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: 1658682
Sex: F
Age: 37
State: NY

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

Lab Data: negative flu/covid

Allergies: 0

Symptom List: Dysphagia, Epiglottitis

Symptoms: Chills, confusion, HA, abdominal pain, nausea, body aches

Other Meds: 0

Current Illness: 0

ID: 1658683
Sex: F
Age: 61
State: FL

Vax Date: 02/02/2021
Onset Date: 08/27/2021
Rec V Date: 08/31/2021
Hospital: Y

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: Hospitalized for febrile illness/sp COVID19. Treated with dexamethasone IV daily and Remdesivir

Other Meds:

Current Illness:

ID: 1658684
Sex: F
Age: 46
State: PA

Vax Date: 08/23/2021
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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Vaccination administered, and patient was observed after 15 minutes for reaction. Felt lightheaded and diaphoretic 15 minutes after vaccine administration- did not lose consciousness; thinks it is anxiety related. Complete resolution of symptoms with supine positioning with slow elevation of head of bed over 15 minutes.

Other Meds:

Current Illness:

ID: 1658685
Sex: F
Age: 10
State: PA

Vax Date: 08/29/2021
Onset Date: 08/29/2021
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: none we are aware of

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient was under the recommended age for the vaccine - Mother knowingly consented and lied about age of patient

Other Meds: none we are aware of

Current Illness: none we are aware of

ID: 1658686
Sex: M
Age: 45
State: UT

Vax Date: 08/10/2021
Onset Date: 08/13/2021
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: MRI, CT-Scan both of brain, Heart Echo and various labs performed at ER on 8/20/21

Allergies: NKDA / NKA

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

Symptoms: Three day post shot (8/13/21) had sever pain/spasms in left side of neck and left shoulder. Pain resolved in about 5-8 minutes. On 8/20/21 I was admitted via ambulance for acute left-sided neck spasms/pain and left shoulder pain accompanied with stroke-like symptoms (numbness of tongue, left arm, lower jaw, impaired speech) and for an AFIB ECG read by paramedics on scene. Transported to local ER. Remained in AFIB FOR SEVERAL HRS. Acute Neck pain/spasms have reoccured several times since ER discharge

Other Meds: N/N

Current Illness: N/N

ID: 1658687
Sex: F
Age: 44
State: MI

Vax Date: 05/01/2021
Onset Date: 08/19/2021
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: corn

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

Symptoms: chest pain, diagnosed pericarditis by CAT scan

Other Meds: none

Current Illness: none

ID: 1658688
Sex: F
Age: 43
State: FL

Vax Date: 04/08/2021
Onset Date: 07/27/2021
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: Covid test, CXR.

Allergies: NKA

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Pt came to ER c/o fever, chills, body aches, fatigue, SOB, nausea, and vomiting.

Other Meds:

Current Illness:

ID: 1658689
Sex: M
Age: 69
State: MT

Vax Date: 03/18/2021
Onset Date: 08/21/2021
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:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Diagnosed and hospitalized with COVID 19.

Other Meds:

Current Illness:

ID: 1658690
Sex: M
Age: 57
State:

Vax Date: 01/27/2021
Onset Date: 08/29/2021
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: positive covid test with symptoms

Other Meds:

Current Illness:

ID: 1658691
Sex: F
Age: 20
State: MN

Vax Date: 02/10/2021
Onset Date: 08/30/2021
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: COVID-19 08/30/2021

Allergies: Penicillins

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient received 2nd Pfizer vaccine on 02/19/2021. She developed symptoms of loss of taste and smell, fever, and chest tightness on 08/29/2021. Positive for Covid-19 on 08/30/2021.

Other Meds: Acetaminophen, Advil, Nexplanon

Current Illness:

ID: 1658692
Sex: F
Age: 62
State: KS

Vax Date: 01/14/2021
Onset Date: 01/14/2021
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: MRI OF BRAIN-NORMAL WENT TO NEUROLOGIST FOR HEADACHES AND DIZZY

Allergies: FLAGELL

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

Symptoms: AFTER 1ST VACCINE SEVERE HEADACHE FOR DAYS...WENT TO DOCTOR AND DAY 10 AND MEDICINE FOR RELIEF DIZZY BRAIN FOG FEVER BODY ACHES CHILLS FATIGUE SORE AT INJECTION SITE AFTER 2ND VACCINE: EXTREME HEADACHES, HAVE HAD THESE ALMOST EVERY DAY SINCE VACCINE DIZZINESS-STILL CONTINUES BRAIN FOG-STILL CONTINUES EXTRENE CHILLS AND SHAKING BODY ACHES FEVER FATIGUE PAIN AT INJECTION SITE

Other Meds: LEVOTHYROXIN CALCIUM MULTIVITAMIN VITAMIN C ZINC FISH OIL

Current Illness: NONE

ID: 1658693
Sex: M
Age: 59
State: TX

Vax Date: 02/11/2021
Onset Date: 02/15/2021
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: Ultrasound

Allergies: KNA

Symptom List: Rash, Urticaria

Symptoms: Right calf swollen 2? Blood clots right knee

Other Meds: Amlodipine Besylate 10MG Lisinopril HCTZ 20/25MG Metoprolol ER Succinate 50MG Centrum Sikver

Current Illness: No

ID: 1658694
Sex: M
Age: 47
State: FL

Vax Date: 03/13/2021
Onset Date: 08/14/2021
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: LA

Lab Data: Tested positive for covid prior to admission at outside clinic approx on 8/9/21.

Allergies: nka

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

Symptoms: 8/14/21: admitted. initially presented to ED with a chief complaint of near syncope, shortness of breath, generalized weakness. tested positive for COVID 19 last Monday. Note, he was vaccinated against COVID-19 with Johnson and Johnson on 3/13/21. Diagnosed with acute hypoxic respiratory failure, covid-19 pneumonia 8/26/21: discharged

Other Meds: amlodipine, aspirin, clopidogrel, dulaglutide, ergocalciferol, ezetimibe, famotidine, isosorbide mononitrate, magnesium oxide, metoprolol (lopressor), mycophenolic acid, prednisone, rosuvastatin, tacrolimus

Current Illness:

ID: 1658695
Sex: F
Age: 33
State: IA

Vax Date: 08/19/2021
Onset Date: 08/22/2021
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: Bactrum

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

Symptoms: Cold sore outbreak beginning Sunday the 22nd and still continuing on August 31. Some are healing and new are showing up. I did have a 102? fever Friday. Sometimes fever and stress trigger a cold sore but this outbreak is the worst I?ve ever had.

Other Meds: Zoloft, Hydroxizine

Current Illness: None

ID: 1658696
Sex: M
Age: 81
State: FL

Vax Date: 01/06/2021
Onset Date: 07/27/2021
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: CXR, covid test-positive.

Allergies: NKA

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

Symptoms: Pt came to ER c/o generalized weakness.

Other Meds:

Current Illness:

ID: 1658697
Sex: F
Age: 58
State: NY

Vax Date: 03/11/2021
Onset Date: 08/31/2021
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: Blood test taken on 8/18/21 and again on 8/25/21

Allergies:

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

Symptoms: After my doctor visit for a yearly checkup and blood work my doctor told me that i did not have any antibodies from the shot i took on March 11,2021 and i would need to go have the shots again.

Other Meds:

Current Illness:

ID: 1658698
Sex: M
Age: 86
State:

Vax Date: 03/04/2021
Onset Date: 08/26/2021
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:

Allergies:

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

Symptoms: Patient came in with a history of mild dementia, confusion, temp 103.3, cough and congestion no vomiting or gi symptoms. Diagnoses: Acute Covid and UTI.

Other Meds:

Current Illness:

ID: 1658699
Sex: F
Age: 43
State: CA

Vax Date: 08/30/2021
Onset Date: 08/31/2021
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: none

Allergies: PEG, polysorbate

Symptom List: Ear pain, Hypoaesthesia

Symptoms: low grade fever, rigors and chills, headaches, muscle weakness in left arm (site of injection), pain in small joints (fingers, toes), profound fatigue, unable to concentrate, sore throat, dry cough

Other Meds: none

Current Illness: none

ID: 1658700
Sex: F
Age: 14
State: MI

Vax Date: 08/30/2021
Onset Date: 08/30/2021
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:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: patient became very dizzy and lethargic and then started vomiting

Other Meds:

Current Illness:

ID: 1658701
Sex: M
Age: 71
State: MI

Vax Date: 02/19/2021
Onset Date: 02/22/2021
Rec V Date: 08/31/2021
Hospital: Y

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

Lab Data: Many tests at hospitals, ERs, physicians' offices, and clinics. Most significant result was a positive test for MOG antibody, which the neurologist considers the primary source of the myelitis.

Allergies: Allergic to Penicillin

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

Symptoms: First symptoms were fatigue and muscle weakness. Developed into significant malaise that led to a neurologist's diagnosis of Transverse Myelitis. Treatment consisted of a 5-day hospital stay during which daily steroid infusions were administered. Followed up with continuing physical therapy.

Other Meds: Simvastatin (40mg), Ibuprofen (200mg), MetaMucil

Current Illness: None

ID: 1658702
Sex: M
Age: 58
State: AR

Vax Date: 08/20/2021
Onset Date: 08/20/2021
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: Patient vaccination record shows that patient previously received 2 doses of Pfizer vaccine (01/07/2021 & 01/28/2021), and 1 dose of Johnson & Johnson vaccine (06/18/2021) prior to receiving first Moderna vaccine on 08/20/21 at our facility. Patient marked "NO" to the question: "Have you had a previous COVID-19 vaccine? If yes, date?"

Allergies:

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

Symptoms: none

Other Meds:

Current Illness:

ID: 1658703
Sex: F
Age: 57
State: MD

Vax Date: 04/25/2021
Onset Date: 05/01/2021
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: Dermatologist Appointment ~6/8/21 - cultures were taken of the large eruption on my forehead Shingles diagnosis 6/10/21 - contacted by office that I tested positive Infection diagnosis (forehead eruption) ~6/17/21 - contacted by office around this date that I tested positive

Allergies: none aware of

Symptom List: Unevaluable event

Symptoms: Developed shingles (ophthalmic) - started a couple weeks after vaccine with eye pain/irritation in one eye that lasted several days, one time discharge from that eye. About a week later developed pain/irritation in other eye. Approx. a week later (~5/30), developed a large red bump on my forehead that later erupted. There were some additional very small skin bumps, but they disappeared on their own. I waited a week to see the dermatologist and was initially prescribed a topical ointment pending the test results. The test results came back positive for shingles and an infection on my forehead. I was prescribed and took medication for shingles and the infection. I have a scar/indentation on my forehead where the large eruption occurred. I also had a dry cough that started right after receiving the vaccine. The cough lasted over 4 weeks. I've never had a dry cough before. As a result of these adverse events and concern that the vaccine negatively impacted my immune system, I did not get the second dose. I rarely get sick and have a very good immune system.

Other Meds: Multi vitamin, Vitamin C, Zinc

Current Illness: none

ID: 1658704
Sex: F
Age: 23
State: TN

Vax Date: 03/01/2021
Onset Date: 03/01/2021
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: EEG - abnormal but no seizure like activity MRI brain - normal CTA chest normal EP/Tilts - negative Holter - sinus tach Multiple ER visits Neurology consult Cardiology consult/EP consult - started on ivabradine without any improvement PCP multiple visits. Unremarkable lab evaluation, extensive bloodwork, stool studies, viral studies.

Allergies: 0

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

Symptoms: Syncope/POTS/refractory tachycardia/fatigue

Other Meds: 0

Current Illness: 0

ID: 1658705
Sex: M
Age: 45
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: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: N/A

Allergies: none

Symptom List: Injection site pain, Pain

Symptoms: Pharmacist administered pneumovax in patient's left deltoid on 8/30/21 around 3:30PM. Within 5 minutes, patient was complaining of severe lower back pain, which he described as "hot" and "firey." Pharmacist escorted him to a seat and provided him with an ice pack. She asked if he had any other symptoms including shortness of breath, trouble breathing, pain at the injection site, itchiness, and arm pain; Patient said he had no other symptoms. Pharmacist examined the injection site and observed no discoloration (including redness), no inflammation, and confirmed the area was not hot to touch. Pharmacist asked the patient if he had any history of reactions from vaccines, history of back pain or history of nerve pain. Patient said he had no history of reaction post-vaccination, no history of back pain, but he mentioned he's had recent nerve pain that he just got medication for. Patient said he had been on gabapentin for 1 day prior to this vaccination. Pharmacist had the patient sit for observation. Within 10-15 minutes, Patient said he started to feel a bit better, and felt well enough to go home. Once Patient got home (roughly 30 minutes later), he called Pharmacist and let him know that he was feeling much better. Pharmacist let him know she would be reaching out to his pain management doctor and following up with him over the next couple weeks. She left a message with the doctor's office that evening, and followed up with the office the next morning (8/31/21) around 9:00AM. Pharmacist spoke to staff at Doctor's office asking to speak with Doctor. Staff stated that Doctor spoke with Patient earlier that morning, and that Doctor does not accept phone calls; he declined speaking with Pharmacist. Pharmacist left a message on Patient's voicemail on 8/31/21 at 11:57AM to see how he was feeling and ask if he was going to seek medical care.

Other Meds: gabapentin, meloxicam, lipitor, metoprolol

Current Illness: new-onset nerve pain

ID: 1658706
Sex: F
Age: 71
State: PA

Vax Date: 06/06/2021
Onset Date: 06/20/2021
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: Audiograms by Audiologist and treatment by an Otolaryngologist

Allergies: Cipro and quinolones

Symptom List: Injection site pain, Menorrhagia

Symptoms: Unilateral, severe sensorineural hearing loss R side midrange to high frequencies

Other Meds: Synthroid 50 mcg po qd

Current Illness: None

ID: 1658707
Sex: F
Age: 73
State: MI

Vax Date: 08/26/2021
Onset Date: 08/28/2021
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: visual exam at Urgent Care on 8/28/21, received benadryl shot and Rx for Methylprednisolone to start 8/29/21 follow-up with Medical Group on 8/30/21 with interview and visual exam, got Rx for triaamcinolone acetonide and Aleve

Allergies: proamitine (?)

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

Symptoms: woke up 8/28/21 with face swollen, right eye almost swollen shut, and hives scattered on rest of body also got flu shot at same time as booster shot - didn't realize I needed to add to item 4 and can't go back on screen

Other Meds: anastrozole, centrum complete, cyanocobalamin, D-3, potassium

Current Illness: next to final herceptin dose 08/27/2021 for breast cancer

ID: 1658708
Sex: F
Age: 28
State: MN

Vax Date: 03/15/2021
Onset Date: 08/26/2021
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: Covid-19 08/26/2021

Allergies: Ibuprofen

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient received 2nd Moderna vaccine on 03/15/2021. Tested positive for Covid-19 on 08/26/2021.

Other Meds: Multi vitamin, Vistaril

Current Illness:

ID: 1658709
Sex: M
Age: 70
State: KY

Vax Date: 02/12/2021
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: RA

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient presented to ED with dyspnea, incessant cough. Patient tested positive 1 week prior to ED visit. Patient still receiving inpatient treatment.

Other Meds:

Current Illness:

ID: 1658710
Sex: F
Age: 33
State: NH

Vax Date: 06/04/2021
Onset Date: 06/14/2021
Rec V Date: 08/31/2021
Hospital: Y

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: Gluten, honey

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

Symptoms: Received pfizer covid vaccine on 6/4 and developed hallucinations/diplopia 1.5 weeks later. Developed BLE paresthesias first and she developed falls . Had bilateral hand paresthesias start about 5 days later, , likely most consistent with guillain Barre. +cyclic vomiting x3 weeks. Facial edema also noted on 6/24. Continued to have BLE and BUE paresthesias, as well as tachypnea. Ultimately had cardiac arrest on 8/8.

Other Meds: Acetaminophen 325mg q4h PRN Aripiprazole 5mg daily Bisacodyl 10mg daily PRN Docusate-senna 100mg-16.2mg BID Fioricet 1mg q4h PRN Fluoxetine 60mg daily Hydroxyzine 25mg TID PRN Ibuprofen 400mg q6h PRN Lansoprazole 30mg daily Lyrica 75mg BID

Current Illness:

ID: 1658711
Sex: F
Age: 12
State: MI

Vax Date: 07/26/2021
Onset Date: 08/24/2021
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: CBC, iron studies on 8/23/2021: hgb 8.7 with platelets 64k and normal WBC and indices CBC, iron studies on 8/31/2021: hgb 9.3, platelets 28k with immature platelet fraction 11.7%. No signs of hemolysis on labs or peripheral smear.

Allergies: Fish containing products, tree nuts

Symptom List: Nausea

Symptoms: 4 weeks after her second shot in the COVID-19 series, the patient developed asymptomatic thrombocytopenia to 64k found during the workup for iron deficiency anemia related to heavy menses. The following week, her platelets were down to 28k with an elevated immature platelet fraction consistent with idiopathic thrombocytopenia purpura. At this visit, her anemia was improving with iron supplementation.

Other Meds: none

Current Illness: none

ID: 1658712
Sex: F
Age: 25
State: NY

Vax Date: 08/22/2021
Onset Date: 08/22/2021
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: Injection site pain

Symptoms: Fever, headache and body aches

Other Meds: Lexapro

Current Illness:

ID: 1658713
Sex: M
Age: 55
State: FL

Vax Date: 02/24/2021
Onset Date: 07/27/2021
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: Covid test, CXR.

Allergies: Codeine, menthol topical.

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

Symptoms: Pt came to ER c/o fever, chills, cough, mild headache for the last few days.

Other Meds:

Current Illness:

ID: 1658714
Sex: M
Age: 64
State: MN

Vax Date: 03/28/2021
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: RA

Lab Data:

Allergies: none

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

Symptoms: Headache(s), sore throat starting 8/28/21

Other Meds: Losartan-Potassium-HCTZ; Fish oil, Flax oil; Ketoconazole cream

Current Illness: none

ID: 1658715
Sex: F
Age: 39
State: AL

Vax Date: 08/25/2021
Onset Date: 08/26/2021
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: none

Allergies: none

Symptom List: Tremor

Symptoms: Chest pain occurred the next day and lingered for 3 days. Pain throughout upper shoulders, neck and arms began on the third day and is still present and getting worse.

Other Meds: none

Current Illness: none

ID: 1658716
Sex: F
Age: 51
State: FL

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

Lab Data:

Allergies: none

Symptom List: Erythema, Pruritus

Symptoms: swelling over anterior clavicle with tenderness

Other Meds: none

Current Illness: none

ID: 1658717
Sex: F
Age: 39
State: CA

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 08/31/2021
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: pt reported cotton mouth, ball in throat, was monitored for 30 minutes post shot. did not progress. able to drink water and no vocal changes. Assessed by NP and sent home.

Other Meds:

Current Illness:

ID: 1658718
Sex: F
Age: 47
State: WI

Vax Date: 08/29/2021
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

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

Symptoms: Swelling, pain, hives, redness, tender to touch, blisters, weakness, dizziness . I applied hydrocortisone and 1 pill (Aleve) .

Other Meds: None

Current Illness: None

ID: 1658719
Sex: M
Age: 69
State: TX

Vax Date: 04/15/2021
Onset Date: 04/16/2021
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: X-ray of lungs: clear and unremarkable. RBC and WBC normal. Kidney functions normal.

Allergies: Sulfa, Trazadone

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Severe chronic shortness of breath upon exertion, ongoing for over 4.5 months.

Other Meds: Tansulosin, Duloxetine, Pantoprazole, Ropinorole, Dicyclomine, Rosuvastatin, Clopidogrel, Mirtazapine, multi-vitamin, probiotics.

Current Illness:

ID: 1658720
Sex: F
Age: 46
State: NJ

Vax Date: 02/08/2021
Onset Date: 05/01/2021
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: Bloodwork on 8/11/2021

Allergies: Latex and Penicillan

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

Symptoms: Strange "bruises" after no trauma. Began the end of May and are continuing.

Other Meds: None

Current Illness:

ID: 1658721
Sex: F
Age: 67
State: KY

Vax Date: 07/27/2021
Onset Date: 08/30/2021
Rec V Date: 08/31/2021
Hospital: Y

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: Patient presented to ED with 1 week history of fatigue, body aches, cough. Patient became so weak she called an ambulance to come to the ED. Patient is still receiving inpatient treatment.

Other Meds:

Current Illness:

ID: 1658722
Sex: F
Age: 73
State: NY

Vax Date: 08/13/2021
Onset Date: 08/14/2021
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: N/A

Allergies: N/A

Symptom List: Pain in extremity

Symptoms: Pt. states that after receiving the 1st dose of J&J 08/13/2021, started experiencing symptoms 08/14/2021 of arm swelling, throbbing pain lasting 24hr, nausea, and dizziness. No noted Primary visit, symptoms lasting 3 days.

Other Meds: Sen Balta 60mg,

Current Illness: N/A

ID: 1658723
Sex: M
Age: 12
State: CA

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:

Allergies:

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

Symptoms: pt report ball in throat and cold in throat, did not progress. kept for 30 min post shot. no vocal changes, no changes in breathing. Assessed by NP and d/c'ed home.

Other Meds:

Current Illness:

ID: 1658724
Sex: M
Age: 39
State: CO

Vax Date: 08/29/2021
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: None

Allergies: NKDA

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

Symptoms: Approximately 12-16 hrs after getting my 3rd booster vaccine (Right Shoulder), I noticed dramatic swelling in my right Axilla (arm pit). No redness, but noticeable swelling. Now 48 hrs later, the swelling remains. I did take a picture showing the swelling.

Other Meds: Daily Multivitamin

Current Illness: None

ID: 1658725
Sex: F
Age: 75
State: FL

Vax Date: 03/12/2021
Onset Date: 07/27/2021
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: Covid test-positive, CXR.

Allergies: Sulfa drugs.

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

Symptoms: Pt came to ER c/o difficulty breathing onset 1 day ago.

Other Meds:

Current Illness:

ID: 1658726
Sex: M
Age: 42
State: WI

Vax Date: 08/22/2021
Onset Date: 08/23/2021
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: Penicillin

Symptom List: Vomiting

Symptoms: Fever of 100+ Fahrenheit. Started after 18 hours, ended by 24 hours. Shortness of breathe and difficulty taking deep breathes. Started after 6 hours, last 48 hours. Enlarged lymph node in my left armpit, with pain. Started after 12 hours, lasted 96 hours. Intense pain throughout my body, like someone was stabbing me all over my body. Started at 18 hours, lasted to 36 hours. All conditions were treated with 81mg Asprin qd, 1000mg Tylenol q4h. 600mg Ibuprofen q6h

Other Meds:

Current Illness:

ID: 1658727
Sex: M
Age: 36
State: KS

Vax Date: 08/25/2021
Onset Date: 08/26/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: CT Scan MRI Scheduled Blood Work

Allergies: N/A

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: The left side of my face feels numb and I have brain fog. I am currently being tested and seen by a medical provider to determine treatment.

Other Meds: N/A

Current Illness: None

ID: 1658728
Sex: M
Age: 66
State: AZ

Vax Date: 03/01/2021
Onset Date: 08/01/2021
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: Patient is having pain in the right side back of the head. Patient also has a lump there. Pain started a few weeks ago and is gradually intensifying.

Other Meds: Lovastatin 40mg Lisinopril 30mg Topriomel 50mg Aspirin 81mg

Current Illness:

ID: 1658729
Sex: F
Age: 75
State: MS

Vax Date: 08/30/2021
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: Covid test today due to recent exposure was positive.

Allergies: No Known Allergies

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient had previously received her first Moderna Covid on 08/20/2021. This was unknown to staff who gave the patient what was thought of as a first dose. When the dose was entered we noted that the patient had a first dose at a pharmacy.

Other Meds: Aspirin 81 mg daily Atorvastatin Calcium 80 mg Benazepril Hydrochloride 20 mg Cyproheptadine 4 mg Ditropan XL 5 mg Fosamax 70 mg Humira 40mg/0.8 ml Lasix 20 mg Methrotrexate 2.5 mg Norvasc 10 mg prednisone 5 mg

Current Illness: 08/31/2021- Tested Positive for COVID

ID: 1658730
Sex: M
Age: 48
State: AL

Vax Date: 08/12/2021
Onset Date: 08/26/2021
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: penicillin

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

Symptoms: pressure in chest, discomfort - effects felt in 90 degree and above temperature, strenuous physical labor; rest, stay out of heat;

Other Meds: prilosec

Current Illness: one week prior: negative covid test, symptoms equal to sinus infection

ID: 1658731
Sex: F
Age: 60
State: KY

Vax Date: 04/15/2021
Onset Date: 08/27/2021
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: RA

Lab Data:

Allergies:

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

Symptoms: tested positive for COVID 19 8/27/2021

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am