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**
PLEASE CHECK BACK SOON
Download the files above while you wait.







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: 1637273
Sex: F
Age: 51
State: CO

Vax Date: 05/21/2021
Onset Date: 08/02/2021
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: Drive-through COVID-19 testing center on 8/2/21 - POSITIVE Result BinaxNOW COVID-19 Self Test on 8/3/21 - POSITIVE Result

Allergies: None

Symptom List: Dysphagia, Epiglottitis

Symptoms: Sinus pressure/headache, runny nose, fever/chills, cough, loss of taste & smell

Other Meds: None

Current Illness: None

ID: 1637274
Sex: F
Age: 60
State: TX

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

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: fever and body aches, nausea and vomiting

Other Meds:

Current Illness:

ID: 1637275
Sex: M
Age: 49
State: CA

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: Blood glucose (8/26/21)

Allergies: Bee sting

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

Symptoms: Diaphoresis, pallor, sensation of facial warmth, anxiety, and nausea

Other Meds: None

Current Illness: Unknown

ID: 1637276
Sex: F
Age: 64
State: OR

Vax Date: 04/08/2021
Onset Date: 04/08/2021
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: This form does not allow for the report I am trying to make, and I think this report is essential to your data-gathering. I want to report that I had Guillain Barr? syndrome in 1966 at the age of 10. There has been alot of concern in the press and social media about history of GBS and the Covid vaccine. I want to stand up and be counted as a person with a history of GBS who had no significant side effects from the Pfizer Covid vaccine.

Other Meds:

Current Illness:

ID: 1637277
Sex: F
Age: 32
State: NV

Vax Date: 08/21/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Period started earlier

Other Meds: None

Current Illness: None

ID: 1637278
Sex: M
Age: 20
State:

Vax Date: 08/26/2021
Onset Date: 08/26/2021
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: Patient had adverse reaction to the first dose of pfizer. He was dizzy and lightheaded Vaccine given at 9:06 AM and reacted at 9:17 AM with dizziness and lightheaded. Also had tunnel vision, skin was clammy and was pale. Was laid down at the time and lifted his feet with ice on head. Vitals signs every 15 minutes. 9:42 AM his vitals were good and he was released at 9:45 AM.

Other Meds:

Current Illness:

ID: 1637279
Sex: F
Age: 23
State: NV

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

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: over 42 days 1st dose 04/14/21, 2nd dose 08/23/21

Other Meds:

Current Illness:

ID: 1637280
Sex: F
Age: 78
State: FL

Vax Date: 02/13/2021
Onset Date: 02/15/2021
Rec V Date: 08/26/2021
Hospital:

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

Lab Data: Tonometry - results varied both were high at first the the norm.

Allergies: Mold, Down feathers

Symptom List: Pharyngeal swelling

Symptoms: I received my second vaccine 2/13/2021. I saw my ophthalmologist 02/15/2021 as a recheck because I fell and hit my head and eye, he noticed my eye pressure increased dramatically. I went back for Laser Treatment on 02/22/2021. I had my left eye done on 2/24/2021. In early March he measured the pressure. My left eye still had a high pressure. On March 25th, The right eye was normal and the left was still high. I had a follow-up appointment on 8/23/2021 and my right eye pressure was normal and the left eye was still high, the doctor had expected it to come down. On 8/25/2021 I had my second laser treatment to my left eye. My concern is that this may have been caused from the vaccine, because I have never had these issues before. I see the doctor again in 2 weeks. 08/21/21 I received my 3 Covid-19 vaccine and I am waiting to see if my pressures go up again. Third vaccine was Moderna in my left arm. Lot# 051E21A.

Other Meds: Armor Thyroid, Losartan, Hydrochlorothiazide, Lipitor, Celebrex, Claritin-D, Hydrocodone, Otezla.

Current Illness: None

ID: 1637281
Sex: F
Age: 45
State: MO

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:

Allergies: Penicillin

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: About 48 hours after 1st dose of Moderna COVID 19 shot, I had tinnitus in my left ear (same side as injection). The tinnitus was constant for days. On day 5 after taking Zyrtec, the ringing lessened to hardly noticeable.

Other Meds: Armour Thyroid, Fabb Tabs

Current Illness:

ID: 1637282
Sex: F
Age: 79
State: OH

Vax Date: 02/01/2021
Onset Date: 08/18/2021
Rec V Date: 08/26/2021
Hospital: Y

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

Lab Data: blood cultures, brain CT, brain MRI, chest xray, breathing therapy, iv antibodies treatment for COVID

Allergies: None

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Extreme Fatigue, Chronic pain in back, escalated mental confusion

Other Meds: Poantoprazole SOD DR, 40 mg/day Methotrexate 2.5 mg x 8 (15 mg) once a week IC Folic Acid 1 mg/day B12 Methylcobalimin 500 mcg/day Vitamin C - 500 mg /day Vitamin E 400 IU/day Vitamin D3, 2000 UI/day

Current Illness: None

ID: 1637283
Sex: M
Age: 14
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: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Vaccine was past the Use By Date, still had not reached original Expiration Date.

Other Meds:

Current Illness:

ID: 1637284
Sex: F
Age: 51
State: AL

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

Lab Data: None

Allergies: Keeflex and NSAIDS

Symptom List: Rash, Urticaria

Symptoms: Extreme Chills and Fever; Severe Pain in Injection Site; Nausea; Dizziness; Trouble Catching Breath and Weakness

Other Meds: Ranexa 1000 mg 2x Day Atorvastatin 80 mg 1x Day Methocarbomal 750 mg 2x Day Tramadol 50 mg 2x Day Multivitamin 2 1x Day Vitamin D3 Gummy 5000 IU 2 1x Day B Complex + B12 Liquid 1 Dropper 1x Day Bayer Low Dose 81 mg 1x Day Iron 1x Day Potass

Current Illness: None

ID: 1637285
Sex: M
Age: 13
State: NV

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

Symptoms: over 42 days 1st dose 06/13/21, 2nd dose 08/10/21

Other Meds:

Current Illness:

ID: 1637286
Sex: F
Age: 63
State: OK

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

Lab Data: None

Allergies: None

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

Symptoms: I got a slight headache about an hour after I received the vaccine. The next day I woke up with a headache and when I got up and started to move around my heart felt like it was beating fast and I felt light headed and weak. I also have elevated blood pressure even after taking medication for 2 days. I have been checking my resting heart rate and it has stayed between 98 and 107.

Other Meds: none at the time although I have been prescribed hydrochlorothiazide 12.5 MG Also, Cyclobenzaprine HCL 10 mg

Current Illness: None

ID: 1637287
Sex: M
Age: 13
State: NJ

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: NKDA; none reported

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

Symptoms: Accompanied by parent, post vaccination reports "feeling dizzy"; denies any additional complaints on assessment. Medical monitoring x15m, po hydration offered / H20 consumed, vitals obtained: HR 94 BP 118/75 O2 sat 99%RA. Reports "feeling fine", with no other complaints reported/ symptoms resolve; released from mobile facility w/parent-mother.

Other Meds: none reported

Current Illness: none reported

ID: 1637288
Sex: F
Age: 74
State: FL

Vax Date: 08/20/2021
Onset Date: 08/25/2021
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: CT scan chest scan, EKG, etc.

Allergies: Rash after 2nd shot

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

Symptoms: Very high blood pressure 200/95 causing vein in eyeball to rupture.

Other Meds: Olmesartan, Tylenol

Current Illness: None

ID: 1637289
Sex: M
Age: 16
State: NV

Vax Date: 08/10/2021
Onset Date: 08/10/2021
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: over 42 days. 1st dose 06/13/21, 2nd dose 08/10/21

Other Meds:

Current Illness:

ID: 1637290
Sex: F
Age: 44
State: NY

Vax Date: 08/25/2021
Onset Date: 08/26/2021
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: Severe upper back pain and burning hot eye sockets

Other Meds:

Current Illness:

ID: 1637291
Sex: F
Age: 12
State: LA

Vax Date: 07/28/2021
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:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Vaccine was past the Use By Date, still had not reached original Expiration Date.

Other Meds:

Current Illness:

ID: 1637292
Sex: M
Age: 60
State: IA

Vax Date: 07/21/2021
Onset Date: 07/22/2021
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: None

Allergies: None

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

Symptoms: Client states that after his first vaccine he developed some numbness in his lower legs at night. Does have a family history of DM. He has not had his HgbA1C checked in a while and does not check his blood sugars.

Other Meds: None

Current Illness: None

ID: 1637293
Sex: M
Age: 49
State: NY

Vax Date: 08/05/2021
Onset Date: 08/07/2021
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: None

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

Symptoms: Itching all over body

Other Meds: Lipitor Metformin

Current Illness: None

ID: 1637294
Sex: F
Age: 75
State: GA

Vax Date: 03/11/2021
Onset Date: 08/02/2021
Rec V Date: 08/26/2021
Hospital: Y

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

Lab Data: PCR+ COVID-19 test

Allergies:

Symptom List: Unevaluable event

Symptoms: Positive covid-19 PCR test and hospitalization

Other Meds:

Current Illness:

ID: 1637295
Sex: F
Age: 34
State: NV

Vax Date: 08/19/2021
Onset Date: 08/19/2021
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: over 42 days. 1st dose 05/25/21, 2nd dose 8/19/21

Other Meds:

Current Illness:

ID: 1637296
Sex: F
Age: 22
State: CA

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

Lab Data: N/A

Allergies: N/A

Symptom List: Injection site pain, Pain

Symptoms: A few hours after getting the second dose (the one listed), my arm was a bit sore. I went to sleep and woke up in the middle of the night around 4am, extremely cold and my arm was too sore to lay on. I had trouble going back to sleep after waking up. Later in the day, I went to take my temperature due to being unreasonably cold, and I had a fever of 100.1?F. I noticed the injection site was a bit swollen, red, and warm to the touch. I couldn't eat because I felt too sick to eat anything, it just made me feel nauseated. Later in the day around 6pm or so, I took my temperature again and it was 102.6?F. During the day I was having hot and cold flashes and sweating a lot. Later in the day after waking up from a nap, around 8pm, I started to feel better and my fever went away. My arm was still sore and the injection site is still swollen, red, and warm to the touch. The next day (8/25/21), I felt fine, but my arm was still a bit sore and the injection site was still swollen, red, and warm to the touch.

Other Meds: Over the counter meds: Tylenol

Current Illness: N/A

ID: 1637297
Sex: F
Age: 66
State: WI

Vax Date: 02/25/2021
Onset Date: 03/20/2021
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: brain CT and MRI lumbar puncture TSH, myoglobin, aldolase, Vit B12, heavy metals, HIV, Hepatitis panel, LYme titer, RPR, VDRL, Immunoglob IgA, Covid

Allergies: NSAIDs, savella, gabapentin, lyrica, diazepam, pantoprazole, prednisone, metformin

Symptom List: Injection site pain, Menorrhagia

Symptoms: pfizer #1 on 2/25/2021 weakness 3/20/2021 subsequently determined by neurologist after MRI and lumbar puncture and serologies June 2021 to be Guillaine Barre

Other Meds: atorvastatin, glimiperide, albuterol,

Current Illness: resolved diverticulitis (one month before)

ID: 1637298
Sex: F
Age: 67
State: OK

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

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

Lab Data:

Allergies:

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

Symptoms: Patient had severe muscle spasm in her foot 1 day after receiving third booster.

Other Meds:

Current Illness:

ID: 1637299
Sex: M
Age: 24
State: TX

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

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient wanted a 1st dose Pfizer but received his 1 dose J&J Janssen vaccine. Pt was informed. Given information on J&J. No adverse events at time of vaccine. Given number for clinic and asked to contact us if he has questions or concerns.

Other Meds:

Current Illness:

ID: 1637300
Sex: M
Age: 86
State: MT

Vax Date: 02/19/2021
Onset Date: 08/17/2021
Rec V Date: 08/26/2021
Hospital: Y

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: Patient fully vaccinated. Diagnosed and hospitalized with COVID 19 from 8/17-8/24/2021

Other Meds:

Current Illness:

ID: 1637301
Sex: M
Age: 33
State: MO

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

Lab Data: EKG done day of reaction 08/26/21

Allergies: none

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

Symptoms: Pt reports headache, chest pressure, eye pressure, diaphoresis and rash. Pt has a red flat rash on chest and upper back

Other Meds: none

Current Illness: none

ID: 1637302
Sex: F
Age: 29
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:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: mushrooms

Symptom List: Nausea

Symptoms: Ten minutes after receiving the vaccine, patient complained of hoarseness. After 20 minutes, she complained of headache and sinus congestion and felt "unbalanced" for a few minutes. Vital signs throughout was stable with O2 sat 100%. After being observed for 45 minutes, her hoarseness resolved, still with headache but reports all other symptoms improved. Patient was discharged home ambulatory with steady gait. Called clinic at 3:09pm and reported that she developed hives and took Benadryl 25mg.

Other Meds: none

Current Illness: none

Date Died: 08/04/2021

ID: 1637303
Sex: F
Age: 71
State:

Vax Date: 07/29/2021
Onset Date: 07/29/2021
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:

Symptom List: Injection site pain

Symptoms: Suddenly more weak , exhausted, all around much worse then she had been feeling as she was in her last days of lung cancer. Within hours of the vaccine she was worse and in two days unresponsive and in a hospice. 4 days after vaccine she died.

Other Meds: Morphine

Current Illness: In her end days of lung cancer was not eating and drinking very little for three days before vaccination was given. She became very ill as she was told she might and was unresponsive and in the hospice two days later. Dying on august 4th. The adverse effects of this vaccine served no purpose to be administered to an imminent end to this dying woman. The vaccines effects would never have gotten in her body till after she had died and only made her more sick and weak then she needed to be.

ID: 1637304
Sex: F
Age: 71
State: TN

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:

Allergies:

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

Symptoms: about a 5 inch area around the injection site became swollen, red, itchy, and hot to the touch

Other Meds:

Current Illness:

ID: 1637305
Sex: F
Age: 80
State: MT

Vax Date: 04/16/2021
Onset Date: 08/18/2021
Rec V Date: 08/26/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Patient fully vaccinated. Diagnosed and hospitalized with COVID 19.

Other Meds:

Current Illness:

ID: 1637306
Sex: F
Age: 79
State: GA

Vax Date: 01/28/2021
Onset Date: 08/03/2021
Rec V Date: 08/26/2021
Hospital: Y

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

Lab Data: PCR+ COVID-19

Allergies:

Symptom List: Tremor

Symptoms: Positive COVID-19 test and hospitalization

Other Meds:

Current Illness:

ID: 1637307
Sex: F
Age: 81
State: IA

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

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

Lab Data:

Allergies: codeine, conch

Symptom List: Erythema, Pruritus

Symptoms: Severe rash, fever, chills, headache lasting about 5 days (not yet over it) Treated with prednisone

Other Meds: thyroxine,Keytruda,lanoprost,trazodone,zolpidem

Current Illness: diverticulitis, lung cancer

ID: 1637308
Sex: F
Age: 1
State: CO

Vax Date: 05/18/2017
Onset Date: 05/27/2017
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: None, as stated above, brought her into the doctor's office, nothing was done.

Allergies: None

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

Symptoms: 10 days after receiving the vaccination, child developed a fever of 104, which lasted about 24 hours. Once the fever broke, she began to develop a rash on her face that then spread throughout her body. She had diarrhea for a week, along with the rash, that also lasted for a week and her skin seemed enflamed and sensitive to the touch. I brought her into the doctor with concerns for the rash/fever/gastro problem and they said they had "no way to know if this was caused by the vaccine", even though the materials described her symptoms to the exact nature and timeline.

Other Meds: None

Current Illness: None

ID: 1637309
Sex: F
Age: 64
State: AZ

Vax Date: 07/31/2021
Onset Date: 07/01/2021
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: N/a

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

Symptoms: Headache since vaccine. Mild elevated temperature

Other Meds: Losartan

Current Illness: N/a

ID: 1637310
Sex: F
Age: 57
State: IL

Vax Date: 02/20/2021
Onset Date: 05/01/2021
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: Blood work

Allergies: Metrizamide dye; Celebrex

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: I did get a slight headache and feeling tired immediately after the vaccine, which resolved within 24 hours. Then beginning 5/1/2021, I went to the doctor for my routine doctor's visit and did blood work. The blood work showed diabetes 128 (fasting) and my blood pressure was high. The doctor prescribed Metformin for my diabetes and added amlodipine for my blood pressure. My sugars levels and blood pressure was still not control so the doctor had to increase the dosages. Recently, the metformin had been increased and added another drug called Trajenta for my diabetes. Also my Amlodipine also increased but due to weight gain and edema, it got changed to Coreg.

Other Meds: Fish Oil; Valium; Potassium; Atorvastatin; Gabapentin; Losartan; Flonase; Ventolin Inhaler; Vitamin D; Allegra

Current Illness: None

ID: 1637311
Sex: F
Age:
State: WI

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: SYR
Vax Site: LA

Lab Data: N/A

Allergies: NO KNOWN ALLERGE

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

Symptoms: Patient was given Johnson& Johnson vaccine around 2:30PM and was advised to wait 15 minutes to observe any possible reaction. She left the pharmacy without any symptoms. An hour and a half later, she came back with rash on her face, none on the body, no fever, no headache, no sign of difficulty breathing. Pharmacist recommended her to take 2 capules of 25mg of Benadryl and wait at the pharmacy for 15 minutes. Pharmacist also recommended her to go to ER if she develops worsening symptoms within a few hours.

Other Meds: N/A

Current Illness: NO

ID: 1637312
Sex: F
Age: 18
State: UT

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: PT WENT PALE AND PASSED OUT. WE CALLED 911 AT MOTHER'S REQUEST AND PT WAS EVALAUATED BY EMTS. PT WAS ABLE TO WALK OFF PREMISES UNAIDED AFTER EVALUATION.

Other Meds:

Current Illness:

ID: 1637313
Sex: F
Age: 41
State: CA

Vax Date: 08/05/2021
Onset Date: 08/05/2021
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: EKG, CT scan, Blood work, X-ray

Allergies: Sensitivity to Motrin, Erythromycin

Symptom List: Pain in extremity

Symptoms: Soreness in my arm, Pain in my left side, My bones are hurting, Fatigue, Brain fog. My legs are still hurting.

Other Meds: Xanax

Current Illness:

ID: 1637314
Sex: F
Age: 64
State: NM

Vax Date: 08/17/2021
Onset Date: 08/24/2021
Rec V Date: 08/26/2021
Hospital:

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

Lab Data:

Allergies: NKDA

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

Symptoms: Itching then rash around injection site.

Other Meds: zinc, vit C, magnesium, D3, cranberry, ginco biloba, joint health triple action

Current Illness: none

ID: 1637315
Sex: F
Age: 38
State: PR

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: Allergies, but do known the cause of.

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

Symptoms: Started with throat discomfort and problems with eating since the vaccine. 3 days of tiredness and headache. Days 5-7 severe allergy all over body and fever.

Other Meds: Vitamins

Current Illness: None

ID: 1637316
Sex: F
Age: 85
State: MT

Vax Date: 04/06/2021
Onset Date: 08/09/2021
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:

Allergies:

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

Symptoms: Patient fully vaccinated. Diagnosed and hospitalized for COVID 19.

Other Meds:

Current Illness:

ID: 1637317
Sex: F
Age: 43
State: CA

Vax Date: 02/23/2021
Onset Date: 02/23/2021
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: I had a lot of blood drawn.

Allergies: I have a sensitivity to niacin, allergic to cats and adhesive.

Symptom List: Vomiting

Symptoms: After receiving the vaccine, I had extreme joint pain, swelling and brain fog. It has become difficult to walk. I'm down to three days of working each week instead of my full time position. My doctors theory is that it gave me an active form of Lyme disease. I have already taken Doxycycline. I am starting to be in the advanced stages of Lyme disease. My next step is that my PCP wants me to see someone who specializes in Lyme disease. I am currently working with my insurance with trying to see this doctor. I've been given anti-inflammatories like naproxen and diclofenac sodium EC. As of today, I am still working with my insurance to try and get in to see this specialist.

Other Meds: I was taking omeprazole, singulair, Flovent (asthma), norco prn and tizanidine. Supplements I take are calcium, B12, multivitamin and biotin.

Current Illness: I was not experiencing any illness.

ID: 1637318
Sex: M
Age: 71
State: CA

Vax Date: 01/12/2021
Onset Date: 08/19/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: date of first vaccine 01/12/2021 date of second vaccine 02/20/2021 On the 7th of August, patient was having upper respiratory type symptoms. COVID PCR revealed that he was COVID positive. patient admitted 08/19/2021 with thromboembolism and COVID pneumonia.

Other Meds:

Current Illness:

ID: 1637319
Sex: F
Age: 51
State: CA

Vax Date: 07/20/2021
Onset Date: 08/10/2021
Rec V Date: 08/26/2021
Hospital:

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

Lab Data: read above EKG , labs 8/10/21 8/26/21 labs and ekg again

Allergies: adverse side effects to Singulair latex foods environmental things banana, avocado, melons, nuts, IV contrast pets, dogs and cats

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

Symptoms: I scanned the bar code to receive questions daily, everyday I reported my symptoms for 1 week left hand finger numbness the next day,chest discomfort, 8/9th lower back pain, kidney area, dark urine Aug 10th vertigo severe while at work, labs and EKG, fast heartbeat 8/19th pcp appt dizziness, right eye pressure 8/21st NP telephone appt for Vertigo and off balance feeling while at work 8/23 NP appt 8/25th covid test negative 8/26th EKG and labs, persistant equillibrium issue since 8/21st and fast heart beat positional, difficulty concentrating

Other Meds: Advair E-ring vitamin C zinc prn meds for Asthma and skin reaction from allergy shots eye drops for dry eyes, tears daily allergy medication

Current Illness: none other than seasonal allergies

ID: 1637320
Sex: M
Age: 53
State: NY

Vax Date: 03/30/2021
Onset Date: 05/21/2021
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: Please contact my Dr. I've had a heart monitor, EEGs EKGs, Bubble tests and blood analysis. I won't say that I have recovered from my stroke, I have to worry about a recurring stroke for the rest of my life.

Allergies: Penicillin

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Migraine 3 weeks after second shot. Followed by Ischemic Stroke.

Other Meds: Colchicine

Current Illness: None

ID: 1637321
Sex: F
Age: 63
State: IL

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: RA

Lab Data: None

Allergies: N/A

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

Symptoms: Patient was given Moderna vaccine that was out of the refrigerator for 24 hours.

Other Meds: Unknown

Current Illness: None

ID: 1637322
Sex: F
Age: 43
State: AL

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

Allergies:

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

Symptoms: After receiving the vaccination patient had to wait 20 to 25. Her arm was sore and red. The muscle became tender. She received a numb and tingly feeling. Where the injection was entered arm started to knot up. The inside of body felt hot. Patient developed chills and developed chills. Felt nausea. Started feeling flu like symptoms that lasted four days. The next day hair was coming out from the roots. The hair dresser called it shedding.

Other Meds:

Current Illness: Codeine Phenergan Susa

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am