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: 1675022
Sex: M
Age: 14
State: AR

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

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

Lab Data: None

Allergies: None

Symptom List: Dysphagia, Epiglottitis

Symptoms: Itchy rash on side and down on lower portion of left arm. No treatment because he just woke up with it today.

Other Meds: None

Current Illness: None

ID: 1675023
Sex: F
Age: 73
State: PA

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

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

Lab Data: n/a

Allergies: Percocet, tramadol, meloxicam, morphine

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient has head to toe itching, her right arm is swollen and red, restless sleep. Started overnight on 9/4/21 and has continued today 9/5/21

Other Meds: Plavix, rest is unknown

Current Illness: unknown

ID: 1675024
Sex: M
Age: 64
State: WA

Vax Date: 06/25/2021
Onset Date: 06/29/2021
Rec V Date: 09/05/2021
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: 1. Severe insomnia (meaning CANNOT get to sleep at all) for three nights (6/29, 6/30, & 7/1). Poor sleep continued until recently. 2. Had a feeling of elevated heart rate during the period of insomnia. 3. Nausua for awhile, then "bloated stomach" feeling and loss of appitite until it finaally subsided around 8/1. 4. Feeling extremely fatigued. This also seemed to finally improve around 8/1. 5. Frequent urination. Meaning having to urinate almost immeditedly following a previous urintion. Except there was little or no flow. This too seemed to inprove around 8/1. 6. Unusually runny nose. This has also gradually improved.

Other Meds: Atorvastatin 80 mg (daily), Sildenafil 20mg (1 ea/week)

Current Illness: None

ID: 1675025
Sex: F
Age: 48
State: AZ

Vax Date: 08/01/2021
Onset Date: 08/25/2021
Rec V Date: 09/05/2021
Hospital:

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

Lab Data: None

Allergies: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Debilitating, relentless full head pain. My head feels like it is in a vice and is being constantly and continuously sqeezed. My entire head hurts to include my face and neck. The pressure reminds me of a headache associated with a CFS leak. It hurts terribly. I have been taking Sudafed sinus, Tylenol, Ibuprofen and saline nasal spray. I am also putting heat pads on my neck, face and head for relief. I am reporting this because I am still in a great deal of discomfort. I typically do an hour of yoga a day, ride my bike for an hour and exercise 4-5 times a week. I eat a healthy plant based diet. I would say I am in the best shape of my life. I have not been able to exercise since the vaccine. I have also been very tired.

Other Meds: None

Current Illness: None

ID: 1675026
Sex: M
Age: 75
State: GA

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

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

Symptoms: Afternoon of injection and next day: Tired, no energy, stomachache, dull headache, arm soreness - tool 2 Tylenol vomited next day.

Other Meds: Azo, Augmentin, Pepcid, cranberry supplies;ement, probiotic, full strength aspirin, fish oil, Rosuvastin, Amlodipine, Clipidogrel, Lisinopril, propranolol

Current Illness: UTI

Date Died: 08/27/2021

ID: 1675027
Sex: M
Age: 74
State: FL

Vax Date: 03/15/2021
Onset Date: 08/21/2021
Rec V Date: 09/05/2021
Hospital: Y

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: SARS-COV-2, NAA, Detected: 08/21/21.

Allergies: Aspirin

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

Symptoms: Patient required hospitalization due to breakthrough infection. He received J&J vaccine on 03/15/21. Hospitalized from 08/21/21 - 08/27/21. Below is copied from patients discharge (death) summary: Patient lost pulse soon after family visit. 4 rounds of ACLS performed. Asystole on monitor Time of death pronounced at 1719. Alerted by RN that patient regained a weak pulse at 1722. Pressors restarted. Patient again lost pulse soon after and 1 round of ACLS was performed. No ROSC obtained. Asystole on monitor. No cardiac activity noted. Time of death 1734. 75 y.o. male with a PMH of HTN, HLD, COVId diagnosed 1 week ago presents to the ED c/o worsening SOB. Over the past week he has been noticing exertional SOB, fatigue and dyspnea. He had been able to recover with rest , today he was not able to get back to baseline so he decided to come in. At triage he was satting in the 70s on RA. He was placed on a nonrebreather at that time.

