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: 1678580
Sex: F
Age: 37
State: TN

Vax Date: 08/06/2021
Onset Date: 08/10/2021
Rec V Date: 09/07/2021
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: NKDA

Symptom List: Dysphagia, Epiglottitis

Symptoms: Pt received Pfizer 1st dose 08/06/2021 and on 08/10/2021 pt started feeling chest tightness that radiated up her thraot and had the feeling of being swollen. Pt started a slight cough and felt out of breath,but could still breath. The symptoms stayed with pt the rest of the day and has been on and off ever since,but on with exertion.

Other Meds: Singulair 10mg, Maca OTC

Current Illness: none

ID: 1678581
Sex: F
Age: 43
State:

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 09/07/2021
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: 1678582
Sex: F
Age: 46
State:

Vax Date: 08/05/2021
Onset Date: 09/07/2021
Rec V Date: 09/07/2021
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: Patient received Pfizer COVID vaccine dose on 4/25/2021, 6/23/2021 and 8/5/2021. Lot number for 8/5/2021 dose #3 listed on this report.

Other Meds:

Current Illness:

ID: 1678583
Sex: F
Age: 18
State:

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 09/07/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1678584
Sex: F
Age: 61
State: PA

Vax Date: 02/20/2021
Onset Date: 02/20/2021
Rec V Date: 09/07/2021
Hospital:

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

Lab Data: Scheduled do an ultrasound.

Allergies:

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

Symptoms: I had fever chills, body aches, pain at injection site. Swelling at lymph nodes at axillary and clavicle. Never went away even before My 3rd dose.

Other Meds: Sildenafil; Nexium; Pepcid

Current Illness:

ID: 1678585
Sex: F
Age: 49
State:

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 09/07/2021
Hospital:

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1678586
Sex: M
Age: 16
State: AL

Vax Date: 08/06/2021
Onset Date: 08/06/2021
Rec V Date: 09/07/2021
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: Pyrexia, White blood cell count decreased

Symptoms: 2nd dose was given one week too early.

Other Meds: Irbesartan 150mg QHS

Current Illness: none documented

ID: 1678587
Sex: M
Age: 48
State:

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 09/07/2021
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: 1678588
Sex: F
Age: 56
State:

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 09/07/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1678589
Sex: F
Age: 47
State: NY

Vax Date: 08/27/2021
Onset Date: 08/28/2021
Rec V Date: 09/07/2021
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: Ibuprofen

Symptom List: Diarrhoea, Nasal congestion

Symptoms: nausea, chills, diarrhea, rash on tops of feet

Other Meds: N/A

Current Illness: N/A

ID: 1678590
Sex: M
Age: 94
State:

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 09/07/2021
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: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: Vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1678591
Sex: F
Age: 68
State: OH

Vax Date: 09/05/2021
Onset Date: 09/06/2021
Rec V Date: 09/07/2021
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 done

Allergies: pcn, sulfa, minocin, cipro

Symptom List: Rash, Urticaria

Symptoms: rapid heart beat, palpitations, some light headedness when palpitations occur

Other Meds: baby aspirin, allegra, multi-vitamin, vitamin c, probiotic, elderberry

Current Illness: cold/sinus infection 3 weeks ago

ID: 1678592
Sex: M
Age: 33
State: TX

Vax Date: 09/02/2021
Onset Date: 09/03/2021
Rec V Date: 09/07/2021
Hospital:

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

Lab Data: none yet

Allergies: NKA

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

Symptoms: The day after my second covid vaccine shot, I felt run down and tired, weak appetite, and ached all over. But I also have been getting nose bleeds nearly every morning since, today it was particularly bad, took almost 5 minutes to stop. Waiting to hear back from doctor about what I should do.

Other Meds: Venlafaxine HCL Er 225mg

Current Illness: none

ID: 1678594
Sex: F
Age: 81
State:

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 09/07/2021
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: 1678595
Sex: F
Age: 53
State:

Vax Date: 08/16/2021
Onset Date: 08/30/2021
Rec V Date: 09/07/2021
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: Ibuprofen; Erythromycin

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

Symptoms: Diagnosed with shingles after vaccination.

