just had a very bad cold. I was home sick for about a week and I am pretty much over my cough now.

Other Meds: Flonase, Zyrtec (10 mg), Fluvoxamine (200 mg), Montelukast (10 mg), Oxybutynin (10 mg)

Current Illness: N/A

ID: 1788734
Sex: M
Age: 29
State: OR

Vax Date: 10/02/2021
Onset Date: 10/02/2021
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: None

Allergies: None stated on VARS

Symptom List: Anxiety, Dyspnoea

Symptoms: This was an administration error with the incorrect second dose Pfizer vaccine given to someone who had received a Moderna first dose. Provide on Duty was called, patient was called, he reported no adverse effects, he returned to site to have his CDC card updated with the correct information.

Other Meds: Unknown

Current Illness: None stated on VARS

ID: 1788735
Sex: M
Age: 53
State: SC

Vax Date: 10/12/2021
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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies: Penicillin

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

Symptoms: Awoke with entire body itching, did not take medicine due to early hour but could not fall back asleep, took shower at 6:20 notice raash on palms. After shower applied OTC hydrocortisone cream to arms. Took benadryl at approximately 6:45. Reported to school, itching had resolved but fellow employees noticed rash on face and I then noticed my forearms had broken out with hives. Nurse took temperature and pulse ox--both normal, but also noticed rash on shoulder blades. Went to Urgent care vitals were normal with BP 130/84 which is only slightly high for me. By the time I saw doctor it seemed hives were less severe. He advised continuing OTC meds and following up with family physician in five days. Today all has resolved except palms are still splotchy red to pink rash occasional mild itching. NO new or strange foods or meds were ingested and he thought the vaccine was the most likely cause. I had COVID diagnosed on Jan 1, 2021 which was mild and resolved within six days, but has a few lingering effects (Brain fog and loss of taste) now resolved. I was hospitalized in late June with Sepsititis secondary to cellulitis. I am currently over weight 266 lbs down from 306 lbs in June. Weight loss is intentional and physician monitored.

Other Meds: Amlodipine Phosphate 10mg/day Losartan Potassium 50mg/day

Current Illness: no other know allergies

ID: 1788736
Sex: F
Age: 49
State: NV

Vax Date: 09/02/2021
Onset Date: 09/02/2021
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: Chills and anusea all night. Headaches for two weeks.

Other Meds:

Current Illness: sinus

ID: 1788738
Sex: F
Age: 55
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: vaccine was mixed with sterile diluent rather than sodium chloride 0.9

Other Meds:

Current Illness:

ID: 1788739
Sex: F
Age: 60
State: NV

Vax Date: 08/02/2021
Onset Date: 08/05/2021
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: None.

Allergies: Contrast Dye and Tylenol

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

Symptoms: Moderna, first injection. Rapid heartbeat, lasting sometimes 20 minutes, with lengths of time up to 4 hours in between event. This has not subsided. Moderna, second injection, Lot 020F21A, date: 08/31/21 Rapid heartbeat, lasting sometimes 20 minutes, with lengths of time up to 4 hours in between events. Today is 10/15/2021 and this continues.

Other Meds: None.

Current Illness: None.

ID: 1788740
Sex: F
Age: 73
State: AZ

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

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

Lab Data: none

Allergies: Sulfa, Tequin, Levequin, Cipro, Humira

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: severe chills and shaking which started suddenly about 11pm and lasted about 3 hours. slight fever of 99.3 to 100.2. i don't know the exact name of the flu shot i got. it just said Senior-dose flu shot. i guessed on the exact type

Other Meds: Gabapentin, Pramipexole Dihydrochloride ER, Fluoxetine Hcl, Glyburide, Metformin ER, atorvastatin, 81 mg aspirin, invokana, hydrochlorothiazide, trulicity, omeprazole,

Current Illness: surgery on ruptured patella tendon in right knee on Sept 13, 2021

ID: 1788741
Sex: M
Age: 18
State: CA

Vax Date: 10/11/2021
Onset Date: 10/13/2021
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: Cat scan blood tests surgery

