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: 1694250
Sex: F
Age: 82
State: GA

Vax Date: 09/10/2021
Onset Date: 09/11/2021
Rec V Date: 09/13/2021
Hospital:

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

Lab Data: unknown

Allergies: none

Symptom List: Dysphagia, Epiglottitis

Symptoms: 21 hours after receiving vaccine patient described being extremely hot, then she became unresponsive and per spouse "passed out"; she was taken via EMS to nearest ER; due to nature of syncopal episode and left sided facial drooping patient was sent via air flight to nearest ER for neuro patients-- it was determined that patient had a TIA ; she remains confused post episode and is being monitored for additional symptoms

Other Meds: Atenolol, fosamax, atorvastatin, aspirin

Current Illness: none

ID: 1694251
Sex: F
Age: 60
State: TX

Vax Date: 02/10/2021
Onset Date: 02/12/2021
Rec V Date: 09/13/2021
Hospital:

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

Lab Data: No

Allergies: No

Symptom List: Anxiety, Dyspnoea

Symptoms: 10feb2021 - 1st dose - Friday , I was the numb in head in face, back of the head and in fingers and toes and feet. Saw the doctor on Friday. After the 2nd shot. The arm didn't and nothing changed.

Other Meds:

Current Illness:

ID: 1694252
Sex: M
Age: 15
State: FL

Vax Date: 08/27/2021
Onset Date: 08/27/2021
Rec V Date: 09/13/2021
Hospital:

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

Lab Data: None

Allergies: none

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

Symptoms: No adverse reactions, minor received incorrect COVID vaccine

Other Meds: none

Current Illness: none

ID: 1694253
Sex: F
Age: 58
State: IN

Vax Date: 09/08/2021
Onset Date: 09/10/2021
Rec V Date: 09/13/2021
Hospital:

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

Lab Data: None

Allergies: Lactose intolerant

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: I developed hives over my entire torso that lasted for appoximately 48 hours.

Other Meds: Multi-Vitamin, Vitamin C, ProBiotics, Coral Calcium, Calcium, Glocosamine Chondroitin, Naproxyn

Current Illness: None

ID: 1694254
Sex: F
Age: 11
State: VT

Vax Date: 09/09/2021
Onset Date: 09/09/2021
Rec V Date: 09/13/2021
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: COVID vaccine given to patient under the age of 12. Mother lied about the patients age in order to get vaccine. This was later found out when trying to bill patients insurance and checking database.

Other Meds:

Current Illness:

ID: 1694255
Sex: F
Age: 76
State: PA

Vax Date: 09/02/2021
Onset Date: 09/06/2021
Rec V Date: 09/13/2021
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: no

Allergies: No

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

Symptoms: Patient is stating that she broke out in severe hives 5 days after receiving the vaccine all over her body

Other Meds: Brilinta, entresto, carvedilol, atorvastatin, isosorbide mononitrate, baby aspirin, lantus

Current Illness: No

ID: 1694256
Sex: M
Age: 48
State: MO

Vax Date: 07/07/2021
Onset Date: 07/14/2021
Rec V Date: 09/13/2021
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: Pyrexia, White blood cell count decreased

Symptoms: Pt started experiencing tingling in the L arm that radiates to the fingers.

Other Meds:

Current Illness:

ID: 1694257
Sex: F
Age: 75
State:

Vax Date: 09/01/2021
Onset Date: 09/01/2021
Rec V Date: 09/13/2021
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: lethargic, nauseous, extremely cold, extreme swelling, redness, and pain of right arm from elbow to shoulder,

Other Meds: Atenolol, Norvasc, doxycycline, vitamin B12, C, D3, calcium

Current Illness: none

ID: 1694258
Sex: M
Age: 70
State: IL

Vax Date: 03/11/2021
Onset Date: 07/28/2021
Rec V Date: 09/13/2021
Hospital:

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

Lab Data: Ultrasound- extensive venous thrombosis in left leg

Allergies: No

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: End of July I noticed swelling and pain in my left leg. I was away from home so when I returned, I made an appointment with my doctor on 8/2. He was concerned about a blood clot in the leg. I had a venous ultrasound which showed an extensive venous thrombosis in the left leg. I was started on oral coagulants, Eliquis. I am still on that. I saw the doctor again on 8/27 and I have another follow up appointment at the end of this month. The pain is better, the selling is gradually getting better. The swelling is still present but improved.

Other Meds: Yes, aspirin 162mg/daily, Aleve 2 tablets/daily, Lipitor 20mg/daily, Toprol XL 50mg/daily

Current Illness: No

ID: 1694259
Sex: F
Age: 52
State: PA

Vax Date: 08/18/2021
Onset Date: 09/04/2021
Rec V Date: 09/13/2021
Hospital:

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

Lab Data: no tests

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Post menopausal bleeding approximately 18days after injection. I have not had a period for over a year and a half until after the Covid vaccine. bleeding has been for at least 9 days so far.

Other Meds:

Current Illness:

ID: 1694260
Sex: F
Age: 21
State: PR

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 09/13/2021
Hospital:

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

Lab Data: UNKNOWN

Allergies: UNKNOWN

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

Symptoms: BIRTH DATE ERROR

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1694261
Sex: M
Age: 50
State: NJ

Vax Date: 08/28/2021
Onset Date: 09/08/2021
Rec V Date: 09/13/2021
Hospital: Y

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

Lab Data: EKG, chest xray, heart echo, cardiac blood tests, sugar test, catscan, MRI (all were found to be negative)

Allergies: None

Symptom List: Rash, Urticaria

Symptoms: Extreme vertigo event lasting 3-4 hours. Extreme dizziness (spinning, intense vomiting, intense sweating). Went by ambulance to hospital and admitted as outpatient continuing observation. No health conditions found and symptoms subsided.

Other Meds: None

Current Illness: None

ID: 1694262
Sex: F
Age: 65
State: MI

Vax Date: 08/23/2021
Onset Date: 08/26/2021
Rec V Date: 09/13/2021
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: N/A

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

Symptoms: Primary notified observation, experiencing symptoms of weakness, confusion, nose bleed with clotting (lasting 3 days).

Other Meds: Zrytec, Asprin

Current Illness: N/A

ID: 1694263
Sex: F
Age: 13
State: IN

Vax Date: 08/03/2021
Onset Date: 08/29/2021
Rec V Date: 09/13/2021
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: Tested muscular and skeletal function, good. - Orthopedic surgeon Tested neurological function - good - Neologist Medications both pharmacist and pediatrician did not see adversely affecting her. Been on them for a long time with no problem.

Allergies: Environmental

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

Symptoms: Full body movement on August 29 that settled in her right arm. Tic-like continuous movement that keep her from using her right arm and hand. She cannot write for school or participate in golf. We have been to a neurologist, orthopedic surgeon, and other doctors trying to help. It has not been fixed and continues to shake back and forth. Unsure what is going on with her arm, but there was no trauma to patient's arm or unreasonable stress. Her having the shot was one change to something patient was given that month.

Other Meds: Amphetamine, zyrtec, allergy shots (monthly)

Current Illness: None

ID: 1694264
Sex: F
Age: 33
State: LA

Vax Date: 09/09/2021
Onset Date: 09/09/2021
Rec V Date: 09/13/2021
Hospital:

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

Lab Data: none

Allergies: None

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

Symptoms: Dizziness 6:00 pm two hrs after administration 3:45 AM- 100.3 fever, muscle aches, chills, fatigue Symptoms came and went through out the day. Toward the end of the day: muscle cramping in hands/fingers; tingling in left hand/fingers

Other Meds: Vit D3; Acid Reducer; OTC Allergy meds; magnesium; Zinc

Current Illness: No

ID: 1694265
Sex: F
Age: 47
State: MO

Vax Date: 04/13/2021
Onset Date: 08/23/2021
Rec V Date: 09/13/2021
Hospital:

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

Lab Data: See Notes from doctor

Allergies: None

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

Symptoms: D dimer showed possible blood clot. Doppler was not showing clot

Other Meds: Sertaline, Mirtazapine, Rosvustatin, Metphormin

Current Illness: Appendicitis 2/21

ID: 1694266
Sex: F
Age: 64
State:

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 09/13/2021
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 experienced chills and muscle aches for 36 hours after receiving her 2nd COVID vaccine.

Other Meds:

Current Illness:

ID: 1694267
Sex: F
Age: 48
State: MI

Vax Date: 08/06/2021
Onset Date: 08/08/2021
Rec V Date: 09/13/2021
Hospital: Y

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

Lab Data: CT, MRI, blood work/tests, EEG, neuro exams, spine assessment

Allergies: none

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Aug 8- my Left arm aches terribly, difficult to move or lift. Also, spine (neck and lower back pain) inflameed terribly, having to take ibuprofen every 4 hours just to take edge off. Aug 13- Spine pain so bad I called DO to make an appt for follow up. Starting to feel "fog" that I did when I had Covid last winter. Aug 20- Fog turned into left sided weakness and first "episode" of dysarthria, confusion, vision changes, sensory changes, taken via ambulence to hosptial. Aug 24- DO appt., he assessed my spine & stated that muscle groups were back to "last Covid" Inflammatory response- spastic, started treatment Aug 25-27- Covid fog getting wores, morning of Aug 27 had next "episode" in the middle of talking tto my husband, my brain and body "froze", I was unable to speak, think, or understand what was happening. My husband reported my eyes stopped blinking, tears came of my eyes, this lasted several seconds. After I "froze", I felt confused, my husband said I kept asking what happened and cried. I was so tired I needed to lay down, felt like I ran a race. Ears ringing often Aug 28- had two more of these episodes of "freezing". My husband took me to hospital, they quickly ruled out stroke and sent me home with no follow up. Ears ringing often. Aug 29- had two more episodes- same freezing in the middle of talking- note that it happens when I am trying to work/process information or recall information Other symptoms, short term memory loss, inablity to process information, vision changes with difficulty focusing with Left eye, ear ringing, sensory sensitivity to lights and sounds, pain in neck and spine, not sleeping at night/restless, nightmares, numbness in face/lips, weakness, loss of balance, slowed motor responses. Aug 30-Sept 1- hospitalized for MRI, EEG, monitoring OT/PT/SLP. Had several witnessed episodes of freezing mid sentence when trying to explain what was happening. Sept 1- today (9/13/2021)- all above symptoms continue, unable to function at typical cognitive or sensory level. Ears ringing a lot. NOTE: I had Covid19 with minor flu symptoms (stuffed sinuses and body aches) and loss of smell beginning on Dec 19, 2020, followed by unsual cognitive and emotional symptoms over the next 3 weeks and an episode on Jan 8, 2021 of Left sided paralasis, aphasia, decreased vision- leading being taken by ambluance to hospital, admitted and 3 day stay- MRI w and w/o contrast of brain with unable to rule out TIA and of cervical spine revealing cervical spine dx (listed above)- OT/PT eval, loss of balance, motor delays, sensory symptoms. Followed by Covid "fog" with cognitive and sensory issues and inablity to function until Feb 8, 2021. Spine dx treatment included PT and osteopathic manipulative treatments. After Feb 8, 2021 cognitive symptoms had fully resolved, ear ringing and spine pain remained, but managable. Further MRI of lower spine (due to increasing pain after Covid19 infection) revelaed other dx, see above.

Other Meds: Ibuprofen, Gummie Fiber, Gummie Multi-vitamin

Current Illness: none

ID: 1694268
Sex: F
Age: 62
State: OH

Vax Date: 04/24/2021
Onset Date: 04/25/2021
Rec V Date: 09/13/2021
Hospital:

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

Lab Data: none

Allergies: none

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: I am still experiencing vertigo, dizziness, neck pain neck stiffness.

Other Meds: none

Current Illness: none

ID: 1694269
Sex: F
Age: 33
State: AR

Vax Date: 09/09/2021
Onset Date: 09/10/2021
Rec V Date: 09/13/2021
Hospital:

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

Lab Data: None to date.

Allergies: No

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

Symptoms: Pleurisy type pain on week 2 after first dose, then back pain, and new event of nerve pain that began all over and now has localized to the trunk (back, chest and abdomen) Feels like a bad sunburn- nerve pain began on 9/10 after my second dose was given on 9/9 and has been worsening.

Other Meds: No

Current Illness: Rhinovirus at time of

ID: 1694270
Sex: F
Age: 33
State: MI

Vax Date: 03/11/2021
Onset Date: 04/17/2021
Rec V Date: 09/13/2021
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: ultrasound-showed one baby did not have a heartbeat blood work- Eosinophil was high

Allergies: no

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

Symptoms: 03/11/2021 - I was not pregnant at the time of the vaccination. I started taking progesterone injection 2ml a day on 03/20/2021. I did an embryo transfer on 03/25/2021. On 04/17/2021 in the evening, I suddenly stated cramping, I was bent over, it was hurting really bad and shortly after that I started bleeding. I went to the Emergency Room. I'm RH negative blood type, to get a Rhogam shot. I had an ultrasound and I was told I was carrying twins. They also did blood work and my Eosinophil count was high. They both (babies) had heart beats, but one was lower than the other. I was put on bedrest. I saw my fertility doctor on 04/20/2021, the one (baby) where the bleed was coming from no longer had a heartbeat. The other one (baby) did have a good heartbeat. I was put back on bed rest, On the 04/27/2021, I returned to the fertility doctor, and neither one (baby) had a heartbeat anymore.

