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: 1798421
Sex: F
Age: 42
State: OK

Vax Date: 10/05/2021
Onset Date: 10/05/2021
Rec V Date: 10/19/2021
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: NKDA

Symptom List: Dysphagia, Epiglottitis

Symptoms: Inappropriate Covid vaccine was inadvertantly administered. Janssen Covid vaccine was administered, previous dose was Pfizer. Client was informed. Supervisor was immediately informed. Client was contacted 10/6/2021 and stated at that time she was doing ok

Other Meds: unknown

Current Illness: unknown

ID: 1798422
Sex: F
Age: 29
State: MN

Vax Date: 01/10/2021
Onset Date: 10/19/2021
Rec V Date: 10/19/2021
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: Tested NAAT positive for COVID 10/19/21 after being fully vaccinated.

Other Meds:

Current Illness:

ID: 1798423
Sex: M
Age: 38
State: CA

Vax Date: 04/14/2021
Onset Date: 10/08/2021
Rec V Date: 10/19/2021
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: no

Allergies: Acetaminophen; Benadryl; Scopolamine; Gabapentin; gluten; Red, orange and blue dye; Doxycycline

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

Symptoms: October 8th - I had a pain in my eye that started and became (felt like something was in my eye) - then it became clear that there was a sty in my eye. Doctor (October 13) (on the said I had an eye infection and I had an ear infection also. My gland of the right side of my neck was swollen. treated with Doxycycline and topical ointment of Erythromycin. I took one dose on October 13th in the pm. On October 14th in the morning - and the morning dose made me very sick. I vomited. I was really sleepy and uncomfortable. Over the next couple of days - experienced chills, fatigue and nose bleed and headache. I felt really awful. My skin got really scaly and dry and I got a rash on the backs of my hands. Then I quit taking it on the 18th - after the PM dose. I went to the doctor on the 18th and they said not to take it anymore. My ears are good now and my eye is on the mend - it's almost better. No medicine to replace the other but I'm continuing to use the Erythromycin gel.

Other Meds: Levothyroxine

Current Illness: Delivered a baby one month before vaccination - no complications

ID: 1798424
Sex: M
Age: 5
State:

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 10/19/2021
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: Mother stated patient's arm was itchy and swollen from top of shoulder to elbow, swollen like twice the size, red, hot and itchy. They gave him Benadryl and Motrin and the next day she thought he had less symptoms but was maybe more swollen. Mother was following up with pediatrician

Other Meds:

Current Illness:

ID: 1798425
Sex: F
Age: 49
State: IL

Vax Date: 09/17/2021
Onset Date: 10/08/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data: Brain MRI and CT scan showed no stroke. All LABs came out normal except low Vitamin B12. Weekly B12 vitamin shots were started for low B12 (235) on Oct.14, 2021 MRI of neck and shoulder was ordered by Dr. but was denied by insurance. Physical therapy was approved. Starts Nov 4, 2021 First available appointment for physical therapy is scheduled for November 4, 2021. First available appointment with cardiologist is scheduled for November 16, 2021. First available appointment with Neurologist is scheduled for December 23, 2021.

Allergies: none

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

Symptoms: September 18, 2021, next day after the shot: muscle pain in the right arm, some weakness and numbness in the left arm radiating to the left leg. These symptoms went away by the following day. Starting around September 29, 2021 : Light symptoms of irregular heartbeat, small palpitations, some numbness and pain in the left arm and leg, overall body weakness. On the night of October 8th, 2021: very bad palpitations overnight kept waking me up on and off. I was sweating, very hot and weak, no fever. In the morning pain in left jaw, radiating to the left shoulder, and left arm, very bad palpitations. I ended up in the ER on stroke alerts. Was discharged after brain MRI and CT scan and no stroke confirmed. I spent all day in bed, was too weak to do anything, called off work. Spent the next day in bed as well. Starting with the October 9, 2021 up to today I am unable to work and keep having the following symptoms: I feel very tired and have to lay down and rest after every small activity I do, like walking or doing dishes. I keep having fast, fluttering and pounding heart beat that comes and goes often. When it comes I get extremely weak and have shortness of breath and have to lay down. It seems like my heart is working very hard. The left side of my body: jaw, neck, shoulder (top and back), arm and leg still hurt and I have numbness and tingling in my face, fingers and now toes. It seems that has intensified since the last time I saw my MD. In addition to that constant pain that I have all the time, I also get sporadic pain that seems to come in painful waves in muscles and joints. I spent the last week laying down most of the time feeling very tired. Just over a month ago, before I got the Covid19 shot, I was doing four mile bike rides, in the hot day, and I was perfectly fine. Today I can?t even go to work. To summarize I have the following: - I get tired very easily - I get weak and have to lay down - Heart palpitations - Weakness in left arm and leg - Pain in left arm and leg - Pain in left shoulder - Occasional pain in left jaw especially during fast, pounding heart beat - Some numbness on left side of face and neck - Tingling and numbness in middle fingers of left hand and toes of left foot - Shortness of breath during heart palpitations - Heaviness and pain around my heart during palpitations - Feeling shaky - It seems like my heart has to work very hard - Delayed coordination in left hand and arm, some in left leg MRI of neck and shoulder was ordered by Dr. but was denied by insurance. Physical therapy was approved. B12 vitamin shots were started for low B12 (235). First available appointment for physical therapy is scheduled for November 4, 2021. First available appointment with cardiologist is scheduled for November 16, 2021. First available appointment with Neurologist is scheduled for December 23, 2021.

