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: 1637601
Sex: F
Age: 17
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: IM
Vax Site: LA

Lab Data: N/A

Allergies: N/A

Symptom List: Dysphagia, Epiglottitis

Symptoms: Allergic reaction that took the form of hives that started 18-24 hours after the shot. It was located on the left side of the neck (same side as the injection). It was small the first 2 days, then began to grow. The biggest it got was on Monday, August 23rd, where it was red, itchy, site and was hot to the touch, and breaking out. We went to Apex Pediatrics on Tuesday, August 24th. They said she could take Benadryl if needed to sleep and was prescribes a topical steroid: Mometasone 0.1% Cream 15 GM - Apply topically to the affected area every day as needed for rash.

Other Meds: Calcium supplement

Current Illness: N/A

ID: 1637602
Sex: F
Age: 40
State: CT

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

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: 3 large bumps on left arm near elbow. One the size of a golf ball. Red and warm to the touch. Painful to patient. Referred to urgent care

Other Meds:

Current Illness:

ID: 1637603
Sex: M
Age: 74
State: GA

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

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

Lab Data:

Allergies:

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

Symptoms: Pt states severe cardiac issues since vax. Presented on 8/24/21 with chills, shortness of breath, low oxygen, weakness, chest pain, vomiting froth, rhonchi/wheezing, all new to the patient.

Other Meds:

Current Illness:

ID: 1637604
Sex: M
Age: 71
State: NC

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

Lab Data:

Allergies: NKA

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Headache- moderate with some dizziness

Other Meds: prednisone 5mg, omeprazole 20mg, atenolol 50mg,

Current Illness: Sinus/bronchial bacterial

ID: 1637605
Sex: F
Age: 34
State: CO

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:

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

Symptoms: Patient received vaccine 5 days before the due date for the second dose in the series, which was 1 day out of the 4 day grace period.

Other Meds:

Current Illness:

ID: 1637606
Sex: M
Age: 37
State: GA

Vax Date: 08/01/2021
Onset Date: 08/01/2021
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: 37 y/o/m without any medical history presented 2 days after vaccine with cardiac complaints. Found lying on boat dock extremely diaphoretic, pale, and weak, complaining of cardiac symptoms. Transported to ER.

Other Meds:

Current Illness:

ID: 1637609
Sex: F
Age: 45
State: NC

Vax Date: 08/04/2021
Onset Date: 08/07/2021
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: Ekg was normal. Bloodwork has not been reported yet.

Allergies: Allergic to iodine, shellfish

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Starting late Friday night/ early Saturday morning (8/7/21) I started feeling numbness in my mouth, cheek and eyelid on my left side. I also experienced numbness and tingling on the tops of my feet on both sides, hands, forearms, and other places around my limbs. I also have eye twitching on my left side and twitching at the corner of my mouth on the same side. Additionally, I have had a low grade fever off and on through today, 8/26/21. Random seeming and short lived bursts of pain throughout the body, including the right hand, right knee, shoulders, thighs and back. The pain only lasts 15-30 seconds. I still have all of these symptoms today. I also feel shaky and have had a higher than normal heart rate on and off. In addition I have had sore lymph nodes in the underarms, groin area and clavicle. I have treated with supplements including turmeric, glutathione, quercetin as well as ibuprofen. I received an ekg and bloodwork at my provider. Prior to seeing her I went to urgent care on 8/8/21 but they did not do or say anything and I received no treatment.

Other Meds: Norethindrone 2.5mg daily and omeprazole 20mg daily

Current Illness: Asthma

ID: 1637610
Sex: M
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:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data: None at this time

Allergies: Flu vaccines Has had reactions not considered allergies to other medications. Labeled as intolerance.

Symptom List: Pharyngeal swelling

Symptoms: Vaccination was given late afternoon. Typical reaction of site tenderness later that evening. By the next morning his arm was more tender. In the following days there has been pain radiating from the injection site upwards towards the base of the skull across his shoulder. Mild headache. Pain radiating down his right arm to the little finger and ring finger on the right hand. He has also had extreme fatigue. Heat has not relieved or eased the pain. Wednesday evening, August 25, the pain level had worsened to his not being able to lift his arm. His hand curled into a clawlike form. NOTE: INR at time of injection was 4.7...goal is 3.5-4.

Other Meds: Warfarin, Citalopram, Melatonin, Vitamin D, Atorvastatin, Pregabalin Tylenol

Current Illness:

ID: 1637611
Sex: M
Age: 15
State:

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

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

Lab Data: 8/25/21 @1710: CK 6177; Troponin <0.01 8/25/21 @1906: CK 6022 8/26/21 @0648: CK 7016

Allergies: NKA

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: 15yo M w hx depression presenting w chest pain found to have rhabdomyolysis

Other Meds: olanzapine 2.5mg daily

Current Illness:

ID: 1637612
Sex: F
Age: 44
State: NY

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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Levaquin

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Parts of my face feel tingly and a little numb. The area around my mouth and top of my check on left side. This started about 20 minutes after shot and has not gone away. It?s been about 5 hours now.

Other Meds: Levothyroxine Phentermine

Current Illness: I had a cold last month And a mild cough earlier in the week Covid tested- Negative

ID: 1637613
Sex: M
Age: 81
State:

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

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

Lab Data:

Allergies:

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

Symptoms: 81 year old male, no major medical history, presented approx 1 month after vaccine with mental and physical decline. At report time, pt was in what appeared to be late stages of dementia. Unable to maintain independent care, and was incoherent. Wife states that she and pt?s doctor blame vaccine.

Other Meds:

Current Illness:

ID: 1637614
Sex: F
Age: 50
State: PA

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

Lab Data: 08/26/201 6:30pm: Visit to Dr. Look at the eye, stained it and informed me of the ulcer on my cornea

Allergies: Latex Sulfa Levaquin Erythomycin

Symptom List: Rash, Urticaria

Symptoms: On Wednesday, August 25, 2021 I had the Shingrix shingles vaccine at 2:30pm. At 10:30pm that evening, I had sudden severe eye pain that lasted through the night, only being slightly improved by Advil. There was some light sensitivity as well as blurred vision. The pain was a little better on Thursday August 26th but still very painful and light sensitivity increasing. I saw the Eye doctor at 6:30pm on Thursday, August 26th who said I had an ulcer on my cornea (we are not 100% sure if it is a reaction to the shingles -which is listed as a rare side effect of Shingrix) or something else that caused it such as my contacts, , but because of the timing and not having any eye problems before the vaccine, we are reporting it anyway. My pharmacist and I also feel that it is probably a reaction from the vaccine as well because of the timing. Dr. placed me on strong antibiotic eye drops that I am to take 3x/day for 5 day. Treatment started on 08/26/21.

Other Meds: Effexor XR 150mg 1x/day Sertraline 50mg 1x/day Lamictal 100mg 1x/day Ativan .5 mg- 1mg PRN Omeprazole 40 mg 2x/day Loratidine 10mg 1x/day Cyclobenzapine 10mg PRN Proventil inhaler PRN Asmanax inhaler PRN Famatodine 40mg 1x/day Vitamin D 4

Current Illness: None

ID: 1637615
Sex: M
Age: 83
State: FL

Vax Date: 05/14/2021
Onset Date: 06/05/2021
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: None

Allergies: None

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

Symptoms: Shingles, Valacyclovir 1 Gram, cured

Other Meds: Omeprazole 20 mg Multivitamin Coconut Oil 2 CoQ10 100 mg Vit C 500 mg Calcium 600 mg+Vit D3 20 mcg Atorvastatin 20 mg Vit D3 50 mcg (2000 iu) Vit A 2400 mcg Glucosamine Sulfate 1500mg/Chondroitin 200mg Magnesium 250 mg

Current Illness: None

ID: 1637616
Sex: F
Age: 15
State: MD

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

Lab Data:

Allergies: None

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

Symptoms: Extreme cramping and bleeding with period.

Other Meds: None

Current Illness: None

ID: 1637617
Sex: M
Age: 45
State: CO

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

Lab Data: I did not go to the ER, waited it out and they subsided after 4-5 hours.

Allergies: None

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

Symptoms: Woke up at 2am to 6am with extreme heart palpitations / spasms - just as body aches /chills were coming on from the second dose, which is normal. The spasms were not necessarily painful, but certainly new and unusual and aggressive. FYI

Other Meds: None

Current Illness: None

ID: 1637618
Sex: F
Age: 26
State: TX

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

Lab Data: N/a

Allergies: Iodine, Melon, Bananas

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

Symptoms: Shortly after receiving the shot I got in my car to ride home and lost consciousness for about 45 seconds. When I came to there was unbearable pressure in my chest and I reminded disoriented for about 2 minutes. My chest pain didn?t subside for about 15 minutes. I went to the ER, but left after waiting for an hour and a half and I had started to feel better.

Other Meds: 1000mg EPA

Current Illness: N/A

ID: 1637620
Sex: F
Age: 47
State: NE

Vax Date: 04/08/2021
Onset Date: 04/10/2021
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: I do not have access to this information

Allergies: sulfa, keflex, morphine

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

Symptoms: Chronic hives started 04/10/21 and still have them today; get new ones every day. Also now suffering from fatigue, shortness of breath, and back pain. Have tried treatment with oral steroids, topical steroids, generic Benadryl, generic Allegra, loratadine, generic Pepcid, generic Singulair, Xolair injections. Seeing primary care doctor and have also seen dermatologist, immunologist, rheumatologist.

Other Meds: Simpesse birth control, women's multi-vitamin, calcium + vitamin D, loratadine

Current Illness: none

ID: 1637621
Sex: M
Age: 22
State: WA

Vax Date: 08/24/2021
Onset Date: 08/25/2021
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: heart fluttering, heart pain, chest pain, and troubled breathing

Other Meds:

Current Illness:

ID: 1637622
Sex: F
Age: 54
State: OR

Vax Date: 06/04/2021
Onset Date: 07/01/2021
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: compression socks stop activities that may aggravate it

Allergies: dairy, pork , penicillin, pet fur, trees, grass, dust, mold

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Swollen ankles started a month after shot very painful wont go away. Never had them in my life. Nothing works to help them.

Other Meds: B complex, D3, Calcium, garlic,

Current Illness: none

ID: 1637623
Sex: F
Age: 36
State: IL

Vax Date: 02/03/2021
Onset Date: 03/01/2021
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: Triptans, monistat

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

Symptoms: Migraines multiple times a week

Other Meds: Fish oil, multivitamin, Lexapro, Xanax (as needed)

Current Illness:

ID: 1637624
Sex: F
Age: 20
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: 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: Patient stated that they always get sick to their stomach when getting vaccines and did vomit receiving after vaccine. Patient stated that this happens all of the time and felt much better after some water and waited 20 minutes before leaving the store.

Other Meds:

Current Illness:

ID: 1637625
Sex: F
Age: 33
State: CA

Vax Date: 02/22/2021
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: Pregnancy Test, ER 04/26/2021

Allergies: N/A

Symptom List: Unevaluable event

Symptoms: About eight weeks after the second dose of the vaccine I had a miscarriage. I had some breakthrough bleeding and I called my doctor. I had an HCG test and the levels were very low. I miscarried after that and the baby was not as far along as I should have been. My HCG levels indicated 1-3 weeks and I should have been 7-8 weeks. Due Date Unknown Pregnancy 4

Other Meds: Birth Control stopped near second dose.

Current Illness: N/A

ID: 1637626
Sex: M
Age: 13
State:

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

Symptoms: Pfizer dose was given after expired date and time, passing the 6 hour threshold.

Other Meds:

Current Illness:

ID: 1637627
Sex: M
Age: 22
State: UT

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: APPROXIMATELY 10 MINUTES AFTER RECEIVING THE SHOT THE PATIENT BEGAN TO FEEL FAINT. HE QUICKLY PROGRESSED TO BECOME DISPONDENT, COLD TO THE TOUCH, WEAK, SWEATING PROFUSELY, AND FACE WAS PALE. AFTER LYING DOWN HE BEGAN TO REGAIN HIS COLOR AND BECAME MORE COHERENT. PARAMEDICS ARRIVED AND CHECKED HIM AND ALL VITALS WERE OK AT THAT POINT.

Other Meds:

Current Illness:

ID: 1637628
Sex: F
Age: 54
State: OR

Vax Date: 06/04/2021
Onset Date: 07/04/2021
Rec V Date: 08/26/2021
Hospital:

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

Lab Data: ER did EKG, XRAY, TSH, CBC and found nothing of significance. Next I had an Echocardiograph and then a monitor on my chest for 7 days. It found heart beat skips. Now referred to Cardiologist. I've never had a heart issue and I am very athletic.

Allergies: pet dander, trees, grass, mold, dairy, fur

Symptom List: Injection site pain, Menorrhagia

Symptoms: Extreme increased heart rate, heart flutters, nausea, gasping for breath. Went to ER on 7/6/2021 because it continued

Other Meds: B complex, D3, Calcium, Garlic

Current Illness: no

ID: 1637630
Sex: F
Age: 27
State: OR

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: SYR
Vax Site: LA

Lab Data:

Allergies: none

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

Symptoms: Dose given at 21 days instead of 28. Scheduling error

Other Meds: N/a

Current Illness: none

ID: 1637631
Sex: M
Age: 14
State: PR

Vax Date: 07/26/2021
Onset Date: 07/26/2021
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: N/A

Allergies: NONE

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Administration error: Mother of the minor comes to the center Mall asking which is the vaccine for underage. They answer PFIZER. Mother reports her son was vaccinated with MODERNA with his first dose. Staff member notifies the nurse in charge and to the director. They collaborate with the mother's allegation and Doctor advices the mother to wait for the vaccine to be approve for 18 year old patients. Nurse who vaccinated the minor is not working in the vaccination center. All staff is reoriented about indications and risk of vaccines.

Other Meds: NONE MEDICATION

Current Illness: NKDA

ID: 1637632
Sex: F
Age: 37
State: SC

Vax Date: 08/19/2021
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: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Itchy, swollen, red, hard, lump, at injection site.

Other Meds: Prozac, vitamin d, Wellbutrin, labatalol,

Current Illness:

ID: 1637633
Sex: F
Age: 23
State:

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

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

Lab Data:

Allergies: Pineapple Latex

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

Symptoms: Nauseau - 5 am 8-25 Dizziness - Ongoing for 48 hours Left armpit lymph node swollen and painful to touch - ongoing for 48 hours

Other Meds: Prednisone Humira Methotrexate Vitamin D Folic Acid Loestrin Valtrex Pepcid Zyrtec

Current Illness:

ID: 1637634
Sex: F
Age: 43
State: ID

Vax Date: 05/12/2021
Onset Date: 07/10/2021
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: RA

Lab Data: (6/12)blood work, x-ray, (6/13) CT scan, (6/20)Ultrasound,(6/23) biopsy of a nodule on thyroid, (8/3)blood work,(8/11-12) thyroid uptake scan, (8/18) blood work and results.

Allergies: Ibuprofen, NSAID's, Sunscreen

Symptom List: Nausea

Symptoms: Headaches, heart aches, palpitations, short of breath, lightheaded, felt faint, sweat at smallest exertion, jittery and shaky, Ongoing Determined a thyroid issue but not sure what kind. May be acute thyroiditis.

Other Meds: Vitamin C, Acidophilous, SF 5000+ 1.1% Sodium fluoride

Current Illness: 5-5-2021 Sinus and Lung congestion w/fatigue

ID: 1637635
Sex: F
Age: 27
State: WA

Vax Date: 08/10/2021
Onset Date: 08/14/2021
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: D Dimer - elevated Platelet count - normal Chest CT - clear Other labs and tests were taken, but I did not receive paperwork with results for any of them. All occurred on 8/26

Allergies: None

Symptom List: Injection site pain

Symptoms: 8/14, four days after vaccination, developed unusual bruising with red spots on the opposite arm of injection. 8/18 began passing bright red blood with loose stools consistently. 8/24 began passing dark blood clots with loose stools, no bright blood present. During this time, began noticing small red and purple spots on different parts of the body, three on the right arm, two on right thigh, one small raised patch on left forearm. 8/24 developed a deep cramp like pain in the hand which persisted and a vein became inflamed and red on the night of the 25th. Checked into the ER early morning on 8/26. Chest CT was clear, platelets were normal range, D-Dimer test was elevated. Was given fluids and sent home after a few hours with a referral to a gastroenterologist. Symptoms still present.

Other Meds: DextroAmphetamine 20mg

Current Illness: None

ID: 1637636
Sex: M
Age: 0
State: MA

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: n/a

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

Symptoms: Patient felt like vomiting and could not stand up. Patient had to lay down on the floor. 911 was called EMT arrived to treat patient.

Other Meds: Lidocaine

Current Illness: n/a

ID: 1637637
Sex: F
Age: 51
State: CA

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: RA

Lab Data: None

Allergies: Client denied any allergies to medications, food or other products

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

Symptoms: Client stated her face and tongue felt, "tingling and thick" within 5 minutes of receiving a Pfizer COVID vaccine (LOT FC3183) in the left deltoid intramuscularly. Lead RN made contact with client who was in no apparent respiratory distress and had a calm demeanor, she stated her tongue felt thick and dry. Skins were warm, dry and normal color for ethnicity. Client denied any shortness of breath (SOB), chest pain (CP), difficulty breathing, dizziness or HA. She stated she otherwise felt fine and denied having any difficulty swallowing and was able swallow sips of water without difficulty or incidence, client was speaking coherently without any slurred or affected speech. A first set of vitals were taken at 1447: BP 120/70, HR: 68, RR 20. Client denied any pertinent medical history, denied any allergies to medications/foods/environment. Client denied any history of anaphylaxis and stated the feeling was similar to "being at the dentist with anesthesia". At 1449 client was given 50mg oral Diphenhydramine. Client continued to be calm and in no apparent distress other than stating her mouth and face were tingling. Client continued to be able to converse coherently and without affect. At 1456 client ambulated to the zero gravity chair without incidence and a second set of vitals were taken: BP 110/72, HR: 62, RR: 18, skins warm, dry and normal color. Client continued to deny any other symptoms such as SOB, CP, difficulty breathing, dizziness or HA. Client stated symptoms of thick tongue and tingling were not worsening. She continued to speak coherently without slurred or affected speech. EMS was activated at 1457. At 1503 care transferred to EMS. Client continued to deny any progression of symptoms, she stated the tingling of mouth and tongue continued and were "not worsening or getting better". EMS advised client to go to ER by medical transport. Client expressed concern regarding not having health insurance. EMS convinced client to go to the ER. Client agreed and ambulated to EMS gurney chair without incidence. She remained in no apparent respiratory distress, skins were normal for ethnicity, client continued to speak clearly. At 1510 client was taken to ER by EMS transport.

Other Meds: None stated

Current Illness: None stated

ID: 1637638
Sex: M
Age: 19
State: NJ

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

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

Lab Data: None

Allergies: none

Symptom List: Tremor

Symptoms: Patient waited his recommended 15 minutes after receiving the vaccine. Upon getting out of the chair to exit the building, the patient passed out and fell onto his face. EMT's were immediately called, and pharmacy staff also immediately attended to the patient.

Other Meds: none

Current Illness: none

ID: 1637810
Sex: M
Age: 50
State: UT

Vax Date: 08/22/2021
Onset Date: 08/22/2021
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: EMS took vitals and blood sugar which were WNL

Allergies: VASOVAGAL RESPONSE TO PENICILLIN INJECTION

Symptom List: Erythema, Pruritus

Symptoms: Pt disclosed that he felt dizzy after PCN shot. When he was questioned about it, he clarified that he did not faint or pass out but he just felt dizzy. When was asked about the timing he said like 20 years ago and no problems since. After pt was administered Pfizer vaccine patient was feeling well and not experiencing any dizziness. The patient was fine again stating no issues with dizziness. Patient got up and was standing in the store and fell backwards and hit his head on the floor. At that point, patient was non responsive, and EMS came and took vitals. They medically released the patient. The patient refused to go to the hospital. During questioning the patient EMS asked if he ever had any issues with passing out before and patient stated yes he has passed out before lots taking blood and with shots (which was inconsistent with what he told us before administration).

Other Meds: UNKNOWN

Current Illness: ANXIETY, OTHER WISE UNKNOWN

ID: 1637811
Sex: M
Age: 65
State: NY

Vax Date: 04/10/2021
Onset Date: 08/26/2021
Rec V Date: 08/26/2021
Hospital:

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data: None

Allergies: None

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

Symptoms: 6 to 10 hours after the vaccine injection on the same day, my nose started bleeding for 10 to 15 minutes

Other Meds: Vitamins, D3 5000 IU daily, B6, twice a week, B12 twice a week, Kelp twice a week, colloidal silver tablespoon twice a week, and several others

Current Illness: None

ID: 1637812
Sex: F
Age: 19
State: UT

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: 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: APPROXIMATELY 10 MINUTES AFTER RECEIVING THE SHOT THE PATIENT BEGAN TO FEEL FAINT. SHE QUICKLY PROGRESSED TO BECOME DISPONDENT, COLD TO THE TOUCH, WEAK, SWEATING PROFUSELY, AND FACE WAS PALE WITH BLUE LIPS. AFTER LYING DOWN SHE BEGAN TO REGAIN HER COLOR AND BECAME MORE COHERENT. PARAMEDICS ARRIVED AND CHECKED HER AND ALL VITALS WERE OK AT THAT POINT.

Other Meds:

Current Illness:

ID: 1637813
Sex: M
Age: 24
State: WA

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: IM
Vax Site: LA

Lab Data:

Allergies: none

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Trouble lifting left arm due to pain in my armpit on the arm that I had the injection. This is the third shoot that I have had really bad swelling for in my arms and arm pit. There has been no treatment or outcome to this situation as of yet.

Other Meds: none

Current Illness: none

ID: 1637814
Sex: M
Age: 28
State: CO

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: None

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

Symptoms: Patient (PT) presented lightheaded and dizzy. He was asked to lay down on the floor. PT began to feel better and sat up after a few minutes. He began to feel dizzy again and laid down again and began to feel better. Patient reported numbness in tips of fingers. He was given crackers and chocolate. He denied feeling dizziness after a few minutes nor did he experience blurred vision. He was fully responsive and stood up, talking and was coherently answering questions by us. About 25 minutes later he left smiling and thanked us for our help. Vitals - 16hr:30: HR 57 - RR 16 - SP02 97% - Bp 122/74. 16hr45min: HR 60 - RR 16 - Sp02 97 - Bp 118/82

Other Meds: None

Current Illness: None

ID: 1637815
Sex: M
Age: 20
State: NH

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

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: N/A

Allergies: N/A

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

Symptoms: PATIENT FELT FAINT AND DIZZY AND NEEDED ASSISTANCE TO STAY UPRIGHT. STATED THAT IT ALWAYS HAPPENS WHEN THEY GET A VACCINE

Other Meds: N/A

Current Illness: N/A

ID: 1637816
Sex: M
Age: 69
State: CA

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

Lab Data: N/A

Allergies: KNA

Symptom List: Pain in extremity

Symptoms: Patient reported feeling okay after getting the vaccination, went to bed, didn't sleep well, awoke for on 08/25/21 at 0600, felt "strange", went to work then had to come home early because he was extremely tired. Patient developed Temp of 103 F, took fever reducer with no change in Temp until today, Temp = 101.3, chills of f and on, diarrhea began today 08/26/21 with patient having several very loos stools prior to calling our office at 4:21 PM.

Other Meds: N/A

Current Illness: NONE

ID: 1637817
Sex: M
Age: 13
State: AL

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: 2
Vax Route:
Vax Site:

Lab Data:

Allergies: n/a

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

Symptoms: syringe malfunction, needle not screwed on tight enough, dose leaked from needle when trying to inject

Other Meds: n/a

Current Illness: n/a

ID: 1637818
Sex: F
Age: 27
State: WV

Vax Date: 01/07/2021
Onset Date: 04/05/2021
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: Allergy to bees

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

Symptoms: Neurological symptoms began on 4/5/21, migraine with numbness/tingling into right arm. Full stroke work-up done per neurologist. Echo (4/14/21) came back abnormal (mild mitral regurgitation, mild tricuspid regurgitation, trace pulmonic regurg, mitral annular calcification). Echo previously done in 02/2019 which was completely normal.

Other Meds: Nortriptyline 25 mg daily

Current Illness:

ID: 1637819
Sex: M
Age: 36
State:

Vax Date: 08/19/2021
Onset Date: 08/21/2021
Rec V Date: 08/26/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Broke out in hives on left leg. Had other small area with hives throughout the body but mainly left leg.

Other Meds: None

Current Illness: None

ID: 1637820
Sex: F
Age: 53
State: NJ

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

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: pt arm hurt at injection site to palm of hand for 20 minutes after injection, needed a cold compress. also felt nauseous

Other Meds:

Current Illness:

ID: 1637821
Sex: F
Age: 25
State: CA

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

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient received Moderna Vaccine on 07/07/2021, pt came in today for second dose of vaccine, pfizer vaccine was administer after being okayed by provider.

Other Meds:

Current Illness:

ID: 1637822
Sex: F
Age: 20
State: NH

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

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

Lab Data: N/A

Allergies: N/A

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

Symptoms: PATIENT FELT LIGHT HEADED AFTER GETTING THE VACCINE DUE TO ANTICIPATION. WE CHECKED THEIR BLOOD PRESSURE WHICH WAS NORMAL.

Other Meds: N/A

Current Illness: N/A

ID: 1637823
Sex: M
Age: 89
State: CT

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: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Lost consciousness after the vaccine. 911 call was made. He was taken to the Hospital Emergency Room by the EMS.

Other Meds:

Current Illness:

ID: 1637824
Sex: M
Age: 69
State: CA

Vax Date: 02/17/2021
Onset Date: 03/02/2021
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: chest x-ray; biopsy of rash site; blood culture; multiple dermatology visits

Allergies: no

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

Symptoms: flea like bites on feet, legs, back arms with rash on back that is starting to go away after use of cortisone creams

Other Meds: Synthroid; Cozaar, diltiazem, baby aspirin

Current Illness: none

ID: 1637825
Sex: F
Age: 64
State: NY

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

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

Lab Data: CTA chest with bilateral segmental and subsegmental PEs on 8/26 LE duplex without DVTs on 8/26

Allergies: ciprofloxacin

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

Symptoms: In the 24hrs after receiving 3rd dose in an immunocompetent patient, patient developed L shoulder pain (received dose in L upper arm) and then developed L pleuritic chest pain. Found to have bilateral segmental and subsegmental non-massive pulmonary embolism, improving with heparin and transition to eliquis. No evidence of DVT.

Other Meds: albuterol prn

Current Illness: none

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am