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: 1825177
Sex: M
Age: 29
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: 1825179
Sex: F
Age: 60
State: NJ

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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: patient received 0.5 ml after a single dose of J&J

Other Meds: atorvastatin

Current Illness:

ID: 1825180
Sex: F
Age: 44
State: CO

Vax Date: 04/28/2021
Onset Date: 05/08/2021
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: I had in May again in July CBC labs checked was normal and just was also normal, they started checking if there was any inflammatory or clotting disorder but none of my labs came back abnormal.

Allergies: Penicillin and codeine, Peanuts, Wheat, Corn, Rice, Soy, Banana, Strawberries, Mango, Cherries.

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

Symptoms: A week after I First notice was red spots from my thigh down to my feet, they were not hives but they were red spots. In august they stated to fade away but now gone completely, My high blood pressure is high and I have never had this issue before. It has always been at an normal range and this time was really high.

Other Meds: Cingular, gabapentin, cyproheptadine, Zyrtec, Allegra, and Iron supplement, Toroidal.

Current Illness: I wasn't sick, I was just taking medication for chronic conditions.

ID: 1825181
Sex: M
Age: 49
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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data: N/A

Allergies: Penicillin

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Dosage administered was incorrectly given. Was given 0.5mL instead of 0.25mL.

Other Meds: N/A

Current Illness: N/A

ID: 1825182
Sex: M
Age: 64
State: CT

Vax Date: 04/15/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data: X-rays - Arthritis and slight dislocated back vertebrate

Allergies: No

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

Symptoms: I experienced a bad reaction as if I had the symptoms of COVID for 12-hours after receiving the vaccine along with sores appeared on my neck and under arm on the right hand side near my back. Approximately 2 weeks later I had a sore on my hear at the crown and then where the neck meets my skull and at the base of my back which have since become worse. I went my normal appointment with my PCP and he referred me to a Orthopedist, Dermatologist, and Rheumatologist in reference to my symptoms. I went to the Orthopedist on 10/14/2021 and he performed an X-ray which he thinks I have arthritis and a slightly dislocated vertebrate in my back. He told me to take over-the-counter Tylenol if the pain persists. He scheduled me for Physical Therapy so that my insurance company will approve the MRI (requires 6 sessions/appointments with the Physical Therapist).

Other Meds: I take diabetic medications - Metformine1000mg, Guliptizide 10, Farxiga 5mg, Statin 40mg, and Glucosamine, Vitamin B-Complex, and Multivitamins.

Current Illness: NoDiabet

ID: 1825183
Sex: F
Age: 78
State: NJ

Vax Date: 08/23/2021
Onset Date: 08/25/2021
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: GP said it was not a poison (such as poison ivy) Dermatologists did biopsies. Believes it is a reaction to some medication. Vaccine is only new medication.

Allergies: Honey/bee pollen, opioids, acrylic monomers

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

Symptoms: Itchy scalp at beginning. Rash started on shoulders, now moved mostly on back.

Other Meds: Amlodipine, Prevacid, Welbutrin, Aleve, Paxil, Singulair

Current Illness:

ID: 1825184
Sex: M
Age: 87
State: WY

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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: PHN administered Moderna boosters at client's retirement residence. Client was present with wife and residency staff member. Staff member filled out the form for the client. White COVID card was reviewed prior to injection and only the first two doses of the primary series were documented. PHN asked client if he consented to getting his Moderna Booster and he did consent. After dose was administered, back at the office, dose was documented and noted that a Moderna Booster had already been given to client the day before by his PCP office.

Other Meds:

Current Illness:

ID: 1825185
Sex: F
Age: 40
State: NJ

Vax Date: 04/29/2021
Onset Date: 04/30/2021
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: I was given an EKG and bloodwork which were both normal. This was after I had been taking aspirin for about a month.

Allergies: Allergic to turmeric and herbal supplements.

Symptom List: Pharyngeal swelling

Symptoms: For over two weeks after my last shot, I was extremely fatigued and bedridden. After 2.5 months, I started developing painful canker sores inside my mouth and had to take acyclovir for months. The last time I needed to take acyclovir was 10/4/2021. In August of 2021, I developed sharp chest pains and extreme shortness of breath, and additional fatigue. My doctor advised me to take 81mg aspirin on a daily basis and these chest pains gradually improved. I only have slight chest pains occasionally, however I?m still battling fatigue and need 12 hours of sleep before I can function properly.

