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: 1684490
Sex: F
Age: 47
State: KS

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

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

Lab Data:

Allergies: NKA

Symptom List: Dysphagia, Epiglottitis

Symptoms: Bilateral left and right pulmonary artery PE's, with development of cerebral aneurysm from blood clot to brain per family members update.

Other Meds: Nuva Ring Exact date in May of vaccination unknown by pt at time of presentation. Stated second injection was in the middle of May 2021.

Current Illness: None

ID: 1684491
Sex: F
Age: 33
State: SC

Vax Date: 08/08/2021
Onset Date: 08/13/2021
Rec V Date: 09/09/2021
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: Site: Itching at Injection Site-Mild, Site: Redness at Injection Site-Mild, Site: Swelling at Injection Site-Mild, Systemic: Allergic: Rash Generalized-Mild, Systemic: pityriasis rosea (per MD diagnosis)-Mild, Additional Details: Patient saw prescriber and was told to report adverse reaction as pityriasis rosea to the pharmacy who administered.

Other Meds:

Current Illness:

ID: 1684492
Sex: F
Age: 46
State: CA

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

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Severe pain in arm, tingling all over body, feel cold and can?t get warm enough, then feel too hot, tired, headache, thirsty, insomnia from pain . Started slowly after 8 hours from vaccine time and progressed throughout the night. Digital forehead temp 98? f and neck and chest is 101?f

Other Meds: Levothyroxine 150 mcg

Current Illness: None

ID: 1684493
Sex: M
Age: 12
State: MI

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

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

Lab Data: None

Allergies: Azithromycin Penicillin

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: After the vaccine, the patient developed a bruise on the inner left arm opposite side of arm from where vaccine was injected, electrical pulsating feeling in his palms intermittently, not healing as quickly as he was, had diarrhea for 2 days but none after that, and had spasms in his hands.

Other Meds: None

Current Illness: None

ID: 1684494
Sex: M
Age: 52
State: CO

Vax Date: 08/25/2021
Onset Date: 08/30/2021
Rec V Date: 09/09/2021
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: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Site: Bruising at Injection Site-Mild, Site: Pain at Injection Site-Mild, Site: Redness at Injection Site-Mild, Systemic: Chills-Mild, Systemic: Diarrhea-Mild, Systemic: Fever-Mild, Systemic: Nausea-Mild, Error: Booster Given Too Early-

Other Meds:

Current Illness:

ID: 1684495
Sex: F
Age: 24
State: VA

Vax Date: 09/08/2021
Onset Date: 09/08/2021
Rec V Date: 09/09/2021
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: Systemic: Confusion-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Severe, Systemic: Shakiness-Severe, Additional Details: I administered the vaccine and the patient sat for 15 minutes with her young daughter. At the end of the 15 minutes I asked if she was ok and she said she was and walked off. Less than 5 minutes later I hear a smack like someone smacking a concrete floor with their bare hand and see her feet in the air and she is laying face down. She sits right up and is pale and confused but responsive. I immediated called EMTs and the fire department arrived and took her to the hospital. Prognosis unknown

Other Meds:

Current Illness:

ID: 1684496
Sex: F
Age: 73
State: OH

Vax Date: 02/04/2021
Onset Date: 08/26/2021
Rec V Date: 09/09/2021
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: Pyrexia, White blood cell count decreased

Symptoms: Patient developed COVID-19 requiring hospitalization post-vaccination.

Other Meds:

Current Illness:

ID: 1684497
Sex: M
Age: 13
State: AL

Vax Date: 09/07/2021
Onset Date: 09/08/2021
Rec V Date: 09/09/2021
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: Systemic: Allergic: Rash (specify: facial area, extremeties)-Mild

Other Meds:

Current Illness:

ID: 1684498
Sex: F
Age: 21
State: NJ

Vax Date: 03/12/2021
Onset Date: 03/28/2021
Rec V Date: 09/09/2021
Hospital:

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

Lab Data: I had a full autoimmune panel done in May of 2021- all negative I had a full allergy panel done in may of 2021- environmental allergies such as beech trees and oak trees I had an allergy prick test done in June of 2021- I became allergic to cherries and birch trees. I am now allergic to foods I have ate my whole life such as pears, peaches, plums, apples, berries, kiwi, pineapple, hazelnut, peanuts, walnuts, oranges, Swiss chard, celery, carrots, golgi berries, potatoes, tomatoes, watermelon, etc.

Allergies: None

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Swollen lips for 5 weeks straight, lesions in the mouth, hives all over the body. I received prednisone and methylprednisolone. I even went into anaphylaxis and was rushed to the ER and given epinephrine. I, now have over 20+ new allergies that I have never had before.

Other Meds: Famotidine, lexapro, lo lo estrin, vitamin D, probiotic, vitamin b12

Current Illness: I had Covid in January of 2021

ID: 1684499
Sex: F
Age: 26
State: FL

Vax Date: 09/02/2021
Onset Date: 09/04/2021
Rec V Date: 09/09/2021
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: Systemic: Allergic: Itch Generalized-Severe, Additional Details: Patient had the vaccine given on 9/2/21 and she was observed for 15 minutes with no reaction, patient came back in on 9/8/21 to repoert that about a day or two after getting the vaccine she developed a rash from the neck to belly button that stayed for about 2 days. she just took benadryl and did not contact dr.

Other Meds:

Current Illness:

Date Died: 09/08/2021

ID: 1684500
Sex: F
Age: 89
State: MI

Vax Date: 03/01/2021
Onset Date: 08/29/2021
Rec V Date: 09/09/2021
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 positive on 8/29/21

Allergies:

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

Symptoms: Patient received Pfizer on 2/8/2021 and 3/1/2021. Patient was admitted to the hospital on 8/29/2021 for COVID pneumonia, and acute on chronic respiratory failure. Patient died on 9/8/2021.

Other Meds:

Current Illness:

ID: 1684501
Sex: M
Age: 32
State: VA

Vax Date: 08/19/2021
Onset Date: 09/03/2021
Rec V Date: 09/09/2021
Hospital:

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

Lab Data: No labs done. Diagnosis made through physical observation and test of the facial muscles.

Allergies: Allergic to IB profen and Advil. Lactose, gluten, and caffeine intolerant

Symptom List: Rash, Urticaria

Symptoms: Developed sudden onset of Bell's Palsy diagnosed and confirmed by 3 separate doctors. Currently on prescriptions for Prednisone (60mg/day for 10 days) and Valtrex (3g/day for 7 days) to treat Bell's Palsy symptoms but no results yet. This is day 3 after starting medication.

Other Meds: On bi-monthly infusion of Remacade for treatment of Crohn's disease.

Current Illness: None other than my chronic condition, Crohn's. But no flare ups or Crohn's type symptoms during this period.

ID: 1684502
Sex: F
Age: 47
State: NC

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

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

Lab Data:

Allergies:

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

Symptoms: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-

Other Meds:

Current Illness:

ID: 1684503
Sex: F
Age: 88
State: OH

Vax Date: 03/17/2021
Onset Date: 09/07/2021
Rec V Date: 09/09/2021
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: Patient developed COVID-19 requiring hospitalization post-vaccination.

Other Meds:

Current Illness:

ID: 1684504
Sex: F
Age: 29
State: IL

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

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

Lab Data:

Allergies:

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

Symptoms: Systemic: Allergic: Rash (specify: facial area, extremeties)-Mild, Additional Details: Patient called back regarding reaction to the vaccine. She had noticed few rashes on both of her legs. She took xyzal (antihistamine) then the rash started getting better and she will contact her doctor to follow up.

Other Meds:

Current Illness:

ID: 1684505
Sex: F
Age: 36
State: FL

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

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

Lab Data:

Allergies:

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

Symptoms: Systemic: Numbness (specify: facial area, extremities)-Medium, Systemic: Tingling (specify: facial area, extemities)-Medium

Other Meds:

Current Illness:

ID: 1684506
Sex: F
Age: 66
State: PA

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

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

Lab Data:

Allergies:

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

Symptoms: Systemic: Body Aches Generalized-Medium, Systemic: Exhaustion / Lethargy-Mild, Systemic: Fever-Medium, Systemic: Headache-Medium, Systemic: Nausea-Medium, Systemic: Vomiting-Medium, Additional Details: Pt still reports symptoms after 2nd shot and is distressed her nausea/vomiting. pt was recommended to see a md if her symptoms continue to worsen and loses appetite.

Other Meds:

Current Illness:

ID: 1684507
Sex: M
Age: 27
State: TX

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

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Systemic: Fainting / Unresponsive-Mild, Additional Details: Patient fainted after immunization was given during the 15 minute observation period. Emergency medical services were contacted and came to check on the patient.

Other Meds:

Current Illness:

ID: 1684508
Sex: F
Age: 25
State: GA

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

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

Lab Data: 8/26- EKG was normal and was diagnosed with a panic attack, which have never happened before

Allergies: none

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Injection site pain, swollen lymph nodes under the left armpit, fainting, panic attack and anxiety, menstrual changes, acid reflux, vertigo

Other Meds: Genvoya, Topamax, Women's vitamins

Current Illness: None

ID: 1684509
Sex: F
Age: 30
State: NC

Vax Date: 09/07/2021
Onset Date: 09/07/2021
Rec V Date: 09/09/2021
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: Site: Itching at Injection Site-Mild, Additional Details: Pressure radiating up the neck to occipital ridge to forehead

Other Meds:

Current Illness:

ID: 1684510
Sex: F
Age: 12
State: IA

Vax Date: 08/21/2021
Onset Date: 08/22/2021
Rec V Date: 09/09/2021
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: N/A. Symptoms were short lived and not severe. No medical treatment needed

Allergies: None

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

Symptoms: Sore arm at injection site and a brief bout of chills

Other Meds: None

Current Illness: None

ID: 1684511
Sex: F
Age: 49
State: MI

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

Other Meds:

Current Illness:

ID: 1684512
Sex: F
Age: 19
State: TN

Vax Date: 09/02/2021
Onset Date: 09/03/2021
Rec V Date: 09/09/2021
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 per pt

Allergies: sulfa

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

Symptoms: pt said that she had sore swollen jaw and swollen arm that itched, she went to the er on 9/3 and the er told her to take benadryl and report the event to the pharmacy.

Other Meds: none

Current Illness: none

ID: 1684675
Sex: F
Age: 15
State: NC

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

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

Lab Data: N/A

Allergies: N/A

Symptom List: Injection site pain, Pain

Symptoms: Fainted; did not fall or sustain any injury. Awoke within less than a minute and felt fine. Observed closely for 30 minutes after.

Other Meds: N/A

Current Illness: N/A

ID: 1684676
Sex: F
Age: 30
State: WV

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

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

Lab Data:

Allergies: Idiopathic anaphylaxis Allergies to: Nystatin Powder, Penicillin, orthonovum, citric acid,

Symptom List: Injection site pain, Menorrhagia

Symptoms: erratic blood pressures, as low as 70/30, orthostatic hypotension, chest pain, light headedness, itchiness

Other Meds: Benadryl, Zyxal, and hydroxyzine

Current Illness: idiopathic anaphylaxis Mastocytosis POTS

ID: 1684677
Sex: F
Age: 47
State: NC

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

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

Lab Data: rapid covid antigen - negative

Allergies: NKDA

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

Symptoms: ** Prolonged symptoms: She reports that she recieved her 1st Pfizer COVID-19 vaccine on 8/30/21 from Pharmacy Symptoms started that night with fever, body aches, chills, sweating, chest pressure, and loss of appetite Fever has been running from 99.4-102.7 and has persisted. rest of symptoms have gradually resolved ; Her fever finally resolved 9/8/2021 Denies CP, SOB, cough, sore throat, congestion, changes to taste/smell, N/V/D She has been taking Tylenol and Motrin scheduled to help with symptoms, which did help She denies any known recent COVID exposures

Other Meds: amLODIPine Besylate-Valsartan 5-320 MG Tablet 1 tablet Orally for BP Once a day. ZyrTEC(Cetirizine HCl) 10 q day. Vyvanse(Lisdexamfetamine Dimesylate) 40 MG Capsule 1 capsule in the morning Orally Once a day. SUMAtriptan Succ

Current Illness: none

ID: 1684678
Sex: M
Age: 65
State: TX

Vax Date: 03/06/2021
Onset Date: 03/13/2021
Rec V Date: 09/09/2021
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: MRI- showed a torn muscle

Allergies: No

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: I noticed after wringing a wash rag out, my arm was really sore for a good 2-3 months. I was unable to sleep on my left side. At night it bothered me more than during the day. It was pretty painful. I had an MRI which showed a torn muscle. The pain is not as bad as it was initially. There is like an indentation in the muscle. There are certain positions I can move my arm where the indentation is visible. Back when it was hurting badly, I was unable to wash my hair. I saw my neurologist who ordered the MRI but did not prescribe me anything. She wanted to recommend me to an orthopedic surgeon, but I refused. Now that it doesn?t hurt as much, I decided I will wait before doing anything with it.

Other Meds: Yes

Current Illness: No

ID: 1684679
Sex: M
Age: 16
State: NJ

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

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient was 16 years old when he received 2 doses of Moderna Covid Vaccine

Other Meds:

Current Illness: Patient was 16 years old and received 2 doses of Moderna Covid Vaccine

ID: 1684680
Sex: M
Age: 53
State: PA

Vax Date: 05/01/2021
Onset Date: 05/02/2021
Rec V Date: 09/09/2021
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: did not report to any medical professional till now

Allergies: none known to meds - just cats

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

Symptoms: the day after the first dose and flu like symptoms, achy joints, and severe head ache after 2nd dose on May 29, 2021 Moderna 054c01A had similar symptoms for 3 days ongoing since then I fatigue easily, at times my heart races, severe joint pain, my arms and legs are often tingling fall asleep, and sometimes loose all feeling in them. I have self medicated with aspirin to help with pain and it sometimes eases the tingling as well. it is more severe when tired or when hot.

Other Meds: Synthroid250mcg, lisinopril 10 mg, atenolol 50 mg, pantoprazole 40 mg

Current Illness: none

ID: 1684681
Sex: F
Age: 54
State: NC

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

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

Lab Data:

Allergies: Erythromycin Epinephrine

Symptom List: Nausea

Symptoms: Internal shakes Like chills no fever Tremors

Other Meds: Lisinopril Omeprazole Estrogen Progesterone Vitamin D Zinc Vitamin C Nature Throid

Current Illness: None

ID: 1684682
Sex: F
Age: 38
State: FL

Vax Date: 08/20/2021
Onset Date: 08/21/2021
Rec V Date: 09/09/2021
Hospital:

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

Lab Data:

Allergies: Seasonal

Symptom List: Injection site pain

Symptoms: I received my shot on Friday afternoon and by Saturday night when I went to sleep I had a wooshing sound in my ears. It calmed down the next day and now intermittently comes and goes and is a high pitched ringing sound now.

Other Meds: Gabapentin, vitamin d

Current Illness: None

ID: 1684683
Sex: M
Age: 72
State: MI

Vax Date: 05/25/2021
Onset Date: 09/03/2021
Rec V Date: 09/09/2021
Hospital: Y

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

Lab Data: COVID-19 test positive on 9/3/2021

Allergies: Ceftriazone (anayphylaxis, shortness of breath, swelling), demerol (heart races), penicillins (hives)

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

Symptoms: Patient presented to emergency department on 9/2/2021 with shortness of breath with symptoms starting approximately 10 days ago. He also admits to cough, nausea, and loss of taste and smell. He stated he had tested positive for COVID-19. He had increased his home oxygen from 3L to 5L at presentation. He was admitted for further management. He was treated with dexamethasone, remdesivir and continued supplemental oxygen at 3L. His symptoms improved and he was discharged home on 9/7/2021.

Other Meds: ammonium lactate (LAC-HYDRIN) 12 % topical cream apixaban (ELIQUIS) 5 MG TABS tablet atorvastatin (LIPITOR) 20 MG tablet carbidopa-levodopa (SINEMET) 25-100 MG tablet carboxymethylcellulose (REFRESH TEARS) 0.5 % ophthalmic solution Cholecal

Current Illness: None known

ID: 1684684
Sex: F
Age: 13
State: MD

Vax Date: 05/13/2021
Onset Date: 07/30/2021
Rec V Date: 09/09/2021
Hospital:

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

Lab Data: None yet

Allergies: None

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

Symptoms: Extremely heavy periods lasting 3 weeks at a time

Other Meds: Sertraline, vyvanse

Current Illness: None

ID: 1684685
Sex: F
Age: 47
State: CT

Vax Date: 08/17/2021
Onset Date: 08/19/2021
Rec V Date: 09/09/2021
Hospital:

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

Lab Data: I am scheduled for allergy study October 4th

Allergies: None

Symptom List: Tremor

Symptoms: I received my first dose of the Moderna vaccine on 8/17 prior to the deadline of 8/31 as mandated by the system. On 8/19 I started itching towards the end of my shift around 5:00pm. By the time I got home I was covered on my entire abdomen, back, neck arms and legs in a rash. This soon progressed and continued over the next 3 days to hard raised swollen welts up to my face almost causing my eyes to swell shut. Upon contacting my primary physician I was instructed not to receive the second dose until an allergy study was performed. However, under the current situation these COVID vaccine allergy studies are limited and are performed once every few weeks and the next day they were offering in September was completely booked (I am on standby for a cancellation). My appointment is October 4th which is after my scheduled second dose September 14.

Other Meds: None

Current Illness: None

ID: 1684686
Sex: M
Age: 37
State:

Vax Date: 08/08/2021
Onset Date: 09/09/2021
Rec V Date: 09/09/2021
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: Patient received J+J vaccine on 3/9/2021 and then received Pfizer vaccine on 8/8/2021 as documented on this report.

Other Meds:

Current Illness:

ID: 1684687
Sex: F
Age: 47
State: NY

Vax Date: 08/21/2021
Onset Date: 08/21/2021
Rec V Date: 09/09/2021
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: N/A

Allergies: N/A

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

Symptoms: Dizziness, fatigue, head ache, numbness and thinking of the upper lip

Other Meds: Levothyroxine

Current Illness: N/A

ID: 1684688
Sex: F
Age: 47
State: NC

Vax Date: 08/27/2021
Onset Date: 08/28/2021
Rec V Date: 09/09/2021
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: 9/4/21 Blood work, ECG, Chest xray, bilateral ultrasound of legs, CT scan of brain, and a CT scan with contrast of lungs

Allergies: None

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

Symptoms: I received the vaccine on 8/27/21. I woke up on 8/28 with a "Charlie horse" in my left calf muscle. On 9/2/21, I began having swelling in my feet and ankles. On 9/4/21, I began experiencing shortness of breath after walking a short distance. I went to Medical Center ED to be evaluated. After numerous tests, I was diagnosed with a left leg DVT and PE. I began taking blood thinners on 9/4/21 and will follow up with a hematologist on 9/20/21.

Other Meds: Tramadol, Aurovela FE, Benadryl

Current Illness: None

ID: 1684689
Sex: F
Age: 47
State: AR

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

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Heavy menses for 9 days and counting. Never experienced more than 6 days in my entire life.

Other Meds: n/a

Current Illness: n/a

ID: 1684690
Sex: F
Age: 51
State: GA

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

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

Lab Data: No lab tests performed.

Allergies: None

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

Symptoms: Heavy menstrual cycle which lasted 14 days. After 3 days, I became dizzy and had extremely low energy. I had to take time off work.

Other Meds: Glucosamine/chondroitin, cranberry supplement, Vitamin D3, Magnesium

Current Illness: None

Date Died: 09/08/2021

ID: 1684691
Sex: M
Age: 82
State: MI

Vax Date: 03/18/2021
Onset Date: 08/19/2021
Rec V Date: 09/09/2021
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: COVID-19 test positive on 8/19/2021

Allergies: Latex (contact dermatitis), Celebrex (rash), lipitor (dizziness), penicillins

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

Symptoms: Patient presented to emergency department on 8/19/2021 with shortness of breath. He was found to be COVID-19 positive and admitted for further management. He was transferred to the ICU on 8/23/2021 due to worsening hypoxia. He was intubated on 8/28/2021. Patient's condition further deteriorated into multisystem organ failure. He was placed on comfort measures on and expired on 9/8/2021.

Other Meds: allopurinol (ZYLOPRIM) 100 MG tablet amLODIPine-benazepril (LOTREL) 10-20 MG capsule ascorbic acid (VITAMIN C) 250 MG tablet aspirin (HALFPRIN) 81 MG tablet Calcium Carbonate-Vitamin D (CALTRATE 600+D PO) clopidogrel (PLAVIX) 75 MG tablet o

Current Illness: None known

ID: 1684692
Sex: F
Age: 51
State: TN

Vax Date: 04/10/2021
Onset Date: 04/11/2021
Rec V Date: 09/09/2021
Hospital:

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

Lab Data: CBC drawn today. No results yet.

Allergies: None

Symptom List: Pain in extremity

Symptoms: Enlarged lymph nodes around collar bone, exquisitely painful, headaches, joint pain, nerve pain, nausea, heart palpitations. The lymph nodes resolved after 7-10 days but the other symptoms are still ongoing.

Other Meds: Armour thyroid 30 mg per day Losartan 50 mg po qday

Current Illness: None

ID: 1684693
Sex: F
Age: 37
State: KY

Vax Date: 04/26/2021
Onset Date: 08/28/2021
Rec V Date: 09/09/2021
Hospital:

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

Lab Data:

Allergies: NKDA

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

Symptoms: POSITIVE COVID

Other Meds: NONE

Current Illness: NONE

Date Died: 05/21/2021

ID: 1684695
Sex: F
Age: 81
State: OK

Vax Date: 02/13/2021
Onset Date: 02/13/2021
Rec V Date: 09/09/2021
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: None - We did not put the two together until she was in the hospital in May.

Allergies: Codeine - Morphine

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

Symptoms: Became unable to take care of her daily activities, unable to remember anything and when she passed away we found that none of her bills had been paid since before she took her 2nd shot. She was disoriented, confused, didn't know where she was or remember speaking with anyone on the phone and just felt overall worse. Since she had the chronic health issues she/we were not aware she had gotten worse as she pulled away from everyone and kept telling us "this episode was just lasting longer". When she passed and I started going through her things I realized it all started after the shot. Nothing had been taken care of after that date. She also had been driving up until March, she herself stopped driving stating she didn't feel comfortable in driving any longer.

Other Meds: Fentanyl Patch; Fluconazole; Clonidine; Albuterol; Atorvastatin; Baclofen; Fluoxetine; Spironolactone; Losartan; Furosemide; Allopurinol; Hydralazine; Estradiol; Verapamil; Lansoprazole; Isosorbide; Clopidogrel; Metoprolol; Nitroglycerine;

Current Illness: Phenomena - UTI

ID: 1684696
Sex: F
Age: 41
State: IN

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

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

Symptoms: When I had the first shot a month ago the site was just red. I had the 2nd shot yesterday and the spot turned red again and I had a slight headache. I woke up this morning and the spot is red and bubbly and a little warm and it only hurts at that spot. I went back to Cvs today and asked them to look at it, they said they believe it to be an allergic reaction and I was to submit a report. They said the redness has a lump in it and it is blistering. They said they think it to be a local allergy since it hasn't spread anywhere yet. They told me to take benadryl for it and I could put cream on it, which I did when I got home. They told me to watch for other adverse effects and if I had any I was to go to the er. So far no other reactions but the blistery rash

Other Meds: topriamate 200 twice a day buspar( generic) 15 mg 3 times a day bupropion hcl xl 300 mg 1 time a day

Current Illness: tennis elbow nothing else

ID: 1684697
Sex: F
Age: 58
State: NC

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

Symptom List: Vomiting

Symptoms: Second Pfizer injection yesterday Body aches, chills, temp 99.9, arm hurts and can't life high, right calf has hurt since the first shot

Other Meds: Baby Aspirin and Ibuproven

Current Illness: None

ID: 1684698
Sex: F
Age: 37
State: TN

Vax Date: 09/07/2021
Onset Date: 09/07/2021
Rec V Date: 09/09/2021
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: NO ADVERSE EVENT. Patient was given Pfizer for her 2nd dose instead of Moderna. Pt is extremely afraid of needles and was asking that we hurry and give the vaccination while her coworkers held her. I asked her for her card but she wanted us to hurry because she was afraid. Others had received Pfizer at that location and I assumed that was what she got as well. However, after she got the shot she asked was it Moderna, and I said no it was Pfizer. She then handed me her card and it was Moderna that she should have received.

Other Meds:

Current Illness:

ID: 1684699
Sex: F
Age: 27
State:

Vax Date: 04/01/2021
Onset Date: 05/01/2021
Rec V Date: 09/09/2021
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: Worsening menstraul cycles - heavier bleeding and associated dizziness, fatigue, intermittent nausea through cycle and unbearable prior to menstraul bleeding.

Other Meds:

Current Illness:

ID: 1684700
Sex: M
Age: 41
State: MD

Vax Date: 03/09/2021
Onset Date: 03/12/2021
Rec V Date: 09/09/2021
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: Tinnitus started three days after vaccination in both ears. Audiogram shows no hearing loss. Tinnitus has persisted for six months.

Other Meds:

Current Illness:

ID: 1684701
Sex: M
Age: 13
State: MI

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

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

Lab Data: none

Allergies: none

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

Symptoms: Meningococcal B was given instead of Menactra

Other Meds: none

Current Illness: none

ID: 1684702
Sex: M
Age: 71
State: NY

Vax Date: 03/27/2021
Onset Date: 07/01/2021
Rec V Date: 09/09/2021
Hospital:

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

Lab Data: eye exam ultrasound MRI

Allergies: penicillin, bee stings

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

Symptoms: After the 2nd dose in March 2021, a few months later around July 2021, I noticed blurry vision in both eyes. I could not read or drive. It was accompanied by headaches afterwards. This episode lasted for 40 minutes then I was able to see and drive again. I still had light sensitivity. My vision did return back to normal. I did follow up with my eye doctor (optometrist) who order an ultrasound and blood test to rule out stroke and blood work came back normal. I also followed up with my PCP who ordered an MRI which was also normal. I went back to the optrometrist who referred me to an opthamologist. I also went to see an opthamologist who did an eye exam which also came back normal and ordered 2 MRIs one around the brain another MRI of the eye socket. I am still having eye pressure pain in both eyes and headaches. Recently, I am also noticing memory loss.

Other Meds: Flaxseed oil

Current Illness: none

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am