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: 1666102
Sex: F
Age: 31
State: MN

Vax Date: 01/12/2021
Onset Date: 08/29/2021
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: COVID 19 Positive

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient is completely vaccinated against COVID 19 and has developed positive COVID test result

Other Meds:

Current Illness:

ID: 1666103
Sex: F
Age: 56
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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: Unknown

Allergies: None

Symptom List: Anxiety, Dyspnoea

Symptoms: Unknown

Other Meds: Unknown

Current Illness: Unknown

ID: 1666104
Sex: F
Age: 44
State:

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

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1666105
Sex: M
Age: 17
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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1666106
Sex: M
Age: 33
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
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: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1666107
Sex: M
Age: 25
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
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:

Allergies:

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

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1666108
Sex: F
Age: 12
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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1666109
Sex: M
Age: 62
State: VA

Vax Date: 02/19/2021
Onset Date: 02/23/2021
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: Went to the emergency room 32 after initial symptoms started. Site check and blood work.

Allergies: None

Symptom List: Pharyngeal swelling

Symptoms: Delayed Cutaneous Hypersensitivity: Rash developed on all parts of the body. Rash started on the upper arms and upper sides. Rash always appeared symmetrically on my body. Rash did not cover the whole body at once. It covered about 10% of my body for hours and then move to other spots, always symmetrically. At times there appeared hives also on parts of my body I'd scratch. Only parts of my body not affected were the soles of my feet, palms of my hands, and from mouth above on my face.

Other Meds: Cholesterol Statin

Current Illness: None

ID: 1666110
Sex: F
Age: 46
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1666111
Sex: M
Age: 47
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
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:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1666112
Sex: M
Age: 76
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: SYR
Vax Site: LA

Lab Data: Unknown

Allergies: None.

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

Symptoms: Unknown

Other Meds: Unknown

Current Illness: Unknown

ID: 1666113
Sex: F
Age: 59
State: OK

Vax Date: 03/24/2021
Onset Date: 03/24/2021
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: DOCTOR WILL BE RUNNING TEXT TOMORROW

Allergies: NONE THAT i KNOW OF

Symptom List: Rash, Urticaria

Symptoms: CAN'T WALK WITH OUT GETTING EXHAUSTED, CAN'T DO MY 20 MIN YOGA WORKOUT,

Other Meds: FLONASE,IRON TABLESTS 65 MG OVER COUNTER, ZYRTEC GENERIC OVER COUNTER,COLLAGEN 1000 MG OVER COUNTER,ALBUTEROL,LISINOPRIL 20MG , HYDROCHLOROTHIAZIDE 25 MG , ATORVASTATIN 10 MG, KIRKLAND BRAND FISH OIL 1000 MG, CALCIUM 600 MG, SINGULAR

Current Illness: ASTHMA, COPD

ID: 1666114
Sex: F
Age: 29
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1666115
Sex: F
Age: 58
State: KY

Vax Date: 06/09/2021
Onset Date: 08/05/2021
Rec V Date: 09/02/2021
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: tested COVID positive 8/6/21 (tested negative for COVID on 7/2/21, 8/16/21, and 8/17/21)

Allergies: NKDA

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

Symptoms: Patient received COVID vaccine on 6/9/21, tested COVID positive 8/6/21 (tested negative for COVID on 7/2/21, 8/16/21, and 8/17/21) 8/5/21: Patient is a 59 y.o. female with past medical history significant for Type II diabetes mellitus, essential hypertension, and known spinal lytic lesions who presented to the ED yesterday for chief complaint of worsening lower back pain. She reports that her pain has progressively impeded her ability to ambulate and complete simple ADL's in the past few weeks. She reports new numbness to her right hip, however denies loss of bladder or bowel control, recent falls, or any other acute complaints today. Of note, the patient was admitted on 7/16 with concern for spinal lesion found. An MR spine was completed, showing 10mm nodule in right superior medial posterior breast and lytic destructive lesion within the L1 vertebral body, right superior portion of T12, as well as large omental deposit. An MRI showed cord and thecal sac compression at this time, prompting ortho, neurosurgery, and IR guided biopsy that was significant for malignant metastatic adenocarcinoma with high suspicion of breast primary site. She was subsequently discharged and mammography guided biopsy of her left breast was completed on 7/28 with pathologic results pending. Workup thus far in the ED has been significant for UTI, elevated CRP, sed rate, MRI with stable findings with exception of re-demonstration of L1 lytic lesion with worsening wedge deformity suggestive of new pathologic fracture. There is additional extensive enhancement throughout the subdural space throughout the thoracic spine, resulting in mass-effect and deformity of portions of the spinal cord. Hospital medicine has thus been consulted for admission of this patient for further management of her symptoms. Patient is a 59 y.o. female with past medical history significant for Type II diabetes mellitus, essential hypertension, and known spinal lytic lesions who presented to the ED yesterday for chief complaint of worsening lower back pain. 1. L1 lytic lesion concerning for malignant metastases with suspected breast primary malignancy - FNA of lumbar spine lesion last month significant for malignant metastatic adenocarcinoma with high suspicion of breast primary site - CT spine shows stable 9mm lytic lesion in T12 vertebral body with no new acute pathologic fracture seen. Extensive multilevel degenerative changes with prominent endplate and similar appearing Schmorl's nodes - Re-demonstration of L1 2.4 cm lytic lesion with worsening wedge deformity suggestive of new pathologic fracture. No acute lytic lesion or fracture identified within the remaining lumbar vertebrae - Extensive enhancement throughout the subdural space throughout the thoracic spine, resulting in mass-effect and deformity of portions of the spinal cord. - Dermatome pattern of numbness consistent with L1 involvement - Mammogram completed on 7/28 with results significant for right breast Bi-RADS 4 suspicious finding. Biopsy results pending. - ED has consulted ortho spine with recommendations pending PLAN - Follow up on ortho spine recommendations - Will initiate dexamethasone 4mg Q6 hours for symptomatic relief - Pain control with oxycodone, PRN morphine for now - PT/OT evaluation ordered and pending 2. Urinary tract infection - UA significant for 100 protein, small bilirubin, trace ketones, 2.0 urobilogen, trace leukocytes, negative nitrites, 6-10 WBC, calcium oxalate crystals, and present bacteria. - No evidence of renal calculi on CT abdomen - Sed rate >111, CRP 163.8, WBC: 10.84 - Patient denies current symptoms including dysuria, hematuria, or urinary frequency PLAN - Start empiric rocephin for now given signs of infection ; discontinue as indicated - Urine culture ordered and pending collection 3. Type II Diabetes Mellitus with hyperglycemia - Poorly controlled; patient A1C 1 month ago 7.8 - Home regimen includes metformin - High glucose today of 151 PLAN -FSBG ACHS -SSI not indicated at this time given stable BG; initiate if changes -Hold patient metformin, PO antihyperglycemic medications until discharge. 4. Essential hypertension - Patient has been normotensive while at the ED with high BP of 133/81 - Home medications include lisinopril-hctz PLAN - Continue to monitor vital signs and trend BP - Hold outpatient antihypertensives for now; restart as indicated - PRN IV antihypertensives for SBP sustained > 180 5. Hypercholesterolemia PLAN - Continue outpatient pravastatin 9. Morbid obesity (POA) - BMI on admission is: 40.72 - complicates multiple aspects of the patient's care PLAN - Diet and exercise counseling to be provided before discharge 8/28/21 Discharge Summary: Admission Date: 8/5/2021 Discharge Date: 08/29/21 Primary Discharge Diagnosis Spinal cord compression due to malignant neoplasm metastatic to spine (CMS/HCC) Secondary Discharge Diagnosis Patient Active Problem List Diagnosis ? Type 2 diabetes mellitus, without long-term current use of insulin (CMS/HCC) ? High cholesterol ? Metastasis to vertebral column of unknown origin (CMS/HCC) ? Closed fracture of first lumbar vertebra (CMS/HCC) ? Morbid obesity (CMS/HCC) ? Cancer associated pain ? Hypothyroidism ? Acute respiratory failure with hypoxia (CMS/HCC) ? Malignant ascites ? Urinary retention ? Spinal cord compression due to malignant neoplasm metastatic to spine (CMS/HCC) ? Peritoneal carcinomatosis (CMS/HCC) Discharge Disposition Home with home health vs. Hospice Outpatient Follow-Up Test Results Pending at Discharge Pending Labs Order Current Status Body Fluid Cell Count W/O Diff - Ascities Collected (08/26/21 1823) CBC and differential Collected (08/11/21 0544) Comprehensive metabolic panel Collected (08/11/21 0544) Fine needle aspiration - Core Biopsy Collected (08/26/21 1816) Cytology - Ascites In process Urine Culture In process AFB Culture, Non Respiratory Source and Acid Fast Stain Preliminary result Fungal Culture, Sterile Body Fluid (NOT CSF) and KOH Preliminary result DETAILS OF HOSPITAL STAY Presenting Problem/History of Present Illness Urinary retention [R33.9] Metastasis to vertebral column of unknown origin (CMS/HCC) [C79.51, C80.1] Closed fracture of first lumbar vertebra, unspecified fracture morphology, initial encounter (CMS/HCC) [S32.019A] Hospital Course Prior to this admission: Patient was admitted on 7/16/2021 with concern for spinal lesion found. An MR spine was completed, showing 10mm nodule in right superior medial posterior breast and lytic destructive lesion within the L1 vertebral body, right superior portion of T12, as well as large omental deposit. An MRI showed cord and thecal sac compression at this time, prompting ortho, neurosurgery, and IR guided biopsy of L7 that was significant for malignant metastatic adenocarcinoma with high suspicion of breast primary site as was ER+/PR+. She was subsequently discharged and mammography guided biopsy of her left breast was completed on 7/28/2021 showing fibroadenoma. Patient is a 59 y.o. female with history of T2DM, metatstatic carcinoma of unknown primary who presented to the emergency department on 8/6/2021 with progressive back pain and imaging concerning for progression of malignancy into spine, found to be COVID positive. On 8/6 she presented with new onset urinary retention with worsened lower back pain. MR of the L spine showed enhancement in the L1 vertebral body (concerning for metastatic disease) as well as compression on the thecal sac and cauda equina. She was admitted to medicine. Neurosurgery was consulted who had no acute surgical intervention to offer. Patient was initiated on dexamethasone as well as remdesivir for COVID-19 infection. Oncology was consulted on 8/10 and recommended initiation of anastrozole and continuation of dexamethasone for cord compression. Radiation oncology was consulted on 8/20 and performed palliative radiation therapy. Overall patient's functional status is very poor. Throughout her entire 23 day hospitalization she was unable to participate in care, unable to walk or urinate without a catheter secondary to her

Other Meds: amlodipine, aspirin, calcium carbonate, fluticasone nasal spray, levothyroxine, lisinopril-hydrochlorothiazide, melatonin, pravastatin, gabapentin, oxycodone, paroxetine, omeprazole, metformin

Current Illness:

ID: 1666116
Sex: M
Age: 12
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: 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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1666117
Sex: F
Age: 28
State: IA

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

Lab Data:

Allergies:

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

Symptoms: The patient has not identified any adverse effects, but the patient did not inform us that she had already been vaccinated with 1 dose of Pfizer before receiving the Johnson & Johnson vaccine.

Other Meds:

Current Illness:

ID: 1666118
Sex: F
Age: 12
State: TX

Vax Date: 08/19/2021
Onset Date: 08/30/2021
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: Ultrasound.

Allergies: No

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

Symptoms: Inflamed appendix.

Other Meds: Zyrtec

Current Illness: No

ID: 1666119
Sex: M
Age: 68
State: MD

Vax Date: 08/25/2021
Onset Date: 08/26/2021
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:

Allergies: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: 8/26/21: At 23 hours, general tiredness; fever of 101.3; fever dissipated in 8 hours 8/28/21: At 60 hours; severe night sweats

Other Meds: 1) Lumigan Opth Soln 7.5ml0.01% - One drop each eye once a day 2) Losartan Tabs 25mg ? Once a day 3) Hydrochlorothiazide Tabs 12.5mg ? Once a day 4) Omeprazole Dr Caps 40mg ? Once a day 5) Atorvastatin Tabs10mg ? Once a day

Current Illness: None

ID: 1666120
Sex: F
Age: 50
State: LA

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

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Site: Swelling at Injection Site-Medium, Systemic: Lymph Node Swelling-Medium

Other Meds:

Current Illness:

ID: 1666121
Sex: M
Age: 60
State: ND

Vax Date: 03/04/2021
Onset Date: 03/04/2021
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: Unknown

Allergies: None.

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

Symptoms: Unknown

Other Meds: Unknown

Current Illness: Unknown

ID: 1666122
Sex: F
Age: 79
State: FL

Vax Date: 02/02/2021
Onset Date: 08/12/2021
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: Went to ENT Dismissed my ears ringing. Said I needed hearing aids. Follow up 09-15-21 for hearing aids.

Allergies: sulfer

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

Symptoms: August 12, 2021 tinnitus - ringing in ears. Constant ringing in my ears still to this date.

Other Meds: aspirin 81 mg, 1 daily ibuprofen 400 mg, 2x daily gemfibrozil 600 mg, 2x daily simvastatin 40 mg, 1x daily lisinopril/hctz 10-1.5 mg, 2x daily

Current Illness: n/a

ID: 1666123
Sex: F
Age: 36
State: TX

Vax Date: 08/25/2021
Onset Date: 08/30/2021
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: n/a

Symptom List: Unevaluable event

Symptoms: numb feeling left side of face following by pain towards the back of my head

Other Meds: pre workout bucked up

Current Illness: n/a

ID: 1666124
Sex: M
Age: 18
State: MN

Vax Date: 09/01/2021
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: LA

Lab Data:

Allergies:

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

Symptoms: Systemic: Chills-Mild, Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Severe, Systemic: Nausea-Severe, Systemic: Shakiness-Medium, Systemic: Vomiting-Severe, Systemic: Weakness-Severe

Other Meds:

Current Illness:

Date Died: 04/30/2021

ID: 1666125
Sex: F
Age: 73
State: TN

Vax Date: 02/04/2021
Onset Date: 04/09/2021
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:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: cough, SOB, hypoxia, confusion

Other Meds:

Current Illness:

ID: 1666126
Sex: M
Age: 97
State: FL

Vax Date: 08/23/2021
Onset Date: 08/27/2021
Rec V Date: 09/02/2021
Hospital: Y

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

Lab Data: POSITIVE COVID TEST 08/27

Allergies: NKA

Symptom List: Injection site pain, Menorrhagia

Symptoms: arrivied via ems from home, fell, per pt missed the chair, no head injury, no LOC, denies any blood thinners, pt did C/O weakness x3 days. Covid exposure 3 days ago

Other Meds: aspirin 81 mg oral tablet, chewable, 81 mg= 1 TAB, PO, Daily melatonin 10 mg oral tablet, 10 mg= 1 TAB, PO, QHS (At bedtime) metFORMIN 500 mg oral tablet, 500 mg= 1 TAB, PO, BID (2 times a day) pravastatin 40 mg oral tablet, 40 mg= 1 TAB

Current Illness:

ID: 1666127
Sex: M
Age: 17
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: 025J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1666128
Sex: M
Age: 67
State: FL

Vax Date: 04/26/2021
Onset Date: 05/11/2021
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: NKA

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Pt came to ER c/o SOB, weakness, dizziness, fever, chills, abdominal pain.

Other Meds:

Current Illness:

ID: 1666129
Sex: M
Age: 66
State: MI

Vax Date: 04/03/2021
Onset Date: 09/01/2021
Rec V Date: 09/02/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Positive covid 19 by PCR, symptomatic

Other Meds:

Current Illness:

ID: 1666130
Sex: F
Age: 41
State: FL

Vax Date: 08/30/2021
Onset Date: 08/31/2021
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: Lisinopril Cipro Latex Egg whites Cows milk

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

Symptoms: Covid arm

Other Meds: Metoprolol Lipitor Multivitamins

Current Illness: N/a

ID: 1666131
Sex: F
Age: 41
State:

Vax Date: 03/21/2021
Onset Date: 03/21/2021
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: The night of the vaccination- dizzy, cold sweat, uncontrollable shivering, muscle pain, headache

Other Meds: Contrave, Vitamin D3, Vitamin C, Zyrtec

Current Illness: None

ID: 1666132
Sex: F
Age: 66
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: 1666133
Sex: F
Age: 65
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: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1666134
Sex: M
Age: 17
State: GA

Vax Date: 08/01/2021
Onset Date: 08/28/2021
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: RA

Lab Data: Creatine, BNP, Troponin, ALT, AST, Ferritin, Ddimer, Fibrinogen, CRP, and ESR all elevated. EKG and ECHO abnormal. Has received solumedrol and IVIG

Allergies: NKA

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

Symptoms: 17y / male presents 8/29/2021 with 4 days of symptoms: fever, tachycardia, vomiting, congestion, and red eyes diagnosed with MIS-C

Other Meds: none

Current Illness: none

ID: 1666135
Sex: F
Age: 55
State: KY

Vax Date: 03/12/2021
Onset Date: 08/25/2021
Rec V Date: 09/02/2021
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: 8/23/21: SARS CoV-2/COVID-19 RNA PCR Detected 8/25/21: - O2 sat 91% on RA at rest. VBG 7.35/55/23/31. - CXR showing mild basilar opacities (L>R) representing atelectasis vs early infection - Afebrile with WBC (8), procal minimally elevated (0.18). CRP (127) d-dimer (0.43) - lymphocytes 7.0% 8/28/21: - lymphocytes 30.0%

Allergies: Shellfish (anaphylaxis), morphine (nausea)

Symptom List: Tremor

Symptoms: History of present illness (8/25/21): This is a 55 year old female with known COVID-19 infection (symptom onset 08/21/21 and positive test 08/23/21) and PMHx including DMII, OSA, HTN, and obesity who presents to ED for progressively worsening shortness of air. Pt. reports initial symptoms included headache, body aches, and nausea/vomiting/diarrhea. She notes a productive cough with green sputum, and has developed left-sided rib pain with coughing. Pt. completed 2 series Pfizer covid vaccination on 03/12/2021. Review of Systems (8/25/21): Constitutional: Positive for activity change, appetite change, chills, fatigue and fever. Respiratory: Positive for cough, chest tightness and shortness of breath. Negative for wheezing. Gastrointestinal: Positive for diarrhea, nausea and vomiting. Negative for abdominal distention, abdominal pain and constipation. Musculoskeletal: Positive for myalgias. Negative for back pain, gait problem and joint swelling. #Acute hypoxic respiratory failure 2/2 SARS CoV2 bilateral pneumonia (8/25/21) - Pt. O2 sat 91% on RA at rest. VBG 7.35/55/23/31. - CXR showing mild basilar opacities (L>R) representing atelectasis vs early infection - Afebrile with WBC (8), procal minimally elevated. CRP (127) LDH () d-dimer (0.43) - 08/25 ? starting Remdesivir and dexamethasone 6 mg PO daily with GI ppx #Acute hypoxic respiratory failure 2/2 COVID-19 PNA (8/28/21) - Initially required O2 via NC - CXR showing mild basilar opacities (L>R) - Continue remdesivir for 5 day course-- > end date 8/29 - Continue dexamethasone for 10 day course-- > end date 9/3 - Trend CRP and CMP while on remdesivir - Mucinex, dextromethorphan, albuterol MDI PRN - Supplemental O2 for sats >92% Discharged home 8/29/21

Other Meds: Amitriptyline, amlodipine, atorvastatin, baclofen, cetirizine, clindamycin 1% external solution, cyclobenzaprine, estradiol (Vivelle-Dot) patch, fexofenadine, fluticasone nasal spray, hydrochlorothiazide, linaclotide, lisinopril, metformin,

Current Illness:

ID: 1666136
Sex: U
Age: 51
State: MI

Vax Date: 04/01/2021
Onset Date: 08/31/2021
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:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Cardiac arrest, covid19 8/20

Other Meds:

Current Illness:

ID: 1666137
Sex: F
Age: 69
State: CA

Vax Date: 08/16/2021
Onset Date: 08/16/2021
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:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1666138
Sex: F
Age: 38
State: IL

Vax Date: 08/29/2021
Onset Date: 09/02/2021
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: Lodine- anti inflammatory Reglan

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

Symptoms: Dizziness Bilateral arm tingling/cold White nail beds when standing

Other Meds: Fluoxetine Alprazolam

Current Illness:

ID: 1666139
Sex: F
Age: 58
State: MN

Vax Date: 08/23/2021
Onset Date: 08/24/2021
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: na

Allergies: Eggs, multiple antibiotics, talwin

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient came in to report today 9/2, that she had been experiencing lasting symptoms after receiving her Moderna shot a week and a half ago. Pt reports redness and a raised area around the injection site (4 inch diameter) and some swelling of the arm. Pt sounds congested and reports feeling absolutely miserable during this time. No change in symptoms over time. Patient has been on prednisone taper (40mg, now on 30mg) for unrelated condition, but it was unable to control symptoms. Recommended seeing regular provider since any minor discomfort should have resolved by now.

Other Meds: Unknown

Current Illness: Asthma like symptoms from recent wildfires in the areas, not debilitating.

ID: 1666140
Sex: M
Age: 44
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: 011J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: Unknown

Allergies: Amoxicillin

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

Symptoms: Unknown

Other Meds: Unknown

Current Illness: Unknown

ID: 1666141
Sex: F
Age: 33
State: IL

Vax Date: 09/01/2021
Onset Date: 09/02/2021
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: No

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

Symptoms: Fatigue, headache, dizziness, nauseous, diarrhea, sore arm

Other Meds: Imitrex, Phentermine, Flexeril, naproxen, Clonazepam, Pantoprazole

Current Illness: No

ID: 1666142
Sex: M
Age: 65
State: MS

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

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: Patient received Moderna vaccine for first in series and Pfizer for second in series accidently. Followed up with patient and reaction reported.

Other Meds:

Current Illness:

ID: 1666143
Sex: F
Age: 56
State: PA

Vax Date: 08/14/2021
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:
Dose Series: 2
Vax Route:
Vax Site:

Lab Data: Negative covid test on 08/26/2021 Negative chest x-ray Negative EKG Follow up with doctor on 02/09/21- chest sounds fine. Treating me for allergies.

Allergies:

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

Symptoms: Minor shortness of breath

Other Meds: Methotrexate Simponi Celebrex Chlorthalidone

Current Illness: Shingles

ID: 1666144
Sex: F
Age: 0
State: MI

Vax Date: 09/02/2021
Onset Date: 09/02/2021
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: 09/02/2021

Allergies: no

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

Symptoms: Patient received vaccine too early. The patient was not due for vaccine until 2023

Other Meds: no

Current Illness: no

ID: 1666145
Sex: F
Age: 40
State: UT

Vax Date: 08/20/2021
Onset Date: 08/28/2021
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: none

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

Symptoms: at day 10 light red round circle surrounding injection site. each day heat and swelling gets bigger and bigger

Other Meds: Effexor Xr

Current Illness: none

ID: 1666146
Sex: M
Age: 5
State: VA

Vax Date: 09/02/2021
Onset Date: 09/02/2021
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: none

Symptom List: Vomiting

Symptoms: Client received both one dose of Pediarix and one dose of IPV in the same visit.

Other Meds: none

Current Illness: none

ID: 1666147
Sex: F
Age: 62
State: PA

Vax Date: 08/05/2021
Onset Date: 08/07/2021
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:

Allergies: None.

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Tightness in the chest area, wheezing, dry cough, a shortness of breath, body aches, severe headaches, fatigue.

Other Meds: None.

Current Illness:

ID: 1666148
Sex: M
Age: 68
State: WI

Vax Date: 03/23/2021
Onset Date: 08/25/2021
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: CORONAVIRUS (COVID 19) RT PCR (URGENT/EMERGENT REQUEST) [275771018] (Abnormal) Collected: 08/25/21 1544 Specimen: NASOPHARYNGEAL SWAB CORONAVIRUS SARS COV 2 PCR (RESP) POSITIVE

Allergies:

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

Symptoms: 68 yo male with PMH of ESRD, hemodialysis T/T/S, CAD, DMT2, who lives at home with 7 other housemates, admitted from our ER with COVID-19 infection on 8/26/21. He presented to ER with complaints of weakness, fatigue, dry cough for about week and a half. In ER COVID-19 PCR positive. CXR without infiltrates. During his stay didn't require supplemental oxygen. Respiratory status being stable. Supportive only treatment has being provided. His fatigue improved significantly, at discharge (9/1/21), he is ambulation without any assistance 150 ft, able to self care. Oxygen level 97% with activities.

Other Meds:

Current Illness:

ID: 1666149
Sex: M
Age: 45
State: GA

Vax Date: 07/17/2021
Onset Date: 07/19/2021
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: ECHO : looks good ETT : looks good Blood test : High CK: 512 range 0-190

Allergies: no

Symptom List: Injection site swelling, Limb discomfort

Symptoms: initial symptom: pressure on the heart on and off for five weeks after the first shot. more severe symptom: heart vibrating at night 2 weeks after first shot 3am most severe symptom: heart vibrating at night. woke me up. could feel a sensation in hands and feet. the night of the second shot 2am.

Other Meds: vitamin D3

Current Illness: no

ID: 1666150
Sex: F
Age: 69
State: VA

Vax Date: 03/17/2021
Onset Date: 03/17/2021
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: RA

Lab Data: Ask my doctor!

Allergies:

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

Symptoms: Began vomiting and having diarrhea an hour after vaccine. Became dehydrated, did not know who I was or where I was. Fell down repeatedly, just laid there trying to figure out what was wrong! Finally fell so hard I broke my spine in two! Repeated trips to ER and admitted each time!

Other Meds:

Current Illness:

ID: 1666151
Sex: F
Age: 15
State: WI

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: RA

Lab Data: N/A

Allergies: none

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

Symptoms: Vaccine stored in immunization refrigerator from deep freeze state on July 20, 2021. Vaccine administered on August 30, 2021 which exceeds recommended storage time. Vaccine vial expiration was August 31, 2021. Client with NO adverse reactions noted.

Other Meds: none

Current Illness: no

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am