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: 1794174
Sex: F
Age: 37
State: IN

Vax Date: 10/15/2021
Onset Date: 10/16/2021
Rec V Date: 10/17/2021
Hospital:

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

Lab Data: None. Did not need medical attention for side effects.

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Fever up to 101.7, fatigue, muscle aches, headache starting around 12 hrs after vaccination lasting approximately 24 hours. No treatment taken.

Other Meds:

Current Illness:

ID: 1794175
Sex: F
Age: 29
State: NE

Vax Date: 10/12/2021
Onset Date: 10/14/2021
Rec V Date: 10/17/2021
Hospital:

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

Lab Data: Blood test on 10/16/21 confirmed miscarriage in progress. HCG ~ 25, Progesterone 0.9.

Allergies: Idiopathic angioedema, triggers are unknown

Symptom List: Anxiety, Dyspnoea

Symptoms: Moderna 1st dose received 9/14/21. Moderna Second dose received 10/12/21. I conceived on or around 9/26/21 and had a positive pregnancy test one day before 2nd dose. I miscarried the pregnancy on 10/14/21, two days after 2nd dose.

Other Meds: Zyrtec, Montelukast, prenatal vitamin

Current Illness:

ID: 1794176
Sex: M
Age: 52
State: MI

Vax Date: 05/01/2021
Onset Date: 05/04/2021
Rec V Date: 10/17/2021
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 to date. I just received a contact for a neurologist to make an appointment.

Allergies: None

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

Symptoms: First couple of weeks was extreme mental fogginess. I am currently experiencing mental fogginess and short term memory loss throughout my daily activities; work, family.

Other Meds: Rosuvastatin, Fenofibrate, Fluticasone Propionate, Multivitamin, Vitamin D3, Vitamin C

Current Illness: None

ID: 1794177
Sex: F
Age: 61
State: CA

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 10/17/2021
Hospital:

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

Lab Data: n/a

Allergies: Bactrim [Co-trimoxazole]Itching AllopurinolRash Penicillin V Potassium

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Nurse administered Pfizer to a patient who had previously received Moderna

Other Meds: Cholestyramine, with Sugar, (QUESTRAN) 4 gram Oral Powd Triamcinolone Acetonide (TRIDERM) 0.5 % Top Crea Losartan (COZAAR) 100 mg Oral Tab Alclometasone (ACLOVATE) 0.05 % Top Crea hydrOXYzine HCL (ATARAX) 50 mg Oral Tab Methylcellulose SF (

Current Illness: HTN (HYPERTENSION) CHF (CONGESTIVE HEART FAILURE), UNSPECIFIED SEVERE OBESITY (BMI >= 40) HYPERTENSIVE HEART DISEASE URINARY INCONTINENCE ADULT OBSTRUCTIVE SLEEP APNEA RIGHT ANKLE INJURY LICHEN SCLEROSUS ET ATROPHICUS OCCULT BLOOD IN STOOL HERPES SIMPLEX BUTTOCK RIGHT ANKLE JOINT PAIN IRRITABLE BOWEL SYNDROME DIARRHEA STRESS STRESS GOUT URTICARIA PRURITUS BENIGN NEVUS OF SKIN

ID: 1794178
Sex: F
Age: 41
State: AZ

Vax Date: 04/29/2021
Onset Date: 05/01/2021
Rec V Date: 10/17/2021
Hospital:

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

Lab Data:

Allergies: None.

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

Symptoms: Persistent daily itching, waking with itchy red welts across skin, particularly in trunk, neck, and arms.

Other Meds:

Current Illness: None.

ID: 1794179
Sex: M
Age: 38
State: NJ

Vax Date: 05/01/2021
Onset Date: 05/01/2021
Rec V Date: 10/17/2021
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: I had an ex Ray of my hip

Allergies: None

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

Symptoms: I have hade osteoarthritis for several years. But I have always been able to manage it. I know eventually I would need to have a hip replacement. 6 months ago I would have said I can go several more years before needing the replacement. Even since I had the first dose of the vaccine my condition worsened many fold. I have pain 24 hour a day even when lying in bed. It's becoming increasingly more difficult to get through the day. To day they don't have an expectation for the very sudden change in condition

Other Meds: None

Current Illness: perthes

ID: 1794180
Sex: F
Age: 32
State: PA

Vax Date: 10/16/2021
Onset Date: 10/16/2021
Rec V Date: 10/17/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Shortly after getting the vaccine as I was sitting in observation I started feeling a tightness in my chest. I couldn't fully catch my breath and I was dizzy. The nurse and Dr. Of the pharmacy came and brought me water and I described how I felt. They encouraged me to wait a while longer The pharmacy Dr. Asked could it be anxiety about getting the shot. I said No. I was comfort about getting it that is why I came. I ask was this normal for me to feel this way, with my chest feeling tight, like something was sitting on it, he said no. He checked on me again about 5mins later. Another 5-10 minutes the nurses came to check on me and gave me a paper of what to do if I still felt uncomfortable, which was go to the hospital. After talking to my husband we decided to leave, hoping fresh air would help relieve the pain. While.leaving I felt dizzy and my hands were tingling. We left and monitored my symptoms at home.

Other Meds:

Current Illness:

ID: 1794181
Sex: F
Age: 42
State: WY

Vax Date: 07/30/2021
Onset Date: 07/31/2021
Rec V Date: 10/17/2021
Hospital:

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

Lab Data: I saw the eye dr and she said I had mild pressure, but thought the blood was coming from my sinuses. She didn?t really know what was going on. I have had lab work since but they haven?t called me with the results yet. I am currently sick with COVID. This is day 8.

Allergies: Latex Codeine

Symptom List: Pharyngeal swelling

Symptoms: I had a major headache and pressure in eyes directly after injection. On the morning of day two I had pressure in the eyes with bleeding coming from what I believe was the tear ducts. I also had bruising that occurred all over my body. The bleeding of the eyes came back about a week after the injection. It has not happened since.

Other Meds: Methyl B12/Folate Vit D Levothyroxine

Current Illness:

ID: 1794182
Sex: F
Age: 60
State: OR

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

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

Lab Data: None because the ER I went to said the wait time is a 6 hour wait so I was on my own

Allergies: No

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: 28 hours after shot given to me , my heart rate plummeted to around 40 beats per minute, causing Inadequate amount of air to the brain causing slurred speech and dizziness and fear of dying.

Other Meds: Yes. Simvastatin, atenolol. Hydrochloride, amlodipine, klor-com.

Current Illness: Weak heart condition

ID: 1794183
Sex: M
Age: 61
State: NC

Vax Date: 05/25/2021
Onset Date: 05/25/2021
Rec V Date: 10/17/2021
Hospital:

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

Lab Data: N/A

Allergies: None

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Adverse events starts after 2nd dose of Moderna Covid vaccine. Right after the day of injection and still continue to current date. Not able to move arm without pains. Not able to perform routine daily activities such as typing computer keyboard and holding Mice device to use computer. Patient not able to play music instruments such as Guitar due to arm pains. Lately the nerve pains moving forward to elbow and hands. The areas of pain expand over time. Hoping the improvement of pain for last 4 months but it's getting worse over time.

Other Meds: Not available

Current Illness: none

ID: 1794184
Sex: F
Age: 82
State: MI

Vax Date: 10/12/2021
Onset Date: 10/12/2021
Rec V Date: 10/17/2021
Hospital:

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

Lab Data:

Allergies: too many to list

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

Symptoms: Day 1could not sleep after receiving the first night and felt unwell with muscle aches all night. Day two morning had racing heart for half an hour and had difficulty stopping the fibrillation and felt ill. Took 325 bufferin. During day rested but had severe diarreaha for five hours during night. Used pedialyte to help electrolytes. Day three felt like myself and began eating regularly.

Other Meds: singulair amlodapine synthroid

Current Illness: none

ID: 1794185
Sex: F
Age: 28
State: KY

Vax Date: 10/08/2021
Onset Date: 10/13/2021
Rec V Date: 10/17/2021
Hospital:

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

Lab Data: 10/13/21 she went to ER and her vital signs were good, EKG clear, and chest xray was clear. 10/16/21 she went to immediate care and they diagnosed her with "pharyngitis" and patient declined COVID test.

Allergies: none

Symptom List: Rash, Urticaria

Symptoms: Few days after receiving 2nd dose of Moderna, patient reports arm swollen, overall sick feeling, coughing, chest pain, lost her voice, balloon head, coughing up bloody mucous. Patient did state she had the first vaccination on 8/10/21 then on 9/ 11/21 she got COVID and received antibody treatment at the hospital on 9/14/21. She has been to ER and immediate care but was discharged from both with no official diagnosis.

Other Meds: none

Current Illness: none

ID: 1794186
Sex: M
Age: 38
State: AZ

Vax Date: 10/16/2021
Onset Date: 10/16/2021
Rec V Date: 10/17/2021
Hospital:

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

Lab Data:

Allergies: Amoxicillin

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

Symptoms: Swelling sensation in middle-ear (both ears). Slight tinnitus. Slightly muffled hearing.

Other Meds:

Current Illness:

ID: 1794187
Sex: F
Age: 39
State: CA

Vax Date: 10/11/2021
Onset Date: 10/14/2021
Rec V Date: 10/17/2021
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: n/a

Allergies: none

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

Symptoms: Herpes labialis outbreak, started on Thursday 10/14. Began using abreva immediately. Saw MD via telehealth on the evening of 10/14. Started on Valtrex on 10/15.

Other Meds: Levothyroxine, natpara, amiloride, potassium chloride, nuva ring, magnesium oxide

Current Illness: none

ID: 1794188
Sex: M
Age: 65
State: TX

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

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

Lab Data:

Allergies: CODEINE, MORPHINE

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

Symptoms: PATIENT'S BLOOD SUGAR SKYROCKETED TO > 300, THEN PLUMMETED TO 23 ON FIRST VACCINE AND BELOW 20 ON SECOND VACCINE AND REQUIRED HOSPITALIZATION.

Other Meds: HUMALOG 200 UNITS/ML, LEVOTHYROXINE 75 MCG, CLOPIDOGREL 75 MG, TACROLIMUS 0.5 MG, OMEPRAZOLE 40 MG, HYDRALAZINE 100 MG, ATORVASTATIN 80 MG,

Current Illness:

ID: 1794189
Sex: F
Age: 77
State: FL

Vax Date: 09/07/2021
Onset Date: 09/10/2021
Rec V Date: 10/17/2021
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: Pt reported muscle pain and cramps that come and go every once in a while duration of 15 minutes. Event started after second dose of Moderna and continued thereafter.

Other Meds:

Current Illness:

ID: 1794190
Sex: F
Age: 68
State: TX

Vax Date: 03/11/2021
Onset Date: 03/24/2021
Rec V Date: 10/17/2021
Hospital:

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

Lab Data: Treated in emergency room. EKG, bloodwork, stress test, appointment made with cardiologist. All tests were normal and not cardiac related. However, intense Tightening continued around my neck. The second vaccine was given on April 1, 2021. It was the Pfizer vaccine given and the left arm. Tightness continued around my neck and subsided after three months. Pfizer booster was given October 7, 2021 and the very next day tightness around my neck and tingling in both legs was noted first thing in the morning. This sensation lasted most of the day. It has been happening every day since the booster. Not tingling around my legs anymore however tightness around my neck continues off and on daily. Cardiac chemical stress test done..

Allergies: None

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

Symptoms: Tightening occurred around my neck and chest area with tingling sensations in both legs from the knees down to the ankles right arm also tangled. This began happening on a daily basis sometimes tightening was more intense with less tingling in legs noted but more tightening around neck and chest. No pain associated with tightness.

Other Meds: Pravastatin 80 mg 1 tab every HS Fosomax 1 tab once wily

Current Illness:

ID: 1794191
Sex: F
Age: 22
State: AZ

Vax Date: 10/15/2021
Onset Date: 10/16/2021
Rec V Date: 10/17/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Swollen at site of injection, sore and warm to touch and tender armpit, onset 1 day after injection. Looks like red and is somewhat hard.

Other Meds: Tri sprintec

Current Illness: N/A

ID: 1794192
Sex: F
Age: 59
State: TN

Vax Date: 07/16/2021
Onset Date: 07/16/2021
Rec V Date: 10/17/2021
Hospital:

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

Lab Data:

Allergies: NKA

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: ?Guillian Barre Type? Symptoms Fatigue Exacerbated Increase Gabapentin

Other Meds: Thyroid pill/Budesonide/Gabapentin/Alprazolam/Mirtazipine/Lexapro/Topamax/HRT Pellets/Famotadine/Maxium D3/DHEA/12HrSudafed/

Current Illness: Bronchitis w/Infection

ID: 1794193
Sex: M
Age: 58
State: CA

Vax Date: 03/12/2021
Onset Date: 03/19/2021
Rec V Date: 10/17/2021
Hospital:

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

Lab Data: Only test has been my A1c result, which was 10.1 (the highest it's ever been). The test was done on June 30, 2021.

Allergies: Allergic to sulfa drugs

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

Symptoms: Shortness of breath, chest pains, extreme fatigue, blood sugar spike

Other Meds: Metformin, Sanctura, Zoloft

Current Illness: None

ID: 1794196
Sex: M
Age: 66
State: MA

Vax Date: 10/10/2021
Onset Date: 10/11/2021
Rec V Date: 10/17/2021
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: I had the shot Sunday. On the following Monday and Wednesday I had clams and scallops for dinner respectively. Later that night I broke out in hives around my torso and upper body. I took Benedryl and prednisone (from a previous reaction) and the rashes faded away. Then on Saturday night I had another allergic (hives) reaction but did not consume any shellfish or fish.

Other Meds:

Current Illness:

ID: 1794197
Sex: M
Age: 29
State: VA

Vax Date: 10/04/2021
Onset Date: 10/11/2021
Rec V Date: 10/17/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Unevaluable event

Symptoms: Chest tightness and pain/discomfort for 2-3 days in chest area. Labored breathing during light exertion

Other Meds: None

Current Illness: None

ID: 1794198
Sex: F
Age: 80
State: SC

Vax Date: 10/12/2021
Onset Date: 10/14/2021
Rec V Date: 10/17/2021
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:

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

Symptoms: arm - red swollen and had a draining affect - patient also stated that it was itchy

Other Meds:

Current Illness:

ID: 1794200
Sex: F
Age: 29
State: NC

Vax Date: 10/06/2021
Onset Date: 10/07/2021
Rec V Date: 10/17/2021
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: Penicillin, hydrocodone cough syrup, arithromycin

Symptom List: Injection site pain, Pain

Symptoms: Received the COVID 19 Pfizer booster at 24 weeks and 1 day pregnant. Received the first two doses prior to conception and did not have any reaction following. The day following the Covid booster (10/7/21) I began to notice a rash on my stomach and back. The rash continued to spread on 10/8/21 and 10/9/21 until spread stopped around 10/10/21. The rash remained mostly on my trunk (stomach, back, and breasts). The rash closely resembled pityriasis rosea. It was hive like in nature and went up my sides were it appeared to be the worst. The rash was not very itchy and did not respond to Benadryl. The rash slowly started to subside beginning 10/16/21 however is still present. I saw the OBGYN on 10/14/21 to ensure baby was ok and not seriously impacted by this immune response. At this time, the baby seems to have not been impacted. Dermatology referrals was put in, but they have not had the capacity to fit me in.

Other Meds: Prenatal vitamin

Current Illness: None

ID: 1794201
Sex: F
Age: 33
State:

Vax Date: 05/03/2021
Onset Date: 05/05/2021
Rec V Date: 10/17/2021
Hospital: Y

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

Lab Data:

Allergies: none

Symptom List: Injection site pain, Menorrhagia

Symptoms: 1) severe constant cough causing shortness of breath-onset 3 days post 2nd shot and lasted about a month or so. 2) chest pain/pressure-onset 1 week post second shot symptoms still ongoing but not as severe. 3) heart palpations/unprovoked tachycardia-onset 1 week post 2nd shot and symptoms still on going. 4) shortness of breath-onset 1 week post second shot symptoms ongoing. 5) pitting edema in extremities-onset 1 week post 2nd shot symptoms still on going 6) numbness in extremities-onset 2 months post 2nd shot symptoms ongoing 7) joint/muscle pain-onset 2 months post 2nd shot symptoms ongoing. 8) dizziness/lightheaded-onset 1 month post 2nd shot symptoms ongoing

Other Meds: none

Current Illness: none

ID: 1794202
Sex: F
Age: 57
State: FL

Vax Date: 10/09/2021
Onset Date: 10/12/2021
Rec V Date: 10/17/2021
Hospital: Y

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

Lab Data: Cta 10/17 Us leg 10/17

Allergies: None

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

Symptoms: Sob wirh act. Worsened. Came to hosp and was dx with many PEs and right Leg dvt. No other obvious caus3

Other Meds: None

Current Illness: None

ID: 1794203
Sex: F
Age: 62
State: CO

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 10/17/2021
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:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient was given a dose of COVID 19 Pfizer vaccine but did not reveal that they previously got a COVID19 JJ vaccine on 3/3/21. Patient was given a COVID 19 Pfizer vaccine on 9/10/21 by a staff pharmacist . system flagged that patient needed a 2nd dose on 10/16/21. After checking state vaccine data base it was discovered that the patient previously gotten a JJ vaccine. After calling the patient, it was also discovered that the patient got a 1st dose of COVID 19 Pfizer vaccine on 8/19/21 a clinic for the Hospital. As of right now giving an mRNa vaccine after one dose of the COVID JJ vaccine is currently not approved .

Other Meds:

Current Illness:

ID: 1794204
Sex: F
Age: 75
State: NC

Vax Date: 08/26/2021
Onset Date: 08/27/2021
Rec V Date: 10/17/2021
Hospital:

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

Lab Data: Chest X-ray, head ct scan, cbc, bmp, hepatic function, egfr, troponin - all normal

Allergies: Compazine, aspirin, erythromycin,

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Diarrhea, nausea, chills, extreme headache, chest pain, elevated hr & bp - transported via ems to er..

Other Meds: Trazadone, melatonin, naturethoid, vita c, d3, q10, iodine, lutein, multivitamin, adrenal complex, adrenal cortex, chlorella, dim pro, pancreatin, wobenzyme

Current Illness: None

ID: 1794205
Sex: F
Age: 44
State: AL

Vax Date: 10/07/2021
Onset Date: 10/08/2021
Rec V Date: 10/17/2021
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: So far, only examination and prescription of Norco until adequate time after vaccine (I was told 14 days out) to receive steroids.

Allergies: Biaxin

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

Symptoms: The vaccine was given higher than usual deltoid IM injection. The next day after vaccine, began experiencing shooting, burning pain from left scapula to left elbow to left wrist. Experienced numbness/tingling to left 4th and 5th fingers and along left side of wrist. The pain awoke me from sleep and have had little to no relief using Ibuprofen, TENS unit, heat or ice as treatment. Since CDC said the side effects of vaccine may last 4 days or so, I waited it out and finally went to see doctor (at Dr's office ) on 10/16/21. I was examined and prescribed Norco for pain as it was too soon after vaccine to receive steroids.

Other Meds: multi-vitamin daily.

Current Illness: none

ID: 1794206
Sex: M
Age: 71
State: GA

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 10/17/2021
Hospital:

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

Lab Data: None

Allergies:

Symptom List: Nausea

Symptoms: Pt received a 3rd vaccine of moderna. Had previously received 2 vaccines of Pfizer. No ( signs or symptoms) adverse reactions thus far.

Other Meds:

Current Illness: Hypertension, Diabetes, hypokalemia ,polyneuropathy,

ID: 1794207
Sex: F
Age: 72
State: CA

Vax Date: 08/13/2021
Onset Date: 10/03/2021
Rec V Date: 10/17/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Pt in ER with an occluded left common femoral artery and origin of the left superficial femoral artery. Occluded left popliteal artery, anterior tibial artery, posterior tibial artery and peroneal artery. Placed on heparin drip

Other Meds:

Current Illness:

ID: 1794208
Sex: M
Age: 63
State: NC

Vax Date: 04/10/2021
Onset Date: 09/28/2021
Rec V Date: 10/17/2021
Hospital: Y

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

Lab Data: Ultra sound

Allergies: Hydrocodone

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

Symptoms: Blood clots in heart, lungs and legs. Currently being treated in hospital

Other Meds: Was told to stop certain meds prior to getting the vaccine.

Current Illness: Rheumatoid Arthritis and Type 2 Diabetic

ID: 1794209
Sex: M
Age: 61
State: CA

Vax Date: 03/12/2021
Onset Date: 09/20/2021
Rec V Date: 10/17/2021
Hospital:

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

Lab Data: 22Sep21: TSH <0.01; 22Sep21: Free T4=3.46; Total T3=2.8; TRAB=25.78; TSI-ARUP=15.00. 14Oct21: TSH<0.01; Free T4=1.5; Total T3=1.5 . My TSH numbers for the past decade are: Over the past decade my TSH has been (2.07, 2.49, 2.02, 1.68, 1.96, 2.41, 2.00).

Allergies: none

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

Symptoms: At time of the 2nd shot my body weight was 166 lbs. Over the next 7 months this has reduced to 155 lbs. On 20Sep21 at 4:30 AM. I awoke to a high heart rate (120 bpm), heart palpitations and arrhythmia (as noted on oximeter display). After blood tests I have been diagnosed with Grave's disease. On 26Sep21 I began a course of Methimazole, and metoprolol as needed. Given Vera-Lastra(2021 Thyroid 31.9 p.1436) paper, there is a finite probability that the vaccine may have played a role. BEFORE I get a booster, I would like to make sure the appropriate tests are done before/after so it can help the community understand if there is a correlation. I am a researcher and I understand the importance of collecting the correct information before/after a potential rare event to fully understand any correlations. Whatever I can do to help, let me know

Other Meds: loratadine

Current Illness: none

ID: 1794210
Sex: F
Age: 33
State: VA

Vax Date: 05/24/2021
Onset Date: 05/31/2021
Rec V Date: 10/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Pancreatic Elastase, Fecal test done at Lab

Allergies: NA

Symptom List: Tremor

Symptoms: FYI the PDF form has a glitch, it does not let me select my vaccine type in #17. I received COVID-19 PFIZER BioNTech. Extreme fatigue and abdominal pain. I will try to submit this online as well. Adverse events: Severe pain in Pancreas, Gallbladder and Liver area. After a sonogram, CT-SCAN w/contrast and fecal tests, I was diagnosed with Insufficient Pancreatic Enzyme, currently on CREAN (pancrelipase) 36,000.

Other Meds: NP Thyroid 90 mg, Magnesium Oxide 250 mg

Current Illness: NA

ID: 1794211
Sex: F
Age: 70
State: OH

Vax Date: 09/09/2021
Onset Date: 09/16/2021
Rec V Date: 10/17/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: 7 or 8 days after vaccine administration patient said a small rash developed around the injection site. It spread to bigger area. No blisters. It itched. It went away about a week later.

Other Meds:

Current Illness:

ID: 1794212
Sex: M
Age: 67
State: AZ

Vax Date: 02/21/2021
Onset Date: 09/15/2021
Rec V Date: 10/17/2021
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: MRIs X-rays ultra sounds ekg

Allergies: None

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

Symptoms: Never been sick more than twice in last 40 years. All of a sudden have blood clot and resultant pulmonary embolisms. In excellent health with no other conditions. Just my belief it is vaccine related and hospital staff agreed.

Other Meds: Nothing

Current Illness: None

ID: 1794213
Sex: M
Age: 48
State: SC

Vax Date: 10/17/2021
Onset Date: 10/17/2021
Rec V Date: 10/17/2021
Hospital:

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

Lab Data: UNKNOWN - PATIENT WAS TAKEN TO ER FOR HEAD/NECK EXAMINATION

Allergies: CODEINE ALLERGY - HE IS UNSURE OF REACTION

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

Symptoms: Patient presented for a 1st dose Moderna vaccine. Gave patient IMZ in IMZ room. As I was discussing and answering addtional questions and chatting with patients (about 5 minutes later), said he was starting to feel lightheaded and then immediately fell forward from the IMZ chair and passed out onto the floor, hitting his head pretty hard. He lost consiousness for about a minute and regained consiousness. Alerted my technician to call 911 due to the possibility of a concussion. Provided patient with an ice pack for his neck (offered drink and snack but EMS told us not to give any food/beverage until they arrived). Patient stay seated on the floor until EMS arrived. He said he felt fine and wife was very worried but he complained of headache, flushing/being hot, and neck pain. Patient wanted to sit instead of remain lying on the floor. EMS arrived - checked pulse, patient was fine - but they took him to local hospital to have his head and neck checked out. Symptoms before: said he was lightheaded. During: loss of consiousness, face turned red. After: headache, flushing, neck pain.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1794214
Sex: M
Age: 21
State: NC

Vax Date: 09/03/2021
Onset Date: 09/04/2021
Rec V Date: 10/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Beginning the day after injection of second Covid-19 Pfizer vaccine: Radiating pain and weakness in arm, neck, shoulder and side of, and opposite, injection site. Headache. Severe heart arrythmia and tachycardia. Chest pain. Chills. Difficulty breathing. Anxiety. Intense whole body joint pain. Two further (milder) episodes of arrythmia and tachycardia since then.

Other Meds:

Current Illness:

ID: 1794215
Sex: F
Age: 58
State: NV

Vax Date: 02/04/2021
Onset Date: 04/01/2021
Rec V Date: 10/17/2021
Hospital:

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

Lab Data: blood work 6/20/21, 08/18/21 Ultrasound of Thyroid 7/2/2021

Allergies: codeine, morphone

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

Symptoms: I developed hyperthyroidism, and then diagnosed with Graves Disease shortly after 2nd dose of Covid Vaccine.

Other Meds: vit E, Vit D, Vit C, Vit K, calcium, probiotic, zyrtec, avorstatin

Current Illness: just environmental allergies.

ID: 1794216
Sex: F
Age: 69
State: OH

Vax Date: 10/13/2021
Onset Date: 10/13/2021
Rec V Date: 10/17/2021
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: patient was vaccinated by a technician who inadvertently selected an expired vial and adminstered an inert dose.

Other Meds:

Current Illness:

ID: 1794218
Sex: M
Age: 37
State: IN

Vax Date: 10/15/2021
Onset Date: 10/17/2021
Rec V Date: 10/17/2021
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: Enlarged axillary lymph nodes, widespread hives on lt arm, chest, back and abdomen. OTC Benadryl 25mg po.

Other Meds: Acyclovir, multi vitamin, vitamin D, Rogaine topical

Current Illness: None

ID: 1794219
Sex: F
Age: 92
State: OH

Vax Date: 10/13/2021
Onset Date: 10/13/2021
Rec V Date: 10/17/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: patient was vaccinated by a technician who inadvertently selected an expired vial and adminstered an inert dose.

Other Meds:

Current Illness:

ID: 1794220
Sex: F
Age: 33
State: VA

Vax Date: 05/24/2021
Onset Date: 05/31/2021
Rec V Date: 10/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Pancreatic Elastase, Fecal

Allergies: N/A

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

Symptoms: On Monday, May 24th, 2021 I received my 2nd shot of Pfizer COVID-19 vaccine. Shortly after the second shot, I started having unexplainable stomach pains. The pain got so severe that I could not eat. On June 25th, 2021 I landed in the Emergency Room at the Hospital. In the ER, they did a full abdominal sonogram and they sent me home with pain killers and anti-nausea medication. I followed up with my Primary Care at hospital. I was prescribed Pantoprazole 40 mg. After 4 weeks, the pain got worse. I was prescribed 2 rounds of XIFAXAN half dose first, then a full dose of 550 mg. I was referred to a Gastroenterologist. I did a CT-SCAN with contract + colonoscopy. I did Fecal tests. I was diagnosed with insufficient Pancreatic Enzyme. I was prescribed CREON (pancrelipase)36,000 Enzymes. I still have pain in my Pancreas, Gallbladder, and Liver area and painkillers no longer bring relief. My gastroenterologist said that it is not clear whether if this is a COVID Vaccine side effect and we do not know, yet. He said if my pain doesn?t go away I need to see a neurologist. I missed about 4 weeks of my job as I had to take time off to recover. In addition, currently, I have persistent abdominal pain that is waxing and wanting, and I have nausea most of the day whether I eat or not. My Doctors ruled this is a new IBS-D (Irritable Bown Syndrome-Diarrhea). However, I did not have such symptoms before, and certainly not to this severity. Additional info: I am 5?2?, 145 Ibs, and I exercise every day. I have been a vegetarian since 2009 and am now a vegan. (I only consumed animal products for a few months in 2020 and 2021) and overall eat very healthy, nutritious and balanced. I wanted to report these events since they arise after my COVID Vaccine and wanted to see if there is a chance we could take a look into this, or if there are any other tests I could perform. I hope I can find relief. Thank you for reading my report. Best Regards

Other Meds: NP Thyroid 90 mg, Magnesium Oxide 250 mg

Current Illness: N/A

ID: 1794221
Sex: M
Age: 77
State: WA

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

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

Lab Data: n/a

Allergies: IVP dye

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

Symptoms: he reported that he felt lightheaded and also felt confused. HIs vitals were normal. It took about 80 minutes before he reported feeling back to normal. He was awake and interactive throughout, not tachycardic, was able to converse the whole time.

Other Meds: xtandi, glipizide, coumadin, metoprolol, zocor, torsemide, vitamin C, ferrous sulfate, albuterol HFAA

Current Illness: acute renal failure, covid pneumonia diagnosed SEpt 26 2021

ID: 1794222
Sex: F
Age: 26
State: VA

Vax Date: 08/30/2021
Onset Date: 09/05/2021
Rec V Date: 10/17/2021
Hospital:

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

Lab Data: Blood work was performed and it was normal.

