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: 1693081
Sex: F
Age: 43
State:

Vax Date: 08/06/2021
Onset Date: 08/06/2021
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: Inflammation SER 59 level

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Right sided temple headache since first day. After 5 weeks headache has not gone away. Inflammation levels are double the normal amount. Had aura 3 times as well.

Other Meds: Atenolol

Current Illness:

ID: 1693082
Sex: F
Age: 52
State: FL

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 09/11/2021
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: none

Symptom List: Anxiety, Dyspnoea

Symptoms: Fever, chills, nausea, lethargy

Other Meds: none

Current Illness: none

ID: 1693083
Sex: M
Age: 35
State: NY

Vax Date: 09/11/2021
Onset Date: 09/11/2021
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: Monitor blood pressure, ice pack, liquids

Allergies: None

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

Symptoms: Cold sweat, dizziness and low blood pressure, almost passing out

Other Meds: None

Current Illness: None

ID: 1693084
Sex: F
Age: 48
State: MD

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:

Allergies: none

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Pfizer vaccine that was provided to the patient was improperly stored in the freezer for greater than 14 days.

Other Meds: n/a

Current Illness: none

ID: 1693085
Sex: M
Age: 79
State: CA

Vax Date: 08/25/2021
Onset Date: 09/08/2021
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: Did not seek medical attention.

Allergies: None

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

Symptoms: Got hives all over back and sides of back. Never had hives before.

Other Meds: Multi vitamin, Vitamin C, Vitamin D3, Zinc, Quercetin, B-Complex, Melatonin, Magnesium

Current Illness: None

ID: 1693086
Sex: F
Age: 49
State: TX

Vax Date: 03/13/2021
Onset Date: 03/15/2021
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: Hearing, tests, MRI, medications, injections

Allergies: NKDA

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

Symptoms: I have sudden hearing loss in right ear completely and now left ear starting to lose hearing also. Got my shot Saturday morning and when I woke up Monday morning to get ready for.work I couldn't hear anymore. I have gone to Mr. R. then went to Audiologist and ENT-Dr. B. got mri done and hearing tests and steroid treatments, antiviral oral meds, antibiotics and even direct steroid injections into my right ear, no success.

Other Meds: Lisinopril, metformin, tylenol

Current Illness: No besides my ex of diabetes and high blood pressure.

ID: 1693087
Sex: M
Age: 43
State: UT

Vax Date: 09/08/2021
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: LA

Lab Data:

Allergies: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Swollen area under arm. Size of baseball

Other Meds: None

Current Illness: Covid

ID: 1693088
Sex: F
Age: 14
State: MD

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: LA

Lab Data:

Allergies: None

Symptom List: Pharyngeal swelling

Symptoms: Pfizer vaccine that was provided to the patient was improperly stored in the freezer for greater than 14 days.

Other Meds: None

Current Illness: None

ID: 1693089
Sex: F
Age: 25
State: KY

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: 1
Vax Route: IM
Vax Site: LA

Lab Data: none at this time

Allergies: No known drug allergies at this time

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Pt received her second moderna inj and, after completing the inj, she stood up and walked over to sit in a chair outside of the inj booth to wait for 15 minutes. She sat down, but after about 5 minutes, a customer yelled at us that someone had fainted. Upon walking out to the pt, she was laying face down on the floor, passed out. She had fainted. We helped her to sit upright, on the floor. She had fallen on floor and landed on her face. Her forehead was read, but her nose seemed ok. She was a little shaky. We gave her a bottle of water to drink and helped her into a wheel chair. Her husband came to pick her up. The tech explained to the husband that she hit her forehead on the floor and needed a ct scan to make sure she did not have a concussion. The husband only replied "ok", asked his wife if she was ready to go and wheeled her out in the wheelchair to his car.

Other Meds: No meds at this time

Current Illness: none at this time

ID: 1693090
Sex: F
Age: 68
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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies: None

Symptom List: Diarrhoea, Nasal congestion

Symptoms: This report is about the second vaccination I received yesterday on 9-11-2021. I had extreme insomnia. I did not sleep AT ALL, all night and have not been able to sleep at all throughout the day (no naps). I did some on-line research and found this was a (possibly rare) side-effect for quite a few people. One person said that she has not slept for 3 weeks after her second vaccine. I take pharmaceutical-strength medications for insomnia. They work perfectly well EXCEPT they didn't work at all last night. I'm truly alarmed at this development. I would like you to add this to your symptom checklist, because it's serious. Try working or driving on no sleep for a few days.

Other Meds: Tramadol, Ambien, Propranolol, Hydroxyzine, Vit D (50,000 IU weekly), Iron, Bupropion

Current Illness: None

ID: 1693091
Sex: F
Age: 28
State: PA

Vax Date: 05/15/2021
Onset Date: 05/15/2021
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: None

Allergies: Gluten, cinnamon, pseudo-fed

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

Symptoms: Immediate dizziness and pain at injection site. Later that day a high fever of 104 Fahrenheit, body aches, muscle spasms, migraine, blurry vision, tinnitus continued for 24 hours. Ringing in ears has continued sporadically since that date. Dizziness continues sporadically as well.

Other Meds: Prenatal Vitamins Iron supplement Glutathione Bee pollen

Current Illness: None

ID: 1693092
Sex: M
Age: 39
State: WI

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: SYR
Vax Site: RA

Lab Data: Paramedics took the patients blood pressure and appeared slightly lower than normal when they first got there, but gradually increased. They also monitored the patient's heart, where he had normal sinus rhythm.

Allergies: NKDA

Symptom List: Rash, Urticaria

Symptoms: Patient came in looking for a Janssen vaccine. He came in asking if the vaccine can make him vomit because he recently broke his jaw and was worried about vomiting with his mouth wired shut. I informed the patient that it is unlikely, but a possibility and asked the patient if he still felt comfortable getting the vaccine. Because his jaw was wired shut, I asked if he's gotten anything to eat today and described to me he had some yogurt and blend fruit, but that is it. Asked how he is feeling today and he said he "felt good" and isn't sensitive to vaccines in the past. After Administering the J&J vaccine into his right deltoid, I asked him to sit in a chair for 15 minutes to make sure he is feeling okay. As I was helping other customers, the Patient said loudly that he wasn't feeling good. As I walked over he repeatedly said he felt like he was going to faint. 5 seconds later he fainted in the chair. I positioned myself so he wouldnt fall out of the chair. and a technician called 911 right away. The patient was unconscious for roughly 10-15 seconds then woke up and appeared very sweaty. A technician and I stayed by the patient's side until paramedics arrived less than 5 minutes later where the patient appeared wake and oriented to where he was. Paramedics thought the reason for the fainting after the vaccine was due to not having enough food in his system due to recently having his jaw wired shut. Pharmacy provided the patient with Gatorade, Ensure, and applesauce to help. Paramedics were here monitoring the patient for 25 minutes Patient stayed for about 1 hour until a friend came and picked him up.

Other Meds: Unknown. Does not fill at this Pharmacy.

Current Illness: Broken Jaw. No other illness

ID: 1693093
Sex: F
Age: 82
State: CT

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

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

Symptoms: no adverse effects second dose was given 7 days after first dose

Other Meds:

Current Illness:

ID: 1693094
Sex: F
Age: 74
State: MD

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: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: n/a

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

Symptoms: Pfizer vaccine that was provided to the patient was improperly stored in the freezer for greater than 14 days.

Other Meds: N/a

Current Illness: n/a

ID: 1693095
Sex: F
Age: 71
State: ME

Vax Date: 09/08/2021
Onset Date: 09/08/2021
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: KNA

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

Symptoms: PT came in 9/10/21 in the afternoon complaining of tingleing sensation up neck and down arm to thumb. RPH let MD know of pt's symptoms. Pt to follow up with MD. PT states was having the tingling since the vacine

Other Meds:

Current Illness:

ID: 1693096
Sex: M
Age: 27
State: OH

Vax Date: 09/07/2021
Onset Date: 09/09/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: 101.5 fever day one of symptoms, severe body aches/twitching, chills/shakes/chattering/sweating, severe headache, throat pain, neck and back pain, 103 fever day 2 of symptoms, 102.5 fever with above symptoms still on day 3. Tylenol and advil switched off throughout the day, does not help the symptoms.

Other Meds:

Current Illness:

ID: 1693098
Sex: F
Age: 50
State: MD

Vax Date: 08/24/2021
Onset Date: 08/01/2021
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:

Allergies:

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

Symptoms: Patient states she is experiencing arm pain from injection site down the length of her arm and into her back.

Other Meds:

Current Illness:

ID: 1693099
Sex: F
Age: 42
State: AZ

Vax Date: 09/09/2021
Onset Date: 09/10/2021
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:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Red, swollen bump, hard, painful

Other Meds:

Current Illness:

ID: 1693100
Sex: M
Age: 53
State: KS

Vax Date: 07/09/2021
Onset Date: 07/09/2021
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: N/A

Allergies: seasonal

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: First: Insomnia, two nights in a row even with sleep aids Second: developed restless leg syndrome. Prescribed pramipexole .125 mg, two pills at bedtime Note: First vaccine given at military med facility. Second vaccine when the side effects began, public pharmacy

Other Meds: simvastatin clariton melanoma unisom

Current Illness: none

ID: 1693101
Sex: F
Age: 39
State: MD

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: Levaquin and Naproxen

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

Symptoms: Pfizer vaccine was improperly stored in the freezer for greater than 14 days.

Other Meds: n/a

Current Illness: Ankylosing Spondylitis

ID: 1693102
Sex: M
Age: 62
State: MD

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

Allergies: n/a

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

Symptoms: Pfizer vaccine that was administered was improperly stored in the freezer for greater than 14 days.

Other Meds: n/a

Current Illness: n/a

ID: 1693103
Sex: F
Age: 15
State: OH

Vax Date: 08/28/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: vaccine administration error: interval. Doses administered on 8/28/2021 and 9/11/2021. less than 17 days between doses.

Other Meds:

Current Illness:

ID: 1693104
Sex: M
Age: 51
State: CA

Vax Date: 09/08/2021
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Referred to emergency room/

Allergies: None

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

Symptoms: Shortness of breath with minimal response to inhaler/nebulizer. Patient also had fever and chills but those resolved in about 1 day.

Other Meds: None

Current Illness: None

ID: 1693105
Sex: M
Age: 30
State: WA

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: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: none

Allergies: none

Symptom List: Injection site pain, Pain

Symptoms: about 5-10 mins after the covid shot, patient felt dizzy, sweaty, vision blurred and itchy and hot(breathing was ok and normal) called 911 and emt came to check him out . They did not give him any treatment and told me to observe him for 30 mins and he can leave if feeling better. patient waited a few more minutes and felt better and left pharmacy

Other Meds: none

Current Illness: none

ID: 1693106
Sex: F
Age: 32
State: MO

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: 1
Vax Route: SYR
Vax Site: LA

Lab Data: only got B/P, HR tested

Allergies: metronidazole, nuts, cinnamon

Symptom List: Injection site pain, Menorrhagia

Symptoms: at 1015 L side of body had sharp pin pricks of pain, shortly after the pain L side from head to toe feels cold. By 1030 L side of face, neck, shoulder, arm, thigh, and ankle tingles. By 1100 L side of face, neck, shoulder feels tight (like being squeezed or scrunched without relaxing). Its now 1510 and the same reaction is still there.

Other Meds: prucalopride, Tylenol, ondansetron

Current Illness: gerd, acid reflux, gastroperesis

ID: 1693107
Sex: F
Age: 48
State: NJ

Vax Date: 08/11/2021
Onset Date: 08/13/2021
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: I don't know

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

Symptoms: I have headache every day, my pulse is over 100

Other Meds:

Current Illness: High blood pressure

ID: 1693108
Sex: F
Age: 26
State:

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

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

Lab Data: MRI

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Pt admitted to hospital with severe dizziness and nausea. MRI positive for cerebellar and medulla infarct

Other Meds:

Current Illness:

ID: 1693109
Sex: M
Age: 43
State: WA

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:
Dose Series: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Redness in the shape of the bandage, minus the padding.

Other Meds: None

Current Illness: None

ID: 1693110
Sex: M
Age: 30
State: NY

Vax Date: 09/02/2021
Onset Date: 09/04/2021
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: N/A

Allergies: Shellfish

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

Symptoms: Patient lost sense of taste within 2 days of the vaccine and developed partial facial paralysis of the right side within 4 days of receiving the vaccine

Other Meds: N/A

Current Illness: N/A

ID: 1693111
Sex: F
Age: 53
State: TX

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

Lab Data:

Allergies: None

Symptom List: Nausea

Symptoms: Whole body muscle pains, 18 hours after 2nd injection

Other Meds: 10mg Clobazam

Current Illness: None

ID: 1693112
Sex: F
Age: 0
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:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKA

Symptom List: Injection site pain

Symptoms: Patient got her first dose of Pfizer on 9/2/21 and got the second dose on 9/11/21, she got it too soon. No adverse reaction noted during post vaccination monitoring. Pt educated to go to the ER at any onset of respiratory problems or even if something don't fell right.

Other Meds: NONE

Current Illness: NONE

ID: 1693113
Sex: F
Age: 65
State: AZ

Vax Date: 02/28/2021
Onset Date: 05/31/2021
Rec V Date: 09/11/2021
Hospital: Y

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

Lab Data: EKG (May 31, - June 3) , CT scan (May 31), Heart Monitor (May 31 - June 3) EKG (July 5) CT Scan (July 5), MRI (July 6), Echogram (July 6) Hospitalized 3 days

Allergies: Biaxin

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

Symptoms: On May 31, 2021, I went into A-Fib and was hospitalized for four days. I did go back into sinus rhythm with medication. On July 5, I thought I having either a stroke or TIA. It turned out to be Bell's Palsy. Prescribed prednisolone, then prednisone. The palsy is almost all gone.

Other Meds: ? Aspirin (81mg/1) - Heart ? Biotin (5000mcg/1) - Hair & Nails ? Amlodipine/Valsartan (10/320 mg) - Blood Pressure ? Omeprazole (40mg/MWF) - Acid Reflux ? Rosuvastatin (Crestor) 10mg/1x ? Vitamin C 2000mg ? Vitamin D3 4000iu

Current Illness: None

ID: 1693114
Sex: F
Age: 29
State: CT

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: RA

Lab Data:

Allergies: Parsnip, Seasonal Allergies

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

Symptoms: Day after Shot: Complete Body Aching; Fever; Vomiting; Fatigue; Sore Arm

Other Meds: Insulin, Lavoxyl, Zoloft

Current Illness: None

ID: 1693115
Sex: F
Age: 25
State: CT

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Tremor

Symptoms: Started vomiting at 8:00 several times. Extreme neasua following the rest of the day

Other Meds: Pristiq, methylfolate, methylphenidate

Current Illness: None

ID: 1693116
Sex: F
Age: 59
State: NC

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

Lab Data:

Allergies: None

Symptom List: Erythema, Pruritus

Symptoms: Chills, fever 102?, nausea, light headed

Other Meds: None

Current Illness: None

ID: 1693117
Sex: M
Age: 69
State: NC

Vax Date: 01/21/2021
Onset Date: 02/20/2021
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: none

Allergies: none

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

Symptoms: Sudden onset clusters of vesicles which evolved into painful, chronic mouth sores which lasted 5 months

Other Meds: Crestor, metoprolol, ASA

Current Illness: hypercholesterolemia, paroxysmal atrial fibrillation

ID: 1693118
Sex: M
Age: 69
State: NV

Vax Date: 03/24/2021
Onset Date: 06/24/2021
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: No test done yet

Allergies:

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

Symptoms: On March 24, 2021, I had the 2nd dose of the Moderna Covid vaccine. I had symptoms just like the 1st dose including slight muscle pain on the injection site. The pain did not bother me even after I guess, a month passed away. However, as time passes by, the pain is getting bad to worse. For days it started from the shoulder radiating to the upper arm, now it radiates to the lower arm as well. I cannot fully raise my left arm because of unbearable pain. Now, the left arm has motion limitations.

Other Meds: omeprazole 40 mg metformin 1000 mg losartan 25 mg metropolol 25 mg pravastatin 10 mg vitamin c 1000 mg zinc 50 mg fish oil

Current Illness:

ID: 1693119
Sex: F
Age: 53
State: FL

Vax Date: 08/30/2021
Onset Date: 08/30/2021
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: Asthenia, Chills, Headache, Myalgia

Symptoms: SHORTNESS OF BREATH AND HEADACHE AFTER VACCINATION.

Other Meds:

Current Illness:

ID: 1693120
Sex: M
Age: 27
State: NC

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: SYR
Vax Site: LA

Lab Data:

Allergies: Sulfa Based Medications

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

Symptoms: 10 minutes after receiving injection, felt shoulder tighten. No noticeable symptoms the same day of vaccine. The next morning when I awoke, 18 hours later, the injection site was swollen about the diameter of a mandarin orange, it is very warm to the touch, and sore. This has continued for the last 8 hours and I am now reporting the reaction.

Other Meds: Modafinil, Sudafed, Tylenol

Current Illness: Sinus infection

ID: 1693121
Sex: F
Age: 44
State: OH

Vax Date: 09/08/2021
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: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: N/A

Allergies: N/A

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

Symptoms: RED , SWALLEN INJECTION SITE, PT HAD FEVER THAT FLUCTUATES, BUT HAS GOTTEN DOWN BY MOTRIN,

Other Meds:

Current Illness: N/A

ID: 1693122
Sex: F
Age: 19
State:

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:

Allergies:

Symptom List: Pain in extremity

Symptoms: Attendee received second dose Pfizer vaccine at 12:35. Lot# EW0179. Attendee was directed to observation area. At 12:50 attendee attempted to stand and started to fall, someone was able to catch her and assist her back to the seated position. Attendee's skin was cool and clammy. Attendee's respirations were not tachypneic or dyspneic. Attendee was then assisted to the cot to lie down, with her legs elevated. HR: 83 BP: 106/80 RR: 16 O2Sat%: 97 12:55 - Attendee stated she felt better, no longer clammy or pale. Sat up in the cot. 13:10 -No voiced complaints- skin warm and dry. Took another set of vital signs before discharge without documentation. Care Practitioner educated on home discharge/adverse reaction instructions and attendee was discharged to home with her friend. Attendee did not have any reported escalation of symptoms and was able to walk out of clinic independently.

Other Meds:

Current Illness:

ID: 1693123
Sex: F
Age: 38
State: SC

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

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

Lab Data: Trying to see if it goes away. Need to work

Allergies: Phenergen

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

Symptoms: Tingling sensations of the head. Mainly left right now.

Other Meds: Vitamin c & vitamin d

Current Illness: Sinus infection

ID: 1693124
Sex: F
Age: 29
State: IN

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: None needed at the moment.

Allergies: Cephlexin, amoxacillin and Penicillin

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

Symptoms: First was a lump on the throat 30 minutes after getting the shot and it has not yet went away. Not sure if that counts as shortness of breath but I was still able to breath. It is 3 hours after when the first symptom started. Also within that time, extream tiredness, severe headache and no energy. I didn't take any medication for the side effects but did take a nap.

Other Meds: None

Current Illness: None

ID: 1693125
Sex: F
Age: 72
State: AZ

Vax Date: 02/18/2021
Onset Date: 09/11/2021
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: Vsafe will not let me report

Other Meds: I am sending this because vsafe will not let me in to report.

Current Illness:

ID: 1693127
Sex: F
Age: 44
State: NV

Vax Date: 04/09/2021
Onset Date: 04/30/2021
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: No tests conducted, I have pictures of my reactions and showed those to the drs

Allergies: Ginger and Fresh Pineapple, Antibiotics: Sulpha drugs, Septra, Macrobid, Penicillin , Codeine

Symptom List: Vomiting

Symptoms: About 1-2 days or so after getting the shot, certain parts of my body started to become itchy. It moved from part to part until about 5 days after the shot I wanted to tear all of my skin off (from head to toe). I contacted my primary physician, PA, he placed me on Hydroxyzine and steroids. I don't remember the amounts. Those seemed to help and by the time I was done with the treatment, say 5-10 days later everything seemed fine until I got my second shot. Second shot came about about a week or two after I was done with my prescriptions. Rec second shot on 04/30/21 and it started again same as above. PA put me on same treatment I believe within 2-5 days after shot. I took that round of pills and it appeared to go away. Within 15-17 days later after treatment stopped I started feeling itchy again but this time it was my back. Itching started one day no rash or spots, next day I had little spots on my back and itching, then by the third day my back was extremely itchy and all rashy. I went to Urgent care, They put me on the same treatment as PA had put me on. Same thing occurred, treatment, went away, 15-17 days later, back again. Another trip to urgent care and same process. After that trip to Urgent care, my primary scheduled an apt and then referred me to the Allergist. I am now seeing Dr. to do what he calls "reboot my blood system". This put me on monthly shots of Xolair Omalizumab, one in each arm (two total) once a month for the next 6 months to a year. And there are no guarantees that it will officially stop the reaction I am having. The only thing different in my life during this time was the shot, so that is the only conclusion I can come too. I eat the same foods, use the same soaps, tried changing things during the process to see if it could have been anything else. Nothing helped and the reaction kept recurring. Since I have been put on the shots, I am not having the reaction on my back. I'm a little itchy on occasion still but it's much better than it was.

Other Meds: Vitamin C, Vitamin E, Singulair (seasonal allergy meds), Cranberry Extract, Biotin, Maybe Flonase (used as needed)

Current Illness: None

ID: 1693128
Sex: M
Age: 34
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: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: coughing, difficulty breathing, vomiting, fever, fell unconscious, seizures taken by ambulance to hospital

Other Meds: Tylenol

Current Illness:

ID: 1693129
Sex: F
Age: 87
State: OR

Vax Date: 03/10/2021
Onset Date: 03/10/2021
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: RA

Lab Data:

Allergies: Morphine-based medication

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

Symptoms: Extremely weary and tired. Slept 18 hrs after vac. Still sleeping many hours during the day. Congestive heart failure

Other Meds: Chlorthalidone 25 mg Meloxicam 15mg Carvedilol 12.5 mg x2-a-day Lisinopril 40mg Nortriptyline 25mg Duloxetine DR 60mg Once a Day Over Fifty for women

Current Illness: None

ID: 1693130
Sex: M
Age: 22
State: DE

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: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Fever, chills, aches, fatigue

Other Meds: None

Current Illness: None

ID: 1693131
Sex: M
Age: 30
State:

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: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Received three vaccines while in clinic. After the third vaccine, began to feel lightheaded. No loss of consciousness. Dilated pupils, clammy and pale. Vitals obtained, initial BP: 96/57, HR 39. Feet elevated and felt better after a few minutes. Final vitals: BP- 116/66, HR 58. Refused further medical treatment and was escorted back to unit.

Other Meds:

Current Illness:

ID: 1693132
Sex: F
Age: 45
State: CO

Vax Date: 04/07/2021
Onset Date: 04/12/2021
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: 8/26/21 X-ray of right toe and foot (no abnormalities detected) Anti-CCP Ab >250 units (strong positive) Rheumatoid Factor 23.5 IU/mL (high) waiting to see rheumatologist suspected of rheumatoid arthritis with no family history or health issues prior to vaccination

Allergies: maybe codeine

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

Symptoms: Soon after 1st vaccine dose, lymph nodes in my left armpit became tender and swollen and stayed that way for several weeks. Also, my left big toe became swollen, red, and painful which persisted for many weeks. I also had joint pain and a general feeling of malaise and inflammation throughout my body. After the second dose, my other lymph node in my right arm pit became swollen and tender for a few weeks. After several months of joint pain and inflammation, I saw my dr for testing. Presently, my toe feels better but foot near toes is sore and achy. My right index finger is stiff, achy, and a bit swollen and my wrists and joints feel achy.

Other Meds: none

Current Illness: none

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am