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: 1692979
Sex: F
Age: 52
State: MO

Vax Date: 08/28/2021
Onset Date: 08/31/2021
Rec V Date: 09/11/2021
Hospital:

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

Lab Data: Ekg cardiac blood work, echogardiagram on 08/31/2031,stress test on 09/02/2021chest xrays ,CT scans with contrast ,covid test urine test. Same test done 09/10/2021 at hospital again

Allergies: Codeine, demerol

Symptom List: Dysphagia, Epiglottitis

Symptoms: Severe chest pain tightness in chest blood pressure very high.trouble breathing .started on 08/31/2021 and continues to be a problem.I was told to there best guess is pluersiey given pain medication .

Other Meds: None

Current Illness: None

ID: 1692980
Sex: M
Age: 71
State: NY

Vax Date: 08/30/2021
Onset Date: 08/30/2021
Rec V Date: 09/11/2021
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: x-rays, blood work, ultra sounds, echo

Allergies: Bactrim Dapsone

Symptom List: Anxiety, Dyspnoea

Symptoms: Fever, shortness of breath, pancytopenia, shock, AKI, Acute Respiratory Failure, abnormal liver function tests thought to be profound immune response to the vaccine booster. I was hospitalized for five days.

Other Meds: Metaprolol Prednisone 8mg Metformin Folic Acid Lovenox Atorvastatin Omeprazole Valsartan Amlodipine Methotrexate Leucovorin Celecoxib Calcium Citrate Vitamin D3

Current Illness: Relapsing Polychondritis Anemic of Chronic Disease Diabetes Type 2 Thrombocytopenia MDS-U

ID: 1692981
Sex: M
Age: 60
State: MN

Vax Date: 09/09/2021
Onset Date: 09/09/2021
Rec V Date: 09/11/2021
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: NA

Allergies: No

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

Symptoms: Nurse administered High Dose vaccine (Fluad) to patient under 65. Patient did not answer phone when called to inform him of error. Left message for patient to call back.

Other Meds: NA

Current Illness: NA

ID: 1692982
Sex: F
Age: 17
State: TX

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

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

Lab Data: N/A

Allergies: Ciprofloxacin

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Numbness and tingling on vaccinated arm.

Other Meds: Mucinex

Current Illness: None

ID: 1692983
Sex: M
Age: 68
State: PA

Vax Date: 01/22/2021
Onset Date: 03/01/2021
Rec V Date: 09/11/2021
Hospital:

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

Lab Data: n/a

Allergies: NKA

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

Symptoms: Patient did receive 2nd dose of Moderna COVID-19 vaccine on 2-20-2021. He claims that every since he had received the COVID vaccine, he has had ringing in his ears beginning in March. He has seen an audiologist and this prescriber stated that their office has been seeing in increase in complaints of ringing in the ears since more individuals have receieved the COVID vaccine. The patient requested that we report the adverse event.

Other Meds: Crestor 20mg daily Humira Breo Ellipta Plavix 75mg Protonix 40mg Carbamazepine 200mg Singular 10mg

Current Illness: N/A

ID: 1692984
Sex: F
Age: 45
State: NC

Vax Date: 09/07/2021
Onset Date: 09/09/2021
Rec V Date: 09/11/2021
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: NKDA

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

Symptoms: PT HAD COVID ARM. RED, ANGRY RIGHT UPPER ARM. FEVER OF 99 DEGREES. PT TOOK ACETAMINOPHEN AND DIPHENHYDRAMINE. ON 9/11/21 THE REACTION WAS BARELY VISIBLE ON HER ARM.

Other Meds: LEXAPRO AND ALPRAZOLAM

Current Illness: NONE

ID: 1692985
Sex: F
Age: 54
State:

Vax Date: 09/10/2021
Onset Date: 09/11/2021
Rec V Date: 09/11/2021
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: codeine

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Pain at injection site started about an hour or so after the shot. Felt ok until around 12:30 AM. Became cold and started shivering. Shortly after developed a headache (back of head and neck). Took two Tylenol around 2 AM. Had muscle pain and nausea all night. In bed for 12 hours but unable to sleep. Took two more Tylenol around 10 AM . Very lethargic and headache lingered into the next day.

Other Meds: Effexor (37.5mg/day), glucosamine and chondroitin, turmeric

Current Illness: N/A

ID: 1692986
Sex: F
Age: 63
State: SC

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

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

Lab Data: None - Only contacted physician's office to inform them of my ignorance (I thought you had to get Shingrix shot each year) and the reaction on my left arm.. I did not go to doctor's office. Today is Saturday. Did not feel it was warranted to go to ER.

Allergies: NKA

Symptom List: Pharyngeal swelling

Symptoms: Dose administered #10:15am 9/9/21 - sore at injection site as expected 9/10/21 7:30 pm - noticed that injection site was warm and area spread to 2.5 x 3 inches. Applied ice pack to injection site.

Other Meds: Metformin 1000mg am & pm Rousuvastatin 20mg qpm Estradiol patch .075mg Valsartan 80mg qam B12 500mcg qam Zyrtec 10mg qam

Current Illness:

ID: 1692987
Sex: F
Age: 59
State: PA

Vax Date: 04/02/2021
Onset Date: 04/09/2021
Rec V Date: 09/11/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Flashing semi circle of light in left eye followed by many floaters - went to doctor was inconclusive and basically have to live with it. One month later identical incident in right eye. About 5 eye doctor visits.

Other Meds: Multi vitamin

Current Illness: None

ID: 1692988
Sex: F
Age: 43
State: MA

Vax Date: 09/08/2021
Onset Date: 09/09/2021
Rec V Date: 09/11/2021
Hospital:

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

Lab Data: ekg, chest ct pe, labs

Allergies: Ancef

Symptom List: Diarrhoea, Nasal congestion

Symptoms: see previous section, session timming me out

Other Meds: famotidine 20mg twice a day

Current Illness: 1st vaccine horrible side effects of runny nose, fever, headache, body aches, chills, fatigue, metal taste in mouth, magnet sticking to chest,lasted around 4-5 days, reported . 14 days exactly from first vaccine fever, fatigue, runny nose, chills, body aches, headache, shortness of breathe, for 4-5 days tested negative for covid and flu , sick enough to go to urgent care. Second vaccine on 9/8 developed fever and body aches , chills that same night chest pain developed at 1 am that lasted all day on thursday . Went to emergency room to have cardiac work up, heart rate 130s on arrival to emergency room , Iv fluids given with no effect on heart rate , continued chest pain, body aches so bad all 3 of these episodes with no relief with medications given. Fever 101.9 no relief with tylenol, d dimer slightly elevated at 545. Chest Ct done to check for pulmonary embolism negative, EKG negative. 7 hours later they decide to discharge me still with chest pain and hear rate of 120 and continued fever . Symptoms resolved next day.

ID: 1692989
Sex: F
Age: 58
State: MN

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 09/11/2021
Hospital:

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

Lab Data:

Allergies: Morphine, Keflex, sulfas, ketamine, Rocephin, vancomycin

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

Symptoms: Dizzy, nausea, syncope, diaphoresis, weakness

Other Meds: Verapamil, Prozac, Buspirone, Alprazolam, Lyrica, Baclofen, Vicodin

Current Illness: None

ID: 1692990
Sex: F
Age: 28
State: FL

Vax Date: 09/03/2021
Onset Date: 09/06/2021
Rec V Date: 09/11/2021
Hospital:

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

Lab Data: None

Allergies: None

Symptom List: Rash, Urticaria

Symptoms: Floaters in vision, left eye

Other Meds: None

Current Illness: None

ID: 1692991
Sex: F
Age: 62
State: MO

Vax Date: 04/07/2021
Onset Date: 04/26/2021
Rec V Date: 09/11/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Approximately 3 weeks from receiving 2nd dose, onset of neck pain, and in the following week progressing to a rash, extreme arm & shoulder pain, extreme muscle weakness/paralysis/lack of ROM in that arm. At ER diagnosed with Left Brachial Plexitis / Autoimmune Plexopathy. Began Prednisone. Continued paralysis.

Other Meds:

Current Illness:

ID: 1692992
Sex: M
Age: 67
State: ID

Vax Date: 04/15/2021
Onset Date: 05/01/2021
Rec V Date: 09/11/2021
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: All of my medical history is with the hospital. I have seen numerous specialists and doctors in order for all of my medical problems to be addressed.

