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: 1112118
Sex: M
Age: 36
State: PA

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 03/18/2021
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: Penicillin

Symptom List: Dysphagia, Epiglottitis

Symptoms: Pt received vaccine and within ~2 minutes started feeling woozy and reported tunnel vision. He alerted his nurse who called for back up. Upon arrival, patient appeared pale and diaphoretic. Pt appeared lethargic but was conscious. Pt moved via stretcher to observation unit at 1601. Pt denied SOB, dizziness, palpitations, rash, itchiness, swollen mouth/tongue. Pt reported he had vasovagal response to another vaccine (tetanus) before. Vitals: 1605 154/108, 95%, 77HR 1608 146/90, 95%, 76 HR 1620 138/90, 95%, 76 HR At 1622 pt reported feeling 'tingly'. lungs clear on auscultation. Occasional PVCs on auscultation. Pt reported history of palpitations. 1636 151/102, 99%, 80 HR Pt reported palpitations subsided and tingling feeling subsided. 1635 141/94, 99%, 75 HR Pt escorted via wheelchair out of facility with a stop at the bathroom and was advised on follow up for additional care should palpitations return or s/s of allergic reaction.

Other Meds:

Current Illness:

ID: 1112119
Sex: F
Age: 28
State: FL

Vax Date: 02/26/2021
Onset Date: 02/28/2021
Rec V Date: 03/18/2021
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: None

Symptom List: Anxiety, Dyspnoea

Symptoms: concerned about poss reaction to 1st covid vaccine - been 17-18 days since vaccine. sx started couple days after she got the vaccine the prednisone affected her bipolar d/o so does not want more prednisone. but still c/o feeling like her lungs are not normal, usually asthma flareup if ill, usually prednisone helps and the inhaled corticosteroid usually helps. also c/o neck and back pains flared up again since covid vaccine though no recent trauma not radiating to arms/legs

Other Meds: Vitamin D3, B Complex 50, Zinc, Ferrous Sulfate, Biotin, Macrobid 100 mg capsule, Spacer for use with inhaler, Alvesco 80 mcg/inh aerosol, Aspirin, predniSONE 20 mg tablet, Albuterol 90 mcg/inh aerosol, Adderall, Hydrocortisone Topical 2.5%

Current Illness: no

ID: 1112120
Sex: M
Age: 76
State: IL

Vax Date: 03/09/2021
Onset Date: 03/11/2021
Rec V Date: 03/18/2021
Hospital: Y

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: Allergen Reactions ? Darvocet-N 100 [Kdc:Acetaminophen+Sorbitan+Propoxyphene

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

Symptoms: 3/18/21 ER Triage Nurse Note: "To er via EMS for eval of weakness and dizziness. States he started with sore throat and head congestion last week. Seen PCP Monday 03-15-21. Started amoxil. Took it for 2 days and became dizzy so he quit taking it. Dizziness got worse and came to ER." 3/18/21 ER HPI: 76 y.o. male who presents with c/o weakness cough and fever for the past seven days. Pt report sx are mod better with rest and worse with movement. Transferred to Hospital, dx: pneumonia dt covid-19 virus

Other Meds: Current Outpatient Medications: ? amoxicillin (AMOXIL) 875 MG tablet, Take 1 tablet (875 mg) by mouth 2 times daily for 7 days, Disp: 14 tablet, Rfl: 0 ? atenolol (TENORMIN) 25 MG tablet, Take 1 tablet (25 mg) by mouth daily, Disp: 30 ta

Current Illness:

ID: 1112121
Sex: F
Age: 62
State: TX

Vax Date: 03/09/2021
Onset Date: 03/16/2021
Rec V Date: 03/18/2021
Hospital:

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

Lab Data:

Allergies: Tetracyclene

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: It started 7 days after the injection. Swollen, itching, warm to the touch and sore

Other Meds:

Current Illness: None

Date Died: 03/15/2021

ID: 1112122
Sex: M
Age: 43
State: CA

Vax Date: 03/13/2021
Onset Date: 03/15/2021
Rec V Date: 03/18/2021
Hospital:

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

Lab Data:

Allergies: PCN Cipro Ertapenem Fosfomycin

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

Symptoms: Patient was admitted for Multi drug resistant UTI (for which he has been admitted many times before). Was hospitalized for 3 days while awaiting cultures, hemodynamically stable, with no lab abnormalities. On the day of discharge (sensitivities to UTI came back, pt to be discharged on cefepime, had PICC line) pt got up from bed, sat on the edge of the bed and was being given belongings by the nurse, alert and oriented and in a pleasant mood, when suddenly pt grabbed at his chest and stated "I can't breathe" and became combative and altered when O2 was attempted to be placed on pt's face; then pt had PEA arrest x3 and unable to achieve ROSC.

Other Meds: Macrobid 100 mg po BID Cefepime 2g daily (3/12-3/19) Dilaudid 2 mg po PRN pain gabapentin 600 mg BID Methotrexate qFriday Metoprolol 25 mg BID Odefsey (HAART) Mirtazipine daily Glipizide, insulin for DM2

Current Illness: Complicated lower UTI (hospitalized for this- received vaccine in house) - MDR bacteria

Date Died: 03/12/2021

ID: 1112123
Sex: M
Age: 77
State: UT

Vax Date: 03/11/2021
Onset Date: 03/12/2021
Rec V Date: 03/18/2021
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: NKA

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

Symptoms: This patient was on hospice, we are reporting this to VAERS at the Medical Directors request d/t patient's death within 48 hours of the second dose vaccine. The death occurred the morning following his second dose of the Moderna COVID-19 Vaccination, vaccine received on 03/11/21 and patient date of death 03/12/21 at 9:41 am. This was a hospice patient with a terminal dx of CKD. This is being reported at the request of the Medical Director for the hospice team, d/t the patient's death occurred within 48 hours of receiving the second dose of this vaccine. The nurse case manager stated the pt was declining as they were on hospice for a terminal condition and had co-morbidities, Pt did show more decline after receiving COVID-19 vaccination and patient passed away within 48 hours of receiving second vaccination dose.

Other Meds: Aspirin, Vit C, Coreg, Excitalopram, Ferrous Sulfate, Pravastatin, Senna Plus, Torsemide

Current Illness: CKD, muscle weakness, Heart Failure, CAD, Diabetes, HTN, Hyperlipidema, Palliative Care

ID: 1112124
Sex: F
Age: 71
State: OH

Vax Date: 03/01/2021
Onset Date: 03/01/2021
Rec V Date: 03/18/2021
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: n/a

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Within 3 hours after 2nd shot: felt pain traveling thru both arms, then throughout body; increasing temperature; overall unwell feeling. Went to bed, slept 10 hours total, took liquids; temperature reached 100; slept 2 hours; took tylenol ; slept thru second nite. 36 hours after shot felt much better; got up and on with my day. It is now 2 weeks later - I feel exhausted. no energy.

Other Meds: montelukast, amlodepine, vit d, fenofexadine, omega3-6-9, glucosomine/chondritin

Current Illness:

ID: 1112125
Sex: F
Age: 69
State: IN

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

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

Lab Data:

Allergies: N/A

Symptom List: Pharyngeal swelling

Symptoms: Bad headache in back of head. Pain behind both ears. Fever of 102.1 for short time. Extreme fatigue.

Other Meds: Aspirin Modafinil Baclofen Pravastatin Calcium Bactrim Fluoxetine Vitamin D Krill Oil Daily Vitamin

Current Illness: N/A

ID: 1112126
Sex: F
Age: 62
State: NC

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 03/18/2021
Hospital:

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

Lab Data:

Allergies: na

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: na

Other Meds: na

Current Illness: na

ID: 1112127
Sex: F
Age: 47
State: AL

Vax Date: 03/13/2021
Onset Date: 03/13/2021
Rec V Date: 03/18/2021
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: Sulfa

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Extreme vertigo for 6 days so far.

Other Meds: lexapro

Current Illness: none

ID: 1112128
Sex: F
Age: 69
State: NY

Vax Date: 03/16/2021
Onset Date: 03/17/2021
Rec V Date: 03/18/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Woke up early morning with chills and a slight fever (99.8), sinus headache and very tired for entire day after vaccine.

Other Meds: Dyclomine, dom-peridone, ciproflaoxacin, multiple vitamin

Current Illness: Diverticulitis

ID: 1112129
Sex: F
Age: 49
State: NC

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/18/2021
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: Pennicillin, sulpha, Chantix, Ibuprofin, benzol peroxide

Symptom List: Rash, Urticaria

Symptoms: Extreme shaking and chills to the point of needing assistance to walk, nausea, migraine and headache, low grade fever, numbness in fingertips, extreme muscle pain (body), sleeplessness, fatigue

Other Meds: Tremfya injections, Acyclovir, Premarin, Rizatriptan, fluticasone, doxycycline, Ajuvy

Current Illness:

ID: 1112130
Sex: M
Age: 65
State: IN

Vax Date: 03/16/2021
Onset Date: 03/17/2021
Rec V Date: 03/18/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Chills

Other Meds:

Current Illness:

ID: 1112131
Sex: F
Age: 42
State: IL

Vax Date: 03/09/2021
Onset Date: 03/18/2021
Rec V Date: 03/18/2021
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: Erythromycin, Reglan, and Tape

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

Symptoms: Noticed on 3/16 the injection site had a little redness and a little itch. It did hurt to scratch it. About the size of a nickel. By 3/17 am the injection site was much larger, very red, raised, and itched very bad. It hurt more to scratch it. About the size of a half dollar. Today, 3/18, the injection site is large, very red, raised, and still itches bad. It is larger than a half dollar now. Almost 2 half dollars. I have done my very best to not scratch it and have been advised to take Benadryl and use a cortisone cream.

Other Meds: Insulin Humulin R U-500 Enalapril HCTZ 10-25 mg Atorvastin Calcium 40 mg Omeprazole 40 mg Buproprion ER 300 mg Valacyclovir 1 gram Hydroxyzine 25 mg Doxycycline Hyclate 100 mg Sertraline 50 mg Benadryl 25 mg

Current Illness: Type 1 Diabetic and Blood Disorder called ITP (low platelets)

ID: 1112132
Sex: F
Age: 62
State: AZ

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/18/2021
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, penicillin, codeine, plaquinel, dilantin, keppra

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

Symptoms: Mild throat swelling, itchy lower half of face, time of shot. Next day rash on chin

Other Meds: Levothyroxine, vitamin d, omeperzole, magnesium, vitamin b12, probiotic

Current Illness: None

ID: 1112133
Sex: F
Age: 30
State:

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/18/2021
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: C/o Generalized itchiness. No rash visible. VSS 123/84 HR 74 100% on RA RR 16. No tongue, lip swelling, no hives. No chest pain, sob. No hx of prior vaccine reaction. Hx of allergies to strawberries with anaphalaxis. Vaccine received at 0925. Pt still c/o itchng at 10:05. Will send to ER for further monitoring as may need antihistamines, steroids, h2 blockers. No signs of anaphalaxis. Will need further monitoring. ED Note: This is a well-appearing and pleasant 30-year-old female who presented to the emergency department for generalized body itching following getting the first dose of Pfizer COVID-19 vaccine at approximately 930 this morning. On presentation patient is well-appearing, respirations are even and nonlabored, she is speaking in complete sentences with normal work of breathing. She denies any symptoms other than itching currently on her upper arms and upper back. She notes that the itching is already starting to resolve and has lessened. There is no rash present on exam, no hives. Airway is clear, uvula midline, patient is tolerating secretions well with no drooling or voice changes and there is no mouth or tongue swelling present. Neck is supple without lymphadenopathy. Patient was observed close to an hour and a half and she remained stable with no changes. At time of discharge patient with no skin reaction, facial, mouth, or tongue swelling. She is speaking in complete sentences with normal work of breathing, respirations even and nonlabored. She appears well and appropriate for discharge. I had an in-depth discussion with her regarding monitoring her symptoms at home seeking emergent care if she has any compromise. We discussed all signs and symptoms that she should look for that would be concerning and need emergent intervention. She indicated that she understood all instructions. Patient was given the opportunity to ask questions. All questions and concerns were thoroughly addressed. Patient indicated she understood all instructions was comfortable with this plan of care. No evidence of Stevens-Johnson syndrome, anaphylaxis, cellulitis, or systemic compromise. Feel supportive care and symptomatic treatment reasonable. I reviewed recent and relevant Chart Entries, Previous Notes, Previous Labs, Previous Radiology studies. Patient ambulated out of the emergency department with a steady gait. Received benadryl and famotidine in the ED and take home prescriptions for famotidine and hydroxyzine.

Other Meds:

Current Illness:

ID: 1112134
Sex: F
Age: 26
State: VT

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/18/2021
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: n/a

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

Symptoms: Upon leaving the vaccination site, I began experiencing "twitching" or mouth spasms on the left side of my face. The exact area was between the corner of the mouth and the cheek area/bone. They were persistent for the remainder of the day on 3/16/21. The twitches/spasms were similar to an eye twitch and lasted into the day on 3/17/21. The twitching subsided today, 3/18/21 but still experiencing them off and on, just not consistent or as frequent.

Other Meds: D-Amphetamine ER 15MG Salt Combo CP

Current Illness: n/a

ID: 1112135
Sex: F
Age: 51
State: IL

Vax Date: 03/09/2021
Onset Date: 03/10/2021
Rec V Date: 03/18/2021
Hospital:

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

Lab Data:

Allergies: fentanyl, latex

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Difficult to fall into sleep, No more deep sleep, half sleep/half awake whole night brain fog during the day light headache occasional light ringing in ears

Other Meds: turmeric, Kelp, Vitamin D, green tea

Current Illness: lung cancer, ashma

Date Died: 02/11/2021

ID: 1112136
Sex: F
Age: 97
State: MN

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

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Patient passed away within 60 days of receiving a COVID vaccine

Other Meds:

Current Illness:

ID: 1112137
Sex: M
Age: 66
State: UT

Vax Date: 03/03/2021
Onset Date: 03/07/2021
Rec V Date: 03/18/2021
Hospital:

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

Lab Data:

Allergies: None that I know of.

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

Symptoms: After first shot I had a sore arm for three days, I was tired for about 36 hours, then nothing, about four days after the vaccine I began to get tingling sensations in my head, mainly back and side only lasting a few seconds and sometimes with this sensation I get an over all body feeling of coldness that lasts a few seconds. I spoke with my PC Dr. he thinks because of my headache history that maybe the head tingling sensations are due to headaches/ migraines, but he thought it would be good to report these sensations in case there may be a connection to the vaccine, I am scheduled to get my second shot on 03-24-2021 I am not saying it was the vaccine, maybe something else but to be safe I wanted to report this strange sensation after getting the first shot. Maybe see if other people had the same or similar sensations. Any advice would be appreciated . Thank you

Other Meds: Nortriptyline 25mg once daily at night. Esomeprazole mag40mg once in morning. Multivitamin once daily. probiotic 20 billion once a day with food. Melatonin 5mg once a day at night. Tylenol for occasional headaches, migraines.

Current Illness: I had a migraine with aura about a month or so before my first shot of Pfizer covid vaccine

ID: 1112138
Sex: F
Age: 66
State: NJ

Vax Date: 02/28/2021
Onset Date: 03/11/2021
Rec V Date: 03/18/2021
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: Nitrofurantoin, possibly ampicillin/penicillin

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

Symptoms: I awoke during the night I received my vaccine with some mild itching of my extremities, but no rashes. This disappeared by the morning. On 3/11/21, I discovered an enlarged lymph node near my left collar bone. As of today, 3/18/21, the lymph node is still palpable and hasn't changed.

Other Meds: Metoprolol Succinate 50 mg

Current Illness:

ID: 1112139
Sex: F
Age: 46
State: NC

Vax Date: 03/04/2021
Onset Date: 03/12/2021
Rec V Date: 03/18/2021
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: Unevaluable event

Symptoms: Swollen lymph node in right armpit started about a week after the vaccination. It?s been a week and has not subsided.

Other Meds: Multivitamin Losartan Lexapro

Current Illness: None

ID: 1112140
Sex: F
Age: 60
State: FL

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/18/2021
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: Penicillin, Keflex, Sulfa, Erythromycin

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

Symptoms: I already alerted you to the rash and itching. I got a headache starting about 30 minutes after the shot. I started having what looked like bruising all along the veins in my arms and hands. Still have that. I went to the doctor and also found that I had high blood pressure and an elevated heart rate. BP 140/90 and Heart rate 85. My normal heart rate is between 55-60 and my usual blood pressure is 108/70. The doctor gave me a steroid shot. This morning, my blood pressure and heart rate were still high and I still had a headache. Then the headache stopped and I took my blood pressure and it was down to around my usual 108/70 and the heart rate was 60. So hopefully I'm starting to recover from this shot.

Other Meds: Claritin and Advil

Current Illness:

ID: 1112141
Sex: M
Age: 52
State:

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/18/2021
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: headache, chills / shivering, fever, body aches. symptoms lasted about 36 hours. took no medications.

Other Meds: none

Current Illness: none

ID: 1112142
Sex: F
Age: 33
State:

Vax Date: 03/15/2021
Onset Date: 03/15/2021
Rec V Date: 03/18/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: 33 y.o. female with history of asthma, SVT, sickle cell trait, eosinophilic esophagitis, asthma, preeclampsia presenting to ER today with scratchy throat after Covid vaccine. Patient was observed for a total of 45 minutes, and brought to the emergency room for provider evaluation. She denies difficulty breathing, difficulty swallowing, throat swelling, drooling or pain. She denies URI complaints, fevers, chills, lightheadedness, dizziness, nausea or vomiting. ED Update: She was given famotidine and Benadryl here in the emergency room. She has no demonstration of hives, rash, induration, or swelling at the injection site. Differential diagnoses for this patient include allergic reaction, however this is most likely related to anxiety. Patient had improvement after medications, was able tolerate p.o. without difficulty. She is no longer complaining of scratchiness in her throat. She states she has Benadryl at home, recommended she can also take Zyrtec daily. Discussed worsening symptoms and when to seek immediate care in the emergency room. Patient verbalized understanding of teaching, feel that she is stable for discharge as she is able to verbalize red flag symptoms. She is able to ambulate out of ER with steady gait.

Other Meds:

Current Illness:

ID: 1112143
Sex: F
Age: 44
State:

Vax Date: 01/26/2021
Onset Date: 01/26/2021
Rec V Date: 03/18/2021
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:

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

Symptoms: ALLERGIC REACTION

Other Meds:

Current Illness:

ID: 1112144
Sex: F
Age: 64
State: PA

Vax Date: 03/08/2021
Onset Date: 03/09/2021
Rec V Date: 03/18/2021
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: sulphur antibiotic

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: woke up on March 9th, 2021 at 5Am with body aches took 2 tylenols went back to bed when i woke felt no better had oatmeal for breakfast, laid on couch all day had egg salad for lunch right after lunch could not get warm had 2 blankets on me, headache, did not have fever at that time went to lay in bed at 5:30PM then about an hour later felt warm but not hot enough to remove blankets, felt feverish took temperture and it was 100.5 at 8:00PM, grandaughter took me to hospital. temp was still 100, i was very dehydrated got intervenous fluid, took blood and chest x-ray, and covaid test, tested negative, Doctor just said I had a bad reaction to the Moderna Shot. Just starting to feel better on this day 3/2-18/2021. Blisters inside mouth on upper lip. they are still there. still do not feel 100%

Other Meds: hydoxinepam 50mg, valium 5mg, advil pm

Current Illness: none

ID: 1112145
Sex: F
Age: 23
State: GA

Vax Date: 03/08/2021
Onset Date: 03/09/2021
Rec V Date: 03/18/2021
Hospital:

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

Lab Data:

Allergies: sulfa

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: I have had severe nausea every single day since the vaccination. It gets worse after I eat food. I begin to gag. I?ve also had diarrhea and loose stools.

Other Meds: methimazole

Current Illness:

ID: 1112146
Sex: F
Age: 50
State: FL

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 03/18/2021
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: Doxycycline, emycin, fresh ginger, celery, carrot, mango

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

Symptoms: within 15 minutes or receipt of the vaccine she began to experience " chest tightness" similar to when she has had bronchospasm in the past. She used her Xopenex inhaler and had resolution of symptoms after 30 minute observation.

Other Meds: Spirivia, Xopenex, Flonase Alvesco, Allergra, escitalopram

Current Illness: None

ID: 1112147
Sex: M
Age: 37
State: MN

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/18/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: Pt reported feeling his pulse was racing 15 minutes after vaccination. Refused medical care and left observation area.

Other Meds:

Current Illness:

ID: 1112148
Sex: F
Age: 65
State: OH

Vax Date: 03/15/2021
Onset Date: 03/15/2021
Rec V Date: 03/18/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Injection site pain

Symptoms: Fatique Aching body

Other Meds: lisinopril 30 mg 1/day hydrochlorothiazide 12.5 mg 1/day clonazepam 0.5 mg 1/day

Current Illness: none

ID: 1112149
Sex: U
Age: 68
State:

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/18/2021
Hospital:

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

Lab Data:

Allergies: Shellfish, fire ants

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

Symptoms: Fever 101 F, severe aches in all muscles, foggy thinking, migraine, dizziness, weird brain zap, mild nausea, mild diarrhea , inability to sleep

Other Meds: Wellbutrin, Effexor, day before I gave platelets to the Red Cross

Current Illness: None

ID: 1112150
Sex: F
Age: 65
State: CA

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 03/18/2021
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: PCN, Gentamicin, doxy and anesthesia

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

Symptoms: 30 mins post vaccination, client complained of new onset tickling in throat, voice hoarseness then cough. Client awake and alert. Vital signs stable, BP slightly elevated 164/71 @ 1226, O2 sats 98%. Blood glucose 154. Per staff protocol, Benadryl discussed but doctor declined to order administration. Daughter is driving her home.

Other Meds: metformin

Current Illness: hx Diabetes

ID: 1112151
Sex: F
Age: 28
State: IN

Vax Date: 02/10/2021
Onset Date: 02/25/2021
Rec V Date: 03/18/2021
Hospital: Y

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

Lab Data:

Allergies: I am allergic to amoxicillin.

Symptom List: Tremor

Symptoms: I had fatigue, headaches, SOB, dizziness. I had a routine check up already scheduled and was seen at that appointment. My blood pressure was elevated; 148/106 at the time of my appointment. I was sent to Labor and Delivery to be seen, I had my blood pressure continued to be high so my OB admitted me. I was induced without complication. My baby was born early but is healthy and home. I had a normal pregnancy up until Dose 2 of the vaccine. I had an estimated date of 03/17/2021 but delivered on 02/26/2021.

Other Meds: I was taking prenatal vitamins.

Current Illness: No

ID: 1112152
Sex: M
Age: 51
State: MD

Vax Date: 03/13/2021
Onset Date: 03/15/2021
Rec V Date: 03/18/2021
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: Erythema, Pruritus

Symptoms: Pt c/o difficulty breathing, esophageal spasms, severe coughing for hours during the night; resolved by 1400 on 3/15/21. 98% sat on ra; increased RHR of 86 bpm (normal is 48-52bpm) -

Other Meds: None

Current Illness: None

ID: 1112153
Sex: F
Age: 69
State: NY

Vax Date: 03/16/2021
Onset Date: 03/17/2021
Rec V Date: 03/18/2021
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: N/A

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

Symptoms: By the next morning I was very nauseous, fever, body aches, temperature, very thirsty, arm hurt, when I got up. It got worse during the day. Could not eat all day. Slept a lot during the day on and off. By evening felt a "little" better but still had all the side effects. Slept well that evening and the following morning felt better. As today has gone by, it is 4:30 PM and am feeling a lot better. So total of 48 hrs. after injection I had the adverse events.

Other Meds: N/A

Current Illness: N/A

ID: 1112154
Sex: F
Age: 72
State:

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/18/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Pt received vaccine at 09:52. 10:22 pt started to itching on arms and back. No visible rash. No chest pain, stridor, sob, tongue or lip swelling. Hx of allergies to pcn, iodine, sulfa, latex. Hx of rash and itching with pneumonia shot. No hx of anaphalxis to vaccines or meds - just itching and rash. VSS . 98 % RA 68. BP 177/84 (pt did not take her BP medication as of this mornig). Pt states she feels well but still itching as of 10:41. Pt appears to have the ability to make her own decisions and would like to talk to husband about going to ER. If pt still itching, recommend pt be evaluated. Pt would like d/w husband and physician prior to going to ER. EMS crew on standby. Note from ED: This is a well-appearing and pleasant 72-year-old female who presented via ambulance for itching response after receiving the Pfizer COVID-19 vaccine today. Patient is very well-appearing. Skin is normal and well-appearing there is no rash or erythema. Patient is speaking in complete sentences with normal work of breathing. Respirations are even and nonlabored. Lung fields are clear to auscultation bilaterally throughout patient denies any shortness of breath or breathing issues, cough or itchy throat. Airway is clear with no tongue or mouth swelling, floor mouth is soft and not elevated mandible is easily palpated, throat is nontender, neck is supple. Heart rate is within normal limits with regular rhythm. She was provided with Benadryl and famotidine as treatment for her itching. Patient was observed for greater than 2-1/2 hours in the emergency department. Patient noted that itching markedly reduced with use of Benadryl I felt patient was appropriate and stable for discharge. I had an in-depth discussion with her regarding she monitor her symptoms closely at home we discussed all symptoms that she should look for that would be concerning and she should make sure to seek emergent care. She was given the opportunity ask questions. All question concerns were thoroughly addressed. Patient indicated she felt good with her care here today with discharge and would monitor herself at home. She was picked up by her husband would also be home to monitor her. Advised her to follow-up with her primary care provider regarding recommendations for whether she should receive her second dose of the vaccine. Provided her with CDC printed out recommendations for vaccine allergic reaction. She was given the opportunity ask questions. All questions and concerns were addressed and answered to the best of my ability. No evidence of Stevens-Johnson syndrome, anaphylaxis, cellulitis, or systemic compromise Feel supportive care and symptomatic treatment reasonable. Urged dermatologic follow up. At time of discharge patient remained well-appearing not in any type of acute distress. She ambulated out of the emergency department with a steady gait. I reviewed recent and relevant Chart Entries, Previous Notes, Previous Labs, Previous Radiology studies.

Other Meds:

Current Illness:

ID: 1112155
Sex: M
Age: 55
State: CA

Vax Date: 03/10/2021
Onset Date: 03/17/2021
Rec V Date: 03/18/2021
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: Cats, Latex, some foods(heartburn)

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: I have itchy red bumps on my lower legs and knees and on the tops of my feet I have red spots the size of silver dollars that are light red in the middle and dark red on the edges. annular demarcation. it's worse on my left foot. my legs feel much colder than the rest of me. I applied a steroid cream and it seems to be getting much better.

Other Meds: No

Current Illness: No

ID: 1112156
Sex: F
Age: 72
State: GA

Vax Date: 02/25/2021
Onset Date: 02/26/2021
Rec V Date: 03/18/2021
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: Terramycin

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

Symptoms: The morning following first dose I woke up with a headache, body aches, slight fever, dizzy & nausea. These went on for the next week. I didn't go into work February 26th. But did go in partial days all the next week. Very uncomfortable. The headache got worse each day until it was very bad. On March 10th I woke up with my left arm in excruciating pain and the headache. Went to urgent care and doctor gave me a shot of Tromodol. When I got to the parking lot, I became very dizzy and my legs gave out and fell in the parking lot down to t he ground. Went to ER and waited for about 3.5 hours and left and went home. Went back to ER on March 12th due to arm in constant pain. Not able to sleep or relax. Wait this time was 3 hours and I was in too much paid so my daughter took me around the corner to urgent care. I was given steroid, muscle relaxer and a cream for my arm. My left arm from muscle up to shoulder and into wrist continues to hut. Today is 3/18/2021.

Other Meds: Vit-D2; Paroxetine, Biopolsol (blood pressure); Atorvastatin, Thyroid medicine, Allopurinol, Ibruporfen

Current Illness: None

ID: 1112157
Sex: M
Age: 71
State: AL

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/18/2021
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: Naispam

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

Symptoms: Vaccination at 0830 am, reactions started at @ 0930 pm while at work, Worked till 0400 am. When I left work my feet felt like they were frostbitten, had chills and temp of 99.9. Went home took 2 Extra Strength Tylenol, went to bed with 100.8 temp. Got up the night of the 16th, chills were gone temp was 101.1. Took more Tylenol drank some fluids tried to eat but couldn't . Went back to bed 3 hrs later temp down to 99.9. got up today at 1130am fill fine ate and drank some, temp now is 99.5 but I fill fine.

Other Meds: Doxycycline 100mg, Glimepiride 2mg, Furosemide 40mg, Metformin 500mg, Lisinopril 20mg, Meloxicam 7.5mg, Allopurinol 300mg, Metolazone 2.5mg, Nexium 40mg, Hydroxyzine 50mg, Gabapentin 300mg, OTC: Fish Oil 1200mg (360mg )mega-3), Caltrate 600

Current Illness: none

ID: 1112158
Sex: M
Age: 45
State: MN

Vax Date: 03/09/2021
Onset Date: 03/09/2021
Rec V Date: 03/18/2021
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: Client presented for second dose Moderna. Unable to depress plunger and vaccine leaked out all of his arm. Estimated only 0.1 ml administered into left arm. Client consented to revaccination in right arm. No issues. Syringe was supply: 1 ml vanish point syringe Lot #2025-06-28.

Other Meds: Unknown

Current Illness: Unknown

ID: 1112159
Sex: F
Age: 65
State:

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 03/18/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Headache. Evaluated by EMS-Cleared

Other Meds:

Current Illness:

ID: 1112160
Sex: M
Age: 52
State: NC

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 03/18/2021
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: na

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

Symptoms: na

Other Meds: na

Current Illness: na

ID: 1112161
Sex: M
Age: 31
State: NJ

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/18/2021
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: RN states, " Patients R-arm cleaned first-upon admin previously drawn up vaccine was leaking from syringe during admin. After admin. was complete, needle removed from arm + detached syringe from needle. Needle was not broken. Pharm. made aware. Pt. then received full 0.5 ml dose in opposite arm per staff recommendation per Moderna guidelines.

Other Meds: No

Current Illness: No

ID: 1112162
Sex: M
Age: 75
State: IL

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/18/2021
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: Vaccination administration Error - This was the patient's second dose of the Covid Vaccine. He was given Moderna and should have been given Pfizer. His first dose on 2-26-21 was Pfizer. We feel the mistake was due to carelessness by the pharmacy staff. No one seems to know the safety and efficacy of receiving a single dose of two different Covid vaccines. Thus far, 3-18-21 the patient has had no adverse effects except for a sore left arm which was the site of the injection.

Other Meds: Metoprolol, Pravastatin, Tamsulosin, Xarelto, Lisinopril, Acetaminophen, Loratadine

Current Illness:

ID: 1112163
Sex: F
Age: 66
State:

Vax Date: 03/09/2021
Onset Date: 03/10/2021
Rec V Date: 03/18/2021
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: FACIAL SWELLING ALLERGIC REACTION Angioneurotic edema, initial encounter

Other Meds:

Current Illness:

Date Died: 03/07/2021

ID: 1112164
Sex: M
Age: 46
State: MN

Vax Date: 03/04/2021
Onset Date: 03/06/2021
Rec V Date: 03/18/2021
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: Amoxicillan Lactose

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

Symptoms: lndividual Suddenly passed away on 3/7/21.....His Psychiartrist stated that there could be an adverse effect with COVID, the COVID Vaccination and medications, with an emphasis on Clozapine

Other Meds: Individual was a number of medications. His Psyciatrist wants Clozapine Emphasized CARBAMAZEPINE 200 MG TABLET Carbamazaepine 100mg ER Tab 12h Clozapine FLUTICASONE PROP 50 MCG SPRAY FOLIC ACID 1 MG TABLET Gabapentin 300mg caps Gabapentin

Current Illness: Had COVID November

ID: 1112166
Sex: F
Age: 68
State: MI

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 03/18/2021
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: NKDA

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Person received Vaccine injection was ambulatory to observation area became lightheaded dizzy, sat in chair skin pale cool diaphoretic. weak ,radial pulse, initial V/S B/P 64/43 HR 114 O2 Sat % 97 RM. air. Pt to stretcher supine color returned to pink warm dry HR decreased to 97 O2 Sat % 98 B/P remains 61/39. 911 called ambulance arrived reassessed person with care taken over and transferred to ED. Pt states to Ambulance personnel that she was not feeling well today prior to arrival for Vaccine.

Other Meds: Hydrochorothiazide, Others unknown

Current Illness: Unknown

ID: 1112167
Sex: M
Age: 36
State:

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 03/18/2021
Hospital:

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

Lab Data:

Allergies: unknown - community pt.

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

Symptoms: Pt. Found unresponsive in observation chair. Attempted sternal rub. Pt. Unconscious ~ 30 seconds, disoriented when finally awoke. Within 1-2 minutes, pt. was able to be re-oriented. EMS called. Pt. Became diaphoretic, stating that he was having a hard time getting air. Pt. Placed on 6L non-rebreather. Pt. Transferred to stretcher without issue. Pt. Able to have normal conversation. Per pt, he often faints when having blood drawn. Pt. Only ate a banana prior to getting his vaccine, pt. Normally has a more robust breakfast. After EMS arrival, VS remained stable. Per EMS BG normal. EMS attempted to get patient to sit up, pt again became increasingly diaphoretic and less responsive/drowsy. Pt. Stated he felt dizzy and was seeing white spots. Pt. Transferred to EMS stretcher and taken to ED. 1009: HR 56, RR 18, BP 129/83, SpO2 93% 1015: HR 59, RR 20, BP 115/80, SpO2 98%

Other Meds: unknown - community pt

Current Illness: unknown - community pt.

ID: 1112168
Sex: F
Age: 37
State: WA

Vax Date: 03/07/2021
Onset Date: 03/09/2021
Rec V Date: 03/18/2021
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: Ibuprofen (rash), Bactrim (Rash, anaphylaxis), lorazepam (throat swelling), penicillins, propranolol (throat swelling)

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

Symptoms: Patient reports that she started having "chest bone pain" on 3/9/2021 after first dose Pfizer Covid vaccine on 3/7/2021. States her heart rate became irregular and elevated on 3/16/2021 and that she developed left calf pain; Patient was already on apixaban (DVT). Patient went to Emergency Department 3/17 - was ruled out for Pulmonary embolism; will have stress test 3/18 and see her cardiologist next week.

Other Meds: Bisoprolol, buspirone, clotrimazole-betamethazone topical, apixaban, famotidine, gabapentin, metformin, pantoprazole, sucralfate, sumatriptan

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm