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: 1825123
Sex: M
Age: 33
State:

Vax Date: 10/25/2021
Onset Date: 10/25/2021
Rec V Date: 10/28/2021
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, expired vaccine given.

Other Meds:

Current Illness:

ID: 1825124
Sex: F
Age: 17
State: MT

Vax Date: 10/26/2021
Onset Date: 10/27/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: None as patient has not experienced any adverse events. Is asymptomatic aside from soreness of right arm.

Allergies: No known allergies

Symptom List: Anxiety, Dyspnoea

Symptoms: Through quality control check on 10/27/2021 it was identified that patient likely received concentrated dose of COVID-19 Pfizer vaccine at 1530 on 10/26/2021. This was confirmed with administering RN. Due to knowledge gap, administering RN gave concentrated dose of COVID-19 Pfizer vaccine from multi-dose vial instead of reconstituting with diluent. Administering RN voiced uncertainty of exact amount administered to patient but did confirm dose was drawn up directly from multi-dose vial. Patient's parents were notified and counseled by Clinic Pediatrician on 10/27/2021. Parents reported that patient has not experienced any adverse events. Parents reported patient was asymptomatic. Pediatrician counseled on monitoring and provided instruction for patient to be seen in clinic or Emergency Department by a physician if any adverse effects arise. 10/27/2021 Pediatric Nursing Supervisor called and followed up with parents. Parents report only soreness of right arm for patient which is not limiting activities. Parent had no fever, body aches, chills, chest pain, or any other concerns for patient. Nursing Supervisor reiterated instruction from Pediatrician for parents should any symptoms arise. Recommended ibuprofen and warm compress for arm soreness. If any worsening of arm soreness despite interventions, parents agreed would have patient evaluated by Pediatrician.

Other Meds: Vyvanse 40 mg capsule once daily Daily multivitamin Vitamin C 250 mg daily Vitamin D 50 mg daily Norethidrone (Aygestin) 5 mg tablets once daily for 10 days during menses Breo 100-25 mg/puff inhaler - dad reports she has not being taking s

Current Illness: None

ID: 1825125
Sex: F
Age: 63
State: NJ

Vax Date: 07/16/2021
Onset Date: 08/26/2021
Rec V Date: 10/28/2021
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: MRI

Allergies: losartan - hair loss lisinopril - angioedema trazodone - nasal congestion topomax - nausea

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

Symptoms: Sudden profound sensorineural hearing loss in right ear. Woke up with no hearing in right ear. Seen by ENT that day, course of oral steroids unsuccessful, three intratympanic injections unsuccessful. Hearing aids now in place.

Other Meds: Humalog, tresiba, Bystolic, atorvastatin, Cymbalta, biotin,

Current Illness: see below

ID: 1825126
Sex: F
Age: 39
State: CA

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

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

Lab Data:

Allergies: N/A

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Sore arm, fatigue

Other Meds: N/A

Current Illness: N/A

ID: 1825127
Sex: F
Age: 15
State: FL

Vax Date: 08/06/2021
Onset Date: 08/27/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data:

Allergies: nuts, seafood

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

Symptoms: She has had recurrent headaches and fatigue since receiving the second dose. Has also had several URI type illnesses. Prior to the vaccine, she was never in the office for sick visits and reportedly never got sick. She did not have history of headaches either.

Other Meds: Took cephalexin starting 8/9/21

Current Illness: 8/9/21- skin infection 9/9/21 - developed viral illness with sore throat, congestion.

ID: 1825128
Sex: F
Age: 75
State: GA

Vax Date: 10/25/2021
Onset Date: 10/27/2021
Rec V Date: 10/28/2021
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: US 4/2021; labs pending

Allergies: antihistamines, ciprofloxacin

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

Symptoms: Black discoloration of feet; intermittent redness of soles and palms

Other Meds: zolpidem 5mg prn, pepcid 20mg qday, carafate 1gm prn, vitain D 1000 units qday, levoxyl 125mcg qday, omeprazole 40mg

Current Illness: none

ID: 1825130
Sex: M
Age: 52
State:

Vax Date: 10/25/2021
Onset Date: 10/25/2021
Rec V Date: 10/28/2021
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: Pyrexia, White blood cell count decreased

Symptoms: Administration error, expired vaccine given.

Other Meds:

Current Illness:

ID: 1825132
Sex: M
Age: 51
State: MI

Vax Date: 03/31/2021
Onset Date: 10/18/2021
Rec V Date: 10/28/2021
Hospital: Y

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

Lab Data: Results Procedure Component Value Ref Range Date/Time DR CHEST SINGLE VIEW Resulted: 10/25/21 0737 Order Status: Completed Updated: 10/25/21 0739 Narrative: Study: One view chest xray Exam date: 10/25/2021 6:29 AM. History: CF bronchiectasis exacerbation, recent COVID. Comparison: 10/21/2021, 10/18/2021, 6/24/2021, 1/10/2019 ________________ Findings: Indwelling central venous line on the right with double ports is without significant change. Strandy subsegmental atelectasis or scarring in the mid right lung is without significant change from 6/24/2021. Lungs are otherwise clear. The heart and mediastinum have a normal appearance. Blunting of the left lateral costophrenic angle is without significant change from 2019 consistent with scarring. There is a mild dextroconvex curvature in the thoracic spine without significant change. Healed fracture deformity in the posterior left seventh rib is again noted. ________________ Impression: Impression: No acute cardiopulmonary disease. DR CHEST SINGLE VIEW Resulted: 10/21/21 1557 Order Status: Completed Updated: 10/21/21 1600 Narrative: EXAMINATION: Single View Chest EXAM DATE: 10/21/2021 2:27 PM TECHNIQUE: Single view chest INDICATION: history of CF with bronchiectasis, admitted with COVID-induced bronchiectasis exacerbation; patient with cough, chest discomfort COMPARISON: October 18, 2021 ENCOUNTER: Subsequent _________________________ FINDINGS: Patient is side bent and rotated to the left. Trachea is midline. Heart size within normal limits. Right-sided port catheter tip extending to the region of the right atrium not significantly changed. Mildly coarse chronic interstitial markings. No acute consolidates or pneumothoraces no interval large effusions though there is minimal blunting to the left costophrenic angle. _________________________ Impression: 1. No significant change. DR CHEST SINGLE VIEW Resulted: 10/18/21 1549 Order Status: Completed Updated: 10/18/21 1551 Narrative: EXAMINATION: Single View Chest EXAM DATE: 10/18/2021 3:01 PM TECHNIQUE: Single view chest INDICATION: Cough, COVID positive, history of CF COMPARISON: Chest radiograph 6/24/2021 ENCOUNTER: Not applicable _________________________ FINDINGS: Right-sided Port-A-Cath is again seen. The cardiomediastinal silhouette is unchanged in appearance. There is no new focal lung consolidation. Chronic parenchymal changes appear similar to prior. No sizable pleural effusion is present. No pneumothorax is visualized. Chronic posterior left rib trauma is noted. ______________________________________ Impression: No new focal lung consolidation. Results Procedure Component Value Ref Range Date/Time Peripheral Blood Culture Collected: 10/18/21 1513 Order Status: Completed Specimen: Blood, Venous Updated: 10/23/21 1701 Cult Blood Peripheral No bacteria or yeast isolated Peripheral Blood Culture Collected: 10/18/21 1443 Order Status: Completed Specimen: Blood, Venous Updated: 10/23/21 1601 Cult Blood Peripheral No bacteri

Allergies: AcetaminophenOther Compazine ErythromycinNausea and Vomiting, Dizziness Prochlorperazine Tetracycline

Symptom List: Pharyngeal swelling

Symptoms: Patient is a 52-year-old man with past medical history significant for Cystic fibrosis F508/ 2789+5G to A mutation with associated, bronchiectasis, chronic pancreatitis, GERD, pancreatic insufficiency and chronic abdominal pain. Additional history includes MAC, for which he was previously on treatment through Infectious Disease including azithromycin, ethambutol, and rifampin, 3 times weekly (10/23/18). He was evaluated for COVID-19 infection and hypoxia on 10/18/2021. His symptoms had started 10/12, noted to be positive on 10/15. He received a good day course of dexamethasone and also remdesivir. He received compassionate use Regeneron on 10/20/2021.His hypoxia was thought to be multifactorial-COVID and bronchiectasis related to cystic fibrosis. He was started on Zosyn on 10/22/2021 in addition to aggressive airway clearance with Pulmozyme, bronchodilator, and hypersaline. Patient was gradually weaned off oxygen supplementation but still required 2L with activity (He has oxygen at home.) His MAC regimen was continued inpatient including inhaled amikacin,azithro and ethambutol and Trikafta. Patients renal function was noted to have been up trending, patient received IV fluid hydration with noted improvement in his renal function. On the day of discharge, white count increased from 10.64 to 12.51. He would receive repeat labs (CBC and BMP) on Monday 10/31/2021 (ordered) He will finish a 14 day course of Zosyn total ( October 22-November 4) Has follow up 12/15/2021

Other Meds: Outpatient Medications amikacin sulfate (AMIKIN) 500 MG/2ML azithromycin (ZITHROMAX) 250 MG tablet benzonatate (TESSALON) 200 MG capsule CALCIUM CITRATE-VITAMIN D3 PO CLOFAZIMINE PO CREON 12000-38000 units delayed release capsule dornase al

Current Illness: Chronic Pancreatitis Cystic Fibrosis

ID: 1825133
Sex: F
Age: 30
State: WA

Vax Date: 05/19/2021
Onset Date: 05/19/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: XRAY, Comprehensive laboratory tests.

Allergies: Penicillin

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Janssen vaccine given/documented at another facility. 5 days after vaccine given patient started having left hip pain. Over the past 5 months this has progressed to involve both hips, both shoulders, wrists, hands, knees, ankles and toes. 10/15/21 - patient started having pain when she swallowed and swelling in right lateral foot and fingers. She has progressively lost mobility and needing to use a wheelchair. She has also experienced bladder spasms and urinary incontinence. Provider Diagnosis of Diffuse Arthralgias

Other Meds: 2% diltiazem w/ 2% lidocaine topical ointment for anal fistula

Current Illness: none

ID: 1825134
Sex: M
Age: 91
State: NJ

Vax Date: 10/26/2021
Onset Date: 10/26/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: no

Allergies: shell fish

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient report that his hearing was effected... he wears an hearing aid and had new batteries and the volume was on max and still wasnt able to hear...the next day the injection site warm to the touch and arm was in pain..

Other Meds: Pravastic finasperide Denta 5000 plus Amoxicillin Tamsulosin tolnafalnate aller-flo vitamin D3

Current Illness: no

ID: 1825135
Sex: F
Age: 61
State: CA

Vax Date: 04/28/2021
Onset Date: 04/28/2021
Rec V Date: 10/28/2021
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: Penicillin, soy

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

Symptoms: I went in and as I was sitting there, I used my inhaler, so they came over to talk to me and made sure there wasn't anything they needed to know. I just told them that I have asthma and I was running late so I ran through parking lot and that's what kicked up my asthma. So I got my second shot and they asked me to go sit down and within 5 minutes they asked me to come sit in the back and watch me. I was shaky and nauseous. And I just did not feel right. So I called a friend of mine and asked her for a favor, so I used a ride share service her over to the clinic to take me home then I used a ride share to send her home. So I came home and I just did not feel good and laid down. That was probably around 2pm. I laid down and I remember it was around 7pm, all of a sudden my right eye went completely black. I couldn't see a thing and my left eye was really fuzzy. And that lasted for about an hour. And then my sight came back but it was super fuzzy. And I'm a caregiver and an author and I couldn't drive and I couldn't see well. So I had to call in sick for caregiving. And as far as being an author, I lost my job because of this.. I wrote for a music magazine.. and I had interviewed some artists and I had 3 articles that needed to be written. And I could not read my notes, so I needed someone to read them for me. And the only way I could read on my computer is to use 42 font. Everything was so fuzzy. And it lasted like that until maybe 3 weeks ago. And so the 3 articles I wrote, my boss was really unhappy with and I lost my job. And as far as caregiving goes, luckily I worked for the same people long enough to know where everything is for them. I was basically doing everything in braille. I could not read well up until about 3 weeks ago and it's starting to get better. Driving scared me like crazy. In May, I was in the backyard with a neighbor and I got really dizzy and I thought I'm going to go lay on the grass and lay down.. but I didn't think I was going to make it and went to my patio. My neighbor said that I slumped over and my head started shaking and I was drooling and I wet myself really badly. All I know is that I've had 3 seizures since then. There are a few times since then that I'm not completely sure if I had them in my sleep. I started sleeping with towels under me to make sure, and they were wet. I probably had 7 seizures since May. My last one I believe I might have had a small one last week, did not wet myself last week, but probably had a small one last week, so that would be 8 seizures. And once I have these seizures, I can't do anything after for 3 days. That's another reason why I hired a caregiver. I couldn't see and I was having seizures. And I live alone. I really think the seizures are coming from the vaccine. I've never had anything like that before nothing. I have not felt well since my second vaccine. My balance has also not been good since then. I'm scared to get a booster - I don't know if I fall under the immunocompromised because I do have asthma. I was also born with a compromised immune system. They've known that as a baby. I will talk to my PCP about whether or not I should get the booster. My appointments have all been on zoom. I did talk to my GP - I told him about it and he's extremely pro vaccine - brushed it off.

Other Meds: Ibuprofen 800mg once daily or as needed, Gabapentin 600mg once daily, Atorvastatin 10mg once daily, Doxetin 10mg once daily, Klonopin 4mg once daily, Baclofen 40mg once daily, Albuterol 2 puffs as needed (around 3 times a day)

Current Illness: None

ID: 1825136
Sex: F
Age: 50
State: AL

Vax Date: 10/23/2021
Onset Date: 10/23/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: None. Monitored at home

Allergies: Latex & Bactrim

Symptom List: Rash, Urticaria

Symptoms: Blood pressure up to 236/119, Heart rate 131, O2 dropped to 79, blood sugar dropped to 36, temp 101.7, SEVERE CHEST, RIB & Upper back pain

Other Meds: Losartan 100mg, Dexilant 60mg, Lisinopril 20mg, Alprazolam 1mg, Metoclopramide 5mg, Promethazine 25mg, Zolpidem 10mg

Current Illness: None

ID: 1825137
Sex: F
Age: 71
State: MI

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

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

Lab Data: None

Allergies: Penicillin, Bactrim

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

Symptoms: This was my 3rd Covid shot. About 20 minutes after leaving the pharmacy my face felt numb on one side as did my arm and hand. I didn't get much sleep the night before so I went home and slept for several hours. It had lessened but was still felt. The next day it was okay.

Other Meds: Baclofen, Lorazepam, Triamiterene, Atorvastatin, Metoprolol ER, Potassium CL Micro, Bupropion, Low dose aspirin, Fish Oil, Vitamin D3, Turmeric, Stool Softener

Current Illness: None

ID: 1825138
Sex: F
Age: 60
State: PA

Vax Date: 10/25/2021
Onset Date: 10/27/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: N/A

Allergies: PCN, sulfa dugs

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

Symptoms: about 12 hrs after booster shot, experienced burning, itching in R lower abdomen. About 12 hrs after that, noticed bumps in ~6" patch across abdomen which are now displaying as pimple-like eruptions in the patch. From prior experience in a medical center, this looks like shingles. OTC treatment+ advil/tylenol and topical 4% lidocaine

Other Meds: multivitamin, escitalopam 10 mg QD, amlodipine 5 mg QQ

Current Illness: none

ID: 1825139
Sex: M
Age: 62
State: MI

Vax Date: 10/26/2021
Onset Date: 10/26/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: N/A

Allergies: Penicillin

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

Symptoms: Dosage administered was incorrect. Received 0.5mL instead of indicated 0.25mL booster.

Other Meds: N/A

Current Illness: N/A

ID: 1825140
Sex: M
Age: 0
State: CA

Vax Date: 10/28/2021
Onset Date: 10/28/2021
Rec V Date: 10/28/2021
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: NO

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

Symptoms: The patient was a family member of a staff member who came in with his mom and dad.. the three of them received Janssen. After they were vaccinated the staff member realized the patient was 17 and not 18.

Other Meds: NO

Current Illness: NO

ID: 1825141
Sex: F
Age: 15
State: TX

Vax Date: 08/13/2021
Onset Date: 10/12/2021
Rec V Date: 10/28/2021
Hospital: Y

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

Lab Data: I was told she was tested for Wast Nile, Zika and other pathogens that have been shown to set off the GBS. She was negative to all. The MRI showed no structural issues, only the inflammation consistent with GBS.

Allergies: None

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

Symptoms: Patient was diagnosed with Acute Guillain-Barre Syndrome. She had a weak ankle on Tuesday, 10/12/2021 and saw a physical therapist who referred her to another PT the next day. On 10/13/2021, she collapsed getting out of bed with weakness in her legs. She saw PT, who referred her to a neurologist, who then sent her to the ER for an MRI, who then sent her to Hospital for that MRI. The MRI happened early morning of 10/14/2021. It showed inflammation consistent with GBS so they put her under to install a central line and do a spinal tap. By hen, she was only able to move her head a couple inches. No movement in her arms and legs, but there was pain everywhere. The tests came back verifying GBS and the Neurologist said it was Acute Motor Axonal Neuropathy. Plasmapheresis began the evening of 10/14/2021 (7 bottles) and IVIG right after. Patient had a total of 5 treatments of plasmapheresis over 10 days, every other day (Thursday, Saturday, Monday, Wednesday and Friday). IVIG then followed on Saturday and another Sunday. Patient worked with PT and OT every day after movement started again. She worked on standing the Friday of the last plasmapheresis, worked on walking with a walker on Saturday and Sunday and could walk on her own a little Monday. She will be working on walking more each day and start outpatient PT at hospital TIRR on November 8, 2021. Please note, patient is 15 and the youngest Studio Company This is really effecting her and her future job opportunities that she has been training for since she was 2 years old!

Other Meds: Vitamin D, Calcium & Cranberry Concentrate

Current Illness: None

ID: 1825142
Sex: F
Age: 67
State: MD

Vax Date: 10/26/2021
Onset Date: 10/28/2021
Rec V Date: 10/28/2021
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: Sulfa drugs, Ibuprofen

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Low grade fever and chills, noted upon awakening on 10/27/2021. Lasted all day and night 10/27-10/28. Epispodes of lightheadedness a few times when I got out of bed, so I stayed in bed all day. Felt nauseous, and fainted on the way to the bathroom at 4AM, 10/28/2021. Woke up immediately upon impact of fall. Dry heaved for a few minutes. Used ice to treat the body aches from the fall Please note that I had an influenza vaccine for age 65+ on October 10, 2021. However, I don't know the specific vaccine, so don't know which box to select for question 22. It was administered by a pharmacist at a community event. Also please note my first two COVID-19 Vaccines were Pfizer

Other Meds: Alendronate Sodium, SAMe, B12, D, Calcium, Raw Enzymes

Current Illness: Mild sinus conjestion

ID: 1825143
Sex: F
Age: 65
State: TX

Vax Date: 12/31/2020
Onset Date: 01/01/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: No

Allergies: Bactrim; INFeD; Tetracycline; Capo ten; Trileptal; IV dye; NSAIDS; Shingle vaccine; Small pox vaccine; Flu mist; Aspirin

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: 01/01/2021 the day after the vaccination when I was trying to raise my arm to the side and up. I could only go 90 degrees, I could not go any further. It resolved on its own, but it took like 5 or 6 months. I talked to my doctor about it in passing, but I did not think it was significant enough to go the doctor's office.

Other Meds: Prograf; Myfortic; Acidophilus; Amlodipine; Evenity; Azelastine; Prevalite; Creon; Domperidone; Hydralazine; Hydrocodone with acetaminophen; Labetalol; Lisinopril; Lupron; Nexium; Ondansetron; Prednisone; Sertraline; Sodium chloride; Tandem

Current Illness: No

ID: 1825144
Sex: M
Age: 25
State:

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

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

Lab Data:

Allergies:

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

Symptoms: Administration error, expired vaccine given.

Other Meds:

Current Illness:

ID: 1825145
Sex: M
Age: 48
State: TX

Vax Date: 08/26/2021
Onset Date: 09/10/2021
Rec V Date: 10/28/2021
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: Monitor BO

Allergies: Shellfish

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

Symptoms: Patient had already had Covid-19 and had been recovered for 12+ months. Regular screening showed that patient was still positive for Covid-19 antibodies. About 2 weeks after vaccination patient did notice some abnormal fatigue and head aches, blood pressure became high and uncontrolled with normal medication for several weeks. at this time patient had Semiquantitative Covid Antibody test and found to have High antibody level >2500. Patient consulted with Primary care Physician, and was told to closely monitor BP for next several weeks and return for follow-up. Over this time BP was monitored and has been been inconsistent even with medication. Also over this time patient has still had abnormal fatigue and continuing onsets of random joint and muscle pain despite no significant change in activity or any injury or trauma. During follow-up with PA , BP medication Dosage was increased, Steroid pack prescribed to address the joint and muscle pain and patient has been referred to a Cardiologist for Echo and further evaluation.

Other Meds: Metroprolol, Vitamin D, Thyroid NP, Ozempic

Current Illness: None

ID: 1825146
Sex: F
Age: 54
State: ME

Vax Date: 09/30/2021
Onset Date: 10/05/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: Skin Culture

Allergies: Sulfa Drugs Keflex

Symptom List: Unevaluable event

Symptoms: I have a skin graft on my leg with a wound vacuum after an accident. It is on my lower right calf since 01/31/2009. Nine days after the first dose of the vaccine I noticed a little blemish in the area of my skin graft. After getting the second dose I got a burning feeling around my skin graft. I then got a rash around the skin graft and then it was all over my body. I went to the ER and they took a culture of the rash. I was prescribed Clindamycin. The results came back positive for Staphylococcus. I had a little trouble swallowing when I was taking the antibiotic. I returned and they thought that it was like a poison ivy rash. I had weeping around the wound and the hive like rash is the worst on my leg. It was extremely poisoned. I was prescribed a steroid and a topical cream. Within a few days, the rash and the swelling went down within a few days. It has been almost three weeks and I still have some rash and the wound, but it is not painful.

Other Meds: N/A

Current Illness: N/A

ID: 1825147
Sex: M
Age: 55
State: WA

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

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

Lab Data:

Allergies:

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

Symptoms: left hand was paralyzed for 45 minutes, 8 hours after shot in left arm.

Other Meds: amlodipine

Current Illness:

ID: 1825148
Sex: M
Age: 29
State: LA

Vax Date: 04/05/2021
Onset Date: 10/26/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: COBAS Liat PCR Sars-Cov2

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Breakthrough COVID19 infection

Other Meds:

Current Illness:

ID: 1825149
Sex: M
Age: 56
State: KY

Vax Date: 02/26/2021
Onset Date: 10/24/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Tested Positive for Covid

Other Meds:

Current Illness:

ID: 1825150
Sex: F
Age: 47
State: IA

Vax Date: 08/30/2021
Onset Date: 09/05/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: none

Allergies: Augmentin

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

Symptoms: itchy raised rash on chest and shoulders/upper back bilaterally

Other Meds: none

Current Illness: none

ID: 1825151
Sex: F
Age: 45
State: VA

Vax Date: 04/09/2021
Onset Date: 08/09/2021
Rec V Date: 10/28/2021
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: Blood test -unsure what kind, but results were normal.

Allergies: Sulfa, Cipro, Gluten

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: About 4 months after vaccine, I had an unusual bruise show up on my vaccine site with a lump. It was pain free so like a regular bruise that didn't hurt even when I pushed on it. It wasn't going away after a week and it wasn't changing size or shape and it was dark blue in color. I was seen and the Doctor felt like it could or couldn't be related to the vaccine but wasn't sure. A week later, rather than healing, it started tp drain in the top half and 2-3 days later the bottom half drained. I have a faint bruise right there, and it took about two weeks to heal and it was just an inexplicable bruise and it wasn't painful and it was just super unusual that it was in the exact spot where I had the vaccine. It's still there but it's not as bad, only an outline.

Other Meds: Ibuprofen

Current Illness: None

ID: 1825152
Sex: F
Age: 42
State: FL

Vax Date: 04/27/2021
Onset Date: 04/27/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: CBC, Pulmonary Function Test

Allergies: NSAIDS, environmental allergies, peanut, eggs, rice, corn

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Almost immediately after the vaccine the Dr. who was monitoring me approached asking was I feeling ok because he noticed I had stating flushing. I advised my throat was a little itchy, but wasn't sure if it was the vaccine or d/t my regular allergies acting. I was monitored and started itching real bad. The itching got worse and my throat irritation got worse so I was given water and monitored and advised to be transported to the ER but I refused. I was eventually released and advised them I would take Zyrtec and if the symptoms worsened I would seek care. I took the Zyrtec when I got home and it did help and stop the symptoms. Various times since the vaccine I have woke up with the itching and burning sensation in my throat and has had to take the Zyrtec daily. If the Zyrtec is missed the symptoms comes back. On Sat 10/23 I woke up because I couldn't breathe or swallow. I took the Zyrtec but it didn't work. I used the inhaler but it took almost 2 hrs. to get relief. So I saw the Dr. on yesterday and was prescribed an Epi-Pen and to use it if the symptoms arised again. I was prescribed Claritin and have to take it every morning and the Zyrtec is now no longer used on an as needed basis, but has to take it nightly on a daily basis now. If these meds aren't taken daily now the symptoms return. I am also now experiencing persistent hives daily that are very very itchy. A pulmonary function test was performed but everything there looked good.

Other Meds: no

Current Illness: no

ID: 1825153
Sex: F
Age: 49
State: CA

Vax Date: 10/15/2021
Onset Date: 10/16/2021
Rec V Date: 10/28/2021
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: Ct scan

Allergies: Benadine

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

Symptoms: Imigraine, nauseous insomnia

Other Meds: My employer mandated this vaccine that I did not agree too, but failure to do so would cause me to loose my job that I've been working for 20 years. I had my 1st vaccine shot October 15th 2021 which was the Pfizer vaccine. Effective Octob

Current Illness: I have a history of headaches and migraines. But have not had a serious migraine since my mid 20'es

ID: 1825154
Sex: F
Age: 16
State: SD

Vax Date: 08/23/2021
Onset Date: 09/07/2021
Rec V Date: 10/28/2021
Hospital: Y

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

Lab Data: Two ER visits and overnight hospitalization, CT scan of the head, video EEG.

Allergies: polymorphous light eruption, papulovesicular type (sun allergy)

Symptom List: Nausea

Symptoms: Developed a non-epileptic seizure disorder 2 weeks after the second shot. The seizures lasted for a few weeks and then went away. At one point she was having up to 12 seizures in a day. The timing of the condition makes us question whether the vaccine could have been the cause. She was diagnosed with psychogenic nonepileptic seizure disorder. Prior to the vaccine, she had no mental health history and was a healthy and normal teen.

Other Meds: none

Current Illness: Diagnosed with polymorphous light eruption (sun allergy) this summer and had been unable to be in the sunlight more than a few minutes without developing hives on her exposed skin.

ID: 1825155
Sex: F
Age: 23
State: WV

Vax Date: 10/28/2021
Onset Date: 10/28/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data:

Allergies: NKDA Allergic to bananas

Symptom List: Injection site pain

Symptoms: hot flushes Numbness Tingling Throat and chest tightness dizziness felt hot all over lip cyanosis

Other Meds: Escitalapram 20 mg

Current Illness:

ID: 1825156
Sex: F
Age: 48
State: SC

Vax Date: 10/26/2021
Onset Date: 10/26/2021
Rec V Date: 10/28/2021
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: Vaccine given was expired, date of expiration is 10/26/2021

Other Meds:

Current Illness:

ID: 1825157
Sex: F
Age: 51
State: IN

Vax Date: 10/26/2021
Onset Date: 10/27/2021
Rec V Date: 10/28/2021
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: Sulfa

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

Symptoms: Fever, HA, body aches, nausea

Other Meds: Metformin, sertraline, aspirin, naproxen, fish oil,synthroid, Zyrtec,

Current Illness: Zero

ID: 1825158
Sex: M
Age: 62
State: NH

Vax Date: 04/27/2021
Onset Date: 08/07/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: Urine Culture ESCHERICHIA COLI 50,000 to 100,000 colony forming units per mL

Allergies: Bee stings, Imaging contrast

Symptom List: Tremor

Symptoms: UTI: Don't believe my Urinary Tract Infection beginning in August had anything to do with my last Covid-19 vaccination in April

Other Meds: Amlodipine Sulfate

Current Illness: None

ID: 1825159
Sex: M
Age: 61
State:

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

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Administration error, expired vaccine given

Other Meds:

Current Illness:

ID: 1825161
Sex: F
Age: 68
State: IN

Vax Date: 10/26/2021
Onset Date: 10/26/2021
Rec V Date: 10/28/2021
Hospital:

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data:

Allergies:

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

Symptoms: headache, fever, chills, muscle aches, nausea- lasting 48 hours

Other Meds:

Current Illness:

ID: 1825162
Sex: F
Age: 69
State: IN

Vax Date: 10/26/2021
Onset Date: 10/26/2021
Rec V Date: 10/28/2021
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: ceclor

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

Symptoms: Every joint in body ached, felt feverish

Other Meds: Metoporol, statin, effexor

Current Illness: none

ID: 1825163
Sex: M
Age: 51
State: NJ

Vax Date: 10/24/2021
Onset Date: 10/28/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data:

Allergies: penicillin

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: patient received moderna after a single J&J dose. Patient received 0.5 ml instead of 0.25

Other Meds:

Current Illness:

ID: 1825164
Sex: F
Age: 36
State: ME

Vax Date: 07/30/2021
Onset Date: 10/19/2021
Rec V Date: 10/28/2021
Hospital: Y

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

Lab Data: Procedure Component Value Ref Range Date/Time CT ANGIO THORAX WITH IV CONTRAST [347775223] Resulted: 10/19/21 1907 Order Status: Completed Updated: 10/19/21 1910 Narrative: EXAMINATION: CT Angiography of the Thorax EXAM DATE: 10/19/2021 6:25 PM TECHNIQUE: Standard protocol CT angiogram images were obtained through the chest following the administration of intravenous contrast. Coronal and sagittal MIP 3-D reformations were performed. CONTRAST: The amount and type of contrast are recorded in the medical record. QPP DOCUMENTATION: At least one of the following dose reduction techniques was utilized: Iterative reconstruction, and/or Automatic Exposure Control, and/or mA/kV adjustment based on body size. INDICATION: PE suspected, high prob, acute dypsnea, hx PE/dvt, recent COVID. COMPARISON: 5/10/2021 ENCOUNTER: Not applicable ____________________ FINDINGS: Base of Neck & Axillae: There is no lymph node enlargement. Mediastinum & Hila: There is no mediastinal or hilar lymph node enlargement. There is a mild 1 cm short axis right hilar lymph node. Nonspecific. Cardiovascular: The heart has a normal size. There is no pericardial effusion. The thoracic aorta is not aneurysmal and there is no dissection. There is no evidence for right heart strain. Pulmonary Arteries: Pulmonary arteries are not well opacified. Limited evaluation for pulmonary embolus. Is also limitations with respiratory motion artifact. There is no evidence of large or central pulmonary embolus. Lungs & Airways: Platelike atelectasis in the anterior right upper lobe near the junction of the right middle lobe. There is respiratory motion artifact somewhat limiting evaluation. No definite infiltrate. Pleural Space: There are no pleural effusions. There is no pneumothorax. Upper Abdomen: Included portions of the upper abdomen are unremarkable. Chest Wall & Musculoskeletal: No significant abnormality. ____________________ Impression: 1. No central large pulmonary embolus. There are limitations with respiratory motion artifact and limited opacification. 2. Platelike atelectasis anterior right upper lobe. Procedure Component Value Ref Range Date/Time Respiratory Pathogens by Film Array [347816505] (Abnormal) Collected: 10/20/21 0900 Order Status: Completed Specimen: Swabbed Collection from Nasopharynx Updated: 10/20/21 1417 Adenovirus PCR Film Array Not Detected Not Detected Coronavirus 229E PCR Film Array Not Detected Not Detected Coronavirus HKU1 PCR Film Array Not Detected Not Detected Coronavirus NL63 PCR Film Array Not Detected Not Detected Coronavirus OC43 PCR Film Array Not Detected Not Detected COVID-19 PCR Detected Abnormal Not Detected Comment: COVID-19 (SARS-CoV-2) test is positive. Clinical correlation with patient history and other diagnostic information is necessary to determine infection status. This test has received Emergency Use Authorization (EUA) by the FDA, but performance has not been evaluated for asymptomatic patients. Testing was performed using a nucleic acid amplifi

Allergies: Haldol [Haloperidol]Anxiety Methylprednisolone

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

Symptoms: Acute hypoxic respiratory insufficiency: Due to Atelectasis and Asthma exacerbation No actual pna / Infiltrate on CTA Tobacco use Hx of DVT / PT Factor 5 Leiden heterozygous Super Morbid Obesity Covid symptoms began on 10/15. Hospitalized 10/19. Patient reluctant to start solumedrol since it makes her incredibly anxious and she doesn't tolerate it. She is agreeable to decadron. Will schedule albuterol inh 4 puffs q 4 hours + q 2 hours prn. Try to avoid aerosolizing nebulizers if able. Monitor covid labs. Encourage tobacco cessation Continue home xarelto CTA thorax done on admission with no PE (atelectasis - no infiltrate) Essential HTN: DM2: Hold home metformin - Start low dose corrective (likely will need inc. Given steroid use). Vte prophy: Cont home Xarelto Diet: General per pt preference Code: Full HISTORY OF PRESENT ILLNESS: Patient is a 37 y.o. female who presents today with covid-19 symptoms and exertional hypoxia. She lives with a friend and she has covid also. She was vaccinated against Covid (in July - J&J). She has been feeling unwell for at least 5 days since 10/15/21. She has been checking her temp and having fevers up to 102.7 last night which was the highest. She has been taking tylenol and ibuprofen. She feels sore all over. She has chest pain that she describes as achy or sore. She has been having a dry cough. She hasn't brought up phlegm. She has had poor po intake. She has hx of DM on metformin. She has a history of asthma. was last hospitalized with asthma a few months ago. She has noticed wheezing in the past few days as well. She is reluctant to try any solumedrol since it makes her really anxious and crawling out of her skin. She has a hx of DVT and PE and takes Xarelto for that (factor 5 leiden hetero). She had nausea and vomiting 2 days ago - that was bilious but no N/V since then. She hasn't had any diarrhea.

Other Meds: Outpatient Medications albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler busPIRone (BUSPAR) 10 MG tablet desvenlafaxine (PRISTIQ) 100 MG 24 hr tablet hydrOXYzine (VISTARIL) 50 MG capsule liraglutide (VICT

Current Illness: Shortness of breath Hypoxia COPD exacerbation

ID: 1825165
Sex: F
Age: 30
State: AK

Vax Date: 10/01/2021
Onset Date: 10/25/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Itching and blistering of the hands

Other Meds:

Current Illness:

ID: 1825166
Sex: F
Age: 77
State: AR

Vax Date: 03/01/2021
Onset Date: 04/15/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: May 20th, Heart center monitor May 28th - follow up June 7th Lab Work June 18 Dr. appt for Heart July 1, Stress Test Aug. 25, ENT Doctor Sept bad sting on tongue Oct. 4, tested positive That is all the appointment I have had.

Allergies: none

Symptom List: Pain in extremity

Symptoms: Ever since my shot, I have had constant headache,,,, head fog, bad sinius problems, very tired every day, mostly in afternoon. I feel like I am going through an early dementia and I was fine a month before this. I have an earache and constantly, I have not had earaches before this. The longer this goes on the more confused in my every day life. I feel this is being taken from me also. I wish I had a treatment to give to you, but there has been none....

Other Meds: none other than my vitamins

Current Illness: none

ID: 1825167
Sex: F
Age: 48
State: OK

Vax Date: 10/22/2021
Onset Date: 10/25/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data:

Allergies: citrus fruit, mango, sulfa, strong scents

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

Symptoms: Light menstral spotting after the vaccination. This also happened after my second vaccination and lasted about a month.

Other Meds: Dapsone 100 mg, Levonor/ethi Estradio 0.15-0.03 Tab,

Current Illness: none

ID: 1825168
Sex: M
Age: 80
State: MI

Vax Date: 02/10/2021
Onset Date: 10/08/2021
Rec V Date: 10/28/2021
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: Lab Results: Other Chemistry: 22-Oct-21 18:46, *Whole Blood Glucose, Glucometer *Whole Blood Glucose, Glucometer 268 [79 - 99 mg/dL]

Allergies: Cipro, flu vaccines, Levaquin, Neosporin, Penicillin

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

Symptoms: Sob, Covid+, Hospital Transfer, BiPAP for respiratory support,

Other Meds: unknown

Current Illness: unknown

ID: 1825169
Sex: M
Age: 45
State: TX

Vax Date: 10/24/2021
Onset Date: 10/25/2021
Rec V Date: 10/28/2021
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: None

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

Symptoms: Swelling at the injection site and swollen lymph node under in arm pit area on left arm (same arm as injection)

Other Meds: 10,000 IU Vitamin D/Orion Pharma Biotin 25,000 MCG, GNC Mega Men One Daily Vitamin

Current Illness: None

ID: 1825170
Sex: F
Age: 43
State: CA

Vax Date: 10/22/2021
Onset Date: 10/22/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data:

Allergies: Sulfa, anaphylaxis

Symptom List: Vomiting

Symptoms: Immediate numbness on left side from hands to feet. Facial numbness. Itchy raspy throat, itchy neck. Tachycardia post injection for 6 days. Severe migraine post injection for 6 days. Nausea. Chills. Joint stiffness.

Other Meds: None

Current Illness:

ID: 1825171
Sex: F
Age: 63
State: TN

Vax Date: 10/18/2021
Onset Date: 10/21/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: Visiting urologist today

Allergies: codin

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Too much pain non stop near urinary tract about 4 to 5 hours and then it is repeatative after 5 to 6 hours but only for hour or two and come back again. Also had fever and body aching as they said was normal after vaccination.

Other Meds: metformin , montelukast sodium , repaglinide , simvastatin , aspirin low dose , estradiol ,

Current Illness: no

ID: 1825172
Sex: F
Age: 38
State: MN

Vax Date: 04/27/2021
Onset Date: 05/01/2021
Rec V Date: 10/28/2021
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: Biopsy (10/2021) Swab test (10 2021)

Allergies: Seasonal Allergies Cats

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

Symptoms: This summer I started getting a lot of vaginal itching. It didn't go away for a long time. September 2021 I seen a doctor, and they said I have an infection . I had to get emergency care. They diagnosed me with lichen sclerosus. They prescribed a steroid cream that is supposed to be applied locally.

Other Meds: none

Current Illness: none

ID: 1825173
Sex: F
Age: 32
State: IN

Vax Date: 10/08/2021
Onset Date: 10/09/2021
Rec V Date: 10/28/2021
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: N/A

Allergies: No Known Drug or food allergies

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Pt developed Shingles

Other Meds: B12 nasal spray, biotin 800 mcg, Calcium Citrate malate 250 mg-Vit D3 2.5 mcg, multivitamin

Current Illness: None

ID: 1825174
Sex: F
Age: 44
State: SC

Vax Date: 10/26/2021
Onset Date: 10/26/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Expired vaccine given, expiration date 10/26/2021.

Other Meds:

Current Illness:

ID: 1825176
Sex: M
Age: 33
State: VA

Vax Date: 05/22/2021
Onset Date: 05/24/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Severe cold for 24 hours

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am