Allergies: None

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

Symptoms: I have been in and out of the hospital since May 2021. It started 2 weeks after the second dosage of the COVID-19 vaccination with a severe ear infection and doctors could not figure out what the cause was. I have been put on numerous amounts of antibiotics and steroids and almost lost my hearing in its entirety because of this problem. It triggered bells palsy on the left side of my face. The infection spread and I ended up with a sinus infection that required surgery. A couple of weeks after surgery, I lost vision in one of my eyes and required hospitalization and the doctors found that my problems were due to inflammation in my blood vessels and inflammation in my kidneys. Since May 2021 I have been placed on numerous amounts of medication, have required hospitalization twice monthly, dealt with almost losing my hearing and vision, required surgery, and now I am dealing with problems with my kidneys.

Other Meds: None

Current Illness: None

ID: 1692993
Sex: F
Age: 50
State: MS

Vax Date: 07/27/2021
Onset Date: 07/29/2021
Rec V Date: 09/11/2021
Hospital:

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

Lab Data: N/A

Allergies: Seafood, Penicillin (all cillins) & Tramadol.

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

Symptoms: Itching that continues to exist at the site, discoloration of my skin on the site & a raising itching, mildly sore rash developing on the site of injection.

Other Meds: Amlodopine for blood pressure but only take it at night. I take vitamin C, mega zinc, B vitamins & D3

Current Illness:

ID: 1692994
Sex: F
Age: 67
State: OR

Vax Date: 05/31/2021
Onset Date: 06/27/2021
Rec V Date: 09/11/2021
Hospital:

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

Lab Data: None

Allergies: Nickle, compazine

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

Symptoms: Shingles - pain developed approximately 3 days, rash began 24 hours before seen in urgent care. Prescription for Valtrex. Symptoms resolved in approximately 2 weeks after beginning medication

Other Meds: Gabapentin, mirapex

Current Illness: Nonr

ID: 1692995
Sex: F
Age: 18
State: TX

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

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

Lab Data: N/A

Allergies: None

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

Symptoms: Numbness and tingling at vaccinated arm.

Other Meds: None

Current Illness: None

ID: 1692996
Sex: F
Age: 59
State: PA

Vax Date: 04/23/2021
Onset Date: 04/26/2021
Rec V Date: 09/11/2021
Hospital:

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

Lab Data: None

Allergies: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Tingling in lower legs and feet. This has continued for months. It does seem to be an ongoing problem. Have not seen a doctor yet...

Other Meds: Multi vitamin

Current Illness: None

ID: 1692997
Sex: M
Age: 26
State: KY

Vax Date: 09/09/2021
Onset Date: 09/10/2021
Rec V Date: 09/11/2021
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: Fainting, collapsing, vomiting, tachycardia 911 call. Taken to emergency room.

Other Meds: None

Current Illness: None

ID: 1692998
Sex: M
Age: 30
State: CA

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

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

Lab Data:

Allergies: None reported

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

Symptoms: The vaccine was administered into the right deltoid muscle. The patient seemed dazed and appeared pale. When asked if he was ok, he stated he had been feeling nervous. After this the patient stared blankly ahead and his breathing choked and stopped momentarily. I assumed anaphylaxis at first and prepared an Epi-Pen. Still seated, he collapsed forward. I attempted to hold him up to stop him from hitting his head on the cart in front of him. There were some slight twitching/jerking movements in his arms. The patient eventually came to and was able to sit up. He was in a sweat and stated he needed water and some air, but was well enough where he declined an ambulance. The patient was provided a bottle of water and allowed to sit in the vaccination area for about 20 minutes to recover.

Other Meds: Unknown

Current Illness:

ID: 1692999
Sex: F
Age: 67
State: NY

Vax Date: 03/28/2021
Onset Date: 04/20/2021
Rec V Date: 09/11/2021
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: Blood Works

Allergies: Sulfa, Cipro, Penicillin-recently discovered

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

Symptoms: About a month after getting the second dose of the vaccine I got a severe rash all over my body. The rash was in big welts all over my body, arms, chest, neck, back and legs. It was very itchy and raised and arm to the touch. I went to the Dermatologist, and I took Benadryl. It would calm down after a few hours and then return the next day. It lasted over two weeks but I had another incidence about five months after the vaccine but it only lasted for one day. I took Benadryl and then it went away and did not return. I have also been diagnosed with drug allergies to Penicillin five months after the vaccine. I am not sure if I was allergic before the vaccine.

