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: 1801572
Sex: M
Age: 65
State: AR

Vax Date: 09/28/2021
Onset Date: 09/30/2021
Rec V Date: 10/20/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: woke up in hot sweat, couldnt swallow or walk straight, diagnosis stroke in medulla, been in rehab at encompass for two weeks and still doing therapy twice a week. Patient described feeling like eyes were going to cross the day after third vaccine which is day before actual stoke (couldnt concentrate)

Other Meds: toprol xl 50mg, celexa 20mg, xalatan eye drop, synthroid 100mcg, gabapentin 100mg, relafen 750mg, osteobiflex, vitamin c, prilosec

Current Illness:

ID: 1801573
Sex: F
Age: 71
State: UT

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 10/20/2021
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: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1801574
Sex: F
Age: 29
State: CA

Vax Date: 10/08/2021
Onset Date: 10/08/2021
Rec V Date: 10/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Systemic: Allergic: Difficulty Breathing-Mild, Additional Details: Paitent states she had difficulty breathing, I did advise patient to go to urgent care or ER, but she said she slept it off and was fine next day.

Other Meds:

Current Illness:

ID: 1801575
Sex: F
Age: 62
State:

Vax Date: 04/05/2021
Onset Date: 09/17/2021
Rec V Date: 10/20/2021
Hospital: Y

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

Lab Data: COVID PCR (9/11/2021) = positive

Allergies: NKDA

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: 62 y.o. female h/o RA, afib (recent ablation, on flecainide, bb, xarelto) who presented with sob. Was fully vaccinated for covid in April. Symptoms for 8 days pta with fatigue, headaches, fevers, n/v/d. Went to ED was started on prednisone and dc'ed, but continued to feel worse over 3-4 days with worse sob and spo2 63% on ambulation at home which prompted her to come in. She normally wears o2 at home, 2L at night but has wearing it throughout the day. She received remdesivir and dexamethasone 10 mg IV. She was discharged to home after receiving 5 days of remdesivir. She returned to the hospital six days after discharge as she had worsening shortness of breath, dyspnea on exertion that started after her last day of dexamethasone. She was admitted to the hospital for 2 additional days, then discharged back to home on dexamethasone to complete a total of 14 days of therapy.

Other Meds: Enbrel, Arava

Current Illness:

ID: 1801576
Sex: F
Age: 54
State: WA

Vax Date: 10/04/2021
Onset Date: 10/05/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data:

Allergies: Gluten, Soy, Environmental - dander, dust, chemicals, trees, weeds, grasses,

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

Symptoms: I have the same symptoms that I had with the first shot, only way worse and they have now persisted for over two weeks. Intense headache, body aches, swollen glands and brain fog. I have tried Tylenol, Ibuprofen, Baclofen, topical rub for pain, natural anti-inflammatory remedies like turmeric and CBD, hot bathes, sauna and massage, but nothing has given me any real relief.

Other Meds: Armour Thyroid, Flovent HFA, Vitamin D, Magnesium, Stress Arrest, TerraZyme, NAC,

Current Illness: I had been the healthiest I have been in years. I have had a chronic migraine that had been getting better in the months before being vaccinated.

ID: 1801577
Sex: M
Age: 73
State: UT

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 10/20/2021
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:

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

Symptoms: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1801578
Sex: M
Age: 51
State: OK

Vax Date: 10/14/2021
Onset Date: 10/15/2021
Rec V Date: 10/20/2021
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: n/a

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Headache, dizziness, ringing in ears. Constant.

Other Meds: Duloxetine 20mg

Current Illness: n/a

ID: 1801579
Sex: F
Age: 72
State: UT

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1801580
Sex: F
Age: 68
State: WA

Vax Date: 10/16/2021
Onset Date: 10/17/2021
Rec V Date: 10/20/2021
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: Penicillin

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: first 24 hrs - achy all over and feverish, took tylenol for sleeping. In 48 hours, achy in all joints, no energy, continued tylenol and rested. In 72 hours pain gone from injection sites but still achy joints. Right elbow red and swollen with cellulitis. In 96 hours, energy back, swelling gone but right elbow still red and itchy.