Other Meds: none

Current Illness: none

ID: 1798426
Sex: M
Age: 61
State: AZ

Vax Date: 01/13/2021
Onset Date: 10/14/2021
Rec V Date: 10/19/2021
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: Positive Covid-19 PCR test

Allergies:

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

Symptoms: Complaint of sore/scratchy throat, headache, and runny nose/congestion

Other Meds:

Current Illness:

ID: 1798427
Sex: F
Age: 45
State: TX

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data: Lab bloodwork

Allergies: Gluten, sulfa, unknown other

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Extreme fatigue within 20 minutes of vaccinations, headaches, inflammation and pain in joints with ongoing flare ups that have continued up to now (6 months), muscle pain for 7 days, sporadic bone pain in left arm and both legs, fatigue continues, frequent headaches, tingling and loss of feeling in feet at times, chest pain a few times, extreme vitamin d deficiency, elevated blood sugar

Other Meds: Onglyza, aspirin, farxiga, venlafaxine, Vacepa, vitamin B12, vitamin D, Vitamin C, Zyrtec.

Current Illness: Depression, Celiac Disease, Type 2 Diabetes

ID: 1798429
Sex: F
Age: 54
State: NY

Vax Date: 04/01/2021
Onset Date: 07/08/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data: High blood pressure. 7/8/21. 8/17/21. 9/14/21 10/12/21 numerous readings at home.

Allergies: Tetracycline Penicillin

Symptom List: Pharyngeal swelling

Symptoms: Vaccine #1: 3/17/21 Vaccine #2: 4/14/21. Went to ER morning of 7/8/21 with nausea, dizziness, headache. Blood pressure was 186/? ( I don't remember bottom) All other tests were negative. Followed up with my doctor monthly. BP has been running high despite continued increase in medication. I'm now on 3x the metoprolol and a new medication losartin. There's no way to guarantee it was the vaccine, but BP was under control previously. It's running around 150/78 now with increased meds. Thought you should know.

Other Meds: Medications: Paraxotene or 25mg, Metoprolol succ er 35mg, lorazepam .5mg, Atorvastatin 10mg, Otc: zyrtec 10mg, flonase 50mcg

Current Illness: None

ID: 1798430
Sex: F
Age: 20
State: TN

Vax Date: 05/31/2021
Onset Date: 10/14/2021
Rec V Date: 10/19/2021
Hospital: Y

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

Lab Data: 10/15/21 ECHO Pericardium, extracardiac: A large pericardial effusion is identified circumferential to the heart, measuring up to 2.5 cm along the LV apex. There is an accentuated RV systolcic contraction without diastolic inversion/collapse. The IVC is normal in size and has normal respirophasic changes. Patient is normotensive with normal heart rate. No findings to suggest tamponade physiology but low pressure pretamponade physiology may be developing with a small degree of right atrial inversion (Clip#40) and significant inflow variation across the tricuspid valve.

Allergies: cat dander

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Pt developed pruritis in May, etiology unknown, work up in progress. Large pericardial effusion was an incidental finding on ECHO as part of her work up. Pt received Pfizer vaccine April/May and then July. Pt underwent pericardiocentesis 10/18/21 with removal of 410 ml fluid. Pt discharged 10/19/21 on indomethacin 50 mg three times daily and colchicine 0.6 mg twice daily for 3 months for pericarditis.

Other Meds: Zoloft

Current Illness: pruritis, etiology unknown, work up in progress. large pericardial effusion was an incidental finding on ECHO as part of her work up. Pt received Pfizer vaccine April/May and then July, symptoms began May.

ID: 1798431
Sex: M
Age: 60
State: PA

Vax Date: 05/14/2021
Onset Date: 06/10/2021
Rec V Date: 10/19/2021
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: CTA of the Chest Echocardiogram

Allergies: Adverse Reactions/Drug Intolerances Fish Containing Products Fish Containing Products Other (See Comments) Medium Intolerance 7/26/2019 Past Updates Pt states he get queasy

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Pulmonary embolism and nonischemic cardiomyopathy. Patient completed 3 months of anticoagulation for a provoked PE because he had just had orthopedic surgery. He is on ongoing medication therapy for nonischemic cardiomyopathy. echocardiogram completed 10/2021 reveals an EF of 23%.

Other Meds: albuterol HFA (VENTOLIN HFA) 90 mcg/actuation inhaler Inhale 2 puffs into the lungs every 6 (six) hours as needed for Wheezing. 5/18/20 apixaban (ELIQUIS) 5 mg (74 tabs) DsPk tablet atorvastatin (LIPITOR) 40 MG tablet escitalopram oxala

Current Illness: Patient underwent left AKA on 5/14/21, his pathology report showed osteomyelitis but with clean margins proximally.

ID: 1798432
Sex: F
Age: 69
State: AZ

Vax Date: 01/12/2021
Onset Date: 09/28/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data: Positive Covid-19 test at facility. Unknown type.

Allergies:

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

Symptoms: Complaint of cough, chills, elevated temperature up to 100.8,headache, runny nose/congestion, loss of taste/smell, myalgia, malaise and nausea/vomiting.

Other Meds:

Current Illness:

ID: 1798433
Sex: M
Age: 12
State:

Vax Date: 10/15/2021
Onset Date: 10/16/2021
Rec V Date: 10/19/2021
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: Egg Allergies,Azithromycin

Symptom List: Rash, Urticaria

Symptoms: Had sore throat the next morning, with headache, and by evening changed to cold. Felt feverish and had muscle aches and body pain. After 2 days developed cough. Still monitoring as of today Oct 19 2021. Gave tylenol for 2 days.

Other Meds: None

Current Illness: None

ID: 1798434
Sex: F
Age: 61
State: NJ

Vax Date: 09/29/2021
Onset Date: 10/06/2021
Rec V Date: 10/19/2021
Hospital: Y

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

Lab Data: Cat scan of the lungs, stress test of the heart.

Allergies: Codeine

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

Symptoms: Vaccine 9/29/21, no problems until 10/06/21 when what seemed to be a small cold starting with dry cough, clear runny nose, small amount of congestion, by 10/10/21 shortness of breathe started to do breathing treatments, same on 10/11/21 at approx 5:45pm I was completed winded and out of breathe and was taken to Medical Center in respiratory destress. I spend the next 3 days in ICU then transferred to medical floor for the next 5 days. I am home now on oxygen and recovering slowly. I was also on a Bipap machine and slowly weaned off of that.

Other Meds: Farxiga - 5mg daily, Montelukast - 10 mg daily, Enalapril Maleate - 5mg daily, Atorvastatin - 40mg daily, Mesalamine 800 mg - 6 tables daily, Symbicort160/4.5 - 2 puffs twice daily, Proair - 2 puffs as needed

Current Illness: No other illnesses at the time or within a month prior

ID: 1798435
Sex: F
Age: 45
State: WA

Vax Date: 09/28/2021
Onset Date: 09/29/2021
Rec V Date: 10/19/2021
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: Full body scan and systems review - 10/13/2021

Allergies: Almonds, Yeast, Avocado, Gluten, Vancomycin, latex, bees and wasps

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

Symptoms: Headache started about 12 hours following and remained constant increasing in severity over the following days becoming a migraine that lasted for 18 days. With that, visual regression, light sensitivity, burning eyes, sensitive to smells and nausea. Extreme fatigue started on day three, disassociation, overly emotional, small rash began on the right arm (hive response) that spread across the chest, torso, left arm and groin area and legs. Foggy headed, chest pain, strong heart palpitations, difficulty breathing. Sore throat, cough, chest pressure, clogged ears, eye pain, full body aches, mental fog, shakes, diarrhea, lack of coordination, full body/joint pain, cold with the inability to get warm. Low BP. Symptoms progressively got worse as each day passed.

Other Meds: Probiotics, Collagen

Current Illness: none

ID: 1798437
Sex: F
Age: 58
State: OH

Vax Date: 10/06/2021
Onset Date: 10/06/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data: Saw a Neurologist 10/13/21 last week who said symptoms would go away eventually. Saw a family physician this week on 10/18/21 who wrote a note for me to limit my workload and work hours this week. I will check in with him again next week to see if there is any improvement.

Allergies: Allergic to cats, horse serum, sensitive to codeine, some types of anesthesia, MRI/CT dye, some medical stabilizers, some medical preservatives

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

Symptoms: Arms and legs severely numb and tingling to point of being asleep even with movement. Could not walk well at 3:30am beginning 3:30am 10/07/21. Left out fingers and toes completely numb. Symptoms waning but still tingling as of 10/19/21. Severe and persistent headache 10/07-10/19/21 (today.) Dizziness even when not moving 10/07-10/19/21 (today.) Chills and cold sweats with no fever at onset-now waning but present. Swollen tongue and eyes as well as lymph nodes under left arm, neck, and groin. Rash on face, head and hands. Racing heart which could be felt in the headache. Not able to communicate properly, scattered thought and unable to find my words the last 13 day and nights. Light sensitivity last 13 days but now waning. Lower back pain. Easily bruised legs. Extreme fatigue and weakness the last 13 days. Have had to take many sick days off work due to these horrible side effects.

Other Meds: None

Current Illness:

ID: 1798438
Sex: F
Age: 72
State: CA

Vax Date: 10/01/2021
Onset Date: 10/08/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data: stress test- normal CT- normal blood work- normal chest xray- normal

Allergies: penicillin sulfa drugs codeine tetracycline indomethacin

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

Symptoms: I had extreme sharp chest pain and enormous lung pressure. I thought I was having a heart attack. I also had weakness, dizziness, nausea and headache. I went to the ER three time in a row and the fourth time was in an ambulance. These symptoms have lasted form 10/8/2021 to today 10/19/2021. I have been completely incapacitated. It's hard to move around or do anything at all. They ran a number of tests in the ER but all came back normal. No diagnosis at this point.

