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: 1518964
Sex: F
Age: 57
State: OK

Vax Date: 04/16/2021
Onset Date: 04/28/2021
Rec V Date: 08/01/2021
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: NKDA

Symptom List: Dysphagia, Epiglottitis

Symptoms: 12 days after receiving Moderna on 4/16/21, pt reported shortness of breath (4/28/21). She started using her nasal steroid (fluticasone) daily and started to feel a little bit better. She then developed swelling of her toes and generalized weakness necessitating a trip to urgent care on 5/21/21. She was treated with an antibiotic for UTI and gout with a prednisone taper. The prednisone helped with the swelling of her toes and feet, but when she finished the steroid course, swelling returned to her feet. She contacted my office and explained her situation. Gout was diagnosed clinically but not with any lab work up. Pain and swelling migrated from one foot to both foot and she had some neuropathic pain significantly limiting mobility. Pt was started on ibuprofen and then added Cymbalta with minimum-moderate improvement. Work up for gout, hepatitis, rheumatoid arthritis, lupus, were negative but ESR and CRP were elevated. Had to give a temporary handicap placard due to limited mobility. Started patient on methotrexate/folic acid on 6/15/21 and am titrating dosing up as needed, currently on 12.5 mg/week.

Other Meds: fluticasone prn allergic rhinitis acetaminophen prn back/knee pain

Current Illness: none

ID: 1518965
Sex: U
Age: 54
State: MD

Vax Date: 01/27/2021
Onset Date: 02/03/2021
Rec V Date: 08/01/2021
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: lactose Intolerance

Symptom List: Anxiety, Dyspnoea

Symptoms: As soon as it went in was very painful more than the first one.Over the next month I Started with Severe Left muscular shoulder/arm pain and numbnessand tingling down to my fingers when reaching stretching or laying on left side (same side as my Covid injection) Couldn't lay on that side or sleep due to pain. Pain got more severe In April lost most of my range of motion. Unable to lift my arm to the side or front, move it behind my back carry my purse, shampoo hair,house chores and of my job without difficulty and constant pain. I saw my PCP and he put me on NSAIDS for a few weeks with no relief , I returned and he did a cortisone injection again relief even after 3 weeks , he ordered an MRI and sent me to an Orthopedic Doctor. She did and Xray and another cortisone injection again no relief. She is going to send me next to physical therapy in hopes that I will get my ability to move my arm back and get some relief from the pain. She did say my arm and shoulder are small and susceptible to injection injuries.

Other Meds: none

Current Illness: none

ID: 1518966
Sex: F
Age: 41
State: NY

Vax Date: 06/02/2021
Onset Date: 07/10/2021
Rec V Date: 08/01/2021
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: Sudden paralysis of hands and arms on July 10 2021. Sudden paralysis of hands and arms on August 1 2021.

Other Meds: Hydrochlorothiazide, Amlomidpene, Klonopin.

Current Illness: Slight cold

ID: 1518967
Sex: F
Age: 12
State: IN

Vax Date: 08/01/2021
Onset Date: 08/01/2021
Rec V Date: 08/01/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: The patient's mother warned pharmacy staff that she often passes out from vaccinations. Immediately after receiving the vaccine, the patient became pale and unresponsive which lasted ~5-10 seconds. Patient then opened her eyes and said her stomach and head hurt. The patient was laid down and placed a damp towel on her head and back of neck. She drank water and had crackers. Pharmacist monitored her for responsiveness and improvement in symptoms for 25 minutes. She remained in the exam room for ~30 minutes until she felt better and was able to safely stand up.

Other Meds: None

Current Illness: N/A

ID: 1518968
Sex: F
Age: 72
State: CA

Vax Date: 02/25/2021
Onset Date: 03/05/2021
Rec V Date: 08/01/2021
Hospital:

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

Lab Data:

Allergies: Eucalyptus Lavender Chocolate

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

Symptoms: It started out with my glands in the back of my neck and around in the front of my torso being swollen up to eight weeks and in about three weeks after the shot I started having feelings like my heart was stretching

Other Meds: Hydrochlorothiazide Progesterone HRT Metformin Lunesta Gabapinton Fish oil Vitamin C Vitamin D3 Hair skin and nails multivitamin Eye vitamins CQ 10 Turmeric

Current Illness:

ID: 1518969
Sex: F
Age: 35
State: MD

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 08/01/2021
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: levofloxacin- visual disturbance

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

Symptoms: On April 6th she received the Johnson and Johnson Covid vaccination. She was asked to wait 30 minutes longer when she mentioned a past allergic reaction to Levaquin which caused visual disturbances. 2 minutes after she sat down to wait the 30 minutes she began to have what felt like an adverse reaction. The floor tiles were morphing/melting together, her heart began to race, it felt like she had a very strong palpitation that took her breath away, she felt short of breath, and she felt heat radiate from her neck to her ears. It felt as if she was going to pass out in her chair. She alerted the medic and was made to wait an additional 40 minutes in that area. A nurse monitored her and explained it was syncope and suggested she had needle phobia(she has never had a problem with needles before.) After this occurred she drove back to home very confused as to what had happened. That evening after the vaccine she had horrible leg pains and was incredibly exhausted. She went to bed early feeling achy in her joints like she had the flu setting in with some nausea. The next couple of days were very confusing and she had what felt like intense mania. Her heart rate had not returned to normal and she was beginning to take notice. Her heart just felt like it is beating "hard" like the bounding heart feeling she remembers from when she had mononucleosis. When she stood up for long periods of time she felt faint, almost immediately. On April 15th, she ended up calling 911. She thought she was having a heart attack. Her heart began to race very fast suddenly while she was rolling balls of playdough with her 3 year old son and she started noticing weakness in her arms, brain fog, heavy chest, and what felt like tightening of her heart muscles. She was having trouble catching her breath as well. When the ambulance got there they clocked her temp as 102 F. . When she arrived at Hospital they assessed her and ran an EKG which revealed at the time the heart was fine, even though it was racing very fast and feeling as though it was being over worked. They ran a chest X-ray as well, and blood work. Before any results came back they offered her an Ativan for ?panic attack?, she was at that point ready to check herself out. When she mentioned this began 2 minutes after the vaccine they pretty much looked at her as if she was being paranoid due to the fact it was the J&J vaccine. When the results came back they told her she had pneumonia and sent her on her way with a Z-Pack. She left that afternoon still feeling very sick and confused, but she assumed it was all related to her ?pneumonia? diagnosis. Sometime after that ER visit she began developing ear pressure behind her right ear (which later spread to both ears) that was intense. It would heighten if she was standing or talking for too long and it would build the pressure throughout her head causing severe pain. It radiated from her head to the back of her neck and into the jawline even. Noise seemed to also be a trigger/ make it worse. The only relief she got was laying down. She began having unusual ?spells? daily some time after that and it became debilitating. She is a stay at home Mom of a 3 yr old boy, and 2 yr old girl and it has not been easy making certain she is all the Mom she can be for them lately. When these spells occur, it almost feels as if she is having either a stroke or a heart attack and she is left feeling very confused and utterly exhausted afterwards. She would have shaking all over like her legs were shaking also her hands shook and she got confused. The shaking lasted about 3-4 minutes then she feels exhausted afterward. Her heart rate would also go up before the shaking. She did not go completely unconscious with the spells. Her husband describes the spells also as shaking of the limbs lasting no more than 3-4 minutes. On April 22nd she ended up seeing her PCP, . He sat down and listened to everything she had to say and was very thorough with testing. He also noticed abnormal amounts of fluid on her right ear and prescribed her Claritin, also for precautionary measure he put her on Aspirin as well. He diagnosed her with probable Lyme disease and started her on Doxycycline 100mg twice daily, for 3 months. Since seeing the Doctor she has noticed daily symptoms but with some improvement, she thinks thanks to the Doxycycline, though some symptoms are new. They seem neurological to her and that is concerning. Her left eye sometimes involuntarily moves on its own- it looks/deviates upward and to the left 2-3 times a week for a few seconds. Her arms tend to tingle and feel weightless at times for a few seconds 2-3 times a week. Her legs tend to buckle under sometimes at the knee or ankles like her knees are forgetting how to carry her weight or like she is drunk, also only lasts a few seconds but 5-6 times a day. She has blurred vision that seems to come and go, worse in mornings and evenings that started in April. Mainly in the am when trying to read small print. But other times eyes are fine. She also has pulsations of her irises going larger and smaller like they are pulsating- that comes with the bounding heart. That can last several minutes to several hours. It comes and goes now, but was all day back in May and June. She also had a weird buzzing or vibrating sensation within her body, almost feels like it stems from her spine in the center. It was in her back/spine at first. Now it is in her legs and left ankle like electricity inside of her body. Can last 20-30 minutes 4-5 times a day. It was a very sharp pain when it happened in the back, but now it is not really even a pain, it is much milder. . The veins in her head throb, and pulsate irregularly. That was in the left parietal region and she could see it move there. Now she also has random muscle twitching in her left thigh, both sides/lateral ribs, Upper chest under the rib cage, the upper arms, now most recently the fingers are twitching randomly middle finger of L hand, and 4th and 5th finger of her R hand, and L foot. This has been more in June and July. She also has twitching at night when she falls asleep. When lying on her r side her face twitches and pulls forward These symptoms were ongoing at the time of her first visit with me 7/15/21

Other Meds: None

Current Illness: None

ID: 1518970
Sex: F
Age: 31
State: HI

Vax Date: 03/01/2021
Onset Date: 07/27/2021
Rec V Date: 08/01/2021
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: Pyrexia, White blood cell count decreased

Symptoms: Cough, throat irritation, nasal congestion, runny nose, diarrhea, decreased taste, decreased smell with positive COVID PCR on 7/30/21

Other Meds: none

Current Illness: none

ID: 1518971
Sex: M
Age: 22
State: VA

Vax Date: 08/01/2021
Onset Date: 08/01/2021
Rec V Date: 08/01/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Pharyngeal swelling

Symptoms: Patient received dose 1 vaccine. While sitting in waiting area for observation patient fainted and fell to floor. Patient briefly had seizure activity in limbs for 5-10 seconds then became alert. Paramedics were contacted and assessed patient. Patient was recommended to follow up with primary care.

Other Meds: Uknown

Current Illness: None

ID: 1518972
Sex: F
Age: 52
State:

Vax Date: 07/24/2021
Onset Date: 08/01/2021
Rec V Date: 08/01/2021
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: I woke up on 8/1/2021 (1 week after vaccination shot) with mild itching and redness at the injection site. It is a raised, red area approximately 3 inches in diameter. No soreness, but it is ?hot.? No other issues.

Other Meds: Multi vitamin

Current Illness: None

ID: 1518973
Sex: F
Age: 25
State: AZ

Vax Date: 07/31/2021
Onset Date: 07/31/2021
Rec V Date: 08/01/2021
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: fruits

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient's color skin change to very pale color and passed out, but regained consciousness. She had a little light headache and felt ok after a few minutes of resting. She did not want us to call 911.

Other Meds: na

Current Illness: no

ID: 1518974
Sex: F
Age: 37
State: SC

Vax Date: 07/30/2021
Onset Date: 07/31/2021
Rec V Date: 08/01/2021
Hospital:

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

Lab Data:

Allergies: Latex, penicillin

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

Symptoms: I woke up the dat after I received my covid vaccine, and my left wrist had some pretty significant pain. It wasn't swollen, but I couldn't put any weight on it. I took some naproxen, put Voltaren gel on it, and took some turmeric hoping it would get better. It didn't. The next day, today, it is worse. I can't move it without it being very painful. I've been to the point of tears all day because of how bad it's hurting. I am contemplating going to an urgent care or ER.

Other Meds: Vyvanse; Baclofen; Multivitamin

Current Illness: None

ID: 1518975
Sex: F
Age: 47
State: VA

Vax Date: 06/01/2021
Onset Date: 07/01/2021
Rec V Date: 08/01/2021
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: Allergic to: Amoxicillin; Minocycline; Sulfa; CT Contrast

Symptom List: Rash, Urticaria

Symptoms: When I received my first injection on 06/03/2021, I experienced fatigue and arm soreness for about three days, which was to be expected. After receiving my second vaccine on 06/30/2021, my health has been rather poor. I?ve been extremely fatigued and have been experiencing heart palpitations for the last week and a half - which is why I visited my physician. They ran a tremendous amount of bloodwork - to which it appears that the Epstein Barr Virus has been reactivated. Also of concern, I had an echocardiogram and my pulmonic valve, for the first time, is showing a trace insufficiency. I had an echocardiogram prior to my vaccine and it showed no such issue.

Other Meds: 50 mcg Synthroid - one time per day

Current Illness: None.

ID: 1518976
Sex: M
Age: 54
State: HI

Vax Date: 05/17/2021
Onset Date: 07/30/2021
Rec V Date: 08/01/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Positive COVID PCR on 7/30/21, patient asymptomatic

Other Meds: none

Current Illness: none

ID: 1518977
Sex: M
Age: 18
State: NY

Vax Date: 08/01/2021
Onset Date: 08/01/2021
Rec V Date: 08/01/2021
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: No Known Drug allergies

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

Symptoms: After administering vaccine patient asked to stay in chair for a few minutes. When his mother came over to him he was seated on the floor. After laying down for a few minutes and drinking some gatorade the patient said he would like to get up and leave. While standing at the counter the patient is believed to have fainted and fallen to the ground hitting his head. He was awake and alert but stated "I don't know where I am". I called 911 and while waiting for EMS to arrive the patient laid down with an ice pack on the back of his neck. He was able to sit up and drink some orange juice. EMS took vitals and his blood glucose. They believe since the patient had not eaten anything today that that could be the cause. After being released by EMS and refusing to go to the hospital the patient left the pharmacy. EMS later came in to inform me that they were contacted again by the patients mother while in the parking lot. The patient again refused to be taken to the hospital.

Other Meds:

Current Illness:

ID: 1518978
Sex: M
Age: 29
State: MA

Vax Date: 07/26/2021
Onset Date: 07/26/2021
Rec V Date: 08/01/2021
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 SPECIFIED BY PATIENT

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

Symptoms: PATIENT GOT VACCINE THEN DURING WAIT PERIOD AFTER HIS HEAD GOT DIZZY AND ROLLED BACKWARDS AND HE EXPERIENCED LOSS OF CONSCIOUSNESS (SYNCOPE) FOR COUPLE MINUTES THEN HE REGAINED CONSCIOUSNESS SHORTLY. AT THAT TIME SINCE I HAD REQUESTED THE TECHNICIAN TO CALL 911 - EMT PERSONNEL WERE ALREADY ON SITE AND MONITORING PATIENT FOR BLOOD PRESSURE ,HEART RATE AND OVERALL ALERTNESS.

Other Meds: N/A JUST REGULAR VITAMINS

Current Illness: PATIENT STATED GETTING BLOOD SHOTS BUT NO OTHER ILLNESS

ID: 1518979
Sex: M
Age: 43
State: PA

Vax Date: 03/06/2021
Onset Date: 03/09/2021
Rec V Date: 08/01/2021
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: None

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

Symptoms: Severe nerve pain, paresthesia, muscle pain, , muscle weakness, muscle spasms, tremor, brain fog

Other Meds: Lamictal (5mg per day)

Current Illness: None

ID: 1518980
Sex: M
Age: 39
State: HI

Vax Date: 03/18/2021
Onset Date: 07/27/2021
Rec V Date: 08/01/2021
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: hydrocodone makes him nauseous

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

Symptoms: fatigue, runny nose, decreased taste, decreased smell. Positive PCR on 07/30/2021

Other Meds: none

Current Illness: none

ID: 1518981
Sex: M
Age: 18
State: TX

Vax Date: 08/01/2021
Onset Date: 08/01/2021
Rec V Date: 08/01/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient felt faint, laid down on the ground. Started sweating perfusely. Said he had tingling in his arms difficulty breathing and chest felt heavy. Ice pack was given. Epipen was not administered. EMS was on site by then very quickly. EMS stated possibly due to anxiety. Patient was hyperventilating and EMS stated this was not a reaction to the shot and this could be anxiety induced/related. Patient did not seem anxious during the shot but got very anxious when he experienced these symptoms. Patient stated he had eaten only two strips of bacon the entire day and had some anxiety with getting the shot.

Other Meds: Adderall

Current Illness: None

ID: 1518982
Sex: M
Age: 49
State: IA

Vax Date: 07/28/2021
Onset Date: 07/28/2021
Rec V Date: 08/01/2021
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: Patient received Pfizer COVID vaccine for first dose 7/7/21, was inadvertantly administered Moderna COVID vaccine for second dose. Per CDC guideline no subsequant dose was adminstered. No adverse physical symptoms reported by patient.

Other Meds: none

Current Illness: antibiotic for tooth abcess

ID: 1518983
Sex: M
Age: 78
State: MI

Vax Date: 02/20/2021
Onset Date: 03/06/2021
Rec V Date: 08/01/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Started urinating blood about 2 weeks after the second dose of Pfizer Covid Vaccine (3/2021)- no pain and never had this before in his life. Went to the doctor- had an ultrasound done and a mass was found. He had a cystoscopy and they determined he had two bladder tumors on the wall of his bladder that were half the size of his bladder and partially obstructing one of his uretors. Surgery was done on 3/30/2021 and 4/13/21 to remove the bladder. BCG treatment for 6 weeks and the cancer is back, surgery to remove tumor again. The doctor would like to remove the bladder and prostate now.

Other Meds: atorvastatin (LIPITOR) 40 MG PO Tab take 40 mg by mouth once every evening. Canagliflozin (Invokana) 100 MG PO Tab take by mouth once daily. Cholecalciferol (VITAMIN D-3 PO) take 5,000 Units by mouth once daily. diphenhydrAMINE (BE

Current Illness: none

ID: 1518984
Sex: M
Age: 65
State: WI

Vax Date: 04/09/2021
Onset Date: 05/23/2021
Rec V Date: 08/01/2021
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: None

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

Symptoms: Vertigo

Other Meds: Atorvastatin, HCl thiazides,

Current Illness: None

ID: 1518985
Sex: M
Age: 23
State:

Vax Date: 08/01/2021
Onset Date: 08/01/2021
Rec V Date: 08/01/2021
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: Patient received dose of vaccine and sat down at the pharmacy waiting area to wait the recommended 15 minutes after vaccination. About 5 minutes after vaccination patient was feeling very light headed, pale and lost consciousness. Patient fell to the floor and was unconscious for about 15 to 30 seconds. While falling to the floor patient potentially hit his head. Patient then regained consciousness and was attended to by the pharmacist on staff while waiting for EMTs. EMTs evaluated the patient and took BP and other vitals. After being evaluated by the EMT patient began to feel better and was able to walk on his own and was driven home by a friend that accompanied him.

Other Meds:

Current Illness:

ID: 1518986
Sex: F
Age: 68
State: OR

Vax Date: 07/10/2021
Onset Date: 07/11/2021
Rec V Date: 08/01/2021
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: Latex Sensitive to sedating medications

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

Symptoms: Vertigo - no treatment - 2 days Shingles - no treatment -2 1/2 weeks Cognitive compromise - 2-3 days

Other Meds: Preservision AREDS2 Eyelea monthly injections

Current Illness: N/A

ID: 1518987
Sex: F
Age: 28
State: MI

Vax Date: 06/09/2021
Onset Date: 07/30/2021
Rec V Date: 08/01/2021
Hospital: Y

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: Appendicitis leading to appendectomy

Other Meds: Prenatal vitamin, calcium, magnesium, hydrocortisone cream

Current Illness:

ID: 1518988
Sex: F
Age: 56
State: TX

Vax Date: 05/08/2021
Onset Date:
Rec V Date: 08/01/2021
Hospital:

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

Lab Data:

Allergies: Aspirin

Symptom List: Injection site pain, Menorrhagia

Symptoms: She got the first Moderna vaccine in left deltoid Saturday 5/8/21 and that felt odd, more so than prior vaccines, and felt pain and funny feeling along lateral arm where had vaccine. The following day, she awoke after sleeping one hour in recliner with pillows under the hand for support and the ipsilateral (left) hand was asleep completely after being asleep for one hour. Wednesday was able to move hand, prior to that it wouldn't move a all. Her left hand was dropped since Sunday and the dorsum of the hand felt dull to sensation, She couldn't move wrist up and middle fingers wouldn't lift. Since then she has regained some function and more feeling (I saw patient 5/20/21). No pain in neck other than usual. No other sx. Went to ER that next day after vaccine and left without MD evaluation but after CT head without contrast (normal ) and CXR ( normal). Has hx of carpal tunnel surgery that wasn't completely successful but never had these symptoms. Seen at ER on 5/12/21 due to arm numbness, feels like is never going to move arm again. Unable to straighten middle and ring finger. Wrist feels weak. Hard to extend wrist and fingers 3 and 4 won't open but will close, when touched the dorsum of hand feels numb. Dull sensation from distal deltoid body on down. Had neck surgery in February.

Other Meds: baclofen 10 mg oral tablet [1 po QID] gabapentin 600 mg oral tablet [1 po QID] HYDROCODONE-ACETAMIN 10-325 MG [1 po q 6 hrs prn] lamoTRIgine 100 mg oral tablet [One tablet BID] PARoxetine HCl 30 mg oral tablet [take 1 tablet (30 mg) by ora

Current Illness: Pain in right ankle and joints of right foot Localized edema

ID: 1518989
Sex: M
Age: 71
State: NC

Vax Date: 01/25/2021
Onset Date: 03/01/2021
Rec V Date: 08/01/2021
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: Muscle pain in shoulders, hips, back, balance problems leg weakness, incoordination, persistent frontal headache, fatigueMRI,

Other Meds: novolog, tresiba.rosuvastatin, zetia, eliquis,lisinopril,hctz

Current Illness: none

ID: 1518990
Sex: F
Age: 26
State: FL

Vax Date: 07/29/2021
Onset Date: 07/29/2021
Rec V Date: 08/01/2021
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: 0

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Reported heart flutter or skipped beats

Other Meds: 0

Current Illness: 0

ID: 1518991
Sex: M
Age: 57
State: NC

Vax Date: 03/01/2021
Onset Date: 07/22/2021
Rec V Date: 08/01/2021
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: time course: sudden deterioration within a week adverse event(s) - upper body muscle/bone pain (symmetrical left and right arm pains and joints) -- left arm symptoms of frozen shoulder - lower body muscle/bone pain (symmetrical left and right hip joints and feet) - fingers (symmetrical left and right) - weak muscles all over body treatment(s) - Advil/Ibuprofen for immediate use - following up with doctor next week for treatment outcome(s) - pain still exists

Other Meds: None

Current Illness: None

ID: 1518993
Sex: F
Age: 31
State: HI

Vax Date: 01/25/2021
Onset Date: 07/27/2021
Rec V Date: 08/01/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: cough, nasal congestion, fatigue, decreased taste, decreased smell. Positive PCR on 07/30/2021

Other Meds: metformin, medroxyprogesterone

Current Illness: none

ID: 1518994
Sex: F
Age: 72
State: CA

Vax Date: 01/02/2021
Onset Date: 04/15/2021
Rec V Date: 08/01/2021
Hospital:

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

Lab Data:

Allergies: Penicillin, Horse serum, Sulfa drugs

Symptom List: Nausea

Symptoms: Mid April 2021 started having pain on the left side of neck upon swallowing. Sometimes it stretched from bottom of ear to my clavicle. After two weeks called my Dr. and he put me on Keflex. After 3 days there was no improvement. I was then scheduled for a barium swallow which was negative. Then was seen by ENT. The total time of this event was about 6 weeks. By the time I saw the ENT the issue had resolved. Now for the last 2 months I am having redness in my left foot and ankle. A doppler ultrasound was normal. I am scheduled to see a vascular specialist this week. 8/2/2021.

Other Meds: Crestor

Current Illness:

ID: 1518995
Sex: F
Age: 21
State:

Vax Date: 07/30/2021
Onset Date: 07/30/2021
Rec V Date: 08/01/2021
Hospital:

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

Lab Data:

Allergies: No

Symptom List: Injection site pain

Symptoms: In order. Weak legs. Heavy breath and rush of heat. I started skipping beats and my heart and breath weren't keeping up. Headache and gradual sense of vertigo. When medical staff realized I was about to collapse after 2 minutes they had me stand up to go lay on the stretcher. I realized I couldn't stand on my feet and sit on a near bench. My ears were obtunded as if I couldn't hear properly anymore. When I laid down with my legs up I started feeling blood flowing again on my face and my ears regained sensibility. After ten minutes I was almost all right. I felt tired the rest of the day but I worked my shift as usual. Next day I couldn't lift my left arm and I was just a little tired. The day after it was manageable.

Other Meds: No

Current Illness: No

ID: 1518996
Sex: F
Age: 47
State: CT

Vax Date: 03/17/2021
Onset Date: 04/18/2021
Rec V Date: 08/01/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: I have had significant daily heart palpitations and spasms in a specific area in my right/ middle section of chest. This occur on a daily basis and began a few months after second shot. They are occurring 50 plus times a day. I had to go to cardiologist and had to wear a heart holter this week and am awaiting results. Additionally I am experiencing dizziness upon standing or sitting for unexplained reasons . My Mother had the same vaccine the week prior and has had the exact same issues. I had rye heart issue on same side as injection site and I also had a rash on leg on same side which went away and then came back a month later.

Other Meds: None

Current Illness: None

Date Died: 02/14/2021

ID: 1518997
Sex: M
Age: 37
State: WV

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 08/01/2021
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: After receiving vaccine he was with me (mom), visiting my grandkids, shopping and eating, for approximately 3 hours at which time I dropped him off at my ex husbands house where he lived. Within 30 minutes he walked to his dad and grabbed his chest and slumped to the ground. Emergency Ambulance was called and attempted unsuccessfully to revive him but transfer to hospital where they worked for an hour. He was placed on life support and transferred to one of their larger facilities. On 2-14-21 they did the brain activity test ad he was pronounced dead. Remain on live support until Core could harvest usable organs

Other Meds: Lecemi- Flex Touch U-100 Insulin Lisinopril 20 MG methocarbamol - 500 mg Metroprolol succinate 100mg Prednisone 20 mg trazodone 50 mg hydroxyzine pamoate 25 mg Ventolin HFA 90 mcg Atorvastatin 40 mg cetirizine 10 mg gaberpentin 400 mg budes

Current Illness: Kidney failure on dialysis Stroke which left him unable to speak High Blood Pressure and cholesterol Type 1 diabetic since he was 12 Amputee (leg)

ID: 1518998
Sex: F
Age: 49
State: ID

Vax Date: 03/20/2021
Onset Date: 03/20/2021
Rec V Date: 08/01/2021
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: Penicillin, sulfa, bees

Symptom List: Tremor

Symptoms: Fever, body aches, headache, nausea, vomiting, fatigue

Other Meds: Synthesis, estradoil

Current Illness: Na

ID: 1518999
Sex: F
Age: 43
State: CA

Vax Date: 07/01/2021
Onset Date: 07/31/2021
Rec V Date: 08/01/2021
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: Macrobid, keflex, mushrooms,

Symptom List: Erythema, Pruritus

Symptoms: First day Sore arm, chest felt heavy for a split second. Next day Woke up at 3am with tachycardia lasted for 2 to 3 mins. Sunday knee soreness, left lower rib cage sore. Mild short of breath and sleepy.

Other Meds: Diltizem CD 120mg twice daily, levothyroxine 0.88mcg, baby aspirin chewable 81mg, vitamin c 1000mg, D3 2000 iu, womens one a day multi vit, iron supplement, elderberry, zinc 50mg.

Current Illness: History of Asthma, tachycardia issues, hypothyroidism, hx of anemia, elevated d dimer,fibroids, over weight

ID: 1519000
Sex: M
Age: 63
State:

Vax Date: 01/16/2021
Onset Date: 07/29/2021
Rec V Date: 08/01/2021
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: covid pos after vaccination

Other Meds:

Current Illness:

ID: 1519001
Sex: M
Age: 57
State: NC

Vax Date: 03/06/2021
Onset Date: 07/22/2021
Rec V Date: 08/01/2021
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: time course: sudden deterioration within the week adverse outcome(s): - upper body muscle/bone pain (symmetrical left and right arms and joints) -- left arm symptoms of frozen shoulder - lower body muscle/bone pain (symmetrical left and right hip joints and feet) - finger pain (symmetrical left and right) - muscle weakness all over body treatment outcome(s): - advil/ibuprofen - meeting doctor next week for treatment outcome(s): - pain still exists

Other Meds: none

Current Illness: none

ID: 1519002
Sex: F
Age: 31
State: SC

Vax Date: 07/30/2021
Onset Date: 07/30/2021
Rec V Date: 08/01/2021
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: Seasonal and environmental allergies, Effexor, ibuprofen

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: 6 weeks pregnant at time of vaccine, due date 3/22/2022. Instant burning and pain in arm following injection, which radiated to neck and down arm. Sweating and hot all over, increased heart rate, then dizziness, facial numbness, nausea and fainted for a minute.

Other Meds: Zyrtec, Claritin, prenatal vitamins

Current Illness: NA

ID: 1519003
Sex: F
Age: 48
State: CA

Vax Date: 01/20/2021
Onset Date: 02/13/2021
Rec V Date: 08/01/2021
Hospital: Y

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

Lab Data:

Allergies: ASA

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

Symptoms: Don't know if they are related: vaccine and pneumothorax. My PCP at that time Dr did not think they were related, but I want to report anyway. Diagnosed with Right apex spontaneous pneumothorax. I was told by pulmonologist that CTA showed possible PE. Was also taking birth control pills at that time (1st and 2nd dose) for endometrial and uterine fibroid pain. As treatment I was given non-rebreather mask with oxygen. Stayed at Hospital for a few days. Had severe chest pain on the 13th which dissipated quickly. Then had back pain. Went to urgent care on the 14th and told to see primary. Went to see my primary on the 15th. Was told to go to ER for testing.

Other Meds: Birth Control Pills

Current Illness:

ID: 1519004
Sex: F
Age: 46
State: OH

Vax Date: 07/30/2021
Onset Date: 08/01/2021
Rec V Date: 08/01/2021
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: Flu shot, penicillin

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

Symptoms: Hives/urticaria in torso, neck, and arms. Ongoing at this time. Taking normal doses of Benadryl.

Other Meds: Vitamin D

Current Illness: No

ID: 1519005
Sex: M
Age: 18
State: GA

Vax Date: 07/29/2021
Onset Date: 08/01/2021
Rec V Date: 08/01/2021
Hospital: Y

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

Lab Data:

Allergies: None

Symptom List: Pain in extremity

Symptoms: Myocarditis- woke up with chest pain. Eval in ER and found to have abn ekg, elevated cardiac enzymes (trop 0.38, ck 634, mb 35.1, proBNP 328).

Other Meds: None

Current Illness: None

ID: 1519006
Sex: F
Age: 68
State: OH

Vax Date: 07/29/2021
Onset Date: 07/29/2021
Rec V Date: 08/01/2021
Hospital:

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

Lab Data:

Allergies: Ampicillin, Septra

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

Symptoms: with the first injection I only recall having some soreness, slight swelling & redness at the injection site for a couple days. The 2nd injection was a very different story: 29July-- Received the injection around 11:00-- in the afternoon I felt tired and then mid to late afternoon started a vague sense of just not feeling well-- only desire to eat easy to digest dinner- no blatant nausea-- as the evening progressed just felt more tired-- injection site was sore, but no redness, found arm bones ached & shoulders- may have run a low grade fever, but never checked it-- just laid on the couch watching TV & no energy to do anything. Think I went to bed around 22:00/23:00-- During the night I woke up about every hour-- didn't sleep well at all-- developed frontal headache in addition to just not feeling well, arms/shoulders achey-- 30July-- got up around 07:00-- no real appetite so just ate some toast-- was up for about 2-3 hrs then had to go back to bed-- think I slept around 3 hrs-- still took another hour to get out of bed-- made some oatmeal then down to the couch-- realized my arms didn't ache anymore & my H/A was less-- laid on the couch for another hour or so-- then as the afternoon progressed I realized my H/A was gone-- I was feeling less fatigued-- I still didn't have my appetite back, but ate a sub for dinner-- 31July-- the only symptom now was my arm was still somewhat sore, & now had slight rash around injection site-- but otherwise felt back to normal 1Aug-- still some soreness at injection site--

Other Meds: Cytomel, Synthroid, Centrum MVI, Fish Oil, Vitamin D, Balanced B-100, Magnesium, DHEA DR, Adrenal Rebuilder, Adrenal Support 1, Combigan, Restasis, Refresh eye drops, Progesterone, BIHRT estrogen/testosterone, n-acetyl cysteine , elidel

Current Illness: none

ID: 1519007
Sex: F
Age: 17
State: NE

Vax Date: 07/30/2021
Onset Date: 07/30/2021
Rec V Date: 08/01/2021
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: Keflex, Varicella vaccine

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

Symptoms: patient described shortness of breath, was taken to ER my mother. per mother, she was treated with albuterol Inhaler, steroid and benedryl and released after a few hours. told to follow up with asthma dr on Monday 8/2/21.

Other Meds: unknown

Current Illness: Asthma

ID: 1519008
Sex: F
Age: 17
State: NV

Vax Date: 08/01/2021
Onset Date: 08/01/2021
Rec V Date: 08/01/2021
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: Patient had trouble breathing, blurred vision within 15 minutes after injection. 911 paramedics came and believed she was having a panic attack. After breathing exercises she started feeling better but was taken to the hospital for further assesment.

Other Meds:

Current Illness:

ID: 1519009
Sex: F
Age: 39
State: TN

Vax Date: 07/31/2021
Onset Date: 07/31/2021
Rec V Date: 08/01/2021
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: penicillin

Symptom List: Vomiting

Symptoms: Patient received 2nd dose at approximately 4:07 pm administered by immunizing technician supervised by pharmacist. At approximately 4:20 patient stated that she felt tightness when breathing. At this time of complaint, the patient said that she felt tightness in her chest when breathing but has asthma. The patient said that her breathing was getting better. Pharmacist administer 10ml of liquid oral benadryl at 4:30 and at 4:36 to equal a total of 50mg. Monitoring of the patient continues, with patient stating that breathing is better. At 4:47pm patient complains that the tip of her tongue feels numb. patient did state that she had no trouble breathing. At 4:55pm, patient complains that she thinks she might have trouble swallowing , at this point pharmacy called 911. Emergency Medical Technicians came and patient stated to the EMT that she does have anxiety and refused to go the hospital because she stated that she was feeling better. At 7:36 pm called and followed up with patient and patient states that her she has no problem breathing but her tongue feels a little numb On 8/1/21, called patient and patient states that she is having aches and body pains and that her tongue was feeling numb still. Pharmacist urged patient to see physician.

Other Meds:

Current Illness: Trigeminal Neuralgia and Fibromyalgia

ID: 1519010
Sex: F
Age: 69
State: FL

Vax Date: 02/06/2021
Onset Date: 02/08/2021
Rec V Date: 08/01/2021
Hospital: Y

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

Lab Data:

Allergies: NOONE

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: AFTER FIRST VACCINE: CONFUSION, MEMORY PROBLEMS, INABILITY TO CARE FOR SELF

Other Meds: SINEMET, AZILECT, LEXAPRO, GOCOVRI, VIT D, SYNHROID,

Current Illness: PARKINONS DISEASE - 18 YEARS

ID: 1519011
Sex: M
Age: 34
State: OR

Vax Date: 05/11/2021
Onset Date: 07/01/2021
Rec V Date: 08/01/2021
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: amoxicillin

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

Symptoms: chest symptoms; discomfort and tachycardia

Other Meds: levothyroxine 75mcg

Current Illness: subclinical hypothyroidism

ID: 1519012
Sex: F
Age: 65
State: IA

Vax Date: 04/23/2021
Onset Date: 05/12/2021
Rec V Date: 08/01/2021
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: none

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Got 2nd shot 04/23/2021 knew I'd be fatigued for a few days. Never got any better at one point could barely lift my arms. Started having shortness of breath that continued until I went to ER. (May 18, 2021). They diagnosed me with enlarged heart, water around my heart, and weakened heart muscle, congestive heart failure after going through many tests. As of right now, I am wearing a defibrillator vest 24/7 in case of heart attack! Hopefully get this off at the end of August then I'm not sure. DR put me on Entresto, Furosemide, Metoprolol, Spironolactone and low doe aspirin. Also, after being in the emergency room I developed a BAD cough that lasted approx. 2 and half months

Other Meds: Glimepiride Citalopram Bupropion Trulicity Metformin OSCAL D3 & calcium Ropinirole Low dose aspirin Omeprazole

Current Illness: none

ID: 1519013
Sex: F
Age: 36
State: HI

Vax Date: 07/22/2021
Onset Date: 07/31/2021
Rec V Date: 08/01/2021
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: Big red rash when shot was administered (around 3in x 5in), itchy

Other Meds:

Current Illness:

ID: 1519014
Sex: M
Age: 48
State: IN

Vax Date: 07/17/2021
Onset Date: 07/24/2021
Rec V Date: 08/01/2021
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: None

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

Symptoms: I have stage 3 chronic kidney disease, and my glomerular filtration rate has consistently been 50 the last two years. I had to go to the lab to have bloodwork done for my kidney function a week after getting the vaccine, and my GFR Rate has dropped to 46 after getting the vaccine. I know that 4 points doesn`t look like a significant number, but when you have stage 3 kidney disease, it is significant, The drop in my GFR rate directly correlates to getting the vaccine.

Other Meds: L-Thyroxine 100MG Lisonopril 10 mg Calcitroil 25 MG

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm