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: 1296546
Sex: F
Age: 75
State: AZ

Vax Date: 04/13/2021
Onset Date: 04/13/2021
Rec V Date: 05/07/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient reports a metallic taste and headache immediately after receiving the vaccine. Metallic taste still continues 20 days post-vaccination and headache has improved.

Other Meds:

Current Illness:

ID: 1296547
Sex: M
Age: 30
State: IN

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/07/2021
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:

Symptom List: Anxiety, Dyspnoea

Symptoms: Got vaccine in my car and parked. Had a little extra bleeding at the time of injection. Once parked, I had immediate and intense nausea. Very dizzy and light-headed. My hearing went away. I closed my eyes for a second and passed out. I awoke about ten minutes later covered in sweat. Felt better at this point and it was my time to leave, so I felt well enough to drive home at that moment. I should have reported the adverse event at the site.

Other Meds:

Current Illness:

ID: 1296549
Sex: F
Age: 56
State: WI

Vax Date: 03/27/2021
Onset Date: 04/30/2021
Rec V Date: 05/07/2021
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: unknown

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

Symptoms: Pt experienced cough, runny nose, sore throat, fever, headache, fatigue, muscle aches, nausea, loss of taste & smell, and abdominal pain. Pt was a household contact to a COVID+ person and became symptomatic following prolonged exposure.

Other Meds: unknown

Current Illness: unknown

ID: 1296550
Sex: F
Age: 66
State: ND

Vax Date: 03/17/2021
Onset Date: 05/01/2021
Rec V Date: 05/07/2021
Hospital: Y

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

Lab Data:

Allergies: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient began to experience minor pain in upper left leg in mid-April; patient noticed extreme swelling and discoloration in left leg evening of 05/01/2021; Admitted to ER morning of 05/02/2021. Diagnosis: Acute deep vein thrombosis (DVT) of left lower extremity; no family history of blood clots and no falls reported by patient. DVT resolved after 24 hours of catheter directed thrombolysis. Residual nonflow limiting disease still present in the below-knee deep veins and popliteal vein with good collateralization of the deep venous system. Minimal residual disease still present in the femoral vein without flow limitation.

Other Meds: Lisinopril 10 mg; multivitamin

Current Illness: Bronchitis

ID: 1296551
Sex: F
Age: 38
State: WI

Vax Date: 04/07/2021
Onset Date: 04/07/2021
Rec V Date: 05/07/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient experienced low blood glucose of 45 about one hour after vaccination. She self treated with carbohydrate intake.

Other Meds:

Current Illness:

ID: 1296552
Sex: M
Age: 42
State:

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: syncopal episode, EMS evaluated, refusal of transport, pt. left site

Other Meds:

Current Illness:

ID: 1296553
Sex: M
Age: 66
State: TX

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 05/07/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Pt was given multiple manufactures of the COVID19 vaccine. Pfizer was administered on 2/10/21 and 3/3/21, while Janssen was administered on 3/12/21

Other Meds:

Current Illness:

ID: 1296554
Sex: M
Age: 30
State: IL

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/07/2021
Hospital:

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

Lab Data:

Allergies: NKA

Symptom List: Pharyngeal swelling

Symptoms: Pt had near syncopal episode following vaccine. Pt states "he has fainted around needles in the past" Vitals taken, hypotensive, reassessed pt after 5 minutes to find vitals WNL. Refused transport to hospital

Other Meds: N/A

Current Illness: N/A

ID: 1296555
Sex: F
Age: 29
State: TX

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/07/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Initial injection site felt a lot of pressure and at first there were mild symptoms of ringing in the ears and mind fogginess. Within 5 minutes after receiving injection I got up and walked less than 10 feet when I began experiencing extreme dizziness, ringing in the ears, lightheadedness, felt warm, and began to feel chills/tingling throughout my whole body but especially in my head. I ended up passing out and was unable to sit up in a chair without assistance. For about 10 minutes I was profusely sweating all over my entire body, had continued chills/tingling, difficulty breathing and was semi coherent. The nurse at the pharmacy had me sniff ammonia salt and gave me water to help. I waited for 20 more minutes before finally feeling able to get up and walk around the store. Body chills and cold sweats continued for a while but no further symptoms at this time (2hrs after vaccination).

Other Meds: Adderall XR

Current Illness: None

ID: 1296556
Sex: F
Age: 45
State: CA

Vax Date: 05/06/2021
Onset Date: 05/07/2021
Rec V Date: 05/07/2021
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: Pencilin

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Shot Date/Time: Thursday, 5/6/2020 4:15p.m. Jansssen That evening I started having minor stomach cramping initially. Overnight I was unable to sleep. About 5a.m. I was incredibly nauseous. I was incredibly weak. I didn't have the strength to stand or sit upright. I sat on the bathroom floor & had to have someone prop me up in front of the commode to vomit into it I was so weak. I repeatedly vomited forcefully for about an hour with accompanying repeated bowel movements. I had a fever.I broke out in a sweat repeatedly - clammy. The most painful part as SEVERE, SHARP NON-STOP ABDOMINAL CRAMPING. I was in the fetal position on the floor writhing in pain after the vomiting & bowel movements slowed. After hours of this... my clamminess turned into chills with my entire body shaking strongly & continuously as I lay on the floor unable to do anything but shiver. I considered going to the emergency room but was able to move in my current state. Who & where should I report this severe adverse event? Note: I'm a 45-year old VERY physically fit athletic female. My only health condition: I take Enbrel for Rheumatoid Arthritis.

Other Meds: Enbrel, Plaquenil, Vitamin C, D, A, NAC, Flax Seed Oil, Fish Oil, Zinc

Current Illness: NONE

ID: 1296557
Sex: F
Age: 58
State: CA

Vax Date: 04/13/2021
Onset Date: 04/13/2021
Rec V Date: 05/07/2021
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: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: 4/13/21 - had reaction after 2 days. Left arm site felt like fire and having severe pain. The following day when she woke up had a huge bumpy spot on both legs and had generalized pain, that evening her bottom lip was swollen. Her son gave her allergy pill and it helped andwent away per client. After that incident it never happened again.

Other Meds: Son gave client allergy pill, did not say the name

Current Illness:

ID: 1296558
Sex: M
Age: 72
State: WI

Vax Date: 03/18/2021
Onset Date: 03/19/2021
Rec V Date: 05/07/2021
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: Codeine

Symptom List: Rash, Urticaria

Symptoms: The patient started to have trouble with his vision after the Covid vaccine. It became worse after the second Covid vaccine. That lot number was EW0158.

Other Meds: tiZANidine (ZANAFLEX) 4 MG tablet TAKE 1 TABLET BY MOUTH EVERY 8 HOURS AS NEEDED FOR MUSCLE PAIN/SPASM gabapentin (NEURONTIN) 300 MG capsule TAKE 1 CAPSULE BY MOUTH THREE TIMES DAILY fluticasone (FLONASE) 50 MCG/ACT nasal spray Spray 2 sp

Current Illness: NA

ID: 1296559
Sex: M
Age: 52
State: NY

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/07/2021
Hospital:

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

Lab Data:

Allergies: fentanyl=anaphylaxis, fish products=anaphylaxis, shellfish products= anaphylaxis hydromophone=confusion/hallucinations prochloperazine=seizures bactrim DS hives codeine= rash insect venom=rash,swelling morphine=palpitations

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

Symptoms: Pt was administered second dose of pfizer after assessment by PA. Pt reported that he felt "hot" within min of administration. Vs stable and pt skin was warm and dry. Pt tolerated po water w/o difficulty. Pt bp and pulse monitored after 30 min watch over at 1335 as pt aroused and still c/o feeling warm. Sandwich and juice offered and refused, cold pack offered and pt placed behind his head. Pt then noted to sleep with easy rr, skin remained warm and dry, no c/o nausea, no redness, itching or hives noted. After 1 hr watch, 1405, pt aroused and was ambulated in the hall with continuous pulse ox which remained above 93% on ra with ambulation 40 feet. Pt c/o "not feeling well', c/o still feeling hot and has a cough that leads to sob. Pt noted to have slight audible wheezing as reported by PA. O2 sats at this time are still maintained above 93% which is pt baseline. Pt was slightly unsteady on his feet while ambulating. Pt to take rescue inhaler but did not bring it with him. Medical response called and pt taken to ED across the hall via WC with this writer. Report given to RN in ED. 1310 152/87 93% 18 1344 147/87 69 96% 97.9 18 1354 130/87 77 94% 18 1404 89 95% 20

Other Meds: Medication List As of 5/7/2021 1:06 PM albuterol sulfate 2.5 mg /3 mL (0.083 %) solution for nebulization, Inhale contents of 1 vial via nebulizer every 4-6 hours as needed. 2.5 mg /3 mL (0.083 %) solution for nebulization, Inhale the

Current Illness: copd,ptsd, severe asthma, chronic pain rt shoulder, rt knee, chronic sinusitis hypersomnolence

ID: 1296560
Sex: M
Age: 22
State: CA

Vax Date: 05/06/2021
Onset Date: 05/06/2021
Rec V Date: 05/07/2021
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: N/A

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

Symptoms: On Thursday, 5/6/21, patient was to receive his second dose of Pfizer COVID vaccine (LOT #: EW0167, exp: 8/2021) at approximately 11:00 am. RN administered patient's second dose in his left deltoid. Client was observed in the Observation Area for 15 minutes with no adverse effects and left vaccination site with a steady gait at approximately 10:50am. RN finished administering his 6 doses around 11:45am and returned his Pod Participant Form for "Vial 24." RN 2 noticed a duplication in vial number 24 Pod forms. Upon further assessment, RN 3 recognized that she had reconstituted the same Pfizer vial, vial 24, twice with 1.8ml of Normal Saline. Issue was elevated immediately to Clinical Lead who advised to call client back to receive the proper full dose. Patient was called at 1:20 pm. RN 2 apologized and explained to client what happened. Patient was understanding and verbalized agreement to come back at 2:15 pm. Patient received his second dose of Pfizer COVID vaccine (LOT #: EW0179, exp: 8/2021) on opposite arm ( Right deltoid) at 2:27 pm. Patient denied history of severe allergic reactions. Patient was observed in Observation Area for 30 minutes. Patient was educated by RN 4 on signs and symptoms of adverse reactions and when to go to the ED/call MD. Patient was also encouraged to sign-up on v-safe. Patient left vaccination site with a steady gait at approximately 3:00 pm.

Other Meds: N/A

Current Illness: N/A

ID: 1296561
Sex: M
Age: 45
State: NY

Vax Date: 04/07/2021
Onset Date: 04/26/2021
Rec V Date: 05/07/2021
Hospital: Y

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

Lab Data:

Allergies: none

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

Symptoms: Presents with cardiomyopathy, eosinophilia --cardiac bx done pt is postive for eosinophilia. MRI suggest acute cardiac inflammation with possibility of apical clot and endomyocardial biopsy suggestive of acute eosionophilic myocarditis. Smear for parasites negative. quantaferon gold negative. Currently in the CICU unit

Other Meds: None

Current Illness: HTN

ID: 1296562
Sex: F
Age: 46
State: UT

Vax Date: 03/06/2021
Onset Date: 03/25/2021
Rec V Date: 05/07/2021
Hospital:

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

Lab Data:

Allergies: NONE

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

Symptoms: SEVERE NOSEBLEEDS THAT REQUIRE MEDICAL ATTENTION

Other Meds: SERTRALINE HCL 100 MG, HYDROCHLOROTHIAZIDE 25 MG, OLMESARTAN MEDOXOMIL 20 MG, TRAZADONE HCL 50 MG, TYLENOL 800 MG, CALCIUM 1200 MG

Current Illness: NONE

ID: 1296563
Sex: F
Age: 55
State: CA

Vax Date: 04/30/2021
Onset Date: 04/30/2021
Rec V Date: 05/07/2021
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: Clarithromycin, Nsaids

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

Symptoms: 55 year old female who has completed a 30-minute observation period with the following signs and symptoms of an adverse reaction: other - reports dizziness,facial tingling,ha,throat tightness, rapid respiration. Pfizer-BioNTech COVID-19 vaccine # 1 in series administered. o Action(s) taken: Epinephrine administered AT 1304, transferred to higher level of care o Allergy to COVID-19 vaccine documented in Aller

Other Meds:

Current Illness:

ID: 1296564
Sex: F
Age: 55
State:

Vax Date: 05/04/2021
Onset Date: 05/06/2021
Rec V Date: 05/07/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient received the vaccine on Tuesday 5/4/21. On Thursday evening 5/6/21 she noticed redness at the injection site. It was mildly warm, red and slightly itchy. Went to see her physician the next day, he circled the red area. It was about 4 inches in diameter. She took benadryl and ibuprofen. No signs up systemic reaction.

Other Meds:

Current Illness:

ID: 1296565
Sex: M
Age: 17
State:

Vax Date: 05/01/2021
Onset Date: 05/01/2021
Rec V Date: 05/07/2021
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: Moderna covid-19 vaccine was administered to a patient aged 17, under the approved age of 18. This was done due to misrepresentation of the birthday by the patient. No adverse event occurred besides off-label use of the vaccine.

Other Meds:

Current Illness:

ID: 1296566
Sex: F
Age: 60
State: SC

Vax Date: 04/07/2021
Onset Date: 04/19/2021
Rec V Date: 05/07/2021
Hospital:

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

Lab Data:

Allergies: Tramadol

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

Symptoms: Symptoms started on 4/19 which was burning pain in my right outer hip radiating down my leg and also into my groin. Pain was significant and Advil didn't help. Saw rash on my right buttock on morning of 4/22 and got diagnosed with Shingles at my doctor's office that same day. Was prescribed Acyclovir antiviral and Gabapentin for pain. Took the antiviral the prescribed 7 days. Have been on Gabapentin since. Amitriptyline was added recently because the pain continues to not be under control and sleeping is a challenge. It has been 19 days approximately since symptoms began and 17 days since diagnosis. I don't know the outcome yet since I still have somewhat of a rash left. The rash was large and and extended from the top of my tailbone down and out toward my hip down into the top of my thigh. The antiviral helped in that blisters never really formed, although I do have the burning pain and itching on the rash and also in the nerve following all through the route down into my foot and groin.

Other Meds: Aciphex, Vitamin D

Current Illness: Had two separate bouts of diarrhea earlier in the month. Had reaction to possibly contaminated food which resulted in a very brief 2 day illness, but diarrhea lasted longer due to IBS-D. Symptoms were very mild, no fever, no cramping, just the diarrhea. I also had sciatic about a week before the second vaccination and took Advil for a couple of days.

ID: 1296567
Sex: F
Age: 44
State: CA

Vax Date: 05/03/2021
Onset Date: 05/04/2021
Rec V Date: 05/07/2021
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: Amoxicillin, bactrim

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

Symptoms: Tender, sore, swelling, erythema and pruritis of skin surrounding injection site. Improving

Other Meds:

Current Illness:

ID: 1296568
Sex: M
Age: 65
State: TX

Vax Date: 04/14/2021
Onset Date: 04/30/2021
Rec V Date: 05/07/2021
Hospital:

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

Lab Data:

Allergies: Flomax

Symptom List: Unevaluable event

Symptoms: Symptom #1: sixteen days after receiving second dose I developed a sinus infection. Had not had a sinus infection in 15 years. Dr gave me Z-Pack and prednisone steroid. Still no relief 7 days later. Symptom #2: also around 16 days after my second dose my tinnitus started getting louder with more shrill variations to the typical cricket chirp type of sounds I have heard for about the last 5 years. Never any relief from these sounds!

Other Meds: Rosuvastatin, lisinipril, metroprolol, zetia, turmeric, omega 3, lipo flavonoid, coqu 10.

Current Illness: None

ID: 1296569
Sex: F
Age: 64
State:

Vax Date: 04/22/2021
Onset Date: 04/23/2021
Rec V Date: 05/07/2021
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: none

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

Symptoms: On 4/23 I had a fever and body aches as predicted. On 4/24 I still had a fever and my left ear had swollen, was painful and red. My nearby lymph nodes were also swollen and painful On 4/25 I still had the same symptoms and I went to urgent care. The doctors there told me to head to the emergency room where I was finally diagnosed with chondritis of the ear. I was given antibiotics and sent home. Finally, after 48 hours on the antibiotics, my symptoms began to subside and I became better.

Other Meds: weekly fosamax; daily Vitamin D, calcium, magnesium, Vitamin B-12

Current Illness: none

ID: 1296570
Sex: F
Age: 37
State: NY

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/07/2021
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: sevoflurane, succinylcholine

Symptom List: Injection site pain, Pain

Symptoms: Given second dose too soon

Other Meds: n/a

Current Illness: primary neoplasm of malignant breast

ID: 1296571
Sex: M
Age: 65
State: CA

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/07/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Injection site pain, Menorrhagia

Symptoms: "Moderna COVID-19 Vaccine EUA", Syncope

Other Meds: Atorvastatin

Current Illness:

ID: 1296572
Sex: F
Age: 70
State: TN

Vax Date: 02/05/2021
Onset Date: 02/06/2021
Rec V Date: 05/07/2021
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: Codeine, Oxycodone, Hydrocodone, Paxil, Celexa, Vesicare, Tramadol

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

Symptoms: Right swollen Lymph node and right submandibular salivary gland swelling and lump (still with possible near future surgery) , swollen tongue(2 days) fatigue (2 days) arm pain at shot site (2 days), fast heartbeat (2 days)

Other Meds: Levothyroxine 75mcg, Nexium 20mg,Restatis eye drop, Align probiotic, Centrum multivitamin for over 50yrs women,,Calcium 1300mg,, Magnesium 400 mg, Omega 3 EPA 1775mg, Omega3 DHA 900mg, Cu, Mn, Zn all trace, Vitamin D3 4000iu

Current Illness: none

ID: 1296573
Sex: F
Age: 89
State: CA

Vax Date: 05/06/2021
Onset Date: 05/07/2021
Rec V Date: 05/07/2021
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 and Erythromycin

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Dizziness, congestion.

Other Meds: Vitamin D, Emergen-C

Current Illness: None.

ID: 1296575
Sex: F
Age: 54
State: IN

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 05/07/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Mild Itching of fingers and injection site 10 minutes after injection. Moderate itching of hands, feet, and neck area. throughout rest of evening. 3AM no more itching, nausea, felt feverish, ( highest temp 99.9) arm very sore took Tylenol every 4 hours. Thurs AM, hot and cold chills throughout the day, entire arm very sore, hands and feet red, hot, swollen, arthritis very painful, Tylenol helpful. Slept most of day and night, felt like I had not slept in days. Friday symptoms persist but beginning to subside.. as of 5:18 PM symptoms light and tolerable. Swelling in hands and feet almost normal, not as tired, body temp fine, only very slight headache occuring.

Other Meds:

Current Illness: Rheumatoid and Osteoarthritis

ID: 1296576
Sex: F
Age: 39
State: IN

Vax Date: 05/06/2021
Onset Date: 05/06/2021
Rec V Date: 05/07/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Severe chills, headache, muscle/body aches, low grade fever, fatigue

Other Meds:

Current Illness:

ID: 1296577
Sex: F
Age:
State: LA

Vax Date:
Onset Date:
Rec V Date: 05/07/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Nausea

Symptoms: Client received two doses of Janssen vaccine. First dose received 03/29/21 and second dose received 05/07/21. No side effects reported.

Other Meds: none

Current Illness: none

ID: 1296578
Sex: F
Age: 37
State: WA

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/07/2021
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: Injection site pain

Symptoms: After about five minutes patient became pale and diaphoretic. Lasted about 20 minutes then patient left after signing an AMA. Patient with mother.

Other Meds: Prescriptions: Wellbutrin; Zoloft

Current Illness: N/A

ID: 1296579
Sex: M
Age: 37
State: TN

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/07/2021
Hospital:

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

Lab Data:

Allergies: no known

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

Symptoms: patient was sweating profusely, stated he was very dizzy and his heart felt funny. Provided patient with a cold, wet paper towel, checked blood pressure at 11:10 was 127/86 and pulse was 91. Provided patient with cold water to drink. Re checked blood pressure at 11:40 am 111/77 and pulse was 74. Patient stayed for almost one hour before he felt well enough to drive. I called the patient to check on him at 1:05 pm and he stated he was feeling ok but his arm was sore. I recommended he apply ice to the sore arm.

Other Meds: unknown

Current Illness: no known

ID: 1296580
Sex: F
Age: 38
State: TN

Vax Date: 04/29/2021
Onset Date: 05/02/2021
Rec V Date: 05/07/2021
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: Amoxil

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

Symptoms: My arm has a swollen, hard lump above the injection site. The surface of my skin has broken out in small white itchy bumps. Also, my injection site is not healing. It keeps scabbing over and if I scratch the scab it bleeds.

Other Meds: Woman's daily multiple vitamin, vitamin C 1000mg

Current Illness: No

ID: 1296581
Sex: F
Age: 40
State: PA

Vax Date: 04/29/2021
Onset Date: 05/06/2021
Rec V Date: 05/07/2021
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: Amoxicillin/penicillin

Symptom List: Tremor

Symptoms: Itchiness, red bumps, warm, sore

Other Meds: Synthroid (75mcg), citalopram (10mg), Wellbutrin (300mg)

Current Illness: None

ID: 1296582
Sex: M
Age: 84
State: FL

Vax Date: 04/06/2021
Onset Date: 04/13/2021
Rec V Date: 05/07/2021
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 known allergies

Symptom List: Erythema, Pruritus

Symptoms: Tired the day after shot, then a week or so later, began c/o mild nausea and mild headache .. comes and goes ... Off and on until this past week when he really hasnt felt like doing anything, legs feel week, short of breath more than usual and BP is sometimes LOW for him ...104 / 60 with lower pulse at 45 or 50 instead of his consistent 66. Also , has had intermittent dizzy, foggy head or wobbly legs.

Other Meds: Atenolol 50mg, clopedrigrel 75mg,,,atorvastatin 40 mg...Tamsulosin .4mg.,,,Amlodipine 10mg...avodart.5...quinipril 40 mg...myrbetriq 50mg...D3 5000...ASA 81mg...cardura 2 mg... Pletal50mg...Breo inhaler

Current Illness: None

ID: 1296583
Sex: M
Age: 75
State: NJ

Vax Date: 02/22/2021
Onset Date: 03/01/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data:

Allergies: None, Slight pollen allergy

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

Symptoms: Tinnitus in right ear. About 10 weeks and is currently subsiding.

Other Meds: Metoprol 75 mg, Telmisartan 80 mg, Montleukast 10 mg, Isosorbide 120 mg, Vit D3 4000 mcg, Vit B12 50 mcg. Metamucil 3 teaspons

Current Illness: None

ID: 1296584
Sex: F
Age: 59
State: MO

Vax Date: 04/12/2021
Onset Date: 04/12/2021
Rec V Date: 05/07/2021
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: none

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

Symptoms: Patient had a seizure about 5 minutes after vaccination was administered. Patient has a history of seizure according to the husband. We were not sure if the seizure started because of the vaccine or because of nervousness before getting the vaccination.

Other Meds: aripiprazole, celecoxib, escitalopram, gabapentin, jardiance, quetiapine, pravastatin, zolpidem

Current Illness: none

ID: 1296585
Sex: M
Age: 57
State: CA

Vax Date: 04/16/2021
Onset Date: 04/19/2021
Rec V Date: 05/07/2021
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: NKA

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: initially, headache, cough, and congestion with shortness of breath. Significant shortness of breath persists

Other Meds: amlodipidine, lisinopril, HCTZ, anaprozole, buproprion, clomid, gabapentin, omeprazole

Current Illness: No acute illness at time of vaccination

ID: 1296586
Sex: F
Age: 54
State: NE

Vax Date: 04/17/2021
Onset Date: 04/18/2021
Rec V Date: 05/07/2021
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: Penicillin Coedeine

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

Symptoms: My arm became swollen and hard. Redness and stinging for 4 days

Other Meds: Lexapro black cohosh

Current Illness: None

ID: 1296587
Sex: F
Age: 45
State: TX

Vax Date: 01/01/2021
Onset Date: 04/06/2021
Rec V Date: 05/07/2021
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: none

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

Symptoms: this patient received both vaccine shots 1-21-21 and 2-11-21. She then went on to become covid pos on 4-6-21

Other Meds: LEVOTHYROXINE

Current Illness: hypothyroid

ID: 1296588
Sex: F
Age: 49
State: CA

Vax Date: 05/06/2021
Onset Date: 05/06/2021
Rec V Date: 05/07/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Pain in extremity

Symptoms: On Thursday, 5/6/21, client was to receive her second dose of Pfizer COVID vaccine at approximately 11:40am. RN administered client's second dose in her left deltoid. Client was observed in the Observation Area for 15 minutes with no adverse effects and left vaccination site with a steady gait at approximately 11:10am. RN finished administering his 6 doses around 11:45am and returned his Pod." Other RN noticed a duplication in vial number. Upon further assessment, Other RN recognized that she had reconstituted the same Pfizer vial, twice with 1.8ml of Normal Saline. Issue was elevated immediately to Clinical Lead who advised to call client back to receive the proper full dose. Client was called at 1:20pm. Other RN apologized and explained to client what happened. Client was understanding and verbalized agreement to come back the next day. Client received her second dose of Pfizer COVID vaccine on opposite arm at 11:26am. Client denied history of severe allergic reactions. Client was observed in Observation Area for 30 minutes. Client was educated by another RN on signs and symptoms of adverse reactions and when to go to the ED/call MD. Client was also encouraged to sign-up. Client left vaccination site with a steady gait at approximately 12:06pm.

Other Meds: N/A

Current Illness: N/A

ID: 1296589
Sex: F
Age: 72
State: MS

Vax Date: 03/30/2021
Onset Date: 04/18/2021
Rec V Date: 05/07/2021
Hospital: Y

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

Lab Data:

Allergies: None

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

Symptoms: 72 y.o. female with head and neck squamous cell carcinoma admitted to the hospital for left-sided weakness LDL 132 Potassium 3.1 MRI brain showed acute to subacute right parietal and right frontal lobe infarct. CTA head and neck showed no significant stenosis HbA1c 5.2

Other Meds: Acetaminophen (TYLENOL PO) albuterol (PROVENTIL HFA;VENTOLIN HFA) 108 (90 Base) MCG/ACT inhaler baclofen (LIORESAL) 20 MG tablet cloNIDine (CATAPRES) 0.1 MG tablet FLUoxetine (PROZAC) 20 MG capsule FLUoxetine (PROZAC) 40 MG capsule HYDROcod

Current Illness: Esophageal varices (HCC Code) Cancer of head and neck (HCC Code) Acute CVA (cerebrovascular accident) (HCC Code) CVA (cerebrovascular accident) (HCC Code) CVA (cerebral vascular accident) (HCC Code)

ID: 1296590
Sex: F
Age: 36
State: CA

Vax Date: 02/07/2021
Onset Date: 02/08/2021
Rec V Date: 05/07/2021
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: NKDA

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

Symptoms: ALL LABS PRIOR TO 2/7/2021 WERE NORMAL 2/7/2021 2nd Pfizer shot 2/8/2021-2/10/2021 Flu-like symptoms: fatigue, headache, injection sight pain 2/11/2021-2/25/2021 Fatigue, sore throat, nausea 2/25/2021 Dr. Apt 2/25/2021- Epstein Barr Virus Antibody Panel- NEGATIVE 2/25/2021 Symptoms remain 3/5/2021 Dr. Apt 3/12/2021 Dr. Apt with labs: WBC, CBC, Glucose, creatine, BUN, bicarbonate, chloride, potassium, sodium NORMAL 3/12/2021 TSH standard range 0.4-4.2 my value 4.8 (ELEVATED) Free T4 NORMAL THYROGLOBULIN ab 0.0-4.0 MY VALUE 11.1 TPO AB- POSITIVE 3/25/21 symptoms: sore throat with white spots on tonsils, fatigue 3/26/21 Dr. Visit Diagnosis Hashimoto Thyroiditis-- started Levothyroxine 50 MCG 4/7/2021 SYMPTOMS: Chest pain, sore throat, fatigue 4/9/2021 Dr. appt 4/14/2021 Dr. Visit with endocrinology 4/21/2021 Dr. visit regular PCP to request labs 4/21/2021 ENT appt visit 4/15/2021 Ultrasound on thyroid (NORMAL) 4/15/21 TSH NORMAL am cortisol, urinalysis, c-reaction protein, amylase, total bilirubin, lipase, alkaline phosphate, AST, ALT NORMAL 4/22/2021 Chest x-ray NORMAL 4/22/2021 EKG 12 or more leads W INT and RPT (bradycardia) 5/6/2021 Ten pass Ozone treatment. Symptoms remain: CHEST PAIN, SORE THROAT, FATIGUE

Other Meds: Prior to 2/7/2021 Triamcinolone acetonide PRN

Current Illness: None

ID: 1296591
Sex: F
Age: 42
State: WA

Vax Date: 04/27/2021
Onset Date: 04/29/2021
Rec V Date: 05/07/2021
Hospital: Y

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

Lab Data:

Allergies: Clindamycin, Metronidazole, Hydrocodone, Sulfa Antibiotics, Trimethoprim

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

Symptoms: Dull chest pain which increased with deep breath or bending over. Blood tests revealed extremely elevated Tropinin-i and CRP levels. Required hospital stay, for 2 days

Other Meds: Estarylla, Cetirizine, Multi Vitamin

Current Illness: none

ID: 1296592
Sex: F
Age:
State: LA

Vax Date:
Onset Date:
Rec V Date: 05/07/2021
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: Client received initial vaccine on 03/29/21 and a second vaccine on 05/07/21. No side effects reported.

Other Meds: PAROXETINE HCL20MG 1 TAB [PO] By Mouth MEDS - AM

Current Illness:

ID: 1296593
Sex: F
Age: 22
State: GA

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/07/2021
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: no

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient received vaccine at 12:10pm used a 23G 1" needle. Patient came over to talk after sitting for 15 minutes and stated that her injection site hurt. Injection site was checked. Patient had minor bleeding and reported having ibuprofen Wednesday. Band-aid was changed and bleeding had stopped. Patient called back around 5pm and stated that her arm was numb. Recommended patient follow up with her PCP or reach out to urgent care.

Other Meds: no

Current Illness: COVID tested positive on 04/08/2021

ID: 1296594
Sex: M
Age: 46
State: DC

Vax Date: 04/13/2021
Onset Date: 04/13/2021
Rec V Date: 05/07/2021
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: No

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

Symptoms: Within seconds of my first vaccine I had a massive headache. 20 mins later I had brain fog. An hour later I had exhaustion and then injection site arm began hurting. This lasted for 48 hours and then I was fine. It came on fast and stayed. I had difficult time thinking or retaining a memory. Second shot had no instant reaction, injection site just slowly began hurting. An hour later, and very suddenly, brain fog hit me and i lost all short term memory, mid sentence. Similar to what I would consider a form of Alzheimer?s. At the same time I developed a headache, not as severe as the first shot, but I was more exhausted than the first shot. Forming sentences, being able to think was very difficult for 72 hours. I was exhausted, arm hurt. After the 72 hours, I lost my sense to smell. I am in my 96 hour since my second injection and still have no sense of smell. I can taste. Never had a fever but for both shots it felt like it was absorbed by my muscles and was then converted to something else which was then released back into my system. It was like I had sore muscles it was like my muscles became the poison. This effect was grossly more profound after the second vaccine. The ability to think was the scariest side effect.

Other Meds: Descovy, Urogenic Blue

Current Illness: No

ID: 1296595
Sex: M
Age: 67
State: CA

Vax Date: 02/28/2021
Onset Date: 03/14/2021
Rec V Date: 05/07/2021
Hospital: Y

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

Lab Data:

Allergies: no

Symptom List: Injection site swelling, Limb discomfort

Symptoms: starting March14 patient experienced occasional headaches eventually experienced loss of balance by week of Apr 12 Apr 16 admitted to ER with subdural hematoma

Other Meds: lexapro asa plavix vit D atrovastin

Current Illness: no

ID: 1296596
Sex: M
Age: 49
State: CA

Vax Date: 05/06/2021
Onset Date: 05/06/2021
Rec V Date: 05/07/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: body and joint aches all over body. pain/swelling/hardness in left shoulder (continues into next day--injection site). cold hands and feet, chills, low-grade fever of 100.4., headache, sinus pressure, diarrhea. thirsty.

Other Meds: none

Current Illness: none

ID: 1296597
Sex: M
Age: 32
State: MT

Vax Date: 04/08/2021
Onset Date: 04/12/2021
Rec V Date: 05/07/2021
Hospital: Y

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

Lab Data:

Allergies: NKDA

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

Symptoms: Healthy 32 yo male with no reported PMH who received 1st dose of the Moderna Covid 19 vaccine at the on 4/8/21 per his report. Patient for establish care/new patient appointment with me on 4/12/12 and found to have significant hyperglycemia (concern for DKA) with a new diagnosis of type 1 diabetes. Patient subsequently admitted to hospital for glucose management.

Other Meds: None

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm