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: 1636451
Sex: F
Age: 78
State: FL

Vax Date: 07/14/2021
Onset Date: 07/26/2021
Rec V Date: 08/26/2021
Hospital:

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

Lab Data: CXR, covid test

Allergies: NKA

Symptom List: Dysphagia, Epiglottitis

Symptoms: URI

Other Meds:

Current Illness:

ID: 1636452
Sex: F
Age: 46
State: MI

Vax Date: 02/05/2021
Onset Date: 02/13/2021
Rec V Date: 08/26/2021
Hospital:

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

Lab Data: none

Allergies: none

Symptom List: Anxiety, Dyspnoea

Symptoms: After the 1st dose of the vaccine, about 8 days later, I started having itchiness on my hands then it started spreading to my arms. I did take Benadryl and use cortisone cream which did not help. I consulted with my doctor who prescribed a round of oral steroid for 5 days. The steroids did help to resolve my rash and itchiness.

Other Meds: Singulair; Toprol; Valtrex; Flexeril; Protonix; Advair Inhaler, Dulera; Multivitamins

Current Illness: none

ID: 1636453
Sex: M
Age: 15
State: NH

Vax Date: 08/09/2021
Onset Date: 08/10/2021
Rec V Date: 08/26/2021
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: N/A

Allergies: No Known Allergies

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

Symptoms: Patient is here today for a bump on his left shoulder. He noticed it a few days after his first Covid vaccine (08/09/2021). It was a big bump but has decreased in size, was painful when moving his arm. Denies fevers and he does not have a fever in office. First vaccine received at beginning of month, due this week for # 2. Few days after tired and sore arm, otherwise well.

Other Meds: lisdexamfetamine (Vyvanse) 10 mg Capsule melatonin 5 mg Tablet

Current Illness: N/A

ID: 1636454
Sex: M
Age: 86
State: TN

Vax Date: 02/20/2021
Onset Date: 08/18/2021
Rec V Date: 08/26/2021
Hospital: Y

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

Lab Data: 8/15/2021 COVID-19SARSAgFIA = DETECTED

Allergies: NO KNOWN ALLERGERIES

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: 8/15/2021 SEEN AT MEDICAL CENTER ER. REPORTED DRY COUGH, FATIGUE. 8/18/2021 RETURNED TO MEDICAL CENTER ER. REPORTS FATIGUE, COUGH, MELAISE, POOR PO INTAKE PROGRESSIVE DYSPNEA.UNABLE TO CARE FOR HIS WIFE (PATIENT IS THE PRIMARY CARE GIVER) DUE TO HIS CURRENT ILLNESS. DX; PNEUMONIA. O2 SAT IN LOW 90s ON 3 L OF O2. PATIENT ADMITTED TO INPATIENT HOSPITAL ON 8/8/21. AS OF 8/26/21 PATIENT NOW ON BIPAP. STATUS POST REMDESIVIR, TREATMENT CONTI WITH DECADRON, BARICITINIB, LOVENOX, ROCEPHIN STATUS POST AZITHROMYCIN. PATIENT IS CURRENTLY HIGH RISK FOR DECOMPENSATION.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1636455
Sex: M
Age: 78
State:

Vax Date: 03/03/2021
Onset Date: 08/24/2021
Rec V Date: 08/26/2021
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:

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

Symptoms: He presented to the ED on 8/24/2021 for fever, nausea, diarrhea and weakness for the two to three days prior to admission. He lives alone at home and was unable to take care of himself, so was admitted to hospital on 8/24 for weakness. Fully vaccinated for COVID-19, no prior infections.

Other Meds:

Current Illness:

ID: 1636456
Sex: F
Age: 30
State: FL

Vax Date: 07/13/2021
Onset Date: 08/25/2021
Rec V Date: 08/26/2021
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: Chest X-ray

Allergies: Eggs augmentin

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

Symptoms: Infiltration of the lungs

Other Meds: Propanalol Lamicatal Omprazol Vitamin C Zinc

Current Illness: N/A

ID: 1636457
Sex: M
Age: 36
State: ND

Vax Date: 08/26/2021
Onset Date: 08/26/2021
Rec V Date: 08/26/2021
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: Had consented for a Moderna vaccine on the registration. Was given Pfizer vaccine. Patient was made aware of the mistake, Made aware of the VARES report. Visibly upset re: the mix up.

Other Meds: None

Current Illness: None

ID: 1636458
Sex: U
Age:
State: WI

Vax Date:
Onset Date:
Rec V Date: 08/26/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Patient received second dose of Pfizer and after about 5 minutes patient started to get very lightheaded/dizzy. She was helped to recliner chair where patient did pass out. BP was checked and was 52/30, pulse 79. She was visibly sweaty. Patient was provided O2 and ice pack to help cool her down. Patient was initially not able to answer questions but after a couple minutes was more aware. Security arrived to assist as well as EMT . Repeat bp readings were 97/48 after 10 minutes and then 103/76 after 20. Patient did not eat for 16 hours prior and feels this contributed to her reaction. EMT personnel did check patient out and patient declined transport to local ER. Patient left 45 minutes after vaccination.

Other Meds:

Current Illness:

ID: 1636459
Sex: F
Age: 29
State: KY

Vax Date: 08/24/2021
Onset Date: 08/24/2021
Rec V Date: 08/26/2021
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: Craning around abdomine, very weak. Headache. Loss of voice. Sore Throat

Other Meds: None

Current Illness: None

ID: 1636460
Sex: F
Age: 35
State: NC

Vax Date: 07/30/2021
Onset Date: 08/02/2021
Rec V Date: 08/26/2021
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: PCN

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient has experienced recurrent/more frequent migraines than ever experienced before post vaccination.

Other Meds: Pristiq 25 mg 1 PO QOD

Current Illness: N/A

ID: 1636461
Sex: F
Age: 28
State: FL

Vax Date: 03/14/2021
Onset Date: 07/26/2021
Rec V Date: 08/26/2021
Hospital:

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

Lab Data: CXR, covid test.

Allergies: Birth control

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

Symptoms: Body aches, fatigue, fever.

Other Meds:

Current Illness:

ID: 1636462
Sex: F
Age: 33
State: TX

Vax Date: 08/17/2021
Onset Date: 08/17/2021
Rec V Date: 08/26/2021
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: n/a

Symptom List: Rash, Urticaria

Symptoms: Dizziness everyday since injection

Other Meds: n/a

Current Illness: n/a

ID: 1636463
Sex: F
Age: 51
State: NJ

Vax Date: 02/06/2021
Onset Date: 02/12/2021
Rec V Date: 08/26/2021
Hospital:

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

Lab Data: breathing test- I was already treated by the time I had the test, so the test came out normal.

Allergies: penicillin; sulfa; tree nuts; asparagus; grass, tree, pollen; dust

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

Symptoms: After a week after my vaccination, 02/12/2021, I noticed I was wheezing. It had been about 10 to 15 years were I had an episode of asthma. This was going on for like a month. I was trying to treat myself, I took some steroids myself. What caught my attention, it was winter of all the season of the year, it's the time of season I feel my best. and I was thinking why am I wheezing in the winter. I went to see my allergist about a month later, on 02/27/2021. The doctor did not think the asthma was related to the vaccine. The doctor put me on a different asthma inhaler and a nasal inhaler. The nasal wasn't bothering me as much as the wheezing . It seemed to have resolved with the 2 inhalers he gave. I did a short course of oral steroid, Prednisone. I am a doctor and I have been double masking since May 2020, and this started like in February, and I wasn't sure if it was the mask, but I really don't think it had anything to do with it, neither did the doctor. My perception is I felt like I am reacting to everything, like the vaccine set off my immune system. All of my allergies just seem to have come back, since 15 years ago. My allergies were just reacting especially during a season, winter, they normally don't react.

Other Meds: Vitamin C

Current Illness: no

ID: 1636464
Sex: F
Age: 32
State: AR

Vax Date: 08/18/2021
Onset Date: 08/18/2021
Rec V Date: 08/26/2021
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: Unknown - follow up with primary care will occur on 9/1/21 for increased heart rate

Allergies: Tavist D Polyhistine D Amoxicillin Cipro Keflex Phenergain Nablecon E-mycin (erythromycin)

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

Symptoms: 1 hour after: feeling faint and dizzy, pain at injection site 4 hours after: previous symptoms with additional symptoms: fever (103.7), body aches, chills, horrible headache, fatigue, nausea, increased resting heart rate and non-resting heart rate (see below), Post-nasal drip, sore throat, congestion, ear ache, increased sweating All above symptoms lasted for 48 hours. After 48 hours fever and aches subsided , but increased feeling of being hot and increased heart rate continued. Sore throat and post nasal drip also continued. Still persisting today - 8/26/21 Heart rate - before receiving 2nd covid shot, resting heart rate was 40s - 50s bpm, now resting heart rate is in the 70s bpm. Heart rate is increasing to 120s from very simple activities, like walking across the yard. No history of heart conditions, very healthy, regularly exercise. 5?6? 115lbs Scheduling a follow up with primary care for increased heart rate on 9/1/21

Other Meds: Synthroid, pulmicort

Current Illness: None

ID: 1636465
Sex: F
Age: 59
State:

Vax Date: 08/21/2021
Onset Date: 08/23/2021
Rec V Date: 08/26/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient received a shingrix dose # 1 vaccine on Saturday 8/21/21 at around 3:00 pm using aseptic technique. She was asked and stayed 30 minutes after to monitor for anaphylaxis because of previous delayed onset arm swelling reaction to a vaccine. She called Tuesday & stated she had a quarter sized red area around the injection site on Monday morning & it increased to red swollen area about 3 inch by 5 inch on Tuesday. She said she iced it and used Benadryl which had prevoiusly helped her to a vaccine reaction in the past. She stated that she also felt nauseous & vomited after eating on Tuesday her stomach wasn't feeling good. It was recommended she follow up with her primary to which she stated she wasn't going to unless she got worse the next day. She had vaccine without reactions after last vaccine reaction & her provider to her it was ok to get her Shingrix vaccine. Her primary doctor office was contacted & informed of her reaction & asked if they would be ok for the patient to get a second dose of the vaccine in 2 to 6 months & they stated they would follow up with the patient & let us know.

Other Meds:

Current Illness:

ID: 1636466
Sex: M
Age: 46
State: FL

Vax Date: 03/13/2021
Onset Date: 08/24/2021
Rec V Date: 08/26/2021
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: PCR test came back positive on 8/24/21.

Allergies:

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

Symptoms: Patient presented to facility with chest pain radiating to left arm. Patient ruled out non-infectious.

Other Meds:

Current Illness:

ID: 1636467
Sex: F
Age: 52
State: PR

Vax Date: 08/25/2021
Onset Date: 08/25/2021
Rec V Date: 08/26/2021
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: Latex; Penicillin; Aspirin; Alcohol; Gluten,

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

Symptoms: Patient reports body itching and redness in face and hands. Allergic reaction was after 15 minutes approximately after the vaccine administration. She received BENADRYL by mouth and was sent to emergency department. We were communicated with patient and she reported she was treated with Solumedrol and BENADRYL by vein. Oxygen was given because her saturation was at SPO2% 92 she was there from 9:50am and approximately at 2 pm discharged.

Other Meds:

Current Illness:

ID: 1636468
Sex: M
Age: 22
State: UT

Vax Date: 08/16/2021
Onset Date: 08/23/2021
Rec V Date: 08/26/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: 1 Week after the shot patient started to have erythema (red and warm) at the injection site. This continued for a few days which alarmed patient who then called the pharmacy to report adverse event.

Other Meds:

Current Illness:

Date Died: 08/10/2021

ID: 1636469
Sex: M
Age: 66
State: WI

Vax Date: 08/10/2021
Onset Date: 08/10/2021
Rec V Date: 08/26/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Patient had heart attack and died at 10:15 PM following dose at 3:00 PM

Other Meds: UNKNOWN

Current Illness: Was scheduled for angioplasty following abnormal stress test. Angioplasty was denied until patient was vaccinated.

ID: 1636470
Sex: F
Age: 31
State: PR

Vax Date: 04/20/2021
Onset Date: 05/27/2021
Rec V Date: 08/26/2021
Hospital:

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

Lab Data: 3 pregnant tests, negative.

Allergies: n/a

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

Symptoms: My menstruation period did not arrive until July 25.

Other Meds: n/a

Current Illness: n/a

ID: 1636471
Sex: F
Age: 20
State: FL

Vax Date: 08/19/2021
Onset Date: 08/26/2021
Rec V Date: 08/26/2021
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: Red hot rash on vaccine injection site, no pain.

Other Meds:

Current Illness:

ID: 1636473
Sex: F
Age: 65
State: FL

Vax Date: 02/09/2021
Onset Date: 02/15/2021
Rec V Date: 08/26/2021
Hospital:

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

Lab Data: none

Allergies: Sulfa

Symptom List: Unevaluable event

Symptoms: I started to get hives on my arm and within a day or 2 it spread down both arms and onto my torso and eventually up ,my leg. It kept spreading. I went to my PCP and they gave me Medrol steroid dose packs. When it continued to spread. My PCP advised me to go to the dermatologist. She advised me it was a drug reaction and gave me a steroid injection which helped to stop the spreading. I used Caladryl gel topically to stop the itching. Overall my symptoms lasted 6 weeks. I had an COVID 19 antibody test completed. My Antibody test results indicated my numbers were much higher than other participants that had been tested. Specifically I tested at a 17 and most participants average around 6 or less with a positive result.

Other Meds: Levothyroxine-1xdaily; Metformin -1xdaily; Inderal-1xdaily; Otezla -1xdaily; Multi Vitamin-1xdaily; Calcium-1xdaily; Losartan- 1xdaily

Current Illness: none

ID: 1636474
Sex: F
Age: 28
State: FL

Vax Date: 08/25/2021
Onset Date: 08/25/2021
Rec V Date: 08/26/2021
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: None

Allergies: PCN

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

Symptoms: Patient reported getting first Moderna Shot prior to incarceration. She was given a shot of Moderna. When recording her shot it was found to be her first dose was Pfizer.

Other Meds: Zyrtec 10 mg every night

Current Illness: none

ID: 1636475
Sex: M
Age: 77
State: FL

Vax Date: 03/14/2021
Onset Date: 07/26/2021
Rec V Date: 08/26/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: CXR, covid test.

Allergies: NKA

Symptom List: Injection site pain, Pain

Symptoms: Nasal congestion, rhinorrhea, sore throat, myalgias.

Other Meds:

Current Illness:

ID: 1636476
Sex: F
Age: 0
State: MT

Vax Date: 03/20/2021
Onset Date: 08/23/2021
Rec V Date: 08/26/2021
Hospital:

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

Lab Data:

Allergies: NKDA, NKA

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient came in for catch up vaccine series and received ActHib. After administration it was noted that the vaccine had expired 10 days prior on 08/13/2021. This was not caught prior to administration. Family was informed of error and patient informed of s/s to watch for. Mother stated patient was doing fine and no adverse reactions noted on day of administration. Patient scheduled for repeat dose in near future.

Other Meds: None

Current Illness: None

ID: 1636477
Sex: F
Age: 42
State: MS

Vax Date: 07/15/2021
Onset Date: 07/15/2021
Rec V Date: 08/26/2021
Hospital:

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

Lab Data: Saw my gyno at my annual exam a few weeks ago. Waiting until 8 weeks after my shot to have my yearly mammogram. It is scheduled for Sept 17. Hoping the pain is gone by then.

Allergies: None

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

Symptoms: I had pain in the left arm for several days after first shot. Expected that. After the second shot I had the same pain but it spread into my left breast. The pain is worse this time, constant throughout the day and going into week 6 with no change. The arm pain has subsided but not the breast and under arm pain.

Other Meds: None

Current Illness: None

ID: 1636478
Sex: M
Age: 20
State: PA

Vax Date: 08/24/2021
Onset Date: 08/24/2021
Rec V Date: 08/26/2021
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: N/A

Allergies: no known allergies

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Vaccination administered and patient was observed after 15 minutes for reaction. After 6 minutes patient complained of headache and "feeling a little weird" to clinical support staff. He was observed for the 15 minutes and still reported feeling weird. He was observed for an additional 5 minutes and was asked again by clinical support staff how he was feeling and he reported he was the same. Patient was asked by clinical support staff if he wanted to stay a little longer for observation and he stated he was ok to go. He was instructed by clinical support staff to contact the office with any other complications.

Other Meds: none

Current Illness:

ID: 1636479
Sex: F
Age: 58
State: AL

Vax Date: 03/01/2021
Onset Date: 04/01/2021
Rec V Date: 08/26/2021
Hospital:

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

Lab Data: X-rays found stool back up

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Bowels closed I've to take lizzness daily to have a bowel movement. Stomach cramps and several pain Got to take Aleve or Tylenol daily

Other Meds: Vitamin D 2000 units Omeprazole Dr 40mg Atorvastatin 10mg Spironolactone 100mg

Current Illness: None

ID: 1636480
Sex: F
Age: 48
State: SC

Vax Date: 04/05/2021
Onset Date: 05/16/2021
Rec V Date: 08/26/2021
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: Change in monthly menstruation cycle. Periods are occurring more frequent, less than 28 days apart. This is not normal for my cycle.

Other Meds: Vitamin D, Losartan, Methimazole, Carvedilol

Current Illness: None

Date Died: 08/25/2021

ID: 1636482
Sex: F
Age: 78
State: TN

Vax Date: 03/01/2021
Onset Date: 08/18/2021
Rec V Date: 08/26/2021
Hospital:

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

Lab Data: COVID +, strep pneumonia +

Allergies: codeine, lisinopril, penicillin, iodine topical, vancomycin

Symptom List: Nausea

Symptoms: Admitted on 8/18/21 for hypoxia, COVID +, and was found to have heart failure exacerbation, UTI, COVID pneumonia. Worsening compensation transferred to ICU for hypoxia and max Vapotherm. pt. taking dexamethasone and remdesivir. Patient DNR/DNI . Not a candidate for monoclonal antibody due to strep pneumonia positive infection. Given supportive care with death on 8/25/21.

Other Meds:

Current Illness:

ID: 1636483
Sex: F
Age: 79
State: NY

Vax Date: 08/01/2021
Onset Date: 08/20/2021
Rec V Date: 08/26/2021
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: Injection site pain

Symptoms: bell's palsy

Other Meds:

Current Illness: none

ID: 1636484
Sex: M
Age: 69
State: WI

Vax Date: 04/01/2021
Onset Date: 08/13/2021
Rec V Date: 08/26/2021
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: Iodinated diagnostic agents, magnesium hydroxide, NSAIDS, Sodium Phosphate

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

Symptoms: Pt received both doses of the Moderna COVID-19 vaccine (on 3/5/2021 and 4/1/2021). Tested positive for COVID on 8/13/2021 Admitted to an outside hospital around 8/17/2021 with cough and shortness of breath, hypotension during dialysis. Found to have COVID pneumonia in that ER. Transferred to another Hospital on 8/20/2021 due to worsening oxygenation, afib, and RVR. Currently in ICU.

Other Meds: Albuterol inhaler, allopurinol, aspirin, clopidogrel, ezetimibefluticasone-umeclidin-vilant inhaler, multivitamin, insulin glargine, insulin regular, lactobacillus, levothyroxine, lutein, magnesium oxide, pantoprazole, pramipexole, predniso

Current Illness:

ID: 1636485
Sex: F
Age: 74
State: FL

Vax Date: 03/04/2021
Onset Date: 07/26/2021
Rec V Date: 08/26/2021
Hospital:

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

Lab Data: CXR, covid test

Allergies: NKA

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

Symptoms: Vomiting, abdominal pain.

Other Meds:

Current Illness:

ID: 1636486
Sex: M
Age: 15
State: AR

Vax Date: 07/21/2021
Onset Date: 07/21/2021
Rec V Date: 08/26/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: Patient received Moderna vaccine under the age of 18 years old. Patient states he had no adverse reactions.

Other Meds:

Current Illness:

ID: 1636487
Sex: F
Age: 31
State: AZ

Vax Date: 05/01/2021
Onset Date: 05/27/2021
Rec V Date: 08/26/2021
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: Topamax, vicodin

Symptom List: Erythema, Pruritus

Symptoms: Racing heart, flutter, palpitations, rash on neck and chest, fatigue for days, migraine, loss of appetite, blurred vision.

Other Meds: Met forming, metoprolol. Aspirin.

Current Illness:

ID: 1636488
Sex: M
Age: 51
State: FL

Vax Date: 03/15/2021
Onset Date: 07/27/2021
Rec V Date: 08/26/2021
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: CXR, covid test

Allergies: NKA

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

Symptoms: URI, dry cough, nasal congestion.

Other Meds:

Current Illness:

ID: 1636489
Sex: M
Age: 89
State: TX

Vax Date: 01/26/2021
Onset Date: 01/26/2021
Rec V Date: 08/26/2021
Hospital: Y

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

Lab Data:

Allergies: Penicillin.

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

Symptoms: Received the Moderna vaccination on 01/08/2021 & received the flu vaccine 18 days after. Suffered 3 seizures the night of receiving the flu vaccination, was hospitalized for 5 days.

Other Meds:

Current Illness:

ID: 1636490
Sex: F
Age: 40
State: VA

Vax Date: 07/10/2021
Onset Date: 07/19/2021
Rec V Date: 08/26/2021
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: apsirin

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: covid 19, injection swollen/red,

Other Meds:

Current Illness:

ID: 1636491
Sex: F
Age: 57
State: VA

Vax Date: 02/18/2021
Onset Date: 02/19/2021
Rec V Date: 08/26/2021
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: Morphine

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

Symptoms: 101.3 fever X 3 days, all flu symptoms- loose stool, nausea, swollen lips lasting several days at first (this symptom has reoccurred twice lasting a day both times), severe itching both shins and both nipples (yes, nipples!), psoriasis type burning rash on both elbows, both antecubital areas, both thumbs. The rash also comes in "flares" like the lip swelling.

Other Meds: 0.075 estrogen; transdermal patch, Vitamin D2; 1250mcg, Probiotic 40B, Multi vitamin

Current Illness: n/k

ID: 1636492
Sex: F
Age: 66
State: OH

Vax Date: 02/17/2021
Onset Date: 04/22/2021
Rec V Date: 08/26/2021
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: Doxycycline , Sumycin-tetracycline , Percocet, oxycodone ?acetaminophen, Omniceff, iodine with Cointreau

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

Symptoms: Posterior vitreous detachment left eye

Other Meds: Simvastatin 20 mg, solantra cream 1%, aspirin 81 mg, multivitamin women?s complete, citracal +D3

Current Illness:

ID: 1636493
Sex: M
Age: 34
State: TX

Vax Date: 03/24/2021
Onset Date: 04/01/2021
Rec V Date: 08/26/2021
Hospital:

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

Lab Data: Blood work for clots and lymph nodes came back normal. Further appointments scheduled

Allergies: Penicillin

Symptom List: Pain in extremity

Symptoms: Pain and swollen lymph nodes, several weeks later numbness and tingling in left side of body.

Other Meds: Multi-vitamin, fish oil

Current Illness:

ID: 1636494
Sex: M
Age: 16
State: NY

Vax Date: 08/25/2021
Onset Date: 08/26/2021
Rec V Date: 08/26/2021
Hospital:

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

Lab Data: NA

Allergies: Gluten

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

Symptoms: Pain at site - and swelling. Swelling to upper arm. Should not be a common side effect after vaccine. This is not normal. Very tender and painful. Tiredness. Was told to report back for eval. Outcome pending.

Other Meds: Clonidine 0.1mg hs Vyvanse 40mg qd Fish oil OTC qd

Current Illness: N/A

Date Died: 08/25/2021

ID: 1636496
Sex: M
Age: 73
State: TN

Vax Date: 04/09/2021
Onset Date: 08/13/2021
Rec V Date: 08/26/2021
Hospital: Y

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

Lab Data: 8/11/21: PATIENT COVID TESTING DONE AT PCP. 8/13/21 CHEST XRAY CONSIST WITH PNEUMONIA

Allergies: NO KNOWN ALLERGERIES

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

Symptoms: 8/11/201 PRESENTED TO ER REPORTED NAUEA, VOMITING AND DIARRHEA DX COVID POSITIVE. DISHCARGED HOME. 8/13/21 PRESENTED TO ER ADMITTED TO HOSPITAL IN PATIENT. BEGAN FEELING SHORT OF BREATH PROGRESSIVELY GETTING WORSE. DX COVID PNEUMONIA. ALSO REPORTED COUGH, DIFFUSE BODY ACHES, CHILLS. PLEURATIC CHEST PAIN, TIRED. REQUIREING O2. 15L. BY 8/17/21 NEW ONSET OF ATRIL FIB. NOTED. 8/18/21 REQUIRING 100% NON RE BREATHER. 8/23/21 100% /40L VIA VAPOTHERM. ICU LEVEL OF CARE. PATIENT INTUBATED ON 8/25/21. AFTER INTUBATION PATIENT WENT IN TO CARDIAC ARREST. 8/25/21 PATIENT DIED.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1636497
Sex: M
Age: 12
State: AR

Vax Date: 07/21/2021
Onset Date: 07/21/2021
Rec V Date: 08/26/2021
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 received Moderna vaccine under the age of 18 years old. Patient had no adverse reaction except for a sore arm.

Other Meds:

Current Illness:

ID: 1636498
Sex: M
Age: 64
State: VA

Vax Date: 03/24/2021
Onset Date: 08/25/2021
Rec V Date: 08/26/2021
Hospital:

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

Lab Data: COVID-19 rapid testing

Allergies: azithromycin: paroxysmal AF Victoza: nausea

Symptom List: Vomiting

Symptoms: Patient received his 2nd COVID-19 vaccine on 3/24/21 therefore was fully vaccinated. Patient was seen at clinic 8/25/21 for symptoms of COVID-19 and tested positive for COVID.

Other Meds: Coenzyme Q10 100 mg capsule MiraLax - powder for reconstitution EpiPen Auto-Injector 0.3 mg kit Vitamin D3 1000 intl units tablet Ventolin HFA CFC free 90 mcg/inh aerosol with adapter primidone 50 mg tablet Tamsulosin Hydrochlori

Current Illness: Diabetes mellitus I25.10 Coronary artery disease E29.1 Androgen deficiency G25.0 Essential tremor E78.9 Lipid disorder K21.9 Gastroesophageal reflux J45.20 Asthma, intermittent Z85.47 History of testicular cancer Z85.820 History of melanoma I86.8 Varicose veins N52.9 Erectile dysfunction Z91.038 Allergy to bee sting N40.1 Enlarged prostate with lower urinary tract symptoms M75.101 Unspecified rotator cuff tear or rupture of right shoulder, not specified as traumatic M75.100 Rotator cuff syndrome M47.22 Osteoarthritis of spine with radiculopathy, cervical region K59.00 Constipation

Date Died: 08/25/2021

ID: 1636499
Sex: M
Age: 56
State: TN

Vax Date: 07/23/2021
Onset Date: 08/05/2021
Rec V Date: 08/26/2021
Hospital:

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

Lab Data: Chest s-ray - patchy parenchymal airspace opacities

Allergies: NKA

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Present on 8/11 following 4-5 days of myalgias, fevers and fatigue. Received only 1 dose of cvocid vaccine. Admitted and started on antibiotics. COVID +. Given decadron and 5 day course of remdesivir. His stay was complicated by AKI and CKD. Respiratory status continued to decline and antibiotics broadened but continued to worsen.

Other Meds:

Current Illness:

ID: 1636501
Sex: M
Age: 65
State: PA

Vax Date: 03/11/2021
Onset Date: 08/10/2021
Rec V Date: 08/26/2021
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: I noticed a couple weeks ago that the injection site for my Moderna covid19 was sore to the touch. It also has a slight green bruise type color. I am not sure if there is any pain running down my left arm but there might be a slight pain to below the elbow.

Other Meds: Lamotrigine 200mg/day

Current Illness: None

ID: 1636502
Sex: F
Age: 33
State: OK

Vax Date: 08/25/2021
Onset Date: 08/25/2021
Rec V Date: 08/26/2021
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

Allergies: Erythromycin - Hives, PCN - Hives, Prozac - Pruritis, Spironolactone - Hives

Symptom List: Injection site swelling, Limb discomfort

Symptoms: tachycardia.

Other Meds: ceterizine 10mg 1 qd, cholecalciferol 125mcg qd, multivitamin, Low low estrin OCP

Current Illness: N/A

ID: 1636503
Sex: F
Age: 72
State: DE

Vax Date: 02/16/2021
Onset Date: 02/16/2021
Rec V Date: 08/26/2021
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: I experienced a fever, pain in arms and felt like I hit a brick wall.

Other Meds:

Current Illness: High blood pressure

ID: 1636504
Sex: F
Age: 36
State: IL

Vax Date: 08/09/2021
Onset Date: 08/10/2021
Rec V Date: 08/26/2021
Hospital:

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

Lab Data: I went for a doctors visit and was diagnosed with an upper respiratory infection. I was given Montelukast, Albuterol, Azythromycin and a steroid.

Allergies: Metoprolol Macrobid Reglan

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

Symptoms: The following day I began to have a very hard time breathing. It then got worse and I could not walk more than a few steps without having to sit down due to not being able to breathe along with chest pains. I am still having a hard time breathing. By Thursday I went to my doctor and he said that I had a severe upper respiratory infection.

Other Meds: Pantoprazole 40 mg Imitrex 50 mg

Current Illness: Sinus infection

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am