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: 1795209
Sex: F
Age: 17
State: OH

Vax Date: 08/29/2021
Onset Date: 08/29/2021
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: Pregnancy test administered Oct 11, 2021 by doctor's office, negative

Allergies: Dial soap, Germ-X, Hay

Symptom List: Dysphagia, Epiglottitis

Symptoms: No period since the first vaccine was administered. She has had severe cramping and spotted for two days, but nothing more. We were advised to follow up with her doctor if no period in 6-8 weeks.

Other Meds: Iron 130mg, Vitamin C 500mg, Vitamin D3 50 mcg, Magnesium 500mg, Cetirizine Hydrochloride 10mg, Doxycycline 100mg, Aripiprazole 2mg, Atomoxetine 80mg

Current Illness: none known

ID: 1795210
Sex: F
Age: 34
State: NV

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

Lab Data: NONE REPORTED

Allergies: NONE REPORTED

Symptom List: Anxiety, Dyspnoea

Symptoms: BEGINNING SUNDAY 10/17/21 PATIENT HAD REDNESS AND SWELLING ON ARM AND DOWN INTO BREAST

Other Meds: NONE REPORTED

Current Illness: NONE REPORTED

ID: 1795211
Sex: F
Age: 43
State: CA

Vax Date: 10/07/2021
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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: BP was taken - high 150s/100s at doctor's appointment.

Allergies: keflex, mild reaction to any antibiotics

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

Symptoms: Thursday night I started getting a fever of 102. I was chilled to the bone, and I couldn?t stop shaking. That happened to me with the 2nd shot as well. By Friday my left armpit started swelling. The skin was stretched tight. I also kept getting chest pain under my left breast. It was a quick sharp pain and then it was gone. Anywhere between 30 mins to 2 hours. Then I ached from head to toe and then I started getting hot and sweaty and that started about 12:30AM Friday morning. I did not feel well, I was sweating. My armpit was still swelling. Swelling in the armpit also went down to arm and hand. I used ice packs to help them out a little bit. But by Monday it was mostly gone. I was nauseous on and off. And then maybe around 10:00am I wasn?t hot and sweaty anymore but I ached and generally did not feel well. Saturday I still had the sharp jab under my left breast and swelling in the arm pit. Sunday the swelling went down and the sharp pains went away on Sunday and Monday. I went to go see the doctor and I already had this appointment set up. I let her know that I was really tired all the way up until Wednesday (last Wednesday). Also to add, I had a bad headache for about a week and that was it. also noted that i went to urgent care monday for headaches and possible ear infection.

Other Meds: ? 4000iu daily vitamin D ? 1000mg vitamin C ? Micardis 5mg daily ? 5 days ago 40mg ? Fluticasone nose spray as needed for allergies

Current Illness: N/A

ID: 1795212
Sex: F
Age: 66
State: IA

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

Lab Data: N/A

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Fluarix Quad was administered as opposed to high dose vaccine for patients 65 and older.

Other Meds:

Current Illness:

ID: 1795213
Sex: F
Age: 55
State: KY

Vax Date: 01/06/2021
Onset Date: 01/06/2021
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: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Racing heart; after first dose my heart raced for about 5 seconds. After second dose I ran a fever and felt like I had the flu for 24 hours. My heart has continued to run fast.

Other Meds: synthroid lexapro

Current Illness:

ID: 1795214
Sex: F
Age: 34
State:

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

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: bee venom, fish allergy, oxycodone -- > anaphylaxis.

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

Symptoms: presented to ED following first COVID vaccine dose. CC generalized itching and scratching feeling in throat. Discharged home. was given steroids, benadryl, famotidine, and ketorolac while in ER.

Other Meds:

Current Illness:

ID: 1795215
Sex: M
Age: 70
State: NJ

Vax Date: 10/13/2021
Onset Date: 10/14/2021
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: N/A

Allergies: N/A

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Pt. states that after receiving the 3rd Booster of Phizer 10/13/2021, started experiencing symptoms 10/14/2021 of pain at the injection site, inflammation of heart wall (self-diagnosed), fatigue, muscle pain, nausea, joint pain, loose stool, and headache. Symptoms have subsided.

Other Meds: Plavix, Losartan, Iron Pill, Hydrochlorothiazide

Current Illness: N/A

ID: 1795216
Sex: M
Age: 73
State: MI

Vax Date: 02/19/2021
Onset Date: 10/11/2021
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:

Allergies: NKDA

Symptom List: Pharyngeal swelling

Symptoms: Hospitalized; COVID-19 vaccine positive; fully vaccinated; Admission Date: 10/11/2021 Discharge Date: 10/13/2021; PRESENTING PROBLEM:Urinary tract infection with hematuria, site unspecified [N39.0, R31.9]Sepsis, due to unspecified organism, unspecified whether acute organ dysfunction present (HCC) [A41.9]Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01]Pneumonia due to COVID-19 virus [U07.1, J12.82]HOSPITAL COURSE: 73 y.o. male who presented with fatigue and found to have Sepsis secondary to UTI with COVID-19 viral pneumonia with 5 days of symptoms prior to admission. The patient has a pmh copd, htn, osa, htn , obesity. He is fully vaccinated with x2 moderna dosing. The patient was treated with remdesivir x 2 days and decadron while hospitalized. Will discharge home on decadron to complete the 10 day steroid coarse. The patient was also given a prescription for mucinex and metformin due to steroid induced hyperglycemia. An A1C is pending. Recommend outpatient follow-up with PCP for BG monitoring. Acute hypoxic respiratory failure resolved, he had a home oxygen evaluation completed and no oxygen is required. The patient is eager to return home. The patient received 2 days of ceftriaxone and will be transitioned home on keflex to complete the antibiotic course. The urine culture is pending upon discharge. Recommend post-hospitalization follow-up with PCP in 1-week. CT abdomen pelvis recommend outpatient follow-up with dedicated kidney imaging with IV contrast is suggested to exclude presence of mass. Due to finding suggestive of bilateral multilobulated kidneys with presence of cortical thickening overlying the left kidney superior pole and the right kidney middle pole probably representing hypertrophied column.

Other Meds: acetaminophen (TYLENOL) 500 MG tablet albuterol (PROAIR HFA) 108 (90 BASE) MCG/ACT inhaler amlodipine (NORVASC) 10 MG tablet ascorbic acid 500 MG tablet aspirin 325 MG tablet atorvastatin (LIPITOR) 40 MG tablet buPROPion (WELLBUTRIN XL) 150

Current Illness: 10.11.21: Office Visit - Fatigue, breathing problems; diarrhea; headache

ID: 1795217
Sex: F
Age: 39
State: CA

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: LA

Lab Data: No work up done. Stayed at home to convalesce. Pt is mostly recovered, by some symptoms persist - see above.

Allergies: NKDA; bee sting venom

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: 10/14/21 at 10:30pm: body aches, unable to sleep, by 1am violent body chills and shakes (subjective fever), teeth chattering, feeling anxious and shaky; by 2:30am vomiting, diarrhea, migraine HA (when closed eyes, saw flashing), metal taste when not vomiting, felt very weak. Vomiting resolved by 5-6 am on 10/15/21, but the rest of the symptoms persisted throughout the weekend. As of today, still feels shaky and week, anxious, with periods of body chills/shakes. Patient was breast feeding during the time she received the third dose and with both of the prior Pfizer vaccine doses. The child had no symptoms after the first one, sick (fussy, crying, fever, decreased appetite) after second dose, and no symptoms after third dose.

Other Meds: post-natal vitamins, Omega 3 supplement

Current Illness: Had COVID-19 - positive test on 08/06/2021;

ID: 1795218
Sex: M
Age: 54
State: OH

Vax Date: 08/26/2021
Onset Date: 10/01/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: PCR- collected on 10/03/2021 resulted on - 10/03/2021

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Fever, Runny nose, Cough, Headache

Other Meds:

Current Illness:

ID: 1795219
Sex: F
Age: 32
State: AZ

Vax Date: 10/11/2021
Onset Date: 10/12/2021
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:

Allergies:

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

Symptoms: The next day after the shot I started having bad cramps and bleeding. It lasted for 4 days and has since resolved.

Other Meds:

Current Illness:

ID: 1795220
Sex: F
Age: 39
State: WA

Vax Date: 09/30/2021
Onset Date: 10/17/2021
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: Watermelon

Symptom List: Rash, Urticaria

Symptoms: Had normal period, followed one week later by another heavier period. This has never happened before.

Other Meds: None

Current Illness: None

ID: 1795221
Sex: M
Age: 57
State: MN

Vax Date: 02/26/2021
Onset Date: 10/04/2021
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: NA

Allergies: KNA

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

Symptoms: Arm muscle near injection site very sore and painful

Other Meds: Sertraline, Rosuvastatin

Current Illness: none

ID: 1795222
Sex: F
Age: 21
State: FL

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: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: N/A

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

Symptoms: about 10min after she COVID shot my daughter had a little Seizure and we went Unconscious. Had to call 911 her BP 88/44? and heart rate was 44?

Other Meds: N/A

Current Illness: NO

ID: 1795223
Sex: F
Age: 63
State: NJ

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

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

Symptoms: Patient was not 65 at time of dose.

Other Meds:

Current Illness:

ID: 1795224
Sex: F
Age: 36
State: PA

Vax Date: 10/07/2021
Onset Date: 10/08/2021
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: None.

Allergies: Penicillin

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

Symptoms: Started menstrual bleeding in the middle of the night. This bleeding was about a week and a half before my expected period. It lasted for several hours then stopped for about 12 hours. It started again much heavier after the 12 hour break. I am still bleeding, though today (day 11) is much lighter than it has been for the past week and a half. I expect/hope to be done bleeding by tomorrow if it continues to lighten.

Other Meds: None

Current Illness: None

Date Died: 10/10/2021

ID: 1795225
Sex: M
Age: 87
State: MN

Vax Date: 03/18/2021
Onset Date: 10/10/2021
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:

Allergies:

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

Symptoms: Patient passed away on 10/10/2021.

Other Meds:

Current Illness:

ID: 1795226
Sex: F
Age: 74
State: CA

Vax Date: 10/06/2021
Onset Date: 10/06/2021
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: Patient received 2 doses of Moderna Covid vaccine from another facility and patient received Pfizer as the booster shot.

Other Meds:

Current Illness:

ID: 1795227
Sex: M
Age: 56
State: MA

Vax Date: 05/27/2021
Onset Date: 05/28/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Spontaneous cataract

Other Meds:

Current Illness:

ID: 1795228
Sex: F
Age: 64
State:

Vax Date: 10/15/2021
Onset Date: 10/18/2021
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: No known allergies.

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

Symptoms: ? PT received Booster dose of Pfizer Friday evening @1900. ? No reaction most of weekend, feeling cold Sunday (17Oct2021) afternoon, symptoms improved. ? @1200 Monday 18 October 2021, while working, PT reported to Observation Lead feeling chilly. ? @ 1225 Safety was notified PT was feeling ill. ? PT escorted to Screened Observation area. ? PT reported shifting feelings of cold & feeling feverish throughout body, core & peripheral. ? Onset of headache, rhinorrhea, fatigue. ? PT Hx of Asthma, no (current) trouble breathing/ exacerbation of condition. ? No hx allergies: food, med. ? @ 1230 BP: 166/90 ? @1236 PT expressed they wanted evaluation by EMS. ? @1240 Site Director initiated emergency call. ? @1245 BP: 171/92, PR: 91, PT reported no improvement in condition. ? @1252 EMS onsite, EMS Evaluation ? @1253, BP: 164/86, PR: 88 ? @1259 BP: 146/107, PR: 91 ? @1300 PT declined transport. Decided to go home to rest & recover. ? @1310 PT left for the day voluntarily, ambulatory, AOx4, and stable. ? PT will follow up with Dr.

Other Meds: n/a

Current Illness: No known illness

ID: 1795229
Sex: F
Age: 28
State: PA

Vax Date: 10/16/2021
Onset Date: 10/17/2021
Rec V Date: 10/18/2021
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: sulfamethoxazole

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

Symptoms: Approximately 10 hours after injection, I received the worst most debilitating acid reflux I had ever had in my entire life. I was getting into bed when it began. I felt like there was a giant lump in my throat that needed out, but I could not vomit. Nothing worked to lessen the symptoms and I did not get any sleep. The next day, the symptoms lessened but I was not feeling right at all. I was weak, tired, shaky, couldn't bend over without feeling sick, had diarrhea and an upset stomach all day. I then noticed a big red patch on my arm where the injection site was. This has never happened to me before during a vaccination and I have been on top of all of them.

Other Meds: Wellbutrin, iron, sertraline, Vyvanse, vitamin d

Current Illness: n/a

ID: 1795230
Sex: M
Age: 78
State:

Vax Date: 02/09/2021
Onset Date: 10/15/2021
Rec V Date: 10/18/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: breakthrough COVID-19 case.

Other Meds:

Current Illness:

ID: 1795231
Sex: F
Age: 11
State: NJ

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

Allergies:

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

Symptoms: Patients mother filled out form indicating patient was 12 when the child was 11 years old. Doctors office was contacted to follow up with patient. Spoke with mother on phone and mother stated child was fine.

Other Meds:

Current Illness:

ID: 1795232
Sex: F
Age: 59
State: LA

Vax Date: 07/18/2021
Onset Date: 10/01/2021
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: NA. I have a 5K deductable and have already spent several hundred dollars and nothing has brought relief so far.

Allergies: NA

Symptom List: Injection site pain, Pain

Symptoms: Over the past several weeks, I have had uncontrollable 'twitching' in my left hand. Primarily between thumb and index finger. Thought it may be a side effect of perscribed med I took for a short time. but I have stopped all perscriptions as none of them were working to help headaches. Twitiching has not continued, but has become somewhat bothersome. I have dropped a cup and have a lot of trouble carring bags and such.

Other Meds: oxybutin, allipuronol, lisonopril, multi vit, herbal headache, 2 other herbal supplement (cant recall names)

Current Illness: NA

ID: 1795233
Sex: F
Age: 95
State: MI

Vax Date: 02/19/2021
Onset Date: 10/10/2021
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:

Allergies: Latex

Symptom List: Injection site pain, Menorrhagia

Symptoms: Hospitalized 10.10.21; COVID-19 positive (10.10.21); Fully Vaccinated Admission Date: 10/10/2021 Discharge Date: 10/13/2021 Admitting Diagnoses: Pneumonia due to COVID-19 virus PRESENTING PROBLEM: Hypoxia [R09.02] Fever, unspecified fever cause [R50.9] COVID-19 virus detected [U07.1] Pneumonia due to COVID-19 virus [U07.1, J12.82] HOSPITAL COURSE: 96 y.o. woman who presented to ED with a fever and hypoxia. Patient is a resident at a facility, where she was noticed to have a fever on 10/10/21. Patient then was transported via EMS to the emergency room. Workup evaluation was noted to be COVID positive. Patient did have a previous COVID test on October 3rd and was negative. At that time patient was transferred from the emergency department was admitted for severe sepsis septic shock and left lower lobe pneumonia. She was admitted from 10/04 to 10/8 which she was discharged home on Ceftin 1 orally 2 times a day for 7 days. Patient did have a large party yesterday with multiple siblings she has a large family 13 and all, and felt fine. Patient on presentation today has no complaints. She was found to have a O2 sat of 89% in the ER. She is not usually on supplemental oxygen. She was treated with decadron and Remdesivir for COVID pneumonia. She had mild infiltrates on CXR. She was weaned off supplemental o2 and noted improvement in her symptoms. She was very weak, PT/OT recommended home health which was set up. She was discharged on 10/13/21.

Other Meds: acetaminophen-codeine (TYLENOL #3) 300-30 MG per tablet amLODIPine (NORVASC) 5 MG tablet Calcium Carbonate-Vit D-Min (CALCIUM-VITAMIN D-MINERALS) 600-800 MG-UNIT CHEW Cholecalciferol 1000 units CAPS docusate (COLACE) 100 MG capsule dorzolam

Current Illness: 10.3.21: ED - to overnight admission - Shock / sepsis - Admission Date: 10/4/2021; Discharge Date: 10/8/2021; chief complaints of nausea and vomiting along with loose stools. The patient complained of severe weakness. However she was noted to have a red streaks of blood in the stool and blood pressure going down. She was subsequently transferred to hospital and admitted in the intensive care unit. She was noted to have elevated lactic acid with a potential imaging finding of left basilar pneumonia. Was started on IV fluids and required vasopressors. She was also started on antibiotics. The patient was the treated for community-acquired pneumonia.

ID: 1795234
Sex: F
Age: 75
State: NY

Vax Date: 10/01/2021
Onset Date: 10/11/2021
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: Seeing ENT doctor on 10/29/21.

Allergies: none

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

Symptoms: Had booster of Pfizer Biontech on 10/1/21. No major effect. On the night of 10/11/21 I got tinnitus in left ear, hissing sound, 24 hours a day. Seeing ENT doctor on 10/29/21.

Other Meds: synthroid, cytomel, metfornin, topamax, estradiol, citracal plus D, B12

Current Illness: Dry mouth

ID: 1795235
Sex: F
Age: 65
State: CA

Vax Date: 03/11/2021
Onset Date: 03/12/2021
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: Did not know to go get tests for reaction everything was closed. I have not been tested for long term effects, but am more tired and concerned about my heart.

Allergies: none

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Heart beating very hard and very rapid , fever, aches, flush, fatigue.

Other Meds: Prozac

Current Illness: none

ID: 1795236
Sex: F
Age: 37
State: VA

Vax Date: 07/15/2021
Onset Date: 07/16/2021
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: RA

Lab Data: echocardio cardiogram - normal 09/28/2021 Lab works- normal blood work was done multiple times EKGS-shown sinus tachycardia orthostatic test -

Allergies: amoxicillin

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: The next night my initial symptom was tachycardia, then the next day I had remors , sweats and a low grade fever. I follow up with my PA. My primary care monitored my heart for two weeks, those results showed tachycardia. They also found I had ventricular tachycardia . I also was started metoprolol 25 mg. Before I even saw a cardiologist, I had been to the emergency room. They scheduled me for an echocardiogram . My blood pressure spiked and I was having intense chest pain and was tachycardic so I went to hospital and was admitted. They diagnosed me with dysautonomia. Trying to manage my symptoms. They don't know if i will get back to my baseline. I still can't do a lot of normal activities. I can't work right now because of my new limits.

Other Meds: emgality

Current Illness: none

ID: 1795237
Sex: F
Age: 52
State: NC

Vax Date: 04/13/2021
Onset Date: 05/23/2021
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: X-ray

Allergies: N/A

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

Symptoms: About 6 hours after my shot, my arm to my fingers got numbness. About 12 hour later, my ankle swelled up twice this sizes. This is why I went to see the doctor for. My ankle finally went down after 2 weeks. I had to physical therapy. Now there is pain in my ankle.

Other Meds: N/A

Current Illness: N/A

ID: 1795238
Sex: F
Age: 78
State: NH

Vax Date: 04/11/2021
Onset Date: 04/11/2021
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: Neurology nerve conduction test. Negative for neuropy

Allergies: augmentin, cipro, levequin, oil of cloves, sulfa drugs

Symptom List: Nausea

Symptoms: neuropathy symtoms feet, hands numb and burning. testing by neurologist shows no neuropathy but still stympstoms. artheritis symtoms arms hands neck, swollen fingers , dropping things neck pain and wrist pains. Had similar reaction to shinrix vacccine but not senior flu shots.

Other Meds: Toprol, vitamin d, b12, c, magnesium, probiotic

Current Illness: None

ID: 1795239
Sex: M
Age: 62
State: CA

Vax Date: 05/12/2021
Onset Date: 05/14/2021
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: 620-5 - Bacteria identified in Skin by Aerobe culture 575-1 - Fungus identified in Skin by Culture 542-1 - Mycobacterium sp identified in Wound by Organism specific culture all ordered 6/25/21 biopsy performed 7/2/21

Allergies: POLLEN EXTRACTS HOUSE DUST

Symptom List: Injection site pain

Symptoms: rash is blistering, bumpy, burning, itchy, and painful, redness, constant, and itching

Other Meds: Adult Low Dose Aspirin alfuzosin Benicar Levitra Lipitor Lyrica nifedipine oxycodone Uroxatral zolpidem clonidine testosterone Flax seed calcium Fish oil Multivitamin D3 Iron 65mg

Current Illness:

ID: 1795240
Sex: F
Age: 32
State: WA

Vax Date: 09/01/2021
Onset Date: 09/01/2021
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: CBC, CMP, TSH

Allergies: amoxicillin, penicillin, ciprofloxacin

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

Symptoms: Headache, difficulty concentrating, fatigue starting 4 hours after the vaccination

Other Meds: unknown

Current Illness: kidney stones

ID: 1795241
Sex: F
Age: 38
State: CA

Vax Date: 02/04/2021
Onset Date: 02/05/2021
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: None

Allergies: NKDA, bee sting/venom

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

Symptoms: 24 hours after the second COVID-19 vaccine dose: chills, body aches, joint pain, fatigue, migraine. Symptoms resolved within 48 hours. Patient was breast feeding during both time that she received the vaccine doses. At the time of the second dose, the baby was 4 months old. He developed symptoms also 24 hours later: fussy, crying, decreased appetite.

Other Meds: post-natal vitamins and Omega3 supplements

Current Illness: none

ID: 1795242
Sex: F
Age: 96
State:

Vax Date: 02/18/2021
Onset Date: 10/14/2021
Rec V Date: 10/18/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: breakthrough COVID-19 case

Other Meds:

Current Illness:

ID: 1795244
Sex: F
Age: 75
State:

Vax Date: 09/27/2021
Onset Date: 10/15/2021
Rec V Date: 10/18/2021
Hospital: Y

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

Lab Data:

Allergies: zolpidem

Symptom List: Erythema, Pruritus

Symptoms: Shortness of breath on exertion, emesis

Other Meds: Albuterol, budesonide, fluoxetine, lorazepam, meloxicam, omeprazole, propranolol, latanoprost, calcium, vitamin D3, vitamin B12

Current Illness:

ID: 1795245
Sex: F
Age: 55
State:

Vax Date: 02/20/2021
Onset Date: 03/27/2021
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: Cipro

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

Symptoms: Worsening tinnitus. Louder, buzzier, now constant.

Other Meds: None

Current Illness: None

ID: 1795246
Sex: F
Age: 59
State: NH

Vax Date: 04/16/2021
Onset Date: 09/17/2021
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: CT scan, chest X-ray, Loads of blood work, vitals, EKGs, blood transfusion.

Allergies: Nicotine gum

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

Symptoms: Symptomatic anemia, syncope event, suspected upper GI bleed secondary to NSAIDS, chronic headache following Covid infection.

Other Meds: 225mg venlafaxine, 40mg atorvastatin, multivitamin, 1200mg fish oil, 600mg calcium, 25mcg D3, 1000mcg B-12

Current Illness: COPD, depression, high cholesterol all under control

ID: 1795248
Sex: F
Age: 28
State:

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

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Numbness and tingling of bilateral arms started after vaccination Numbness and tingling of right side of face and mouth 2 days after vaccination

Other Meds:

Current Illness:

ID: 1795249
Sex: F
Age: 38
State: CO

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: SYR
Vax Site: LA

Lab Data: none

Allergies: none

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

Symptoms: Client presented to clinic for Janssen's COVID-19 vaccine with her husband. Client appeared anxious and had multiple questions about the safety and efficacy of the vaccine prior to administration. Client stated she was being required to have the vaccine and was not happy about it and was very nervous. Client cried briefly and reported that her heart rate felt 'fast' due to anxiety. Client ceased crying, reported that her questions were answered, and consented to the vaccine. COVID-19 Janssen was administered at 10:25am. At 10:28am, client reported feeling dizzy, lightheaded, nauseous and was visibly pale and diaphoretic. Client was lowered safely to the ground with the help of her husband. Within 20 seconds, the client began to feel better and pallor had diminished. Client reported that she had passed out during a blood draw previously, but never problems with vaccine. Client slowly resumed a sitting position and returned to a chair. Client declined juice, but drank water and reported feeling much better. At about 10:38, client again felt faint, was pale and diaphoretic and was lowered to the ground. Client stated that the muscles in her neck, near her throat, felt tight, but anxiety related. Client denied problems breathing or sensation of swelling in throat or mouth. No hives were present. Client was given a cold compress, snack and juice and reported that the tight muscles in her neck had gone away. Client reported feeling better and resumed sitting in chair. Client was making conversation, but at about 10:55am, client reported feeling faint and was moved to the ground. At this time, additional nursing staff were called in. Client reported that the tightness in her neck had returned and she was still feeling lightheaded. Client denied symptoms of anaphylaxis, reported no problems breathing. Informed the client's husband that we advised EMS services due to delayed recovery. The client began to cry and shake uncontrollably. Monitored the client on the ground while we called 911 at 11:00am. EMS arrived at 11:05am and assessed the client for about 15 minutes. Vital signs and EKG were all normal. No signs of anaphylaxis. Client continued to feel dizzy, appeared diaphoretic and pale, and could not stop shaking. Client was advised to seek medical treatment as a precaution and to be monitored. Client was unable to stand unassisted due to lightheadedness when standing. Client was transported via ambulance to Hospital.

Other Meds: none

Current Illness: none

ID: 1795250
Sex: F
Age: 47
State: WA

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

Allergies:

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

Symptoms: - Sore arm at the injection site followed by severe lymph nodes inflammation (right armpit & near the breast & throat/neck areas) - Followed by all right side joints inflammation; pain in right side wrist, shoulder rotator, hip, knee, & ankle - Noted bit of heart pain, increased heart burn at night and an inability to manage breathing while performing cardio exercises like running & bicycling - A month after the 2nd vaccine, right side hip inflammation/pain & breathing issues remain - Did not need visit the doctor due to lack trust in the medical community for being truthful about the side effects of the vaccine. Also, possibility of their lack of knowledge.

Other Meds:

Current Illness:

ID: 1795251
Sex: F
Age: 88
State: MI

Vax Date: 05/07/2021
Onset Date: 10/09/2021
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:

Allergies: NKDA

Symptom List: Pain in extremity

Symptoms: Hospitalized; COVID-19 positive (10.9.21); Fully vaccinated Attending Physician: MD Date of Admission: 10/9/2021, Hospital Day: 5 Date of Discharge: 10/13/2021 PRESENTING PROBLEM: COVID-19 virus infection [U07.1] COVID-19 [U07.1] HOSPITAL COURSE: Patient is a 88 y.o. female with a history of chronic expressive aphasia secondary to TBI in 2018 as well as hypertension, B12 deficiency, chronic osteoarthritis with hip pain, who lives with her daughter and son-in-law. At baseline the patient has expressive aphasia, but is able to understand speech and follow commands. Patient is able to feed herself and is independent in her ADLs. Patient's daughter reports that she had noted the patient to be panting yesterday, and also noted decreased appetite. She also observed her mother to be sleeping most of the day yesterday. Today she had an episode of explosive diarrhea with nausea and vomiting. The patient did have C difficile in May of 2021, and because of her diarrhea she was brought to the emergency department. The patient nausea, vomiting and diarrhea slowly improved. Likely due to COVID-19. She was treated supportively. Her diet was advanced and tolerated. Her diarrhea resolved. Hematology evaluated her due to her anemia and thrombocytopenia which they feel is reactive. Her folate and B12 levels were checked and were normal. SPEP pending. Patient will follow up with PCP. Daughter indicated that she is looking for a nursing home for the patient as her husband (daughter's) just had a heart attack and has hip pain and inability to take care of patient for too long. The patient will isolate until 10/19. PT/OT evaluated her and recommended home with assist. She was discharged with daughter to her home in the meantime in stable and improved condition. Active Issues Requiring Follow-up Issue: covid infection Recommended follow-up provider/specialty: pcp for cytopenias What is needed: CBC, possible hematology referral if does not resolve (hematology felt that this is reactive due to covid)

Other Meds: acetaminophen (TYLENOL) 500 MG tablet Calcium-Phosphorus-Vitamin D (CALCIUM GUMMIES PO) citalopram (CELEXA) 20 MG tablet gabapentin (NEURONTIN) 100 MG capsule losartan (COZAAR) 25 MG tablet Multiple Vitamins-Minerals (ZINC PO) traMADol (ULT

Current Illness: NA

ID: 1795252
Sex: F
Age: 35
State: WA

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

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

Lab Data: I had some blood work ordered but it hasn't been done. It should be done by today 10/18

Allergies: I'm allergic to Penicillin, and Doxycycline

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

Symptoms: In 30 minutes my ear plugged completely and my nose started running. I had fatigue, and the next day on the 2nd of October i had the worse Diarrhea and nausea symptoms of my life. I had a heart rate bellow 50 and its very abnormal. My heart rate is usually fast. I got tighten of chest and chest pressure. On day 4 my ear that had gotten plugged caught an infection and I lost hearing and i got a loud ringing that hasn't been resolved . This was on my left ear, I'm currently on Dexamethasone to try to resolve it. My chest pressure feels like a swollen feeling but it comes and goes. I felt vascular headache pain as if it was my veins hurting and they would come as go. My menstrual cycle has not started on time. I have been instructed by the doctor to not take the second dose.

Other Meds: I took Allegra 180mg Over the counter , as needed. I take almost every day Vitamin C 1000mg capsule And Vitamin D tablet

Current Illness: None

ID: 1795253
Sex: M
Age: 56
State: CA

Vax Date: 09/30/2021
Onset Date: 10/13/2021
Rec V Date: 10/18/2021
Hospital: Y

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

Lab Data: hgb=4.6, +Coombs, Tbili=13, DBili=1.6, retic ct=0.48%, haptoglobin<9, LDH=578

Allergies: none

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

Symptoms: severe autoimmune hemolytic anemia receiving prednisone, rituximab and transfusions still hospitalized

Other Meds: amlodipine

Current Illness: hypertension, obstructive sleep apnea

ID: 1795254
Sex: M
Age: 75
State: CO

Vax Date: 03/23/2021
Onset Date: 10/11/2021
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: Patient admitted to hospital with COVID after receiving vaccine series

Other Meds:

Current Illness:

Date Died: 09/25/2021

ID: 1795256
Sex: M
Age: 30
State: CA

Vax Date: 08/01/2021
Onset Date: 08/01/2021
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: see above

Allergies: NKDA

Symptom List: Vomiting

Symptoms: Patietn recived J & J vaccine early August and within 2 weeks became SOB. He presented to Medical center after syncopal episode and had acute thrombosis of RCA on 9/25 /21 . He underwent PCI and thrombectomy . He was noted to have Cardiomyopathy at this time with EF < 20% . Several hours later while in the ICU he had siexzure followed by PEA arrest with ABG Po2 28 ( presumed pulmonary embolus ) and was pronounced dead at that time

Other Meds: none known

Current Illness: Obesity ,

ID: 1795257
Sex: F
Age: 93
State: OH

Vax Date: 02/03/2021
Onset Date: 10/06/2021
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: PCR Collected on 10/07/2021 resulted on 10/08/2021

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Cough, nasal drainage

Other Meds:

Current Illness:

ID: 1795258
Sex: F
Age: 20
State:

Vax Date: 10/18/2021
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:

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

Symptoms: Patient was feeling nauseous. Felt stabbing pain in her stomach. Felt lump in her throat.

Other Meds:

Current Illness:

ID: 1795259
Sex: F
Age: 45
State: CA

Vax Date: 10/15/2021
Onset Date: 10/16/2021
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:

Allergies: NKDA

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient was added into the schedule this morning due to painful swelling and warm to touch feeling of her L Axilla. Patient did receive her COVID booster on 10/15/2021 and her symptoms became present on 10/16/21 however she is unsure if it is a reaction to the booster or not. Nodule is approximatley the size of a baseball. She does have pain w/ movement.

Other Meds: None

Current Illness: N/A

ID: 1795260
Sex: M
Age: 47
State: MN

Vax Date: 01/12/2021
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:

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

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

Other Meds:

Current Illness:

ID: 1795261
Sex: F
Age: 74
State: OR

Vax Date: 10/04/2021
Onset Date: 10/07/2021
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: At 72+ hours post injection I began coughing. Coughing has persisted with clear sputum. This has required continued use of an Albuterol inhailer to clear airway Cough persists!

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am