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: 1658137
Sex: F
Age: 49
State: GA

Vax Date: 03/06/2021
Onset Date: 03/22/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: Pre mana-Ouse

Allergies: none

Symptom List: Dysphagia, Epiglottitis

Symptoms: Mestral period non stop for 2 months

Other Meds: Aderral, Synthroid, Escitalopran

Current Illness: none

ID: 1658138
Sex: F
Age: 18
State: TX

Vax Date: 07/29/2021
Onset Date: 07/29/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: none

Allergies: none

Symptom List: Anxiety, Dyspnoea

Symptoms: Employee reports having fever of 101F, chills, and body aches later that night. Employee states fever and chills resolved by morning but the body aches continue until the next day.

Other Meds: none

Current Illness: none

ID: 1658139
Sex: F
Age: 44
State: OH

Vax Date: 08/27/2021
Onset Date: 08/29/2021
Rec V Date: 08/31/2021
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: Site: Redness at Injection Site-Mild, Systemic: Chest Tightness / Heaviness / Pain-Medium, Systemic: neck stiffness/pain in the morning followed by chest pain and a diagnosis of pleurisy-Medium, Additional Details: neck stiffness/pain the next morning following vaccine followed by chest pain/tightness and 2 ER visits both ending with diagnosis of pleurisy

Other Meds:

Current Illness:

ID: 1658140
Sex: F
Age: 59
State: CA

Vax Date: 08/30/2021
Onset Date: 08/30/2021
Rec V Date: 08/31/2021
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: Error: Wrong Dose of Vaccine - Too High-

Other Meds:

Current Illness:

ID: 1658141
Sex: F
Age: 55
State: FL

Vax Date: 01/05/2021
Onset Date: 07/02/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: 7/2/21: CXR-negative, Covid test-positive.

Allergies: Chantix

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

Symptoms: Pt came to ER c/o: fever, chills, headache, generalized aching, weakness, and fatigue. Onset 1 week prior. Temp 102 F.

Other Meds:

Current Illness:

ID: 1658142
Sex: F
Age: 31
State: FL

Vax Date: 08/26/2021
Onset Date: 08/26/2021
Rec V Date: 08/31/2021
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: Error: Wrong Route (SC, IM, etc.)-

Other Meds:

Current Illness:

ID: 1658143
Sex: M
Age: 18
State: TX

Vax Date: 08/28/2021
Onset Date: 08/28/2021
Rec V Date: 08/31/2021
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: Systemic: tingling eyes-Medium, Systemic: Flushed / Sweating-Mild, Additional Details: called ambulance

Other Meds:

Current Illness:

ID: 1658144
Sex: M
Age: 29
State: MD

Vax Date: 08/30/2021
Onset Date: 08/30/2021
Rec V Date: 08/31/2021
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: Systemic: Dizziness / Lightheadness-Severe, Systemic: Flushed / Sweating-Severe, Systemic: Nausea-Medium, Additional Details: patient began to feel nauseas and dizzy so laid supine. He described feeling flush. He has a needle phobia so may have been associated with some level of anxiety. The patient kept coughing, denied any throat/breathing trouble but was given benadryl preventatively. patient waited additional time period to recover before leaving the facility

Other Meds:

Current Illness:

ID: 1658145
Sex: M
Age: 38
State: CA

Vax Date: 08/30/2021
Onset Date: 08/30/2021
Rec V Date: 08/31/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-

Other Meds:

Current Illness:

ID: 1658146
Sex: M
Age: 39
State: IL

Vax Date: 08/27/2021
Onset Date: 08/28/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: none yet

Allergies: n/a

Symptom List: Diarrhoea, Nasal congestion

Symptoms: 8/28 had splitting headache and stiff neck, severe body aches throughout the day; on 2 instances during 8/28 I had about 10 second period of unfamiliar heart palpitations each time which I've never experienced in my life 8/29 Upon waking my body aches were gone, but I still had a headache with stiff/sore neck the whole day 8/30 Headache was not as severe as preceding day; more dull in nature still had stiff/sore neck the whole day 8/31 This morning, still have stiff/sore neck and only dull headache sensation occurs when I turn my head quickly, or walk swiftly (I regularly workout, but have not since I've been vaccinated, and don't know if my body/head can tolerate exercise at this time)

Other Meds: i do not take any medications

Current Illness: none

ID: 1658322
Sex: M
Age: 84
State: GA

Vax Date: 02/02/2021
Onset Date: 08/10/2021
Rec V Date: 08/31/2021
Hospital: Y

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

Lab Data: 08/21/2021 PCR+ COVID-19 test

Allergies:

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

Symptoms: Subjective fever (felt feverish), Runny nose/Congestion, Cough, Hospitalization 8/21/2021 due to fall

Other Meds:

Current Illness:

ID: 1658323
Sex: F
Age: 47
State: FL

Vax Date: 08/01/2021
Onset Date: 08/07/2021
Rec V Date: 08/31/2021
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: NSIDS Tylenol Reglan

Symptom List: Rash, Urticaria

Symptoms: I have noticed sever pain in joints. When I walk my heels and ankles ache, my elbows and knees ache as well but not as severely as the back of my heels and ankles. I have not worn any new shoes or injured by any any activities. Pain is relieved by not bearing weight.

Other Meds: Vitamin D B12 injection every other week Flexeril Zanax Elequis

Current Illness: None

ID: 1658324
Sex: F
Age:
State: GA

Vax Date: 08/24/2021
Onset Date: 08/31/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data:

Allergies: No e

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

Symptoms: Early onset of men?s teal cycle

Other Meds: None

Current Illness: None

ID: 1658325
Sex: F
Age: 58
State: KY

Vax Date: 01/26/2021
Onset Date: 08/23/2021
Rec V Date: 08/31/2021
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: PT WAS FULLY VACCINATED WITH PFIZER VACCINE - DOSE 1 1/4/21 (LOT EL0140), DOSE 2 1/26/2021 (LOT ELO140). S/O 8/23/21, TESTED + 8/27/21

Other Meds:

Current Illness:

ID: 1658326
Sex: F
Age: 66
State: MA

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 08/31/2021
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: Pt verbalized nka

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

Symptoms: Pt arrived today to receive her 2nd Pfizer vaccine. Pt approached my desk and informed me she did not have her vaccine card. She requested a new Covid-19 vaccination record card. I confirmed her full name and DOB via System and I noticed two vaccines documented in System, one from 7/14/21(Pfizer) and one for today. I wanted to confirm that I filled out her card correctly therefore I signed into Database and noticed the pt receive the J&J vaccine on 3/12 and Pfizer on 7/14/21. I asked the pt if she ever received the J&J vaccine and she answered with "no". I then checked Database again to confirm the right pt, DOB, address and asked the pt again if she received any vaccine besides the Pfizer one and she said "no". I explained to the pt that our records show she received the J&J vaccine on 3/12/21. I explained to her that there is not enough information/adverse effects with taking J&J and Pfizer together and she should not have received the Pfizer vaccine. I informed the pt that we may not be able to give her the 2nd pfizer due to this guideline. I informed her I would check with my charge nurse who confirmed that the pt should not receive the 2nd Pfizer vaccine. Pt appeared upset and left stating "now I am not fully vaccinated". Pt then returned about 20 minutes later and approached a different nurse to receive her 2nd Pfizer vaccine. Per nurse the pt stated she is here to receive her 2nd vaccine and did not have her vaccine card. The charge nurse was notified and walked over to the pt and nurse to inform her the pt was already here to receive her pfizer vaccine but we couldn't due to her receiving the J&J vaccine already The pt then stated she was here just to receive her vaccine card. The nurse completed her vaccine card, which included the J&J and Pfizer vaccine information.

Other Meds: Medication list unavailable via system and pt was not found in database

Current Illness: Medical illnesses not available in System and pt was not found in database.

ID: 1658327
Sex: F
Age: 44
State: CA

Vax Date: 07/08/2021
Onset Date: 07/08/2021
Rec V Date: 08/31/2021
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: Penicillin, other antibiotics and laytex

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

Symptoms: Within a few hours the right arm became extremely sore. By the end of the day I could barely lift the arm. That night I had trouble sleeping due to the pain in the arm. Next day - continued right arm pain- severe, headache Day two - chest discomfort- pounding, pressure , headache Day Three- slight labored breathing arm began to feel better and less pain in the arm, headaches The week of the shot- continued chest discomfort/ pressure, ringing ears and pain in ear, headaches, arm pain better. Called Hospital and they stated no need to be concerned and that the issues would go away. Following week- headaches, ear pain, one cold sore on lip, chest discomfort and cough developed called Hospital and informed of the issues. On 7-29-2021 at 4:30 pm received second shot as planned based on Hospital Advise- No new side effects As of August 31, 2021 I have intermittent ear pain and severe cough that will not go away. Chest pain has been intermittent and no arm pain. Sore is gone. Headaches are better but intermittent.

Other Meds: None

Current Illness: None

ID: 1658328
Sex: F
Age: 87
State: FL

Vax Date: 05/01/2021
Onset Date: 07/24/2021
Rec V Date: 08/31/2021
Hospital: Y

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

Lab Data: 7/24/21: Covid test-negative, CXR.

Allergies: NKA

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

Symptoms: Pt came to ER via EMS for weakness, hypotensive, near syncope.

Other Meds:

Current Illness:

ID: 1658329
Sex: F
Age: 47
State: MA

Vax Date: 08/20/2021
Onset Date: 08/21/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data:

Allergies: sulfa, cillins, zithromax, cefpodoxime, ciproflaxin, gluten

Symptom List: Ear pain, Hypoaesthesia

Symptoms: * within the first 12 hours post-vaccination: Fever up to 101.7, joint pain, muscle aches, not able to move off the couch. ended by about 48 hours post-vaccination. * about 36 hours post vaccination developed a large enflamed, (inflammation, pain at rest and at touch, and heat) red area about 7cm by 7cm on the upper left arm. Itching started about 24 hours after enflamed area appeared. enflammed area took about 6 days to resolve, itching continued for another 2 days. Reached out to my provider on 8/24 as enflamed area was >2 x the size that I'd developed post 2-nd vaccination dose in March. Was advised to watch and reach out if it spread or got worse. It spread a tiny bit, but did not get worse in terms of pain, heat, itching, or redness. Provider followed up on 8/30, but site was largely resolved.

Other Meds: Cimzia (last dose 8/13/2021 - no doses since then) Methotrexate (last dose 8/8/2021 - no doses since then)

Current Illness: none

ID: 1658331
Sex: M
Age: 57
State: NY

Vax Date: 04/08/2021
Onset Date: 04/12/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: EKG 04/13/21

Allergies: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: I get like I was having a heart attack, my heart was racing, shortness of breadthe, extreme chest pain. Describes as potential myocarditis

Other Meds: None

Current Illness: None

ID: 1658332
Sex: F
Age: 37
State: IA

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

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

Lab Data:

Allergies:

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

Symptoms: Patient received a dose of Pfizer vaccine 8.30.21 that was mixed with 1.8 sterile diluent (sterile water) instead of 1.8ml Normal Saline.

Other Meds:

Current Illness:

ID: 1658333
Sex: F
Age: 62
State:

Vax Date: 04/21/2021
Onset Date: 08/27/2021
Rec V Date: 08/31/2021
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: positive test 8/27

Allergies: no known allergies

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

Symptoms: Breakthrough COVID first vax 3/31. 62 y/o female presents with complaints of SOB. Pt states that she is normally on O2 as needed and for the last 2 days, she has experienced worsening SOB and cough needs to be on 2L O2 all the time via nasal cannula. Pt states she had fever, chest pain, and orthopnea. Lives with boyfriend both vaccinated. Still hospitalized on this date

Other Meds:

Current Illness:

ID: 1658334
Sex: F
Age: 71
State: CA

Vax Date: 02/15/2021
Onset Date: 02/16/2021
Rec V Date: 08/31/2021
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: coconut sulfa drugs

Symptom List: Unevaluable event

Symptoms: The next day my upper arm swelled up, the site was warm to the touch and it itched. This lasted for several days. I saw my doctor, he said what I had was "Moderna Arm" and gave me info to report it to the CDC so they could follow my progress. It has been to long for me to remember much more. Check with the CDC for more info. It was fresh back in February, and I reported it all, at that time.

Other Meds: atorvastatin 20mg Vit D Vit B Multi vitamin aspirin 80mg

Current Illness: none

ID: 1658335
Sex: F
Age: 70
State: KY

Vax Date: 04/05/2021
Onset Date: 08/23/2021
Rec V Date: 08/31/2021
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: PT WAS FULLY VACCINATED WITH MODERNA. 2/26/21 (LOT 022M20A) + 4/5/21 (LOT 017B21A). S/O 8/23/2021, TESTED + 8/27/2021

Other Meds:

Current Illness:

ID: 1658336
Sex: F
Age: 49
State:

Vax Date: 06/07/2021
Onset Date: 06/07/2021
Rec V Date: 08/31/2021
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: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1658337
Sex: M
Age: 38
State:

Vax Date: 06/07/2021
Onset Date: 06/07/2021
Rec V Date: 08/31/2021
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: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1658338
Sex: M
Age: 64
State:

Vax Date: 06/07/2021
Onset Date: 06/07/2021
Rec V Date: 08/31/2021
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: 1658339
Sex: F
Age: 68
State: CA

Vax Date: 06/22/2021
Onset Date: 08/23/2021
Rec V Date: 08/31/2021
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: blood clot on left leg

Other Meds: no

Current Illness:

ID: 1658340
Sex: F
Age: 84
State:

Vax Date: 06/07/2021
Onset Date: 06/07/2021
Rec V Date: 08/31/2021
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: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1658341
Sex: F
Age: 62
State: OH

Vax Date: 08/29/2021
Onset Date: 08/29/2021
Rec V Date: 08/31/2021
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: Patient said she was cold but her skin was on fire. She Started that she was hallucinating and had a high fever. She also had a bad headache. She was waking up with night sweats.

Other Meds: Neurontin 100mg Prilosec 40mg Cymbostain 40mg Vitamin C

Current Illness:

ID: 1658342
Sex: F
Age: 68
State: FL

Vax Date: 02/18/2021
Onset Date: 05/05/2021
Rec V Date: 08/31/2021
Hospital: Y

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

Lab Data: CT-scan, blood test, MRI

Allergies: none

Symptom List: Nausea

Symptoms: Acute deep vein Thrombosis and pulmonary embolism

Other Meds: Losartan 100 mg, Atorvastatin 20 mg, Raloxifene 60 mg, Fenofibrate 54 mg, Citracal, Vitamin D

Current Illness: none

ID: 1658343
Sex: M
Age: 18
State: WI

Vax Date: 08/28/2021
Onset Date: 08/30/2021
Rec V Date: 08/31/2021
Hospital: Y

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

Lab Data: EKG - 8/30/2021 Troponin - 8/30/2021

Allergies: No Known allergies

Symptom List: Injection site pain

Symptoms: Patient presented to the Emergency Department with Chest Pressure. EKG presented as abnormal. Provider states that the patient may have myocarditis as an etiology of his diffuse ST segment elevation. Patient also has an elevated troponin. Patient was transferred to a larger hospital with a Cardiology provider.

Other Meds: Ibuprofen q6hrs PRN for pain

Current Illness: None documented

ID: 1658344
Sex: M
Age: 21
State:

Vax Date: 06/07/2021
Onset Date: 06/07/2021
Rec V Date: 08/31/2021
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:

ID: 1658345
Sex: F
Age: 65
State: FL

Vax Date: 04/19/2021
Onset Date: 07/26/2021
Rec V Date: 08/31/2021
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: CXR, covid test-positive.

Allergies: Bactrim, compazine

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

Symptoms: Congestion, Cough, headache, generalized body aches.

Other Meds:

Current Illness:

ID: 1658346
Sex: M
Age: 17
State: IA

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

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

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: Patient received 2nd Pfizer covid vaccine that had been diluted with 1.8 sterile diluent (sterile water) instead of 1.8 normal saline.

Other Meds:

Current Illness:

ID: 1658347
Sex: M
Age: 42
State:

Vax Date: 08/05/2021
Onset Date: 08/05/2021
Rec V Date: 08/31/2021
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: Patient had emesis following J+J vaccine and has been notified he will be flagged for any future potential boosters. Patient verbalized understanding.

Other Meds:

Current Illness:

ID: 1658349
Sex: M
Age: 70
State:

Vax Date: 02/07/2021
Onset Date: 08/16/2021
Rec V Date: 08/31/2021
Hospital: Y

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: Cycle threshold 8/16/21 = 22.7

Allergies:

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

Symptoms: Hospitalization with COVID-19 Reported per vaccine EUA

Other Meds:

Current Illness:

ID: 1658350
Sex: F
Age: 28
State: TX

Vax Date: 08/28/2021
Onset Date: 08/30/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data:

Allergies: None known of

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

Symptoms: Currently pregnant with due date 12/26/2021 Having heart palpitations and shortness of breath

Other Meds: Tylenol 500mg - 3Pm Tylenol 1000mg - 100pm

Current Illness:

ID: 1658351
Sex: M
Age: 32
State:

Vax Date: 06/07/2021
Onset Date: 06/07/2021
Rec V Date: 08/31/2021
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: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1658352
Sex: F
Age: 39
State: DE

Vax Date: 02/24/2021
Onset Date: 02/25/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: not yet

Allergies: None

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

Symptoms: I received the second vaccine on 2/24/2021, on 2/25/2021 I had body aches and pain, my back was really bad, I had received an injection in my lumbar region on 2/15/2021 and was feeling great until the second injection. I saw my APRN and was prescribed a steroid which helped, but as soon as I finished the pain came right back. I saw my eye doctor in May, and he wants me to get lab work and testing for and myasthenia graves. I have never had any eye problems in the past. One of my first symptoms was a terrible headache and eye pain. It was very scary. I was diagnosed with Covid-19 on 8/25/2021. My lungs were affected with getting Covid-19, I am shortness of breath, I am on an antibiotic beginning on 08/27/2021 and I was given antibiotics and an inhaler and told to take baby aspirin. I am still struggling at this point.

Other Meds: HTCZ; Lisinopril; Lamictal; Wellbutrin; Buspar

Current Illness: None

ID: 1658353
Sex: M
Age: 63
State:

Vax Date: 06/07/2021
Onset Date: 06/07/2021
Rec V Date: 08/31/2021
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: 1658354
Sex: F
Age: 43
State: MO

Vax Date: 08/09/2021
Onset Date: 08/09/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: Aug 28, 2021- EKG, Chest X-Ray

Allergies: none

Symptom List: Pain in extremity

Symptoms: Aching pain and stiffness in left arm, spread further down arm to elbow, left shoulder in back and moving into chest area to top of left breast and neck on left side. Swelling was noticed on Aug 28, 2021 about 9am in all stiff areas. Used heat massager; no help

Other Meds: Lexapro 20mg once daily Protonix 10mg once daily

Current Illness: none

ID: 1658355
Sex: F
Age: 28
State: GA

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: None

Allergies: Sulfa

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

Symptoms: Patient Given 1st dose Moderna 03/26/2021. Patient given 2nd dose Pfizer today 08/31/2021. Disclosed to patient. No adverse effects in 30 minutes of monitoring.

Other Meds: NA

Current Illness:

ID: 1658356
Sex: F
Age: 62
State: GA

Vax Date: 07/30/2021
Onset Date: 08/20/2021
Rec V Date: 08/31/2021
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: 08/20/2021 PCR+ COVID-19 test at hospital

Allergies:

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

Symptoms: Shortness of breath or difficulty breathing, Chest pain, covid pneumonia, hospitalization in ICU

Other Meds:

Current Illness:

ID: 1658357
Sex: F
Age: 82
State: IL

Vax Date: 04/10/2021
Onset Date: 08/06/2021
Rec V Date: 08/31/2021
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:

Allergies: None

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

Symptoms: August 6, patient fell getting out of bed and hit right side arm/hip on door. No head impact August 9, patient at ER with confusion, CT scan of brain normal August 10, patient at ER again with stroke like symptons, non-verbal, confusion, extreme headache. Admitted to hospital for 3 days August 27, patient has extreme pain in lower left leg, after ultrasound blood clot both acute and chronic found in leg. Lung scan also showing blood clots. Patient admitted and put on Heparin for 48 hours

Other Meds: Furosemide 40 mg or 20 mg x 1 per day. Zolpidem 10 mg x 1 per night. Promethazine HCI 12.5 mg x as needed for Nausea. Hydrocodone-acetaminophen 10-325 mg tabs x as needed. Alprazolam 2 mg x as needed. Started Rivaroxaban 15 & 20 M

Current Illness: None

ID: 1658359
Sex: F
Age: 40
State:

Vax Date: 06/07/2021
Onset Date: 06/07/2021
Rec V Date: 08/31/2021
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: 1658360
Sex: M
Age: 69
State: NJ

Vax Date: 03/23/2021
Onset Date: 08/30/2021
Rec V Date: 08/31/2021
Hospital: Y

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

Lab Data: 8/30/21 SARS-CoV2 Antigen + 8/31/21 SARS-CoV-2 Igm 1.40, and IgG 2.61

Allergies: NKDA

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Admitted to hospital with weakness, fatigue, dizziness, found to be COVID 19 +

Other Meds: FLOMAX 0.4MG BY MOUTH DAILY" SYNTHROID 120MCG BY MOUTH DAILY" XANAX 0.25MG BY MOUTH DAILY" Benazepril 40mg by mouth daily chlorthalidone 50 mg Tablet po daily escitalopram oxalate 20 mg Tablet Directions: 1 tablet oral daily (Active)

Current Illness:

ID: 1658361
Sex: M
Age: 29
State:

Vax Date: 06/07/2021
Onset Date: 06/07/2021
Rec V Date: 08/31/2021
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: 1658362
Sex: M
Age: 30
State: NJ

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 08/31/2021
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: No reported allergies

Symptom List: Injection site swelling, Limb discomfort

Symptoms: patient become warm, sweaty and unresponsive while seated. the patient was placed on the ground and was kept there for 10 minutes until first responders arrived to the scene.

Other Meds: None

Current Illness: No

ID: 1658363
Sex: M
Age: 52
State: IA

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

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: Patient received his first dose of Pfizer covid vaccine and it had been mixed in a vial with 1.8 sterile diluent (sterile water) instead of 1.8 normal saline

Other Meds:

Current Illness:

Date Died: 08/06/2021

ID: 1658364
Sex: M
Age: 46
State: CA

Vax Date: 03/12/2021
Onset Date: 08/06/2021
Rec V Date: 08/31/2021
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: covid PCR positive on 7/31/2021

Allergies:

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

Symptoms: Death from Covid Pneumonia

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am