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: 1682918
Sex: F
Age: 29
State: OH

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

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

Lab Data: BAMP, CBC, HS Troponin, magnesium level, urine pregnancy, urinalysis, ECG12 lead, XR chest

Allergies: PCN

Symptom List: Dysphagia, Epiglottitis

Symptoms: 11:30pm on day of dose 9/4, I felt nauseous. I got up from my desk to walk about 15 steps to the bathroom and lost consciousness. In coming to, I was hot and sweaty. When EMTs arrived my bp was 80/a number I don?t remember but low. Bs was 114

Other Meds: Gabapentin, Cyclobenzaprine, Lexapro

Current Illness: NA

ID: 1682919
Sex: F
Age: 84
State:

Vax Date: 04/02/2021
Onset Date: 04/17/2021
Rec V Date: 09/08/2021
Hospital: Y

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: Patient presented to the ED and was subsequently hospitalized for UTI, and started on a PPI for likely duodenal ulcer within 6 weeks of receiving COVID vaccination.

Other Meds:

Current Illness:

ID: 1682920
Sex: F
Age: 33
State: FL

Vax Date: 09/04/2021
Onset Date: 09/04/2021
Rec V Date: 09/08/2021
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: None

Allergies: None

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

Symptoms: Pt began experiencing warmth and hives at around 3pm on Saturday. She took a Benadryl and felt better. By Monday, it became more hot and swollen, felt weak/non-functional. She went to ER in which she works and got an ultrasound revealing edema. They gave her a Rocephin shot and it has improved but still a little red.

Other Meds: Unknown

Current Illness: None

ID: 1682921
Sex: F
Age: 35
State: MN

Vax Date: 09/08/2021
Onset Date: 09/08/2021
Rec V Date: 09/08/2021
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: Patient was administered Moderna vaccine on 8/11/2021. Patient was then administered Pfizer vaccine on 9/8/2021. Reporting that patient did not complete a series of Moderna (dose 1), because Pfizer was given as dose 2.

Other Meds:

Current Illness:

ID: 1682922
Sex: F
Age: 65
State: KS

Vax Date: 08/30/2021
Onset Date: 09/02/2021
Rec V Date: 09/08/2021
Hospital:

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

Lab Data:

Allergies: Bactrim/sulfa, Celebrex

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

Symptoms: red itchy rash to right upper arm approximately 6cm wide x 3 cm long at site of 2nd COVID injection.

Other Meds: Bupropion, Co Q-10, Duloxetine, Vitamin D, Naproxen, Plaquenil, Rosuvastatin, Tramadol

Current Illness: none reported

ID: 1682923
Sex: M
Age: 17
State: MN

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

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

Lab Data:

Allergies:

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

Symptoms: Patient under 18 yo

Other Meds:

Current Illness:

ID: 1682924
Sex: M
Age: 35
State: IL

Vax Date: 03/23/2021
Onset Date: 04/04/2021
Rec V Date: 09/08/2021
Hospital: Y

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

Lab Data: 4/4/21 COVID 19: Positive 4/8/21 Chest xray: Negative

Allergies: Bactrim, morphine, metoclopramide

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient complained of constant pain in his throat as well as right ear has been going on for past 2 days. Patient also states he has some dysphagia. He describes the pain as stabbing in nature. Rates it a 10/10. States it is constant. States begins at the right ear and radiates down the right side of his neck. The swelling is no aggravating factor with no relieving factors. Patient was recently admitted and discharged after being treated for an abscess on the right side of his neck. However was noted the patient had a new tremor as scheduled for additional radiation chemotherapy. Patient denies any headache, vision changes, fever, chills, shortness of breath, increased cough, chest pain, heart palpitations, nausea vomiting diarrhea, constipation, abdominal pain, difficulty urinating, increased urinary frequency, blood in his urine, painful urination, patient denies any new numbness or tingling in his extremities. Patient denies any new edema in his extremities. Patient denies any recent sick contacts. Patient denies any recent travel. Patient has a significant medical history of squamous cell cancer of the tongue. HIV. Opioid addiction. CPAP. Diagnosed with COVID-19 on 04/04/2021. Received dexamethasone IV, 1L normal saline, fentanyl and ketorolac. Placed on ertapenem for neck. Discharged on 4/9/21. Then re-admitted on 4/11 for dysphagia. PEG tube placed 4/13/21. Discharged 4/16/21.

Other Meds: Clonidine, genvoya, gabapentin, ibuprofen, vraylar, zubsolv

Current Illness: Recurrence of a neck abscess. He presents with right-sided neck pain redness and swelling. He was recently admitted into the hospital March 2, 2021. ENT was consulted and patient underwent an I&D and removal of purulence fluid on the right side of his neck.

ID: 1682925
Sex: M
Age: 41
State:

Vax Date: 08/26/2021
Onset Date: 08/28/2021
Rec V Date: 09/08/2021
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: Chest pain

Other Meds:

Current Illness:

ID: 1682926
Sex: M
Age: 46
State: OR

Vax Date: 08/24/2021
Onset Date: 08/24/2021
Rec V Date: 09/08/2021
Hospital:

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

Lab Data: EKG, CBC, CMP

Allergies: NKA

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Chest pain, shortness of breathing and fatigue. decompensation of previously well managed cardiomyopathy, CHF

Other Meds: losartan, carvedilol, furosemide, buspirone

Current Illness:

ID: 1682927
Sex: M
Age: 32
State: IA

Vax Date: 09/07/2021
Onset Date: 09/08/2021
Rec V Date: 09/08/2021
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: Vaccine given after Johnson and Johnson vaccine given at another facility

Other Meds:

Current Illness:

ID: 1682928
Sex: M
Age: 77
State: TN

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

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

Lab Data: 9/1/21: Hypoxic on room air in the 80s. Leukocytosis 24,000, Chest xray with ground-glass opacities bilaterally, lactate 2.5, creatitine 2.7 with unknown baseline

Allergies: NKA

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

Symptoms: Ongoing Hospitalization: Transferred from Medical Center for COVID pneumonia and hypoxia. Began having symptoms 9/2. Tested positive 9/3, continued having shortness of breath. 9/7 worsening chills, fever and shortness of breath with some pain when breathing in his upper chest. Given Rocephin, azithromycin, dexamethasone, lovenox, high flow oxygen.

Other Meds: Unknown

Current Illness: Unknown

ID: 1682929
Sex: F
Age: 68
State:

Vax Date: 02/11/2021
Onset Date: 09/02/2021
Rec V Date: 09/08/2021
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: Patient had positive COVID test on 9/2

Other Meds:

Current Illness:

ID: 1682930
Sex: F
Age: 57
State: CA

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

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

Lab Data: previous had shingles vaccine, and several shingles outbreaks. Antiviral aclovir given by doctor. No history of kidney problems prior to this event. Hospitalized for 3 days for AKD. EGFR 20 vs. >60-80 as expected.

Allergies: shellfish, honeybee, wasp, hornet, sulfa, neomycin, codeine

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

Symptoms: activation of shingles, left leg within 4 hours of receiving 1st dose of moderna. 7 days later I was hospitalized with acute kidney failure

Other Meds: synthroid, vit d3, vit b12, losartan, nexium, cosentyx

Current Illness: none

ID: 1682931
Sex: F
Age: 51
State: RI

Vax Date: 08/14/2021
Onset Date: 08/17/2021
Rec V Date: 09/08/2021
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: None

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

Symptoms: Intense Pain from hips to toes for 2 days . Now continue to ache . Also had dizziness that comes and goes .

Other Meds: Multivitamin Iron

Current Illness: None

ID: 1682932
Sex: F
Age: 75
State: FL

Vax Date: 03/04/2021
Onset Date: 08/29/2021
Rec V Date: 09/08/2021
Hospital:

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

Lab Data: 8/30/21 - Covid test; 9/2/21 - Covid test results - Negative

Allergies: Allergic to Minocycline; Lactose Intolerant

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

Symptoms: 8/29/21 - Dry Cough; 8/30/21 Deeper cough, low grade fever, fatigue. Outpatient visit with Dr. Performed Covid test and prescribed isolation and bed rest. Fully recovered by 10/3/21.

Other Meds: Atorvastatin)- 20 mg, 1xday; EEMT generic- Estrogen/Methyl testosterone ? 1.25/2.5 mg daily; Detrol LA (Tolterodine generic)- 4 mg daily; Melatonin ? 5 mg; CitraCal ? 630 mg; Vitamin D3 ? 50 mcg; Aspirin ? 81 mg

Current Illness: None

ID: 1682933
Sex: M
Age: 81
State: PA

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

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

Lab Data: Ref Range & Units 4 d ago 1 mo ago Neutrophils 45.0 - 75.0 % 42.0Low 37.1Low Lymphocytes 19.0 - 46.0 % 45.3 52.1High Monocytes 2.0 - 12.0 % 8.2 6.4 Eosinophils 0.0 - 4.0 % 2.8 3.2 Basophils 0.0 - 1.5 % 1.3 1.0 Immature Granulocytes 0 - 2 % 0.4 0.2 Neutrophils Absolute 2.20 - 8.00 10*3/uL 1.95Low 1.84Low Lymphocytes Absolute 0.90 - 5.00 10*3/uL 2.10 2.59 Monocytes Absolute 0.20 - 0.80 10*3/uL 0.38 0.32 Eosinophils Absolute 0.00 - 0.40 10*3/uL 0.13 0.16 Basophils Absolute 0.00 - 0.40 10*3/uL 0.06 0.05 Immature Granulocyte Absolute 0.00 - 0.22 10*3/uL 0.02 0.01 WBC Count 4.8 - 10.8 10*3/uL 4.6Low 5.0 RBC Count 4.60 - 6.20 10*6/uL 3.71Low 3.49Low Hgb 14.0 - 18.0 g/dL 11.3Low 10.7Low Hct 42.0 - 52.0 % 34.0Low 32.8Low MCV 80.0 - 100.0 fL 91.6 94.0 MCH 27.0 - 33.0 pg 30.5 30.7 MCHC 32.0 - 36.0 g/dL 33.2 32.6 Platelet Count 150 - 450 10*3/uL 11Low Panic 66Low

Allergies: nkda

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

Symptoms: sought and received third dose Moderna August 2 because he read "cancer patients should get it" He had diffuse B cell lymphoma treated with R-CHOP with CR in 2016, no recurrence, but platelets 100-120, 000 and stable since 2017 follow up labs as noted showed platelets to 60,000 less than a week later and 11, 000 by September. Completely asymptomatic and no other new meds or diseases. Awaits bone marrow biopsy and PET imaging, but nothing else to suggest lymphoma recurrence (highly symptomatic presentation in 2016) no thromboembolic signs or symptoms now

Other Meds: losartan, apixaban, hydrochlorothiazide, atorvastatin, doxazosin, glimeperide, omeprazole, metformin

Current Illness: none

ID: 1682934
Sex: M
Age: 25
State: WI

Vax Date: 04/07/2021
Onset Date: 09/06/2021
Rec V Date: 09/08/2021
Hospital: Y

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

Lab Data:

Allergies: Hydroxychloroquine

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

Symptoms: Pt received first and only dose to be fully vaccinated with the J&J Janssen vaccine on 4/7/2021. Pt began to have symptoms of COVID and tested positive on 9/6/2021 at a local ED. He was then transferred later that day for inpatient care. He is still currently inpatient being treated for covid on our general med unit.

Other Meds: Aspirin, Dialyvite vitamin, cinacalcet, ferric citrate, metoprolol, mupirocin ointment, omeprazole.

Current Illness:

ID: 1682935
Sex: F
Age: 69
State: IL

Vax Date: 04/02/2021
Onset Date: 08/31/2021
Rec V Date: 09/08/2021
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: No covid symptoms, was here for psychiatric issue and found to be Covid +

Other Meds:

Current Illness:

ID: 1682936
Sex: M
Age: 81
State: MN

Vax Date: 01/22/2021
Onset Date: 09/04/2021
Rec V Date: 09/08/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: productive cough of yellow-green sputum and low grade fevers. starting 9/4/21

Other Meds: Losartan; Magnesium; Eliquis; Vitamin D; Daily vitamin; Amlodipine

Current Illness: none

Date Died: 08/27/2021

ID: 1682937
Sex: F
Age: 92
State: KY

Vax Date: 05/07/2021
Onset Date: 08/27/2021
Rec V Date: 09/08/2021
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: Resident was end of life care, tested positive for COVID-19 8/26/21 and expired

Other Meds:

Current Illness:

ID: 1682939
Sex: F
Age: 66
State: MN

Vax Date: 02/04/2021
Onset Date: 09/02/2021
Rec V Date: 09/08/2021
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: Fully Vaccinated employee developed symptoms and tested positive for Covid-19

Other Meds:

Current Illness:

ID: 1682940
Sex: F
Age: 40
State: MN

Vax Date: 04/08/2021
Onset Date: 06/26/2021
Rec V Date: 09/08/2021
Hospital:

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

Lab Data: MRI of the brain without contrast on 6/30/2021. A visit as soon was available with a neurologist on 7/21/21 and then extensive blood tests, lumbar puncture, MRIs with and without contrast of the brain, cervical and thoracic spine which were completed in the following three weeks. The follow-up on 8/11/2021 with the formal diagnosis of Multiple Sclerosis and the recommended initiation of very expensive medication.

Allergies: St. John's Wort, Shellfish, White fish, seasonal, cats

Symptom List: Unevaluable event

Symptoms: 2.5 months later I experienced partial right facial paralysis, tingling into the right upper and lower extremity as well as weakness with flexion of the right lower extremity. I was placed on prednisone immediately for possible Bells Palsy without much immediate relief of symptoms. MRI of the brain did demonstrate demylenating condition, on the same side of the brain where the vaccination was given, which was later determined to be Multiple Sclerosis.

Other Meds: Cholecalciferol, Vitamin C, Zinc, Quercitin

Current Illness: None known

ID: 1682941
Sex: M
Age: 28
State: NC

Vax Date: 09/08/2021
Onset Date: 09/08/2021
Rec V Date: 09/08/2021
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: Rash on face, sore throat, and tachycardic

Other Meds: naproxen, 250 MG, TABLET, ORAL TAKE ONE doxycycline

Current Illness: Covid-19 10AUG2021

ID: 1682942
Sex: M
Age: 49
State: ME

Vax Date: 03/31/2021
Onset Date: 03/31/2021
Rec V Date: 09/08/2021
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: none

Symptom List: Injection site pain, Pain

Symptoms: Fever 104 degrees, chills, sweating, shaking uncontrollably symptoms lasted approximately 24 hours. I treated myself with tylenol.

Other Meds: Lisinopril, atorvastatin

Current Illness: none

ID: 1682943
Sex: F
Age: 22
State: MI

Vax Date: 08/18/2021
Onset Date: 08/18/2021
Rec V Date: 09/08/2021
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: Patient was charted on incorrectly for first dose. It stated she got Pfizer but really received Moderna. Upon arrival for her second vaccine she did not have her CDC card so the nurse wrote her a new chart based on the Pfizer vaccine in chart and then gave her a second Pfizer vaccine.

Other Meds:

Current Illness:

ID: 1682944
Sex: M
Age: 68
State:

Vax Date: 02/10/2021
Onset Date: 09/02/2021
Rec V Date: 09/08/2021
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: Patient had a positive COVID test on 9/2/2021

Other Meds:

Current Illness:

ID: 1682945
Sex: M
Age: 57
State: KY

Vax Date: 08/25/2021
Onset Date: 09/07/2021
Rec V Date: 09/08/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: hospitalized with covid pna

Other Meds:

Current Illness:

ID: 1682946
Sex: M
Age: 20
State: AR

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

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

Lab Data: Patient was taken to ER and was evaluated by staff in triage. Patient had EKG, UA, blood work, X-ray, and a covid test all done in ER. Patient left the ER without being re-evaluated.

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient came in at 1400hrs to get second Pfizer vaccination. She had her 1st vaccine on 04/28/2021 without any complication. She reported history of Seizure and had follow-up with PCP yesterday, as outpatient. She reported taking Keppra and confirmed taking her daily dosage today. She reported having a snack approximately 45 minutes prior to this visit, including fluid. Patient drove here on her own with no problems. Her 2nd dosage was administered at 1405hrs. She was directed to sit across the main floor in direct view of the providers to facilitate monitoring. A full bottle of water was also given to patient. A few minutes later, Client developed a seizure. This was witness by pharmacists, R/N (volunteer nurse today) and myself. Patient fell on the floor from the sitting position. Immediate assistance was provided to keep her from any sharp objects or walls. Her head and body was stabilized to prevent further injuries. Patient had a good pulse throughout her seizure that lasted for about 8 minutes. Her breathing was also monitored and she vomited scant amount of sputum on carpet floor. Good chest rise was observed and her color was normal. Her skin felt very warm and so her sweater was removed to assist with body temperature. No cyanosis was observed during the event. ED was already alerted and they arrived at vaccination center at approximately 1415hrs. After a few minutes, patient regained consciousness and was taken by EMS personnel to ER. She was stable at the time of her transfer to EMS.

Other Meds: Keppra 750mg 2 tablets BID, lamotrigine 100 mg BID

Current Illness:

ID: 1682947
Sex: F
Age: 30
State: FL

Vax Date: 03/04/2021
Onset Date: 03/05/2021
Rec V Date: 09/08/2021
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: MRI (June 2021)

Allergies: N/A

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

Symptoms: After the vaccine, I developed a terrible headache, which was initially deemed to be a temporary side effect of the vaccination. This headache never subsided and has persisted for 6 months straight, with no alleviation. It is not alleviated by OTC pain killers or prescriptions from neurologists. This headache can be felt in various places around my head, as well as in my ear canals and often behind the eyes. I have tried countless remedies to no avail.

Other Meds: Azathioprine; Prednisone; Plaquenil

Current Illness: N.A

ID: 1682948
Sex: F
Age: 31
State: PA

Vax Date: 08/13/2021
Onset Date: 08/13/2021
Rec V Date: 09/08/2021
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: The Pfizer Covid-19 vaccine was diluted incorrectly. 2.0 mL was used instead of 1.8 mL. We were notified by the nurse who administered in 8/16/21. We called Pfizer before calling the patients to see what they recommended. They said they did not recommend giving the dose and that the CDC says that the dose should not be reported. Our Medical Director called the patient on 9/7/21 and reported the following: Advised her of the vaccine error around the CoVID shot. 2mL of saline used for diultion vs. 1.8mL. Explained what that meant in terms of "extra salt water" being given. Advised it was not a matter for an unknown substance being given. Patient expressed concern and being upset. "I don't understand how this happened." "You're injecting people with things, how could you do this." I apologized for the mistake and assured her that we were taking actions to correct our process in the future. She expressed frustration that she is only finding out about the error now. I again apologized. She stated that the error made her not want to get the second dose. I strongly advised that she get the second dose. I explained that I've known her for several years and her kids. I would want her and the kids to be as protected as possible. I advised that she does NOT have to receive the second dose here and I could understand if she makes that decision, but I advised strongly that she consider getting it elsewhere. I also advised that we spoke with Pfizer and based on their recommendations and the CDC, they would not recommend that she needs any extra dosing and to just complete the second dose as previously planned. Patient again expressed being upset at the error and at the delay in notification. I again apologized and offered to help her in any way I could or answer any further questions. She denied any and the conversation ended.

Other Meds:

Current Illness:

ID: 1682949
Sex: F
Age: 63
State: AR

Vax Date: 04/01/2021
Onset Date: 04/01/2021
Rec V Date: 09/08/2021
Hospital: Y

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

Lab Data: COVID19 positive on 9/2/21

Allergies: NKDA

Symptom List: Injection site pain

Symptoms: Pt hospitalized with COVID19 on 9/5/21. Transferred to another Hospital. She initially presented with SOB on 9/2, and was found to be COVID-positive. Currently hospitalized on BiPap.

Other Meds: unknown

Current Illness: unknown

ID: 1682950
Sex: F
Age: 80
State: FL

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

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

Lab Data:

Allergies: keflex, bactrim, some probiotics

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

Symptoms: Approximately 8 hrs. after injection began to have severe chills, bundled up, took sleeping pill and went to sleep. Woke multiple times during night with aching muscles and joints. Early AM awoke with chills gone but increased body ache, temp 99.8, headache. Symptoms persisted during that day and evening with feeling of total fatigue which kept me in bed all day. Tylenol 500mg. gave some relief. Slept better that night and were improved enough to return home.

Other Meds: liothyronine. liothyroxine, premarin, montelucast, guifenecsin, aspirin 81 mg., zyrtec., multivitamins, acidopholis probiotic, prednisone,proair albuterol inhaler, albuterol and sodium chloride by inhalation

Current Illness: COPD with bronchiectasiis

ID: 1682951
Sex: F
Age: 48
State:

Vax Date: 03/26/2021
Onset Date: 04/01/2021
Rec V Date: 09/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: X-ray of left shoulder

Allergies: ciprofloxacin, cephalexin, metoclopramide, oxycodone, Saphris

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

Symptoms: Patient reports left shoulder pain that possibly started after receiving second dose of the Moderna vaccine. She reports left shoulder pain started several months ago and believes possibly around the time after receiving vaccine to left arm.

Other Meds: Albuterol sulfate nebulizer, albuterol sulfate inhaler, Breo Ellipta inhaler, bupropion, clonazepam, imatinib, montelukast

Current Illness:

ID: 1682952
Sex: M
Age: 57
State:

Vax Date: 01/15/2021
Onset Date: 09/02/2021
Rec V Date: 09/08/2021
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: Patient had a positive COVID test on 9/2/2021

Other Meds:

Current Illness:

ID: 1682953
Sex: F
Age: 11
State: KS

Vax Date: 09/08/2021
Onset Date: 09/08/2021
Rec V Date: 09/08/2021
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: Erythema, Pruritus

Symptoms: Mom brought patient in for Pfizer vaccine at local outreach vaccine clinic. She lied about the patient's DOB. I asked mom and patient "you are 12, right?" and they both said yes. Vaccine was given. Patient doesn't turn 12, until 2021. Health Care will call mom and notify her.

Other Meds:

Current Illness:

ID: 1682954
Sex: M
Age: 62
State: NC

Vax Date: 09/05/2021
Onset Date: 09/07/2021
Rec V Date: 09/08/2021
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: Latex, sinus allergies

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

Symptoms: Patient developed a rash on his face Tuesday morning. Rash isn't spreading and is not itching. Recommended Benadryl to help with the rash. Advised to see a doctor if it spreads/gets worse or if it had not gone away by next week.

Other Meds:

Current Illness:

ID: 1682955
Sex: F
Age: 79
State: NY

Vax Date: 07/23/2021
Onset Date: 07/23/2021
Rec V Date: 09/08/2021
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: Unknown

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

Symptoms: 15 minutes post vaccine she stated that s h e felt unwell and anxious. Vitals were taken at 12:25pm . At 12:45pm she was given a bottle of water and vitals taken and alerted supervisor and took Pt. to ED and handed off for further evaluation.

Other Meds: Unknown

Current Illness: Unknown

ID: 1682956
Sex: F
Age: 30
State: CT

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

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

Lab Data: A few hours before getting the injection I had a heart ultrasound done and had a visit and bloodwork weeks before. Nothing was amiss or unusual that would cause swelling and pain in my legs and feet like I was experiencing. After dealing with the usual swelling and pain I spoke with the Cardiologist's office and everything was perfect healthwise with my scan and I have never had swelling like this before so I was advised to contact the CDC.

Allergies: Surgical tape, amoxcicillian, pollen, ragweed, grass, mustard seed, mangoes, apples, peanuts, tree nuts

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: I recieved the shot around 12pm and after a couple hours my arm felt really sore I got achy and felt stiff in my joints. Then my legs and feet were extremely swollen around 9pm that same night and it was painful it felt like my legs were being squeezed tightly. It continued for 3 days and after the three days it went away.

Other Meds: Fenofibrate, levothyroxine, xyzal, montelukast, pantoprazole. Naturemade B-complex, turmeric, women's one a day prenatal vitamins, D3, cranberry.

Current Illness: Diverticulitis and Uti 2 weeks before and was treated 2 weeks before with cipro and Flagyl.

ID: 1682957
Sex: F
Age: 42
State: TN

Vax Date: 08/29/2021
Onset Date: 08/30/2021
Rec V Date: 09/08/2021
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: Antibiotics

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

Symptoms: Patient stated that the next day she noticed a lump on her arm, The lump went away and came back on 9/6/2021 about the size of a half dollar. The next day it was the size of a lemon sized and hot to the touch. The next day it was the size of a half orange. Patient experienced a high level of fatigue

Other Meds: 20mg Distalic Prenatal vitiamin

Current Illness:

ID: 1682958
Sex: M
Age: 14
State: TX

Vax Date: 09/06/2021
Onset Date: 09/08/2021
Rec V Date: 09/08/2021
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: wbc 13.

Allergies:

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

Symptoms: Chest pain, tachycardia

Other Meds: None

Current Illness: none

ID: 1682959
Sex: M
Age: 87
State:

Vax Date: 02/10/2021
Onset Date: 09/02/2021
Rec V Date: 09/08/2021
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: Patient tested positive for COVID on 9/2/2021

Other Meds:

Current Illness:

ID: 1682960
Sex: M
Age: 55
State: MI

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

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

Lab Data:

Allergies:

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

Symptoms: Patient received his first and second dose in Jan and Feb. He scheduled this app as a "first dose" so was given a third dose in error.

Other Meds:

Current Illness:

ID: 1682961
Sex: F
Age: 12
State: PA

Vax Date: 08/13/2021
Onset Date: 08/13/2021
Rec V Date: 09/08/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: The patient received a dose that was diluted with 2.0mL dilutant instead of 1.8mL. We were notified by the nurse who administered it on 8/16/2021. We first called Pfizer to see what their recommended actions were. They recommended not administering the dose and said the CDC recommends not repeating the dose. Our Medical Director spoke to the patient's mother on 9/7/21 which is also when the child received their second dose of the Pfizer Covid-19 vaccine. She reported: Spoke with mother Provided more detail of the error She is frustrated because this is the second vaccine error that occured for this child in 2 months Was given an expired vaccine in June I apologized and advised that we are working hard to identify system errors and correct them. I advised that we will be retraining everyone on vaccines She stated that her husband wants to pull kids out of the office. She wants to keep them here as she likes the doctors but is frustrated on the mistakes. I advised that I share in her frustration and again apologize. We discussed that we checked with Pfizer and the CDC and no further action is needed at this time. She is requesting that from now on, I visually oversee all vaccine administration for her family

Other Meds:

Current Illness:

ID: 1682962
Sex: F
Age: 33
State: NC

Vax Date: 08/26/2021
Onset Date: 09/01/2021
Rec V Date: 09/08/2021
Hospital:

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

Lab Data: Went to medical facility and was diagnosed on Sep 2, 2021

Allergies: N/A

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

Symptoms: Bells Palsy right side of face

Other Meds: N/A

Current Illness: N/A

ID: 1682963
Sex: F
Age: 23
State: TX

Vax Date: 06/27/2021
Onset Date: 07/26/2021
Rec V Date: 09/08/2021
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: None known

Symptom List: Vomiting

Symptoms: The patient is a 23 year old female, PMHx , presents to the ER c/o intermittent L sided chest pain and arm pain/paresthesias x 3 weeks. States to become more short of breath with exertion with gradual increased swelling of extremities, and gradual weight gain.

Other Meds: Medroxyprogesterone 10mg daily for 10 days each month, pantoprazole 40mg every morning, sumatriptan nasal spray.

Current Illness:

ID: 1682964
Sex: M
Age:
State: NV

Vax Date: 06/06/2021
Onset Date: 06/16/2021
Rec V Date: 09/08/2021
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: EKG, MRI, CT scan

Allergies: None

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: On June 15, I started feeling heated, tired, and numbness to my left arm. On the 16th, I noticed my left arm, left leg, and the left side of my face was numb, and I went to the ER. I was diagnosed as having a stroke and admitted for 2 days. Then I was transferred to a rehab facility. I still receive outpatient therapy from the rehab center.

Other Meds: None

Current Illness: None

ID: 1682965
Sex: F
Age: 44
State: AR

Vax Date: 09/08/2021
Onset Date: 09/08/2021
Rec V Date: 09/08/2021
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: pt blood pressure dropped and pt felt faint. Had pt lie on floor and took blood pressure at 1:20 was 112/73 and pulse of 49. monitored pt and rechecked blood pressure at 1:25 was 117/86 and pulse of 61, at 1:30 was 91/53 pulse of 52. gave pt salty potato chips and pt was drinking a dr pepper. blood pressure at 1:35 was 126/82 and pulse of 58. pt felt fine and sat in break room for another couple minutes then said he was fine.

Other Meds:

Current Illness:

ID: 1682966
Sex: M
Age: 1
State: MI

Vax Date: 09/07/2021
Onset Date: 09/07/2021
Rec V Date: 09/08/2021
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: NO

Symptom List: Injection site swelling, Limb discomfort

Symptoms: NO KNOWN ADVERSE EFFECTS. PT WAS GIVEN EXPIRED VACCINE

Other Meds: NO

Current Illness: NA

Date Died: 09/08/2021

ID: 1682967
Sex: F
Age: 56
State: TN

Vax Date: 09/08/2021
Onset Date: 09/08/2021
Rec V Date: 09/08/2021
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:

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

Symptoms: Patient death.

Other Meds:

Current Illness:

ID: 1682968
Sex: F
Age: 60
State: NY

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

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

Lab Data: none

Allergies: none

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

Symptoms: The night after receiving my first shot my ears have rang a very loud high pitch all the time there is never a break from this. I also reported this everytime I was phoned..

Other Meds: none

Current Illness: none

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am