VAERS 2021 Database www.vaers.hhs.gov

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

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

COVID19 Lot Number

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

Incidents per State

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

ID: 1632965
Sex: F
Age: 38
State: WI

Vax Date: 10/14/2020
Onset Date: 10/14/2020
Rec V Date: 08/25/2021
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: fish, shell fish, metformin

Symptom List: Dysphagia, Epiglottitis

Symptoms: hives and rash on arm, neck and face. Scratchy throat. trouble breathing

Other Meds: duloxetine, cetirizine, albuterol

Current Illness: none

ID: 1632966
Sex: F
Age: 27
State: NE

Vax Date: 08/23/2021
Onset Date: 08/24/2021
Rec V Date: 08/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: N/A

Allergies: Gluten & Dairy

Symptom List: Anxiety, Dyspnoea

Symptoms: After about 24 hours after recieving the second shot, I noticed a rash forming on my arm. It?s now been 48 hours after the shot and the rash is growing larger. It itches and burns slightly, but not to the point where it is unbearable.

Other Meds: Prenatal Vitamin

Current Illness: None

ID: 1632967
Sex: M
Age: 60
State: GA

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

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: Patient is a 60 y.o.male with PMH DM2, HTN, dyslipidemia who presents to ED on 8/2/2021 for worsening SOB, weakness and dry cough at home. He reports fevers, chills and diarrhea. He initially came to the ED on 7/29/2021- he was not hypoxic so he was sent home. He then had worsening symptoms so returned. Rapid test positive int he ED 8/2/2021. CXR with progression of bilateral infiltrates. Admitted, provider consulted on 8/2/2021 for COVID PNA, acute resp failure, increasing O2 requirement. Hospital course: 8/2- admitted; Actemra. 8/3- Provider consulted, on heated high flow nasal cannula. 8/4- transfer to ICU status

Other Meds:

Current Illness:

ID: 1632968
Sex: F
Age: 87
State: CA

Vax Date: 08/24/2021
Onset Date: 08/24/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: N/A

Allergies: NKA

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient was fine in the morning her cognition was as normal was oriented to time place not date. 4 hours after Moderna booster was called by father in law. She could not feed herself nor open her mouth. This writer assessed her skin color normal BP Pulse rate and Respiratory rate all within normal limits. O2Sat was at 98% she was afebrile and did have output. Her eyes were glossy she had no memory of myself her son or her husband. She would answer a question with maybe 2-3 words which had nothing to do with question followed by word confabulation. such as "Did you IIIIZZZZTTTZZZ" always letters and no full sentances that made sense. this went on till 3 am. They were going to take her to her Physician today. (08/25/2021) Caregiver got her up at 10 am. dressed her put her in the wheelchair( she is non-ambulatory). She is normal. No odd speech.She can answer questions and is fully aware of her surroundings. It is amazing her come back! Please look into this. Thank You

Other Meds: Coumadin Lisinopril Metoprolol

Current Illness: Dementia Neuropathy Controlled Hypertension Hyperlipidemia

ID: 1632969
Sex: F
Age: 78
State:

Vax Date: 08/25/2021
Onset Date: 08/25/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: After administering the vaccine, we realized it had been approximately 17 hours since the vaccine was punctured. Moderna is good for 12 hours after being punctured.

Other Meds:

Current Illness:

ID: 1632970
Sex: M
Age: 72
State: AR

Vax Date: 08/20/2021
Onset Date: 08/20/2021
Rec V Date: 08/25/2021
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: Accidently gave Pfizer still of Moderna. Have spoken with patient no adverse reactions noted at this time.

Other Meds:

Current Illness:

ID: 1632971
Sex: M
Age: 36
State: CO

Vax Date: 08/16/2021
Onset Date: 08/18/2021
Rec V Date: 08/25/2021
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: no

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Persistent shortness of breath with exertion, requiring prescription of the Albuterol inhaler. Conservative outpatient treatment adequate for this case.

Other Meds: Meloxicam bid, Cetirizine qd, Fluticasone /inh qd

Current Illness: no

ID: 1632972
Sex: F
Age: 60
State:

Vax Date: 05/01/2019
Onset Date: 09/01/2019
Rec V Date: 08/25/2021
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: Two months after receiving my final dose of Shingrix, I began have shingles outbreak approximately every month. I now have chronic recurring shingles.

Other Meds:

Current Illness: none

ID: 1632973
Sex: F
Age: 66
State: IA

Vax Date: 08/24/2021
Onset Date: 08/24/2021
Rec V Date: 08/25/2021
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: No adverse event but vaccine was found to be expired. Vial removed from freezer on 7.20.2021 and expired on 8.20.2021. Dose given on 8.24.2021.

Other Meds:

Current Illness:

ID: 1632974
Sex: M
Age: 65
State: CA

Vax Date: 08/25/2021
Onset Date: 08/25/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: N/A

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: On 8/25/21, (Pharmacist) did a PFIZER COVID-19 vaccine for patient. She did NOT dilute the vaccine and gave the patient 6 doses of the un-diluted vaccine to the patient. The patient did not report any side effects from the vaccine. Pharmacist called the CDC and spoke with a co-worker who advised her to have patient monitor for any adverse events. We will follow up with patient later today and tomorrow to check on him.

Other Meds:

Current Illness:

ID: 1632975
Sex: F
Age: 57
State: VA

Vax Date: 07/09/2021
Onset Date: 07/11/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: Ultrasound, very enlarged lymph node

Allergies: Shellfish; penicillin; metformin

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

Symptoms: I had the usual malaise and fever the first couple of days after the second dose. My arm swelled up about 80% of my upper arm. It was visibly red and swollen. It moved out of the injection site, like 4 inches around. That resolved itself in about 7 to 10 days. I thought I was fine. It was ugly and concerning because of my immunocompromise condition. The doctors checked it 3 times. I thought everything was resolved. The redness went away. The swelling seem to be going away. 2 weeks after that I started having a very acute pain in my whole arm. I went to the doctor and they ordered an ultrasound. They found a very enlarged lymph node that was blocking the drainage. My oncologist said that should take 6-8 weeks to resolve. I am halfway through. They prescribed some tramadol and that was not very effective, so I did not use most of it. They suggested Voltaren gel, and that has provided some moderate relief. I am also using a TENS machine and it seems to be helping.

Other Meds: Trulicity; Jardiance; insulin; multivitamin; biotin; iron; vitamin D

Current Illness: None

ID: 1632976
Sex: F
Age: 48
State:

Vax Date: 02/10/2021
Onset Date: 01/14/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: none

Allergies: latex

Symptom List: Rash, Urticaria

Symptoms: I had really bad shoulder joint pain and went away, headache and took Tylenol. Second shot the whole side hurt, like I have fallen on the right. Mostly on my shoulder. arm and hip and leg whichever site I had the injection on. Blood pressure is higher.

Other Meds: lisinopril; multivitamin

Current Illness: Mid November 2020 - COVID

ID: 1632977
Sex: F
Age: 51
State: MN

Vax Date: 08/01/2021
Onset Date: 08/03/2021
Rec V Date: 08/25/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Patient presented to pharmacy stating they needed their 1st dose of Covid vaccine. Weeks after we gave the shot, we found out the patient had already received a J&J vaccine and 2 Pfizer vaccines at other facilities.

Other Meds:

Current Illness:

ID: 1632978
Sex: M
Age: 43
State: MI

Vax Date: 04/09/2021
Onset Date: 04/16/2021
Rec V Date: 08/25/2021
Hospital: Y

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: Pennicillians

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

Symptoms: Dizziness, light headed, intense spinning vertigo on May 4, 2021 about 25 days after injection. Ongoing vision and balance/vertigo issues. Ringing in both ears.

Other Meds: Claratin, Vit D, C, Multivitamin

Current Illness: None

ID: 1632979
Sex: F
Age: 67
State: WI

Vax Date: 07/22/2021
Onset Date: 07/23/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: None, my doctor feels it is not necessary. I did get an antibody test every time I gave blood and it showed antibodies.

Allergies: Lupron, Morphine, Flu shot due to egg allergy, Demerol, Celebrex, Tetanus when original, did ok with synthetic, oats, seasonal allergies, Horses, hay, Extreme vomiting from general anesethia. Bee stings

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

Symptoms: It began with a strong metal taste in my mouth, still hadn't gotten my smell and taste back from COVID. Still have that. Extreme fatigue, intense COVID headache which lasted over two weeks. The worst was it kicked in my Fibromyalgia, I had not suffered with it in nearly two years and this was a huge flare. It is getting better but the pain from Fibromyalgia is debilitating. I am a nurse and couldn't pump the cuff. Then I began having hot flashes, which I have not had in 15 years. The Fibromyalgia and hot flashes all came after I was given Lupron. Wondering if there are common ingredients? I was forced into getting this vaccine, I felt since I had COVID and less than a 3% chance of getting it again I should not have even gotten this vaccine. I will NOT get the second one, I cannot risk my health, too close to retirement and I want to enjoy it healthy!

Other Meds: Vitamin D 3, B complex

Current Illness: None

ID: 1632980
Sex: F
Age: 76
State: CA

Vax Date: 01/25/2021
Onset Date: 04/01/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: Initial EKG; Ecocardiogram; pulmonary test for sleep apnea; heart stress test. All inconclusive...noting mild sleep apnea.

Allergies: Codeine sensitive

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

Symptoms: Post Second shot ( 2-15-2021): Sore arm, tired, achy April 1/2021- AFIB first noticed. Saw doctor that day. EKG test. Later appointment with a cardiologist for other tests.: Heart palpitations/afib: Encounter for screening for cardiovascular disordersInconclusive results. Only 3-4 other very light afib events that went away in about an hour or two.

Other Meds: Gabapentin, Tylenol, vitamins

Current Illness: NONE

ID: 1632981
Sex: F
Age: 49
State:

Vax Date: 07/01/2021
Onset Date: 08/01/2021
Rec V Date: 08/25/2021
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: n/a

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

Symptoms: Menstruation cycle began early - on day 10 post vaccine - and lasted twice as long as normal. I have not had another period since; time will tell if I do. I've been very regular, historically.

Other Meds: n/a

Current Illness: n/a

ID: 1632982
Sex: F
Age: 33
State: AR

Vax Date: 08/17/2021
Onset Date: 08/22/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: CRP 46.6, Troponin <0.012, WBC 10.9, %NEUT 66.3, #NEUT 7.2, D-DIMER 462

Allergies: Keflex, PCN

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Pt presented to ER with c/o abd pain and cramping in the left upper quadrant. Occurred 3 days ago. Pt received her 1st Pfizer vaccine 8 days ago at an out of state location. During ER visit, pt's HR was elevated and increased greatly with any exertion up to 135-150s. ER physician is concerned for possible myocarditis and discharged the patient with a referral for an echocardiogram and cardiology appt referral.

Other Meds: Vitamin C oral, Vitamin D oral, Zinc oral, Quercetin oral

Current Illness:

ID: 1632983
Sex: F
Age: 48
State: CO

Vax Date: 07/29/2021
Onset Date: 08/16/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data:

Allergies: PCN, Keflex, Sulfa, Propranolol

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Urticaria throughout scalp, ears, neck; diffuse macular rash to upper and lower extremities Most severe for 48 hours, now over 2 weeks of continued intermittent symptoms

Other Meds:

Current Illness:

ID: 1632984
Sex: F
Age: 79
State: MD

Vax Date: 08/23/2021
Onset Date: 08/23/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: none

Allergies: cipro, scents, pollens, adhesive tape

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

Symptoms: disorientation, confusion, opening closets and drawers without reason, could not answer simple questions back to normal in 24 hrs

Other Meds: Anastrozole 1mg 1 in am Breast Cancer Metformin 750 mg ER 1 in pm Diabetes Type 2 Simvastatin 40 mg 1 in pm Cholesterol Bisoprolol Fumerate 5 mg 1 in pm Blood Pressure Aspirin 81 mg 1 in am Heart, Arteries Hydrochlorothiazide (HCTZ) 12.5 mg

Current Illness: none

ID: 1632985
Sex: M
Age: 43
State: IA

Vax Date: 08/24/2021
Onset Date: 08/24/2021
Rec V Date: 08/25/2021
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: No adverse event, but vaccine was found to be expired. Removed from freezer on 7.20.2021 expired on 8.20.2021 and given on 8.24.2021.

Other Meds:

Current Illness:

ID: 1632986
Sex: M
Age: 60
State:

Vax Date: 03/25/2021
Onset Date: 08/23/2021
Rec V Date: 08/25/2021
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: Breakthrough case. Covid positive on 8/23/2021 by PCR test

Other Meds:

Current Illness:

ID: 1632987
Sex: F
Age: 14
State: NY

Vax Date: 06/05/2021
Onset Date: 06/07/2021
Rec V Date: 08/25/2021
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: Went to see pediatrician on 08/25/2021. My daughter was prescribed oral contraceptives in am effort to regulate her cycle.

Allergies: None

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

Symptoms: My daughter began having irregular and unusually long menstruation beginning on 06/07/2021. Pediatrician recommended that I send an adverse reaction report. My daughter's menstrual cycles have been growing increasingly close together and the last one involved bleeding for an entire month.

Other Meds: Allegra once daily; Nature Made Kids Multivitamin with Omega-3

Current Illness: None

ID: 1632988
Sex: M
Age: 48
State: AZ

Vax Date: 03/13/2021
Onset Date: 08/25/2021
Rec V Date: 08/25/2021
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: N/A

Symptom List: Injection site pain, Pain

Symptoms: NONE STATED.

Other Meds: N/A

Current Illness: NONE

ID: 1632989
Sex: M
Age: 13
State: AR

Vax Date: 07/20/2021
Onset Date: 07/20/2021
Rec V Date: 08/25/2021
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: Patient received Moderna vaccine under the age of 18 years old. Patient had no adverse reactions except a sore arm.

Other Meds:

Current Illness:

ID: 1632990
Sex: F
Age: 33
State: MI

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

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

Lab Data: 8/24/21 pt went to hospital

Allergies:

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

Symptoms: -arm sore, next day traveled up to shoulder and neck, and pain down to center of back. also problems taking in a deep breath. -8/24/21, left arm still sore. went to ER. they did test to check for blood clots and some blood work, sent her home with antiinflamatory

Other Meds:

Current Illness:

ID: 1632991
Sex: M
Age: 62
State: IA

Vax Date: 08/24/2021
Onset Date: 08/24/2021
Rec V Date: 08/25/2021
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:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: No adverse event, but vaccine was found to be expired. Removed from freezer on 7.20.2021 expired on 8.20.2021 and given on 8.24.2021.

Other Meds:

Current Illness:

ID: 1632992
Sex: F
Age: 29
State: MS

Vax Date: 08/25/2021
Onset Date: 08/25/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: N/A

Allergies: cats, mosquito bites, flu vaccine, seasonal

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: I got the vaccine at around 13:52. I was fine at first, just a bit of soreness at the injection site. Then, I began to itch in my hands, then my feet. Then, I began to notice my hands get puffy and my chest begin to hurt a bit. My coworker looked at me and told me I had hives all over my face and in my scalp. They also began to appear on my hands. This was around 14:45. So, I took benadryl to offset the affects, but then I began to feel hot all over. So, I informed the individual that administered the shot and I ended up receiving Epinephrine via EpiPen. Question 23: I have had full body hives and occasional sore throat from various flu vaccines prior and do get hives from TB skin tests.

Other Meds: Zoloft, Flonase, Lamictal, melatonin, valerian

Current Illness: NA

ID: 1632993
Sex: F
Age: 16
State: NY

Vax Date: 08/25/2021
Onset Date: 08/25/2021
Rec V Date: 08/25/2021
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: Moderna vaccine given to 16 year old

Other Meds:

Current Illness:

ID: 1632994
Sex: F
Age: 88
State: KS

Vax Date: 01/20/2021
Onset Date: 08/23/2021
Rec V Date: 08/25/2021
Hospital: Y

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

Lab Data: COVID test was positive on 08/23/2021

Allergies: iodine, diltiazem

Symptom List: Nausea

Symptoms: COVID-19 breakthrough case, COVID test was positive on 08/23/2021

Other Meds:

Current Illness:

ID: 1632995
Sex: F
Age: 16
State:

Vax Date: 08/25/2021
Onset Date: 08/25/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Patient with history of syncope with blood draws experienced syncope within several seconds of dose 2. She recovered within seconds and was monitored for 30 minutes and demonstrated a return to baseline.

Other Meds:

Current Illness:

ID: 1632996
Sex: F
Age: 49
State: CA

Vax Date: 04/05/2021
Onset Date: 05/09/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: July 14th went to doctors

Allergies:

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

Symptoms: Thought I was allergic to something, broke out in a rash. Then it had bruising. Dr said it was Shingles

Other Meds: n/a

Current Illness:

ID: 1632997
Sex: M
Age: 2
State:

Vax Date: 08/20/2021
Onset Date: 08/20/2021
Rec V Date: 08/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: n/a

Allergies: N/A

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

Symptoms: Within the day of vaccination, area next to vaccine shot became read and hurt. The redness grew as big as a half dollar size and was hard, soar, and warm to touch. Child complained constantly that it hurt. it's been 5 days and redness has gone down but it's still a hard half dollar size and soar to the touch. Child has began itching it.

Other Meds: N/A

Current Illness: N/A

ID: 1632998
Sex: M
Age: 56
State: MI

Vax Date: 04/17/2021
Onset Date: 05/05/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: Haven't gone to doctor

Allergies: No

Symptom List: Tremor

Symptoms: Severe inflammation in hips, legs, ankles and feet

Other Meds: None

Current Illness: O

ID: 1632999
Sex: M
Age: 26
State: MS

Vax Date: 08/24/2021
Onset Date: 08/24/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: None

Allergies: Amoxicillin

Symptom List: Erythema, Pruritus

Symptoms: Patient reported numbness and tingling to the corner of the left side of his mouth approximately 45 minutes after vaccination given.

Other Meds: None

Current Illness: None

ID: 1633000
Sex: F
Age: 52
State: TN

Vax Date: 08/06/2021
Onset Date: 08/18/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: None. If rash continues will visit local clinic for further evaluation.

Allergies: No known allergies

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

Symptoms: Rash erupted on abdomen and chest area following first shot. Subsided with antihistamine and topical steroids. More extensive rash/hives erupted approximately 10 days following second shot that covers from pelvic/top of thigh area all the way to the chest area. Extensive break out of the abdomen and sides that covers to the lower back. Antihistamines and topical steroids used but the rash lasted longer and did not respond as well to OTC treatment.

Other Meds: None

Current Illness: None

ID: 1633001
Sex: F
Age:
State: WA

Vax Date:
Onset Date:
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: None

Allergies: Penicillin; sulphur drugs; ZithroMax; Demerol

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

Symptoms: About 1 AM the day following the second shot I woke with a fever, body aches and chills for about 5 hours. I developed mild hives about 8 AM that same day and they progressively worsened as the day wore on. I took one Benadryl about 1 PM and needed to retake one every four hours; the hives lasted four days. I called a call-in nurse on day 3; she told me that as the Benadryl was controlling it to wait until day 5 and if I did not see improvement, to schedule a doctor?s appointment. By day four I was able to go 6-8 hours before needing Benadryl; the hives receded on day 5 and I did not need Benadryl any longer. I was able to control the hives with one 25 mg. tablet.

Other Meds: Advair; calcium; magnesium; Vitamin D; Vitamin K; Strontium II

Current Illness: None

ID: 1633002
Sex: F
Age: 44
State: CA

Vax Date: 04/12/2021
Onset Date: 05/01/2021
Rec V Date: 08/25/2021
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

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Flare up of my arthritis started 2-3 weeks after my second vaccine shot. Then two-three months after that I started experiencing nerve pain/neuropathy in my right arm. I have never experienced nerve pain as part of my chronic disease.

Other Meds: Celebrex Enbrel Vitamin D Multivitamin

Current Illness:

ID: 1633003
Sex: F
Age: 64
State: TX

Vax Date: 08/20/2021
Onset Date: 08/20/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: none

Allergies: sulfa, latex

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

Symptoms: 8/20: 6 hours after injection began feeling sluggish with mild headache; afebrile ; left arm exquisitely tender 8/21: 12 hrs after injection (5:30am) full blown and extensive myalgias & arthralgias, headache, and fever up to 101.5; by 6pm I could no longer tolerate the aches/pains and took acetaminophen 1g po - repeated again at 10:30pm. 8/22: much improved, but extreme fatigue, febrile @ 100.0, down to 99.0 by bedtime; arm tender only to direct contact 8/23-25: residual fatigue, afebrile

Other Meds: Plaquenil 200mg 3x/wk Citalopram 10mg/d Estradiol Prometrium 100mg/d Gabapentin 100mg BID Levothyroxine 112mcg/d

Current Illness: none

ID: 1633004
Sex: F
Age: 38
State: CA

Vax Date: 08/18/2021
Onset Date: 08/22/2021
Rec V Date: 08/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Pain and soreness within one hour after shot. On day 5 I developed rash and itching.

Other Meds: None

Current Illness: No

ID: 1633005
Sex: F
Age: 15
State:

Vax Date: 08/16/2021
Onset Date: 08/16/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data:

Allergies: Nka

Symptom List: Pain in extremity

Symptoms: Patient fainted in passenger seat of car within seconds of vaccine. She recovered to baseline slowly over 30 minutes and improved markedly with snacks. She reports not having eaten lunch.

Other Meds:

Current Illness:

ID: 1633006
Sex: F
Age: 38
State: OH

Vax Date: 05/14/2021
Onset Date: 06/01/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: None

Allergies: PCN

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

Symptoms: My hair rapidly fell out in June and July following my vaccines. It is so bad I am wearing a wig now. I never wore a wig before the vaccines.

Other Meds: Sugar Bear Hair, multi-vitamin, Lamictal, Lexapro, Amlodipine, Hydrochlorothiazide, Metorprolol, Metformin, Allopurinol, Trazadone, Atorvastatin

Current Illness: None

ID: 1633007
Sex: F
Age: 27
State: CA

Vax Date: 08/25/2021
Onset Date: 08/25/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: none

Allergies: none

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

Symptoms: Syncope

Other Meds: n/a

Current Illness: none

ID: 1633008
Sex: M
Age: 59
State: CA

Vax Date: 08/23/2021
Onset Date: 08/24/2021
Rec V Date: 08/25/2021
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: Latex Codeine

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

Symptoms: Patient stated that she has hives on her arm. Patient stated that she is allergic to latex and they put a band aid on her arm and the provider stated that the band aid was latex free. The hives are very itchy and red.

Other Meds:

Current Illness:

ID: 1633009
Sex: F
Age: 35
State: MA

Vax Date: 01/28/2021
Onset Date: 02/08/2021
Rec V Date: 08/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: Biopsy

Allergies: None

Symptom List: Vomiting

Symptoms: 10 days after the vaccine, I developed a very large rash on the back of my right shoulder and rash on the calf of my right leg. The rash was red, very itchy and in a circular pattern. I did take Benadryl cream which did not help at all. I did go see a dermatologist and I was prescribed a steroid cream (triamcinolone) which did not improve the rash. I was also getting more spotty rashes on legs, back of arms and back of shoulders. I went back to the dermatologist who took a biopsy of one of the spotty rash. The biopsy results found that it was a reaction to a medication. I was still having severe itching and made an appointment with an specialist/allergist on 3/17/2021. The allergist felt very strongly that it was a reaction to the vaccine. I was prescribed a stronger steroid cream (Clobetasol) twice a day, Claritin pills 4 times a day for 1 month, which resolved my rash. I had this rash for 3 months and after seeing the allergist and doing a second round of medications, the rash has resolved.

Other Meds: Levothyroxine

Current Illness: None

ID: 1633010
Sex: M
Age: 56
State: MN

Vax Date: 08/25/2021
Onset Date: 08/25/2021
Rec V Date: 08/25/2021
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: Gave a dose of air to patient instead of the actual vaccine, we did correct our mistake and ended up giving the pt the correct Covid vaccine the same day and time.

Other Meds:

Current Illness:

ID: 1633011
Sex: M
Age: 14
State: IA

Vax Date: 08/20/2021
Onset Date: 08/20/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: None.

Allergies: None

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

Symptoms: Patient's sister came in and had already been given the Moderna at age 17 from another facility. We had to give sister Moderna #2 even thought she was 17. It was explained to mom that the vaccine Moderna is for ages 18 and older. Mom wanted patient to receive vaccine since sister did. This was okayed by the doctor, and patient's PCP and his nurse were also made aware. Patient had no adverse effects.

Other Meds: None

Current Illness: None

ID: 1633012
Sex: F
Age: 39
State: TN

Vax Date: 02/24/2021
Onset Date: 03/01/2021
Rec V Date: 08/25/2021
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: N/A the doctor just said what I am I supposed to do. She scheduled blood work I was so disappointed that she didn't care or want to help I haven't been back since. No one will help I've continued to reach out to medical professionals online who can't help me either.

Allergies: Yes, I have allergies to some medications

Symptom List: Injection site swelling, Limb discomfort

Symptoms: I now have magnetism in my body after receiving my Pfizer Covid 19 Vaccines. It started around the injection site and over time it has spread to the top half of my body. I have reached out to people all over the country only to get no answers as to why this is happening to me and several other around the world. I am not the only one. There are videos all over the internet and no one can give me answers. My doctor thought it was bizarre but did nothing to help me. I know several other people with this side effect. It started where I got my shot. Now It has spread to my entire upper body and I contacted Pfizer months ago and the gave me report number #UFAJH6E5. I called back to update my case and no one knew nothing about what to do with the report number. I contacted vares months ago and just received a callback today from a lady. The magnets hurt a bit and throb when you put the on your body. So many people are experiencing this. I have been shocked that this has not been more widespread on t.v. Please look it up and watch the videos. I'm not a I'm a mother that's scared about this. The batteries I held to my body caused a weird pain. It is odd I know ... But I'm not the only one. Please help me understand why this is spreading through our bodies.

Other Meds: N/A

Current Illness: Stomach Disease, Celiac Disease

ID: 1633013
Sex: M
Age: 70
State: FL

Vax Date: 01/31/2021
Onset Date: 02/14/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: Brain MRI, endoscopy, blood work, etc all available but it was all clear.

Allergies: Demerol. Lectin in red kidney beans.

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

Symptoms: I was fine for 7-10 days after the jab. No reactions other than minor soreness. Then the digestive and neurological conditions emerged. Never had anything like them previously. PLEASE NOTE: I am not claiming that the second vaccine caused either or both of these conditions. I'm ask if you have received similar incident reports.

Other Meds: None.

Current Illness: dry cough and acidic stomach from eating chili (red kidney beans) that I had not sufficiently washed.

ID: 1633014
Sex: F
Age: 55
State: KY

Vax Date: 04/01/2021
Onset Date: 08/21/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: Quidel Antigen

Allergies:

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

Symptoms: Covid 10 positive 8/22/21 with 8/21/21 onset

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am