Other Meds: Duloxetine- 20mg once daily ibuprofen- once daily tylenol- once daily

Current Illness: none

ID: 1798439
Sex: F
Age: 24
State: CA

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data: - CBC (elevated immature monocytes and granulocytes) - COMPREHENSIVE METABOLIC PANEL, NON-FASTING (Nothing to note) - SEDIMENTATION RATE (abnormal) - - CHEST X-RAY (contour of left ventricle/left atrium is abnormal)

Allergies:

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

Symptoms: - Chest pain and enlarged left ventricle/ - Allergic reaction resulting in swelling of the throat and airways, subsided after 24 hours - Lymphadenopathy and sharp pain in many lymph nodes - Tingling in the legs, spread from one to both legs and now arms - Extreme pain and shortness of breath when walking - On and off oscillating medium and low grade fever (103F to 100F)

Other Meds:

Current Illness:

ID: 1798440
Sex: F
Age: 68
State: IN

Vax Date: 10/12/2021
Onset Date: 10/14/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data: 10/14/21 Ophthalmologist consult, ER visit with CT of the brain and carotid ultrasound

Allergies: NKDA

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Unknown lot number, immunization given at the hospital clinic. Booster immunization received 10/12/2021. Pt woke up on 10/14/21 with blindness of left eye. Diagnosed with central retinal artery occlusion.

Other Meds: Fluoxetine, losartan, metoprolol ER, vitamin D

Current Illness: None

ID: 1798441
Sex: F
Age: 36
State: WA

Vax Date: 04/16/2021
Onset Date: 10/08/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data: 11th - COVID 19 - test - Rapid - negative - Urgent Care - just had the test COVID there.

Allergies: sensitivity to Valtrex medication

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Follow up report: sore throat; coughing; fever, runny nose, chest congestion, diarrhea. I still have the cough and chest congestion and runny nose. The sore throat resolved on the 13th. The diarrhea resolved on the 12th. Over the counter Mucinex cold medicine.

Other Meds: Levothyroxine; Phentermine; Prilosec OTC; 4000 IU of Vit D

Current Illness: no

ID: 1798443
Sex: M
Age: 71
State: NJ

Vax Date: 01/29/2021
Onset Date: 02/02/2021
Rec V Date: 10/19/2021
Hospital: Y

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

Lab Data: MRI brain done on 2/4/21 at hospital was negative. Serial labs sowed up trending CPK values. EMG confirmed demyelinating Neuropathy.

Allergies: None

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

Symptoms: got vaccine 1/29/21, 2/2/21 developed heaviness, tingling of arms and legs. He developed double vision on 2/4/21, unable to walk by 2/6/21. Was hospitalized. Developed right facial droop on 2/8/21. Had right ptosis on 2/9/21. Started on IVIG with slow resolution of symptoms. Today feels 70% recovered. He is able to walk unaided but still feel not back to full strength.

Other Meds: Amlodipine, Benazepril, Atorvastatin, Vitamin D

Current Illness: BPH, Agent orange exposure, HTN, hyperlipidemia

ID: 1798444
Sex: F
Age: 31
State: TX

Vax Date: 10/19/2021
Onset Date: 10/19/2021
Rec V Date: 10/19/2021
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: None

Allergies: Patient marked NO to having any allergies to food, medication, vaccine components, latex

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

Symptoms: the vaccine was administered into the right muscle 0.3ml , no reaction patient did fine and was told to stay 15 minutes for observation. She stayed and felt fine and left to drive home and started to feel itchy and fast heart rate so she went to the ER and they are monitoring her there and had not given epinephrine , steroid or benadryl and were just monitoring her . I asked her permission to call her tomorrow to see how she was doing and she was grateful.

Other Meds: None listed on Vaccine Informed consent form

Current Illness: patient marked no illnesses on consent form

ID: 1798445
Sex: F
Age: 29
State: AZ

Vax Date: 01/15/2021
Onset Date: 10/06/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data: Positive Covid-19 test, unknown type.

Allergies:

Symptom List: Unevaluable event

Symptoms: Complaint of headache, runny nose/congestion, myalgia and malaise.

Other Meds:

Current Illness:

ID: 1798446
Sex: F
Age: 70
State: MS

Vax Date: 10/19/2021
Onset Date: 10/19/2021
Rec V Date: 10/19/2021
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: tramadol, clopidogrel

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

Symptoms: mistakenly gave 0.5ml instead of 0.3ml-(no adverse s/s at this time)-

Other Meds: omeprazole 40mg, klonopin 1mg, diclofenac 75mg, losartan 100mg, rosuvastatin 10mg, sertraline 25mg, metoprolol er 25mg, amlodipine 2.5mg

Current Illness:

ID: 1798447
Sex: F
Age: 11
State: CO

Vax Date: 07/24/2021
Onset Date: 07/24/2021
Rec V Date: 10/19/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Patient's age was different than actual age. Patient was 11 during time of shot but had stated that her age was 12.

