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From the 10/15/2021 release of VAERS data:

Found 29,365 cases where Vaccine targets COVID-19 (COVID19) and Manufacturer is MODERNA and Serious



Case Details

This is page 9 out of 2,937

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VAERS ID: 919604 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2020-12-30
Onset:2020-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Alanine aminotransferase normal, Anion gap decreased, Aspartate aminotransferase normal, Basophil count normal, Basophil percentage decreased, Blood albumin normal, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood calcium normal, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood magnesium normal, Blood potassium decreased, Blood sodium normal, Blood thyroid stimulating hormone normal, Blood urea nitrogen/creatinine ratio, Blood urea normal, Carbon dioxide decreased, Chest X-ray normal, Chest discomfort, Cough, Dizziness, Eosinophil count decreased, Eosinophil percentage decreased, Glomerular filtration rate, Haematocrit normal, Haemoglobin normal, Hypoaesthesia, Immature granulocyte count increased, Immature granulocyte percentage increased, Injection site hypoaesthesia, Injection site pain, Lymphocyte count decreased, Lymphocyte percentage decreased, Mean cell haemoglobin concentration normal, Mean cell haemoglobin normal, Mean cell volume normal, Mean platelet volume normal, Monocyte count normal, Monocyte percentage decreased, Nausea, Neutrophil count increased, Neutrophil percentage increased, Pain in extremity, Platelet count normal, Protein total normal, Red blood cell count normal, Red blood cell nucleated morphology, Red cell distribution width increased, Throat tightness, Troponin normal, White blood cell count normal
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Haematopoietic leukopenia (narrow), Peripheral neuropathy (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Myelodysplastic syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (narrow), Sexual dysfunction (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amitriptyline 25 mg PO QHS Bupropion XL 150 mg PO Daily Cyanocobalamin 1000 mcg PO once weekly Ferrous sulfate DR 324 mg PO Daily Levothyroxine 100 mcg PO Daily Methocarbamol 500 mg PO TID prn muscle spasms Scopolamine 1.5 mg patch transder
Current Illness:
Preexisting Conditions: Anemia Asthma Depression Hypothyroidism secondary to thyroid cancer s/p thyroidectomy Hypertension Migraines Vertigo
Allergies: No known allergies
Diagnostic Lab Data: Chest X-ray (12/30/20 @ 1737): The cardiac and mediastinal silhouette are unremarkable. The lungs are free of infiltrates and masses. I see no acute chest disease on today''s film. CBC w/diff (12/30/2020 @ 1658) WBC: 9.0 RBC: 4.38 Hemoglobin: 13.3 Hematocrit: 39.8 MCV: 90.9 MCH: 30.4 MCHC: 33.4 RDW SD: 40.4 Platelet: 264 MPV: 9 NRBC Percent: 0.0 NRBC Absolute: 0.000 Absolute Neutrophil: 8.4 (H) Lymphocyte Absolute: 0.4 (L) Monocytes Absolute, Automated: 0.11 Absolute Eosinophil: 0.00 (L) Basophil Absolute: 0.03 Absolute Immature Granulocytes: 0.03 (H) Neutrophil percent: 93.6 (H) Lymphocyte percent: 4.6 (L) Monocyte percent: 1.2 Eosinophil percent: 0.0 Basophil percent: 0.3 Immature Granulocytes percent: 0.30 (H) CMP (12/30/2020 @ 1658) Sodium: 136 Potassium: 3.3 (L) Chloride: 106 CO2: 21 Anion gap: 9 Glucose: 137 (H) BUN: 15 Creatinine: 1.01 BUN/Creatinine Ratio: 14.9 Calcium: 9.2 Protein total: 7.9 Albumin: 4.6 AST: 12 ALT: 17 ALP: 50 eGFR non-African American: $g60.0 eGFR African American: $g60.0 Bilirubin total: 0.4 Magnesium: 2.0 TSH: 2.52 Cardiovascular (12/30/2020 @ 1658) Troponin: <0.015
CDC Split Type:

Write-up: Presented to the ED after developing chest tightness, cough, lightheadedness, and throat closing sensation. She received the Moderna COVID-19 vaccine on the morning of presentation. Within 15 minutes of receiving the vaccine she developed pain and numbness, starting at the injection site traveling down the ulnar aspect of her arm, and nausea. Over the next several hours she continued to develop worsening nausea, chest tightness, cough, lightheadedness, and the sensation that her throat closing. She took PO Benadryl 25mg; however, her symptoms were not alleviated. She was subsequently evaluated in the ED. ? Received PO Benadryl 25mg, IV Benadryl 25mg, Epinephrine 0.3mg x 2, IV Famotidine 20mg, IV Solumedrol 125mg & 60mg, DuoNebs x 3, Racepinephrine x 1.


VAERS ID: 919624 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2020-12-29
Onset:2020-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Asthenia, Blood pressure decreased, Chills, Decreased appetite, Dizziness, Fatigue, Headache, Hot flush, Lymphadenopathy, Mobility decreased, Nausea, Pain in extremity, Paraesthesia, Speech disorder, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies: Penicillin
Diagnostic Lab Data: no
CDC Split Type:

Write-up: Around 10 or 11 pm, arm pain, chills, fatigue, headache, nausea, swollen lymph nodes, lightheadedness, fainted in tub. Next day, fatigue all day, couldn''t talk, or eat. Went back to bed again. The following day hot flashes, weakness. went to ER. Felt like blood pressure was dropping, tingling in legs, difficulty lifting her head.


VAERS ID: 919633 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2020-01-04
Onset:2020-12-30
   Days after vaccination:361
Submitted: 0000-00-00
Entered: 2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Alanine aminotransferase normal, Angiogram cerebral normal, Anion gap decreased, Arteriogram carotid normal, Aspartate aminotransferase normal, Basophil count normal, Basophil percentage, Blood albumin normal, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood calcium normal, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood potassium normal, Blood sodium normal, Blood urea nitrogen/creatinine ratio, Blood urea normal, Carbon dioxide normal, Chest X-ray normal, Computerised tomogram head normal, Electrocardiogram, Eosinophil count normal, Eosinophil percentage, Facial paralysis, Facial paresis, Feeling hot, Glomerular filtration rate, Haematocrit normal, Haemoglobin normal, Hypoaesthesia, Immature granulocyte count increased, Immature granulocyte percentage increased, Immediate post-injection reaction, Injection site hypoaesthesia, Injection site warmth, Lymphocyte count normal, Lymphocyte percentage decreased, Mean cell haemoglobin concentration normal, Mean cell haemoglobin decreased, Mean cell volume normal, Mean platelet volume increased, Monocyte count normal, Monocyte percentage, Muscular weakness, Nausea, Neutrophil count normal, Neutrophil percentage increased, Palpitations, Platelet count normal, Protein total normal, Red blood cell count normal, Red blood cell nucleated morphology, Red cell distribution width, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Haematopoietic leukopenia (broad), Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hearing impairment (broad), Hypersensitivity (narrow), Myelodysplastic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol 90 mcg/actuation 2 puffs inhaled q4h prn sob/wheezing Aspirin EC 81 mg PO Daily Bupropion SR 150 PO Daily Calcium carbonate + Vitamin D 600mg PO Daily Cinnamon Bark 2 capsules PO Daily prn Clonazepam 0.5 mg PO Daily prn anxiety Cl
Current Illness: N/A
Preexisting Conditions: Asthma Fibrocystic breast disease Hyperlipidemia Irritable bowel syndrome Insomnia Migraines Polycystic ovarian syndrome
Allergies: Latex gloves - Anaphylaxis Iodine - Swelling Shellfish - Unknown Oseltamivir - Unknown Tramadol - Itching, N/V
Diagnostic Lab Data: CT Head w/o contrast (12/31/20 @ 1813) READING: I see no evidence of hemorrhage, mass effect, abnormal attenuation, extra-axial lesions, ventriculomegaly or other suspicious intracranial pathology. Included paranasal sinuses, mastoids and middle ears are clear. Calvarium intact. IMPRESSION: no acute intracranial pathology Chest X-Ray (12/31/20 @ 1821) READING: No suspicious cardiomediastinal pathology. No infiltrates or other suspicious pulmonary or pleural pathology. I see no acute abnormality. CT Angiogram w/o contrast (12/31/20 @ 1816) READING: Both common carotid arteries and the vertebral arteries are patent and normal. Do not see any plaque or stenosis. Both carotid bifurcations are normal. The internal carotid arteries remain patent throughout the course without stenosis or occlusion in the basal artery is normal. Anterior posterior cerebral arteries widely patent without stenosis or occlusion. No arterial venous malformation or aneurysm or other vascular abnormalities. IMPRESSION: No arterial stenotic or occlusive disease of the head or neck EKC 12-Lead (12/31/20 @ 1728) Systolic Blood Pressure: 172 Diastolic Blood Pressure: 96 Vent Rate: 93 Atrial Rate: 93 PR Interval: 150 QRS Interval: 78 QT Interval: 356 QTC Interval: 442 P Axis: 66 R Axis: 25 T Axis: 22 CBC w/diff (12/31/20 @ 1845) WBC: 6.4 RBC: 5.28 Hemoglobin: 14.2 Hematocrit: 43.7 MCV: 82.8 MCH: 26.9 (L) MCHC: 32.5 RDW SD: 37.8 Platelet: 197 MPV: 11 (H) NRBC Percent: 0.0 NRBC Absolute: 0.000 Absolute Neutrophil: 4.9 Lymphocyte Absolute: 1.1 Monocytes Absolute, Automated: 0.38 Absolute Eosinophil: 0.07 Basophil Absolute: 0.05 Absolute Immature Granulocytes: 0.01 (H) Neutrophil percent: 75.2 (H) Lymphocyte percent: 16.8 (L) Monocyte percent: 5.9 Eosinophil percent: 1.1 Basophil percent: 0.8 Immature Granulocytes percent: 0.20 (H) CMP (12/31/20 @ 1845) Sodium: 138 Potassium: 3.9 Chloride: 105 CO2: 28 Anion gap: 5 (L) Glucose: 82 BUN: 19 (H) Creatinine: 0.88 BUN/Creatinine Ratio: 21.6 Calcium: 9.8 Protein total: 7.8 Albumin: 3.9 AST: 24 ALT: 23 ALP: 71 eGFR non-African American: $g60.0 eGFR African American: $g60.0 Bilirubin total: 0.8
CDC Split Type:

Write-up: Presented to the ED with cc of left sided facial and LUE numbness and weakness x 1 days. Patient received her COVID-19 vaccination on 12/30/2020 around 1PM. Immediately after the injection in her left shoulder, she began to feel warmth and numbness in her left shoulder, arm, neck, face, and chest. She reports later experiencing nausea, palpitations, and left arm weakness. Her symptoms persisted, and her family noted a left sided facial droop which prompted her ED visit. In the ED, patient was noted to have some left sided facial droop and left arm and leg weakness. CT head and CTA showed no acute abnormalities. Tele-neurology was consulted who recommended admission to rule out acute stroke. Ultimately, work up was negative and symptoms resolved. Symptoms appear to be related to the vaccine.


VAERS ID: 919665 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2020-12-29
Onset:2020-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Blood test, Chest X-ray, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Synthroid Claritin Dexilent Terbinafine Vitamin D & B12
Current Illness:
Preexisting Conditions: Hypothyroid GERD
Allergies: Bactrim
Diagnostic Lab Data: Blood work 12/30/20 Chest X-ray 12/30/20
CDC Split Type:

Write-up: Severe joint aches, fever-type symptoms, nausea


VAERS ID: 919827 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: California  
Vaccinated:2020-12-22
Onset:2020-12-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 11J20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain lower, Abdominal pain upper, Appendicectomy, Appendicitis, Computerised tomogram abdomen abnormal, Discomfort, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: penicillin
Diagnostic Lab Data: evaluated by urgent care physicians and determined to likely be presenting with an appendicitis. Diagnosis of acute appendicitis confirmed and surgery performed to remove appendix.
CDC Split Type:

Write-up: Began experiencing nausea and general stomach pains the morning after receiving the vaccine. After one day of pain and discomfort I woke the following morning (~44hrs after receiving the vaccine) to extreme acute abdominal pain in the lower right abdomen. Went to Urgent Care facility and was diagnosed by CT scan as having acute appendicitis. An emergency appendectomy was scheduled and performed for later that evening. I stayed at the Hospital overnight on 12/24/2020 post operatively on IV antibiotics to recover from the appendectomy. Was discharged from the hospital on 12/25/2020 and have been recovering for about 10 days now with limitted activity.


VAERS ID: 920280 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-04
Onset:2021-01-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Asthenia, Dizziness, Hyperhidrosis, Hypertension
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Multivitamins
Current Illness: DENIES
Preexisting Conditions: DENIES
Allergies: DENIES
Diagnostic Lab Data:
CDC Split Type:

Write-up: 54yoM presented for a sudden-onset diaphoresis and loss of body strength. Pt had received COVID-19 vaccine this morning at the clinic and noted severe sweating all over the body while lying in bed @ approx 2030. Then pt described severe loss of body strength with dizziness as he was trying to sit up and get to his feet from the floor. Denied palpitation, chest pain, headache, N/V, LOC. His symptoms continued for 20mins until he drank a cup of water. At approx 2050, smoked E-cigarette and arrived at facility at 2100. On arrival, pt denied any symptoms, however, vitals indicated severe hypertension: BP 188/99, HR 56, T 97.6 F. Pt given 81mg ASA x2 and immediately transported to hospital.


VAERS ID: 920326 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Indiana  
Vaccinated:2020-12-29
Onset:2020-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Erythema, Hospice care, Localised oedema, Skin warm
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-01
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cetirizine, Lactaid
Current Illness: G30.1 Alzheimer''s disease with late onset (Primary) M19.90 Unspecified osteoarthritis, unspecified site J44.9 Chronic obstructive pulmonary disease, unspecified I95.1 Orthostatic hypotension J45.909 Unspecified asthma, uncomplicated R13.12 Dysphagia, oropharyngeal phase M15.0 Primary generalized (osteo)arthritis M85.80 Other specified disorders of bone density and structure, unspecified site Note: Osteopenia J30.9 Allergic rhinitis, unspecified F41.1 Generalized anxiety disorder M24.511 Contracture, right shoulder M24.512 Contracture, left shoulder M24.521 Contracture, right elbow R29.3 Abnormal posture M17.4 Other bilateral secondary osteoarthritis of knee M25.561 Pain in right knee R26.89 Other abnormalities of gait and mobility Z74.1 Need for assistance with personal care Z91.81 History of falling M62.81 Muscle weakness (generalized) R29.6 Repeated falls R27.8 Other lack of coordination R63.3 Feeding difficulties E73.8 Other lactose intolerance R53.1 Weakness I95.89 Other hypotension
Preexisting Conditions: G30.1 Alzheimer''s disease with late onset (Primary) M19.90 Unspecified osteoarthritis, unspecified site J44.9 Chronic obstructive pulmonary disease, unspecified I95.1 Orthostatic hypotension J45.909 Unspecified asthma, uncomplicated R13.12 Dysphagia, oropharyngeal phase M15.0 Primary generalized (osteo)arthritis M85.80 Other specified disorders of bone density and structure, unspecified site Note: Osteopenia J30.9 Allergic rhinitis, unspecified F41.1 Generalized anxiety disorder M24.511 Contracture, right shoulder M24.512 Contracture, left shoulder M24.521 Contracture, right elbow R29.3 Abnormal posture M17.4 Other bilateral secondary osteoarthritis of knee M25.561 Pain in right knee R26.89 Other abnormalities of gait and mobility Z74.1 Need for assistance with personal care Z91.81 History of falling M62.81 Muscle weakness (generalized) R29.6 Repeated falls R27.8 Other lack of coordination R63.3 Feeding difficulties E73.8 Other lactose intolerance R53.1 Weakness I95.89 Other hypotension
Allergies: Lactose
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Redness and warmth with edema to right side of neck and under chin. Resident was on Hospice services and expired on 1.1.21


VAERS ID: 920368 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Indiana  
Vaccinated:2020-12-29
Onset:2020-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood creatinine increased, Blood urea increased, Body temperature increased, Chest X-ray abnormal, Decreased appetite, Dyspnoea, Erythema, Full blood count, Hospice care, Influenza virus test negative, Lung infiltration, Metabolic function test, Respiratory rate increased, Vital functions abnormal, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-01
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Acetaminophen, Atenolol, Colace, Lisinopril, Mirtazapine, Omeprazole, Simvastatin, Vitamin D3
Current Illness: F03.90 Unspecified dementia without behavioral disturbance E78.5 Hyperlipidemia, unspecified K21.9 Gastro-esophageal reflux disease without esophagitis I10 Essential (primary) hypertension Z74.09 Other reduced mobility M62.81 Muscle weakness (generalized) R13.12 Dysphagia, oropharyngeal phase R26.81 Unsteadiness on feet R27.8 Other lack of coordination R41.841 Cognitive communication deficit R54 Age-related physical debility D53.9 Nutritional anemia, unspecified R29.6 Repeated falls M13.80 Other specified arthritis, unspecified site M25.512 Pain in left shoulder M19.012 Primary osteoarthritis, left shoulder K59.09 Other constipation R26.89 Other abnormalities of gait and mobility R63.8 Other symptoms and signs concerning food and fluid intake M85.89 Other specified disorders of bone density and structure, multiple sites Note: Osteopenia M24.512 Contracture, left shoulder J43.9 Emphysema, unspecified
Preexisting Conditions: U07.1 2019-nCoV acute respiratory disease (Primary) F03.90 Unspecified dementia without behavioral disturbance E78.5 Hyperlipidemia, unspecified K21.9 Gastro-esophageal reflux disease without esophagitis I10 Essential (primary) hypertension Z74.09 Other reduced mobility M62.81 Muscle weakness (generalized) R13.12 Dysphagia, oropharyngeal phase R26.81 Unsteadiness on feet R27.8 Other lack of coordination R41.841 Cognitive communication deficit R54 Age-related physical debility D53.9 Nutritional anemia, unspecified R29.6 Repeated falls M13.80 Other specified arthritis, unspecified site M25.512 Pain in left shoulder M19.012 Primary osteoarthritis, left shoulder K59.09 Other constipation R26.89 Other abnormalities of gait and mobility R63.8 Other symptoms and signs concerning food and fluid intake M85.89 Other specified disorders of bone density and structure, multiple sites Note: Osteopenia M24.512 Contracture, left shoulder J43.9 Emphysema, unspecified
Allergies: quinine sulfate
Diagnostic Lab Data: Influenza Swab: 12/30/20-Negative Results CBC: 12/30/20 showed WBC of 14.1 (H) CMP: 12/30/20 showed BUN: 113 (H); Creatinine 2.7 (H) CXR: 12/30/20 showed: Conclusion: A mild left lower lung infiltrate
CDC Split Type:

Write-up: 12/30/2020 07:02 AM Resident noted to have some redness in face and respiration were fast. Resident vital signs were abnormal except blood pressure. Temp at the time was 102.0 F taken temporal. Resident respirations were 22 labored at times. Pulse is 105 and pulse ox 94% on room air. Resident is made comfortable in bed. Notified triage of change in condition also made triage aware of resident receiving Covid vaccination yesterday morning. Resident appetite and fluid consumption has been poor for few days. 12/30/2020 07:32 AM Received order from agency to administer Acetaminophen 650mg suppos rectally due to resident not wanting to swallow anything including fluids, medications and food. This writer administered medication as NP ordered. Will monitor for effectiveness and adverse effects if any. 12/30/2020 08:41 AM Received new orders to obtain Flu swab, obtain CBC and BMP, and Chest Xray all to be obtained today. Notified family of resident having temperature and vital signs excluding b/p that was abnormal. Family was thankful for call and inierated to nurse that family does not want resident sent to hospital. Did educate family on benefits of Hospice services, but family persistant on continued daily care provided by nursing staff. Requests visits if decline continues. Family assured if resident continues to decline, facility will accomandate resident family to be able to be at bedside when time comes to do so. NP ordered IVF and IV Levaquin on 12/31/20. Family chose at that time to sign for Hospice services and not have resident provided with IVF or IV Antibiotics


VAERS ID: 920726 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2020-12-29
Onset:2020-12-31
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dysarthria, Electrocardiogram normal, Full blood count normal, Hypoaesthesia, Injection site rash, Lymphadenopathy, Magnetic resonance imaging brain normal, Magnetic resonance imaging neck, Platelet count normal, Troponin normal
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 12/31/20 MRI of brain, Carotid Artery CBC, Platelet panel, Troponin, EKG
CDC Split Type:

Write-up: 12/31/20 around 11am Numbness in right hand and right cheek, 5 minutes later, slurred speech. Episode lasted approximately 10 minutes. Treated in ER. Labs, MRI, all normal 1/3/21 Swollen lymph node to left axilla 1/4/21 Rash to injection site


VAERS ID: 920771 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Illinois  
Vaccinated:2020-12-29
Onset:2020-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20A / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tachycardia, resident was sent out to the hospital for evaluation on 12/30/2020 and came back to the facility on 12/31/2020.


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