VAERS 2021 Database www.vaers.hhs.gov

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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: 1794951
Sex: F
Age: 54
State: IA

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data:

Allergies: NKA

Symptom List: Dysphagia, Epiglottitis

Symptoms: Rash started at injection site with in an hour of receiving vaccine, patient later experienced nausea and shortness of breath. patient is still having issues with shortness of breath while going up stairs

Other Meds: Vitamin C, Vitamin D3, Zinc

Current Illness: None

ID: 1794952
Sex: M
Age: 24
State: MN

Vax Date: 10/18/2021
Onset Date: 10/18/2021
Rec V Date: 10/18/2021
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:

Symptom List: Anxiety, Dyspnoea

Symptoms: Received booster dose of Pfizer vaccine when original series was Moderna.

Other Meds:

Current Illness:

ID: 1794953
Sex: M
Age: 64
State: IL

Vax Date: 03/15/2021
Onset Date: 10/16/2021
Rec V Date: 10/18/2021
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: N/A

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

Symptoms: Presents to the ED for evaluation of fall. Tested positive for COVID on admission 10/16/2021

Other Meds: N/A

Current Illness: N/A

ID: 1794954
Sex: F
Age: 80
State: FL

Vax Date: 10/15/2021
Onset Date: 10/18/2021
Rec V Date: 10/18/2021
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: Injection site is red, inflamed, and warm to the touch down to below the elbow, the primary care provider has been contacted.

Other Meds:

Current Illness:

ID: 1794955
Sex: M
Age: 58
State: FL

Vax Date: 08/02/2021
Onset Date: 08/09/2021
Rec V Date: 10/18/2021
Hospital: Y

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

Lab Data: Covid test

Allergies: Phenergan

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

Symptoms: Pt came to ER c/o low oxygen reading at home, SOB, productive.

Other Meds:

Current Illness:

ID: 1794956
Sex: M
Age: 59
State: MI

Vax Date: 09/10/2021
Onset Date: 09/17/2021
Rec V Date: 10/18/2021
Hospital: Y

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: 10/7/2021 note: 10/6/21: new right pneumothorax, improving GGO bilaterally, worsening consolidative changes, no PE 10/7/21: chest tube placed for worsening pneumothorax, intubated and started on MV Plan: Start IV diuresis Start Broad spectrum Abx pending bronch cultures given elevation in WBC and procalcitonin Start Inhaled Veletri Obtain echocardiogram Patient has single organ failure currently, His case was discussed with ECMO staff, CTCCU unable to offer ECMO due to lack of circuits Continue to monitor. We are still able to effectively ventilate. 10/13/2021 note: COVID PNA Remdesivir 9/21-9/25 Previously on dexamethasone; currently on Solumedrol 40mg q 12 hours MRSA screen negative Pseudomonas pneumonia Cx (+) on 10/7 BAL, resistant to meropenem and ceftazidime Small Right Pneumothorax - s/p right chest tube 10/7 Pneumomediastinum CXR 10/9 showed 1.4 cm right apical PTX - CT was not tidalling, chest tube flushed F/u CXR showed PTX apparently resolved 10/17/2021 note: Acute Respiratory Failure w/Hypoxemia ETT 10/7-Present NMB 10/7- Present, failed paralytic wean 10/14 Prone 10/7-10/12 Inhaled Veletri 10/7-10/14, restarted 10/16- present with some improvement in pO2 Lung protective ventilation, 6 ml/kg PBW = 438 Steroid taper changed to methylpred 60mg IV BID 10/15, decrease to 30mg BID 10/17 Beta d glucan and aspergillus negative Bilateral upper and lower extremity ultrasounds 10/13 (+) right cephalic vein superficial thrombophlebitis CT angio thorax 10/15 negative for PE, widespread peripheral fibrotic changes and patchy consolidative disease COVID PNA Remdesivir 9/21-9/25

Allergies: Penicillin

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

Symptoms: Hospitalized 09/21/2021; COVID-19 positive 09/17/2021; fully vaccinated Admission note 09/21/2021: ASSESSMENT Principal Problem: Pneumonia due to COVID-19 virus Pertinent Results: - CT angio thorax Showed 1. Negative for pulmonary embolism. 2. Redemonstration of chronic bilateral pulmonary infiltrates which have pattern that can be seen in the setting of Wegener's granulomatosis. Patient on 6 L nasal cannula without respiratory distress. Procalcitonin elevated at 0.33 Normal white blood cell count Normal lactic acid Mildly elevated AST and ALT; normal bili. Plan: continue close monitoring and continuous pulse ox; wean oxygen as tolerated to maintain saturations greater than 92%. continue Decadron for total of 10 days. continue remdesivir x5 days. low threshold to consider coverage for bacterial pneumonia patient worsens clinically or develops productive cough; patient states that his current cough is dry and nonproductive. consider benefit pulm consult tomorrow if patient worsens clinically requires more oxygen support dresser given history of granulomatosis with polyangiitis trend COVID inflammatory labs including a complete blood count, CRP, D-dimer also trend AST and ALT with repeat CMP tomorrow morning Note from 09/25/2021: Acute hypoxic respiratory failure - stable COVID pneumonia COVID positive 9/17 w/ symptom onset around 9/10. CT angio thorax consistent with COVID w/ also chronic pulmonary infiltrates seen with GPA, negative for PE. Worsening respiratory status since admission requiring BiPAP and transfer to ICU on 9/22. Now remains stable on HFNC with slightly decreased oxygen reuirements. -steroids increased to 20 mg for 5 days, then 10 mg for 5 days - 3 days of azithromycin complete, Day 3/5 of CTX -CRP trending down, DD trending up, will monitor -low threshold for intubation -Remdesivir ordered -self proning encouraged and patient completing successfully -MICU on consult, trend COVID labs, lovenox DVT ppx 09/28/2021 note: Worsening respiratory status since admission requiring BiPAP and transfer to ICU on 9/22-23 but he was not intubated and then transferred back to the floor. 3 days of azithromycin complete, 5 days of CTX completed 9/26. Remdesivir completed x5 days 9/25. Plan: CTA thorax 9/27 demonstrated worsening of bilateral consolidations. Will change steroids to Solu-medrol 30mg BID and add PCP ppx with bactrim D dimer increasing (4k to 12k), will repeat today and if continuing to increase would consider evaluation of upper extremities with dopplers. self prone as able will obtain ABG now to evaluate patient's oxygenation status, patient currently appears comfortable and is saturating high 90s with high-flow nasal cannula and non-rebreather. No current need for intubation however patient is very high risk. Would avoid BiPAP given his pneumomediastinum. Pneumomediastinum Noted on CTA thorax 9/27. Likely 2/2 COVID/ARDS. Free air present in the anterior mediastinum and left hilum. No evidence of esophageal or tracheal perforation on CTA. Plan: daily CXR, repeat CXR today shows widening of the mediastinum consistent with known pneumomediastinum. no need for antibiotics at this time Additional note on 09/28/2021: Since transfer out of ICU, patient had worsening O2 requirements last night with tachypnea and HFNC 100% FiO2 a/ NRB so was transferred back to the ICU. Since ICU transfer, has been stable and does not appear to be in any respiratory distress. steroids increased to Solumedrol 40 mg q8 hours Restarted on antibiotics: Vanc/Cefepime for empiric coverage 10/1/2021 note: Since GPA is not likely large contributing factor, will start to wean from steroids starting with 40 mg methylprednisolone BID for 3 days followed by 40 mg daily for 3 days and then will discontinue steroids. Continue PCP ppx with bactrim until off steroids. Continue cefepime through 10/4 for a total of 7 days Encourage patient to self-prone as tolerated Patient continues to require high flow and nonrebreather with 60 L O2 and 100% FiO2. Wean as tolerated with goal of >90% O2 saturation.

Other Meds: acetaminophen (TYLENOL) 500 MG tablet calcium carbonate (TUMS) 500 MG chewable tablet enalapril (VASOTEC) 10 MG tablet folic acid (FOLVITE) 1 MG tablet ibuprofen (MOTRIN) 200 MG tablet metoprolol succinate-XL (TOPROL-XL) 25 MG 24 hr tablet

Current Illness:

ID: 1794957
Sex: M
Age: 70
State: VA

Vax Date: 10/16/2021
Onset Date: 10/17/2021
Rec V Date: 10/18/2021
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: No Known Allergies

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient was given 2 Pfizer COVID vaccine doses instead of one Pfizer COVID vaccine and one Flu vaccine dose.

Other Meds: Unknown

Current Illness: Unknown

Date Died: 10/04/2021

ID: 1794958
Sex: M
Age: 69
State: FL

Vax Date: 09/16/2021
Onset Date: 09/20/2021
Rec V Date: 10/18/2021
Hospital: Y

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

Lab Data: SARS-CoV2 RT-PCR Positive 09/24/2021 SARS-CoV2 RT-PCR Positive 09/27/2021 SARS-COV2 IgG N Negative 09/27/2021 SARS-COV2 IgG N S/C Index 0.77 09/27/2021

Allergies: NKA

Symptom List: Pharyngeal swelling

Symptoms: Fever, diarrhea, shortness of breath, weak. Went to hospital, tested positive for Covid-19 and died.

Other Meds:

Current Illness: Hypertension, Diabetes, Afib, Cerebral infarction

ID: 1794959
Sex: F
Age: 70
State: KY

Vax Date: 12/29/2020
Onset Date: 10/09/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Tested Positive for Covid

Other Meds:

Current Illness:

Date Died: 10/14/2021

ID: 1794960
Sex: F
Age: 59
State:

Vax Date: 09/20/2021
Onset Date: 10/08/2021
Rec V Date: 10/18/2021
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: CK = 12,945 on 10/8, decreased to 6,210 on 10/14 Creatinine = 1.3 on 10/8, increased to 1.8 on 10/14

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: 10/8/2021 - Patient c/o fatigue, inability to walk, decreased appetite, fever, chills, and low back pain. Noted CK is elevated (> 12,000). A CT scan was also done and showed colitis. Patient is admitted with rhabdomyolysis (possibly due to the COVID vaccine of which the second dose was given on 9/20/2021) and colitis. Note that she has a PMH of rhabdomyolysis from April 2021. Patient was admitted to the hospital from 4/30 to 5/19/2021 with rhabdomyolysis and her first COVID vaccine was given on 4/2/2021. Patient was given IV fluids and continued on the levofloxacin which was started on 10/5/2021 for sinusitis. 10/10/2021: Patient became hypotensive, was given fluid boluses, transferred to the ICU and started on pressors. 10/11/2021: C. diff pCR test came back positive and antibiotics were changed to oral vancomycin and IV metronidazole 10/12/2021: Patient was intubated; coffee ground emesis from OGT after intubation and patient was transfused with PRBCs 10/13/2021: Hemodynamics worsened, patient developed acute renal failure. CRRT was ordered, but never started due to instability 10/14/2021: Patient made comfort measure and expired

Other Meds: Alprazolam, ASA, Clopidogrel, Levofloxacin, Rosuvastatin, Trelegy Ellipta, Verapamil

Current Illness: None

ID: 1794961
Sex: F
Age: 33
State: NH

Vax Date: 04/12/2021
Onset Date: 04/15/2021
Rec V Date: 10/18/2021
Hospital: Y

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

Lab Data: Date of Study: 9/24/2021 Autonomic Testing Reason for study: Question small fiber or autonomic neuropathy; postural orthostasis Heart rate, deep breathing: Normal heart rate variability for age with the average difference of 5 cycles being 19 beats per minute. Valsalva maneuver: Normal Valsalva ratio of 1.9. Normal blood pressure response to the Valsalva maneuver. Tilt study: 5 minutes of continuous blood pressure and heart rate monitoring were performed with the patient in a supine position. Thereafter, the patient was elevated to a 70? heads up tilt position for 10 minutes, then subsequently returned to a supine position for an additional 5 minutes of recording. The baseline heart rate fluctuated between 90-95 bpm, increasing to 120-125 bpm during the tilt. There was no associated change in blood pressure. Quantitative sweat test: Reduced total sweat production from the proximal leg and distal leg. Normal total sweat production from the forearm and foot sites. Clinical correlation: Abnormal autonomic studies, reflecting dysfunction of the sympathetic sudomotor fibers. Additionally, the tilt examination is abnormal, with a pattern suggestive of the postural orthostatic tachycardia syndrome. Of note, such findings can be seen within the context of a small fiber or autonomic neuropathy.

Allergies: codeine/morphine - nausea/vomiting

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

Symptoms: Initially started as feverish feeling, generalized weakness and fatigue. Went to local ED ~8 times and initially diagnosed with dehydration and hypokalemia. Came to Hospital on 7/24/21 for 2nd opinion. found to have severe orthostatic hypotension with palpitations meeting POTs criteria. seen by endocrine, neurology, cardiology and discharged after few weeks on potassium replacement and to increase hydration. Autonomic function test done in 9/2021 shows signs suggestive for POTS and autonomic dysfunction of sympathetic sudomotor fibers. Possible in small fiber or autonomic neuropathy.

Other Meds: Levothyroxine 75mcg daily. on and off multivitamins

Current Illness: none

ID: 1794962
Sex: M
Age: 43
State: IN

Vax Date: 10/16/2021
Onset Date: 10/18/2021
Rec V Date: 10/18/2021
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: Achy, flu like, feeling run down, head ache (which I rarely get),hot and sweaty. However, I can still function and work. Just feel awfully run down.

Other Meds:

Current Illness:

ID: 1794963
Sex: F
Age: 38
State: IA

Vax Date: 08/25/2021
Onset Date: 09/15/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: CT head/brain w/o contrast, EKG, CBC w/diff, CMP, TSH, D-Dimer, and urine drug screen on 09/15/2021

Allergies: penicillin

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

Symptoms: patient went to ER for pain behind right knee that extended up to her thigh with intermittent numbness/tingling of lower leg, patient also having bilateral numbness/tingling, dx with peripheral neuritis

Other Meds: Ubrelvy 50mg, Gabapentin 300mg tid, Tri-Lo-Mili

Current Illness: none

ID: 1794964
Sex: M
Age: 69
State: NY

Vax Date: 04/03/2021
Onset Date: 04/01/2021
Rec V Date: 10/18/2021
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: X-Rays (04/2021-10/2021) Blood Work (06/2021)

Allergies: Anti-Inflammation Medications

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

Symptoms: Pt. states that after receiving the 2nd dose of Moderna 04/03/2021, started experiencing symptoms mid-04/2021 of fatigue, numbness in the hands (both), pain in the tendons with inflammation, and pain at the injection site. Primary visits (estimated 4 visits unknown) X-Rays preformed and determined age-related. X-ray preformed again *2 weeks ago stated (still determined age-related) Blood Work preformed with Markers for Inflammation. Still continuing to experience symptoms.

Other Meds: Omeprazole 20mg

Current Illness: N/A

ID: 1794965
Sex: M
Age: 41
State: OH

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 10/18/2021
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: Extreme chills and shaking for several hours followed by three days of fatigue, body and headaches.

Other Meds: none

Current Illness: none

ID: 1794966
Sex: F
Age: 59
State: MI

Vax Date: 09/15/2021
Onset Date: 09/15/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: COVID - NEGATIVE

Allergies: Zomax.

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

Symptoms: Swelling of throat and face, hives, took 2 Benadryl.

Other Meds: None.

Current Illness:

ID: 1794967
Sex: F
Age: 29
State: WA

Vax Date: 10/14/2021
Onset Date: 10/14/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: Negative covid test, administered 10/16

Allergies: latex

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

Symptoms: 9 hours after injection, all-over body exhaustion 10 hours after injection, convulsion-like chills & fever of 103.9 24 hours after injection, pressure on chest (like someone firmly pressing a hand into the center of my chest, affecting my breathing) and a cough develop 48 hours after injection, non-stop sneezing develops

Other Meds: lamictal, oral birth control

Current Illness:

ID: 1794968
Sex: F
Age: 33
State: MN

Vax Date: 01/30/2021
Onset Date: 10/15/2021
Rec V Date: 10/18/2021
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: Tested NAAT positive for COVID 10/15/21 after being fully vaccinated.

Other Meds:

Current Illness:

ID: 1794969
Sex: F
Age: 35
State: PA

Vax Date: 02/06/2021
Onset Date: 02/06/2021
Rec V Date: 10/18/2021
Hospital: Y

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

Lab Data: Lab work-D dimer elevated, Urine was abnormal CT Scan-Clot in lung Right lower lung and lung damage infarction Bilateral Doppler series- showed clot in left calf Echocardiogram -normal

Allergies: morphine, latex, penicillin, Lamictal, zelnorm, avalox, ancef, clindamycin,

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Shortly after I got my shot within 2 hours it started with body aches, fever 101, headaches, chest tightness for about 4 days. I was taking Tylenol, magnesium, zinc, vitamin c, and was using nebulizer. It felt like I had covid all over again. In beginning of June, I had trouble breathing, my breathing been of since my vaccines. I was rushed to Hospital after I went to Urgent Care, I had a blood clot in my leg and a blood clot in my lung with lung damage. They put me on oxygen, ran test, Heparin drip, antibiotics, Lovenox injections. I went home after 2 days with nursing services for 6 to 8 weeks. I was bed ridden with oxygen, I still have oxygen. I have been off blood thinners for a month and I have to be retested to see if i can go completely off of them or be put back on them.

Other Meds: Protonix, Topamax, Valtrex, Zanaflex, marinol, quanapin, Lyrica, metformin, Seroquel extended release, Phenergan, Zyrtec, singular, Flovent, ProAir.

Current Illness: none

ID: 1794970
Sex: F
Age: 48
State: KY

Vax Date: 02/03/2021
Onset Date: 10/12/2021
Rec V Date: 10/18/2021
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: Tested Positive for Covid

Other Meds:

Current Illness:

ID: 1794971
Sex: M
Age: 34
State: PR

Vax Date: 05/13/2021
Onset Date: 06/13/2021
Rec V Date: 10/18/2021
Hospital: Y

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: Troponin test; stress test; radiology, nuclear medicine; echocardiogram; EKG; blood work. The first diagnosis was chest pain. The final diagnosis was Angina Instable.

Allergies: None

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

Symptoms: After first dose, 10 mins, I started getting dizzy and feeling weird. I had to sit down because I almost fell. I felt my heart racing. That lasted for a couple of minutes. After the second dose, I did not feel anything right away but at night I felt like I had a fever and fatigue. The next day they all went away. Then, like a month after I felt something weird in my heart. It felt like some tingling. It was on and off. I waited for a month. Then, I went to get some medical tests done and they came back abnormal. They sent me to the hospital and I was admitted. I was hospitalized for a week. They did troponin test, stress test, radiology, nuclear medicine, echocardiogram, EKG, blood work. The first diagnosis was chest pain. The final diagnosis was Angina Instable. They prescribed me Metoprolol. Sometimes I still feel the tingling but not very often.

Other Meds: None

Current Illness: None

ID: 1794972
Sex: F
Age: 41
State: TX

Vax Date: 09/17/2021
Onset Date: 10/17/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: 10/3/2021 -ER Bloodwork was elevated white blood cells, EUN - low, criacnin was low, potassium was low. PNI - 0.05 Chest Xray - normal CT Scan - normal 10/12/2021 Bloodworks - Normal. PNI 0.05, CL was high. criacnin was low, potassium was a little low again Chest Xray - normal

Allergies: mushrooms , cephalosporins

Symptom List: Unevaluable event

Symptoms: Right after the vaccine I felt dizzy, confused and couldn't catch my breathe and very nauseas and a headache. I also felt the same after my 1st dose but it want as bad. The 2nd it hit immediately. I was struggling more than my typical migraine. The week before last, my heart was pounding and the felt arm was tingling and hurting and checked my BP and was out range Went to the ER 10/3/2021 and 10/12/2021 ,last week chest pains, left arm was arm, a little into my neck . Hypokalemia, 2nd ER visit- I was resting, all of the sudden, I had pressure and pain in my chest. Called EMT from home - elevated BP 156/111 in hospital. Went to ER, kept overnight for observation. I had headache, nauseas and super dizzy. I still feel extreme fatigue, nauseous and hard time concentrating .I am having a really hard time at work in nursing school.

Other Meds: modafanil (last evening), nurtec (last nigh before),

Current Illness: no

ID: 1794973
Sex: F
Age: 43
State: CA

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

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

Lab Data: none

Allergies: sulfonamides - anaphylaxis; clarithromycin - rash

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

Symptoms: Injection site reaction, still ongoing as of 10/18/21, still not resolved. Area directly below injection site is warm, and initially very tender, although tenderness is slowly improving and now starting to itch. No tracking, area is localized but not sharply demarcated. Area is hard. Plan to start icing the area as still unresolved after almost 3 days. Area is roughly 10 cm x 4 cm Area was examined by husband (who is an ID physician) to ensure was not extravasation of product or cellulitis (confirmed only injection site reaction). Pt has also had angioedema reactions to mosquito bites, and severe redness (w/o induration) with PPD shots over time, so may have skin hypersensitivity to certain agents. Reaction did not occur with 1st 2 COVID vaccines

Other Meds: fluticasone nasal spray, Vit D 5000 units, omeprazole 40 mg, Apri (birth control), AHCC 1500 mg, ibuprofen 400-600 mg q6h prn

Current Illness: none

ID: 1794974
Sex: M
Age: 30
State: FL

Vax Date: 10/17/2021
Onset Date: 10/18/2021
Rec V Date: 10/18/2021
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: none

Symptom List: Injection site pain, Pain

Symptoms: Chest Pain, shortness of breath, and headache

Other Meds: none

Current Illness: none

ID: 1794975
Sex: F
Age: 56
State: OH

Vax Date: 04/14/2021
Onset Date: 04/16/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: No

Allergies: Amoxicillin; yellow dye 5

Symptom List: Injection site pain, Menorrhagia

Symptoms: My arm was extremely swollen and had a reddish pink rash that extended beyond a 3inch square. On Monday 4/19, I contacted my allergy doctor. I was prescribed prednisone. I took that for a week and all symptoms resolved.

Other Meds: Between 2nd and 3rd round Chemo (during month of April); steroids; ibuprofen; acetaminophen; magnesium; S CLARITIN; RESTASIS; olopatadine

Current Illness:

ID: 1794976
Sex: M
Age: 83
State: MN

Vax Date: 03/06/2021
Onset Date: 10/15/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data:

Allergies: Please contact patient's primary care provider for further questions.

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

Symptoms: Patient vaccinated for and then tested positive for COVID-19.

Other Meds: Please contact patient's primary care provider for further questions.

Current Illness: Please contact patient's primary care provider for further questions.

ID: 1794977
Sex: F
Age: 31
State: CA

Vax Date: 05/01/2021
Onset Date: 05/01/2021
Rec V Date: 10/18/2021
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: IgE Egg whites collected 9/30/21 results delivered 10/5/21

Allergies: none at the time

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: After receiving Covid vaccine I developed an allergy to egg whites. This was confirmed with food allergy testing. Allergy was not present prior to the vaccine.

Other Meds: daily vitamin

Current Illness: none

ID: 1794978
Sex: F
Age: 48
State:

Vax Date: 08/02/2021
Onset Date: 08/27/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data:

Allergies: penicillin, bactrim

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Heavier than usual menstrual bleeding. Cycle doubled in length from typical 8 days to 16 days. More days with an occurrence of menstrual blood clots including later days in the cycle (12 and 13). Subsequent cycle was also unusually long 15 days with clots for 12 days. Current "normal" periods for patient are 7 to 9 days with clots seen 3 or 4 days.

Other Meds: iron and vitamin D supplements

Current Illness:

ID: 1794979
Sex: F
Age: 35
State: CO

Vax Date: 09/09/2021
Onset Date: 09/23/2021
Rec V Date: 10/18/2021
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: None

Allergies: Shellfish products

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

Symptoms: Received Moderna on 09/23/21 at which time she experienced shortness of breath, chest tightness, palpitations and wheezing. Led to multiple medical visits. Then received 2nd injection of Pfizer, at the instruction of allergy specialist. W/in 25 minutes of administration, developed SOB, wheezing, chest tightness, hoarseness, difficulty swallowing and lymphadenopathy in the neck. This led to multiple medical visits including emergency room visit. Her symptoms are managed only with high-dose steroids.

Other Meds: Mobic, Phentemine, Norgestimate-ethinyl estradiol, Avidoxy, Retin-A, Pepcid, Zyrtic

Current Illness: None

ID: 1794980
Sex: F
Age: 57
State: IL

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

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

Lab Data:

Allergies: none

Symptom List: Nausea

Symptoms: I was supposed to get a Flu shot, and the pharmacy gave me a fourth dose of phizer covid 19 vaccine instead. Starting the night of the vaccine I had diarrhea, I had nausea, headache

Other Meds:

Current Illness: none

ID: 1794981
Sex: F
Age: 52
State: CO

Vax Date: 10/12/2021
Onset Date: 10/19/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: none yet

Allergies: none

Symptom List: Injection site pain

Symptoms: I received the moderna covid vaccine in my left arm from pharmacy on Oct 12th. The injection did cause me quite a bit of pain. Since then I?ve had very bad and consistent pain, mainly in the upper left side of my back. The pain became worse 2 days after and hasn?t let up, making it difficult to relax, sleep, sit...just about everything. At times the pain even shoots down as far as my left foot. On Oct 18th (today's date) I tried getting an appointment with my health care facility but haven't been successful you...but I'll continue trying.

Other Meds: none

Current Illness: none

ID: 1794982
Sex: F
Age: 76
State: NY

Vax Date: 05/14/2021
Onset Date: 06/01/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: yes 3 MRIs- xrays

Allergies: penicillin, x-ray dye

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

Symptoms: Couldn't get out of bed. Left part of her body became paralyzed. She has bad pain if she tries to raise both arms up. Pain in the back of her neck.

Other Meds:

Current Illness: no

ID: 1794983
Sex: F
Age: 23
State: LA

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

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

Lab Data:

Allergies:

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

Symptoms: Numbness in arm after vaccine after waiting the 15 minutes. Patient went to MD to get it checked out

Other Meds:

Current Illness:

ID: 1794984
Sex: F
Age: 27
State: CT

Vax Date: 04/16/2021
Onset Date: 04/18/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: EKG, Chest XRay and Ultrasound on 4/18/21 at hospital Bloodwork - Do not recall exact date, was ordered by primary care and rheumatologist

Allergies: Biaxen allergen Sensitivity to ricotta cheese

Symptom List: Tremor

Symptoms: Had COVID-19 positive test on 3/1/21. Isolated 10 days and was cleared to get vaccine due to mild symptoms (described earlier) and clearance of symptoms by first date of vaccine appointment on 3/19/21. First vaccine 3/19/21. Noticed some discomfort in chest after this date such as tightness (left side only) that could be alleviated if I twisted my body a certain way and would almost make a "pop" like cracking knuckle would. (I did not experience this at all during isolation period and do not recall if I noticed it at all in days between isolation ending and first vaccine since it was about 10 days apart). Had second dose 4/16/21. Was in bed with side effects (tired, sore arm, fever) on 4/17/21. On 4/18/21 I noticed that I could not take full deep breaths easily and still noticed discomfort in my chest. I went to an urgent care and they referred me to an Emergency Room. I was there for several hours. Chest XRay/ultrasound/EKG all normal and sent home told it may be costochondritis and to take ibuprofen for discomfort/inflammation. Symptoms did not improve with time and ibuprofen. Had an appointment with a Rheumatologist who confirmed suspicion based on symptoms of Costochondritis. Ordered bloodwork (all normal) and prescribed diclofenac topical gel when chest is tender and 7.5 mg meloxicam for inflammation. After 1 month, upped to 15mg meloxicam which helped alot. Been on this medication for several months. Back to 7.5mg as of 10/10/21 to try to wean off medication since symptoms have improved (but not ceased) since onset.

Other Meds: Mirena IUD, Vitamin E supplement, Womens Multivitamin

Current Illness: Had COVID-19 (minor symptoms) in Feb/March. Felt sick 2/27/21 (congestion, headache, tired) and felt fine when I woke up on 2/28/21. Got tested anyways on 3/1/21 and tested positive 3/1/21. Isolated 10 days. Had no difficulty breathing, fever, cough, major congestion, had some minor headache, loss smell/taste on day 8. Had itchy knees/elbows on day 9.

ID: 1794985
Sex: F
Age: 26
State:

Vax Date: 10/12/2021
Onset Date: 10/12/2021
Rec V Date: 10/18/2021
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: Bactrim

Symptom List: Erythema, Pruritus

Symptoms: Acute hearing loss. Feeling of fullness in my left ear with partial hearing loss. Began experiencing it a few hours after vaccine administration. Nothing else in my day could have explained the hearing loss. Pseudoephedrine, naproxen, and tylenol have not helped. Nothing has helped to relieve it. I called the nurse triage line a few days after the event and they suggested pseudoephedrine and to call back the next week if things have not resolved.

Other Meds: Junel

Current Illness: None

ID: 1794986
Sex: F
Age: 39
State: MN

Vax Date: 03/24/2021
Onset Date: 10/15/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Tested NAAT positive for COVID 10/15/21 after being fully vaccinated.

Other Meds:

Current Illness:

Date Died: 10/08/2021

ID: 1794987
Sex: M
Age: 65
State: TN

Vax Date: 03/06/2021
Onset Date: 09/30/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: Positive COVID-19 test

Allergies: No known allergies

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

Symptoms: Patient expired from COVID-19 on 10/8/21 after being vaccinated

Other Meds: Acalabrutinib, Atorvastatin, Benazepril/HCTZ, Naproxen, Pantoprazole, Mirabegron

Current Illness: unknown

ID: 1794988
Sex: F
Age: 47
State: IL

Vax Date: 10/16/2021
Onset Date: 10/16/2021
Rec V Date: 10/18/2021
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 - my doctors are useless and can't seem to agree on what I should do. Same idiots who refused to give me a medical exemption so...

Allergies: azithromycin flu vaccines preservatives bananas oranges Most lotions, detergents, perfumes, deodorants, and cleaning products

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Minor tongue and lip swelling occurred within minutes. I was monitored for 30 minutes and swelling didn't appear life threatening. 2 hours after vaccination I broke out in hives and my blood pressure dropped significantly. Since then, I have been taking Benadryl regularly to control hives and tongue/lip swelling. Additionally, I have stopped my blood pressure medication due to my blood pressure jumping from very low (68.42 at the lowest) to normal range (115/76 highest). This has resulted in severe dizziness. Primary doctor advised this morning (Monday - 2 days after shot) to simply monitor blood pressure and continue taking Benadryl. Allergist advised going to ER due to blood pressure. Neither is willing to change their vote... As I'm currently handling all symptoms, I'm choosing to skip the ER for now unless I have another extreme drop in BP. I also had the "normal" vaccine reactions of severe headache, body aches, and fever.

Other Meds: Amlodipine (5 mg once a day) Allegra (180 mg once a day) Lexapro (10 mg once day) - began taking this medication as a result of panic attacks due to being forced to take the COVID vaccine despite known reaction to flu vaccine. Iron Suppleme

Current Illness: None

ID: 1794989
Sex: M
Age: 26
State: NC

Vax Date: 10/16/2021
Onset Date: 10/16/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data:

Allergies: PENICILLIN

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

Symptoms: Patient fainted around 5 minutes after injection. Patient has a history of fainting with injections dating back to pre-adolescence. Pharmacist asked patient to please plan to stay 30 minutes instead of the usual 15 due to history. Patient's mother was present, just in case he fainted. Patient seemed fine with injection and pharmacist sat with him first 5 minutes after to make sure. Almost immediately after the pharmacist walked away, patient fell over in chair in waiting area. Patient completely lost consciousness for less than a minute.

Other Meds: NONE KNOWN

Current Illness: NONE KNOWN

ID: 1794990
Sex: M
Age: 11
State: TX

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: NONE

Allergies: NOT REPORTED

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

Symptoms: RECEIVED VACCINE AS 11 YEAR OLD. UNDERAGED.

Other Meds: NOT REPORTED

Current Illness: POSITIVE FOR COVID-19 ILLNESS. DATE UNKNOWN.

ID: 1794991
Sex: F
Age: 69
State: SC

Vax Date: 03/17/2021
Onset Date: 03/31/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: No

Allergies: Codeine, sulfur

Symptom List: Pain in extremity

Symptoms: I experienced loss of hearing in my left ear. Went to ER, there was fluid behind my ear drum.

Other Meds: Vitamins

Current Illness: No

ID: 1794992
Sex: F
Age: 70
State: IL

Vax Date: 02/18/2021
Onset Date: 10/17/2021
Rec V Date: 10/18/2021
Hospital: Y

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

Lab Data: CHEST X-RAYS, LABS- NO SIGNIFICANT RESULT

Allergies: N/A

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

Symptoms: SHORTNESS OF BREATH

Other Meds: N/A

Current Illness:

ID: 1794993
Sex: F
Age: 79
State:

Vax Date: 10/18/2021
Onset Date: 10/18/2021
Rec V Date: 10/18/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: tingling of lips and tongue, had trouble swallowing (no trouble breathing)

Other Meds:

Current Illness:

Date Died: 10/17/2021

ID: 1794994
Sex: M
Age: 67
State: DE

Vax Date: 10/14/2021
Onset Date: 10/17/2021
Rec V Date: 10/18/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: Informed of cardia event and dealth 10/17/2021

Other Meds:

Current Illness:

ID: 1794995
Sex: F
Age: 53
State: CA

Vax Date: 09/19/2021
Onset Date: 09/20/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: No additional tests

Allergies: Sulfa, keflex antibotics - Also unknown - Doctors unable to determine

Symptom List: Vomiting

Symptoms: Monday AM (swelling in right armpit, right side of face looked odd - slightly puffy/stiff) Tuesday AM (swelling increased still in right armpit, uncomfortable, facte still off) Wednesday AM (swelling still in right armpit, slight decrease, ache developed in right shoulder along collarbone area to right side of neck, tickle on right side of throat and numbness/tingling on right side of mouth. Right side of face more stiff and when I tried to smile, right side of mouth would not turn up. I would try to force it and right side would quiver and shake. Sent notice to my primary and was advised to call 911 if emergency or get a face to face with urgent care. Went to urgent care and was diagnosed with slight case of Bell's Palsy, was prescribed Deltasone & Valtrex. I did NOT take either drug. Over the course of the next week, armpit swelling reduced and face puffiness/stiffness seem to subside. Have tightness on right side when I force mouth movement to right side .

Other Meds: None

Current Illness: None

ID: 1794996
Sex: F
Age: 59
State: IN

Vax Date: 08/26/2021
Onset Date: 09/02/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: N/A

Allergies: N/A

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Pt. states that after receiving the 1st dose of Phizer 08/26/2021, started experiencing symptoms 09/02/2021 of headaches, fatigue, and weakness. Neurologist appt. scheduled 11/12/2021. Still continuing to experience symptoms.

Other Meds: Dilantin

Current Illness: N/A

ID: 1794997
Sex: F
Age: 37
State: ND

Vax Date: 10/17/2021
Onset Date: 10/18/2021
Rec V Date: 10/18/2021
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: None

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

Symptoms: Severe migraines within 24 hours of vaccine. Took ibuprofen and migraine went away about 6 hours later. Headaches persist, much like a head cold.

Other Meds: Depoprovera

Current Illness: None

ID: 1794998
Sex: M
Age: 67
State: NJ

Vax Date: 10/15/2021
Onset Date: 10/15/2021
Rec V Date: 10/18/2021
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: none

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient received 2nd dose of Pfizer Covid-19 vaccine instead of Moderna. The first dose the patients received was Moderna.

Other Meds:

Current Illness:

ID: 1794999
Sex: M
Age: 85
State: OH

Vax Date: 10/14/2021
Onset Date: 10/14/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: No reported issues with vaccination. Patient received Pfizer BioNTech instead of Moderna as second dose. Patient did not have vaccine card, has dementia (not known by pharmacy in advance), and wife left him alone at the pharmacy for the vaccination. Wife called the next day to inform the pharmacy that the incorrect dose was received.

Other Meds:

Current Illness:

ID: 1795000
Sex: M
Age: 23
State:

Vax Date: 04/10/2021
Onset Date: 10/11/2021
Rec V Date: 10/18/2021
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:

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

Symptoms: break through case of Covid 19 infection after vaccination

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am