Other Meds: AREDS 2

Current Illness: none

Date Died: 09/13/2021

ID: 1801581
Sex: F
Age: 81
State:

Vax Date: 03/08/2021
Onset Date: 09/10/2021
Rec V Date: 10/20/2021
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:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: pt presented with SOB and hypoxia despite being on 3L O2 via NC; placed on nonrebreather; oxygen requirement increased; hypotension occurred; O2 sats dropped; pt was a DNR/DNI; condition declined and she died in the hospital

Other Meds:

Current Illness:

ID: 1801582
Sex: F
Age: 23
State: UT

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 10/20/2021
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: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1801583
Sex: F
Age: 26
State: UT

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1801584
Sex: F
Age: 24
State: LA

Vax Date: 10/13/2021
Onset Date: 10/13/2021
Rec V Date: 10/20/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Same day as injection experienced burning in hand of injected arm. Next day experienced swollen lymph under injected arm. Then same hand started intense itching, then peeled. Also if hand was bumped would bleed easily. Non injected arm - hand fine. 1 week later and hand feels tender and skin rough.

Other Meds:

Current Illness:

Date Died: 10/15/2021

ID: 1801585
Sex: M
Age: 88
State: TX

Vax Date: 04/06/2021
Onset Date: 09/20/2021
Rec V Date: 10/20/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: COVID Positive on 9/20/21 using Roche LIAT SARS assay platform using PCR or equivalent Nucleic Acid Amplification(NAA) technology.

Allergies: NKDA

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

Symptoms: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 3/9/2021 and 4/6/2021. Presented to ED on 9/20/2021 after being found down in barn where he was working. The fall was not witnessed, and family does not believe he hit his head as only abrasions noted are on elbows. Patient found to be COVID positive and treatment with Dexamethasone, remdesivir, and baricitinib, HFNC oxygen started. Patient developed confusion and agitation on 9/25/2021. Patient began to experience SOB on 10/1/2021, and enterococcus bacteremia noted. On 10/5/2021 patient developed tachycardia and worsening hypoxia. Patient condition continued to deteriorate and family decided comfort measures on 10/11/2021. Patient expired on 10/15/2021.

Other Meds: Aspirin 81 mg QD, Diclofenac 2 grams topical QID PRN, Doxycycline 100 mg QD, Mycophenolate 1000 mg QAM 500 mg QPM, Simvastatin 40 mg QD

Current Illness:

ID: 1801586
Sex: F
Age: 58
State: TX

Vax Date: 08/18/2021
Onset Date: 08/18/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: NONE

Allergies: NKA

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

Symptoms: CLIENT RECEIVED J&J COVID VACCINE ON 4/8/2021 PRIFIRST PFIZER DOSE ON 8/18/2021. UNKNOWN IF CLIENT RECEIVED SECOND PFIZER DOSE.

Other Meds: NOT REPORTED

Current Illness: NOT REPORTED

ID: 1801587
Sex: F
Age: 68
State: IL

Vax Date: 04/05/2021
Onset Date: 06/12/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: No

Allergies: Penicillin, Neurontin, alcohol

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

Symptoms: 2 months after the injections I got shingles. I was unable to get in with my skin doctor, so I contacted my internist who prescribed antivirals. I took them and the shingles ran its course and disappeared after a couple weeks. I have had shingles before so I am able to identify it. This time was different because usually I experience a burning sensation but this time it was as if my nerves were hypersensitive about 4 days before they erupted

Other Meds: Doctor's prescriptions: metformin 500mg/2xday, lisinopril sodium 40mg/1xday, amlodipine 5mg/1xday, atorvastatin 20mg/1xday, timolol .5%/1 drop per eye Vitamin D 4000 unit/day, Vitamin b12 1000mg/day Alavert

Current Illness: No

ID: 1801588
Sex: M
Age: 14
State: TX

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

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

Lab Data: No medical test or laboratory results related to the adverse event exist to my knowledge.

Allergies: There were no allergies to medications, food, or other products that were reported by the client or parent.

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

Symptoms: No adverse events was noted. No treatment was provided. Client remained in the observation area for 15 minutes and left with parent. No signs of acute distress was observed or noted. The client left the observation area at 1257.

Other Meds: No prescriptions, over-the-counter medications, dietary supplements, or herbal remedies were being taken at the time of vaccination as reported by the client and parent.

Current Illness: There were no ilnesses reported at the time of vaccination or up to one month prior as reported by client and parent.

ID: 1801589
Sex: F
Age: 38
State: OR

Vax Date: 10/16/2021
Onset Date: 10/19/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: No

Allergies: No

Symptom List: Ear pain, Hypoaesthesia

Symptoms: It caused my menstrual cycle to begin nearly 2 weeks early. I track my cycle. I am very regular. My menstrual cycle should have started 11/6/21. The only other time this has ever happened was when I contracted Covid earlier this year. I?m reporting this because I think it?s important to look at the fact that this is occurring and if it?s creating any long-term reproductive issues. I was forced through my employer and the governor to get both vaccines even though I already had Covid and was ill for 3 weeks. Requiring any shot but especially the second shot is more harmful than helpful. I believe the second shot is creating an overload to the system with harmful effects which is also backed by studies.

Other Meds: Methyl folate 500mcg Methyl b12 800mcg

Current Illness: No

ID: 1801590
Sex: F
Age: 48
State: WA

Vax Date: 10/02/2021
Onset Date: 10/13/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: 10/13/21 - CT scan, MRI, blood tests, etc.

Allergies: N/A

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Bell's Palsy, onset 10/13/21, treatment with prednisone and Valtrex, currently unresolved

Other Meds: Eloquis

Current Illness: N/A

ID: 1801591
Sex: F
Age: 58
State: KY

Vax Date: 02/08/2021
Onset Date: 10/06/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: COVID19 test 10/6/2021

Allergies:

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

Symptoms: Positive COVID19 test 10/6/2021

Other Meds:

Current Illness:

ID: 1801592
Sex: M
Age: 49
State:

Vax Date: 03/20/2021
Onset Date: 09/24/2021
Rec V Date: 10/20/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Rapid Covid 19 test (9/24/2021) = positive

Allergies:

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

Symptoms: Patient presented to an outside hospital on 9/24/2021 with shortness of breath. Due to increasing oxygen requirements, he was transferred and admitted to this facility on 9/26/2021. He required heated high flow oxygen, remdesivir, dexamethasone, and baricitinib. He was eventually discharged to home on oxygen.

Other Meds:

Current Illness:

ID: 1801593
Sex: F
Age: 70
State: IL

Vax Date: 10/07/2021
Onset Date: 10/12/2021
Rec V Date: 10/20/2021
Hospital: Y

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

Lab Data: see above

Allergies: penicillins - anaphylactic shock

Symptom List: Unevaluable event

Symptoms: Pfizer Dose 1 2/11/21 (EN5318) Pfizer Dose 2 3/11/21 (EL9266) Pfizer Dose 3 10/7/21 (30145ba) 10/13/21: Patient is a 70-year-old female who presents to the emergency room with a roughly 3-4 day history of some intermittent chest discomfort with some increasing shortness of breath and dyspnea on exertion. Within the last 6 weeks the patient did have a right ACL repair which was essentially uneventful. Patient has been attending regular therapy sessions and notes that she has been very mobile over the last 6 weeks and denies any prolonged periods of immobility. Patient does have a history of a blood clot within her family as her mother did have a history of a blood clot but the patient openly notes that the blood clot was only diagnosed after her mother was diagnosed with a malignancy. Otherwise there is no known family history of a bleeding or blood clot disorder. Patient denies any previous history of blood clots and denies any blood clots in her lower extremities and also denies any blood clots within her lungs. Most recently the patient did just within the last few days receive her COVID booster vaccine which she believes was the Pfizer vaccine. We discussed reviewed the patient's medical history, current medications, imaging studies, vital signs, laboratory studies and emergency room records. Answered the patient's questions as best I could and also discussed the reasons and diagnoses that she is being admitted to the hospital. Briefly discussed the possible length of stay which for this patient may be 2-3 days. 10/15/21: Patient is a 70-year-old female with recent history of orthopedic surgery to the right lower extremity, who was admitted on 10/13/2021 with acute bilateral PEs, DVT of right lower extremity, and hypertension. She was also mildly hypoxic in relation to the PEs. She was started on therapeutic Lovenox and admitted to the intensive care unit where she was monitored closely. Her echocardiogram showed no right heart strain. She was transitioned to Eliquis yesterday. There has been no drop in her hemoglobin. The patient has remained stable, though slightly hypertensive. She was started on amlodipine 5 mg p.o. daily to be paired with her benazepril 20 mg p.o. daily. This improved her blood pressures. The patient was transitioned to the med surge floor yesterday. She has had no red or yellow alarms on telemetry. Her vitals have been stable. She has been able to transition off of supplemental oxygen. Today she denies shortness of breath at rest, dyspnea on exertion, chest pain, palpitations. She is requesting to go home.

Other Meds: atorvastatin 20 m gPO QD benazepril 20 mg PO QD probiotic 1 cap PO QD biotin 1 tab PO QD vitamin D 2000 mg PO QD Glucosamine Chondroitin 1 cap PO QD Uqora Control 2 tabs PO QD omeprazole 20 mg PO QD tolterodine LA 4 mg PO QD

Current Illness:

ID: 1801594
Sex: F
Age: 66
State: WA

Vax Date: 10/14/2021
Onset Date: 10/14/2021
Rec V Date: 10/20/2021
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: no

Allergies: Pollen Extract, Amoxicillin

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

Symptoms: Pt states she feels a lot better today. Temperature today was 98.8 F at 8am. Dizziness and nausea have resolved. R arm is still very swollen down to elbow. Arm redness has decreased and itchiness has resolved. Pt states she will apply a cool compress to arm to help with swelling. Advised pt to call back if symptoms do not continue to improve or worsen or if previous symptoms local reaction with erythema and itching, certainly seems like some mild local allergic reaction. I agree that if this has not happened previously with tdap or 1st dose of Covid vaccine then ok to get these. patient can also premedicate with Advil and Benadryl

Other Meds: NO

Current Illness: no

ID: 1801595
Sex: F
Age: 37
State: WV

Vax Date: 10/14/2021
Onset Date: 10/14/2021
Rec V Date: 10/20/2021
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 reports that immediately after receiving her Pfizer booster shot, she felt a sharp pain that radiated from her underarm to her breast. Reports that lymph nodes on same side of neck and area under her arm became swollen. Reports that symptoms lasted for 4 days but did not prohibit her from working. Denies fever.

Other Meds:

Current Illness:

Date Died: 04/14/2021

ID: 1801596
Sex: F
Age: 64
State: NY

Vax Date: 04/13/2021
Onset Date: 04/14/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: complete autopsy

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient died within 72 hours of second dose. Extensive medical history including HTN, ESRD on dialysis and DM. Autopsy revealed cause of death to be Hypertensive and atherosclerotic cardiovascular disease with DM in part two. Vaccine didn't contribute to death.

Other Meds:

Current Illness:

ID: 1801597
Sex: M
Age: 26
State: KY

Vax Date: 02/04/2021
Onset Date: 10/11/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: COVID19 test 10/11/2021

Allergies:

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

Symptoms: Positive COVID19 test 10/11/2021

Other Meds:

Current Illness:

ID: 1801598
Sex: F
Age: 69
State: NY

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

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

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Error: Wrong Dose of Vaccine - Too High-

Other Meds:

Current Illness:

ID: 1801599
Sex: F
Age: 70
State: UT

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

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

Lab Data: None. pt denies adverse events at this time

Allergies: NDKA

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient came to clinic for flu vaccine. Pt qualified for Fluzone High Dose Influenza Vaccine. Patient checked in correctly per protocol, patient consented for vaccine and filled out consent correctly per protocol. Vaccine prepared correctly and labeled correctly per protocol. (COVID/Flu Clinic Supervisor). Ordered vaccine correctly and handed consent to MA and had MA repeat back order to verify correct vaccine was being given. MA went to do a task by his work station . MA had left Pfizer-BioNTech vaccine on work table. MA administered COVID-19 Pfizer Bio-NTech vaccine in left deltoid. Patient received COVID-19 Vaccine in ERROR. Patient notified. Patient was educated about vaccine and all questions answered. Patient given vaccine information handout. Patient received COVID-19 vaccine. This was her 4th dose. Previous doses and lot numbers 02/03/2021 EL9269, 02/24/2021 EN6203, 08/23/2021 FC3183. All vaccines were Pfizer-BioNtech. This fourth does was FF2587. Patient was observed for 60 minutes for adverse side effects, no adverse side effects detected or reported by patient. Patient was discharged in stable condition. Patient instructed to RTC or the ED if any questions or concerns. Medication error reported to Pfizer Manufacturer. Pfizer did not have current data or research regarding fourth dose administration. Medical director made aware. Rendering Provider made aware. No further actions or orders received by medical for that patient. Supervisor made aware. Director of Operations made aware. Plan for process improvement in place.

Other Meds: atorvastatin glipizide losartan metformin

Current Illness: bilateral cataracts type 2 diabetes mellitus

ID: 1801600
Sex: M
Age: 39
State: ID

Vax Date: 10/01/2021
Onset Date: 10/03/2021
Rec V Date: 10/20/2021
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: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: Chronic fatigue.

Other Meds: HYDROCHLOROTHIAZIDE, LISINOPRIL

Current Illness: None

ID: 1801601
Sex: F
Age: 55
State: CA

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

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

Lab Data: N/A

Allergies: Medication: Erythromycin

Symptom List: Nausea

Symptoms: Jaw locked in the middle of night Also experiencing typical symptoms however sever- fever, joint pain. violent chills, body aches, dizziness

Other Meds: Lisinopril Olmeprozole Trazadone

Current Illness: N/A

ID: 1801602
Sex: F
Age: 49
State: PA

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

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

Lab Data: None

Allergies: None

Symptom List: Injection site pain

Symptoms: Diarrhea

Other Meds: Celexa, buspirone

Current Illness: None

ID: 1801603
Sex: F
Age: 12
State: TX

Vax Date: 08/18/2021
Onset Date: 08/18/2021
Rec V Date: 10/20/2021
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: NKA

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

Symptoms: UNDERAGED CHILD. DOB STATED ON CONSENT IS DATE. SYSTEM STATES CORRECT DOB IS OTHER DATE. CHILD RECEIVED FIRST DOSE AND SECOND DOSES OF PFIZER ON 9/8/2021 (LOT#EW0177)

Other Meds: NOT REPORTED

Current Illness: NOT REPORTED

ID: 1801604
Sex: F
Age: 51
State: WA

Vax Date: 05/04/2021
Onset Date: 05/05/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: N/A

Allergies: N/A

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

Symptoms: I got really sick the next day, fever 100.1, Unable to move, walk and to do selfcare, Turning really red, very swollen and heartbeat was super fast, I wasn't able to eat.

Other Meds: Steroid treatment a month prior, Over the counter Sudafed, Mucinex, Synthroid, Ibuprofen and Tylenol.

Current Illness: I have P-enca, I also Have Granulomatosis with polyangiitis.

ID: 1801605
Sex: M
Age: 27
State: NY

Vax Date: 09/15/2021
Onset Date: 09/17/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: I went to an urgent care facility when the pain got really bad and they did an EKG. They diagnosed me with costochondritis. The symptoms subsided to a degree a couple weeks later but not completely. I tried to exercise and and I was unable to continue after 5 minutes due to chest pain. I then received the second dose on October 13th at 11:40am and pain returned.

Allergies: No

Symptom List: Tremor

Symptoms: I noticed a knot in my chest shortly after receiving the vaccine. Then The knot turned into a pain and a burning sensation. I tried to take anti-inflammatories and it helped to relieve the symptoms temporarily. However once the drugs wore off the symptoms returned.

