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: 1825230
Sex: F
Age: 37
State: NC

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: IM
Vax Site: LA

Lab Data:

Allergies: Procardia Imitrex

Symptom List: Dysphagia, Epiglottitis

Symptoms: Dizziness Weakness Heart palpitations

Other Meds: None

Current Illness: None

ID: 1825231
Sex: F
Age: 80
State: MI

Vax Date: 03/18/2021
Onset Date: 10/26/2021
Rec V Date: 10/28/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Covid + on 10/26/2021. Received Moderna vaccine with 1st dose on 02/18/2021 and 2nd dose on 03/18/2021. Patient admitted into hospital on 10/19/2021 Per H & P: HISTORY OF PRESENT ILLNESS: The patient is an 80-year-old female with known history of stage IV poorly differentiated nonsmall cell lung carcinoma, favoring squamous cell type, diagnosed in 02/2020. She presented with back pain. Workup showed lytic lesion at L3 with mild acute pathologic compression fracture and multiple bilateral lung nodules, right lower leg, mediastinal, hilar adenopathy and rib metastasis. She then had a PET scan on 02/23 which showed abnormal metabolism in the root of the mesentery and abdominal retroperitoneal with some projecting into the small bowel. MRI of the brain on 02/21/2021 was negative. She underwent chemotherapy with Taxol carbo Keytruda with improvement of the disease burden on restaging scans in June and back pain improved as well. She is currently on Keytruda maintenance. The patient was seen by neurosurgery as well as radiation oncology. She then developed perforation, was found to have ischemic colitis, underwent colectomy and eventually transferred to inpatient rehabilitation. While on the inpatient rehab unit, she had persistent nausea and vomiting, which the initial AAS was negative. She was given anti-emetics and PPI, but the nausea and vomiting persisted. Then the output from the ostomy decreased, although her oral intake was poor. Per ID Note: Assessment and Plan Positive rapid COVID-19 test in patient that has been fully vaccinated and is asymptomatic. This could certainly be a false positive result Status post subtotal colectomy for colonic perforation and peritonitis Lung cancer with skeletal metastases on immunotherapy Recommendations: I have ordered COVID-19 by PCR to determine if previous test was positive false positive. In the meantime maintain isolation precautions. If COVID-19 testing is truly positive one could consider monoclonal antibody treatment as certainly she would be at some risk for progression. The patient is ready for discharge from an Infectious Disease standpoint. Yes [ _ ] No [ _ ] Subjective She has occasional cough but she thinks is going well. No chest pain or abdominal pain. No shortness of breath. No fevers. Objective The patient was going to be transferred to the rehabilitation unit and she was tested for COVID-19 and the rapid test was positive. She is fully vaccinated and she is basically asymptomatic. Imaging and laboratory results reviewed. White count is 4.3. Creatinine 0.8.

Other Meds:

Current Illness:

ID: 1825232
Sex: M
Age: 53
State: IN

Vax Date: 10/26/2021
Onset Date: 10/27/2021
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:

Allergies: Almonds

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

Symptoms: High fever (103), severe joint and muscle pain, full loss of ADLs and unable to work at all.

Other Meds: Zyrtec, atorvastatin, amlodipine and valsartan

Current Illness: None

ID: 1825233
Sex: M
Age: 62
State: MI

Vax Date: 04/06/2021
Onset Date: 10/21/2021
Rec V Date: 10/28/2021
Hospital: Y

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

Lab Data: Recent Labs 10/20/21 1841 WBC 5.30 HGB 14.2 HCT 39.7* PLATELET 124* SODIUM 131* POTASSIUM 4.6 CHLORIDE 95* HCO3 25 CREATININE 1.13 BUN 22* GLUCOSE 113*

