VAERS 2021 Database www.vaers.hhs.gov

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VAERS Updated: 11/12/2021
** VAERS DATABASE Last updated: November 12, 2021**
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Manufacturers

Total Manufacturer
46,870MODERNA
532GLAXOSMITHKLINE BIOLOGICALS
353PFIZER\BIONTECH
231MERCK & CO. INC.
221UNKNOWN MANUFACTURER
62SEQIRUS, INC.
25DYNAVAX TECHNOLOGIES CORPORATION
13EMERGENT BIOSOLUTIONS
12SANOFI PASTEUR
9NOVARTIS VACCINES AND DIAGNOSTICS
5PFIZER\WYETH
5PAXVAX
2TEVA PHARMACEUTICALS
2PROTEIN SCIENCES CORPORATION
1BERNA BIOTECH, LTD.
1INTERCELL AG
1CSL LIMITED

COVID19 Lot Number

VAX LOT Total
2S9CL1,906
1,575
289
IMM209286
252
236
229
s029456178
171
UT7065MA166
155
149
145
S034636133
107
U62828AA103
100
98
P10025327596
U6737AA85
UJ446AA79
78
78
59
57
4BH3254
4F47253
52
27656352
50
PP9L548
49TM346
42
40
38
MENVEO38
4F47237
R1B252M36
34
C5763AA30
93362229
25
300057A24
UNK24
22
CW311621
18
17
15
UH894AB15
3Y7NL12
R1B743M12
EJ168611
el128410
10
10
10
9
ARBA141A9
UNK9
8
UNK8
8
1F4EB8
Unknown7
7
No batch number6
5
5
UJ090AA5
5
5
4
4
4
UNK4
JEV18K95E4
UNK3
A115A3
Z127A3
3
3333324181073
2
2
2
TAR352
1
1
1
1
1
A739081
1
1
1
1
1
037K20A68,542
EL128447,700
133

Incidents per State

State Total
15,185
CA14,096
NY7,507
TX7,196
FL6,939
IN5,527
PA4,560
IL4,179
OH4,054
AZ3,856
MI3,771
NJ3,411
MA3,278
VA3,208
NC3,114
WA3,034
GA2,864
MD2,652
MN2,534
CO2,532
WI2,457
MO2,029
OR1,943
TN1,715
CT1,693
KY1,603
OK1,226
AL1,201
KS1,162
IA1,157
SC1,106
NM1,065
UT973
AR951
LA945
NE829
NV797
ME795
MT789
NH756
ID674
AK661
WV661
PR650
MS585
HI536
RI510
VT441
SD361
ND356
DE350
DC239
WY209
GU32
AS16
VI13
MP9
MH3
FM2
QM1
XB1

ID: 1041257
Sex: F
Age: 37
State: OR

Vax Date: 01/13/2021
Onset Date: 02/03/2021
Rec V Date: 02/19/2021
Hospital:

Lab Data:

Allergies:

Symptoms: 2nd dose 1 week early; A spontaneous report was received from a health care professional concerning a 38 year old, female patient who received Moderna's COVID-19 Vaccine (mRNA-1273) and received a second dose 1 week early (inappropriate scheduling of vaccine administered). The patient's medical history was not provided. Concomitant product use was not provided by the reporter. The patient received their first of two planned doses of mRNA-1273 (Batch number: 025J20-2A) on 13-JAN-2021. On 03-FEB-2021, approximately the patient received their second of two planned doses of mRNA-1273 (Batch number: 025J20-2A) intramuscularly for prophylaxis of COVID-19 infection. The patient received the second dose 1 week early from 28 day recommendation. Treatment information was not provided/unknown. The patient received both scheduled doses of mRNA-1273 prior to the event(s); therefore, action taken with the drug in response to the event(s) is not applicable. The event, second dose 1 week early, was considered resolved/recovered.; Reporter's Comments: This report refers to a case of inappropriate scheduling of vaccine administered for mRNA-1273 (Batch number: 025J20-2A) with no associated AEs.

Other Meds:

Current Illness:

ID: 1041258
Sex: M
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 02/19/2021
Hospital: Y

Lab Data:

Allergies:

Symptoms: Cannot walk; Cannot move arms; Still ill with gas; Initial information received on 14-Dec-2020 regarding an unsolicited valid serious case received from a consumer or non-healthcare professional (reference number: US-SA-SAC20210202000763). This case involves a 69-year-old male patient who experienced cannot walk (gait disturbance), cannot move arms (mobility decreased) and still ill with gas (flatulence), while he received INFLUENZA VACCINE. Medical history, past medical treatment, past vaccination, concomitant medication and family history were not provided. On an unknown date, the patient received a dose (double) of suspect INFLUENZA VACCINE (produced by unknown manufacturer) [lot number, expiry date not reported] via an unknown route at an unknown administration site for prophylactic vaccination. On an unknown date, the patient developed serious cannot walk (gait disturbance), cannot move arms (mobility decreased) and still ill with gas (flatulence) (unknown latency) following the administration of INFLUENZA VACCINE. The patient was hospitalized for these events for 90 days (in hospital 3 months). It is also reported, the patient was rest home over a month. Details of laboratory data not reported. It was not reported if the patient received any corrective treatment. At the time of reporting, the event outcome reported as unknown for cannot walk and cannot move arms and not recovered for still ill with gas (going on 5 months now). Information on the batch number was requested.; Sender's Comments: This case concerns 69-year-old male patient who experienced gait disturbance, mobility decreased and flatulence after vaccination with INFLUENZA VACCINE. The time to onset is unknown. Additional information regarding patient's medical history, condition at the time of vaccination, lab data excluding other predisposing etiologies would be needed for complete assessment of the case. Based upon the reported information, the role of the suspect vaccine cannot be assessed.

