VAERS 2021 Database www.vaers.hhs.gov

Main Page | All 2021 Deaths | Videos
VAERS Updated: 10/01/2021
** VAERS DATABASE Last updated: October 1, 2021**
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Manufacturers

Total Manufacturer
187,133MODERNA
33,878JANSSEN
2,321PFIZER\BIONTECH
1,091GLAXOSMITHKLINE BIOLOGICALS
983UNKNOWN MANUFACTURER
363MERCK & CO. INC.
229SEQIRUS, INC.
45DYNAVAX TECHNOLOGIES CORPORATION
41NOVARTIS VACCINES AND DIAGNOSTICS
29SANOFI PASTEUR
18EMERGENT BIOSOLUTIONS
8PAXVAX
7TEVA PHARMACEUTICALS
4PFIZER\WYETH
3BERNA BIOTECH, LTD.
2SMITHKLINE BEECHAM
2INTERCELL AG
2PROTEIN SCIENCES CORPORATION
1CSL LIMITED

Incidents per State

State Total
77,548
AK1,869
AL5,581
AR3,688
AS47
AZ14,288
CA61,984
CO11,665
CT8,149
DC1,663
DE1,807
FL37,749
FM5
GA15,058
GU120
HI2,453
IA4,625
ID2,692
IL20,334
IN24,007
KS4,615
KY7,696
LA4,887
MA14,654
MD12,514
ME3,129
MH11
MI18,739
MN12,528
MO9,710
MP29
MS2,790
MT2,375
NC16,368
ND1,356
NE2,880
NH3,100
NJ17,634
NM3,916
NV4,239
NY34,355
OH19,081
OK6,195
OR8,636
PA23,083
PR2,370
QM2
RI2,088
SC6,411
SD1,212
TN9,131
TX35,174
UT4,273
VA14,937
VI64
VT1,676
WA14,909
WI11,259
WV2,388
WY861
XB5
XL1
XV2

ID: 1063981
Sex: M
Age: 65
State: CA

Vax Date: 02/14/2021
Onset Date: 02/16/2021
Rec V Date: 03/01/2021
Hospital: Y

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

Lab Data:

Allergies: NKA

Symptom List: Dysphagia, Epiglottitis

Symptoms: Day one was low-grade fever and fatigue. Day two was vomiting. Day three through five was vomiting and continuous diarrhea. Hospital admission on day five for dehydration. Diarrhea continued through day eight post vaccination.

Other Meds: Metformin Glimeperide Jardiance Trulicity Pravachol Ramapril Fish oil Aspirin Vitamin B12 Multi vitamin

Current Illness: None

ID: 1063982
Sex: F
Age: 86
State: NH

Vax Date: 02/09/2021
Onset Date: 02/10/2021
Rec V Date: 03/01/2021
Hospital:

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

Lab Data:

Allergies: NKDA, reports hayfever allergy

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient received Moderna VAX 1500 on 2/9/2021. Patient waited 30 observation period (son-in-law in same care and reported bee sting allergy) 1900 reported sore arm with no other signs/symptoms of adverse reactions 1500 on 2/10/2021 Patient reported systemic urticaria to daughter. 1505 daughter gave 25mg of diphenhydramine, Patient stated "skin was crawling." 1520 Patient's daughter administered 0.3mg epinephrine with immediate relief of symptoms (daughter and son-in-law both have own epinephrine Rx's due to allergies)

Other Meds: metoprolol 50mg qd, wellbutrin 100mg qd, "statin" 40mg qd

Current Illness:

ID: 1063983
Sex: F
Age: 73
State: IA

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 03/01/2021
Hospital:

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

Lab Data:

Allergies: Cortisone shots, Celebrex, Mobic, Erythromycin, Ansaids, Levaquin, Cefprozil, Prosed-DS tablets, Potassium CL 10 MEQ, Z-pack, Detrol, Amitriptyline-25 mg., Duloxetine-20 mg., Paroxetine-10mg., Premarin cream (Got itchy for months after being given 2 Cortisone shots 3 wks. apart in 2002, During those months I became itchy from many colognes, make-up, and fabric finishes. Food--feel better if I drink almond milk and stay away from cream cheese

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

Symptoms: After 15 min. (4:10 p.m.) I left the Dr. office to go to the store in the same town. While there (about 4:15 p.m.) I started a bad headache, neck hurt and feeling "strange". While waiting in the check out line I felt hot and weak. After a few min. when I got home ( about 5:15 p.m.) my face felt tight and I became itchy on all parts of my body except not as much on my legs. The next day the headache was not as bad but still itchy especially on my face, head and back. My arm was not any more sore than with a flu shot. The next day the headache was gone, the arm was not sore, but I was still itchy. The itching would come and go for about a week.

Other Meds: Prescriptions: Vesicare-5 mg. daily, Alfuzosin-10mg. daily, Restasis eye drops -2x daily, Clindamycin-1% gel-as needed, Fluticasone-.05 cream-as needed, Hydrocortisone 2.5% cream-as needed, Clobetasol-.05% ointment-2x a day on Sat. & Sun.

