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: 1658783
Sex: F
Age: 47
State: MS

Vax Date: 08/20/2021
Onset Date: 08/21/2021
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: N/A

Allergies: N/A

Symptom List: Dysphagia, Epiglottitis

Symptoms: soreness of left arm ,fatigue, chills, muscle aches, and sinus symptoms.

Other Meds: Norvasc 5mg , Prevacid 30mg , Pepcid 40 mg , Multivitamin, , Vitamin C , Garlic soft gel, Probiotics , Biotin , Claritin, and Benadryl .

Current Illness: N/A

ID: 1658784
Sex: F
Age: 33
State: FL

Vax Date: 03/30/2021
Onset Date: 07/16/2021
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: 7/16/21: Covid test: positive.

Allergies: NKA

Symptom List: Anxiety, Dyspnoea

Symptoms: Pt came to ER with URI onset 1 week prior. Nasal congestion, rhinorrhea, and sore throat.

Other Meds:

Current Illness:

ID: 1658785
Sex: M
Age: 74
State:

Vax Date: 03/10/2021
Onset Date: 07/31/2021
Rec V Date: 08/31/2021
Hospital: Y

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: Cycle threshold 7/31/21 = 24.7

Allergies:

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

Symptoms: Hospitalization with COVID-19 Reported per vaccine EUA

Other Meds: mycophenolate

Current Illness:

ID: 1658786
Sex: M
Age: 27
State:

Vax Date: 08/13/2021
Onset Date: 08/13/2021
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: During monitoring period post Pfizer initial COVID-19 vaccine, pt experienced sweating, flushing, chills, lightheadedness, nausea. VS: 135/83, P 53, R 19, O2 95%. IM Benadryl administered per patient request, blanket and water provided. VS: 143/85, R 21, P 59, O2 100%, orange juice given. Repeat VS in opposite arm: VS 152/90, P 60, R 10, O2 100%. 12:41 VS: 140/75, R 20, P 60, O2 100%. o Patient was discharged to home in care of parent.

Other Meds:

Current Illness:

ID: 1658787
Sex: F
Age: 44
State: IA

Vax Date: 04/08/2021
Onset Date: 04/13/2021
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: 4-22-2021- multiple vaginal testing, urine testing 4-23-2021- CT Scan of abdomin- Negative 4-23-2021- Urinalysis 4-23-2021- CBC with Differential 4-23-2021- Basic Metabolic Panel I can forward all test results if necessary

Allergies: Penicillin Erythromycin

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

Symptoms: Approximately 5 days after having the vaccine I started having terrible lower back pain. (4-13-2021)I had noticeable blood in my urine just a few days after receiving the vaccine. Each day the pain grew progressively worse. On 4-22-2021 I visited the OBGYN because I was having so much abdominal pain. They did some testing but before I got the results a day had passed and I was in worse pain. On 4-23-2021 I felt like I kept needing to urinate. I sat in bed that night and began feeling a contracting feeling and felt an urgency to push. I sat on the toilet and was in a lot of pain but I wanted to push. It felt like my bladder was contracting. When I was done there were approximately 3 clumps of blood in the stool with bloody red urine. I immediately went to the emergency room. In the emergency room over the course of a few hours I probably passed 15 to 20 additional clumps. The nurse collected the clumps which appeared to be blood clots. They were looked at under a microscope and determined they were NOT kidney stones but indeed just tissue and blood clots. It was very very painful. I was given a CAT scan to make sure I didn't have any kidney stones and the scan was negative. After receiving test results I was put on antibiotics and sent home. I felt bad for about 4 additional days and things started turning around.

Other Meds: None

Current Illness:

ID: 1658788
Sex: F
Age: 36
State: UT

Vax Date: 08/03/2021
Onset Date: 08/03/2021
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: None

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

Symptoms: Within minutes I had heat/tingling in my right foot. It comes and goes. It has been happening since I got the shot almost a month ago. It happens at least a few times every hour to sometimes many times in just 10 minutes.