Allergies: Amoxicillin

Symptom List: Pharyngeal swelling

Symptoms: At 1st got headache then body aches, woke up the next day (tuesday 10/12/2021) with a fever 100.05 and 1/2 my face felt numb and strange. Woke up the next day (weds 10/12/2021) and had a stomach ache that slowly progressed to a severe pain in lower right abdomen area. Had to be taken to the ER and was diagnosed with appendicitis and had my appendix removed the next day (thursday 10/14/2021). Ive never had an issue with my appendix prior to this

Other Meds: Motrin 800 mg Melatonin 10 mg

Current Illness: None

ID: 1788742
Sex: M
Age: 33
State: CA

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

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

Lab Data: none

Allergies: none

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: patient experienced mild syncope - elevated patients feet and provided cold compress until patient recovered fully

Other Meds: none

Current Illness: none

ID: 1788743
Sex: M
Age: 77
State: WA

Vax Date: 09/03/2021
Onset Date: 09/04/2021
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: Nothing but vital signs checked by EMT crew.

Allergies: Sulfa medications

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Received 3rd Covid Pfizer booster shot 9/3/21. Woke up 9/4 with bad chills and a fever of 103.6. Disoriented as to date and time. Spouse called EMTs who checked vital signs and advised she give patient Tylenol and he should be fine. She did as instructed and fever came down as expected. approximately 4 weeks later patient once again developed a fever of 103with chills and disorientation. Again successfully treated with Tylenol. Of not, patient recalls he had his flu shot 9/24/21. Not given at our facility and I have no further information on it.

Other Meds: Zyloprim 100mg ASA 81mg atorvastatin 80mg Klonopin 0.5mg colchisine 0.6 mg benadryl PRN famotidine 40mg gabapentin 300mg TID Norco TID PRN Toprol XL 50mg procardia XL 30mg Nitrostat PRN Miralax 17gram daily senna viagra 100mg PRN zolpidem1

Current Illness: Only chronic illnesses

ID: 1788744
Sex: M
Age: 22
State: MO

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

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

Lab Data: none

Allergies: shellfish, penicillin, latex

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

Symptoms: Patient received Dose #1 and Dose #2 with Moderna. Patient mistakenly administered Pfizer for Dose #3 (immunocompromised). Patient reports no adverse effects

Other Meds: Tenofovir, methotrexate, folic acid

Current Illness:

ID: 1788745
Sex: F
Age: 71
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: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: vaccine was mixed with sterile diluent rather than sodium chloride 0.9

Other Meds:

Current Illness:

ID: 1788746
Sex: F
Age: 37
State: OH

Vax Date: 04/08/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data: They did a COVID test to rule it out - negative result.

Allergies: sulfa drugs

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

Symptoms: Late night on the 27th, I had low grade fever and some muscle aches; and some stomach issues (upset stomach). Tuesday morning, the diarrhea started and lack of appetite for most of the day. There was still some low grade fever then. That persisted through Thursday and I went to Urgent Care on Thursday. They recommended fluids and to eat a bland diet until that cleared. No treatment at Urgent Care - I was a little dehydrated but they didn't have to do IV fluids and my vitals were gone. I did not have a fever at the time of the appt. It went on all that week - it got midday on that Friday and went back to work (at home) that day and by Saturday, I was fine. Pregnancy history: I had a miscarriage in 2019; second pregnancy at this time; Date of birth: May 27th - twin girls - one was 5 lbs 8 oz and the other 5 lbs and 11 oz. They came three weeks early. They were suppose to be due the middle of June. I didn't have any complications but I just ran out of room. Note: I had the second whooping cough vaccine - two or three weeks after dose 2 of the COVID vaccine.

Other Meds: Prilosec; Standard Multivitamin; B12; Calcium Carbonate; Vit D; Vit B combo; Pre natal vitamin and baby Aspirin

Current Illness: no

ID: 1788747
Sex: F
Age: 68
State: MI

Vax Date: 03/01/2021
Onset Date: 07/07/2021
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: none

Allergies: wheat

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

Symptoms: Course of Shingles with Valacyclovir for 1 week. After one week of drug symptoms subsided somewhat. Still having residual pain and discomfort.

