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: 1814854
Sex: M
Age: 76
State: MI

Vax Date: 01/27/2021
Onset Date: 10/04/2021
Rec V Date: 10/25/2021
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: WEAKNESS

Other Meds:

Current Illness:

ID: 1814855
Sex: M
Age: 79
State: MI

Vax Date: 02/26/2021
Onset Date: 10/19/2021
Rec V Date: 10/25/2021
Hospital: Y

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

Lab Data:

Allergies: Pravastatin

Symptom List: Anxiety, Dyspnoea

Symptoms: Hospitalized 10/19/2021; COVID-19 positive 10/19/2021; fully vaccinated Assessment and Plan COVID 19 Pneumonia Acute Hypoxic Respiratory Failure Presenting symptoms: SOB, cough, fever. COVID 19 detected by PCR: 10/19/2021. Symptomatic day: 4 CXR pending Received Decadron 6mg oral, Remdesivir in ED. Current oxygen saturation 91%, oxygen requirement 3L NC Severe Respiratory isolation Dexamethasone 6 mg oral daily 1/10 days Remdisivir day 1. Will need daily CMP monitoring for liver and renal toxicities. Daily labs CBC with differential, CMP, D-dimer Monitor Ins/Outs Continuous pulse oximetry and telemetry VTE prophylaxis with Lovenox 10/21/2021 note: Patient hypotensive, tachypneic with oxygen requirement increased to 10L intermediate flow. Reassessed patient at bedside. He reports that he feels the same as this morning with shortness of breath at rest and frequent cough. He is not feeling lightheaded or dizzy. Recheck bp of 106/60 RR 20 Procal level indicates very low likelihood of bacterial infection. Continue to monitor. Consider repeat CXR if symptoms worsening 10/24/2021 note: Assessment/Plan COVID 19 Pneumonia Acute Hypoxic Respiratory Failure Presenting symptoms: SOB, cough, fever. COVID 19 detected by PCR: 10/19/2021. CXR as above Severe Respiratory isolation Oxygen requirement: 9L NC Dexamethasone 6 mg oral daily 4/10 days Remdisivir day 4. Will need daily CMP monitoring for liver and renal toxicities. Daily labs CBC with differential, CMP, D-dimer Monitor Ins/Outs Continuous pulse oximetry and telemetry VTE prophylaxis with Lovenox COPD No increased sputum production or purulence, do not suspect acute exacerbation at this time. - Continue home inhalers dulera, spiriva - Scheduled albuterol q4h

Other Meds: albuterol (PROVENTIL) (2.5 MG/3ML) 0.083% nebulization albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler azaTHIOprine (IMURAN) 50 MG tablet budesonide/formoterol (SYMBICORT) 160-4.5 MCG/ACT inhaler Calciu

Current Illness: Office visit 10/19/2021: FEVER. Patient states that he started about 4 days ago with an upper respiratory tract infection. Patient states that as a decreased sense of smell and taste. Patient states that he has been fatigued and short of breath. Patient states he has a dry cough but no headache. Patient's wife took his temperature last night was 102 F. a patient denies any chest pain leg swelling. Patient denies any headaches nasal congestion or nasal discharge. Patient denies a sore throat, nausea or vomiting. Patient states he has been using his nebulizers and inhalers more so than normal. Oxygenation room air ambulating 82% DR personally have reviewed the images and relate the findings to the patient. Patient has peripheral infiltrates noted in both lungs consistent with COVID pneumonia no pneumothorax mediastinum within normal limits slightly enlarged heart. 1. Fever, unspecified fever cause DR CHEST 2 VIEWS FRONTAL AND LATERAL possible covid, needs covid testing, 2. Hypoxia DR CHEST 2 VIEWS FRONTAL AND LATERAL CXR, needs covid testing, will give supplemental O2. will need to go to hospital. 3. Pneumonia due to COVID-19 virus I did call the ER and explained the findings to the ER doctor Dr., patient was sent by car to the emergency department

ID: 1814856
Sex: M
Age: 82
State: KS

Vax Date: 10/01/2021
Onset Date: 10/23/2021
Rec V Date: 10/25/2021
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: SULFA

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

Symptoms: Fever, nausua, fatigue, , sweats, soreness at injection site

Other Meds:

Current Illness: Reaction to cat bite, stroke treatment.

ID: 1814857
Sex: M
Age: 62
State: CO

Vax Date: 04/22/2021
Onset Date: 10/04/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: Basic blood testing for my annual physical and urine analyses.

Allergies: Allergies to Penicillin

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: I swollen Joints like Popeye elbow.

Other Meds: Lisinopril for High Blood pressure

Current Illness: N/A

ID: 1814858
Sex: F
Age: 39
State: KY

Vax Date: 02/23/2021
Onset Date: 10/18/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Developed symptoms of Covid on 10/18/2021 and tested positive on 10/23/2021.

Other Meds:

Current Illness:

ID: 1814859
Sex: F
Age: 35
State: MO

Vax Date: 10/18/2021
Onset Date: 10/18/2021
Rec V Date: 10/25/2021
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: no

Allergies: no

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

Symptoms: 13 minutes after received vaccine felt like hair ball was stuck in throat, feet and hands were cold, face and body was hot, also labored breathing was going on *forcing self to breathe, rash broken out on face and arms, difficulties swallowing, Benadryl in left arm with iv and epi iv in right arm, in ambulance she vomited, emt said throat was closing and almost touching, painful leg and arm twitching, after getting discharged had a pokey tongue, headache, dry mouth. allergic to vaccine.

Other Meds: no

Current Illness: no

ID: 1814860
Sex: M
Age: 74
State: SC

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

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

Lab Data: NA

Allergies: NA

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: This patient was not eligible for a 3rd dose of this vaccine AT THE TIME that it was given. No true adverse reaction.

Other Meds: unknown

Current Illness: NA

ID: 1814861
Sex: M
Age: 73
State: MI

Vax Date: 02/26/2021
Onset Date: 10/13/2021
Rec V Date: 10/25/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: breakthrough case, hospitalized

Other Meds:

Current Illness:

ID: 1814862
Sex: F
Age: 71
State: NJ

Vax Date: 03/04/2021
Onset Date: 10/23/2021
Rec V Date: 10/25/2021
Hospital: Y

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

Lab Data: 10/23/2021 - SARS-CoV-2 Antigen (-) 10/23/2021 - SARS-CoV-2 PCR (+) 10/23/2021 - SARS-CoV-2 IgM 0.65, and IgG 4.03

Allergies: Peaches, and sulfa medications.

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: 71 yr old female with PMH of breast cancer, cirrhosis of the liver and brain lesions presents for evaluation of expressive aphasia. Patient was tested positive with COVID-19 on 10/18/21 and received the monoclonal antibody infection on 10/19/21. Denies chest pain, abdominal pain or SOB. .

Other Meds: aspirin 81 mg tablet,chewable Directions: 1 tablet oral daily (Active) cyanocobalamin (vitamin B-12) 50 mcg Lozenge (Active) exemestane 25 mg Tablet Directions: 1 tablet oral daily (Active) furosemide 40 mg Tablet Directions: 1 tablet

Current Illness:

ID: 1814863
Sex: M
Age: 70
State: IN

Vax Date: 08/16/2021
Onset Date: 08/16/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: Seeing my Arthritis Dr on third would have been there weeks ago but had my yearly physical scheduled in Oct and decided to wait until after

Allergies: low grade seasonal allergies

Symptom List: Diarrhoea, Nasal congestion

Symptoms: 5 hours after second injection sever fatigue slept 48 hours with flu symptoms, whole body ache. Massive headache neck pain sever after 2 days the headache and neck pain subsided I have had since then a monster of a arthritis flare up Prior to vaccine I had a light nuisance arthritis occasionally in rist and hands Now my body aches 24-7 at times my hands hurt so badly I can't dress eat pickup a cup of coffee or get keys out of pants pocket without real pain. I have pain in knees back neck everywhere This is all day and night I awake at night in pain repeatedly every night. I deeply regret my vaccination

Other Meds: meloxicam 7.5 mg once a day low dose aspirin once each day

Current Illness: none

ID: 1814864
Sex: M
Age: 55
State: WI

Vax Date: 09/09/2021
Onset Date: 09/23/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: I am scheduled for tests. The soonest they could get me in is November 12th 2021.

Allergies: none

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

Symptoms: I have hearing problems two weeks after the Moderna first shot. My right ear is ringing and the hearing is muffled. I also had pressure in the right ear. I did take Ibprofin and the pressure was reduced. I have had the ringing and muffled hearing for 4 weeks.

Other Meds: none

Current Illness: none

ID: 1814865
Sex: M
Age: 50
State: GA

Vax Date: 04/20/2021
Onset Date: 09/07/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: Covid

Allergies: Penicillin

Symptom List: Rash, Urticaria

Symptoms: September 7 mid-morning I started having a runny nose but it wasn't really bad and I didn't pay much attention to it. September 8 it was a little more and I did a home covid test and it was negative, but on September 9 I did another home test and it was positive, so I went to the Doctor and did a PCR and it was positive so I received monoclonal antibodies. Symptom wise, it was like a minor head cold but on day 3 it felt like someone wrapped a chain around my chest, but after the antibody shot within 3 days it was all gone. It didn't go into my chest at all. Within a week I tested negative again and was back to normal. I was down in bed during it for at least a day and a half.

