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: 1805983
Sex: M
Age: 41
State: IA

Vax Date: 10/14/2021
Onset Date: 10/14/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data: 3 - lead EKG, pulse oximetry, respiration rate, and blood pressure (every 5 minutes) on 10/14/2021

Allergies: lamotrigine

Symptom List: Dysphagia, Epiglottitis

Symptoms: anaphylaxis (confusion, dizziness, itchiness on face and neck, rash/flushing of face, neck, and chest, and difficulty breathing)

Other Meds: Allegra

Current Illness: none

ID: 1805984
Sex: M
Age: 60
State: MO

Vax Date: 04/14/2021
Onset Date: 04/15/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data: none

Allergies: None

Symptom List: Anxiety, Dyspnoea

Symptoms: double vision- continued for 3months left eye will not turn to the left not being able -cyst cranial nerve palsy Diagnois by Ophthalmologist

Other Meds: Vitamins

Current Illness: None

ID: 1805985
Sex: F
Age: 43
State: MS

Vax Date: 10/19/2021
Onset Date: 10/19/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data: None

Allergies: lisinopril and augmentin

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

Symptoms: Began with a piercing headache, all-over body aches, and joint pain that was near debilitating. These started at 7 hours and 15 min post-injection (felt completely normal up until symptoms began). Injection site EXTREMELY sore. These symptoms lasted for 48 hours from onset despite alternating Tylenol and Motrin every 3-4 hours. 48 hours after injection, I began running a fever (101) which only lasted about 8 hours.

Other Meds: Yazmin birth control, HCTZ, Amlodopine, Zyrtec, CoQ10, Fish oil, Women's Daily Vitamin

Current Illness: None

ID: 1805986
Sex: F
Age: 44
State:

Vax Date: 10/19/2021
Onset Date: 10/21/2021
Rec V Date: 10/21/2021
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: Approximately 10 minutes after vaccination patient was uneasy on feet and almost fainted. After laying down recovered within a couple of minutes.

Other Meds:

Current Illness:

ID: 1805987
Sex: F
Age: 55
State: OH

Vax Date: 10/13/2021
Onset Date: 10/18/2021
Rec V Date: 10/21/2021
Hospital: Y

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

Lab Data:

Allergies: Penicillins, Morphine Derivatives

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

Symptoms: Pulmonary Embolism needing hospitalization and treatment with anticoagulation

Other Meds: Lisinopril 10mg, Pantoprazole 40mg, Vyvanse 30mg

Current Illness:

ID: 1805988
Sex: F
Age: 50
State: OH

Vax Date: 09/01/2021
Onset Date: 09/01/2021
Rec V Date: 10/21/2021
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: Na

Allergies: None

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

Symptoms: Headache Stiff neck hives & breakout

Other Meds: Flonase Zyrtec omeperazole sumatriptan

Current Illness: None

ID: 1805989
Sex: F
Age: 65
State: CA

Vax Date: 10/20/2021
Onset Date: 10/21/2021
Rec V Date: 10/21/2021
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: aspirin, penicillin, amoxycillin,statin shellfish, peppers, latex

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Flu shot -hives started after 3 hours. by 1230am itchy and swollen; hives on my left arm-vaccination site

Other Meds: none

Current Illness: none

ID: 1805990
Sex: F
Age: 44
State: TX

Vax Date: 10/21/2021
Onset Date: 10/21/2021
Rec V Date: 10/21/2021
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: The patient came to the pharmacy to receive a Covid vaccine for the pfizer but instead received a flu vaccine.

Other Meds:

Current Illness:

ID: 1805991
Sex: M
Age: 76
State:

Vax Date: 04/22/2021
Onset Date: 04/23/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Slight swelling at injection site, feeling of low-grade fever the next day. Slight feeling of euphoria.

Other Meds:

Current Illness:

ID: 1805992
Sex: F
Age: 43
State: IL

Vax Date: 10/08/2021
Onset Date: 10/09/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data: N/A

Allergies: N/A

Symptom List: Diarrhoea, Nasal congestion

Symptoms: PATIENT DEVELOPED VERY BIG BRUCE AT THE INJECTIONS SITE AFTER PFIZER BOOSTER DOSE. EVEN AFTER 12 DAYS OF SHOT, IT'S STILL VERY ITCHY. PATIENT DID NOT HAD THIS KIND OF REACTION FROM FIRST TWO DOSES. PATIENT IS AWAITNG FROM DOCTOR'S RESPONSE ON BRUSE.

Other Meds: N/A

Current Illness: N/A

ID: 1805993
Sex: F
Age: 42
State: CA

Vax Date: 05/01/2021
Onset Date: 05/10/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data: waiting on results from MRI and EEG....

Allergies: penicillin

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

Symptoms: Reactions to the second shot started with my eyes feeling weird and sensitive to light. Pupils were dilated at different sizes. Approx. a week later my right side felt weird, heavy and I had high anxiety, thought I was having a stroke. I than developed extreme dizziness, sweaty palms and was very nauseous. These symptoms passed (not my eyes, that is a constant) and I developed other symptoms over the next few months. Achy legs, left big toe numb, shaky hand, brain fog, dissociation along with suicidal thoughts and extreme pins and needles over my whole body. Tons of eye floaters, tinnitus, electrical shocks, pain under my arms (swollen lymph nodes), internal shaking, terrible ear pressure, head feels like it's underwater and under pressure, pressure across my cheeks and nose, insomnia. My symptoms come and go and some days are better than others. Not all symptoms last (thanks god!) This is VERY scary. I am trying to get answers, but really need the medical community to step up and help those that have had AE!

Other Meds: vitamin D, multi-vitamin

Current Illness: none

ID: 1805994
Sex: M
Age: 77
State:

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/21/2021
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: Patient developed bleeding, but stopped after a few minutes. He also reported swollen arm which got much better today. He mentioned it never happened to him before

Other Meds:

Current Illness:

ID: 1805995
Sex: F
Age: 22
State: NC

Vax Date: 10/15/2021
Onset Date: 10/20/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data:

Allergies: none known

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

Symptoms: allergic reaction, including swollen face/eyes/throat that required patient to seek medical attention

Other Meds: unknown

Current Illness: none known

ID: 1805996
Sex: F
Age: 56
State: NJ

Vax Date: 10/16/2021
Onset Date: 10/18/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data: n/a

Allergies: N/A

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

Symptoms: Patient complains of getting swollen lymph nodes on chest by the same side of the vaccinated arm 2 days after receiving dose. The arm itself is fine and not sore but the main concern is the swollen lymph node.

Other Meds: n/a

Current Illness: N/A

ID: 1805997
Sex: F
Age: 50
State: OH

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/21/2021
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: No

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

Symptoms: Benadryl before and continually but still broke out in severe hive all over face and neck, headache worse than ever & didn?t think neck could get more stiff but did and hacking/coughing the next morning with sore throat

Other Meds: Omeperazole sumatriptan Zyrtec Flonase

Current Illness: No

ID: 1805998
Sex: M
Age: 59
State: NJ

Vax Date: 10/01/2021
Onset Date: 10/08/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data: None

Allergies: Unknown

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

Symptoms: I have experienced muscle pain, headache and tiredness after the injection, but I though it's usual symptoms after vaccination and didn't report it. Then I start experiencing chest pain with increased blood pressure on Day 8 after injection. These symptoms were continuing about 10 days. I started treatment with Hydralazine 50 mg daily, Atenolol 50 mg daily, Hydrochlorothiazide 25 mg daily, Ibuprofen 600 mg twice a day, Lisinopril 20 mg daily and continued this treatment for10 days until my blood pressure start normalizing, chest pain, headache and muscle pain disappeared.

Other Meds: None

Current Illness: None

ID: 1805999
Sex: F
Age: 54
State: AL

Vax Date: 10/21/2021
Onset Date: 10/21/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data:

Allergies: NKDA

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

Symptoms: The patient was given a Moderna vaccine that was left out of the fridge over night (longer than 12 hours). There were no adverse events encountered.

Other Meds: N/A

Current Illness: N/A

ID: 1806000
Sex: M
Age: 22
State: ME

Vax Date: 10/21/2021
Onset Date: 10/21/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient experienced a vasovagal response after receiving vaccination. Patient reported feeling like he was going to pass out, clammy, hot and appearance looked pale. Pharmacist assessed blood pressure and after about 30 minutes, patients appearance and symptoms improved.

Other Meds:

Current Illness:

ID: 1806001
Sex: M
Age: 54
State: VA

Vax Date: 10/07/2021
Onset Date: 10/14/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data: 10/15/21: EKG--prelim dx atrial fibrillation 10/20/21: CBC, CMP, TSH all normal, mildly elevated BNP 10/21/21: EKG--LVOT-VA

Allergies: Lodine (NSAID) Horse Serum

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: 10/14/21 0630: palpitations, tachycardia noted in AM and intermittently throughout the day. 10/14/21 1830: Increased tachycardia, lightheadedness, A fib noted on smartwatch 10/15/21: 1300: Saw cardiologist, prelim Dx of A. Fib, placed on Biotel patch monitor x 2 weeks. 10/21/21: Seen by second cardiologist/electrophysiologist: NOT A. fib but a left ventricular outflow tract-ventricular arrhythmia. (LVOT-VA). Plan to place on flecanide, consider ablation if Sx persist after data from monitor download reviewed

Other Meds: Nasacort B12 Vitamin D Omega 3 Elderberry

Current Illness: none

ID: 1806003
Sex: M
Age: 42
State: SC

Vax Date: 10/06/2021
Onset Date: 10/20/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data:

Allergies: N/A

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

Symptoms: Constant Itching in armpits

Other Meds: None

Current Illness: None

ID: 1806157
Sex: F
Age: 42
State: CA

Vax Date: 10/21/2021
Onset Date: 10/21/2021
Rec V Date: 10/21/2021
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: N/A

Allergies: None reported

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

Symptoms: Patient expressed she was very nervous about receiving COVID-19 vaccine. Patient vaccinated, minutes later started to c/o felling dizziness and lightheaded. Vitals were taken BP 78/55, HR 86, resp 14 O2 97% . Patient was then offered water and had her laid down. Patient started to feel better, vitals retaken every 5 minutes last vitals taken at 0935 BP136/85, hr 91, resp 14. Patient was was able to walk out feeling much better @0945

Other Meds: None reported

Current Illness: None reported

ID: 1806158
Sex: M
Age: 64
State: NY

Vax Date: 10/18/2021
Onset Date: 10/18/2021
Rec V Date: 10/21/2021
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: Unevaluable event

Symptoms: Patient received Shingrix on 10/18/21 that expired on 10/1/21. I have not heard from the patient regarding any adverse reactions.

Other Meds:

Current Illness:

ID: 1806159
Sex: F
Age: 54
State: OH

Vax Date: 10/01/2021
Onset Date: 10/17/2021
Rec V Date: 10/21/2021
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, morphine

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

Symptoms: Fever, 12 hr post injections 100.4, nausea, chills, muscles aches, fatigue, small itchy spots developed 48 hrs post injections and continue to develop 144 hrs. Post injections. Small red spots extremely itchy on thighs (mostly right thigh? They develop into small blisters.

Other Meds: Covid and flu vaccines, lisinopril

Current Illness:

ID: 1806160
Sex: M
Age: 82
State: NY

Vax Date: 10/20/2021
Onset Date: 10/20/2021
Rec V Date: 10/21/2021
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 received SHINGRIX on 10/20/21 that expired on 10/1/21. I have not heard from the patient regarding any adverse reactions.

Other Meds: SHINGRIX

Current Illness:

ID: 1806161
Sex: M
Age: 66
State: NC

Vax Date: 02/26/2021
Onset Date: 03/16/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data: MRI Rapid Xray EKG X-rays Pulmonary function test

Allergies: None

Symptom List: Injection site pain, Menorrhagia

Symptoms: Effective 03/16/2022, could not breath laying flat on my back. Determined to be paralyzed Diaphragm, right side of body.

Other Meds: Atorvastatin 80 mg Olmesartan Medoxomil 40 mg Tadalafil 20 mg

Current Illness: None

ID: 1806162
Sex: M
Age: 43
State: KY

Vax Date: 10/14/2021
Onset Date: 10/16/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data: CT scan 10/20/2021

Allergies: None

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

Symptoms: Severe headache in back of right side of head started two days after shot. Sensitivity of noise shortly after that and a few days later I woke up with a numb tongue. Throughout that same day I noticed the facial drooping and went to the ER to get checked for possible stroke. Stroke was ruled out by CT scan and I was diagnosed with Bells Palsy

Other Meds: Vitamin C Acyclovir Wellbutrin Omeprozole Amlodipine Asprin81 Vitamin B12

Current Illness: None

ID: 1806163
Sex: F
Age: 75
State: NY

Vax Date: 10/20/2021
Onset Date: 10/20/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient received SHINGRIX on 10/20/21 that expired on 10/1/21. I have not heard from the patient regarding any adverse reactions.

Other Meds: SHINGRIX

Current Illness:

ID: 1806164
Sex: M
Age: 18
State: CA

Vax Date: 10/21/2021
Onset Date: 10/21/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data: 3:54 PM SYSTOLIC BP 109 DIASTOLIC BP 66 HR 69 O2 SAT 98 4:07 PM SYSTOLIC BP 89 DIASTOLIC BP 72 HR 70

Allergies: NA

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: AT APPROXIMATELY 3:53 PM, PATIENT EXPERIENCED DIZZINESS AND FAINTING AND IT WAS NOTIFIED TO PHARMACY STAFF BY THE PATIENT'S SISTER. PATIENT WAS ABLE TO SIT UP AND THEN PROCEED TO LAY DOWN ON A COT. VITALS WERE TAKEN AT 3:54 PM AND REASSESSED AT 4:07 PM. PATIENT'S DIZZINES SYMPTOM RESOLVED AND WAS ABLE TO LEAVE WITH HIS SISTER. A PHONE CALL WAS MADE TO THE PATIENT AT 5:15 PM AND PATIENT STATED THAT HE IS NO LONGER FEELING ANY DIZZINESS.

Other Meds: NA

Current Illness: NA

ID: 1806165
Sex: F
Age: 92
State: MI

Vax Date: 02/16/2021
Onset Date: 10/13/2021
Rec V Date: 10/21/2021
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:

Allergies: Benicar [Angiotensin Receptor Blockers] Codeine Contrast Dye [Ivp Dye, Iodine Containing]Hives Darvon [Aspirin] Levofloxacin Nickel Oxycodone Propoxyphene Hcl Quinidine Sulfa Drugs Tramadol HclDizziness Xarelto [Rivaroxaban]Myalgia

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

Symptoms: Hospitalized twice (10.13.21; 10.18.21); COVID-19 positive (10.13.21); fully vaccinated PRESENTING PROBLEM: COVID-19 virus infection [U07.1] COVID-19 [U07.1] 10.13.21 HOSPITAL COURSE: Patient is a 93 y.o. female who presented with weakness. PMHx of HTN, hypothyroid, Afib anticoagulated with coumadin . Patient presented with 2 week of hx progressive generalized weakness and fatigue. Denies focal weakness , numbness or tingling. Denies fall . Use walker at baseline to walk. States now with limited ability to stand or walk. She complained of decreased po intake due to loss of appetite. Recently she has been treated for a possible urinary tract infection. Patient presented at PCP office for ppm interrogation. When she returned home she was unable to stand due to too weak . In ED covid testing positive. She was not hypoxic . Calcium level elevated at 11.2 other electrolytes normal . Baseline ckd troponin elevated at 30 with delta rise of 4 . Hgb stable 13.6. ct head unremarkable, cxr wit stable chest . Patient was admitted for management of generalized weakness. She remained on room air. She did not qualify for Covid treatment. She was evaluated by PT OT and was recommended home with assist with home health and 24 hour supervision by family for atleast a week after discharge. Patient's daughter at bedside agreed to provide the above care. She was discharged home in stable condition. 10.18.21 HISTORY OF PRESENT ILLNESS: Patient is a 93 y.o. female who presents today with weakness and fatigue. Daughter is present at the bedside. Patient was in the hospital last Wednesday overnight for fatigue and weakness that started the beginning of October. She had a UTI and was placed on antibiotics. She was struggling to get up and had a hard time on and off. She got tested at the hospital and was COVID positive but family thinks that she was having COVID even prior to her admit. She did get her COVID vaccines x 2 but did not yet get the booster. She lives at independent living at discharge. She has had children staying with her. On Saturday daughter at bedside was with her and she was up and able to walk to the bathroom. She was not eating much or drinking much. Last night her son was with her and she was up almost every hour and she had frequency and incontinence which is not normal for her. She also had a fall with her son last night around 10pm. She had a skin tear to her neck, arms and bruising on her arm and hip. She is on coumadin. She was unable to get up on her own and family is having a hard time caring for her at home so they brought her back in. Per daughter she has been more awake the last few hours than she has been all day. Daughter notes that she is not having a cough or respiratory complaints. Her oxygen has been stable the whole time per daughter. ROS and medical history reviewed with family. In the ER patient was noted to have UA that was positive she was started on rocephin and IVF. Her renal function was near baseline. She had Ca 13 up from 10.5 the other day. Her bicarb was 33 today. Initial lactic acid was 2.9. She did not meet sepsis criteria. She had normal HR, normal WBC and was afebrile. She had an INR 2.5 and Hgb 12.9. She had elevated BP in the ER but improved now though still high. Due to her fall she had extensive imaging in the ER. XR of the right elbow negative for acute fracture. CXR negative for acute process. CT cervical spine and CT head negative for acute process. EKG showed ventricular paced rhythm with LVH. She will be admitted to the hospitalist team for generalized weakness, hypercalcemia, UTI and COVID.

Other Meds: cholecalciferol (VITAMIN D) 2000 units CAPS citalopram (CELEXA) 10 MG tablet HYDROcodone-acetaminophen (NORCO) 5-325 MG per tablet levothyroxine (SYNTHROID) 75 MCG tablet loperamide (IMODIUM) 2 MG capsule metoprolol succinate-XL (TOPROL-XL)

Current Illness: 10.4.21: Office Visit - Fatigue, falling asleep, weight loss; dyspnea 10.13.21: Being treated for a UTI; weak, fatigued, slurred speech 10.13-10.14.21 - ED to hospital admission - COVID-19 positive - admitted for weakness

ID: 1806166
Sex: M
Age: 41
State: CA

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 10/21/2021
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: Nausea

Symptoms: Patient complained of nausea and dizziness after receiving vaccine. Noted to be hypotensive. Monitored for 1 hour. VSS, patient tolerating liquids, oriented x3. Discharged to home accompanied by wife.

Other Meds: none

Current Illness: none

ID: 1806167
Sex: F
Age: 57
State: WA

Vax Date: 10/16/2021
Onset Date: 10/18/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data: allergan test 10/11/2021

Allergies: sulfa, cypro, septra, tetracycline, eurithromyacin, most antibiotics and medications

Symptom List: Injection site pain

Symptoms: after 2nd dose of vax I was sick, low grade fever, headaches, pain in my throat lymphnoids both sides, pressure in ears and now I cannot hear in my right ear and my left ear has pressure and I have headaches that are ongoing

Other Meds: methlprednisone, zirtec, famotidine, hydroxyclorequin, prevastatin,

Current Illness: sinus infection, paratitus

ID: 1806168
Sex: M
Age: 60
State: CO

Vax Date: 09/27/2021
Onset Date: 10/18/2021
Rec V Date: 10/21/2021
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: has sensitivity to hazelnuts

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

Symptoms: vaccine was administered too low on the right arm. Bruising, pain was slighty radiating up to the shoulder and down towards the elbow. Patient took ibuprofen often and acetametaphen

Other Meds: multivitamin, synthroid, vitamin-c,

Current Illness: none

ID: 1806169
Sex: F
Age: 49
State: TX

Vax Date: 08/25/2021
Onset Date: 08/25/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data:

Allergies: NKA

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

Symptoms: Caused bursitis in my right shoulder. Started the night of the vaccine, lasted 6 weeks. I ended up getting a steroid injection to the shoulder since it wasn?t getting better.

Other Meds: Exemestane, MVI, ambien, melatonin

Current Illness: None

ID: 1806170
Sex: M
Age: 67
State: MI

Vax Date: 02/13/2021
Onset Date: 10/13/2021
Rec V Date: 10/21/2021
Hospital: Y

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

Lab Data:

Allergies: doxycycline

Symptom List: Tremor

Symptoms: Hospitalized (10.13.21); COVID-19 positive (10.13.21); fully vaccinated Admission Date: 10/13/2021 Discharge Date: Oct 15, 2021 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hypoxia [R09.02] Pneumonia due to COVID-19 virus [U07.1, J12.82] COVID-19 [U07.1] HOSPITAL COURSE: Patient is a 68-year-old male without medical history of chronic obstructive pulmonary disease on chronic 2 L oxygen, paroxysmal atrial fibrillation, hypertension, mi BPH, GERD he presented to the hospital with acute on chronic hypoxic respiratory failure and at generalized complaints of fatigue. He patient was admitted to the hospital for an acute exacerbation of chronic obstructive pulmonary disease. He was also found to be COVID positive patient was vaccinated with Pfizer vaccine in February of 2021. Patient did have an x-ray performed in the hospital which did not reveal evidence of infiltrate. Patient was admitted to the hospital treated with dexamethasone, remdesivir. He did well with treatment. His oxygen requirement decreased back to his baseline and he was no longer having any symptoms of fevers or chills. He was feeling well enough to be discharged home. Patient was treated for elevated hypertension in the hospital he was started on Norvasc which she is to continue outpatient and follow-up with his primary care physician Discharge diagnosis: 1. Acute on chronic hypoxic respiratory failure- secondary to his underlying COPD with now acute excerebration with superimposed covid 19 infection. 2. -COVID-19 3. Hypertension accelerated 4. Paroxysmal atrial fibrillation 5. GERD

Other Meds: albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler alendronate (FOSAMAX) 70 MG tablet amLODIPine (NORVASC) 5 MG tablet ascorbic acid (VITAMIN C) 500 MG tablet aspirin 81 MG enteric coated tablet buPROPion

Current Illness: Reported to PCP on 10.13.21 before ED: The patient has been struggling for last 3 to 4 days. Today he has 104 temperatures with myalgias and chills. Cough is significant with minimal sputum. No nausea vomiting or diarrhea. Tachycardia is present.

ID: 1806171
Sex: F
Age: 50
State: HI

Vax Date: 01/11/2021
Onset Date: 10/20/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Individual became symptomatic with headache, fatigue, nasal congestion, muscle body ache. Tested positive for COVID 19 on 10/20/21.

Other Meds:

Current Illness:

ID: 1806172
Sex: M
Age: 41
State: PA

Vax Date: 08/05/2021
Onset Date: 09/15/2021
Rec V Date: 10/21/2021
Hospital: Y

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: I will be more than happy to send all his tests and lab work over to you when I have an "agent"

Allergies:

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

Symptoms: When he was due for his second shot, he got covid itself. So he couldn't get the second vaccine.. He faired ok after first shot except tired, short of breath quicker than normal, irritable, ... When he got Covid he slept for three days straight....Everything escalated from there. Sitting back I can see now that he was retaining fluid for a good month or more. I had to take him to the er, he couldn't breath...on Oct.10th 9:00 pm, EKG showed something weird right away... I will send all paper work from his labs...At the end of it a week in the hospital in congestive heart failure at 42... Catherization showed his arteries are completely clear. Its Cardio Myopathy, myocarditis. he lost 15 lbs of fluid on lasics. He had to come home with a vest that has a defribrulator in it for three months. And worse yet, he doesn't have health insurance. He was signed up to go on in November during open enrollment.

Other Meds: Sertraline 50mg, Omeprezol 40, Losartin 100mg

Current Illness:

ID: 1806173
Sex: F
Age: 62
State: NY

Vax Date: 10/21/2021
Onset Date: 10/21/2021
Rec V Date: 10/21/2021
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: NKDA, no known allergies to food or other products

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

Symptoms: Patient received 0.3ml of COVID19 pfizer vaccine as Booster. Patient was watched in the clinic for 15 minutes after receiving dose and discharged without any noted adverse reaction or complaints. Pfizer vaccine vial was NOT diluted with 1.8ml of 0.9% Sodium Chloride prior to administration of dose. Error was discovered only after patient had left clinic. Supervisor notified. Remainder of vial was discarded. Patient was called, patient stated that she felt good and had no symptoms of fever, headache, arm pain, body aches, or shortness of breath. Advised patient to continue to watch for any adverse reaction of the vaccine, such as persistent fever, shortness of breath, severe headache, or chest pain, and to go immediately to the nearest emergency department if these symptoms present.

Other Meds:

Current Illness:

ID: 1806174
Sex: F
Age: 43
State: AZ

Vax Date: 10/19/2021
Onset Date: 10/20/2021
Rec V Date: 10/21/2021
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: Penicillin, onions, nickel

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Ringing in both ears

Other Meds:

Current Illness:

ID: 1806175
Sex: M
Age: 73
State: MD

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/21/2021
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: Shingrix vaccine

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

Symptoms: Chills started at about 7 pm after shot. Fever followed and shot up to over 102 degrees. Fever lowered over next 2 days, but temperature didn't return to normal for 2+ days.

Other Meds: Citalopram

Current Illness: None

ID: 1806176
Sex: M
Age: 27
State: TX

Vax Date: 04/15/2021
Onset Date: 06/08/2021
Rec V Date: 10/21/2021
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: Bloodwork confirms elevated eosinophylls and IgE

Allergies: None

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

Symptoms: Chronic Spontaneous Urticaria; no food, environment, or other triggers; flare ups every 4-6 hours at random locations on entire body.

Other Meds: None

Current Illness: None

ID: 1806177
Sex: F
Age: 63
State: MI

Vax Date: 06/02/2021
Onset Date: 10/13/2021
Rec V Date: 10/21/2021
Hospital: Y

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

Lab Data:

Allergies: metformin - diarrhea sulfamethoxazole

Symptom List: Pain in extremity

Symptoms: Hospitalized (10.13.21); COVID-19 positive (10.13.21); fully vaccinated Admission Date: 10/13/2021 Discharge Date: Oct 21, 2021 Discharge Disposition: home or self care Active Issues Requiring Follow-up: Acute hypoxic respiratory failure secondary to COVID-19 pneumonia Follow-up with primary care provider Patient was discharged on 2 L nasal cannula with activity, wean as able DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hypokalemia [E87.6] Acute kidney injury [N17.9] Acute respiratory failure with hypoxia [J96.01] Pneumonia due to COVID-19 virus [U07.1, J12.82] HOSPITAL COURSE: Patient was admitted to the hospital with COVID-19 pneumonia. She had acute hypoxic respiratory failure needing up to 8 L nasal cannula. Patient is given remdesivir which she finished 5 days of. Patient was also on Decadron for which she finished her course as well. Patient was weaned down to room air at rest and 2 L of oxygen with activity. Patient was subsequently discharged home with supplemental oxygen to use only with activity. Patient is instructed to follow-up with her primary care doctor in the next week and determine if she can completely wean off of oxygen at that time. She also had an acute kidney injury during her stay so her lisinopril and hydrochlorothiazide were held temporarily. These were restarted the day prior to her discharge.

Other Meds: amLODIPine (NORVASC) 5 MG tablet amoxicillin (AMOXIL) 500 MG capsule atorvastatin (LIPITOR) 40 MG tablet cetirizine (ZYRTEC ALLERGY) 10 MG tablet DULoxetine (CYMBALTA) 30 MG delayed release capsule empagliflozin (JARDIANCE) 25 MG TABS fenof

Current Illness: NA

ID: 1806178
Sex: F
Age: 25
State: AZ

Vax Date: 10/21/2021
Onset Date: 10/21/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient experienced severe lightheadedness. Patient was given candy and it did not help. Patient started to tense up with their hands and could not relax them. Patient was able to feel touch but not able to unclench hands Patient said their hands went numb and had a tingling sensation in both hands. Patient could breathe and did not have any swelling from the neck up. Paramedics were called and patient was evaluated. Patient was alert and able to walk after evaluation.

Other Meds:

Current Illness:

ID: 1806179
Sex: F
Age: 51
State: KS

Vax Date: 10/01/2021
Onset Date: 10/03/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data: 10/4/21 - CBC, CMP - both normal 10/4/21 - CXR - elevated right hemidiaphragm.

Allergies: Naproxen - hematuria Augmentin - rash

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

Symptoms: Severe pleuritic chest pain., shortness of breath,

Other Meds: Dyazide, levothyroxine, Calcitriol, calcium, Effexor

Current Illness: None

ID: 1806180
Sex: M
Age: 45
State: FL

Vax Date: 01/06/2021
Onset Date: 03/01/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data: Yes, two different labs show high TSH and abnormal Thyriod Function.

Allergies: None

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

Symptoms: Perfectly healthy male with blood work and physical every year. After vaccination series, developed abnormal thyroid condition. TSH levels are suddenly high after several labs.

Other Meds: None

Current Illness: None

Date Died: 10/19/2021

ID: 1806181
Sex: F
Age: 81
State: MI

Vax Date: 03/08/2021
Onset Date: 10/15/2021
Rec V Date: 10/21/2021
Hospital: Y

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

Lab Data:

Allergies: CodeineItching, Rash PenicillinsItching Protonix [Kdc:edetic Acid+pantoprazole]Nausea and Vomiting Sulfa DrugsItching

Symptom List: Vomiting

Symptoms: Deceased; Hospitalized (10.15.21); COVID-19 positive (10.15.21); fully vaccinated Discharge Provider: MD Primary Care Physician at Discharge: DO Admission Date: 10/15/2021 Date of Death: 10/19/21 Time of Death: 4:45 PM Preliminary Cause of Death: Acute hypoxemic respiratory failure due to COVID-19 (HCC) Discharge Disposition: Deceased DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hypoxia [R09.02] Pneumonia due to COVID-19 virus [U07.1, J12.82] HOSPITAL COURSE: The patient is an 81 year old female with HX of DM type 2, hypertension, diastolic heart failure, body dementia, and obesity who presented with complaint of worsening shortness of breath in the setting of known COVID. The patient is vaccinated and symptoms started 10-9-21. In the emergency department she was hypoxic and required oxygen via mask. She was hypokalemic. She was admitted to the hospitalist service and started on Decadron and remdesivir. Her oxygen requirements worsened and she was placed on high-flow nasal cannula. Steroids were transitioned to IV Solu-Medrol. Overnight of 10/19 pt had worsening hypoxia w/ HFNC w/ 100% FiO2 and non-rebreather. Pt was evaluated by provider overnight, pt confirmed that she was DNR/DNI. After discussion with pt and daughter over the phone decision was made to transition to comfort care. Morning of 10/19, pt appeared comfortable noted interest in hospice and consult was placed. She was started on morphine and versed drip, she was terminally weaned from HFNC. In the afternoon, was called to bedside by nursing staff. Patient resting supine in bed with eyes closed and is unresponsive to verbal and painful stimuli. No spontaneous respirations. No palpable pulses. Bilateral pupils fixed and dilated. No heart sounds auscultated over entire precordium. No breath sounds auscultated in either lung field. Patient pronounced dead at 16:45 on 10/19/2021. Next of kin, daughter, present at bedside, verbalize remaining family notified. Family has not yet decided funeral arrangements, are pursuing cremaiton per pt wishes. Pt PCP Dr notified via answering service. Dr was also notified of pt passing. TIME OF DEATH: 16:45 DATE OF DEATH: 10/19/2021

Other Meds: amLODIPine (NORVASC) 10 MG tablet atorvastatin (LIPITOR) 10 MG tablet cholecalciferol (VITAMIN D3) 50 MCG (2000 UT) capsule cholestyramine (QUESTRAN) 4 g packet dicyclomine (BENTYL) 10 MG capsule escitalopram (LEXAPRO) 20 MG tablet furosemi

Current Illness: 9.16.21: Office Visit Cardiology - Dyspnea, chest pain, Postural dizziness with presyncope 10.11.21: ED - day 4 with COVID-19 here with chest pain. Patient has no history of cardiac disease. Patient has negative CTA for PE, discussed pulmonary nodule. She has an ambulatory pulse ox of 93% on room air without increased work of breathing. She does not qualify for monoclonal antibodies due to being fully vaccinated for COVID with Moderna.

ID: 1806182
Sex: M
Age: 33
State: VA

Vax Date: 05/01/2021
Onset Date: 07/01/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data: Blood panel - 07/2021 Stool culture - 8/2021 Colonoscopy - 9/2021

Allergies: None

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Started to have gastrointestinal issues. Never had any of these issues before the vaccine. I was subsequently diagnosed with ulcerative colitis via colonoscopy.

Other Meds: None

Current Illness: None

ID: 1806183
Sex: F
Age: 49
State: CA

Vax Date: 09/30/2021
Onset Date: 10/20/2021
Rec V Date: 10/21/2021
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: Loratadine

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

Symptoms: Pt reports 20 days later renewed soreness in left arm that pt got shot in, as well as itching all over and upset stomach. These resolved within the day.

Other Meds:

Current Illness:

ID: 1806184
Sex: F
Age: 34
State:

Vax Date: 10/11/2021
Onset Date: 10/12/2021
Rec V Date: 10/21/2021
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: On 10/18/2021, one week after COVID vaccine was received, and after seeing two physicians, whom had never seen this before, it was decided that the reaction had caused and Encapsulated infection at the injection site. Therefore, I was prescribed Bactrim. Site is still trying to heal and sore to the touch 10 days after vaccine was received.

Allergies: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Sever redness and swelling the next morning after vaccine was received. Injection site hot to the touch. Swelling continued to increase, covering the majority of my upper left arm. Center, injection site, bright red with swelling around the area. A knot formed at injection site. Area still hot to the touch for over a week after vaccine was received.

Other Meds: Lo loestrin 24fe Metoprolol Omeprazole

Current Illness: None

ID: 1806185
Sex: F
Age: 35
State: CA

Vax Date: 10/15/2021
Onset Date: 10/15/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: PT WAS GIVEN PFIZER AT ONE SIRE CAME TO OUR SIRE TO GET THE 2ND COVID VACCINE. I WAS GIVING MODERNA ALL DAY AND THOUGHT THEY WERE HERE FOR THE MODERNA. I NEGLECTED TO ASK FOR THEIR CARD BEFORE GIVING THE INJECTION AND SAW AFTERWARD THAT THEY WERE PREVIOUSLY GIVEN PFIZER FOR 1ST DOSE. THEY SAT HERE IN CLINIC 30-40 MINUTES AFTER WITH NO REACTION. HAVE CHECKED ON THE PT MORE THAN ONCE AND IS DOING WELL AND NO REACTION TO DATE.

Other Meds:

Current Illness: ANXIETY, FIBROMYALGIA

ID: 1806357
Sex: F
Age: 65
State: CA

Vax Date: 10/07/2021
Onset Date: 10/10/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data: EKG, labs, sonogram, cardiac cath

Allergies: Topramax

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

Symptoms: Chest pain>ED visit>EMERGENCY cardiac cath> dx tako tsubo>ICU admit.

Other Meds: Propranolol 80 mg ER am. Propranolol 20mg pm. Atorvastatin 10mg am. T3T4 compounded thyroid med am. Bioidentical HRT- estradiol/progesterone creams. Latanoprost gtts each eye hs. Various vitamins including tumeric.

Current Illness: None

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am