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: 1642041
Sex: M
Age: 70
State: OK

Vax Date: 02/19/2021
Onset Date: 08/10/2021
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: Medical centers, Rapid Covid-19 test, positive results.

Allergies: none

Symptom List: Dysphagia, Epiglottitis

Symptoms: Began with severe sinus issues, turned into migraine symptoms, light sensitive. Took an at home Covid-19 test kit, it showed positive. Went to the Medical clinic, they did a rapid Covid-19 test, it came back positive. Headache lasted several days, felt extremely exhausted, small cough. Symptoms began to clear up after a week. No problems since.

Other Meds: Lisinopril, Trintellis, Atorvastation, Meloxican,

Current Illness: none

ID: 1642042
Sex: F
Age: 59
State: AK

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

Lab Data: N/a

Allergies: lisinopril, pregabalin, amoxicillin, ascorbic acid, cats, dogs, dust, grass, methotrexate, mold, PCN, tetracyclines

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient called at this time reporting she believes she is having a reaction to the covid vaccine she received yesterday. She was noted to received her first dose of Pfizer vaccine yesterday afternoon. She reports her arm does not hurt and denied any rash, swelling, or SOB. She reports that she went to bed very early in the afternoon around 1600 and woke around 2200 and found she had an incontinent diarrhea BM. She reports she cleaned herself up and went back to bed and reports when she woke up again she had an emesis. She reports no further diarrhea or emesis throughout the day, but states she is "not feeling good" with a severe HA and "regretting it".

Other Meds: Gabapentin, Vit D., Pilocarpine, ondansetron, voltaren gel, psyllium, hydroxychloroquine, atorvastatin, Carafate, simethicone, labetalol, baclofen, loratadine, B12 injections, pramipexole, chlorhexidine, albuterol, lidocaine topical, cyclos

Current Illness: Patient reports none.

ID: 1642043
Sex: F
Age: 22
State: OK

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

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

Lab Data: Bloodwork, urine analysis, EKGs, Blood pressure checks. Constant monitoring with heart monitor until Friday evening.

Allergies: Bactrim

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

Symptoms: I experienced tachycardia all night long. Heart rate stayed at 120-130 while resting and would elevate to 150-160 if I stood up. Went to Emergency room where I was admitted. I was given a medication to lower heart rate along with fluids, but my heart rate seemed to be coming down around the same time my other (more typical) vaccine side effects subsided. These effects included body aches, fever and nausea. My resting heart rate returned to a more normal rate during the daytime on Thursday.

Other Meds: Spironolactone, 100 mg Novolog Insulin in pump Vitamin D supplement Iron supplement

Current Illness: N/A

ID: 1642045
Sex: F
Age: 7
State:

Vax Date: 03/01/2010
Onset Date: 08/25/2021
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: Herpes Zoster in someone who has never had Varicella symptoms.

Other Meds:

Current Illness:

ID: 1642046
Sex: F
Age: 50
State: HI

Vax Date: 01/11/2021
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: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Fully vaccinated and tested positive for Covid-19

Other Meds:

Current Illness:

ID: 1642047
Sex: F
Age: 56
State: MO

Vax Date: 08/27/2021
Onset Date: 08/27/2021
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: None to date

Allergies: Sulfa, penicillins

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

Symptoms: Pharmacist drew up vaccine for technician. While administering shot the needle came disconnected from syringe. This caused product to leak on patient's arm and there was still remaining product in syringe. Technician was confident that minimal dose was administered, so a full dose was administered to patient.

Other Meds: None

Current Illness: None

ID: 1642048
Sex: M
Age: 28
State: OR

Vax Date: 02/26/2021
Onset Date: 08/23/2021
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: Sore arm.

Other Meds:

Current Illness:

ID: 1642050
Sex: M
Age: 14
State:

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Pt reported lightheadedness and could not see (could not see at all). Pupils became dilated. Pt stated within a few minutes that items in his field of vision began to look purple and shortly after he could tell me how many fingers I was holding up and could follow my finger. Pt was sweaty and gave him an ice pack to cool him down. Pt was ok and said he felt normal and fine within 20 minutes. Told guardian to monitor him throughout the night and if anything comes up to take him to the emergency department. Guardian stated she would f/u with his guardian regardless.

Other Meds:

Current Illness:

ID: 1642051
Sex: M
Age: 18
State: KS

Vax Date: 04/30/2021
Onset Date: 05/01/2021
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: Lots of blood work, tests for Celiac disease, diabetes, endocrine system, liver workup, upper endoscopy, brain MRI, neurological workup, infectious disease tests, CT scan and xray of abdomen Tests ran from May - July, 2021

Allergies: Allergic to Penicillin

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Extreme/debilitating fatigue, gut/stomach bloating and burping, intolerance to certain foods, agitation, brain fog

Other Meds: None

Current Illness: None

ID: 1642052
Sex: F
Age: 13
State: DE

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

Lab Data: UNKNOWN

Allergies: NONE

Symptom List: Diarrhoea, Nasal congestion

Symptoms: PATIENT COMPLAINED OF TROUBLE BREATHING, TIGHT THROAT, TINGLE IN LIPS, EARS & THROAT 10 MINUTES AFTER VACCINATION. HAD PATIENT CONTROL THEIR BREATHING, 25MG DIPHENHYDRAMINE LIQUID ADMINISTERED ORALLY. SYMPTOMS REMAINED & PATIENT WENT TO URGENT CARE. UPON RETURN FROM URGENT CARE (1 HOUR LATER), SYMPTOMS WERE RESOLVED & PATIENT FWAS PRESCRIBED HYDROXYZINE 25MG TABLETS FOR ANXIETY.

Other Meds: unknown

Current Illness: unknown

ID: 1642053
Sex: F
Age: 72
State: CA

Vax Date: 02/25/2021
Onset Date: 07/23/2021
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: Shellfish, sulfa drugs

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

Symptoms: I had a heart attack and stent inserted on 7/25/2021. Not reporting a direct adverse reaction

Other Meds: Hydroxyurea 500 mg Pravastatin 30 MG Plavix 75 mg Protonix 40 MG Carvedilol 12.5 MG Isosorbide mononit er 30 mg Losartan Potassium 25 MG CoQ10 Vit D Vit B12

Current Illness:

ID: 1642254
Sex: F
Age: 32
State: FL

Vax Date: 07/01/2021
Onset Date: 07/02/2021
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: Urgent care clinic visit on 7/16 Emergency room visit 7/22 Cardiologist 7/26 Primary care Dr visit on 7/29 Pulmonologist 8/19

Allergies: None

Symptom List: Rash, Urticaria

Symptoms: Swollen throat, shortness of breath, heart palpitations, nausea, lightheaded, extreme fatigue, weakness, shivering without fever, ticks around arm & sides, tenderness by rib cage, unable to walk, ache on arm that got the vaccine shot, hands go numb, heaviness in left chest , tender chest,

Other Meds: None

Current Illness: None

ID: 1642255
Sex: F
Age: 38
State: VA

Vax Date: 08/14/2021
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: N/A

Allergies: None known

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

Symptoms: 7 days after the injection- my arm started becoming really itchy and swelled up. There was a hard lump at injection site and it was itchy for a few days. Again, it did not start until 7 days after my first Moderna shot.

Other Meds: None

Current Illness: None

ID: 1642256
Sex: F
Age: 14
State:

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

Lab Data:

Allergies:

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

Symptoms: Loss of consciousness, anxious, jittery

Other Meds:

Current Illness:

ID: 1642257
Sex: F
Age: 40
State: MI

Vax Date: 08/22/2021
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: LA

Lab Data:

Allergies: None

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

Symptoms: Rash on left arm (warm to touch, pink) on Wednesday. Took benedryl. Woke up Thursday to extreme headache, joint and muscle pain, extreme lethargy. Took ibuprofen, water. Slept almost 18 hours. Still feeling faint muscle/joint pain and headache on Friday.

