VAERS 2021 Database www.vaers.hhs.gov

Main Page | All 2021 Deaths | Videos
VAERS Updated: 11/12/2021
** VAERS DATABASE Last updated: November 12, 2021**
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Manufacturers

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

COVID19 Lot Number

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

Incidents per State

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

ID: 1331324
Sex: M
Age: 37
State: NC

Vax Date: 05/19/2021
Onset Date: 05/19/2021
Rec V Date: 05/19/2021
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: NO

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient reported sweating, dizziness and nausea.

Other Meds: Unknown

Current Illness: Unknown

ID: 1331325
Sex: F
Age: 14
State: CA

Vax Date: 05/19/2021
Onset Date: 05/19/2021
Rec V Date: 05/19/2021
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: At 15:18 pt reported to observation RN that she is feeling dizzy. Pt noted to be pale, vitals takes at 15:20 are: T: 97.4 P: 75 RR: 20 BP: 138/80 O2: 99%. Pt provided water at her request and feet propped up on a chair. Pt vitals taken again at 15:30 are: T: 98.3 P: 91 RR: 16 BP: 119/74 O2: 99%. Pt reported dizzy feeling subsided. Pt discharged at 15:45 in her mother's care.

Other Meds: None

Current Illness: Patient's mom reported to observation RN that the patient has a history of feeling dizzy anytime she receives a vaccine.

ID: 1331326
Sex: F
Age: 46
State: CO

Vax Date: 05/15/2021
Onset Date: 05/19/2021
Rec V Date: 05/19/2021
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: I started having menstual spotting 4 days after the vaccine. I have never spotted in between periods Prior to this.

Other Meds: Flonase, trazadone

Current Illness: None

ID: 1331327
Sex: M
Age: 41
State: IL

Vax Date: 05/18/2021
Onset Date: 05/18/2021
Rec V Date: 05/19/2021
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: Fever, headaches, chills, blurry vision.

Other Meds: None.

Current Illness: None.

ID: 1331437
Sex: M
Age: 66
State: PA

Vax Date: 03/11/2021
Onset Date: 03/20/2021
Rec V Date: 05/19/2021
Hospital:

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

Lab Data: 03/20/21 1719 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 03/20/21 1245 | Final result | Specimen: Swab from Nasopharynx COVID-19 SARS-CoV-2 Overall Result DetectedCritical

Allergies: NKA

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

Symptoms: 3/20/2021 Emergency Medicine Exposure to COVID-19 virus Dx Covid-19 Screening Reason for Visit Progress Notes (Physician Assistant) ? ? Emergency Medicine ? ? Encounter Date: 3/20/2021 ? ? Signed Cosigned byMD at 3/22/2021 1:59 PM Expand AllCollapse All MDM Number of Diagnoses or Management Options Exposure to COVID-19 virus: Diagnosis management comments: Here due to a Covid positive exposure from his daughter who he lives with who tested positive for COVID-19 on March 16, 2021. Patient has no symptoms at this time. Vital signs are within normal limits except for an elevated blood pressure 164/97 mmHg. Patient states that his blood pressure is elevated when he goes to the doctor's office. Patient instructed to monitor his blood pressure and if remains elevated he is to follow-up with his PCP for further evaluation. Physical examination as documented. Orders placed for COVID-19 PCR. Obtained and results pending at this time. Quarantine instructions discussed. Diagnosis exposure to COVID-19. Patient struck to follow-up with his PCP as needed.

Other Meds: aspirin 81 mg tablet atorvastatin (LIPITOR) 10 mg tablet lisinopril (PRINIVIL,ZESTRIL) 40 mg tablet multivitamin 400 mcg tablet omega-3 fatty acids-fish oil (OMEGA 3 FISH OIL) 684-1,200 mg capsule,delayed release(DR/EC) simvastatin (ZOCOR)

Current Illness:

ID: 1331438
Sex: F
Age: 38
State: TX

Vax Date: 05/18/2021
Onset Date: 05/18/2021
Rec V Date: 05/19/2021
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: none

Allergies: Penicillin Sulfa Phenergan Morphine

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

Symptoms: Started with small welts with white circles noted on arm where vaccine given. Same type welts were then on Left Chest, Right Chest, Neck, Lower jaw, jaw to lips and then seen on Eyebrows - Employee taken to ED- treated with Dexamethasone 10 mg IM, Famotidine 20 mg PO, Benadryl 50 mg, Prednisone 50 mg daily for 5 days.

Other Meds: Pantoprazole, Cyclobenzaprine, Montelukast Sodium, Budesonide/formoterol

Current Illness:

ID: 1331439
Sex: M
Age: 26
State: MA

Vax Date: 05/18/2021
Onset Date: 05/18/2021
Rec V Date: 05/19/2021
Hospital:

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

Lab Data: N/A

Allergies: NONE

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: PATIENT IS AFRAID OF NEEDLES, HE WAS ANXIOUS AT TIME OF VACCINATION. AFTER VACCINE WAS GIVEN, PHARMACIST TOLD PATIENT TO BE SEATED AND WAIT 15 MINUTES. ABOUT 10 MINUTES LATER, PHARMACY STAFF HEARD PATIENT SAYING 'GOING DOWN' HE WAS SLIDING DOWN THE CHAIR. PHARMACIST RUSHED OUT TO THE PATIENT AND SECURED AREAS AND HELD PATIENTS ARM AND SHOULDER MAKING SURE HE IS NOT HITTING ANYTHING WITH HIS HEAD. PHARMACIST ASKED ANOTHER PHARMACIST TO CALL 911 AND MANAGEMENT TO THE PHARMACY. ALSO CALLED PATIENTS FATHER TO COME IN FROM PARKING LOT, HE SPOKE TO PATIENT AND MADE SURE HE IS FINE AND AMBULANCE CREW CAME VERY QUICK AND CHECK ON PATIENT. PATIENT WAS AWAKE AT THE TIME, NO INJURIES. CREW TOOK HIM TO EMERGENCY ROOM FOR FURTHER EXAMINATION.

Other Meds: N/A

Current Illness: N/A

ID: 1331441
Sex: M
Age: 25
State: IN

Vax Date: 05/12/2021
Onset Date: 05/13/2021
Rec V Date: 05/19/2021
Hospital: Y

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

Lab Data: 15 May, 0330: arrived at emergency room. EKG and heart ultrasound conducted, showed pericarditis. Blood tests conducted and showed elevated hormonal levels indicating heart was under heavy stress.

Allergies: -

Symptom List: Pharyngeal swelling

Symptoms: Pericarditis. Initial symptoms were noticeable upon waking up the morning after receiving the vaccine, ~ 20 hours after vaccination. Initial symptoms: extremely elevated heart rate (~160 bpm). Heart rate fell to more reasonable, but still high, ~120 bpm after 2-3 hours. Roughly 36 hours after vaccination, began noticing soreness in the chest. Upon waking the following day (~48 hours after vaccination), chest soreness had progressed to pain (rating: 4/10), which remained roughly 6 hours to roughly 1400 that day, when the pain subsided along with all symptoms. Later, at roughly 2000 the same day (~58 hours after vaccination), there was a sudden and extreme flair up of chest pain (rating: 8/10) which radiated down the inside of both arms, this lasted 1.5 hours and then subsided just as suddenly as it came on. I went to sleep, then was woken up by another extreme episode of pain (rating: 7/10) at 0230 the morning of 15 May, again extreme chest pain radiating down both arms.

Other Meds: -

Current Illness: -

ID: 1331442
Sex: M
Age: 58
State: GA

Vax Date: 05/12/2021
Onset Date: 05/19/2021
Rec V Date: 05/19/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient had signs of lightheadedness.

Other Meds:

Current Illness:

ID: 1331443
Sex: F
Age: 62
State: IA

Vax Date: 05/05/2021
Onset Date: 05/11/2021
Rec V Date: 05/19/2021
Hospital:

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

Lab Data: Dr appointment, no labs

Allergies: Penicillin, sulfa, levaquin, niacin, Bactria

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Tinnitus

Other Meds: Metoprolol, metformin, levothyroxine, atorvastatin,asa, isosorbide, Losartan, magnesium, multi vitamin, calcium, co q 10, zinc, vitamin c, vitamin d, vitamin b complex, ambiance, tramadol, flexeril

Current Illness: None, had just fiMushed prednisone taper

ID: 1331444
Sex: F
Age: 29
State: CA

Vax Date: 03/01/2021
Onset Date: 05/01/2021
Rec V Date: 05/19/2021
Hospital:

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

Lab Data: My doctor confirmed non-viable pregnancy in April and then I naturally miscarried in May.

Allergies: none

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

Symptoms: I don't believe this is due to the vaccine but I was still recommended to fill this out. I miscarried and my pregnancy ended in May. I got my first shot in February very early in my pregnancy when I wasn't aware I was pregnant. I then proceeded the get my second shot which at that I knew I was maybe 6 weeks into pregnancy. I've never been pregnant before and the estimated date of delivery would have been November 2021.

Other Meds: Prenatal Vitamins

Current Illness: seasonal allergies

ID: 1331445
Sex: M
Age: 27
State: CA

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

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

Lab Data:

Allergies: None

Symptom List: Rash, Urticaria

Symptoms: patient stated he was feeling dizzy a few minutes after shot. Patient had remained in immunization booth due to potential for issue. Patient continued to feel dizzy, and was asked to lie down with feet elevated. The dizziness began to get better and receded a few minutes later. Patient stated dizziness was gone but had some feeling of heat and sweating for a few minutes after. Patient was moved to waiting area a few minutes later and remained for 15 minutes, with no additional symptoms.

Other Meds: None

Current Illness: None

ID: 1331446
Sex: F
Age: 40
State: NY

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

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

Lab Data: Vital signs: BP of 160/100 mmHg, HR of 72, regular. SPO2 of 98% on room air

Allergies: Seafood, pineapple, peanut butter, penicillin, and pollen.

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

Symptoms: Itching on arms and back, with feeling their throat was closing up.

Other Meds: Benadryl, Zyrtec, and Flonase PRN

Current Illness: Denies.

ID: 1331447
Sex: F
Age: 53
State: NH

Vax Date: 05/10/2021
Onset Date: 05/17/2021
Rec V Date: 05/19/2021
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: NONE

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

Symptoms: RAISED BUMP AND RASH AT INJECTION SITE ONE WEEK AFTER RECEIVING INJECTION

Other Meds:

Current Illness:

ID: 1331449
Sex: M
Age: 63
State: PA

Vax Date: 03/11/2021
Onset Date: 03/29/2021
Rec V Date: 05/19/2021
Hospital:

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

Lab Data: 03/29/21 2031 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 03/29/21 1140 | Final result | Specimen: Swab from Nasopharynx COVID-19 SARS-CoV-2 Overall Result DetectedCritical

Allergies: Allegra [Fexofenadine]Headaches ErythromycinNausea and Vomiting LisinoprilRash

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

Symptoms: UNKNOWN

Other Meds: ALPRAZolam (XANAX) 0.25 mg tablet cetirizine (ZyrTEC) 5 mg tablet citalopram (CeleXA) 20 mg tablet diclofenac sodium (VOLTAREN GEL) 1 % gel EPINEPHrine (EPIPEN) 0.3 mg/0.3 mL injection syringe gabapentin (NEURONTIN) 600 mg tablet losartan (

Current Illness:

ID: 1331450
Sex: F
Age: 49
State: PA

Vax Date: 05/13/2021
Onset Date: 05/13/2021
Rec V Date: 05/19/2021
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: Rash started on May 13 after second dose of Pfizer Covid Vaccine. Irregular Menstrual Cycle started on May 16

Other Meds:

Current Illness:

ID: 1331451
Sex: F
Age: 51
State: RI

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

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

Symptoms: VACCINE WAS ADMINISTERED 7 HOURS AFTER VIAL WAS INITIALLY PUNCTURED

Other Meds:

Current Illness:

ID: 1331452
Sex: F
Age: 47
State: NJ

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

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

Lab Data:

Allergies: Demerol, penicillin

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Pt received Johnson vaccine at 5:36 pm and around 6:17 complained about pins and needles in her hands traveling to the back and her fingertips were cold and little to no sensation

Other Meds:

Current Illness:

ID: 1331453
Sex: F
Age: 33
State: MI

Vax Date: 05/14/2021
Onset Date: 05/15/2021
Rec V Date: 05/19/2021
Hospital:

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

Lab Data: None

Allergies: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: The next morning I woke up and my upper arm at and around the inject site was swollen, hard to the touch, splotchy red, and also warm to the touch. I had no other symptoms. This lasted for 3 days. It is now Tuesday May 19th and it?s slightly swollen but that is all.

Other Meds: Prescription Lexapro

Current Illness: None

ID: 1331454
Sex: F
Age: 21
State:

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

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

Lab Data:

Allergies: NO

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

Symptoms: MEMBER WAS PROVIDED THE SECOND DOSE OF PFIZER VACCINE AFTER BEING ADMINSITERED THE FIRST DOSE OF MODERNA. PROPER CDC RECOMMENDATIONS WERE FOLLOWED AND NO ADDITIONAL DOSES WERE ADMINSITERED.

Other Meds: NO

Current Illness: NO

ID: 1331455
Sex: F
Age: 48
State: AL

Vax Date: 04/21/2021
Onset Date: 05/17/2021
Rec V Date: 05/19/2021
Hospital: Y

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: Basic metabolic panel, COVID 19 test, comp metabolic panel, brain natriuretic peptides, CBC with Diff, estimatedCrCl, estimatedGFR, Free T-4,glucose point of care, Magnesium, Potassium, Prolactin, Stroke, PT, Troponin-I, TSH, UA w culture reflex South/East, Venipuncture Collection Charge, CT brain w/o contrast, DX Chest portable, EKG, EEG All tests were done 05/17 and 05/18/2021.

Allergies: Allergic to mangoes

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

Symptoms: On Monday, 05/17/2021 at approximately 3:30am, I had a seizure at home. According to my husband and daughter, it lasted a few minutes. When I came to, I remember being disoriented, dizzy, nauseous, sweating and headache in the back of my head. I was taken to the Hospital.

Other Meds: Vitamins C & D

Current Illness: None

ID: 1331457
Sex: F
Age: 28
State: NJ

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

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

Lab Data: Final BP was 117/76

Allergies: n/a

Symptom List: Unevaluable event

Symptoms: Patient fainted after getting shot. She remained seated and did not fall. When patient woke up, I monitored her for 30 minutes and took several blood pressures.

Other Meds: n/a

Current Illness: n/a

ID: 1331458
Sex: F
Age: 35
State: DE

Vax Date: 05/15/2021
Onset Date: 05/19/2021
Rec V Date: 05/19/2021
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: Urine Blood POC May 7 2021 - Result Trace Next Urinalysis tomorrow 5/20/21

Allergies: Doxycycline

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

Symptoms: 4 days after my first dose I experienced hematuria. I experienced it again a few weeks later. I received my second shot and 4 days later experienced hematuria for the third time since the first shot.

Other Meds: DIM Collagen

Current Illness: None

ID: 1331459
Sex: M
Age: 72
State: PA

Vax Date: 03/11/2021
Onset Date: 03/15/2021
Rec V Date: 05/19/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Probable COVID-19 (Resolved) Specimen information: Swab / Nares Added: 3/15/2021 by POCT COVID-19 Antigen (Collected 03/15/21) Onset date: 3/15/2021 Resolved: 3/29/2021 (Expired) Add: Rule-Out COVID-19 and Respiratory Viruses Add: SARS-CoV-2 (related to COVID-19) Add: Rule-Out SARS-CoV-2 (related to COVID-19) Add: Probable COVID-19

Allergies: NKA

Symptom List: Injection site pain, Pain

Symptoms: Office Visit 3/15/2021 with, PA-C COVID-19 Dx Follow-up Reason for Visit Progress Notes , PA-C Encounter Date: 3/15/2021 Cosigned by: DO at 3/20/2021 6:25 PM Expand AllCollapse All Assessment/Plan Problem List Items Addressed This Visit None Visit Diagnoses COVID-19 - Primary Unfortunately, patient does not meet criteria for monoclonal antibody infusion therapy as he is 10 days from start of symptoms. At this time I have sent in a prescription for Tessalon Perles and a ProAir inhaler for him to use with increased cough or shortness of breath. You tested positive for COVID-19 today. Discussed recommendation for self-isolation from others at home. You should try to stay in the specific sick room and use a separate bathroom if possible, even if you are feeling better. You can be around others 10 days after your symptoms first appeared, and you have had 24 hours without fever without the use of fever reducing medications, and other symptoms of COVID-19 are improving. If you do come into contact with others at home, you should stay six feet away and wear a mask. Please follow good handwashing hygiene: wash your hands with warm water and soap for 20 seconds, or when hand washing is not available, use an alcohol based hand sanitizer that is at least 60% alcohol. Please stay well hydrated and rest. May use tylenol for fever, chills, or pain. You may also use hot tea with lemon and honey to soothe your cough and salt water gargles for any sore throat. If you develop difficulty breathing, persistent pain or pressure in your chest, have any confusion, difficulty staying awake, please call us or go to the ED. Relevant Medications albuterol HFA (PROAIR HFA) 90 mcg/actuation inhaler benzonatate (TESSALON) 200 mg capsule Other Relevant Orders POCT COVID-19 Antigen (Completed) Pulse oximetry (Completed) SUBJECTIVE PT 72 y.o. male who presents for a sick visit with concern for possible COVID 19. Reports onset of symptoms started 10 days ago. Information was obtained from PATIENT. Reports some dry cough, mild shortness of breath, occasional headache, increased fatigue, loss of taste and smell, decreased appetite, congestion, rhinorrhea. Reports loose stool. Denies wheezing, fever, chills, myalgias, sore throat, ear pain, n/v. He was exposed to an individual who was exposed to someone with COVID. He had his flu shot and his first dose of the COVID-19 vaccination. Review of Systems Constitutional: Positive for fatigue. Negative for chills and fever. HENT: Positive for congestion and rhinorrhea. Negative for ear pain and sore throat. Respiratory: Positive for cough and shortness of breath. Negative for wheezing. Gastrointestinal: Positive for diarrhea. Negative for nausea and vomiting. Neurological: Positive for headaches.

Other Meds: albuterol HFA (PROAIR HFA) 90 mcg/actuation inhaler hydroCHLOROthiazide (HYDRODIURIL) 12.5 mg tablet lisinopriL (ZESTRIL) 20 mg tablet rosuvastatin (CRESTOR) 10 mg tablet sildenafiL (REVATIO) 20 mg tablet

Current Illness:

ID: 1331460
Sex: F
Age: 14
State: CA

Vax Date: 04/28/2021
Onset Date: 04/28/2021
Rec V Date: 05/19/2021
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: No adverse effects. Patient and patient's mother arrived for their second Pfizer shot at day 21 of first shot. Patient's mother stated that her birthday is actually year 2004 which has the patient at the age of 14 when she received the first shot. The mother admitted to being dishonest about her age and about bringing her insurance and ID card on the first visit because "she was so sick from a prior H1N1 infection that she had to get it then even though she didn't qualify." The mother also stated that she accepted any consequence of her dishonesty but it was for her daughter. I had called Coordinator in Charge to initially verbally report the incident and to get direction on the second shot. Since the patient currently qualifies at the current time we administered the second vaccine and also filing a VAERS report. Mother's address is the same as daughter.

Other Meds:

Current Illness:

ID: 1331461
Sex: F
Age: 44
State: IN

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 05/19/2021
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: Cellulitis at injection site of 2 inches x 2 inches

Other Meds:

Current Illness:

ID: 1331462
Sex: F
Age: 42
State: RI

Vax Date: 03/11/2021
Onset Date: 03/11/2021
Rec V Date: 05/19/2021
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: EKG

Allergies: Penicillin-anaphylactic

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: It started as soon as I got the vaccine. I had a feeling of heat travelling down my arm followed by a pins and needles sensation. I stayed for 30 minutes and I could feel a strange feeling of pins and needles seemed to be travelling up my neck and into my face. When I saw that my arm was swollen. My arm started to itch and I was taken into the observation area and checked out. I went home and four hours later I felt like I couldn't take a deep breath and I started to get a headache, chills and fatigue. The next day my arm and face were still little numb and I was still having a little trouble breathing. On day four I still felt like I couldn't take a deep breath and my heart rate was erratic. On the fifth day I went to an Urgent Care clinic. My blood pressure and heartrate were a little high. I went to the doctor the next day because they had found some hardening of my heart. After five weeks I still have a little feeling of pins and needles in my left arm and in the left side of my face.

Other Meds: Tegretol 400mg Multivitamin Probiotic

Current Illness:

ID: 1331463
Sex: F
Age: 24
State: FL

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

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

Lab Data: N/A

Allergies: NKDA

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Administered 2nd dose in left arm and the needle was faulty and the dose spilled out of syringe. It definitely appeared that patient missed the full dose so I immediately administered another dose in the right arm as indicated in guidelines. Notified patient of the defective syringe leading to missed dose which is why additional vaccine was given in Right arm and she was very understanding.

Other Meds: N/A

Current Illness: N/A

ID: 1331465
Sex: M
Age: 62
State: TX

Vax Date: 05/06/2021
Onset Date: 05/06/2021
Rec V Date: 05/19/2021
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: NA

Allergies: NA

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

Symptoms: NURSE GAVE A .6CC INSTEAD OF .3CC

Other Meds: NA

Current Illness: NA

ID: 1331466
Sex: M
Age: 64
State:

Vax Date: 05/03/2021
Onset Date: 05/19/2021
Rec V Date: 05/19/2021
Hospital: Y

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

Lab Data:

Allergies: nka

Symptom List: Nausea

Symptoms: Per family member patient had a stroke and was admitted

Other Meds: n/a

Current Illness: unknown

ID: 1331467
Sex: M
Age: 58
State: RI

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

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: VACCINE WAS ADMINISTERED 9+1/2 HOURS AFTER THE VIAL WAS PUNCTURED.

Other Meds:

Current Illness:

ID: 1331468
Sex: F
Age: 11
State: VA

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

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

Lab Data: None

Allergies: none

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

Symptoms: No adverse events, Pfizer vaccine was given to a patient younger than 12 years old because her mother purposely changed her daughter's date of birth so her daughter can get the vaccine, after the vaccine was given the claim got rejected by the insurance for invalid date of birth, this is when the pharmacist called the mother and she told the pharmacist, that she did that on purpose because she wants her daughter to get the vaccine before her trip this summer!

Other Meds: None

Current Illness: none

ID: 1331469
Sex: M
Age: 39
State: UT

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

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

Symptoms: A dose of the Moderna vaccine was left over from the prior day vaccinations. The dose had been set aside for disposal, the technician preparing for the days vaccinations grabbed the dose by mistake and may have administered to the above patient.

Other Meds:

Current Illness:

ID: 1331470
Sex: M
Age: 61
State: PA

Vax Date: 03/11/2021
Onset Date: 04/03/2021
Rec V Date: 05/19/2021
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: 04/03/21 1625 Influenza/RSV/COVID PCR Collected: 04/03/21 1524 | Final result | Specimen: Swab from Nasopharynx Influenza A Not Detected Respiratory Synctial Virus Not Detected Influenza B Not Detected COVID-19 SARS-CoV-2 Overall Result DetectedCritical LABORATORY: CBC: Results from last 7 days Lab Units 04/10/21 0627 04/08/21 0628 04/07/21 0821 WBC AUTO K/mcL 8.0 7.4 7.9 HEMOGLOBIN g/dL 10.5* 10.5* 9.9* HEMATOCRIT % 30.9* 30.6* 29.4* PLATELETS K/mcL 236 209 211 NEUTROS PCT AUTO % 69 67 73 LYMPHS PCT AUTO % 17 19 14 MONOS PCT AUTO % 10 9 10 EOS PCT AUTO % 2 3 2 CHEMISTRY: Results from last 7 days Lab Units 04/10/21 0627 04/09/21 0607 04/08/21 0628 SODIUM mmol/L 142 138 137 POTASSIUM mmol/L 3.6 3.3* 3.1* CHLORIDE mmol/L 107 108* 106 CO2 mmol/L 21 20* 22 BUN mg/dL 17 16 19 CREATININE mg/dL 1.32* 1.17 1.23 CALCIUM mg/dL 8.2* 8.1* 8.2* Results from last 7 days Lab Units 04/09/21 0607 04/08/21 0628 04/07/21 0559 MAGNESIUM mg/dL 1.9 1.9 1.9 COAGULATION: OTHER TESTS: 0 Lab Value Date/Time TROPONINI 0.03 (H) 10/17/2020 2159 TROPONINI 0.03 (H) 10/17/2020 1832 TROPONINI 0.03 (H) 10/17/2020 1139 TROPONINI 0.05 (H) 08/18/2020 2156 TROPONINI 0.05 (H) 08/18/2020 1816 TROPONINI 0.05 (H) 08/18/2020 1232 TROPONINI 0.08 (H) 01/23/2020 1348 TROPONINI 0.09 (H) 01/23/2020 1119 TROPONINI 0.03 (H) 04/10/2019 2337 TROPONINI 0.03 (H) 04/10/2019 2023 TROPONINI 0.03 (H) 04/10/2019 1743 TROPONINI 0.12 (H) 05/13/2017 0613 TROPONINI 0.17 (H) 05/13/2017 0225 TROPONINI 0.09 (H) 05/12/2017 2114 TROPONINI 0.04 09/05/2014 0224 IMAGING: X-ray Hip Left 2 Or 3 Views Result Date: 4/2/2021 XR HIP 2 OR 3 VIEWS LEFT IMPRESSION: Degenerative changes of the left hip. No acute osseous abnormality. END OF IMPRESSION: INDICATION: Pain in left hip. Patient complains of increasing left hip pain. History of recent stroke affecting the left side. TECHNIQUE: Provided are 2 views of the left hip include AP and frog-leg lateral images. COMPARISON: None available FINDINGS: No acute fracture or dislocation is identified. Mild degenerative changes are present at the left hip. No focal bone lesion is identified. Surgical clips are noted in left groin. Vascular calcifications and vascular stenting are noted in the left thigh region. There appears to be a Foley catheter in place. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. Ct Pelvis Without Contrast Result Date: 4/3/2021 CT PELVIS WO CONTRAST IMPRESSION: There are no acute findings. END OF IMPRESSION: INDICATION: Left hip pain. TECHNIQUE: Noncontrast scans were obtained through the pelvis with multiplanar reconstructions. CONTRAST: No contrast was administered. COMPARISON: August 21, 2020. FINDINGS: There is no fracture or hip dislocation. There is mild joint space narrowing in both hips, and there are osteophytes about the left femoral head. Findings are compatible with osteoarthritis, similar to the prior study. There is no effusion noted. There are no periarticular s

Allergies: Ace InhibitorsAngioedema / Facial Swelling Contrast [Iodinated Contrast Media]Hives / Urticaria ClindamycinItching Statins-hmg-coa Reductase InhibitorsDizziness / Lightheaded

Symptom List: Tremor

Symptoms: ED to Hosp-Admission Discharged 4/3/2021 - 4/10/2021 (7 days) Hospital MD Last attending ? Treatment team Severe sepsis with acute organ dysfunction Principal problem Discharge Summary MD (Physician) ? ? Internal Medicine HOSPITAL INPATIENT DISCHARGE SUMMARY HOSPITALIST GROUP . Date: 4/10/2021 Admission Date: 4/3/2021 Length of stay: 6 Days PCP: MD Discharging provider: MD Admission diagnosis: Primary Admission Diagnosis Hospital Problems POA * (Principal) Severe sepsis with acute organ dysfunction Yes Left hip pain Yes Primary osteoarthritis of left hip Yes Intractable vomiting with nausea Yes Acute metabolic encephalopathy Yes COVID-19 virus infection Yes Gastrointestinal hemorrhage with hematemesis No Urinary tract infection associated with indwelling urethral catheter Yes HPI: Admitted with severe left hip pain and altered mental status. patient with history of stroke Was also found to have Covid positive at the time of admission Hospital Course: Following issues were addressed during this hospitalization Acute encephalopathy: At the time of admission Most likely secondary to gabapentin Held medication during this hospitalization and also stopped at the time of the discharge. Patient was started on this medication recently due to his left hip pain. COVID-19 infection D-dimer was elevated at the time of presentation. CT chest ruled out pulmonary embolism. Ultrasound did not reveal any DVT. Patient did not qualify for any convalescent plasma remdesivir during this hospitalization as he is saturating well on room air. Possible catheter associated urinary tract infection Patient with chronic indwelling Foley catheter. Urine culture grew Staphylococcus hemolyticus and Enterococcus faecalis faecalis. Patient was started on ampicillin during this hospitalization he completed the 5-day course. Sepsis ruled out at the time of admission Acute kidney injury present at the time of admission Suspect underlying chronic kidney disease Patient needs to follow-up with the PCP for the follow-up on the creatinine in 1 week. Left hip pain Patient underwent extensive work-up during this hospitalization. MRI of the left hip showed high-grade tear of the iliopsoas tendon. Patient was seen by orthopedics recommending continued therapy and pain management. Acute GI bleed, presented as coffee-ground emesis Acute on chronic anemia Iron deficiency anemia Underwent extensive work-up during this hospitalization. CT angiogram of abdomen pelvis revealed suspected bleeding in the stomach. Patient underwent EGD which showed severe esophagitis most likely cause of the bleed. Gastroenterology recommending continuing pantoprazole twice daily. Patient hemoglobin remained stable during this hospitalization. Biopsy did not reveal any H. pylori infection. Patient was seen by PT OT during this hospitalization who recommended acute inpatient rehab. But patient and family decided to take the patient home patient was discharged home in stable condition with home health.

Other Meds: acetaminophen 500 mg oral tablet blood sugar diagnostic (ACCU-CHEK AVIVA PLUS TEST STRP) strip blood-glucose meter kit BREO ELLIPTA 100-25 mcg/dose blister with device calcium carbonate-vitamin D3 600 mg(1,500mg) -400 unit per tablet diclof

Current Illness:

ID: 1331471
Sex: F
Age: 44
State: TX

Vax Date: 05/19/2021
Onset Date: 05/19/2021
Rec V Date: 05/19/2021
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: Patient complained of pain from injection site of right shoulder extending to right next and upper right chest. Pain would not go away while waiting in pharmacy. 911 was called, came, picked up patient in 30 minutes.

Other Meds: none

Current Illness:

ID: 1331473
Sex: F
Age: 62
State: CA

Vax Date: 04/13/2021
Onset Date: 04/27/2021
Rec V Date: 05/19/2021
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: none

Allergies: cipro, sulfa, erythromycin

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

Symptoms: swelling/soreness of left axillary lymph nodes, starting 2 weeks after 1st dose. Subsided within a few days. Reoccurred starting 3 days after the 2nd dose. Subsided after almost 2 weeks.

Other Meds: multivitamin/multimineral vitamin C, D3 niacin zinc glucosamine/MSM turmeric

Current Illness: none

ID: 1331474
Sex: F
Age: 68
State: OR

Vax Date: 05/18/2021
Onset Date: 05/18/2021
Rec V Date: 05/19/2021
Hospital:

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

Lab Data: MRI brain is pending (she was due for an MRI brain anyways).

Allergies: none

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

Symptoms: Patient has a history of seizures. Patient was feeling fine, then found herself on the floor. She hit the top of her head with a small amount of blood (on blood thinners). No tongue biting, no urinary incontinence.

Other Meds: aspirin, atorvastatin, biotin, multivitamin, Lamictal, Dyazide

Current Illness: none

ID: 1331475
Sex: F
Age: 44
State: IL

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 05/19/2021
Hospital:

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

Lab Data: Chest Xray with contrast and bloodwork panel scheduled

Allergies: Sulfa drugs, latex, fluoride

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Rash and fever at two hours after injection, followed by difficulty breathing. Two days later still have difficulty breathing. Doctor visit with prescription for epi-pen and stronger asthma medication.

Other Meds:

Current Illness:

ID: 1331476
Sex: F
Age: 27
State: TN

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

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

Lab Data: HR 75 SPO2 98 BP118/72

Allergies:

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

Symptoms: 28 WEEKS PREGNANT- PT EXPERIENCED SYNCOPE AND VOMITING

Other Meds:

Current Illness:

ID: 1331477
Sex: M
Age: 41
State: GA

Vax Date: 05/19/2021
Onset Date: 05/19/2021
Rec V Date: 05/19/2021
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: N/A

Allergies: N/A

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

Symptoms: WHILE GIVING AN IMMUNIZATION TO THE PATIENT, THE HEAD OF THE NEEDLE WAS NOT SCREWED ON COMPLETELY AND DRIPPED DOWN THE PATIENT'S ARM. I TOLD THE PATIENT THAT THE HEAD OF THE NEEDLE WAS NOT SCREWED ON TIGHT TO THE NEEDLE, SO I WOULD HAVE TO READMINISTER THE VACCINE. I TOLD THE PATIENT THAT THE NEEDLE WAS IN THE ARM BUT THE VACCINE MAY NOT HAVE WENT INTO HIS ARM AT ALL. SO HE AGREED TO RETAKE THE VACCINE.

Other Meds: N/A

Current Illness: N/A

ID: 1331478
Sex: F
Age: 51
State: WA

Vax Date: 04/10/2021
Onset Date: 04/11/2021
Rec V Date: 05/19/2021
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: Pain in extremity

Symptoms: Migraines several days after vaccine, severe migraine on 4/23

Other Meds: Tylenol, Estradiol, melatonin, unisom, ashwaghanda, multivitamin, vitamin D, vitamin B12

Current Illness: fibromyalgia, trigeminal neuralgia

ID: 1331479
Sex: F
Age: 30
State: MA

Vax Date: 04/30/2021
Onset Date: 04/30/2021
Rec V Date: 05/19/2021
Hospital:

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

Lab Data: 19May21: office visit to urgent care

Allergies: None

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

Symptoms: At the time of administration, there was a sharp pain at the shot location which felt internal. I could not lift my arm without extreme pain for one week. For 12 hours after administration, I experienced fever, chills, body aches, and sharp pains shooting down my extremities. Arm pain in the shoulder/deltoid area (area of injection) continues to current day, approximately 3 weeks after injection. I?ve been to an urgent care facility who believes my nerve was affected by the injection needle. Additional testing and treatment may be needed if not healed within one week.

Other Meds: Junel 1/20 birth control, spironolactone 50mg, vitamin D, vitamin B12, probiotic.

Current Illness: None

ID: 1331481
Sex: M
Age: 70
State: CA

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

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

Lab Data:

Allergies:

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

Symptoms: PT RECEIVED FIRST J AND J VACCINE ON 4/21/21 AT THE DRUGGIST AND RECD A PHONE CALL NEXT DAY FROM THE DRUGGIST STATING THEY HAD BEEN GIVEN EXPIRED MODERNA VACCINE INSTEAD. DR CONSULTED AND OK TO RECD J AND J SINCE 2 WEEKS HAD PASSED. PT RECD J AND J VACCINE TODAY.

Other Meds:

Current Illness:

ID: 1331482
Sex: M
Age: 46
State: FL

Vax Date: 05/19/2021
Onset Date: 05/19/2021
Rec V Date: 05/19/2021
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: N/A

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

Symptoms: PATIENT BECAME DIZZY AND FAINTED FOR A FEW MINUTES. WHEN PATIENT WOKE UP HE WAS PALE AND I CHECKED TO MAKE SURE HE WAS BREATHING. HE SAID HE WAS BREATING FINE BUT WAS VERY DIZZY. HE GOT NAUSEAS WITH SENSATION OF VOMITING.

Other Meds: N/A

Current Illness: N/A

ID: 1331483
Sex: M
Age: 44
State: IL

Vax Date: 05/10/2021
Onset Date: 05/17/2021
Rec V Date: 05/19/2021
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: slight cat allergy.

Symptom List: Vomiting

Symptoms: Around 10am I was feeling a bit hungry and my stomach seemed 'sore'. I air fried some chicken for myself, but still felt hungry. I was feeling rather irritable, and an hour or two later I was violently vomiting. I tried to drink some water shortly after, and that did not help. My stomach was still rather upset and I vomited again an hour later. I laid down on the couch the rest of the day with my stomach feeling rather upset in way I've not really experienced before. I was able to sleep for a few hours and I was able to drink small amounts of water by midnight. I felt a bit cold but I don't remember anyone saying I had a fever. I was irritable, deep breaths kinda hurt, and I was a tad dizzy most of the day. I was able to eat and drink the next morning, but my abdomen was sore. It still is a bit sore, but I feel almost 100%.

Other Meds: Men's ONe a Day Health vitamin

Current Illness:

ID: 1331484
Sex: M
Age: 28
State: NY

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

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

Lab Data: none

Allergies: none noted on form

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: patient was nervous and Apprehensive to get COVID vaccination but still wanted to get it, pt was given Moderna Vaccine and while sitting for the 15 minutes (within 5 minutes), he started to feel warm and Nauseated (he was with his mother who notified us that he wasn't feeling good). Pt was given Ice Pack to put on the back of his neck. After waiting the allotted time, pts mother said she was taking him home. A follow-up call was made to check on pt , and mother said he was feeling fine. After they left the store, and he continued to use Ice Pack and went out for lunch and felt better.

Other Meds: unknown

Current Illness: unknown

ID: 1331485
Sex: M
Age: 19
State: OR

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 05/19/2021
Hospital:

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

Lab Data: None

Allergies: None

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

Symptoms: After receiving vaccine, pt had vasovagal event and "fell out of" open car door, waking on ground. Intermittent vomiting x 30 min.

Other Meds: Xyzal, OTC acid reflex medication

Current Illness: None

ID: 1331486
Sex: F
Age: 39
State: NV

Vax Date: 05/17/2021
Onset Date: 05/18/2021
Rec V Date: 05/19/2021
Hospital:

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

Lab Data: None yet - but possible labs or ER visit tomorrow suggested by my dr if the fevers don?t resolve because I do not have a spleen

Allergies: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Shot given at 4pm on 5/17/2021. By 10:30am on 5/18 I spiked 102.5 fever. My arm was so sore I could barely lift it. It wasn?t red or itchy, but was puffy and swollen. I had horrible body/joint/muscle aches. Fever came down over course of day but came back up at 3am on 5/19/21 to 103.3. I called my dr and he advised to continue with fluids and Tylenol today and tonight and to call him tomorrow.

Other Meds: Gabapentin, lyrica, Topamax, Novolog, Effexor, protonix, zofran, oxycodone, MS Contin, Creon

Current Illness: None

ID: 1331487
Sex: F
Age: 22
State: PA

Vax Date: 03/12/2021
Onset Date: 04/19/2021
Rec V Date: 05/19/2021
Hospital:

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

Lab Data: 04/20/21 0532 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 04/19/21 1256 | Final result | Specimen: Swab from Nares COVID-19 SARS-CoV-2 Overall Result DetectedCritical

Allergies: NKA

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

Symptoms: UNKNOWN - EXPOSURE

Other Meds: Outpatient Medications albuterol HFA (VENTOLIN HFA) 90 mcg/actuation inhaler clindamycin-tretinoin (ZIANA) gel FLUoxetine (PROzac) 40 mg capsule nitrofurantoin, macrocrystal-monohydrate, (MACROBID) 100 mg capsule spironolactone (ALDACTONE)

Current Illness:

ID: 1331489
Sex: M
Age: 30
State: IN

Vax Date: 05/17/2021
Onset Date: 05/18/2021
Rec V Date: 05/19/2021
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:

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

Symptoms: Occured 20 hours after the shot and lasted for 11 hours. Cold sweats. Headache. No appetite. Sluggishness. Overall felt awful

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am