VAERS 2021 Database www.vaers.hhs.gov

Main Page | All 2021 Deaths | Videos
VAERS Updated: 11/12/2021
** VAERS DATABASE Last updated: November 12, 2021**
PLEASE CHECK BACK SOON
Download the files above while you wait.







Manufacturers

Total Manufacturer
199,106MODERNA
36,710JANSSEN
5,381PFIZER\BIONTECH
2,555GLAXOSMITHKLINE BIOLOGICALS
1,469UNKNOWN MANUFACTURER
897MERCK & CO. INC.
627SEQIRUS, INC.
112DYNAVAX TECHNOLOGIES CORPORATION
91SANOFI PASTEUR
75NOVARTIS VACCINES AND DIAGNOSTICS
40EMERGENT BIOSOLUTIONS
14PAXVAX
12TEVA PHARMACEUTICALS
12PROTEIN SCIENCES CORPORATION
9PFIZER\WYETH
4BERNA BIOTECH, LTD.
4SMITHKLINE BEECHAM
3INTERCELL AG
1MEDIMMUNE VACCINES, INC.
1CSL LIMITED

COVID19 Lot Number

VAX LOT Total
2S9CL7,949
7,473
2,547
1,506
1,187
1,051
1,049
s0294561,043
866
IMM209861
816
UT7065MA766
657
579
U62828AA563
557
538
U6737AA516
515
S034636506
4F472471
458
P100253275449
444
276563436
429
418
4BH32414
MENVEO404
PP9L5362
UJ446AA337
319
306
290
271
49TM3270
R1B252M253
4F472179
933622147
C5763AA144
CW3116134
3Y7NL126
UNK114
113
ARBA141A105
104
103
96
300057A90
79
1F4EB73
R1B743M62
56
UJ090AA55
51
UH894AB46
45
UNK44
UNK42
42
EJ168638
Unknown36
35
34
32
32
26
el128424
24
A115A22
22
EN620222
21
UNK20
20
19
Z127A19
19
17
JEV18K95E15
12
111798PI12
10
A739088
No batch number8
3333324181078
6
6
TAR356
5
5
U6935AA5
UNK5
4
unknown4
3
2
55RB72
2
2
2
2
2
U7124AA2
JEV18A68E2
2
ABYB05BA1
1
1
1
1
AMVA436A1
1
1
TJ3521
A130A; VIS give1
1
U7140BB1
1
1
SP UP016AA1
1
1808P08802/ESV01
037K20A300,947
EL1284288,578
57,766
1,432

Incidents per State

State Total
82,750
CA62,821
FL38,209
TX36,512
NY34,921
PA23,646
IN23,622
IL20,597
MI19,590
OH19,426
NJ18,413
NC16,769
GA15,932
WA15,351
VA15,234
MA14,876
AZ14,206
MN12,940
MD12,656
CO11,908
WI11,425
MO10,240
TN9,685
OR8,768
KY8,437
CT8,300
SC6,700
OK6,293
AL5,692
LA5,025
IA4,825
KS4,821
UT4,637
NV4,374
NM3,967
AR3,807
ME3,161
NH3,096
NE2,918
MS2,859
ID2,785
WV2,469
HI2,459
PR2,417
MT2,414
RI2,076
DE1,868
AK1,830
VT1,734
DC1,715
ND1,388
SD1,269
WY866
GU118
VI69
AS47
MP29
MH8
XB6
FM4
QM3
XV2
XL1

ID: 1825500
Sex: F
Age: 40
State: DC

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

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

Lab Data: See item 18. All on 10/23/21

Allergies: Sulfa (hives ) Keflex, Cephalexin(c dif) Clyndamyacin (c dif) Erythromycin (c dif) Cat, rabbit dander, wool, cigarette smoke (runny eyes/nose, difficulty breathing

Symptom List: Dysphagia, Epiglottitis

Symptoms: Tacchycardia at 110 bpm with no other symptoms 2 hours after vaccine. Continued through the night to include fever, aches, chills. Increased to 125-150 bpm the next morning and it became increasingly difficulty to breathe, was lightheaded, had chest pain, slowness of speech/thought. Went to ER. No fever, blood pressure 115/79. Chest x ray, CAT scan, bloodwork, 3 bags saline therapy, Tylenol. After 13 hours, breathing, lightheaded, slowness, and chest pain resolved but heart rate was still above 120. Discharged to recover at home with high heart rate, soreness, and a swollen lymph node in my left underarm/chest. Heart rate slowly declined over the following 48 hours as other side effects resolved.

Other Meds: Balsalazide 750 mg cap roxane 3 capsules 3xda Folic acid .4 mg tablet 1 tab 1xda NORG-ETHIN ESTRA 0.25-0.035 MG (birth control, taken continuously) Vitamin D 5000 IU 1 capsule 1xda Calcium/Magnesium/Zinc 1xda Vitamin B12 5000mg sublingual

Current Illness:

ID: 1825501
Sex: M
Age: 92
State: MI

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

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

Lab Data: COVID-19 test positive on 10/18/2021

Allergies: IV dye (rash, itching)

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient presented to emergency department due to a critical lab value indicating thrombocytopenia from his oncologist office. During admission patient was found to be COVID-19 positive. He became symptomatic and was treated with supplemental oxygen and dexamethasone. Patient was discharged home on 10/26/2021 with supplemental oxygen.

Other Meds: atenolol (TENORMIN) 50 MG tablet enalapril (VASOTEC) 5 MG tablet furosemide (LASIX) 20 MG tablet metFORMIN (GLUCOPHAGE) 850 MG tablet multivitamin-minerals tablet predniSONE (DELTASONE) 10 MG tablet simvastatin (ZOCOR) 40 MG tablet sitaGLI

Current Illness: None known

ID: 1825502
Sex: F
Age: 70
State: CO

Vax Date: 10/25/2021
Onset Date: 10/26/2021
Rec V Date: 10/28/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: N/A

Allergies: N/A

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

Symptoms: I went to go see my doctor is because I started having a lump under my left armpit, low grade temp, chills, muscle and joint pain, these symptoms started on 10/26/207 and yesterday I saw my doctor and I was scheduled for an ultrasound. My doctor also told me to start taking my Allery medication (Claritin) and Cephalexin 500 MG 3 times for 1 week, just in case this is some type of allergy.

Other Meds: Multiple vitamins daily, Allopurinol, Lovastatin, Levothyroxine.

Current Illness: N/A

ID: 1825503
Sex: M
Age: 48
State: WA

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

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

Lab Data: 1628 BP na HR 44 RR na O2SAT 98% Sitting 1630 BP 116/84 HR 72 RR 16 O2Sats 97% Supine 1640 BP 118/88 HR 71 RR 16 O2 Sat 97% Supine 1652 BP 128/80 HR 71 RR 16 O2 Sat 97% Sitting 1658 BP 115/78 HR 69 RR 16 )3 Sats 96 Standing Pt discharged from our care at 1700, ambulated by self to car. VS stable. Impression: Vasal vagal response. Recovered and sent home.

Allergies: NKA

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: 48 yo male received JJ Covid 19 vaccine Lot #211A21A, 1st dose at 1625. At 1628, while in the observation area, he stated "not feeling well and going to pass out." ET, RN, stood in front of pt. , held his shoulders, called for assist, place pulse ox on index finger, HR 44, O2 sat 97%,, pt passed out momentarily, skin cool/clammy to touch, diaphoretic. At 1630 Pt transferred to WC and taken to room and transferred to guerney to lie down, with stand by assist. Pt. stated "feeling better.' Pt. stated "I usually pass out when getting shots" before receiving vaccine, stand by RN at pt side during vaccine, pt then walked to observation area with c/o dizziness. Pt. reported he was "reluctant about taking the vaccine, but needed it for work..Pt. denies CP, SOB, NV, has no hx of diabetes, and said he did not eat or drink much today.

Other Meds: none

Current Illness: none

ID: 1825504
Sex: F
Age: 34
State: ID

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: nka

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

Symptoms: Pt was in waiting room after her COVID booster vaccine. She received the COVID booster about 10-15 minutes after her flu shot. About 10 minutes after the COVID booster., she reported becoming hot and feeling like she "needed to get some air". She began coughing and stated it felt like something "hard" was stuck in her throat. She coughed very hard to point she was gagging and throwing up mucous. After throwing up small amount of phlegm she reported feeling better. BP during cough was elevated but came back down. O2 sats normal. Patient denied feeling like throat was swelling or any mouth tingling. Denied itching. No rash. Was held 1 hour and was feeling herself again with normal VS.

Other Meds:

Current Illness:

ID: 1825505
Sex: M
Age: 28
State: IL

Vax Date: 10/15/2021
Onset Date: 10/19/2021
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: ECHO ON 10/23/21, LABS ON 10/22/21

Allergies: PENICILLIN

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

Symptoms: CP, SOB WITH EXERTION

Other Meds: NONE

Current Illness: POSITIVE COVID 09/30/2021

ID: 1825507
Sex: F
Age: 63
State: TX

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

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

Lab Data:

Allergies: PCN, tetracycline, Bactrim

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Lymphedema Antibiotics NSAID?s, lab work to be drawn on 11/1/2021

Other Meds: None

Current Illness: None

ID: 1825508
Sex: F
Age: 41
State: WI

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: LA

Lab Data:

Allergies: n/a

Symptom List: Pharyngeal swelling

Symptoms: Itches at injection site, a large lump/bump in arm with redness about 2 inches in diameter, sore and hot to touch.

Other Meds: zyrtec and vitamin D

Current Illness: a cold that lasted about 1 week

ID: 1825511
Sex: M
Age: 32
State: OH

Vax Date: 10/15/2021
Onset Date: 10/16/2021
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: Penicillin

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Woke up next day with rash. Rash continued to spread for 9days, when I sought care. Was prescribed a topical steroid and antihistimine. Situation is still unresolved.

Other Meds: Fluticasone propionate/ salmeterol diskus inhalation powder

Current Illness: N/a

ID: 1825512
Sex: F
Age: 59
State: MO

Vax Date: 09/29/2021
Onset Date: 09/01/2021
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: None

Allergies: Penicillian

Symptom List: Diarrhoea, Nasal congestion

Symptoms: First dose I had mild fatigue and chest pain for about 1 hour. Second shot I felt a little confused, abdominal pain, chest pain, fatigue and headache. Chest pain lasted 2 days on and off. Abdominal pain has lasted over a week. It has gotten better, but Im still bloated from it.

Other Meds: Armour, lumen, restasis, testosterone cream, estrogen patch, Imvexxy, progesterone, multi vitamin, juice plus 3 blends, Magnesium, B2, D3, fish oil Dim

Current Illness: Hashimoto's hypothyroidism

ID: 1825513
Sex: M
Age: 42
State: NY

Vax Date: 04/01/2021
Onset Date: 07/01/2021
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:

Allergies:

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

Symptoms: Diarrhea, stomach pain

Other Meds:

Current Illness:

Date Died: 09/20/2021

ID: 1825514
Sex: F
Age: 87
State:

Vax Date: 03/06/2021
Onset Date: 09/12/2021
Rec V Date: 10/28/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: pt diagnosed positive for COVID, received monoclonal antibodies and afterwards became hypoxic, transferred to ED and admitted to hospital; hx of CAD, OSA, COPD; O2 @15 L via NC; pt found in room with O2 off her face; coded a total of 3 x; after the last code, family made her a DNR; pt's condition worsened and she died in the hospital; COVID pneumonia

Other Meds:

Current Illness:

ID: 1825516
Sex: M
Age: 21
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: Blood pressure 100/54

Allergies: NONE

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

Symptoms: Patient showed syncope, body wide muscle contraction, patient became stiff and would have fallen to the floor if not already in a chair. Event lasted around 30 seconds

Other Meds: N/A

Current Illness: NONE

ID: 1825517
Sex: F
Age: 29
State: MI

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: SYR
Vax Site: LA

Lab Data: None yet

Allergies: Allergy to gluten

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

Symptoms: Widespread body ache and intense pain in joints, fever for past 48 hours, and migraine headache that has yet to resolve. Unable to work.

Other Meds: Xarelto, Paxil, Wellbutrin, Seroquel, vitamin B12, iron supplement

Current Illness: Pulmonary embolism

ID: 1825518
Sex: M
Age: 72
State: MI

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

Lab Data: no

Allergies: augmentin

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

Symptoms: Woke up with the chills and he had a low fever. His sense of balance had started being off, very fatigue and having brain fogs. Constantly having tiredness and body aches.

Other Meds: triamterene-hctz 37.5-25mg, propranolol 80mg, atorvastatin 80mg, amlodipine 5mg, valsartan 160mg

Current Illness:

ID: 1825519
Sex: F
Age: 43
State: IN

Vax Date: 09/20/2021
Onset Date: 09/21/2021
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. I cannot afford to go to the doctor due to my poor insurance policy with high deductibles and out of pocket expenses making me essentially cash pay. I'm trying to save up my money just to establish with a new doctor since I have moved to and haven't even been able to do that since I am losing so much money falling asleep at my desk.

Allergies: Rash to adhesives leading to blisters if left on long term (hours +)

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

Symptoms: With my chronic fatigue syndrome (cause never able to be diagnosed) I always feel run down and sleep is unrefreshing. Kind of like when someone has a minor cold. After the first shot I felt more fatigued but still functional. After the second shot, however, I got quite sick with an immune reaction by the next day. The fever went away, but the fatigue has turned to absolute lethargy that has never gone away. Unless I am stimulated by something, I cannot stay awake. When I try to do my job, which involves extensive typing all day, I keep falling asleep and have to start over and/or recheck all my work. I am hemorrhaging money due to this (I get paid by the amount of work I do, not by the hour) and struggling to pay my bills. I felt like I had a gun to my head to get this shot since I have been trying to find a more stable hourly job, but I regret it so much now as I feel horrible and struggle to stay awake every day for more than a month now. I have NEVER had anything like this with my chronic fatigue syndrome. I've felt run down chronically, yes, but I have never struggled to stay awake all day every day the second I am not being stimulated (i.e. I can drive just fine, but the second I sit down and try to do anything boring and repetitive, I'm constantly nodding off and waking up when I start to fall over in my chair). This is extremely scary, frustrating, and financially destroying me.

Other Meds: Microgestin, metoprolol, bupropion, Pepcid, Claritin, super C vitamin (vitamin C, vitamin D, zinc), B12, trazodone.

Current Illness: no acute illnesses

ID: 1825521
Sex: M
Age: 39
State: LA

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

Allergies: NONE

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

Symptoms: -FATIGUE, CHILLS, BODY ACHES, HEADACHE, INJECTION SITE SORENESS -FIRST 2 COVID VACCINE DOSES WERE PFIZER (HAD SIMILAR REACTION TO FIRST DOSE OF PFIZER BUT THAT LASTED SEVERAL DAYS)

Other Meds: SERTRALINE, TOPIMAX

Current Illness: NONE

ID: 1825522
Sex: F
Age: 71
State: MI

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

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

Lab Data:

Allergies: Acetaminophen

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient was given a Pfizer vaccine that was outside temperature range. Clinic Supervisor and Patient notified. Supervisor called Pfizer company

Other Meds: ALCOHOL PREP PADS PadM Apply 1 each topically daily. Use as directed to test blood sugar daily budesonide-formoteroL (SYMBICORT) 80-4.5 mcg/actuation inhaler Inhale 2 puffs into the lungs 2 (two) times daily. calcium-vitamin D (CALCIUM-VIT

Current Illness: Diabetes, hypertension

ID: 1825523
Sex: F
Age: 34
State: MI

Vax Date: 12/18/2020
Onset Date: 02/01/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: Ultrasound April 2021, TSH, CBC, CMP April 2021, Uterine Ablation September 2021

Allergies: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: For the last 7 years my period has been very predictable. However, once I got the vaccine, I started spotting monthly. One time, the spotting was so bad that it turned into a period right after I had a period.

Other Meds: Vitamin C, Zinc, Vitamin D, Cymbalta, Ibuprofen, Tylenol, Apple Cider Vinegar, Tumeric

Current Illness: None

ID: 1825525
Sex: M
Age: 8
State:

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

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

Lab Data: None

Allergies: NKA

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

Symptoms: Given 0.3 ml of Pfizer Covid vaccine at 8 years old .

Other Meds: Multivitamin daily

Current Illness: None

ID: 1825526
Sex: M
Age: 68
State: NJ

Vax Date: 09/16/2021
Onset Date: 09/20/2021
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: None

Allergies: Meloxicam

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

Symptoms: Severe asthma response lasting one month - extremely severe bronchospasms and dry coughing for one month; finally resolved with receipt of a prescription for CIPRO and Prednisone.

Other Meds: Symbicort,

Current Illness:

ID: 1825528
Sex: F
Age: 44
State: IA

Vax Date: 09/16/2021
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: Blood work was normal. X ray was normal. I believe the ultrasound was okay, they did order any changes to my current dose of Eliquis.

Allergies: Reglan, Phenergan, mercaptopurine, pentasa

Symptom List: Unevaluable event

Symptoms: A couple weeks after the second vaccine I started feeling pain and noticed swelling in my right arm that was similar to the last time I had a blood clot. But this time I also felt pain on the right side of my neck. Went to see Dr . He ordered a panel of blood tests and an xray. I also saw a nurse practicioner who ordered an ultrasound of my arm and shoulder /neck area. They found a spot on the ultrasound that was new but couldn't tell if it was a blood clot or nerve. Waiting to hear back from vascular surgeon.

Other Meds: Levothyroxine, Eliquis, Hydrocodone-Acetaminophen

Current Illness: Lymphedema in right arm, plantar fasciitis

ID: 1825529
Sex: M
Age: 81
State: MI

Vax Date: 04/03/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data: Lab Results: Other Chemistry: 21-Oct-21 20:21, Chemistry 14 Profile Estimated GFR African American 101.65 [60.00 - 130. ml/ min] Estimated Glomerular Filtration Rate 84.01 [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) 21-Oct-21 20:21, 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: 21-Oct-21 20:21, CBC White Blood Cell Count 9.6 [4.5 - 11.0 K/cmm] Red Blood Cell Count 5.80 [3.90 - 5.60 M/cmm] Hemoglobin 16.7 [12.0 - 17.3 g/dL] Hematocrit 50.1 [36.0 - 53.0 %] Mean Corpuscular Volume 86.4 [80.0 - 100.0 fl] Mean Corpuscular Hemoglobin 28.8 [26.0 - 34.0 PG] Mean Corpuscular Hemoglobin Concn 33.3 [31.0 - 37.0 %] Red Cell Distribution Width 13.9 [11.5 - 14.5 %] *Platelet Count 152 [140 - 440 K/cmm] Mean Platelet Volume 8.1 [7.4 - 10.4 FL] Automated Neutrophils % 76 [ %] Automated Lymphocytes % 12 [ %] Automated Monocytes % 12 [ %] Automated Eosinophils % 0 [ %] Automated Basophils % 0 [ %] Absolute Neutrophil Count 7.3 [1.0 - 8.0 K/cmm] Absolute Lymphocyte Count 1.1 [1.0 - 5.0 K/cmm] Absolute Monocyte Count 1.2 [0.1 - 0.8 K/cmm] Chemistry Panels & Profiles: 21-Oct-21 20:21, Chemistry 14 Profile Sodium Level, Serum 141 [136 - 144 mmol/L] Potassium Level, Serum 4.1 [3.6 - 5.1 mmol/L] Chloride Level, Serum 103 [101 - 111 mmol/L] Total Carbon Dioxide, Serum 24 [20 - 30 mmol/L] Blood Urea Nitrogen, Serum 13 [8 - 26 mg/dL] Creatinine Level, Serum 0.87 [0.61 - 1.24 mg/dL] Anion Gap 14 [8 - 16 mmol/L] Glucose, Serum 162 [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 9.6 [8.4 - 10.2 mg/dL] Albumin Level, Serum 3.8 [3.5 - 5.0 g/dL] Phosphorus Level, Serum 2.9 [2.3 - 4.7 mg/dL] Bilirubin, Total 0.5 [0.3 - 1.0 mg/dL] Protein Total Level, Serum 7.1 [6.5 - 8.1 g/dL] Aspartate Aminotransferase (SGOT) 20 [15 - 41 U/L] Alanine Aminotransferase (SGPT) 10 [17 - 63 U/L] Alkaline Phosphatase, Serum 109 [41 - 150 U/L] Lactic Dehydrogenase (LDH), Serum 256 [125 - 220 IU/L] Chest X Ray 1 view, EKG

Allergies: no known allergies

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

Symptoms: increased confusion, weakness, mild cough.

Other Meds: unknown

Current Illness: unknown

ID: 1825530
Sex: F
Age: 67
State: CO

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

Lab Data:

Allergies: none

Symptom List: Injection site pain, Pain

Symptoms: pt had numbness of upper lip and lower nose within a few minutes of receiving vaccine. She was given benadryl and observed for 45 min. Symptoms subsided. No other issues. Pt reports similar issues with prior to 2 shots, but not as bad

Other Meds: none

Current Illness: breast cancer

ID: 1825531
Sex: F
Age: 75
State: MA

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: SYR
Vax Site: LA

Lab Data: none

Allergies: None

Symptom List: Injection site pain, Menorrhagia

Symptoms: Woke up next morning after shot and arm couldn't move . Arm is hot red swollen and painful even 3 days later. Pt feels nauseous continuously.

Other Meds: aspirin, metformin, januvia, lisinopril, sertraline, b-12

Current Illness: None

ID: 1825532
Sex: F
Age: 72
State: DE

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

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

Lab Data: None

Allergies: Sulfa drugs, seasonal allergies, cats

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

Symptoms: It wasn't until Tuesday morning 09/28/2021 that I started feeling tired and achy. I had no fever but I felt lethargic and I laid down and didn't work that day and by Wednesday morning I felt much better and more like myself other than still having the aches and pain in injection site. It was very different from my first two vaccines. I was very sleepy and tired and fatigued, but by 09/29/2021 it was cleared up.

Other Meds: Valsartan 40 mg, 81 mg baby aspirin, a number of vitamins from C to Tumeric.

Current Illness: None

ID: 1825533
Sex: F
Age: 69
State: MA

Vax Date: 09/30/2021
Onset Date: 10/10/2021
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: X-rays

Allergies: none that I am aware of

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: After doing exercises on 10/10/2021, I had back pain. I do not believe this is related to the Pfizer vaccine. However, I received a call from the CDC asking me to enter the information in this database based on my entries. I went to see the orthopedist on 10/18/2021. He took X-rays and prescribed 500 mg Naproxen and physical therapy My back pain has resolved substantially since onset.

Other Meds: Ziprasidone, sertraline, levothyroxine, atorvastatin, viviscal, one-a-day multiple vitamins (over 50 yr), citracal

Current Illness: none

ID: 1825535
Sex: F
Age: 51
State: MD

Vax Date: 10/18/2021
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: RA

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient presented to hospital to receive her first dose of Pfizer COVID vaccine on 10/18/2021 at 11:18am. After being observed for 30 minutes, she stated that her tongue was tingling/numb. She has had allergic reactions to medications in the past and normally takes Benadryl which works. She was given Benadryl 25mg liquid by mouth and after 20-25 minutes, she was stable. She later returned to the Emergency department around 1300 as requested by her primary care provider a her tongue and face are numb. She was given IM SoluMedrol. She was then stable once again and was discharged.

Other Meds:

Current Illness:

ID: 1825536
Sex: F
Age: 61
State:

Vax Date: 09/20/2021
Onset Date: 09/27/2021
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: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: Acute/progressive worsening of weakness resulting in flaccid paralysis (pt. unable to transfer d/t weakness in all extremities). Neuro surgical intervention required.

Other Meds:

Current Illness:

ID: 1825537
Sex: M
Age: 19
State: NJ

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: IM
Vax Site: RA

Lab Data:

Allergies: Augmentin

Symptom List: Nausea

Symptoms: A sudden nose bleed out of both nostrils that did not stop until I came to the Emergency Room. I received gauze that were injected with medicine and had to be prescribed antibiotics.

Other Meds:

Current Illness: Strep Throat

ID: 1825538
Sex: F
Age: 11
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:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

Symptom List: Injection site pain

Symptoms: Per mother's report, Near syncopal and minor twitching

Other Meds: none

Current Illness: none

ID: 1825539
Sex: F
Age: 43
State: CA

Vax Date: 08/29/2021
Onset Date: 09/04/2021
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: vicodin

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

Symptoms: Severe, debilitating headaches beginning 6 days after injection. Headaches have been occurring intermittently, and now are less intense but longer in duration. No prior history of headaches. Also, arthritis of the right wrist and thumb joints began 2 days after injection and have remained persistent.

Other Meds: none

Current Illness: none

ID: 1825540
Sex: F
Age: 67
State:

Vax Date: 10/23/2021
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: RA

Lab Data: Elevated troponin, peak of 0.26 CRP 7.3 cMRI with non-CAD scar (epicardial/midmyocardial) along the basal and mid inferior/inferolateral segments consistent with myocarditis and normal stress testing without evidence of inducible ischemia

Allergies: hornets, penicillin

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

Symptoms: is a 67 y/o F with a PMHx significant for hyperlipidemia, OSA (on CPAP), and osteoporosis who presented with chest pain and was ultimately found to have myocarditis, likely 2/2 her 3rd dose of the Moderna COVID vaccine. Her recent history is significant for 6 months of fatigue for which she has undergone workup with her PCP and felt to have CFS. On Saturday 10/23/21, she received the 3rd dose of the Moderna COVID vaccine around 1030 AM and began to notice full body myalgias by 3pm. She continued to experience severe, full body myalgias accompanied by fever/chills through that Sunday 10/24. She felt relatively well on Monday 10/25 however, on Tuesday 10/26 she developed severe central chest pressure that was pleuritic in nature. It was not positional nor exertional. Rated the pain as 5/10 at its worst. Pain radiates to back but not up her neck or down her L arm. There was no associated SOB, nausea/vomiting, diaphoresis. She did note DOE but this its unclear if this is related to her HPI or chronic, ongoing fatigue. She initially presented to urgent care and was noted to have a troponin elevation of 0.17 so she was sent to the ER. In the ER, she was mildly tachycardic to the low 100s. Repeat troponin was 0.26. ECG showed sinus tachycardia with slight PR depression in the inferior leads on my read. D-dimer was normal at 0.51. CRP was elevated at 7.3. Influenza, SARS-CoV-2, and RSV PCR testing was negative. CXR showed no acute cardiopulmonary abnormality. She was given aspirin, 1 L LR, and started on a heparin infusion for ACS r/o. Repeat troponin downtrended to 0.18-0.16. TTE demonstrated an LVEF 70%, grade I diastolic dysfunction, normal RV size and function, no wall motion or valvular abnormalities, trivial anterior pericardial effusion. Given suspicion for myocarditis, cMRI was obtained which showed normal LVEF and RVEF, non CAD scar (epicardial/midmyocardial) along the basal and mid inferior/inferolateral segments consistent with myocarditis and normal stress testing without evidence of inducible ischemia. She was initiated on Colchicine and discharged home with this. Pt's blood pressure not amendable to a BB. Follow up was scheduled with cardiology and primary care.

Other Meds: Alprazolam 0.25mg TID PRN, Buproprion 150mg daily, Omega 3 daily, Hyoscyamine 0.125mg sublingual q6h PRN, Progesterone 100mg daily, Tumeric 500mg oral daily, Valacyclovir 500m oral daily.

Current Illness:

ID: 1825541
Sex: F
Age: 51
State:

Vax Date: 02/19/2021
Onset Date: 08/17/2021
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: Tremor

Symptoms: COVID 19

Other Meds:

Current Illness:

ID: 1825542
Sex: M
Age: 60
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: None

Allergies: None

Symptom List: Erythema, Pruritus

Symptoms: Immediately after being vaccinated, client felt dizzy for a few minutes. He then had elevated blood pressure with the highest at 172/110.

Other Meds: Sudafed PE and Benedryl

Current Illness: No

Date Died: 09/23/2021

ID: 1825543
Sex: M
Age: 77
State: TN

Vax Date: 02/09/2021
Onset Date: 09/07/2021
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: 09/07/2021 positive antigen test for NCOV-2019 SARS-CoV-2 Ag Resp Ql IA.rapid: 09/08/2021 positive PCR for NCOV-2019 2019-NCOV RNA PNL XXX NAA+PROBE:

Allergies: Unknown

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

Symptoms: Covid-19 diagnosis and symptom onset 9/7/2021 including cough, pneumonia

Other Meds: Unknown

Current Illness: Unknown

ID: 1825544
Sex: M
Age: 58
State: CA

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

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

Lab Data:

Allergies:

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

Symptoms: Body aches, headache, fatigue. Resolved 10/28/2021.

Other Meds:

Current Illness:

ID: 1825545
Sex: F
Age: 51
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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies: Penicillin as a child (unknown reaction) Sulfa as a young adult (hives and photosensitivity)

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Pt states that she started feeling fatigued, slightly nauseous and had a headache within a few hours after receiving the vaccine. The symptoms, along with feeling "foggy brained" went on for the remainder of the evening and into the next day. Pt reports leaving work on 10/27 as a result. Pt states that now, on 10/28 at 1500, she is feeling back to normal.

Other Meds: None

Current Illness: None

ID: 1825546
Sex: M
Age: 59
State: IL

Vax Date: 04/11/2021
Onset Date: 10/08/2021
Rec V Date: 10/28/2021
Hospital: Y

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

Lab Data:

Allergies: no known drug allergy

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

Symptoms: Chief Complaint This patient is a pleasant 59-year-old man with no significant past medical history and has been adequately immunized with a Johnson & Johnson Covid vaccine March 2021 has been admitted for multifocal pneumonia and acute hypoxic respiratory failure due to COVID-19. Duration of symptom is almost 2 weeks and has 2 other family members sick with Covid 19 History of Present Illness This patient is a pleasant 59-year-old man who works as a painter. He stated that he has been having unhygienic workplace and may have caught infection somewhere at workplace. He became acutely aware and symptomatic with cough fever body aches nausea loss of appetite and diarrhea about 2 weeks ago. He has been living and household consist of his daughter wife who is been sick with similar cough and congestive symptoms but improved not needing any hospitalization. Patient himself has been awake alert oriented x4 sitting upright using supplemental oxygen by nasal cannula and does not show any signs of distress or toxicity/resting comfortably. Earlier had some back pain and intractable cough low appetite into loose stool. He has been brought in and does not qualify for remdesivir, steroid therapy has been initiated supplemental oxygen as well as antitussive therapy advised and infectious disease service requested to see the patient.

Other Meds: unknown

Current Illness: unknown

ID: 1825547
Sex: F
Age: 33
State:

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

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

Lab Data:

Allergies:

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

Symptoms: COVID 19

Other Meds:

Current Illness:

ID: 1825548
Sex: F
Age: 56
State: KY

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: LA

Lab Data: none

Allergies: macrodantin

Symptom List: Pain in extremity

Symptoms: Right arm redness, warmth and soreness at injection site began 10/26/2021. right distal cervical lymph node tenderness began 10/27/2021 Both adverse events are still active today 10/28/2021

Other Meds: Vitamin B12, D, E and zyrtec

Current Illness: nasal congestion and runny nose

ID: 1825549
Sex: F
Age: 41
State:

Vax Date: 04/07/2021
Onset Date: 09/11/2021
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:

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

Symptoms: COVID 19

Other Meds:

Current Illness:

ID: 1825551
Sex: M
Age: 63
State: SD

Vax Date: 10/25/2021
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: NKA

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

Symptoms: Per patient's wife who called this morning, said patient had rash on upper left leg over the evening yesterday. This morning it has moved down the left leg and has also seen lip swelling on face on left side only. Only left side affected. No breathing difficulty noticed.

Other Meds: Sertraline 100mg, Phenytoin 100mg, Dilantin 30mg, Topiramate 100mg, Simvastatin 40mg

Current Illness:

ID: 1825554
Sex: M
Age: 64
State: DE

Vax Date: 04/23/2021
Onset Date: 04/24/2021
Rec V Date: 10/28/2021
Hospital: Y

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

Lab Data:

Allergies: None

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

Symptoms: 4/24 -6/11/21: Approximately weekly episodes of fatigue, fever, lethargy lasting 1-2 days. 6/12 - 6/13/21: Symptom listed above plus shortness of breath, mild chest discomfort. 6/14 - 6/15/: Symptoms above plus heart arrhythmia 6/16 - 6/18/21: Hospitalized for pulmonary embolisms (both lungs). Treated with heparin IV, then subcutaneous lovenox. 6/18/21 - Discharged and prescribed Eliquis 5mg twice daily.

Other Meds: Losartan/HCL, multi-vitamin, vitamins D-3, E, omega-3, curcumin

Current Illness: None

ID: 1825555
Sex: M
Age: 24
State: OR

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: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: none

Allergies: none

Symptom List: Vomiting

Symptoms: No adverse reaction but vaccine admin error. Patient fist dose on 09/12/2021 was Pfizer.

Other Meds: none

Current Illness: no

ID: 1825556
Sex: M
Age: 56
State: VT

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

Lab Data:

Allergies: None

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Was told I could get the Moderna Booster and Flu shot together. within 24 hours I had a fever of 104. Sat in cool bath for 90 minutes and took Tylenol to get it down to 100. Stayed around 100 for the remainder of the evening. I do not know which seasonal flu shot was given, so I just picked the top one.

Other Meds: Metoprolo 25 mgs Chlorthalidone .25 mgs Diltiazem ER 120 MG CoQ10 Asprin .81 mgs

Current Illness: None

ID: 1825557
Sex: F
Age: 30
State: ND

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

Lab Data: none

Allergies: unknown

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

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

Other Meds: unknown

Current Illness: unknown

ID: 1825558
Sex: F
Age: 60
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: NONE

Allergies: GLUTEN; LATEX; CODEINE

Symptom List: Injection site swelling, Limb discomfort

Symptoms: 10/26 - HOT TO THE TOUCH, SEVERE BODY ACHES, CHILLS, SEVERE INTENSE HEADACHE, HIVE RASH THAT'S GROWING IN DIAMETER , 10/27 - HOT TO THE TOUCH, SEVERE BODY ACHES, CHILLS, SEVERE INTENSE HEADACHE, HIVE RASH THAT'S GROWING IN DIAMETER , DIARREA, ABDOMINAL CRAMPING

Other Meds: TRIAMTERENE; NP THYROID 60; TURMERIC; VIT. C; ZINC; MAGNESIUM; ZYZAL; FLONASE; BIOTIN; BioTe HRT THERAPY

Current Illness: N/A

ID: 1825559
Sex: F
Age: 44
State: TX

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

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

Lab Data: None

Allergies: None

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

Symptoms: A couple of weeks after my second shot I started shedding a lot of hair and I'm still having that. I also had the usual stuff like fever. No medical care sought, and this is still ongoing.

Other Meds: Metoprolol 50 mg, tetracycline, Lexapro, birth control, np thyroid, multivitamin, vitamic c daily

Current Illness: None

ID: 1825561
Sex: M
Age: 49
State: OH

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

Lab Data:

Allergies: PCN - rash. Percocet, Demerol, Morphine - rash.

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

Symptoms: Began fatigue and arm soreness Tuesday, the night of vaccination. During the night he was uncomfortable with generalized body aches and pains, chills/shivering. Fever 101, rising to 103. Began taking acetaminophen and ibuprofen regularly for fever and severe body aches/pain. Temp remained 103 all Wednesday. Fatigue all Wed; shortness of breath in the evening. Put on his CPAP and went to bed. Thursday AM, woke with a bad rash on the front of his neck, across chest, underarms and belly. The rash is painful. Denies itching. His temp was down to 100. Fatigue persists. He called his PCP and reported this to the nurse and has not received a call back from the doctor. He reports no problems with the first two Pfizer Covid shots.

Other Meds: Losartan, HCTZ, Dexilent, ASA, Pravastatin, Ambien, Trazadone

Current Illness: Denies

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am