Other Meds: Glipizide, Lisinopril 20 mg, multivitamin, 1000 units B3, 500 mL Vitamin C

Current Illness: None

ID: 1814866
Sex: F
Age: 35
State: NE

Vax Date: 10/20/2021
Onset Date: 10/21/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: 10-23-21- Hospital ER Chest x-ray blood labs

Allergies: Ammox.- med Milk Peas Peanuts

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

Symptoms: Pre medicated with 1000mg tylenol and 50mg Benadryl 24 hours after shot: sore throat and cough 48 hours after shot: voice lost, nasal passages closed 72 hours after shot: nasal passages closed, throat began closing. Went to ER per recommendation from on call nurse. Given breathing treatment, IV steroid, IV 50mg Benadryl, blood work taken (normal), chest x-ray (normal), oxygen levels fine.....released with Oral steroid for 5 days

Other Meds: Zyzal- allergy med Z-pak Thrive suppliment Effxor 125mg singular 5mg

Current Illness: Allergies

ID: 1814867
Sex: F
Age: 33
State:

Vax Date: 10/15/2021
Onset Date: 10/23/2021
Rec V Date: 10/25/2021
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:

Allergies:

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

Symptoms: Fetal demise at 22 3/7 weeks pregnant.

Other Meds:

Current Illness:

ID: 1814868
Sex: F
Age: 51
State: NE

Vax Date: 08/12/2021
Onset Date: 08/15/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: Doppler, Blood draws Doctor will have exact dates

Allergies: Penicillin, Morphine, Hydrocodone, Codeine, Aspirin Latex, Creosote, All weed killers

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

Symptoms: Three days after first injection high fever, presenting signs of peripheral Neuropathy, chest pains equaling ER visit. Second injection within 24 hours extreme all over body pain, fatigue, increased chest pains, difficulty breathing, veins ruptured in left leg presenting as a blood clot. Had to have a Doppler test. Continuous chest pain, severe back pain, loss of feeling in hands and feet, loss of balance, dizziness, continuous migraines, difficulty walking or holding items

Other Meds: None

Current Illness: None

ID: 1814869
Sex: F
Age: 39
State: AL

Vax Date: 03/18/2021
Onset Date: 03/28/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: May 12, 2021-ENT Dr. prescribed prednisone for a month (21 days followed by 10 days tapering off) May 18, 2021- MRI; came back clear June 2, 2021- Dr diagnoses me with Menieres Disease. I have another inner ear fullness and popping/vertigo episode and he prescribed me 10 days of steroids; it didn?t fix anything. August 19, 2021- Balance test; found uncompensated vestibular dysfunction and CNS involvement. August 27, 2021- bloodwork from general practitioner; came back clear August 21, 2021- received acupuncture; did not help September 1, 2021- started vestibular physical therapy; 4 concurrent weeks with no change September 8, 2021- started new ENT; does NOT think I have Menieres Disease. October 7, 2021- started me on triamterene (diuretic) with low sodium diet; blood work. Has helped just a little bit but not much. October 14, 2021- Dr. says bloodwork came back with high ANA levels. Awaiting what we?re going to do next.

Allergies: NONE

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

Symptoms: Vaccine received on 3/18/2021 Brain fog and dizziness started on 3/28/2021 Progressively worsened until first intense vertigo episode on 5/3/2021. After this date, dizziness is constant. (1st) ENT prescribed meclizine, it did not help. Also prescribed prednisone, 21 days of strong dosage followed by 10 days tapering off. It helped a little, but did not fix anything. Episodes seemed to be worse around menstrual cycle, lasting days. Audiologist did balance test on Aug 19, 2021 and found uncompensated vestibular dysfunction and CNS involvement. Referred to PT for Vestibular Rehab (did 4 weeks), it didn?t help. Referred to neurologist; he was useless. Currently waiting to see 2nd neurologist. Ever since the balance test on Aug 19, I have had 3-5 intense vertigo and inner ear episodes every single week. Every. Single. Week.

Other Meds: Multivitamin Chlorophyll Turmeric Super Lysine Sacc B probiotic

Current Illness: NONE

ID: 1814870
Sex: F
Age: 74
State: FL

Vax Date: 02/07/2021
Onset Date: 02/10/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: I had an echocardiogram and blood work.

Allergies: Penicillin.

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

Symptoms: About 53 hours after receiving my second dose, I felt a large palpitation. I didn't think anything of it, but I fainted and fell to the floor. I had cuts in my head. During the course of my visit, the doctors told me that I had supraventricular tachycardia. I had a referral to a cardiologist. He ordered a two-week portable monitor for me. After that, I saw another doctor, who is an interventional cardiologist. He noticed that I had SVT. He recommended that I have an internal monitor. I have a telephone beside my bed that records my heart rhythm at night. If I have a feeling during the day, I can push a button and it will point out the time that I felt it to the doctor that is viewing my results. I was switched from losartan and now I'm taking metoprolol and flecainide 50mg 2x per day. While in the hospital, I was under 24-hour observation.

Other Meds: Losartan; Pepcid; Citracal; Multivitamin; Vitamin D3.

Current Illness: I was not experiencing any illness.

ID: 1814871
Sex: F
Age: 71
State: SC

Vax Date: 09/28/2021
Onset Date: 09/29/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: X-ray, foot

Allergies: Apples; almonds

Symptom List: Ear pain, Hypoaesthesia

Symptoms: The next day after the vaccine I developed a low grade fever. Body aches and pains and severely tired feeling. Couldn't sleep for 2 nights in a row but the 3rd night I slept for over 10 hrs in a row. The heel of my left foot begin to ache and has gotten worse over time. I saw my Podiatrist today who injected the heel with cortisone and it is currently being monitored with an appointment scheduled in the next 4 weeks.

Other Meds: Losartan; Brio; Synthroid

Current Illness: No

ID: 1814872
Sex: F
Age: 73
State: SC

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

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

Lab Data: NA

Allergies: NA

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Patient was not eligible for a 3rd dose AT THE TIME. No true "adverse event".

Other Meds: unknown

Current Illness: NA

ID: 1814873
Sex: F
Age: 47
State: CA

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

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

Lab Data: SARS-COV-2 MOLECULAR, COVID-19(RAPID-ABBOTT) Collection Time: 10/08/21 1:52 PM Result Value Ref Range Spec Source THROAT COVID-19 (SARS CoV-2, Molecular) Negative Negative RESPIRATORY VIRUS PANEL BY PCR(INCLUDES SARS COV-2) Collection Time: 10/08/21 4:30 PM Result Value Ref Range PCR RP Interp See Note Adenovirus (RVP) Not Detected Not Detected Coronavirus 229E (NOT COVID-19) Not Detected Not Detected Coronavirus HKU1 (NOT COVID-19) Not Detected Not Detected Coronavirus NL63 (NOT COVID-19) Not Detected Not Detected Coronavirus OC43 (NOT COVID-19) Not Detected Not Detected COVID-19 (SARS COV-2 RNA,RT PCR) Not Detected Not Detected Human Metapneumovirus (RVP) Not Detected Not Detected Human Rhinovirus/Enterovirus (RVP) Not Detected Not Detected Influenza A (RVP) Not Detected Not Detected Influenza B (RVP) Not Detected Not Detected Parainfluenza Virus 1 Not Detected Not Detected Parainfluenza Virus 2 Not Detected Not Detected Parainfluenza Virus 3 Not Detected Not Detected Parainfluenza Virus 4 Not Detected Not Detected Respiratory Syncytial Virus (RVP) Not Detected Not Detected Bordetella parapertussis (IS1001) Not Detected Not Detected Bordetella pertussis (ptxP) Not Detected Not Detected Chlamydia pneumoniae (RVP) Not Detected Not Detected Mycoplasma pneumoniae (RVP) Not Detected Not Detected Spec Source NASOPHARYNGEAL SWAB

Allergies: Asa [Aspirin]Hives Biaxin [Clarithromycin]Other Nucala [Mepolizumab]Shortness of Breath Pfizer Covid-19 Vaccine (Eua) [Covid-19 Vacc,mrna(pfizer)(pf)]Anaphylaxis Xolair [Omalizumab]Shortness of Breath

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

Symptoms: 47 year old Female history of asthma (hx of intubation), LE DVT 2011 on xarelto and DM2 presenting with dyspnea. Admitted with asthma exacerbation triggerd by covid 19 booster 10/8/21. Responded to steroids and nebs. Pulm consulted. Patient weaned to room air and symptoms resolved. Plan to taper prednisone with pulm f/u as outpatient. Discussed with Dr and patient stable for discharge home.

Other Meds: sertraline (ZOLOFT) 50 mg Tablet predniSONE (ORASONE, DELTASONE) 10 mg Tablet metFORMIN (GLUCOPHAGE) 500 mg Tablet ascorbic acid, vitamin C, (Vitamin C) 500 mg Tablet pyridoxine, vitamin B6, (VITAMIN B6) 100 mg Tablet MULTIVITAMIN ORAL

Current Illness: Asthma

ID: 1814874
Sex: M
Age: 67
State: MI

Vax Date: 01/14/2021
Onset Date: 10/11/2021
Rec V Date: 10/25/2021
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:

Allergies:

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

Symptoms: dyspnea

Other Meds:

Current Illness:

ID: 1814875
Sex: M
Age: 59
State: MI

Vax Date: 04/14/2021
Onset Date: 10/20/2021
Rec V Date: 10/25/2021
Hospital: Y

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

Lab Data: SARS-COV-2 Positive 10/22/2021 SARS-COV-2 (COVID19), POINT OF CARE, MOLECULAR/PCR - OFFICE NO chest xray done

Allergies:

Symptom List: Unevaluable event

Symptoms: Patient's wife is covid positive, unvaccinated. Patient symptomatic with nasal congestion, loss of taste and smell, mild cough, onset 10/20/21. Patient admitted for dialysis.

Other Meds:

Current Illness:

ID: 1814876
Sex: F
Age: 55
State: MI

Vax Date: 04/16/2021
Onset Date: 04/19/2021
Rec V Date: 10/25/2021
Hospital: Y

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

Lab Data: Hospitalized July 13, 14, 15 Emergency Room Hospitalized July 28 through July 31

Allergies: Bee Stings

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

Symptoms: Began with hives and facial swelling. After the 2nd vaccine, hives covered entire body, face, eyes, lips, tongue and throat swelling, I also developed anaphylaxis.

Other Meds: Synthroid Lexipro Omeprazole

Current Illness: None

ID: 1814877
Sex: F
Age: 73
State: TX

Vax Date: 09/24/2020
Onset Date: 09/24/2020
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: Covid -19 Test

Allergies: Latex & adhesive

Symptom List: Injection site pain, Pain

Symptoms: On the way home after the vaccine I felt a strange sensation going up my neck on the left side. About the next day I started having I started having 'side effects' almost immediately and for longer than the 1-2 days listed. So when the 'side effects' drug on into the 4th day I thought maybe it was irritants/allergies since many people on social were having bad allergy symptoms, so I took a ZyrtecD. Also took it the next day. I was not having results like I usually do...so that meant not irritants/allergies. I was getting alarmed as I was still having the same symptoms as listed as possible side effects to shot as well as symptoms of flu & C-19. Since I had had back to back flu symptoms as a 'reaction' to the flu shot 20 years ago, I doubted I had the flu because it did not feel the same. Dr. had told me that now they were going to have to test for both C-19 & flu as the symptoms are similar. Anyway, I messaged Dr. did she think I needed a C-19 test? One was scheduled for the next day. Got the results 2 days later. Negative. I also was having mental issues: racing thoughts, unable to make decisions, extremely short term memory, trouble figuring out how to drive places and could no longer do Sudoku--even the easiest when I had been able almost always finish all levels. I slowly got better physically. However the mental aspects have been even slower to get better. It appears that I'm not going to get back to how I was b4 that flu vaccine. When doing research about these mental issues I was having I ran across info about mercury. I then found a link with mercury symptoms...linked to vaccines.

Other Meds: Azelastine Hydrochloride Nasal Spray .15 or Xlear Sinus spray as needed as of 2019-6 Zyrtec-D as needed Meta Mucil fiber wafer 1 day Multi vitamin Vitamin Code Women 50 & Wiser Biotin 5,000mcg Calcium 500 mg Co Q10 100 mg Lutein 20 mg M

Current Illness:

ID: 1814878
Sex: F
Age: 40
State: IN

Vax Date: 10/23/2021
Onset Date: 10/24/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data:

Allergies: Dairy

Symptom List: Injection site pain, Menorrhagia

Symptoms: My lymphnodes in my armpit on the side of my injection have swollen to an uncomfortable size and are a little painful.

Other Meds: Valacyclovir, sertraline, Lisinopril, pantoprazole

Current Illness: Just seasonal allergies

ID: 1814879
Sex: F
Age: 83
State: NJ

Vax Date: 06/22/2021
Onset Date: 10/22/2021
Rec V Date: 10/25/2021
Hospital: Y

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

Lab Data: 10/22/2021 SARS-CoV-2 Antigen (+)

Allergies: Penicillin and IV contrast

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

Symptoms: presenting with productive cough for 3 days with fever at home (

Other Meds: cloNIDine 0.3 mg/24 hour Patch Weekly (Active) furosemide 20 mg Tablet Directions: 1 tablet oral daily (Active) gabapentin 300 mg Capsule Directions: 1 capsule oral twice a day (Active) hydrALAZINE 50 mg Tablet Directions: 1 tablet or

Current Illness:

ID: 1814880
Sex: M
Age: 47
State: FL

Vax Date: 06/22/2021
Onset Date: 09/13/2021
Rec V Date: 10/25/2021
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: 4 follow up visits and prescription of the following eye drops in treatment: -Durezxol 1% Sol -Prednisolone Acetate Op 1% Sol -Cyclopentolate HCL Op 1% Sol -BromSite Op 1% Sol

Allergies: N/A

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Extreme inflamation of all joints Uvitis (Inflamatory Immune Response) inflamtion in eye causing light sensitity, pain, and loss of vision

Other Meds: amlodipine losartan

Current Illness:

ID: 1814882
Sex: F
Age: 49
State: WI

Vax Date: 04/22/2021
Onset Date: 06/09/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: Gall bladder removal 10/13/2021

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Gall stones, colic leading to gall bladder removal. Potentially had stones before the shot, but increased colic after probably due to unrelated weight loss plan.

Other Meds: None

Current Illness: Gall stones may have been around before the vaccination but colic after. May not be related to the vaccination.

ID: 1814883
Sex: F
Age: 50
State: VT

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: None

Allergies: Sulfa antibiotics Pink dye

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

Symptoms: Starting 4 hours post injection, I had uncontrollable shaking, feeling freezing cold and could not get warm, exhaustion, 103+ fever, body aches, chills, then I woke up 8 hours post injection with violent vomitting, SEVERE headache, severe nausea, unable to keep down any fluids. These symptoms lasted 48 hours. I continued to feel exhausted, unable to think clearly, mild fever(100) and headache, decreased appetite, slight nausea for 5 additional days. Then brain fog and malaise for another 5 full weeks.

Other Meds: Acyclovir Multi vitamin Dietary supplements: d3, fish oil, beets and greens, milk thistle and a few others

Current Illness: None

ID: 1814884
Sex: F
Age: 39
State: MN

Vax Date: 10/04/2021
Onset Date: 10/18/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: EKG 10/25/21

Allergies: amoxicillin gluten sensitive

Symptom List: Nausea

Symptoms: 2 wks after first vaccine experienced chest pain along L breast and radiated to sternum and L neck. Pressure below the sternum. itching/aching in random areas of body.

Other Meds: Zinc oral progesterone cyclically

Current Illness: none

ID: 1814885
Sex: M
Age: 82
State: MI

Vax Date: 03/18/2021
Onset Date: 10/14/2021
Rec V Date: 10/25/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: cough, shortness of breath, cough

Other Meds:

Current Illness:

ID: 1814886
Sex: F
Age: 24
State: FL

Vax Date: 10/04/2021
Onset Date: 10/18/2021
Rec V Date: 10/25/2021
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: NONE

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

Symptoms: Pt reports skin rash under left arm. Rash is round, light pink in appearance and non-pruritic. Pt states noticing rash about 2weeks after first dose of Pfizer Covid19 vaccination

Other Meds: ZYRTEC AND DEPO PROVERA SHOT

Current Illness: NONE

ID: 1814887
Sex: F
Age: 53
State: MI

Vax Date: 04/21/2021
Onset Date: 10/05/2021
Rec V Date: 10/25/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Breakthrough case

Other Meds:

Current Illness:

ID: 1814889
Sex: F
Age: 35
State: TX

Vax Date: 10/22/2021
Onset Date: 10/23/2021
Rec V Date: 10/25/2021
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: N/a

Symptom List: Tremor

Symptoms: Seizures, massive hives, headaches but mostly Seizures

Other Meds: Tramadol, antibiotics

Current Illness: N/a

ID: 1814890
Sex: M
Age: 34
State: IN

Vax Date: 10/14/2021
Onset Date: 10/14/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: 10/17/2021: Clinic

Allergies: None

Symptom List: Erythema, Pruritus

Symptoms: 10/14/2021: Upon shot, immediatie pain in injection site(differed from other shots). Approximately 25 minutes after the shot, pain throughout entire left arm and numbness/tingling in fingertips. Approximately 35 minutes after the shot, sweating and several minutes of shortness of breath. Pain in entire left arm and numbness/tingling in fingertips did not subside. 10/15/2021: Pain in entire left arm and numbness/tingling in fingertips entire days. 10/16/2021: Was awoken to burning/stabbing pain in left arm, neck, shoulder, and back area. Pain affected entire mobility drastically. Was limited in movement and incapacited from normal mobility. 10/17/2021: Was not able to see doctor on 10/16, so went to Clinic. Was prescribed muscle relaxers and 800mg Ibuprofen. Pain was still present, mobility only slightly improved. Numbness and tingling continued. 10/18/2021 through 10/22/2021: Movement/mobility continued to improve. Took the prescribed medications every day as prescribed. Did not participate in normal workout/gym/cardio routines; Took the week off to rest body. 10/23/2021 through 10/24/2021: Stopped taking prescribed medicine. Felt much better. Movement/mobility close to back to normal. 10/25/2021: Woke up with sorness in shot injection area. Entire left arm, shoulder, and neck sore... just not de-mobilizing like last time. Took prescribed muscle relaxer.

Other Meds: None

Current Illness: None

ID: 1814891
Sex: F
Age: 39
State: CT

Vax Date: 05/19/2021
Onset Date: 09/25/2021
Rec V Date: 10/25/2021
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: E.R. car scan without catscan 10/11/21 Neurology Oct 22,2021

Allergies: none

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

Symptoms: Started having nerve pain in my scalp, burning pin and needles throughout my scalp and pressure in the middle of my scalp . Kept me up for almost 2 1/2 weeks at night, had to apply icepack on head.. Went and had CT cat scan. at the E.R. and had to follow up with neurologist. Never had this feeling before. Started feeling better but I feel the pins in my scalp here and there.

Other Meds: none

Current Illness: none

ID: 1814892
Sex: F
Age: 29
State: AZ

Vax Date: 01/26/2021
Onset Date: 10/20/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: Positive Covid-19 PCR test.

Allergies:

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

Symptoms: Complaint of headache, runny nose/congestion, and body aches.

Other Meds:

Current Illness:

ID: 1814893
Sex: F
Age: 77
State: IN

Vax Date: 10/15/2021
Onset Date: 10/16/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: has appointment with audiologist on 11/10/21

Allergies: none

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient said she noticed increased hearing loss the morning after receiving 3rd dose (booster) on 10/15/21. Patient has previously had hearing loss but worsened after receiving vaccination.

Other Meds: lisinopril 20mg, atorvastatin 40mg, metoprolol tartrate 25mg, metrolol tartrate 50mg, calcium citrate, CoQ 10, multivitamin, baby aspirin

Current Illness:

ID: 1814894
Sex: F
Age: 69
State: FL

Vax Date: 10/22/2021
Onset Date: 10/22/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: None

Allergies: PCN

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

Symptoms: Headache, total body muscle aches and back spasms, total body Joint Pain

Other Meds: Synthroid, Metropolol XL, Venofaxine, Vitamin D, amlodipine,

Current Illness: None

ID: 1814895
Sex: M
Age: 59
State: MN

Vax Date: 05/06/2021
Onset Date: 05/17/2021
Rec V Date: 10/25/2021
Hospital: Y

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

Lab Data:

Allergies: Allergy to eggplant

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

Symptoms: I had a heart attack. One stent was used on the date of the attack and another stent added in June of 2021.

Other Meds: Humalog and Lantus insulins, multi-vitamins, 81 mg aspirin, lisinopril

Current Illness: Juvenile diabetic since age 12.

ID: 1814896
Sex: M
Age: 51
State: CA

Vax Date: 10/21/2021
Onset Date: 10/22/2021
Rec V Date: 10/25/2021
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: none

Symptom List: Pain in extremity

Symptoms: Increasing body aches spreading beyond injection location approx. 15-20 hours after injection. Chills and moderate headache occurring approx. 30 hours after injection. Dissipation of most effects except residual soreness at injection site after approx. 40 hours.

Other Meds: Vitamin D 5000 IU, Kirkland multi-vitamin supplement, zinc

Current Illness: None

ID: 1814897
Sex: M
Age: 80
State: MI

Vax Date: 01/22/2021
Onset Date: 10/12/2021
Rec V Date: 10/25/2021
Hospital: Y

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

Lab Data: Positive on admission 10.11.21

Allergies:

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

Symptoms: SOB

Other Meds: Levothyroxine, pravachaol, metformin, lantus, uoloric, pepcid, daily aspirin

Current Illness:

ID: 1814898
Sex: F
Age: 85
State: MA

Vax Date: 04/07/2021
Onset Date: 05/08/2021
Rec V Date: 10/25/2021
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: CTA chest, venous doppler US legs

Allergies: Penicillin, Sulfas, Cephalosporins, Phenytoin, Atorvastatin

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

Symptoms: Bilateral DVT and pulmonary embolism 1 month later, on 5/8/2021

Other Meds: Clonidine 0.1 mg daily, Pravastatin 80 mg daily, Keppra 250 mg twice a day, Vitamin D 2,000 units daily, Multivitamin 1 tablet daily

Current Illness: Mild dementia Autonomic dysfunction Labile HTN / Orthostatic hypotension Recurrent syncope from orthostatic hypotension HPL Aortic atherosclerosis Prediabetes, HbA1c 6.3% Intracranial aneurysm w/ spontaneous right SDH s/p craniotomy at St V. 1993 Seizure disorder Bronchiectasis (CT 2014 MWMC) Hyperthyroidism Anemia Vitamin D deficiency (23) S/p right THR

ID: 1814899
Sex: F
Age: 48
State: AZ

Vax Date: 01/12/2021
Onset Date: 10/13/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: Positive Covid19 test of unknown type.

Allergies:

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

Symptoms: Complaint of elevated temperature/fever, runny nose/congestion, myalgia, and malaise

Other Meds:

Current Illness:

ID: 1814901
Sex: M
Age: 75
State: WI

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

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

Lab Data: none

Allergies: none known

Symptom List: Vomiting

Symptoms: Came down with severe chills that evening, vomiting and upper body trunk weakness. I needed help sitting up in bed; my wife had to sit behind me to keep me upright in bed. Due to upper body weakness, walking was difficult to the point of using a walker to help me be mobile.

Other Meds: timolol, lantaprost, muro, 81 mg aspirin, tylenol, eliquis, diltiazem, furosemide, pantoprazole, pravastatin, pregabalin.

Current Illness: none

ID: 1814902
Sex: F
Age: 12
State: MN

Vax Date: 10/22/2021
Onset Date: 10/22/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: BG 87 POCT

Allergies: NKA

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient had episode of convulsions and loss of consciousness immediately following injection (within one minute). Convulsions witnessed by medical assistant after administering. Patient moved to patient bed; diaphoretic, pallor, BP 70/45, bradycardic mid 40s,o2 98-100% RA. Elevated legs, pushed fluids. BP recheck 90s/50s, recheck again low 100s/70s (15 minutes after the event), pulse returned to high60s-mid70s after interventions. Patient transferred to Hospital via EMS to rule out seizure due to witnessed convulsions. Patient c/o weakness and fatigue. No loss of bowel/bladder.

Other Meds:

Current Illness:

ID: 1814903
Sex: M
Age: 35
State: TX

Vax Date: 10/18/2021
Onset Date: 10/18/2021
Rec V Date: 10/25/2021
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: Abbott at home Covid-19 Antigen test 2x, both negative.

Allergies: None

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

Symptoms: Moderate to Severe Upper respiratory symptoms including : Cough, Phlegm/Sputum/Productive cough, Weezing, Fever, Fatigue, Nasal Discharge, Headache, night sweats, Ear Drainage, Difficulty sleeping. I have had a previous COVID-19 infection resulting in mostly digestional issues. Doctor has diagnosed me with Viral Upper Respiratory Infection, Currently on MethylPREDNISolone dose pack 4mg and Benzonatate 100mg to deal with symptoms. Symptoms still mildly present as of 10/25/2021.

Other Meds: None

Current Illness: None

ID: 1814904
Sex: F
Age: 34
State: AZ

Vax Date: 02/24/2021
Onset Date: 10/22/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: Positive Covid-19 antigen test x 2, 15 minutes apart.

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Complaint of shortness of breath/difficulty breathing, cough, headache, runny nose/congestion, loss of taste/smell, and myalgia.

Other Meds:

Current Illness:

ID: 1814905
Sex: F
Age: 46
State: VA

Vax Date: 10/23/2021
Onset Date: 10/23/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: EMS monitored blood pressure, pulse and blood sugar. EMS had been on seen for standby due to a community event. Blood pressure elevated, readings listed above. Patient signed a refusal to transport. Family member advised medical transport. See above evaluation. Patient was 11 month post gastric bypass, Hypertensive.

Allergies: NKDA

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

Symptoms: Patient was administered a booster dose of Janssen (Johnson & Johnson) per guidelines. Patient was in Recovery area and appeared to have difficulty holding her head up. Recovery nurse/MRC was on site. Stated that the patient seemed disoriented and answered questions slowly. Pt. stated that she did not feel well and that she had not eaten that morning. Stated that she just thought she needed food. Pt. was slightly diaphoretic and had difficulty stating her name and information. EMS was already located on the site/community clinic site and was notified. EMS monitored b/p, pulse and blood sugar as well. B/P was 160/100 (palpable diastolic), monitored again with B/P and Heart monitor. Those readings were: 190/108 and 180/108. EMS checked blood sugar, registered at 71. Heart rate ranged from 56-59 bpm per monitor. Pt. stated that she could not remember when she took her medication, but did not think had been within last 12-24 hours. A family member was called to assist. Strongly encouraged the patient to be transported for further evaluation. Patient signed a refusal of care provided by the EMS. Family member also tried to persuade patient to be transported for evaluation. Patient refused medical transport.

Other Meds: Pt. stated that she takes blood pressure medication, and a medication for diabetes.

Current Illness: Stated she was 11 months post gastric bypass surgery. Diabetes, Hypertension.

ID: 1814906
Sex: M
Age: 59
State: CA

Vax Date: 10/03/2021
Onset Date: 10/13/2021
Rec V Date: 10/25/2021
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: On admission: CT head, CTA Head and Neck, CT Perfusion, MRI w/o contrast shows no acute abnormalities. - MRI with contrast shows subtle FLAIR signal of cerebral cortex especially in region of temporal lobes, possibly inflammation - LP (10/14): CSF studies: 153 glucose, 105 protein, 6.9 AG, 0 RBC, 5 wbc's - CRP and ESR elevated - Meningitis/encephalitis panel negative - Solu-medrol 1g daily; 5 doses completed on 10/20/21. - switch to PO Keppra 1500mg BID for seizures - Seizure precautions - HIV, HHV6, WNV PCR - negative. - Dr. (Stroke Neurology) consulted. Appreciate recommendations: - the patient can be discharged and will follow up with Dr. in 4 weeks.

Allergies: NKDA

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

Symptoms: Unknown Brand or lot numbers of Vaccines Patient had Covid booster shot (3rd injection) on October 5th along with getting Flu vaccine as well as Shingrex at an different facility, Admitted to Hospital on 10/13/21 with Diagnosis: Principal Problem: Acute metabolic encephalopathy Active Problems: Seizure (CMS/HCC) Altered mental status Fever Neurologic: Metabolic encephalopathy, secondary meningitis vs paraneoplastic vs autoimmune vs. Seizure vs post-vaccination

Other Meds:

Current Illness: None

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am