Other Meds: Nasacort, Remicade, insulin, vitamin d, levothyroxine, Effexor, fluoxetine

Current Illness: None

ID: 1642258
Sex: F
Age: 53
State: TX

Vax Date: 04/17/2021
Onset Date: 04/22/2021
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: STARTED GETTING BLOOD WORK IN JUNE THAT SHOWED ALARMING LIVER NUMBERS SO RE-TESTED WITHIN 24HRS.

Allergies: NONE

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

Symptoms: NOTICED INFLAMMED CUTICLES THAT WERE SENSITIVE TO WATER WHEN I GOT UP IN MIDDLE OF NIGHT TO USE BATHROOM. NEXT MORNING MY LEFT EYELID WAS ALSO INFLAMMED. THIS WAS DAILY. I STARTED HAVING ISSUES WITH MY LEFT EAR. NOTHING COULD TOUCH MY CUTICLES WITH OUT DISCOMFORT. I GOT A RASH ON MY NECK SHOULDERS AND ARMS THAT I THOUGHT WERE STRESS HIVES. THE RASH BECAME RED AND INFLAMMED. WENT TO HOSPITAL CLINIC AND THEY SAID I HAD AN INFECTION BECAUSE OF THE REDNESS IN MY EAR CANAL AND ARM. THEY PRESCRIBED AN ANTIBIOTIC AND STEROID. I TOOK BOTH AND NOTHING IMPROVED. BY NOW MY RANGE OF MOTION WAS DECREASING AND I WAS EXHAUSTED. I COULD NO LONGER RAISE MY HANDS ABOVE MY HEAD AND I TOOK HOURS TO GET DRESSED. I ALWAYS FELT LIKE I HAD DONE 30 MINUTES OF SWIMMING LAPS AND THEN TRIED TO PULL MYSELF OUT OF THE POOL FROM THE DEEP END. I MADE AN APPOINTMENT WITH MY PCP IN JUNE

Other Meds: BLOOD BUILDER, EMERGEN-C PLUS IMMUNE SUPPORT

Current Illness: NO

ID: 1642259
Sex: F
Age: 61
State: OR

Vax Date: 07/26/2021
Onset Date: 07/26/2021
Rec V Date: 08/27/2021
Hospital: Y

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

Lab Data: CT scans, one with contrast; MRI with contrast, blood tests, echocardiagram and more conducted at Hospital 7/26/21 to 8/1/21.

Allergies: Penicillin

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

Symptoms: Ischemic stroke occurred approximately 2 hours after Shingrix vaccination.

Other Meds: Losartan/HCTZ Estradiol

Current Illness: None

ID: 1642260
Sex: F
Age: 32
State: MI

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

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

Lab Data: NOT APPLICABLE

Allergies: NO

Symptom List: Ear pain, Hypoaesthesia

Symptoms: PATIENT WAS FEELING DIZZY ,SO i AND MY TECHNICIAN HELPED HER TO LIE DOWN ON THE FLOOR. WE GAVE HER WATER AND GAVE HER ICE PACK. SHE WAS TALKING TO US AND WITH IN 5-7 MINUTES ,SHE WAS COMPLETELY OKAY , SHE WAKS OUT OUR CLINICAL ROOM AND SET ON CHAIR. WE OBSERVE HER FOR ANOTHER 30 MINUTES , SHE WAS FINE AND I ALSO CALLED HER AFTER 6 HOURS ,SHE WAS FINE . SHE MENTIONED THAT SAME SITUATION HAPPENED IN PAST WHEN SHE HAD TATTOO DONE.

Other Meds: MULTI VITAMINS

Current Illness: NO

ID: 1642261
Sex: F
Age: 53
State: WI

Vax Date: 08/17/2021
Onset Date: 08/18/2021
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: Pelvic Blood test

Allergies: Compazine

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: I got the shot shortly after 9:00 a.m. and woke up with a very heavy menstrual cycle. I hadn?t had a period since April so thought I was going through menopause. The only time I have passed this much blood and clots was after giving birth. I went to the doctor today as it is still very heavy. I am now 10 days into having this. It would be extremely helpful if you can provide information of how long is it okay to be bleeding like this. My doctor did a pelvic exam and notated I am still clotting and bleeding heavily. She prescribed medroxyprogesterone to stop the bleeding. I am going to hold off on taking that for another week to see if it will slow down or stop. The side effects of that pill are not the greatest. I don?t regret getting the Moderna shot. I am letting you know so you can help women with what to expect and how long should it last before you menstrual cycle is a concern.

Other Meds: One a day vitamin, fiber, fish oil, probiotic, magnesium

Current Illness: Cold

ID: 1642262
Sex: M
Age: 13
State: CA

Vax Date: 08/22/2021
Onset Date: 08/23/2021
Rec V Date: 08/27/2021
Hospital: Y

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

Lab Data: Echo showed good function and no abnormalities. Serial EKGs showed mild ST segment elevation and early repolarization. Troponin peaked around 8 and steadily fell.

Allergies: None

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

Symptoms: 13 year old identical twin boy who started having chest pain approximately 24 hours after 2nd dose of vaccine. Chest pain was persistent and he then developed shortness of breath so was brought to ED. Found to have troponin very elevated and EKG with some ST segment elevation and was admitted for acute myocarditis.

Other Meds: None

Current Illness: None

ID: 1642263
Sex: F
Age: 72
State: FL

Vax Date: 08/22/2021
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: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: unknown

Allergies: codeine, opioids/morphine, methylprednisolone

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

Symptoms: Patient said she is completely tense cannot relax/ cannot sleep. She says her teeth have been grinding.

Other Meds: unknown

Current Illness: unknown

ID: 1642264
Sex: F
Age: 73
State: CO

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

Lab Data: N/A

Allergies: No

Symptom List: Unevaluable event

Symptoms: Patient was given an expired vaccine. The vaccine was left out over night and drawn up by a technician that did not know it was not a new vial. The patient was immediately notified and consented to receive a non-expired vaccine which was immediately administered.

Other Meds: Unknown

Current Illness: Unknown

ID: 1642265
Sex: F
Age: 45
State: CT

Vax Date: 08/27/2021
Onset Date: 08/27/2021
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: blood pressure by ems

Allergies: none

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

Symptoms: patient felt weak and sat on floor and 911 was called and patient was keep alert and conscous while ems got to pharmacy. patient has history of syncope with blood draws and was taken to hospital to be checked out

Other Meds: unknown

Current Illness:

ID: 1642266
Sex: M
Age: 42
State: AK

Vax Date: 03/01/2021
Onset Date: 03/19/2021
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:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Constant headachs everyday, arms falling asleep

Other Meds:

Current Illness:

ID: 1642267
Sex: F
Age: 61
State: WA

Vax Date: 08/13/2021
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: 1
Vax Route: SYR
Vax Site: LA

Lab Data: 8-27-2021EKGabnormalities, currently wearing a 48 hr holter monitor. Two urgent care visits (8-18-2021) felt like passing out, migraine, stomache, (8-18-2021 Sent to ER)for stomache, nausea, heart palpitations. (8-22-2021) heart palpitations, dizziness, nausea, vomiting) ((8-25-2021) Primary care , fatigue, nausea, heart palpitations

Allergies: Eurythrmycn

Symptom List: Injection site pain, Menorrhagia

Symptoms: Severe migraine, body aches, nausea, gastrointestinal, sore arm, shakiness, weak, fogginess, heart palpitations, feels like ?the flu?

Other Meds: None

Current Illness: None

ID: 1642268
Sex: F
Age: 68
State:

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

Lab Data:

Allergies:

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

Symptoms: Patient immediately had swelling form, size of half a golf ball. Patient felt fine, not difficulty breathing or history of reaction to vaccines. After a 15 minute observation period, patient was allowed to leave.

Other Meds:

Current Illness:

ID: 1642269
Sex: M
Age: 27
State: NM

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

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient was nervous about getting vaccine, did well after vaccine still seemed nervous would not sit was pacing back and forth but insisted he felt ok then at about 15minuts after shot said he didnt feel well. Patient seemed sweaty , said tongue felt funny, his blood pressure was taken was 160/96. had patient lie down put ice pack on him checked tongue and throat not swollen, blood pressure didnt come down pulse was 100 so called paramedics. After they arrived they checked his vitals patient started to feel better paramedics decided was his choice to go to hospital patient refused the paramedics said he was stable so patient had someone pick him up instead and was feeling muc better by time he left.

Other Meds: fluoxetine

Current Illness:

ID: 1642270
Sex: F
Age: 26
State: CA

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

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Late/missed period

Other Meds: Muscle relaxer-as needed Advil/ Tylenol- as needed

Current Illness:

ID: 1642271
Sex: F
Age: 52
State: TX

Vax Date: 08/26/2021
Onset Date: 08/27/2021
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: Codiene

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

Symptoms: Fever, body aches and can?t lift my arm

Other Meds: Trazodone Fenofibrate Farxiga Lipitor and Adderall

Current Illness: None

ID: 1642272
Sex: M
Age: 63
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:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: None

Allergies: NKA

Symptom List: Nausea

Symptoms: Muscle cramps bilateral lower extremities, gene evaluation malaise, left arm pain

Other Meds: Eliquis, Vit C, Super B, Centrum mini

Current Illness: None

ID: 1642273
Sex: M
Age: 13
State: CA

Vax Date: 08/22/2021
Onset Date: 08/23/2021
Rec V Date: 08/27/2021
Hospital: Y

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

Lab Data: Echo showed good function and no effusion or abnormalities Serial EKGs showed mild ST segment elevation with early repolarization Troponin peaked at 7 and steadily fell to 1.2 by discharge

Allergies: None

Symptom List: Injection site pain

Symptoms: 13 year old identical twin boy who started having chest pain approximately 24 hours after 2nd dose of covid vaccine. Chest pain was persistent and within 48 hours he developed shortness of breath so mom brought him to ED. Found to have elevated troponin and EKG with some ST segment elevation and was admitted for acute myocarditis.

Other Meds: None

Current Illness: None

ID: 1642274
Sex: M
Age: 32
State: ID

Vax Date: 08/26/2021
Onset Date: 08/27/2021
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: None

Allergies: None

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

Symptoms: 100.4 degree fever temporal after 1000mg of Tylenol 2-3 hours ago. Uncontrollable shivers at times. Body feels sore and have a headache. But the most concerning symptoms is minor purple discoloration of my fingernails and toenails. No shortness of breath though

Other Meds: Tylenol

Current Illness: None

ID: 1642275
Sex: F
Age: 45
State: WA

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:

Allergies: Egg, sulfa, acetaminophen, codeine, epinephrine

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

Symptoms: Intense headache within 1 hour of vaccine, followed by dizziness and severe nausea. Tried to rest, but woke up shortly after with widespread muscle contractions, pain, and cramping. Headache was worse. Eyes were tearing uncontrollably. Fever measured 105.2 by forehead reading. Started to increase fluid intake and took aspirin for fever reduction at the advice of one of my doctors. Terrible fatigue and weakness followed. Unable to sleep since right after vaccination. Unable to tolerate solid food. Unable to sit upright in bed without fever spiking. Fever remaining between 102-103 with aspirin and cool compresses. Continued muscle cramps all over body. Headache resolving, but scalp tenderness remains. Changes in vision also.

Other Meds: Turmeric, glucosamine/chondroitin/MSM, ginger, vitamin D

Current Illness:

ID: 1642276
Sex: F
Age: 52
State: CT

Vax Date: 08/19/2021
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: IM
Vax Site: LA

Lab Data: unknown

Allergies: unknown

Symptom List: Tremor

Symptoms: noticed arm swelling and itching that was getting worse following shot on 8/19 and called pharmacy on 8/27. told her to call her primary care physician for followup

Other Meds: unknown

Current Illness: unknown

ID: 1642277
Sex: F
Age: 29
State: VA

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

Lab Data: N/A

Allergies: No known allergies

Symptom List: Erythema, Pruritus

Symptoms: Part of the left side of my face and neck is numb. Feeling is very similar to when they numb your mouth at a dentist office.

Other Meds: Prenatal vitamins (because breastfeeding infant), vitamin d2, Pepcid

Current Illness: None/ gallbladder attack

ID: 1642278
Sex: F
Age: 62
State: MD

Vax Date: 06/30/2021
Onset Date: 07/10/2021
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:

Allergies:

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

Symptoms: Upon reviewing screening questions with pt she informed me that she developed severe swelling under the arm in which the 1st dose of the vaccine was given (right arm) 1-2 weeks after receiving it. She is a breast cancer survivor. She consulted with her PCP (Dr.) and was using ice packs. The swelling eventually went down after 3 weeks.

Other Meds:

Current Illness: Asthma

ID: 1642279
Sex: M
Age: 52
State: AL

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

Lab Data: none

Allergies: no known allergies

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

Symptoms: starting 2 days after the vaccine pt reported severe anxiety, panic attack, and heart racing, checked blood pressure, with a reading of 200/100, unable to work because of increased anxiety and panic attacks, on 8/23/21 was the first visit to the clinic to report symptoms. On 8/27/21 pt reported to the clinic for the same reason, panic attacks are not improving and wants a referral and more time off, states he is not going to be able to work due to his panic and anxiety. Pt reports feeling good and never having panic attacks until the vaccine.

Other Meds: Buspar, xanax, lisinopril

Current Illness: none

ID: 1642280
Sex: F
Age: 33
State: MA

Vax Date: 04/01/2021
Onset Date: 06/02/2021
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: Ultrasound (02-Jun-2021, 10-Jun-2021)

Allergies: Iv contrast

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Was likely in first days of pregnancy during receipt of the second dose of Pfizer vaccine on 22/apr/21. Pregnancy was not discovered until several weeks after vaccination. At the first ultrasound (scheduled for 9 weeks from proposed date of conception?02/jun/21 the fetus was reported as measuring small and after second ultrasound the following week it was determined that the pregnancy was not viable and miscarriage began on 18-Jun and completed on 25-Jun-2021.

Other Meds: None

Current Illness: None

ID: 1642281
Sex: M
Age: 41
State: CA

Vax Date: 07/16/2021
Onset Date: 08/02/2021
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: Did an EKG and a series of blood tests on August 19th, and they all came out regular/negative.

Allergies: None

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

Symptoms: Racing heart and irregular heartbeat for three weeks (and still ongoing).

Other Meds: Lexapro (10 mg)

Current Illness: None

ID: 1642282
Sex: F
Age: 49
State: IL

Vax Date: 08/27/2021
Onset Date: 08/27/2021
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: N/A

Allergies: NKDA

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

Symptoms: Patient was to receive a Moderna vaccination for her 2nd Covid-19 vaccine dose but a Pfizer was given by mistake

Other Meds: Unknown

Current Illness: unknown

ID: 1642283
Sex: M
Age: 31
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: N/A

Symptom List: Pain in extremity

Symptoms: During observation period, patient became unresponsive/syncope

Other Meds: None known

Current Illness:

ID: 1642284
Sex: F
Age: 47
State: IL

Vax Date: 08/22/2021
Onset Date: 08/22/2021
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: None

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

Symptoms: Extremely heavy menstrual cycle, was not due for 2 weeks

Other Meds: Vitamin D3, Vitamin C, Zinc, Echinacea

Current Illness: None

ID: 1642285
Sex: F
Age: 13
State: NY

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

Lab Data: None

Allergies: None

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

Symptoms: Patient (13 years old) was inadvertently given the Moderna Covid-19 shot although it is not indicated for use under the age of 18.

Other Meds: None

Current Illness: None

ID: 1642286
Sex: F
Age: 43
State: OH

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

Lab Data:

Allergies:

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

Symptoms: The patient was waiting in the store for her 15 minute observation period after her 2nd covid vaccine. A few minutes after the dose, she came back to say her throat felt a little swollen and itchy. A dose of Diphenhydramine 50 mg was given right away.

Other Meds:

Current Illness: Penicillin

ID: 1642287
Sex: F
Age: 18
State: MO

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

Lab Data:

Allergies: PENICILLINS

Symptom List: Vomiting

Symptoms: PATIENT REPORTED HIVES STARTING SOON AFTER SHE LEFT FOLLOWING HER FIRST DOSE OF PFIZER COVID VACCINE

Other Meds: UNKNOWN

Current Illness: NONE KNOWN

ID: 1642288
Sex: M
Age: 44
State: RI

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

Lab Data:

Allergies: NONE REPORTED

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient was non responsive with eyes open/lost consciousness at least 2 times. The patient regained consciousness within a couple minutes. The patient was sweating and felt cold. We got him to the ground and gave him ice packs. The patient stated they had not eaten anything so after he was starting to feel better we gave him food and water. We monitored the patient's blood pressure which was elevated but heart rate was normal. We continued to monitor the patient until he was fully recovered and wanted to leave.

Other Meds: UNKNOWN

Current Illness: NONE REPORTED

ID: 1642289
Sex: F
Age: 33
State: TX

Vax Date: 08/27/2021
Onset Date: 08/27/2021
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 received pfizer vaccine when asking for Moderna. IT informed the site lead of the issue and ut was then brought to the nurse attention to ask what mistakes might have been made/ what happen. The patient did speak over any questions she had about the pfizer vaccine.

Other Meds:

Current Illness:

ID: 1642290
Sex: M
Age: 25
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: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Low blood pressure (approiximately 95/52), elevated blood pressure (unknown reading), low blood sugar (unknown reading)

Allergies: kna

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient came back to the pharmacy counter after about 10 minutes of sitting in the waiting area complaining of dizziness and tingling in his hands and feet. We sat him back down in the immunization area and took his blood pressure which was about 95/52, he appeared pale with mention of shortness of breath but did not feel his throat was closing. He mentioned feeling like he was going to lose consciousness but never did. I call 911 and we were about to administer benadryl but EMS suggested not to as they were very close. EMS came in administered oxygen, and noted elevated blood pressure, and low blood sugar (stats unknown). After giving medical attention for approximately 30 minuted patient left the area on his own power without further medical attention.

Other Meds: unknown

Current Illness: unknown

ID: 1642291
Sex: M
Age: 52
State: NY

Vax Date: 03/15/2021
Onset Date: 03/15/2021
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: MRI recommended, but awaiting advice of orthopedist.

Allergies:

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

Symptoms: I have severely limited mobility in my right shoulder, and sharp pain when I lift objects. Initially I thought it was the standard side effect of the shot, but this condition has remained since March 15. I reported it to a doctor at a urgent care clinic and they recommend I see an orthopedic doctor. I am not able to get an appointment until September.

Other Meds:

Current Illness:

ID: 1642292
Sex: F
Age: 28
State: VA

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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: after receiving vaccine patient said she was feeling faint, wanted staff to call ambulance. she was very anxious before getting vaccine

Other Meds: None

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am