Allergies: NONE

Symptom List: Vomiting

Symptoms: On August 30,2021, patient received her 1st Covid vaccine. 6 days later she began cramping. It continued til the 18th of September when she began bleeding. On the 19th she passed the baby at home (at 16 weeks) and went to ER where she passed the placenta. She was treated and sent home. Her due date was March 20th and a C-section was scheduled for the 13th.

Other Meds: PRENATAL VITAMINS

Current Illness: NONE

ID: 1794223
Sex: F
Age: 56
State: CA

Vax Date: 04/07/2021
Onset Date: 04/08/2021
Rec V Date: 10/17/2021
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:

Allergies: No known drug allergies

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient developed orthopnea, dyspnea on exertion, fatigue after receiving the Johnson & Johnson covid-19 vaccine. 1 week after the vaccine, she developed a profuse disseminated non-pruritic hyperpigmented rash that started on the hands and spread to the body, self-resolved. She had 2 episodes of pericarditis within 3-4 months of vaccine administration, once in July 2021 and once in August 2021. She developed bilateral transudative pleural effusions necessitating therapeutic thoracentesis. she also has thrombocytopenia and normocytic anemia that was not present prior to vaccine. She has been now diagnosed with renal thrombotic microangiopathy confirmed on biopsy, now in renal failure requiring hemodialysis. All labs related to thrombotic microangiopathy work-up for causes such as SLE, TTP has been negative. The thrombotic microangiopathy seems to be related to the vaccine or a potential malignancy as an incidental 2cm pancreatic head mass has been found that may be malignant.

Other Meds: Amlodipine 10mg qday, metoprolol tartrate 50mg BID

Current Illness: hypertension, eczema, chronic right knee pain, now found to have a 2cm pancreatic head mass that has not been biopsied or characterized

ID: 1794224
Sex: F
Age: 21
State: NM

Vax Date: 06/18/2021
Onset Date: 06/18/2021
Rec V Date: 10/17/2021
Hospital:

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

Lab Data: -

Allergies: -

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

Symptoms: Pain and edema on the area of application, it started 1 day after the vaccine administration. Pain in legs possible related to vaccine that started 1 hour after application

Other Meds: -

Current Illness: -

ID: 1794225
Sex: F
Age: 53
State: GA

Vax Date: 10/12/2021
Onset Date: 10/14/2021
Rec V Date: 10/17/2021
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: Pulse oximeter readings were 95-96 on room air, slight expiratory wheeze Today, 10/17, I continue to have intermittent shortness of breath whenever I move about. This is not normal for me- I am a registered nurse who works 12-hour shifts.

Allergies: Codeine, celebrex

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Shortness of breath, feelings of breathlessness (2 days, starting on 10/14/2021) Additionally, tiredness, malaise, aching in joints, soreness at injection site

Other Meds:

Current Illness: N/A

ID: 1794226
Sex: F
Age: 68
State: TN

Vax Date: 10/13/2021
Onset Date: 10/13/2021
Rec V Date: 10/17/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

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

Symptoms: Patient received Pfizer/BioTech COVID booster shot at approximately 12:30pm on 10/13/21. Patient stated that right arm was slightly sore and that she experienced some mild hallucinations the same evening. The next morning (10/14/21) she noticed what appeared to be an "X" on the right arm where the injection had been administered. She thought it may have been a contact irritation (mentioned possibly a latex reaction) but I advised the patient that we only use non-latex bandages and nitrile gloves during administration of vaccines. The patient continued to monitor the area which was warm to the touch, itchy and continued to grow in size. She presented mid-day to the pharmacy on 10/17/21 to ask the pharmacist their professional opinion of what to do about the reaction. The pharmacist advised the patient that the incident needed to be reported to VAERS for documentation but that the patient could treat the area locally with over the counter antihistamines (i.e. Benadryl, Claritin) and 1% Hydrocortisone. I advised the patient to draw around the borders of the rash to monitor the response to the OTC treatments and that as a precaution she should follow up with her PCP Monday morning 10/18/21.

Other Meds: Adderall 30mg three times daily, Vyvanse 70mg - one per day , Motegrity 2mg one per day, Rosuvastatin 5mg once daily.

Current Illness: None documented

ID: 1794227
Sex: F
Age: 51
State: FL

Vax Date: 09/20/2021
Onset Date: 09/23/2021
Rec V Date: 10/17/2021
Hospital:

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

Lab Data:

Allergies: Nkda

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

Symptoms: Daily headaches, including migraines with visual disturbances.

Other Meds: Naturethroid, claritin, pepcid

Current Illness: N/A

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am