Other Meds: nadolol 10mg daily

Current Illness: none

ID: 1788748
Sex: F
Age: 29
State: UT

Vax Date: 09/07/2021
Onset Date: 09/07/2021
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: N/A

Allergies: Cow's milk

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

Symptoms: That night my arm was extremely sore, to the point that I could not perform mundane daily activities without severe pain. Over the next couple of days my mucus turned brown and red. Later it hanged to yellow and green. My body was achy and I had a headache.

Other Meds: ZYRTEC; NASONEX; MULTIVITAMIN; NORETHINDRONE; Stool softener

Current Illness:

ID: 1788749
Sex: F
Age: 45
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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: vaccine was mixed with sterile diluent rather than sodium chloride 0.9

Other Meds:

Current Illness:

ID: 1788750
Sex: F
Age: 38
State: VA

Vax Date: 10/15/2021
Onset Date: 10/15/2021
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: vaccine was mixed with sterile diluent rather than sodium chloride 0.9

Other Meds:

Current Illness:

ID: 1788751
Sex: M
Age: 77
State: MD

Vax Date: 02/24/2021
Onset Date: 03/10/2021
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:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Diarrhea started two weeks after vaccination. Initially very large volume with increased frequency Evaluated patient July 2021, continued to have diarrhea but less volume and less frequent As of 10/2021- diarrhea improved, but still on antidiarrheal agent twice a day.

Other Meds:

Current Illness:

ID: 1788752
Sex: F
Age: 21
State: MN

Vax Date: 10/15/2021
Onset Date: 10/15/2021
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: History of hives and multiple allergies (environmental and medication but pt could not name types of medicine.

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Patient complained of throat constriction 30 mins post vaccine, became pale. Vials signs wnl. Epi administered and EMS called, patient taken to hospital for observation. Per patients mother report given benedryl and steroids in the hospital, under observation.

Other Meds: Unk

Current Illness:

ID: 1788754
Sex: F
Age: 74
State: IL

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

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

Lab Data:

Allergies:

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

Symptoms: Possibly under diluted dose of the vaccine

Other Meds:

Current Illness:

ID: 1788755
Sex: F
Age: 0
State: NY

Vax Date: 02/12/1965
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: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: 56 year old female had second dose of moderna vaccine, became dizzy and diaphoretic after administration. pt monitored for 30 mins. symptoms did not improved, patient appeared pale, VS 154/77 , Hr 62 95 RA Hr 65. pt report increase dizziness . EMS called , patient to be transferred to Er

Other Meds:

Current Illness:

ID: 1788756
Sex: F
Age: 43
State: TN

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

Lab Data: EKG heart monitor for 7 days comprehensive metabolic panel- normal CBC and TSH -normal thyroid was normal TPROT was slightly above the normal range, but most likely because of my allergies I am having right now.

Allergies: sulfa drugs latex and certain adhesives seasonal allergies

Symptom List: Unevaluable event

Symptoms: 09/28/2021, the day after the vaccine, I noticed a flutter in my throat like a palpitation, and just palpitations. I was having upper back pain that was radiating to my chest. Everything else was pretty normal. And it continued throughout the week until Monday, 10/11/2021. On 10/11/2021-The doctor did an EKG trying to figure out why my heart rate was so high. I have general anxiety, but she was still concerned because it is never gets that high. On 10/11/2021- She put a heart monitor on me for 7 days to monitor it. The fluttering I was experiencing has calmed down, and I will know the results of my heart rate, when the doctor gets the results back from the heart monitor.

Other Meds: vitamins b, c, d & e liquid magnesium as needed, but not at the time of the vaccination alprazolam as needed

Current Illness: no I had a rapid COVID-19 test the day before- it was negative

ID: 1788758
Sex: F
Age: 33
State: NY

Vax Date: 03/23/2021
Onset Date: 03/24/2021
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:

Allergies: Penicillin

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

Symptoms: The morning after vaccination (about 18 hours post-vaccination), I woke up very dizzy, had a fever, nearly fainted, was weak, and lethargic. This subsided by about 24 hours post-vaccination. My first period following vaccination came one week early, the second period was two weeks late and my period have not been regular since receiving the vaccine. I have always had regular period prior to vaccination.

Other Meds: None

Current Illness: None

ID: 1788759
Sex: F
Age: 70
State: KY

Vax Date: 01/28/2021
Onset Date: 09/22/2021
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: COVID+ Referral for EUA Covid Antibody Treatment - casirivimab & imdevimab 600-600 mg iv infusion - famotidine (PEPCID) injection 20 mg - diphenhydrAMINE (BENADRYL) injection 25 mg - EPINEPHrine (EPIPEN) injection 0.3 mg patient tested positive on home test, but patient's husband was seen here in our office and tested positive. 9/25/21 Rec'd regeneron infusion

Other Meds:

Current Illness:

ID: 1788760
Sex: F
Age: 33
State: VA

Vax Date: 03/24/2021
Onset Date: 03/24/2021
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: I have had allergy testing done - to see if it a contact dermatitis - that has presented to be negative; I have been on an autoimmune diet for 35 days but have not seen a reduction in symptoms yet but am keeping on it for now. I am getting acupuncture once a month to try to help with inflammation.

Allergies: Not known

Symptom List: Injection site pain, Menorrhagia

Symptoms: Initially after the vaccine, I was sick for about 48 hours. My menstrual cycle was affected very severely - a lot of cramping and pain. I also had irregular timing with my menstrual cycle. I also experienced numbness and tingling in wrists and legs, thighs - shooting down - for two months post vaccine. I work out regularly usually but I was unable to workout at my normal pace for at least a month. And still to this day, I feel like I can't reach the same cardiovascular level that I use to in my workouts. I have had Eczema over the last five years or so - little patches now and then. But since then, it has been exacerbated and I am in a flare - and sometimes I can't work because the palm on my right hand, lesions on inside of nose - bilateral and my earlobes (bilateral) - are bleeding or agitated. Never has it been in this severity before. Steroid cream for the eczema symptoms - that hasn't been helpful so we've stopped that. For numbness and tingling - I was doing ibuprofen to reduce inflammation and I upped my Omega 3's to help with overall body inflammation and I'm still taking that three times a day. My timing of my menstrual cycle is back to normal now. The numbness and tingling stopped after a couple of months. Mainly the skin condition has continued. And I do still feel like I have to stop and catch my breath sometimes and I never had that problem before. I do still have a bit of numbness and tingling in my temple region - that is very subtle and is intermittent. That may have started a bit later than the other tingling and numbness symptoms started but not sure when it did. Have had Primary care visits and have an upcoming dermatology appt - they may do a biopsy.

Other Meds: Vit D; magnesium for sleep; omega 3's

Current Illness: No

ID: 1788761
Sex: F
Age: 30
State: CA

Vax Date: 10/04/2021
Onset Date: 10/07/2021
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: Blood work 10/9/21, blood clot test 10/9/21, 10/11/21, X-rays 10/9/21, EKG 10/9/21, BP 10/9/21, 10/11/21, (all came back normal).