Other Meds: Lisinopril (unknown) Metformin 500mg BID Pravastatin (unknown) Ammonium Lactate 12% Lotion Apply a moderate amount topically twice daily Fexofenadine 180mg tablets. Take one tablet every day by mouth as needed. Folic acid 1mg tablet. Take

Current Illness:

ID: 1675028
Sex: F
Age: 75
State: MN

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 09/05/2021
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: penicillin sulfa Cipro

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: severe pain at injection site (controlled with 1 extra-strength Tylenol); fatigue; chills & fever (101.5 at highest); mild nausea fever lasted until midday the following day, but chills lasted only several hours

Other Meds: glucosamine/chondroitin Vitamin C (2,000 mg) Calcium w/Vit. D3

Current Illness: breast cancer

ID: 1675029
Sex: F
Age: 33
State: PA

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 09/05/2021
Hospital:

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

Lab Data: Patient went to ER and was kept for observation and sent home with pepcid, steroid pack and an epipen.

Allergies: Augmentin and sulfa drugs, some vaccine components of a flu shot years ago

Symptom List: Pharyngeal swelling

Symptoms: Patient become unbearably itchy about 20 minutes post injection.

Other Meds: N/A

Current Illness: N/A

ID: 1675030
Sex: F
Age: 13
State:

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

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

Lab Data: blood work (5/26/2021) , upper GI endoscopy with biopsies (7/8/2021), upper GI series (7/9/2021) tests are normal, biopsies are normal, persistent vomiting diagnosed as functional dyspepsia

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Since the day that she received the COVID vaccine, she has been feeling nausea and throwing up every evening. This never happened before the vaccine.

Other Meds:

Current Illness:

ID: 1675031
Sex: M
Age: 72
State: CA

Vax Date: 08/17/2021
Onset Date: 08/18/2021
Rec V Date: 09/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Eye exam on 8/31/21

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Blurred vision + eye irritation started the day after second Covid shot and continues to present. Started Maxitrol Rx on 9/2/21

Other Meds: Acyclovir

Current Illness:

ID: 1675032
Sex: M
Age: 48
State: FL

Vax Date: 08/27/2021
Onset Date: 09/04/2021
Rec V Date: 09/05/2021
Hospital:

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

Lab Data: He will be going to Dr. on the 9th, unless we can get him in earlier.

Allergies: n/a

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

Symptoms: He hasn't had a nose bleed since he was a young teen. Pt took the injection on the 27th of August. The morning of Sept 4, 2021 at approx. 6:30am he suffered a 15 min long nose bleed. That the end result was a large blood clot that he was able to get out. We have documentation of it. The morning of Sept 5, 2021 at approx. 4:11am he suffered another nose bleed that lasted about 5 min. After a couple of medium sized blood clots came out the the bleeding stopped. Then, the nose bleed started again at 8:40am where a few smaller clots came out proceeded by him spitting a clot out through his mouth. We have video and pictures.

Other Meds: n/a

Current Illness: none

ID: 1675033
Sex: F
Age: 59
State: NC

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

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

Lab Data: None yet

Allergies: Penicillin, Sulfur, Lorcet, Darvocet, Percocet, Aleve, Dilaudid, latex.

Symptom List: Rash, Urticaria

Symptoms: I became severely nauseated, lost my appetite for 3 days but I had to force myself eat in order to take the antibiotics my Dr prescribed. Sinuses became infected, urine changed color from lite yellow to dark brown, my body ached so badly, severe headaches, terrible chest congestion and severe coughing, eyes felt like they wanted to bulge out of the sockets because they hurt so bad.

Other Meds: Metformin, Zetia, Steglatro, Crestor, Vitamin C, Vitamin D3, Vitamin E, CoQ10, Tummeric, Women's one a day, Zinc, 81mg aspirin.

Current Illness:

ID: 1675034
Sex: F
Age: 34
State: AL

Vax Date: 08/10/2021
Onset Date: 08/20/2021
Rec V Date: 09/05/2021
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: Hair loss and facial numbness

Other Meds:

Current Illness:

ID: 1675035
Sex: M
Age: 20
State: AZ

Vax Date: 08/09/2021
Onset Date: 08/13/2021
Rec V Date: 09/05/2021
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: Urine Analysis 08/28/2021 Blood drawn waiting for results 09/02/2021

Allergies:

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

Symptoms: Coldness in my left arm, balls were achy for two days, got little red marks on my arms, a little blood when I wiped one time, blood in nose, muscle spasms, pain in fingertips, a twitch in my right eye that comes and goes, can't get hard, left thumb turned blue for a second, fingers were white when I got out of the shower, back pain.

Other Meds:

Current Illness:

ID: 1675036
Sex: F
Age: 22
State:

Vax Date: 12/18/2020
Onset Date: 09/02/2021
Rec V Date: 09/05/2021
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: PATIENT HAD PFIZER VACCINE ON Dose 1 date: 12/18/2020, Dose 2 date: 01/8/2021, AND TESTED POSITIVE TO COVID ON 9/2/21.

Other Meds:

Current Illness:

ID: 1675037
Sex: M
Age: 45
State: VA

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

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

Lab Data: Nurse said some symptoms may be expected so I called my doctor on day 2 to let them know of the symptoms I had.

Allergies: Hay/Grasses

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

Symptoms: Received vaccine at 8 am and then went to work as a PE teacher. I was on my feet all day. First signs of fatigue and chills began around 4 pm that same day. Chills and fever developed and continued throughout the night. No cough or sneezing. I woke up the next morning with a mild headache and fever (although the fever seemed lower). I took 2 Ibuprofen and within a couple hours the headache was gone and fever was almost completely gone. Symptoms were gone by day 2 afternoon. Left arm was sore at injection point for a couple days. I also had stomach gas starting on day 2 for a couple days but that could be from something I ate.

Other Meds: Vitamin D3 one tablet per day but not taken on day of vaccination.

Current Illness:

ID: 1675039
Sex: F
Age: 54
State: CA

Vax Date: 08/08/2021
Onset Date: 08/19/2021
Rec V Date: 09/05/2021
Hospital:

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

Lab Data: Pfizer vaccine

Allergies: N/A

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

Symptoms: Extreme migraine headache lasted for 3 days, nausea, joint pain, body aches, brain fog

Other Meds: N/A

Current Illness: N/A

ID: 1675040
Sex: F
Age: 47
State: NJ

Vax Date: 12/18/2020
Onset Date: 12/19/2020
Rec V Date: 09/05/2021
Hospital:

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

Lab Data:

Allergies: sulfa, percoset, codeine

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Woke up next morning feeling like my throat was going to close, worst migraine had in 20 years, nausea and vommitting started and wouldn't stop. Had to call doctor for a perscription to settle my stomach - ondansetron

Other Meds: tramadol, claritin, rhinocort aqua, singulair, arnuity inhaler, synthroid, vit b-6, vit c, calcium, vit d, biotin, glucosamine chondroitin, vit e, topomax, prolia

Current Illness:

ID: 1675041
Sex: M
Age: 32
State: MI

Vax Date: 08/07/2021
Onset Date: 08/16/2021
Rec V Date: 09/05/2021
Hospital:

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

Lab Data: Multiple visits to urgent care. Negative Covid test 9/2/21

Allergies: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Severe fatigue, muscle fatigue, cough and chest pain developed 9 days later.

Other Meds: Fineasteride, omeprozale

Current Illness: None

ID: 1675042
Sex: M
Age: 91
State: MO

Vax Date: 02/25/2021
Onset Date: 02/25/2021
Rec V Date: 09/05/2021
Hospital: Y

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

Lab Data:

Allergies: unknown

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

Symptoms: fell at Assisted Living apartment 8/27/2021. could not get up/walk thus ambulance called. Taken to hospital and found to be febrile and COVID (+). Son says that the delirium and weakness are the primary issues during hospitalization. Oxygenation is fine. NO ICU stay. Still admitted as of Sunday 9/05/2021 with no discharge date known.

Other Meds: unknown

Current Illness: unknown

ID: 1675043
Sex: M
Age: 12
State: KY

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

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: EKG: HR 101, sinus rhythm L axis deviation WBC 11, normal, plts: 245 Have asked for Respiratory pathogen panel, EBV/CMV/HHV-6 serum PCR COVID nucleocapsid metabolic panel ECHO

Allergies: Sulfa, cephalosporins

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

Symptoms: Nausea, vomiting, myalgia, HA (after second Pfizer dose, dose given 9/2, felt symptoms 9/3) 9/4- chest pain (4-6hrs)

Other Meds: Aripiprazole, cetirizine, claritin, venlafaxine, buspirone, oxycarbazepine

Current Illness: N/A

ID: 1675044
Sex: F
Age: 80
State: OH

Vax Date: 09/05/2021
Onset Date: 09/05/2021
Rec V Date: 09/05/2021
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: Allergy to Tetnus toxin caused to feel unwell almost 40 years ago. Eggs caused pt to get upset stomach, but she also has colon issues that she thought were probably the cause

Symptom List: Unevaluable event

Symptoms: After asking for and confirming they wanted the flu shot, receiving receipt of flu vaccine, and receiving the flu shot, the patient was upset about receiving a flu shot instead of the covid vaccine. We discussed the request and confirmation of flu shot, the receipt the patient received for the flu shot and the patient's discussion with the patient asking about previous flu shots. She then requested the covid vaccine and it was administered to her.

Other Meds: none that we are aware of

Current Illness: nothing

ID: 1675045
Sex: M
Age: 61
State: NJ

Vax Date: 07/22/2021
Onset Date: 07/27/2021
Rec V Date: 09/05/2021
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: none

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

Symptoms: Feeling sick for the last 5 weeks with elevated body temp/heat , pressure especially on the left side of the head with lack of appetite and constant ringing in the left ear , symptoms on some days are milder but always coming back ...

Other Meds: NAD, Vitamins, NAC , PQQ , msm, Vitamin D , C ,omega 3

Current Illness: none

ID: 1675046
Sex: F
Age: 79
State: CA

Vax Date: 08/31/2021
Onset Date: 09/02/2021
Rec V Date: 09/05/2021
Hospital:

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

Lab Data: None

Allergies: Suspect pollen allergies. Not recently diagnosed.

Symptom List: Injection site pain, Pain

Symptoms: Severe runny nose and sneezing. Note that this has happened on several occasions in previous years, but not in 2020.

Other Meds: Atorvastatin, Levothyroxine, multivitamin tablet

Current Illness: None

ID: 1675047
Sex: M
Age: 16
State: NC

Vax Date: 08/21/2021
Onset Date: 08/22/2021
Rec V Date: 09/05/2021
Hospital:

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

Lab Data: Strep-negative

Allergies: None

Symptom List: Injection site pain, Menorrhagia

Symptoms: Hearing loss in left ear. Head/sinus congestion

Other Meds: None

Current Illness: None

ID: 1675048
Sex: F
Age: 34
State: NJ

Vax Date: 09/02/2021
Onset Date: 09/02/2021
Rec V Date: 09/05/2021
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: Latex, Emla cream, entex

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

Symptoms: Left arm redness and purple bruising starting the night of the same injection day. Middle of the night woke up with sweats and aching joints, headache. Breastfeeding my four month old infant, green watery diarrhea for her the following day/ general crankiness/fussy. I had to work the following day, Friday, and had to pump breastmilk. My supply was literally half the amount of ounces I normally pump, and I consume 90-120 ounces of water from my water bottles everyday , plus other liquids so reduction in breastmilk is not something normal for me.

Other Meds: Pre natal vitamin, 1 PO QD Colace 1 PO QD Vitamin D 1 PO QD

Current Illness: None

ID: 1675049
Sex: F
Age: 50
State: OR

Vax Date: 08/16/2021
Onset Date: 08/16/2021
Rec V Date: 09/05/2021
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: Complete blood work done 9/3/21.

Allergies: None

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: 15 minutes after receiving first dose, got up to leave the pharmacy and the room started spinning and the floor felt like it was moving. I almost fell. Since then I have had headache, room spinning, dizziness, nausea, blurred vision, electrical shocks in legs and chest, diarrhea, sweating, heat intolerance, unsteady walking, flushed face, groin pain, body aches, insomnia, vertigo, weakness, canker sores, burning body rash, brain fog.

Other Meds: Vitamin D, Vitamin C, Zinc, Tizanidine, Maxalt, Fiorcet

Current Illness: None

ID: 1675050
Sex: F
Age: 38
State: ND

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

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

Lab Data:

Allergies: Gabapentin

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Fever; body aches; chills; sharp leg pains; sore arm; fatigue.

Other Meds: Propranolol; Xanax; Paxil

Current Illness: No

ID: 1675051
Sex: M
Age: 39
State: VA

Vax Date: 06/14/2021
Onset Date: 06/14/2021
Rec V Date: 09/05/2021
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: No lab tests were performed

Allergies: Peanut allergy

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

Symptoms: Severe fever reaching 102 degrees and sustained illness for 4 days post vaccination. Cold sweats and chills were frequent with significant soreness to impair ability to work. NSaids and Acetaminophen were unable to break the fever until the 4th day.

Other Meds: None

Current Illness: No prior illnesses

ID: 1675052
Sex: F
Age: 57
State: MD

Vax Date: 05/14/2021
Onset Date: 05/17/2021
Rec V Date: 09/05/2021
Hospital: Y

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

Lab Data:

Allergies: lisinopril

Symptom List: Nausea

Symptoms: Bilateral Pain in arms, as well as swelling, stiffness. Pain 10/10 on scale. Unable to lift arm all the way in the air. Limited motion. On left arm pain also moves down arm. Right Arm is 2-3/10 on scale with similiar issues. MD stated to her that she had a "Frozen Shoulder" secondary to post vaccination. Treated with ice. Pt went to hospital 30AUG2021 and given brace.

Other Meds: amitriptyline, gabapentin, sucralfate, tresiba, advair 250/50, albuterol

Current Illness:

ID: 1675053
Sex: M
Age: 53
State: IN

Vax Date: 07/26/2021
Onset Date: 07/27/2021
Rec V Date: 09/05/2021
Hospital:

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

Lab Data: No medical tests completed, I monitored my symptoms.

Allergies: Shellfish

Symptom List: Injection site pain

Symptoms: Woke up next mourning with sweats, mild fever, moderate headache, body aches and some chest pains that lasted for 2 days and slowly subsided.

Other Meds: None

Current Illness: None

ID: 1675054
Sex: M
Age: 77
State: CA

Vax Date: 02/17/2021
Onset Date: 09/04/2021
Rec V Date: 09/05/2021
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 pcr + 9/4

Allergies: lisinopril

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

Symptoms: hospitalized for MI and noted to be covid positive with hypoxia

Other Meds: metoprolol, colchicine, lipitor, hytrin, hyzaar, asa, vitamin d, allopurinol

Current Illness: NA

ID: 1675055
Sex: F
Age: 38
State: MN

Vax Date: 08/04/2021
Onset Date: 08/05/2021
Rec V Date: 09/05/2021
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: Celiac disease Amoxicillin

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

Symptoms: Left arm became extremely sore with scar tissue build up with a 3 inch radius in the deltoid. It has been a month and there is still a small amount of scar tissue built up in the arm. Complete fatigue and no energy for 7 days after the first injection. Headache daily with severe nausea and diarrhea. Felt off for the entire time and very ill.

Other Meds: Prozac 30 mg Claritin 10 mg

Current Illness: None

ID: 1675056
Sex: F
Age: 48
State: IN

Vax Date: 09/01/2021
Onset Date: 09/02/2021
Rec V Date: 09/05/2021
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: Penicillin

Symptom List: Tremor

Symptoms: Swollen lymph nodes under both arms. Much larger on the left side, which was the injection site.

Other Meds: Lexapro 5mg

Current Illness:

ID: 1675057
Sex: F
Age: 38
State: PA

Vax Date: 09/02/2021
Onset Date: 09/03/2021
Rec V Date: 09/05/2021
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: Not applicable

Symptom List: Erythema, Pruritus

Symptoms: Day after having the shot I developed mouth sores, 1 on the right side and bottom of my tongue, and 1 on the bottom of my mouth under my tongue all on the right side, they hurt when I eat and talk mostly. My left armpit has a tender and sore spot towards the back of my pit. Other symptom I am experiencing is flushed face mainly my upper cheeks are redder in the mornings. These 3 symptoms I have been experiencing for 3 days now. I had the shot on a Thursday and it is now Sunday.

Other Meds: Enskyce birth control pill

Current Illness: None

ID: 1675059
Sex: M
Age: 34
State: WA

Vax Date: 05/04/2021
Onset Date: 05/28/2021
Rec V Date: 09/05/2021
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: The hospital has records

Allergies: None.

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

Symptoms: About a month after receiving 2nd dose of Pfizer shot. I started to have pain in my left arm (where I received the injection). The pain continued so much that I could not sleep at night. I suddenly began to not have the normal use of my left arm or motor function that I generally have. I couldn't raise my left arm without help of my right (this was painful to do itself) This continued for weeks before I could be seen by a Doctor. It has been now 3 months. I have been passed around Dr after Dr without them being able to find the reason to my pain or how to regain function. I am supposed to see a nerve specialist next. I cannot work due to my arm. My muscle compared to my right arm feels atrophied. The Dr's have never seen this and also suspect that it could be due to the vaccine. They asked me to report it.

Other Meds: None.

Current Illness: None.

ID: 1675060
Sex: M
Age: 54
State: CA

Vax Date: 04/23/2021
Onset Date: 04/24/2021
Rec V Date: 09/05/2021
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: None

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

Symptoms: Severe headaches 24/7, migraine-like, beginning approx. 24 hours post vaccine and lasting 3 weeks. An additional 2 months of headache pain, less severe in nature.

Other Meds: Omega-3 fish oil 1000mg, Quercetin 800mg, resveratrol 700mg, CoQ10 Ubiquinone, Chelated magnesium 100mg

Current Illness: PACS (post-acute covid-19 syndrome)

ID: 1675061
Sex: F
Age: 13
State: MD

Vax Date: 09/04/2021
Onset Date: 09/04/2021
Rec V Date: 09/05/2021
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: No

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient's guardian was wrongly informed the date for second dose and received a second dose 10 days sooner than it should be. The first dose was given on 8/24/21 then second dose was given on 9/4/21 instead of 9/14/21. Patient's mother didn't report any adverse effect.

Other Meds: Not reported

Current Illness: Not reported

ID: 1675062
Sex: F
Age: 47
State: NJ

Vax Date: 01/08/2021
Onset Date: 09/05/2021
Rec V Date: 09/05/2021
Hospital:

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

Lab Data: Brain Ct scan - 4/3/21, Brain MRI 5/21, Balance Test 5/21, Blood work 4/3/21, Hearing Test 5/21, VT - therapy for vertigo 6/21-7/21

Allergies: sulfa, percoset, codeine, tramadol

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

Symptoms: Vertigo - 1st time ever had happened. Came on all of a sudden, no accident occurred, without any warning, didn't hit my head...was just sitting in a car that wasn't moving. The weirdest feeling started in my head, felt dizzy, lightheaded, when tried to walk couldn't walk in a straight line, felt all this pressure in my left ear and my head almost like I was getting a headache, but didn't....within a couple hours it progressed and ended up in the ER because every time I tried to walk my whole body would start shaking and felt nausea as well, that the room was spinning. Have battled vertigo, dizziness, pressure in my left ear, and head since that day.

Other Meds: claritin, rhinocort aqua, singulair, arnuity inhaler, synthroid, vit b-6, vit c, calcium, vit d, biotin, glucosamine chondroitin, vit e, topomax

Current Illness:

ID: 1675063
Sex: F
Age: 56
State: NC

Vax Date: 02/01/2021
Onset Date: 02/16/2021
Rec V Date: 09/05/2021
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: Cardiac MRI and stress test. Wore a heart monitor for 2 weeks This past month my hearty rate drops in the 40?s for extended periods of time and I have shortness of breath severe along with mild chest pain.

Allergies: Codeine Metformin

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

Symptoms: 4 days after the 2nd Moderna Vaccine I began having tachycardia and runs of PVCs along with severe shortness of breath after walking only 100 feet. Now my heart rate began dropping in the 40?s for extended periods of time.

Other Meds: Lorazepam HCTZ Propranolol

Current Illness: Anxiety Depression Cellulitus of bilateral lower legs after 12 hrs work!!

ID: 1675064
Sex: F
Age: 70
State: NM

Vax Date: 08/09/2021
Onset Date: 08/14/2021
Rec V Date: 09/05/2021
Hospital:

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

Lab Data: Doctor did not give me any treatment. He said it will just dissipate over time.

Allergies: Sulfa, gluten and dairy sensitivities

Symptom List: Pain in extremity

Symptoms: I got my first jab on 8/9/21. On 8/14/21, I had a severe hemorrhage on the sclera of my left eye. I went to Urgent Care, the doctor who attended to me denied it was a side effect of the vaccine. No treatment. My second jab was done on 8/31/21 and on 9/5/2021 had a hemorrhage again of the sclera, this time on the right eye. It is definitely a side effect of the Pfizer vaccine.

Other Meds: Armour Thyroid, Betaine Hcl, vitamins C, D3, zinc, Astragalus Root, B complex, Probiotics, collagen, magnesium glycinate, levocetitizine

Current Illness:

ID: 1675065
Sex: F
Age: 18
State: NJ

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

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

Lab Data: mom gave benadryl and emergency services called

Allergies: Augmentin, Rocephin, Omnicef, Zantac

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

Symptoms: pt said throat felt like had a lump

Other Meds: unkown

Current Illness: unknown

ID: 1675066
Sex: F
Age: 75
State: FL

Vax Date: 02/06/2021
Onset Date: 08/27/2021
Rec V Date: 09/05/2021
Hospital: Y

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

Lab Data: SARS-COV-2, NAA, Detected: 08/18/21.

Allergies: Casirivimab & Imdevimab

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

Symptoms: Patient required hospitalization due to breakthrough infection. She received Pfizer vaccine (2nd dose in series 02/06/21). Hospitalized from 08/27/21 - 08/31/21. Below is copied from discharge summary: Patient with known COVID. Family states slightly more confused and breathing faster as well as increased fatigue. Family also contacted PCP and was concerned because of chest pain. PCP one to rule out PE. I also discussed with the family the patient's not appear to have a recent cardiac workup for ACS. Patient discharged with no s/s of acute distress noted. Discharge instructions provided. Patient voiced understanding. IV removed. Personal belongings returned to patient. Packet for son given to him at time of pick up

Other Meds: alendronate (FOSAMAX) 70 MG Oral Tablet TAKE 1 TABLET BY MOUTH EVERY 7 DAYS. TAKE IN AM WITH A FULL GLASS OF WATER ON EMPTY STOMACH. DO NOT EAT, DRINK OR LIE DOWN FOR NEXT 30 MIN. Patient taking differently: Take 70 mg by mouth once a week.

Current Illness:

ID: 1675067
Sex: M
Age: 46
State: MO

Vax Date: 04/06/2021
Onset Date: 08/27/2021
Rec V Date: 09/05/2021
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: unknown

Allergies: unknown

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

Symptoms: Patient symptoms began on 08-23-21with a positive test result on 08-27-21. He was tested when he went in for dialysis. He hasn't been in the ICU during this hospital stay. He had heart surgery 2 years ago and has a kidney condition requiring him to receive dialysis twice a week. He is also on antibiotics for infection in his system.

Other Meds: unknown

Current Illness: unknown

ID: 1675068
Sex: F
Age: 47
State: NJ

Vax Date: 08/21/2021
Onset Date: 08/21/2021
Rec V Date: 09/05/2021
Hospital:

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

Lab Data: The EMT's took my blood pressure and it was 150+/99.

Allergies: sulfa, percoset, codeine, tramadol

Symptom List: Vomiting

Symptoms: 10 Minutes after received the vaccine, felt like my throat was going to close, like it was hard to swallow. I started to feel lightheaded and nausea as well. I broke out in a sweat as well.

Other Meds: claritin, rhinocort aqua, singulair, arnuity inhaler, synthroid, vit b-6, vit c, calcium, vit d, biotin, glucosamine chondroitin, vit e, topomax, vitamin b12, meclizine

Current Illness:

ID: 1675069
Sex: F
Age: 57
State: OH

Vax Date: 08/13/2021
Onset Date: 08/14/2021
Rec V Date: 09/05/2021
Hospital:

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

Lab Data: Scans on 08/31/2021 visual clots dvts

Allergies: Codeine

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Had flulike symptoms for 4 days then cramping muscles Charlie horses in legs bout week later started getting red marks on legs and arm emergency room on 08/30/2021 had thrombophlebitis in leg and arm went for scan next morning and found multiple bloodclots started on Eliquis no history of clots before and no family history they couldn't say what caused it

Other Meds: Synthroid and. Trandolapril

Current Illness:

ID: 1675070
Sex: M
Age: 64
State: HI

Vax Date: 07/10/2021
Onset Date: 08/11/2021
Rec V Date: 09/05/2021
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: 8/28/21 ER visit for Nausea, weight loss, dehydration, abdominal pain. Not able to eat. CT scan done with Contrast: Negative 8/31/21: MRI Enterography performed: Negative for obstructions.

Allergies: N/A

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

Symptoms: Started on 8/11/21. Severe Constipation, Nausea, Abdominal pain and Fatigue. Rx: Antinausea meds.

Other Meds: Humira Lomotil

Current Illness: N/A

ID: 1675071
Sex: F
Age: 25
State: SC

Vax Date: 09/04/2021
Onset Date: 09/04/2021
Rec V Date: 09/05/2021
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:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1675072
Sex: F
Age: 44
State:

Vax Date: 01/09/2021
Onset Date:
Rec V Date: 09/05/2021
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: sore arm, headache from vaccine #2

Other Meds:

Current Illness:

ID: 1675073
Sex: F
Age: 32
State: TX

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

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

Lab Data:

Allergies: None

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

Symptoms: High fever, migraine, dizziness, lightheaded, chills and sweats. Much worse than the 2nd shot. This was my booster

Other Meds: Stribild

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am