Allergies: No Known Drug Allergy

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: PLAN Acute respiratory failure with hypoxia COVID-19 pneumonia: - symptom onset: 10/06 - (+) COVID: 10/21 - fully vaccinated - CTA chest: No PE. Bilateral pneumonia, likely COVID. Chronic changes of sarcoidosis - started on decadron. Continue for 10 day course - Begin remdesivir. - if continues to have fever or worsening symptoms begin antibiotics for superimposed bacterial pneumonia - supportive measures, prone positioning - daily labs Sarcoidosis OSA on CPAP: - continue symbicort - continue combivent - on chronic steroids--hold for now while on decadron. - CPAP at HS Hyperlipidemia: - statin DVT prophylaxis: lovenox sq Code Status: Full code History obtained from patient, ED physician/records, and personally reviewed past medical records. History of Present Illness Patient is a 63 y.o. male who presents today with fatigue and shortness of breath. Patient has a history of sarcoidosis, OSA on CPAP, Hyperlipidemia. Per patient, about a week ago he began having fatigue, chills, shortness of breath and cough. It became much worse about 3-4 days ago and he thought that it was improving, however, he started having severe fatigue and shortness of breath and cough over the last 24-48 hours. He has had fever, chills, body aches. He has had diarrhea which is now seeming to improve, however, he has not been eating very much and trying to stay hydrated. He is fully vaccinated against COVID. He does not have any known sick contacts, however, he does have children who work in retail and feels he may have gotten something from 1 of them. In ED, patient was hypothermic in ED and placed on Bear Hugger. Temperatures improved. Found to be hypoxic to low 80s. Placed on HFNC. COVID positive. CTA chest shows covid pneumonia. Started on decadron

Other Meds: Outpatient Medications budesonide/formoterol (SYMBICORT) 160-4.5 MCG/ACT inhaler ipratropium-albuterol (COMBIVENT RESPIMAT) 20-100 MCG/ACT inhalation solution pravastatin (PRAVACHOL) 20 MG tablet predniSONE (DELTASONE) 5 MG tablet Respirato

Current Illness: Sarcoidosis

ID: 1825234
Sex: M
Age: 39
State: SC

Vax Date: 10/18/2021
Onset Date: 10/19/2021
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:

Allergies: None

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

Symptoms: Have had a mild to moderate headache that started just after 24 hours after 2nd shot. It has now lasted 10 days. Mornings are usually a little better, but head still feels cloudy. Over the counter pain relievers do not really help very much. Now have also had chest tightness for the last three days. I have no history of ever having headaches, maybe one per year previously.

Other Meds: None

Current Illness: None

ID: 1825235
Sex: F
Age: 57
State: FL

Vax Date: 09/22/2021
Onset Date: 09/22/2021
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: Primary doctor office had me get an ultrasound of thyroid to be sure thyroid was OK. I heard when I went back for follow-up that results of ultrasound were normal.

Allergies: Had allergic reaction to a flu shot on 11/06/2009.

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

Symptoms: My tongue tingled and burned after vaccine. Was recommended to take Benadryl. Also, the next day, noticed white vertical lines on tip of tongue that swelled. Went back to pharmacist. He saw swollen vertical lines on tongue. Emailed pics to doctor office. They called in steroids. Then, on 9/28/2021, throat started feeling weird like swollen and thought neck may be too so went back to pharmacist and an Urgent Care. Urgent care gave me a steroid injection as well. They suggested follow up with primary doctor.

Other Meds:

Current Illness:

ID: 1825236
Sex: F
Age: 27
State: KS

Vax Date: 10/19/2021
Onset Date: 10/21/2021
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: Blood was taken and I was sent to the hospital for a MRI on 10/27/21

Allergies: N/A

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Two days after getting the vaccine i became dizzy, confused, felt sedated, my vision was blurry and I started seeing black dots that looked like nats flying in front of my eyes. It is now over a week later and these symptoms are still happening.

Other Meds: Vyvanse for add

Current Illness: N/A

ID: 1825237
Sex: F
Age: 74
State: NC

Vax Date: 09/27/2021
Onset Date: 10/18/2021
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: No known

Symptom List: Pharyngeal swelling

Symptoms: I broke out in shingles, Herpes Zoster, with a rash across the right side of my chest and down my arm. I had never had a shingles outbreak before. I had also started losing hair about two weeks before and it continues. I saw my PCP who prescribed Valacyclovir 1 gram three times a day for one week. The sores have scabbed over and are starting to heal after one week on medication.

Other Meds: Valtrex 500 mg daily

Current Illness: None

ID: 1825238
Sex: M
Age: 88
State: NE

Vax Date: 03/05/2021
Onset Date: 10/27/2021
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: 10/26/2021 -SARS Coronavirus-2, PCR detected

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Pt was exposed to a COVID positive grandson, developed SOB and tested positive also. Admitted to the hospital 10/27/21

Other Meds:

Current Illness:

ID: 1825239
Sex: F
Age: 51
State: AZ

Vax Date: 04/24/2021
Onset Date: 04/24/2021
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: Kidney lab panel BUN, creatinine, globulin, EGFR - was 81 ml -min; globulin 3.6 g/gl; sodium 136.70

Allergies: TYLOX

Symptom List: Diarrhoea, Nasal congestion

Symptoms: On 04/24/2021, within one hour of the vaccination, I had a weird feeling on my right kidney area. A bubbly feeling, like a liquid bubbly feeling, a weird feeling, and ever since I been having pain in that area. I went to see my doctor twice in regards to the pain. The 1st time was in May and then in October. She ran some labs and my BUN, creatinine, globulin, those results were abnormal. I have never had any problems with those results before. They diagnosed me as dehydrated. They asked me if I was dehydrated. I drink about a gallon of water a day. When I went back this month they are saying it is muscle related. They want me to do Physical Therapy. I want them to watch my kidney closely. I do not want to be someone who needs a new kidney down the road. On 05/23/2021- I had my period. I bled for 5 days, I was supposed to be menopausal and this happened. I have been menopausal for like 2+ years.

Other Meds: Naproxen; FLEXERIL

Current Illness: No

ID: 1825240
Sex: F
Age: 38
State: CA

Vax Date: 08/25/2021
Onset Date: 09/05/2021
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: Very tired, high blood pressure, lost of feeling on right side of the body

Other Meds:

Current Illness:

ID: 1825241
Sex: F
Age: 65
State: IL

Vax Date: 10/09/2021
Onset Date: 10/14/2021
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: Mammogram and breast ultrasound done on Oct 26. ( Negative for cancer)

Allergies: None

Symptom List: Rash, Urticaria

Symptoms: 5 days after receiving COVID booster, inflammation of Left breast in me (65 year old woman) including redness, pain and swelling. 5 Days after symptoms developed, I was examined by Gynecologist and mastitis was diagnosed and treated with antibiotics.

Other Meds: Rosuvastatin, fish oil, multivitamins, Vitamin D 3

Current Illness: None

ID: 1825242
Sex: M
Age: 73
State: GA

Vax Date: 09/30/2021
Onset Date: 10/02/2021
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: NKDA

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

Symptoms: 2 days after the vaccine he started having a pretty intense headache up to 8/10 for about 2 weeks until a few days at which it started to improve and is now around a 2 on 10/15/2002. The headache was initially in the back of the head and down the neck, now is in the front of the head. Denies any other neurological symptoms, no blurry vision, no weakness, slurred speech, did have full body fatigue for 1 week post vaccine.

Other Meds: levothyroxine Plaquenil

Current Illness:

ID: 1825243
Sex: F
Age: 39
State: HI

Vax Date: 05/10/2021
Onset Date: 05/11/2021
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:

Allergies:

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

Symptoms: pt states she developed chills, fever, sore muscles along with loss of taste and smell. Fever and chills lasted about 48 hours but the sore muscles and loss of taste and smell lasted four weeks. Pt went to her clinic and she was treated with Tylenol. This seemed to help relieve her symptoms. Pt no longer has any symptoms other than a sore left arm.

Other Meds:

Current Illness:

ID: 1825244
Sex: M
Age:
State: IL

Vax Date:
Onset Date: 10/22/2021
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: 10/23/2021 - Covid-19 by NAAT - Positive 10/23/2021 - CT Head/Brain - No acute intracranial abnormality 10/23/2021 j- Chest X-ray - No acute cardiopulmonary disease

Allergies: No known allergies

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

Symptoms: Admitted to the hospital for left hand tingling, and neuropathy. Tested positive for Covid-19. Hospitalized from 10/23/21 - 10/25/2021.

Other Meds: Aspirin; Cetirizine; Clonidine; Cyclobenzaprine; Cymbalta; Docusate Sodium; Doxazosin; Enalapril; Furosemide; Gabapentin; Lidocaine Patch; Lipitor; Naproxen; Omeprazole; Ozempic; Quetiapine; Toprol-XL; Ventolin HFA

Current Illness:

ID: 1825245
Sex: F
Age: 89
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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies: None

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

Symptoms: Chills,extreme weakness, diarrhea , fever until 7 am 10/28/2021

Other Meds: Gabapentin,triamterene,temazapam,levothyrozine.carpidopa/levodopa

Current Illness: None

ID: 1825246
Sex: F
Age: 58
State: NJ

Vax Date: 09/18/2021
Onset Date: 09/19/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: I had a ultrasound and monogram.

Allergies: None.

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

Symptoms: After getting the booster shot I was extremely tired for a day. I start to experience pain in my arm pit and my breast area. It got worse in 48 hours. I could feel lumps near my breast area.

Other Meds: I take prescribed medication.

Current Illness: None.

ID: 1825247
Sex: F
Age: 42
State: TX

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

Allergies: none

Symptom List: Ear pain, Hypoaesthesia

Symptoms: arm pain, generalized muscle pain, nausea, vomiting, upset stomach, headache, fatigue, light sensitivity, fever, chills

Other Meds: Unithroid 75mcg once daily

Current Illness: none

ID: 1825248
Sex: M
Age: 60
State: NC

Vax Date: 04/28/2021
Onset Date: 10/18/2021
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: 21st COVID test, positive result, nasal swab, doctor's office

Allergies: No

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Head congestion with a cough and a low grade fever. I had some body aches. I took ibuprofen and Nyquil and some Benadryl. I also took, later on, oxymetazoline, for nasal decongestant. Good food/smoothies and vegetable soups. I am mostly recovered now. I still have a cough and am still in quarantine. I have some fatigue but that is improving Note: I had a flu vaccine, September 21st, I had that.

Other Meds: Lisinopril

Current Illness: No

ID: 1825250
Sex: M
Age: 76
State: MN

Vax Date: 02/16/2021
Onset Date: 10/26/2021
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: iodine-contrast dye

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

Symptoms: This patient is experiencing chills with sweating going in cycles. No coughing but does feel slightly short of breath. His wife was just diagnosed with Covid 19 yesterday. They have both been vaccinated.. symptoms starting 10/26/21

Other Meds: ?Metoprolol Succinate ER 25 MG Tablet Extended Release 24 Hour 1 tablet Oral Once a day ?Losartan Potassium 50 MG Tablet 1 tablet Orally Once a day ?Midodrine HCl 2.5 MG Tablet 1 tablet Orally once a day ?Clopidogrel Bisulfate 75 M

Current Illness: none

ID: 1825251
Sex: F
Age: 71
State: TX

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

Allergies:

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

Symptoms: Error: Incorrect Reconstitution-

Other Meds:

Current Illness:

ID: 1825252
Sex: F
Age: 71
State: TX

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:

Allergies:

Symptom List: Unevaluable event

Symptoms: Error: Incorrect Reconstitution-

Other Meds:

Current Illness:

ID: 1825253
Sex: F
Age: 34
State: NJ

Vax Date: 04/27/2021
Onset Date: 06/12/2021
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: Was not able to do any analysis because I didn't have the resources to do the analysis.

Allergies: Acetaminophen; Ibuprofen; Tramadol; Ketoprofen; Clindamycin

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

Symptoms: When I had both vaccine doses I had normal head pain discomfort associated general chest discomfort but pain on chest was very light and I thought it was something normal. I did not pay much attention and I took Naproxen and rested, but pain on chest was increasing to the point that on 10/19/21 I went to the medical since I was feeling fatigue because of the pain I felt shortness of breath and sever pain. I was referred to a Cardiologist assessment and analysis, but I have not been able to assume such cost for such evaluation. I visited my doctor to find out if it was an adverse effect I still have not been able to to analysis to find out any information

Other Meds: Etanercept

Current Illness: Asthma; Post-union headaches; Ankylosing spondylitis; Degenerative disc disease.

ID: 1825254
Sex: F
Age: 85
State: MN

Vax Date: 01/26/2021
Onset Date: 10/27/2021
Rec V Date: 10/28/2021
Hospital: Y

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

Lab Data: 10/25/2021- COVID positive

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: pt developed s/s of COVID and tested positive, was admitted to the hospital

Other Meds:

Current Illness:

ID: 1825255
Sex: F
Age: 85
State: IN

Vax Date: 10/20/2021
Onset Date: 10/23/2021
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: 10/27/2021 MD ordered CBC, CMP and Sedimentation Rate. 10/28/2021 Urine culture results in. No treatment at this time.

Allergies: None prior to vaccine

Symptom List: Injection site pain, Menorrhagia

Symptoms: 10/22/2021Elevated temp of 102.0 . Treated with Tylenol 500 mg. Effective. 10/25/2021 Scattered red rash noted on lower right extremity. Order received for Hydrocortisone cream 2.5% 2 times a day for 10 days. Effective. Benadryl Allergy Capsule 25 mg ordered this date. Effective. Seen by Nurse Practitioner. 10/27/2021 Physician in house visit. Resident complains of right neck, arm and right shoulder pain however is able to move extremity. MD note " Impression is reaction to COVID vaccine". Order received to start Prednisone 20 mg 1 tablet 2 times a day for three days.

Other Meds: Protein Powder, Cranberry Tablet, Metoprolol ER 25 mg, Risperd, Metoprolol Succinate ER Extended Release 25 mg, Cranberry Tablet, Active Protein Powder, Risperdal 0.5 mg, Vitamin D tablet, Dorzolamide HCL 2% 1 drop both eyes, Hydrcortisone

Current Illness: UTI

ID: 1825256
Sex: F
Age: 78
State: CT

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: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Error: Shoulder Joint Injury (prolonged pain, tingling, etc.)-

Other Meds:

Current Illness:

ID: 1825257
Sex: F
Age: 30
State: DC

Vax Date: 10/22/2021
Onset Date: 10/22/2021
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 work on 10/23/2021 came back normal.

Allergies: Amoxicillin

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Fatigue started at 7pm on 10/22/2021. Body aches, fever (102 degrees Fahrenheit), and nausea started at 9pm on 10/22/2021. At 10pm, intractable vomiting started until about 1am on 10/23/2021. Visited ER for intravenous Zofran and fluids. Subsequent migraine on 10/24/2021 and lingering nausea until 10/25/2021.

Other Meds: Birth control, 28-day pill pack

Current Illness: None

ID: 1825258
Sex: F
Age: 36
State: TN

Vax Date: 09/10/2021
Onset Date: 09/26/2021
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: Two positive urine cultures at local urgent care on 9/29/2021 and 10/9/2021.

Allergies: none

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: UTI symptoms began within 2 weeks of receiving 2nd dose. Went to a walk in clinic and received 5 days of Macrobid for positive urine culture, 3 days after finishing that course, went back to walk in with a raging UTI and severe pain. Then was given 5 days of Bactrim. After that course of antibiotics finished, the provider called and said my UTI was resistant to Bactrim and put me on 7 days of Macrobid. UTI symptoms continued for 3 weeks.

Other Meds: none

Current Illness: none

ID: 1825259
Sex: F
Age: 40
State: AZ

Vax Date: 03/26/2021
Onset Date: 03/26/2021
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: I avoid sulfa drugs because both of my parents are allergic to it.

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

Symptoms: I stood up after the vaccine and I was walking around the store and I had to sit down in the middle of an aisle because I got so dizzy, like the world was spinning and I couldn't see straight. For the rest of the day, I felt yucky and it lasted for 1 1/2- 2 hours and I had positional vertigo. The next morning I had a headache and body aches and I took some Aleve and I was fine by the time I went to bed that night. I also had a sore arm.

Other Meds: Birth control; Wellbutrin XL; Lexapro; Frova Migraine; albuterol inhaler; magnesium.

Current Illness: None

ID: 1825260
Sex: F
Age: 40
State: NY

Vax Date: 07/22/2021
Onset Date: 10/01/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: None

Allergies: Sulfa drugs, bacrim, tetracycline, amoxicillin, laytex

Symptom List: Nausea

Symptoms: I?ve been having weird sensations in my legs that has never happened before. Both legs get the sensation of being wet and cold without being wet or cold. It?s partially weird after having what may have shingles on my lower back. There?s no question in my mind that these symptoms are from t he vaccine. My period is also still messed up and I?m still getting bruising on my legs without having hurt myself. Once again , this has never happened to me with my cycle or bruising since I?ve been an adult. Please remember that death is not the only measure of safety for the Covid vaccine.

Other Meds: Lexapro 5mg, bupropion 300mg

Current Illness: Nome

ID: 1825261
Sex: F
Age: 52
State: CA

Vax Date: 04/30/2021
Onset Date: 08/01/2021
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: X rays, normal degenerative arthritis, MRI, normal degenerative arthritis

Allergies: Oral steroids; prednisone; diphenhydramine; azithromycin; latex; oranges & orange products; nightshade; sensitive to many foods; all furry animals

Symptom List: Injection site pain

Symptoms: I've been experiencing joint pain all over, especially in my spine and my hips. Mainly my neck and my lower back and right hip. I had x-rays done and an MRI of both my neck and lower back and I guess from what they said, it's normal degenerative arthritis. They put me through physical therapy to see if there was any change and there is no change. I'm not getting any better. As far as the aches and pains, the aches and pain seem to be getting a little worse. I don't know if it's attributed to age or if it's attributed to the vaccine. Age as in wear and tear. Comes in waves.

Other Meds: Green Tea

Current Illness: Gastrointestinal issues; esophagus was eroded at the time taking too many vitamins; did have a lot of nausea and vomiting between first and second dose of vaccine (don't think it was related to the vaccine but to issue listed above)

ID: 1825262
Sex: F
Age: 44
State: NC

Vax Date: 09/30/2021
Onset Date: 09/30/2021
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: Error: Shoulder Joint Injury (prolonged pain, tingling, etc.)-

Other Meds:

Current Illness:

ID: 1825263
Sex: F
Age: 81
State: WA

Vax Date: 10/22/2021
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: IM
Vax Site: RA

Lab Data: EKG abnormal, blood work abnormal

Allergies: Lovenox injectable

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

Symptoms: I woke up the morning after the vaccine with a sore arm. It also felt warm to the touch and was swollen. I had a low grade fever. I slept most of the day and felt as thought I was coming down with a cold. My chest also felt tight and I had a headache most of the day. They next day, I felt slightly better and my fever went down. I was still fatigued. About 3 days later I woke up so short of breath I could not breathe. I went to sit in my recliner and called my doctors office. I saw my doctors PA and she did some tests including an EKG and blood work. She wants to see me back next week. Nothing has been conclusive. However, whatever she prescribed me has helped me breathe better. The PA also wants me to follow up with my cardiologist.

Other Meds: Vitamin C; aspirin; atenolol; famotidine; hydrochlorothiazide; levothyroxine; losartan; multivitamin; vitamin D; hydroxyurea; loratadine; B complex

Current Illness: None

ID: 1825264
Sex: F
Age: 62
State: MD

Vax Date: 04/01/2021
Onset Date: 05/15/2021
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: Biopsy of the skin in multiple locations showed spongiotic dermatitis.

Allergies: IVP dye and a type of chemotherapy

Symptom List: Tremor

Symptoms: Roughly a month after getting her vaccine, she began having skin irritation that began to occur, sores broke out over her entire body and then would crust over, patient went to her PCP and got another opinion. After biopsy she was diagnosed with spongiotic dermatitis. She has not had any period of relief since the outbreak started. Has been taken off of the hydrochlorothiazide medication, currently seein dermatology specialist who is completing further tests on her.

Other Meds: hydrochlorothiazide 25 mg, metoprolol 100mg, potassium 10mg, atorvastatin 40mg, metformin 1000mg, lisinopril 10mg, aspirin 81mg, Dyloxetine hcl 60mg, farxiga 10mg

Current Illness:

ID: 1825266
Sex: F
Age: 40
State: AZ

Vax Date: 04/22/2021
Onset Date: 04/22/2021
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: I avoid sulfa drugs because both of my parents are allergic to it.

Symptom List: Erythema, Pruritus

Symptoms: I had told the nurse I was dizzy beforehand so she wanted me to sit there to keep an eye on me. I did get dizzy but not as bad as the first dose, but more of a light headed feeling versus everything moving around me, but it could be that I was sitting down and not standing. The light headedness stuck with me most of the day, and that afternoon about 3-4 PM my legs and arms were really achy and by the next morning when I woke up my whole body hurt and felt like I had a really bad flu. The blankets on my bed even hurt my legs so I took an Aleve again and it helped but I would say it didn't completely go away for another 24 hours. It wasn't until mid day Sunday I actually felt okay again. I could walk but my legs felt heavy. By the time I went to bed on Sunday it seemed okay, and on Monday morning they were fine. I did run a low grade fever around 100 starting 24 hours after vaccine, and that lasted for maybe 12 hours and I didn't have it by the time I went to bed that night.

Other Meds: Birth control, Wellbutrin 150 XL, Lexapro 10 mg, Frova Migraine medication 10 mg, Albuterol inhaler, Magnesium.

Current Illness: None

ID: 1825267
Sex: M
Age: 84
State: UT

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

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

Lab Data: extracranial study on 7/21/2021

Allergies: NONE

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

Symptoms: Patient suffered blood clots in carotid artery, weariness in the head. Surgery was performed to put stint in. Weariness went away.

Other Meds: ELIQUIS

Current Illness: NONE

ID: 1825268
Sex: M
Age: 43
State: CA

Vax Date: 03/05/2021
Onset Date: 08/15/2021
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: Blood test and Ultrasound tests, approximately August 15th.

Allergies: None

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

Symptoms: Multiple verified blood clots. Clots began in mid-August and are continuing. Currently three blood clots in the legs with no family or personal history of blood clots in an active person.

Other Meds: Centrum Multi-Vitamin Zyrtec

Current Illness: None

ID: 1825269
Sex: F
Age: 48
State: PA

Vax Date: 10/21/2021
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: IM
Vax Site: LA

Lab Data: Na

Allergies: Clarithromycin, erythromycin, novaCaine, prednisone

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Rash, torso front and back, Benadryl, ongoing, very itchy, hot

Other Meds: Altavera

Current Illness: None

ID: 1825270
Sex: M
Age: 72
State: FL

Vax Date: 09/22/2021
Onset Date: 10/03/2021
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: I have test taken on November 19th, 2021 but not related to the adverse condition - It was for routine blood work before seeing my Doctors next week.

Allergies: Insect bites.

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

Symptoms: For the past several weeks, my Blood Pressure has gone way up. My Doctor had me do blood test, it came back - good. It sometimes went to 167/101 extremely high and I feel flushed in my face all the time. I see my Doctor on November 2nd, 2021. Doctor just prescribed Hydroxzyzine HCL 25 mg today for the anxiety I am experiencing worrying about this medical condition of high blood pressure. I am not positive the problem I am experiencing is from the vaccinations (3) I received but it happened shortly afterwards. Was hospitalized one day in early march because my BP went so high.

Other Meds: Lisinopril 10 mg, Lovastatin 20 mg, Tamsulosin 0.4 mg. Sometimes Vitamin D3, Vitamin C, CoQ10

Current Illness: None

ID: 1825271
Sex: M
Age: 41
State: FL

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

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

Symptoms: injection site soreness chills body ache neck pain flushing headache weakness fatigue

Other Meds: vitamin D zinc

Current Illness:

ID: 1825272
Sex: F
Age: 86
State: CA

Vax Date: 10/18/2021
Onset Date: 10/20/2021
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: Cardio version chest xray 12 lead ecg

Allergies: Iodine Levaquin

Symptom List: Pain in extremity

Symptoms: Atrial fibrillation with cardioverson

Other Meds: atorvastatin 40 mg oral tablet digoxin 50 mcg/mL (0.05 mg/mL) oral elixir, 125 mcg= 2.5 mL, Oral, Daily Eliquis 2.5 mg oral tablet, 2.5 mg= 1 tab, Oral, BID furosemide 20 mg oral tablet levETIRAcetam 100 mg/mL oral solution lisinopril 2

Current Illness: Cardiomyopathy Chronic obstructive pulmonary disease CKD (chronic kidney disease) Depression Heart failure Methicillin resistant Staphylococcus aureus Non-Hodgkin lymphoma Peripheral vascular disease

ID: 1825273
Sex: F
Age: 60
State: AZ

Vax Date: 09/29/2021
Onset Date: 09/29/2021
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: Sensitivity to preservatives, flavor enhancers, stabilizers in fooods

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

Symptoms: Projectile Vomit within 8 to 10 hours after the shot. Sense of smell and taste distorted, everything smells and tastes like gasoline and produces more nausea. It has continued for a month now.

Other Meds: None

Current Illness: None

ID: 1825274
Sex: F
Age: 58
State: KY

Vax Date: 04/11/2021
Onset Date: 06/10/2021
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: So far no one has answers they seem to ignore it like it?s nothing but I know my body and it?s not normal at all. When one pustule disapates another one pops up !

Allergies: Bees

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

Symptoms: Anxiety is something I have never had and since the first of June 2021 I have had bad reaction with water pustules popping up under my skin on my hands and severe itching in those areas . I have never had this problem ever and the shit has done something to my skin.

Other Meds: Myrrh, vitamin C sleep aide, stay awake

Current Illness: No

ID: 1825275
Sex: M
Age: 28
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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: chills, fever (102.7 F), sweats, headache, lower back pain, muscle weakness, muscle fatigue

Other Meds: biotin, collagen, fish oil, multi-vitamin

Current Illness:

ID: 1825276
Sex: U
Age:
State: OK

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

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

Lab Data: was seen at the ER where labs and a head CT was done, the stroke was identified and he was transported where he was evaluated . he was then discharged to rehab for PT / OT at rehab

Allergies:

Symptom List: Vomiting

Symptoms: Patient had a Left cerebellar ischemic stroke from an acute stenosis of the PICA . no previous vascular history or embolic history

Other Meds:

Current Illness:

ID: 1825277
Sex: F
Age: 67
State: GA

Vax Date: 10/23/2021
Onset Date: 10/24/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data:

Allergies: Sulfa drugs

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Fever of 103 starting g at 4am the next day along with chills, shaking, headache, fatigue, nausea. Took motrin which helped bring fever down to 100-101 but fever returned all that day. The next morning (10/25), I had a fever of 101 with chills and headache. I stayed in bed those two days. By 10/26, I was better other than a sore and swollen arm. Arm is still slightly sore and itchy today 10/28

Other Meds: Wellbutrin Lipitor Xanax

Current Illness: UTI

ID: 1825278
Sex: M
Age: 47
State: SC

Vax Date: 09/17/2021
Onset Date: 09/21/2021
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: On 9/22 a heart MRI confirmed their suspicion of myocarditis and showed inflamation and scarring to my heart.

Allergies: None

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

Symptoms: On 9/21/2021, 4 days after receiving the shot I had chest pressure and pain. I went to the emergency room where my EKG showed abnormal and my Troponin levels were elevated. I was transported to a surgical hospital and spent 2 days there after being diagnosed with Myocarditis

Other Meds: Testosterone, probiotic, vitamin D, C, A, Zinc.

Current Illness: None

ID: 1825279
Sex: F
Age: 65
State: IN

Vax Date: 10/25/2021
Onset Date: 10/26/2021
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: Bacterium amoxicilin

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Fever, chills, headache, body aches.

Other Meds: Paxil Recuip Aspirin linsenprol atorvastatin

Current Illness: No

ID: 1825280
Sex: M
Age: 59
State: MA

Vax Date: 01/13/2021
Onset Date: 01/14/2021
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: RA

Lab Data:

Allergies:

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

Symptoms: He states he developed red itchy rash on bilateral inner thighs & right arm the day after he had Covid Vaccine #1. Vaccinated in Left arm. He has been using Cortisone Creme. Rash on right arm is now faint pink & the rash on inner thighs is improving. He stated that he "Self reported" to the CDC, Pfiser & contacted his PCP.

Other Meds:

Current Illness:

ID: 1825281
Sex: F
Age: 73
State: MO

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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: Physical examination on 10/14/21. As patient had recovered further testing not deemed necessary

Allergies: NKDA

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

Symptoms: Booster 10/12 at about 3 pm. Just had some arm soreness that evening. She was restless going to sleep. She woke up about 3 am with chills, diaphoresis, headache and tinnitus, and passed out--ended up on the floor. She woke up at 0630 with nausea, dry heaves, watery diarrhea. She felt "crappy:" the rest of the day with a "low grade headache". She noted that there were things moved around in her bathroom and realized that she must have been disoriented during the middle of the night. She has a scratch on her ankle and nose and a knot on her head. She was able to shower later in the morning and didn't eat anything other than crackers yesterday due to nausea. She had water. She feels better today. Not taking aspirin.

Other Meds: rosuvastatin, vitamin D3, propranolol, cetirizine, fluticasone spray, lisinopril-HCTZ

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am