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: 1825336
Sex: F
Age: 68
State: NY

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: None yet.

Allergies: Codeine

Symptom List: Dysphagia, Epiglottitis

Symptoms: Headache, chills, body aches, fever 100.4, nausea. Symptoms lasted 30 hours. Nausea and inability to eat lasted 3 days. Patient suffered similar effects after second dose. Third dose was a half dose but caused worse side effects.

Other Meds: Calcium, vitamin D, Lutein

Current Illness: None

ID: 1825337
Sex: M
Age: 57
State: MA

Vax Date: 10/10/2021
Onset Date: 10/13/2021
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: Gatifloxacin

Symptom List: Anxiety, Dyspnoea

Symptoms: Right shoulder sore post 2 weeks vaccine date About 3-4 days post vaccine, an area on lower left leg right above the ankle developed what appeared to be areas of blood vessel bursts under the skin - 5 circular areas developed, the largest was 1/2 inch across. Spots did not blemish when pressed, meaning, there was no change in color when pressed upon. 2 Physicians inspected area and collaborated and stated they didn't know what it was. I was given a topical steroid cream and told to return in two weeks if it became worse. I did not use cream and areas cleared but left a blemish under the skin at 2 weeks post vaccine.

Other Meds: Entresto 49/51 2 X Daily Sotalol 80 2 X Daily Xarelto 20 1PD

Current Illness: None

ID: 1825338
Sex: M
Age: 56
State: GA

Vax Date: 05/20/2021
Onset Date: 05/20/2021
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: Cryropractor not sure of the date probably in July at least a month after the second shot. Results neck pain gone and he did not find anything wrong with my shoulders.

Allergies: Lactose Intenerate, Percocet

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

Symptoms: Tylenol and Extra Strength Excedrin for headache that lasted 8 to 10 weeks. No longer have continuous headaches. Fatigue, Muscle aches, Shoulders are killing me because of no strength, Cramps, Numbness and Tingling of Arms and Legs are all still ongoing today 10/28/2021

Other Meds: Tylenol, Extra Strength Excedrin

Current Illness: none

ID: 1825339
Sex: F
Age: 54
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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data: None

Allergies: Penicillin, compazine, phenegren, codeine, sulfa,

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Severe nausea and vomiting, severe headache, tiredness, and chills

Other Meds: Low dose aspirin, cinnamon and multivitamins

Current Illness: None

Date Died: 10/27/2021

ID: 1825340
Sex: F
Age: 64
State: FL

Vax Date: 12/29/2020
Onset Date: 10/10/2021
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:

Allergies:

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

Symptoms: Case of a 65 years old female with past medical history of high blood pressure, HFrEF, COPD, CAD with CABG x 5 and hyperlipidemia presents to the ED due to complaints of shortness of breath, On EMS arrival patient was found in the 70s O2 room air, given breathing treatments during route to the ED, she is vaccinated against covid. She has been exposed to family members at home. Denies any hx of diarrheas, abdominal pain, headache, fever or other associated symptoms. Urine and bowel pattern within normal limits, patient is also aware that she has a mass in her lung and she has been unable to have a CT, since she has been denies twice by her insurance. Patient is independent ADLs and instrumental ADLs. Denies any toxic habits/ former smoker On admission: ProBNP is 29783. Her creatinine is noted to be 5.2. Previous creatinine from September of 2021 was 2.4. EKG shows sinus rhythm at 73 beats per minute with incomplete right bundle-branch block. XR Chest 1V 1. Focal masslike opacity in the left midlung. This may reflect a well-defined focus of consolidation or pneumonia however a mass is not ruled out. Further characterization with CT chest recommended. 2. Left basilar infiltrates and adjacent mild left-sided effusion. 3. Background of COPD and scattered fine reticular opacities suspected chronic. Tested + COVID 10/10/2021 1256

Other Meds:

Current Illness:

ID: 1825341
Sex: F
Age: 77
State: MN

Vax Date: 03/13/2021
Onset Date: 10/27/2021
Rec V Date: 10/28/2021
Hospital: Y

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:

Allergies:

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

Symptoms: Vaccine breakthrough, inpatient admit to a general medical floor

Other Meds:

Current Illness:

ID: 1825342
Sex: F
Age: 40
State: TX

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: LA

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Woke up at 4am feeling nauseous after taking the vaccine at 4:45 pm the day prior. Lack of appetite, body aches, chills in the morning and nausea. At around noon, I started feeling very nauseous and my ear started ringing, I had shortness of breath, and thought I was going to pass out. My heart was racing My legs were pumping and I laid down on my back. The feelings dissipated shortly. Then, at 8pm, all symptoms disappeared and i felt 100%

Other Meds: Thyroid medication, oxybutin

Current Illness: None

ID: 1825343
Sex: F
Age: 60
State: IL

Vax Date: 04/20/2021
Onset Date: 04/21/2021
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: Tdap vaccine

Symptom List: Pharyngeal swelling

Symptoms: Fever and covid arm for five day post second covid vaccine. Started the day after vaccine. Two weeks later developed a rash at the injection site that lasted a week

Other Meds: Premarin cream, Atorvastatin , multivitamin, magnesium, Calcium w/ vit d, Omega 3

Current Illness: none

ID: 1825344
Sex: F
Age: 48
State: DC

Vax Date: 09/27/2021
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: None, resolved at time of visit.

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: At dose#2 visit patient reported facial redness and peeling for 1 week onset 72 hours after Pfizer dose#1. She denied symptoms of severe allergy including urticaria or other rash, angioedema, throat swelling, respiratory symptoms, presyncope. Rash resolved with antihistamines after 1 week.

Other Meds:

Current Illness:

ID: 1825345
Sex: M
Age: 65
State: MI

Vax Date: 03/22/2021
Onset Date: 10/18/2021
Rec V Date: 10/28/2021
Hospital: Y

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

Lab Data: Lab Results: Other Chemistry: 18-Oct-21 21:32, Chemistry 14 Profile Estimated GFR African American 53.92 [60.00 - 130. ml/ min] Estimated Glomerular Filtration Rate 44.56 [60.00 - 130. ml/ min] Estimated GFR Value <60 ml/min/1.73 sq meters is indicative of chronic kidney disease <15 ml/min/1.73 sq meters is indicative of kidney failure The Estimated GFR is calculated by the four variable MDRD equation. Limitations of this calculation include: Decreased accuracy for values >60 Decreased accuracy in the hospitalized/severely ill patient populations Disregard EGFR values for infants and children (should not be applied to this age group) 18-Oct-21 21:32, Magnesium Level, Serum Magnesium Level, Serum 1.8 [1.6 - 2.6 mg/dL] 18-Oct-21 21:32, Troponin I Troponin I <0.01 [0.00 - 0.03 ng/mL] Normal: <= 0.03 ng/mL Indeterminate: 0.04-0.29 ng/mL Suggestive of Myocardial Damage: >= 0.30 ng/mL CBC-Differential-Morphology: 18-Oct-21 21:32, CBC White Blood Cell Count 7.8 [4.5 - 11.0 K/cmm] Red Blood Cell Count 4.58 [3.90 - 5.60 M/cmm] Hemoglobin 14.5 [12.0 - 17.3 g/dL] Hematocrit 43.0 [36.0 - 53.0 %] Mean Corpuscular Volume 93.9 [80.0 - 100.0 fl] Mean Corpuscular Hemoglobin 31.7 [26.0 - 34.0 PG] Mean Corpuscular Hemoglobin Concn 33.8 [31.0 - 37.0 %] Red Cell Distribution Width 13.6 [11.5 - 14.5 %] *Platelet Count 138 [140 - 440 K/cmm] Mean Platelet Volume 7.8 [7.4 - 10.4 FL] Automated Neutrophils % 86 [ %] Automated Lymphocytes % 8 [ %] Automated Monocytes % 6 [ %] Automated Eosinophils % 0 [ %] Automated Basophils % 0 [ %] Absolute Neutrophil Count 6.7 [1.0 - 8.0 K/cmm] Absolute Lymphocyte Count 0.6 [1.0 - 5.0 K/cmm] Absolute Monocyte Count 0.4 [0.1 - 0.8 K/cmm] Chemistry Panels & Profiles: 18-Oct-21 21:32, Chemistry 14 Profile Sodium Level, Serum 138 [136 - 144 mmol/L] Potassium Level, Serum 4.0 [3.6 - 5.1 mmol/L] Chloride Level, Serum 101 [101 - 111 mmol/L] Total Carbon Dioxide, Serum 24 [20 - 30 mmol/L] Blood Urea Nitrogen, Serum 33 [8 - 26 mg/dL] Creatinine Level, Serum 1.57 [0.61 - 1.24 mg/dL] Anion Gap 13 [8 - 16 mmol/L] Glucose, Serum 123 [70 - 99 mg/dL] The above reference range for glucose is appropriate for the fasting state. For random specimens, values up to 140 mg/dL are considered normal. Calcium Level, Serum 9.3 [8.4 - 10.2 mg/dL] Albumin Level, Serum 4.0 [3.5 - 5.0 g/dL] Phosphorus Level, Serum 2.1 [2.3 - 4.7 mg/dL] Bilirubin, Total 0.6 [0.3 - 1.0 mg/dL] Protein Total Level, Serum 7.7 [6.5 - 8.1 g/dL] Aspartate Aminotransferase (SGOT) 26 [15 - 41 U/L] Alanine Aminotransferase (SGPT) 16 [17 - 63 U/L] Alkaline Phosphatase, Serum 73 [41 - 150 U/L] Lactic Dehydrogenase (LDH), Serum 235 [125 - 220 IU/L] Routine Urinalysis: 18-Oct-21 21:32, Urinalysis Color YELLOW [YELLOW] Clarity, Urine CLEAR [CLEAR] Specific Gravity, Urinalysis 1.025 [1.005 - 1.03 SGU] *Ph, Urine 5.0 [5.0 - 8.0 ph units] Protein, Urinalysis 1+(30) [NEGATIVE mg/dL] Glucose, Urinalysis NEGATIVE [NEGATIVE mg/dL] Ketones, Urine TRACE

Allergies: No known allergies

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Syncope, dizziness,

Other Meds: unknown

Current Illness: unknown

ID: 1825346
Sex: F
Age: 65
State: NY

Vax Date: 10/26/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies: macrolides, cipro and moxifloxacin

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

Symptoms: Patient couldn't move her arm after the flu shot on Tuesday 10/26/2021 at 1:20pm. Today is Thursday 10/28/2021 9:15am, her left arm is still hurting and can't move or pick up items with her left arm. I informed the patient to visit her primary doctor to discuss further in regards to her symptoms. My upper management will contact her tomorrow 10/29/2021 for follow up on her doctor visit today.

Other Meds: n/a

Current Illness: n/a

ID: 1825348
Sex: F
Age: 65
State: MD

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: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Swollen lymph node under arm, severe headaches, and arm pain since vaccine

Other Meds:

Current Illness:

ID: 1825349
Sex: M
Age: 84
State: FL

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

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

Lab Data:

Allergies: None

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

Symptoms: Severe swelling and in left shoulder. Limited mobility in arm. Cannot move arm with being in pain.

Other Meds: Warfin, Altez, Crestor, Metropolo, Water pill

Current Illness: None

ID: 1825350
Sex: F
Age: 68
State: NJ

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: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: NKDA

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

Symptoms: Pt received vaccine on 10/25/21. Went to hosp on 10/26; c/o painful arm/ couldn/t move/ thought arm was out of socket. Was sent home from hosp, told to take APAP. Pt reported being fine next day.

Other Meds: none on file

Current Illness: none reported

ID: 1825351
Sex: F
Age: 38
State: IN

Vax Date: 09/20/2021
Onset Date: 09/27/2021
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: Holter monitor 10/07/21-10/14/21 EKG 10/01/21 Echocardiogram 10/18/21 Blood work 10/01/21

Allergies: None

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

Symptoms: Sudden onset of tachycardia and heart dysrhythmias. On or around Monday September 27th while lying in bed I felt my heart skip a beat and then has some tachycardia. On Friday October 1st while driving my heart again went into tachycardia and I was seen in the ER and upon arrival my heart rate was 172 and my BP was elevated and I was told by the ER staff that they believed I had a run of SVT. Had another episode on 10/08/21, 10/09/21 and 10/21/21. I made an appointment with a cardiologist and he has diagnosed it as AV nodal re-entry tachycardia or PSVT.

Other Meds: Nitrofurantoin Mono/Mac 100 mg Caps

Current Illness: UTI

ID: 1825352
Sex: M
Age: 24
State: ND

Vax Date: 09/22/2021
Onset Date: 09/22/2021
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: Unknown

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

Symptoms: No adverse events occurred after expired vaccine was administered.

Other Meds: Unknown

Current Illness: Unknown

ID: 1825353
Sex: M
Age: 47
State: NJ

Vax Date: 04/02/2021
Onset Date: 10/27/2021
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: SARS-CoV-2 Antigen and PCR (+) 10/28 SARS-CoV-2 IgM 0.11, and IgG 0.04 on 10/28/2021

Allergies: NKDA

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

Symptoms: Admitted to ED with complaints of chest pain x 2-3 days. Admitted for evaluation and subsequently found to have SARS-CoV-2 Antigen +, followed by PCR positive.

Other Meds: No medications

Current Illness:

ID: 1825355
Sex: M
Age: 70
State: NC

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

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

Lab Data: Normal CBC, CMP (other than mild BUN/Creatinine elevations), TSH, CRP.

Allergies: penicillin, Armour thyroid

Symptom List: Ear pain, Hypoaesthesia

Symptoms: The day after vaccination the patient had onset of dense fatigue. This symptom has been accompanied by headaches, hoarseness, increased neuropathic pain, orthostatic dizziness. These symptoms have now persisted for one month without significant improvement. He had similar symptoms after Pfizer COVID vaccine #2 which persisted for about 4 weeks prior to starting to improve but which lasted for about 3 months total. He brought this to my attention at office visit on 10/27 as his symptoms had not begun to improve.

Other Meds: oxycodone-APAP, tizanidine, levothyroxine, ibuprofen, gabapentin, dutasteride, duloxetine, doxepin, Adderall, vitamin D, biotin, B complex, Vitamin C, zinc, turmeric, magnesium, lutein-zeaxanthin

Current Illness: No acute illness.

ID: 1825357
Sex: M
Age: 54
State: ND

Vax Date: 09/22/2021
Onset Date: 09/22/2021
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: None.

Allergies: Unknown

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: No adverse events occurred after expired vaccine was administered.

Other Meds: Unknown

Current Illness: Unknown

ID: 1825358
Sex: M
Age: 92
State: NJ

Vax Date: 10/19/2021
Onset Date: 10/23/2021
Rec V Date: 10/28/2021
Hospital: Y

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

Lab Data: +PCR and + Antigen 10/23 +PCR and + Antigen 10/27 Labs stable including hemoglobin. Abdominal imaging did not show any acute abdominal process to correlate with rectal bleeding

Allergies: Unknown

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

Symptoms: I am the epidemiologist reporting on behalf of 92-year-old male patient. The patient received two doses of the Pfizer vaccine on 03/16/21 and 04/06/21. The patient received their third dose of the Pfizer vaccine on 10/19/21. On 10/23/21 (four days post dose 3), the patient tested positive for COVID-19 via PCR and rapid test after being admitted to hospital for rectal bleeding. On 10/23, reports from physician state that ?he has been feeling lethargic and weak since with occasional diarrhea and more recently rectal bleeding for which she came to hospital for further evaluation. He is afebrile here in the hospital but he has been breathing well on room air. Despite rectal bleeding, labs are stable including hemoglobin. Abdominal imaging did not show any acute abdominal process to correlate with rectal bleeding. Surveillance Covid testing was done that came back positive, chest x-ray was done that did not show any acute process or pneumonia.? Patient was discharged on 10/25/21. On 10/27/21 (eight days post dose 3), the patient tested positive again for COVID-19 via PCR and rapid test.

Other Meds: Unknown

Current Illness: Unknown

ID: 1825359
Sex: M
Age: 57
State: ID

Vax Date: 03/16/2021
Onset Date: 03/23/2021
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: TROPONIN - X2 2019 NOVEL CORONAVIRUS SARS-COV-2 BY PCR

Allergies: VANCOMYCIN, METFORMIN, DICLOFENAC SODIUM

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

Symptoms: CHEST PAIN, SHORT OF BREATH, OVERALL FELT VERY UNWELL. I WOKE UP AT 1AM FEELING THIS WAY, IT PROGRESSED THROUGH THE MORNING. FINALLY I WAS SCARED ENOUGH TO GO TO THE EMERGENCY DESPITE THE COVID RISK. AT THE HOSPITAL THEY DID AN EKG, TOOK LABS, AND DID A COVID TEST. THEY PERFORMED 2 TRONPONIN TESTS TO INSURE THAT I HAD NOT HAD A HEART ATTACK. BOTH TESTS WERE NORMAL. COVID CAME BACK NEGATIVE. THE EMERGENCY ROOM NEVER CAME TO A DEFINITIVE DIAGNOSIS BUT SUGGESTED MY COVID VACCINATION MAY HAVE CAUSED THIS.

Other Meds: SPIRONOLACTONE, WARFFARIN, OMEPRAZOLE, GABAPENTIN, DILTAZEM, DOFETILIDE, LOSARTAN, ZINC GLUCONATE, VITAMIN D3, MAGNESIUM OXIDE, VITAMIN B12, MULTI-VITAMIN

Current Illness: NONE

ID: 1825360
Sex: F
Age: 25
State: FL

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: Ibuprofren, penicillin, amoxicillin, vancomycin

Symptom List: Unevaluable event

Symptoms: Itching, rash

Other Meds: Birth control

Current Illness: N/A

ID: 1825361
Sex: M
Age: 64
State: VA

Vax Date: 10/21/2021
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:

Allergies: None

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

Symptoms: Within 20 hours of receiving my second vaccine, I experienced fatigue, chills, and body aches. Slightly more than 24 hours later, my temperature rose to 100.3 and remained that high for the next ten hours. Approximately 60 hours after receiving the vaccine, I developed a sore throat, which turned into draining sinuses, and then a cough. The cough becomes pronounced at times and continues (as well as the sinus drainage) now one week after vaccination and 5 days after onset of first symptom. Interestingly, sinuses and expectorant from cough is CLEAR. There is no sign of infection, only symptoms.

Other Meds: Lisinopril 10mg Rosuvastatin Vitamins C & D, calcium, magnesium, zinc turmeric, Centrum Silver multi-vitamin

Current Illness: None

ID: 1825362
Sex: F
Age: 36
State: ND

Vax Date: 09/22/2021
Onset Date: 09/22/2021
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: None.

Allergies: unknown

Symptom List: Injection site pain, Pain

Symptoms: No adverse events occurred after expired vaccine was administered.

Other Meds: unknown

Current Illness: unknown

ID: 1825363
Sex: M
Age: 60
State: SC

Vax Date: 09/28/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Bad Headache/Lesions on the roof of mouth/Red rash upper body and shoulders/

Other Meds:

Current Illness:

ID: 1825364
Sex: F
Age: 36
State: VT

Vax Date: 12/28/2020
Onset Date: 12/29/2020
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: none

Allergies: none

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

Symptoms: - Previously reported changes in mensural cycle Intermittent arm pain at injection site. On and off arm feels like it did the day after the initial shot. Sore with muscle pain at that site. Happens at least weekly if not daily. Uncomfortable to move arm too much - uncomfortable when using arm, even when only using arm for typing on a keyboard. Tylenol helps some.

Other Meds: Prozac, Wellbutrin

Current Illness: none

ID: 1825365
Sex: F
Age: 22
State: TX

Vax Date: 05/06/2021
Onset Date: 06/03/2021
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: ER visit 09/14 pneumonia Follow with another ER Costochondritis perachondritis More labs more X-rays more CT bilateral pleural effusions with associated minimal posterior atelectasis bilaterally.

Allergies: Peanut

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Shortness of breath Rapid heart rate

Other Meds: None

Current Illness: None

ID: 1825366
Sex: M
Age: 60
State: ND

Vax Date: 09/22/2021
Onset Date: 09/22/2021
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: None

Allergies: unknown

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: No adverse events occurred after expired vaccine was administered.

Other Meds: unknown

Current Illness: unknown

ID: 1825367
Sex: U
Age: 77
State: TN

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

Lab Data:

Allergies:

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

Symptoms: Developed swelling in upper lip.

Other Meds:

Current Illness:

ID: 1825368
Sex: M
Age: 26
State: NJ

Vax Date: 09/14/2021
Onset Date: 09/15/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: I had an: Chest Xray EKG Echo All to make sure my heart was not effected.

Allergies: Shellfish

Symptom List: Nausea

Symptoms: Costocondritis is what my doctor has diagnosed me with. My chest is difficult to breath, move, and participate in every day activities. IT effects my mental health alot because my chest has not been okay since I have received the vaccine. It has now been around 6-7 weeks and it is still very present in my chest.

Other Meds: None

Current Illness: none

ID: 1825369
Sex: F
Age: 28
State: CA

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:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data: N/A

Allergies: Seasonal allergies, various minor food allergies, previous allergic reaction to prick based allergy testing (pressure based allergy?)

Symptom List: Injection site pain

Symptoms: Between 12-24 hours after receiving the Pfizer covid 19 booster shot, I woke up with a swollen arm pit under my left arm, soreness at the injection site, general soreness in my back, and fatigue. My arm pit is still tender to the touch and sore.

Other Meds: N/A

Current Illness: N/A

ID: 1825370
Sex: F
Age: 78
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: N/A

Allergies: Norco

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

Symptoms: Pt. states that after receiving the 3rd Booster of Moderna 10/26/2021, started experiencing symptoms 10/27/2021 of chills and fatigue lasting 24hrs. No noted Primary visit/communications. Symptoms have subsided.

Other Meds: Motoperol, Zanex

Current Illness: N/A

ID: 1825371
Sex: M
Age: 70
State: MN

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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Unknown

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

Symptoms: One of my nurses drew up the syringe with the vaccine that she mixed. After the administration, was noted that she did not add the appropriate amount of diluent. I did not catch the error until after the shot was given.

Other Meds: Unknown

Current Illness: None

ID: 1825372
Sex: M
Age: 57
State: ND

Vax Date: 09/22/2021
Onset Date: 09/22/2021
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: None.

Allergies: Unknown

Symptom List: Tremor

Symptoms: No adverse events occurred after expired vaccine was administered.

Other Meds: Unknown

Current Illness: Unknown

ID: 1825373
Sex: F
Age: 34
State: VA

Vax Date: 08/04/2021
Onset Date: 08/27/2021
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: On 10/26, I got an EMG. Doctor stated no nerve damage was observed.

Allergies: None

Symptom List: Erythema, Pruritus

Symptoms: I received my first Pfizer COVID shot on 8/4/21. About 24 hours after getting the vaccine my lips went numb and tingly. My entire mouth, tongue, and fingertips followed soon after. On the evening of 8/5, I went to an ER and they stated it was from the vaccine and symptoms should subside. Tingling and numbness lasted in my lips and finger tips the longest. As of today, symptoms are mostly gone. On 8/27, I received my second dose. This dose did not seem to impact the numbness or tingling.

Other Meds: Oral birth control and multivitamins

Current Illness: None

ID: 1825374
Sex: F
Age: 53
State: FL

Vax Date: 10/22/2021
Onset Date: 10/22/2021
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: NA

Allergies: NA

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

Symptoms: Caused significant flare up of bi-polar symptoms beginning with my version of mania, which is rage (lasting for two days). Followed by a major depressed episode that has lasted almost a week (still in it). Swelling, redness and soreness at injection site.

Other Meds: Biotin, Vitamin C, Biotin, Calcium Citrate, Gabapentin, Gastri Bypass Multi-Vitamin, Iron, Lamictal, Magnesium, Melatonin, Methyl Folate, Seroquel, Super B Complex, Topamax, Valocyclovry, Vitamin D3, Wellbutrin XL

Current Illness: NA

ID: 1825375
Sex: F
Age: 87
State: NJ

Vax Date: 09/15/2021
Onset Date: 10/10/2021
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: US conducted on 10/10/21 in the HMC ED confirmed the presence of a LLE DVT.

Allergies: Asparagus allergy- reaction unknown

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

Symptoms: Patient received Moderna third dose vaccine on 9/15/21, reported leg pain and swelling on 10/10/21. The patient went to ED and confirmed via US DVT of the left lower extremity. She is currently taking Eliquis DVT dosing and following up with cardiology appropriately.

Other Meds: Myrbetriq, Qvar Inhaler

Current Illness: N/A

ID: 1825376
Sex: F
Age: 12
State: IA

Vax Date: 10/19/2021
Onset Date: 10/01/2021
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: Vials of Pfizer COVID vaccine were stored in the refrigerator with a use-date expiration on 10/19 at 1:30pm. On 10/19, approximately 1 hour after this, the patient was given their first dose of COVID vaccine with this vaccine. No harm detected.

Other Meds:

Current Illness:

ID: 1825377
Sex: M
Age: 67
State: TX

Vax Date: 03/31/2021
Onset Date: 03/31/2021
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: NKA

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

Symptoms: CLIENT RECEIVED FIRST PFIZER VACCINE 3/16/2021 RECEIVED SECOND DOSE TOO EARLY ON 3/31/2021

Other Meds: NOT REPORTED

Current Illness: NOT REPORTED

ID: 1825378
Sex: M
Age: 58
State: ID

Vax Date: 10/21/2021
Onset Date: 10/21/2021
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: NONE

Allergies: VANCOMYCIN, METFORMIN, DICLOFENAC SODIUM

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

Symptoms: I RECEIVED THE VACCINATION AT 11:00 AM. BY 5:00 PM I WAS SO TIRED I COULD NOT STAY AWAKE. I USED THE TOILET AND FELL ASLEEP ON THE TOILET. THE NEXT MORNING I ATTEMPTED TO WORK (I WORK FROM HOME) AND I WAS SO TIRED I WOULD FALL ASLEEP DURING ZOOM CALLS. ON SATURDAY MORNING I WOKE UP FEELING VERY MISERABLE. ALL OF MY LARGE MUSCLES HURT, I FELT LIKE I HAD BEEN RUN OVER BY A TRUCK. THIS GRADUALLY STARTED GETTING BETTER. BY 3:00 PM THE MUSCLE ACHES AND SLEEPINESS WERE GONE.

Other Meds: SPIRONOLACTONE, WARFFARIN, OMEPRAZOLE, GABAPENTIN,

Current Illness: NONE

ID: 1825379
Sex: M
Age: 14
State: IA

Vax Date: 10/19/2021
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: LA

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: Vials of Pfizer COVID vaccine were stored in the refrigerator with a use-date expiration on 10/19 at 1:30pm. On 10/19, approximately 2 hours after this, the patient was given their first dose of COVID vaccine with this vial. No harm detected.

Other Meds:

Current Illness:

ID: 1825380
Sex: F
Age: 58
State: VA

Vax Date: 09/24/2021
Onset Date: 09/28/2021
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: not yet

Allergies: Pork

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

Symptoms: First covid vaccine, standard Side effects (headache, fatigue, worsening of muscle aches and pains, rash), second vaccine (same side effects, may better tolerated although I started a RA flare shortly afterwards and eventually had to start low dose presdnisone). Booster shot, --covid #3, tolerated fine at first, although at this time was on prednisone for RA flare, that had greatly improved. 4 days later while at home, no stress went outside to garden (nice weather) walked back into house, and instantly started sweated and felt extreme tireness, lightheadness and got extreme heart palpitations. since I was alone I called my husband and told hime my heart was pounding so hard I thought it was going to come out of my chest. I do not have cardiac problems. I took my BP, it was normal, my HR was 157. I relaxed and stayed calm and repeated my BP and HR every 15 mins as we monitored it. After 1 hour the Hr went down to 92. I thought maybe I was have a hot flash and almost went to ER. but things calmed down. I had another episode of heart rate resting up to 122 a few days later, since my RA got worse again after the 3rd shot, I had to bump up prednisone. I see DR next week. I have not had an issue since and as of today, by RA flare seems to be better. I will be f/u wit dr soon

Other Meds: Naprosyn as needed, prednisone low dose, Enbrel

Current Illness: Rheumatoid Arthritis, doing well. Was in Remission until starting series of covid vaccines in March 2021.

ID: 1825381
Sex: F
Age: 45
State: WV

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

Lab Data: No tests, went to PCP and he referred me to Neurology. Unfortunately long waiting list to get it. Appointment isn't until January 6th.

Allergies: prior reaction to flu and tetanus vaccine (similar symptoms) , otherwise no allergies

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

Symptoms: The morning of the 14th woke up with numbness/tingling in feet with pain in legs, 15th tingling started in lower legs with same pain in legs, 16th tingling all the way up thighs and in hands, had palpitations numerous times through the day, felt like I was going to pass out several times, even while sitting, legs felt very fatigued 17th palpitations went away, but all other symptoms remained the same for several days. When walking up stairs, legs felt very fatigued and I would get burning in the muscles to the point I could only climb 1 flight of stairs before having to rest my legs. Tingling in my hands went away around the 25th. Tingling in upper legs went away around the same time, but the tingling in the feet and lower legs is still present today. Fatigue/weakness in legs improving. Now able to climb 2 flights of stairs with only minimal fatigue, no more burning in the muscles.

Other Meds: Calcium, Vitamin D, Vitamin A, B complex, Collagen, zinc

Current Illness: none

ID: 1825382
Sex: F
Age: 53
State: FL

Vax Date: 06/17/2021
Onset Date: 06/18/2021
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: I had an MRI on October 1st and the radiologist report said I had Tendonitis at the injection site and in my left shoulder, and also said I had a tear. I then scheduled an appointment with a specialist, and while he confirmed I did have Tendonitis, he said i did not have a tear in my shoulder. He also confirmed that I do not have range of motion in my left arm.

Allergies: None

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

Symptoms: I have chronic pain in my left arm at the vaccine site. This pain started within 24 hours and has gotten worse with time. I have a mild constant headache in my arm, and when I do certain movements, the pain is so severe, it takes my breath away. The best way to describe it is like a labor contraction that I breathe through for anywhere from 30 seconds to a minute and the excruciating pain subsides until the next time. Just this past week, I was taking stairs down and I happen to step down hard with my left foot, and although I felt absolutely no pain in my foot or my leg, the pain piercing in my shoulder was so so severe, I had to stop and sit down and take deep breathes until it passed. This has been going on since June 18th, so over 4 months. I have never experienced any kind of chronic pain in my life. This has been debilitating, I can't shower, wash my hair, get dressed, open a car door, drive, or sleep through the night without pain.

Other Meds: None

Current Illness: None

ID: 1825383
Sex: F
Age: 13
State: IA

Vax Date: 10/19/2021
Onset Date: 10/01/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: Vials of Pfizer COVID vaccine were stored in the refrigerator with a use-date expiration on 10/19 at 1:30pm. On 10/19, approximately 2 hours after this, the patient was given their first dose of COVID vaccine with this vial. No harm detected.

Other Meds:

Current Illness:

ID: 1825384
Sex: M
Age: 17
State: IA

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: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Pt was 17 and given Moderna... will turn 18 in one month

Other Meds:

Current Illness:

ID: 1825385
Sex: M
Age: 38
State: LA

Vax Date: 04/22/2021
Onset Date: 07/17/2021
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: Echocardiogram, CT scan

Allergies: none known

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

Symptoms: Atrial fibrillation resulting in emergency room visit and hospital stay. Lost consciousness for brief period due to onset of AFib. Treated with beta blockers which has normalized heart rhythm.

Other Meds: one a day multivitamin; daily probiotic

Current Illness: none

ID: 1825386
Sex: F
Age: 16
State: IA

Vax Date: 10/19/2021
Onset Date: 10/01/2021
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: Vials of Pfizer COVID vaccine were stored in the refrigerator with a use-date expiration on 10/19 at 1:30pm. On 10/19, approximately 2 hours after this, the patient was given their first dose of COVID vaccine with this vial. No harm detected.

Other Meds:

Current Illness:

ID: 1825387
Sex: F
Age: 52
State: MN

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

Lab Data: none

Allergies: Erythromycin, oxycodone,

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

Symptoms: Chills, UNCONTROLABLE SHAKING, fingers and toes were white and blue, sinus congestion, sore neck, headache, cough, chest discomfort, sore throat, fever 101.7 and weakness.

Other Meds: Hydroxychloroquine, folic acid, Celebrex, methotrexate, baby aspirin, Fish oil, Zyrtec, zinc, turmeric, Calcium,

Current Illness: Zero negative RA and Hypothyroid

ID: 1825389
Sex: F
Age: 74
State:

Vax Date: 03/27/2021
Onset Date: 10/25/2021
Rec V Date: 10/28/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am