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: 1670668
Sex: M
Age: 72
State: TX

Vax Date: 09/03/2021
Onset Date: 09/03/2021
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:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Error: Booster Given Too Early-

Other Meds:

Current Illness:

ID: 1670669
Sex: M
Age: 46
State: AL

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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: unknown

Symptom List: Anxiety, Dyspnoea

Symptoms: A round of patient came into the clinic from a group home. States that she asked several times is everyone here for a Pfizer vaccines. She stated everyone said yes and the shot was administered. After giving the shot she then states the patient stated that he needed a Moderna vaccine.

Other Meds: none

Current Illness: unknown

ID: 1670670
Sex: M
Age: 48
State: CA

Vax Date: 08/17/2021
Onset Date: 08/17/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1670671
Sex: M
Age: 16
State: WI

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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data: Unsure. Mom signed release form and patient did not leave with paramedics.

Allergies: N/A

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Second dose of Pfizer-BioNTech vaccine administered. Patient became slightly aloof as his mom noticed a change in his facial expression and a slight disconnected look in his eyes. Mom asked if patient was ok, to which he stated "yes" and attempted to stand up, but became lightheaded and vision became "dark" and patient fell over into mom's arms. Patient laid on floor for approx 10 minutes before attempting to sit up again, but again became dizzy and weak and vision became "dark" so patient laid down once again. EMS arrived shortly after and tended to patient. Given a bottle of water in the meantime, and patient stated he was nervous and had a fear of needles.

Other Meds: NiA

Current Illness: N/A

ID: 1670672
Sex: F
Age: 57
State:

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

Lab Data: None

Allergies: Sulfa

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

Symptoms: Chest area is sore when lifting up arm. Feels as though she tore a muscle on the entire left side.

Other Meds: None

Current Illness: None

ID: 1670673
Sex: F
Age: 15
State: MA

Vax Date: 08/31/2021
Onset Date: 08/31/2021
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: The medication was mixed with the wrong diluent and administered intramuscularly into the patients left arm.

Other Meds: None

Current Illness: heart murmur, scoliosis

ID: 1670674
Sex: M
Age: 35
State: KY

Vax Date: 04/08/2021
Onset Date: 08/29/2021
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: Pyrexia, White blood cell count decreased

Symptoms: Tested positive for Covid 19

Other Meds:

Current Illness:

ID: 1670675
Sex: F
Age: 32
State: MN

Vax Date: 04/14/2021
Onset Date: 08/26/2021
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: Positive results

Other Meds:

Current Illness:

ID: 1670676
Sex: F
Age: 70
State: NC

Vax Date: 03/31/2021
Onset Date: 04/16/2021
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: ECHO. No cause found

Allergies: erythromycin, lexapro

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Spontaneous continuous cardiac arrythmia. EKG showed frequent PVC's. Controlled with initiation of Metoprolol 25mg BID. Arrythmia spontaneously stopped early august 2021 and med stopped. No further episode

Other Meds: none

Current Illness: none

ID: 1670677
Sex: F
Age: 37
State: CA

Vax Date: 08/19/2021
Onset Date: 08/19/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1670678
Sex: F
Age: 40
State: KY

Vax Date: 03/04/2021
Onset Date: 08/31/2021
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: CBC; iron; vitamin B12; folate; ferritin;TSH; TIBS levels; Fecal occult test.

Allergies: Aspirin; Ibuprofen; Stadol.

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

Symptoms: Diagnosed with anemia on 8/31/2021.

Other Meds: Zyrtec; Trelegy; singulair; probiotic; fish oil; multi-vitamin; albuterol inhaler; goats rue; alfalfa; torbagun.

Current Illness: None.

ID: 1670679
Sex: M
Age: 67
State: KY

Vax Date: 03/15/2021
Onset Date: 08/28/2021
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:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: PT VACCINATED WITH PFIZER 2/22/21 (LOT EL3302) + 3/15/21 (LOT EN6206). S/O BEGAN 8/24/2021, TESTED + 8/28/2021

Other Meds:

Current Illness:

ID: 1670680
Sex: M
Age: 20
State: CA

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: LA

Lab Data:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1670681
Sex: F
Age: 58
State: WA

Vax Date: 07/12/2021
Onset Date: 07/13/2021
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: KNDA

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

Symptoms: Patient Complained of brain fog - trouble thinking. also some pressure in sinus area? says its getting better but persisting - i reccomenede she contact her dr when she told us this upon getting seconf Moderna shot.

Other Meds: RX: Armour Thyroid

Current Illness: No

ID: 1670682
Sex: M
Age: 61
State: OK

Vax Date: 08/18/2021
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: Contact the facility

Allergies: None

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

Symptoms: Low blood sodium

Other Meds: Lisinopril, Metroprolol

Current Illness: None

ID: 1670683
Sex: F
Age: 70
State:

Vax Date: 04/20/2021
Onset Date: 08/31/2021
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: Tested positive for Covid 19

Other Meds:

Current Illness:

ID: 1670684
Sex: F
Age: 15
State: CA

Vax Date: 08/18/2021
Onset Date: 08/18/2021
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:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1670685
Sex: M
Age: 36
State: OR

Vax Date: 04/16/2021
Onset Date: 06/17/2021
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: N/a

Allergies: Menacycling.

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Gout flare that lasted 30 days with continued lingering effects.

Other Meds: Nothing other than supplements that I?ve been taking for years. Multi vit. Zinc. Etc

Current Illness: N/a

ID: 1670686
Sex: F
Age: 31
State: MD

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

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Arms face and back have severe acne that I've never had before. And a half dollar size rash in the Injection site

Other Meds:

Current Illness:

ID: 1670687
Sex: M
Age: 58
State: MN

Vax Date: 09/01/2021
Onset Date: 09/03/2021
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: None sought at this time. Presuming swelling of lip will subside.

Allergies: Miscellaneous food allergies-raw carrots, celery, macadamia nuts, apples, pears, almonds, peanuts

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

Symptoms: Severely swollen upper lip (estimate twice+ normal size due to swelling) which first started September 3 at 1 am. Body aches, stomach aches, head ache, shivering experienced September 2nd but had subsided by early morning Septermber 3rd. Swollen lip still present as of the date and time of this filing.

Other Meds: Normal multivitamin, Coq10

Current Illness: None. Allergies to tree and grass pollen but both were listed as low pollen count at the time of allergic reaction to Moderna Covid vaccine shot #2.

ID: 1670688
Sex: M
Age: 18
State: CA

Vax Date: 08/18/2021
Onset Date: 08/18/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1670689
Sex: M
Age: 17
State: TN

Vax Date: 08/30/2021
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: Troponin 42 CRP 89 Respiratory viral panel pending COVID IgG pending (nucleocapsid)

Allergies: No

Symptom List: Unevaluable event

Symptoms: Patient was vaccinated on a Monday evening. He had systemic reactogenicity the next day with diffuse myalgia and headache that occurred that evening. The next day headache was worse and that evening/morning he developed chest pain, dyspnea. Was seen at an OSH - had elevated troponin and CRP ECG, ECHO, and cMRI c/w myocarditis without pericardial effusion. Treatment with NSAID's alone at time of submission

Other Meds: None

Current Illness: None; potential exposure to COVID-19 two months prior to first vaccination.

ID: 1670690
Sex: F
Age: 46
State: GA

Vax Date: 08/31/2021
Onset Date: 09/01/2021
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: NONE

Allergies: Percocet

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

Symptoms: LEFT ARM HOT TO TOUCH AND PAINFUL, FEVER 101, NAUSEA, BODY ACHES, HEADACHE, SWEATING, FATIGUE, AND JUST DID NOT FEEL WELL

Other Meds: Prilosec

Current Illness: bronchitis

ID: 1670691
Sex: F
Age: 30
State: RI

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

Lab Data: nothing reported

Allergies: No medication allergies reported

Symptom List: Injection site pain, Pain

Symptoms: Patient was vaccinated at workplace on Thursday, September 2nd at 1pm. Infection nurse contacted facility today, September 3rd at approximately 2pm. Notifying office manager about the event that had occurred. This morning the patient was standing in the laundry room, ?felt faint and tried grabbing onto the folding table for support.? She doesn?t remember falling, but her coworker heard a bang and ran in to find her lying on the floor. The patient seemed fine after a few minutes but we called her family to come pick her up and encouraged her to go to urgent care. Family and patient refused any medical treatment, per the facility. The patient informed the infectious control nurse that her medical history includes dizziness., The patient was fine after the vaccine was administered on September 2nd, and reports that her legs started aching later that night and she felt really tired. This morning she felt achy and tired, but not enough that she had to stay home.

Other Meds: Adderall Gabapentin Nortriptyline No other medications reported to us

Current Illness: No other illnesses reported

ID: 1670692
Sex: F
Age: 49
State:

Vax Date: 07/29/2021
Onset Date: 07/30/2021
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: 6pm vaccine 2am: woke to Difficulty Breathing, tightness of chest, thirsty, hallucination, rash on arm. about 12hr duration Patient slept most of the day, then began walking bit by bit until symptoms resolved

Other Meds:

Current Illness:

ID: 1670693
Sex: M
Age: 41
State: CA

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: 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: 1670694
Sex: F
Age: 32
State: CA

Vax Date: 08/07/2021
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: Hydrocodone-Acetaminophen

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Chest pain, possible pericarditis. Seen in ED, discharged home with Naproxen for pain

Other Meds:

Current Illness: ADJUSTMENT DISORDER W MIXED DISTURBANCE OF EMOTIONS AND CONDUCT SEASONAL ALLERGIC RHINITIS ASTHMA, UNSPECIFIED MODERATE PERSISTENT ASTHMA FHX OF BREAST CANCER HX OF SPOUSE OR PARTNER ABUSE, EMOTIONAL LUMBAR RADICULOPATHY LUMBOSACRAL RADICULOPATHY

ID: 1670695
Sex: F
Age: 44
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:
Dose Series: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: reglan

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: chills, bone pains, muscles pains; fever (102); headache lasting days

Other Meds: nexium;advair; singular

Current Illness:

ID: 1670696
Sex: F
Age: 12
State: CA

Vax Date: 08/18/2021
Onset Date: 08/18/2021
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:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1670697
Sex: F
Age: 70
State: NC

Vax Date: 03/31/2021
Onset Date: 06/24/2021
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: Pet scan; bone biopsy; more extensive biopsy of second site.

Allergies: Erythromycin; Lexapro.

Symptom List: Nausea

Symptoms: Swollen lymph node rt axilla found on routine mammogram. Biopsy revealed lymphoma. Asymptomatic.

Other Meds: None.

Current Illness: None.

ID: 1670698
Sex: F
Age: 37
State:

Vax Date: 08/27/2021
Onset Date: 08/28/2021
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: Walk in clinic visit, lab work, chest xray 8/31/21 follow up visit with PCP 9/2/21

Allergies: NSAIDs Sulfa Neomycin

Symptom List: Injection site pain

Symptoms: Within 12 hours of vaccine suffered from what felt like diagraph paralysis and neck tightness/swelling has continued for 7 days (9/3/21)

Other Meds: Multivitamin B12 Vitamin D3

Current Illness: None

ID: 1670699
Sex: F
Age: 49
State: KS

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: None

Allergies: Sulfa

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

Symptoms: Patient was given a 3rd dose. Pt did not have any adverse reactions to dose given.

Other Meds: Loratadine 10mg daily Risperdal 1 mg daily at HS Vistaril 50mg BID

Current Illness: None

ID: 1670700
Sex: F
Age: 34
State: AR

Vax Date: 08/13/2021
Onset Date: 08/23/2021
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: RA

Lab Data: 9/1/2021- They did an ekg & that test result was abnormal. They also did chest X-ray, ct scan & took blood. Said my heart was inflamed.

Allergies: No

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

Symptoms: A little over a week after getting 2nd dose, I started getting a high resting heart rate, chest pain, chest tightness, shortness of breath & joint pain.

Other Meds: Prenatal vitamins & vitamin d3.

Current Illness: No

ID: 1670701
Sex: M
Age: 72
State: TX

Vax Date: 09/03/2021
Onset Date: 09/03/2021
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:

Allergies:

Symptom List: Tremor

Symptoms: Error: Booster Given Too Early-

Other Meds:

Current Illness:

ID: 1670702
Sex: M
Age: 14
State: TN

Vax Date: 08/28/2021
Onset Date: 08/31/2021
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: Covid positive

Allergies: No

Symptom List: Erythema, Pruritus

Symptoms: Covid positive, lymph node swollen.

Other Meds: Emergence; Mucinex; flonase

Current Illness: No

ID: 1670703
Sex: M
Age: 12
State: CA

Vax Date: 08/18/2021
Onset Date: 08/18/2021
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:

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: 1670704
Sex: F
Age: 33
State: IL

Vax Date: 08/20/2021
Onset Date: 08/21/2021
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: Gabapentin, Codine

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

Symptoms: On August 20, 2021 I went to a local pharmacy to receive my second dose of the Cov-19 vaccine. After being injected I was told to wait in the store for 15 minutes but then I was allowed to leave. I was in no way watched for reaction of any kind, I was left to sit by myself. After leave I began to have a headache so I took 2 Tylenol. I went home and went to sleep. The nest morning I with extreme arm pain and I was very fatigued, I rested most of the day. That evening my family and I went to town for dinner, on the way home my my upper thighs began to cramp and I was experiencing nerve pain. I also felt as though I was floating almost outside of myself. Sunday I spent all day in bed resting and continued to have leg and nerve pain. Sunday night around 10 PM I started experience what I would equate to as electrical shock just above my right knee in my thigh. I could feel the shocks through the whole right side of my body. This went on at random intervals for 4 hours. I finally was able to fall asleep. The nest morning I called my doctor and asked to make an appointment. I explained my symptoms to the office and was told they would relay the message to the nurse who would call me back. That morning I was still experiencing muscle cramps and nerve pain in both thighs. A couple hours later the nurse returned my phone call and informed me the doctor said there was nothing they could do, that these were normal symptoms and I was to alternate Tylenol and Ibuprofen. I asked the nurse what I was to do if the shocks and pain continued and she was unable to give me an answer. Since then I have not experienced any more shocks, but I am experiencing nerve pain in my legs and arms above and beyond the normal of my every day life with a Fibromyalgia.

Other Meds: Montelukast 10mg, Duloxetine 90mg, Metoprolol 50mg, Amitriptyline 10mg, Vitmin D3 4000IU, Loratadine 10mg

Current Illness:

ID: 1670705
Sex: M
Age: 39
State:

Vax Date: 04/01/2021
Onset Date: 04/02/2021
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: Blood tests, heart tests, balance and reflex tests. Diagnosed with vestibular Neuritis

Allergies: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: During the night following the vaccination, I collapsed feeling sick and very dizzy. I could not get up off the floor where I had fallen and the paramedics had to be called by my wife. They arrived and found me on the floor in the ensuite bathroom. They could not get me up off the floor. Eventually taken to A&E due to falling blood pressure and general state of dizziness and sickness. Finally diagnosed with Vestibular Neuritis.

Other Meds: Nothing

Current Illness: None

ID: 1670706
Sex: F
Age: 39
State: AZ

Vax Date: 08/30/2021
Onset Date: 09/03/2021
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: Amoxicillin, Pennicillin

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

Symptoms: Pt. states that after receiving the 2nd dose Pfizer 08/20/2021, started experiencing symptoms 09/03/2021 of Shingles diagnosed, auxiliary swelling, and missed periods (x2). Primary visit 09/03/2021, recommendation for anti-viral. Still continuing to experience symptoms.

Other Meds: N/A

Current Illness: N/A

ID: 1670707
Sex: M
Age: 59
State: MA

Vax Date: 07/25/2021
Onset Date: 07/26/2021
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: right knee xray 7/30/21 ; SED rate elevated at 37 ; CRP elevated at 128.2 ; BMP normal ; LFT elevated ALT at 91 and AST at 57

Allergies: none

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

Symptoms: patient with history of right knee replacement several years ago. prosthetic right knee only. one day after vaccination patient reports pain redness and swelling of right knee only. severe by days 3 and 4 post vaccination. evaluated in office 7/30/21. improved with treatment of ceftriaxone 1 gram IM x 1 dose and doxycycline 100mg BID x 10 days. however note follow up agency report -- same reaction after 2nd dose as well.

Other Meds: oxycodone, atorvastatin, lisinopril, hydrochlorothiazide

Current Illness: none

ID: 1670708
Sex: F
Age: 26
State: MO

Vax Date: 08/13/2021
Onset Date: 08/20/2021
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: Pain in extremity

Symptoms: Sudden onset menstrual period and heavy bleeding. Bleeding lasting longer than usual with more blood loss.

Other Meds: Prenatal vitamins

Current Illness:

ID: 1670709
Sex: F
Age: 13
State: CA

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

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

Lab Data:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1670710
Sex: F
Age: 34
State: CA

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

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

Lab Data: None

Allergies: None

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

Symptoms: Arm extremely painful, pain all the way to collar bone with fluid and raised . All through upper trap area

Other Meds: None

Current Illness: None

ID: 1670711
Sex: F
Age: 58
State: CT

Vax Date: 03/10/2021
Onset Date: 03/11/2021
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: Called medical doctor, spoke with on call doctor. Dr. told me I had a UTI and to have a urine culture. I did not go for a urine culture as I knew I did not have a UTI.

Allergies: Codeine. Milk

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

Symptoms: Approximately 8 hours after vaccine I had urinary incontinence, no muscle strength in lower limbs, blurred vision. Fell upon trying to stand when getting out of bed, unable to walk. needed help of my daughter to get back in bed. Needed to where Depends for 2 days. These side effects last 2 days then gradually improved. Common side effects of Temp 99, Headache, and chills, and malaise.

Other Meds: Omeprazole 40 mg capsule Budesonide 3 mg 24 hr capsule Diphenoxylate-atropine 2.5-0.025 mg per tablet Topiramate 50 mg tablet Cyanocobalamin 1,000 mcg/mL injection vial Escitalopram oxalate 10 mg tablet Alalprazolam 0.25 mg tablet TramadolL

Current Illness: None

ID: 1670712
Sex: F
Age: 36
State: CA

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: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Anaphylactic shellfish allergy, severe nausea to synthetic opiates i.e. Vicodin

Symptom List: Vomiting

Symptoms: Severe headache, severe body ache, chills, exhaustion

Other Meds: Multi-vitamin, fiber, biotin, probiotic, collagen, and vitamin D

Current Illness:

Date Died: 05/14/2021

ID: 1670713
Sex: F
Age: 98
State: MO

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

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

Lab Data:

Allergies: suphur

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: After her first dose she has a metalic taste in her mouth but was ok but after her 2nd dose, the metallic taste was worse and her muscles and limbs were weak and it changed her life. she was in a nursing home and was neglected. She was vomiting. Not sure if she had covid but she could not do anything and became sick . before she died, the back of her month had like nest. she died on 05/14/2021

Other Meds: Tylenol, women vitamins apresoline, isordil titration oral, pravastatin,,pro tonic, isosorbife, aspirin, vitamin D, folic acid

Current Illness: none, not sure

ID: 1670714
Sex: F
Age: 14
State: CA

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

Allergies:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1670715
Sex: F
Age: 59
State: CO

Vax Date: 08/31/2021
Onset Date: 09/02/2021
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: none

Allergies: sulfa, thimerosal

Symptom List: Injection site swelling, Limb discomfort

Symptoms: lymph node inflammation on side of injection after third dose, fever, chills, vomiting and diarrhea after both doses

Other Meds: VItamin D, red yeast rice, curcumin

Current Illness: none

ID: 1670716
Sex: F
Age: 88
State:

Vax Date: 08/30/2021
Onset Date: 08/30/2021
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: Patient received Moderna vaccine from outside facility (unknown) and was seen in the emergency center for hypertension/a fib. Discharged the next day in stable condition. No information regarding vaccination other than date.

Other Meds:

Current Illness:

ID: 1670717
Sex: M
Age: 92
State: CA

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

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

Lab Data: chest xray 9/2 with focal Right sided infiltrate, not consistent with viral pneumonia, may have had superimposed bacterial pneumonia not hypoxemic CRP within normal limits (0.2mg/dL) on 9/2/21 d-dimer 2.58ug/mL on 9/2/21 wbc 13.4 on 9/2/21

Allergies: lovastatin, simvastatin

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

Symptoms: breakthrough COVID 19 infection - only symptom was fatigue and generalized weakness. no shortness of breath, no cough

Other Meds: vitamin b12, vitamin c, albuterol, amlodipine, Combivent, Lipitor, Lasix, multivitamin, Wellbutrin, Aricept, alvesco

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am