Other Meds: Lexa Pro

Current Illness: No

ID: 1801606
Sex: F
Age: 69
State: IL

Vax Date: 10/14/2021
Onset Date: 10/14/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: No

Allergies: Penicillin, Neurontin, alcohol

Symptom List: Erythema, Pruritus

Symptoms: On Thursday night I started having pain on my upper thigh On Friday it went down the inside of e leg. By Saturday it was sciatica patterned pain that goes down my leg and my back. On Sunday it went done both he inside and outside of my right leg. Took Tylenol to help me sleep. I knew I had an appointment on Tuesday. My doctor was unsure if it was related to the vaccine at all because I do have a bad back. It has gotten better. It is at a point where it is noticeable if I take a step wrong but it is going away. I expect in a week it will be completely gone. I am also doing stretching exercises and using heat and ice.

Other Meds: Doctor's prescriptions: metformin 500mg/2xday, lisinopril sodium 40mg/1xday, amlodipine 5mg/1xday, atorvastatin 20mg/1xday, timolol .5%/1 drop per eye Vitamin D 4000 unit/day, Vitamin b12 1000mg/day Alavert

Current Illness: No

ID: 1801607
Sex: M
Age: 65
State: WV

Vax Date: 10/19/2021
Onset Date: 10/19/2021
Rec V Date: 10/20/2021
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 known

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

Symptoms: I went into afib around 11pm it lasted all night ending about 8:30am. I dont have episodes its been well controlled with meditation and avoiding certain foods and drinks and dehydration. I hadnt consumed anything out of the ordinary and had taken the meds the usual times. If i get a bit dehydrated it often sets off an episode. Maybe that happens with the vaccine for a little while after. I didnt go to a doctor.

Other Meds: Atenolol, Flecainide, 81mg aspirin

Current Illness: None

ID: 1801608
Sex: F
Age: 63
State: KY

Vax Date: 10/20/2021
Onset Date: 10/20/2021
Rec V Date: 10/20/2021
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: Administer MODERNA covid-19 vaccine to patient and significant amount of vaccine (more than 70% of vaccine) leaked due to syringe and needle malfunction. Did research on CDC guideline about COVID-19 vaccine, CDC recommend to administer the authorized dose immediately in the opposite arm. Explained and printed out CDC guideline to patient about incident and patient agreed to get full amount (5 mL) vaccine on opposite arm.

Other Meds:

Current Illness:

ID: 1801609
Sex: F
Age: 41
State: NY

Vax Date: 02/19/2021
Onset Date: 02/21/2021
Rec V Date: 10/20/2021
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: I experienced shingles , I had itching and a rash on my right side. I also had a fever

Other Meds: Vitamins, Advil

Current Illness:

ID: 1801610
Sex: F
Age: 33
State: IN

Vax Date: 10/15/2021
Onset Date: 10/15/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: NA

Allergies: NA

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

Symptoms: moderate/severe headache: Oct 16, 8:00 am - 11:55 pm, resolved moderate body aches, soreness: Oct 16, 8:00 am - 11:55 pm, resolved moderate chills, tiredness: Oct 15 11:55pm - Oct 16 11:55pm, resolved moderate injection site pain: Oct 15 6:00 pm - Oct 19 11:55 pm, resolved bump under ear, possible swollen lymph nodes: Oct 18 5pm - present, haven't went away

Other Meds: prenatal vitamins

Current Illness: NA

Date Died: 10/06/2021

ID: 1801611
Sex: F
Age: 72
State: KY

Vax Date: 02/21/2021
Onset Date: 10/06/2021
Rec V Date: 10/20/2021
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: Clinic Laboratory Report: 9/16/2021

Allergies: N/A

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

Symptoms: Patient had a breakthrough infection and expired while infected with virus.

Other Meds: N/A

Current Illness: N/A

ID: 1801612
Sex: F
Age: 11
State: SD

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

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

Lab Data: N/A

Allergies: N/A

Symptom List: Pain in extremity

Symptoms: The patient did not experience an adverse event in relation to receiving the COVID-19 vaccine. The patient was age 11 years 7 months at the time vaccine was administered, as her documentation form was filled out incorrectly and guardian had verbalized patient was twelve years of age.

Other Meds: N/A

Current Illness: N/A

ID: 1801613
Sex: F
Age: 53
State: KY

Vax Date: 03/01/2021
Onset Date: 10/18/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: COVID19 test 10/18/2021

Allergies:

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

Symptoms: Positive COVID19 test 10/18/2021

Other Meds:

Current Illness:

ID: 1801614
Sex: F
Age: 69
State: MN

Vax Date: 03/26/2021
Onset Date: 03/26/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: As above.

