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: 1637071
Sex: M
Age: 27
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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1637072
Sex: M
Age: 40
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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

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

Other Meds:

Current Illness:

ID: 1637073
Sex: M
Age: 50
State: FL

Vax Date: 04/12/2021
Onset Date: 08/03/2021
Rec V Date: 08/26/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: CXR, covid test

Allergies: Lisinopril

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

Symptoms: Weakness, decreased urine output, tightness in upper back.

Other Meds:

Current Illness:

ID: 1637074
Sex: F
Age: 54
State: NY

Vax Date: 03/11/2021
Onset Date: 08/12/2021
Rec V Date: 08/26/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose 03/11/21 2nd dose 04/01/21 Diagnosed covid positive:08/18/21 Symptom onset:08/12/21 Exposure:home Symptoms:SOB, COUGH,FATIGUE,RUNNYNOSE

Other Meds:

Current Illness:

ID: 1637075
Sex: F
Age: 39
State: CA

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: None

Allergies: N/A

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

Symptoms: At aprox 10Pm on 8/20/21, I started to feel anxious but in a daze at the same time. From there and very quickly I began to at first feel my legs getting very hot, then my ears, I then felt tingly, weak, and very anxious, I was driving home and had to pull over, I became very thirsty, I went into a gas station to get Gatorade, I then began sweating as much as if I had just completed a spin class, it was dripping down my face, I then thought I was going to vomit, felt very dizzy and thought I was going to pass out. I started to panic as my breathing got heavier. My side effects went from zero to full blown hot flashes, vomit and dizzy in a matter of maybe an hour, it was very quick, I literally felt my body getting worse ans worse minute by minute, I got home, laid down and tried to relax .. after about 20 mins of being home, the dizzy went away, I was exhausted and then my body became so sore, i did not want to move. The soreness lasted about24 hours. I did not seek medical treatment because It all happened so fast, I'm a single mother, I had my children home with me and I did not want to leave them or scare them .

Other Meds: Prozac, busporine, hydroxine.

Current Illness: None

ID: 1637076
Sex: F
Age: 79
State: CT

Vax Date: 01/31/2021
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: None

Allergies: Fish Oil, Biaxin, Crestor, Estrogens, Metrondiazole

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

Symptoms: Routine testing for outbreak, resident tested positive

Other Meds: Unknown as resident vaccinated prior to admission

Current Illness: Vaccinated prior to admission

ID: 1637077
Sex: F
Age: 67
State: OR

Vax Date: 03/02/2021
Onset Date: 03/02/2021
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: CT scan. February

Allergies: Versed, Fentanyl

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Fever, chills, muscle aches, vomiting, headache, lightheaded, stomach pain,. Symptoms lasted 12 hours. I had a recurring headache after 1st dose of Moderna dated 01/25/21. I was given a CT scan in February.

Other Meds: Zinc 50 mg, Biotin 10mg, Vitamin D3 62.5 mcg.

Current Illness: None

ID: 1637078
Sex: M
Age: 65
State:

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Patient reports having a seizure at 2am the day after vaccination. States it lasted about 2 hours and the next day he was unable to balance and lost vision in one of his eyes. A day later he reports that he returned to normal health.

Other Meds:

Current Illness:

ID: 1637079
Sex: M
Age: 31
State: KY

Vax Date: 08/11/2021
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: LA

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1637080
Sex: M
Age: 33
State: NY

Vax Date: 01/27/2021
Onset Date: 08/14/2021
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:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose01/10/21 2nd dose 02/27/21 Diagnosed covid positive:08/16/21 Symptom onset:08/14/21 Exposure:community Symptoms:fever, fatigue,loss of smell/taste, runny nose,HA

Other Meds:

Current Illness:

Date Died: 08/24/2021

ID: 1637081
Sex: M
Age: 87
State: TN

Vax Date: 03/09/2021
Onset Date: 08/12/2021
Rec V Date: 08/26/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Case received Moderna vaccine x 2. Last dose received on 3/9/2021. Patient developed signs and symptoms of COVID 19 Infection on 8/24/2021. Case was tested positive for COVID 19 on 8/24/2021 and was admitted to Medical Center ED on 8/24/2021 and Case expired while still in the hospital on 8/24/2021.

Other Meds:

Current Illness:

ID: 1637082
Sex: M
Age: 67
State:

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: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies: none

Symptom List: Rash, Urticaria

Symptoms: temporary paralysis of both legs , lasting roughly 15 minutes, also headache, dizziness and weakness of limbs

Other Meds: losartan 50 mg , fenofibrate 48 mg

Current Illness: none

ID: 1637083
Sex: M
Age: 22
State: KY

Vax Date: 08/11/2021
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: LA

Lab Data:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1637084
Sex: M
Age: 28
State: IN

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: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: I was extremely sore in my injection site on this 2nd shot. So much so that my entire body was feeling strained. I woke up the next morning feeling out of it and almost had an inebriated sensation in the sense of feeling light headed and partially disoriented. I tried to drive to work when I noticed that my motor skills were lacking as well and almost got hit by a vehicle turning into an intersection and almost hit a vehicle returning home. I also had a completely drained energy feeling and stomach ache and rested in bed for the rest of the day. The next day at work I experienced profuse hot flashes and sweating fits off and on. Later on the day I felt like I might have sweated it out possibly? Every day sense my body seems to be getting better. I'm back to working out moderately and living casually. Was just very alarming and the fact I had to take a point at work was not ideal.

Other Meds: Amino acids and L-Carnitine

Current Illness:

ID: 1637086
Sex: M
Age: 18
State: KY

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:

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

Symptoms: **Administration Error** 06/08/21 Administrator asked the patient was he there for a COVID vaccine he said yes. After getting the phizer vaccine he later stated that he was not there for a COVID vaccine. Patient had already received the J&J vaccine on 06/08/2021.

Other Meds: Allery medication

Current Illness:

ID: 1637087
Sex: M
Age: 46
State: MO

Vax Date: 07/21/2021
Onset Date: 07/27/2021
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: COVID positive by PCR 7/28

Allergies: IV contrast

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

Symptoms: Pt admitted to hospital. Chief complaint: Shortness of breath, hyperglycemia History of Present Illness: Patient is a 46-year-old male who presented to the ED with increased heart rate, difficulty breathing and confusion. He has a complex past medical history of diabetes mellitus, hypertension, hyperlipidemia. Patient is he is oriented x3 but a poor historian. Patient reports that increased glucose values is the chief reason he is in the hospital. In the ED, he was tachycardic, tachypnoeic, hypertensive, febrile, hypoxic (SpO2 86% on room air). Labs revealed WBC >10.8, elevated neutrophils, low sodium of 117, acidemia, elevated BUN/Cr, elevated CRP/ Ferritin. He was started on 60 L 80% HFNC. CT Chest and CT Abd & pelvis were done. Off note, he received his 1st vaccination of Pfizer COVID-19 on Wednesday 7/21 and started feeling bad right away. He also reported that his blood sugars have been up and down in the past few weeks.

Other Meds: albuterol, atorvastatin, amlodipine, vitamin D

Current Illness: AKI, sepsis

ID: 1637088
Sex: F
Age: 66
State:

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: None

Allergies: flowers, cigarettes, rubber, petroleum-based products

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

Symptoms: At approximately 1654, patient reported slight tingling of the tongue to RN. Patient denied itchiness, rashes, hives, trouble swallowing, trouble breathing. Patient denied swelling and numbness of tongue, lips, and throat. Patient reported she had a similar reaction to her first dose of Pfizer Covid Vaccine. Patient reported she felt the same slight tingling sensation of the tongue. Patient reported her symptom started a "few hours" after her vaccination and "went away on its own". Patient reported allergies to flowers, cigarettes, rubber and petroleum-based products. Patient reported history of thalassemia and no current medications. At 1657, RN assessed patient vital signs: blood pressure 142/86 mmHg, pulse 65 beats/minute, and SpO2 99%. At 1658, RN offered diphenhydramine oral solution. Patient agreed to diphenhydramine oral solution. At 1700, RN administered 50 mg diphenhydramine oral solution. At 1705, RN reassessed patient vital signs: blood pressure 146/88 mmHg, pulse 57 beats/minute, and SpO2 99%. Patient reported "I can still feel it a little less". At 1710, RN reassessed patient vital signs: blood pressure 138/80 mmHg, pulse 55 beats/minute, and SpO2 99%. At 1715, RN reassessed patient vital signs: blood pressure 138/88 mmHg, pulse 57 beats/minute, and SpO2 99%. Patient reported she was "getting better" and can "barely feel it". At 1729, patient reported her symptom is "gone". Patient denied tingling of tongue. RN educated patient on signs/symptoms of when to seek emergency care, to follow up with primary care physician, and to sign up on v-safe. At 1730, patient left facility with husband. Patient left facility with unlabored respirations and steady gait.

Other Meds: Vitamin (vit) B12, vit D, vit D3, magnesium, vit C

Current Illness: none reported

ID: 1637089
Sex: M
Age: 19
State: KY

Vax Date: 08/10/2021
Onset Date: 08/10/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1637090
Sex: M
Age: 58
State: CA

Vax Date: 04/28/2021
Onset Date: 05/12/2021
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: grass pollen

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Uncharacteristic difficulty retaining a set of ideas, facts, or people, after transferring to a different focus.

Other Meds: Loratadine

Current Illness: no

ID: 1637091
Sex: M
Age: 65
State: NY

Vax Date: 07/01/2021
Onset Date: 08/23/2021
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: none

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

Symptoms: Herpes zoster without complication. Treated with valacyclovir 1000 mg TID for 7 days. Due to excoriations over affected areas, patient also treated with keflex 500 mg 4x daily for 7 days.

Other Meds: none

Current Illness:

ID: 1637092
Sex: F
Age: 54
State: KY

Vax Date: 08/10/2021
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: 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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1637093
Sex: F
Age: 41
State: NC

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: IM
Vax Site: LA

Lab Data:

Allergies: All nuts and seeds Kiwi Apricots Peanuts Bactrim Outdoor :ragweed pollen

Symptom List: Unevaluable event

Symptoms: Chills Body aches - severe Sore throat Headache SOB - slight

Other Meds: Albuterol Vitamin b Fatty 15

Current Illness: Basic outdoor rhinitis

ID: 1637094
Sex: M
Age: 79
State: MI

Vax Date: 05/18/2021
Onset Date: 08/16/2021
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: LA

Lab Data:

Allergies: Codine

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

Symptoms: Pt Was admitted on 08/16/2021 Still in the hospital tested positive on 08/16/2021. Pt was admitted with 2 days of diarreah , fatigue, Weakness, dizzyness and difficulty breathing with a pulse ox. of 81%. Pt was Place on high flow Nasal cannula at 40% o2. On Solumedrel and completed Remdesivir on 8/21. Given one dose actemra Given on 8/17.

Other Meds: Unknown

Current Illness: Unknown

ID: 1637095
Sex: F
Age: 69
State: MA

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 called and left voicemail on 8/26/21 stating she was experiencing an unusual reaction to her flu shot that she received on 8/24/21. The pharmacist on duty called the patient back and went over what was happening. The patient stated that the night she received her vaccine, "a purple waterfilled raised area" appeared on the arm her vaccination was administered on. This was not at the site of the immunization but further down on her arm. Her arm became swollen and red to the touch. She did not seem to think she had a fever but stated she did not feel well. The purple raised area turned white today. The patient stated she has mycosis fungoid. The pharmacist advised her to go to urgent care sooner than later and follow up with her dermatologist.

Other Meds:

Current Illness:

ID: 1637096
Sex: F
Age: 38
State: NC

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

Lab Data: none

Allergies: none

Symptom List: Injection site pain, Menorrhagia

Symptoms: Saturday morning, I woke up with severe pain in my Left arm and was unable to raise arm above my head. I took ibuprofen and that resolved by the afternoon. Since Saturday night around 9 pm, I have been experiencing blurred vision, dizziness, nausea, back pain, joint pain and shortness of breath on exertion

Other Meds: levocetirizin sudafed nasal spray

Current Illness: none

ID: 1637097
Sex: F
Age: 73
State: SC

Vax Date: 06/08/2021
Onset Date: 06/09/2021
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: tree nuts, facial cosmetics, perfumes, detergents, sesame and sunflower seed, sudafed

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

Symptoms: Woke up at 1 AM shivering so bad, hardly could put on a pair of socks for my cold feet. Shivered for 3 hours, then fell asleep. Woke up at 4 AM with 102 fever, took Tylenol. Fell asleep woke up at 6:30 could hardly get out of bed, to take dog outside. Took me three days to get back to normal.

Other Meds: Centrum Silver for Women, CVS D3 50 mg, CVS Chewable C 500 mg, SolaGarden Tart Cherry 500 mg. Hakala Lab Boro Tabs 30 mg.

Current Illness: none

ID: 1637098
Sex: M
Age: 50
State: KY

Vax Date: 08/09/2021
Onset Date: 08/09/2021
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: Nausea, Pain in extremity, Pyrexia

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1637099
Sex: F
Age: 39
State: NH

Vax Date: 03/31/2021
Onset Date: 04/27/2021
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: 5/3/21-Lots of bloodwork done, Chem, cbc, D-Dimer, T4, lyme & other tick panels: al normal 6/2021- Brain MRI normal As of 8/26/21- Left leg still has some tingling & feels swollen but isn't 8/26/21-More lab tests done & a lumbar MRI ordered

Allergies: Sensitivity to wheat but not gluten intolerant

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Vaccine #1 3/31/21 at 7pm at pharmacy: 10 minutes after vaccine was administered a sensation traveled up my right arm into my throat leaving a "full sensation" in the back of my throat. Sent to urgent care. Assessed for anaphylaxis. No swelling in throat or breathing issues. Dr. recommended Benadryl. Sensation resolved within 4 hours. Vaccine #2 4/21/21 at 7:30pm : That same "full sensation" in my throat returned at minute 4 post vaccine. I was monitored for 45 minutes. No issues arose, just the stable sensation. Was sent home. No medications taken. The "full sensation" in my throat had resolved about 14 hours post vaccine. Within 15 hours I had flu-like symptoms. Mild fever of 99.9*F, chills, headache & muscle aches. I continued my 10hr shift at work. When I got home, I took an Aleve for the headache & within an hour I was back to normal. I was tired for about 24 hour after this but nothing that I couldn't do my day to day stuff from. I started my period on 4/26 & on 4/27- mid-July I got full paresthesia in my arms, legs & torso. Nothing in my hands, feet or face. Torso was very sensitive to heat.

Other Meds: Women's Multi-Vitamin, Vitamin D3/K2, Vitamin C

Current Illness: Sprained left ankle at the beginning of March

ID: 1637100
Sex: F
Age: 61
State:

Vax Date: 08/10/2021
Onset Date: 08/24/2021
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: emergency surgery with pericardial window 8/24/2021

Allergies: none

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

Symptoms: Pericardial effusion presenting with cardiac tamponade

Other Meds: none

Current Illness:

ID: 1637101
Sex: F
Age: 53
State: FL

Vax Date: 04/02/2021
Onset Date: 08/04/2021
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: RA

Lab Data: CXR, covid test.

Allergies: Aspirin, benzocaine, codeine, floxin, liquor, morphine, orajel mouthwash, red wine, vicodin.

Symptom List: Nausea

Symptoms: Cough, sinus congestion, SOB.

Other Meds:

Current Illness:

ID: 1637102
Sex: M
Age: 76
State: NC

Vax Date: 02/19/2021
Onset Date: 05/15/2021
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: Chest X-Ray, Blood Test

Allergies: NA

Symptom List: Injection site pain

Symptoms: I was experiencing severe long term cough/congestion in my chest. I had a pulmonary infection, it lasted 1 month. I was wheezing, coughing, shortness of breath, it was very uncomfortable. I saw my PCP who prescribed antibiotics and steroids. I had a chest x-ray and blood work also. I had two rounds of each and he prescribed a inhaler Trelegy. After I started the new inhaler and 2nd round of medicines I have been fine.

Other Meds: Amlodipine Besylate, Anoro Ellipta Inhaler, Proair- HFA Inhaler, Alfuzosin HCL ER, Atorvastatin, Celebrex, Senior Multivitamin, Calcium Caltrate 630mg, 1,000 fish oil, Vitamin D3, Tadalafil

Current Illness: NA

ID: 1637103
Sex: M
Age: 30
State: KY

Vax Date: 08/10/2021
Onset Date: 08/10/2021
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: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1637104
Sex: F
Age: 67
State: TX

Vax Date: 02/25/2021
Onset Date: 02/26/2021
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: Joint pain developed in fingers of left hand the day after injection, which has not improved. A month after injection my doctor tested for lupus and rheumatoid arthritis. Both tests negative.

Other Meds:

Current Illness:

ID: 1637105
Sex: M
Age: 46
State: PA

Vax Date: 08/18/2021
Onset Date: 08/25/2021
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: None

Allergies: None

Symptom List: Tremor

Symptoms: Injection site developed localized redness, slightly raised. No itching or pain noted.

Other Meds: Claritin 1 tab daily

Current Illness: None

ID: 1637106
Sex: M
Age: 32
State:

Vax Date: 01/08/2021
Onset Date: 01/09/2021
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 listed in AHLTA

Symptom List: Erythema, Pruritus

Symptoms: 32 Y/O male presents to clinic for rash along entire body for 2 days. States he received to COVID vaccine 3 days ago and the rash started shortly after. Pt states that he has had a similar reaction to the smallpox vaccine presenting with the same reaction. Pt states that the rash is along his entire body and that it is very itchy. States he is not currently having pain but he is having discomfort and issues sleeping due to the itching keeping him up. States it is worse on both arms and his legs than the other areas. Denies change in soaps, detergents, any new medications, lotions, or changes in lifestyle that would cause the outbreak. Pt is currently on arming status but does not arm up at this time. Approximately one day later he developed an intensely pruritic rash all over his body but worse on arms and legs. He presented for evaluation on 12 Jan where the physical exam was as follows: Maculopapular rash noted along anterior and posterior portions of entire body except face/neck/feet.

Other Meds: None listed in AHLTA

Current Illness:

ID: 1637107
Sex: F
Age: 50
State: MO

Vax Date: 07/22/2021
Onset Date: 07/22/2021
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: COVID Positive by PCR 7/22/2021

Allergies: NKA

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

Symptoms: Pt admitted to hospital Pt is a 50 year old woman with a PMH of newly diagnosed breast Ca (this year) -s/p initial chemo and just received second dose of Taxol. She is FU with Dr. She received her second dose of Covid vaccine last Tuesday. On Friday, she developed a fever with chills. She then developed cough and diarrhea. Fevers have persisted and she feels weak and very fatigued. Diarrhea is better since Monday. Cough is still present but is some better. She feels a little dyspneic, has no appetite but denies any NV . No melena or HC. Prior to her breast cancer, she had no PMH. She is alert and in no acute distress but appears ill and tired. Sats remain OK while she is talking - on RA. Exam as noted. Mucosa dry. Port L ant chest is intact with No erythema or sts. Lungs with good bilat BS . Coarse crackles R base. NO wheezes. CV RRR wom. Abd soft, no tenderness. extr wo edema or rash. Labs and xray as detailed in note. vss BP 145/81 Pulse 94 Temp 99.2 ?F (37.3 ?C) Resp 19 Ht 5' 4" Wt 245 lb SpO2 94% BMI 42.05 kg/m2 Assessment and POC and as detailed in Resident note: -- Acute febrile illness, multisystem complaints cw viral illness, likely Covid. Inflammatory markers high. Lactate negative. PCR sent. IF negative, will send viral panel. HOlding abx for now with close observation and will start for CAP if sx change. Blood cultures obtained. UA negative. Supportive symptomatic care with close monitoring for potential for deterioration requiring acute intervention. -- Breast cancer -- Obesity with high BMI Due to medical issues in the assessment and plan, continued hospitalization will be required. Assessment and plan, medications, test results, discharge plans, follow up and plan of care as detailed in Dr. note and discussed with patient and with resident.

Other Meds: Claritin, prilosec

Current Illness: R ductal carcinoma of breast

ID: 1637108
Sex: M
Age: 70
State: KY

Vax Date: 07/08/2021
Onset Date: 07/08/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1637109
Sex: F
Age: 68
State: TN

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

Lab Data: None

Allergies: NKA

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Vaccine administered to patient in wheelchair in back of van. Pt had been reclined position prior to vaccination but raised to receive the injection. While speaking to spouse, patient closed eyes and did not respond to husband for a few seconds. Husband thinks she "passed out". Patient did respond to nurse immediately. No further problems.

Other Meds: Unknown

Current Illness: Unknown

ID: 1637110
Sex: F
Age: 59
State: AZ

Vax Date: 07/19/2021
Onset Date: 07/19/2021
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:

Allergies: Beta blocker, percocet = itching. Pt thinks she may be allergic to most meds.

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

Symptoms: Severe swelling, chills, sweating, nausea, weight loss. Severe pain. Pt reports out of body experience/delerium she thinks due to the pain for 48 hours. Pt has treated with ice, rest, and some exercises she was told to do by her provider. Pt states she has had similar reactions in the past to prednisone and dexamethasone injections.

Other Meds: None at the time

Current Illness: Laryngitis since 2019.

ID: 1637111
Sex: F
Age: 53
State: GA

Vax Date: 05/17/2021
Onset Date: 06/26/2021
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: I could nit get into see my doctor and had access to medication at home. I took recommended dose and condition subsided in 5 days.

Allergies: None

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

Symptoms: Shingles. Rash on right side of upper back, very swollen and painful lymph nodes under arm and right side. Feeling like i had the flu with body aches and joint pain

Other Meds: Divigel Biotin

Current Illness:

ID: 1637112
Sex: F
Age: 39
State: KY

Vax Date: 08/03/2021
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:

Allergies:

Symptom List: Pain in extremity

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1637113
Sex: F
Age: 46
State: CA

Vax Date: 08/20/2021
Onset Date: 08/22/2021
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: Unknown. was seen in the Emergency Room. Was placed given off work order for 2 days per, covering Supervisor.

Allergies: No known Allergies

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

Symptoms: On 08/25/21 @ 1346, reported she developed SOB 2 days after receiving her 2nd Pfizer vaccine dose. Admits SOB has worsened and is evident at rest and more severe with exertion. Admits to fever/chills and headaches initially post vaccination. F/C have resolved. H/A has improved with Ibuprofen. Denies CP, palpitations, injection site pain/redness/swelling/rash. Admits to missing work on 08/23/21 -08/24/21 due to SOB. Care coordination with Home Dept, Human Resources and ED Charge Nurse) for further follow-up. was escorted by her supervisor to the ED for further eval. HCW admit to minor injection site discomfort with Pfizer Dose #1 given 7/30/21.

Other Meds: Zyrtec(Generic form), Levothyroxine 300 mcg

Current Illness: None Reported

ID: 1637114
Sex: F
Age: 46
State: CA

Vax Date: 08/20/2021
Onset Date: 08/22/2021
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: Unknown. was seen in the Emergency Room. Was placed given off work order for 2 days per, covering Supervisor.

Allergies: No known Allergies

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

Symptoms: On 08/25/21 @ 1346, reported she developed SOB 2 days after receiving her 2nd Pfizer vaccine dose. Admits SOB has worsened and is evident at rest and more severe with exertion. Admits to fever/chills and headaches initially post vaccination. F/C have resolved. H/A has improved with Ibuprofen. Denies CP, palpitations, injection site pain/redness/swelling/rash. Admits to missing work on 08/23/21 -08/24/21 due to SOB. Care coordination with Home Dept, Human Resources and ED Charge Nurse) for further follow-up. Was escorted by her supervisor to the ED for further eval. Admit to minor injection site discomfort with Pfizer Dose #1 given 7/30/21.

Other Meds: Zyrtec(Generic form), Levothyroxine 300 mcg

Current Illness: None Reported

ID: 1637115
Sex: F
Age: 64
State: CA

Vax Date: 03/16/2021
Onset Date: 03/16/2021
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: EKG, blood work, chest X-ray & exam. EKG showed my heart beat skipping off & on. Then straightened out. Also, same as above

Allergies: Iodine dye She?ll fish

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

Symptoms: 3:00 pm face got puffy, got flush & lasted about an hour. By 8:00 pm I had extreme pain when I tried to walk. Right leg. It got a little better, I could walk but couldn?t lift my leg without a lot of pain for 1 week. I consulted my doctor & she said to take Advil. I took it for several days & symptoms went away. 2nd vaccination- within 5 minutes I had a cold sensation throughout my limbs. Then my blood pressure went very high & was erratic for several hours. I was advised to go to emergency hospital .

Other Meds: Famotidine Levothyroxine Armour

Current Illness:

ID: 1637116
Sex: F
Age: 36
State: KY

Vax Date: 08/03/2021
Onset Date: 08/03/2021
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: 1637117
Sex: M
Age: 43
State: TX

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: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: NONE

Allergies: PENICILLIN, AMOXICILLIN

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: TESTICULAR PAIN 6/10, DIZZINESS, SHORTNESS OF BREATH ON EXERTION, FLUSHING, ANGER 10/10

Other Meds: SYNTHROID, ATORVASTATIN, MULTIVITAMIN, ZINC, VITAMINS C & D

Current Illness: NONE

ID: 1637118
Sex: F
Age: 47
State: TX

Vax Date: 07/20/2021
Onset Date: 07/20/2021
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: not known

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

Symptoms: Patient was given Moderna as first Covid Vaccine and we gave Pfizer as second dose. Patient had no complaints, no adverse outcome, and no treatment was required

Other Meds: not known

Current Illness: not known

ID: 1637119
Sex: F
Age: 81
State: FL

Vax Date: 01/29/2021
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: CXR, covid test.

Allergies: Dilaudid, morphine

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Hallucinations, fever.

Other Meds:

Current Illness:

ID: 1637120
Sex: F
Age: 66
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:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1637121
Sex: F
Age: 40
State:

Vax Date: 07/17/2021
Onset Date: 08/23/2021
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:

Allergies:

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

Symptoms: Acute limb ischemia of right leg required an open thromboembolectomy of right common femoral, SFA and profunda artery and a right lower extremity 4-compartment fasciotomy

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am