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: 1659138
Sex: F
Age: 43
State: FL

Vax Date: 07/28/2021
Onset Date: 07/30/2021
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: None

Allergies: None

Symptom List: Dysphagia, Epiglottitis

Symptoms: Severe headache, not sleeping well and pain in lower extremities and never had these symptoms before

Other Meds: None

Current Illness: None

ID: 1659139
Sex: F
Age: 70
State:

Vax Date: 02/10/2021
Onset Date: 08/13/2021
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: Cycle threshold 8/9/21 = 25.4

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Hospitalization with COVID-19 Reported per vaccine EUA

Other Meds:

Current Illness:

ID: 1659140
Sex: M
Age: 77
State: FL

Vax Date: 03/17/2021
Onset Date: 08/29/2021
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:

Allergies: NKA

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

Symptoms: Vaccinated patient hospitalized with COVID-19.

Other Meds:

Current Illness:

ID: 1659141
Sex: F
Age: 42
State: CA

Vax Date: 08/26/2021
Onset Date: 08/31/2021
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: 8/29 ER visit labs, chest Xray, IV fluids, currently on Holter monitor

Allergies: n/a

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Metallic taste in mouth and palpitations/tachycardia

Other Meds: n/a

Current Illness: n/a

ID: 1659142
Sex: F
Age: 46
State: KS

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: N/A

Allergies: None

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

Symptoms: Client was given a Pediatric dose of Hep B instead of an Adult dose of Hep B on this day. Client is just starting a Hep B series, & this was her first dose in that series. RN contacted Health Department for guidance & Client was given a 2nd injection of Pediatric Hep B on the same day, to equate a total of 1 ml, or the equivalent of an adult dose of Hep B. No serious harm to patient except for she had to endure one extra needle stick for the 2nd injection. Otherwise, no adverse effects were noted. Client plans to continue with her Hep B series as scheduled.

Other Meds: None

Current Illness: None

ID: 1659143
Sex: M
Age: 75
State: FL

Vax Date: 02/04/2021
Onset Date: 08/26/2021
Rec V Date: 08/31/2021
Hospital: Y

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

Lab Data: (coutpatient walk in SARS CoV AG postiive on 8/16/21)

Allergies: NKA

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

Symptoms: He completed Covid Pfizer vaccines on 2/4/21. He noted cough, body aches, and nasal congestion, and he was tested covid antigen-positive at walkin clinic on 8/16/21. Despite receiving monoclonal antibody as an outpatient on 8/20/21, his symptoms of SOB and weakness were worse, so he came to Hospital on 8/26/21 and was admitted. He is now requiring 6L of oxygen and is currently on the 6th day of hospitalization.

Other Meds:

Current Illness:

ID: 1659144
Sex: F
Age: 31
State: MI

Vax Date: 08/26/2021
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: none

Allergies: NKDA

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Pt requested a Covid vaccination. After receiving the vaccine and as I was putting the vaccine into system, it was discovered that the pt was not truthful with the nurse and had received the same vaccine 06/16/2021. Notified of same when discovered. Pt has had no ill effects as of this report.

Other Meds: doxycycline 100mg BID Buspar 10mg BID Zyprexa 10mg q day

Current Illness: psych

ID: 1659145
Sex: M
Age: 14
State: AZ

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: EGGS

Symptom List: Pharyngeal swelling

Symptoms: GAVE SHOT AT 12:25 CALLED 911 12:37 THICK TONGUE HARD TO BREATH AND SWALLOW

Other Meds: UNKNOWN

Current Illness: ASTHMA HAS EPI PEN

ID: 1659146
Sex: M
Age: 47
State: WA

Vax Date: 04/07/2021
Onset Date: 08/03/2021
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-19 test

Allergies: None known

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Client reported a breakthrough case of COVID-19 diagnosed by a medical provider after receiving 2 doses of Moderna on 03/07/21 and 04/07/21 from this ARNP.

Other Meds: Belsomra PRN, paroxetine

Current Illness: None known

ID: 1659147
Sex: F
Age: 44
State: TX

Vax Date: 08/18/2021
Onset Date: 08/18/2021
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: N/A

Allergies: None reported or disclosed.

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient received flu vaccine on 8/18/21 at around 10 AM. Patient did not contact the pharmacy or pharmacist until 8/30. Patient states that she had tremendous pain after receiving the vaccine and was concerned about the shot being too high on the arm causing this pain. Patient was counseled to perform light stretching on the arm by circular rotations to help the pain subside. Patient states that for greater than 1 week, she has been experiencing pain and not being able to move her arm fully. She states that she has tried hot/cold cream, ice on her arm, and taking ibuprofen to manage the throbbing pain at night. Patient states she would go see her PCP because she feels as if the pain will not go away.

Other Meds: None reported or disclosed.

Current Illness: None reported or disclosed.

Date Died: 08/01/2021

ID: 1659148
Sex: M
Age: 63
State: WA

Vax Date: 02/28/2021
Onset Date: 08/01/2021
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: Patient tested positive for COVID-19 on 07/27/2021

Allergies: Unknown

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

Symptoms: Patient died of COVID-19 illness on 08/01/2021

Other Meds: Unknown

Current Illness: Unknown

ID: 1659149
Sex: M
Age: 46
State: PA

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data: Blood tests ran showing everything looked ok Covid test given to make sure I didn't have the virus at that moment Elevated blood pressure and pulse were monitored.

Allergies: Strawberries

Symptom List: Rash, Urticaria

Symptoms: Hospital listed it as "Adverse reaction to Covid-19 vaccine" Symptoms were: Fever of 104 Uncontrolled chills that shook the ambulance. Heart racing for at least and hour or more. Trouble breathing. Dizziness and almost passed out when I tried to walk to the bathroom High Blood Pressure

Other Meds: none that day. Usually take a 1 a day vitamin

Current Illness: none

ID: 1659150
Sex: M
Age: 23
State: TX

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: None at this time.

Allergies: None.

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

Symptoms: After 1 min of receiving the vaccine I began to feel faint and passed out at the pharmacy. My arm began to feel itchy and I started to have an intense headache. 911 had to be called.

Other Meds: None.

Current Illness: Cold

ID: 1659151
Sex: F
Age: 49
State: TX

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: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: Doctors appointment scheduled for Sept 10th to follow-up.

Allergies: Sulfa

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

Symptoms: Received Pfizer 2nd dose in left arm on Aug 26, 2021. on Aug 28th began to feel pain in center of left armpit down to just above left breast. Felt like a lump. Then lymph node swelling, with surrounding tissue feeling like it was filled with water- sore to the touch. Swelling and pain went down 48 hours after.

Other Meds: Vitamins: D3, Bariatric Advantage Ultra Multivitamin w/Iron, Calcium Citrate

Current Illness: No illnesses but had Gastric sleeve surgery on July 21, 2021

ID: 1659152
Sex: F
Age: 39
State: FL

Vax Date: 08/11/2021
Onset Date: 08/12/2021
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: None

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

Symptoms: Wednesday afternoon, 3:15pm I received the shot in my left arm. Wednesday I felt achy tight muscles in my neck on my traps, down the right side of my back, and into my right calf. I am an athlete and have regular issues with this path of muscles. Thursday morning and most of the day, my left deltoid was so sore I couldn't lift my left arm. In the evening, I was working on the computer and my left elbow was rubbing on the desk and getting sore, so eventually I looked down to notice on the inside of my left arm above the elbow I had blisters forming. I touched them and they felt tingly and itchy like when I get a cold sore on my lips. It was a dried skin patch with blisters. Friday by midday 6 blisters had formed. 3 in a curved line, 2 small ones inside the curve and one above it. Friday night at 10pm, the 3 were full blisters with brown colored liquid in them. Not clear like my cold sores get. Monday, August 16th, the blisters burst or were scraped off at some point during activity and turned into red scabs. For the next several days, they were healing. Tuesday night, August 24th I noticed them again being extremely itchy. I wanted to scratch them, but when i touched them, they hurt like I was touching an open wound. From August 24th, until today, August 31st, there hasn't been much change, they are still very itchy. I have put Abreva on them. My mother who was a pediatric ICU nurse for 30 years said they look like shingles. I have not been to a doctor to have them looked at.

Other Meds: Caffeine from drinking coffee

Current Illness: Jet lag

ID: 1659153
Sex: F
Age:
State: FL

Vax Date:
Onset Date: 08/25/2021
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: NKA

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

Symptoms: Vaccinated patient hospitalized with COVID-19.

Other Meds:

Current Illness:

ID: 1659154
Sex: M
Age: 70
State:

Vax Date: 04/08/2021
Onset Date: 08/05/2021
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: Cycle threshold 8/1/21 = 18.3

Allergies:

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

Symptoms: Hospitalization with COVID-19 Reported per vaccine EUA

Other Meds:

Current Illness:

ID: 1659155
Sex: F
Age: 82
State: GA

Vax Date: 04/09/2021
Onset Date: 07/18/2021
Rec V Date: 08/31/2021
Hospital: Y

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

Lab Data: During her visit on 18 July hospital admission she received negative Covid test result. The CT scan of the head and MRI of the brain shows no abnormality responsible for the seizures. EEG was consistent with abnormal epileptiform discharges. D-dimer test was normal. There is no history of coronary artery disease during the examination she was alert and oriented her cognitive abilities were normalDuring the hospital stay patient has no previous history of febrile seizures, stroke other neurological issues or psychosomatic issues. The onset of the seizures started approximately 4 weeks after the second dose of motor no Covid 19 shot.

Allergies: Penicillin

Symptom List: Ear pain, Hypoaesthesia

Symptoms: On July18 2021 patient we are asked to the medical Hospital after experiencing at nocturnal seizure. Around 6:30 AM the boyfriend and the daughter found that the patient was having a seizure and unable to wake her up. She came out of the seizure And remained unconscious but breathing heavily. There was also blood on her pillowcase that she had bitten her tongue. 911 was called and the EMTs also were notable to wake her up. She finally woke up in the ambulance and was able to respond but was unable to remember. She has amnesia regarding the event. The patient was in altered sensorium for about an hour after the seizure took place postictally she was taken to the emergency room and admitted to the Hospital for about 2 days. Patient to record at least 3 additional incidents between May 18 to July 18 where she would wake up with the blood on the pillow and swollen tongue where she had an apparent seizure in her sleep while she was alone. The patient was diagnosed to have a nocturnal epilepsy or nocturnal seizures and was started on Keppra

Other Meds: Herbal,Losartan,Metoprolol,Zinc,Green tea Quercetin

Current Illness: none

ID: 1659156
Sex: F
Age: 65
State: IL

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: The patient reported to the pharmacy for their second dose of the Pfizer vaccine. The patient was accidentally given a dose of the Janssen COVID vaccine in place of their second Pfizer vaccine. The patient was monitored for 30 minutes after the event and reported feeling no side effects and reported the same as they did after receiving their initial Pfizer dose. The patient did not receive any additional treatment or care after being monitored.

Other Meds:

Current Illness:

ID: 1659157
Sex: M
Age: 54
State: OK

Vax Date: 08/24/2021
Onset Date: 08/24/2021
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: Screening sheet showed no known allergies

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

Symptoms: At a work place COVID vaccine clinic the patient requested a Janssen vaccine. It was confirmed that he had not had a COVID vaccine from completed patient form and verbally. Upon adding his information into the state immunization data base it was found that the patient had received a Moderna vaccine from another establishment in June. When identified, patient was asked about this and he stated he though it was a flu shot. An interpretor was brought in and the patient confirmed this again in his native language. Location where the Moderna vaccine was given was called and this vaccination was confirmed. Patient was held for a longer observation after vaccination and nursing on site at work location was notified. No adverse signs/symptoms seen or noted. State immunization board labeled Moderna shot as invalid.

Other Meds:

Current Illness:

ID: 1659158
Sex: F
Age: 29
State:

Vax Date: 01/26/2021
Onset Date: 08/30/2021
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:

Allergies:

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

Symptoms: Tested COVID POSITIVE 8/30/21

Other Meds:

Current Illness:

ID: 1659159
Sex: F
Age: 35
State: TX

Vax Date: 02/26/2021
Onset Date: 03/20/2021
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: Thyroid tests TSH: 0.01 on 5/25/2021 TSH: 6.00 on 7/2/2021

Allergies: Hyrocodone

Symptom List: Unevaluable event

Symptoms: Lower neck pain

Other Meds: Prenatal vitamins Probiotics

Current Illness: NA

ID: 1659160
Sex: F
Age: 43
State: ME

Vax Date: 02/20/2021
Onset Date: 02/22/2021
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: CBC-normal, MRI-normal, EEG-normal

Allergies: No

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

Symptoms: 2/22 Around 6am I woke up super cold, had chills and couldn't stop shaking. My BP was spiking, and my HR was going from high and lowering frequently between the high 100's to low 40's and felt as if my heart was skipping beats, pounding at other times and my chest just felt really tight. My body temp was running like 96. I was very sensitive to lights and sounds feeling like my brain was in a fog. I had an internal feeling of doom, feeling like I was so scared as if I was going to die, but I had nothing sad going on in my life, this feeling lingered a few days until around 2/28. All of these feelings went on for days but lessened in intensity. I felt so sick. At times I would break out in sweats but would be freezing cold. On Monday and Tues, I tried to go to work but had to leave sick. On Wed 2/24 I got so sick at work I was transported to the ER. My BP was really high when I arrived, CBC was done but was normal and nothing could be found. I was monitored for about 5hrs and was released with no clue as to what was going on, but they did validate I was not having a Heart attack. That night I was so cold nothing could relieve the cold. I clothed heavily, used a heating pad and drank warm fluids, but was still super cold. Still having the light and sound sensitivity and when I was around light I felt as if my BP was spiking giving me that internal feeling of doom again. On 7/15 an MRI was done that ruled out a stroke. On 7/17 I was transported by ambulance to Medical Center because my HR fell so low, I thought I was having a heart attack, the chest pain and pressure returned and the light and sound sensitivity and the feeling of doomed returned also. To date I now suffer from light and sound sensitivity causing me to have to go in a dark room at times until it passes. I'm limited with the places I can go because of the light and sound sensitivity gets so bad at times. My BP and HR is still going up and down for no apparent reason, the feeling of doom is up and down. My brain feels on overload, and I get overwhelmed and overstimulated at times. I go into shaking spells and my BP and HR spike during this time also. 7/30 and EEG was done to rule out seizures. Various other testing is being ordered for further.

Other Meds: Lysine; Copaxone injections; Clonazepam; Carvedilol

Current Illness: No

ID: 1659161
Sex: F
Age: 47
State: AL

Vax Date: 08/09/2021
Onset Date: 08/10/2021
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: codeine, morphine

Symptom List: Injection site pain, Pain

Symptoms: I have been extremely nauseous ever since I have been vaccinated.

Other Meds: Coreg, aspirin, vitamins D, C

Current Illness: none

ID: 1659162
Sex: F
Age: 74
State: MN

Vax Date: 02/27/2021
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: SYR
Vax Site: LA

Lab Data: POSITIVE SARS-COV-2 TEST REPORTED 8/19/21

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: SOB, CONGESTION, COUGH, FATIGUE

Other Meds:

Current Illness:

ID: 1659163
Sex: F
Age: 22
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: 025J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: none

Allergies: penicillin

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

Symptoms: got itchy and hives all over, went to ER got benadryl, medrol, and vistaril. told not to get second dose of vaccine and will be on steroid pills and vistaril pills going forward as treatment.

Other Meds: none

Current Illness: none

ID: 1659164
Sex: F
Age: 77
State:

Vax Date: 02/06/2021
Onset Date: 08/06/2021
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: Cycle threshold 8/7/21 = 19.3

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Hospitalization with COVID-19 Reported per vaccine EUA

Other Meds: prednisone

Current Illness:

ID: 1659165
Sex: F
Age: 73
State: MI

Vax Date: 08/25/2021
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: UNK
Vax Route: IM
Vax Site: RA

Lab Data: none

Allergies: pcn, sulfa drugs, adhesives including coban

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: rash on arms, stomach, waist, upper thigh, intense itching. Treated with hydrocortisone, ketoconazole, Benadryl, Allegra. Rash spread

Other Meds: biotin, preservision, vitamin C,

Current Illness:

ID: 1659166
Sex: F
Age: 81
State: FL

Vax Date: 01/05/2021
Onset Date: 07/21/2021
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: 7/21/21: Covid test positive. CXR.

Allergies: Codeine, Enalapril, gabapentin, iodine, neurontin, sulfa drugs, tape.

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

Symptoms: Pt came to ER with difficulty breathing onset just prior to arrival to ER.

Other Meds:

Current Illness:

ID: 1659167
Sex: F
Age: 15
State: UT

Vax Date: 08/24/2021
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: N?A

Allergies: Amoxicillin and Penicillin

Symptom List: Nausea

Symptoms: On 8/24/2021 my daughter- Lili, received her first dose of Pfizer vaccine (EW0168) at the Hospital (Pediatrics). Two days later (8/26), she started experiencing runny nose, scratchy throat, headache, muscle pain and fever (39.0?C). It lasted until Sunday (8/29). On Sunday we?ve discovered that her skin on hand palms is peeling off. (small patches) As of today, most of her symptoms are gone, with the exception of runny nose. My biggest concern is peeled skin - is that normal?

Other Meds: N/A

Current Illness: None

ID: 1659168
Sex: F
Age: 27
State: TX

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

Lab Data:

Allergies: spider bites

Symptom List: Injection site pain

Symptoms: PT complained at 10 minutes post vaccination of itchiness on the arm that later extended to the right arm and legs. No hives observed during assessment. No difficulty breathing, PT is talking normally and is alert. O2 sat 100 and HR 74 PT stated she has seasonal allergies and is allergic to spider bites and stated she took a decongestant in the a.m. No other history of chronic disease reported. RN provided a tablet of Diphenhydramine (Benadryl) 25 mg at 0900 hrs. and educated about the possible side effects of the medication. PT stayed until 0940 hrs. when symptoms started to cease. PT was educated to seek medical help if symptoms return or get worse or if difficulty breathing occurs.

Other Meds: Decongestant

Current Illness: N/K

ID: 1659169
Sex: M
Age: 54
State: MO

Vax Date: 04/10/2021
Onset Date: 05/05/2021
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:

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

Symptoms: Bell's Palsy. Visible May 5, 2021, resolved in 2 weeks without treatment..

Other Meds: Carvedilol, Ramipril, atorvastatin

Current Illness: None

ID: 1659170
Sex: F
Age: 33
State: WI

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: Covid19 test (8/6/21), chest xray (8/30/21)

Allergies: None

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

Symptoms: At the beginning of August I developed a cough, headache, and a bit of nasal congestion. I was on vacation, and when I returned home I received a covid19 test, on Aug 6th, which was negative. I went into urgent care of Aug 7th due to difficulty breathing with sickness and my asthma. The nurse practioner diagnosed me with bronchitis. I was put on Prednisone for 4 days and issued an inhaler (my inhaler was expired and hadn't been used for years).I again went in on Aug 13th, and the bronchitis continued. They put me on a decreasing dose of prednisone, an antibiotic, and some coughing medication. I last went in on Aug 30th, where I had a chest xray due to having some blood in my coughed up mucus for a short time after waking up on 8/30/21. Chest xray came back good, and that the bronchitis continues, but no longer hindering everyday activities. I DO NOT BELIEVE THIS IS DUE TO MY VACCINE. We have had unusual drought and fires where I reside that have impacted our air quality not like I've ever seen. For about a month before this, we have had off an on issues with air quality. My asthma, and a cold from my 3 year old son, I believe triggered this issue. He had a cough, that was gone after about a week.

Other Meds: Prenatal vitamin

Current Illness: None

ID: 1659171
Sex: F
Age: 81
State:

Vax Date: 04/09/2021
Onset Date: 08/09/2021
Rec V Date: 08/31/2021
Hospital: Y

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

Lab Data: Cycle threshold 8/3/21 = 21.1

Allergies:

Symptom List: Tremor

Symptoms: Hospitalization with COVID-19 Reported per vaccine EUA

Other Meds: prednisone

Current Illness:

ID: 1659172
Sex: F
Age: 92
State: NJ

Vax Date: 05/21/2021
Onset Date: 08/29/2021
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: positive SARS-CoV-2 Ag and PCR

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Severe COVID-19 pneumonia requiring bipap and ICU admission

Other Meds:

Current Illness:

ID: 1659173
Sex: M
Age: 59
State: TX

Vax Date: 08/06/2021
Onset Date: 08/07/2021
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: Ultrasound 08/09/2021

Allergies: N/A

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

Symptoms: Pt. states that after receiving the 1st dose of Pfizer 08/06/2021, started experiencing symptoms 08/07/2021 of severe left leg pain, difficulty walking (lasting a week), and moving through both legs. Urgent Care visit 08/09/2021, muscle spasms Ultrasound (no blood clots found). 7 days symptoms have subsided.

Other Meds: N/A

Current Illness: N/A

ID: 1659174
Sex: M
Age: 70
State: TN

Vax Date: 02/26/2021
Onset Date: 02/26/2021
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: Sent to oncology

Allergies: none

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

Symptoms: lump at injection site, lump in chest wall

Other Meds:

Current Illness: no

ID: 1659175
Sex: M
Age: 87
State: FL

Vax Date: 01/17/2021
Onset Date: 07/21/2021
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: 7/21/21: Covid test: positive, CXR.

Allergies: NKA

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Pt came to ER with difficulty breathing and respiratory problems. Onset was just prior to arrival.

Other Meds:

Current Illness:

ID: 1659176
Sex: F
Age: 63
State: MO

Vax Date: 01/22/2021
Onset Date:
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: 08/02/21 CBC, CMP, ANA, Hepatitis C, Thyroid panel

Allergies: Morphine, Sulfa, Keflex

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

Symptoms: 01/23/21-large bump at injection site left arm, ,extremely warm and painful to touch. The next day the redness and warmth was from my shoulder to my elbow and I was itchy in that area. about 1 month later I broke out in a red raised rash on my upper body that was itchy and felt like I had a sever sunburn.This continued to last for months. I took Medrol dose packs and IM injections of cortisone with no relief. I continued with this rash for months. I then started developing sores in my mouth and nose, enlarged lymph nodes in my neck. and saw an ENT doctor. first week in July 2021 started having hair loss and rash continued. Nail beds are becoming discolored and rash is reoccurring. I have an appointment to see a Rheumatologist this week to see what might be causing all these issues.

Other Meds: Metformin, Jardiance, Lisinopril/hctz, Pantoprazole, Cymbalta, Fluoxetine, Acetaminaphen, High cholesterol med

Current Illness: None

ID: 1659177
Sex: F
Age: 56
State: VA

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

Allergies: Penicillin, ibuprofen, aspirin

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

Symptoms: Immediate pain at vaccination site, which spread down the arm over the next several hours. Eight hrs post-injection, fever of 101F, chills, severe myalgia

Other Meds: None

Current Illness: None

ID: 1659178
Sex: M
Age: 39
State: MN

Vax Date: 01/27/2021
Onset Date: 08/29/2021
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: POSITIVE SARS-COV-2 BY PCR FROM SPECIMEN COLLECTED 8/29/21

Allergies:

Symptom List: Pain in extremity

Symptoms: INCREASED SOB

Other Meds:

Current Illness:

ID: 1659179
Sex: M
Age: 75
State: CA

Vax Date: 06/26/2021
Onset Date: 07/26/2021
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: No known allergies

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

Symptoms: None stated.

Other Meds: A month into the vaccination, my father (this form is being submitted by his daughter) started experiencing vertigo, heart palpitations and hard of breath. Dizziness has been ongoing on a daily basis. Currently also taking medication for h

Current Illness:

ID: 1659180
Sex: F
Age: 80
State: CA

Vax Date: 03/04/2021
Onset Date: 03/01/2021
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: Hospital

Allergies: None

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

Symptoms: Sore arm, rash on that arm later, muscle weakness

Other Meds:

Current Illness: None

ID: 1659181
Sex: F
Age: 72
State:

Vax Date: 03/08/2021
Onset Date: 08/09/2021
Rec V Date: 08/31/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Hospitalization with COVID-19 reported per vaccine EUA

Other Meds:

Current Illness:

ID: 1659182
Sex: M
Age: 38
State: OH

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: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: None

Allergies: None

Symptom List: Vomiting

Symptoms: High feaver, swelling is the left arm sore and hot lymph nodes and throat swelled shut rash and feaver chicken pox scares became red and inflamed lasting over 72 hours

Other Meds: None

Current Illness: None

ID: 1659183
Sex: M
Age: 48
State: PA

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

Lab Data:

Allergies: LISINOPRIL

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: INITIAL DATE/TIME OF VIAL ENTRY WAS 8/30/21 14:30. DOSE WAS ADMINISTERED ON 8/31/21 07:44, APPROXIMATELY 17.25 HOURS AFTER FIRST ENTRY INTO VIAL AND 5.25 HOURS PAST THE MANUFACTURER'S RECOMMENDED BEYOND USE DATE/TIME. THIS WAS HIS SECOND DOSE IN THE SERIES (FIRST DOSE REPORTED AS GIVEN 6/2/21 BY A DIFFERENT PROVIDER). PATIENT HAS NOT REPORTED ANY OTHER ADVERSE EFFECTS SINCE RECEIVING THE DOSE. MANUFACTURER WAS CONTACTED FOR RECOMMENDATION TO REPEAT/COUNT THE DOSE, REPLY PENDING.

Other Meds: AMLODIPINE 10MG DAILY FLONASE 100MCG EACH NOSTRIL DAILY LOSARTAN 25MG DAILY TRAZODONE 50MG HS

Current Illness:

ID: 1659184
Sex: F
Age: 52
State: MI

Vax Date: 06/23/2021
Onset Date: 07/26/2021
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: RA

Lab Data:

Allergies: Penicillin, sulfa

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

Symptoms: Shingles breakout, blisters on lips

Other Meds: None

Current Illness: None

ID: 1659185
Sex: F
Age: 60
State: MD

Vax Date: 06/23/2021
Onset Date: 06/26/2021
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: blood work - EKG - EVERYTHING NORMAL

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: chills, headache, tired, loss appetite for a weeks, tingling throughout entire left arm,

Other Meds: blood pressure meds cholesterol meds

Current Illness:

ID: 1659186
Sex: F
Age: 64
State: NC

Vax Date: 03/05/2021
Onset Date: 03/05/2021
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: dilaudid, demerol, milk

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

Symptoms: Within 5 min my pulse was racing 120 plus and I did not feel right. I turned very red, my BP went way up like 225/120. EMT hooked me up to a monitor and kept me there for approx 30 min. My BP and pulse started to come down and they let me go home. Very tired rest of day and lightheaded. Slept for 12 hours that night. Next day felt better.

Other Meds: Amlodipine 5mg, Losartan 100mg, Metoprolol SUCC ER 50mg, Multivitamin Women 50+, Red Yeast Rice 1200mg, D3 25mcg, Vitamin C 1000mg.

Current Illness: none

ID: 1659187
Sex: F
Age: 52
State: NY

Vax Date: 04/06/2020
Onset Date: 04/06/2021
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: I have seen a dermatologist, endocrinologist, and primary.

Allergies: EES, Tetracyclin, Cipro, Ceftin

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

Symptoms: Severe Hives on day of injection that spread from the vaccinated arm and over to the other arm. Rash located on the trunk up to the collar bone onto the buttocks. They turned into sores/ulcers that were EXTREMELY itchy. When the sores fell of they left deep holes that have become infected. I also had heart issues, my pulse was at 165.

Other Meds: Taltz, Tylenol, Mobiq, methylprednisolone, metoprolol, cymbalta

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am