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: 1105760
Sex: F
Age: 71
State: CA

Vax Date: 03/09/2021
Onset Date: 03/09/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Pt was given 0.3mL of Moderna (second dose) instead of the recommended dosage 0.5mL of Moderna.

Other Meds:

Current Illness:

ID: 1105761
Sex: F
Age: 37
State: MI

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 03/16/2021
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: just penicillin

Symptom List: Anxiety, Dyspnoea

Symptoms: very mild tingling face. muscular changes in face during first 18 hours post vaccine. slightly fatigued day 2 slightly elevated heart rate during intense exercise days 3-4 Generally, however, I feel fine and plan to get the second dose!

Other Meds: Loryna, generic yaz Magnesium Zinc Magnesium Threonate Potassium GNC womens multivitamin nacetyl cysteine 600 mg fish oil b vitamins probiotics

Current Illness: none

ID: 1105762
Sex: F
Age: 42
State: VA

Vax Date: 03/03/2021
Onset Date: 03/05/2021
Rec V Date: 03/16/2021
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: None

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

Symptoms: Pulsative tinnitus

Other Meds: Mesalamine

Current Illness: None.

ID: 1105763
Sex: F
Age: 60
State: NY

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Immediately after vaccination, hematoma started to form. Ice was applied to affected area

Other Meds: Synthyroid, Crestor, lisinopril and Zyrtec

Current Illness: None

ID: 1105764
Sex: F
Age: 65
State: CA

Vax Date: 03/04/2021
Onset Date: 03/04/2021
Rec V Date: 03/16/2021
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: Approx. 6 hours after first dose - she developed a funny feeling in her head. This feeling became profuse sweating, stomach irritability, blacked out and fell to the ground. She had chills and ringing in her ears. symptoms resolved by next morning.

Other Meds: 81 mg ASA once daily, Vit D 1000IU daily, Vit B 1000 daily

Current Illness: none

ID: 1105765
Sex: F
Age: 48
State:

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/16/2021
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: Shellfish, penicillin, Bactrim

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

Symptoms: tingling in mouth and lips, itchiness on neck, given Benadryl IM with improvement

Other Meds: Metoprolol, Losartan

Current Illness:

ID: 1105766
Sex: M
Age: 32
State: NY

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

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

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Syncope shortly after administration

Other Meds:

Current Illness:

ID: 1105767
Sex: F
Age: 59
State: NJ

Vax Date: 03/12/2021
Onset Date: 03/15/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: Peanuts, Bee Vemon

Symptom List: Pharyngeal swelling

Symptoms: Three days after the 2nd vaccine injection I started experiencing muscle weakness in both legs and arms. To navigate stairs in my home I use a banister on both sides, not much difficulty. Since Monday, 3/15/2021, I have much more difficulty using my walker, navigating stairs, getting in and out of cars.

Other Meds: Wellbutrin XL - 300 mg, Olmesartan Medoxomil/HC 40-12.5mg, Effexor 225 mg, Abilify - 5 mg, Lamictal 500 mg, Calcium with D 500mg, Zinc Picolinate 50, mg, Magnesium 500 mg, Biotin 10 mg, Juice Festive Fruits, Juice Festive Vegetables, Multi-

Current Illness: N/A

ID: 1105768
Sex: F
Age: 68
State: CO

Vax Date: 02/24/2021
Onset Date: 03/01/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: Penacilin and Sulfa, cephrolaxin

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Started on lower left leg at cellutis, leg swelled to double in size, deep red rash, then blisters, skin opened up and started to drain, then got what appeared to be a staph infection, doctor ordered topical antibiotic then burning inflamed red rash and more blisters, then when it started to clear up a new rash over right arm, then chest, then left arm and still burning hot and still not responding to Benadryl. Tried topical Benadryl too

Other Meds: Coumadin 10mg 4 days per week 7.5 Coumadin 3 days per week , Pravastatin 40mg 1 day per week, azithromycin 250mg tablet 1 per day x 5 days, tylenol tablets, Mupirocin 2% topical for infection from rash 2 times per day, antacid tablets calci

Current Illness: flue facine fall 2020, pulmonay hypertension, heart issues, cellulitus, on oxygen 24/7

ID: 1105769
Sex: F
Age: 42
State: TX

Vax Date: 03/07/2021
Onset Date: 03/07/2021
Rec V Date: 03/16/2021
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: n/a

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Redness, hot to the touch (injection site), itchy and swollen.

Other Meds: Synthroid 88 mcg

Current Illness:

ID: 1105771
Sex: F
Age: 70
State: IN

Vax Date: 02/01/2021
Onset Date: 03/09/2021
Rec V Date: 03/16/2021
Hospital: Y

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

Lab Data:

Allergies: morphine, oxycodone

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

Symptoms: Patient presented to emergency department in afib RVR with heart rate in 180's. Patient has no known history of afib, and stated that the heart rate of 180 started several days prior to arriving to emergency department. Patient was given IV push of 15mg cardizem, heart rate came down to 130. Patient then placed on cardizem drip at 10 mg/hr. Afib still present, but heart rate controlled in 120's. Patient underwent transesophageal echocardiography with cardioversion in order to convert patient back to normal sinus rhythm. Patient also stated that she slept for an extra 4 hrs/day for several days following vaccination and developed a scaly rash on injection site. Patient currently admitted in ICU under close monitoring.

Other Meds: losartan, carvedilol, levothyroxine, prolia, citalopram, vitamin d-3, vitamin b-12

Current Illness:

Date Died: 02/19/2021

ID: 1105772
Sex: F
Age: 93
State: MA

Vax Date: 02/11/2021
Onset Date: 02/12/2021
Rec V Date: 03/16/2021
Hospital: Y

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

Lab Data:

Allergies: None known

Symptom List: Rash, Urticaria

Symptoms: My mother died on February 19, 2021. She had her 2nd dose vaccine on 2/11, on 2/12 it was noted that she was not able to walk, on 2/13 she was walking at 30%, on 2/14 she was walking with difficulty, on Monday 2/15 she was throwing up violently and her blood pressure dropped, so she was sent to Clinic. My sister was told she was just constipated and she had A Fib (never reported before to us). My sister was then told on 2/16 early a.m. that she had a blood clot that destroyed her colon. Due to age surgery would likely not be successful. She then died on the Friday. We are reporting in the event that the Pfizer vaccine was somehow a contributing factor to the A fib or to the Clot. She has no history of A fib or clotting prior to this incident. She was 93, and did have dementia, but was able to eat normal foods prior to this. What was unusual was the challenge in walking the day after the shot. Other than that no difference was observed until the day she was admitted to the hospital emergency room. She was a resident at Assisted Living, Memory Care, and that is where she received the vaccine. The mailing address I provided is her mailing address prior to death.

Other Meds: Vitamin D, Docusate Softgel, Amlodipine, Trazodone, Multivitamin, Clonidine, Sea, Lisinopril, Citalopram, Acetamin, Pantoprazole, Santyl Ointment, Calcium Antacid Chew, Olanzapine

Current Illness: Dementia with associated mental illness, and high blood pressure. Bed sore on foot.

ID: 1105773
Sex: M
Age: 42
State: ID

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: NKDA

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

Symptoms: Patient was given vaccine at approximately 10:20am and completed 15 minute monitoring in office. Patient returned to clinic at approximately 10:45 with complaints of left arm numbness, tongue tingling, tongue swelling, and speech difficulty. 0.3mg Epipen and 50mg benadryl was administered and patient immediately reported resolution of tongue swelling and speech difficulty. Patient was transported via EMS per clinic protocol.

Other Meds: None

Current Illness: None

ID: 1105774
Sex: F
Age: 68
State: IL

Vax Date: 02/15/2021
Onset Date: 02/22/2021
Rec V Date: 03/16/2021
Hospital: Y

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: Allergen Reactions ? Other Nausea And Vomiting Narcotic pain meds ? Statins ACHINESS

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

Symptoms: Sent: 3/4/2021 7:55 AM Subject: Non-Urgent Medical Question For a full week now, I have been battling diarrhea and a very hyperactive stomach and intestines. Provider prescribed some bentyl Sunday to ease my cramping. At early onset I had some nausea too. I'm wondering if I don't need some blood work, whatever you think and maybe recheck my TSH too. Dr. already ordered a UA with culture which were both negative. That was done because of back pain over left kidney a couple of weeks ago. Diagnosis: Theo. My intestines have never been right since my surgery, but this gassiness and hyperactivity is much more extreme. I tried Metamucil and it blew my guts up even worse. I know I'm due for a CT scan. I see Dr. March 22. I'm trying to hold off until then because I want to discuss with him why I prefer to have all scans at specific facility. I just wanted to get your advice since it's been a week now. I did get my second Moderna vaccine on February 15 and Fulvestrant injections on Feb. 22. My issues started on Feb. 25. Oddly, right now as I'm typing this, my gut is much calmer. Yesterday was my worst day with diarrhea. 3/13/21 ER for back pain - transferred to second hospital - remains admitted there as of 3/16/21 History of Present Illness: Patient is a 68-year-old female with known metastatic ovarian cancer under active treatment since 2004, currently on fulvestrant after a massive debulking surgery by Dr. last July (2020). Patient presented to outlying emergency room with flank pain & transferred here with severe bilateral hydronephrosis on imaging. Patient had severe left flank pain about 2 weeks ago. Treated with tylenol, motrin, and heat and pain eventually dissipated. Then Tuesday and Wednesday pt did a lot of yard work and lifting. Thursday patient woke up with excruciating right flank pain. Nothing has made it better. Patient has tried ice, heat, tramadol Tylenol, Motrin, steroids and pain persists. Additionally patient having nausea and vomiting. She has started to have burning with urination. Pain is excruciating stabbing. Radiates to the groin. Patient has also started running fevers today. She feels pretty miserable. Also patient notes difficulty with her bowels since her last surgery. Prior to surgery she took Linzess every day. Since surgery it has been suggested she does not need this medication. Patient does note little to no notice when her bowels decide to move. Severe significant gas. Other times patient feels quite constipated. UA suggests possible infection with positive nitrites, 1+ leukocyte esterase and 3+ blood. WBC 2.1, Cr 1.0, K 3.0 CT scan with multiple abnormalities, but most notably severe bilateral hydronephrosis without obvious obstructing lesion. Multiple scattered nodular densities concerning for metastatic disease. Patient transferred for higher level of care and urology consultation.

Other Meds: Current Outpatient Medications: ? Biotin 1 MG CAPS, Take 1 capsule by mouth daily , Disp: , Rfl: ? Calcium-Magnesium-Vitamin D (CALCIUM 1200+D3 PO), Take 1 tablet by mouth daily , Disp: , Rfl: ? DEXILANT 60 MG capsule, TAKE ONE CAPS

Current Illness:

ID: 1105775
Sex: F
Age: 83
State: PA

Vax Date: 03/07/2021
Onset Date: 03/08/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: EXTREME ARM PAIN RESULTING IN PRESCRIPTION OF MEDROL DOSE PAK

Other Meds:

Current Illness:

ID: 1105776
Sex: F
Age: 88
State: NY

Vax Date: 02/28/2021
Onset Date: 03/08/2021
Rec V Date: 03/16/2021
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: None

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

Symptoms: Rash injection arm for 2 days itchy and red and slightly raised

Other Meds: SIMVASTATIN

Current Illness: None

ID: 1105777
Sex: F
Age: 41
State:

Vax Date: 03/04/2021
Onset Date: 03/04/2021
Rec V Date: 03/16/2021
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: allergy to compazine

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

Symptoms: low grade fever, extreme body aches, fatigue

Other Meds: pantoprazole, citalopram, metoprolol, metformin, fexofenadine, birth control pill

Current Illness: none

ID: 1105779
Sex: M
Age: 58
State: NC

Vax Date: 03/02/2021
Onset Date: 03/12/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Redness, swelling, slight burning lasting at 5 days.

Other Meds: Eliquis 2.5 milligrams/day

Current Illness:

ID: 1105780
Sex: F
Age: 44
State: WA

Vax Date: 03/13/2021
Onset Date: 03/14/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: Allergic to erythromycin and shell fish

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Fever of 102.6, body aches, chills, tiredness, headache, pain at injection site, coughing.

Other Meds: Buspirone, bupropion, estradiol, Zyrtec, Allegra, magnesium, vitamin D

Current Illness: None

ID: 1105782
Sex: F
Age: 82
State: NY

Vax Date: 02/14/2021
Onset Date: 03/05/2021
Rec V Date: 03/16/2021
Hospital: Y

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

Lab Data:

Allergies: None

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

Symptoms: Developed Bell's Palsy 3/5/21 and was hospitalized 3/7/21 for 2 days .

Other Meds: Sevelamer carbonate, simvastatin, lidocaine-prilocaine, furosemide, doxazosin, amlodipine

Current Illness: n/a

ID: 1105783
Sex: M
Age: 60
State: MO

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/16/2021
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: antihistamines and dramamine

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

Symptoms: Pt began to feel lightheaded and dizzy. He did pass out while sitting in chair. Quickly came back, woke back up and was able to answer orientation questions. He did report that this always happens to him when he takes antihistamines. Observed for a period of 5-7 minutes and felt / looked better. Told him we would observe him for a period of 30 minutes. Within 5 minutes, he had the exact same reaction. Patient passed out, was pale and diaphoretic. Blood pressure was 65/39 with HR 45 (3/16 @ 1430). At that time, he was moved to a gurney and placed in Trendelenburg position. Patient observed. repeat blood pressure at 1435 was 104/64 with HR 68. Patient continued in Trendelenburg position. Patient observed until 1455. Repeat blood pressure at 1452 was 105/69 with HR 73. Patient looked and felt better. He refused to go to ED. Wife to stay with patient and observe this evening and afternoon.

Other Meds: UNKNOWN

Current Illness: unknown

ID: 1105784
Sex: F
Age: 54
State: MI

Vax Date: 01/15/2021
Onset Date: 01/15/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: cobalt, motrin, amoxicillin, cats

Symptom List: Unevaluable event

Symptoms: My lips started to tingle (same reaction as cobalt allergy before my lips swell). I asked if I could take benadryl (which I brought with me). The person watching us texted someone and they came in and looked at me, asked me what was happening, took my blood pressure and said to take 2 benadryl. I told the nurse I only take one benedryl when this happens. She said take 2 benadryl. I did take 2 benadryl 12 minutes after my vaccine. My blood pressure went up. They called an ambulance and I went to the Hospital. My blood pressure was 176/105 at 11:50 am. While I was in the ER, I took a selfie and noticed that I had a rash. No one mentioned that earlier so I am guessing that is why they had me take 2 benadryl. At the ER I was put on an IV - NS .09% 1000ML at 12:27 pm. Then at 13:04 I was given Pepcid 40 MG/NS 250 ML IV at 500 ml/hr intravenous. At 1:12 pm my blood pressure was 138/96 and at 2:31 pm it was 135/70. My rash went away then. Up until last week I have been taking benadryl and/or pepcid everyday since the vaccine. I would still get a rash. I have not had the rash for about 5 days.

Other Meds: Equate allergy relief

Current Illness:

ID: 1105785
Sex: M
Age: 73
State: MD

Vax Date: 02/15/2021
Onset Date: 02/22/2021
Rec V Date: 03/16/2021
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: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: Tininitud

Other Meds: Metropolol, Alendonate Sodium, Flomax,tamsulosin

Current Illness:

ID: 1105786
Sex: M
Age: 76
State: IA

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 03/16/2021
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: Blood sugar levels increased over 100 points. Averaged around 260.

Other Meds: Baby aspirin, Red Yeast Rice, Adult multivitamin, Metformin 2000mg

Current Illness: none

ID: 1105787
Sex: F
Age: 66
State: WI

Vax Date: 03/11/2021
Onset Date: 03/11/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: Bee sting: Allergy shellfish: Allergy latex: Allergy

Symptom List: Injection site pain, Menorrhagia

Symptoms: Pt received her 1st Moderna covid vaccine at Clinic on 3/11/21. She noted a history of bee stings and that she has an epi pen at home so was given the shot and monitored for 30 minutes. 20 minutes post vaccine, patient noted she felt dizzy and somewhat disoriented. She noted a dry throat and like her arms and legs felt funny "like jello". Her husband alerted staff at the vaccination site and EMS assessed her. She said she was told her blood pressure was high for her but otherwise vitals were fine. She denied itching, or shortness of breath or trouble breathing. She actually asked her husband to go home and get her epi pen and he returned with it and was given a dose of epi and sent to the local emergency room for evaluation. She said she felt better by the time she got their but was monitored for a number of hours. She felt completely fine by the time she was discharged. She noted for a few days following the vaccine she felt fatigued and a slightly itchy spot at injection site but that's it.

Other Meds: Vitamin D3 1000 UNIT Tablet 1 tablet Orally Once a day. Loratadine 10 MG Tablet 1 tablet Orally Once a day, Notes: otc. EpiPen 2-Pak 0.3 MG/0.3ML Solution Auto-injector inject 1 pen Injection as needed, Notes: on file.

Current Illness: none.

ID: 1105788
Sex: F
Age: 73
State: TX

Vax Date: 01/28/2021
Onset Date: 01/28/2021
Rec V Date: 03/16/2021
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: No

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

Symptoms: I exp nausea and slight headache lasting 8 hours.

Other Meds: Blood pressure, Thyroid, Folic, Vit D3, Vit C, Cholesterol, Beta Blocker medications

Current Illness: Bronchitis taken Z Pack stop taking Monday prior to Dose 2 vaccine

ID: 1105789
Sex: F
Age: 48
State: CA

Vax Date: 03/15/2021
Onset Date: 03/16/2021
Rec V Date: 03/16/2021
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: NO

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: 2:17 pm, Suddenly client felt faint, Layed her in exam room table gave, water & crackers, 2L 02 via adult face mask sat 100%. vitals; 139/82 HR 98. 2:30 felt, cold & clammy, shakey and tingling body & nausea vitals 125/70 HR 95 O2 sat 100% . By 3:00 previous symptoms subside , new symptoms dry mouth, headache 7/10 and nausea vitals 145/85 HR 105, taken of 2L 02. Called 911, emergency transport to AV emergency room. Patient choose to be driven to AVH emergency room by daughter who was at her mothers bedside during observation.

Other Meds: NO

Current Illness: No

ID: 1105791
Sex: F
Age: 79
State: AZ

Vax Date: 03/09/2021
Onset Date: 03/10/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Extreme weakness requiring short emergency room stay (3 hours)

Other Meds:

Current Illness: None

ID: 1105792
Sex: F
Age: 64
State: NY

Vax Date: 03/04/2021
Onset Date: 03/04/2021
Rec V Date: 03/16/2021
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: Latex

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

Symptoms: Developed hives three (3) hours after vaccine administration; Treatment--Benadryl (25mg) po

Other Meds:

Current Illness:

ID: 1105794
Sex: F
Age: 52
State: TN

Vax Date: 03/08/2021
Onset Date: 03/15/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: Codiene While taking. Disulfiram I cannot have any alcohol while taking the medication. They did not use an alcohol swab before giving the vaccine

Symptom List: Nausea

Symptoms: The day of the injection my injection site was sore and tender to the touch. But no other side effects until yesterday. Seven days after the 1st vaccine I began feeling tired and had a headache that has lasted two days. Then the area around my injection site became swollen red and very painful to touch. The site is also very itchy.

Other Meds: Adderal. 30 mg 2x day Lexapro 20 mg 1Xday Clonazpam 1xday Disulfiram 250 mg 1xday Xytal daily allergies

Current Illness: Lyme and Babesia positive for past five years and Disulfiram is helping kill the disease in my body. I?m halfway through a 90 day treatment.

ID: 1105795
Sex: F
Age: 50
State: ID

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: hx med rxns (tongue swelling) to: Sulfas BP med

Symptom List: Injection site pain

Symptoms: Pt felt slight headache coming on - was not sure if might progress to full-blown hemiplegic migraines - stated can be brought on by stress; requested check-up and VS, monitoring prior to departure.

Other Meds: Migraine meds: Topamirate 75mg po QD Lisinopril po QD Emgality inj Q month Mg++ po QD Fioricet PRN migraines Anti-nausea med PRN migraines

Current Illness: none

ID: 1105796
Sex: F
Age: 24
State: MA

Vax Date: 03/15/2021
Onset Date: 03/16/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Arm swollen, +induration, unable to move freely. Denies fever, skin breakdown. Used Tylenol, Motrin with minimal relief

Other Meds:

Current Illness:

ID: 1105797
Sex: F
Age: 73
State: NY

Vax Date: 03/13/2021
Onset Date: 03/14/2021
Rec V Date: 03/16/2021
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: raw pineapple, grass and tree allergies seasonally, lidocaine

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

Symptoms: On 03/14, I had a slight headache all day, a sore left arm where the injection was given. The site was warm and a large red, itchy spot beneath the injection site appeared. My normal temp is 97. I felt flushed all day and my temp was 98.6 at its highest. I took 1 tylenol 500 tablet at 3pm and another 1 tablet at 9 pm. On Monday, 03/15, all symptoms were gone except for my slightly sore arm and the red spot which was lessening. On 03/16, my left arm is almost back to normal.

Other Meds: Early AM on 03/13 took a zyrtec allergy pill OTC type

Current Illness: None

ID: 1105798
Sex: M
Age: 63
State: NJ

Vax Date: 03/06/2021
Onset Date: 03/15/2021
Rec V Date: 03/16/2021
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: NONE

Symptom List: Tremor

Symptoms: Moderna COVID?19 Vaccine: Left arm rash slightly below injection site, 9 days after 1st Dose. Raised circular rash, itching and warm. I am using Cortizone 10 Maximum Strength cream to relieve itching

Other Meds: DAILY MEDICATION ? 3/6/21 NAME TABLET FREQUENCY 1. ATORVASTATIN 10mg

Current Illness: NONE

ID: 1105799
Sex: F
Age: 72
State: CO

Vax Date: 02/05/2021
Onset Date: 03/02/2021
Rec V Date: 03/16/2021
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: Penicillins, amoxicillin, aspirin, tylenol, ibuprofen, eliquis, iodine & seafood

Symptom List: Erythema, Pruritus

Symptoms: Within 15 minutes of injection, back if throat & back of tongue began to tingle & burn. I could feel my whole face & throat tightening up. Began to have swallowing difficulty. I was getting a woozie feeling within 30 minutes. I took 100mgm benedryl by mouth w about a pint of water. For the next 50-60 minutes, the tightness continued as far as below my collar bones face very tight swollen. Red raised itchy rash started all over my body. Had epipen in hand as well as stat dose of prednisone to take if necessary. (I have an allergic reaction protocol in hand from my doc for these cases. Transport to ER is always there if needed) . Took about an hour for the benedryl to start countering the adverse affect. Took another 100 mgm at the 4 hr post injection time mark. By bedtime about 10pm, I felt very fatigued, throat & back of tongue very sore & raw feeling.

Other Meds: Synthroid, diltizeim, metropolol, losartan, lasix, encruise inhaler, singular, B12 injectable, calcium, fergon, eye vitamins

Current Illness: None

ID: 1105800
Sex: F
Age: 37
State: VA

Vax Date: 02/08/2021
Onset Date: 03/10/2021
Rec V Date: 03/16/2021
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: Hives on arms and chest

Other Meds: Humalog Insulin, Sertraline, iron gummies, Goli gummies, and Vitamin D

Current Illness: Diabetes

ID: 1105804
Sex: F
Age: 62
State: WA

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 03/16/2021
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: sulfa thomixine

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

Symptoms: Whole body is sore like as if I just ran a mile and every muscle hurts. shoulder/injection site hurts. Legs especially hurt.

Other Meds: vimpat, topiramate, pravastatin, fenobarbital, sertraline hydrochloride, vitamin P5P, vitamin D3, magnesium

Current Illness: No

ID: 1105805
Sex: F
Age: 35
State: CO

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/16/2021
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: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Facial numbness which began 17-18 minutes after the injection. Tingling/numbness in jaw area, from ears to chin on both sides. Lasted only a minute or two and went away. Face has continued to feel flushed for 2 hours since. No other reaction.

Other Meds: Propranolol Iron Supplement Vitamin C Supplement Magnesium Supplement Riboflavin Supplement

Current Illness: None

ID: 1105806
Sex: F
Age: 26
State: CA

Vax Date: 02/15/2021
Onset Date: 02/19/2021
Rec V Date: 03/16/2021
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: N/a

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

Symptoms: Unexplained dizziness, feeling very disoriented, almost vertigo like symptoms but it has affected my entire body not just my head. I?ll be functioning normally and then a wave of dizziness runs through me. This has persisted for nearly 4 weeks with only minor improvement. It feels like I?m ?off?, not debilitating enough to cancel work/plans, but persistent enough to know something isn?t normal. Had no symptoms prior to receiving the shot.

Other Meds: N/a

Current Illness: N/a

ID: 1105807
Sex: F
Age: 21
State: MO

Vax Date: 03/10/2021
Onset Date: 03/11/2021
Rec V Date: 03/16/2021
Hospital: Y

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: None

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

Symptoms: Patient received first dose of Moderna COVID-19 vaccine on 2/10/21 and had a large, red, inflamed area on her arm at the injection site for a few days, but otherwise tolerated vaccine well. She received the second dose of the Moderna COVID-19 vaccine on 3/10/21 and the next day (3/11/21) developed fatigue and lightheadedness while exercising, which continued for the next few days. She developed acute onset, sharp chest pain on 3/13/21 AM which did not resolve so she presented to an ED. Vitals were normal but labs notable for troponin I which peaked at 4.36, CK 758, d-dimer 640. CBC/CMP and EKG were unremarkable and initial TTE with EF ~45%. Repeat TTE obtained a few days later with normal LV and RV size/function without any wall motion abnormalities. Cardiac MRI obtained with normal LV function (EF 64%) but late gadolinium enhancement in a subepicardial distribution within the inferolateral wall of the left ventricle at the base most compatible with myocarditis. ESR and CRP were normal. Further workup to determine etiology of myocarditis was negative (ANA, ANCA, RF, hepatitis panel, HIV, full respiratory viral panel, COVID-19 PCR). She was placed on metoprolol succinate 12.5mg XL daily and will follow up with a cardiologist as an outpatient. Family concerned that COVID-19 vaccine was the trigger/underlying etiology of her myocarditis.

Other Meds: None

Current Illness: None

ID: 1105808
Sex: M
Age: 35
State: HI

Vax Date: 03/05/2021
Onset Date: 03/06/2021
Rec V Date: 03/16/2021
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: Pain in extremity

Symptoms: Patient received his first dose of Pfizer covid19 vaccine on 3/5/21. Over the next few days he developed progressive right facial weakness and was evaluated in the emergency dept. It progressed over the next week to severe R sided facial nerve palsy and has remained in this condiiton at the time of this report. He was started on Valacyclovir and prednisone with minimal improvement

Other Meds: None.

Current Illness: None

ID: 1105809
Sex: F
Age: 88
State: IL

Vax Date: 02/18/2021
Onset Date: 03/11/2021
Rec V Date: 03/16/2021
Hospital: Y

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

Lab Data:

Allergies: nka

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

Symptoms: 3/13/21 ER HPI -> transferred to hospital 88 y.o. female who presents to the Hospital Emergency Department by private auto with her daughter. Apparently, the patient has a 2 day history of intractable nausea and vomiting. She states she has vomited more than 5 times over the last 2 days. She has become more and more weak. She states she has been having coffee-ground emesis. No definite fever. The patient had a similar episode to this a few months ago. The patient does take nightly ibuprofen. She also take iron on a daily basis because of chronic anemia. She is not on any blood thinners. When the patient did get to the ER she had an episode of vomiting and it did appear coffee-ground. She is having a little bit of epigastric abdominal pain. No history of GI bleed in the past 3/16 note from Hospital Hospital Course: 88 y.o. female with a past history significant for hypertension, renal artery stenosis, arthritis, skin cancer presented to hospital with nausea/vomiting and transferred to another hospital on 3/13/2021 for GI evaluation. Patient developed coffee ground emesis and had NG tube placed, yielding 1800 cc of coffee-ground emesis. She was also noted to be hypertensive. A CT done at the outside hospital revealed a large hiatal hernia with a significantly distended herniated portion of the stomach and a portion in the left upper quadrant compatible with a gastric outlet obstruction. Transferred to another hospital and GI consulted. Underwent EGD on 3/14 with results as noted below. Recommended to continue PPI, avoid NSAIDs if possible and repeat EGD in 8 weeks as outpatient. NG-tube removed and tolerated diet. No further bleeding noted. Hgb remained stable. Medically stable for discharge. Counseled on medication use and diet. Patient or daughter had no further questions or concerns on discharge.

Other Meds: Current Outpatient Medications: ? amLODIPine (NORVASC) 5 MG tablet, Take 1 tablet (5 mg) by mouth daily, Disp: 90 tablet, Rfl: 1 ? Apoaequorin (PREVAGEN EXTRA STRENGTH) 20 MG CAPS, Take 1 capsule by mouth daily, Disp: , Rfl: ? cephALEX

Current Illness:

ID: 1105810
Sex: F
Age: 57
State: FL

Vax Date: 03/12/2021
Onset Date: 03/13/2021
Rec V Date: 03/16/2021
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: Contrast Dye

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

Symptoms: Muscle aches and pains and extreme fatigue the day after. Resolved by the day after that. Am 96 hours out from vaccine and still have red arm and some slight swelling at injection site and some pain, slight though. Still feels a tad warm.

Other Meds: Amlodipine-Valsartan, Crestor, Aspirin, Metformin

Current Illness: None

ID: 1105811
Sex: F
Age: 61
State: FL

Vax Date: 03/08/2021
Onset Date: 03/08/2021
Rec V Date: 03/16/2021
Hospital: Y

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

Lab Data:

Allergies: no

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

Symptoms: 61 yo female admitted with palpitations and flushing since getting the Covid 19 Vaccine on 3/8.. She was prescribed metoprolol and a short course of steroids by her pcp for symptomatic relief which patient took 1 dose of metoprolol and did not start steroids. She came to the ED due to her symptoms, Her main concern was why did she react to the Vaccine., and wanted answers.

Other Meds: unknown

Current Illness: no

ID: 1105812
Sex: F
Age: 14
State: OH

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: Child age 14 received vaccine.

Other Meds: Sythroid

Current Illness:

ID: 1105813
Sex: F
Age: 68
State:

Vax Date: 02/17/2021
Onset Date: 03/03/2021
Rec V Date: 03/16/2021
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: Large red ring around injection site. Lasted a week. Itchy. Hot.

Other Meds:

Current Illness:

ID: 1105815
Sex: F
Age: 37
State: SC

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/16/2021
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 stated

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

Symptoms: Scenario: Pharmacist administered immunization and patient had immediate reaction to imz. The patient has multiple health conditions such as lupus, cerebral palsy, and is currently on dialysis. She indicated on the PQCF that she had never had an adverse reaction after a vaccine but after the incident, her husband indicated this was normal and not uncommon. SIG: Pharmacist Administered Immunization What happened (Describe in detail, what occurred)? * The patient came in for a covid vaccine; this was the first of a 2 series of Pfizer. * The pharmacist injected the immunization and a few minutes afterwards the husband called for the pharmacist to come because his wife didn't feel well. She immediately became unresponsive and her eyes rolled back into her head but she came to. She was responding somewhat to questions but she was also slightly mentally impaired at baseline due to her co-morbidities. She never fell to the ground or wanted to lie down, so not a true faint. * The pharmacist offered to call 911 but they both declined. The patient was given water and a banana and taken to a private area to recover until she fell well enough to leave. How did it happen? * The Pharmacist administered an appropriate, routine vaccine per protocol. *Patient had an somewhat immediate reaction (~4 minutes) after the vaccine. *The pharmacist followed the adverse event protocol. CPR was not administered nor benadryl. Why did it happen (Root Causes)? * Unknown; patient has no known allergy to the vaccine but has had adverse reactions to different procedures in the past. Plan of Action * Make sure all pharmacists are refreshed and aware of the adverse reaction protocol. *Document reaction as a SCRT and with VAERS. What specific task will take place to prevent future recurrence? *N/A. Who: * Pharmacist Where: * clinic When: *All pharmacists at location must review by 3/20.

Other Meds: n/a

Current Illness: Lupus, Cerebral Palsy, and dialysis,

ID: 1105816
Sex: F
Age: 38
State: IL

Vax Date: 03/11/2021
Onset Date: 03/11/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient symptoms: chills and body aches (initiated 12 hours post injection. Lasting for 8 hours) pain at the injection site (lasting at least 5 days post injection). No interventions sought. Breastfeeding Infant: Infant (39 days old at the time the vaccination was administered to the breastfeeding mother) who exclusively breastfeeds experienced emesis of breastmilk and stomach contents starting 12 hours post injection lasting for approximately 6 hours. In addition, increased nasal secretions/mucous noted. Symptoms resolved naturally without interventions

Other Meds: prenatal vitamin

Current Illness: N/A

ID: 1105817
Sex: M
Age: 60
State: AZ

Vax Date: 03/09/2021
Onset Date: 03/13/2021
Rec V Date: 03/16/2021
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: Bells Palsey symptoms have returned. Right side of my face twitching and drooping

Other Meds: None

Current Illness: None

ID: 1105818
Sex: F
Age: 34
State: IL

Vax Date: 03/13/2021
Onset Date: 03/13/2021
Rec V Date: 03/16/2021
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: unknown

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

Symptoms: The needle came off the syringe. The medic felt that .50-.75% of the dose was administered. Department of Public Health notified and dose will not be repeated.

Other Meds: unknown

Current Illness: unknown

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm