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**
PLEASE CHECK BACK SOON
Download the files above while you wait.







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: 1683020
Sex: F
Age: 75
State: IN

Vax Date: 02/19/2021
Onset Date: 09/01/2021
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: COVID-19 antigen test with a positive result.

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient received the Pfizer COVID-19 vaccine on 1/27/21 and 2/19/21 so was fully vaccinated when they tested positive for COVID-19 on 9/1/21.

Other Meds:

Current Illness:

ID: 1683021
Sex: F
Age: 26
State: MA

Vax Date: 03/05/2021
Onset Date: 03/12/2021
Rec V Date: 09/08/2021
Hospital:

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

Lab Data: 03/12/2021 ultrasound, bloodwork, EKG, urine and CT with Contrast- A clot was found.

Allergies: latex, Keflex

Symptom List: Anxiety, Dyspnoea

Symptoms: On 03/12/2021 at about 4am I woke up with pain in my right side in the should and back, below right lung area in the back. At 2:3-pm I went to Urgent care and they referred me to the ER-I had a clot, I was given Xarelto and oxy. I am still in recovery, with Xarelto.

Other Meds: I take oral contraceptives'

Current Illness: no

ID: 1683022
Sex: F
Age: 42
State: FL

Vax Date: 06/11/2021
Onset Date: 06/11/2021
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:

Allergies:

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

Symptoms: Very painful injection, limited arm motion without pain especially in shoulder. Still in daily pain 3 months later, can not lift arm over head or put any strain on tricep muscle

Other Meds:

Current Illness:

ID: 1683023
Sex: M
Age: 83
State:

Vax Date: 02/01/2021
Onset Date: 09/03/2021
Rec V Date: 09/08/2021
Hospital: Y

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 breakthrough, symptomatic. Inpatient admit 9/3-9/8.

Other Meds:

Current Illness:

ID: 1683024
Sex: F
Age: 72
State: MO

Vax Date: 09/02/2021
Onset Date: 09/04/2021
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: none

Allergies: Neosporin,codeine

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

Symptoms: The day after shot it looked like there was an area under the skin that was holding fluid. Then two days after my shot my arm looked like it had a hive about 2x3 inches. It was red, swollen, hot and painful. I took Sudafed for that day and the next. I also iced it but only on 2nd day after shot. Today, 6 days after, it is no longer swollen but still slightly red, and somewhat hot and painful to the touch. It looks like a giant "birth mark" and still looks a bit like the vaccine pooled in that area under my skin. Arm still sore.

Other Meds: Serevent, Pulmicort,leflunomide,Ferrex Iron,omeprazole

Current Illness: none

ID: 1683025
Sex: F
Age:
State:

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

Allergies:

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

Symptoms: Came to ER with abdominal pain and vomiting, states is vaccinated, is poor historian. Discharged 9/2/2021 Vaccine date is unknown

Other Meds:

Current Illness:

ID: 1683026
Sex: M
Age: 59
State: CA

Vax Date: 03/24/2021
Onset Date: 04/01/2021
Rec V Date: 09/08/2021
Hospital: Y

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

Lab Data: I was tested for many tests: Cancer, aids, syphilis, etc.

Allergies: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Probably the 8th of April I started to get bloody noses and couldn't get them to stop. I got blood blisters in my mouth. On April 11th I woke up with measles like bumps all up and down my legs, I went to the ER. I was kept in the hospital for 4 days. All of my symptoms were caused from a lack of blood platelets. I was given about 6 packets of blood platelets and about 6 vials of Ab Ig. Once given that I came out of the hospital and my blood platelets have been staying up.

Other Meds: Lisinopril; cholesterol medication; water pill; hydroxycut

Current Illness: No

ID: 1683027
Sex: M
Age: 89
State: IN

Vax Date: 03/23/2021
Onset Date: 09/07/2021
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: COVID-19 Sofia antigen test with a positive result.

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Patient received the Pfizer COVID-19 vaccine on 3/2/21 and 3/23/21 so was fully vaccinated when they tested positive for COVID-19 on 9/7/21.

Other Meds:

Current Illness:

ID: 1683028
Sex: F
Age: 39
State: OK

Vax Date: 07/25/2021
Onset Date: 07/31/2021
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: 7/31/2021 CT reported negative by patient, reported blood work negative.

Allergies: codeine, demerol, latex; intolerance of tachycardia to darvocet

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Pt reported an immediate headache that lasted 5 days, refractive to OTC treatment. On 5th day, had a syncopal event at work, EMS took to ER on 7/31/2021. Negative organic work up. Developed left upper arm numbness and facial twitching day 10 (5 days after hospital treatment). No meds given at the hospital.

Other Meds: vit C 1000mg 1 per day

Current Illness: denies

ID: 1683029
Sex: M
Age: 39
State: TX

Vax Date: 08/29/2021
Onset Date: 09/06/2021
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: none

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Ongoing headache and joint/muscular pain

Other Meds: none

Current Illness: none

ID: 1683030
Sex: F
Age: 0
State: MA

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

Lab Data: N/A

Allergies: PATIENT HAS HAD REACTIONS TO INJECTABLE PENICILLIN

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

Symptoms: PATIENT REPORTED SWELLING, HEAT, PAINFUL INECTIONSITE, RED AND RAISED RASH

Other Meds: ADDERALL

Current Illness: N/A

ID: 1683031
Sex: F
Age: 39
State: GA

Vax Date: 02/12/2021
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: SYR
Vax Site: RA

Lab Data: NA

Allergies: Allergic to doxycycline, sulfa based drugs, Pseudocholinesterase deficiency syndrome leads to anesthesia concerns.

Symptom List: Rash, Urticaria

Symptoms: I have been getting intermittent migraines (I have tracking data of dates, severity, and possible triggers) for over a year. During this specific incident, the pain was in a different location, and didn't respond to any of my usual tricks to get it to clear. I tried to resolve on my own at home for about 4 days before seeking medical care. It took me an additional week to actually be able to get medical care. With help from a pharmacist I was able to get it manageable and saw my doctor for a new migraine prescription on August 26th. I have had intermittent headaches since then.

Other Meds: Symbicort BID, Claritin SID, Tylenol as needed.

Current Illness: None

ID: 1683032
Sex: M
Age: 48
State: CA

Vax Date: 08/24/2021
Onset Date: 08/26/2021
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:

Allergies: NKA

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

Symptoms: Numbness, loss of grip strength, loss of feeling, tingling and pain on left side of body. Effecting left arm and hand more than the left leg. But also has same symptoms in left leg but not as severe as left arm/hand. Excessive sweating, lack of concentration.

Other Meds: Dilantin, Norco, Oxycontin, Celexa, Albuterol

Current Illness:

ID: 1683033
Sex: F
Age: 47
State: CO

Vax Date: 03/10/2021
Onset Date: 09/01/2021
Rec V Date: 09/08/2021
Hospital: Y

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: Positive COVID-19 test

Other Meds:

Current Illness:

ID: 1683034
Sex: M
Age: 69
State: CO

Vax Date: 02/16/2021
Onset Date: 08/30/2021
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:

Allergies:

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

Symptoms: POSITIVE COVID DX ON 8/30/2021

Other Meds:

Current Illness:

Date Died: 09/05/2021

ID: 1683035
Sex: F
Age: 94
State: MI

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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: autopsy performed

Allergies: unknown

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

Symptoms: Patient reported to family that she began feeling tired and weak after the second dose on 9/3. Passed away in her home on the couch sometime during the night of 9/5

Other Meds: amlodipinem bisoprolol, eliquis, furosemide, potassium, atorvasatatin, pravastatin

Current Illness: In hospital for MI "one month ago" for MI then spent two weeks in rehab facility

ID: 1683036
Sex: F
Age: 50
State: HI

Vax Date: 08/30/2021
Onset Date: 09/03/2021
Rec V Date: 09/08/2021
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: shrimp

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

Symptoms: Pain and swollen in and under left armpit from Friday 9/3/21 until today, although pain has lessened. Headache, nausea, and vomiting on Sunday 9/5/21.

Other Meds: topical eczema cream

Current Illness: none

ID: 1683037
Sex: M
Age: 46
State: TX

Vax Date: 08/20/2021
Onset Date: 08/26/2021
Rec V Date: 09/08/2021
Hospital:

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

Lab Data: At the emergency room on the first day of event I was given an IV of saline, they took blood for analysis and a CT scan.

Allergies: none

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Headache developed followed by fainting spell, narrowed vision, head and neck pressure, kaleidoscope eye and later progressed into migraine like symptoms. Debilitating head pain, sensitivity to light and sound and slight nausea. this persisted for four days before slowly fading in intensity. Slight headache and occasional swelling of head and neck pressure persist to this day.

Other Meds: none

Current Illness: none

ID: 1683038
Sex: F
Age: 30
State: HI

Vax Date: 01/12/2021
Onset Date: 09/07/2021
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:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: malaise, headache, dry cough

Other Meds:

Current Illness:

ID: 1683039
Sex: F
Age: 23
State: KY

Vax Date: 03/31/2021
Onset Date: 09/08/2021
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: Covid positive unknown source

Other Meds:

Current Illness:

ID: 1683040
Sex: F
Age: 54
State:

Vax Date: 04/16/2021
Onset Date: 04/17/2021
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: Bruising on all arms and legs, approximately 6 per limb. Resolved in 1 week without treatment.

Other Meds:

Current Illness:

Date Died: 08/30/2021

ID: 1683041
Sex: F
Age: 81
State: WA

Vax Date: 04/06/2021
Onset Date: 08/30/2021
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: UNKNOWN

Allergies: UNKNOWN

Symptom List: Unevaluable event

Symptoms: Upon the regulatory authority reviewing their weekly notifiable conditions death report, they came across a report of decedent where the death certificate COD literal text is indicated to be: ACUTE MOTOR NEURON DISEASE SERUM REACTION TO VIRAL VACCINE Here is some additional decedent details: DOD: 08/30/2021 We speculate that the COD literal text is in reference to COVID-19 vaccinations since those were the most recent two vaccinations that this person had received based on data. Here are the COVID-19 vaccine dose dates: 3/16/2021 (Pfizer) 4/06/2021 (Pfizer)

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1683042
Sex: M
Age: 45
State: MA

Vax Date: 03/04/2021
Onset Date: 08/02/2021
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: EKG; ultrasound; cardiac monitor

Allergies: No

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

Symptoms: Unexpected lightheadedness. Still trying to figure out what's causing it.

Other Meds: Yes

Current Illness: No

ID: 1683043
Sex: F
Age: 55
State: WI

Vax Date: 04/05/2021
Onset Date: 09/02/2021
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: Adhesive bandages - rash and nonspecific skin eruption Azithromycin 5 day dose pack - facial swelling Bee Stings - Swelling and Flushing Latex - rash

Symptom List: Injection site pain, Pain

Symptoms: Patient contracted COVID-19 after being fully vaccinated

Other Meds: famotidine 20mg HS hydrochlorothiazide-triamterene 25mg-37.5mg daily levothyroxine 88mcg daily liothyronine 10mcg daily lisinopril 10mg daily loratadine 10mg daily metoprolol 100mg daily omeprazole 20mg daily sertraline 25mg daily valacyclo

Current Illness: None Documented

ID: 1683044
Sex: M
Age: 41
State: TX

Vax Date: 05/12/2021
Onset Date: 06/04/2021
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: COVID PCR 4/18 Fluvid negative 6/20 Biofire negative 6/20 Cepheid negative 7/1 Biofire negative 7/1 Cepheid negative COVID Serology 7/7 SARS-CoV-2 IgG (Architect) 0.02 (negative) Inflammatory Markers CRPH 6/20 27.794 => 7/2 25.084 => 7/8 17.154 => 7/23 13.813 => 8/26 4.027 => 9/7 2.581 ESR 7/4 127 => 7/8 116 => 7/23 38 => 8/26 94 => 9/7 70 Ferritin 6/20 >1500 => 7/6 1068 => 7/8 959 => 7/23 541 Culture Data 4/18 BCx x 2 NG 6/20 BCx x 2 NG 7/1 BCx x 2 NG 7/2 Sputum culture with light growth of MSSA BCx x 2 NG Serology 6/21 HIV 4th gen negative 7/2 Lyme ELISA negative, WB IgG and IgM negative (but one positive IgM band) Rickettsial panel (includes Q fever) negative 7/3 Blastomyces Urinary Antigen negative Histoplasma Urinary Antigen negative Galactomannan negative Fungitell negative Cryptococcal Ag negative 7/4 Coccidioides IgM negative 7/5 HIV PCR not detected 7/6 Brucella serology negative Q fever serology negative Toxoplasma serology negative Syphilis screen nonreactive CMV IgG positive EBV IgM negative EBV early Ab IgG positive Bartonella serology negative Quantiferon negative 7/8 Francisella tularensis serology negative 8/26 Rickettsial panel (includes Q fever) negative Exam Date/Time 07/08/2021 06:50 Procedure Name PET/CT WHOLE BODY Reason for Study fever of unknown origin Clinical History fever of unknown origin Impression 1. No discrete hypermetabolic infectious source identified in the chest, abdomen or pelvis. 2. There is diffuse marrow activation in the axial skeleton. This is nonspecific and can be due to anemia, chronic illness or hematologic disorders. 3. Increased hypermetabolic activity within the right glenohumeral shoulder joint is nonspecific. Frequently, this is seen with degenerative synovitis however given asymmetry compared to the left, infection or other inflammatory causes remain differential considerations. Exam Date/Time 07/05/2021 13:21 Procedure Name CT ABD & PELVIS W CONTRAST Reason for Study Rule out abscess Impression Negative CT of the abdomen and pelvis. Exam Date/Time 07/01/2021 05:03 Procedure Name CT CHEST PE STUDY WITH CONTRAST Reason for Study "R/O PULMONARY EMBOLISM" **EMERGENCY ADD ON FOR TODAY** Impression No evidence for acute pulmonary arterial embolus. Indeterminate 4 mm left lower lobe nodule. A 12 month follow-up chest CT could be considered if the patient is at elevated risk for malignancy. Limited evaluation of the upper abdomen on this exam. Appearance of mild fat stranding adjacent to the partially visualized stomach might be due to adjacent vessels, but correlate clinically. If there is concern for gastritis or other acute abdominal process, dedicated abdominal imaging could provide further evaluation. Exam Date/Time 07/01/2021 03:46 Procedure Name CHEST SINGLE VW Reason for Study CHEST PAIN Impression No acute cardiopulmonary di

Allergies: Penicillin

Symptom List: Injection site pain, Menorrhagia

Symptoms: Fever of unknown origin with profound systemic inflammation. Hospitalized twice 6/20/2021 and 7/1-7/8/2021. 6/20 for suspected myocarditis (based on chest pain, tachycardia, troponin leak, ECGs with sinus tachycardia [w/o evidence of pericarditis], bedside echo 6/20 reported as "appeared normal") and 7/1-7/8 for FUO. Extensive evaluation to date has not revealed a likely infectious etiology. The patient meets proposed criteria for a definitive case of MIS in an adult: Fever > 3 days AND GI symptoms + hypotension AND laboratory evidence of inflammation AND elevated troponin + neutrophilia AND receipt of COVID vaccine (they do not specify a timeline, but his onset of symptoms was within 12 weeks of receipt of COVID vaccine).

Other Meds: None

Current Illness: None

Date Died: 08/31/2021

ID: 1683045
Sex: M
Age: 86
State:

Vax Date: 01/30/2021
Onset Date: 08/18/2021
Rec V Date: 09/08/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: positive COVID test; hypoxic; septic shock

Other Meds:

Current Illness:

ID: 1683046
Sex: F
Age: 38
State: MN

Vax Date: 01/28/2021
Onset Date: 08/31/2021
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: 9/7/21 SARS/COV-2, NAAT positive

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: COVID positive >14 days post vaccine series

Other Meds:

Current Illness:

ID: 1683047
Sex: F
Age: 34
State: CA

Vax Date: 08/24/2021
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: RA

Lab Data: None

Allergies: Sulfa

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: I had the regular side effects for a couple of days. I started getting a bad headache and bad foot and leg pain. I took Tylenol every 4 hours. A few days later the headache started to go away but then I started getting these big bumps all over my body, but mostly my leg. They were hard bumps that itch. I had them on my back, thighs, joints, feet, legs. It hurts to walk because of the swelling from the bump around my ankles. On the second of September, I went to Urgent Care. A few days later I went to the ER, but they couldn't help me. I saw a dermatologist and diagnosed me with Erythema nodosum. He said it's possible that the vaccine triggered an immune response and could be due to pregnancy. My due date is March 6, 2022.

Other Meds: Aspirin; prenatal vitamins; calcium with vitamin D supplement

Current Illness: None

ID: 1683048
Sex: M
Age: 60
State: CA

Vax Date: 05/04/2021
Onset Date: 05/04/2021
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: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: I now have great pain and loss of range of motion in my left shoulder. Both the first shot and the second were given at the tip of my shoulder. I had to take my shirt off to give the persons giving the shots the access they wanted. When I asked why so high up the arm both ladies told me this was "per CDC guidelines" like it was a rehearsed response. My doctor and everyone I talked to said the shots should have been in the muscle lower down the arm from the shoulder. Pharmacy has bad information as to how to correctly give the shot.

Other Meds:

Current Illness:

Date Died: 09/07/2021

ID: 1683049
Sex: F
Age: 85
State: GA

Vax Date: 03/24/2021
Onset Date: 09/07/2021
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: Patient death

Other Meds:

Current Illness:

ID: 1683050
Sex: F
Age: 52
State: KY

Vax Date: 01/28/2021
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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Covid positive...work related

Other Meds:

Current Illness:

ID: 1683051
Sex: M
Age: 28
State: AZ

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

Lab Data: Unknown

Allergies: None known

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

Symptoms: After receiving the Pfizer Covid-19 Vaccine patient during 15 minute observation started to say he wasn't feeling very well and was feeling dizzy. After stating this he started to lean in his chair and starting making sounds with his throat..gargling sounds like he couldn't breathe and then began to lose consciousness. He was brought down to the floor from the chair and an Epi-pen was administered and shortly after he came through. Paramedics arrived afterwards and they took him to the local hospital.

Other Meds: unknown

Current Illness: None known

ID: 1683052
Sex: F
Age: 15
State: PA

Vax Date: 08/26/2021
Onset Date: 08/26/2021
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: n/a

Allergies: Soy, rosemary

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

Symptoms: Patient was given vaccine underthe age recommended by the manufacturer.

Other Meds:

Current Illness: n/a

ID: 1683053
Sex: F
Age: 44
State:

Vax Date: 09/02/2021
Onset Date: 09/07/2021
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: none

Symptom List: Tremor

Symptoms: itchy skin that turned into red, puffy welts on neck and scalp

Other Meds: levothyroxin, vitamin d, zinc, meloxicam, aspirin, zyrtec, mirilax

Current Illness: none

ID: 1683054
Sex: F
Age: 41
State:

Vax Date: 03/14/2021
Onset Date: 08/30/2021
Rec V Date: 09/08/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Has MS, had worsening weakness, admitted for worsening symptoms of MS. Fever 102

Other Meds:

Current Illness:

ID: 1683055
Sex: F
Age: 73
State: NC

Vax Date: 09/03/2021
Onset Date: 09/04/2021
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:

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

Symptoms: SWOLLEN, RED, PAINFUL ARM, MINOR BLISTERING THAT DEVELOPED WITHIN 3 DAYS OF DOSE. PATIENT APPLIED ICE AND TOOK IBUPROFEN. AGREED WITH TREATMENT, ADVISED PT COULD ALSO TAKE BENADRYL

Other Meds:

Current Illness:

ID: 1683056
Sex: M
Age: 65
State: GA

Vax Date: 05/22/2021
Onset Date: 08/11/2021
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:

Allergies:

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

Symptoms: PUI reported he went to work and began to feel bad, went to the ER ad tested positive for COVID. PUI informed he had several stints in his heart and thought he was having issues. . PUI stated he was a patient at from 8/11-8/14/21.

Other Meds:

Current Illness:

ID: 1683057
Sex: M
Age: 56
State: AZ

Vax Date: 09/02/2021
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: patient stated that he can provide a detailed list if needed

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient stated that since receiving the vaccine he has insomnia. He is unable to sleep.

Other Meds:

Current Illness:

ID: 1683059
Sex: M
Age: 25
State: OR

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: 011J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: none

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

Symptoms: After getting the vaccine small bumps appeared in my veins and I have extreme joint pain in my thumb joint and my wrist. It began with my thumb, hurting badly when I moved it, feeling stiff and achy and has proceeded to move to my wrist.

Other Meds: none

Current Illness:

ID: 1683060
Sex: M
Age: 92
State:

Vax Date: 07/07/2021
Onset Date: 07/17/2021
Rec V Date: 09/08/2021
Hospital: Y

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: Patient presented to the ED and was subsequently hospitalized for NSTEMI within 6 weeks of receiving COVID vaccination.

Other Meds:

Current Illness:

ID: 1683061
Sex: F
Age: 56
State: MO

Vax Date: 09/01/2021
Onset Date: 09/01/2021
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: SULFA, POTASSIUM DICHROMATE

Symptom List: Pain in extremity

Symptoms: DIZZY, HEADACHE, TIREDNESS, JOINT PAIN, NAUSEA, FEELING UNWELL, DIARRHEA,

Other Meds: PREDNISONE, ESCITOLOPRAM, PRAZOSIN, BUSPIRONE

Current Illness: EAR SURGERY AUGUST 3

ID: 1683062
Sex: M
Age: 17
State: NH

Vax Date: 08/27/2021
Onset Date: 08/29/2021
Rec V Date: 09/08/2021
Hospital: Y

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

Lab Data: Maximum troponin on 8/30/21 was 0.23. Troponin was within normal limits on recheck after discharge on 9/8/21. EKG on 8/30 initially with junctional escape rhythm which later resolved. Telemetry without signs of arrhythmia. Echocardiogram with normal function. Cardiac MR with normal structure and function and without any delayed gadolinium enhancement. Holter monitor planned for 9/15-9/16.

Allergies: none

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

Symptoms: Developed mild chest pain which progressed into severe chest pain overnight. Presented to the ED and was found to have elevated troponin and CRP , diagnosed with myocarditis. Started on ibuprofen which he continues on. Symptoms have mostly improved except with exertion but has reported palpitations.

Other Meds: none

Current Illness: anxiety hand tremors (undiagnosed etiology following extensive work-up)

ID: 1683063
Sex: F
Age: 69
State:

Vax Date: 02/01/2021
Onset Date: 08/28/2021
Rec V Date: 09/08/2021
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:

Allergies:

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

Symptoms: Was admitted to hosp. with fever 102.8, and dehydration with cough

Other Meds:

Current Illness:

ID: 1683064
Sex: F
Age: 44
State: MI

Vax Date: 08/27/2021
Onset Date: 09/03/2021
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: Debating if I should go to the ER.

Allergies: None

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

Symptoms: Tremors/Chills hours after 2nd injection. Feeling of no circulation in forearms, hands, feet, sometimes entire body. Very uncomfortable feeling that isn't going away since approx 3rd-4th day of the injection.

Other Meds: Effexor-XR

Current Illness: None

ID: 1683065
Sex: F
Age: 53
State: GA

Vax Date: 06/04/2021
Onset Date: 06/09/2021
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: Various Test Ran

Allergies: None

Symptom List: Vomiting

Symptoms: Pain, nerves in chest and breast area damaged and has moved to the right side of the body. Nerve status out of a scale from 1-10 is currently a 9.

Other Meds: Losartan (once daily) Insulin (once daily) Vitamin D

Current Illness: None

ID: 1683066
Sex: F
Age: 38
State: KY

Vax Date: 03/01/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: hospitalization for IVF, on RA so no remdesivir or dexamethasone

Other Meds:

Current Illness:

ID: 1683067
Sex: F
Age: 68
State: MN

Vax Date: 03/26/2021
Onset Date: 09/05/2021
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: RA

Lab Data: C-REACTIVE PROTEIN (INFLAMMATION) COMPREHENSIVE METABOLIC PANEL DIAGNOSTIC OCCULT BLOOD (GUAIAC), SPECIMEN 1 LAB ONLY-COMPLETE BLOOD COUNT WITH DIFFERENTIAL LAB ONLY-URINE MICROSCOPIC REFLEX LACTIC ACID LIPASE MAGNESIUM SARS-COV-2, INFLUENZA A+B, AND/OR RSV NUCLEIC ACID TESTING PANEL URINE DIP, REFLEX TO MICROSCOPIC, REFLEX TO CULTURE CULTURE, BLOOD performed 2 times Imaging Tests CT ABDOMEN PELVIS WITH CONTRAST EKG

Allergies:

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

Symptoms: Abdominal Pain Vomiting Hematemesis with nausea Right upper quadrant abdominal pain Hypokalemia Other secondary hypertension Abnormal LFTs Elevated lipase Calculus of bile duct without cholangitis with obstruction

Other Meds:

Current Illness:

ID: 1683068
Sex: F
Age: 77
State: OH

Vax Date: 03/04/2021
Onset Date: 08/30/2021
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: Covid 19 test- August 30th, PCR 30th, Antibody infusion 09/02/2021

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: I had a bad cold and a fever 101F August 30th, which encouraged me to go take the covid rapid test the results came back positive. I received a monoclonal infusion for the treatment of contracting Covid-19 on 09/02/2021

Other Meds:

Current Illness:

ID: 1683069
Sex: F
Age: 45
State: NM

Vax Date: 03/17/2021
Onset Date: 08/23/2021
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: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: Break through Covid + on 8/23/21 after both vaccines.

Other Meds:

Current Illness:

ID: 1683070
Sex: M
Age: 52
State: MN

Vax Date: 06/11/2021
Onset Date: 07/22/2021
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: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Patient hospitalized for s/p lumbar fusion within 6 weeks of receiving COVID vaccination.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am