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**
PLEASE CHECK BACK SOON
Download the files above while you wait.







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: 1821849
Sex: M
Age: 73
State: CA

Vax Date: 10/22/2021
Onset Date: 10/22/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Administration error, injected 0.5 ml instead of 0.25 ml for the booster dose

Other Meds:

Current Illness:

ID: 1821850
Sex: M
Age: 28
State:

Vax Date: 10/25/2021
Onset Date: 10/26/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Rash, chills, nausea, fatigue. Called TM health, made a primary care appt, was given prednisone for rash.

Other Meds:

Current Illness:

ID: 1821851
Sex: M
Age: 40
State: WI

Vax Date: 04/10/2021
Onset Date: 10/25/2021
Rec V Date: 10/27/2021
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: Cats - Itchy Eyes

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

Symptoms: Patient contracted COVID after being fully vaccinated Runny nose, cough, fatigue, congestion, chills, Body aches, headache.

Other Meds: Aspirin 650mg q4hr PRN for pain Nicotine Gum

Current Illness: None documented

ID: 1821852
Sex: M
Age: 48
State: DE

Vax Date: 04/02/2021
Onset Date: 04/03/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data: EKG, CXR, D-Dimer, Stress Test, Echocardiogram - April 2021

Allergies: NKA

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Initially severe myalgia and arthralgia on Day #2, which resolved. Day #5 developed heart pounding, palpitations, tightness in chest and throat, decreased exercise tolerance.

Other Meds:

Current Illness:

ID: 1821853
Sex: M
Age: 72
State: NY

Vax Date: 10/23/2021
Onset Date: 10/23/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data:

Allergies: No

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

Symptoms: Mental confusion, fatigue, feverish feeling, cramping, diarrhea, nausea

Other Meds: Vitamin B12, Vitamin D3, Omeprazole, Tylenol

Current Illness: None

ID: 1821854
Sex: F
Age: 26
State: KS

Vax Date: 10/23/2021
Onset Date: 10/23/2021
Rec V Date: 10/27/2021
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: Penicillin

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

Symptoms: Approximately an hour and a half after receiving the vaccine I removed the band aid that was applied to the injection site. When I removed the band aid I noticed that there was a small area of skin around the injection site that was red, swollen, and hot to the touch. This area was approximately the size of my fingertip, and hurt when touched. It also hurt to raise my arm. Over the next 48 hours this rash began to worsen. By 24 hours post-vaccination it had grown to approximately 4-5 centimeters, was swollen, red, painful, hot to the touch and radiating heat, hurt when touched, and hurt when I moved my arm. It had also developed a goosebump-like texture. The pain was burning and tingling in sensation, and radiated outward from the injection site to approximately my elbow. I had a headache, and was dizzy, lightheaded, and nauseous. These systemic symptoms began approximately an hour and a half post vaccination and continued to worsen along with the rash. I iced my arm and treated with Tylenol and Zyrtec. The next day (48 hours post-vaccination) the rash continued to worsen, with the same symptoms (pain, heat, swelling, restricted movement of my arm), and my systemic symptoms persisted. I reached out to my primary care provider and was instructed to treat with Advil in addition to Tylenol, and to call in the morning if the rash continued to worsen overnight. The next morning when I woke up, the rash had grown in size, and the pain, heat, swelling, and restricted movement of my arm persisted, along with the systemic symptoms. I called my doctor and was instructed to come into the clinic for evaluation. By the time I was seen at the clinic it had been approximately 68-69 hours since the vaccine was administered. The size of my rash was measured, and it measured at approximately 5-6 cm. I was instructed to begin taking famotidine and Benadryl along with the Zyrtec, to take Advil and Tylenol round the clock, and to ice my arm. I was instructed to return if the rash worsened, if my systemic symptoms worsened, or if new symptoms began. I began treatment immediately with 40 mg of Benadryl 1x/day, 10 mg of Zyrtec 1x/day, and 20 mg of Famotidine 1x/day, as well as 400 mg of Advil and 500 mg of Tylenol every 4-6 hours, and icing the area when possible. By 96 hours post-vaccine administration the swelling had gone down, and the area was no longer as hot to the touch (though still warmer than the surrounding skin). The red coloring and goosebump-like texture persisted, but the burning pain had been reduced to an itching sensation, and the pain that restricted movement of the arm had lessened.

Other Meds: Buproprion XL 300 mg daily Sertraline 10 mg daily Adderall IR 20 mg 2x/day

Current Illness: No illnesses at the time of the vaccine. From approximately 10/7/2021 through 10/14/2021 I had a cold. My primary symptoms were sinus congestion, headaches, and fatigue. I did not have a fever, and I did not have any rashes or other skin irritation.

ID: 1821855
Sex: F
Age: 54
State: MA

Vax Date: 03/23/2021
Onset Date: 03/24/2021
Rec V Date: 10/27/2021
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: Sulfa drugs; Cipro antibiotics; macrolide antibiotics; Cortizone injection; CYP2C19 deficiency; gluten intolerance; dairy intolerance; histamine intolerance (Mast celll disease)

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Mast Cell Attack; severe pressure headache; pain in left ear; burning eyes; runny nose; sore muscle at injection site, upper right arm; Sore tongue w/ 2 ulcers; sore throat; partial loss of smell and taste.

Other Meds: Adapalene; albuterol inhaler; AJOVY; Creon; Cromolyn sodium oral solution 10ml; cromolyn sodium nasal spray; Cromolyn sodium ophthalmic solution; Emgality; epinephrine injector; Famotidine; fluticasone nasal spray; indomethacin 25 MG; Ipra

Current Illness: MCAS (mast cell activation syndrome); Fibromyalgia; Post Lyme Disease Syndrome; chronic migraine; SUNCT headaches; eczema; nummular eczema

ID: 1821856
Sex: F
Age: 32
State: WY

Vax Date: 10/25/2021
Onset Date: 10/26/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Pharyngeal swelling

Symptoms: Woke up feeling extremely tired, achey, had chills, sore arm. As the day went on I was nauseous and have a swollen lymph node in injection arm. And I have had a headache whenever I move for 2 days.

Other Meds: Daily vitamin

Current Illness: None

ID: 1821857
Sex: F
Age: 33
State: MN

Vax Date: 04/01/2021
Onset Date: 10/03/2021
Rec V Date: 10/27/2021
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

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: cough, shortness of breath, headache, sore throat- off and on, ear pain. tested positive for covid19 10/5/21 LOT #1 not available

Other Meds: Benzonate; Doxycycline; Clobetasol; Dizepam; Sprintec

Current Illness: none

ID: 1821858
Sex: F
Age: 80
State: NJ

Vax Date: 03/29/2021
Onset Date: 04/02/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data: None

Allergies: None

Symptom List: Diarrhoea, Nasal congestion

Symptoms: My arm started hurting after two days. It lasted about a week, I could not breathe and I received asthma treatment.

Other Meds: Pantoprazole-20MG Aspirin Kandesartan Metoprolol Eperenone Ezetimibe Prozac

Current Illness: None

ID: 1821859
Sex: M
Age: 14
State: AZ

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

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

Lab Data: Rapid strep on 10/26/2021 which was negative Rapid flu test on 10/26/2021 which was negative

Allergies: NKA

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

Symptoms: Fever, body aches, cough, sore throat since day of vaccination lasting until now (10/27/21)

Other Meds: N/A

Current Illness: N/A

ID: 1821860
Sex: M
Age: 24
State: CO

Vax Date: 09/19/2021
Onset Date: 09/23/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data: 3 X-rays (colon, lung and stomach)

Allergies: None

Symptom List: Rash, Urticaria

Symptoms: Severe stomach pains. Diarrhea. Vomitting. Got 2nd vaccine Phfizer WM4335 IM LA Dose 2. Persistant cough, trouble breathing, inflammed lungs. Now on antiboitics, steriod, inhaler. Has scheduled an appointment radiologist for lung x-ray. Now taking emergency state leave from job. Vaccine was mandated by job, no medical or religious exception.

Other Meds: None

Current Illness: None

ID: 1821861
Sex: M
Age: 68
State: CA

Vax Date: 10/22/2021
Onset Date: 10/22/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Administration error, injected 0.5 ml instead of 0.25 ml for the booster dose

Other Meds:

Current Illness:

ID: 1821862
Sex: F
Age: 86
State: MD

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

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

Lab Data:

Allergies: NKDA

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

Symptoms: ** VACCINATION ADMINISTERED BY INCORRECT ELIGIBILITY ** THE PATIENT WAS GIVEN VACCINATION ON 10/27/21 ON AN OUTSIDE CLINIC. AFTER PATIENT SUBMITTED THE FORM, PHARMACY SUPERVISOR FOUND OUT THE PATIENT HAS HER SECOND SHOT ON 5/26/21, WHICH WAS LESS THAN 6 MONTH AGO, VIA DATABASE. THE FORM WAS REMOVED FROM THE FILE, BUT WHEN I AND NURSES AT CLINIC WENT TO THE UPSTAIRS TO GIVE PATIENTS SHOTS, I RUSHED AND GAVE THE PATIENT VACCINATION WHICH THE NURSE POINTED (WHO WAS USING THE OLD LIST). AFTER GIVING THE SHOT, I REALIZED THE RX HAD BEEN REMOVED FROM THE FILE BECAUSE OF THE ELIGIBILITY ISSUE.

Other Meds:

Current Illness:

ID: 1821863
Sex: F
Age: 61
State: WI

Vax Date: 05/04/2021
Onset Date: 10/26/2021
Rec V Date: 10/27/2021
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: No known allergies

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

Symptoms: Patient contracted COVID after being fully vaccinated Asymptomatic - Exposure

Other Meds: None documented

Current Illness: None Documented

ID: 1821864
Sex: F
Age: 57
State: NY

Vax Date: 10/27/2021
Onset Date: 10/27/2021
Rec V Date: 10/27/2021
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: None reported

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

Symptoms: Post administration of 2nd dose of Pfizer pt. presented with Dypnea, coughing,and chest tightness. EMS was activated.5L Oxygen administered via nasal cannula . EMS administered albuterol and transferred pt. to hospital.

Other Meds: None reported

Current Illness: None reported

ID: 1821865
Sex: F
Age: 68
State: IA

Vax Date: 10/22/2021
Onset Date: 10/22/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data: none

Allergies: Ampicillin, Clindamycin, Kaprex, Levaquin, Celebrex, Sulfa

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

Symptoms: Flu-like symptoms: body aches, bad headache, nausea, chills, and extreme lethargy for 2 days. Began to recover Monday, but still had h/a and I was very tired, I didn't feel normal until Tuesday, 10/26. My husband received the same vaccination at the same time and didn't have these symptoms, just a little tired over the weekend. I just slept and sipped on drink.

Other Meds: none

Current Illness: sumatriptan prn

ID: 1821866
Sex: F
Age: 67
State: CA

Vax Date: 10/24/2021
Onset Date: 10/25/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data: None

Allergies: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Felt lightheaded immediately after injection, but that sensation had disappeared before the 15 minute waiting period expired. Began to experience body aches and sore arm approximately 12 hours after vaccine. Body aches lessened the following day, but I continued to experience strong fatigue and mild headache for two days following vaccination. By the third day all symptoms were gone, other than a mild ache at injection site.

Other Meds: Daily multi vitamins

Current Illness: None

ID: 1821867
Sex: F
Age: 33
State: MA

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

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Patient came in with CDC Card with record of first two doses of Moderna (2nd dose received 5/26/2021) for a Moderna booster dose. Patient was screened by a nurse and the dose was administered. As they were being documented in the state registry, it was discovered that she received her booster dose five months after their 2nd dose instead of six months. The nurse reports that the patient felt fine after their 15 minute waiting period and left the clinic.

Other Meds:

Current Illness:

ID: 1821868
Sex: M
Age: 80
State: NJ

Vax Date: 10/26/2021
Onset Date: 10/26/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data: none

Allergies: amoxacillin, animals, environmental

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

Symptoms: Pain upper right arm, lethargy, malaise, head-ache. Aspirin, bed rest.

Other Meds: aspirin, Ginko biloba, one-a-day vitamins, saw paletto, asthma, high blood pressure, BPH

Current Illness: none

ID: 1821869
Sex: F
Age: 1
State: IA

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

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

Lab Data:

Allergies:

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

Symptoms: Patient was given a flu vaccine from last years formulation 2020/2021 and expired on 06/30/2021, no adverse reaction or problems noted

Other Meds:

Current Illness:

ID: 1821870
Sex: F
Age: 28
State: WI

Vax Date: 10/03/2021
Onset Date: 10/04/2021
Rec V Date: 10/27/2021
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: Chills, body aches, fever, nausea, vomiting, drop in milk supply.

Other Meds:

Current Illness:

ID: 1821871
Sex: F
Age: 59
State: IL

Vax Date: 03/26/2021
Onset Date: 05/05/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data: NO

Allergies: Allergic to prednisone. I get really bad chest pains

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

Symptoms: Severe drainage of sinuses, server headache for the first 3 days, Stomach & rib cage was hurting because of all the coughing. The couching last for about 3-4 weeks, Even after i saw my doctor & she gave me antibiotics. I had a lot of body aches as well. The body ache has not gone away. I have joint pain & muscle pain.

Other Meds: I do drink herbal tea, I drink it every night before bed

Current Illness: NO

ID: 1821872
Sex: F
Age: 74
State: MD

Vax Date: 10/27/2021
Onset Date: 10/27/2021
Rec V Date: 10/27/2021
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: NKDA

Symptom List: Injection site pain, Pain

Symptoms: **IMPROPER/WRONG ELIGIBILITY USED FOR BOOSTER SHOT** THE PATIENT WAS GIVEN VACCINATION ON 10/27/21 ON AN OUTSIDE CLINIC. AFTER PATIENT SUBMITTED THE FORM, THE SUPERVISOR OF THE VACCINATION CLINIC FOUND OUT THE PATIENT HAS HER SECOND SHOT ON 5/26/21, WHICH WAS LESS THAN 6 MONTH AGO. THE FORM WAS REMOVED FROM THE FILE, BUT WHEN I AND NURSES WENT TO THE UPSTAIRS TO GIVE PATIENTS SHOTS, I RUSHED AND GAVE THE PATIENT VACCINATION WHICH THE NURSE POINTED (WHO WAS USING THE OLD LIST). AFTER GIVING THE SHOT, I REALIZED THE RX HAD BEEN REMOVED FROM THE FILE BECAUSE OF THE ELIGIBILITY ISSUE.

Other Meds:

Current Illness:

ID: 1821873
Sex: F
Age: 54
State: MA

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data: None

Allergies: Sulfa drugs; Cipro antibiotics; macrolide antibiotics; Cortizone injection; CYP2C19 deficiency; gluten intolerance; dairy intolerance; histamine intolerance

Symptom List: Injection site pain, Menorrhagia

Symptoms: Reactions to COVID-19 Vaccine: (immediately) tingling and numbness in tongue, a little pain & swelling in tongue, Burning eyes, headache ... (Next Day) severe headache, severe tinnitus, Sore arm, tongue feels strange, severe fatigue, severe nausea ... (Friday) headache, severe tinnitus, tongue feels strange, fatigue, breathless, nausea ... (Sat) headache, severe tinnitus, tongue feels strange, fatigue, nausea.

Other Meds: 2021: my prescriptions Adapalene; albuterol inhaler; AJOVY; Creon; Cromolyn sodium oral solution 10ml; cromolyn sodium nasal spray; Cromolyn sodium ophthalmic solution; Emgality; epinephrine injector; Famotidine; fluticasone nasal spray;

Current Illness: MCAS (mast cell activation syndrome); Fibromyalgia; Post Lyme Disease Syndrome; chronic migraine; SUNCT headaches; eczema; nummular eczema;

ID: 1821874
Sex: F
Age: 42
State: IL

Vax Date: 09/28/2021
Onset Date: 09/30/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data: N/A

Allergies: N/A

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

Symptoms: I had tingling upper left lip. It began to swollen, red of the lip and gums. My mouth like it was burn inside. Upper lip was swollen every morning and then goes away throughout the day. My tongue was red and irritative. The symptoms did not respond to mouth waste and antibiotics that was prescribed by the doctor. After a third visit to the doctor, they gave me a steroid that help but did not make it go completely away.

Other Meds: Solvent

Current Illness: N/A

ID: 1821875
Sex: F
Age: 45
State: CA

Vax Date: 10/21/2021
Onset Date: 10/21/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data: no

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Started with a headache and fever for 3 days. Throwing up blood. Has open sores in the back of her cheek and throat. Sent pictures to her rheumatologist and she stated that she is having a bad reaction to the vaccine. Have an appt in a few days.

Other Meds: neupro patch, singulair, advair

Current Illness:

ID: 1821876
Sex: F
Age: 32
State: UT

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

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

Lab Data: Took blood pressure and said she was fine

Allergies: Pears various fruits

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Started convulsing. Eyes started rolling back and fainted. Had to call the paramedics. Right after she got the shot she said she was feeling light headed and didn?t feel good.

Other Meds: Adderall

Current Illness: None

ID: 1821877
Sex: M
Age: 42
State: MI

Vax Date: 09/23/2021
Onset Date: 09/25/2021
Rec V Date: 10/27/2021
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: 10/11/21: blood work to detect heart damage with normal results. 10/20/21: blood work to detect blood clots in brain with normal results. 10/21/21: echocardiogram stress test found abnormalities including swollen valve leaflet and dilated left ventricle. referred to cardiologist and waiting for call back. 10/22/21: brain MRI normal

Allergies: Nuts, amoxicillan

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

Symptoms: Mild flu symptoms resolved after 7-10 days. Tingling/numbness started in extremities on 9/25/21 and has spread to face (current). Shortness of breath and chest pain/tightness started on 9/25 and has persisted. Blood work (10/20/21) and brain MRI (10/22/21) for tingling/numbness yielded normal results. Symptoms persist. Blood work for heart (10/11/21) yielded normal results. Echocardiogram stress test for heart (10/21/21) found abnormalities including swollen valve leaflet and dilated left ventricle.

Other Meds: Albuterol inhaler for asthma

Current Illness: NONE

ID: 1821878
Sex: F
Age: 28
State: WI

Vax Date: 10/24/2021
Onset Date: 10/25/2021
Rec V Date: 10/27/2021
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: Nausea

Symptoms: Fever, chills, body aches, headache, mastitis

Other Meds:

Current Illness:

ID: 1821879
Sex: M
Age: 75
State: OK

Vax Date: 04/22/2021
Onset Date: 06/15/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data: Chemical stress test 06/29/2021 angiogram and a stent and was 99% blockage.

Allergies: Codeine; Lipitor; Zantac

Symptom List: Injection site pain

Symptoms: 06/15/2021 give a chemical stress test that he failed. Chemical stress test 06/29/2021 angiogram and a stent and was 99% blockage. Hospitalized overnight.

Other Meds: Pantoprazole; Pacerone; alfuzosin; Entresto; clopidogrel; metoprolol; metformin; NovoLog; pravastatin; multivitamin; vitamin C; saw palmetto; aspirin; Thera Tear

Current Illness: No

ID: 1821880
Sex: F
Age: 28
State: OH

Vax Date: 10/17/2021
Onset Date: 10/19/2021
Rec V Date: 10/27/2021
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 induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Patient received Covid 19 Pfizer booster shot. After receiving vaccine; patient waited 15 minutes and reported no reaction. Two Days later, patient calls reporting of arm pain. counseled pt this is common reaction for vaccination and how to treat the reaction. Informed pt to follow up with if continue to have pain. followed up with pt on 10/27/21 to see if reaction is still happening. Pt informed she still has small injection site pain, no redness, and small warm to touch. Patient reports no fever, but just fatigue. Patient reports pain has decreased. Counseled pt again how to treat symptoms and to follow up with pcp if symptoms worsen.

Other Meds:

Current Illness:

ID: 1821881
Sex: M
Age:
State: OK

Vax Date:
Onset Date: 10/27/2021
Rec V Date: 10/27/2021
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:

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

Symptoms: Invalid booster dose given too soon. patient aware and no symptoms reported

Other Meds:

Current Illness:

ID: 1821882
Sex: F
Age: 26
State: GA

Vax Date: 09/12/2021
Onset Date: 10/23/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: loss of strength in my left arm, back pain, and mild chest pains.

Other Meds: Tylenol

Current Illness:

ID: 1821883
Sex: F
Age: 66
State: PR

Vax Date: 09/17/2021
Onset Date: 09/01/2021
Rec V Date: 10/27/2021
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: None, I do not eat meat.

Symptom List: Erythema, Pruritus

Symptoms: I had pain in my left arm after my vaccine, also diarrhea. I went to the hospital partially for anxiety, pain in her heart and chest. I feel so tired and fatigued had two doctors appointment earlier today. I lost my appetite. I still have these symptoms today. I want these pandemic to be over.

Other Meds: Tylenol

Current Illness: None reported.

ID: 1821884
Sex: F
Age: 32
State: MI

Vax Date: 04/28/2021
Onset Date: 04/30/2021
Rec V Date: 10/27/2021
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: N/A - on medical leave from work. Currently uninsured as a result.

Allergies: None

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

Symptoms: Fever (~100-101), muscle aches starting late 4/29/21 - dissipated by 5/3/21. Headache & sinus pain w dry nasal passages, fatigue began 4/29/21 also and continue presently, though fatigue reduced. Early May 2021 the following symptoms began and not improved: Increased resting heart rate, transient palpitations, nightly chest pain, transient tinnitus, sinus congestion with dry nasal passages, nosebleeds 1-3x/week, pulse/pressure felt in neck up to temple on left side only, constant dry & scratchy eyes with transient minor ache- can no longer wear contacts.

Other Meds: Adderall 20mg 2x/day; Wellbutrin SR 150mg 1x/day; Lamictal 25mg 1x/day; Klonopin 1mg 1x/day; Remeron 15mg 1x/day; Promethazine 25mg as needed for migraine nausea; Maxalt 10mg as needed for migraine; Tylenol & Ibuprofen as needed for headach

Current Illness: None

ID: 1821885
Sex: F
Age: 60
State: WA

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

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

Lab Data:

Allergies:

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

Symptoms: Patient under age 65 received Fluzone HD rather than Fluzone regular flu shot.

Other Meds:

Current Illness:

ID: 1821886
Sex: F
Age: 73
State: CA

Vax Date: 10/26/2021
Onset Date: 10/26/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data: Unknown

Allergies: Unknown

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Pt came in requesting a pneumonia shot. However, upon presenting her paperwork, she also brought out her immunization card as well and the nurse ended up giving her her third booster of Pfizer. Pt just had her second dose of Pfizer on 8/29/21 so pt is too early for it.

Other Meds: Unknown

Current Illness: Unknown

ID: 1821887
Sex: F
Age: 22
State: TX

Vax Date: 10/27/2021
Onset Date: 10/27/2021
Rec V Date: 10/27/2021
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: Penicillin

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

Symptoms: Chills, chest pain, fatigue, body aches -- onset 2-3 hrs post vaccine.

Other Meds:

Current Illness:

ID: 1821888
Sex: F
Age: 34
State: VA

Vax Date: 10/14/2021
Onset Date: 10/14/2021
Rec V Date: 10/27/2021
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: CT CTA THORAX W/WO CONTRAST 10/20/2021 DRUG SCREEN COMPREHENSIVE URINE 10/20/2021 POINT OF CARE TESTING PANEL 10/20/2021 CBC WITH DIFFERENTIAL 10/20/2021 BASIC METABOLIC PANEL 10/20/2021 TSH 10/20/21 TROPONIN I 10/20/2021 EGFR 10/20/21 ECG 12-LEAD 10/20/2021 BASIC METABOLIC PANEL 10/18/2021 CBC WITH DIFFERENTIAL 10/18/2021 URINALYSIS AUTO ONLY 10/18/2021 POCT SARS-COV-2, ANTIGEN 10/18/2021

Allergies: shrimp, kiwi, sulfa antibiotics, miconazole

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

Symptoms: First afternoon: weird taste in mouth, tingling hand, pain in arm (hurts to lift and heavy feeling), dizzy, fever of 99 F (norm is 97.7). Day 2: Difficulty sleeping night before, arm hurt to even touch from shoulder to elbow, headache which turned into a migraine by the end of the day, pulse ranged from 85 to 104 bpm while sitting (normal pulse mid-60s to mid-70s resting) , skin pink and flushed (legs, arms, stomach, chest, face, etc.), loss of appetite and nausea. Tremors in hands. Pain in neck. Day 3: Difficulty sleeping continued, arm starting to feel better, head still hurt, still no appetite (down 2.4 lbs), still fever of 99.1. High pulse and tremors in hands and arms. Day 4: Difficulty sleeping still. Temperature was normal that morning. Arm hurt way worse all the way from my deltoid to my shoulder. I could barely use my arm. Pulse still will not go down below 85 bpm. Tremors in hands especially bad when I woke up and my heart felt like it was racing. Still flush. Decided to take blood pressure, it came up as 189/111 on my wrist blood pressure monitor, double checked it using a arm blood pressure reader about a half hour later it came up as 129/86. Which is still a lot higher than my normal but closer. Ate some lunch which caused diarrhea within the hour. Day 5: Still difficulty sleeping, pulse still high, arm hurts up in the shoulder and between where my shoulder meets my body. Called Teledoc who told me to go to Urgent Care. My temperature there was 99.1. They ran several tests such as bloodwork, covid test, urinalysis, and EKG. The PA said test were normal all but the EKG stating I have PVCs and she referred me to a cardiologist. Day 6: Still difficult sleeping, arm finally feeling almost back to normal, weighed in at 130 lbs (3.8 lbs less than normal), temperature of 99.3, pulse still really high. Day 7: Slep even less, heart was pounding, decided to go to the hospital. When I arrived heart rate was at 145 bpm and a blood pressure of 132/99. I was admitted. They ran a bunch of tests and put me on an IV. The IV seemed to be helping. Apparently I was very dehydrated. They said I had Sinus Tachycardia. I was feeling better and blood pressure and pulse were back to acceptable levels so they discharged me. Still tired but feeling better afterwards. Day 8: Still exhausted. Pulse getting down into the 70s if I stay still, but if I do anything like wash dishes it's back up to around 130 bpm. Eating more normal now.

Other Meds: daily vitamin

Current Illness: None

ID: 1821889
Sex: F
Age: 26
State: IL

Vax Date: 10/12/2021
Onset Date: 10/12/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data: I informed my doctor and she did not order any tests.

Allergies: Penicillin Amoxicillin

Symptom List: Pain in extremity

Symptoms: Vaccine 1030 am. I took tylenol at 1 while at work as I felt achey and started getting a headache. Come 5pm I got chills which I assume meant I was getting a fever. Once I got home I had gotten the chills so bad my body shook fairly aggressively. Checked my fever, 101. Took another tylenol 500. An hour later, I was getting more feverish. Took my temp and it was up to 103. At which point I took another tylenol given it was out of the 6 hr window for 2 pills. I stripped and had to drop my AC to 62 and another hour later it was down to 102. But from 630 pm until roughly 3am my heart rate was 115-120 and some chest tightness consistently while resting. I was up and down on fever between 101 and 102 which I took medicine for when necessary. Headache and extreme back/shoulder pain that kept me awake. Finally all broke at 3am and was seemingly fine at 5 after 2 hours of sleep. 101 fever the following 2 days and for roughly 5 days after I had spikes in my heart rate and shortness of breath just walking down the hallway.

Other Meds: Minicyclin

Current Illness: None

ID: 1821890
Sex: M
Age: 62
State: OR

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

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

Lab Data: n/a

Allergies: None listed by pt

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

Symptoms: Pt received Pfizer booster, but was wanting a Moderna booster.

Other Meds: None listed by pt

Current Illness: None listed by pt

ID: 1821891
Sex: F
Age: 92
State: KS

Vax Date: 10/20/2021
Onset Date: 10/26/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data: did not do labs or chest x-ray due to resident on Hospice care resident is not doing well and is expected to pass

Allergies:

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

Symptoms: low 02 sats ( 39%) increased congestion in lungs with shortness of breath crackles through out lungs increased heart rate above 100

Other Meds:

Current Illness:

ID: 1821892
Sex: F
Age: 54
State: MA

Vax Date: 10/17/2021
Onset Date: 10/17/2021
Rec V Date: 10/27/2021
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: Sulfa drugs; Cipro antibiotics; macrolide antibiotics; Cortizone injection; CYP2C19 deficiency; gluten intolerance; dairy intolerance; histamine intolerance

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

Symptoms: 100 Fever; pain & muscle ache at injection site; daily pressure headache at forehead; fatigue; daily migraine; dizzy; nauseous; eyes burning (mast cell attack?); partial loss of smell and taste.

Other Meds: 2021: my prescriptions Adapalene; albuterol inhaler; AJOVY; Creon; Cromolyn sodium oral solution 10ml; cromolyn sodium nasal spray; Cromolyn sodium ophthalmic solution; Emgality; epinephrine injector; Famotidine; fluticasone nasal spray;

Current Illness: MCAS (mast cell activation syndrome); Fibromyalgia; Post Lyme Disease Syndrome; chronic migraine; SUNCT headaches; eczema; nummular eczema

ID: 1821894
Sex: F
Age: 56
State: MO

Vax Date: 08/31/2021
Onset Date: 09/03/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data: Saw provider

Allergies: H1N1 shot - anaphylactic reaction "intolerance to some foods"

Symptom List: Vomiting

Symptoms: Client called health office to report having a "lupus flare" Reported having one for ten days after first dose, 21 days after second dose, and now ongoing still from 09/03/2021. Flare up described to nurse as the following; nausea, headache/migraine, losing weight (estimated 12 pounds), and now feeling very tired since started the medication Reglan. Client reported letting her providers know. Client is able to communicate with Rheumatologist over mychart online. Client reported Rheumatologist has warned her it maybe a few months until the flare up gets better. Has follow up in April with provider. Educated to call and let provider know immediately if conditions worsen or with any other questions or concerns.

Other Meds: Medications reported by Client today; Sucralfate Dexilant Dicyclomine Plaquenil Levothyroxine Baclofen Atenolol Azathioprine Gel diclofenac savella Benazepril Spironolactone Malox Milk of Mag Lasix Tylenol Xarelto Ferrous Sulfate Flo

Current Illness: See below

ID: 1821895
Sex: F
Age: 40
State: CA

Vax Date: 03/25/2021
Onset Date: 03/25/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Day of 1st injection I developed crippling headaches. The next day I started having muscle pain, joint pain, headaches continued. In the days that followed I developed a rash that I eventually determined to be from essential oils in a cleansing pad I have been using for years. All symptoms subsided after the 2nd dose. Headaches continue to this day briefly but more overtly is the sensitivity/allergy to essential oils, specifically tea tree oil. I have continued to have hive/rash outbreaks wherever I use tea tree oil, an oil I have been using regularly and with no issue for years. I was prescribed and used clobetasol propionate .05% to treat the hives/rash and it helped.

Other Meds: none

Current Illness: none

ID: 1821896
Sex: F
Age: 27
State: IN

Vax Date: 10/25/2021
Onset Date: 10/26/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: At four am I stood up from using the bathroom and blood rushed to my head my ears began ringing very very loudly. I thought I would vomit or pass out. Thankfully it passed but then at 7 am I was very careful to stand up slowly and make no sudden movements but it happened again. I was seated this time when the loud ringing started in my ears, my vision went completely white and then I passed out. When I came to I had a splitting pounding headache for about 30 minutes. The rest of the day I had little to no energy and walking would leave me breathless.

Other Meds: None

Current Illness: None

ID: 1821897
Sex: F
Age: 51
State: CA

Vax Date: 04/20/2021
Onset Date: 04/27/2021
Rec V Date: 10/27/2021
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: They ran blood test and a few hearing test. I saw different specialist and physical therapist.

Allergies: Nothing

Symptom List: Injection site swelling, Limb discomfort

Symptoms: I was hearing crickets in areas where there was no crickets. I made a search online and I noticed that it was a side effect of covid. I went to the doctor and I was told that I had lost my hearing on the left ear. I work standing up as a cashier, and I cant stand more than 45 minutes. I was feeling really dizzy at this time. I have a hard time with my balance.

Other Meds: Nothing

Current Illness: None

ID: 1821898
Sex: F
Age: 35
State:

Vax Date: 05/20/2021
Onset Date: 07/01/2021
Rec V Date: 10/27/2021
Hospital: Y

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

Lab Data: labs drawn- serum creatinine 1.47 kidney ultrasound kidney biopsy

Allergies: sulfa

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

Symptoms: Serum creatinine found elevated July 2021. Kidney Biopsy 10/25/21 confirmed acute tubular eschemia.

Other Meds: lo estrin zyrtec

Current Illness: none

ID: 1821899
Sex: M
Age: 70
State: UT

Vax Date: 02/23/2021
Onset Date: 02/27/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data: CAT scan.

Allergies: No

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

Symptoms: On 02/27/2021, under my left jaw was I had a swollen lymph node and a little bit sore and tender to the touch. They gave me both an injection and antibiotic pills and it eventually went away. About a month or 2 later in my cheek, right in front of my right ear, just below your temple. I had a swollen lymph node. I self treated it with an antibiotic. I had a similar experience with the 1st dose of the Moderna, on 01/20/2021, on the right side under my chin, under my jaw, and I just took and an antibiotic and it went away.

Other Meds: Eliquis; Simvastatin; Losartan; Omega 3; Glucosamine; Metformin

Current Illness: No

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am