Allergies: Amoxicillin; environmental allergies

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

Symptoms: Monday after I received the vaccine I started feeling the arm soreness which I was expecting. I was getting headaches, but it wasn't super painful. It was manageable as expected. On Tuesday night, I had an episode where I was getting chest pressure and light headed. And I had severe tension headaches in front and back of head. Wednesday it was tension headaches, lightheadedness. The best way I can describe it is being tipsy. So moving losing some coordination but still being able to walk and function. On Thursday was when I started feeling pressure on my chest and tension headaches. I was also starting to feel pain in the left and right sides of my chest. On Saturday I went to work (active) 9am-10pm. around 10:30 am I started to feel lightheaded and stepped outside, I was outside for about 15 minutes. I felt like I was gonna pass out and I decided to go into the museum. If I passed out someone would find me there. I went back inside and sat down and drank water. And same thing as Tuesday night I waited for it to pass. I was the senior technician there and worked through then went to the hospital at 6:30pm after work. So I was at the ER until 10:30pm. Blood work, x-rays, EKG, BP, everything came back normal. I was prescribed with over the counter ibuprofen 200mg every 6-8 hours with meals. My diagnosis was uncertain cause of chest pain. I ended up getting a doctor's note for the rest of the week (Saturday 10/9). And then on Monday I got another appointment at a HCF because the chest pain would subside and then I have episodes where it's a very sharp stabbing pain throughout my chest as well as pressure. And I was told after taking pain killers that it would subside. I was prescribed to take 600mg of ibuprofen every 6 hours prescribed on 10/11 (Monday). I've just been having pain pressure on my chest. The pain after medication is manageable. I cant be on certain positions when I sleep and it gives me more pain. Usually around the time I take medication, I get a pain flare off. Sometimes I have to take medication earlier than 6 hours. And it's extreme. And now it's more located on the left side in between my breasts. I did have another check up over the phone today 10/15. I asked for another set of x-rays and I was just told to take Tylenol in between the ibuprofen. Other than that I was just told to wait for it subside. Still ongoing. I've also noticed that the pain happens when I'm breathing. When I breathe in, it's the sharpest, when I hold it in, there's no pain. When I breathe out, it's milder than breathing in.

Other Meds: N/A; ibuprofen as needed

Current Illness: N/A

ID: 1788762
Sex: F
Age: 30
State: CA

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

Lab Data: On 10/15 in the ER I was given CBC w/ diff, comprehensive metabolic panel, ER troponin-1, HCG,serum, qualitative ECG 12 lead, x ray chest AP portable

Allergies: Sulfa

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: On 10/13 the night I got my shot I had difficulty sleeping, slept only 2-3 hours which is very unusual, 10/14 started experiencing mild chest pain, 10/15 went to ER doctor because chest pain persisted. My sleep returned to normal by 10/14

Other Meds: None

Current Illness: None

ID: 1788892
Sex: F
Age: 80
State: NY

Vax Date: 02/17/2021
Onset Date: 06/11/2021
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: RA

Lab Data:

Allergies: contrast dye (hives/blood pressure changes)

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: 6/11/21 - admitted to local hospital, took off 3,000ml fluid in pleural cavity - subsequent to this had kidney failure, other organ failure during this hospitalization. Since this hospital stay has visiting nurse come every couple of days to drain via port in back - and is being followed by cardio and renal MD as well as oncology/hematology. Doctor recently mentioned that patient should be getting fluid analysis.

Other Meds: amlodipine besylate/benazepril 5/10, triamterene/HCTZ(or other diuretic, cannot recall specific name at time of vaccination), muro 128

Current Illness: no

ID: 1788893
Sex: M
Age: 74
State: CA

Vax Date: 09/29/2021
Onset Date: 10/07/2021
Rec V Date: 10/15/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Sore arm, rash, hives, redness, and itching.

Other Meds:

Current Illness:

ID: 1788894
Sex: F
Age: 60
State: TX

Vax Date: 04/08/2021
Onset Date: 04/08/2021
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: RA

Lab Data: Echo sonogram- mild leakage of aortic valve and aorta was slight enlarged 8/21/2021 EKG- normal 8/16/2021

Allergies: Amoxicillin; Keflex; Most of the narcotics; Soy beans; Soy; MSG; Cantaloupe; Rag weed; Mountain cedar; flowers; chocolate; red dyes

Symptom List: Nausea

Symptoms: I experienced fatigue. I had a phantom smell since when I had caught covid before the vaccine. I experienced tiredness and bone and joint pain in my feet. My doctor told me to add magnesium to my diet for it, and it has helped with the pain in my feet. I was sleeping for 12 hours all the way through about September 2021. I still have fatigue but its not as sever as it was the first 6 weeks since getting the vaccine. My tissue is prone to bleed more. My allergies has gotten worse. I found out I had a heart murmur On July 28th. I saw the cardiologist on August 16th and had an EKG done. I had an echo sonogram on August 21st . I get tired and sleepy more. The tooth behind the one I injured awhile ago, tooth 30, the tooth was in perfect health. On September 4th my gum was sore, and there was an abscess on my gum. The bone had absorbed between the root of the tooth when I had seen my endodontist on 9/8/2021. I had the tooth extracted 9/10/2021 by the oral surgeon.

Other Meds: Montelukast sodium 10mg 1xday; Flonase 50mcg 2xday; Losartan Potassium 100mg 1xday Levothyroxine sodium 50mcg 1xday; Tylenol 500mg; Multivitamin with minerals 1day; CO-Q 10 200mg 1xday; Probiotics 2xday; Cranberry 930mg; Pomegranate 200mg 1

Current Illness: none

ID: 1788895
Sex: F
Age: 39
State: NC

Vax Date: 04/11/2021
Onset Date: 04/12/2021
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:

Allergies:

Symptom List: Injection site pain

Symptoms: Wrong vaccine. Should have received 2nd dose of Pfizer and received 2nd dose of Moderna instead.

Other Meds:

Current Illness:

ID: 1788896
Sex: F
Age: 11
State: CO

Vax Date: 09/23/2021
Onset Date: 09/23/2021
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:

Allergies:

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

Symptoms: Patient was brought to vaccine clinic by parent/guardian. With claims of patient's birthdate being 03/13/2009. Parent/guardian filled out medical information/consent forms stating that the information provided to us regarding the patient was true. State records found that patient's birthdate was 03/13/2010, placing her outside the 12 year old minimum age for receiving the Covid-19 Pfizer-BioNtech vaccine. Parent/guardian was contacted via phone and verbally stated that patient's birthdate was 03/13/2009.

Other Meds:

Current Illness:

ID: 1788897
Sex: M
Age: 83
State: TX

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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: None.

Allergies: None

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

Symptoms: Round welts ranging from quarter size to baseball size on back and arms, with severe itching.

Other Meds: Lisinopril, Vitamin D, Gabapentin

Current Illness: None

ID: 1788898
Sex: M
Age: 46
State: MI

Vax Date: 04/09/2021
Onset Date: 09/21/2021
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: PSR test for COVID and receive Antibody treatment.

Allergies: No, environmental allergies to dust and mold

Symptom List: Tremor

Symptoms: On 09/21/2021 everyone in house was sick and family member tested positive and on 09/22/2021, had a headache, and congestion. The patient tested posted positive for COVID had the antibodies treatment on 09/23/2021 only side effect was headache and stuffy noise.

Other Meds: No

Current Illness: No

ID: 1788900
Sex: F
Age: 57
State: AZ

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: NKA

Symptom List: Erythema, Pruritus

Symptoms: Pt felt feverish, chills, muscle aches, pain/redness/itching at injection site.

Other Meds: Oral contraception

Current Illness: none

ID: 1788901
Sex: F
Age: 37
State: CT

Vax Date: 04/07/2021
Onset Date: 05/11/2021
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.

Allergies: None

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

Symptoms: Menstruation period has shortened from its normal length of around 32 to 35 days to 26 to 30 days.

Other Meds: None

Current Illness: None

ID: 1788902
Sex: F
Age: 43
State: CA

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

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

Lab Data: Bloodwork and Covid Test.

Allergies: Doxycycline

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

Symptoms: On day of vaccine I experienced a Heavy arm, a couple minutes after shot I felt dizzy then I felt better, went home, and that evening I had chills and fever, took TYLENOL, during the night I had fever and chills, next day I felt better. I continued to have fatigue for a couple months after I started having lots of anxiety and panic attacks, In July I had a very bad cough, I drove myself to the urgent care 07/17/2021. On July 18 I visited the same urgent care, they did some tests and transported me to the ER. The ER they did a covid test and I was also diagnosed with pneumonia. I have recovered from covid and pneumonia but I have not recovered from anxiety.

Other Meds: None

Current Illness: None

Date Died: 05/20/2021

ID: 1788903
Sex: M
Age: 84
State: NY

Vax Date: 02/17/2021
Onset Date: 02/18/2021
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: NKDA

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Before vaccine, was suffering from health problems. Starting 2/18/21 (day after first Moderna vaccine) - defibrillator went off, went to hospital and was sent home. then 2/19 the defibrillator went off again at home, stayed at hospital for a couple days, 4 days after arrived home got another defibrillator shock - back to hospital, was treated for hypoxia. Patient was on hospice 2.5 months and then passed 5/20/21.

Other Meds: synthroid, finasteride, amiodarone, trulicity, tamsulosin, invokana, clopidogrel, bumetanide, ezetimibe, multivitamin, carvedilol, rosuvastatin

Current Illness: thyroid disease, non-hodgkins lymphoma (2x), kidney disease, heart disease

ID: 1788904
Sex: F
Age: 37
State: AK

Vax Date: 04/15/2021
Onset Date: 04/17/2021
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: I'm still waiting to see a doctor.

Allergies: Pineapple; coconut; shrimp

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

Symptoms: Two days after the vaccine I had heart complications. I had heart palpitations, I had a fever, body tremors, headaches, and nausea and night sweets. They went away, I haven't taken anything to help. I'm seeing the doctor on November 3rd.

Other Meds: Escitalopram; B complex; iron; D3

Current Illness: None

ID: 1788905
Sex: F
Age: 28
State: WA

Vax Date: 05/13/2021
Onset Date: 05/27/2021
Rec V Date: 10/15/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Plugged ears and vertigo.

Other Meds:

Current Illness:

ID: 1788906
Sex: M
Age: 65
State: LA

Vax Date: 03/11/2021
Onset Date: 07/30/2021
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: MRI - 2% blockage in my heart COVID Test - Negative Stress Test - Normal Blood Work - Normal

Allergies: Penicillin

Symptom List: Pain in extremity

Symptoms: I experienced extreme heart palpitations that keep going and I went to the ER. While I was waiting in the ER to see the doctor, my heart slowed down. The ER doctor took some blood samples and I was placed on a treadmill to have a stress test down. and did an MRI to take pictures of my heart. It showed that I has a 2% blockage. I was released from the ER even though I was still not feeling good. The ER doctor misdiagnosed me as having a heart attack from my blood work. The event caused me to lose weight and I haven't felt the same since. I also have a random coughing spell that comes and goes which I never had until I took the vaccine. I had to wear a heart monitor for two weeks and I had one episode of heart palpitations and stopped taking the medication prescribed because it made me feel worse. I haven't had any further symptoms and will not be taking the booster shot because I'm afraid the same thing will happen again.

Other Meds: I was taking medication for Arthritis, Hypertension, and supplements.

Current Illness: No

ID: 1788907
Sex: F
Age: 38
State: VA

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: none listed

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

Symptoms: About 5 minutes after receiving vaccine I was told the patient had vomited. We gave her a wet compress and then later a plain cold pack and remained with her. She stated she felt hot, then cold, and her arms were heavy. She said she felt like she might faint, but she did not. She sat still for awhile. Five to 10 minutes later she said she was feeling better. She then said she thought it was an anxiety attack because she had been nervous about the vaccine. She stated she felt fine and left.

Other Meds:

Current Illness: no acute

ID: 1788908
Sex: F
Age: 41
State: UT

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

Lab Data: None.

Allergies: Horseradish, darvocet

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

Symptoms: Arm because red and tender at injection site a few hours following the injection but by the next morning there appeared to be a patchy rash in the surrounding area and my arm was very warm and sore. That evening the red had continued to spread and the rash became itchy. This continued the 2nd day so I reached out to the pharmacy to ask at what point I should be concerned. They asked me to fill out this form and said they would check in with me again tomorrow and May recommend a visit to urgent care if it hasn't cleared up by morning. I've been recording the growth of the rash by photograph.

Other Meds: Nikki, dorzolamide

Current Illness: Had a cold 10 days prior. Had a precautionary COVID test which returned a negative result.