Other Meds: Lexapro, progesterone, statin and thyroid

Current Illness: None

ID: 1658789
Sex: F
Age: 40
State: IN

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

Lab Data: None

Allergies: Adhesive to band aids

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Fever around 101 for 24 hours, body aches, extreme fatigue, chills, migraines, extreme dizziness, vertigo

Other Meds: Effexor 150mg (once daily) Vyvanse 50mg (once daily) Folic Acid 1mg (once daily) Methotrexate 25mg (per week)

Current Illness: None

ID: 1658790
Sex: F
Age: 45
State: MA

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

Lab Data: None

Allergies: lidocaine, sulfa and morphine

Symptom List: Pharyngeal swelling

Symptoms: Patient received the first dose of Moderna on 2/3/21 but never received the second dose. When patient reported to the ED for a infected ankle MD wanted to administer the second dose of COVID vaccine. MD accidentally ordered Janssen vaccine instead of Moderna. Error was not caught by pharmacy nor nursing. No patient harm reported.

Other Meds:

Current Illness: fractured ankle, infected bone of ankle, substance abuse

ID: 1658791
Sex: F
Age: 34
State: MD

Vax Date: 05/25/2021
Onset Date: 05/25/2021
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: Bloodwork labs came back normal only low on vitamin D and reflexes are were normal.

Allergies: Sulphur; Phentermine; shell fish

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: It started on the same day in left arm, on and off twitching on left arm for a day or two. 6 weeks later it spread throughout my whole body - neck, feet, buttocks', etc., 8 weeks later it died down. Bottom left part of my head like a stabbing pain like the nerve pain. I saw 3 different doctors.

Other Meds: No

Current Illness: No

ID: 1658792
Sex: F
Age: 51
State:

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

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: During monitoring period post Pfizer COVID-19 vaccine, pt experienced hypertension, flushing, dizziness, lightheadedness, faint feeling, chills, nausea, rapid heart rate. VS: 155/98, P 101, R 25, O2 98%. Upon assessment, patient oriented x 4, states she was "blacking out" sweating profusely. Stated some tingling of bottom lip. Patient initially refused emergency medication after about 10 minutes agreed to IM Benadryl 25mg x 1. Patient remained in extended Observation for an hour and a half. Ice applied, water, blanket. Notified family members via phone that she had a reaction but began to feel better after an hour and 30 minutes. Patient discharged to home. VS: 125/71, P 59, R 19, O2 100%

Other Meds:

Current Illness:

ID: 1658793
Sex: F
Age: 58
State: GA

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

Lab Data:

Allergies: N/A

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

Symptoms: Vomiting, chills, light head, fever

Other Meds: Vraylar

Current Illness: Ear infection

ID: 1658794
Sex: M
Age: 43
State: MN

Vax Date: 12/21/2020
Onset Date: 08/25/2021
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: PCR Test

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Employee tested positive for COVID 19 after being vaccinated.

Other Meds:

Current Illness:

ID: 1658795
Sex: F
Age: 66
State: MI

Vax Date: 02/27/2021
Onset Date: 03/02/2021
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: EKG - normal - March 2021 Stress test - normal - March 2021

Allergies: SULFA drugs

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

Symptoms: After the second dose (2/27/2021), less than a week later, I started having major heart palpitations. I may not have put that on the v-safe check in because I did not relate it to the vaccine at the time. But this is all new to me, it never happened before. On March 3rd 2021 I had a severe reflux attack as well. My blood pressure was also sky high which has never happened to me before. The heart palpitations were very scary. I went to the ER for that after my vaccine and they gave me a beta blocker and set me up with a cardiologist. I am not on BP medications for this issue and still have heart palpitations even with medication now so I am not recovered.

Other Meds: Omeprazole 40MG every morning; Flonase; Diazepam as needed for anxiety; Multivitamin; Fish Oil; Digestive Enzyme; Vitamin D; Mucinex

Current Illness: N/a

ID: 1658796
Sex: M
Age: 62
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: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: n/a

Allergies: none

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

Symptoms: Syncope (fainting) occurred 2 to 3 minutes after administering the vaccine. Patient started reaction by saying he is not feeling well , then immediately appeared to be loosing consciousness. pharmacist assisted patient immediately to lie down flat on the floor to prevent falls and injuries. Paramedic were notified. Patient then started saying they feel a bit better and mentioned he had history of fainting after seeing needles and usually get very anxious in similar vaccine situations. Around 15 minutes after incident patient was completely recovered , he refused to be transported to hospital when checked by paramedics and left facility with no injuries and felling well.

Other Meds:

Current Illness: none

ID: 1658797
Sex: M
Age: 86
State:

Vax Date: 02/12/2021
Onset Date: 08/09/2021
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: LA

Lab Data: Cycle threshold 8/10/21 = 14.4

Allergies:

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

Symptoms: Hospitalization with COVID-19 Reported per vaccine EUA

Other Meds:

Current Illness:

ID: 1658798
Sex: F
Age: 48
State:

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

Symptoms: During monitoring period post Pfizer COVID-19 vaccine, pt experienced *Hypertension, Slower Heart Rate, Nausea, Facial Flushing and Chills. o Patient declined medications. Water, blanket, distraction techniques and comfort measures initiated. Patient discharged to home with family. Left the clinic in stable condition.

Other Meds:

Current Illness:

ID: 1658799
Sex: F
Age: 61
State: MI

Vax Date: 08/21/2021
Onset Date: 08/25/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: twice had cbc ,crp ,cxr, blood cultures, chemistry panel, urine, legionella x1 , covid x3 all negative no sore throat , no nasal drainage

Allergies: none

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

Symptoms: I went off enbrel/methotrexate 8/18 knowing i wanted booster #3 on 8/21. I got vaccine 8/21, next day got a fever which i expected and was happy to get, Next 2 days I worked and was fine, on 8/25 i started running fevers of 101-102.2 consistantly with no other symptoms, went to Dr had labs, all labs were normal, on Saturday 8/28Ii went to ER with temp 101.9 heart rate 144 covid negative all labs including cxr neg, gave me IV ROCEPHIN & ZITHROMAX went home on doxycycline , Sunday woke up no longer fevering but short of breath, went to Dr on Monday 8/30 he put me on steroids tapered dose and I feel really good today. I am not saying this is the vaccine, I'm not sure what the window for adverse effects is. I wanted it badly as I am a nurse as well but for data's sake this is interesting, it did happen just 4 days after vaccine and all labs including xray were negative, also had neg blood cultures. not looking for compensation just to add to your data for #3 booster if it applies, still glad I got it, sad i had to take steroids but it was 9 days after vaccine so hopefully that wont hurt it any.

Other Meds: held methotrexate since 08/18/2021 in prep for vaccine, held enbrel, on synthroid and hormones menopause

Current Illness: on going RA controlled with methotrexate and enbrel

ID: 1658800
Sex: M
Age: 49
State: GA

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:

Allergies: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Blurry/ Double vision

Other Meds: Tylenol

Current Illness: None

ID: 1658801
Sex: F
Age: 70
State: AZ

Vax Date: 06/09/2021
Onset Date: 07/17/2021
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: hip xray

Allergies: none

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: sudden onset pain in left hip, quick progression from limping to needing a cane

Other Meds: multivitamin, b12,magnesium

Current Illness:

ID: 1658802
Sex: F
Age: 11
State: MI

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

Allergies: Amoxicillin and penicillin

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

Symptoms: None

Other Meds: None

Current Illness: none

ID: 1658803
Sex: M
Age: 67
State:

Vax Date: 02/12/2021
Onset Date: 08/12/2021
Rec V Date: 08/31/2021
Hospital: Y

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: Cycle threshold 8/9/21 = 12.6

Allergies:

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

Symptoms: Hospitalization with COVID-19 Reported per vaccine EUA

Other Meds:

Current Illness:

ID: 1658804
Sex: M
Age: 63
State:

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:

Allergies:

Symptom List: Unevaluable event

Symptoms: Pt arrived to COVID vaccine clinic Ambulatory with guiding cane (pt hx blindness). Pt received 2nd dose of pfizer and waited for 15 min post injection. While waiting for transportation pt states he felt sleepy as if he needed to lay down. Pt was escorted back to vaccine monitoring area and was assessed by RN. VS: 166/92, 174/101, 172/98, 171/94, 182/93. EMS was called to site. Pt wife was called for notification and to collect any recent changes in health. Pt status was drowsy and arousable, pt frequently would close his eyes not respond unless sternal rub was performed. Given his behavior and cardiac medical history pt was taken to ER once EMS arrived.

Other Meds:

Current Illness:

ID: 1658805
Sex: M
Age: 72
State: CA

Vax Date: 08/21/2021
Onset Date: 08/22/2021
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: Patient went to the ER

Allergies: Losartan, Meperidine, Tramadol, latex

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

Symptoms: Accelerated HTN, dizziness, "just felt sick"

Other Meds: Unknown

Current Illness: HTN, DM, Hypothyroidism, Glaucoma and other eye diseases

ID: 1658806
Sex: F
Age: 46
State: AL

Vax Date: 08/23/2021
Onset Date: 08/23/2021
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: Arithromicyn

Symptom List: Injection site pain, Pain

Symptoms: Headaches, diarheaa, soreness at injection site,

Other Meds: NONE

Current Illness: NONE

ID: 1658807
Sex: F
Age: 13
State: SC

Vax Date: 08/26/2021
Onset Date: 08/27/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: none

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Mother states at approximately 4:30pm on 8/27/21, patient had seizure lasting 45 seconds involving eye rolling, full body movements, and diaphoresis. Five minutes later, she appeared to have another seizure lasting 90 seconds involving eye rolling, upper body movements, and diaphoresis. Temperature not taken, mother states pt. did not feel warm. Following seizure, no further symptoms. Mother states this was first seizure like activity noted in patients medical history and patient suffers no residual effects. Mother denies seeking medical care at time of seizure and monitored patient at home. Mother states pt. medically stable for the last 72 hours. Report was made to Pediatric Office on 8/31/21 @ approximately 9:30AM.

Other Meds:

Current Illness: hidradenitis supperativa

ID: 1658808
Sex: M
Age: 78
State: FL

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

Lab Data: none

Allergies: Tramadol and ASA

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

Symptoms: Facial flushing, mild redness to chest and bilateral upper extremities . Completely resolved by next morning.

Other Meds: Therapeutic M one po q day, Vitamin C 500 mg po q day, Juven one packet po bid, Alogliptin 12.5 mg po q day, ?Metformin 500 mg po bid/ac, Lantus 25 units SC q day, Azopt 1% one gtt in right eye bid, Travatan Z one gtt in left ?eye qhs, Tim

Current Illness: DM Type 2 Ocular Hypertensio; Glaucoma Dementia Constipation PE A Fib HTN Pain

ID: 1658809
Sex: M
Age: 63
State: FL

Vax Date: 05/17/2021
Onset Date: 07/19/2021
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: LA

Lab Data: 7/19/21: CXR: pneumonia,

Allergies: NKA

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Pt in ER with SOB x 1 week, tested positive for Covid.

Other Meds:

Current Illness:

ID: 1658810
Sex: F
Age: 34
State: TX

Vax Date: 08/29/2021
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: UNK
Vax Route: IM
Vax Site: RA

Lab Data: N/A

Allergies: NKA

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Extreme body aches and chills starting on 8/30/21. Swollen injection site accompanied by rash/hives around injection site.

Other Meds: Multivitamin

Current Illness: N/A

ID: 1658811
Sex: M
Age: 43
State: WV

Vax Date: 08/01/2021
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: Na

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

Symptoms: Chest pains every day since first shot

Other Meds: Na

Current Illness: Na

ID: 1658812
Sex: M
Age: 67
State: MN

Vax Date: 03/10/2021
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: 1
Vax Route: IM
Vax Site: RA

Lab Data: Positive SARS-CoV-2 by PCR from specimen collected 8/30/21

Allergies:

Symptom List: Nausea

Symptoms: This case meets vaccine breakthrough criteria review. SxS include generalized weakness, diarrhea, cough, loss of taste and smell, chills, decreased urination, decreased appetite.

Other Meds:

Current Illness:

ID: 1658813
Sex: M
Age: 17
State:

Vax Date: 08/04/2021
Onset Date: 08/04/2021
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: During monitoring period post Pfizer vaccine #1 COVID-19 vaccine, pt experienced Nausea, Lightheadedness, Lip tingling, Hypertension, Wheezing, Dizziness, Tachypnea, Heat Sensation, Dry mouth. Water provided, ice applied, then medications administered as patients symptoms were not relived. Given PO benadryl & epi-pen. Patient reported feeling better. After extended time in Observation post vaccine, patient left the clinic in stable condition with mom and siblings.

Other Meds:

Current Illness:

ID: 1658814
Sex: M
Age: 37
State:

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: NONE

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

Symptoms: RECIEVED VACCINE AT 1000 A.M. STARTED FEELING HOT AND DIZZY, AT 1010 AM., LASTED ROUGHLY 5 MINUTES. GOT UP TO INFORM STAFF, STANDING MADE ADVERSE SYMPTOMS VANISH. STAFF MADE ME WAIIT 15 MORE MINUTES BEFOR LEAVING HOSPITAL. FEELING HOT AND DIZZY REOCCURED AT LEAST 5 TIMES THROUGH-OUT DAY, ONE TIME STANDING MADE WORSE. ALL EVENTS LASTED ROUGHLY 5 MINUTES. AROUND 9 PM FELT ICE COLD HEADACHE FRONTAL LOBE AND PAIN IN CHEST. WENT SLEEP AT 930 PM. WOKE UP 530 AM SAME HEADACHE BUT CHEST PAIN GONE. HEADACHE CONTINUED TILL AROUND 9 AM.

Other Meds: ZYRTECH 34 HOURS PRIOR ANTI-REFLUX 48 HOURS PRIOR

Current Illness: GERD POSSIBLY IBS

ID: 1658815
Sex: F
Age: 50
State: DE

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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Soar arm. Soar lower back. Tired and general blah feeling.

Other Meds: Lisinopril/HCTZ Flovent Allegra (generic) Calcium

Current Illness: Seasonal allergies

ID: 1658816
Sex: F
Age: 70
State:

Vax Date: 03/26/2021
Onset Date: 08/15/2021
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: Cycle threshold 8/14/21 = 29.7

Allergies:

Symptom List: Tremor

Symptoms: Hospitalization with COVID-19 Reported per vaccine EUA

Other Meds:

Current Illness:

ID: 1658817
Sex: M
Age: 53
State: CA

Vax Date: 05/19/2021
Onset Date: 07/28/2021
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: Erythema, Pruritus

Symptoms: Ramsey Hunt Syndrom 7/28/21 Tongue painful and tingling 8/1/21 Headache, fatigue 8/02/21 Headache, fatigue, nausea Video visit with Doctor P. 8/03/21 Covid test negative 8/04/21 ER visit for Bells Palsy, vertigo sent home with Valtrex and Prednesone 8/06/21 Taken by ambulance to ER for extreme vertigo, nausea, weakness, headache and admitted to Hospital 8/06/21-8/8/21 In-Patient at Hospital diagnosed Ramsey Hunt 8/31/21 Complete hearing loss continues as does the facial paralysis.

Other Meds: Flomax .4mg, NP Tyroid 90mg

Current Illness: None

ID: 1658818
Sex: F
Age: 50
State: CA

Vax Date: 08/28/2021
Onset Date: 08/29/2021
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: Shellfish, aspirin, artificial sweeteners

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

Symptoms: Hard sore & hot lump entire upper left arm, and very hard and sore armpit with enlarged lymph nodes. Only reporting as it has now been 3 days still painful. Also had flu like symptoms sore stiff back & neck with chills next day.

Other Meds: Hydrocodone, Ganapetin, Meloxicam

Current Illness: None

ID: 1658819
Sex: F
Age: 83
State: MI

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

Lab Data:

Allergies: Egg, Sulfa, Miconazole, Bacitracin, Neomycin, Polymyxin B

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

Symptoms: Cellulitis of left upper extremity (Primary) Comments: #2 Covid last week. Worsening left deltoid tenderness/redness/itching since. No fever. No SOB. Keflex now. Cool compress. Oral Zyrtec for itch. ROV 10 days Orders: - cephalexin (KEFLEX) 500 mg capsule; Take 1 capsule (500 mg total) by mouth 2 (two) times a day for 10 days. Dispense: 20 each; Refill: 0

Other Meds: Lipitor,Plavix,lasix, levothyroxine, lisinopril, lopressor, Omeprazole

Current Illness: None

ID: 1658820
Sex: M
Age: 79
State:

Vax Date: 02/20/2021
Onset Date: 08/15/2021
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: Cycle threshold 8/15/2021 = 25

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Hospitalization with COVID-19 Reported per vaccine EUA

Other Meds:

Current Illness:

ID: 1658821
Sex: M
Age: 70
State: NY

Vax Date: 01/10/2021
Onset Date: 01/28/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: check with cardiologist

Allergies: penicillin allergy

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

Symptoms: Ischemic Stroke left side of brain. Right side of body initially paralyzed and speech slurred. Received TPA within 1 hour in emergency room. Full recovery, no lasting deficits.

Other Meds: lipitor 20 mg

Current Illness: none

ID: 1658822
Sex: F
Age: 20
State: SC

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: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Patient received both doses of Moderna COVID-19 vaccine in May-2021. Was diagnosed with COVID-19 on 29-Aug-2021. Patient has had flu like symptoms (fever, body aches, cough, runny nose, chest tightness) since 25-Aug-2021. Got PCR test for COVID-19 on Saturday 28-Aug-2021 and received positive results on 31-Aug-2021.

Other Meds: None

Current Illness: None

ID: 1658823
Sex: F
Age: 48
State: FL

Vax Date: 08/16/2021
Onset Date: 08/20/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: n/a

Allergies: none

Symptom List: Pain in extremity

Symptoms: Symptoms: hives on left leg very swollen Time; 4 days after 2nd vaccination Treatment; pt has been taking Benadryl and using hydrocortisone cream Outcome: Hives healing but taking longer, has been there for about 11 days

Other Meds: -cyclobenzaprine -oxycodone/apap 7.5-325

Current Illness: n/a

ID: 1658824
Sex: M
Age: 13
State: NY

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:
Dose Series: 2
Vax Route:
Vax Site:

Lab Data: none

Allergies: penicillin

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

Symptoms: Arm - Red, Swollen, soreness, hot and Below injection site red rash Afternoon - my son said it was like his insides were shaking...( jittery feeling) Evening - Legs rocking back and forth and head moving all over the place Next day - rocking and jitters stopped - still red hot pain swollen and inflamed injection site Felt better and mostly back to normal with no pain 4 days later

Other Meds: none

Current Illness: none

ID: 1658825
Sex: M
Age: 21
State: MI

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: N/A

Allergies: tacrolimus (intolerable adverse effects)

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

Symptoms: Patient mistakenly received 0.3 ml of the Pfizer vaccine prior to reconstitution with normal saline. The patient has not experienced any adverse effects as of 15 minutes after the vaccine.

Other Meds: Augmentin Cellcept Cyclosporine Prednisone

Current Illness: None (Augmentin for possible perforated tympanic membrane)

ID: 1658826
Sex: M
Age: 44
State: FL

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: 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: I received 2nd dose of Moderna COVID-19 vaccination on 8/13/21. A few hours after I felt fatigued. The fatigue did not go away in "1 to 3 days" as widely reported. 17 days aftert the second dose I am still experiencing chronic fatigue and brain fog that has kept be homebound . I have not been able to work or have had to decline participating in job interviews. Before the injection I was very fit and active: lifting weights, jogging and cycling. Now I feel fatigued after light walking or basic household chores. The vaccine caused a powerful immune system "flare" and debilitating neuroinflammation. I have been following the advice fo online doctors and taking antihistimates, Vitamin C, Quercetin and NAC to help.

Other Meds: Fish oil, Melatonin

Current Illness: none

ID: 1658827
Sex: F
Age: 66
State: MI

Vax Date: 01/30/2021
Onset Date: 02/03/2021
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: Colonoscopy normal Spring 2021, Upper scope of intestines normal Spring 2021

Allergies: Sulfa Drugs

Symptom List: Vomiting

Symptoms: February 3rd, I started getting diarrhea and had to take two Imodium, I had blood in my stool and was vomiting up bile as well. I went to the hospital on Friday the 5th of February. They said it was probably a colon infection, they did not know. But it was the first time ever I thought I was going to die. I had straight blood coming out of my rectum and I was sitting on the toilet with the room spinning. They gave me two strong medications; I cannot remember what and after about a week after the medications I was feeling better. I am still achy and tired in my body though. I get wore out faster than I usually would. I have not had any bloody diarrhea since then though. I do not feel myself, don't want to go for walks like I used to or anything like that. Physically I am not as strong since getting the vaccine.

Other Meds: Omeprazole; Flonase; Diazepam; Fish Oil; Vitamin D; Magnesium; Mucinex

Current Illness: N/A

Date Died: 08/30/2021

ID: 1658828
Sex: F
Age: 62
State:

Vax Date: 04/30/2021
Onset Date: 08/13/2021
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: Cycle threshold 8/14/21 = 24.4

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Hospitalization with COVID-19 Reported per vaccine EUA

Other Meds: trelegy ellipta, flonase

Current Illness:

ID: 1658829
Sex: F
Age: 43
State: IN

Vax Date: 04/19/2021
Onset Date: 07/20/2021
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: none

Allergies: none

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

Symptoms: I felt a localized area of pain in my left underarm, about the size of a quarter. It was there upon waking in the morning on Tuesday and Wednesday, July 20 and 21. It went away a few minutes after getting up for the day, each day. I called my doctor and did a telehealth appointment with her, describing the symptoms. She told me axillary nerve pain was a potential adverse effect of my Moderna covid vaccine. No treatment was given, since the pain did not continue past Wednesday, July 21.

Other Meds: Vitamin D supplement daily.

Current Illness: none

ID: 1658830
Sex: U
Age:
State: CT

Vax Date:
Onset Date:
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: Hospital 8/25 they 8/28/2021

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Already disclosed

Other Meds:

Current Illness:

ID: 1658831
Sex: F
Age: 90
State: MT

Vax Date: 04/12/2021
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: covid infection despite immunization

Other Meds:

Current Illness:

ID: 1658832
Sex: F
Age: 30
State: MS

Vax Date: 08/24/2021
Onset Date: 08/25/2021
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: PCN

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

Symptoms: Chills, fever, multiple near syncope episodes, headache, nausea, vomiting, diarrhea, dizziness, weakness.

Other Meds: Ambien, Zoloft, & Birth Control

Current Illness: None

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am