Other Meds: Niagen, Krill oil

Current Illness: N/A

ID: 1825186
Sex: M
Age: 67
State: IL

Vax Date: 02/23/2021
Onset Date: 08/05/2021
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:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: tinnitus

Other Meds:

Current Illness:

ID: 1825187
Sex: F
Age: 62
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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Administration error, given expired vaccine.

Other Meds:

Current Illness:

ID: 1825188
Sex: F
Age: 95
State: MI

Vax Date: 05/27/2021
Onset Date: 10/26/2021
Rec V Date: 10/28/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Covid + on 10/26/2021. Received Pfizer with 1st dose on 04/27/2021 and 2nd dose on 05/27/2021. Per ED Note: Patient is a 95-year-old woman with a past medical history significant for TIA, COPD on 2 L of oxygen at night at home, hyperlipidemia that presents emergency department with a fall from home. Patient states she lives with her son and that she has been falling more frequently as of late. The patient states that she lost balance at home while walking fell backwards onto her behind and then laid back on the ground. Patient states she could not get up and EMS was called. Patient's son is at bedside and states that the patient has been "losing her balance more". The son states they witnessed this fall and states that the patient did not hit her head or lose consciousness. Patient denies any pain or injuries at this time. Patient denies any unilateral weakness or sensory changes. The patient denies fever, chills, sweats, dizziness, headache, double or blurry vision, difficulty swallowing, throat or mouth or tongue swelling, shortness of breath, chest pain, palpitations, abdominal pain, nausea vomiting, diarrhea, constipation, and urinary symptoms. Patient was seen by myself and my attending. Vital signs reviewed by myself and within normal limits unless noted above. Ecare/old charts were reviewed and the pertinent findings related to the chief complaint are as noted. If performed, all laboratory data and radiographic imaging were reviewed by me and within normal limits except as noted. Please see attending radiology dictation for further information on imaging studies. Due to patient's history and presentation, focused physical, work-up, and assessment initiated. Imaging ordered. Imaging returning largely within normal limits. IV established and labs drawn. Due to patient's recurrent falls, she needs to be admitted to the hospital with physical therapy, Occupational Therapy and social work consulted. Labs returned demonstrating the patient is Covid positive. Patient to be admitted. Page sent out to the patient's PCP, Dr. who accepts admission. ID and pulmonology consulted.

Other Meds:

Current Illness:

ID: 1825189
Sex: F
Age: 68
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: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies: Amoxicillin-rash

Symptom List: Rash, Urticaria

Symptoms: Patient received booster shot of Moderna. Previously had two Pfizer shots. About 7 minutes into her observation she began experiencing chest ache at about 1 to 2/10. VS were 143/76 and 132/80, HR 72, 98%. Patient wanted to go to ED to get further workup because she is concerned about side effects of COVID vaccine related to myocarditis.

Other Meds:

Current Illness:

ID: 1825190
Sex: M
Age: 62
State: TX

Vax Date: 05/18/2021
Onset Date: 05/18/2021
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: No tests to date. I have informed the Doctor's assistant of the pain.

Allergies: None

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

Symptoms: Constant pain in left arm at location of shot. More pain with movement and with lifting. Has been new and constant since the second shot. Has spread to chest, shoulder, and upper left back muscles. Ibuprofen reduces pain and mostly receded to arm muscle at injection area. Flares up to include other muscle groups without Ibuprofen.

Other Meds: Aspirin

Current Illness: None

ID: 1825192
Sex: F
Age: 15
State: SD

Vax Date: 10/05/2021
Onset Date: 10/25/2021
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: MRI pending Physical Exam Pt will need surgery to reattach the tendon and muscles

Allergies: none

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

Symptoms: She developed a distal biceps tendon tear of the right

Other Meds: Clindamycin Gel for acne, Escitalopram 15mg, Methylphenidate 10mg ER.

Current Illness: none

ID: 1825194
Sex: M
Age: 75
State: MI

Vax Date: 02/10/2021
Onset Date: 10/20/2021
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: IM
Vax Site: LA

Lab Data: Results Procedure Component Value Ref Range Date/Time US RENAL COMPLETE WITH BLADDER [347948555] Resulted: 10/21/21 0225 Order Status: Completed Updated: 10/21/21 0227 Narrative: EXAMINATION: Kidney and Bladder Ultrasound EXAM DATE: 10/20/2021 11:09 PM TECHNIQUE: Ultrasound of the kidneys and bladder. INDICATION: UTI. COMPARISON: CT 11/29/2018 _________________________ FINDINGS: The examination is overall limited due to portable technique and overlying soft tissue. Right Kidney: The right kidney measures 11.2 x 6.3 x 6.9 cm(length x AP x width) in dimension. There is cortical renal scarring. No hydronephrosis is present. No mass is present. Left Kidney: The left kidney measures 11.3 x 7.2 x 6.6 cm(length x AP x width) in dimension. There is cortical renal scarring. No hydronephrosis is present. There is a 1.3 cm cyst. Bladder: Decompressed and not seen. ADDITIONAL FINDINGS: None. _________________________ Impression: 1. No acute abnormality. No hydronephrosis. 2. Bilateral cortical renal scarring. DR CHEST 2 VIEWS FRONTAL AND LATERAL [347948542] Resulted: 10/20/21 1308 Order Status: Completed Updated: 10/20/21 1310 Narrative: EXAMINATION: Frontal and Lateral View Chest EXAM DATE: 10/20/2021 12:56 PM TECHNIQUE: Frontal and lateral views INDICATION: Fever, requiring oxygen support. COMPARISON: 4/16/2014 chest x-ray ENCOUNTER: Not applicable _________________________ Impression: Moderate low lung volumes. Patchy mid to lower lung predominant opacities and mild interstitial prominence can be seen with pulmonary edema and/or potential atypical infection. No evidence of pleural effusion or pneumothorax. The cardiac silhouette appears normal in size. Procedure Component Value Ref Range Date/Time Peripheral Blood Culture [347948538] Collected: 10/20/21 1351 Order Status: Completed Specimen: Blood, Venous Updated: 10/25/21 1701 Cult Blood Peripheral No bacteria or yeast isolated Peripheral Blood Culture [347948539] Collected: 10/20/21 1345 Order Status: Completed Specimen: Blood, Venous Updated: 10/25/21 1701 Cult Blood Peripheral No bacteria or yeast isolated Urine Culture [347948545] (Abnormal) Collected: 10/20/21 1400 Order Status: Completed Specimen: Urine, catheter Updated: 10/22/21 0410 Bacterial culture, urine >=100,000 CFU/mL Klebsiella pneumoniae Abnormal Susceptibility Klebsiella pneumoniae Not Specified Ampicillin Resistant Ampicillin/sulbactam Susceptible Cefazolin Susceptible 1 Ceftriaxone Susceptible Ciprofloxacin Susceptible Gentamicin Susceptible Nitrofurantoin Susceptible Tobramycin Susceptible Trimethoprim/Sulfamethoxazole Susceptible 1 For uncomplicated UTIs due to E. coli, K. pneumoniae, and P. mirabilis, cefazolin predicts susceptibility to oral cephalosporins including cephalexin, cefpodoxime, cefprozil, cefdinir, and cefuroxime. Linear View COVID-19 PCR [347948534] (Abnormal) Collected: 10/20/21 1237 Order Status: Completed Specimen: Swabbed Collection from Nasopharynx Updated: 10/20/21 1330 C

Allergies: CephalosporinsHives Nsaids

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

Symptoms: Patient is a 76 y.o. male admitted to the service on 10/20/2021 with acute hypoxemic respiratory failure secondary to COVID 19 pneumonia, generalized weakness. PMHX significant for CKD III, CAD S/P PCI, essential HTN, DM II, prostate CA S/P radiation, chronic urinary incontinence, morbid obesity. Pt received modera vaccine x 2, last dose in Feb 2021. Onset of symptoms 10/14. He was treated with remdesivir (x4 days) and decadron during stay. He was able to wean to 1 L FIO2 at rest, 2 L with activity by day of DC. Home FIO2 was arranged. Home care service were arranged. The patient is stable for DC home on 10/23/2021.

Other Meds: Acetaminophen (TYLENOL EXTRA STRENGTH PO) amoxicillin-clavulanate (AUGMENTIN) 875-125 MG per tablet aspirin 81 MG tablet ASPIRIN 81 PO atorvastatin (LIPITOR) 80 MG tablet dexamethasone (DECADRON) 6 MG tablet glimepiride (AMARYL) 4 MG tablet

Current Illness:

ID: 1825195
Sex: F
Age: 49
State: MA

Vax Date: 05/18/2021
Onset Date: 06/07/2021
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: Steroid cream prescribed, not helping - very itch, and burning

Allergies: N/A

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

Symptoms: rash that is in he form of blotch , spinal lumbar, left knucle, right had, under left armpit, groin area, lip,

Other Meds: Albuterol and Flovent

Current Illness: N/A

ID: 1825196
Sex: M
Age: 28
State: MI

Vax Date: 09/22/2021
Onset Date: 10/26/2021
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:

Allergies:

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

Symptoms: Covid + on 10/26/2021. Received Janssen vaccine on 09/22/2021 Per ED Note: 29-year-old male who is on Zyprexa, noncompliant presents the ED for the above complaint. Patient states that he was at work and got an altercation with a coworker, had made threatening remarks to coworker and was ultimately fired from his job. Patient states that he also made suicidal remarks as well as homicidal remarks to police officer. Patient states that he is post take Zyprexa daily however does not take it daily. Patient has a history of inpatient hospitalization for psych. Patient states that he "wants to stay in the hospital forever "and does not want to go back. Patient does endorse alcohol use as well as marijuana use. Patient denies any other symptoms. Patient denies any auditory visual hallucinations. Patient was the ED for psych eval. Patient has been petition for suicidal homicidal ideation. Patient admitted to these statements. Patient reportedly does take Zyprexa however does not take it every day, is noncompliant. My assessment patient is agitated but otherwise is not responding to any internal stimuli and responding to my questions. Patient is requesting to "stay in the hospital forever "and does not want to return. At this time I did order a psych panel for patient and did consult social work. Patient psych panel was unremarkable. RUDS positive for marijuana. Patient will be going upstairs to Annex. 10/26/2021: 9:38 AM D/w social work - plan transfer 10:07 AM Patient's Covid test resulted positive. Update social worker as to patient's positive Covid test. Social worker reports still in contact and will follow up regarding bed availability. 11:42 AM D/w social worker - no Covid beds available at Kingwood this time. Ambulance/transfer canceled. Social work request Psychiatry consult, Dr. Consult ordered. Final Impression: Homicidal ideations Suicidal ideations Schizoaffective disorder COVID-19

Other Meds:

Current Illness:

ID: 1825197
Sex: M
Age: 60
State: NH

Vax Date: 04/28/2021
Onset Date: 07/01/2021
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: I had blood work done yesterday October 27, 2021

Allergies: None.

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Two months in July I start to have joint pains. I am currently going to doctor to find the issue.

Other Meds: I am prescribed to take blood thinners.

Current Illness: None.

ID: 1825198
Sex: M
Age: 49
State: MI

Vax Date: 04/29/2021
Onset Date: 05/03/2021
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:

Allergies: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Chronic muscle soreness (back, shoulders, arms, legs). Advil PRN. Condition is ongoing.

Other Meds: None

Current Illness: None

ID: 1825199
Sex: M
Age: 56
State: NJ

Vax Date: 10/23/2021
Onset Date: 10/23/2021
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: patient received 0.5 ml after a single J&J dose

Other Meds: lisinopril pravastatin

Current Illness:

ID: 1825200
Sex: F
Age: 35
State: FL

Vax Date: 04/15/2021
Onset Date: 04/16/2021
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: CT Scan 4/16/2021 - normal. Doctors told me it was most likely pancreatitis related to COVID-19 vaccination. Discharged with pain medication.

Allergies: Penicillian, Bee Venom

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

Symptoms: Severe upper abdominal pain. Pain increasing with any intake of food or water.

Other Meds: Cimzia, Sprintec, Zyrtec, Valtrex, Tylenol after reaction.

Current Illness: None.

ID: 1825201
Sex: M
Age: 8
State: AL

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: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies: None

Symptom List: Unevaluable event

Symptoms: Arm swelling and pain within 30 minutes of injection

Other Meds: QuilliChew ER

Current Illness: None

ID: 1825202
Sex: M
Age: 22
State:

Vax Date: 10/25/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Administration error, given expired vaccine.

Other Meds:

Current Illness:

ID: 1825203
Sex: M
Age: 44
State: VA

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: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: N/A

Symptom List: Injection site pain, Pain

Symptoms: One day following my Pfizer booster vaccination (dose 3 overall), I noticed that the lymph node below my left arm (the arm used for vaccination) was very swollen and tender to the touch.

Other Meds: N/A

Current Illness: N/A

ID: 1825204
Sex: F
Age: 51
State: VA

Vax Date: 02/28/2021
Onset Date: 03/01/2021
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: ENT exam and Epley maneurver, treatment with cortisone, allergy medications

Allergies: sulfa

Symptom List: Injection site pain, Menorrhagia

Symptoms: vertigo immediately after each dose followed by episodes of veritigo and chronic dizziness

Other Meds: vibryd, crestor, melatonin, curcumin, CBD

Current Illness: none

ID: 1825205
Sex: F
Age: 53
State: CA

Vax Date: 10/24/2021
Onset Date: 10/26/2021
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:

Allergies: None

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

Symptoms: 3-4? red circle around injection site. Appear day after injection and I still have it 3 days later. It is firm, hot, sore and slightly itchy. I?ve been taking benedryl but hasn?t had much effect. This did not occur with my first two vaccines but did with this booster.

Other Meds: Wellbutrin, vitamin D, Zyrtec

Current Illness: None

ID: 1825206
Sex: F
Age: 72
State: KY

Vax Date: 10/15/2021
Onset Date: 10/15/2021
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: patient went to ER

Allergies: n/a

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient received pfizer booster and then started to suffer from seizures and was in the ER

Other Meds: PANTOPRAZOLE SOD 40MG TAB

Current Illness: n/a

ID: 1825207
Sex: F
Age: 32
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: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Vaccine administered had expired, expiration date is 06/3082021

Other Meds:

Current Illness:

ID: 1825208
Sex: M
Age: 42
State: FL

Vax Date: 10/25/2021
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: 1
Vax Route: IM
Vax Site: RA

Lab Data: None.

Allergies: None

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

Symptoms: Fever, Chills and Body Aches onset 9 hours after injection. Tachycardia and Insomnia continued until approximately 4am on 10/26. Symptoms persisted, including fever and night sweats, until the morning of 10/28/21. Injection site soreness persists.

Other Meds: None

Current Illness: None

ID: 1825209
Sex: F
Age: 59
State: CA

Vax Date: 09/17/2021
Onset Date: 09/17/2021
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: NONE

Symptom List: Nausea

Symptoms: FACIAL AND THROAT SWELLING, DIFFICULTY BREATHING, MYALGIAS, ARTHRALGIAS, PURITIC RASH, WEAKNESS

Other Meds: Gabapentin, Metformin, Methadone, Morphine, Rosuvastatin

Current Illness: none

ID: 1825210
Sex: F
Age: 66
State: AZ

Vax Date: 04/09/2021
Onset Date: 05/01/2021
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: Mri on shoulders, hips and cervical neck on June 8th.

Allergies: nka

Symptom List: Injection site pain

Symptoms: Three weeks after my 2nd covid 19 dose, I experienced severe joint pains in arms, hands, back, and hip to the point of not being able to take care of my daily routine, ie shower, cooking ect. I was in tears as it was really debilitating . I made appointment with my pcp at that time, Nurse practicioner. He referred me to a pain clinic. They proscribed anti inflammatories that did not help. I went to Physical therapy which helped more. I do the exercizes daily now, but I'm still debilitated in moving the way I used to. It was a sudden overnight onset which was very alarming. I reported to Dr that I'd gotten the Pfizer vaccine three weeks prior to this onset.

Other Meds: Benecar 25mg

Current Illness: none

ID: 1825211
Sex: M
Age: 87
State: MI

Vax Date: 02/14/2021
Onset Date: 10/20/2021
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: LA

Lab Data: Results Procedure Component Value Ref Range Date/Time DR CHEST 2 VIEWS FRONTAL AND LATERAL Resulted: 10/21/21 0009 Order Status: Completed Updated: 10/21/21 0011 Narrative: EXAMINATION: Frontal and Lateral View Chest EXAM DATE: 10/20/2021 11:18 PM TECHNIQUE: Frontal and lateral views INDICATION: Weakness, covid positive.. COMPARISON: Chest radiographs 3/25/2021, 11/3/2019, 12/12/2017. ENCOUNTER: Not applicable _________________________ FINDINGS: The heart size is within normal limits. Moderate hiatal hernia. No pulmonary vascular distention. Smaller scarring and/or atelectasis at the left lung base. No focal consolidation. No pleural effusion or pneumothorax. Left humeral head surgical anchors. _________________________ Impression: 1. No acute cardiopulmonary findings. 2. Moderate hiatal hernia. I have personally viewed the images, discussed the findings with MD, reviewed the interpretation, and agree.

Allergies: Tiotropium Bromide [Tiotropium] Oxycontin [Oxycodone] SpirivaOther

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

Symptoms: Patient is an 88M with h/o CAD, A-Fib on chronic Eliquis, HTN, HLD, NIDDM, CKD, seizure disorder on chronic AED, chronic anemia, GERD, gout and OSA, who presents today with generalized weakness and progressive inability to attend to ADL's. He lives at home with his spouse, who was recently diagnosed with COVID. He has symptoms of fatigue, intermittent subjective fever and chills, appetite change, dry cough, myalgias/arthralgias and lightheadedness. In the ER, he was afebrile, hypertensive, tachycardic and tachypneic, saturating normally on baseline 2L via NC. CXR shows no acute processes with mention of moderate sized HH. EKG shows rate-controlled A-Fib with non-specific ST changes, but no e/o ACS. COVID PCR + He received monoclonal antibody 10/22 and was started on decadron 6 mg daily for persistent fevers. His fevers resolved. He was weaned to home O2 requirement. He was medically stable for discharge. PT/OT recommends SAR

Other Meds: acetaminophen (TYLENOL) 325 MG tablet albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler allopurinol (ZYLOPRIM) 300 MG tablet apixaban (ELIQUIS) 2.5 MG tablet aspirin 81 MG tablet benzocaine-menthol (CEPAC

Current Illness:

ID: 1825212
Sex: F
Age: 48
State: TX

Vax Date: 10/01/2021
Onset Date: 10/01/2021
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: none

Allergies: Cipro and levaquin antibiodics

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

Symptoms: Immediate metallic taste. It has been 4 weeks since the vaccine and it has not gone away at all.

Other Meds: Valsartan 160 mg twice daily Levothyroxine 175 mcg once daily

Current Illness: joint pain

ID: 1825213
Sex: F
Age: 65
State: WY

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none per patient

Symptom List: Tremor

Symptoms: Patient is having "nerve pain" on medial aspect of the left arm that extends from the elbow to the wrist.

Other Meds: none per patient

Current Illness: none per patient

ID: 1825214
Sex: M
Age: 58
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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: N/A

Allergies: None

Symptom List: Erythema, Pruritus

Symptoms: Patient received incorrect dose of Moderna 0.5mL instead of 0.25mL

Other Meds: N/A

Current Illness: N/A

ID: 1825215
Sex: F
Age: 45
State: VA

Vax Date: 10/05/2021
Onset Date: 10/19/2021
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: EKG was normal. An echocardiogram was ordered but not yet done. Platelets were high, sedimentation rate was high, and c reactive protein was high. CPK-MB was normal.

Allergies: none

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

Symptoms: Heart palpations started about one week after receiving the vaccine. Then, 3 weeks later I began coughing and noticed heart palpitations. Then, my heart began racing and felt like it was fluttering. My pulse was 144 and I feel dizzy and faint. I sat down and after about 3 minutes my pulse went down to 112. It remained 108-115 while at rest for the next 4 hours. Four hours later, my pulse went down to the 90s and a few hours later it went down to 80. The next day I felt tenderness in my left shoulder and left upper chest area, abdomen was swollen, upset stomach with diarrhea, mild heart palpitations, and felt tired. I visited my PCP the next day.

Other Meds: Zyrtec

Current Illness: none

ID: 1825216
Sex: M
Age: 77
State: MI

Vax Date: 03/04/2021
Onset Date: 10/26/2021
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: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Covid + on 10/26/2021. Received Pfizer vaccine with 1st dose on 02/10/2021 and 2nd dose on 03/04/2021. Per ED Note: This is a 78-year-old male past medical history of CKD on dialysis, diabetes, hypertension, chronic anemia is presenting to the emergency department today with generalized weakness that has been progressively worsening over the last several weeks. He is also complaining of right lower extremity pain. Apparently he is supposed to have a stent placed at the end of this week by some of his providers at Hospital. He indicates that he has noticed that the smell has been progressively worsening. His wife is also drawn a line around some redness that has started extending itself up the patient's leg. Otherwise, his wife states that she has been having difficulty taking care of him at home because he has been having difficulties ambulating because of not only the pain but the weakness diffusely. She has had to call the ambulance on multiple occasions throughout the week because she is been unable to get him up off of the toilet. Otherwise, the patient denies any fevers, chills, shortness of breath, chest pain, diarrhea ED course: This is a 78-year-old male presented to the emergency room today with complaints of generalized weakness. His wife also states that he has had multiple falls over the last several weeks we will obtain a head CT as well as basic labs. Will obtain blood cultures and start the patient on IV antibiotics as apparently the patient has been on antibiotics for the last 2 weeks. We will plan for admission and evaluate to ensure that there is no sign of osteomyelitis or gas gangrene of his right foot. Patient is Covid positive, he is agreeable to be transferred to our Hospital Center if a bed opens. Will admit him to the emergency department initially. Either way if the bed opens up the patient will be admitted. I did speak to the on-call attending here at emergency department who is agreeable and would like infectious disease nephrology and podiatry consulted. A bed did open up at hospital, patient is agreeable to transfer, an ambulance is called. Final Impression:

Other Meds:

Current Illness:

ID: 1825217
Sex: M
Age: 28
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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Administration error, given expired vaccine.

Other Meds:

Current Illness:

ID: 1825218
Sex: F
Age: 46
State: AZ

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: 011J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: none

Allergies: unknown

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

Symptoms: Patient submitted a note that she told the pharmacist (which was me that gave her the vaccine) that she needed Benadryl, she DID NOT talk to me about this and I was not aware of any reaction the patient may have had, and she did not specify what kind of reaction she had. She needs to get her next shot at the doctors office for safety.

Other Meds: unknown

Current Illness: unknown

ID: 1825219
Sex: F
Age: 73
State: NY

Vax Date: 09/17/2021
Onset Date: 09/17/2021
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: sulfa

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

Symptoms: The evening after receipt of vaccine I experienced extreme fatigue, fever of 101 and severe headache. After 2 days the fever abated however 6 weeks later I am still getting daily headaches that worsen as the day progresses and for at least 4 weeks after was experiencing daily vertigo. after 5 weeks I had office visit with my internist Dr who agreed that symptoms were likely triggered by the booster. I also saw a neurologist on October 26, 2021 and he agreed that symptoms were triggered by the Moderna booster. while I was given Trazasdone, various supplements and take xtra strength Tylenol, nothing as been effective

Other Meds: omaprazole Lipitor yuvafem

Current Illness:

ID: 1825220
Sex: M
Age: 59
State: TX

Vax Date: 10/08/2021
Onset Date: 10/14/2021
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: Hearing test results showed Meniere's disease

Allergies: Dust; pollen; naproxen

Symptom List: Pain in extremity

Symptoms: I am not sure that they are related, but I was recently diagnosed with Meniere's disease. I had body aches, a very slight fever that lasted for about 18 hours. I saw my ENT and that is how I was diagnosed.

Other Meds: Prefer not to list

Current Illness: No

ID: 1825221
Sex: M
Age: 68
State: MA

Vax Date: 02/09/2021
Onset Date: 10/18/2021
Rec V Date: 10/28/2021
Hospital: Y

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

Lab Data: positive covid test on 10/18/21 chest x ray impression on 10/18/21: patchy interstitial opacities may represent multifocal pneumonia

Allergies: No known allergies

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

Symptoms: Patient tested positive for covid on 10/11 with sxs of fever, cough and congestion and presented to BWH ED on 10/18/21. Patient is fully vaccinated. Patient was appropriately treated and was discharged on 10/21/21.

Other Meds: amlodipine, aspirin, vitamin d3, empagliflozin, fenofibrate, glimepiride, hydrochlorothiazide, irbesartan, metoprolol succinate, rosuvastatin

Current Illness: N/A

ID: 1825222
Sex: M
Age: 53
State: UT

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Have not had any tests or labs of any kind done. Research said to give it a week to subside before seeking medical attention.

Allergies: None

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

Symptoms: Moderna Booster. Within 24 hours noticed swelling on his left side, in the armpit area. The swelling is quite significant. Only a little painful when trying to feel for lymph nodes.

Other Meds: Ibersartan, Amlodipine,low dose aspirin,rosuvastatin,baclofen

Current Illness: None

ID: 1825223
Sex: M
Age: 70
State: TX

Vax Date: 09/27/2021
Onset Date: 10/04/2021
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: No tests done. I was prescribed Triamcinolone Acetonide cream 0.1%.

Allergies: Menthol or menthol vapor causes burning and redness in eyes.

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

Symptoms: Approximately 5 days after the injection, I developed a bad itchy red rash on neck, arms, upper chest, and across abdomen. After about ten days (I first thought it might be from poison ivy, even though there is none in my yard at present) I went to a dermatologist and she said it wasn?t poison ivy and looked like a drug reaction.

Other Meds: Tamsulosin 0.4 mg daily Finasteride 5mg daily Ibuprofen 600mg as needed (usually only 4-5 times per month) Melatonin 5mg daily

Current Illness: None

ID: 1825224
Sex: M
Age: 72
State: OH

Vax Date: 09/22/2021
Onset Date: 09/23/2021
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: ER monitoring

Allergies: no known

Symptom List: Vomiting

Symptoms: Patient said that at the time the vaccines were given, he felt fine. The next day he felt terrible his arms and neck hurt and he had a low blood pressure of 93/50 and went to the ER. He did not have any follow up and fell fine now.

Other Meds: lisinopril 10, atorvastatin 80, Plavix 75, metformin xr 75,

Current Illness:

ID: 1825225
Sex: M
Age: 38
State: MO

Vax Date: 10/27/2021
Onset Date: 10/28/2021
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:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Seizure-Medium, Systemic: Shakiness-Medium

Other Meds:

Current Illness:

Date Died: 10/27/2021

ID: 1825226
Sex: M
Age: 79
State: NE

Vax Date: 02/19/2021
Onset Date: 08/29/2021
Rec V Date: 10/28/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Pt presented to Emergency Room at local Medical Center on August 29, 2011 with complaints of not feeling right and fell at home. The patient was diagnosed with COVID-19 infection, he was previously fully vaccinated on 2/19/2021 & 3/12/2021. Patient completed Remdesivir and Decadron, patients oxygen requirements increased during hospitalization, requiring additional course of steroids. Patient required CPAP during the Hospital Course. After using the CPAP, the patient developed a facial abscess. ENT did an incision and drainage. The patient completed antibiotics. Patient was admitted to a Specialty Hospital. to continue care. On 10/27/2021 the patient met with the physician and family members and due to his significant decline, poor prognosis and increased oxygen needs, the patient chose to go comfort cares and expired on 10/27/2021 1835.

Other Meds:

Current Illness: COVID- 19, HTN, Hyperlipidemia, Chronic Kidney Disease stage III, Hearing Loss, Centrilobular emphysema, CHF, CAD and Osteoarthritis.

ID: 1825227
Sex: F
Age: 71
State: IL

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: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Swelling of arm in the area where the pneumovax was given. Mild pain as well

Other Meds:

Current Illness:

ID: 1825228
Sex: F
Age: 40
State: GA

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:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Site: Swelling at Injection Site-Medium, Systemic: Body Aches Generalized-Medium, Systemic: pt stated pain on first day and 2nd day very painful 3rd could not lift arm and swollen under the arm pits and painful on left side of breast-Medium, Systemic: Lymph Node Swelling-Medium, Additional Details: patient stated her left arm was painful on first day and 2 nd day the left side of arm hurt on the third she was unable to lift her arm and under the armpit it was swollen and left side of her breast hurts

Other Meds:

Current Illness:

ID: 1825229
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: RA

Lab Data:

Allergies:

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

Symptoms: Administration error, given expired vaccine

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am