ID: 1788909
Sex: F
Age: 15
State: ID

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: NONE REPORTED

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

Symptoms: Patient was nervous about getting the vaccine to start but she seemed fine right after the shot. She walked over to another chair to sit down. About a minute or two after sitting down in the chair she passed out and started having a seizure. Myself and another adult in the room got her safely to the floor. The seizure lasted just a few seconds but she was sweating and white. We called 911 and kept her calm and sitting while waiting for the paramedics to arrive. She slowly regained color in her face and was feeling better by the time paramedics arrived.

Other Meds: NONE

Current Illness: NONE

ID: 1788910
Sex: F
Age: 27
State: TX

Vax Date: 05/07/2021
Onset Date: 05/07/2021
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: None

Symptom List: Vomiting

Symptoms: I began to feel very dizzy as well as shaky. My heart rate accelerated and I experienced shortness of breath. I called a nurse, and she told me that if my symptoms did not stop soon, then I need to go to the hospital.

Other Meds: None

Current Illness: None

ID: 1788911
Sex: F
Age: 35
State: CA

Vax Date: 05/05/2021
Onset Date: 05/06/2021
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: Blood test 5/22/2021 6/21/2021 Urine test 5/22/2021 Normal

Allergies: mild eye allergy for unknown reason

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Fever (>102 for 24 hours. Nausea, dizziness, and vomiting for 1 month. Low grade fever (>99.5F) for 5 months. Tinnitus for 5 months.

Other Meds: multivitamin

Current Illness: eye allergy

ID: 1788913
Sex: F
Age: 48
State: GA

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

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

Lab Data: n/a

Allergies: n/a

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

Symptoms: Patient has a red itchy rash on left arm. Patient desribes it being warm to the touch itchy and also very knotted under the injection site. Patient states its has been 2 weeks that she has had the rash.

Other Meds: n/a

Current Illness: no

ID: 1788914
Sex: F
Age: 62
State: WA

Vax Date: 10/12/2021
Onset Date: 10/15/2021
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:

Allergies: SULFA

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Sore, sensitive to touch, red, and warm to touch.

Other Meds: LOSARTAN, SIMVASTATAN, XANAX

Current Illness:

ID: 1788915
Sex: F
Age: 51
State: WA

Vax Date: 08/13/2021
Onset Date: 10/11/2021
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: RA

Lab Data: COVID status positive on 10/11/21.

Allergies: aripiprazole, olanzapine, penicillin, quetiapine, sulfa, erythromycin

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

Symptoms: Patient received Pfizer COVID vaccine on 7/23/21 and 8/13/21. On 10/11/21, patient is admitted to our facility for COVID-19 infection (she was exposed to COVID about 1 week previously by her unvaccinated caregiver) and general weakness due to her cancer history (no hypoxia). As of today (10/15/21), patient is still admitted in our med/surg unit.

Other Meds: acetaminophen prn, albuterol inh prn, divalproex er, dronabinol, flunicasone nasal sp prn, metoprolol, mirtazapine

Current Illness:

ID: 1788916
Sex: M
Age: 62
State: AK

Vax Date: 04/15/2021
Onset Date: 08/31/2021
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: Drive thru test, positive email response received Medications Administered Name Date REGEN-COV (EUA) 60 mg-60 mg/mL intravenous solution Inject 10 mL by intravenous route. Notes: 2.5 mL given SC x 4 doses; R upper arm, L upper arm, R lateral abd, L lateral abd

Allergies: Nafcillin Rash Loratadine Swollen dry cracked face

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

Symptoms: Covid positive test 9/8/21 approx 4pm testing time medium to heavy cold symptoms, nose throat and some chest congestion Monoclonal antibodies treatment on 9/10/21 heaviest symptoms on 9/5/21 Medications Administered Name Date REGEN-COV (EUA) 60 mg-60 mg/mL intravenous solution Inject 10 mL by intravenous route. Notes: 2.5 mL given SC x 4 doses; R upper arm, L upper arm, R lateral abd, L lateral abd

Other Meds: Toujeo insulin Humalog Insulin LOPID (aka gemfibrozil) Lisinopril Atorvastatin Metoprolol ER Succinate Magnesium Potassium Chelate Potassium Glaconate 88mg Asprin

Current Illness: none

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am