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: 1666812
Sex: M
Age: 64
State: CA

Vax Date: 04/15/2021
Onset Date: 04/25/2021
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: Blood test 05-19-21 ACETYLCHOLINE RECEPTOR BINDING ANTIBODY 2.26 H; Blood test 06-15-21 ACETYLCHOLINE RECEPTOR BINDING ANTIBODY 1.88 H

Allergies: Penicillin

Symptom List: Dysphagia, Epiglottitis

Symptoms: Hiking 2 weeks after 2nd dose Moderna Vaccine. Started seeing severe double vision. Next day said go to ER. MRI came out fine, ER Dr. referred to ophthalmologist. After 2 visits ophthalmologist request myasthenia gravis test which came back positive. Saw neurologist 06/03/21, had many tests, CT, CTA, MRI, etc testing positive for myasthenia gravis. Never had any previous eye or neurological issues, saw on-line that COVID patients in Italy came down with MG and that virus may trigger MG. Saw on news 07-12-21 that the J&J vaccine may trigger a similar auto-immune condition. I fought to get the vaccine and would take it again but think this may be connected, the timing is too suspicious.

Other Meds: Simvastatin 20mg/day, Aspirin 81md/day, Multiple Vitamins,

Current Illness: None

ID: 1666813
Sex: F
Age: 42
State: NV

Vax Date: 07/24/2021
Onset Date: 07/24/2021
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: None

Allergies: None

Symptom List: Anxiety, Dyspnoea

Symptoms: I?ve always had an occasional heart palpitation but ever since my second moderna dose I?m have constant palpitations.I also skipped my period for a month,along with serious fatigue now.

Other Meds: One a day vitamin, nature?s bounty hair vitamin, tizanidine,ambien

Current Illness: None

ID: 1666814
Sex: M
Age: 47
State: GA

Vax Date: 07/18/2021
Onset Date: 08/01/2021
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: none

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

Symptoms: Patient is experiencing bilateral lower extremity numbness and tingling to the point where he cannot feel his feet, he cannot feel the floor, and he is almost falling.

Other Meds: none

Current Illness: none

ID: 1666815
Sex: F
Age: 54
State: FL

Vax Date: 03/15/2021
Onset Date: 03/21/2021
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: 3-22-2021 to 3-24-2021; Chest X-ray; EKG; Echocardiogram; Chest CT scan; Coronary CTA Scan; Blood tests/Count; Hematology; Routine Coagulation; Routine Chemistry; Lipids CV Risks; Urine Chemistry; Urinalysis Autoimmune; General Serology; Molecular Infections; April and May 2021 Holter Scan; Echocardiogram; September 1, 2021; EKG

Allergies: None known

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Chest pain, shortness of breath, rapid heart rate, painful breathing, symptoms developed 6 days after vaccine on 3/21/2021 and progressed rapidly. 3/22/2021 I was sent to ER by my PCP. My condition had worsened, I was in a lot of pain with difficulty breathing and a very rapid heart rate. I was admitted to Hospital through the ER after they diagnosed my condition as pericarditis.

Other Meds: Amlodipine 10 mg; Levothyroxine 100 mcg

Current Illness: None

ID: 1666816
Sex: M
Age: 35
State: GA

Vax Date: 08/13/2021
Onset Date: 08/14/2021
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: Celexa, Oxycodone,morphine, naproxen, pennicilin

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

Symptoms: Dizziness and brain fog. Severe fatigue for 14 days

Other Meds: omeprazole

Current Illness:

ID: 1666817
Sex: F
Age: 32
State:

Vax Date: 04/15/2021
Onset Date: 08/28/2021
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: Patient became ill and tested PCR positive for Covid > 14 days after the completion of vaccine series

Other Meds:

Current Illness:

ID: 1666818
Sex: F
Age: 59
State: MN

Vax Date: 01/14/2021
Onset Date: 08/31/2021
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: none

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: cough, fatigue, HA, body aches. starting on 8/29/21

Other Meds: probiotic; Calcium; Ibuprofen; Vitamin D and C

Current Illness: none

ID: 1666819
Sex: F
Age:
State: IL

Vax Date: 03/01/2021
Onset Date: 03/01/2021
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: I am more fatigue. Now I am more panic attacks than before.

Other Meds: Hydrochories

Current Illness:

ID: 1666820
Sex: F
Age: 11
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKMA

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: I gave Meningococcal B instead of the Meningococcal polysaccharide. No adverse reacation

Other Meds: no medication

Current Illness: none

ID: 1666821
Sex: F
Age: 42
State: GA

Vax Date: 08/04/2021
Onset Date: 08/06/2021
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: MRI of the brain; pending results from doctor; scheduled 09-09-2021 for MRI results

Allergies: Cleaning chemicals; Keflex (causes rash and chest pressure); I suffer from allergies and they have given me steroids for treatment

Symptom List: Diarrhoea, Nasal congestion

Symptoms: I received my vaccine on 08-04-2021 and experienced terrible, bad headaches. For five days I could not get up from bed. I also vomited on the day of the vaccine. I went to see my PCP but he was not taking any appointments. I then started to take Tylenol for pain. When I take the Tylenol medication my pain goes down a bit but I have to be taking the Tylenol every 4-6 hours. I can not lie flat on my bed, and my head pain is located at the back of my head and base of neck region. I also apply Vicks vapor rub for the pain. My left arm is hurting and I also have numbness sensation that radiates to my hand. I had lab work done, and all my results were normal. An MRI of the brain was performed yesterday and I was put an IV intravenously. My doctor called me and told me for me to continue taking the two mediations for my migraine headaches, which are Amitriptyline and Topiramate. I also have the sensation to vomit but I can not vomit. I have nausea that does not go away. I will see my doctor on 09-09-2021 for my MRI results.

Other Meds:

Current Illness:

ID: 1666822
Sex: F
Age: 34
State: IL

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

Lab Data:

Allergies: Almonds Avocado fresh fruit and veggies diamox cipro vancomycin fiorcet kelflex latex topiramate bananas

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

Symptoms: Vomiting, weakness , vision changes ,blurry vision , vision off focus

Other Meds: Furosemide potassium

Current Illness: Papilledema, psudeotumor ( idopatic intercrainal hypertension) asthma sleep apnea anemia

ID: 1666823
Sex: F
Age: 23
State: MD

Vax Date: 04/24/2021
Onset Date: 04/24/2021
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: unknown

Allergies: unknown

Symptom List: Rash, Urticaria

Symptoms: The client was driving home after injection with Moderna COVID19 vaccine Lot 009C21A, LA via IM, stated that her neck felt like it was on fire, and started to have difficulty breathing. Pt drove back to the clinic and wanted EMS assessment. Pt states nut allergy.

Other Meds: un known

Current Illness: unknown

Date Died: 08/19/2021

ID: 1666824
Sex: F
Age: 76
State: PA

Vax Date: 02/28/2021
Onset Date: 08/19/2021
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: Unknown

Other Meds:

Current Illness:

ID: 1666825
Sex: M
Age: 52
State: TN

Vax Date: 08/26/2021
Onset Date: 08/27/2021
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: None

Allergies:

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

Symptoms: Soreness at point of injection, migraine headache, chills, sweats, nausea, shortness of breath, tightness in chest. Extreme fatigue.

Other Meds: Benazepril /Trelegy Ellipta/ Eszopiclone/ Fluoxetine/Fenofibrate/Albuterol/ Fluticasone/Montelukast Azelastine/Rosuvastatin/Alprazolam Vitamin D/Zinc/Fish oil/Glucosamine joint supplement

Current Illness:

ID: 1666826
Sex: F
Age: 62
State: AZ

Vax Date: 08/27/2021
Onset Date: 08/27/2021
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: Codeine, Demerol

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

Symptoms: Pain, unable to lift my arm. Extreme pain trying to move my arm. Nausea, vomiting. Flu symptoms.

Other Meds: Gaba pentin, ambian, calcium, vitamins, A, D. K,

Current Illness: None

ID: 1666827
Sex: F
Age: 79
State: MI

Vax Date: 03/15/2021
Onset Date: 09/01/2021
Rec V Date: 09/02/2021
Hospital: Y

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

Lab Data:

Allergies: NKMA

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

Symptoms: Pt had been feeling unwell (generalized malaise) for the past 10 days. She suffered a ground level fall while in the shower and was found to have an occluding thrombus of the proximal ICA as well as COVID-19.

Other Meds: Celexa Cozaar Ditropan Toprol XL Zetia

Current Illness:

ID: 1666828
Sex: F
Age: 72
State: WA

Vax Date: 03/02/2021
Onset Date: 03/03/2021
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: Cervical and shoulder x-rays- diagnosis was brachial plexus neuritis

Allergies: Sulfa; bee stings

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

Symptoms: I received the injection at about 12 and I was fine. I became uncomfortable with upper back pain when I went to bed. I really didn't sleep that night because of the discomfort. By the next day I was able to get up and make my self breakfast but I felt very faint so I went back to bed. I didn't eat or drink most of that day. No fever that I recall. The pain centered in the upper right back, around the shoulder blade. Through the next few days it radiated down the arm with lots of pain. All of this pain was on the right side. Tingling in the hand. I medicated with pain medicine until the following week when I went to the chiropractor. After 2 weeks of seeing the chiropractor he determined that the pain was severe enough we should do something else. After the third week I saw the PA and her diagnosis was brachial plexus neuritis and she put me on steroids for a few days and there was some relief the first day and then not. When I called her after the 5 days were off. She put me on a high dose steroid. I used Tramadol when Tylenol did not do anything. At the end of the treatment with steroids the pain started to increase again and she gave me Flexeril muscle relaxer for about 5-6 nights at bed time. Then finally 3 months till the day after this all started it went away as quickly as it had come. That happened in June 2nd. I also saw a neurosurgeon and orthopedic surgeon for shoulder pain. The neurosurgeon looked at the x-rays and did not order an MRI. I continued to walk every day, I was able to sleep once I saw that particular physician.

Other Meds: Hydralazine 25 mg 4 times a day; Bisoprolol 5 mg daily; Detrol LA 2 mg daily; 8 hour Tylenol twice a day; Fenofibrate145 mg daily; Doxycycline Mono 100 mg daily; Ambien; Omeprazole 20 mg once or twice a day; L-Thyroxine 50 mcg daily; Flonas

Current Illness: None

ID: 1666829
Sex: M
Age: 50
State:

Vax Date: 08/23/2021
Onset Date: 08/30/2021
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:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: everything hurts, dizzy, bad chest pains, all symptoms of virus

Other Meds:

Current Illness:

ID: 1666830
Sex: F
Age: 32
State: MN

Vax Date: 08/16/2021
Onset Date: 08/17/2021
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: 8/18/21 - ecg, chest X-ray, blood tests, chest ct 8/26/21- follow up appointment, feeling better

Allergies: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Sore muscles, joints, and skin 8/17/21 am. Temperature of 103F 8/17/21 pm 8/18/21 am - severe pulsing pain in chest that?s subsided in urgent care and was replaced by a feeling of pressure on the chest

Other Meds: Prenatal vitamin

Current Illness: None

ID: 1666831
Sex: F
Age: 23
State:

Vax Date: 05/26/2021
Onset Date: 08/19/2021
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:

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

Symptoms: Patient became ill and tested PCR positive for Covid > 14 days after the completion of vaccine series

Other Meds:

Current Illness:

ID: 1666832
Sex: M
Age: 34
State: MD

Vax Date: 04/24/2021
Onset Date: 04/24/2021
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: unknown

Allergies: unknown

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

Symptoms: After vaccination with Moderna COVID19 vaccination, Lot 009C21A, the patient states felt warm and tingly and became sweaty and dizzy. Pt refused transport.

Other Meds: unknown

Current Illness: unknown

ID: 1666833
Sex: F
Age: 44
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: N/A

Allergies: sulfa drugs

Symptom List: Unevaluable event

Symptoms: headache, muscle aches, fatigue

Other Meds: Allertec, sinus decongestant, Vitamin D, Turmeric, probiotics, Magnesium, Calcium, Zinc, Fish Oil, Stelara, metformin

Current Illness: none

ID: 1666834
Sex: M
Age: 21
State: CA

Vax Date: 09/02/2021
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: CBC and CMP.

Allergies: Penicillin

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

Symptoms: Patient received vaccine around 0940 and around 1200-1230 patient described feeling warm/hot, body began to turn red. experienced headaches and nausea with 1 episode of emesis prior to arrival to ED. patient arrived to Emergency department at 1300, was placed on monitors, IV placed. IV fluids given and antiemetics and pain meds given. patient discharged with sick note.

Other Meds: none

Current Illness: none

ID: 1666835
Sex: F
Age: 20
State: AZ

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: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKA

Symptom List: Injection site pain, Pain

Symptoms: Rash/hives developing on neck, torso and under arms, sent to ER/urgent care

Other Meds: None

Current Illness: None

ID: 1666836
Sex: F
Age: 67
State: GA

Vax Date: 02/19/2021
Onset Date: 08/06/2021
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:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient symptoms onset was on 8/6, she was hospitalize at Hospital in city from 8/10 through 8/16 and diagnosed with COVID pneumonia. She will be in isolation until 8/26. PUI other underlying condition/risk factors lung cancer, melanoma and previously suffered a stroke.

Other Meds:

Current Illness:

ID: 1666837
Sex: F
Age: 52
State: TX

Vax Date: 01/20/2021
Onset Date: 02/10/2021
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: MRI , Scope with ENT, hearing exam

Allergies: No

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

Symptoms: February 10, 2021 left ear was having tinnitus. Went to general practitioner a month later and the prescribed Zertec and Phlonaise for the pressure in your ear, looked at ear an stated it was bulging but not infected said that you had pressure in the ear. Six weeks later for a visit still had tertius and pressure and was referred to the audiologist. Audiologist a full evaluation no hearing loss in either ear but Asymmetrical pressure with left ear having a lot of pressure. Then was referred to ENT end of June. She did a scope from note to ear and also notice pressure in left ear and was referred to Gastroenterologist. 08/15/2021 order an MRI of brain to look at Choclear nerver have brain MRI normal.

Other Meds: Zertec 10 mg, Estodial .02 twice a week patch, Prilosec 20 mg 1 daily, Hydrochlorothiazide 25 mg once a day,

Current Illness: No

ID: 1666838
Sex: F
Age: 63
State: IL

Vax Date: 08/16/2021
Onset Date: 08/16/2021
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: Went to Dr on 8/19/21 physical examine was done

Allergies: no

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Racing heart and burning scalp .Hives on right side of head . Feels like a headache on right side

Other Meds: no

Current Illness: no

ID: 1666839
Sex: F
Age: 20
State: MD

Vax Date: 04/24/2021
Onset Date: 04/24/2021
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: unkown

Allergies: unknown

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: After vaccination with Moderna COVID19 009C21A vaccination in LA via IM, the patient is feeling faint, feeling dizzy, hot, sweaty, and decreased hearing in the left ear (has had similar reactions in past).

Other Meds: unknown

Current Illness: unknown

ID: 1666840
Sex: F
Age: 58
State: CA

Vax Date: 08/31/2021
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: patient states that she is allergic to many things

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

Symptoms: patient stated that her hands, ears, and eyes became swollen, red and itchy, seeing blurry, throat burning,

Other Meds: not known

Current Illness: not known

ID: 1666841
Sex: M
Age: 33
State: AL

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: After giving injection and importing information into database we discovered pt. had previously received the Janssen vaccine on 3/10/21. I called pt. to ask if this information was correct and he said that "I didn't know that I could not receive both.". Pt, was asymptomatic at the time I spoke with him on the phone.

Other Meds:

Current Illness:

ID: 1666842
Sex: F
Age: 40
State: CT

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: PATIENT HAS A HISTORY OF GBS AND A FEW HOURS AFTER ADMINISTRATION SHE STARTED HAVING NUMBNESS IN THE LOWER PART OF HER FACE AND HER HANDS. OVER THE COURSE OF A FEW DAYS IT SPREAD TO HER EXTREMETIES AND HAS NOT RESOLVED AS OF 9/2/21.

Other Meds:

Current Illness:

ID: 1666843
Sex: F
Age: 21
State: SD

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

Lab Data:

Allergies: none

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

Symptoms: after about 5 hours of getting the COVID vaccine patient experienced elevated blood pressure, feeling achy and off. Felt her heart racing. Sat down at work and was just staring off into space. Eyes rolled back. Felt like she was going to pass out, but did not lose consciousness. she was taken to the emergency room lab work done, everything normal, did get better with rest. recommendations to go home and rest and drink plenty of fluids.

Other Meds: vesicare 10mg

Current Illness:

ID: 1666844
Sex: F
Age: 29
State:

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

Lab Data:

Allergies:

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

Symptoms: Got Pfizer COVID vaccine in 8/2021, since has been having numbness, tingling in both hands and both feet. Right foot has been going numb. Has never had issues before.

Other Meds:

Current Illness:

ID: 1666845
Sex: F
Age: 33
State: NV

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: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Tremor

Symptoms: 2 hours after getting shot, I had rapid heart beating along with fever and fatigue. Then around 8pm I began having a hard time breathing, I could not take full inhalation?s and my throat was swollen.

Other Meds: Synthroid 75mcg Symbicort 160/4.5 Montelukast 10mg Vitamin C Zinc Vitamin D

Current Illness: None

ID: 1666846
Sex: F
Age: 46
State: OR

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

Lab Data: None

Allergies: Sulfa drugs

Symptom List: Erythema, Pruritus

Symptoms: Vomiting, severe muscle and joint pain, headache

Other Meds: Wellbutrin, effexor, Lamictal, provigil, Ativan, zofran

Current Illness: None

ID: 1666847
Sex: M
Age: 39
State: KS

Vax Date: 08/12/2021
Onset Date: 08/15/2021
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: None.

Allergies: Fin Fish, Shellfish

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

Symptoms: I have had (2) cases of urticaria in a short period of time since my vaccination and have not eaten any foods that can trigger my food allergy. Any epinephrine injection was required to combat anaphylaxis. Stomach issues still persist.

Other Meds: Desvenlafaxine

Current Illness: None

ID: 1666848
Sex: M
Age: 39
State: KS

Vax Date: 08/12/2021
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: None.

Allergies: Fin Fish, Shellfish

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

Symptoms: I have had (2) cases of urticaria in a short period of time since my vaccination and have not eaten any foods that can trigger my food allergy. Any epinephrine injection was required to combat anaphylaxis. Stomach issues still persist.

Other Meds: Desvenlafaxine

Current Illness: None

ID: 1666849
Sex: F
Age: 18
State: OH

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:

Allergies: NKA

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: PATIENT WAS GIVEN SECOND DOSE OF MODERNA AT ONLY A 20 DAY INTERVAL

Other Meds: NONE

Current Illness: NONE REPORTED

ID: 1666850
Sex: F
Age: 50
State: MO

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

Lab Data:

Allergies:

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

Symptoms: 2:50 Pt complained of numbness and tingling at the tip of her tongue and a funny taste in her mouth after vaccination. 2:55 Benadryl 25mg given. 2:58 Vitals were stable throughout her episode. 2:55 151/92. o2 sat 100% pulse 81 3:20 final vitals B/P 120/79, 02 sat 100 pulse 68 3:30 Pt. felt much better, tingling and taste in her mouth was gone. Advised to follow up with MD.

Other Meds:

Current Illness:

ID: 1666851
Sex: F
Age: 47
State: WA

Vax Date: 07/24/2021
Onset Date: 07/24/2021
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: None

Allergies: Sulfa, vioxx, slight rash from penicillin

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

Symptoms: Since last report my breathing issues worsened. Just doing small chores caused me being unable to breath. My lungs hurt. Dr prescribed ventolin inhaler and Symbicort. I'm starting to be able to breathe better.

Other Meds: Viibryd, Buproprion SR, amitryptaline, tizanidine, emgality, Ubrevly, zyrtec, ibuprofen, excedrin migraine, Flonase, mucinex (due to first vaccine), hyaluronic acid, magnesium 1000mg, vitamin d3 5000IU, alive ultra multivitamin, garden of l

Current Illness: Seasonal allergies Breathing issues from first vaccine

ID: 1666852
Sex: M
Age: 71
State: IL

Vax Date: 03/04/2021
Onset Date: 09/01/2021
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: Blood test

Allergies: None

Symptom List: Pain in extremity

Symptoms: I requested a blood test to determine how effective my vaccine still is after six months. The results of the blood test was non-reactive. According to the doctor, I am not protected at all anymore, just six months after my vaccination and I don?t know what to do now.

Other Meds: Call me and I will let you know. I am not going to list them all here.

Current Illness: Smoldering multiple myeloma

ID: 1666853
Sex: F
Age: 53
State: MO

Vax Date: 09/02/2021
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:
Dose Series: 2
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: Patient was given 1st Moderna dose from a vial that had been sitting out for more than 12 hours.

Other Meds:

Current Illness:

ID: 1666854
Sex: F
Age: 19
State: MI

Vax Date: 08/04/2021
Onset Date: 08/21/2021
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: Serum Beta HCGs 9/1/21: 13 8/25/21: 365 8/23/21 : 600

Allergies: Penicillin

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

Symptoms: Spontaneous Abortion at approx. 6 weeks gestation.

Other Meds: Prenatal vitamin daily Iron 325 mg daily

Current Illness: None

ID: 1666855
Sex: F
Age: 68
State: AZ

Vax Date: 08/03/2021
Onset Date: 08/31/2021
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: Rocephin,Wellbutrin, bellamine

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

Symptoms: Mild aches and pain

Other Meds: Atenolol,atorvastatin, escitalopram,estradiol, methylphenidate, quinapril, multi vitamin, fish oil, vitamin c,d,b12,coq10,turmeric,baby aspirin,probiotic,zinc,acid reducer, calcium, collagen,

Current Illness:

ID: 1666856
Sex: F
Age: 26
State: NY

Vax Date: 08/26/2021
Onset Date: 08/31/2021
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: x-ray 8/31/21 at hospital

Allergies:

Symptom List: Vomiting

Symptoms: Patient developed pain, redness, and swelling at site of injection 8/31/21. Did a telemedicine visit on 8/31/21 and was directed to go to the emergency department as they thought could be a blood clot. Went to ED and received an x-ray and was told to follow up with her primary provider. She was seen by her primary care provider today, 9/2/21, who said based on the appearance of her arm today, 9/2/21, it was the wrong location in the upper arm/deltoid region that the shot was given which is what caused the issue and not the vaccine itself. Patient's primary care provider said appears she is healing just fine at this time.

Other Meds: eliquis

Current Illness:

ID: 1666857
Sex: M
Age: 60
State: MD

Vax Date: 04/24/2021
Onset Date: 04/24/2021
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: unkown

Allergies: unknown

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: patient states side effects of trouble breathing with first vaccination on 3/31/2021 Moderna COVID 19 vaccine Lot number 025B21A.

Other Meds: unknown

Current Illness: unknown

ID: 1666858
Sex: M
Age: 47
State: MI

Vax Date: 07/05/2021
Onset Date: 09/01/2021
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: NKMA

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

Symptoms: Pt has a past medical history of Down Syndrome , recurrent left knee effusions, acalculous cholecystitis s/p cholecystectomy, and anemia who presented to the hospital for acute blood loss with left knee effusion likely due to a ruptured hemorrhagic baker's cyst. He was also asymptomatic COVID-19 positive.

Other Meds: hydrocodone-ibuprofen 5mg-200mg tab PO q4hr

Current Illness:

ID: 1666859
Sex: F
Age: 17
State: OH

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

Symptom List: Injection site swelling, Limb discomfort

Symptoms: It was realized at the time the patient presented for her second covid 19 vaccine, that the patient was 17yo at the time of administration, rather than 18 yo or >. CDC was contacted and since patient was 12-17 yrs of age, and Moderna was inadvertently administered as the first dose instead of Pfizer-Bio N Tech, it was indicated to administer Moderna as the second dose (as off-label use), and to report this incident to VAERS, as a vaccine administration error. Since the provider who had ordered the vaccine in August was not in the office, the on-call provider was consulted with the information from CDC, and direction was given to administer the second Moderna vaccine. Patient and parent were also made aware of this situation.

Other Meds: cloNIDine HCL 0.1 mg tablet, escitalopram 10 mg tablet, sirolimus 1 mg tablet

Current Illness:

ID: 1666860
Sex: F
Age: 19
State: NC

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

Lab Data: N/A

Allergies: None

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

Symptoms: The vaccine vial was dilated on 8/31/21 at 5:40pm. The vaccine vial should have been discarded at 11:40pm on 8/31/21 however the clinical staff administered the vaccine in error more than 36+ hours after it had been diluted. This error was not recognized until after the patient had been observed for 15 minutes and discharged.

Other Meds: Zyrtec, Iron tablets, Flonase, norgestrel-ethinyl estradiol.

Current Illness:

ID: 1666861
Sex: M
Age: 67
State: CA

Vax Date: 03/19/2021
Onset Date: 03/20/2021
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: bloodwork urine

Allergies:

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

Symptoms: sleeping 20 hours a day, dizzy, tired, no control or concentration, memory loss

Other Meds: biktarve, palpuprozol, atorvaspalpine, lasenoprol, trazedone, terazosin, perocitan, gabapatchin, multivitamin, b-12, vitamin d3

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am