Other Meds: Claritin; Celebrex; Prilosec

Current Illness: None

ID: 1678596
Sex: M
Age: 29
State: NY

Vax Date: 09/04/2021
Onset Date: 09/04/2021
Rec V Date: 09/07/2021
Hospital:

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

Lab Data: Hydration and extended observation.

Allergies:

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

Symptoms: Patient complained of nausea and dizziness.

Other Meds: Ibuprofen

Current Illness:

Date Died: 09/03/2021

ID: 1678597
Sex: F
Age: 73
State: TN

Vax Date: 03/26/2021
Onset Date: 08/22/2021
Rec V Date: 09/07/2021
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: Actos, aspirin, bactrim, celebrex, clindamycin, glipizide, pencillins

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

Symptoms: Admitted on 8/22/2021 with fever, cough, dyspnea and decreased appetite. Had contact with COVID + person 6-7 days prior. COVID + on admission.. Received remdesevir 5 day course, steroids, azythromycin, rocephin. Intubated on 8/25. recovering well and extubated on 8/31. on 9/1 complaint of right hip pain and had episode of decompensation requiring intubation nd pressors. CT showed acute retroperitoneal bleed. Received blood products. Bleeding stabilized but continued acute renal failure and electrolyte abnormalities. Family opted for comfort care measures.

Other Meds:

Current Illness:

ID: 1678598
Sex: F
Age: 60
State: FL

Vax Date: 03/20/2021
Onset Date: 09/04/2021
Rec V Date: 09/07/2021
Hospital: Y

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: he patient presents with difficulty breathing. The course/duration of symptoms is 61-year-old female asthmatic presents with increasing shortness of breath. Patient diagnosed at home 1 week ago with coronavirus. Patient states she did get the Johnson & Johnson vaccination back in March or April. Patient states that she went to have the outpatient autoimmune immunoglobulins given however her O2 sats were below 90 and she was instructed to go to the hospital. In triage on room air her O2 sat was 86%. She denies coughing up any sputum she does complain of shortness of breath with any exertion. She has had some body aches. She has had no fever. She has had some nausea but no vomiting. She states her whole family at home has coronavirus. She does work in daycare.. Degree at onset mild. Degree at present severe. The Exacerbating factors is exertion. The Relieving factors is oxygen. Risk factors consist of asthma. Prior episodes: none. Therapy today: none. Associated symptoms: cough and nausea.

Other Meds:

Current Illness:

ID: 1678599
Sex: F
Age: 64
State: OH

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 09/07/2021
Hospital:

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

Lab Data: NA

Allergies: NA

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Pt. complained of chest pain (left side) that lasted a couple of seconds. Vitals: OxSat 98%, HR 93, BP132/84, @ 0930, 130/78 @ 9041. Pt monitored for additional 15 min. States she felt ok, and returned to work.

Other Meds: NA

Current Illness: NA

ID: 1678600
Sex: M
Age: 56
State:

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 09/07/2021
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: 1678601
Sex: M
Age: 33
State:

Vax Date: 08/10/2021
Onset Date: 09/07/2021
Rec V Date: 09/07/2021
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: Patient received J+J COVID vaccine on 5/23/2021 and received Pfizer vaccine on 8/10/2021 as documented on this report.

Other Meds:

Current Illness:

ID: 1678602
Sex: F
Age: 34
State: OH

Vax Date: 09/01/2021
Onset Date: 09/01/2021
Rec V Date: 09/07/2021
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: Unevaluable event

Symptoms: 30 minutes post Covid vaccine #1 patient experienced facial "tightness and numbness"; patient stated that sensation felt as if she was wearing a tight mask; sensation lasted 30 to 60 minutes; symptoms returned one day later and also lasted 30 to 60 minutes; no symptoms since then;

Other Meds:

Current Illness:

ID: 1678603
Sex: M
Age: 72
State: GA

Vax Date: 08/26/2021
Onset Date: 08/26/2021
Rec V Date: 09/07/2021
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: Covid 19 Test - Negative X-rays - Pulmonary infiltrate in left lung on CXR

Allergies: Seasonal

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

Symptoms: Difficulty breathing, pain/heaviness/congestion in chest, chills, headache, severe headache, feeling miserable, right arm pain.

