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: 1656209
Sex: F
Age: 39
State:

Vax Date: 07/17/2021
Onset Date: 08/29/2021
Rec V Date: 08/30/2021
Hospital: Y

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: Hospital 8/29/21. Received 2nd Pfizer COVID shot 7/31/21

Other Meds:

Current Illness:

ID: 1656211
Sex: F
Age: 38
State: TX

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

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Vaccine Name - Pfizer Vaccine Date - ? 08/27/2021 Is this your first or second dose- 1st Date of symptom onset - ? 08/27/2021 Symptoms - ? Swelling of lymph nodes behind ears, and on neckline on right side at first. Swelling has now progressed to left side. Throbbing in head. Last day of work and shift - ? Worked 8/27/2021, called in 8/28/2021, and is now back at work. Home remedies- Employee stated she has not done anything but rest. Stated that she did not want to interfere with any immune response so she was just waiting it out. Any improvement-Employee stated that the right side swelling is starting to get better but is not gone yet, and the left side is still the same. Recommendation- Advised employee to take tylenol or ibuprofen if not allergic per package instructions to ease any pain and swelling, if symptoms persist to contact her PCP, and to inform us of any new or worsening symptoms. Employee voiced understanding Employee of information ? Yes Employee voiced any concerns ? No Employee?s questions answered to employee?s satisfaction -Yes

Other Meds:

Current Illness:

ID: 1656212
Sex: M
Age: 57
State: TX

Vax Date: 08/27/2021
Onset Date: 08/29/2021
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: None

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

Symptoms: Rash, much like shingles.

Other Meds: None

Current Illness: None

ID: 1656213
Sex: F
Age: 49
State: PA

Vax Date: 04/22/2021
Onset Date: 05/02/2021
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: Pulmonary Function Test 7/23/2021, Abdominal Ultrasound 8/17/2021, Brain MRI 9/7/2021

Allergies: prochloperazine

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: From 5/2/2021-current I have experienced balance/equilibrium problems, Tingling in my arms and feet, Numbness in my feet, 30lb weight loss, cognitive and memory issues, persistent headaches, muscle weakness, bowel issues, stomach cramps, malaise and fatigue, shortness of breath and chest tightness.

Other Meds: metformin iron supplement

Current Illness: None

ID: 1656214
Sex: F
Age: 64
State: VA

Vax Date: 08/18/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies: Codeine

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

Symptoms: Itchy and rash at injection site, fever, tender and rash has begin to spread all over the arm.

Other Meds: Synthroid 50mg (once daily) Hydrochlorothiazide 12.5mg (once daily) Pantoprazole 40mg (once daily) Diltiazem ER 180mg (once daily)

Current Illness: None

ID: 1656215
Sex: F
Age: 67
State: KY

Vax Date: 02/25/2021
Onset Date: 03/07/2021
Rec V Date: 08/30/2021
Hospital: Y

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: March 8, 2021: Chest x-ray, CT head & neck, EKG, ECHO, lipid/hepatic/tsh panels August 13, 2021: CT head, chest x-ray, CBC & metabolic panel, EKG, heart monitoring, urinalysis, brain MRI

Allergies: none

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

Symptoms: I was completely healthy prior to the vaccine. Less than 2 weeks after receiving the vaccine, I had an attack involving chest pain, extreme headache, dizziness, shortness of breath so severe I went to the emergency room. After multiple tests, they could only diagnose me with sudden onset hypertension. I went on to have multiple episodes same as the first day of this attack for months. After months of chest palpitations, dizziness, loss of vision, shortness of breath, monitoring found cardiac arrhythmia and have received a pacemaker. I believe the vaccine impacted my heart and led to the arrhythmia situation.

Other Meds: baby aspirin Synthroid Losartan

Current Illness: none

ID: 1656216
Sex: F
Age: 14
State: FL

Vax Date: 08/25/2021
Onset Date: 08/27/2021
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: Pyrexia, White blood cell count decreased

Symptoms: Hive like rashes on face, eyes, mouth, back, arms, legs. Low fever 99.5, stuffy head. Benadryl in higher doses and Tylenol. Dr. prescribed a medication.

Other Meds: Tylenol, Concerta

Current Illness:

ID: 1656217
Sex: M
Age: 49
State: KY

Vax Date: 08/27/2021
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:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: C/O headache and rapid heart rate. Moved to stretcher, gave 25mg PO Benadryl. BP 170/90. Called RRT. Taken to Emergency Department for further evaluation.

Other Meds:

Current Illness:

ID: 1656218
Sex: F
Age: 33
State: IL

Vax Date: 02/26/2021
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: IM
Vax Site: LA

Lab Data: COVID at-home test on 8/19/21 was positive and second test on 8/26/21 was positive.

Allergies: N/A

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: After an outbreak of COVID at my daughter's summer camp, both her (5 yrs old - unvaccinated) and myself contracted COVID. This was on 8/17/21. I was ill for about 7 days and was unable to work for many of those days due to being sick. I definitely had more symptoms and more severity than my daughter did who is unvaccinated due to her age. We remained in quarantine for 10 days.

Other Meds: Once a day women's multivitamin

Current Illness: N/A

ID: 1656219
Sex: F
Age: 33
State: TX

Vax Date: 08/10/2021
Onset Date: 08/20/2021
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: 8/20/2021 ? Lab tests: CBC w/diff, comprehensive metabolic panel, d-diner quantitative, glomerular filtration rate, NT-Pro BNP, pregnancy urine, troponin T. Imaging tests: ECG 12-led, XR chest 1 view. All results came out negative or normal. 8/23/2021 ? Lab tests: comprehensive metabolic panel. No virus detected. Normal. ECG - normal. Imaging test ? CT scan shows enlarged left acollarte lymph node.

Allergies: None

Symptom List: Diarrhoea, Nasal congestion

Symptoms: CT scan showed enlarged left acollarte lymph node, chest pressure and pain, neck pressure and pain, perpetual dizziness, feeling faint, inability to concentrate, headache, tingling and coldness in hands and feet, adrenaline surges, nervous system triggered without stimulation or stress, heart palpitations, sensation of drowning during sleep. These symptoms have been present on and off since 8/20/2021. I was advised to take ibuprofen and follow an anti inflammatory diet and take anti inflammatory supplements, which have not been helpful for symptom management.

Other Meds: None

Current Illness: None

ID: 1656220
Sex: F
Age: 51
State: WA

Vax Date: 04/11/2021
Onset Date: 04/01/2021
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: MRI brain and C spine pending

Allergies:

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

Symptoms: Patient reported onset of paresthesia's in fingers and toes in late April, about 1-2 weeks after her vaccination. They improved significantly in July and have been stable since . Neurologic exam is normal. I'm ordering MRI brain and C spine to r/o transverse myelitis or MS. We don't plan any treatment unless they worsen again.

Other Meds:

Current Illness:

ID: 1656221
Sex: F
Age: 16
State: KY

Vax Date: 08/28/2021
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: SYR
Vax Site: RA

Lab Data:

Allergies: None

Symptom List: Rash, Urticaria

Symptoms: Severe headache - front of head

Other Meds: None

Current Illness: None

ID: 1656222
Sex: F
Age: 43
State: LA

Vax Date: 08/20/2021
Onset Date: 08/20/2021
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: none-severe angioedema-primary md considered this anaphylactic . deemed life threatening to take another covid vaccine and unsure on how i will react on future vaccines like flu or other covid shots. md would prescribe steroidal treatment if symptoms were to restart getting worse

Allergies: Shellfish, PCN, Latex, Insect stings, MODERNA VACCINE

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

Symptoms: Severe pain in left arm and itching started about 6 hrs after the vaccine, by 16 hrs after the vaccine, eyes were swollen shut, some sob, difficulty swallowing , fever along with rash on face and neck. started taking high doses of benadryl (already had epipens on hand from insect allergy). took benadryl q 2 hrs until throat swelling went down, and some edema left face. approximately 4 hrs. started taking benadryl q 4 hours routinely x 48 hrs thereafter, took lasix qd x 3 days to help reduce the swelling, then benadryl q hs x 7 more days

Other Meds: Losartan qd, xyzal qd, celebrex qd, ibuprofen just prior to injection

Current Illness: just HTN-controlled

ID: 1656223
Sex: F
Age: 47
State: NY

Vax Date: 08/10/2021
Onset Date: 08/10/2021
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: n/a

Allergies: na

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

Symptoms: Post Menopause for 22 months. I Have had not bleeding or spotting in those 22 months. 2 hours after the shot I started bleeding heavily with large size blood clots. I have been bleeding for 21 days straight.

Other Meds: Albuterol

Current Illness: na

ID: 1656224
Sex: F
Age: 43
State: FL

Vax Date: 08/29/2021
Onset Date: 08/30/2021
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: none

Allergies: none

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

Symptoms: Ocular Migraine

Other Meds:

Current Illness:

ID: 1656225
Sex: M
Age: 43
State: CA

Vax Date: 01/26/2021
Onset Date: 02/08/2021
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: None

Allergies: Bactrim

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

Symptoms: Can not sleep easily, Brain Fog, Memory Recall has become worst.

Other Meds: None

Current Illness: None

ID: 1656226
Sex: F
Age: 51
State:

Vax Date: 08/27/2021
Onset Date: 08/28/2021
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:

Allergies: none

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

Symptoms: Extreme fatigue, headache, body aches, rash not at injection site. It is a rash that has in the past been diagnosed as shingles but an visit with doctor diagnosed as contact dermatitis.

Other Meds: Metoprolol, sertraline, buspirone, advil, advil PM, melatonin

Current Illness: None

ID: 1656227
Sex: M
Age: 18
State:

Vax Date: 08/11/2021
Onset Date: 08/11/2021
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: 10 minutes after his vaccine, he reported being unable to see. His mom noticed that he had "no pupils"(?pinpoint pupils). He passed out 1-2 minutes later. LOCx 2 minutes. He was lowered him to the ground by his mom and a nurse. Afterwards, he was quiet and appeared confused (ie. "he was looking around"). Laid on the couch until the next morning. Did not feel normal until the next morning.

Other Meds:

Current Illness:

ID: 1656228
Sex: F
Age: 41
State: TN

Vax Date: 01/23/2021
Onset Date: 08/30/2021
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: EKG, Full blood panel (BMP, CBC, electrolytes, cholesterol, thyroid) date 3/5/21

Allergies: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Heart palpitations at night. Dr diagnosed as tachycardia. Treated with atenolol 25mg

Other Meds: Hailey 24 FE, montelukast 10mg, doxepin 25mg, carisoprodol 350mg, estazolam 2mg, fluticasone nasal spray, iptatropium 0.06% nasal spray, multi vitamin, red yeast rice, glucosamine/chondroitin/MSM, vitamin B complex, vitamin D, fish oil, bio

Current Illness: None

ID: 1656229
Sex: F
Age: 39
State: CA

Vax Date: 08/28/2021
Onset Date: 08/28/2021
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:

Allergies: NONE

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

Symptoms: This patient received Pfizer for her 1st and 2nd ( 12/22/2020 and 01/10/2021) , but she received Moderna for her booster shot on 08/28/2021. She requested Moderna as a booster shot while she was looking for her vaccine card. It turned out to be Pfizer that she received but she believed Moderna would work better as a booster since she is MD herself. She did not present any side effects or adverse reactions though.

Other Meds:

Current Illness: NONE

ID: 1656230
Sex: F
Age: 57
State: PA

Vax Date: 02/22/2021
Onset Date: 03/01/2021
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: None

Allergies: I had a reaction to Penicillin when I was 6 years old

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

Symptoms: I started noticing some brain fog, but I was not really sure. I discussed it with my doctor. My hair changed texture, it went from being thick and straight to being curly and frizzy and thin. It literally was falling out by the handful. I cannot say for sure it was the vaccine, but it started a month after. I went to the doctor in April, and we started discussing it. He referred me to a dermatologist and unfortunately it took months to be seen. I was not seeing until 08/12/2021. They did not do any medical tests or prescribed any medications. They said they do not know what the cause was. They said they noticed that my hair is growing back. They suggested to use Rogaine to help with the growth. I was Covid positive the Monday after thanksgiving of 2020. I do not know if this is related. I know when I went for my first dose it was 01/25/2021 and they said it was within the 90 day timeframe of active disease but they said they will still give me the vaccine because I work in healthcare. I am still in the process of recovering.

Other Meds: Gralise; Naproxen; Venlafaxine; Bupropion; Rosuvastatin calcium; multi vitamin; B12; vitamin C; vitamin E; Mometasone cream

Current Illness: None

ID: 1656231
Sex: F
Age: 58
State: MN

Vax Date: 03/17/2021
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: LA

Lab Data:

Allergies: Food extracts Metoprolol Tartrate Pollen Contrast Hazelnut Morphine Singulair Carvedilol Mold

Symptom List: Unevaluable event

Symptoms: POSITIVE COVID TEST 8/29/21

Other Meds: acetaminophen (TYLENOL) 325 mg oral tablet aspirin enteric coated 325 mg oral delayed release tablet baclofen (LIORESAL) 5 mg oral Tab clobetasol (TEMOVATE) 0.05 % sclp docusate sodium (COLACE) 100 mg oral capsule

Current Illness:

ID: 1656232
Sex: F
Age: 70
State: OH

Vax Date: 08/16/2021
Onset Date: 08/17/2021
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:

Allergies:

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

Symptoms: Patient says she started feeling nauseous the next day and was tired for a couple days. Then 1 week after injection developed a red blotchy rash all over injection site down to elbow (was still visible when pt presented to pharmacy on 8/30). Also stated she has a connective tissue disorder that has been flaring up since injection and has had increased stiffness in hands.

Other Meds:

Current Illness:

ID: 1656233
Sex: F
Age: 53
State: TX

Vax Date: 08/27/2021
Onset Date: 08/28/2021
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:

Allergies: Pennicilin

Symptom List: Injection site pain, Pain

Symptoms: Smokey/Cloudy eyes for about 3 -4 hours

Other Meds: Lisinipril Rosuvastatin Welbutrin

Current Illness: None

ID: 1656234
Sex: M
Age: 58
State: AR

Vax Date: 08/20/2021
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: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: codeine makes me itch

Symptom List: Injection site pain, Menorrhagia

Symptoms: 4 days after 2nd shot the top of my head hurt as if I had bumped it hard. Day 5 it felt like I had been hit by a hammer on my head. A quarter size spot was starting to get red. Day 6 red bumps appeared and pain radiated on my entire head and most of my face. By evening the bumps were blisters. Same up to day 10; the blisters are larger and sorer, pain is more intense. I took 500mg Valacyclovir on day 7, 8, and 10. SHINGLES

Other Meds: none

Current Illness: none known

ID: 1656235
Sex: M
Age: 55
State: TX

Vax Date: 03/11/2021
Onset Date: 03/11/2021
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: None

Allergies: None

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

Symptoms: sore throat, head congestion, total fatigue, mild fever, lung congestion, coughing, difficulty in breathing, coughing up phlegm all day, coughing until I wold throw up,

Other Meds: Vitamin C, Multivitamin, fish oil, glucosamine,

Current Illness: None

ID: 1656236
Sex: M
Age: 28
State:

Vax Date: 08/05/2021
Onset Date: 08/05/2021
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: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient states he felt lightheaded, extremely weak, diaphoretic, nausea, chills and had one episode of vomiting while on site. Patient contacted today by phone by myself. Advised patient to follow up with PCP when eligible for booster vaccine to have administered in controlled setting (PCP office or hospital) secondary to CDC since he vomited within 15 minutes of having vaccination. Patient verbalized understanding and is in agreement with assessment.

Other Meds:

Current Illness:

Date Died: 08/29/2021

ID: 1656237
Sex: F
Age: 80
State: KY

Vax Date: 03/05/2021
Onset Date: 08/29/2021
Rec V Date: 08/30/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient is a 81 y.o. female with history of COPD/emphysema on oxygen at home who presents with shortness of breath, chest pain, and nausea. She states her symptoms started this past Thursday. They progressively worsened with time. She normally wears 2 L of oxygen at home at night at baseline. However, her oxygen needs have had to increased since this past Thursday and she was up to 10 L oxygen at home today prior to coming to the emergency department. She came to the emergency department on Saturday 08/21/2021 and was positive for COVID-19. She did not require any more oxygen to be admitted at that time. She did have her COVID-19 vaccine and was fully vaccinated well over a month ago. She denies any other complaints today. Of note, she states only 1 of her lungs is working at 100% as the other 1 is being collapse by an uneven diaphragm. She had a car accident recently and had a ruptured sternum with diaphragmatic rupture. Hospital Course: Patient was treated for COVID-19 protocol. Unfortunately, her respiratory status continued to decompensate. She began telling staff that she was ?done ?and ?ready to go to the lord.? After difficult discussion, patient elected to make herself comfort measures only. Aggressive measures were discontinued and her family was allowed to visit say goodbye. She passed away 08/29/2021 at 1007. May she rest in peace.

Other Meds:

Current Illness:

ID: 1656238
Sex: F
Age: 47
State:

Vax Date: 08/03/2021
Onset Date: 08/12/2021
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: I'm severely allergic to bee stings. I got stung by a bee on my left palm on June 24, 2021. I displayed vomiting (3 times), diarrhea, severe abdominal pain, cold sweat, rash from chest to my feet, itching. My left hand and arm also swelled up, which lasted about 5 days.

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

Symptoms: 8/11 - rash and itchiness on the left arm where the shot was given, dull pain in my left underarm and a lump under the left armpit 8/17 - swelling of the area under my right jaw near the throat. It was blocking part of my airway on the right side. The left side felt normal. It started around 6am and lasted about 20 minutes. 8/18 - 20 - Same area under my right jaw near the throat swelled up and went after 15- 20 minutes 8/24 - same swelling occurred again and went away after 20 minutes 8/28 & 8/30 - sensation of a bug crawling on my left leg

Other Meds: Multi vitamins, Move free joint health by Schiff, Lutein & Zeaxanthin by trunature, and salmon oil.

Current Illness: None

ID: 1656239
Sex: F
Age: 64
State: MN

Vax Date: 03/26/2021
Onset Date: 08/26/2021
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: on 8/30/21: CMP, D-Dimer, occult blood, CBC with differential, lipase, magnesium, PT/INR, PTT, sars/flu/RSV, troponin CT abdomen pelvis with contrast, CTA chest, EKG, Xray Chest portable

Allergies:

Symptom List: Nausea

Symptoms: chest pain, multiple subsegmental pulmonary emboli without acute cor pulmonale; anemia, massive GI bleed, tachycardia, lightheadedness, midepigastric abdominal pain, bilateral adrenal masses.

Other Meds:

Current Illness:

ID: 1656240
Sex: M
Age: 72
State: CA

Vax Date: 04/12/2021
Onset Date: 04/13/2021
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: n/a

Symptom List: Injection site pain

Symptoms: Soreness in arm and feeling tired

Other Meds: n/a

Current Illness: n/a

ID: 1656241
Sex: M
Age: 63
State: CA

Vax Date: 04/07/2021
Onset Date: 04/09/2021
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: ECG report said Ok. Blood work multiple inflammation flags no feedback from doctors.

Allergies:

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

Symptoms: heart palpitations, skipping beats

Other Meds: losartan, gabapentin,atenolol,pepcid ac.

Current Illness: diabetes, high bp, Gerd

ID: 1656242
Sex: F
Age: 35
State: TX

Vax Date: 08/02/2021
Onset Date: 08/02/2021
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: RA

Lab Data: EKG for rapid heart rate and blood pressure he found a PVC

Allergies: No

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

Symptoms: 6 hours after the injection, I started having a lot of dizziness and ringing in my right ear and that continued up until 08/29/2021. I saw my Dr. on the 8/20/2021. I had an EKG for rapid heart rate and blood pressure. He a found a PVC. He does not think it is necessarily caused by the vaccine but may have been flared up by the vaccine and also induced by the stress of the media. I started a steroid, on 08/28/2021, methylprednisolone. As of 08/29/2021 the ringing in my ear has stopped.

Other Meds: IUD

Current Illness: No

ID: 1656243
Sex: M
Age: 68
State: MN

Vax Date: 11/03/2020
Onset Date: 11/11/2020
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: Tremor

Symptoms: Patient stated that he was completely paralyzed. He could not walk or feed himself.

Other Meds: Lasortin 100mg daily Cinvastic 20mg daily Stool softner

Current Illness:

ID: 1656244
Sex: M
Age: 73
State: OH

Vax Date: 08/23/2021
Onset Date: 08/25/2021
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: Severe headache, pens and needles all over the body.

Other Meds:

Current Illness:

ID: 1656245
Sex: M
Age: 26
State: OH

Vax Date: 06/14/2021
Onset Date: 06/15/2021
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:

Allergies:

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

Symptoms: Having hives on my arms and chest area since the shot. Have been on two different steroid packs, soon as I get off the steroids the hives come right back. I have no known allergies.

Other Meds:

Current Illness:

ID: 1656246
Sex: M
Age: 12
State: NJ

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

Lab Data:

Allergies: PENICILLIN

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

Symptoms: swollen LYMPH NODE UNDER THE LEFT ARMPIT. NOT PAINFUL

Other Meds: MULTIVITAMIN

Current Illness: LAST MONTH A LITTLE COLD

ID: 1656247
Sex: M
Age: 17
State: CA

Vax Date: 08/20/2021
Onset Date: 08/20/2021
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:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: 17 year old above patient received Janssen by error. Until today follow up has been done , no adverse event reported from a patient or parent. Proper counseling done at the time and day of vaccination and during follow up.

Other Meds:

Current Illness:

ID: 1656248
Sex: F
Age: 55
State: PA

Vax Date: 02/12/2021
Onset Date: 02/13/2021
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:

Allergies:

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

Symptoms: Shoulder pain- has persisted, has not resolved severe headache, nausea, fever

Other Meds:

Current Illness:

ID: 1656249
Sex: M
Age: 19
State: MN

Vax Date: 08/27/2021
Onset Date: 08/27/2021
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: This was second moderna dose. patient also passed out after first dose. I gave vaccine, patient seemed fine then passed out about 30 seconds later. was out for 30-40 seconds then came back to feeling very light headed and he was also very pale. I offered water and crackers. he sat with me and his mom for 20-30 minutes and was feeling fine when they left. -mom stated that his sister also reacted the same way.

Other Meds:

Current Illness:

ID: 1656250
Sex: F
Age: 50
State: OH

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

Lab Data:

Allergies: N/A

Symptom List: Pain in extremity

Symptoms: Patient came into get a Shingles vaccine but was accidently given a Covid19 Pfizer vaccine. She reported no side effects after about 15 minutes and also on a follow up call about 1 hour later.

Other Meds: N/A

Current Illness: N/A

ID: 1656251
Sex: F
Age: 34
State: ND

Vax Date: 04/08/2021
Onset Date: 05/01/2021
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: 6/1/21 - EKG - Sinus tachycardia present; otherwise normal ECG 6/1/21 - TSH Reflex - <0.01 (Standard Range: 0.40-5.00 uIU/mL) 6/1/21 - FT4 Reflex - 2.4 (Standard Range: 0.7-1.5 ng/dL) 6/16/21 - NM Thyroid I123 With Uptake and Scan - Hyperthyroidism indicated. Thyromegaly. No toxic notule. 24 hour thyroid iodine uptake of 59.5%. For reference purposes, normal our thyroid uptake ranges from 8-28%. 24 hour iodine uptake study most compatible with Graves' Disease. 8/19/21 - Free T3 - 3.7 (Standard Range: 1.7-3.7 pg/mL) 8/19/21 - FT4 Reflex - 1.4 (Standard Range: 0.7-1.5 ng/dL) 8/19/21 - TSH Reflex - <0.01 (Standard Range: 0.40-5.00 ulU/mL)

Allergies: none

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

Symptoms: I received my 2nd Pfizer vaccination in April 2021 and in early May 2021, I started noticing my resting heart rate slowly increasing day by day and my heart felt like it was constantly pounding. I also started losing more hair than usual & would sweat excessively. After about a month of these symptoms not improving, I finally saw my primary care physician. I had an EKG completed and some blood work to check my thyroid levels. It was revealed that my TSH was extremely low and my FreeT4 was high. I was referred to an endocrinologist who, after more testing, confirmed a diagnosis of Graves Disease on June 16th. I was prescribed methiMAzole (commonly known as Tapazole) at a dose of 10mg once daily. I recently had my thyroid levels re-checked after two months of being on the medication and my FreeT4 and FreeT3 are back to the normal ranges, while my TSH still remains extremely low.

Other Meds: none

Current Illness: none

ID: 1656252
Sex: M
Age: 28
State: KY

Vax Date: 07/15/2021
Onset Date: 08/21/2021
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:

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

Symptoms: had both doses of COVID vaccine and then tested positive for COVID 19

Other Meds:

Current Illness:

ID: 1656253
Sex: F
Age: 47
State:

Vax Date: 01/07/2021
Onset Date: 08/25/2021
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: Date Tested/Results: 8/28/21, POSITIVE Covid-19 Vaccine Yes/No: Yes Date of last dose: 1/7/21 8/30: EE still symptomatic. Has a fever, cough, fatigue, congestion. EE reported that she is covid positive, 8/28/21. Discussed that she will need to quarantine x10 days since s/s first appeared and 24 hrs pased since last fever without fever reducing medications. EE instructed to call hotline back after she is released from quarantine. DOH to notify EE as well. EE will need to clear with clinic when cleared from quarantine and no longer having symptoms.

Other Meds:

Current Illness:

ID: 1656254
Sex: F
Age: 51
State: FL

Vax Date: 08/04/2021
Onset Date: 08/04/2021
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: Floxin, Dairy Products

Symptom List: Vomiting

Symptoms: Swollen, itchy hands, redness and swelling around hand joints. Pain in left shoulder muscles.

Other Meds: Aimovig, Vitamin D, Magnesium, Ashwagandha, Instaflex, Brain Boost, Celexa

Current Illness: Auto Immune (Rheumatoid)

ID: 1656255
Sex: F
Age: 32
State: TX

Vax Date: 08/19/2021
Onset Date: 08/19/2021
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:

Allergies: Amoxicillin Clindamycin

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Fever of 101.8 (12-36 hours after vaccine) Body Aches and Chills (12-36 hours after vaccine) Sore lymph nodes (12-36 hours after vaccine) Arm soreness (onset 5 days after vaccine) Redness (onset 5 days after vaccine)

Other Meds: None

Current Illness: Pregnancy (delivered on July 20, 2021)

ID: 1656256
Sex: F
Age: 75
State: CA

Vax Date: 02/16/2021
Onset Date: 02/16/2021
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: Neuro visit with Dr. EMG was done . Severe muscle weakness in legs . Also left arm

Allergies: sulfa

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

Symptoms: Extreme Fatigue following vaccines. light headed and dizzy.

Other Meds: Adolophine2.5 5mg ,enalapril 20mg 2x a day pravastian 20 mg Synthroid flovant inhaler monlutolukast sodium 10 elderberry vitamin c d3 magnesium echinacea Turmeric

Current Illness: no

ID: 1656257
Sex: F
Age: 51
State: CA

Vax Date: 03/16/2021
Onset Date: 03/31/2021
Rec V Date: 08/30/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Heart Testing-03/31/2021 Covid-19 Rapid Test 07/23/2021

Allergies: Seasonal Allergies

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Two weeks after the second dose of the vaccine I felt winded suddenly. I had a cold feeling in the middle of my chest. I was very uncomfortable and I went to the ER the next morning. I was diagnosed with a Heart Attack. I was told I had 90% Occlusion and I was treated immediately. I was hospitalized for five days and I had to go back after 10 days because I had chest spasms. I had another Angioplasty and they said my blood flow was slow. I am still taking blood thinners and having some chest spasms. I was experiencing some tiredness and then I got body aches. The body aches were very bad in my muscles that came and went for 5 days. . I was extremely tired. I got mouth lesions five days after I felt the tiredness. on my tongue and on the roof of my mouth. I had light headaches and I did not loose my sense of smell or taste. I tested positive for Covid-19 07/23/2021.. Since then I have developed a persistent cough and nasal drip which is lingering at the moment. It has been four weeks and I did not have this cough during the first 14 days.

Other Meds: Xanax Claritin

Current Illness:

ID: 1656258
Sex: F
Age: 80
State: CA

Vax Date: 04/08/2021
Onset Date: 08/08/2021
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:

Allergies:

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

Symptoms: breakthrough infection; pneumonia

Other Meds:

Current Illness:

ID: 1656259
Sex: F
Age: 50
State:

Vax Date: 04/26/2021
Onset Date: 08/22/2021
Rec V Date: 08/30/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Fully vaccinated, found to be positive for covid-19 with bilateral PEs, hospitalized 2 days, required oxygen support with nasal cannula for less than 24hrs. Was discharged on room air with anticoagulant for PE

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am