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: 1666052
Sex: M
Age: 61
State: CA

Vax Date: 08/30/2021
Onset Date: 08/30/2021
Rec V Date: 09/02/2021
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: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-

Other Meds:

Current Illness:

ID: 1666053
Sex: M
Age: 62
State: FL

Vax Date: 08/30/2021
Onset Date: 08/31/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data: N/A

Allergies: Codeine

Symptom List: Anxiety, Dyspnoea

Symptoms: Fever of 103-104, body aches, chills from about 4am-4pm 8/31/2021

Other Meds: Losartan50mg,Crestor40mg,Zetia20mg,Metformin 800,Aspirin

Current Illness: N/A

ID: 1666054
Sex: F
Age: 37
State: MA

Vax Date: 03/28/2021
Onset Date: 03/28/2021
Rec V Date: 09/02/2021
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: MRI, ultrasound, blood work, biopsy

Allergies: Sulfa drugs

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

Symptoms: On 2/28/2021, I got the 1st dose and about 10 days after the 1st vaccine, I had severe headache, exhaustion and large swollen gland on my right arm pit. The vaccine was in my left arm. The swollen gland was painful to the touch. I did go to Urgent Care and was tested for Covid and Lyme disease and everything came back normal. I was instructed to go ahead and get the 2nd vaccine even though I was having symptoms. I got the 2nd vaccine on 3/28/2021 and started feeling even worse. I did see my doctor, who ran blood work and ultrasound and the blood work showed very low platelets and increased liver enzymes. I was instructed to go to the ER. I had a full work up and CAT scan. I was diagnosed with ITP which is an automimmune disease. I was to follow up with a hematologist. A few days later, I woke up with a large bruise on my neck so I went to the ER again. I was turned away and sent home. My PCP did blood work again and based on the results from the blood work I was told to go to the ER where they finally admitted me with ITP and I stayed in the hospital for 5 days. I was given IV medications to bring my platelets levels back up. I was discharged with directions to follow with hematologist. I had to do blood work every week and on my weekly blood work, my liver enzymes were elevated and I was referred to a specialty hospital. On 5/3/2021 I was admitted to be monitored and they did a liver biopsy. The biopsy showed that I had autoimmune hepatitis. The doctor said it was a reaction to the vaccine. I was given high doses of steroids and antirejection medication called Cellcept that I have to take every day. I did see an rheumatologist who said that my conditions were an adverse reaction from the vaccine.

Other Meds: IUD

Current Illness: Psoriasis

ID: 1666055
Sex: F
Age: 65
State: FL

Vax Date: 05/06/2021
Onset Date: 05/08/2021
Rec V Date: 09/02/2021
Hospital: Y

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

Lab Data: Covid test-positive, CXR.

Allergies: Sulfa drugs.

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Pt came to ER c/o chest pain, SOB, nausea, vomiting, syncope, and diarrhea.

Other Meds:

Current Illness:

ID: 1666056
Sex: M
Age: 24
State: NV

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1666057
Sex: M
Age: 15
State: IN

Vax Date: 08/31/2021
Onset Date: 09/01/2021
Rec V Date: 09/02/2021
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: N/A

Allergies: Amoxicillin and the Flu vaccine

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

Symptoms: I started to have a sore throat and runny nose on the 1st of September around 4:00pm.

Other Meds: None

Current Illness: None

ID: 1666058
Sex: F
Age: 17
State:

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

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

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: The vanishpoint syringe jammed halfway through vaccination so I had to draw up the remainder to give to the patient.

Other Meds: When I was giving her the 2nd Pfizer Covid vaccination, the Vanishpoint syringe (w/ attached needle) wouldn't depress fully(it jammed halfway). I drew up the remainder amount left in the syrgine and gave the patient the remainder. At the

Current Illness:

ID: 1666059
Sex: M
Age: 67
State: KY

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 09/02/2021
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: Error: Booster Given Too Early-

Other Meds:

Current Illness:

ID: 1666060
Sex: M
Age: 52
State: NJ

Vax Date: 04/27/2021
Onset Date: 05/01/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data: No tests completed

Allergies: None

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Tinnitus

Other Meds: None

Current Illness: None

ID: 1666061
Sex: F
Age: 49
State: KY

Vax Date: 08/17/2021
Onset Date: 08/17/2021
Rec V Date: 09/02/2021
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: codeine (itching, unknown), sulfacetamide (itching, rash), hydrocodone-acetaminophen (abdominal pain, sweating, nausea), gluten protein (sore throat symptom), penicillins (unknown, rash), valdecoxib (swelling and unknown)

Symptom List: Diarrhoea, Nasal congestion

Symptoms: 8/17/21: 49yoF presenting with allergic reaction s/p 2nd dose of Moderna COVID-19 vaccination. Ptn reports receiving having similar symptoms after the first dose so she took Benadryl prior to receiving her second dose today. Ptn received the vaccination at 1400 today when she began to develop symptoms 10 minutes after vaccination administration reporting scratchy, irritated sensation in her throat causing her to feel like she needs to repeatedly clear it, splotchy rash on her chest, and feeling SOA. Clinic called EMS and she was brought to the ED. Ptn reports she feels the same as she did during initial symptom presentation. Ptn has not taken any medication for symptoms prior to presentation. Reports she feels she needs to keep her neck distended to prevent feeling short of air. She also reports her BP usually runs softer with systolics in the 110s. Denies lightheadedness, presyncope, N/V/D, abdominal pain. Clinical Impressions as of Aug 18 2000 Allergic reaction to COVID-19 vaccine MDM Number of Diagnoses or Management Options Allergic reaction to COVID-19 vaccine Diagnosis management comments: MS4 MD Candidate 2022 Patient is a 49-year-old woman with history of multiple drug allergies who presents to the emergency department with concerns for an reaction to the COVID-19 vaccine. Patient is hemodynamically stable and afebrile on presentation. Patient demonstrates mild facial swelling with no other concerning signs on physical exam. Patient already has taken 50 mg of by mouth Benadryl at home prior to the onset of her symptoms. I will provide the patient with IM epinephrine and IV Benadryl and IV Decadron for control of her allergic reaction. On re-evaluation of the patient she notes that her swelling has significantly improved after her by mouth Benadryl and is not requiring any IM or IV medications. Patient was re-evaluated and continues to be in the morning. Patient is comfortable with discharge. Patient was counseled on likely allergic reaction the COVID-19 vaccination. Patient was discharged in stable condition with strict return precautions. Pt is well appearing on exam. Arrives after 2nd Moderna vaccine; she had similar allergic response after 1st dose. Asymptomatic on my exam. No respiratory issues, no n/v or s/s significant allergic event. She refused meds. Pt discharged home.

Other Meds: pantoprazole, pregabalin

Current Illness:

ID: 1666062
Sex: M
Age: 57
State: FL

Vax Date: 04/08/2021
Onset Date: 05/09/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data: Covid test-positive. CXR.

Allergies: NKA

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

Symptoms: Pt came to ER c/o nonproductive cough, fever, and body aches for the past few days.

Other Meds:

Current Illness:

ID: 1666063
Sex: M
Age: 30
State: NC

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

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

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Systemic: Allergic: Itch Generalized-Severe, Systemic: Allergic: Rash Generalized-Medium

Other Meds:

Current Illness:

ID: 1666064
Sex: M
Age: 80
State: ND

Vax Date: 03/04/2021
Onset Date: 03/04/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data: Unknown

Allergies: None

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

Symptoms: Unknown

Other Meds: Unknown

Current Illness: Unknown

ID: 1666065
Sex: F
Age: 77
State: MN

Vax Date: 02/17/2021
Onset Date: 09/01/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient has a case of breakthrough COVID

Other Meds:

Current Illness:

ID: 1666066
Sex: F
Age: 50
State:

Vax Date: 08/17/2021
Onset Date: 08/26/2021
Rec V Date: 09/02/2021
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: Platelet counts: 8/26 - 3 8/27 - 1 8/28 - 5 8/29 - 44 8/26 Ddimer - 1220 Fibrinogen - 261 aPTT - 25.1 (usual range 21-31)

Allergies:

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

Symptoms: ITP per heme/onc provider. Received dexamethasone 40 mg po daily x4 doses from 8/26 to 8/29

Other Meds:

Current Illness: COVID-19 confirmed via PCR in Iran on approximately 7/12/21, negative result (unknown test, unknown date) since that time, but again positive via PCR on 8/26/21

ID: 1666067
Sex: M
Age: 29
State: GA

Vax Date: 09/01/2021
Onset Date: 09/01/2021
Rec V Date: 09/02/2021
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: Systemic: Fainting / Unresponsive-Mild, Systemic: pt after recived the covid pfizer first vaccine walked to designated areas to sit down for 15 minutes as i direct him to the seat and i did sea him seating comftably and i went back to pharmacy another patient yelled out taht patient is falling off chair-Mild

Other Meds:

Current Illness:

ID: 1666068
Sex: F
Age: 51
State: IN

Vax Date: 08/12/2021
Onset Date: 08/13/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data: Blood work, EKG, Chest X-ray

Allergies: Bactrim; Macrobid

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

Symptoms: The next morning I was sitting in my chair watching tv and my fit bit buzzed and my heart rate was 120. I was tired and fatigued and my heart rate stayed elevated for a week and I became dizzy and my heart rate kept spiking and I had a lot of skipped beats and palpitations. I went to doctor.

Other Meds: Vit C; Vit D; toxin pull

Current Illness:

ID: 1666069
Sex: F
Age: 45
State: TX

Vax Date: 08/17/2021
Onset Date: 08/22/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data: Doctor appointment with Dr. on September 1, 2021.

Allergies: no known allergies

Symptom List: Ear pain, Hypoaesthesia

Symptoms: I had a shingles outbreak that began 6 days after my 2nd vaccine. Online reports show that there is an increased amount of people who are experiencing shingles within 14 days of the vaccine. I experienced the onset of shingles 6 days after the injection.

Other Meds: L-thyroxine (synthroid) tabs - 50MCG - once daily Trospium Chloride ER Caps - 60MG - once daily

Current Illness: none

ID: 1666070
Sex: M
Age: 52
State: WI

Vax Date: 04/01/2021
Onset Date: 08/21/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data: SARS-COV-2 RNA - Positive

Allergies: n/a

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: COVID sx started 8/21/23 + test recorded 8/23/21

Other Meds: n/a

Current Illness: none

ID: 1666071
Sex: F
Age: 28
State:

Vax Date: 07/11/2021
Onset Date: 07/12/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data:

Allergies: No

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

Symptoms: Moderna COVID-19 Vaccine EUA In the morning after the first injection of the moderna vaccine I started feeling very tired, my arm (where I got the injection) was hurting and I had a headache. I took an ibuprofen in the evening and the symptoms went away. On the 13-Jul-2021, in the morning, I was feeling irritated in my stomach. During the day, this got worse. I had stomach pains and did not feel like eating. This symptom resolved on the 14-Jul-2021 in the evening. I also experienced diarrhea during the 14-Jul-2021. Also around 2-3 days after the vaccination, my arm pit was hurting very much and I suspect swollen lymph nodes to have caused this. This symptom resolved after a few days. One week after the injection (18-Jul-2021) the side of injection was swollen, red and warm. This symptom resolved after a few days.

Other Meds: Contraceptives

Current Illness: No

ID: 1666072
Sex: F
Age: 22
State: CA

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 09/02/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1666073
Sex: F
Age: 34
State: FL

Vax Date: 08/27/2021
Onset Date: 08/28/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data: NONE YET

Allergies: TALCUM POWDER

Symptom List: Unevaluable event

Symptoms: OVER A PERIOD OF 1 HOUR: ELEVATED HEART RATE WHILE RESTING, 88-111 BMP; POUNDING HEART; SHORTNESS OF BREATH

Other Meds: LIPOSOMAL VITAMIN C, DAILY, 15 MG

Current Illness: NONE

ID: 1666074
Sex: F
Age: 46
State: MS

Vax Date: 08/13/2021
Onset Date: 08/25/2021
Rec V Date: 09/02/2021
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: Iodine, shellfish, lincocin, penicillin, vicryl stiches

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

Symptoms: Moderate pain in the back of right leg/calf area beginning the night of Aug 25 2021, around 8 pm. Increasinly more painful with a feeling of tightness, especially upon walking. I elevated and iced area and after 2 hrs called nurse hotline on back of insurance card. Took a Tylenol and Flexeril. No improvement by Thurs morning. Went to an Urgent Care clinic by 2 pm Thurs. FNP said blood flow was good but noticed swelling and discoloration. Pain upon touch but no warmness, fever, or severe pain upon flexing, only moderate. Was prescribed 10 mg of prednisone for 4 days. Was told likely inflammation. Improvement after 3 days of the steroids.

Other Meds: Lisinopril, 10 mg 1x daily Gabapetin 300 mg 2x daily Tylenol 500mg as needed Flexeril 5 mg as needed

Current Illness: Lupus, Rheumatoid arthritis, Neuralgia, Hypertension, Prediabetes, Intracranial hypertension (no known cause yet), elevated cholestorol level, as of Aug 9, 2021

ID: 1666075
Sex: F
Age: 50
State: MD

Vax Date: 08/23/2021
Onset Date: 08/24/2021
Rec V Date: 09/02/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Tests taken included MRI with or without contrast, MRI, Echocardiogram, Ultrasound to examine carotid arteries, blood tests including tests to rule out genetic blood clotting issues, neurology consult on Sept 1. Results indicated nothing unusual.

Allergies: amoxicillin

Symptom List: Injection site pain, Pain

Symptoms: Aug 23- received Flu and Shingles vaccines from Pharmacy, 2PM Aug 24- Symptoms experienced: Body aches, Feverish but not over 100.4 degrees, general malaise, flu symptoms but NO respiratory issues. Aug 25- Symptoms: Continued body ache and general flu symptoms that resolved in the afternoon. Aug 26- Symptoms: I woke up with severe vertigo (room was spinning while in bed), nausea, vomiting and unable to walk straight. Hearing loss and loud ringing in left ear. Went to Urgent Care. Given and prescribed anti nausea medication. Ears were clear. Symptoms resolved within 2-3 hours of symptoms onset. Final diagnosis: tinnitus. Aug 30- Went to ENT doctor. Ears were also clear. Diagnosis: Miniere's. Prescribed Prednisone, 17 day course to resolve hearing loss. Aug 31- Symptoms: 6AM in shower stall. Generalized weakness on the right side. Body was leaning towards the right side with my right leg unable to hold my weight. Had to finally sit on shower floor. Unable to clench my right hand, left hand was OK. Unable to call out loudly for help, felt my mouth wasnt functioning. Visions blurred, foggy. Unable to stand up. Symptoms resolved within 10 minutes. Went to Urgent Care again but staff suggested I contact ENT doctor as Urgent Care was limited in what they can do for me. ENT doctor strongly suggested I go to ER. I was admitted to Hospital for observations. Tests taken included MRI with or without contrast, MRI, Echocardiogram, Ultrasound to examine carotid arteries, blood tests including tests to rule out genetic blood clotting issues, neurology consult. Discharged from hospital on Sept 1. Final diagnosis: TIA. Prescribed aspirin and statins.

Other Meds: lisinopril 20mg lexapro 5mg

Current Illness: none

ID: 1666076
Sex: M
Age: 28
State: CA

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

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1666077
Sex: M
Age: 76
State: FL

Vax Date: 04/28/2021
Onset Date: 08/29/2021
Rec V Date: 09/02/2021
Hospital: Y

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

Lab Data: POSITIVE COVID TEST

Allergies: LOSARTAN, ATORVASTATIN, PREDNISONE, ROCEPHIN, SULFA DRUGS, LISINOPRIL, LEVOFLOXACIN

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

Symptoms: pt reports he has been sick since 8/20 and tested postive for covid a couple days ago, sob and o2 level was low

Other Meds: acetaminophen 325 mg oral tablet, 650 mg= 2 TAB, PO, Q4H (Every 4 hours), PRN albuterol 2.5 mg/3 mL (0.083%) inhalation solution, 2.5 mg= 3 mL, NEB, 4 times a day, PRN allopurinol 100 mg oral tablet, 100 mg= 1 TAB, PO, Daily furosemide 4

Current Illness:

ID: 1666078
Sex: M
Age: 43
State: FL

Vax Date: 04/30/2021
Onset Date: 05/09/2021
Rec V Date: 09/02/2021
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: Covid test, CXR.

Allergies: Niacin, vancomycin.

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Pt came to ER c/o right lower quadrant pain and fever, symptoms started a few days prior.

Other Meds:

Current Illness:

ID: 1666079
Sex: F
Age: 49
State: CA

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

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

Date Died: 09/01/2021

ID: 1666080
Sex: M
Age: 80
State: TN

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

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

Lab Data:

Allergies:

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

Symptoms: PT IS A BREAKTHROUGH CASE OF COVID-19 AND EXPIRED ON 9/1/2021.

Other Meds:

Current Illness:

ID: 1666081
Sex: M
Age: 35
State: CA

Vax Date: 08/18/2021
Onset Date: 08/18/2021
Rec V Date: 09/02/2021
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: Nausea

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1666082
Sex: M
Age: 67
State: ND

Vax Date: 03/04/2021
Onset Date: 03/04/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data: Unknown

Allergies: None

Symptom List: Injection site pain

Symptoms: Unknown

Other Meds: Unknown

Current Illness: Unknown

ID: 1666083
Sex: M
Age: 51
State: AZ

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

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

Lab Data: June 2021. Labs and CT scan of chest have returned normal.

Allergies: Donnatol

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

Symptoms: Variable Lymphadenopathy in the axillary, clavicular, and inguinal areas. Joint pain in shoulders, back, pelvis and hips.

Other Meds: Metformin, lisinopril, januvia, glimipride, vitamin D, multivitamin

Current Illness: None

ID: 1666084
Sex: F
Age: 26
State:

Vax Date: 08/30/2021
Onset Date: 08/30/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data: None

Allergies: None

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

Symptoms: Extreme soreness in left arms, unable to move left arm, fainting spells , dizziness and passing out

Other Meds: Loestrin 1/20 mg (once daily) Celexa 10mg (once daily)

Current Illness: None

ID: 1666085
Sex: F
Age: 52
State: CA

Vax Date: 08/18/2021
Onset Date: 08/18/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1666086
Sex: F
Age: 37
State: CT

Vax Date: 08/29/2021
Onset Date: 08/29/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Dose was administered from vial that was initially punctured 2 days prior, therefor expired. Patient did not experience any reaction aside from expected side effects of vaccine. Patient did report sore arm the night of injection, and body aches the day following.

Other Meds:

Current Illness:

ID: 1666087
Sex: M
Age: 51
State: PA

Vax Date: 08/30/2021
Onset Date: 09/01/2021
Rec V Date: 09/02/2021
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: Blood test Urgent care - D Dimer results were high indicating possible blood clot (09/01/2021) - was sent to ER as a result for CT to check for Clots. ER - administered CT - found no blood clots - advised shortness of breath was possible side effect of vaccination.

Allergies: None

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

Symptoms: Sever shortness of breath - resulted in trip to urgent care for blood test and then ER for CT following blood test results

Other Meds: None

Current Illness: None

ID: 1666088
Sex: F
Age: 34
State: GA

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

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

Lab Data: Blood work 07/28/2021

Allergies: Vancomycin - anaphylaxis Cipro - hives and itching Codeine - hive and itching Trazadone - severe headache

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

Symptoms: Started having full body muscle spasms, pulling me into a fetal position for approx 2 hours, then the spasms intensified and the muscles in my legs, feet, and toes tensed up so bad, pulling my feet and toes into different directions to the point I thought it was going to either break or dislocate my toes and ankles. The muscles were so tight my circulation was cut off, and my feet/toes were purple. I started convulsing all over my body. Head to my legs. All I could do was scream, cry, and beg God to make it stop. This lasted 9 hours. The following morning my neck muscle, to the left side of my spine started hurting, it got worse throughout the day. I took prescription strength ibuprofen, used muscle rub, neck massage, and a tens unit. But it continued to worsen. By the afternoon I could no longer move my head at all. My pcp told me to go to the ER. I was given 2 doses of roboxin, morphine & a bag of IV fluids. After about 4 hours it finally started to ease up and I could move my head a little. By the next day I could move my neck normally. My PCP has advised me not to get the 2nd dose. To this day I am still having muscle spasms, however they are tolerable.

Other Meds: Celexa 40mg, wellbutrin 150mg, synthroid 325mcg, valtrex 1g, lebatolol 100mg,

Current Illness: None known

ID: 1666089
Sex: F
Age: 22
State: CA

Vax Date: 08/18/2021
Onset Date: 08/18/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1666090
Sex: F
Age: 67
State: FL

Vax Date: 08/27/2021
Onset Date: 08/28/2021
Rec V Date: 09/02/2021
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: NKA

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

Symptoms: Burst blood vessel in the right eye.

Other Meds: multivitamins, vitamin D, Tylenol

Current Illness: N/A

ID: 1666091
Sex: F
Age: 51
State: GA

Vax Date: 08/07/2021
Onset Date: 08/17/2021
Rec V Date: 09/02/2021
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: NKA

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

Symptoms: Numbing, burning, pain, and weakness in both hands and arms. Started on 8/17, progressed on 8/19, numbing and pain was so bad, I went to the ER on 8/22. Left hand was wrapped. Taken off work. Referred to Orthopedic specialist. Recommended therapy. Taken off work.

Other Meds: None

Current Illness: None

ID: 1666092
Sex: M
Age: 63
State: MI

Vax Date: 03/16/2021
Onset Date: 03/18/2021
Rec V Date: 09/02/2021
Hospital: Y

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

Lab Data: unknown according to pt none were done

Allergies: NKDA

Symptom List: Pain in extremity

Symptoms: Pt was given the J&J shot and within 24 hours experienced weakness to the point that he was unable to move his legs. He had decreased circulation in the lower extremities and was hospitalized. Since that time he has been confined to a wheelchair.

Other Meds: Vit D, Zyrtec,

Current Illness: Lyme disease,

ID: 1666093
Sex: F
Age: 27
State: CA

Vax Date: 08/18/2021
Onset Date: 08/18/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1666094
Sex: F
Age: 75
State: ND

Vax Date: 03/04/2021
Onset Date: 03/04/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data: Unknown

Allergies: None

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

Symptoms: Unknown

Other Meds: Unknown

Current Illness: Unknown

ID: 1666095
Sex: M
Age: 59
State: FL

Vax Date: 07/21/2021
Onset Date: 08/29/2021
Rec V Date: 09/02/2021
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 COVID TEST 08/29

Allergies: NKA

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

Symptoms: arrived via EMS from home, c/o SOB, Fever, loss of taste, Was COVID NEG on Monday, not getting any better, When EMS arrive pt O2sat @ 60's in RA

Other Meds: AMLODIPINE

Current Illness:

ID: 1666096
Sex: M
Age: 16
State: CA

Vax Date: 08/16/2021
Onset Date: 08/16/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1666097
Sex: M
Age: 77
State: FL

Vax Date: 04/27/2021
Onset Date: 05/02/2021
Rec V Date: 09/02/2021
Hospital:

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

Lab Data: Covid test-pos, CXR.

Allergies: Tape, carbidopa-levodopa, effexor, fentanyl, keflex, nifedipine, nubain, savella, sulfa drugs, tramadol.

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Pt came to ER c/o fever, generalized weakness, bilateral leg pain onset 1 day prior.

Other Meds:

Current Illness:

ID: 1666098
Sex: F
Age: 43
State: NJ

Vax Date: 08/17/2021
Onset Date: 08/31/2021
Rec V Date: 09/02/2021
Hospital: Y

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

Lab Data:

Allergies: None

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

Symptoms: Appendicitis.

Other Meds: None

Current Illness: None

ID: 1666099
Sex: F
Age: 75
State: IN

Vax Date: 08/31/2021
Onset Date: 09/01/2021
Rec V Date: 09/02/2021
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: high fever to 102.8 extreme diarrhea and urine of yellow color not seen before no balance, couldn't walk symptons started going away 9-3 evening except diarrhea

Other Meds: chemo drugs every two weeks

Current Illness:

ID: 1666100
Sex: M
Age: 46
State: CA

Vax Date: 08/17/2021
Onset Date: 08/17/2021
Rec V Date: 09/02/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1666101
Sex: F
Age: 65
State: CO

Vax Date: 09/01/2021
Onset Date: 09/01/2021
Rec V Date: 09/02/2021
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: Gluten, tomatoes, cherries, lemons, pineapple

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

Symptoms: headache, balance is off, tired, no energy - drink electrolyte water and stayed home from work

Other Meds: Vitamin C, Vitamin E, Vitamin D. Lycopene, Bilberry, Omega 3, Reveratrol, B-12, CoQ10, Calcium, Zinc,

Current Illness: None. Perfectly healthy.

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am