Other Meds:

Current Illness:

ID: 1041259
Sex: F
Age:
State: CA

Vax Date:
Onset Date:
Rec V Date: 02/19/2021
Hospital:

Lab Data:

Allergies:

Symptoms: severe anaphylaxis; Initial information received on 09-Feb-2021 regarding an unsolicited valid serious case received from a physician. This case involves female patient who experienced anaphylaxis (anaphylactic reaction), while she received vaccine RABIES VACCINE. The patient's medical history, past medical treatment, vaccination, concomitant medication and family history were not provided. On an unknown date, the patient received a dose of suspect RABIES VACCINE (produced by unknown manufacturer) lot number not reported via an unknown route at an unknown administration site for prophylactic vaccination. The patient developed a serious severe anaphylaxis (anaphylactic reaction) (unknown latency) following the administration of RABIES VACCINE. This event was assessed as medically significant. The reaction happened in the mid-90's (patient believes it may have been 1996 but is unsure the exact year), and now presented to see if we could determine the component of the vaccine that may have caused the reaction. Patient had contacted multiple people at the university and involved with Rabies Vaccination program, and they are unsure which rabies vaccine would have been given. Patient feels, it was likely Imovax, but this is not certain. If she able to determine which vaccine the patient received, only can test the relevant components. This is particularly relevant for her now as she is interested in COVID vaccination, and want to confirm that the rabies vaccine she received in the past did not contain polyethylene glycol (PEG)/polysorbates [what are thought to be the allergenic components in the messenger ribonucleic acid (mRNA) COVID vaccines]. None of the current Rabies vaccines contains these ingredients to my knowledge, but she want to confirm with the manufacturer that prior formulations did not include them either. Laboratory details were not reported. It was not reported if the patient received a corrective treatment. The event outcome was unknown for anaphylactic reaction. Batch number has been requested for suspect product for this case.; Sender's Comments: This case concerns a female patient presented with anaphylactic reaction after vaccination with RABIES VACCINE (unknown manufacturer). The time to onset is unknown. Medical history, concomitant medication, lab data ruling out alternative etiologies would be needed for complete assessment. Based upon the reported information role of an vaccine cannot be assessed.

Other Meds:

Current Illness:

ID: 1041260
Sex: F
Age:
State:

Vax Date: 11/01/2020
Onset Date:
Rec V Date: 02/19/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Redness; Swelling; Itching; This spontaneous case was received on 07-Jan-2021 from Med Communications (reference number: SEQW21-00089), reported by other non-health professional (consumer) and concerned a female patient of unreported age. The patient's medical history included allergy to polyethylene glycols (PEG). The patient's concomitant medications were not reported. On an unspecified date in Nov-2020, the patient was vaccinated with Flucelvax Quadrivalent (influenza vaccine, subunit influenza virus vaccine polyvalent; anatomical location, dose, route of administration: not reported) for flu prevention. The batch number was not reported. On an unspecified date, 30 hours after receiving Flucelvax Quadrivalent, as reported, the patient developed swelling, redness and itching. The outcome of the events was not reported. The reporter assessed the events as related to Flucelvax Quadrivalent. As reported, the patient had mild adverse reaction to Flucelvax Quadrivalent. The reporter assessed the case as non-serious. Company comment: A patient of an unreported age was vaccinated with Flucelvax Quadrivalent. On an unspecified date, 30 hours after receiving Flucelvax Quadrivalent, the patient developed swelling, erythema and pruritus. Causal role of the suspect vaccine is assessed as possibly related.; Reporter's Comments: Consumer inquires if Flucelvax Quad contains PEG. She wants to know because she is allergic to it, but on November she got Flucelvax Quad and she only had a mild adverse reaction (swelling, redness and itching).; Sender's Comments: A patient of an unreported age was vaccinated with Flucelvax Quadrivalent. On an unspecified date, 30 hours after receiving Flucelvax Quadrivalent, the patient developed swelling, erythema and pruritus. Causal role of the suspect vaccine is assessed as possibly related.

Other Meds:

Current Illness: Allergy to chemicals

ID: 1041261
Sex: F
Age:
State:

Vax Date: 10/25/2018
Onset Date:
Rec V Date: 02/19/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Rash; This spontaneous case was received on 08-Jan-2021 from physician via Med Communications (reference number: SEQW21-00113) and concerned a female patient of an unknown age. The patient's medical history and concomitant medications were not reported. On 25-Oct-2018, the patient was vaccinated with Flucelvax Quadrivalent (influenza vaccine, subunit influenza virus vaccine polyvalent; dose: 0.5 ml, route of administration: intramuscular, indication and anatomical location: not reported). The batch number reported was 252659 and expiry date was 31-May-2019. On an unspecified date, unknown amount of time after receiving Flucelvax Quadrivalent, the patient developed rash. The outcome of the event was not reported. The reporter did not provide causality assessment. The case was assessed as non-serious. This case is linked with cases 202100472 and 202100473 (the same patient). Company comment: The event of 'rash' is considered as related to Flucelvax Quadrivalent.; Sender's Comments: The event of 'rash' is considered as related to Flucelvax Quadrivalent.

Other Meds:

Current Illness:

ID: 1041262
Sex: F
Age:
State: NY

Vax Date: 09/24/2020
Onset Date:
Rec V Date: 02/19/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Allergic to thiomersal; Rash; This spontaneous case was received on 08-Jan-2021 from physician via Med Communications (reference number: SEQW21-00113) and concerned a female patient of an unknown age. The patient's medical history and concomitant medications were not reported. The patient's past vaccinations included Flucelvax Quadrivalent on 25-Oct-2018 and Afluria Quadrivalent on 04-Oct-2019 for flu prevention, after which the patient developed rash both times. On 24-Sep-2020, the patient was vaccinated with Flucelvax Quadrivalent (influenza vaccine, subunit influenza virus vaccine polyvalent; dose: 0.5 ml, route of administration: intramuscular and anatomical location: not reported) for flu prevention. The batch number was not reported. On an unspecified date, unknown amount of time after receiving Flucelvax Quadrivalent, the patient developed rash and discovered that she was allergic to thiomersal. The outcome of the events was not reported. The reporter did not provide causality assessment. The case was assessed as non-serious. This case is linked with cases 202100471 and 202100472 (the same patient). Company Comment: A female patient of an unknown age developed allergy to chemicals (reported as allergic to thiomersal) and rash after vaccination with the suspect product, Flucelvax Quadrivalent. There is lack of information regarding the vaccination date and events onset date. Therefore, chronology is unassessable. Information regarding the underlying medical history, related diagnostic findings and concomitant medications have not been provided. Although chronology is unclear, causality of the suspect product cannot be totally excluded and is assessed as possible (defaults to related in the safety database for reporting purposes).; Sender's Comments: A female patient of an unknown age developed allergy to chemicals (reported as allergic to thiomersal) and rash after vaccination with the suspect product, Flucelvax Quadrivalent. There is lack of information regarding the vaccination date and events onset date. Therefore, chronology is unassessable. Information regarding the underlying medical history, related diagnostic findings and concomitant medications have not been provided. Although chronology is unclear, causality of the suspect product cannot be totally excluded and is assessed as possible (defaults to related in the safety database for reporting purposes).

Other Meds:

Current Illness:

ID: 1041263
Sex: F
Age:
State:

Vax Date: 02/01/2018
Onset Date: 02/01/2018
Rec V Date: 02/19/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Hives generalized all over her body; Allergic reaction; This spontaneous case was received on 08-Jan-2021 from other non-health professional (consumer) via Med Communication (reference number: SEQW21-00106) and concerned a female patient of an unknown age. The patient's medical history and concomitant medications were not reported. On an unspecified day in Feb-2018, the patient was vaccinated with Flucelvax Quadrivalent (influenza vaccine, subunit influenza virus vaccine polyvalent, dose, route of administration and anatomical location: not reported) for influenza prophylaxis. The batch number was not reported. On an unspecified day in Feb-2018, four hours after receiving Flucelvax Qudrivalent, the patient had hives generalized all over her body. The patient experienced an allergic reaction. It was not anaphylaxis. The patient was treated with Benadryl (diphenhydramine hydrochloride) and the reaction was resolved within 24 hours. The reporter wanted to know what was the ingredient that caused the allergic reaction. On an unspecified date in Feb-2018, the patient was recovered from the events. The reporter assessed the events as related to Flucelvax Quadrivalent. The case was assessed as non-serious. Company comment: The events of allergic reaction and 'hives' are assessed as related to Flucelvax Quadrivalent.; Reporter's Comments: The reporter wanted to know what was the ingredient that caused the allergic reaction.; Sender's Comments: The events of allergic reaction and 'hives' are assessed as related to Flucelvax Quadrivalent.

Other Meds:

Current Illness:

ID: 1041264
Sex: F
Age:
State:

Vax Date: 01/01/2021
Onset Date: 01/01/2021
Rec V Date: 02/19/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Rash, but it was hardly a rash at all; This spontaneous case was received on 13-Jan-2021 from other non-health professional (consumer) via Med Communications (reference number: SEQW21-00170) and concerned a female patient of an unspecified age. The patient's concurrent conditions included many allergies and eczema. The patient's concomitant medications were not reported. On an unspecified date in Jan-2021, the patient was vaccinated with Flucelvax Quadrivalent (influenza vaccine, subunit influenza virus vaccine polyvalent; dose; 0.5 ml, route of administration and anatomical location: not reported) for influenza prophylaxis. The batch number was not reported. On an unspecified date in Jan-2021, an unknown amount of time after receiving Flucelvax Quadrivalent, the patient experienced rash, but it was hardly a rash at all. The outcome of the event was not reported. The reporter did not provide a causality assessment. This case as assessed as non-serious. Company comment: The event of 'rash' is considered as related to Flucelvax Quadrivalent.; Sender's Comments: The event of 'rash' is considered as related to Flucelvax Quadrivalent.

Other Meds:

Current Illness: Allergy NOS; Eczema

ID: 1041265
Sex: F
Age: 46
State:

Vax Date: 01/03/2013
Onset Date: 01/03/2013
Rec V Date: 02/19/2021
Hospital:

Lab Data: Test Name: Blood pressure; Result Unstructured Data: All good; Test Name: Blood oxygen level; Result Unstructured Data: All good

Allergies:

Symptoms: Lump in her throat; This spontaneous case was received on 13-Jan-2021 from other non-health professional (consumer) via Med Communications (reference number: SEQW21-00155) and concerned a 46-year-old, female patient. The patient's concurrent conditions included anxiety disorder. The patient's concomitant medications were not reported. The patient stated she had influenza vaccines before and never had an issue. On 03-Jan-2013, the patient was vaccinated with Afluria (TIV) (influenza vaccine; route of administration, anatomical location, dose: not reported) as prevention of seasonal influenza. The batch number was not reported. On the same day, after receiving Afluria (TIV), the patient experienced a lump in her throat. The patient stated she had no swelling in her throat and was able to breath. Moreover, the patient stated she did not experience any anaphylactic shock and had no other complications. On an unspecified date, three and a half months after receiving Afluria (TIV), the patient was still experienced "a lump in her throat". On an unspecified date, the patient visited emergency room (ER), and had blood oxygen level and blood pressure measured, and results were all good. The patient also stated she is going to consult with an allergist and requested to be provided the ingredients of the Afluria (TIV) vaccine. At the time of initial reporting, the patient had not recovered from the event. The reporter did not provide a causality assessment, but the patient stated she was not sure if the above experienced adverse event is related to her anxiety disorder or not. The case was assessed as non-serious. Company Comment: A 46-year-old, female patient developed a pharyngeal mass on the same day after vaccination with the suspect product Afluria (TIV). More information regarding the related diagnostic findings is needed. Due to plausible time relationship, causality of the suspect product cannot be totally excluded and is assessed as possible (defaults to related in the safety database for reporting purposes).; Sender's Comments: A 46-year-old, female patient developed a pharyngeal mass on the same day after vaccination with the suspect product Afluria (TIV). More information regarding the related diagnostic findings is needed. Due to plausible time relationship, causality of the suspect product cannot be totally excluded and is assessed as possible (defaults to related in the safety database for reporting purposes).

Other Meds:

Current Illness: Anxiety disorder

ID: 1041266
Sex: F
Age: 26
State:

Vax Date: 10/26/2020
Onset Date: 10/26/2020
Rec V Date: 02/19/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Nausea; Headache; This is a spontaneous case was received on 18-Jan-2021, reported by other non-health professional to Med Communications (reference number: SEQW21-00213) and concerned a 26-year-old, female patient. The patient's concurrent conditions were not reported. The patient was not taking any concomitant medications. On 26-Oct-2020, the patient was vaccinated with Flucelvax Quadrivalent (influenza vaccine, subunit influenza virus vaccine polyvalent; dose: 0.5 ml, anatomical location and route of administration: not reported) for flu prophylaxis. The batch number reported was 283849 and expiry date reported was 30-Jun-2021. On the same day, after receiving Flucelvax Quadrivalent, reported as ever since, the patient had been suffering from headaches and nausea. On an unspecified date, the patient visited numerous medical specialists and underwent tests in search of a root cause. The patient's father stated she had done tons of blood works, cat scan of the brain and the pelvis. The treatment measures included steroids and migraine medicines. At the time of initial reporting, the patient had not recovered from the events. The reporter did not provide causality assessment. Company comment: The events of nausea and headache are assessed as related to Flucelvax Quadrivalent.; Sender's Comments: The events of nausea and headache are assessed as related to Flucelvax Quadrivalent

Other Meds:

Current Illness:

ID: 1041267
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 02/19/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Flush feeling all over body; Lightheaded; Weak; This spontaneous case was received 19-Jan-2021 from other non-health professional (consumer) via Pfizer (reference number: 2020502909) and concerned a female patient of an unreported age. The patient's relevant medical history and concomitant medications were not reported. The patient had no known allergies. On an unspecified date in 2018, the patient was vaccinated with Afluria (TIV) (influenza vaccine; dose, route of administration, anatomical location and indication: not reported). The batch number was not reported. On an unspecified date in 2018, immediately after receiving Afluria (TIV), the patient was lightheaded, weak and had flush feeling all over her body. The patient went to the hospital, sat in the waiting room for about 30 minutes and symptoms went away totally. The patient did not require treatment. On the same day, the patient recovered from the events. The reporter did not provide causality assessment. The patient hadn't had a flu shot since per her doctor's advice. The patient wanted to get Pfizer-Biontech COVID-19 Vaccine, and she wanted to know what ingredients Afluria TIV and Pfizer-Biontech COVID-19 Vaccine might have in common. The case was assessed as non-serious. Company comment:The patient developed flushing, dizziness and asthenia on the same day after receiving Afluria (TIV). Chronology is suggestive. The patient's relevant medical history and concomitant medications were not reported. Considering all above mentioned, causal relationship for all events is assessed as possibly related (defaults to ''related'' in the safety database for reporting purposes).; Sender's Comments: The patient developed flushing, dizziness and asthenia on the same day after receiving Afluria (TIV). Chronology is suggestive. The patient's relevant medical history and concomitant medications were not reported. Considering all above mentioned, causal relationship for all events is assessed as possibly related (defaults to ''related'' in the safety database for reporting purposes).

Other Meds:

Current Illness:

ID: 1041268
Sex: U
Age:
State:

Vax Date: 10/01/2020
Onset Date: 10/01/2020
Rec V Date: 02/19/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Pain to gums and teeth; Pain to gums and teeth; This spontaneous case from was received on 25-Jan-2021 from non-heath professional (consumer) and concerned a patient of an unreported age and gender. The patient's medical history and concomitant medications were not reported. On an unspecified date in Oct-2020, the patient was vaccinated with Flucelvax Quadrivalent (influenza vaccine, subunit influenza virus vaccine polyvalent; dose, route of administration, indication and anatomical location: not reported). The batch number was not reported. On the same day, a few hours after receiving Flucelvax Quadrivalent, the patient experienced pain in gums and teeth. The outcome of the events was not reported. The reporter did not provide a causality assessment. Company Comment: A of an unreported age and gender developed toothache and gingival pain on the same day after vaccination with the suspect product, Flucelvax Quadrivalent. Information regarding the underlying medical history, related diagnostic findings and concomitant medications have not been provided. Due to lack of information, causality for the reported events is unassessable.; Sender's Comments: A of an unreported age and gender developed toothache and gingival pain on the same day after vaccination with the suspect product, Flucelvax Quadrivalent. Information regarding the underlying medical history, related diagnostic findings and concomitant medications have not been provided. Due to lack of information, causality for the reported events is unassessable.

Other Meds:

Current Illness:

ID: 1041269
Sex: F
Age: 68
State:

Vax Date: 11/13/2020
Onset Date: 11/13/2020
Rec V Date: 02/19/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Pressure on the side of her face radiating into temple; Right arm and shoulder swelling; Right arm and shoulder swelling; Wasn't able to bent the arm; Trouble thinking; She felt she couldn't breath; Fatigue; Allergic reaction within 1-2 hours of receiving the vaccines; Fever; She felt the medicine was trapped in the tissue of her arm; Sharp pains at the injection site; The patient was administered both vaccines in the right arm; This spontaneous case was received on 27-Jan-2021 from other health professional via Med Communications (reference number: SEQW21-00323) and concerned a 68-year-old, female patient. The patient's concurrent conditions included 22 allergies including allergy to dog and cat hair. The patient stated she had allergy alert and the allergies were listed in their computer. The patient's past medical history included anaphylaxis. The patient's concomitant medications included levothyroxine, Singulair (montelukast sodium) and sucralfate, all used for unreported indications. On 13-Nov-2020, the patient was vaccinated with Flucelvax Quadrivalent (influenza vaccine, subunit influenza virus vaccine polyvalent; dose: 0.5 ml, anatomical location: right deltoid, route of administration: not reported) (explicitly coded as 'Product administration error') for influenza prophylaxis. The batch number reported was 283852 and expiry date was 30-Jun-2021. On the same day, the patient was vaccinated with non-company co-suspect pneumococcal vaccine (brand not specified, anatomical location: right arm, dose, route of administration, indication and batch number: not reported). On the same day, one to two hours after receiving Flucelvax Quadrivalent and pneumococcal vaccine, the patient had an allergic reaction. The patient started having fever, pressure on the side of her face radiating into temple, right arm and shoulder swelling, and fatigue. She was not able to bent the arm, and she had trouble thinking. At night the patient felt she couldn't breath and had to get up and walk around. The patient felt that the medicine was trapped in the tissue of her arm. The patient also had sharp pains at the injection site. The patient called the physician's office and was told he was not available. She was advised to come into the office, but she was a private duty medical assistant (MA) and was taking care of a patient and unable to leave. The patient had drunk detox tea and kept the injection site warm. At the time of initial reporting, the patient had not recovered from the events. The reporter did not provide a causality assessment. The case was assessed as non-serious. Company comment: A 68-year-old patient was vaccinated with Flucelvax Quadrivalent and non-company co-suspect pneumococcal vaccine. On the same day, after receiving vaccines, the patient had an allergic reaction. The patient started having pyrexia, pressure on the side of her face radiating into temple, right arm and shoulder swelling, and fatigue. She was not able to bent the arm, and she had trouble thinking. At night the patient felt she couldn't breath and had to get up and walk around. The patient felt that the medicine was trapped in the tissue of her arm (Feeling abnormal) The patient also had vaccination site pain. Causal role of the suspect vaccine is assessed as possibly related for head discomfort, joint swelling, peripheral swelling, pyrexia, hypersensitivity, injected limb mobility decreased, bradyphrenia, dyspnoea, fatigue, and vaccination site pain. The patient was administered both vaccines in the right arm. Feeling abnormal is assessed as not related to the suspect vaccine. Product administration error is assessed as not related based on company's conventions. Brighton Collaboration criteria could not be assessed, due to lack of information.; Sender's Comments: A 68-year-old patient was vaccinated with Flucelvax Quadrivalent and non-company co-suspect pneumococcal vaccine. On the same day, after receiving vaccines, the patient had an allergic reaction. The patient started having pyrexia, pressure on the side of her face radiating into temple, right arm and shoulder swelling, and fatigue. She was not able to bent the arm, and she had trouble thinking. At night the patient felt she couldn't breath and had to get up and walk around. The patient felt that the medicine was trapped in the tissue of her arm (Feeling abnormal) The patient also had vaccination site pain. Causal role of the suspect vaccine is assessed as possibly related for head discomfort, joint swelling, peripheral swelling, pyrexia, hypersensitivity, injected limb mobility decreased, bradyphrenia, dyspnoea, fatigue, and vaccination site pain. The patient was administered both vaccines in the right arm. Feeling abnormal is assessed as not related to the suspect vaccine. Product administration error is assessed as not related based on company's conventions. Brighton Collaboration criteria could not be assessed, due to lack of information.

Other Meds: LEVOTHYROXINE; SINGULAIR; SUCRALFATE

Current Illness: Allergy NOS (She says she has allergy alert and the allergies are listed in their computer.); Allergy to animal

ID: 1041270
Sex: F
Age: 72
State:

Vax Date: 11/23/2020
Onset Date:
Rec V Date: 02/19/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Unable to move her arms from the elbow up but this was worse in the left arm/Felt paralyzed from the elbows up to the shoulders/still having problems with pulling up her pants; Shoulders went tight; Lymph nodes were swollen/swelling in her armpit, groin and base of neck; Chills; Rash in her arm pits; Some pain at the injection site; Hear a clicking sound in her shoulder joints and feels some relief afterward; This spontaneous case was received on 09-Feb-2021 reported by other non-health care professional (consumer) to Med Communications (reference number: SEQW21-00442) and concerned a 72-year-old, female patient. The patient's concurrent conditions included thyroid issues and blood pressure problems. The patient's concomitant medications included unspecified thyroid medication and blood pressure medication. On 23-Nov-2020, the patient was vaccinated with Seqirus influenza virus vaccine polyvalent (brand not specified; anatomical location: left arm, dose, route of administration: not reported) as influenza prophylaxis. The batch number was not reported. On an unspecified date in 2020, about a week to ten days after receiving influenza virus vaccine polyvalent, the patient said her shoulders went tight and she had the chills, lymph nodes were swollen and she experienced some pain at the injection site. The patient also experienced swelling in her arm pits, groin and base of neck. The patient had rash in her arm pits and was unable to move her arms from the elbow up, but this was worse in the left arm. The patient felt paralyzed from the elbows up to the shoulders and could hear a clicking sound in her shoulder joints and felt some relief afterward. The patient visited her physician twice and was given prednisone and celebrex and instructed on exercises to help with shoulders. At the time of initial reporting on 09-Feb-2021, the patient had not recovered from the event of 'vaccination site pain' since she still had problems with some pain. Also, the patient was recovering from all other events since it was reported that the medications helped and the she was better, but still had problems with pulling up her pants. The reporter assessed the events as related to influenza virus vaccine polyvalent. The reporter stated that the patient received her first flu vaccine ever on 23-Nov-2020 and has had reactions to it. Company comment:The patient developed mobility decreased, joint stiffness, lymphadenopathy, chills, rash, vaccination site pain and joint noise after vaccination with the suspect product, influenza virus vaccine polyvalent. Chronology seems plausible. No alternative etiology was provided. Causality for joint noise is assessed as not related as the event likely developed due to other experienced events (mobility decreased and joint stiffness). Considering all above mentioned, causal relationship for all other events is assessed as possibly related (defaults to ''related'' in the safety database for reporting purposes).; Reporter's Comments: The reporter stated the patient received her first flu vaccine ever on 23-Nov-2020 and has had reactions to it.; Sender's Comments: The patient developed mobility decreased, joint stiffness, lymphadenopathy, chills, rash, vaccination site pain and joint noise after vaccination with the suspect product, influenza virus vaccine polyvalent. Chronology seems plausible. No alternative etiology was provided. Causality for joint noise is assessed as not related as the event likely developed due to other experienced events (mobility decreased and joint stiffness). Considering all above mentioned, causal relationship for all other events is assessed as possibly related (defaults to ''related'' in the safety database for reporting purposes).

Other Meds:

Current Illness: Blood pressure abnormal; Thyroid disorder NOS

ID: 1041272
Sex: F
Age: 46
State: OH

Vax Date: 01/08/2021
Onset Date: 01/08/2021
Rec V Date: 02/19/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: First dose - fever, severe headache, achy. 2 weeks later - rash on face and then injection site. 3 weeks later - rash on face and then injection site again. Second dose - fever but NO headache, extreme exhaustion, and achy to the point where I could not even brush my hair. Rash at injection site and all over arm.

Other Meds: Lamictal, Yasmin, Vitamin D, Fish Oil, Folic Acid

Current Illness: None

ID: 1041273
Sex: F
Age: 70
State: SC

Vax Date: 02/17/2021
Onset Date: 02/17/2021
Rec V Date: 02/19/2021
Hospital:

Lab Data: None

Allergies: Penicillin Sulfur Iodine adhesive glues Seasonal Allergies

Symptoms: Sore arm, headache, nausea, sweats Time: from 7PM (Feb. 17th) until morning of the second day (Feb. 19th).

Other Meds: Lovaza 1gm BID Vytorin 10/20 QD (Bed) Multi-vitamin 1 pill QD Vitamin D-3 50 mcg BID Probiotic 10 QD (PM) Tylenol PM 1 QD Aller-Tec 1 QD Flonase 2 puffs QD (AM) Saline 2 puffs QD (AM) Montelukast 10mg QD (PM)

Current Illness:

ID: 1041274
Sex: F
Age: 58
State: CA

Vax Date: 02/16/2021
Onset Date: 02/16/2021
Rec V Date: 02/19/2021
Hospital:

Lab Data: Urine test, blood test, pelvic exam, biopsy of uterine lining

Allergies: none

Symptoms: Pain and difficulty urinating, large amount of blood in urine, continuing for 40 hours.

Other Meds: none

Current Illness: none

ID: 1041275
Sex: F
Age: 56
State: MI

Vax Date: 02/02/2021
Onset Date: 02/02/2021
Rec V Date: 02/19/2021
Hospital:

Lab Data: SEE ABOVE

Allergies:

Symptoms: Patient had an Allergic Reaction unknown cause . Onsite EMS was called vitals were taken BP 157/96 100% O2 room air HR 92. Patient treated, transported by the EMS to the hospital.

Other Meds: Norvasc Pill

Current Illness:

Date Died:

ID: 1041276
Sex: M
Age: 87
State: IL

Vax Date: 02/12/2021
Onset Date: 02/13/2021
Rec V Date: 02/19/2021
Hospital: Y

Lab Data:

Allergies: None

Symptoms: on 2/13 at 7:30am resident was observed congested, foaming at the mouth. transferred to the hospital, verbal report from hospital nurse stated the resident was admitted for hypercalcemia and dehydration. The resident expired on 2/14/21 at 9:30am. Died on 2/14/2021

Other Meds: Namenda, Mirtazapine, Multi-vitamin, Loratidine, Effexor XR

Current Illness: Hypertension, dementia, arthritis

ID: 1041277
Sex: F
Age: 73
State: FL

Vax Date: 02/16/2021
Onset Date: 02/17/2021
Rec V Date: 02/19/2021
Hospital:

Lab Data: none

Allergies: gluten, dairy

Symptoms: sore at site of injection with circle of red skin about 4 inches in diameter fading slightly by 3rd day (today) area is hard and skin sensitive to touch No other symptoms

Other Meds: nexium,spironolactone, eliquis, metoprolol, telmisartan, zioptan,combigan, probiotic, magnesium,coQ10,D-3,Vit C,Zinc

Current Illness: A fib, adrenal problems

ID: 1041278
Sex: F
Age: 55
State: MA

Vax Date: 02/16/2021
Onset Date: 02/16/2021
Rec V Date: 02/19/2021
Hospital:

Lab Data:

Allergies: none

Symptoms: Swollen Arm with intense pain, Extreme Headache, 102 Fever, body weakness, extreme fatigue

Other Meds: Celexa, Vit D3, Aleve

Current Illness: tennis elbow

ID: 1041279
Sex: F
Age: 82
State: PA

Vax Date: 02/06/2021
Onset Date: 02/10/2021
Rec V Date: 02/19/2021
Hospital: Y

Lab Data: cat scan and body scan, mri, injection, heart monitor-2/10-2-11

Allergies: morphine, sulphur

Symptoms: 1st day sore arm, 4th day-stroke like reaction, had to go to er

Other Meds: levothyroxine 112mcg, lisinopril 20mg, baby aspirin 81 mg , atorvastatin 20mg,

Current Illness: n/a

ID: 1041280
Sex: F
Age: 86
State: NM

Vax Date: 02/10/2021
Onset Date: 02/17/2021
Rec V Date: 02/19/2021
Hospital:

Lab Data: None

Allergies: none

Symptoms: Swelling and discomfort in muscle that received injection

Other Meds: elequis; diltiazim, levothyroxine, liothroxine, lisinopril, aloelax,

Current Illness: none

ID: 1041281
Sex: M
Age: 32
State: TX

Vax Date: 01/28/2021
Onset Date: 02/18/2021
Rec V Date: 02/19/2021
Hospital:

Lab Data:

Allergies: None

Symptoms: Soreness at injection site beginning ~2 hours after administration and lasting ~5 days. Chills beginning ~12 hours after injection and lasting ~12 hours, with low-grade fever. Tachycardia beginning ~16 hours after injection and lasting ~16 hours. Insomnia beginning ~16 hours after injection and lasting ~12 hours. Headache beginning ~16 hours after injection and lasting ~12 hours. Malaise and muscle/joint soreness beginning ~16 hours after injection and lasting ~24 hours. Fever and soreness responded to ibuprofen (800 mg PO every 8?10 hours). All adverse effects with the exception of soreness at the injection site resolved completely within ~24 hours of onset (~36 hours after administration).

Other Meds: Multivitamin Fexofenadine (generic OTC antihistamine)

Current Illness: None

ID: 1041282
Sex: F
Age: 67
State: CA

Vax Date: 02/18/2021
Onset Date: 02/18/2021
Rec V Date: 02/19/2021
Hospital:

Lab Data: none

Allergies: Itchiness with Penicillin

Symptoms: Sensation of swollen tongue

Other Meds: None

Current Illness: High Cholesterol

ID: 1041283
Sex: F
Age: 24
State: VA

Vax Date: 02/17/2021
Onset Date: 02/18/2021
Rec V Date: 02/19/2021
Hospital:

Lab Data: None.

Allergies: None.

Symptoms: Excruciating left side of face/head pain. In jaw, neck, face, above and around eye. Extreme sensitivity to light and sound. Began around 19:00. Tried OTC Motrin and Tylenol with no relief. Tried Orajel since the pain felt similar to maybe a toothache but have had no teeth issues. No relief from anything. Pain was 9/10. Around 5am pain completely went away. No more issues since then.

Other Meds: Novolog insulin-insulin pump, Effexor, vitamin B12, women?s multi vitamin.

Current Illness: None.

ID: 1041284
Sex: F
Age: 66
State: MN

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 02/19/2021
Hospital:

Lab Data: 2/17/21 Facility saliva Covid-19 test: negative

Allergies: penicillin antibiotics sulfa antibiotics

Symptoms: 2/11/21:sore arm 2/12/21: swollen lymph glands in neck, slight sore throat, in evening fever 100.6 F maximum 2/13/21: swollen lymph glands in neck, slight sore throat, afebrile, generalized rash over trunk and anticubital area 2/14/21: swollen lymph glands in neck, slight sore throat, afebrile, rash mostly faded 2/15/21 to 2/18/21 swollen glands in neck, slight sore throat, afebrile, no rash 2/19/21 (today): swollen lymph glands in neck, slight sore throat (improving), afebrile, no rash

Other Meds: levothyroxine vitamin D

Current Illness: none

ID: 1041285
Sex: F
Age: 34
State: TN

Vax Date: 01/04/2021
Onset Date: 01/11/2021
Rec V Date: 02/19/2021
Hospital:

Lab Data: EKG Urine analysis Blood work CBC metabolic panel

Allergies:

Symptoms: I was shadowing another interpreter on Jan. 11, 2021 and started to feel warm, nausea. I sat down and the PA asked if I was ok and then I don't remember anything. I then fainted and my Heart rate was 30 and they called a code blue. They took me to the ER and ran test and gave me IV and everything came back normal. After that incident, there was at least two other times I had to sit down because I was getting all the same symptoms again and thought it would happen again. I did donate blood on January 8. I was feeling fine when prior and the following two days.

Other Meds: Vitron C Calcium Vitamin D Paroxetine -10mg Nuvaring

Current Illness:

ID: 1041286
Sex: F
Age: 27
State: MD

Vax Date: 02/13/2021
Onset Date: 02/13/2021
Rec V Date: 02/19/2021
Hospital:

Lab Data: None

Allergies: Medications: NKDA Food: Gluten, nightshades, pineapple Other: almond oil (topical)

Symptoms: Delayed cellulitis-like reaction/rash (delayed edema & erythema, pruritus at injection site lasting 5+ days, tenderness of injection site lasting 5+ days, pain and limited mobility of shoulder joint on side of injection, malaise & lethargy, mild posterior auricular lymph node swelling & tenderness)

Other Meds: Vitamins (B complex, D3)

Current Illness: None

ID: 1041287
Sex: M
Age: 75
State: UT

Vax Date: 02/05/2021
Onset Date: 02/10/2021
Rec V Date: 02/19/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: A sort of tingling in chest and arms.

Other Meds: None

Current Illness: None

ID: 1041288
Sex: F
Age: 72
State: AZ

Vax Date: 02/18/2021
Onset Date: 02/18/2021
Rec V Date: 02/19/2021
Hospital:

Lab Data: nonr

Allergies: Lamotrigine Latex

Symptoms: Approximately 40 minutes following the injection, I experienced an increase in heart rate. Not painful but noticeable. Stopped activity and returned to normal within 30 minutes

Other Meds: Medicine Dosage Taken Lisinopril 10 mg Daily Synthroid 150mcg Daily Atorvastatin 40 mg D

Current Illness: none

ID: 1041289
Sex: F
Age: 74
State: MO

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

Lab Data:

Allergies:

Symptoms: Patient inadvertently received 1st dose of Moderna and 2nd dose of Pfizer.

Other Meds:

Current Illness:

ID: 1041290
Sex: F
Age: 72
State: AR

Vax Date: 02/09/2021
Onset Date: 02/10/2021
Rec V Date: 02/19/2021
Hospital:

Lab Data: None. Contacted pharmacy that gave me the shot and the pharmacist had a similar reaction. Asked me to file.

Allergies: None

Symptoms: Shot on Feb 9 - Arm had a knot below injection site that was about 2 ? below injection site and red the next day. Soreness, swelling and redness went away about 4 days later. However, some swelling, itching and redness returned on Feb 17 and continues today.

Other Meds: Ofev, Valsartan, Atorvastatin, Pot Chloride, MEQ ER, Flutivasone Propionate Nasal Spray, Diclofenac Sodium Topical Gel (hands), Tylenol Arthritis 8 hour, Caltrate w/ Vit D, monthly Vit B-12 injections

Current Illness: None

ID: 1041291
Sex: F
Age: 40
State: NY

Vax Date: 02/04/2021
Onset Date: 02/04/2021
Rec V Date: 02/19/2021
Hospital:

Lab Data: None

Allergies: PCN hives

Symptoms: Within a couple minutes I began having tingling of my chin that worked up to my forehead. My throat felt like I had a lump in it. I felt off like I may pass out. My vision seemed a little blurry. This lasted about an hour. I felt itchy all over my body. This lasted for several hours.

Other Meds: Wellbutrin XL 150 Lorsartan 20 mg Hydrochlorthiazide 12.5 Mini pill oral contraceptive

Current Illness: HTN Anxiety Irregular menstrual cycle due to cyst and fibroids

ID: 1041292
Sex: F
Age: 94
State: CT

Vax Date: 02/18/2021
Onset Date: 02/18/2021
Rec V Date: 02/19/2021
Hospital:

Lab Data: n/a

Allergies: NKA

Symptoms: ? of shaking chill

Other Meds: Amlodipine, calcium carbonate, Albuterol inhailer, Clonodine, Depakote sprinkles, metoprolol tartrate, methimazole, Trazodone

Current Illness:

ID: 1041293
Sex: M
Age: 27
State: SC

Vax Date: 01/29/2021
Onset Date: 01/30/2021
Rec V Date: 02/19/2021
Hospital:

Lab Data: Contact PCP for specific tests results.

Allergies: None

Symptoms: Signs/Symptoms: Urinary tract pain, WBC's in urine, bilateral epididymitis, 101.2 fever (1/30 to 2/3), chills, no bacterial/other infection identified on urinalysis or culture. Treatment: Rocephin, azithromycin, cipro

Other Meds: Adderall

Current Illness: None

ID: 1041294
Sex: F
Age: 46
State: MA

Vax Date: 02/17/2021
Onset Date: 02/17/2021
Rec V Date: 02/19/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Patient developed headache ~20 minutes after vaccine administration. Vitals at 11:28 AM: O2 98%, HR 91, BP 156/85. Vitals at 11 41 AM: O2 99%, HR 90, BP 149/90. Patient reported feeling anxious given her history of anaphylaxis to peanuts. Patient was monitored for 60 minutes. She did not develop any new or worsening symptoms throughout 60 minute observation period and she remained well appearing throughout. Reviewed s/sx anaphylaxis (facial swelling, throat itching or tightness, shortness of breath, vomiting) and advised her to call 911 immediately if these occur today.

Other Meds:

Current Illness:

ID: 1041295
Sex: F
Age: 43
State: MT

Vax Date: 02/16/2021
Onset Date: 02/17/2021
Rec V Date: 02/19/2021
Hospital:

Lab Data:

Allergies: Penicillin - rash

Symptoms: Chills, body aches/pains, fever, sore arm

Other Meds: Psyllium Husk Supplement, Vitamin D, Digestive Enzymes, Probiotic

Current Illness:

ID: 1041296
Sex: F
Age: 60
State: MD

Vax Date: 02/15/2021
Onset Date: 02/16/2021
Rec V Date: 02/19/2021
Hospital:

Lab Data: Diagnosis was done via Telemed. Was prescribed 7 day dosage of steriods 3 pills per day.

Allergies: none

Symptoms: Hives on the neck, breast and torso .

Other Meds: Amlodipine Besylate 5mg

Current Illness: none

ID: 1041297
Sex: F
Age: 32
State: VA

Vax Date: 01/02/2021
Onset Date: 02/07/2021
Rec V Date: 02/19/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: I started bleeding on the 4th, doctor stated threaten miscarriage. I had blood clots and vomiting'. I was taking to emergency room. I was giving a DNC because I had a miscarriage.