Other Meds: Spironolactone. Vitamins

Current Illness: N/A

ID: 1693000
Sex: M
Age: 35
State: CA

Vax Date: 08/19/2021
Onset Date: 09/04/2021
Rec V Date: 09/11/2021
Hospital:

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

Lab Data: Tests are ongoing. MRI scheduled for September 14 and EEG is scheduled for September 21st. CT Scan performed shortly after the event on September 4th came back unremarkable Blood tests on September 4th came back with slightly lower potassium levels. Follow up EKG, blood and urine lab tests on September 7 with Cardiologist and Primary Physician was unremarkable. Cardiology stress test performed on September 10 was unremarkable

Allergies: none

Symptom List: Unevaluable event

Symptoms: Healthy 36 year old adult with no prior symptoms suddenly collapsed and suffered a Tonic Clonic Seizure (Grand Mal Seizure) lasting about 11 minutes.

Other Meds: none

Current Illness: none

ID: 1693001
Sex: M
Age: 73
State: CA

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

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

Lab Data:

Allergies: Tramadol Niacin

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

Symptoms: High dose flu vaccine caused pain at injection site, muscle aches,skin sensitivity, diarrhea, low grade fever, never in over 40 years of getting the vaccine has there been any reaction, now7 months after getting the moderna covid vaccine i have the same reaction i received from the second dose of the moderna vaccine. Reaction lasted overnight for about 18 hours

Other Meds: Lisinopril 10 mg Pravastatin20mg Vitamin D3 50 mg

Current Illness: None

ID: 1693002
Sex: M
Age: 36
State: PA

Vax Date: 08/16/2021
Onset Date: 08/24/2021
Rec V Date: 09/11/2021
Hospital:

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

Lab Data: None,

Allergies: IV Contrast

Symptom List: Injection site pain, Pain

Symptoms: Patient received his 3rd dose. About a week later his psoriasis exploded all of his body. He had sores literally from the top of his head to the soles of his feet. It had never been this bad. This lasted about 2 weeks then subsided without medical intervention. We think the dose sent his immune system into overdrive while it created antibodies and resulted in a severe psoriasis flare.

Other Meds: Clobatesol 0.05%, carvedilol 25mg, levothyroxine 50mcg, entresto 97/103, aspirin 81mg, furosemide 60mg (am) & 40 mg (pm), omeprazole 40 mg, duloxetine 30 mg, atorvastatin 20 mg, clonazepam 0.5mg, oxycodone 5mg, spironolactone 25mg,

Current Illness: Recurrent gout, psoriasis, heart failure, hypothyroidism, stroke, AFIB

ID: 1693003
Sex: F
Age: 37
State: WI

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

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

Lab Data:

Allergies: Sulfa Drugs, Latex, contrast dye

Symptom List: Injection site pain, Menorrhagia

Symptoms: Janssen COVID-19 Vaccine EUA. Fever, chills , nausea, vomiting, diarrhea, headache, muscle aches, extreme weakness, and dizziness in the first 72 hours. The subsequent 72 hours I've experienced diarrhea, extreme dizziness, body aches, and skin discoloration in the injection site.

Other Meds: Excedrin migraine

Current Illness: nothing

ID: 1693004
Sex: M
Age: 34
State: TX

Vax Date: 04/26/2021
Onset Date: 05/17/2021
Rec V Date: 09/11/2021
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: Penicillin allergy

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

Symptoms: After my first Pfizer shot, that arm was sore for the rest of the day and the following day, with no other symptoms. After my second Pfizer shot, that arm was sore the next day. For three days I felt ill: the fatigue, body aches, and general malaise of an immune response. These symptoms subsided in intensity after 3 days but persisted approximately a week. The primary complaint is this: before my second shot, I was exercising (running 2.5 miles, then going to the gym) almost every day (at least 5 days a week). After the shot, I developed tightness in my chest, elevated heart rate, persistent shortness of breath, etc, and I was only able to exercise a few hours per week in total before becoming fatigued and winded. These symptoms persisted strongly for approximately 1 month, but it took approximately 3 months before I began to feel as strong as I had felt prior to the second shot.

Other Meds: None

Current Illness: None

ID: 1693005
Sex: M
Age: 61
State: NY

Vax Date: 09/08/2021
Onset Date: 09/10/2021
Rec V Date: 09/11/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient's wife called and reported that patient has a lump under the armpit. Advised pt to see md if it doesn't get better

Other Meds:

Current Illness:

ID: 1693006
Sex: M
Age: 24
State: CA

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

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

Lab Data: N/A

Allergies: N/A

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient was here for his second dose of Moderna. He initially received his first dose August 7, 2021. Pt received Pfizer this morning, versus the Moderna. Soldier was accepting of the situation and there was no adverse reaction. Adverse reported per Command. Pt knew that both vaccines were MRNA related and the efficacy would be ideal. Pt talked to on scene.

Other Meds: N/A

Current Illness: N/A

ID: 1693007
Sex: F
Age: 47
State: NC

Vax Date: 07/08/2021
Onset Date: 07/15/2021
Rec V Date: 09/11/2021
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: All labs performed by Physicians

Allergies: Sulfa, Penicillin

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

Symptoms: Thyroid shut down Inflammation Chronic pain Prescription totals 5 different meds Pain Management specialist Immunology specialist

Other Meds: None

Current Illness: Inflammation, fibromyalgia

ID: 1693008
Sex: F
Age: 78
State: AL

Vax Date: 09/01/2021
Onset Date: 09/02/2021
Rec V Date: 09/11/2021
Hospital:

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

Lab Data:

Allergies: Macrobid

Symptom List: Nausea

Symptoms: Hives, intense itching head to feet, came and went for two days, then solid for 18 hours until sought help at urgent care. Received steroid shot and prednisone, Pepcid, and Zyrtec and Benadryl. Back to normal after 10-12 hours. This was the booster, first two shots were January 18, February 15, hardly any side effects with those.

Other Meds: Omeprasole, raloxifene, krill oil, magnesium as needed for leg cramps, calcium, multi-vitamins

Current Illness:

ID: 1693009
Sex: F
Age: 81
State: MO

Vax Date: 02/03/2021
Onset Date: 09/11/2021
Rec V Date: 09/11/2021
Hospital:

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

Lab Data:

Allergies: PENICILLIN BETA BLOCKERS ALPHA AGONISTS

Symptom List: Injection site pain

Symptoms: increased intraocular pressure and blood pressure, chronic and continuing

Other Meds: ATORVASTATIN 20MG

Current Illness: N/A

ID: 1693010
Sex: M
Age: 64
State: ID

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

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

Lab Data: N/A

Allergies: No Known Drug Allergies

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

Symptoms: Patient did not report any adverse events.

Other Meds: Unknown

Current Illness: Unknown

ID: 1693011
Sex: F
Age: 33
State: NJ

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

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

Lab Data: On 09/11/2021 - physical exam - bronchospasm, rapid Covid test - negative, chest X-ray - negative

Allergies: Erythromycin

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

Symptoms: Received vaccine 9/10/21 and within 5 minutes I felt flush of warmth and unwell. Went home after 15 minutes, and started feeling nauseous. Then felt hot and cold with chills. Within about an hour felt like when you accidentally inhaled a sip of water coughing and dry heaving, unable to catch breath. Took Zyrtec D, unrelieved. Next day, still short of breath with face occasionally feeling warm and turning red off and on, body/muscle aches, along with unusual menstruation (since mirena IUD placed 2/5/19 usually not bleed much if at all). 9/11/21, finally went to Immediate Care Walk in and was treated for bronchospasm. Received shot of solumedrol and nebulizer in office and was sent home on titrating dose of prednisone, inhaler, and nebulizers.

Other Meds: None

Current Illness: None

ID: 1693012
Sex: F
Age: 19
State: NC

Vax Date: 09/11/2021
Onset Date: 09/11/2021
Rec V Date: 09/11/2021
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: Received a moderna vaccine and passed out about 5-10 minutes later. She was alert and talking then passed out for about a minute. I went out and she was breathing. Called 911. She woke up and vomited. Stated she felt better. Paramedics arrived and talked to her and took vitals. She opted to be taken to the hospital.

Other Meds:

Current Illness:

ID: 1693013
Sex: F
Age: 53
State: CT

Vax Date: 08/25/2021
Onset Date: 08/28/2021
Rec V Date: 09/11/2021
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: Aspirin

Symptom List: Erythema, Pruritus

Symptoms: Itching started in the body after three days of getting the first dose of the vaccine, at first it started on my right side of the body then the next day on my left, then my arms, then my legs, and day by day it got worse, at the area where it was itching it got red and I could feel heat coming from it. Then I saw my doctor and she told me that I had an allergic reaction from the vaccine and so I can not take the second dose and then she prescribed me Prednisone 10 mg tablet to take for nine days.

Other Meds: Metformin Hcl 1,000mg tablet Glipizide ER 10mg tablet Amlodipine Besylate 10mg tablet Atorvastatin 10mg tablet Vitamin D3 25mcg (1000iu) tablet

Current Illness: None

ID: 1693014
Sex: M
Age: 32
State: TX

Vax Date: 09/11/2021
Onset Date: 09/11/2021
Rec V Date: 09/11/2021
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: After 5 minutes felt the symptoms of shock. Rising anxiety and heart rate. Light headed and cold sweat. I felt like I would faint. I laid flat on the ground and was better in about a minute and could stand up and sit in a chair again. 15 minutes later I was relatively normal.

Other Meds:

Current Illness:

ID: 1693015
Sex: F
Age: 21
State: OH

Vax Date: 08/07/2021
Onset Date: 08/07/2021
Rec V Date: 09/11/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Pfizer COVID 19 EUA; left arm tingling (for about 1 hour), difficulty breathing and tongue and lips tingling (for about 2 hours) all with occurred within 4 hours of getting vaccine

Other Meds:

Current Illness:

ID: 1693016
Sex: M
Age: 57
State: NJ

Vax Date: 06/09/2021
Onset Date: 06/16/2021
Rec V Date: 09/11/2021
Hospital:

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

Lab Data: In August 2021 (day unknown), I underwent a stress echocardiogram with treadmill.

Allergies: Pollen, grass, dust, trees.

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: On about 6/16/2021, when I got up at about 6:00 AM, I noticed that I felt a pressure and rapid fluttering in my chest. Ever since then, I have continued to feel the pressure and fluttering. It feels rather achy, sort of like I have a bruise in that area. The feeling is uncomfortable and causes me to toss and turn in bed and awaken early in the morning. I have also experienced extreme fatigue and sweating. My head seems to have also swollen, because caps now feel tighter and I sweat whenever I wear them. Caps are so uncomfortable now that I either have to loosen them or else take them off. I went to see my cardiologist, in July 2021. I told him about the chest pressure and fluttering, and he scheduled me to undergo a stress echocardiogram with treadmill in August 2021. I underwent the test, and Dr. said afterwards that he would have liked to see my heartrate achieved to a higher level on the treadmill. Dr. has scheduled me to undergo a carotid ultrasound on 9/30/2021

Other Meds: Atenolol, amlodipine, pantoprazole, clonazepam.

Current Illness: None.

ID: 1693017
Sex: F
Age: 63
State: VT

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

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

Lab Data: N/a

Allergies: Penicillin, atorvastatin

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

Symptoms: Muscle aches, rigors, chills. Took ibuprofen, acetaminophen.

Other Meds: Simvistatin. Claritin, Vit B, Vit D, dosusate

Current Illness: None

ID: 1693018
Sex: F
Age: 48
State: CT

Vax Date: 02/12/2021
Onset Date: 03/11/2021
Rec V Date: 09/11/2021
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: June 25- albumin serum level 2.5 Protein level 2.9

Allergies: None

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

Symptoms: Positive albumin upon dip at Dr. office. Not followed up on til June 25th when I went to Hospital ER for chest heaviness. Lab worked showed Nephrotic Syndrome (low albumin and Protein levels in blood work).

Other Meds: Lipitor 40 mg daily Metformin 1g BID ASA 81 mg daily Zetia 10mg daily

Current Illness: None

ID: 1693019
Sex: F
Age: 46
State: OH

Vax Date: 08/31/2021
Onset Date: 09/07/2021
Rec V Date: 09/11/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

Symptom List: Pain in extremity

Symptoms: Nose bleeds multiple times a day, clotted blood,

Other Meds: Effexor, buspar, adderall, amitriptyline, omeprazole,

Current Illness: None

ID: 1693020
Sex: M
Age: 89
State: MO

Vax Date: 01/26/2021
Onset Date: 09/09/2021
Rec V Date: 09/11/2021
Hospital: Y

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

Lab Data: unknown

Allergies: unknown

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

Symptoms: Increasing severity of SOB

Other Meds: unknown

Current Illness: unknown

ID: 1693021
Sex: F
Age: 51
State: KY

Vax Date: 08/27/2021
Onset Date: 09/06/2021
Rec V Date: 09/11/2021
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: tested positive on 09/07/2021

Other Meds:

Current Illness:

ID: 1693022
Sex: F
Age: 47
State: IA

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

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

Lab Data:

Allergies:

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

Symptoms: Patient received first dose or Moderna and got second dose of Pfizer by pharmacy error

Other Meds:

Current Illness:

ID: 1693023
Sex: F
Age: 42
State: TX

Vax Date: 09/11/2021
Onset Date: 09/11/2021
Rec V Date: 09/11/2021
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

Symptom List: Vomiting

Symptoms: Needle sank back into the syringe when needle touched patient skin. No vaccine was injected in patient arm. New dose was given to patient.

Other Meds: Birth control and over-the-counter vitamins

Current Illness: None

ID: 1693024
Sex: F
Age: 43
State: CO

Vax Date: 07/31/2021
Onset Date: 07/31/2021
Rec V Date: 09/11/2021
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: Patient was given 3rd dose on 7/31/21.

Other Meds:

Current Illness:

ID: 1693025
Sex: M
Age: 67
State: IN

Vax Date: 03/10/2021
Onset Date: 08/18/2021
Rec V Date: 09/11/2021
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: Covid 19 - positive

Allergies: seasonal allergies

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

Symptoms: I had fatigue, post nasal drip, coughing, lost of taste and smell and I had a slight fever. I had been with our daughter who was visiting us and I went in and tested positive. I had an infusion after I tested and after 24 hours I felt better of receiving that infusion.

Other Meds: Rosuvastatin, Calcium 5mg every other day , losartan-HCTZ 100.125 mg once daily, Centrum once a day, glucosamine chondroitin, vit d3, aspirin 81 mg

Current Illness:

ID: 1693026
Sex: F
Age: 18
State: TX

Vax Date: 07/30/2021
Onset Date: 07/31/2021
Rec V Date: 09/11/2021
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: Patient self reported adverse event on 09/11/2021 upon presentation for 2nd dose in the series at which time a brief medical history and questionnaire was administered. Provider was not aware of event on 7/31/2021 until 09/11/2021. No other test were performed as patient stated she had recovered.

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient reported a bloody nose that she could not get to stop for approximately 3 minutes. After the bloody nose stopped, patient reported feeling light headed and passed out for approximately 10 seconds.

Other Meds:

Current Illness:

ID: 1693027
Sex: F
Age: 45
State: AR

Vax Date: 08/31/2021
Onset Date: 09/02/2021
Rec V Date: 09/11/2021
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: Irregular menses, PMS mood symptoms cramping, bleeding still and no sign of slowing down. Headaches daily.

Other Meds: None

Current Illness: None

ID: 1693028
Sex: M
Age: 47
State: LA

Vax Date: 09/07/2021
Onset Date: 09/08/2021
Rec V Date: 09/11/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: The vaccine was administered on Tuesday morning and the patient started having signs of a fever blisters. The patient states they have a history of fever blisters when stressed and had an outbreak the following day, Wednesday (9/8). As this report is being submitted on Saturday (9/11), the patient's symptoms have spread from their upper lip to the side of their side burn. The patient shows no sign of blockage of airways and can breath and is experiencing erythema on the face. I have suggested the patient to try an antihistamine but if symptoms persist to check with their doctor for further treatment.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am