Current Illness: None

ID: 1063984
Sex: F
Age: 80
State: WI

Vax Date: 02/20/2021
Onset Date: 02/21/2021
Rec V Date: 03/01/2021
Hospital: Y

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

Lab Data:

Allergies: hydrocodone - severe restless legs

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient had her second COVID vaccine on 2/20/21. The next day she developed diffuse body aches. She went on to develop worsening dyspnea and fever to 103?F on February 23. She had a fever again on February 24. The patient also experienced a few episodes of vomiting and diarrhea but no abdominal pain and had pain of the legs, right greater than left. Blotchy red patches of the hands and arms developed. She therefore presented to the ER on 2/25/21. See full history below from infectious disease note on 3/1/21: Patient is an 80 year old female who has a past medical history notable for hypertension, dyslipidemia, and hypothyroidism. The patient was diagnosed with a high-grade lymphoma of the retroperitoneum in 2004 and completed 4 cycles of multi-chemotherapy (Cytoxan, Adriamycin, vincristine, methotrexate, and IT chemotherapy (Magrath-like regimen)). She completed 4 cycles with complete remission on PET scan. The biopsy of a left cervical lymph node in 2007 revealed follicular lymphoma and she completed radiation therapy to the neck with complete remission. A left axillary lymph node biopsy in 2016 revealed grade-3 follicular lymphoma with mixed follicular and diffuse histology. Chemotherapy was pursued. The biopsy of a pelvic lymph node in 2019 was consistent with G1-2 follicular lymphoma. ?She completed radiation to the pelvis in May of 2019. ?She developed progressive pelvic adenopathy in April of 2020 and received 5 cycles of chemotherapy. Subsequent CT showed improvement in the adenopathy. ?Her course was complicated by pulmonary emboli (September 2020). ?In November of 2020 she was started on maintenance Rituxan every 2 months. ?She received the 2-dose Pfizer COVID vaccine series on 1/29/21 and 2/20/21. With the above background, the patient presented to the emergency room on February 25, 2021 with complaints of diffuse body aches, which had developed that day after receiving her second dose of COVID-19 (SARS-CoV-2) vaccine. ?She went on to develop worsening dyspnea and fever to 103?F on February 23. ?She had a fever again on February 24. The patient also experienced a few episodes of vomiting and diarrhea but no abdominal pain and had pain of the legs, right greater than left. Blotchy red patches of the hands and arms developed. ?She called Oncology on February 20 and it was recommended that she go to the emergency room for evaluation. ? She was afebrile on presentation to the emergency room. ?She was tachycardic, however, with a pulse rate of 117 bpm. ?She was breathing at 48 breaths per minute. ?Blood pressure was 105/80 mmHg. ?Oxygen saturation by pulse oximetry was 96%. Examination was notable for paraspinous muscle tenderness, tachypnea, mild respiratory distress, and a mildly distended abdomen. ?Mild erythematous patches of the feet and forearm were noted, as well as evidence of edema of the right leg from the knee to the lower leg. The peripheral blood leukocyte count measured 0.8x10e3/?L. ?ANC was 0.48x10e3/?L. ?Platelets measured 96x10e3/?L. ?Creatinine was 0.97 mg/dL. ?AST was 86 and ALT 20 U/L. The lactic acid level of the venous blood was 3.6 mmol/L. The procalcitonin level of the blood measured 28.37 ng/mL. The C-reactive protein level was 313.7 mg/deciliter. The creatine kinase (CK) level was 4023 U/L. ?LDH measured 314 U/L. Troponin was 3.22 ng/mL. ?Urinalysis showed 6-10 wbc?s, 0-2 rbc?s/hpf, 3+ blood, negative nitrites, hyaline and granular casts as well as amorphus crystals. A chest radiograph showed possible, but not definite, mild atelectasis or infiltrate at the left lung base. ?A radiograph of the right tibia/fibula showed circumferential soft tissue edema seen within the knee and upper to mid aspect of the lower leg. ?EKG showed sinus tachycardia but no evidence of arrhythmia or ischemia. Cultures of specimens of the blood were obtained. ?The patient was started empirically on vancomycin and cefepime and was admitted. ? Faint erythema and ecchymosis of the right leg extending to the dorsal right foot and right wrist erythema were noted following the patient?s admission. ?Her condition subsequently destabilized with increased respiratory rate, worsening pain, and hypotension, so she was transferred to the ICU. An abdominopelvic CT on February 25 revealed a small amount of free fluid in the abdomen around the liver, cholelithiasis with no evidence of acute cholecystitis or biliary dilatation, a nonobstructing 5-mm stone of the mid pole of the left kidney, coronary artery calcifications, mild infiltration of the fat in the inferior retroperitoneum and along the right common iliac region with small nodes in this region, similar compared with September 24, 2020, but improved compared with April 30, 2020, and consistent with response of lymphoma to chemotherapy; a myomatous uterus. A CT scan of the right lower extremity showed extensive edema about the subcutaneous tissues of the right lower leg and infiltration of the fat about the muscles of the right lower leg, likely representing cellulitis and fasciitis, and possible myositis. However, there was no air within the subcutaneous tissues or muscles to suggest necrotizing fasciitis and no evidence of abscess. ? ? The patient?s antibiotic treatment was later changed to vancomycin, piperacillin-tazobactam and clindamycin. Cultures of specimens of the blood were later reported as being positive for methicillin-susceptible Staphylococcus aureus on 2/2 sets. Repeat blood cultures (February 26) were positive as well. Her antibiotics were modified to cefazolin monotherapy. Repeat blood cultures on Feb 27 and 28 were negative. ? TTE completed 2/27/21 without obvious vegetation. ? TODAY (3/1/21): Cultures negative 2/27 and 2/28. Remains on IVIG. Afebrile. She complaints of continued pain in the Right leg and swelling at that left arm. Exam GENERAL: NAD EYES: Sclera and conjunctiva clear NECK: no adenopathy LUNGS: Breath sounds normal and symmetric. No rales or wheezes. HEART: regular rhythm, no murmur appreciated ABDOMEN: Soft without mass, tenderness, organomegaly or hernia. EXTREMITIES: RLE with ecchymosis, slight overlying erythema and anterior blister: blistering more pronounced today. left foot with plantar erythema, some tenderness today. LUE fullness with some heat/tenderness SKIN: No other rashes or other abnormalities are noted. NEUROLOGICAL: alert, appropriate Assessment 1. MSSA septicemia with shock. Positive blood cultures 2/25 and 2/26 thus far. Negative since 2/27. 2. Multifocal cellulitis and interstitial infective myositis of LE- suspect related to above. CT scan was negative for apparent necrotizing infection. 3. Elevated CK due to above- improving 4. Recurrent lymphoma- has been on maintenance rituximab (11/2020). Immunocompromised state. 5. Low immunoglobulins- remains on IVIG 6. Positive urine cultures with Staph aureus- this is typically secondary seeding from bacteremia rather than primary staph uti. CT abd/pelvis negative for nidus of infection along GU track (no renal abscess for example) 7. LUE swelling/tenderness. ? Plan 1. Cont Cefazolin without change: goal dosing 8gm/24hr 2. Following repeat blood cultures, negative thus far (tentative D0= 2/27/21) 3. Pending course, anticipate likely TEE--- > presently precluded due to thrombocytopenia 4. Will obtained LUE doppler for completeness given pain/swelling here. Down the line, may need to consider additional imaging (CT?) if concern for abscess, etc). 5. ID will follow along with you. Please call if any questions/concerns. Patient is still admitted, and is in the ICU.