Other Meds: 1. Aspirin 81mg 2. Amlodipine Besylate 5mg 3. Alfuzosin HCL 10 mg 4. Carvedilol 6.5 mg (2x) 5. Ranexa/Ranolazine 1000mg (x2) 6. Finasteride 5mg 7. Nitrostat/Nitroglycerin 50mcg (as needed) 8. Pantoprazole 40 mg 9. Atorvastatin 20 mg. 10.

Current Illness: None

ID: 1678604
Sex: F
Age: 44
State:

Vax Date: 02/01/2021
Onset Date: 09/03/2021
Rec V Date: 09/07/2021
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: None stated.

Other Meds:

Current Illness:

ID: 1678605
Sex: F
Age: 22
State: LA

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

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

Lab Data:

Allergies: unknown

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient received vaccine and waited her 15 mins. Patient stated that she went back to work and started to feel bad. Patient came back to the vaccine clinic where she was instructed to sit down. Upon sitting down patients vitals and O2 sat checked and noted to be in normal ranges. WIth an elevated heart rate. Patient was instructed to take some deep breaths. Patient was talking and laughing. Patient given some water and crackers. 5 mins after given food and water patient threw-up the water and crackers. Patient states that her head feels light and dizzy. Patient encouraged to go to hospital seeing that patient stated that symptoms not getting better. Ambulance ride offered and patient refused to go via ambulance. Patient stated that she would go with her emergency contact (Her mom). Patient's mom called, mom came and picked patient up. Patient instructed to go to ER. Patient verbalized understanding. Patient called Tuesday morning. Patient states that she is feeling much better. She states that her mom took her to urgent care and it was later determined that the patient was having a panic attack.

Other Meds: None

Current Illness: none

ID: 1678606
Sex: F
Age: 60
State: MN

Vax Date: 02/17/2021
Onset Date: 09/01/2021
Rec V Date: 09/07/2021
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: Patient swabbed at our offsite testing location. Please contact PCP with further questions.

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

Symptoms: Patient vaccinated for and then tested positive for COVID-19 on 9/1/21.

Other Meds: Patient swabbed at our offsite testing location. Please contact PCP with further questions.

Current Illness: Patient swabbed at our offsite testing location. Please contact PCP with further questions.

ID: 1678607
Sex: M
Age: 82
State: MI

Vax Date: 08/31/2021
Onset Date: 09/01/2021
Rec V Date: 09/07/2021
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: None

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Client reported fatigue and arm pain later on on the date of vaccination. She reports he was able to play golf and work. He had Friday off. Reports over the weekend he became so fatigued he could not get out of bed. Is feeling a bit better today.

Other Meds: Eliquis, Protonix, Lisinopril, Trazodone, Ezetimibe, Lipitor, Inhaler

Current Illness: None

ID: 1678609
Sex: F
Age: 40
State: OH

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

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

Lab Data: NA

Allergies: NA

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Pt reported to feel dizzy. BP: 124/80, After 15min monitoring pt reports feeling better. Pt left the facility, symptoms resolved.

Other Meds: Topomax, Wellbutrion, Clonidine, Methadone, GAbapentin

Current Illness: NA

ID: 1678611
Sex: F
Age: 51
State: PA

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 09/07/2021
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: Fri Sep 03, 2021 1705 No significant abnormalities CBC and differential(!) [JG] 1735 Troponin T: <0.01 [JG] 1748 No significant abnormalities Basic Metabolic Panel [JG] 1748 No consolidation, no mediastinal widening XR chest 1 view portable [JG]

Allergies: Wellbutrin [Bupropion Hcl] Abilify [Aripiprazole] GabapentinSwelling Lamictal [Lamotrigine]Swelling Seroquel [Quetiapine] Zyprexa [Olanzapine] Adhesive Tape-siliconesRash Adhesive [Tape] Geodon [Ziprasidone Hcl] Risperidone Trazodone

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

Symptoms: Patient given Pfizer Covid vaccine in Right vastus lateralis IM. Patient requested site due to being "unable to get shots in her arms." Patient had CDC information sent to her that stated Deltoid or Thigh muscles can be used for administration. At 15 minute mark patient began complaining of tight right sided neck muscle, feeling dizzy and extremely tired. Also complained of feeling as if there was a "hole in her chest that went to her back." . Patient requesting transport to the ER. Ambulance called and patient transported to hospital.

Other Meds: calcium carbonate (TUMS ORAL) citalopram (CeleXA) 10 MG tablet prednisoLONE acetate (PRED FORTE) 1 % ophthalmic suspension RESTASIS 0.05 % ophthalmic emulsion Ventolin HFA 90 mcg/actuation inhaler

Current Illness:

ID: 1678612
Sex: F
Age: 41
State:

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 09/07/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: Vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1678613
Sex: M
Age: 30
State:

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 09/07/2021
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: Vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1678614
Sex: F
Age: 75
State: TX

Vax Date: 01/28/2021
Onset Date: 01/28/2021
Rec V Date: 09/07/2021
Hospital:

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

Lab Data: bloodwork ekg chest xray EVERYTHING NORMAL

Allergies:

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

Symptoms: upper back pain, nausea, weight loss (30 pounds), cant sleep, weakness, brain fog, depression, hair loss,

Other Meds:

Current Illness:

ID: 1678615
Sex: F
Age: 20
State:

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 09/07/2021
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: Vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1678616
Sex: F
Age: 51
State:

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 09/07/2021
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: Vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1678617
Sex: F
Age: 33
State:

Vax Date: 09/03/2021
Onset Date: 09/04/2021
Rec V Date: 09/07/2021
Hospital:

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

Lab Data: None yet. Considering going to hospital soon

Allergies: None

Symptom List: Erythema, Pruritus

Symptoms: Arm sore Tired Nauseous Night sweat Fast heartbeat, pulse Extremely jittery Hot flashes Ocular migraine Vivid dreams Trouble focusing and remembering what I?m doing/saying Heartburn? Not sure if that?s the right word but a pain/tightness in chest The need to do a little cough Feels like not enough breath to talk Wrist pain (feels like my blood is too thick or something. No other way to describe it)

Other Meds: None

Current Illness: Slight cold a few weeks before

ID: 1678618
Sex: F
Age: 36
State: IL

Vax Date: 08/30/2021
Onset Date: 09/01/2021
Rec V Date: 09/07/2021
Hospital:

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data: None

Allergies: None

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

Symptoms: Rash on the third day

Other Meds: Vitamins for calcium fish oil iron

Current Illness: None none none

ID: 1678619
Sex: M
Age: 51
State:

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 09/07/2021
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: Vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1678620
Sex: F
Age: 36
State: NJ

Vax Date: 03/04/2021
Onset Date: 03/08/2021
Rec V Date: 09/07/2021
Hospital:

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

Lab Data: 08/12/2021- In office screening from Neurologist 08/12/2021- Blood Work 11/2021 Have a Follow up with the Neurologist

Allergies: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: 05/08/2021- Brain Fog, Intense Anxiety. Forgetfulness Primary Care Physician referred me to a Neurologist 06/12/2021- Cyst on breast- tested non cancerous

Other Meds: Multivitamin, Glucosamine chondroitin

Current Illness: None

ID: 1678622
Sex: M
Age: 49
State:

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 09/07/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1678623
Sex: F
Age: 34
State: WI

Vax Date: 09/02/2021
Onset Date: 09/04/2021
Rec V Date: 09/07/2021
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: Hives appeared on 9/4/21, present all over the body. Very itchy. Benadryl helped symptoms subside.

Other Meds:

Current Illness:

ID: 1678624
Sex: M
Age: 20
State: TX

Vax Date: 09/04/2021
Onset Date: 09/04/2021
Rec V Date: 09/07/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Pain in extremity

Symptoms: Patient was coming into clinic to receive their second dose of Moderna, but received Pfizer.

Other Meds: none

Current Illness: none

ID: 1678625
Sex: F
Age: 48
State: MN

Vax Date: 12/21/2020
Onset Date: 09/05/2021
Rec V Date: 09/07/2021
Hospital:

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

Lab Data: Covid-19 PCR test, positive (9/6/21)

Allergies:

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

Symptoms: Developed Covid-19 symptoms, tested positive for infection.

Other Meds:

Current Illness:

ID: 1678626
Sex: F
Age: 76
State: FL

Vax Date: 09/03/2021
Onset Date: 09/04/2021
Rec V Date: 09/07/2021
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 Sulfa

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

Symptoms: Patient reports chills, headache and fever even after taking Tylenol. Soreness and hot to the touch at the injection site - resolved after 24 hours. Swollen gland in neck - still present. Very lethargic for about 20 hours. Rash that started on trunk and moved to legs and arms that is still present. Patient wished all symptoms to be reported even after speaking with staff about how it is all to be expected.

Other Meds:

Current Illness:

ID: 1678627
Sex: M
Age: 24
State:

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 09/07/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: Vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1678628
Sex: M
Age: 48
State:

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 09/07/2021
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:

Symptom List: Vomiting

Symptoms: Vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1678630
Sex: F
Age: 48
State: VA

Vax Date: 05/25/2021
Onset Date: 07/01/2021
Rec V Date: 09/07/2021
Hospital:

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

Lab Data: July 9 - chest x-ray (left lung not clear) July 26 - chest x-ray (left lung not clear), COVID PCR test (negative), referral to pulmonologist

Allergies: Penicillin

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: On May 27, after the 2nd injection, I became very sick and weak. This continued for roughly 5 days. I was really dehydrated and blacked out briefly in my living room. Then in early June, I developed a cough that was producing a large amount of mucus. I took cough medicines and decongestants, but nothing seemed to work. The cough got worse - I began coughing up blood - and was short of breath. On July 9, I went to urgent care and they performed a chest x-ray. They saw the congestion in my left lung and said I had bronchitis, something I have never had before. They prescribed a steroid, cough medicine, and antibiotic. I felt better for a few days but once I was done with the steroid, it got worse again and I went back to the urgent care 2 1/2 weeks later. They conducted another chest x-ray and COVID PCR test (neg). My left lung had not cleared up and my chest was hurting. They prescribed cough medicine with codeine and another round of antibiotics to treat what they thought was severe bronchitis. The cough medicine didn't work, and I have gotten better over time, but as of today, am still coughing up mucus but it is clear now (not bloody or green). The doctor referred me to a pulmonary specialist, whom I haven't yet seen.

Other Meds: Synthroid, Sertraline, Spironolactone, multi-vitamin, fish oil

Current Illness: N/A

ID: 1678631
Sex: M
Age: 60
State:

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 09/07/2021
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: Vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1678632
Sex: M
Age: 28
State:

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 09/07/2021
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: Vaccine expired in fridge

Other Meds:

Current Illness:

ID: 1678633
Sex: F
Age: 34
State: MI

Vax Date: 09/02/2021
Onset Date: 09/02/2021
Rec V Date: 09/07/2021
Hospital:

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

Lab Data:

Allergies: Pet Dander Other Cigarette Smoke

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

Symptoms: Patient to advised she was given two doses in her vaccine yesterday; Received a double dose of pfizer vaccine.

Other Meds: albuterol HFA (ALBUTEROL) 108 (90 Base) MCG/ACT inhaler Ascorbic Acid (VITAMIN C) 500 MG CAPS azelastine (ASTELIN) 0.1 % nasal spray Bacillus Coagulans-Inulin (PROBIOTIC FORMULA PO) cetirizine (ZYRTEC ALLERGY) 10 MG CAPS Cholecalciferol (VI

Current Illness: NA

ID: 1678634
Sex: F
Age: 54
State:

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 09/07/2021
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:

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

Symptoms: Vaccine expired in fridge

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am