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: 1640978
Sex: F
Age: 47
State: MD

Vax Date: 08/24/2021
Onset Date: 08/24/2021
Rec V Date: 08/27/2021
Hospital:

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

Lab Data: none done

Allergies: Allergic to most environmental things "everything per her allergist" Azithromycin Cefpodoxime Codeine Hydrocodone Benadryl Oxycodone

Symptom List: Dysphagia, Epiglottitis

Symptoms: Throat swelling, nausea, fatigue, sore throat

Other Meds: Lexapro

Current Illness:

ID: 1640979
Sex: F
Age: 54
State: MS

Vax Date: 08/24/2021
Onset Date: 08/25/2021
Rec V Date: 08/27/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: None

Allergies: None

Symptom List: Anxiety, Dyspnoea

Symptoms: Swollen and painful lymph-nodes in the right breast and arm pit. Pain level of 5/10 mostly a constant dull ache with an occasional sharp 10/10 pain.

Other Meds: Lisinopril Xigduo Rouvastatin

Current Illness: None

ID: 1640980
Sex: F
Age: 47
State: FL

Vax Date: 08/20/2021
Onset Date: 08/21/2021
Rec V Date: 08/27/2021
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: No

Allergies:

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

Symptoms: Low grade fever, joint pain, fatigue.

Other Meds: Lyrica; Plaquenil; Otezla; Prednisone; Losartan; Nifedipine; Adulate; Imuran; TRICOR; Pristiq; Furosemide; Klonopin; Oxycodone; Stanyel

Current Illness: no

ID: 1640981
Sex: M
Age: 36
State:

Vax Date: 08/25/2021
Onset Date: 08/26/2021
Rec V Date: 08/27/2021
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: Severe vertigo with vomiting

Other Meds:

Current Illness:

ID: 1640982
Sex: F
Age: 42
State: PA

Vax Date: 08/25/2021
Onset Date: 08/25/2021
Rec V Date: 08/27/2021
Hospital:

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

Lab Data: Cbc, bmp, covid test

Allergies: Dilaudid, demerol, cipro

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

Symptoms: Brain fog, difficulty concentration, heart palpitations, blurred vision, slow reactions, since 2 hours following first vaccine

Other Meds:

Current Illness:

ID: 1640983
Sex: M
Age: 65
State: FL

Vax Date: 03/05/2021
Onset Date: 07/21/2021
Rec V Date: 08/27/2021
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: CXR, covid test

Allergies: NKA

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

Symptoms: Cough and fever x 3 days

Other Meds:

Current Illness:

ID: 1640984
Sex: F
Age: 27
State: OK

Vax Date: 08/11/2021
Onset Date: 08/12/2021
Rec V Date: 08/27/2021
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: Patient reported feeling weak and shaking 24 hours after injection. Also reported symptoms of stomach flu/flu, numbness in her hands and blueness in her lips. These lasted approximately 1 week post vaccination.

Other Meds:

Current Illness:

ID: 1640985
Sex: F
Age: 48
State: OH

Vax Date: 08/20/2021
Onset Date: 08/25/2021
Rec V Date: 08/27/2021
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: ZITHROMAX, LATEX

Symptom List: Pharyngeal swelling

Symptoms: sore throat, runny nose, headache, tired, achy

Other Meds: MULTIVITAMIN, ZINC, VITAMIN D, CALCIUM AND VITAMIN C

Current Illness: NONE

ID: 1640986
Sex: M
Age: 22
State: FL

Vax Date: 08/19/2021
Onset Date: 08/21/2021
Rec V Date: 08/27/2021
Hospital:

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

Lab Data: EKG: sinus rhythm HR 63 bpm Normal variant of ECG

Allergies: NKDA, NKA

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient states he received Pfizer vaccine dose #1 19AUG2021. Palpitations started 21AUG2021 due to heart rate feeling faster and more forceful when laying down before bed and after eating food. Denies pain but has discomfort localized at chest when laying down. Denies radiation. Symptoms wake patient out of sleep one time per night. Denies nausea/vomiting. Denies numbness or tingling. Denies pain in chest, jaw, or arms. Denies similar symptoms. EKG completed 27AUG2021 with normal results and HR 63. Patient has an appointment to see surgeon for a referral to cardiology. Patient informed to follow up if symptoms worsen and as needed.

Other Meds: Finasteride 1mg 1tab daily. (Started taking July 24, 2021)

Current Illness: NONE

ID: 1640987
Sex: M
Age: 67
State: OK

Vax Date: 03/26/2021
Onset Date: 04/18/2021
Rec V Date: 08/27/2021
Hospital:

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

Lab Data: hearing exam diagnose from EMT TINNITUS

Allergies: none

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Ringing in right ear now in august ringing in both ears. in trusive and life changing

Other Meds: propranalol 80 omeprazole 20

Current Illness: none

ID: 1640988
Sex: F
Age: 91
State: GA

Vax Date: 02/07/2021
Onset Date: 08/12/2021
Rec V Date: 08/27/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Patient hospitalized due to COVID-19. Patient is fully vaccinated.

Other Meds:

Current Illness:

ID: 1640989
Sex: F
Age: 37
State: OH

Vax Date: 08/23/2021
Onset Date: 08/23/2021
Rec V Date: 08/27/2021
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:

Symptom List: Rash, Urticaria

Symptoms: Patient administered undiluted Pfizer vaccine. Patient has not endorsed any adverse effects from receiving undiluted dose.

Other Meds:

Current Illness:

ID: 1640990
Sex: F
Age: 16
State: FL

Vax Date: 08/24/2021
Onset Date: 08/25/2021
Rec V Date: 08/27/2021
Hospital:

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

Lab Data: chest xray, ekg, troponin, crp, esr, cbc, cmp, ddimer

Allergies: gentamicin

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

Symptoms: nausea, gagging, fever, diarrhea, chills, chest pain

Other Meds: none

Current Illness: none known

ID: 1640991
Sex: F
Age: 50
State: VA

Vax Date: 08/22/2021
Onset Date: 08/23/2021
Rec V Date: 08/27/2021
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: 8/25/21 - ECG, nothing found

Allergies: NSAIDs shellfish alliums (garlic, onion) mango nitrile gloves (the accelerant used to blow them off the molds, inside the gloves) bandage tape cumin mint (very mild) trees mold

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

Symptoms: Heart rate spiked approximately 30+ bpm consistently for any movement, and 15 bpm at rest, per data. (It may not be as accurate as medical testing, but is sufficient to show changes within its own data-set, which go back several years.) Heart rate would spike to 150 gently walking up a flight of steps. Drinking a soda also spiked my heart rate for 5-6 hours, which is abnormal. (On the plus side, I now know how long before bedtime to avoid caffeine, since it apparently processes out of my system in 5-6 hours.) Over four days, gradual improvement back to normal. However, for the first two days, I couldn't do anything more than lay down and avoid anything even slightly stressful to avoid a dangerously high heart rate. The simple act of standing took it up 15 points, to the area it would normally have been if I was running up and down the steps with full baskets of laundry. Shot was Sunday afternoon, reaction started shortly after midnight on Monday. I was woken up by my cardiac response, so this wasn't anxiety-induced. I also wasn't particularly worried about the shot so, again, not anxiety-induced. And I was doing slow breathing and such to calm my heart rate, so not anxiety-induced. At about 3 am on Tuesday morning, I was laying down and my heart rate abruptly jumped 15 points out of nowhere, which was the final straw and I went to the ER. Of course, it was the final straw - my heart rate had started normalizing, so they found nothing on the ECG. The next day, my heart rate was nearing normal. The day after (Thursday), it was seemingly completely back to normal. However, if I had been TOLD that an extreme racing heart was a potential side effect and should normalize within 3-4 days, rest if it happened and see a cardiologist if it doesn't normalize within four days, take these precautions if it exceeds XXXX bpm, visit the ER if YYYYY happens, I would have been spared an ER visit.

Other Meds: Benadryl Breo Allegra Montelukast Escitalopram Vitamin D Tagamet

Current Illness:

ID: 1640992
Sex: M
Age: 65
State: VT

Vax Date: 01/19/2021
Onset Date: 07/02/2021
Rec V Date: 08/27/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Described above. Also blood tests and x-rays.

Allergies: none

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

Symptoms: I developed what was thought to be pneumonia which was treated with an antibiotic and improved. About 10 days later I developed swelling in my right foot and calf. A blood clot was suspected and I was sent to the hospital for and ultrasound which confirmed that I had a massive blood clot in my right leg from my groin to my ankle. I was advised to go to the emergency room, was admitted to the hospital,and a CAT scan taken of my lungs which showed that both of them had emboli. I was placed on a heparin drip for two days and now take blood thinner medication.

Other Meds: Atorvastatin, Lisinopril/HCTZ, Meloxicam, Omelprazole, Krill oil, Multivitamin

Current Illness: arthritis, GERD

ID: 1640993
Sex: M
Age: 52
State: NY

Vax Date: 08/23/2021
Onset Date: 08/25/2021
Rec V Date: 08/27/2021
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: CT on 8/25 with findings of large right intraventricular hemorrhage

Allergies: None

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

Symptoms: Intracranial hemorrhage 2 days after vaccine. Initially thought to be hypertensive hemorrhagic stroke but his wife informed us that he got the vaccine on Monday and had been feeling sick with chills. She found him unconscious in his bathtub. He was taken to the OR with neurosurgery for craniectomy, and remains intubated, critically ill at this time.

Other Meds: Calcium, Vitamins

Current Illness: None

ID: 1640994
Sex: M
Age: 74
State: TX

Vax Date: 02/24/2021
Onset Date: 02/25/2021
Rec V Date: 08/27/2021
Hospital:

Vax Type: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data: X-Rays, MRI, scheduled for EMG

Allergies: None

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

Symptoms: Neuropathy and loss of balance RLE, bottom of R foot

Other Meds: Levothyroxine SOD 0.2MG (200mcg) tab, By mouth 1 daily qty-90 on Mon, Tues, Thurs, Fri, Sun, Levothyroxine SOD 0.175MG(175mcg), by mouth 1 daily, Wed and Saturday Losartan 100MG Take 1 tab daily, qty 90 Amlodipine Besylate 5MG take 1

Current Illness: Post Polio

ID: 1640995
Sex: F
Age: 72
State: LA

Vax Date: 08/06/2021
Onset Date: 08/23/2021
Rec V Date: 08/27/2021
Hospital: Y

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

Lab Data: Bone marrow aspiration and biopsy 8/25/21 revealed aplastia.

Allergies: Codeine, Lipitor, lexapro, lisinopril, losartan, sertraline, meperidine

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient presented with profound pancytopenia on 8/23/2021 WBC 1000 Hgb 4g/do Plt 2000

Other Meds: Multivitamin, vitamin b12 Diamond, Norvasc, Xanax, Astelin, Jardiance, Flonase, Xalatan, metformin, metoprolol, Prilosec, Crestor, Effexor

Current Illness: None

ID: 1640997
Sex: M
Age: 49
State: FL

Vax Date: 08/26/2021
Onset Date: 08/27/2021
Rec V Date: 08/27/2021
Hospital:

Vax Type: PNC13
Manufacturer: PFIZER\WYETH
Vax Name: PNEUMO (PREVNAR13)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data: None so far

Allergies: Sun screen

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Rapids heart beat. Passed out in bathroom hitting head on floor. Out 5-10 minutes

Other Meds: None

Current Illness: None

ID: 1640998
Sex: F
Age: 30
State: WI

Vax Date: 08/26/2021
Onset Date: 08/26/2021
Rec V Date: 08/27/2021
Hospital:

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

Lab Data: Unknown to pharmacy

Allergies: TDAP

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

Symptoms: paresthesia of the left arm, tachycardia, fatigue and confusion. Patient was discharged from urgent care/ER day of. Advised to rest and call pharmacy with any questions or concerns. Patient states she has recovered, just feeling tired after discharge which is a normal side effect of receiving the vaccine.

Other Meds: - amlodipine - lisinopril - metformin -vyvanse -oxcarbazepine - montelukast

Current Illness: n/a

ID: 1640999
Sex: F
Age: 34
State: TX

Vax Date: 08/11/2021
Onset Date: 08/14/2021
Rec V Date: 08/27/2021
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: Took vaccine on 8/11 had a reaction 3 days later 8/14, while she was out of town. Upper GI stomach pain, esophagus pain, horrible re-flux after a couple of days moved to throat and now has mouth and gum sores headache consistent over last week and half. Returned on 8/21 from vacation, She scheduled an appt. to see a PCP about the symptoms

Other Meds:

Current Illness:

ID: 1641000
Sex: F
Age: 78
State: NC

Vax Date: 08/26/2021
Onset Date: 08/26/2021
Rec V Date: 08/27/2021
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: Unevaluable event

Symptoms: Client was given Pfizer on 8/26/2021 Had received Moderna on 7/28/2021

Other Meds:

Current Illness:

ID: 1641002
Sex: F
Age: 82
State: IN

Vax Date: 02/23/2021
Onset Date: 03/01/2021
Rec V Date: 08/27/2021
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: nka

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

Symptoms: Soreness in arm. pain in arm cant lift arm hip pain trouble walking knees ache and pain terrible itching shin feels like its going to crumble

Other Meds: atorvastatin eloquist blood pressure preservision

Current Illness: no

ID: 1641003
Sex: M
Age: 37
State: FL

Vax Date: 08/27/2021
Onset Date: 08/27/2021
Rec V Date: 08/27/2021
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: ADMINISTRATION ERROR : Pt. received a 3rd Booster of Phizer 08/17/2021, Previously received 1st Moderna 04/15/2021 & 2nd Moderna 05/15/2021. No known symptoms at the time.

Other Meds: N/A

Current Illness: N/A

ID: 1641004
Sex: F
Age: 48
State: TX

Vax Date: 05/05/2021
Onset Date: 06/03/2021
Rec V Date: 08/27/2021
Hospital:

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

Lab Data: EKG on June 25, daily monitoring with at home arm wrap pressure taker, EKG on Aug 5. Normal EKG both times, gradual reduction of pressure to normal zones according to BP taker.

Allergies: lactose intolerance

Symptom List: Injection site pain, Menorrhagia

Symptoms: Extremely high blood pressure - chest constrictions - difficulty breathing. Started Blood pressure medicine June 25, was not sufficient so added diuretic July 10, drastic shifts in blood pressure level so added additional blood pressure medicine to the other two on August 5. Now steady pressure in a normal zone

Other Meds: Venlafaxina, Milk Thistle, Vitamin D, Progesterone, Omeprazole

Current Illness: None

ID: 1641005
Sex: F
Age: 31
State: MN

Vax Date: 08/01/2021
Onset Date: 08/01/2021
Rec V Date: 08/27/2021
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: Swollen painful underarm, muscle pains, fatigue

Other Meds:

Current Illness:

ID: 1641006
Sex: F
Age: 75
State: NC

Vax Date: 08/24/2021
Onset Date: 08/25/2021
Rec V Date: 08/27/2021
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: penicillin

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Injection given SC instead of IM resulted in patient reporting fever, heart palpitations, chills, and weakness approximately 24 hours after administration. At 36 to 38 hours post administration, the patient reported that the back of her left arm had a very large red area. All symptoms began improving on day 3.

Other Meds:

Current Illness:

ID: 1641007
Sex: M
Age: 33
State: AL

Vax Date: 08/20/2021
Onset Date: 08/22/2021
Rec V Date: 08/27/2021
Hospital:

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

Lab Data:

Allergies: Artificial Grape

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient Diagnosed with Bells Palsy , numbness to left side of face

Other Meds: Multivitamin and Ibuprofen

Current Illness: none

ID: 1641008
Sex: F
Age: 51
State: SD

Vax Date: 05/27/2021
Onset Date: 08/13/2021
Rec V Date: 08/27/2021
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: blood work stomach x-ray stull sample COVID-19 test

Allergies: Amoxicillin

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

Symptoms: I was nausea with vomiting. I went to see the doctor about this. They did blood work, stomach x-ray, and stool sample, all came out normal. They also did a COVID-19 test, which came out negative.

Other Meds: Metformin 2xday; Optic 1xweek; Overtid Staten

Current Illness:

ID: 1641009
Sex: M
Age: 73
State: KY

Vax Date: 03/03/2021
Onset Date: 08/25/2021
Rec V Date: 08/27/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: Pfizer on 3/3 and 3/24. Positive on 8/25 admitted on 8/25-current

Other Meds:

Current Illness:

ID: 1641010
Sex: F
Age:
State: WI

Vax Date:
Onset Date: 08/16/2021
Rec V Date: 08/27/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Injection site pain

Symptoms: Moderna was given patient is 17 years of age- patient waited 30 min for observation, no symptoms.

Other Meds: none

Current Illness: none

ID: 1641012
Sex: F
Age: 62
State: NY

Vax Date: 08/25/2021
Onset Date: 08/25/2021
Rec V Date: 08/27/2021
Hospital:

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

Lab Data:

Allergies: Latexes Shellfish Sulfates

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

Symptoms: at 30 minutes post vaccine patient complained or redness to right inner arm; red streaks noted+ itching; small red spots noted; denies sob or itchy throat. patient continued to remained in conference room under observation. patient stated itchiness had decreased; streaks gone; approximately 4 red spots remained at additional 30 minutes post vaccination. MD came to see patient ; he recommended patient to take Benadryl and to watch rash ; if it increases or if sob, difficulty breathing occur patient to go to ER. patient verbalized understanding. left clinic ambulatory in no distress. patient remained in clinic for 1 hour.

Other Meds: unknown

Current Illness: unknown

ID: 1641013
Sex: M
Age: 27
State: NC

Vax Date: 08/25/2021
Onset Date: 08/25/2021
Rec V Date: 08/27/2021
Hospital:

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

Lab Data: NA

Allergies: no

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

Symptoms: Received Dose #1 of Moderna on 3/30/2021

Other Meds: no

Current Illness: no

Date Died: 08/21/2021

ID: 1641014
Sex: M
Age: 83
State: TN

Vax Date: 02/17/2021
Onset Date: 08/17/2021
Rec V Date: 08/27/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: Case had covid vaccines x 2 with last dose administered on 2/17/2021. Developed symptoms of Covid 19 on 8/17/2021. Case had a positive COVID 19 lab test on 8/18/2021 was admitted to Medical Center. Case Expired while still hospitalized on 8/21/2021.

Other Meds:

Current Illness:

ID: 1641015
Sex: F
Age: 24
State: MN

Vax Date: 04/07/2021
Onset Date: 08/24/2021
Rec V Date: 08/27/2021
Hospital:

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

Lab Data: 8/26/21 COV/SARS2, Positive

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Covid positive >14 days post vaccine series.

Other Meds:

Current Illness:

ID: 1641016
Sex: M
Age: 61
State: OH

Vax Date: 07/06/2021
Onset Date: 08/24/2021
Rec V Date: 08/27/2021
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: Nasopharyngeal swab collected 8/24/21

Allergies: N/A

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

Symptoms: Non-Hospitalized Breakthrough, receiving inpatient therapy at the hospital at time of positive test, he remains without SOB, chest pain, nausea, diarrhea, getting his therapies in his room until his 10 days of quarantine have been completed, he remains positive and upbeat, and denied any new complaints today other than continued congestion.

Other Meds: dexamethasone (DECADRON) 4 MG tablet, Take 1 tablet by mouth every 8 hours for 14 doses, Disp: 42 tablet, Rfl: 0 ? diazePAM (VALIUM) 5 MG tablet, Take 1 tablet by mouth every 8 hours as needed for Anxiety for up to 10 doses., Disp: 10 tabl

Current Illness: Cancer remission - glioblastoma

ID: 1641017
Sex: F
Age: 24
State: NC

Vax Date: 08/26/2021
Onset Date: 08/26/2021
Rec V Date: 08/27/2021
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: Ibuprofen

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

Symptoms: Arm Soreness, Sharp Headaches, Nausea and Vomiting, stuffy nose

Other Meds: Adderall

Current Illness:

ID: 1641018
Sex: M
Age: 52
State: KY

Vax Date: 03/24/2021
Onset Date: 08/24/2021
Rec V Date: 08/27/2021
Hospital:

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

Lab Data: Rapid antigen COVID 19 test

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: patient has been diagnosed with COVID as of 8/24/21- Cough, body aches, nasal congestion

Other Meds:

Current Illness:

ID: 1641019
Sex: M
Age: 60
State: SC

Vax Date: 01/29/2021
Onset Date: 02/28/2021
Rec V Date: 08/27/2021
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: Tetanus shot

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

Symptoms: Constant ringing in the ears.

Other Meds:

Current Illness:

ID: 1641020
Sex: M
Age: 55
State: KY

Vax Date: 02/27/2021
Onset Date: 02/28/2021
Rec V Date: 08/27/2021
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: Holter monitor March 10-24, 2021.

Allergies: Altace

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

Symptoms: High blood pressure, palpitations and arrhythmias.

Other Meds: Tacrolimus, Myfortic, Prednisone, Coreg, Aspirin, Pravastatin, Magnesium, Calcium, B-Complex

Current Illness: N/A

ID: 1641021
Sex: F
Age: 16
State: TX

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 08/27/2021
Hospital: Y

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

Lab Data: 6/16/21 MRI/MRV- Venous sinus thrombosis

Allergies: NKDA

Symptom List: Pain in extremity

Symptoms: New onset sinus venous thrombosis 15 days after 2nd dose of COVID19 vaccine. Patient did had other predisposing factors that include use of OCP, sinus issues since she is a swimmer, and dehydration at admission.

Other Meds: OCP, spironolactone, and doxyxycline at home.

Current Illness: Acne and hx ovarian cyst

ID: 1641022
Sex: F
Age: 43
State: CA

Vax Date: 05/03/2021
Onset Date: 05/06/2021
Rec V Date: 08/27/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

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

Symptoms: After day 3:Heart pain Lung pain Weak Tired Heart fluttered 1 week after : All within 1 day Severe fast onset headache , bulging eyes , pain behind eyes . Sensitive to any sound or light . Never felt anything like it in my life Following day after headache : eyeballs had blood in eyes . Took about a week before the blood turned to a yellow color and started fading . Same day felt pain like small piercing pain behind right calf . And behind upper thigh. Upper thought was piecing and dull. Both sensitive when I tried to touch my skin . . Continue to have heart flutter since vaccine and at times trying to catch breath during flutter . Comes on when resting or active .

Other Meds: None

Current Illness: None

ID: 1641023
Sex: M
Age: 41
State: FL

Vax Date: 07/29/2021
Onset Date: 08/04/2021
Rec V Date: 08/27/2021
Hospital:

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

Lab Data: Covid test

Allergies: NKA

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

Symptoms: Came to ER with body aches, fever, tension-type headache, episode of vomiting day before ER visit.

Other Meds:

Current Illness:

ID: 1641024
Sex: M
Age: 59
State: PA

Vax Date: 02/22/2021
Onset Date: 08/09/2021
Rec V Date: 08/27/2021
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: 08/16/21 1201 Respiratory virus detection panel Collected: 08/16/21 1052 | Final result | Specimen: Swab from Nasopharynx Adenovirus Not Detected Mycoplasma pneumoniae Not Detected Chlamydophila pneumoniae Not Detected Parainfluenza Not Detected COVID-19 SARS-CoV-2 Overall Result DetectedCritical Enterovirus/Rhinovirus Not Detected Coronavirus Not Detected Respiratory Syncytial Virus Not Detected Influenza A Not Detected Bordetella pertussis Not Detected Influenza B Not Detected Bordetella parapertussis Not Detected Metapneumovirus Not Detected Results Procedure Component Value Ref Range Date/Time X-ray chest 1 view [3297931861] Resulted: 08/16/21 1556 Order Status: Completed Updated: 08/16/21 1556 Narrative: XR CHEST 1 VW PORT IMPRESSION: Bilateral hazy opacities (right greater than left) consistent with atypical pneumonia. This nonspecific imaging pattern can be seen with Covid-19. Other considerations include but are not limited to other infectious etiologies or noninfectious etiologies. END OF IMPRESSION: INDICATION: Shortness of Breath Dyspnea, positive Covid. TECHNIQUE: Portable AP view of the chest was obtained. COMPARISON: None available. FINDINGS: The cardiac silhouette is normal in size.

Allergies: LisinoprilOther (document details in comments)

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

Symptoms: ED to Hosp-Admission Discharged 8/16/2021 - 8/21/2021 (5 days) Hospital. Last attending treatment team, acute respiratory failure with hypoxia (CMS/HCC) Principal problem. Presenting Problem/History of Present Illness/Reason for Admission. Acute respiratory failure with hypoxia (CMS/HCC); Multifocal pneumonia; COVID-19. Patient is a 59-year-old male with past medical history of hypertension, hyperlipidemia, diabetes, gout hypothyroidism, hemochromatosis presented to the emergency room with a chief complaint shortness of breath that started 1 week ago and was getting worse with time associated with cough, fever, chills, decreased appetite, generalized weakness and fatigue. Patient received his 2 Moderna Vaccine shot, the ED labs showed white blood cell count 8.5, H and H 15.4/42.9, chemistry showing sodium of 134 potassium 3.3 was replaced chloride 94, BUN/creatinine 22/1.70, magnesium one-point was replaced, troponin 0.07 CRP 247.9, ferritin 695, chest x-ray showed bilateral infiltrate, D-dimer was elevated 1.41 CTPA was negative for PE showed bilateral infiltrate, patient was requiring 10 L of specialty cannula with saturation 92%, patient was endorsed to me for further evaluation and management/hospitalization. Hospital Course Acute hypoxic respiratory failure with sepsis due to COVID-19 pneumonia. Due to the above presentation patient was admitted to the hospital, started on remdesivir and Decadron patient oxygen requirement continues to worsen initially patient was placed on high flow nasal cannula up to 70% with a flow 45, pulmonology was consulted and recommendation was to give Actemra, Actemra was given and patient was continued on Decadron patient symptoms started to improve gradually and we were able to wean down the oxygen patient was switched to regular nasal cannula and on the day of discharge patient had a rest exercise oximetry which showed the patient will only require 2 L of oxygen with exertion and at night, during my evaluation patient was setting 97% on 2 L, patient to be discharged on tapered dose of Decadron also patient received Zithromax due to mildly elevated procalcitonin during hospitalization. Patient saturation improved significantly, patient currently saturating 95% 4 L nasal cannula. Patient received Actemra 8/17, ISB, Albuterol 4 times daily. -CRP trending down 247.9-247.9-145.5--83.5-45.7-7.6 -CTPA is negative for PE - Non-STEMI type II -Likely demand mismatch ischemia related Covid 19 pneumonia and sepsis -Not having any chest pain - Hypomagnesemia -Magnesium replacement was given during hospitalization - Diabetes -Patient to resume his oral meds, fingerstick stabilized during hospitalization patient received insulin during hospitalization, I am expecting that his glucose measurement will improve with tapering down the steroids, and to follow-up with the PCP and continue to monitor his fingerstick at home **Patient was evaluated by me today. Patient is alert awake oriented x4, no signs of respiratory distress, discussed with the patient regarding current discharge plan he is agreeable Treatments: IV steroids, IV remdesivir, Actemra

Other Meds: albuterol HFA (PROVENTIL;VENTOLIN) 90 mcg/actuation inhaler allopurinoL (ZYLOPRIM) 100 mg tablet alogliptin (NESINA) 25 mg tablet amLODIPine (NORVASC) 10 mg tablet aspirin 81 mg tablet atenoloL-chlorthalidone (TENORETIC) 100-25 mg per

Current Illness:

ID: 1641025
Sex: F
Age: 56
State:

Vax Date: 12/21/2020
Onset Date: 08/25/2021
Rec V Date: 08/27/2021
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: PATIENT RECEIVED PFIZER COVID VACCINE ON Dose 1 date: 12/21/2020 AND Dose 2 date: 01/11/2021. PATIENT TESTED POSITIVE TO COVID ON 8/23/21

Other Meds:

Current Illness:

ID: 1641026
Sex: F
Age: 38
State: GA

Vax Date: 01/15/2021
Onset Date: 01/15/2021
Rec V Date: 08/27/2021
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: Macadamia nuts

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Moderna COVID-19 Vaccine EUA I have had since first injection a weird tingle or itch in my back. The same spot every time. The center of my back, to the right. Feels like bugs are crawling under my skin. This happens daily. Sometimes once daily, sometimes several times a day

Other Meds: Oral contraceptives

Current Illness: None

ID: 1641027
Sex: F
Age: 45
State: WI

Vax Date: 08/25/2021
Onset Date: 08/25/2021
Rec V Date: 08/27/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient wanted the Johnson and Johnson vaccine, but the administrator did not thoroughly review the consent form and administered Pfizer.

Other Meds:

Current Illness:

ID: 1641028
Sex: M
Age: 41
State: FL

Vax Date: 08/25/2021
Onset Date: 08/25/2021
Rec V Date: 08/27/2021
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: Shortly after vaccination, patient began to feel light-headed and pale. Patient was given some water and ice pack and placed on observation for an additional 15 minutes. Patient's symptoms shortly resolved and was discharged.

Other Meds:

Current Illness:

ID: 1641029
Sex: M
Age: 75
State: AZ

Vax Date: 03/08/2021
Onset Date: 03/10/2021
Rec V Date: 08/27/2021
Hospital:

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

Lab Data: 8/19/2021 a biopsy was performed - 8/26/2021 Biopsy results - drug related dermatitis

Allergies: None

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

Symptoms: 2 Days after the 2nd dose of Pfizer vaccine, Welts appeared on his back and chest. Using some over the counter creams to address itching. Over time the welts decreased in size and spots broke out all over his body ...much smaller but causing tremendous itching. These spots covered whole body including extremities...everywhere except face. When nothing seemed to address getting rid of the rash and not associating the rash at this time, he secured an appointment with his primary care doctor, who then referred him to the Dermatology dept. This process took a month. The first visit with Doctor, Dermatologist prescribed Clobetasol Propionate cream which was used for 3 weeks to no avail. Doctor then prescribed Tacrolimus Ointment which again was used for 3 weeks to no avail. On Aug. 19th Doctor performed a biopsy and the results were drug related Dermatitis. At this time steroid medication is being prescribed which hasn't started yet. Because of Type 1 diabetes, there was a hesitancy of using steriods.

Other Meds: Insulin, Verapamil, Losartan, Atorvastatin, Fluoxetine, Bupropion, Doxycycline, Vitamin D3, Centrum Silver-Men

Current Illness: None

ID: 1641030
Sex: F
Age: 37
State: FL

Vax Date: 08/25/2021
Onset Date: 08/26/2021
Rec V Date: 08/27/2021
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: Triptans

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

Symptoms: Pain and swelling in face where dermal fillers were previously injected on 5/22/2020.

Other Meds: Lo lo esterin contraception daily, bee pollen daily

Current Illness: None

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am