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: 1655798
Sex: M
Age: 44
State:

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 08/30/2021
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: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1655799
Sex: M
Age: 58
State: TX

Vax Date: 02/22/2021
Onset Date: 08/15/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data: Test for SARS-Cov-2 / COVID 19 administered 8/21/21 was positive. Previous self-administered (8/18/21) nasal swab was negative - I did not trust it as I don't think I did it correctly (I was outside and it was raining, with a bunch of coughing people around me - I wanted to get away fast!)

Allergies: na

Symptom List: Anxiety, Dyspnoea

Symptoms: ** My wife and I were BREAKTHROUGH CV19 cases six months AFTER vaccination ** This is WHY I'm reporting! My adverse response to vaccine was very mild - a slight headache the day following 1st vaccine and a feeling of jet lag the day following the 2nd. We suspect we were infected on plane flight by a coughing, whining young boy sitting behind us. We were wearing masks, but we did not have eyes in back of our head and have no idea what he and his family were doing behind us. When we suspected we were positive (confirmed w positive PCR tests for both of us), we took care to isolate for the CDC recommended time frames and consulted w healthcare professionals. We are always careful to wear masks in indoor public places. Our symptoms were relatively mild, like a modest cold. The worst was bad sinus headache for me. Sneezing and some coughing from nasal drip. Loss of taste and smell (very slowly returning). No fever, no sore throat. I felt fatigued, but never bedridden. On my most tranquil day, per my iPhone, I still logged 12,000+ steps (away from others, of course - easy to isolate). Slowed me down but by no means did it stop me. IGG protecting lungs and other organs worked well - thank you, Phizer /BioNTech. IGA in nasal passage did not work well, obviously.

Other Meds: quinaretic 20 / 12.5

Current Illness: na

ID: 1655800
Sex: M
Age: 31
State: TX

Vax Date: 08/30/2021
Onset Date: 08/30/2021
Rec V Date: 08/30/2021
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: Patient stated he felt hot and was sweating, then he felt cold. Vitals were taken: BP 124/78, temp , 93.4, HR 89. Patient had a granola bar with him; he ate bar, stated he was feeling better. Advised to drink electrolytes. Patient confirmed he understood. Patient was cleared.

Other Meds:

Current Illness:

ID: 1655801
Sex: M
Age: 21
State:

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 08/30/2021
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: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1655802
Sex: F
Age: 36
State: PA

Vax Date: 04/20/2021
Onset Date: 06/03/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data:

Allergies: N/a

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

Symptoms: I think this is still a little early to tell if the length of my period was truly impacted by the vaccine or not but it has shortened by a couple days (average) the past 3 cycles - which would have been all of the cycles since being fully vaccinated. I changed BC to a non-hormonal IUD on June 1st. The first cycle after getting the IUD was 30 days; then they were all pretty consistent at 27-28 days with the exception of 2 months which were 31 and 32 days. The start dates of the 2 longer cycles were Feb 5, 2020 (100% pre-vaccination) and March 8, 2020 (first shot received March 23). Considering I already had one long cycle prior to any vaccination I do not think the following cycle being longer had to due with the fact that received my first vaccine at Day 16 of my cycle. I had two normal cycles following that: April 9th was the start of a 28 day cycle - I received my second dose of COVID vaccine on April 20th which was day 12 of my cycle. The following cycle also seemed normal at 27 days starting on May 7th. However, that was my last normal cycle. I have since had 3 cycles all at 25 days. Given that my cycle history only goes back 14 months I am a little hesitant to say this is definitely a result of the vaccine but I do feel like I was pretty regular at the 27/28 day mark with it never being less than that until the past 3 months. Also, this is still considered a regular cycle length so I am not concerned but figured I should give the information for study purposes.

Other Meds: Singulair; Claritin; Vitamin B-12

Current Illness: none

ID: 1655803
Sex: F
Age: 48
State:

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 08/30/2021
Hospital:

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1655804
Sex: F
Age: 52
State: PA

Vax Date: 08/07/2021
Onset Date: 08/08/2021
Rec V Date: 08/30/2021
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: penicillin

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Never had any issues with knees, about knees hurt, swollen after 2 nd shot toes hurt along with knees. Felt swollen and painful. Maybe joint pain. today is 8/30/.21 a lot better today.

Other Meds: none

Current Illness: none

ID: 1655805
Sex: F
Age: 47
State: NC

Vax Date: 03/17/2021
Onset Date: 03/18/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data: N/A

Allergies: Sulfa drugs, codeine, salmon

Symptom List: Pharyngeal swelling

Symptoms: Both arms remain red at injection site, 5 months after vaccines.

Other Meds:

Current Illness:

Date Died: 08/29/2021

ID: 1655806
Sex: M
Age: 76
State: NY

Vax Date: 03/09/2021
Onset Date: 08/18/2021
Rec V Date: 08/30/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Pt had a breakthrough case of COVID 19 in August 2021 required hospitalization, mechanical ventilation and then he expired on 8/29/21

Other Meds:

Current Illness: DM

ID: 1655807
Sex: M
Age: 62
State: OH

Vax Date: 05/11/2021
Onset Date: 05/11/2021
Rec V Date: 08/30/2021
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: none

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Bad buzzing/ringing in the ears.

Other Meds: Vit c/Vit d/aspirin/linispril/astrovastin(all 10 years plus) humalog-lantus(3 years)

Current Illness:

ID: 1655808
Sex: M
Age: 40
State: AL

Vax Date: 08/17/2021
Onset Date: 08/17/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: VasoVagal response. Drop in BP. Paramendics evaluated and transported due to low BP

Other Meds:

Current Illness:

ID: 1655809
Sex: F
Age: 24
State:

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 08/30/2021
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: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1655810
Sex: M
Age: 15
State: NY

Vax Date: 08/28/2021
Onset Date: 08/29/2021
Rec V Date: 08/30/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Body aches, fever, headache,chills. Ongoing.

Other Meds: None

Current Illness: None

ID: 1655811
Sex: M
Age: 47
State:

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 08/30/2021
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: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1655812
Sex: F
Age: 39
State:

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 08/30/2021
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1655813
Sex: F
Age: 50
State:

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 08/30/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1655814
Sex: F
Age: 55
State: IL

Vax Date: 08/26/2021
Onset Date: 08/27/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data: None

Allergies: Levaquin, mold, smoke

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

Symptoms: - Severe Headache - Tingling in Both Arms on and Off - Occasional Blurry Vision - Euphoric Sensation, Very Incoherent like symptoms and Severe Weakness - Severe Swollen Injection Site and Upper Arm -2nd Day Severe Allergy like symptoms, sinuses, dry eyes, severely swollen sinus membranes -Fever of 102.8 day 2 & 3 -Day 4 still fever of 100 -Day 4 Severe Headache Returned

Other Meds: Fish Oil, Amlodipine 5mg, 1 Aspirin 81mg

Current Illness: None

ID: 1655815
Sex: F
Age: 34
State:

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1655817
Sex: F
Age: 31
State:

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1655818
Sex: M
Age: 50
State: CA

Vax Date: 08/18/2021
Onset Date: 08/27/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data: None

Allergies: None

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

Symptoms: Extreme chest restriction for 2 hours. Pain in molars, jaw, arms and chest area. Rapid heart rate, rapid shallow breathing. Never experienced the severity of these symptoms in my life.

Other Meds: None

Current Illness: None

ID: 1655819
Sex: M
Age: 45
State:

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 08/30/2021
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: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1655820
Sex: F
Age: 51
State: NM

Vax Date: 02/19/2021
Onset Date: 06/25/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data: EKG, Cardio vision

Allergies: Augmentin

Symptom List: Unevaluable event

Symptoms: I had a colposcopy on June 25. Then that's went the did EKG and said that my heart was out of rhythm. I went to see my cardiologist. He put me on two medicines. One a blood thinner. He scheduled me a cardio vision on this past Friday, August 27. I will see my cardiologist tomorrow, August 31 at 11 am to see what the next step is.

Other Meds: Lisinopril; HTZ

Current Illness:

ID: 1655822
Sex: M
Age: 70
State:

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1655823
Sex: F
Age: 37
State: AR

Vax Date: 07/09/2021
Onset Date: 07/10/2021
Rec V Date: 08/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Ultrasound

Allergies: Penicillin; Dairy; Gluten; Nuts

Symptom List: Injection site pain, Pain

Symptoms: On Saturday, July 10, 2021, I woke up feeling tired as if I didn't sleep well the night before. I felt slightly feverish with bone and joint aches. I felt irritable throughout day. I had very little energy. I just felt tired, grumpy, slightly feverish, and I was physically hurting with aches. On Sunday, the next morning, when I woke up, I felt a weird pain between my arm and my breast when I leaned on my arm. I felt a large lump. When I raised my arm up, I could see a lump there between my armpit and breast. I waited about two hours and noticed the lump started growing so I went to the ER, and they did a ultrasound, but they didn't see a blood clot. They concluded that it was just a reaction to the shot. I monitored the lump, and it took about 3 days for it to go away visibly but it went away fully after about a week. I was recommended to go to my PCP to check on lump to make sure nothing else was wrong. My PCP said everything was fine after doing a physical exam on me. He said it was just a reaction to something new in my body. I went home and throughout the week the swelling went down, and I could no longer feel it anymore after about 7 days.

Other Meds:

Current Illness:

ID: 1655824
Sex: F
Age: 49
State:

Vax Date: 12/31/2020
Onset Date: 08/25/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: COVID Positive 8/27/21

Other Meds:

Current Illness:

ID: 1655825
Sex: F
Age: 26
State:

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 08/30/2021
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: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1655826
Sex: M
Age: 61
State: NY

Vax Date: 03/16/2021
Onset Date: 03/17/2021
Rec V Date: 08/30/2021
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: I had a video appointment with my primary care physician's office the week after the shot. They advised me to not get the second dose. They referred me to an ENT doctor. I went to them in May and had my hearing check and an audiologist performed a hearing test. The audiologist confirmed slight hearing loss(not COVID related) and tinnitus. Both the ENT doctor and audiologist recommended that I do not receive the second does of vaccine.

Allergies: Cats, Horses

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: I started having severe tinnitus. I previously had tinnitus, but the severity was greatly increased. It went from a scale of 1-10 from a 2 to a 7 or 8. It subsided after a few hours, then came and went sporadically. It still comes and goes periodically. I have also noticed an increased sensitivity to high end noises, to the point where I must now bring earplugs to avoid pain.

Other Meds: Asacol, Fenofibric Acid, Vitamin E, Glucosomine, prantoprozole, Lecithin

Current Illness: None

ID: 1655827
Sex: F
Age: 50
State: KY

Vax Date: 02/10/2021
Onset Date: 08/24/2021
Rec V Date: 08/30/2021
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: Covid 19 positive 08/25/21 with 08/24/21 onset

Other Meds:

Current Illness:

ID: 1655828
Sex: M
Age: 25
State:

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 08/30/2021
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: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1655830
Sex: M
Age: 13
State: MD

Vax Date: 06/08/2021
Onset Date: 06/08/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data: Chest x-ray 06/13/2021

Allergies:

Symptom List: Nausea

Symptoms: First day started with 103 degree fever, shivering and muscle pain. Getting worse with cough and lethargy continues for 5 days, on 5th day severe asthma attack, seen in urgent care and transported to ER where he received iv steroids to stabilize and x-ray found bronchitis, he also had a seizure at home and wet the bed. During this I did stay in touch with pediatrician almost daily. On day 5, my son was coughing so bad that he was vomiting and could not catch a breath.

Other Meds: Wellbutrin

Current Illness: Anxiety, adhd,

Date Died: 08/27/2021

ID: 1655831
Sex: M
Age: 59
State: IA

Vax Date: 08/19/2021
Onset Date: 08/27/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data: Autopsy done. I don't think I will be informed of the results

Allergies:

Symptom List: Injection site pain

Symptoms: The patient died from COVID 19 symptoms. His body was being taken to be autopsied on 08/27/2021. I was notified after he had passed.

Other Meds:

Current Illness: According to the ambulance crew member that called the patient had started having COVID 19 symptoms on Sunday 08/15/2021 and was tested for COVID on 08/19/2021. However when he was here filled out his paperwork and stated that he didn't have any symptoms and hadn't been tested.

ID: 1655832
Sex: F
Age: 28
State:

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

Date Died: 08/17/2021

ID: 1655833
Sex: M
Age: 60
State: FL

Vax Date: 04/21/2021
Onset Date: 08/15/2021
Rec V Date: 08/30/2021
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: COVID19 PCR detected 8/15/21

Allergies: Unable to obtain

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

Symptoms: 8/15/21: Patient arrived at the ER due to sudden collapse. EMS was called at 1349 and on arrival the patient was in asystole and apneic. Patient underwent emergent right frontal ventriculostomy. COVID-19 PCR came back positive on 8/15/21. Serum creatinine on admission was 1.39 which has gotten worse at 2.67. Patient intubated/mechanically ventilated, sedated; on 3 vasopressors. Stage 5 [Hunt and Hess] SAH associated with diffuse brain edema/herniation. 8/17/21: patient expired. Note: Spouse did not report symptoms of COVID-19 prior to cardiac event. Unknown if COVID-19 was symptomatic or asymptomatic due to patients unresponsive at admission. Please note: Spouse reports 2 doses of Pfizer vaccine in March 2021. Patient received first dose Pfizer vaccine on 3/31/2021 Lot # EN6198 and the second dose on 4/21/2021 Lot # ER8732

Other Meds: amlodipine, aspirin, atorvastatin, clonidine, clopidogrel, hydralazine, lisinopril, metoprolol

Current Illness:

ID: 1655834
Sex: F
Age: 44
State: TX

Vax Date: 08/30/2021
Onset Date: 08/30/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data: None.

Allergies: None

Symptom List: Tremor

Symptoms: Patient felt a sudden drop in blood pressure and weakness. Patient recovered within two minutes.

Other Meds: None

Current Illness: None

ID: 1655835
Sex: M
Age: 38
State:

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 08/30/2021
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: Erythema, Pruritus

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1655836
Sex: F
Age: 53
State: OH

Vax Date: 05/26/2021
Onset Date: 06/29/2021
Rec V Date: 08/30/2021
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: Had MRI brain, spinal tap, EMG, multiple labs.

Allergies: none

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

Symptoms: 1 week post 2nd MMR vaccine started having bilat (more on left) leg pain then moving into left arm. Then turned into Charlie-horse type cramps and stiffness in legs. States unable to bend knees and ankles all of time and severe Charlie horses 1-3 times/night. Had MRI brain, spinal tap, EMG, multiple labs. No alternative causes at this point. Patient is on steroids and states symptoms are better while on, but once stops, symptoms worsen again.

Other Meds: restasis eye drops- dry eyes

Current Illness: denies

ID: 1655837
Sex: M
Age: 27
State:

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1655838
Sex: M
Age: 60
State:

Vax Date: 08/25/2021
Onset Date: 08/27/2021
Rec V Date: 08/30/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Vaccine given at outside facility on 8/25, then seen at outside facility and started on cipro and flagyl, allergic reaction started including diffuse , itchy, body rash with tongue and lip swelling, eye swelling, no dyspnea, currently admitted, stable

Other Meds:

Current Illness:

ID: 1655840
Sex: F
Age: 61
State: VA

Vax Date: 08/13/2021
Onset Date: 08/13/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data: N/A

Allergies: Lobster, Crab, Shrimp

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

Symptoms: Pt. states that after receiving the 1st dose of Moderna 08/13/2021. started experiencing symptoms 6hrs later, right hip (welps/hives), continuing to spread throughout the body. Some would disappear and new rashes would appear. Primary visit 08/18/2021 recommended steroid shot, Benadryl (continuing). Still continuing to appear.

Other Meds: Valsartan, Lexapro, Tegretal, Attenial

Current Illness: N/A

ID: 1655841
Sex: M
Age: 66
State:

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1655842
Sex: M
Age: 33
State: FL

Vax Date: 08/29/2021
Onset Date: 08/29/2021
Rec V Date: 08/30/2021
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: Pain in extremity

Symptoms: *Chest Pain (Left Side) Swollen Lymph Node (Left Armpit) Shortness of breath Increased heart rate

Other Meds: Zinc BCAA

Current Illness: None

ID: 1655843
Sex: F
Age: 48
State:

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1655844
Sex: M
Age: 30
State: NY

Vax Date: 03/15/2021
Onset Date: 04/03/2021
Rec V Date: 08/30/2021
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: Not that I know of

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

Symptoms: I don't believe this is related to the shot, but it is a hard-to-diagnose health issue that arose at the time of having my second vaccination and has persisted since. Soon after the second shot, I developed gastrointestinal issues that were similar to gastritis or an infection both in the upper and lower parts of my stomach/intestines. It became unignorable by April 3rd and I went for a general check-up with a doctor who took blood tests and felt around my stomach. Blood tests came back all clear and he wasn't concerned however a week or so later the pain was fairly strong and I went to a urgent care. They did a urine test which came back fine but recommended me to a GI specialist. The GI specialist has done a breath test for bacteria that came back negative, he also did a colonoscopy that showed no obvious issues beyond irritation and he took a biopsy and ordered blood tests for celiac and gluten intolerance that we are awaiting results for. The pain is less bad but still present to this day and we are yet to come to a diagnosis. Again, I don't believe this is linked to the vaccine but thought it was mentioned anyway as it is a new medical event since having the shot.

Other Meds: Ashwagandha (since stopped) and multi vitamins

Current Illness: None

ID: 1655845
Sex: M
Age: 38
State:

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 08/30/2021
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: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1655846
Sex: U
Age: 36
State:

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 08/30/2021
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: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1655847
Sex: M
Age: 15
State: PA

Vax Date: 07/29/2021
Onset Date: 08/07/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data: Aug 12, 2021 EKG Aug 13, 2021 Covid test- Negative Aug 27, 2021 Bloodwork

Allergies: None

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Fast heartbeats, PVCs, difficulty breathing one night, severe rash, nausea, elevated blood pressure

Other Meds: None

Current Illness: None

ID: 1655848
Sex: M
Age: 40
State:

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 08/30/2021
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: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1655849
Sex: F
Age: 41
State: WA

Vax Date: 03/01/2021
Onset Date: 05/01/2021
Rec V Date: 08/30/2021
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: Extremely heavy menstrual cycles. My periods used to last approximately 5 days and bleeding was relatively even throughout. Starting in May (2nd dose of my vaccine was administered on April 28th), the duration of my period has shortened to around 3 days with the 2nd day being extremely heavy bleeding - as if all of the bleeding is occurring on that 2nd day. I?ve also experienced some spotting in May but that is no longer occurring. The extremely short and heavy cycles are still occurring, however.

Other Meds: Prozac - 20 mg

Current Illness:

ID: 1655850
Sex: F
Age: 47
State: KY

Vax Date: 04/03/2021
Onset Date: 08/21/2021
Rec V Date: 08/30/2021
Hospital: Y

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

Lab Data: PCR COVID-19 NASAL SWAB-POSITIVE

Allergies: NKA

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

Symptoms: ADMITTED TO HOSPITAL ON 8/21/21 FOR CENTRALIZED ABDOMINAL PAIN TIMES 4 DAYS. LAPAROSCOPIC EXPLORATION SURGERY WAS PLANNED. NO OTHER SYMPTOMS ARE NOTED.

Other Meds: COENZYME, PROZAC, TRICOR, NEURONTIN, SYNTHROID, MEVACOR,

Current Illness:

ID: 1655851
Sex: M
Age: 73
State: OH

Vax Date: 03/05/2021
Onset Date: 03/22/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data: acetylcholine receptor blocking, binding and modulating antibodies were positive.

Allergies: none

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

Symptoms: new onset myasthenia gravis, with positive antibodies, symptoms included ptosis and diplopia.

Other Meds: enalapril, hydroclororothiazide, metoprolol, alprazolam

Current Illness: none

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am