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: 1662979
Sex: F
Age: 46
State: KY

Vax Date: 06/10/2021
Onset Date: 08/27/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: fully vaccinated using Janssen on 6/10/21; s/o 8/27/21, tested + 8/28/21

Other Meds:

Current Illness:

Date Died: 08/08/2021

ID: 1662980
Sex: M
Age: 75
State: TN

Vax Date: 12/22/2020
Onset Date: 08/03/2021
Rec V Date: 09/01/2021
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: coughing, wheezing, O2 sat of 80%

Other Meds:

Current Illness:

ID: 1662981
Sex: F
Age: 37
State: FL

Vax Date: 07/29/2021
Onset Date: 07/30/2021
Rec V Date: 09/01/2021
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: Hearing tests, MRI

Allergies: None

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

Symptoms: Dizziness, nausea, sudden deafness in right ear. Prolonged vertigo symptoms from 7/30/21 to present (9/1/21). Diagnosed with labyrthitis by ENT. Daily lightheadedness/dizziness with no relief.

Other Meds: Birth Control

Current Illness: Seasonal Allergies

ID: 1662983
Sex: M
Age: 19
State: NJ

Vax Date: 08/20/2021
Onset Date: 08/21/2021
Rec V Date: 09/01/2021
Hospital: Y

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

Lab Data: ecg done 8/23 showing signs c/w pericarditis troponin done same day and next day rising to 2 telemetry showing 8 beat NSVT on 8/24 cardiac MRI done 8/26 showing findings c/w myocarditis with LGE in the inferior and inferolateral wall

Allergies: none

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: chest pains/sob started within 72 hours resulting in visit to ER and where pt was admitted

Other Meds: none

Current Illness: none

ID: 1662984
Sex: M
Age: 65
State: KY

Vax Date: 04/07/2021
Onset Date: 08/05/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data: positive for COVID on 8/5/21 & 8/14/21 (tested negative COVID 8/13/21)

Allergies: penicillin (rash)

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

Symptoms: Patient received COVID vaccine 4/7/21, tested positive for COVID on 8/5/21 & 8/14/21 (tested negative COVID 8/13/21) 8/5/21: HPI A 65 y.o. male diabetes and hypertension with penicillin allergy presenting as a trauma alert. Patient was on a moped swerved to avoid a car and then fell off the moped onto his right side. Does not have any loss of consciousness was not wearing helmet. Complaining of significant pain in his right ankle with obvious deformity exposed also complaining of right upper extremity pain denies any pain anywhere else. Tourniquet placed above right ankle at 655pm. 8/16/21: Hospitalization Admit Date/Time: 8/5/2021 7:11 PM Discharge Date: 08/16/21 Referring provider name and address: No referring provider defined for this encounter. Chief Concern, Brief History of Present Illness, and Hospital Course 65 yr old male admitted due to moped accident on 8/5. Upon hospitalization the following concerns were noted: Open trimalleolar fracture, scaphoid fracture, pulmonary nodules and COVID 19 positive. Right trimalleolar fracture was fixed on 8/6 by ortho in OR. Scaphoid fracture was considered non-op. Pulmonary nodules were incidental findings and it is recommended to have follow up with PCP. He was asymptomatic with COVID the whole hospital stay and completed the 10-14 day of isolation required per health department. PT recommended HWA. Patient is tolerating room air and diet. Alert and oriented. Having normal BM's and voiding on own. Pain well controlled with oral pain medications. Patient is medically ready to be discharged home with his daughter who is aware that he was COVID positive. Follow up with PCP in 1 week for post-hospitalization visit and for pulmonary nodules Follow up with Ortho on 8/27 Surgeries and Procedures Procedures performed in this encounter Procedures ? Case Request Operating Room: EXTERNAL FIXATION, LOWER EXTREMITY #1 in OR1A (trauma room): I&D, Ex-fix R open Trimal Supine, berchtold w/ extension, C-arm, , ortho soft tissue, Cysto tubing, Synthes large ex-fix w/ extra long bars, splint cart Pulmonary nodules Overview Addendum 8/12/2021 8:27 Incidental finding on CT Findings may be infectious or inflammatory Informed 8/7 Recommend short-term follow-up CT in 3 months to confirm resolution and/or stability COVID-19 Overview Addendum 8/15/2021 7:09 AM Isolation protocol Tolerating room air Mobility and IS Discontinued tele but continued pulse oximetry Monitor respiratory status Must stay in isolation for 20 days since 1st positive test (8/25) per policy. Per Health department, he could discharge and if remains /asymptomatic, would only isolate for 14 days - Covid test: negative 8/13. Positive COVID on 8/14- Will discuss with IPAC today what needs to be done

Other Meds: aspirin, atorvastatin, ibuprofen, mefenamic acid, methocarbamol, oxycodone

Current Illness:

ID: 1662985
Sex: F
Age: 34
State: TN

Vax Date: 08/31/2021
Onset Date: 09/01/2021
Rec V Date: 09/01/2021
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: Prescribed ondansetron for vomiting

Allergies: Codine

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

Symptoms: Severe head ache chest pains also vomiting and ache body

Other Meds:

Current Illness: Anxiety

ID: 1662986
Sex: M
Age: 47
State: GA

Vax Date: 01/26/2021
Onset Date: 08/10/2021
Rec V Date: 09/01/2021
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:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: patient was admitted to the hospital on 8/10 @4am. His diagnosis is COVID Pneumonia. She stated his symptoms began on 8/4 with fever and body aches and diarrhea and nausea. She said he went to be tested on 8/6 and tested negative but was very sick with symptoms. then tested again and was positive on 8/10. She stated he has a history of Diabetes and hypertension and has Obesity

Other Meds:

Current Illness:

ID: 1662987
Sex: M
Age: 21
State: KY

Vax Date: 03/30/2021
Onset Date: 08/28/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: pt fully vaccinated 3/30/21; tested + 8/28/21

Other Meds:

Current Illness:

ID: 1662988
Sex: F
Age: 65
State: CA

Vax Date: 02/27/2021
Onset Date: 07/05/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data: Three x-rays, followed by a CT Scan with contrast.

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Walking Pneumonia - given antibiotics on 7/8 and inhaler Subsequent xray 1 month later, pneumonia not resolved, set for CT Scan CT Scan on 8/22, pneumonia not resolved and now a 6mm nodule on right mid lobe lung.

Other Meds:

Current Illness:

ID: 1662990
Sex: F
Age: 30
State: MO

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 09/01/2021
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: unknown

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Numbness to cheek, stomach pain, nausea

Other Meds: Unknown

Current Illness: Unknown

ID: 1662991
Sex: F
Age: 66
State: NE

Vax Date: 02/04/2021
Onset Date: 07/13/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data: Ultrasound - Urology CT Scan

Allergies: Clarithromycin; Doxycycline; Gantanol; Penicillin

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

Symptoms: Very very tired, arm hurt a little; felt nauseous for about three days; I rested and slept. Immediately after the vaccine. In July, they found more kidney stones in a regular follow up - ultrasound and a CT scan after that and kidney stones. We are in a holding pattern right now to see if they give me any trouble. Have not had any new pain. I also have spinal stenosis in my lower back and that is what is causing the pain in my right side that I am feeling.

Other Meds: Viloxazine - 175 mg and 137.5 mg every day; Glimepiride - 4 mg every day; Tresiba shot I do every day - 44 units (insulin); Carvedilol - 12.5 mg one tablet twice a day; Clopidogrel - 75 mg once a day; Atorvastatin - 40 mg once a day; Farxi

Current Illness: no

ID: 1662992
Sex: F
Age: 66
State: NY

Vax Date: 02/22/2021
Onset Date: 02/22/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data: Part of COVID study, I have had a lot of test. CT Scan in ER

Allergies: penicillin

Symptom List: Rash, Urticaria

Symptoms: I woke up in middle of night and my arm was killing me, I did not take aspirin for it because I was so tired and for days I was so fatigued I could not even lift my head, I had brain fog and trouble breathing. I'm still really fatigued. I can not get through the day without taking a nap. I have been having horrible sweats like drinch sweating. Foods have started disagreeing with me, an example dill and garlic since my vaccine. I have lived off garlic.

Other Meds: Metformin 500 mg daily; Rosuvastatin 5mg daily; multi vitamin; vitamin D; B

Current Illness:

ID: 1662993
Sex: F
Age: 42
State:

Vax Date: 09/01/2021
Onset Date: 09/01/2021
Rec V Date: 09/01/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: patient received a pfizer vaccine, and should have received Moderna for COVID-19

Other Meds:

Current Illness:

ID: 1662994
Sex: F
Age: 83
State: MT

Vax Date: 03/04/2021
Onset Date: 08/06/2021
Rec V Date: 09/01/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: SARS-CoV-2 RNA Resp Ql NAA+probe DETECTED Ordered Test: SARS-CoV-2 RNA Resp Ql NAA+probe Ordered Test Codes: 94500-6 (LN LOINC)/ Status: Final Accession Number: Specimen Source: SOFT TISSUE SAMPLE Specimen Site: ENTIRE NASOPHARYNX(181200003) Specimen Collection Date/Time: 2021-08-06 10:12:00.0 SARS-CoV-2 (COVID-19) RNA [Presence] in Specimen by NAA with probe detection (SARS Coronavirus 2 RNA) Detected Ordered Test: SARS-CoV-2 (COVID-19) RNA [Presence] in Specimen by NAA with probe detection (SARS Coronavirus 2) Ordered Test Codes: 94309-2 (LN LOINC)/2019nCoV (L LOCAL) Status: Final Accession Number: Specimen Source: Other Specimen Site: Specimen Collection Date/Time: 2021-08-06 00:00:00.0

Allergies: ? Penicillins Rash and Headache Tolerated piperacillin-tazobactam 4/7/2021 Tolerated ampicillin-sulbactam 4/7-4/9/2021

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

Symptoms: Case completed Pfizer Covid series on 3/4/2021, then was admitted to hospital on 8/6/2021 with Covid contributing to exacerbation of her co-morbidities.

Other Meds: acetaminophen (TYLENOL) 500 mg tablet Take 2 tablets by mouth 3 times daily as needed for Pain or Fever. 5/21/21 Aloe-Sodium Chloride (AYR SALINE NASAL GEL) SWAB 1 Application by Nasal route Twice daily as needed. 5/21/21 amLODIPine

Current Illness: None

ID: 1662995
Sex: F
Age: 37
State:

Vax Date: 01/14/2021
Onset Date: 09/01/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Breakthrough case of covid. PCR test on 9/1/2021 resulted positive lab

Other Meds:

Current Illness:

ID: 1662996
Sex: F
Age: 25
State: GA

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 09/01/2021
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: Within about 5 minutes, I started experiencing my heart beating really fast. I got hot really fast. The pharmacist had me sit down for - minutes. After that time, it felt like it wouldn't go away so I went and got some water. I went home and told my parents that I felt really weird. My heart was still pounding. This went on for about a week and a half. It felt like there was a burn sensation in my chest. It felt irregular. I couldn't really workout or anything. Any time I tried doing anything laborious, I felt shortness of breath. It was an uncomfortable, burning, irregular feeling that I was experiencing. By the 2 week mark, I started feeling normal again. The day after I got my first vaccine, I went to a gastro appointment and they took my blood pressure. It was sky high. I have been put on some blood pressure medicine.

Other Meds: Dicyclomine - 1xday/10mg

Current Illness:

ID: 1662998
Sex: M
Age: 58
State: OR

Vax Date: 08/18/2021
Onset Date: 08/19/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Days 2-4 after vaccine: body ache, tiredness, occasional headache, muscle pain where shot was administered on first day Days 6-7: light cough, stuffy nose Days 8-14: Tired, itchy eyes, foggy headed, intermittent headaches,

Other Meds: Multi vitamins

Current Illness: None

ID: 1662999
Sex: M
Age: 53
State: WI

Vax Date: 02/24/2021
Onset Date: 05/01/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data: pulmonary function test- diagnosed me with COPD

Allergies: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: On June 20th I had a physical exam. I got wheezing. They did a breathing test, a pulmonary function test, medical diagnosis was COPD. They prescribed Albuterol inhaler and Stiolto Respimat. The wheezing and coughing its the worst part of it.

Other Meds: Multivitamin; Atorvastatin; Prednisolone acetate,

Current Illness: None

ID: 1663000
Sex: M
Age: 4
State: MN

Vax Date: 10/15/1999
Onset Date: 09/01/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data:

Allergies: unknown

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Patient received the Pfizer vaccine on 4/4 then the moderna vaccine on 5/2

Other Meds: unknown

Current Illness: unknown

ID: 1663001
Sex: F
Age: 19
State: KS

Vax Date: 09/01/2021
Onset Date: 09/01/2021
Rec V Date: 09/01/2021
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: unknown

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

Symptoms: PT was given 0.3 ml of undiluted Pfizer COVID-19 vaccine, enough for 6 doses.

Other Meds: unknown

Current Illness: None known

ID: 1663002
Sex: F
Age: 31
State: RI

Vax Date: 08/17/2021
Onset Date: 08/24/2021
Rec V Date: 09/01/2021
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: We

Allergies:

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

Symptoms: Excessive phlegm, shortness of breath, severe persistent cough

Other Meds:

Current Illness: Sinus infection 08/05/2021

ID: 1663003
Sex: F
Age: 50
State: CA

Vax Date: 04/01/2021
Onset Date: 05/01/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data: Pursuing mammogram and ultrasound. Symptom of hardened vein is still there.

Allergies:

Symptom List: Unevaluable event

Symptoms: One month after injection, noticed indentation in right breast area; then noticed hard cord (vein) running from abdomen to breast area (with the indentation). Saw urgent care doctor in early July who confirmed the symptoms looked like "Mondor's Disease."

Other Meds: multi-vitamin, iron

Current Illness:

ID: 1663004
Sex: M
Age: 62
State:

Vax Date: 05/15/2021
Onset Date: 08/01/2021
Rec V Date: 09/01/2021
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: EF 15-20%

Allergies:

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

Symptoms: New onset systolic heart failure presented with acute decompensated heart failure

Other Meds:

Current Illness:

ID: 1663006
Sex: M
Age: 30
State: TX

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 09/01/2021
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: unknown

Symptom List: Injection site pain, Pain

Symptoms: Became painful at site and in left elbow/fingers with noticeable swelling and warmth to the left elbow the morning following the vaccine,. Greater pain with extension of joint.

Other Meds:

Current Illness: unknown

ID: 1663007
Sex: F
Age: 28
State: VA

Vax Date: 08/31/2021
Onset Date: 09/01/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data:

Allergies: Amoxicillin

Symptom List: Injection site pain, Menorrhagia

Symptoms: Large (2.5 inch), raised, red, painful bump/welt at injection site.

Other Meds: Daily vitamin, no-estrogen birth control pills

Current Illness: Mild Cold

ID: 1663008
Sex: F
Age: 22
State: OR

Vax Date: 08/02/2021
Onset Date: 08/15/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data: CBC, iron panel, hcg

Allergies: NKDA

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

Symptoms: abnormal vaginal bleeding 2 weeks after vaccine. Occurred 2 weeks after normal menstural cycle.

Other Meds: None

Current Illness: None

ID: 1663009
Sex: F
Age: 70
State:

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 09/01/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: sulfer, lasenopril, hylaronic acid, lactose intolerance

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: injection site hurts, fever, chills,

Other Meds: pramarin, amloadapine, calcium vitamin d, samethacone, maradadine

Current Illness:

ID: 1663010
Sex: M
Age: 52
State: WI

Vax Date: 03/19/2021
Onset Date: 07/26/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data: COVID-19 testing July 26

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Breakthrough COVID 19 infection

Other Meds: None

Current Illness: None

ID: 1663011
Sex: M
Age: 30
State: WI

Vax Date: 08/19/2021
Onset Date: 08/27/2021
Rec V Date: 09/01/2021
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: Non

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

Symptoms: Client report receiving first COVID vaccine on 08/19/21, adverse reaction began on 08/27/21. Symptom of chills began that night. The next day (08/28/21) began to feel like he had a fever, temp checked showed a low grade temp. Started to have diarrhea, it began to be liquid diarrhea. Report he would have abdominal pain and liquid diarrhea after anything that he would eat or drink. Also would have breathing pain under his shoulder at times. Client has tried Imodium with no improvement.

Other Meds: None

Current Illness: None

ID: 1663012
Sex: F
Age: 14
State: VA

Vax Date: 07/14/2020
Onset Date: 08/12/2020
Rec V Date: 09/01/2021
Hospital:

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

Lab Data: Blood work 2/5/21 and 5/24/21 thyroid levels fine No Lyme disease markers

Allergies: Unknown

Symptom List: Nausea

Symptoms: RASH -Pityriasis Rosea aching joints, arthritis type symptoms

Other Meds: NONE

Current Illness: None

ID: 1663014
Sex: M
Age: 70
State: PA

Vax Date: 02/24/2021
Onset Date: 06/23/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data: Blood, CAT Scans 3x, MRI and Brian Anagram while in the hospital assigned Neurologist schedule 09/23/2021

Allergies: CT scan was tested to allergies; environmental allergies; Menison antibiotic

Symptom List: Injection site pain

Symptoms: 06/22/2021 exercised :30 on stationary bike and not adverse effect. On the morning 06/23/2021 dizziness and started drifting to the left, reflux feeling, waited next day and going 6/24/2021. Hospital did blood sample and CT scan, results of the CT scan said it looks like a possible AVM and shonting and after that he was assigned a neurological interventionist. Wanted an MRI on 06/26/2021 , not AVM or shonting present do a brian anagram, told her that not AVM or shonting present do a brain anagram. 06/29/2021 release and said another MRI after two months on 08/18/2021. Has appoint with Dr. 09/17/2021. Hemorrhagic on right side of brain intensive care neurological area. Another CAT scan with contrast stayed their for six days. Radiologist

Other Meds: Hypertension; Lacentapril 500 mg twice day; blood pressure medication; 10mg Crestor Statin; 181 mg of baby aspirin; Vitamin D, C; Probiotic and usually fish oil.

Current Illness: No

ID: 1663015
Sex: M
Age: 34
State:

Vax Date: 05/01/2021
Onset Date: 08/01/2021
Rec V Date: 09/01/2021
Hospital: Y

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

Lab Data: CT angio with multiple bilateral scattered pulmonary emboli are seen overall moderate severity which are basilar predominant

Allergies:

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

Symptoms: acute pulmonary embolism

Other Meds:

Current Illness:

ID: 1663016
Sex: F
Age: 12
State: WA

Vax Date: 07/16/2021
Onset Date: 08/16/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data: Examination by pediatrician.

Allergies: Oral allergy syndrome to apple, carrot, hazelnut, walnut. Environmental allergies to trees, grasses, weeds, animal dander

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

Symptoms: Dry cough, inflammation around thyroid - she has had these previously, but they have become worse - may not be related to the vaccine, but we were told to report it.

Other Meds: Zyrtec, probiotics, allergy shots 1x weekly

Current Illness:

ID: 1663017
Sex: M
Age: 22
State: IN

Vax Date: 09/01/2021
Onset Date: 09/01/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data: NA

Allergies: NA

Symptom List: Tremor

Symptoms: The patient received his second dose of the Moderna COVID-19 vaccine around 2:30 p.m. Roughly 10 minutes later he reported that he was feeling warm and had a headache. He also said he felt nauseated. Since he works outside as a cart pusher he felt that he should go home and rest. I took his temperature which was normal. He went home around 3 p.m.

Other Meds: NA

Current Illness: NA

ID: 1663018
Sex: M
Age: 71
State: CA

Vax Date: 09/01/2021
Onset Date: 09/01/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data: N/A

Allergies: nka

Symptom List: Erythema, Pruritus

Symptoms: Patient was walking around and fell, maybe passed out. Walked the patient over to a seat and he passed out again. I then called for an ambulance and monitored the patient until the ambulance arrived. Patient was sweating profusely so I had the patient lay down on the ground on his side until ambulance arrived. Patient did not want to go with the ambulance as he felt like he didn't need it. He was back to normal and left the facility.

Other Meds: Eye drops for cataract surgery, ciprofloxacin, prednisolone, ketorlac

Current Illness: cataract surgery

ID: 1663019
Sex: M
Age: 17
State: MN

Vax Date: 04/17/2021
Onset Date: 04/17/2021
Rec V Date: 09/01/2021
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: unknown

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

Symptoms: Patient was given the Pfizer vaccine at 17 years of age before it was approved for this age

Other Meds: unknown

Current Illness: unknown

ID: 1663021
Sex: M
Age: 45
State: OH

Vax Date: 04/14/2021
Onset Date: 08/31/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data: POC test resulted positive on 9-1-2021

Allergies:

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

Symptoms: nasal congestion

Other Meds:

Current Illness:

ID: 1663022
Sex: F
Age: 62
State: WY

Vax Date: 02/26/2021
Onset Date: 07/24/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data: Echo Cardiogram

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: I had symptoms of I got a metal taste in my mouth. I had slight nausea. These are what I had after the first dose. I did get COVID I had bad headaches, no sensation for food, bad aches, and pains, I had bad back pain. The breathing was the worst. I went back to the doctor and now I have been diagnosed with heart murmur. I had a heart echo today.

Other Meds:

Current Illness:

ID: 1663023
Sex: F
Age: 76
State: MO

Vax Date: 08/24/2021
Onset Date: 08/24/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data:

Allergies: NKDA

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

Symptoms: Employee gave vaccine to patient from a vial from the fridge that had been punctured greater than 12 hours. Vaccine remained in the fridge so there was not a temperature excursion, only the vial being punctured longer than 12 hours.

Other Meds:

Current Illness:

ID: 1663024
Sex: F
Age: 34
State:

Vax Date: 12/18/2020
Onset Date: 09/01/2021
Rec V Date: 09/01/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Breakthrough case

Other Meds:

Current Illness:

ID: 1663025
Sex: F
Age: 28
State: MD

Vax Date: 09/01/2021
Onset Date: 09/01/2021
Rec V Date: 09/01/2021
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: Penicillin , Sulfa antibiotics, Toradol

Symptom List: Pain in extremity

Symptoms: Patient received vaccine, after a minute she felt dizzy and lightheaded, and started having a seizure for about 30 seconds . After it was over she still felt lightheaded and had vision problems so we laid her down. After a few minutes she started feeling better and at that point the ambulance and EMTs arrived in store to assess her. She was taken to the hospital to receive further treatment.

Other Meds: Lexapro , Medical Marijuana

Current Illness: None

ID: 1663026
Sex: M
Age: 85
State: TX

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data: n/a

Allergies: nkda

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

Symptoms: pt was not feeling well yesterday after his 2nd immunization. Daughter states he did not want to eat this morning, was sleeping more than normal, and urniated on himself which is not normal. Pt also fell down this morning and the paramedics came to check pt over. She states they didn't tell her anything but did not take the pt to the hospital. Daughter states she will take pt to ER.

Other Meds: unknown

Current Illness: none specified

ID: 1663027
Sex: F
Age: 46
State: NJ

Vax Date: 08/28/2021
Onset Date: 08/30/2021
Rec V Date: 09/01/2021
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: Sulfa, latex

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

Symptoms: Covid arm rash appeared less than 48 hours after injection. Other side effects included intense shaking, chills, fever, headache within 16 hours of injection.

Other Meds: Synthroid, Claritin

Current Illness: No

ID: 1663028
Sex: F
Age: 57
State: CA

Vax Date: 08/06/2021
Onset Date: 08/16/2021
Rec V Date: 09/01/2021
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: Statins

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

Symptoms: Blood Sugars went very high. Then the fluctuation just continue to go on for another two weeks. I was not able to get control over it.

Other Meds: Metformin, Beet root,Fenofibrate,Losartan potassium, Vitamin B complex,81 mg of aspirin, Turmeric

Current Illness: None

ID: 1663030
Sex: M
Age: 41
State: TX

Vax Date: 03/08/2021
Onset Date: 03/01/2021
Rec V Date: 09/01/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: CIDP - EMG.

Allergies: none

Symptom List: Vomiting

Symptoms: weakness, fatigue, CIDP

Other Meds: none

Current Illness: none

ID: 1663031
Sex: F
Age: 41
State: AL

Vax Date: 08/30/2021
Onset Date: 08/30/2021
Rec V Date: 09/01/2021
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:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient called complaining of severe rash and blisters on feet

Other Meds:

Current Illness:

ID: 1663032
Sex: F
Age: 75
State: WA

Vax Date: 02/23/2021
Onset Date: 09/01/2021
Rec V Date: 09/01/2021
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: none

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

Symptoms: After COVID patient continued to experience fatigue. We do NOT think this is a result of the vaccine. The fatigue continued and in March 2021 we began more tests to determine the cause of the fatigue. She has slightly low Hemo numbers. Eventually they found problem proteins in her blood that lead to a diagnosis of Waldenstrom's lymphoma. We are getting a second opinion. No one has suggested this is due to the vaccine.

Other Meds: basic vitamins, B-12, iron

Current Illness: COVID

ID: 1663033
Sex: F
Age: 49
State: HI

Vax Date: 08/01/2021
Onset Date: 09/01/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Noticable pain and swelling at injection sight. Used warm compress. Headache. Untreated because I can't take pain relievers. Mild dizziness upon standing.

Other Meds: Hydroxychloroquine, atoravastatin, aspirin, nipfedapine, welbutrin, vit D, Calcium, multi vitamin.

Current Illness: No

ID: 1663035
Sex: M
Age: 93
State: GA

Vax Date: 01/12/2021
Onset Date: 08/10/2021
Rec V Date: 09/01/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Patient daughter completed the interview as they are a patient at Hospital. Wife stated patient is not aware of how exposure occurred, she has continue to practice safety protocols. Wife informed patients oxygen levels were greatly diminished before hospital admission.

Other Meds:

Current Illness:

ID: 1663036
Sex: F
Age: 15
State: OH

Vax Date: 08/07/2021
Onset Date: 09/01/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data: POC resulted positive on 9-1-2021

Allergies:

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

Symptoms: symptoms started 9-1-2021

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am