Allergies: Penicillin, regular flu shot (needs egg free).

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

Symptoms: She got her vaccine at 11:04 AM she stayed for the 20 minutes and did not have any reaction and felt fine. Then at about 11:00 PM she started shaking uncontrollably like chills, which went on to body aches, nausea, headache and stomach ache. She took her temp a couple hours later and it was 103. She had a rough night and hardly slept. The next morning she could not get up out of bed, and thought it was just a backache and was able to sit up on the side of her bed, and realized it was from her both kidneys. Then it went on when she got up and was very weak and could hardy walk. As she walked to the bathroom and got to the bathroom she had incontinence, and then for 2 1/2 days felt as if she had a UTI/burning and frequency or urination. Every time she went to the bathroom she had incontinence again which she did not have an issue with that prior. Then she felt kind of dizzy, lack of appetite, headache, joint pain. She then felt much better on Monday, and it just kind of went away. She did call a nurse hotline on Sunday and they kind of dismissed it, and they told her that she had COVID, and she informed them that she tested negative. They told her if she got worse to go to the ER, but it never did, and was concerned about the reaction. The kidney problems went on for about a day, and the UTI feeling went on for a couple of days. On both occasions of getting her vaccines on the following Monday's it was like a switch went off and she was fine. She gets her groceries on Friday nights and she was finishing her grocery shopping and standing in the middle of an isle and she could not move/walk. Her legs were not able to move, and had to think about it, had pain in her legs. After a couple of minutes of standing in a daze and felt like they were lead. It then stopped and then while pushing her groceries again it happened again in the parking lot, and then had to lift her legs one at a time into the car. She then had to wait for a while in the car, was able to drive home, still had some symptoms, and was exhausted. That reaction lasted for about 10 days on 3/14/21. Then on Monday about noon she was fine. The nurse hotline told her that she should see her doctor, that they felt that maybe it was MS and they dismissed that it was related to the vaccine. The same thing happened after the 2nd vaccine again, exactly the same time, same place and exactly the same vaccine, also on Friday as well, lasting for 10 days also. She went to her PCP and was tested in July and told her that she had no evidence of anything regarding MS. Her legs also swelled and could hardly walk and was painful going up and down stairs which was about a week after the 2nd one. She had x-rays and was diagnosed with severe arthritis in both knees, which she did not have arthritis prior to this. The pain slowly went away by the end of September. She is now almost normal other than very weak in her legs as she was almost unable to walk, had to use a cane all of the time and use objects to stabilize her to walk. She is now afraid of falling as her knees would give out when they were swollen or what that was due from. She is trying to figure out if she should have the booster. She did have a really bad leg injury in February of 2020 when she fell on the ice and fell underneath her car, and landed on her knees and tore the muscles on her knees, and also hurt her shoulder. It took about 6 weeks for them to heal. She wonders if the pain after the vaccines were related to her previous fall, systemic issues.

Other Meds: Amlodipine, Hydrochlorothiazide, potassium.

Current Illness: None.

ID: 1801615
Sex: M
Age: 22
State: NV

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

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

Lab Data: BP: 133/71 O2: 99 HR: 51

Allergies:

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

Symptoms: Patient collapsed approximately 8 minutes after receiving the vaccine, legs were twitching before patient regained consciousness and attempted to walk out the front door of the pharmacy. Patient reported not remembering anything about the collapse. Patient also hit face on shelving near chair where he was sitting. We provided ice packs, water, and cookies while patient rested.

Other Meds:

Current Illness:

ID: 1801616
Sex: F
Age: 72
State: WA

Vax Date: 03/20/2021
Onset Date: 03/27/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: Dr. ran a lot of tests. Chest X-ray was normal. ECG was abnormal compared to previous one. Showed possible anterior infarct. Ran labs for tsh, BNP, Basic metabolic panel, CBC/PLT/Diff. I had a few numbers that were high or low but most were within normal range. My GFR was low and blood glucose was around 153. She had me take an exercise stress echo on May 27th. It showed a tachycardia issue. I am now taking a beta blocker.

Allergies: Lisinopril

Symptom List: Vomiting

Symptoms: I was fine the first week. Then I noticed the COVID arm thing-swollen, red and sore. And then I started having issues breathing when I was standing and trying to carry on a conversation with someone. I have never had breathing issues before when talking. It would come and go for a few weeks. I didn't talk to my doctor at that time. It was after the second dose and I was having lots of issues that I finally saw my primary care doctor. I had all of the flu like issues-fever, chills, total body aches and the shortness of breath again. This all started about 12 hours after the second dose. I was sick for a few days.

Other Meds: Losartan 100 mg, Doxycycline 100 mg, Simvastatin 40 mg, Metformin 2000 mg, D3, B12, Calcium, low dose aspirin,

Current Illness: None

ID: 1801617
Sex: F
Age:
State: CA

Vax Date: 08/24/1921
Onset Date: 08/25/1921
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: hospital. dr.

Allergies: Allergic to a lot of things

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Fever, inflammation, shooting pains, insomnia, severe bloating and abdominal cramping and sharp pains. Violent vomiting and diarrhea. So many symptoms. Shooting in all my joints. Loss of fine motor skills, cognitive impairment, tightness in chest, hard to breathe, swollen throat, stiff neck, couldn?t walk. Post COVID multi system inflammatory syndrome.

Other Meds:

Current Illness: None

ID: 1801618
Sex: F
Age: 78
State: IL

Vax Date: 10/15/2021
Onset Date: 10/16/2021
Rec V Date: 10/20/2021
Hospital: Y

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

Lab Data: EKG 10/16/2021 Cat-Scan 10/16/2021

Allergies: Amperinal, Isotril

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

Symptoms: Pt.'s Daughter states that after receiving the 3rd Booster of Phizer 10/15/2021 (received High-Dose Influenza) , started experiencing symptoms 10/16/2021 of confusion/headache before going into A-Fib and a Blood Clot in the Brain resulting in Mild Stroke. Hospitalized 10/16/2021/ discharged 10/19/2021. Cardiologist appt. 10/21/2021, Neurologist 11/09/2021 for Follow-Up.

Other Meds: N/A

Current Illness: N/A

ID: 1801619
Sex: F
Age: 48
State: TN

Vax Date: 10/15/2021
Onset Date: 10/16/2021
Rec V Date: 10/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None ordered.

Allergies: Augmentin causes rash/hives

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Pt. reported that the morning after receiving her 1st Moderna vaccine, she started itching on her neck, then bilateral upper extremities, and is now moving to her back, and the side of her torso. Pt. administered 8mg Decadron intramuscularly to right upper outer quadrant of buttocks.

Other Meds: Buspirone 15mg twice daily Cetirizine 10mg once daily Multivitamin once daily Sertraline 50mg once daily Trazodone 100mg every night at bedtime

Current Illness: Anxiety disorder Cough

ID: 1801620
Sex: M
Age: 46
State:

Vax Date: 04/15/2021
Onset Date: 04/17/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: CT scans of jaw, sinus, neck X-Ray, Brain MRI, upcoming another brain MRI, cervical/thoracic/lumbar spine MRIs.

Allergies: none

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

Symptoms: I don't have reason to believe this is caused by vaccine...but a few days later I started to have pain in my upper right jaw. Thought it was tooth pain. Dentist checked and teeth were ok. Dr. scanned sinuses, also ok. Pain spread throughout right side of face. Sent me to neurologist who thought it was trigeminal neuralgia or TMJ (or both). Pain has now spread through right side of body; pain and numb/weakness. I had brain MRI that was negative, now doing another brain MRI, and full spine MRI looking for possible MS

Other Meds: none

Current Illness: none

ID: 1801621
Sex: F
Age: 74
State: MO

Vax Date: 04/09/2021
Onset Date: 10/15/2021
Rec V Date: 10/20/2021
Hospital: Y

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: DEVELOPED FATIGUE, ABDOMINAL DISCOMFORT, NAUSEA ON 10/15. TESTED (+) 10/15. ADMITTED TO local HOSPITAL FROM 10/15 THROUGH 10/18

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am