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: 1651477
Sex: M
Age: 36
State: CT

Vax Date: 08/28/2021
Onset Date: 08/28/2021
Rec V Date: 08/28/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: patient reported profuse sweating. provided water and checked in on patient. after 20 minutes sympotoms had resolved and patient was released

Other Meds:

Current Illness:

ID: 1651478
Sex: M
Age: 43
State: NJ

Vax Date: 08/27/2021
Onset Date: 08/27/2021
Rec V Date: 08/28/2021
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: Penicillin

Symptom List: Anxiety, Dyspnoea

Symptoms: Metal taste in mouth 1 hour after vaccine shot given.

Other Meds: Atenolol-50mg, pravastatin- 40, vitamin D3

Current Illness: None

ID: 1651479
Sex: F
Age: 46
State: AR

Vax Date: 08/01/2021
Onset Date: 08/28/2021
Rec V Date: 08/28/2021
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: After 1st and 2nd dose of Pfizer covid shot had breakthrough mentraul bleeding within 5 days of each shot. Have menstruation 3 times in 1 month

Other Meds: Omeprazole, sertraline. Levothyroxine

Current Illness:

ID: 1651480
Sex: F
Age: 56
State: FL

Vax Date: 04/23/2021
Onset Date: 06/08/2021
Rec V Date: 08/28/2021
Hospital:

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

Lab Data: CBC / differential, ANA (+), iron & TIBC, Factor V Leiden Mutation -L,Sedimentation Rate- Western-L, C-Reactive protein, quant, Sjogren?s AB, Anti-SS-A/-SS-B (all NEG),PTT-LA Screen, DRVVT screen, Hexagonal Phase confirm, Antithrombin lll Activity, Prothrombin (Factor ll) & Cardiolipin (IGA, IGG, IGM) all negative

Allergies: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: 2nd shot received 5/24/2021. About the second week in June noticed 4 round res spots about the size of a pea on left dorsal foot. Over the next few weeks multiple areas on bilateral arms, legs, thigh and hip with Red blotches all over. Still persist as if this date.

Other Meds: Vitamin D, MVI, Kholik, super Ginkgo, Red yeast Rice, Elderberry gummy, apple cider vinegar gummy, vit B complex

Current Illness: None

ID: 1651481
Sex: M
Age: 68
State: HI

Vax Date: 08/28/2021
Onset Date: 08/28/2021
Rec V Date: 08/28/2021
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: Undetermined medication - reported with difficulty breathing as symptom.

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

Symptoms: Patient received a Pfizer booster vaccination instead of a Moderna booster vaccination. Patient monitored for 30 minutes following administration. No signs or symptoms of allergic or adverse reactions observed. Patient left clinic site with no issues.

Other Meds: Unknown

Current Illness: Recently diagnosed with prostate cancer.

ID: 1651482
Sex: M
Age: 47
State: CO

Vax Date: 07/01/2021
Onset Date: 07/01/2021
Rec V Date: 08/28/2021
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: NA

Allergies: UNKNOWN

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

Symptoms: Patient received the Moderna Vaccine. 4 days after the 1st dose he had blurry vision. This lasted for 24-48 hours roughly 6 days after the 1st dose he noticed more floaters in his vision. These were more pronounced for weeks 8 days after the 1st dose he broke out with a rash on his back and his arms. The rash lasted for a few days, then resolved. Then the rash reappeared in the same areas days later. He also states he developed itchy bumps on his head and when he would work out he would get really itchy palms. 8-9 days after 1st dose he developed "sinus symptoms" that lasted 2 weeks.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1651483
Sex: F
Age: 61
State: AR

Vax Date: 08/28/2021
Onset Date: 08/28/2021
Rec V Date: 08/28/2021
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: latex, cephalosporins

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Itching on arms and torso 60 seconds after administration of vaccine.

Other Meds: None

Current Illness: muscle spasm

ID: 1651484
Sex: F
Age: 65
State: NC

Vax Date: 03/11/2021
Onset Date: 04/21/2021
Rec V Date: 08/28/2021
Hospital:

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

Lab Data: First degree heart block and unexplainable irregular hear beats.

Allergies: Sulfa, latex, codine

Symptom List: Pharyngeal swelling

Symptoms: A month after receiving second dose, I had heart palpitations and irregular heart beats.

Other Meds: None

Current Illness: None

ID: 1651485
Sex: F
Age: 42
State: MO

Vax Date: 08/20/2021
Onset Date: 08/27/2021
Rec V Date: 08/28/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Lump at injection site, red, painful beginning 1 week after injection

Other Meds: None

Current Illness: None

ID: 1651486
Sex: F
Age: 36
State: CA

Vax Date: 08/27/2021
Onset Date: 08/28/2021
Rec V Date: 08/28/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Back ache, headache, chills, fever, fatigue

Other Meds:

Current Illness:

ID: 1651487
Sex: F
Age: 46
State: AZ

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

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

Lab Data:

Allergies: PCN

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

Symptoms: None stated.

Other Meds: large red blotchy skin in area of vaccinatin

Current Illness: Graves Disease

ID: 1651488
Sex: M
Age: 14
State: HI

Vax Date: 08/28/2021
Onset Date: 08/28/2021
Rec V Date: 08/28/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data: N/A

Allergies: None reported

Symptom List: Rash, Urticaria

Symptoms: Patient received his first dose today at approximately 10:30 AM and was placed in the observation area immediately after the vaccination. After 5 minutes the patient's parents reported to the vaccination staff that the patient was experiencing mild dizziness after the vaccine was administrated. The patient was evaluated by the physician and nurse on site and later allowed to leave when his symptoms subsided. The patient remained stable, conscious, and without any other symptoms beside mild and intermittent nausea which was resolved by the time of his departure from the site. Patient did not required any further interventions and was escorted to his parents' privately owned while without any difficulties.

Other Meds: Unknown

Current Illness: Not reported

ID: 1651489
Sex: M
Age: 18
State: OH

Vax Date: 08/27/2021
Onset Date: 08/28/2021
Rec V Date: 08/28/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

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

Symptoms: patient came into clinic with upper lip swelling.

Other Meds:

Current Illness:

ID: 1651490
Sex: F
Age: 19
State: GA

Vax Date: 08/01/2021
Onset Date: 08/01/2021
Rec V Date: 08/28/2021
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: Z pack and codeine

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

Symptoms: The night of my vaccine, my ears swelled from the inside of the ear canal. I lost all hearing in both ears for about a week and a half. I was in excruciating pain, I could not touch my ears, with horrific migraines and deep pain down my neck and jaw. I was given amoxicillin which did nothing, then I was prescribed a heavier antibiotic which I no longer have the bottle of to write the name, which opened my ears. I was given steroid drops and a pain killer. I still am in excruciating pain with the exact same symptoms in the exact same places, but at least I can hear in a tunnel-like fashion.

Other Meds: Buesbar

Current Illness:

ID: 1651491
Sex: F
Age: 47
State: NC

Vax Date: 01/18/2021
Onset Date: 01/25/2021
Rec V Date: 08/28/2021
Hospital:

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

Lab Data: No test or labs. No medications given/taken.

Allergies: Bacitracin; cipro statins

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

Symptoms: Approximately 1 week after my 1st dose I began have numbness and tingling in both lower arms and hands (left greater than right). It continued until approximately 2 months after the 2nd dose. I saw my PCP on 3/2/21 regarding my symptoms and she diagnosed it as carpal tunnel. I received no treatment. The symptoms have completely gone away.

Other Meds: Vitamins; viibryd; probenecid-colchicine

Current Illness: None

ID: 1651492
Sex: F
Age: 63
State: FL

Vax Date: 08/01/2021
Onset Date: 08/20/2021
Rec V Date: 08/28/2021
Hospital:

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

Lab Data: none

Allergies: none

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

Symptoms: Woke in the middle of the night with sore arm, severe headache and severe nausea. It lasted all the next day - very severe, with mental fogginess. 2 days of not feeling well after that, lessened symptoms.

Other Meds: Multi vitamin, vitamin D3, vitamin C, CoQ10, magnesium

Current Illness: none

ID: 1651494
Sex: F
Age: 23
State: VA

Vax Date: 08/28/2021
Onset Date: 08/28/2021
Rec V Date: 08/28/2021
Hospital:

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

Lab Data:

Allergies: penicillin

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

Symptoms: when i was talking to pt before admin of 2nd dose of Pfizer COVID vacc,, she mentioned she had swelling in her knuckles about one hour after the first dose (she was home already) and last week she had a rash and swollen area on the same arm that she got first dose of covid in, and there was also pain in the arm but it went away. first dose was also in right arm. about 15-20 min after 2nd dose, she stated she was having pain in arm and tingling in hands. both palms were visibly spotty. she states no prior rxn to any vaccine ever. pt gave me permission to administer PO of liquid diphenhydramine to her. she declined offer to contact resuce squad. i checked in q 5 minutes for 20 minutes. she said pain was less and hands back to normal. she again declined my offer to call rescue squad. breathing always normal. family members were with her and said they would drive her home and seek medical attention if anything else happened.

Other Meds:

Current Illness:

ID: 1651495
Sex: M
Age: 15
State: TX

Vax Date: 08/28/2021
Onset Date: 08/28/2021
Rec V Date: 08/28/2021
Hospital:

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

Lab Data: BP: 134/74 HR: 107 RR: 16 O2: 99% BS: 96

Allergies: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Eyes rolled in back of head, begin having seizures, came to and then passed out again momentarily.

Other Meds: None

Current Illness: None

ID: 1651496
Sex: M
Age: 28
State: PA

Vax Date: 08/02/2021
Onset Date: 08/02/2021
Rec V Date: 08/28/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Fever 102. Shaking. Chills Aches pain Hot cold sweats. Weakness

Other Meds: Wellbutrin.

Current Illness: None

ID: 1651497
Sex: F
Age: 53
State: TX

Vax Date: 08/05/2021
Onset Date: 08/06/2021
Rec V Date: 08/28/2021
Hospital:

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

Lab Data: Hearing test, Steroids,

Allergies: none

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

Symptoms: Intense, persistent, high pitched tinnitus. Impacting sleep, daily functioning,sanity.

Other Meds: estrodiol, progesterone, Lunesta

Current Illness: none

ID: 1651498
Sex: M
Age: 39
State: NC

Vax Date: 08/28/2021
Onset Date: 08/28/2021
Rec V Date: 08/28/2021
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: Pt received a Pfizer vaccination on 8/28 reported feeling lightheaded and then passed out but came too within seconds, Pt remained in seat entire time. Pt reported he frequently passed out when getting vaccinations which was not disclosed prior to administration, vaccination questionnaire was marked no to fainting. Pt was monitored 30 minutes and provided water, pt reported full recovery

Other Meds:

Current Illness:

ID: 1651499
Sex: F
Age: 40
State: CA

Vax Date: 08/27/2021
Onset Date: 08/28/2021
Rec V Date: 08/28/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Unevaluable event

Symptoms: I went to a local clinic to get the J&J vaccine since Kaiser does not carry it. I went to bed at 9pm not feeling well. At 1:37 I woke up with chills and fever and sweating. I took Tylenol for the severe headache and fever. I woke up several times with the same symptoms - Tylenol did nothing for them. At 5 am I woke up sweating with fever, sore arm, my joints in hands hurt, the muscles in my calves are so sore, it?s hurting to stand or walk. The headache is still with me at 3:24 the next day. I now have nausea when I eat or drink anything my mouth waters like I want to vomit. I will add I had severe covid last year and a lot of my symptoms are reminding me of covid - which is why I was hesitant to getting any kind of vaccine. If the pain in my arm doesn?t subside in a few days or my symptoms don?t subside I?ll be seeking medical help with my primary doctor at Kaiser.

Other Meds: Adult vitamins, collagen, levothyroxine, phentermine, birth control pills.

Current Illness: Hypothyroidism

ID: 1651500
Sex: M
Age: 31
State: NC

Vax Date: 08/28/2021
Onset Date: 08/28/2021
Rec V Date: 08/28/2021
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: None per patient's report

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

Symptoms: Patient received Janssen Covid-19 vaccine at 1435 and approximately 1436 patient fell onto floor and began having seizure-like activity. 911 called and EMS assumed care of patient

Other Meds: None per patient's report

Current Illness: none per patient's report

ID: 1651501
Sex: M
Age: 29
State:

Vax Date: 01/16/2021
Onset Date: 08/24/2021
Rec V Date: 08/28/2021
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: HA, dry throat, nasal congestion, and lessoning of smell.

Other Meds:

Current Illness:

ID: 1651502
Sex: M
Age: 53
State: TX

Vax Date: 08/25/2021
Onset Date: 08/26/2021
Rec V Date: 08/28/2021
Hospital:

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

Lab Data: august 25 blood work, EKG, and chest x ray. Dr said everything looked good

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: I woke up on thursday 26th and my body was achy. I went to school, I am a teacher and coach, and continued to feel worse. All of my joints where hurting and my muscles ached. About 10:00 am I felt like in need to throw up as I left my classroom, I felt like I was about to pass out. I made my way to a fellow teachers room, waved at them for help and laid on the floor. He move me to an office where our school nurse, athletic trainer, and head nurse soon arrived. My blood pressure was 60/40 and O2 levels in the 60's. I became incoherent, and they were forcing me to stay awake. An AED was hooked up to me along with oxygen. I was never shocked, but they said the AED was telling them to shock me. The paramedics soon arrived but me in the ambulance, started an IV and did and EKG. I started feeling better and they ran blood work and did a chest x ray and everything came back good. Friday I stayed home and was very tired and dizzy at times. My heart rate will drop at time to the 50's it is usually in the 60's. Saturday they day of this writing I will feel weak and just not right.

Other Meds: dextroampamphet er 20 mg Fluoxetine 20 mg 0.5 ml testosterone injection

Current Illness:

ID: 1651503
Sex: F
Age: 38
State: CA

Vax Date: 08/20/2021
Onset Date: 08/21/2021
Rec V Date: 08/28/2021
Hospital:

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

Lab Data: EKG 12, Blood Labs white blood cell differential, CBC, Troponin, Phosphate, Magnesium, Chemistry panel, CT head scan, IV fluids, released with medications Meclazine an Zofran 8/24/21

Allergies: Morhine, Bee Venom

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

Symptoms: Fainting spells occured the following day and persisted over the course of 3 days. Food not tasting normal, this symtom lasted a week. Bad taste in my mouth- metallic, lasting 3 days. Hypertension, this symtom is ongoing off and on. I typically have low Blood Pressure. Dizzy spells- this symtom persists still. Vomiting- this symtom persists still. Nausea- this symtom persists still.

Other Meds: Topiramate, Famotidine, Tylenol

Current Illness:

ID: 1651504
Sex: F
Age: 50
State: WV

Vax Date: 04/15/2021
Onset Date: 08/16/2021
Rec V Date: 08/28/2021
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: Metronidazole, mobic, bactrim

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Temperature ranging 101-103, moderate joint pain, fatigue, tearful. Last about 12 hours and started slowly going away. I felt worse after the vaccine than I did when I had covid in December of 2020. The reason I?m reporting this is because I?ve had mild to moderate joint pain and fatigue since having the vaccine.

Other Meds: Vitamin D, singular,plaquenil, vistaril, buspar, advair, albuterol

Current Illness: Sjogrens, asthma

ID: 1651505
Sex: M
Age: 92
State: MA

Vax Date: 08/24/2021
Onset Date: 08/26/2021
Rec V Date: 08/28/2021
Hospital: Y

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

Lab Data: MRI brain.

Allergies: None known

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: 2 days following vaccine experienced LLE weakness, found to have embolic CVA on right.

Other Meds: Albuterol, Amlodipine, Lipitor, Carvedilol, Codeine, Lantus, Victoza, Nystatin, Protonix, Prednisone, Torsemide, Trazodone, Valsartan

Current Illness: Metastatic Lung Cancer

ID: 1651506
Sex: F
Age: 13
State: MN

Vax Date: 08/07/2021
Onset Date: 08/14/2021
Rec V Date: 08/28/2021
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: ER visit, diagnosis made on clinical symptoms and appearance.

Allergies: no

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

Symptoms: Bell's palsy diagnosis, with symptoms beginning 1 week after the Covid19 Pfizer vaccine.

Other Meds: no

Current Illness:

ID: 1651507
Sex: F
Age: 41
State: TN

Vax Date: 08/19/2021
Onset Date: 08/21/2021
Rec V Date: 08/28/2021
Hospital:

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

Lab Data: Recorded blood pressure readings. Ekg t wave appeared to be abnormal.

Allergies: Stadole and codeine.... Poultry

Symptom List: Nausea

Symptoms: After receiving the pfizer covid vaccine, within hours felt flushed....lightheaded..., slight headache with minutes of receiving vaccine. Felt as if I was running fever, no fever. The following day...neck pain with chest discomfort...assuming acid reflux or something...discomfort continues for few days, took my blood pressure, extremely high...I have never seen my blood pressure high like this...waited for another day...ended up going to the ER for neck pain, chest discomfort, symptoms of what is said to be heart attack, didn't get worked up as much at ER...blood still extremely high...dr. says nothing...but follow up with Dr. I have proof of my blood pressure, never been dx with hypertension....I regret that I decided to get vaccinated...I will not return for second required dose..next week...after what I'm experiencing...I'm going to share with others within my community....I am scared.

Other Meds: Otc nexium and otc ibuprofen

Current Illness: Nothing, I do have PCOS and heart murmur....no illness whatsoever , only attended physical therapy for dislocated shoulder ..but dislocated back in May 2021.

ID: 1651508
Sex: F
Age: 44
State: NY

Vax Date: 08/28/2021
Onset Date: 08/28/2021
Rec V Date: 08/28/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Injection site pain

Symptoms: 2nd Dose given before scheduled appointment. Dose give 13 days after 1st dose.

Other Meds: Unknown

Current Illness:

ID: 1651509
Sex: F
Age: 20
State: KS

Vax Date: 08/28/2021
Onset Date: 08/28/2021
Rec V Date: 08/28/2021
Hospital:

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

Lab Data: BLOOD PRESSURE, BLOOD GLUCOSE AND PULSE OX COMPLETED BY EMERGENCY RESPONSE, RESULTS UNKNOWN

Allergies: NONE

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

Symptoms: PT RECEIVED FIRST MODERNA COVID SHOT IN LEFT DELTOID, A FEW MINUTES LATER PT FELT FAINT AND WHEN TO THE FLOOR. PT WAS GIVEN ICE PACK AND BEGAIN TO REGAIN CONSCUOISNESS. 911 EMERGENCY SERVICES WERE CONTACTED AND ARRIVED ON SCENE, PT WAS FEELING BETTER.

Other Meds: UNKNOWN

Current Illness: NONE

ID: 1651510
Sex: F
Age: 47
State: NE

Vax Date: 12/30/2020
Onset Date: 08/16/2021
Rec V Date: 08/28/2021
Hospital: Y

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

Lab Data: 8/16/21 WBC 157,000

Allergies: none

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

Symptoms: chronic phase chronic myeloid leukemia

Other Meds:

Current Illness:

ID: 1651511
Sex: F
Age: 79
State: TX

Vax Date: 08/28/2021
Onset Date: 08/28/2021
Rec V Date: 08/28/2021
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: NO

Symptom List: Tremor

Symptoms: After receiving the vaccine patient was seated at the monitoring place and after some time she fell to the ground. She was able to talk at that time and we called 911 and per them she had low glucose level . Once they treated her she left home . she was able to walk.

Other Meds: NO

Current Illness: DIABETES

ID: 1651512
Sex: M
Age: 30
State: CA

Vax Date: 08/27/2021
Onset Date: 08/27/2021
Rec V Date: 08/28/2021
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: penicillin (rxn as a child)

Symptom List: Erythema, Pruritus

Symptoms: approximately 5 minutes following the vaccination, patient began to experience lightheadedness, altered sensation in his arm, and shortness of breath. He proceeded to lose consciousness. He was placed supine on the floor, but continued to have increased tone in his extremities and did not regain consciousness for approximately 10-15 seconds. When he regained consciousness he noted that he had lost bladder control. He was diaphoretic, weak, pale, and nauseous for approx 30 minutes. He was given water, offered food (he had complained of being hungry earlier) but was too nauseous to eat. He was given a glucose 4 gram tablet, which he vomited, and then offered a sports drink. Patient left accompanied by wife and was instructed to seek an evaluation by a medical professional.

Other Meds: none reported

Current Illness: none reported

ID: 1651513
Sex: F
Age: 30
State: TX

Vax Date: 08/28/2021
Onset Date: 08/28/2021
Rec V Date: 08/28/2021
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: 127/85 , BP 107, HR 5P.2 99%

Allergies:

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

Symptoms: Patient came to crew claiming to feel dizzy and racing heart. Patient claims to handle needles shots, and blood draws fine. Crew took vitals and they were ? at room air. Second set of vitals where taken and hypertension was discovered. 152/94 BP 107 HR 99%. Patient signed an AMA advised if she feels worse to go to hospital.

Other Meds:

Current Illness:

ID: 1651514
Sex: F
Age: 33
State: NV

Vax Date: 08/27/2021
Onset Date: 08/27/2021
Rec V Date: 08/28/2021
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: Unknown

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

Symptoms: Patient showed up at the pharmacy for her first shot of Pfizer vaccine. Pharmacist administered the injection at approximately 5:15PM, I used 1ml disposable syringe(manuf: Tkmd, Lot 20210120, manuf date 1/21/21, exp date 1/20/2026) and safety needle 23G x1in (REF: BER235, LOT 210310, manuf date: 03/21, exp date: 03/26) to draw up the vaccine. Vaccine used was Pfizer Lot FA4785, exp date 10/31/21, mixed at 4:52PM. I wiped down her left deltoid with 70% alcohol pad (Mfr #58-204, exp 10/2023, LOT: CHAJ10-01) and inject 0.3ml intramuscularly. Patient was in great discomfort as the vaccine entered her muscle, the injection site swollen up immediately and blood oozed out. Her left ring finger and pinky finger were shaking and she said the entire arm felt tingling and numb. I gave patient 25mg benadryl immediately and observed her for 30 minutes. Patient felt ok afterward and left the pharmacy.

Other Meds: Unknown

Current Illness: None

ID: 1651515
Sex: M
Age: 14
State: IL

Vax Date: 08/20/2021
Onset Date: 08/20/2021
Rec V Date: 08/28/2021
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 known

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Vaccination was given two inches below the deltoid muscle

Other Meds: none known

Current Illness: none known

ID: 1651516
Sex: M
Age: 56
State: TN

Vax Date: 08/02/2021
Onset Date: 08/03/2021
Rec V Date: 08/28/2021
Hospital:

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

Lab Data: None

Allergies: Ace-inhibitor (ie zestorectic)

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

Symptoms: Adverse event: patient reported rapidly beating heart 6-12 hours after vaccine while sleeping. Extreme concern. Lasted about 20 minutes. Reported to PCP week of 23 Aug 2021. Doctor recommended proceed second dose.

Other Meds: Elquis, atenolpl-chlorthal, klor-con, iron, miltivitamin

Current Illness: None

ID: 1651517
Sex: F
Age: 20
State: WA

Vax Date: 08/28/2021
Onset Date: 08/28/2021
Rec V Date: 08/28/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: The last day of my menstrual period was 5 days ago. Within one hour of the vaccine, I experienced severe cramping in my lower abdomen that felt like PMS cramps. Within two hours of the shot, I began to bleed heavily as if my menstrual period had begun again, passing clots ranging in size from a sesame seed to a quarter.

Other Meds: Adderall 5mg extended release

Current Illness: None

ID: 1651518
Sex: F
Age: 85
State: CA

Vax Date: 02/24/2021
Onset Date: 03/16/2021
Rec V Date: 08/28/2021
Hospital:

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

Lab Data: Bullis Pempagoid

Allergies: none

Symptom List: Pain in extremity

Symptoms: Pimples, itching, blisters, since March 16, 2021

Other Meds: Atorvastatin 20mg, Amlodipine Basylate 5mg, Bystolic 10 mg Escitalopram Oxalate 10 mg zolpidem 5 mg baby aspirin 1

Current Illness: none

ID: 1651519
Sex: M
Age: 31
State: KY

Vax Date: 08/28/2021
Onset Date: 08/28/2021
Rec V Date: 08/28/2021
Hospital:

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

Lab Data: vitals all normal 8/28/2021 by EMS

Allergies: none

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

Symptoms: patient was light headed, fainted, woke up in cold sweat and pale

Other Meds: none

Current Illness: none

ID: 1651520
Sex: F
Age: 51
State: IL

Vax Date: 08/26/2021
Onset Date: 08/27/2021
Rec V Date: 08/28/2021
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: Sulfa Antibiotics, Penicillin

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

Symptoms: Patient stated broke out in hives one day after the vaccination. Patient stated took benadryl. I advised patient to seek medical attention.

Other Meds:

Current Illness:

ID: 1651521
Sex: F
Age: 33
State: OK

Vax Date: 08/27/2021
Onset Date: 08/27/2021
Rec V Date: 08/28/2021
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: 08/27/2021-08/28/2021 Bloodwork done EKG three different times CAT scan of my chest to check for pulmonary embolism l- came back negative Covid test-came back negative Chest x ray- came back negative

Allergies: Flexeril, flagyll, keflex, cyclozeprenine, latex, gluten, all nuts

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

Symptoms: After received Johnson and Johnson vaccine at 12:30, I felt dizzy and a little spacey. Arm was only sore for a couple minutes. Some soreness in my shoulder muscle too. Felt a little tired. 3:36 pm- chills, shaking, teeth chattering, 4:30 pm-felt tired and laid down but didn?t fall asleep. Sudden electric shock like spasm in abdomen. 5:09 pm-throat feels a bit hoarse 5:56 pm-Running a 99.1 fever 6:48 pm-Chest pain 7:10 pm-left leg pain 10:59 pm-headache and 99.2 fever 11:45-worsening headache, pain behind my eyes, muscle aches, chills, took quercentin and a zinc lozenges 12:11 am-chills worsening, muscle aches, super cold, sore left arm where shot was given, just took 500 mg of Tylenol 1:25 am-100.6 fever, squeezing headache, chest pain like someone is sitting on my chest 1:52 am-101.1 fever, pulse 126 when standing up, heaviness on my chest is not dissipating 2:01 am-102 2:35 am-normal ekg at house but sinus Arythmia 3:30 am-arrived at ER 3:42 am- just got triaged, saw two nurses , got blood work taken, and an ekg done. Chest feels great. Only feel heaviness when I breathe in deeply and then I have to cough. Cough is dry. 5:21 am-99.1 fever came back, chills, muscle aches, chest pain, tightness in chest 7:12 am-102.5 fever now, pressure squeezing headache, chest pain, lower back pain, shortness of breathe, ear pain in both ears 9:30-given a bag of fluids via iv, toradol pain reliever and zofran. All tests came back normal! So yay!

Other Meds: Zinc

Current Illness:

ID: 1651522
Sex: F
Age: 31
State: MA

Vax Date: 08/27/2021
Onset Date: 08/28/2021
Rec V Date: 08/28/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: Ultrasound, CT scan

Allergies: N/a

Symptom List: Vomiting

Symptoms: Currently 29 weeks pregnant. Severe chest pain triggering ER visit

Other Meds: Prenatal vitamin

Current Illness: N/a

ID: 1651523
Sex: F
Age: 18
State: KY

Vax Date: 08/28/2021
Onset Date: 08/28/2021
Rec V Date: 08/28/2021
Hospital:

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

Lab Data: N/A

Allergies: NKDA

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: patient had received her shot and was being taken to a post vaccination chair when she appeared disoriented and slumped against the pharmacist who assisted her to the groend. The patient passed out for no more than 30 seconds and came to without any further intervention. She layed down a few minutes and then got herself up to a chair and was observed for at least 20 more minutes. She did not experience any further symptoms and declined any further intervention. Prior to receiving the vaccine, she had been very nervous about it.

Other Meds: NONE THAT I WAS AWARE OF

Current Illness: N/A

ID: 1651524
Sex: M
Age: 17
State: AL

Vax Date: 08/28/2021
Onset Date: 08/28/2021
Rec V Date: 08/28/2021
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 undilated dose of Pfizer vaccine. Administering technician, thinking that the pharmacist previously diluted the vial, failed to add the diluent while drawing up and administered the dose. Patient has not yet experienced any adverse reaction on Day 1. However, the patient has had a recent bout of COVID infection and is likely to experience some systemic side effects.

Other Meds:

Current Illness:

ID: 1651525
Sex: U
Age:
State: PA

Vax Date:
Onset Date:
Rec V Date: 08/28/2021
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: None

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Day 1- Day 2fever 102, headache, tired, vomiting, nausea, diarrhea, sore at injection site, body aches Day 3 tired, nausea, headache Day 7-9- low grade fever off and on, dizziness, menier?s or vertigo, spinning, tinnitus, nausea

Other Meds:

Current Illness:

ID: 1651526
Sex: F
Age: 27
State: MD

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 08/28/2021
Hospital:

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

Lab Data: Went to ER today had blood work and X-ray to rule out a number of things and nothing. I suspect this is chest wall inflammation

Allergies: None

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

Symptoms: Shortness of breath 30 mins after, extreme fatigue, chest pain beginning on day 2 after, chest heaviness lightheaded short of breath now on day 9 no resolution

Other Meds: None

Current Illness: None

ID: 1651527
Sex: M
Age: 35
State: TX

Vax Date: 08/28/2021
Onset Date: 08/28/2021
Rec V Date: 08/28/2021
Hospital:

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

Lab Data: BP: 118/69 Pulse: 81 SpO2: 97%

Allergies: none

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

Symptoms: Patient felt panic, dizzy and weak. Attended by EMS

Other Meds: none

Current Illness: none

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am