Other Meds:

Current Illness:

ID: 1798448
Sex: F
Age: 50
State: MI

Vax Date: 08/19/2021
Onset Date: 09/09/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data: none

Allergies: sulfa

Symptom List: Injection site pain, Menorrhagia

Symptoms: vaginal bleeding began Sept 9, 2021 and has continued since then.

Other Meds: lisinopril lexapro curcumin vitamin c vitamin d niacin multi vitamin vitamin b complex

Current Illness: none

ID: 1798449
Sex: F
Age: 51
State: CO

Vax Date: 04/19/2021
Onset Date: 04/24/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data: Endometrial biopsy on 06/16/2021- negative

Allergies: Pet dander, pollen

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

Symptoms: My period started 5 days after the second shot. I have not had a period for 8 months prior to that. I thought I was in menopause but I am not. They have continued monthly ever since. I called my doctor a couple of days later because a friend suggested me to do it. They said not to worry about it. I had another period in May 17 and I called the doctor again and they told me to get in to get that checked out. I went in and got an endometrial biopsy on 06/16/2021, which came back normal.

Other Meds: Imitrex for migraines, Trazadone for insomnia, Valtrex, Ibuprofen as needed, Zyrtec, baby Aspirin, vitamin D, probiotic, B complex, multi vitamin, turmeric

Current Illness: None

ID: 1798450
Sex: F
Age: 57
State: NC

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 10/19/2021
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: sulfa drugs, gluten, dairy

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: A few hours after first shot my arm began to feel sore and that evening I woke with fever. The next day was a Wednesday and I had a headache and felt dizzy getting up out of bed. I also felt swollen and sore close to my right ear on my low cheek bone for two days. The following morning, upon opening my eyes the room began to spin. I could not get out of bed for a good 10 minutes. Was throughout the day with vertigo. If I turned my head to the left or right even to brush my hair the room would spin and I had to hold onto the counter to keep form falling. Frid was the same. I started some meclizine, just 1/4 of a pill as I am sensitive to meds. Sat. I had to ask my husband to drive me. When I layed down at night my head started spinning and when I turned in bed at night especially to my right (same side where I felt swollen), I felt more dizzy. On Saturday Oct 9th, I was still unsteady on my feet. I notice today and every day, I feel very tired around 3pm and until the evening. I don't feel good in my head....like something is moving around. I was less dizzy a week after the shot, but I have continued to have dizzy sensations when I lie down and get up. And if I bend over. I read on line that people who had vestibular issues in the past, had dizziness. I never read anything about that symptom before tkaing the shot. I only read about flu like symptoms and or headache. I wish someone had used the word dizzy or I wouldn't have gotten this shot. I am not planning to get the next one.

Other Meds: Lexothyroxine, Sertraline, Oxybutinin, Lyrica, Allgegra, Vit D Zinc, multi, adrenal support, oregano

Current Illness: none

ID: 1798451
Sex: F
Age: 29
State: NY

Vax Date: 04/09/2021
Onset Date: 04/10/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data: 9/27/21 Bacterial Culture on lips: Few Yeast + Heavy growth Serratia Liquefactions. 10/6/21 Bacterial Culture on lips: Moderate Yeast Growth

Allergies: Peanuts, anaphylaxis.

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Additional information for Item 9: Atorvastatin 10mg, 1x a week. Additional information for Item 10: Cobalt, Nickel, + hydroperoxides of linalool ? minor reactions. Additional information for Item 18: 4/9/21 | First covid Pfizer vaccine. 4/10/21 Severe menstrual cramping / bleeding for 15 days. (i skip placebo birth control pills, so should not have gotten a period at all). Mid-April: Saw OB, blood work & vaginal ultrasound came back normal. She linked it to vaccine side effects & said my menstrual cycle would go back to normal in 3 months. 4/30/21 | Second covid Pfizer vaccine, breakthrough bleeding/periods continues. Throughout May, hard pieces of skin begin developing on the peaks of upper lips. As time continues, those hard/dry patches move to the sides of my nose, then back to my lips, and so on. 6/21/21 Severe burning/pain while urinating, I had assumed it was just linked to the ongoing menstrual issues. 7/4/21 Upper and lower lips becoming increasingly dry and chapped. Start experiencing a few days of extreme lethargy. (this will start to become 1-2x a week from here on out). 7/25/21 ? 7/29/21 Severe vaginal burning/irritation. Call OB, she advises that it's a yeast infection and to get a 3-day Monistat from Pharmacy. 8/4/21 ? 8/6/21 Severe dryness/swelling/burning/itching on both upper and lower lips (almost as if having an allergic reaction). Teledoc appointment - was told this could be a systemic yeast infection. Prescribed Mupirocin and Ketoconazole topicals. Called OB to update her, she agreed that it was a systemic yeast infection and told me to continue topicals. Prescribed fluconazole 150mg once every 6 days for 4 weeks. Touchbase with GP to fill her in, she agrees with the above diagnosis. 8/11/21 ? 9/19/21. Some relief on both upper and lower lips, but continued severe dryness in addition to a more pronounced, red lip line. Severe eye/throat irritation (itchiness, dryness) Menstrual cycle has returned to normal. 9/22/21 ? 9/26/21Major upper and lower lip flare-up. Severe swelling, itching, burning, in addition to 3 key locations with pus (peaks on upper lips + middle of lower lip). Continued eye/throat discomfort, Appointment with GP, she refers me to a Dermatologist. 9/27/21 Dermatologist appointment: Concluded that it was allergy based, prescribed topical steroid (Desonide .05%) and daily Zyrtec. After further discussion, also took bacterial culture to rule out bacterial infection. Throughout the week, lethargy is increased to 3-4 days as well as pretty bad chills. 10/1/21 Culture Results: Heavy growth of Serratia Liquefaaciens. Dermatologists takes me off zyrtec + desonide, prescribes Gentamicin. Discuss results with GP, she refers me to an Infectious Disease doctor. Recommended to MD to get blood work/culture & urine tested to have all results in time for ID appointment. Temperature 99.3. Blood Sugar 49. All other results were normal 10/4/21 - 10/5/21: Burning and itching on upper lip, turning into some small blistering outside of the lip line. Dermatologist followed up with additional results which showed yeast growth. She wants to take a viral culture, switch me to an oral antibiotic and put me on nystatin anti-fungal topical. 10/6/21 Allergist Appointment: Doctor does not think it's cold sores since nothing has ever scabbed over. He says there is skin sloughing although unsure as to what is causing it. Took a bacterial culture, and will be doing a patch test on 10/11/21 to rule out any eczema or chemical allergy. 10/7/21 Dermatologist Follow up: Dual-treatment medication (topical, gentamicin 3x a day & oral, levofloxacin 750mg) for a week. He would potentially recommend a lip biopsy, but is deferring to the Infectious Disease doctor's treatment plan. 10/8/21 Worst flare up yet, really swollen and raw lips/face. Super painful, really itchy, almost went to ER. 10/11/21 Allergist appointment for patch test. 10/13/21 Allergist appointment, patch test & culture results. Very few allergies shown from patch test, which confirms that there is no allergy correlation to what's been happening on my lips. Culture results showed moderate yeast growth, and no serratia growth. He is deferring to the ID for treatment. 10/15/21 Infectious Disease Appointment: Thinks Serratia + Yeast are secondary infections from an underlying cause. Prescribed Fluconazole 100mg 1x a day for 7 days, as well as topical (using ketoconazole in the meantime) 2x a day for 7 days. Did bloodwork to test for vitamin levels / tb. UPCOMING: 10/22/21 Infectious Disease Follow up Appointment, 10/27/21 Dermatologist Lip Biopsy, 11/4/21 Dermatologist Follow up, 1/12/22 Dermatologist.

Other Meds: Adderall XR 15mg, Levothyroxine 50mcg, Nikki tablets

Current Illness: none

ID: 1798452
Sex: M
Age: 43
State: NJ

Vax Date: 09/01/2021
Onset Date: 09/18/2021
Rec V Date: 10/19/2021
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: Penicillin

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

Symptoms: Metallic taste and swollen lymph Nodes.

Other Meds: Atenlol Praveatatin

Current Illness:

ID: 1798453
Sex: F
Age: 52
State: WA

Vax Date: 03/19/2021
Onset Date: 03/01/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data: No not yet. I am looking to do another viral panel.

Allergies: Food allergies; anything in the class of penicillin.

Symptom List: Nausea

Symptoms: The biggest symptom I experienced was pain and swelling in my breast glands and armpits. It traveled into my armpits from right to left. I have noticed swelling in other parts of my body. My knees, legs and arms. It was lasting pain at the injection site. The lymph node swelling has not gone away. It continues to come and go. Most recently, I have been exposed to a seasonal virus. It activated the lymph node swelling again. it is more on left side. It is intensity that comes and goes. I read that this was pretty common. This has now been going on for seven months. It concerns me, I can not rule out any other source yet. This started with the vaccine. When I had my out break out my shingles years ago. I am having new pains in the same area of my old symptoms of the shingles virus. I believe this is causes this reaction in my body. I think that is related to the shingles virus and the Epstein barr.

Other Meds: Progesterone; multivitamin.

Current Illness: No.

ID: 1798454
Sex: F
Age: 37
State: CA

Vax Date: 10/11/2021
Onset Date: 10/11/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data: NA

Allergies: Penicillin

Symptom List: Injection site pain

Symptoms: That night after the vaccine, patient developed swelling and pain to the lymph nodes in her right axillae, which then worsened over the next few days, developed redness to the breast. This over the course of a week started to resolve. Currently is still swollen, mildly tender, and some redness still present but not as bad as initial.

Other Meds: NA

Current Illness: NA

ID: 1798456
Sex: F
Age: 45
State: NJ

Vax Date: 09/27/2021
Onset Date: 10/14/2021
Rec V Date: 10/19/2021
Hospital: Y

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

Lab Data: CT of the head. MRI, EEG, blood work. 10/14/21-10/18/21.

Allergies: none

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

Symptoms: Severe dizziness, difficulty speaking, seizure like movements, weakness, brain fog, difficulty breathing

Other Meds: none

Current Illness:

ID: 1798457
Sex: F
Age: 67
State: AZ

Vax Date: 01/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data: Positive Covid-19 test, unknown type.

Allergies:

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

Symptoms: Complaint of cough, chills, elevated temperature, headache, runny nose, congestion, myalgia and malaise.

Other Meds:

Current Illness:

ID: 1798458
Sex: F
Age: 31
State: PA

Vax Date: 10/16/2021
Onset Date: 10/17/2021
Rec V Date: 10/19/2021
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: None

Symptom List: Tremor

Symptoms: Tired, body aches, hives, rash, itching, low grade fever, chills

Other Meds: None

Current Illness: None

ID: 1798459
Sex: F
Age: 40
State: CA

Vax Date: 08/11/2021
Onset Date: 08/13/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data: On 10/15 I had a full panel done and tested for autoimmune disorders and lyme. My doctor tested my reflexes in the office as well. Everything has come back normal. Neurology has been consulted and thinks I do not have a neurological disorder and thinks this is related to the vaccine.

Allergies: Flagyl

Symptom List: Erythema, Pruritus

Symptoms: 48 hours after 2nd shot I had severe neck pain on the right side. Doctor advised me to take motrin. That night when trying to sleep my nerves felt like they were vibrating in my upper spine area. The vibrations went down to my arms, my legs. Next morning the neck pain was much better but every single night since then my nerves vibrate all through out my body. I get toe pain and finger pain. Sometimes tingling feelings in my hands and feet and nose. I can't sleep at night due to the vibrations. Over the last 4 weeks I have frequent muscle spasms through out the day that last hours sometimes.

Other Meds: None

Current Illness: None

ID: 1798460
Sex: M
Age: 56
State: FL

Vax Date: 09/25/2021
Onset Date: 09/01/2021
Rec V Date: 10/19/2021
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: None

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

Symptoms: Duplicate vaccination. Patient requested and received vaccine on 9/15/21 and came in again on 9/25/21 for a 2nd dose. On 9/25/21, patient did not remember if he had gotten the vaccine already and his profile was not reviewed for duplications and no DUR rejections displayed at time of processing. RPh on duty was made away of the duplication by our Clinical Services team. RPh attempted to reach out to patient to collect more information. Unable to reach patient at this time, will continue to reach out.

Other Meds: Steglatro, Glucophage XR, and Gabapentin

Current Illness: Unknown

ID: 1798461
Sex: M
Age: 57
State: PA

Vax Date: 10/18/2021
Onset Date: 10/18/2021
Rec V Date: 10/19/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: received 1ml instead of .5ml

Other Meds:

Current Illness:

ID: 1798462
Sex: F
Age: 32
State: WA

Vax Date: 10/19/2021
Onset Date: 10/19/2021
Rec V Date: 10/19/2021
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: NKDA/NKA

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Immediately after receiving shot experienced right arm numbness, tingling, pins/needles from neck to finger tips. Started to develop hot, itchy, blotching rash at injection site approximately 4 inches in diameter.

Other Meds:

Current Illness: Minor Cold

ID: 1798463
Sex: F
Age: 41
State: KS

Vax Date: 10/15/2021
Onset Date: 10/16/2021
Rec V Date: 10/19/2021
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:

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

Symptoms: Patient reports that the day after her vaccine her arm swelled up and was bright red, hot and painful. She didn't report until today 10/19/21. At time of my observations the swollen area was still quite large (about 4-5 inches in diameter ), warm to touch, red (although patient reports the redness as reduced mildly since day 1), and painful.

Other Meds:

Current Illness:

ID: 1798464
Sex: F
Age: 66
State: CA

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 10/19/2021
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: None

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

Symptoms: Severe headache, chills, fever, body aches, loss of appetite

Other Meds: None

Current Illness: None

ID: 1798465
Sex: M
Age: 48
State: NC

Vax Date: 07/29/2021
Onset Date: 07/29/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data: None

Allergies: NKDA

Symptom List: Pain in extremity

Symptoms: Deafness in the LEFT ear along with pain for three weeks following the vaccination (both first and second doses). Complete recovery.

Other Meds: aspirin entered on 11-01-2017 81 mg one by mouth daily gabapentin 600 mg tablet prescribed on 06-29-2021 TAKE ONE TABLET BY MOUTH 2 TIMES A DAY glimepiride 1 mg tablet prescribed on 06-29-2021 Take 1 tablet every day by oral route for 90 da

Current Illness: None

ID: 1798466
Sex: M
Age: 28
State: AL

Vax Date: 09/17/2021
Onset Date: 09/28/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data: EKG, CBC, CMP, CKMB, Troponin, Thyroxine, FT4, Echo, Holter Monitor

Allergies: None

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

Symptoms: Patient was vaccinated on 17 October 2021 with Pfizer/BioNTech, as ordered. Patient reports that he had a few episodes of chest pain prior to presenting to the ER on 28 Sep 2021, but ignored them because he is young, and he did not know the vaccine could case heart problems and his symptoms were not initially severe. On 28 Sep 2021, Patient had mowed his lawn at 1230 and then went to class, where he was sitting in a chair and when he leaned forward his chest got tight with shortness of breath, that resolved when he leaned back but returned when he leaned forward again. Patient called Health Clinic for advice or to get an appointment and was advised to go to local ER. Patient took the vaccine because he was told that he would not be required to get the vaccine unless it was FDA approved. Patient reports that Pfizer BioNtech and Pfizer Comminarty were the same. Patient reports that he absolutely would NOT have taken the vaccine if he knew it was not the FDA approved Pfizer vaccine.

Other Meds: None

Current Illness: None

ID: 1798467
Sex: M
Age: 40
State: CA

Vax Date: 04/16/2021
Onset Date: 05/15/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data: Doctor visit with Dr: They did an EKG, didn't notice abnormal heart rhythms. He thought it might be related to breathing issues, prescribed an albuterol inhaler, that hasn't really helped me to make the symptoms go away when it comes back.

Allergies: Penicillin

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

Symptoms: It is still going on, off and on. Left side upper chest pain. Axillary and below the nipple line, where my heart is, it seems. It's like a sharp pain. Sometimes, it hurts more when I breathe deeply. It happens every few days and some worse than others. Some days real painful and some days it just feels kind of weird.

Other Meds: Turmeric occasionally; multivitamin; glucosamine chondroitin

Current Illness: No

ID: 1798468
Sex: F
Age: 11
State: IA

Vax Date: 09/26/2021
Onset Date: 09/26/2021
Rec V Date: 10/19/2021
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's parent consented to patient being 12 years old, but patient was actually born later and was not actually old enough to receive vaccine. Patient's parent reported that the insurance company had the wrong date of birth, so the pharmacist-on-duty agreed to vaccinate the patient and bill the claim for the vaccine later. Patient returned to the pharmacy on Sunday, 10/17/21 to receive her 2nd dose and the insurance issue had not been resolved. At this time, the pharmacist-on-duty consulted the Registry Information System and noted that the date of birth was listed as the patient being 11. The pharmacist refused to administer the 2nd Pfizer vaccine at that time. The pharmacist then called the Dept of Public Health on Tues, 10/19 and reported the incident.

Other Meds:

Current Illness:

ID: 1798470
Sex: F
Age: 68
State: NY

Vax Date: 10/15/2021
Onset Date: 10/15/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data: Nothing

Allergies: Aspirin, Erythromycin, clindomycin

Symptom List: Vomiting

Symptoms: About 10pm my heart began beating very fast. Usual resting rate 62-72 bpm, it was between 90-110 bpm at rest, walking it went up once to 120. The elev rate lasted for several hours, then came into 80-90 range and stayed there for the next day. It still seems slightly elevated for me but is within normal range at this time.

Other Meds: Synthroid, cytomel, metoprolol, Vit C, Vit D, multivitamin

Current Illness: None

ID: 1798471
Sex: M
Age: 57
State: TX

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

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

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: No adverse events were reported at the time of discovery. The patient was informed to report any unusual symptoms to the pharmacy.

Other Meds:

Current Illness:

ID: 1798472
Sex: F
Age: 31
State: PA

Vax Date: 10/16/2021
Onset Date: 10/17/2021
Rec V Date: 10/19/2021
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: fatigue, tired, nauseous, headache, body aches, severe body rash/hives, fever, chills

Other Meds: None

Current Illness: None

ID: 1798473
Sex: F
Age: 29
State: AZ

Vax Date: 02/05/2021
Onset Date: 10/06/2021
Rec V Date: 10/19/2021
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: Positive Covid-19 test of unknown type.

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Complaint of cough, elevated temperature, sore/scratchy throat, and runny nose/congestion,

Other Meds:

Current Illness:

ID: 1798474
Sex: F
Age: 49
State: SC

Vax Date: 10/12/2021
Onset Date: 10/13/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data: none

Allergies: none

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

Symptoms: 24 hours after vaccine (booster) fever,aches,shivering, you like symptoms, swelling and pain at injection side, fatigue, 48hrs after flu like symptoms gone, still having fatigue, large,hard,swollen,feverish knot at injection site, 7 days later severe,bumpy rash at injection site,still very red.

Other Meds: Effects 150mg, losartin

Current Illness: none

ID: 1798475
Sex: M
Age: 26
State: NY

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

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

Lab Data: none

Allergies: nka

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

Symptoms: within 3 minutes of vaccine, pt complained of dizziness, lightheadedness. Pt stated may be hypoglycemia or anxiety. Pt waited 30 minutes, drank water and orange juice. symptoms subsided

Other Meds: none

Current Illness: none

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am