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: 1636971
Sex: M
Age: 59
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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: 8/26/21 CBC and troponin negative 8/26/21 covid PCR negative

Allergies: Erythromycin Doxycycline

Symptom List: Dysphagia, Epiglottitis

Symptoms: I became dizzy shortly after getting the vaccine approx 20 min. At around 10 pm that night started getting a cough and was having trouble swallowing. My dizziness became worse and I started to feeling my heart skipping and pounding in my chest.

Other Meds: None

Current Illness: None

ID: 1636972
Sex: M
Age: 20
State: OR

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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: none

Allergies: none

Symptom List: Anxiety, Dyspnoea

Symptoms: It is not an adverse reaction. patient wrote on the consent form that he had moderna as the first dose. he did not bring his cdc card. when we tried to bill the second shot , it turned out that he actually got Pfizer as his first shot.

Other Meds: none

Current Illness: none

ID: 1636973
Sex: F
Age: 69
State: CA

Vax Date: 02/13/2021
Onset Date: 04/26/2021
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: All stool tests resulted in "not detected"; FECAL GLOBIN BY IMMUNOCHEMISTRY, CLOSTRIDIUM DIFFICILE TOXIN/GDH W/REFL TO PCR, SAL/SHIG/CAMPY, CULTURE AND SHIGA TOXIN, EIA W/RFL TO E.COLI, CULTURE , OVA AND PARASITES WITH GIARDIA ANTIGEN , ROTAVIRUS ANTIGEN DETECTION Colonoscopy July 14, 2021

Allergies: None

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

Symptoms: Gastrointestinal - immediate onset of watery diarrhea multiple times on the first day 4/26/2021 ; multiple watery stool events each day 5- 6 times; after 3-4 weeks, mild improvement, During July 2021 more improvement but still loose stool, 3 times per day; continued improvement to soft bowel movement 2 times per day, but not watery. August 10, 2021 - first normal bowel movement that has continued to date of this submission.

Other Meds: Lipitor 10 mg - 1 x daily Baby aspirin - 1 x am. Repatha - 1 x every 2 weeks (injection for cholesterol) B12 daily, D3 daily

Current Illness: None

ID: 1636974
Sex: M
Age: 53
State: KY

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1636975
Sex: F
Age: 92
State: NC

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

Lab Data: None at this time

Allergies: None listed on registration form

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

Symptoms: Patient here for Dose #3. Previous two doses were Moderna. Today, third dose administered was Pfizer.

Other Meds: Unknown

Current Illness: Unknown

ID: 1636976
Sex: F
Age: 48
State: NY

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

Allergies:

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

Symptoms: mild urticaria immediately post vaccine, then for several weeks after, tachycardia and weight loss

Other Meds:

Current Illness:

ID: 1636977
Sex: M
Age: 65
State: GA

Vax Date: 03/24/2021
Onset Date: 08/02/2021
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:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Difficulty breathing, hospitalization, high flow oxygen treatment

Other Meds:

Current Illness:

ID: 1636978
Sex: M
Age: 64
State: CA

Vax Date: 03/08/2021
Onset Date: 03/16/2021
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: LA

Lab Data: Same as above. Results are nothing can be done. The Many doctors have said there is NO cure.

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Severe Tinnitus that has been continuous. Several doctors appointments, hearing test, flushing of the ears. I've had to increase my blood pressure medication. Due to lack of sleep, now taking Nortriptyline. The many doctors have said there is NO cure.

Other Meds: Atorvastatin Amlodipine

Current Illness:

ID: 1636979
Sex: F
Age: 56
State: KY

Vax Date: 07/28/2021
Onset Date: 07/28/2021
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:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1636980
Sex: F
Age: 73
State: MA

Vax Date: 08/11/2021
Onset Date: 08/13/2021
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: none. I will see my doctor on 9/8/21 for a checkup, so I am waiting until then.

Allergies: none except nickel

Symptom List: Diarrhoea, Nasal congestion

Symptoms: headache, dizziness, confusion, forgetfullness and increasing paranoia. The parahnoia increased over the following several days to almost psychotic ideations (that i was the chosen savior), fears of dying, visions of the world ending, and extreme suicidal ideation. I myself am a psychotherapist so I forced myself to do meditations, talk to colleagues and attempt to calm myself. The paranoia has subsided today (8-26-21). although dull headache continues, with some memory problems.

Other Meds: no prescriptions. herbs - glutathione, vit c, antihistamine (diphendydramine), hawthorne berry and leaves, Yarrow leaves, bromelain and Quercitin

Current Illness: I have had lingering reactions to Lyme disease for last 5 years

ID: 1636981
Sex: M
Age: 86
State: FL

Vax Date: 03/10/2021
Onset Date: 08/03/2021
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: Biaxin, clarithromycin, PCN

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

Symptoms: Shivering, nasal congestion, dry cough, fall, fevers, tachycardic.

Other Meds:

Current Illness:

ID: 1636982
Sex: M
Age: 5
State: IA

Vax Date: 08/24/2021
Onset Date: 08/26/2021
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: none

Allergies: sensitivity to dairy

Symptom List: Rash, Urticaria

Symptoms: baseball sized localized swelling, redness, and pain at the injection site 48 hours post injection

Other Meds: none

Current Illness: none

ID: 1636983
Sex: M
Age: 63
State: PA

Vax Date: 06/02/2021
Onset Date: 06/08/2021
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 test

Allergies: none

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

Symptoms: extreme fatigue, low platelets in blood count

Other Meds: Flecainide, metoprolol, metformin. lisinopril, xarelto

Current Illness: none

ID: 1636984
Sex: F
Age: 27
State:

Vax Date: 08/11/2021
Onset Date: 08/12/2021
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:

Allergies: lithium

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

Symptoms: pt describes foot pain which started only after vaccination. It is unclear that this is related but patient felt strongly it was possible

Other Meds: None

Current Illness: none

ID: 1636985
Sex: F
Age: 39
State: TN

Vax Date: 12/29/2020
Onset Date: 12/29/2020
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: Naproxen

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

Symptoms: I had the Pfizer vaccine here at the hospital on 12/29/20. I had no immediate reaction, however, within 12 hours I had some major joint swelling. My joints in my hands were so swollen I had trouble gripping my phone, holding a glass, writing, etc. Swelling and aching in my knees, hip pain that caused me to avoid using the steps. I assumed this may be a normal reaction, therefore treated with anti inflammatories. The following week I returned to work and on Jan 7th was still having bad joint pain from the vaccine. Graciously, doctor gave me a steroid pack to help me get back to baseline. I did as advised by my manager and contacted a department were I was asked several questions, etc. and I thought nothing of it. It was very scripted as if she were reading from something. I assumed I would be provided documentation. Unfortunately, I did not keep a record of who I spoke with to which I now regret. Things were so ?urgent? in healthcare at the time, I had faith the correct measures were being taken. Obviously, I did not get the second dose. When completing the vaccine exemption form, it required uploaded documentation. I physically went to this department 8/17/21 and spoke with the manager. She has no record of the event. She said that sometimes it just gets reported to the VAERS system. I was given their contact info. She says all cases are to be reported to them but that our facility does not have access to those records. They only make the report. I called the number for VAERS and it was never reported.

Other Meds: none

Current Illness: None

ID: 1636986
Sex: F
Age: 16
State: LA

Vax Date: 07/28/2021
Onset Date: 08/26/2021
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: NKA

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

Symptoms: Vaccine was beyond the Use By Date, not beyond the expiration date.

Other Meds:

Current Illness:

ID: 1636987
Sex: F
Age: 35
State: KY

Vax Date: 08/06/2021
Onset Date: 08/06/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1636988
Sex: M
Age: 61
State: OK

Vax Date: 08/24/2021
Onset Date: 08/24/2021
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: None

Allergies: blood pressure medication but could not remember name

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Pfizer vaccine was diluted incorrectly. Client states his arm is sore but other than that he feels fine.

Other Meds: Client could not remember the names of his medication

Current Illness: None

ID: 1636989
Sex: F
Age: 78
State: IN

Vax Date: 08/26/2021
Onset Date: 08/26/2021
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: none

Allergies: none reported

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Pt wanted Pfizer manufacturer and received Moderna due to lack of communication between tech - pharmacst and then pharmacist and patient. After talking to patient about vaccine manufacturers, patient was completely fine with receiving Moderna vaccine

Other Meds: none reported

Current Illness: none reported

ID: 1636990
Sex: M
Age: 38
State: MA

Vax Date: 08/23/2021
Onset Date: 08/24/2021
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:

Allergies:

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

Symptoms: Fatigue, shoulder and neck pain worsening over last 4 days, diarrhea, nausea

Other Meds:

Current Illness:

ID: 1636991
Sex: F
Age: 41
State: KY

Vax Date: 02/17/2021
Onset Date: 02/18/2021
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: Bloodwork 04/19/2021- A1C was high as in the past, liver enzymes are elevated. 04/26/2021 additional blood work-Rocky mountain fever was found. BP was elevated, Cholesterol was high. 04/27/2021 bloodwork done at the ER- nothing abnormal Besides the IGA and IGR one was negative and one positive but I do not recall which one, A1C high and glucose, liver enzymes high Creatine low. CT was done of abdomen finding were-fatty liver, ovarian cyst and liver was enlarged.

Allergies: No.

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

Symptoms: 02/18/2021 just cold chills, cold to the touch all over, run a low grade fever, headaches, fatigue and sleepiness, loss of apatite, lethargic -that lasted 10-12 hours. Remain fatigued, chills and headaches for the next 8 days. About three /four weeks post shot I then felt bad again, across my torso and shoulders. 04/26/2021 I went to see my family Dr. I had regular bloodwork done a week before. He sent me for additional blood work. I have been to three specialist Infection disease, Rheumatology, Gastroenterology. I have been put on Celebrex 200mg 2x daily, and Enalapril 2.5mg once a day. On the 04/27/2021 ended up in the ER, with BP 176/107.

Other Meds: I was taking Allegra 180, B12, Metoprolol extended relief, V-D twice a week, Ozempic.

Current Illness: No.

ID: 1636992
Sex: M
Age: 51
State: GA

Vax Date: 04/10/2021
Onset Date: 06/04/2021
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: Various - from June to August

Allergies: N/A

Symptom List: Unevaluable event

Symptoms: Shingles - prescription Arthritis Bone Spur

Other Meds: Losartan Atorvastatin Hydrochlorothiazide

Current Illness: N/A

ID: 1636993
Sex: M
Age: 37
State: KY

Vax Date: 08/06/2021
Onset Date: 08/06/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1636994
Sex: F
Age: 34
State: FL

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: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Patient reported excessive vomiting for 13 hours after the vaccine , body chills and aches, headache, and diarrhea. Patient continues to have these symptoms.

Other Meds:

Current Illness:

ID: 1636995
Sex: F
Age: 23
State:

Vax Date: 08/24/2021
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:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient stated that on the third day she was experiencing tingling and numbness in her feet. He left leg went numb and she could not move it at all.

Other Meds:

Current Illness:

ID: 1636996
Sex: M
Age: 58
State: MA

Vax Date: 04/26/2021
Onset Date: 05/03/2021
Rec V Date: 08/26/2021
Hospital:

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

Lab Data: See above.

Allergies: Escitalopram, rash

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

Symptoms: ITP. Pt with baseline thrombocytopenia in the previous year due to liver disease, but baseline >150-160K. Pt administered Pfizer vaccine on 4/26/2021. At the time of the administration, platelet count was 183,000. The chart erroneously lists heparin as an allergy, even though HIT testing was negative. Platelet count precipitously dropped to 6,000 by 5/4/2021, although the drop began on 5/3/2021, and possibly 5/2/2021. Pt experienced uncontrolled epistaxis, and was transfused a total of 10 units of platelets between 5/5-5/19/2021. He was treated unsuccessfully with Dexamethasone 40mg PO QD x 4, with only transient rise to 28K on 5/7/2021, and later drop back to 3K that same day. He was subsequently given IVIG 1gm/kg on 5/7/2021. After failure to improve to any significant degree, he was started on weekly Rituxan on 5/18/2021, and also given an additional two doses of IVIG 1gm/kg (on 5/21-5/22/2021). Platelet count began to rise on 5/22/2021, and had normalized by 5/31/2021.

Other Meds:

Current Illness: Hepatic encephalopathy, non-purulent cellulitis

ID: 1636997
Sex: M
Age: 80
State: SC

Vax Date: 07/26/2021
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: LA

Lab Data:

Allergies: none

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Deep pain in large muscles after any activity,, ASA does relieve it but would rather not take it.

Other Meds: dailey vitamin

Current Illness: none

ID: 1636998
Sex: F
Age: 40
State: KY

Vax Date: 08/06/2021
Onset Date: 08/06/2021
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:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1636999
Sex: F
Age: 51
State: NY

Vax Date: 03/17/2021
Onset Date: 03/17/2021
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:

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

Symptoms: 30 min post vaccine, patient started to experience throat clearing, itching on the left side of her face and per chart notes, rash on her chest. She had premedicated with Benadryl before her injection. She went back to the hospital emergency room as she started having tongue tingling and more throat symptoms. She reports receiving epinephrine, more Benadryl, and Pepcid, and not sure about steroids. Within an hour, her symptoms started to resolve. She was back to baseline the following day. Tryptase level was normal. ED attending documentation suggests possible vocal cord dysfunction as confounding the presentation.

Other Meds:

Current Illness:

ID: 1637000
Sex: F
Age: 54
State: MO

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: RA

Lab Data: no

Allergies: no

Symptom List: Nausea

Symptoms: chills, fever stomach ache itching at site . bumps at site . spoke with pharmacist and was to that she now has chicken pox

Other Meds: gabapin, womens immune health , prolar adavre inhaler dulera inhaler,nublizer albuterol duloxetuine lorazepam levothyroxine rosuvaxuvtin , trazodone tizanizine tramdol

Current Illness: no

ID: 1637001
Sex: F
Age: 5
State: NC

Vax Date: 08/23/2021
Onset Date: 08/25/2021
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: NONE

Allergies: NONE

Symptom List: Injection site pain

Symptoms: REDNESS WITH MILD INDURATION AROUND THE INJECTION SITE ON THE LEFT DELTOID AREA , WARM TO THE TOUCH, NO FEVER. RX: CEFDINIR 250MG/5 ML; 5 ML PO Q12H FOR 10 DAYS.

Other Meds: NONE

Current Illness: NONE

ID: 1637002
Sex: F
Age: 65
State: FL

Vax Date: 01/07/2021
Onset Date: 08/03/2021
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: CXR, covid test

Allergies: Bactrim, Compazine, Paxil, Tape

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

Symptoms: SOB, productive cough.

Other Meds:

Current Illness:

ID: 1637003
Sex: M
Age: 63
State: WI

Vax Date: 05/21/2021
Onset Date: 08/21/2021
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: RA

Lab Data: COVID-19 PCR via NP, 8/12/21 Positive Chest x-ray (performed prior to admit to this hospital), 8/21/21 with mild patchy diffuse ground glass opacities

Allergies: Atorvastatin

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

Symptoms: Pt received first dose of Moderna COVID-19 vaccine on 4/3/21, second dose on 5/1/21. Lot numbers not specified in electronic medical record (EMR). Pt was admitted to hospital 8/21/21 after initial COVID diagnosis via ER on 8/8/21. Pt admitted with intermittent breakthrough fevers as high as 102 degrees F. Persistent nausea, decreased appetite, SOB/wheezing. No vomiting. Pt admitted after substantial SOB on 8/21/21. Admitted to gen med, discharged home 8/23/21.

Other Meds: Lisinopril tab daily Multivitamin daily Pravastin Sodlum (Pravachol) tab daily

Current Illness: N/A

ID: 1637004
Sex: M
Age: 41
State: KY

Vax Date: 08/06/2021
Onset Date: 08/06/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1637005
Sex: F
Age: 50
State: MS

Vax Date: 08/11/2021
Onset Date: 08/12/2021
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: None

Symptom List: Erythema, Pruritus

Symptoms: Right deltoid area was swollen and tender to palpation . The patient had limited movement at right shoulder due to pain in deltoid area. She is unable to perform her job. 5 days of prednisone was given as an empirical trial.

Other Meds:

Current Illness:

Date Died: 08/18/2021

ID: 1637006
Sex: M
Age: 64
State: NC

Vax Date: 02/12/2021
Onset Date: 08/05/2021
Rec V Date: 08/26/2021
Hospital: Y

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: Benzocaine, ciprofloxacin, diphenhydramine, doxycycline, erythromycin, tetracycline, zonisamide

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

Symptoms: 65 year old male with history of CKD, medullary sponge kidney with recurrent nephrolithiasis presenting for myalgias, fatigue and decreased PO intake for the past 4 days. Symptoms started on 5Aug with fevers and myalgias and presented for COVID test that was initially negative. Continued to have worsening shortness of breath and fatigue and went to be evaluated on 07Aug and found to be COVID pos and was given prednisone taper and albuterol inhaler and discharged home. Since then was having new right flank/abdominal pain consistent with previous kidney stones and called the urology clinic to try to get and appointment and when describing his symptoms was told to go to the ED to be evaluated. Endorses fevers, headache, shortness of breath and cough but denies nausea, vomiting, diarrhea, chest pain, dysuria, polyuria, hematuria, hematemesis, melena, lower extremity edema, orthopnea. Patient died 18 Aug 2021, COD COVID-19 pneumonia.

Other Meds: Multiple

Current Illness:

ID: 1637007
Sex: M
Age: 68
State: MN

Vax Date: 01/29/2021
Onset Date: 08/15/2021
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: Augmentin, Lisinopril

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

Symptoms: 10 day history starting around 8/15/21 of sinus congestion with headache. Has minimal non productive cough. No SOB but had fever yesterday. (8/23/21)

Other Meds: Losartan, Amolodipine; Atorvastatin

Current Illness: none

ID: 1637008
Sex: F
Age: 33
State: KY

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

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1637009
Sex: M
Age: 74
State: TN

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

Lab Data: Blood work, chest xray.

Allergies: Balsam of Peru Propylene Glycol Cashew nut Eggs Pork/Chicken

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

Symptoms: Fever and lost all muscular strength. Fell onto floor and could not get up or turn over. Confused stated of mind and garbled speech. Spouse thought I was having a stroke and called 911. At ER, I was treated for dehydration and given Hydrocortisone due to my ACTH Insufficiency. Recovered in about 2 days.

Other Meds: hydrocortisone Valtrex levothyroxine Dupixent Xolair

Current Illness:

ID: 1637010
Sex: F
Age: 26
State: IL

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

Lab Data:

Allergies:

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

Symptoms: headache, chills, mild temperature, extreme nausea, dry heaves

Other Meds:

Current Illness:

ID: 1637011
Sex: F
Age: 63
State: MD

Vax Date: 08/16/2021
Onset Date: 08/17/2021
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: N/A

Allergies: N/a

Symptom List: Pain in extremity

Symptoms: Patient experienced a severe chest tightness a day after providing the vaccinations. Patient describe it as she was able to breathe but the tightness was very painful as she though twice about calling emergency number. She got headache, feverish and chills. She felt tired/exhausted and lasted for 4 days after the providing the vaccines.

Other Meds: N/a

Current Illness: N/A

ID: 1637012
Sex: F
Age: 85
State:

Vax Date: 02/10/2021
Onset Date: 08/25/2021
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: CRP, CMP, D-Dimber, occult blood, CBC with diff, lactic acid, magnesium, protime/INR, PTT, SARS/flu/RSV, troponin

Allergies:

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

Symptoms: chest pain, non-sTEMI, D-Dimer, leukocytosis

Other Meds:

Current Illness:

ID: 1637013
Sex: F
Age: 36
State: SC

Vax Date: 01/12/2021
Onset Date: 04/12/2021
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: physical confirmation by 2 physicians of shingles rash. Confirmation of chickenpox as child.

Allergies: codeine (rash), keflex (hives)

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

Symptoms: developed shingles eruption and nerve pain under left breast. Treated with Valtrex 1 gram TID x 7 days. Resolved. Second eruption May 2021 in same location. Same treatment, then placed on Valtrex 500mg prophylactic. Resolved. In June, same eruption below left breast, then shingles crossed midline under right breast. Same treatment, then placed on Valtrex 1 gram qd as prophylactic. On 08/17, new shingles eruption back of neck right side, crossed midline to left side. New eruptions under both sides of breast. Shingles on neck far worse in terms of number, nerve pain, and size. Placed again on Valtrex 1 gram TID and am still on this dose. Also placed on Metanx for post-herpetic neuralgia.

Other Meds: nadolol (migraine prevention), tizanidine (tension headache prevention), meloxicam (joint pain), Tri Lo Mili (BPC), Escitalopram (depression), Seed Probiotic, Zyrtec OTC,

Current Illness: none

ID: 1637014
Sex: M
Age: 23
State: PA

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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKDA

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

Symptoms: Patient reported feeling extremely flushed, slight sensation of throat closing/swelling, and chest tightness. Also reported numbness of lips. These reported events occurred approximately 10 minutes after the vaccine was administered

Other Meds: Adapalene gel, Clindamycin gel

Current Illness:

ID: 1637015
Sex: F
Age: 35
State: KY

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: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1637016
Sex: F
Age: 30
State: NC

Vax Date: 08/19/2021
Onset Date: 08/20/2021
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:

Allergies: Penicillin and sulfa

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Are has a hard swollen lump at injection site and itches.

Other Meds: Birth control

Current Illness:

ID: 1637017
Sex: M
Age: 28
State: LA

Vax Date: 07/28/2021
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: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Vaccine was beyond the Use By Date, not beyond the expiration date.

Other Meds:

Current Illness:

ID: 1637018
Sex: F
Age: 39
State: WI

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:

Allergies: No

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Night of 8.25.21 and continuing: Severe: body aches, joint pain, fatigue Moderate: headache, fever and throat mucus

Other Meds: Lamotrigine, 200mg Adderal, 15mg Niki (birth control)

Current Illness: None

ID: 1637019
Sex: F
Age: 34
State: AL

Vax Date: 08/07/2021
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: IM
Vax Site: RA

Lab Data:

Allergies: N/a

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

Symptoms: Vertigo starting on day 14 after 1st injection

Other Meds: Vitamin D3, prenatal gummies for lactation, sunflower lecithin

Current Illness: Mastitis in July

ID: 1637020
Sex: M
Age: 90
State: ND

Vax Date: 02/08/2021
Onset Date: 08/24/2021
Rec V Date: 08/26/2021
Hospital: Y

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

Lab Data: 8/24/21-PCR, CXR, Bloodwork

Allergies: azithromycin

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

Symptoms: patient hospitalized for COVID disease. diagnosis date 8/24/21. Presented to the ED with generalized weakness, low heart rate, low blood pressure over last few days. Chest Xray shows LLL Infiltrate.

Other Meds: acetaminhphen 650mg PO Q4H PRN, albuterol 0gm INH Q2H PRN per dose instruction, albuterol/ipratropium 3ml NEB QIDRT PRN, amlodipine besylate 5mg PO Daily SCH, artificial tears 0ml eyeboth QID SCH per dose instruction, aspirin 81mg PO daily

Current Illness: unknown

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am