Other Meds: ? acetaminophen (TYLENOL) 500 MG tablet Take 500 mg by mouth every 4 hours as needed for Fever or Pain Maximum allowable Acetaminophen amount = 4 Grams (4000 mg) / 24 hours. ? ? ? acyclovir (ZOVIRAX) 400 MG tablet TAKE 1 TAB TWICE DAILY 60

Current Illness: none

ID: 1063985
Sex: F
Age: 77
State: NY

Vax Date: 02/25/2021
Onset Date: 02/25/2021
Rec V Date: 03/01/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: c/o lower bilateral arm pain and shaking of arms. Arms did not shake when on her lap. Denied chest pain or SOB .

Other Meds: Plavix

Current Illness: Arm pain following fall

ID: 1063986
Sex: F
Age: 38
State: ID

Vax Date: 02/23/2021
Onset Date: 02/23/2021
Rec V Date: 03/01/2021
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:

Allergies:

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

Symptoms: tacchycardia, High blood pressue, redness on vaccine arm, mild flushing

Other Meds:

Current Illness:

ID: 1063987
Sex: F
Age: 65
State: DE

Vax Date: 02/27/2021
Onset Date: 02/27/2021
Rec V Date: 03/01/2021
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: ceclor, Keflex, minocin, macrolides, penicillins

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Technician thought the dose looked funny in the syringe but, didn't notify the pharmacist until she gave the vaccine and the next one pulled funny too. Then she notified me about the vaccine looking funny and upon inspection, there was no vaccine in the syringe. We pulled the rest of the shots in the vial and found that there was an extra shot. We concluded that this patient must not have actually received any vaccine in her dose and called her back to give her another dose. Patient was fine at the time of the incident and I followed up with her n 48 hours and she is still fine and no side effects to her arm. She did say that she had a headache but, that could have been due to the weather and not necessarily the vaccine and otherwise she feels fine with no other side effects or health issues.

Other Meds: albuterol HFA, Dulera, gabapentin 300mg, lidocaine topical ointment, oxycodone/apap

Current Illness: nka

ID: 1063988
Sex: F
Age: 65
State: CA

Vax Date: 02/23/2021
Onset Date: 02/23/2021
Rec V Date: 03/01/2021
Hospital:

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

Lab Data:

Allergies: no allergies

Symptom List: Pharyngeal swelling

Symptoms: 15 minutes after her dose, patient was leaving and fell to the floor. She was unconscious briefly and woke up within a couple of seconds. She was breathing heavy and 911 was called. She stayed on the ground for about 10 minutes and refused treatment. She kept asking not to start any IVs on her. Patient eventually recovered and refused the ambulance. Follow up call to her house later that day indicated she was doing fine and did not need any further treatments.

Other Meds: none

Current Illness: no illnesses

ID: 1063989
Sex: F
Age: 41
State: CA

Vax Date: 03/01/2021
Onset Date: 03/01/2021
Rec V Date: 03/01/2021
Hospital:

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

Lab Data:

Allergies: Cats, spiders, dust

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient beckoned for assistance. Voiced that she was feeling ?light-headed and dizzy. ?Once assessed patient is flushed and sweaty. She remains alert and oriented x 3. States that she hasn?t eaten lunch but does have some snacks in her car. Denies allergic reactions such as hives, itching, or SOB. Vitals signs obtained and WNL. States that she had EPI when she was 5 years old but does not recall the reasoning. Offered bottle of water but denied. Stayed with patient for duration of recovery time. Symptoms subsided at 1340. Patient educated on general side effects of vaccinations and voices understanding. Patient signed report form and was released at 1348.

Other Meds: NONE

Current Illness: None

ID: 1063990
Sex: F
Age: 61
State: NC

Vax Date: 02/05/2021
Onset Date: 03/01/2021
Rec V Date: 03/01/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Developed left sided facial droop on afternoon of 3/1/2021. was seen clinic internal medicine. Diagnosed with probable Bell's Palsy at outpt clinic prior to CT and MRI, treated with prednisone taper and valcyclovir. Pt scheduled for 2nd covid vaccine on 3/5/2021

Other Meds: Albuterol, Amlodipine, Breo Ellipta, HCTZ, Levothyroxine, Lisinopril, Metoprolol, Montelukast, Potassium, Simvastatin

Current Illness: None

ID: 1063991
Sex: F
Age: 57
State: NY

Vax Date: 02/27/2021
Onset Date: 02/27/2021
Rec V Date: 03/01/2021
Hospital:

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

Lab Data:

Allergies: Tomatoes, Ceclor , Zoloft

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

Symptoms: Face (cheeks from under eye to jaw line on both sides of face) turned very red and blotchy. At one point, strange sensation in the throat then went away. Face redness lasted approximately 3 hours. Was also fatigued. Felt back to normal after 3 hours.

Other Meds: 600 mg calcium supplement, vitamin d 1000, benecol. Plant Stanols 2 g, Coramega. Omega -3 2000mg fish oil

Current Illness: None

ID: 1063992
Sex: F
Age: 73
State: CO

Vax Date: 02/26/2021
Onset Date: 02/26/2021
Rec V Date: 03/01/2021
Hospital:

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

Lab Data:

Allergies: None to my knowledge

Symptom List: Rash, Urticaria

Symptoms: Nausea, diarrhea, rib cage pain so bad I couldn't lie down/sleep, exhaustion, Muscle aches and pain, loss of appetite, cough,

Other Meds: Alprazolam .25mg 1 every 12 hrs as needed Omeprazole DR 20mg once a day Buspirone 15mg Twice per day Escitalopram 20mg per day Vitamin D3, C, and B12

Current Illness: Bad lower back pain, awaiting a third injection on March 23, 2021 Stage 3 Kidney Decease

ID: 1063993
Sex: F
Age: 69
State: CO

Vax Date: 02/24/2021
Onset Date: 02/24/2021
Rec V Date: 03/01/2021
Hospital:

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

Lab Data:

Allergies: Fentanyl Versed [Midazolam

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

Symptoms: Vertigo started @ 1100pm on 02/24/2021. Patient describes it as "very bad" and the "whole room was spinning." Patient had "to hold onto to items to walk to bathroom." After 12 hrs. she still felt dizzy but it had improved . Sunday it improved more where she could go for a walk. Vertigo has resolved

Other Meds: cyanocobalamin, vitamin B-12, (VITAMIN B-12 PO) Lysine 1,000 mg Tab multivitamin (HEXAVITAMIN) per tablet TURMERIC-HERBAL COMPLEX NO.278 PO UNITHROID 100 mcg tablet valACYclovir (VALTREX) 500 mg tablet

Current Illness: Plantar fasciitis

ID: 1063994
Sex: F
Age: 17
State: PR

Vax Date: 03/01/2021
Onset Date: 03/01/2021
Rec V Date: 03/01/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: NO ALLERGIES

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

Symptoms: PATIENT WITH 17 YEAR OF AGE , WAS ADMINISTER COVID 19 MODERNA VACCINE. SHE WORKS AT THE LONG TERM CARE FACILITY OF THE CLINIC.

Other Meds: NOT KNOWN

Current Illness: NO

ID: 1063995
Sex: F
Age: 70
State: OH

Vax Date: 02/01/2021
Onset Date: 02/01/2021
Rec V Date: 03/01/2021
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: penicillin, Bactrim, codeine

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

Symptoms: About 6 hours after receiving shot, patient had sore arm that went into the armpit area and by 9 pm that day she was feeling soreness/pain all along left side including arm down to elbow, front and back of left shoulder, as well as left side of neck and chest. This pain was most severe the first 2 days and lasted a total of about 5 days. On February 3rd , she started feeling cold symptoms and blood pressure went up to 164/93 , this decreased with a dose of her blood pressure medicine. Then starting on 2-11-21 she woke up with a racing heart and shortness of breath, on 2-12-21 a racing heart again occurred. She went to see her doctor who performed an EKG , found some abnormality and adjusted her heart/ blood pressure medications. Her doctor did not feel the heart and shortness and breath were due to vaccine specifically.

Other Meds: Metoprolol Er 50mg , 2 daily , amlodipine 5mg daily, valsartan-hctz 160/25 daily, lansoprazole 30mg twice daily, potassium OTC 99mg :1 at breakfast and 2 at lunch, vitd 3 2000 units daily, calcium 600 mg daily , centrum :1 daily

Current Illness: none known

ID: 1063996
Sex: F
Age: 78
State:

Vax Date: 02/24/2021
Onset Date: 02/26/2021
Rec V Date: 03/01/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: red, hot, swollen area on my arm about 3" by 6" in size that started about 2 days after injection and started to get better 5 days after injection. Treated with ice. Outcome unknown at this time.

Other Meds:

Current Illness:

ID: 1063997
Sex: F
Age: 66
State: WA

Vax Date: 02/25/2021
Onset Date: 02/26/2021
Rec V Date: 03/01/2021
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: Penicillin, Sulfa, Shrimp, Guava

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

Symptoms: Taste is off causing loss of appetite, stomach upset, diarrhea starting today.

Other Meds: Methocarbamol 325mg at bedtime, Ambien 3.33mg at bedtime, Levothyroxine 100mg morning, Kirkland Joint Health 1 tablet morning

Current Illness: N/A

ID: 1063998
Sex: F
Age: 33
State: MA

Vax Date: 02/28/2021
Onset Date: 02/28/2021
Rec V Date: 03/01/2021
Hospital:

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

Lab Data:

Allergies: Erythromycin (Hives)

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Approximately 8 hours after vaccination, vaccination site (1-inch diameter) became red, swollen, itchy, and warm to the touch. As of 3/1/2021 4:30 PM, the itch has resolved. No other symptoms present.

Other Meds: N/A

Current Illness: N/A

ID: 1063999
Sex: F
Age: 73
State: AZ

Vax Date: 02/27/2021
Onset Date: 02/27/2021
Rec V Date: 03/01/2021
Hospital:

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

Lab Data:

Allergies: IV contrast dye

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Individual reports that 2 hours post vaccination with dose #2 of Covid19 Moderna vaccine, she experienced the sensation that her throat was swelling and her eyes swelled almost closed. She states that she took one 25mg tablet of Benadryl PO at immediate onset of symptoms and within 20 minutes she felt the symptoms start to subside. She states the symptoms did not fully clear up until several hours later. She also reports that her legs felt "very heavy" and she was very lethargic. She also reports having a very sore arm still. Individual reported feeling the throat swelling sensation following a CT scan with use of contrast dye. She states she did not seek emergency help or visit a provider for the incident.

Other Meds: Unknown

Current Illness:

ID: 1064000
Sex: F
Age: 57
State: PA

Vax Date: 02/24/2021
Onset Date: 02/24/2021
Rec V Date: 03/01/2021
Hospital:

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

Lab Data:

Allergies: CODINE

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

Symptoms: Pain, swelling, redness at injection site. Could not lift arm. Extreme tiredness and fatigue. Dizziness and headache. Body aches all over (most likely the shot caused a flare to my ostearthritis). Stomach ache, vomiting, chills, runny nose and fever. Symptoms similar to the flu. Started Wednesday evening after shot received and got worse over the next few days. Went to bed early during the week after work. Was totally exhausted. Was in bed all day Saturday, Sunday and had to take off work on Monday. Seem to be feeling a little better this evening. Fever broke; sweated on and off all day.

Other Meds: NO

Current Illness: NO

ID: 1064001
Sex: M
Age: 66
State: ID

Vax Date: 02/23/2021
Onset Date: 02/23/2021
Rec V Date: 03/01/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKA

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

Symptoms: Patient c/o general weakness, dyspena, lightheadedness. No increase in resp effort. Vital signs: 92/62-52-14-96% O2 Sat. Alert and orients. Skin cool and clammy. Breath sounds clear. Cap refil 4 sec. Laid supine. Monitored patient for 35 min. Vital signs: 132/88-70-96% O2Sat. Patient returned to basesline. No dizziness or lightheadedness. Patient discharge home.

Other Meds: Vitamins

Current Illness:

ID: 1064002
Sex: F
Age: 94
State: CA

Vax Date: 02/25/2021
Onset Date: 02/25/2021
Rec V Date: 03/01/2021
Hospital:

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

Lab Data:

Allergies: Aspirin

Symptom List: Unevaluable event

Symptoms: Dizziness 110/60 BP o2 96% P-62 13/60 @12:30pm

Other Meds: Lipitor

Current Illness:

ID: 1064003
Sex: F
Age: 37
State: CA

Vax Date: 01/11/2021
Onset Date: 01/19/2021
Rec V Date: 03/01/2021
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:

Allergies: None

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

Symptoms: Rhabdo

Other Meds: None

Current Illness: None

ID: 1064004
Sex: M
Age: 50
State: NY

Vax Date: 02/25/2021
Onset Date: 02/25/2021
Rec V Date: 03/01/2021
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: RN adminstered 1.0ML erroneously. The patient did not experience any adverse reactions.

Other Meds: Uknown

Current Illness: Uknown

ID: 1064005
Sex: F
Age: 23
State: MI

Vax Date: 02/27/2021
Onset Date: 02/27/2021
Rec V Date: 03/01/2021
Hospital:

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

Lab Data:

Allergies: Amoxicillin, Penicillin, Sulfa, Red Dye 40

Symptom List: Injection site pain, Menorrhagia

Symptoms: Within the first 10 minutes of receiving the vaccine I felt extremely lightheaded, eyes were blurry for 5-10 minutes, and extreme sweating all over my body. These symptoms subsided after 25 minutes. I then became on and off light headed through the remainder of the day. The day after receiving the vaccine I felt a lot of brain fog, forgetfulness, and fatigue. The night of day two I had a sudden onset of nausea and headache which only lasted 20 minutes. During this time I was massaging the injection site because it was sore.

Other Meds: June Fe 1/20 (Birth Control)

Current Illness:

ID: 1064006
Sex: M
Age: 54
State: NY

Vax Date: 02/25/2021
Onset Date: 02/25/2021
Rec V Date: 03/01/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: RN adminstered 1.0ML erroneously. The patient did not experience any adverse reactions.

Other Meds: Uknown

Current Illness: Uknown

ID: 1064007
Sex: M
Age: 69
State: CA

Vax Date: 03/01/2021
Onset Date: 03/01/2021
Rec V Date: 03/01/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient given COVID-19 vaccine and within 5 minutes patient became unresponsive in and out of consciousness intermittently answering questions, diaphoretic, hypotensive and desaturated. O2 given, Vitals signs taken , FS checked, IV started, 911 called patient transported to nearest hospital.

Other Meds:

Current Illness:

ID: 1064008
Sex: M
Age: 85
State: NY

Vax Date: 02/25/2021
Onset Date: 02/25/2021
Rec V Date: 03/01/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: RN adminstered 1.0ML erroneously. The patient did not experience any adverse reactions.

Other Meds: Uknown

Current Illness: Uknown

ID: 1064009
Sex: M
Age: 43
State: NY

Vax Date: 02/25/2021
Onset Date: 02/25/2021
Rec V Date: 03/01/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: RN adminstered 1.0ML erroneously. The patient did not experience any adverse reactions.

Other Meds: Uknown

Current Illness: Uknown

ID: 1064010
Sex: F
Age: 24
State: IL

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 03/01/2021
Hospital:

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

Lab Data:

Allergies: Penicillin/shellfish

Symptom List: Nausea

Symptoms: After an half hour of observation patient c/o of light headedness. Patient was laid down for 15 minutes and vitals were taken. BP was 155/99. At 345 PM nurse noted redness on cheeks and neck. Denied itchiness, no noted SOB or difficulty swallowing. On follow-up on 2/16/2021 Patient says she went home took Benadryl and rested. Says she had chills, and headache throughout weekend but on Tuesday she was back to feel normal.

Other Meds:

Current Illness:

ID: 1064011
Sex: F
Age: 63
State: UT

Vax Date: 02/13/2021
Onset Date: 02/14/2021
Rec V Date: 03/01/2021
Hospital:

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

Lab Data:

Allergies: sulpha

Symptom List: Injection site pain

Symptoms: February 14--fever, body aches, headache, fatigue February 22/23/24--headache, fatigue February 27/28 & March 1--headache, fatigue

Other Meds: Bayer aspirin

Current Illness: none

ID: 1064012
Sex: F
Age: 51
State: NY

Vax Date: 02/25/2021
Onset Date: 02/25/2021
Rec V Date: 03/01/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: RN adminstered 1.0ML erroneously. The patient did not experience any adverse reactions.

Other Meds: Uknown

Current Illness: Uknown

ID: 1064013
Sex: F
Age: 71
State: PA

Vax Date: 02/24/2021
Onset Date: 02/24/2021
Rec V Date: 03/01/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: peanuts, cashews

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

Symptoms: Metalic sensation in tongue and back of throat. Onset within 5 minutes. Did not worsen, gradually improved, about 50% better within 30 minutes. No tongue or lip swelling. Breathing normally. The patient describes feeling a similar sensation after her first vaccination that lasted for about 1 hour and then resolved.

Other Meds: Avorstatin, nexium

Current Illness: none

ID: 1064014
Sex: F
Age: 77
State: WI

Vax Date: 02/09/2021
Onset Date: 02/09/2021
Rec V Date: 03/01/2021
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: Fish, seafood, oranges, penicillin, and cane products

Symptom List: Tremor

Symptoms: Client report having COVID in November 10, 2020. Client received first dose on 02/09/21 at 2 pm, reaction of SOB began two hours later. SOB progressed to chest pain and fatigue. She sat at kitchen table to relax and rest, fell asleep for 2 hours. When she woke up she continued to have trouble breathing, drank some warm tea, went to bed and slept for 12 hours. This is not usual for her sleep schedule. The next day she felt better for a couple of hours then had some difficulty breathing again. She went to Urgent Care. EKG and chest X-ray preformed came back normal. Blood pressure was elevated. Client given 4 puffs of an inhaler. Discharged to home.

Other Meds: Vit D, hydrocodone, gabapentin, mercaptopurine, vitamins

Current Illness: None

ID: 1064015
Sex: F
Age: 48
State: CA

Vax Date: 02/27/2021
Onset Date: 02/27/2021
Rec V Date: 03/01/2021
Hospital:

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

Lab Data:

Allergies: Red and purple grape and wine cats

Symptom List: Erythema, Pruritus

Symptoms: Red rash on face and back

Other Meds: Lamotrigine 25 mg PO daily

Current Illness: None per patient

ID: 1064016
Sex: F
Age: 23
State: CA

Vax Date: 02/26/2021
Onset Date: 02/26/2021
Rec V Date: 03/01/2021
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:

Allergies: None

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

Symptoms: Symptoms began immediately after injection. Shoulder pain, limited range of motion lasting about 48 hours, bruising at site of injection, tingling and pain down the right arm and fingers lasting up to time of report

Other Meds: None

Current Illness: None

ID: 1064017
Sex: F
Age: 66
State: CA

Vax Date: 03/01/2021
Onset Date: 03/01/2021
Rec V Date: 03/01/2021
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: Penicillin, Azithromycin, Tetracycline, Sulfa, ZIthromax, Morphine, Bananas, Bee stings, Beets

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

Symptoms: Complaint of dizziness. Denies shortness of breath, chest pain, difficulty breathing and pain. No blurred vision. Patient did not eat or take prescribed medications prior to vaccination. Patient alert and oriented x3. Vitals: BP 120/78, T 97.9, P 89, R 18, O2 95%. Vitals prior to discharge BP 122/80, T 97.4, P 91, R 20, O2 95%. Patient discharged from clinic.

Other Meds: Trazadone, Venlafaxine, Nifedipine, Vitamin B complex, Vitamin C, Multivitamin, Tumeric

Current Illness: None

ID: 1064018
Sex: M
Age: 40
State:

Vax Date: 03/01/2021
Onset Date: 03/01/2021
Rec V Date: 03/01/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: fainted with preceding anxiety after getting the vaccine

Other Meds:

Current Illness:

ID: 1064019
Sex: F
Age: 87
State: CO

Vax Date: 02/20/2021
Onset Date: 02/22/2021
Rec V Date: 03/01/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Two days after injection pain in upper back began. When inspected there was a rash. The rash has spread to cover most of her upper left side of her back, under the left arm and across the left side of her chest. Patient says that it feels like it is spreading down her arm now. She visited the doctor on 3/1/2021 thinking it was an allergic reaction. The doctor diagnosed her with shingles. Patient has never had shingles in the past.

Other Meds: Warfarin, Digoxin, Vitamin D

Current Illness: None

ID: 1064020
Sex: F
Age: 46
State: MA

Vax Date: 01/04/2021
Onset Date: 01/11/2021
Rec V Date: 03/01/2021
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: Sulfur

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

Symptoms: I exp swelling, hardness itchiness and redness at thef injection site lasted 3 days without intervention.

Other Meds:

Current Illness: No

ID: 1064021
Sex: M
Age: 65
State: IN

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

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

Lab Data:

Allergies: NONE

Symptom List: Pain in extremity

Symptoms: Acute kidney failure . Hospitalized 2/10/2021.

Other Meds: Omeprazole, losartan, amlodipine, metoprolol.

