VAERS 2021 Database www.vaers.hhs.gov

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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: 1406600
Sex: M
Age: 47
State: OK

Vax Date: 05/10/2021
Onset Date: 05/10/2021
Rec V Date: 06/17/2021
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: Pfizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1406601
Sex: F
Age: 60
State: AL

Vax Date: 04/20/2021
Onset Date: 04/01/2021
Rec V Date: 06/17/2021
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: ACE Inhibitors, Morphone

Symptom List: Anxiety, Dyspnoea

Symptoms: I have noticed some short term memory or recall issues that is noticeable by me. My family has also noticed this delay of recall.

Other Meds: Bisoprolol 10mg daily, Losartan 100mg daily, Prilosec 20mg daily, Citalopram 20mg daily, Lovaza 4gm daily. Metformin 500mg twice daily, Rybelsus 7mg daily, ASA 81mg daily, Fenofibrate 145mg daily,

Current Illness: Covid-19

ID: 1406602
Sex: M
Age: 47
State: OK

Vax Date: 05/03/2021
Onset Date: 05/03/2021
Rec V Date: 06/17/2021
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:

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

Symptoms: Pfizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid,client contact and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1406603
Sex: F
Age: 43
State: CT

Vax Date: 04/27/2021
Onset Date: 04/28/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: adhesive

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: I had soreness in my left arm I was not concerned about it. Within 24hrs the headaches became more intense. From that pint forward I have had a headache everyday. I have had double vision, blurred vision, dizziness and watery eyes. Depending on what side it is on, my pupil will be dilated on that side. The pain is so bad that I sometimes just want to lock myself in a dark room. I have went to multiple doctors. Bloodwork showed elevated ALT, but nothing was done. MRI of brain was done and showed some inflammation. About 2 weeks ago, I was diagnosed with cluster headaches and CNS lupus. I already have lupus so I am aware the vaccine did not directly cause this. I have started on anti seizure meds which has calmed things down a bit. The headaches are still around but not as debilitating as they were. After the vaccine, I did experience some joint pain and selling but they were not the biggest concern. I will be seeing the neurologist on Tuesday 6/22, I will be doing bloodwork. I was tested for antibodies but I have absolutely no antibodies. I was tested with my fianc? who received the vaccine on the same day. He was off the charts with antibodies. There has been some talk of receiving another shot but because of my reaction, I am not sure where we will go from here.

Other Meds: Yes, benlysta, acthar, levothyroxine, Plaquenil, folic acid, gabapentin, tramadol

Current Illness: Systemic lupus

ID: 1406604
Sex: F
Age: 60
State: OR

Vax Date: 04/12/2021
Onset Date: 04/12/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: Sulfa Clindamycin Dilaudid Morphine

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

Symptoms: Fever12 hrs Fatigue 12 hrs Swollen Breast Glands left side on going

Other Meds: Vit D Calcium

Current Illness: N/A

ID: 1406605
Sex: F
Age: 30
State: OK

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 06/17/2021
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: Pfizer vaccine administered after being stored at a regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1406606
Sex: M
Age: 66
State: OK

Vax Date: 05/04/2021
Onset Date: 05/04/2021
Rec V Date: 06/17/2021
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: Pfizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1406607
Sex: M
Age: 18
State: AR

Vax Date: 06/09/2021
Onset Date: 06/11/2021
Rec V Date: 06/17/2021
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: Pharyngeal swelling

Symptoms: Pt presented to clinic on 06/15/2021 c/o chest pain, Ha, sore throat starting two days after receiving second dose Pfizer COVID19 vaccine. Chest Xray normal. Labs: Sed Rate, Troponin, C-Ractive Protein, CBC, CMP. EKG, two leads with elevated T. Awaiting Troponin.

Other Meds:

Current Illness:

ID: 1406608
Sex: F
Age: 45
State: OK

Vax Date: 05/03/2021
Onset Date: 05/03/2021
Rec V Date: 06/17/2021
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: Pfizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid,client contact and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1406609
Sex: F
Age: 48
State: VA

Vax Date: 03/29/2021
Onset Date: 03/30/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Ever since I got the vaccine I have felt like I'm going to jump out of my skin. My anxiety level is very high and at times it is debilitating. I also had a debilitating headache for 3 weeks and the inflammation in my body was astronomical. I'm still suffering from inflammation and quite uncomfortable at times. I had an irregular heartbeat for several weeks. Also the vaccine brought me out of menopause. I had my period every two weeks (3 times). And now my periods are back and longer than they were before. My asthma is at its worst because of the inflammation. I am uncomfortable on a daily basis because of the anxiety that has come with this shot that will not go away. It is a daily occurrence.

Other Meds: Montelukast

Current Illness: N/A

ID: 1406610
Sex: M
Age: 68
State: MA

Vax Date: 03/05/2021
Onset Date: 03/16/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: None known

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

Symptoms: 11 days after first vaccination, in left arm I noticed lymph node swelling in left neck between ear and clavicle. Consulted Dr. He recommended getting next vaccination in right arm. Did so, and noticed no change in left neck and no swelling in right neck. Dr. arranged for ultrasound exam of neck. Findings suspicious of malignancy led to CAT scan with contrast, fine needle biopsy, and PET scan . All indicated likely malignancy and a potentially primary tumor on the left tonsil. Excisional biopsy of tonsil confirmed HPV-mediated Squamous cell carcinoma. Seven weeks of cis-platin chemotherapy and radiation were implemented starting May 18 and planned to continue until July 7, 2021.

Other Meds: Topical triamcinolone, topical Elidel, topical clindamycin, aspirin, multivitamin, Vitamin D, fish oil, magnesium, Chondroitin/Glucosamine, occasional sildenafil,

Current Illness: None

ID: 1406611
Sex: M
Age: 46
State: MI

Vax Date: 03/20/2021
Onset Date: 03/27/2021
Rec V Date: 06/17/2021
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:

Symptom List: Rash, Urticaria

Symptoms: Some chests pain. I had a headache. I went doctor, thought it was a chest inflammation. He did an EKG that came back negative. He did some muscle movements in chest. He also stated if I had any tingling in my arm to get to the ER. He also did some blood work. He did give me a presentation to take.

Other Meds: Atorvastatin 50mg, 1xday Align 1xday Fiber 7.5g 1xday

Current Illness:

ID: 1406612
Sex: F
Age: 59
State: AL

Vax Date: 05/28/2021
Onset Date: 05/30/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: penicillin, Suprax antibiotic

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

Symptoms: Vaccine was administered at 4PM on a Friday afternoon. The next day, Saturday night, I woke up with my heart in A-fib. 180 bpm. I awoke frightened with tight chest, and thought I was having a heart attack. Very scary. I went to the E.R. and they gave me an IV drug to slow my heart down. It took several hours and they said if it didn't slow with the drug, they'd have to "shock" my heart back to a normal pace. I was terrified of that possibility. Luckily, it did slow eventually and they sent me home. I WILL NOT be taking the second shot.

Other Meds: Amlodipine, Atenolol, Metformin, Atorvastatin, Eliquis, Hydralazine, Losartan, Bupropion, Allopurinol

Current Illness: None

ID: 1406613
Sex: F
Age: 21
State: OK

Vax Date: 05/03/2021
Onset Date: 05/03/2021
Rec V Date: 06/17/2021
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:

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

Symptoms: Pfizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1406614
Sex: F
Age: 27
State: OK

Vax Date: 05/03/2021
Onset Date: 05/03/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Pfizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1406615
Sex: F
Age: 33
State: IN

Vax Date: 06/15/2021
Onset Date: 06/16/2021
Rec V Date: 06/17/2021
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: Soreness on arm, tiredness/fatigue, and a fever

Other Meds: Prenatal vitamins, magnesium, and vitamin D3

Current Illness:

ID: 1406616
Sex: M
Age: 24
State: OK

Vax Date: 05/03/2021
Onset Date: 05/03/2021
Rec V Date: 06/17/2021
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: Pfizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid,client contact and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1406617
Sex: F
Age: 22
State: OK

Vax Date: 05/03/2021
Onset Date: 05/03/2021
Rec V Date: 06/17/2021
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: Pfizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1406618
Sex: M
Age: 52
State: NC

Vax Date: 03/13/2021
Onset Date: 03/13/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: In March I had a pain in my left calf muscle that I could not identify with getting hit or injuring it in any way. I called Urgent care because i read and heard about problem with the J&J vaccine that it was giving people blood clots. Urgent care said there was no need to come in that there was very little reason to believe that it was a blood clot. Then in June I woke up to very severe pain in my left leg from my foot all the way to my thigh. It was hot, swollen and I could barely bend my knee. I went to Urgent Care and they sent me across the street to the Hospital for an ultra sound on my leg. Here are the result from the ultra sound. Real time color Doppler imaging and spectral analysis were performed during ultrasound evaluation of the left lower extremity is performed. There is persistent occlusive deep venous thrombosis within the mid to distal superficial femoral vein extending nonocclusive bleed to involve the popliteal vein and exclusively within the proximal popliteal and peroneal veins of the calf. The doctor put me on 3 week of taking a blood thinner twice a day and then will go down to taking one blood thinner once a day for 6 months. I also saw MD. Here are his notes from my Drs appt. Patient is seen today, 6/14/2021, to discuss management of left leg DVT. Patient presented to urgent care on 5/20/2021. He had noticed soreness in his left leg for a couple of days and then he awoke that day and the leg was swollen. The duplex scan showed that he had occlusive clot involving left superficial femoral vein extending through popliteal vein down to peroneal vein in the left calf. He was started on rivaroxaban 15 mg twice daily. He transitions to 20 mg rivaroxaban daily tomorrow. The leg soreness has eased slightly but the swelling has not improved. He did have a repeat duplex scan on 6/7/2021 which was unchanged. Thrombus persisted but was not worse. He has not had chest pain or breathing issues or dyspnea. He does recall that about 4 weeks earlier he had a muscle spasm sensation in the left calf. He had received a Johnson & Johnson Covid immunization in late February, 2021. He was aware of the public information about venous clotting in women who had received the J&J vaccine and was also aware that it involved cerebral veins. He called his provider and was asked questions about the leg and otherwise the answers were negative. So imaging was not obtained. The muscle spasm sensation did not recur. His family history is negative for clots in his personal history for clots is otherwise negative. He is a maintenance manager. He has not had lengthy travel recently. He also denies any trauma to the legs. He has a history of GERD from which she had developed iron deficiency anemia in June 2020. He had undergone EGD has a result. He also had a colonoscopy when he turned 50 years of age and had polyps removed and then had repeat colonoscopy 6 months later. This evaluation occurred with Dr. of gastroenterology. His colonoscopy was on 12/20/2018. One of the polyps was a hyperplastic polyp. The second was a tubulovillous adenoma with high-grade dysplasia/intramucosal adenocarcinoma, 2 cm size. Polyps were excised. Had repeat endoscopy on 7/10/2019 he had a hyperplastic polyp in his rectum. Also he had a PSA checked in summer 2020. It was 0.5. He is a smoker only of very infrequent cigars, perhaps every 6 to 8 months. PAST MEDICAL HISTORY: GERD Sigmoid colon polyps, resected December 2018 and June 2019 Left leg DVT, May 2021 Sleep apnea Iron deficiency anemia related to gastritis. Diagnosed June 2020, treated with oral iron ADHD History of depression MEDICATIONS: has a current medication list which includes the following prescription(s): amlodipine, escitalopram, esomeprazole, multivit-iron-fa-calcium-mins, prednisone, rivaroxaban, unknown home medication, and tadalafil. ALLERGIES: Patient has no known allergies. PAST SURGICAL HISTORY: Vasectomy 2 colonoscopies, first in December 2018 and second in July 2019 EGD on 2 occasions, first in March 2019 and second in June 2020 FAMILY HISTORY: Father died age 66. He had a pacemaker and was on blood thinners Mother died of a throat cancer. She was a heavy smoker. Died at age 60 1 brother and 1 sister are healthy SOCIAL HISTORY: Smokes cigars, perhaps twice a year. Never smoked cigarettes Alcohol use maybe 4 beers on the weekend Previously married and divorced 3 children, 2 daughters and 1 son ranging in age from 17 through 21 REVIEW OF SYSTEMS: Significant for persistent soreness in his left leg albeit easing over the last 3 days and persistent swelling in his left leg including dorsum of his foot General: Denies weight loss, no issues with energy, denies night sweats HEENT: No mouth or throat soreness, no issues with hearing, no tinnitus, no issues with taste No epistaxis Resp: Denies cough, exertional dyspnea, sputum production. Heart: No palpitations, no exertional chest pain, no lightheadeness or dizziness when standing Gi: No dysphagia. No heartburn, Denies nausea or vomitting. Bowels are regular, no diarrhea or constipation. Denies melena or hematochezia GU Denies hematuria. No dysuria. No incontinuence. Skin: No rash, no petechiae, no dryness. No itching or burning. Musculoskeletal: No bone pains, no joint pains or swelling. No localized weakness Neurologic: Denies headaches, no double vision, no weakness, no change in sensation Psychiatric: Good spirits, sleeping well, no anxiety, normal mood Endocrine: Denies heat or cold intolerance. Heme: No easy bruising PHYSICAL EXAMINATION: BP (!) 142/99 | Pulse 95 | Temp 97.6 ?F (36.4 ?C) | Resp 18 | Ht 6' 3" (1.905 m) | Wt 295 lb (133.8 kg) | SpO2 96% | BMI 36.87 kg/m? Appears alert, oriented, not in distress. Well developed Psychiatric: Patient is alert oriented ?4, good spirits, interacts appropriately He has swelling in his left leg DATA: CBC: .5/20/2021: WBC 7.49 X10^3/uL; Hemoglobin 14.8 g/dL; Hematocrit (calc.) 43.4 %; Neutrophil (%) 75.4 %; MCV 98.4 fL; Platelet 141 X10^3/uL* CMP: 4/22/2021: Bicarbonate (TCO2) 25 mmol/L; BUN/Creatinine 16; Calcium, total 9.0 mg/dL; AST (SGOT) 41 IU/L*; ALT (SGPT) 38 IU/L; Alkaline Phosphatase 62 IU/L; Bilirubin, Total 0.4 mg/dL; Protein, total 6.9 g/dL; Albumin 4.3 g/dL; Albumin / Globulin 1.7 5/20/2021: Sodium 142 mEq/L; Potassium 4.6 mEq/L; Chloride 103 mEq/L; BUN 13 mg/dL; Creatinine 1.2 mg/dL; Glucose 110 mg/dL*; Calcium, Ionized 1.17 mmol/L ASSESSMENT: 1. Left lower extremity DVT. Etiology unclear. No definite provocation. He did receive a Johnson & Johnson Covid vaccine in late February, 2021. He first noticed a muscle spasm sensation in left calf in mid April, 2021 and then had onset of soreness 2 days before his visit with swelling onset the day of his urgent care visit, 5/20/2021. Currently on rivaroxaban. Transitioning now to the 20 mg daily dose. Family history negative for DVT as is his personal history. PSA was unremarkable and summer 2020. Has had prior colonoscopy in December 2018 and June 2019. Did have finding of sigmoid colon polyps with atypia in 1 and possible noninvasive adenocarcinoma. Repeat scope showed hyperplastic polyp but no additional polyps. Has also had EGDs in March 2019 and June 2020 because of GERD and iron lack anemia. Non-smoker. I discussed with patient that we would usually treat him for 6 months with anticoagulation and then reassess to determine whether it is safe to discontinue therapy. But if he has ongoing swelling and soreness in his leg it would be difficult to stop treatment because we would lose one of our early indicators of recurrence of DVT. I also suggested that we should do a lab panel to assure that he does not have any underlying inherited or acquired abnormality that predispose to this clot, since we do not have any clear-cut causative etiology. (We discussed that the Covid immunization may have been his predisposition, but that existing data suggest that this is a risk factor in females and that most of the episodes were central nervous system venous clots.) PLAN: 1. So we will draw lab

Other Meds: LEXAPRO 10MG, rivaroxaban 20 mg Tab, esomeprazole 40 mg, tadalafiL 10 mg Tab, c-pap, amLODIPine 5 mg Tab

Current Illness: None

ID: 1406619
Sex: M
Age: 46
State:

Vax Date: 06/10/2021
Onset Date: 06/10/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Dose was administered outside of the recommended time window after first vial puncture.

Other Meds:

Current Illness:

ID: 1406620
Sex: F
Age: 25
State: OK

Vax Date: 05/03/2021
Onset Date: 05/03/2021
Rec V Date: 06/17/2021
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:

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

Symptoms: Pfizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid,client contact and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1406621
Sex: F
Age: 50
State: OK

Vax Date: 05/12/2021
Onset Date: 05/12/2021
Rec V Date: 06/17/2021
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: Unevaluable event

Symptoms: Pfizer vaccine administered after being stored at a regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1406622
Sex: F
Age: 22
State: WI

Vax Date: 06/15/2021
Onset Date: 06/15/2021
Rec V Date: 06/17/2021
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: After receiving the first COVID vaccine, patient reported being extremely dizzy and lightheaded. The patient was given orange juice from her boyfriend and stated she began to feel better. After an additional 5 minutes patient began to lay down on chair reporting feeling extremely dizzy again. The store manager, called 911. Patient was examined but did not go with EMT. She left the store with her boyfriend. Patient did report to the EMTs a history of anxiety and also reported that she was nervous to get the shot.

Other Meds: No prescriptions - OTC/dietary unknown

Current Illness: Patient reported to EMTs she had a history of anxiety and reported being nervous to get the shot.

ID: 1406623
Sex: F
Age: 27
State: OK

Vax Date: 05/03/2021
Onset Date: 05/03/2021
Rec V Date: 06/17/2021
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:

Symptom List: Injection site pain, Pain

Symptoms: Pfizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1406624
Sex: M
Age: 26
State: OK

Vax Date: 05/10/2021
Onset Date: 05/10/2021
Rec V Date: 06/17/2021
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: Pfizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid,client contact and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1406625
Sex: F
Age: 25
State: IL

Vax Date: 05/26/2021
Onset Date: 05/26/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Client states that as the day progressed after her vaccination, she began to swell...hands, face, legs. States "I looked like I had gained 30 lb. " She called and notified her MD and was advised to not take anymore COVID vaccine. She was not seen by a MD for evaluation. States swelling resolved by evening of 5/27/2021 and has had no more problems.

Other Meds: None

Current Illness: None

ID: 1406626
Sex: M
Age: 13
State: MI

Vax Date: 06/16/2021
Onset Date: 06/17/2021
Rec V Date: 06/17/2021
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: Nausea, Pain in extremity, Pyrexia

Symptoms: Pain under arm, armpit area (possible lymph nodes), with no swelling

Other Meds: none

Current Illness: none

ID: 1406627
Sex: F
Age: 29
State: OK

Vax Date: 05/03/2021
Onset Date: 05/03/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Pfizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1406628
Sex: F
Age: 19
State: OK

Vax Date: 05/10/2021
Onset Date: 05/10/2021
Rec V Date: 06/17/2021
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: Pfizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid,client contact and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1406629
Sex: F
Age: 52
State: NC

Vax Date: 01/19/2021
Onset Date: 01/30/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: succinylcholine

Symptom List: Nausea

Symptoms: I woke up the morning of January 30, 2021 and it felt like my heart was racing. I checked my vitals with a wrist cuff BP monitor and my pulse was over 100. This lasted for several minutes before going away. I experinced the same thing at least 2 to 3 more times on separate occasions which prompted me to seek medical attention on Friday, February 5th. I scheduled a visit to see my PCP for 2/9/21 and messaged my oncologist. My oncologist ordered a STAT echocardiogram. That was not completed until after my PCP office visit. After the results of the echocardiogram were received I was referred to a cardiolgist.

Other Meds: Femara, Saxenda, phentermine, multi vitamin, vitamin d 2000 units, biotin 10,000 units, Claratin, low dose asprin, Alieve,

Current Illness: none

ID: 1406630
Sex: F
Age: 18
State: IN

Vax Date: 06/15/2021
Onset Date: 06/15/2021
Rec V Date: 06/17/2021
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: Shaking and being severely cold - June 15,2021 around 10 pm (took 2 Advil to try and relieve symptoms) Feeling very lightheaded and feeling close to passing out - June 16,2021 (took 2 Advil to help with symptoms) Left underarm lymph node beginning to swell up - June 17,2021

Other Meds: N/A

Current Illness: N/A

ID: 1406631
Sex: M
Age: 58
State: SC

Vax Date: 03/30/2021
Onset Date: 04/01/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: After 2nd. shot on Tuesday: early on Thursday morning woke up 102+ degree temp, extreme nausea, sweating, severe headache, joint stiffness and head felt like I was in a fog. Severe systems lasted for four days. Today (6/17/21) still having headaches, head fog, and severe joint stiffness in hands elbows and ankles. Taking Tylenol and Advil for relief.

Other Meds: Tylenol

Current Illness:

ID: 1406632
Sex: M
Age: 17
State:

Vax Date: 06/14/2021
Onset Date: 06/14/2021
Rec V Date: 06/17/2021
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: Dose was administered outside of the recommended time window after first vial puncture. Dose deemed Invalid.

Other Meds:

Current Illness:

ID: 1406633
Sex: M
Age: 42
State: OK

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 06/17/2021
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: Tremor

Symptoms: Pfizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1406634
Sex: F
Age: 42
State: IA

Vax Date: 03/11/2021
Onset Date: 03/11/2021
Rec V Date: 06/17/2021
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: Amoxicillin

Symptom List: Erythema, Pruritus

Symptoms: An hour or two after my first Covid-19 Pfizer vaccine, I noticed a depression/dent in my arm at the injection site. At first I thought the Band-Aid was just pulled very tight, but upon removal I realized there was a fairly large (nickel-quarter sized) dimple/depression in my arm that had not been there before. It is still there to date.

Other Meds: None

Current Illness: None

ID: 1406635
Sex: M
Age: 36
State: MO

Vax Date: 02/26/2021
Onset Date: 03/26/2021
Rec V Date: 06/17/2021
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:

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

Symptoms: The symptoms of this adverse event were noticeable tiredness and weakness continue beyond a week after the second vaccine dose. Went to primary doctor who then sent me to physical therapy. During my first visit, the physical therapist found that the was significant weakness on the left side of my body. The therapist suspects the vaccine shot temporarily enhanced a previously unknown issue enough where it became noticeable. The therapist says this 'enhancement' effect would go away in time.

Other Meds: Allegra 12-hour with Decongestion, Atorvastatin

Current Illness: None

ID: 1406636
Sex: F
Age: 63
State: ME

Vax Date: 12/21/2020
Onset Date: 05/25/2021
Rec V Date: 06/17/2021
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: pcn, dicyclomine

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

Symptoms: Had vaccine, noted regular arm soreness. 5 months later developed lump at site, arm pain awakening her at night.

Other Meds: centrum multivitamin, vitamin d

Current Illness: na

ID: 1406637
Sex: F
Age: 64
State: OK

Vax Date: 05/12/2021
Onset Date: 05/12/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Pfizer Vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid, client contacted, and recommended dose repeated.

Other Meds:

Current Illness:

ID: 1406639
Sex: F
Age: 29
State: OK

Vax Date: 05/04/2021
Onset Date: 05/04/2021
Rec V Date: 06/17/2021
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:

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

Symptoms: Pfizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid,client contact and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1406640
Sex: F
Age: 31
State: OK

Vax Date: 05/12/2021
Onset Date: 05/12/2021
Rec V Date: 06/17/2021
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:

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

Symptoms: Pfizer vaccine administered after being stored at a regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1406641
Sex: F
Age: 20
State: OK

Vax Date: 05/04/2021
Onset Date: 05/04/2021
Rec V Date: 06/17/2021
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: Pfizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1406642
Sex: F
Age: 47
State: IN

Vax Date: 06/10/2021
Onset Date: 06/10/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: Fentanyl, Methadone, Penicillin, Beef, Carrots, Chia Seeds, Dairy, Eggs, Pineapple, Strawberries, pears, Sesame Seeds, Nickel, Pollen, Cat, Dog, pollen, cockroaches, dust/dust mites, cigarette smoke,

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

Symptoms: within 10 minutes of 2nd vaccine - I got extremely dizzy and felt as I had a cloud around my head - after a little while I told nurses on duty they took me in the back and watched my vital signs until normal range. Then on Saturday morning noticed a rash/hives on neck and upper collar bone area. Sunday evening did a call to see what I could take/do for the itchiness as the antihistamine that I take daily for allergies wasn't helping at all! Suggested I add topical cortisone cream. Monday 6/14/21 contacted my allergist as now I also have the rash/hives on arm, he suggested I take an additional dose of either Claritin or Allegra to help and if have trouble breathing go to ER. Tuesday 6/15/21 evening noticed additional rash/hives on either side of hip area and stomach area. I continue to have this rash/hives - although it does seem to be going away very very slowly with the added antihistamine

Other Meds: omeprazole 40mg - daily Vitamin D3 4000 iu - daily Xyzal - daily multi-vitamin - daily elderberry syrup - daily

Current Illness: none

ID: 1406643
Sex: M
Age: 68
State: TX

Vax Date: 05/20/2021
Onset Date: 05/22/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: None known

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

Symptoms: Weakness brain fog for 2 months

Other Meds: Lysonapril 5mg

Current Illness: None

ID: 1406644
Sex: F
Age: 35
State: OK

Vax Date: 05/03/2021
Onset Date: 05/03/2021
Rec V Date: 06/17/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: Pfizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1406645
Sex: M
Age: 17
State: OK

Vax Date: 05/03/2021
Onset Date: 05/03/2021
Rec V Date: 06/17/2021
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: Pfizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid,client contact and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1406646
Sex: M
Age: 19
State: OK

Vax Date: 05/12/2021
Onset Date: 05/12/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Pfizer Vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid, client contacted, and recommended dose repeated.

Other Meds:

Current Illness:

ID: 1406647
Sex: F
Age: 16
State:

Vax Date: 06/14/2021
Onset Date: 06/14/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Dose was administered outside of the recommended time window after first vial puncture. Dose deemed Invalid.

Other Meds: ceterizine

Current Illness:

ID: 1406648
Sex: F
Age: 24
State: OK

Vax Date: 05/06/2021
Onset Date: 05/06/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Pfizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1406649
Sex: M
Age: 19
State: OK

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Pfizer vaccine administered after being stored at a regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1406650
Sex: F
Age: 63
State: OK

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 06/17/2021
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: Pfizer Vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid, client contacted, and recommended dose repeated.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm