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: 1636665
Sex: F
Age: 35
State: OH

Vax Date: 08/12/2021
Onset Date: 08/16/2021
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: none

Allergies: none

Symptom List: Dysphagia, Epiglottitis

Symptoms: Light headed daily that lasts for hours at a time.

Other Meds: none

Current Illness: none

ID: 1636666
Sex: F
Age: 69
State: OR

Vax Date: 04/08/2021
Onset Date: 04/09/2021
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: CT Scan result- Edema Upper and lower GI- no problems

Allergies: Codene

Symptom List: Anxiety, Dyspnoea

Symptoms: No appetite Nausea Vomiting Edema in abdomen Weight loss

Other Meds: Metformin Toujeo Primidone Citalipram Hydrbromide Losartan Potassium Actos

Current Illness: None

ID: 1636667
Sex: F
Age: 61
State: NC

Vax Date: 08/26/2021
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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: N/A

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

Symptoms: THE VACCINATION STATE REGISTRY WAS ON A GLITCH WHEN I SPOKE WITH THE PATIENT ABOUT THIS SHOT - SHE SAID SHE RECEIVED A SHINGLES SHOT 7 YEARS AGO, SO WE WENT AHEAD AND DID THE SHINGRIX TODAY BECAUSE SHINGRIX CAME OUT ABOUT 4 YEARS AGO. AFTER I WAS ABLE TO GET BACK INTO THE REGISTRY I DISCOVERED THE PATIENT ALREADY COMPLETED THE SHINGRIX SERIES PREVIOUSLY.

Other Meds: N/A

Current Illness: N/A

ID: 1636668
Sex: F
Age: 53
State: ME

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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data: N/ ? ,I couldn?t drive myself to the hospital ,I wasn?t in condition to do so

Allergies: N/a

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: 1 hour after vaccination my skin turned red and itchy, my whole body was itching ,then around 10 pm I start having severe headache I vomit 2 times ,then the chills and earache started ,had fever of 101F chills continued till 8 am next morning now my throat is sore and my ears hurts ..I never been sick like this in my life ,passed out 2 times ..now about 24 hours later I still have severe headache ,earaches and start coughing

Other Meds: N/a

Current Illness: Battling kidney stones ,was just in ER last week ,but due to mandate our Gov place in I had no choice but get vaccinated while suffering with kidney issues ?I did discuss with my PCP possibility to delay vaccination ,she stated I will be ok ?easy said when she isn?t the one in pain

ID: 1636669
Sex: F
Age: 61
State: WI

Vax Date: 08/04/2021
Onset Date: 08/04/2021
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 Did not seek medical attention

Allergies: None known

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

Symptoms: s/s onset approx at 5pm on 08/04/2021 described as very tired "I needed a nap". Upon waking at 6:30pm described "excruitiating pain Lt arm which did lessen over next 3 days". She reports fatigue could be due to recent stress: spouse died, recent move/ relocation (packing & unpacking etc.), baby kitten requiring a lot of care.

Other Meds: Unknown

Current Illness: No

ID: 1636670
Sex: M
Age: 78
State: MI

Vax Date: 03/26/2021
Onset Date: 08/17/2021
Rec V Date: 08/26/2021
Hospital: Y

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: Avelox

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

Symptoms: Admitted 8/23 InPatient Hospital with Shortness of Breath and Diarreah at hospital. Pt still hospitalized three days now

Other Meds: Unknown

Current Illness: Unknown

ID: 1636672
Sex: F
Age: 65
State: AR

Vax Date: 07/26/2021
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: LA

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: vaccine used past the 12 hour window of use after vial punctured. Stored in fridge entire time and cleaned between each use with alcohol. Pt contacted and no adverse reaction, pt states no problems

Other Meds:

Current Illness:

ID: 1636673
Sex: M
Age: 15
State: WA

Vax Date: 04/02/2021
Onset Date: 04/02/2021
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:

Symptom List: Pharyngeal swelling

Symptoms: PATIENT 15 AT TIME OF IMMUNIZATION WHEN EUA FOR 16 AND OLDER

Other Meds:

Current Illness:

ID: 1636674
Sex: M
Age: 32
State: PA

Vax Date: 04/08/2021
Onset Date: 05/01/2021
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:

Allergies: Shell fish allergy

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Developed severe allergies that lasted more than a week. Constant running of the nose and sneezing all day long.

Other Meds: None

Current Illness: None

Date Died: 08/24/2021

ID: 1636675
Sex: F
Age: 66
State: IL

Vax Date: 07/14/2021
Onset Date: 08/24/2021
Rec V Date: 08/26/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient was admitted to Medical Center on 8/11/21 in respiratory distress. Patient expired on 8/24/21 vaccine dates were 1st dose Pfizer vaccine on 7/14/21 2nd dose 8/4/21.

Other Meds:

Current Illness:

ID: 1636676
Sex: F
Age: 66
State: CA

Vax Date: 02/15/2021
Onset Date: 03/29/2021
Rec V Date: 08/26/2021
Hospital: Y

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

Lab Data: March 30, 2021 Flu & Covid PCR, CT, urinalysis, AST, BUN, CBC, Creatinine, electrolytes, glucose, liver function, lipase, white blood differential

Allergies: Sulfa drugs

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

Symptoms: Was sick day after 2nd vaccine for about 24 hours (regular, to be expected). Then had appendicitis 42 days later and ended up with appendectomy the next day

Other Meds: None

Current Illness: none

ID: 1636677
Sex: M
Age: 21
State: WA

Vax Date: 08/20/2021
Onset Date: 08/21/2021
Rec V Date: 08/26/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Rash, Urticaria

Symptoms: Continuong after 1 week: Massive swelling of left side of body, liquid build up of left side of body, muscle fatigue, fever, chills, excessive sweating, head pain, diminished mental capacity, limited muscle capacity

Other Meds: None

Current Illness: None

ID: 1636678
Sex: F
Age: 45
State: PA

Vax Date: 08/23/2021
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: None

Allergies: No known allergies

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

Symptoms: Lightheadedness, shakiness, sweating upon onset of symptoms; elevated BP; nausea, headache, body aches throughout the day, low grade temperature in evening; onset of sore throat in pm & next am with worsening headache & continued body aches throughout the next day.

Other Meds: claritin, omeprazole, vitamin C, multi-vitamin

Current Illness: None

ID: 1636679
Sex: M
Age: 83
State: MN

Vax Date: 02/19/2021
Onset Date: 02/19/2021
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: No

Allergies: Lipitor

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

Symptoms: I had chills, fever and vomiting all night long. It only last for about 8 hrs. They had to increase my blood pressure meds to bring my blood pressure down after all that.

Other Meds: Lovin; Lysine; Metoprolol; Losartan; Amlodipine; Finasteride; Aspirin; Rosuvastatin; Tamsin

Current Illness: No

ID: 1636680
Sex: M
Age: 55
State: WA

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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Red Apple, Red Grapes

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

Symptoms: Monderna COVID Vaccine was drawn on 08/24/21 @ 12:41pm and was given outside the 12 hour period recommended by manufacture. Vaccine was given on 08/25/21 @ 2:40.

Other Meds:

Current Illness:

ID: 1636681
Sex: F
Age: 58
State: MS

Vax Date: 08/02/2021
Onset Date: 08/03/2021
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: AZITHROMYCIN, DICYCLOMINE, CODEINE, MORPHINE

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

Symptoms: STARTED ON 08/03/21 - 1 DAY POST VACCINATION - EARS RINGING, HEADACHE FROM FRONT HAIRLINE TO BACK OF NECK, PAIN IN SHOULDER BLADE, FOGGY, ANXIOUS. TYLENOL NOT HELPING. 08/25/21 - CHRONIC EARS RINGING AND HEADACHE. PATIENT TOLD TO CALL COVID HOTLINE. I TOLD HER TO SEE A DR OR NP ON 8/25/2021. I CALLED AT 11:30 AM 8/26/21 - PATIENT DID NOT SEE NP/DR. SHE IS FEELING BETTER TODAY.

Other Meds: FLUTICASONE NASAL SPRAY, AUGMENTIN 875 MG, XANAX, B-12 SHOT RECENTLY, CLARITIN-D.

Current Illness: SINUS INFECTION, ALLERGIES, POSSIBLE AUTO-IMMUNE SYNDROME

ID: 1636682
Sex: F
Age: 41
State: AR

Vax Date: 06/15/2021
Onset Date: 06/15/2021
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:

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

Symptoms: vaccine used past the 12 hour window of use after vial punctured. Stored in fridge entire time and cleaned between each use with alcohol. second dose given 7/14/21 also given past 12 hour window, vaccine same lot number but different vials. Pt contacted and no adverse reaction, pt states no problems

Other Meds:

Current Illness:

ID: 1636683
Sex: F
Age: 41
State: NY

Vax Date: 07/01/2021
Onset Date: 08/01/2021
Rec V Date: 08/26/2021
Hospital: Y

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

Lab Data:

Allergies: none

Symptom List: Ear pain, Hypoaesthesia

Symptoms: massive Pulmonary embolism leading to cardiac arrest and respiratory failure

Other Meds: none

Current Illness:

ID: 1636684
Sex: F
Age: 46
State: MN

Vax Date: 07/27/2021
Onset Date: 07/27/2021
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: none

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Patient came in to get 2nd dose of Moderna and said her first dose caused her arm to swell up big and red. She said it went up almost into her armpit area. She said it didn't hurt any more than a tetanus shot. It lasted about a week, but the swelling did show up on her mammogram she had about a week after her first shot.

Other Meds: lisinopril

Current Illness:

ID: 1636685
Sex: M
Age: 74
State: MI

Vax Date: 05/21/2021
Onset Date: 08/21/2021
Rec V Date: 08/26/2021
Hospital: Y

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

Lab Data: COVID 19 positive on 8/21/21.

Allergies:

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

Symptoms: Patient admitted to hospital on 8/21/21 for pneumonia due to COVID-19 virus. Patient had received 2 Moderna vaccines, on 4/17/21 and 5/21/21.

Other Meds:

Current Illness:

ID: 1636686
Sex: M
Age: 70
State: CA

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: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: none

Allergies: Unknown

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

Symptoms: Administration error, lot had expired one day prior on 8-24-2021.

Other Meds: Unknown

Current Illness: Unknown

ID: 1636688
Sex: F
Age: 49
State: AL

Vax Date: 02/01/2021
Onset Date: 02/19/2021
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 yet

Allergies: pennicillin methimazole

Symptom List: Unevaluable event

Symptoms: Rapid Heart Rate - still on going Fever Chills Headache Muscle Pain Leg Pain

Other Meds: tirosint zetia xopenex

Current Illness: Thyroid- Hypothyroidism, Graves Disease Asthma (history of lung collapse)

ID: 1636689
Sex: F
Age: 19
State: OH

Vax Date: 08/23/2021
Onset Date: 08/23/2021
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:

Allergies:

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

Symptoms: PATIENT REPORTED RASH AT INJECTION SITE 8/25/21. PATIENT REPORT LOW GRADE FEVER 8/24/21 ONLY. NO ITCHING OR SPREADING.

Other Meds:

Current Illness:

ID: 1636690
Sex: F
Age: 57
State:

Vax Date: 08/19/2021
Onset Date: 08/19/2021
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:

Allergies: Enviromental

Symptom List: Injection site pain, Pain

Symptoms: Feeling fatigued, drained, tired Pain in right side of back, and pain behind both knees, as if vaccine triggered an adverse arthritic reaction Tickle in throat Soreness in roof of my mouth Difficulty sleeping

Other Meds: Vitamin C Elderberry

Current Illness:

ID: 1636691
Sex: F
Age: 26
State: WI

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

Allergies: No

Symptom List: Injection site pain, Menorrhagia

Symptoms: Chills, fever, headache, extremely sore arm that?s hurts to even move

Other Meds: Ritalin

Current Illness: No

ID: 1636692
Sex: F
Age: 46
State: AR

Vax Date: 08/02/2021
Onset Date: 08/02/2021
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:

Allergies:

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

Symptoms: vaccine used past the 12 hour window of use after vial punctured. Stored in fridge entire time and cleaned between each use with alcohol. Pt contacted and no adverse reaction, pt states no problems

Other Meds:

Current Illness:

Date Died: 08/26/2021

ID: 1636693
Sex: M
Age: 83
State: IN

Vax Date: 04/10/2021
Onset Date: 08/18/2021
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:

Allergies: ASPIRIN

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: double PE

Other Meds:

Current Illness:

ID: 1636694
Sex: F
Age: 54
State: FL

Vax Date: 04/15/2021
Onset Date: 04/16/2021
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: My Dr prescribe .50 milligrams of the atenolol whig I take when it is spiking. was on antibiotic for kidney infection.

Allergies: Codine

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: On the day of the shop my face became numb on the left side. By the next morning my ankles were swelling and my blood pressure was excessively high. I had a pain in my lower back by the 4th day. It has been about 5 months and I am still having spikes in my blood pressure and just had a terrible kidney infection.

Other Meds: Attenlol .25 millagrams 1 time a day. for blood pressure

Current Illness: None

ID: 1636695
Sex: F
Age: 68
State: IN

Vax Date: 07/08/2021
Onset Date: 08/17/2021
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: Dilaudid and morphine- shortness of breath and dizziness; Darvon- shortness of breath; Celebrex- ulcers and esophagitis; Cymbalta- ulcers and esophagitis; Prestique- ulcers and esophagitis; Metals; bandaids- glue on them; flu vaccine

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

Symptoms: I started having headache right after I received the second shot that weren't real bad so dealt with them. Later that week they turned to migraines. So I went to urgent care and was told it was sinusitis they were extremely inflamed and gave me amoxicillin 75mg 2x daily and sad that will help, I still have the headaches.

Other Meds: Allegra 180mg daily; gabapentin 600mg 1tab 3x daily; hydroxychloroquine 200mg daily; losartan 50mg daily; tizanidine 4mg daily; nortriptyline 10mg daily; omeprazole 40mg daily; orencia 250mg IV once a month at a clinic; hydrocodone 10mg/3.

Current Illness: no

ID: 1636696
Sex: M
Age: 58
State: KS

Vax Date: 08/09/2021
Onset Date: 08/11/2021
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: Pain medicine makes me anxious and depressed but that is not an allergy. I do have seasonal allergies that are normal and under control with zyrtec.

Symptom List: Nausea

Symptoms: I broke out in hives all through my sweat areas and my eyes. I thought it was poison ivy first and my doctor gave me an allergy shot on the afternoon of 8-12-21. 24 hours later everything flamed back up much worse and the early morning 1:00 AM of 8-14-21 I had to go to the emergency room. The doctor there gave me IV fluids and something the knocked me out for 12 hours along with prednisone. This calmed everything down to a scratching situation. She also advised me talk to the doctor before I took another vaccine shot. today is the 26th of August and I still have hives but they stay manageable with Zyrtec and Binadril.

Other Meds: blood pressure - statin for cholesterol - Prostate medicine

Current Illness: none

ID: 1636697
Sex: F
Age: 65
State: FL

Vax Date: 08/10/2021
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: UNK
Vax Route: IM
Vax Site: LA

Lab Data: POSITIVE COVID TEST 08/18/2021 @ 1928

Allergies: PENICILLIN, SINGULAIR, SULFA DRUGS

Symptom List: Injection site pain

Symptoms: cardiac arrest - cpr in progress. COVID POSITIVE

Other Meds: TRAZODONE, LISINOPRIL, LEVOTHYROXINE, ATORVASTATIN, ASPIRIN

Current Illness:

ID: 1636698
Sex: F
Age: 53
State: OK

Vax Date: 08/20/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data: EMERGENCY ROOM: 8/23/21 - CHEST XRAY, 3 EKG'S, BLOOD WORK

Allergies: none

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

Symptoms: THE SAME DAY I RECEIVED THE SECOND DOSE I STARTED TO HAVE INTERMITTENT TACHYCARDIA PULSE RATE SHOOTS UP ANYWHERE FROM 110 TO 140 WHILE AT REST. DOING NOTHING AND MY HEART STARTS TO SPEED UP AND SORT OF POUND. I ALSO HAD SOME OCCASIONAL CHEST PAINS WHICH WERE LIKE A SQUEEZING CRAMP IN THE UPPER MIDDLE OF MY CHEST THAT CAME AND WENT THROUGHOUT THE DAY X 3 DAYS. THAT RESOLVED BUT THE TACHYCARDIA HAS NOT STOPPED. IT EVEN HAPPENS WHILE I AM SLEEPING AND WAKES ME UP. I HAVE ZERO HEALTH ISSUES AND HAVE NEVER HAD THIS HAPPEN BEFORE.

Other Meds: Wellbutrin daily Vitaman D3

Current Illness: no illnesses whatsoever

ID: 1636699
Sex: M
Age: 15
State: WA

Vax Date: 04/26/2021
Onset Date: 04/26/2021
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:

Allergies:

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

Symptoms: PATIENT 15 AT TIME OF IMMUNIZATION - EUA FOR 16 AND OLDER

Other Meds:

Current Illness:

ID: 1636700
Sex: M
Age: 13
State: IL

Vax Date: 08/18/2021
Onset Date: 08/19/2021
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: Strep throat swab came back negative

Allergies: none

Symptom List: Tremor

Symptoms: Before giving him his first dose of the Pfizer vaccine, I informed the pharmacist that Pt has had a cough for about a week prior. They told me it was ok to give him the shot. Approximately 12 hrs after receiving the shot, he got a fever which got up to 104, body aches, sore arm, tired, and chills. It only lasted for 24 hours but his cough got worse. I took him to his dr. on July 29, 2021, He had a lung infection and was put on a 10 day course of antibiotics. His cough subsided but did not go away. His 2nd dose was given on August 18, 2021. He still had a lingering cough. Approximately 8 hours after getting the 2nd dose is when the symptoms started. He had a fever of 102, body aches, chills are tired. His cough got worse. August 20, 2021 I took him to his doctor for a check up. She ordered an X-ray. X-ray came back showing he had some air pockets around his heart so we were told to go to the ER for further evaluation. At the ER he was monitored, his vitals were all good so we were sent home with steroid liquid medication along with steroid inhaler. He has a follow up appointment with his doctor later this afternoon.

Other Meds: Tylenol as needed for headaches Senna laxative 8.5 mg daily

Current Illness: Cough since the week of July 12, 2021

ID: 1636701
Sex: F
Age: 73
State: CA

Vax Date: 08/23/2021
Onset Date: 08/23/2021
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: Erythema, Pruritus

Symptoms: Administered a 5 days expired vaccine to patient. Patient left Clinic without any complain of any signs or symptoms. Contacted patient same day after found out patient was given an expired vaccine. Informed and apologize of the adverse event of giving her the expired vaccine. Patient report doing fine with no concerns. Scheduled per CDC guideline to return to Clinic to re-vaccinate for her second dose of Varicella. Patient agreed with plan.

Other Meds:

Current Illness:

ID: 1636702
Sex: F
Age: 59
State:

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

Allergies: none

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

Symptoms: numbness/tingling in right posterior neck and head, then noticed right sided facial droop. consistent with bells palsy

Other Meds: none

Current Illness: none

ID: 1636703
Sex: F
Age: 29
State: WA

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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKA

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

Symptoms: Monderna COVID Vaccine was drawn on 08/24/21 @ 12:41pm and was given outside the 12 hour period recommended by manufacture. Vaccine was given on 08/25/21 @ 4:28pm.

Other Meds:

Current Illness:

ID: 1636704
Sex: F
Age: 30
State: IN

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Within about 5 minutes of receiving the first dose of Pfizer vaccine, after I was sitting in the waiting area, I suddenly started sweating, had to gasp for air (was wearing a mask and had to lift it briefly for a breath of air), and felt an intense drowsiness and like I was about to faint. My eyes were closing, my body felt heavy, there was a warm feeling going up my neck and into my head. I was about to call out to the nurse but then it was gone. Just like that. And didn?t happen again. I even stayed longer than the 15 minute requirement to be safe, and I sat in my car in the parking lot for another 30 minutes, and I did not have any other side effects. I felt really embarrassed to say anything because when I got checked in, no one told me, ?If you start to feel funny, let us know.? They just acted like no one has any affects ever. I didn?t even know who I would ask for help if I was going to faint. I guess they would have noticed me on the floor and would have come over! Anyway? It was a small side effect, very sudden, very early after receiving the vaccine, and nothing since then, but I wanted to report it. Thank you.

Other Meds:

Current Illness:

ID: 1636705
Sex: M
Age: 28
State: PA

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: 011J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: none

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

Symptoms: costochondritis

Other Meds: none

Current Illness: none

ID: 1636706
Sex: M
Age: 70
State: CA

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: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Unknown

Allergies: Unknown

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

Symptoms: Administration error, lot had expired one day prior on 8-24-2021.

Other Meds: Unknown

Current Illness: Unknown

ID: 1636707
Sex: M
Age: 38
State:

Vax Date: 07/22/2021
Onset Date: 07/22/2021
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: Xray, Hemogram, ECG, ESR 8/3/2021 Echocardiogram 8/4/2021 ECG 8/11/2021

Allergies:

Symptom List: Pain in extremity

Symptoms: I had shortness of breath, chest pain on my left side, and malaise that started roughly 20 minutes after the shot. Malaise lasted for two days after the shot with the chest pain intensifying each day and peaking around 7 days after along with my blood pressure reaching 174/94. 35 days later I am still having chest pain and it is hard to sleep through the night.

Other Meds:

Current Illness:

ID: 1636708
Sex: F
Age: 64
State: FL

Vax Date: 02/26/2021
Onset Date: 07/26/2021
Rec V Date: 08/26/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: C/O ABD PAIN, NAUSEA, SYNCOPY.

Other Meds:

Current Illness:

ID: 1636709
Sex: M
Age: 55
State: AR

Vax Date: 07/23/2021
Onset Date: 07/23/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: vaccine used past the 12 hour window of use after vial punctured. Stored in fridge entire time and cleaned between each use with alcohol. Pt contacted and no adverse reaction, pt states no problems only sore arm

Other Meds:

Current Illness:

ID: 1636710
Sex: F
Age: 52
State: VA

Vax Date: 04/22/2021
Onset Date: 05/01/2021
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: Transvaginal ultrasound

Allergies: None

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

Symptoms: I have been post menopausal since July 2020. Just over 1 week after the vaccine I had a 4 day mini-period. I was surprised but didn't link it to the vaccine or have a lot of concern. When I visited my PCP for an annual physical in June, I mentioned it to her. She was concerned about it enough to order a transvaginal ultrasound to make sure nothing was wrong. The ultrasound was normal and confirmed I am post menopausal. In reading about other people's experiences, I learned that breakthrough bleeding and periods for women many years in menopause was occurring. Oddly, in a doctor visit my 19 year old daughter also mentioned having an unusual period mid-cycle in the month following her vaccination.

Other Meds: Lisinopril 20 mg

Current Illness: None

ID: 1636711
Sex: F
Age: 50
State: IN

Vax Date: 04/16/2021
Onset Date: 08/25/2021
Rec V Date: 08/26/2021
Hospital: Y

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

Lab Data: ELEVATED D DIMER

Allergies: NKDA

Symptom List: Vomiting

Symptoms: COUGHING UP DIME SIZE BLOOD CLOTS PER ER NOTE

Other Meds:

Current Illness:

ID: 1636712
Sex: F
Age: 52
State: TN

Vax Date: 07/21/2021
Onset Date: 08/04/2021
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: None

Allergies: Penicillin, Morphine

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Mild heart palpitations that come and go. It's not been consistent and I haven't looked into treatment.

Other Meds: Armour Thyroid, Pregnenolone, Amlodipine Olmesartin, Vitamin D, B12, HRT of Biest and Estradiol, Spironolactone

Current Illness: None

ID: 1636713
Sex: F
Age: 89
State: GA

Vax Date: 02/13/2021
Onset Date: 03/01/2021
Rec V Date: 08/26/2021
Hospital: Y

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

Lab Data: Doctor heart specialist in city . Patient doesn't remember what test were done.

Allergies: no

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

Symptoms: On March 3rd patient went to Dr. and was transferred by ambulance to hospital . patient was Afib . patient was extremely fatigue. patient had no blood pressure.

Other Meds: no

Current Illness: no

ID: 1636714
Sex: F
Age: 64
State: CA

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

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

Lab Data: 08/25/21 0425 08/25/21 0420 08/24/21 2200 08/24/21 1820 08/24/21 1453 08/24/21 0407 08/23/21 2046 08/23/21 1240 08/21/21 0040 08/20/21 1810 NA 135 -- -- 139 -- 140 137 139 < > 139 K 7.1* -- -- 3.7 -- 3.5 3.6 3.9 < > 3.6 CO2 28 63* 62* 30 67* 32 29 27 < > 26 | 45 CL 103 -- -- 99* -- 102 100 101 < > 104 BUN 30* -- -- 31* -- 30* 31* 25 < > 32* CR 0.96 -- -- 1.04 -- 0.96 0.99 0.98 < > 0.77 RBS 233* -- -- 320* -- 84 269* 180* < > 288* PHOS 4.5 -- -- 4.8* -- 4.5 -- 3.5 -- 4.1 MG 2.6* -- -- 2.0 -- 2.4* 2.1 2.2 < > 2.1 < > = values in this interval not displayed. Recent Labs 08/25/21 0425 08/24/21 0407 08/23/21 0455 08/22/21 0425 08/21/21 0425 08/20/21 0410 WBC 19.0* 19.4* 17.1* 22.3* 27.0* 25.7* HGB 9.7* 11.3* 11.4* 11.4* 11.9 12.2 HCT 30.6* 34.4 35.1 35.2 37.5 36.3 PLT DECREASE* | 110* | NORMAL 134* 141 167 183 204 MCV 100 97 97 97 96 95 NEUT 96* 87* 92* 82* 86* 83* LYMPH -- 6* 4* 9* 7* 9* MONO -- 5 3* 6 5 7 EOS -- 2 0 2 0 0 Recent Labs 08/23/21 2046 PTT 26.8 Recent Labs 08/24/21 0407 08/23/21 2046 08/23/21 1530 08/23/21 0455 08/22/21 2355 08/22/21 1612 08/22/21 1403 LACTATE 0.9 2.0* 1.2 0.9 1.5 1.3 2.2* Recent Labs 08/25/21 0425 08/24/21 0407 08/23/21 1240 BNP 524* 527* 372*

Allergies: nkda

Symptom List: Injection site swelling, Limb discomfort

Symptoms: 64 Y female with h/o HLD, DM2, cigarette smoker, vaccinated for COVID in March 2021, initially admitted 8/5 for AHRF in setting of COVID PNA (s/p toci x 2 and iNO) requiring escalation to ICU for bradycardia to the 20s, transferred to floor 8/10, then transferred back to the ICU 8/14 for increasing O2 req on HFNC 60L 100% with chest pain and trop elevation (0.37). Found to have acute MI on EKG 8/15 with ongoing chest pain, scheduled for intubation and PCI. In ICU, CP has resolved, amio and dobutamine drips were started, pt is extubated, and proning to improve oxygenation. On 8/22, had increasing oxygen requirement with CXR showing worsening infiltrates c/f PNA so decadron was increased to 20 mg daily and Zosyn was restarted out of c/f secondary bacterial/fungal/opportunistic PNA. Continuing to have increasing oxygen needs 8/23-25 with elevated inflammatory markers and increase in BNP c/f COVID inflammation and ?CHF so pulse dosing methylprednisolone, increasing respiratory support to CPAP, and continuing to diurese. Note pt is till in the ICU on 8/26/21

Other Meds: Prior to Admission Medications Outpatient Home Medications Taking? Citalopram (CeleXA) 10 mg Oral Tab Takes Regularly Sig: Take 3 tablets by mouth daily Simvastatin (ZOCOR) 20 mg Oral Tab Takes Regularly Sig: Take 1 tablet by mouth every ev

Current Illness: None

ID: 1636715
Sex: M
Age: 73
State: SD

Vax Date: 02/10/2021
Onset Date: 02/24/2021
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: RA

Lab Data: CT Heart score screening, 03/30/2021 Left Main: 0 Left Anterior Descending: 106 Total Agatston Score: 131 This score is at the 42 percentile EKG and chest xray 04/06/2021 read as normal. Bruce protocol and Cardiolite stress test 04/09/2021 both read as normal.

Allergies: None

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

Symptoms: About 2 weeks after the second injection, I developed chest tightness and easy shortness of breath (1 flight of stairs). I swim over a mile, three times a week and have not experience those symptoms. The symptoms lasted about 3 months and then went away.

Other Meds: tadalafil, rosuvastatin, multivitamin, fish oil, aspirin

Current Illness: None

ID: 1636716
Sex: M
Age: 51
State: TX

Vax Date: 03/12/2021
Onset Date: 03/12/2021
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: NONE

Allergies: NONE

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

Symptoms: SORENESS AT INJECTION SITE. HEADACHE. CHILLS.

Other Meds: NONE

Current Illness: NONE

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am