Other Meds: Prenatal vitamins Multi-Vitamins Levothyroixine

Current Illness: None

ID: 1041298
Sex: F
Age: 88
State: MA

Vax Date: 02/17/2021
Onset Date: 02/17/2021
Rec V Date: 02/19/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Patient experienced nausea. consulted with NPdid vitals o2 98% hr 94 hx of afib bp 146/91; patient was feeling fine stayed 30 minutes had caregiver with her to drive home

Other Meds:

Current Illness:

ID: 1041299
Sex: F
Age: 24
State: IN

Vax Date: 02/18/2021
Onset Date: 02/18/2021
Rec V Date: 02/19/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Mild arm pain appeared immediately. From 12am - 4am I experience severe chills (despite putting on multiple layers and blankets) that caused me shiver so severely I felt like I was convulsing. No position was comfortable when lying down and nothing made the chills better. I also felt dehydrated, which is unusual for me. From 4am - 6:30am the symptoms reversed and I got extremely hot and uncomfortable. At 8am I noticed a prominent red, warm patch of swelling around the injection site.

Other Meds: SERTRALINE

Current Illness:

ID: 1041300
Sex: F
Age: 73
State: CA

Vax Date: 02/11/2021
Onset Date: 02/13/2021
Rec V Date: 02/19/2021
Hospital:

Lab Data: Blood tests, CT scan of head

Allergies: penicillin

Symptoms: Beginning on 2nd day after 2nd vaccination (on 2/13/21), I experienced swelling in my upper right gum area. I presumed it was a tooth abscess. Swelling significantly increased over next two days. Finally had dental appointment on Monday, 2/15/21. Dentist determined it was probably NOT an abscess. He sent me to ER for an antibiotic IV drip. After labs and CT scan of my head I was diagnosed with cellulitis. I had an IV drip of antibiotic clindamycin for 4 hours and was sent home with 7 day prescription of oral clindamycin and 3 day presciption of ibuprofen. Over next two days (2/16-2/17) face swelling diminished?as of today (2/19) it's not completely gone.

Other Meds: losartan potassium,metoprolol, spironolactone

Current Illness: none

ID: 1041301
Sex: M
Age: 82
State: DE

Vax Date: 01/23/2021
Onset Date: 01/24/2021
Rec V Date: 02/19/2021
Hospital:

Lab Data:

Allergies: none known

Symptoms: Severe neuropathy pain throughout day after. Gabapentin was ineffective, so took 800mg ibuprofen twice during the day. Back to normal the following day.

Other Meds: gabapentin, synthroid, simvastatin, lisinipril, B12 injection

Current Illness: none

ID: 1041302
Sex: F
Age: 59
State: CA

Vax Date: 02/17/2021
Onset Date: 02/17/2021
Rec V Date: 02/19/2021
Hospital:

Lab Data: None

Allergies: Sulfa drugs- can get hives

Symptoms: Within a half hour my face went numb. More so from the top of my to my forehead. Neck felt like I was in a car accident. Medical Director at the site said extreme rare, but should go away in 24 hours that was Wednesday night. Friday morning still numb.

Other Meds: Magnesium, Vitamin C , Zinc, levrothyxin, estradiol.

Current Illness: 24 he Stomach virus -negative COVID a test

ID: 1041303
Sex: F
Age: 36
State: TX

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/19/2021
Hospital:

Lab Data:

Allergies: Sulfur, Dilaudid, Codeine

Symptoms: Redness in hand, left and right arm. Itchy throat, pain and rash on back left arm. Benadryl 50mg IM. Called at 3PM to assess patient, seen patient being called due to numbness both hands and mild rash in palms. No SOB, only itchy throat. Has had some reaction to Dilaudid and just took Benadryl which helped. Physical Exam: No abnormal findings, Skin mild redness at fingers. Released in 15 minutes. 50mg IM Benadryl. Patient sleeping no SOB. No decrease rash on palms, mild redness to cheeks. Itchy throat, no stridor or swallowing problems. Counselled patient and friend if SOB and throat closes go to ER. Can take Benadryl q6 OTC if needed. Patient understands.

Other Meds: Tylenol

Current Illness: None

ID: 1041304
Sex: F
Age: 75
State: MA

Vax Date: 02/18/2021
Onset Date: 02/18/2021
Rec V Date: 02/19/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Patient arrives to obs; PT states patient felt lightheaded. Patient reports feeling high, VS 212/98,C 127, 100% frightened breathing shallow and quickly. Emotional support given, transported to stretcher. BP 189/104 hr 105 99% awake and alert. Continues to repot lightheadedness. She states walking down from vaccination she had an aura type experience. 10:50 BP 214/97HR 104, 99%, Respiratory arrived. Followed by MD and IV nurse. 10:55 213/88 HR92 99%. Transferred to ER by IV Nurse and administrator.

Other Meds:

Current Illness:

ID: 1041305
Sex: M
Age: 17
State: NY

Vax Date: 02/19/2021
Onset Date: 02/19/2021
Rec V Date: 02/19/2021
Hospital:

Lab Data:

Allergies: None

Symptoms: After receiving the vaccine or states he began to feel faint. Pt and Pt?s mother state this happens when he has blood drawn. Pt was seated in a wheelchair and moved to the exam area. Pts vitals are stable. Pt states he is feeling better and would like to leave. Pt?s mother states she is comfortable with leaving. Pt did not require transport to hospital.

Other Meds: None

Current Illness: None

ID: 1041306
Sex: F
Age: 60
State: WI

Vax Date: 02/18/2021
Onset Date: 02/18/2021
Rec V Date: 02/19/2021
Hospital:

Lab Data: Called all 3 doctors, out of office on Frdays no emergency numbers. Emergency nurse for doctor will call back. I am worried it will throw me into a muscle episode that people with arthritis have.

Allergies: Hydrochlorothorozide Penicilin Morphine

Symptoms: Flared up rhumatism and muscle disease. Muscles swollen and achy, still snd hard to move. Chills. Site of injection swollen sore and the impression on bandaid on arm. Told to take mefication dicoflenic. No help. All doctors outof office on Friday

Other Meds: Diclofenic Vitamen d Linisopril Diclocymine Topiramate Simvastatin Pantoprozole Cyclobenzaprine

Current Illness: Rhumitism arthritis Headaches

ID: 1041307
Sex: F
Age: 72
State: PA

Vax Date: 02/11/2021
Onset Date: 02/12/2021
Rec V Date: 02/19/2021
Hospital:

Lab Data: none needed

Allergies: none

Symptoms: fever 100-101 forabout 6 -12hr overall body aches, chills, intermittent for 18 hr headache 24 hr sore left arm 18 hr

Other Meds: synthroid, rosuvastatin, omeprazole, lisinopril,zoloft

Current Illness: none

Total 2021 VAERS Injuries: 134,999

Page last modified: 14 December 2021 10:42pm