Current Illness: NONE

ID: 1064022
Sex: F
Age: 46
State: CA

Vax Date: 03/01/2021
Onset Date: 03/01/2021
Rec V Date: 03/01/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: 1349 Pt felt flushed, dizzy, nauseous. VS o2 sat 98% ra, HR-85, B/P 128/82, R-20. 1357 pt reports she only feels slightly queezy. 1400 Pt reports nausea resolved, B/P 120/78, P-72, O2 sat 98% ra, R-18. Pt stood up and walked around no issues noted. Pt released to go home. She did notify her husband of what had happened. Pt instructed to f/u with MD as needed. Pt verbalized understanding of theses instructions.

Other Meds: Lexapro

Current Illness: none

ID: 1064023
Sex: F
Age: 38
State: PA

Vax Date: 02/27/2021
Onset Date: 02/27/2021
Rec V Date: 03/01/2021
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: Pennicilian, erythromyacin, zithromax, biaxin, sulfa, cephtin, thimerosol, pears, peanuts

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

Symptoms: Fever, shaking, little headache, dizziness, very large and painful lump on arm bigger than a golf ball on night 1, swollen welts on night 2, large spread out welts and rash on day 3. I'm still on day 3. Very painful red and hot rash.

Other Meds: Vitamin D, Ambien, Levathyroxine, and citirizine

Current Illness: None

ID: 1064024
Sex: F
Age: 68
State: CA

Vax Date: 02/27/2021
Onset Date: 02/27/2021
Rec V Date: 03/01/2021
Hospital:

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

Lab Data:

Allergies: no

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

Symptoms: Approximately 6 hours later, fever, chills (teeth chattering), mental blurriness, had to go to bed, tossed and turned all night, sweating, next day the same, and symptoms lasted from severe to moderate until the next night, and today, two days later, still feeling not quite "here." Put off working out for yesterday and today, because I was kind of pummeled from this. No one else had these issues, among the people I know. I would like to get me back and hope tomorrow is better.

Other Meds: Yes. Valsartan, amlodipine; multivitamin, COQ10, red yeast rice, milk thistle, biotin, brain supplement (omegas), HyAcid, Choline/Inositol, gluc/chron/MSM , turmeric/pepper, krill oil, collagen

Current Illness: no

ID: 1064025
Sex: F
Age: 16
State: CA

Vax Date: 02/27/2021
Onset Date: 02/27/2021
Rec V Date: 03/01/2021
Hospital:

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

Lab Data:

Allergies: Banana, Chicken, Kiwi, Nuts, Pineapple

Symptom List: Vomiting

Symptoms: 16 year old patient was administered Moderna vaccine rather than Pfizer vaccine

Other Meds:

Current Illness:

ID: 1064026
Sex: F
Age: 74
State: CA

Vax Date: 02/25/2021
Onset Date: 02/25/2021
Rec V Date: 03/01/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: patient c/o tingling and numbness (slight) on L arm all the way to fingertips. No itching noted. No c/o pain V/S 98% RA 70 HR 19 cmp 130/60 BP @2:52pm v/s 97% RA 79 HR 19cmp 120/80 Patient stable symptoms improved left at 2:57pm

Other Meds:

Current Illness:

ID: 1064027
Sex: M
Age: 45
State: NY

Vax Date: 02/09/2021
Onset Date: 02/09/2021
Rec V Date: 03/01/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: 1. Diaphoretic 10 minutes after vaccine administration 2. Tongue swelling 3. Right arm cold and left arm hot 4. Throat tightening Was treated with Bendryl and EpiPen then sent to the ER

Other Meds:

Current Illness:

ID: 1064028
Sex: F
Age: 40
State:

Vax Date: 02/27/2021
Onset Date: 02/27/2021
Rec V Date: 03/01/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Sulfamethoxazole/trimethoprim Metronidazole Morphine Lamotrigine Topiramate Fluoxetine Oxycodone/acetminophen Ketorolac Azithromycin Vancomycin IV Dye Nuts Seafood

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Anaphylactic reaction - patient intubated for airway protection.

Other Meds: Methadone 10 mg Q4H Insulin glargine 34 units once daily Liraglutide 1.8 mg once daily

Current Illness:

ID: 1064029
Sex: M
Age: 68
State: OR

Vax Date: 02/26/2021
Onset Date: 02/27/2021
Rec V Date: 03/01/2021
Hospital:

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

Lab Data:

Allergies: penicillin

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

Symptoms: Fever, chills, body aches, cough, weakness, and frequent urination.

Other Meds: Atorvastatin, fish oil, triple omega, multivitamin, trazodone

Current Illness: sinus infection

ID: 1064030
Sex: M
Age: 64
State: NH

Vax Date: 02/21/2021
Onset Date: 02/22/2021
Rec V Date: 03/01/2021
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: Sulfa based drugs

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

Symptoms: Severe flu like symptoms, weakness, nausea, vomiting, muscle aches, dry throat, difficulty swallowing, 102 temperature

Other Meds: 02 on demand, Albuteral, Apixiban, Cellcept,Dicyclamine,Pantoprazole. Kepra, Ferrous gluconate, Vit D3, Vit C

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm