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: 1670114
Sex: F
Age: 16
State: NC

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

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

Lab Data: patient was transported via ambulance to hospital

Allergies: none reported

Symptom List: Dysphagia, Epiglottitis

Symptoms: about 10 minutes after vaccine was given patients lips started to swell and tongue. 2 tablets of Benadryl were given. a few minutes later patients throat started to close. 911 was called and an Epi-pen was given to patient

Other Meds: not specified

Current Illness: none discussed

ID: 1670115
Sex: F
Age: 58
State:

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 09/03/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1670116
Sex: M
Age: 47
State: IN

Vax Date: 08/27/2021
Onset Date: 08/27/2021
Rec V Date: 09/03/2021
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: Vial was incorrectly label with expiration date, expired vaccine was given.

Other Meds:

Current Illness:

ID: 1670117
Sex: F
Age: 74
State: NC

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

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

Lab Data: CT Scan, MRI, Cardiac Testing

Allergies: Codeine; bee; wasps stings

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: I started running a low grade fever. I had chills and a headache and nausea. It lasted for several days. My body felt like someone had beat me. Every joint and muscle ached. Several months later I started feeling weird. I went to the bathroom and I fainted and hit my head as a result. I had a CT scan completed on March 15th and I was advised I may have had a stroke. Then an MRI was completed to check for the possibility of blood clots. There were no blood clots detected at that time. I also contracted COVID-19, I started feelin a little off on 8/17/2021 and tested positive on 8/20/2021. I lost my taste and smell I also had a headache. I also was put on antibiotics for 10 days because I developed a sty on my left eye. I went to the eye doctor and was prescribed an additional 14 days and was still taking them at the time I contracted COVID-19.

Other Meds: Probiotic; One A Day multivitamin; vitamin C; Citrucel; B complex with vitamin C; vitamin C; vitamin B12; vitamin D3; milk thistle; vitamin B6; Bayer aspirin; Celebrex; magnesium; omeprazole; calcium citrate; Plaquenil

Current Illness: None

ID: 1670118
Sex: F
Age: 26
State:

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 09/03/2021
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: 1670119
Sex: F
Age: 51
State: VA

Vax Date: 04/16/2021
Onset Date: 04/17/2021
Rec V Date: 09/03/2021
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: None

Allergies: None

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

Symptoms: Pulsatile tinnitus: noticed after first shot, then faded somewhat before the second dos, when it returned strongly. It has faded over time to be almost imperceptible now. There seem to be triggers: exercise (heart-rate elevation), alcohol (red wine), and stress (work).

Other Meds: Loratadine Probiotic Fish oil supplement Women?s multi-vitamin Clobetasol

Current Illness: None

ID: 1670120
Sex: F
Age: 57
State: ND

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

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

Lab Data: n/a

Allergies: sulfa

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Vaccine deemed expired after vaccine was administered.

Other Meds:

Current Illness:

ID: 1670121
Sex: M
Age: 55
State:

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 09/03/2021
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: Vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1670122
Sex: F
Age: 52
State: GA

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

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

Lab Data: None

Allergies: Morphine

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Ten minutes after the injection I had a burning feeling. My arm was physically hotter from shoulder to elbow for several hours after injection. This was also confirmed by the tech that administered the vaccine. Headache started 2 hours after injection and turned into a migraine 5 hours after injection. Blood and bruising at injection site. 24 hours later - severe pain in left arm, cannot raise over head. Migraine and nausea persisting even after OTC meds. Moderate fatigue and dizziness.

Other Meds: None

Current Illness: None

ID: 1670123
Sex: M
Age: 25
State: IN

Vax Date: 08/27/2021
Onset Date: 08/27/2021
Rec V Date: 09/03/2021
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: Vial was incorrectly marked with expiration date, expired vaccine was given

Other Meds:

Current Illness:

ID: 1670124
Sex: F
Age: 60
State: ND

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

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

Lab Data: n/a

Allergies:

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

Symptoms: Vaccine deemed expired after vaccine was administered.

Other Meds:

Current Illness:

ID: 1670125
Sex: M
Age: 38
State: MD

Vax Date: 08/18/2021
Onset Date: 08/21/2021
Rec V Date: 09/03/2021
Hospital:

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

Lab Data: Chest x-ray

Allergies: None

Symptom List: Rash, Urticaria

Symptoms: Diagnosis - Myocarditis Symptoms - Chest pain Treatment - Naproxen 500 mg PO BID, and rest Until additional safety data are available, experts recommend that people who develop myocarditis or pericarditis after a first dose of an mRNA COVID-19 vaccine defer receiving the second dose.

Other Meds: Unknown

Current Illness: None

ID: 1670126
Sex: M
Age: 49
State:

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 09/03/2021
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: 1670127
Sex: F
Age: 24
State:

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 09/03/2021
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: Vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1670128
Sex: F
Age: 28
State: IN

Vax Date: 08/27/2021
Onset Date: 08/27/2021
Rec V Date: 09/03/2021
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: Vial was incorrectly labeled with expiration date, expired vaccine was given.

Other Meds:

Current Illness:

ID: 1670129
Sex: M
Age: 76
State:

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 09/03/2021
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: Vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1670130
Sex: F
Age: 76
State: ND

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

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

Lab Data: n/a

Allergies:

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

Symptoms: Vaccine deemed expired after vaccine was administered to patient.

Other Meds:

Current Illness:

ID: 1670131
Sex: M
Age: 67
State:

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 09/03/2021
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: Vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1670132
Sex: M
Age: 66
State: MI

Vax Date: 02/10/2021
Onset Date: 04/04/2021
Rec V Date: 09/03/2021
Hospital:

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

Lab Data: EKG - 4/21/2021 at 2:00pm at hospital Halter Monitor - 5/14/2021 - 5/28/2021 Heart Stress Test with Ultra Sound - 6/15/2021 Watch - 4/22/2021 - present

Allergies: Tetracycline, Lactose intolerant

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Premature Ventricular Contractions. Irregular heart beats, out of breath from low exercise, fatigue.

Other Meds: PRESCRIPTION Alprazolam (Xanax) Ezetimibe (Zetia) Ibuprofen Metoprolol Tartrate Montelukast Sodium (Singulair) Stiolto Respimat Tamsulosin HCl (Flomax) Ventolin HFA 18gm Xarelto OTC Cetirizine HCl (Zyrtec 24 hour) Fluticasone Propionate (G

Current Illness: None

ID: 1670133
Sex: F
Age: 58
State:

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 09/03/2021
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: Vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1670134
Sex: M
Age: 53
State: IN

Vax Date: 08/27/2021
Onset Date: 08/27/2021
Rec V Date: 09/03/2021
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: Vial was incorrectly labeled with expiration date, expired vaccine was given.

Other Meds:

Current Illness:

ID: 1670135
Sex: F
Age: 70
State: OH

Vax Date: 02/03/2021
Onset Date: 02/17/2021
Rec V Date: 09/03/2021
Hospital:

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

Lab Data: No

Allergies: Sulfa

Symptom List: Unevaluable event

Symptoms: I had a rash from my shoulder to my elbow, That called it Moderna arm. It was raised and bright red, it took two weeks for it to fade.

Other Meds: Vitamins; spiranoacpone

Current Illness: No

ID: 1670136
Sex: M
Age: 55
State: ND

Vax Date: 03/04/2021
Onset Date: 03/04/2021
Rec V Date: 09/03/2021
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: n/a

Allergies:

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

Symptoms: Vaccine deemed expired after vaccine was administered to patient.

Other Meds:

Current Illness:

ID: 1670137
Sex: F
Age: 50
State:

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 09/03/2021
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:

Symptom List: Injection site pain, Pain

Symptoms: Vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1670138
Sex: M
Age: 63
State:

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 09/03/2021
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: Vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1670139
Sex: F
Age: 85
State: KY

Vax Date: 03/05/2021
Onset Date: 09/01/2021
Rec V Date: 09/03/2021
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:

Allergies:

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

Symptoms: Patient presents on 3/7/21 with shortness of breath. She has been very weak and been coughing for several days. Her shortness of breath is severe. She is now requiring noninvasive ventilation to maintain oxygen saturations in the emergency room. She is otherwise quite groggy and sleepy and very poor historian. She is also in respiratory distress, receiving noninvasive ventilation with BiPAP. Required inpatient admission to ICU.

Other Meds:

Current Illness:

ID: 1670140
Sex: F
Age: 55
State: NC

Vax Date: 08/18/2021
Onset Date: 08/25/2021
Rec V Date: 09/03/2021
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: Nausea, Pain in extremity, Pyrexia

Symptoms: after 5 minutes of initial shot had 5 minutes of severe stinging followed by redness, heat and swelling which lasted few days......on 8th day, began itching badly. was trying to only lightly rub spot and not scratch. began spreading redness, swelling and heat. On 9th day, redness was about 3" x 5" patch at its worse. it slowly went away after several days. I was asked to "report" this by a professional.

Other Meds:

Current Illness:

ID: 1670141
Sex: F
Age: 28
State: TX

Vax Date: 09/02/2021
Onset Date: 09/03/2021
Rec V Date: 09/03/2021
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: Employee calling to report a reaction after receiving a COVID-19 vaccine. Vaccine Name - Pfizer Vaccine Date - ? 09/02/2021 Is this your first or second dose- 2nd Date of symptom onset - ? 09/03/2021 Symptoms - ? fatigue, bodyache Last day of work and shift - ? 09/02/2021 Home remedies- none Any improvement- no Recommendation- Advised employee to take Tylenol/Ibuprofen per package instructions as needed for any pain. If symptoms continue, worsen, or new ones develop follow up with PCP. Employee voiced understanding Employee of information ? Yes Employee voiced any concerns ? No Employee?s questions answered to employees satisfaction -Yes

Other Meds:

Current Illness:

ID: 1670142
Sex: M
Age: 63
State: OH

Vax Date: 09/02/2021
Onset Date: 09/02/2021
Rec V Date: 09/03/2021
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: medabolic panel and CBC normal

Allergies: none

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

Symptoms: nausea and syncope up tp 30 min after second dose of pfizer COVID vaccine administration discharged on zofran

Other Meds: duloxetine, lidocaine, naproxen, omeprazole

Current Illness: none

ID: 1670143
Sex: F
Age: 55
State: NJ

Vax Date: 08/13/2021
Onset Date: 08/13/2021
Rec V Date: 09/03/2021
Hospital:

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

Lab Data: none

Allergies: Sulfa drugs oxcarbazepine Trileptal Lamotrigine

Symptom List: Nausea

Symptoms: Nausea, diarrhea, severe headache, dizziness, arm & neck pain, weakness, muscle aches, sleepiness, light sensitivity. Symptoms started about 12 hours after vaccine and lasted for 3-5 days.

Other Meds: Venlafaxine Alprazolam Rosuvastatin Losartan Vitamin D3 Multivitamin

Current Illness: Allergic reaction to oxcarbazepine

ID: 1670144
Sex: M
Age: 59
State: IN

Vax Date: 08/27/2021
Onset Date: 08/27/2021
Rec V Date: 09/03/2021
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: Vial was incorrectly labeled with expiration date, expired vaccine was given.

Other Meds:

Current Illness:

Date Died:

ID: 1670145
Sex: M
Age: 72
State:

Vax Date: 02/12/2021
Onset Date: 09/02/2021
Rec V Date: 09/03/2021
Hospital: Y

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

Lab Data: covid + 9/2/2021

Allergies: no known

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

Symptoms: Breakthrough COVID. First vaccine 1/22/2021. 70-year-old male A staff member in the nursing home was positive for COVID-19 and passed it on to multiple patient is in the nursing home. The patient was brought in for shortness of breath and hypoxemia. He was poorly responsive an ABG showed acute hypercapnic respiratory failure. He was intubated. he patient underwent PEA arrest. Preliminary cause of death: Cardiac arrest. Due to: COVID-19.

Other Meds:

Current Illness:

ID: 1670146
Sex: F
Age: 57
State:

Vax Date: 03/22/2021
Onset Date:
Rec V Date: 09/03/2021
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: Rash all over body

Other Meds:

Current Illness:

ID: 1670147
Sex: F
Age: 70
State: OH

Vax Date: 03/03/2021
Onset Date: 03/17/2021
Rec V Date: 09/03/2021
Hospital:

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

Lab Data: No

Allergies: Sulfa

Symptom List: Tremor

Symptoms: Indigestion for two weeks. Stomach discomfort.

Other Meds: Vitamins; blood pressure medicine

Current Illness: No

ID: 1670148
Sex: M
Age: 42
State: ND

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

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

Lab Data: n/a

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Vaccine deemed expired after vaccine was administered to patient.

Other Meds: elequis

Current Illness:

ID: 1670149
Sex: M
Age: 32
State: FL

Vax Date: 03/18/2021
Onset Date: 08/25/2021
Rec V Date: 09/03/2021
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: None

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

Symptoms: While playing casual basketball I suddenly lost the feeling in my arms, over a few minutes I collapsed to the ground twice with a racing heart. The workload was light. A few days later the same thing happened while I was mowing the lawn. Both times I was plenty hydrated. Nothing like this has ever happened to me. I am a fairly fit person and a very healthy BMI (6'1", 165lb). I am worried I am having a heart-related complication from the vaccine. What is happening seems very similar to other reports I have read. I need medical help and do not know who to go to. Each time took me about 30 minutes to stop being dizzy. I've had several bouts of numbness in my fingertips of both hands since.

Other Meds: None

Current Illness: None

ID: 1670150
Sex: M
Age: 69
State: LA

Vax Date: 09/01/2021
Onset Date: 09/01/2021
Rec V Date: 09/03/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: Nursing home requested vaccination for patient and patient signed consent. Upon entering Pfizer first dose vaccine in links discovered patient had previously receieved a Janseen vaccine on 06/01/2021. No adverse event occured while monitoring patient after pfizer vaccine was administered.

Other Meds:

Current Illness:

ID: 1670151
Sex: F
Age: 36
State: ND

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

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

Lab Data: n/a

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Vaccine deemed expired after vaccine was administered to patient.

Other Meds:

Current Illness:

ID: 1670152
Sex: M
Age: 50
State: ND

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

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

Lab Data: n/a

Allergies:

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

Symptoms: Vaccine deemed expired after vaccine was administered to patient.

Other Meds:

Current Illness:

ID: 1670153
Sex: M
Age: 23
State: AR

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

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

Lab Data:

Allergies:

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

Symptoms: I woke up in the middle of the night with a 102.9 graver, and heavy shivering.

Other Meds:

Current Illness:

ID: 1670154
Sex: M
Age: 43
State: LA

Vax Date: 09/01/2021
Onset Date: 09/01/2021
Rec V Date: 09/03/2021
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: Nursing home requested patient receive COVID vaccine. We gave Pfizer first dose and upon entering into links discovered patient received Moderna vaccines on 1/20/21 and 4/27/21. Patient signed consent to receive vaccine and had not adverse reaction during time period observed post vaccination.

Other Meds:

Current Illness:

ID: 1670155
Sex: M
Age: 72
State: NJ

Vax Date: 05/04/2021
Onset Date: 09/02/2021
Rec V Date: 09/03/2021
Hospital: Y

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

Lab Data: SARS-CoV-2 Antigen and PCR (+) on 9/2

Allergies: Shellfish; pioglitazone

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

Symptoms: Admitted with Positive COVID 19 to hospital on 9/2/21; developed severe fatigue and worsening dyspnea.

Other Meds: Aspirin 81 mg po daily Tricor 145 mg po daily Insulin Detemir 70 units SQ qhs Fosinopril 10 mg po daily

Current Illness:

ID: 1670156
Sex: M
Age: 23
State: TN

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

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

Lab Data: EMS checked Blood pressure and Blood sugar; both in normal range

Allergies: None

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

Symptoms: Immediately after the vaccination was given, patient appeared to have passed out. Regained consciousness within a minute, became responsive. Within the next 5 minutes, had another episode of unconsciousness that lasted almost a minute. I alerted the staff at that time to call 911. While on the phone with 911, patient regained consciousness but did not feel well at all. Patient then proceeded to throw up while waiting on EMS to arrive. Patient was transported to the hospital for evaluation.

Other Meds: None

Current Illness: None

Date Died: 08/30/2021

ID: 1670157
Sex: F
Age: 58
State: WI

Vax Date: 07/27/2021
Onset Date: 08/07/2021
Rec V Date: 09/03/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Client's husband reported client received a flu shot on 7/27/21 when symptoms began. ( does not indicate client received the influenza vaccine and last documented shot was given on 8/23/16.) Symptoms included fatigue, aches mostly in hip, dehydration, and breathing difficulties, which continued to get worse throughout the week. On 8/6/21 husband found client on floor in the bathroom. When paramedics arrived, client refused to go to the hospital. On 8/7/21, husband physically brought client to Hospital where she was admitted with COVID pneumonia. She was in the ICU, ventilated and passed away on 8/30/21.

Other Meds:

Current Illness:

ID: 1670158
Sex: F
Age: 56
State: MI

Vax Date: 04/09/2021
Onset Date: 08/21/2021
Rec V Date: 09/03/2021
Hospital: Y

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

Lab Data:

Allergies: NKDA

Symptom List: Vomiting

Symptoms: Hospitalized; COVID-19 positive 8.27.21; fully vaccinated (still hospitalized currently) Patient is a 56 y.o. female who presents to hospital. Patient only speaks Spanish, translator was used during the interview. The patient states that she has been having difficulty breathing, back pain, and worsening cough and worsening fatigue. It all started On Saturday she developed a headache and a fever. Monday, everything got progressively worse. Came in today mainly because of the worsening shortness of breath. She had a Johnson and Johnson vaccination back in April. Chief complaint; SOB, weakness. Problem List; Principal Problem: COVID-19; Active Problems: Elevated LFTs, Hypoxia; Assessment and Plan: Medical Decision Making; Sepsis secondary to COVID 19, No respiratory distress, only requiring 2L/min oxygen. Start on Decadron and Remdesivir. Date of symptom onset: 8/21/2021.

Other Meds: Acetaminophen (TYLENOL) 500 MG tablet; Cyclobenzaprine (FLEXERIL) 5 MG tablet; Ibuprofen (MOTRIN) 200 MG tablet; Metformin (GLUCOPHAGE) 1000 MG tablet; Omeprazole (PRILOSEC) 20 MG delayed release capsule.

Current Illness: COVID-19 positive 8.27.21 (symptoms started 8.21.21).

ID: 1670159
Sex: M
Age: 61
State: LA

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

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

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Nursing home requested patient be vaccinated and patient signed consent form. We gave first dose pfizer and upon entering into vaccine system discovered patient previously received Janssen vaccine on 06/01/2021. Patient had no adverse event during time period monitored post vaccine.

Other Meds:

Current Illness:

ID: 1670160
Sex: M
Age: 25
State: TX

Vax Date: 09/02/2021
Onset Date: 09/02/2021
Rec V Date: 09/03/2021
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: N/A

Allergies: N/A

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

Symptoms: After patient was admitted vaccine, he was noted to have clammy skin, Pt was aware and he complain of feeling cold, Epipen administered to him on rt and left thigh. VS was unable to register at first. Skilled nurse put him on 02 via n/c, after few mins 02 was 141/73, 103, 02 sat 99% with 02 in n/c. Blood sugar 105.

Other Meds: N/A

Current Illness: N/A

ID: 1670161
Sex: M
Age: 75
State: ND

Vax Date: 03/04/2021
Onset Date: 03/04/2021
Rec V Date: 09/03/2021
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: n/a

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Vaccine deemed expired after vaccine administered to patient.

Other Meds:

Current Illness:

ID: 1670162
Sex: M
Age: 64
State: FL

Vax Date: 08/27/2021
Onset Date: 08/27/2021
Rec V Date: 09/03/2021
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: pain in arm and elbow, headaches, red rash at injection site/neck

Other Meds: metoprolol tartrate finasteride mevothyroxine

Current Illness:

ID: 1670163
Sex: M
Age: 22
State: AL

Vax Date: 08/31/2021
Onset Date: 09/01/2021
Rec V Date: 09/03/2021
Hospital:

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

Lab Data: 9/1/21 EKG, Accula SARS-Cov-2 Test, Cardiac Profile, CBC with differential, Comprehensive Metabolic panel, D-dimer quantitative EKG, and Chest X-ray., .9% sodium chloride. All tests were normal,, except for the fast heart rate. Was Covid negative. 9/2/21 EKG, Thyroid bloodwork (T4, Free and TSH, 3rd generation). Blood tests came back normal. Scheduled an echocardiogram for 9/29

Allergies: NONE

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

Symptoms: Fever and rapid heart rate. Went to ER and had blood tests and EKG and IV fluids. Heart rate was up in the 160's and came down to the 120's. This was about 15 hours after the vaccine was administered. He has never had any symptoms like this before. Saw a cardiologist on 9/2. His heart rate had gone down to 107 and he still had a fever.

Other Meds: NONE

Current Illness: NONE

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am