Other Meds: prenatal vitamin DHA vitamin D estradiol patches 0.1 ml applying them every 3 days for IVF estradiol tablets 2 mg 3x day for IVF

Current Illness: I had a migraine from the estradiol

ID: 1694272
Sex: F
Age: 61
State: OH

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 09/13/2021
Hospital:

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

Lab Data:

Allergies: No known drug allergies

Symptom List: Unevaluable event

Symptoms: The patient called stating she experienced severe back pain after receiving the Moderna COVID-19 vaccine. She went to the hospital and was prescribed Flexeril and Prednisone. She was told at the hospital it was most likely related to arthritis.

Other Meds: Lexapro 20mg, Bupropion 75mg, Quetiapine 100mg, Vistaril 25mg, Lipitor 40mg, Losartan 100mg, HCTZ 25MG

Current Illness:

ID: 1694274
Sex: M
Age: 66
State: OH

Vax Date: 07/01/2021
Onset Date: 09/09/2021
Rec V Date: 09/13/2021
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: covid + 9.9.21, CXR clear

Allergies: iodine, hydrocodone, propoxyphene, diatrizoate, bees, lyrica

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

Symptoms: breakthrough covid + case, asymptomatic, admit for CP r/o MI

Other Meds: albuterol, ASA, Vit C, atorvastatin, citalopram, ezetimibe, HCTS, insulin glargine, isosorbide mononitrate, synthroid, liraglutide, lisinopril, loratadine, metformin, pantoprazole, K-dur, risperidone, tamsulosin, tiotropium, topiramate

Current Illness: DM uncontrolled with multiple ED visits related to no adherence to fiet and medication regimen

ID: 1694275
Sex: M
Age: 65
State: OR

Vax Date: 09/05/2021
Onset Date: 09/06/2021
Rec V Date: 09/13/2021
Hospital:

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

Lab Data: no

Allergies: no

Symptom List: Injection site pain, Pain

Symptoms: 105.8 fever and seizures for several hours. Woke up the next day at 1am. ER didn't admit me on 6Sep2021 at 11pm . Shakes and chest is feeling weird. Pain in shoulders, hip and knees. My heart is going weird. Still have fever at 101. About an hour ago , there is pain in my chest. I have a slow heart and its beating at 90.

Other Meds: no

Current Illness: no

ID: 1694276
Sex: F
Age: 43
State: AL

Vax Date: 03/25/2021
Onset Date: 03/25/2021
Rec V Date: 09/13/2021
Hospital:

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

Lab Data: Stool samples , CBC panel

Allergies: None

Symptom List: Injection site pain, Menorrhagia

Symptoms: Within hours of the vaccine I began to not have bowel movement control. I was having severe diarrhea for 10 days, multiple times a day. Without control. I had two visits to the doctor which required IV fluids for dehydration and stool samples collected, blood work done to check for bacteria etc. all normal. Was prescribed Metronidazole and it was successful within 24 hours. I did delay my second dose because of this complication. I lost 10 lbs with in this time frame, onset of diarrhea. I have since switched to moderna and received my second dose 9/12/2021

Other Meds: None

Current Illness: None

ID: 1694277
Sex: M
Age: 37
State: MN

Vax Date: 01/22/2021
Onset Date: 09/12/2021
Rec V Date: 09/13/2021
Hospital:

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

Lab Data: 9/12/21 Home COVID test.

Allergies:

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

Symptoms: Breakthrough COVID

Other Meds:

Current Illness:

ID: 1694278
Sex: F
Age: 58
State:

Vax Date: 07/13/2021
Onset Date: 07/13/2021
Rec V Date: 09/13/2021
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 received the vaccine on day 21 instead of day 28.

Other Meds:

Current Illness:

ID: 1694279
Sex: F
Age: 55
State: MI

Vax Date: 05/12/2021
Onset Date: 05/30/2021
Rec V Date: 09/13/2021
Hospital:

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

Lab Data:

Allergies: Codeine

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Day after 2nd dose: Headache, light sensitivity, fever, fatigue 2.5 weeks after 2nd dose: Headache, shooting pain in head/ear, skin sensitive to touch on scalp, lesions, eye pain. Visit to ER -diagnosed with Shingles. Treatment: Valacyclovir 10 days & steroid for 5 days. Did not resolve. Continued Valacyclovir 10 more days with Antibiotic eye ointment. Cornea lesions resolved. Nerve pain continued. 9/10/21 started treatment for possible new shingle recurrence - Valacyclovir & eye ointment.

Other Meds: Vitamin C and Multi vitamin on occasion

Current Illness: None

ID: 1694280
Sex: M
Age: 65
State:

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

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

Lab Data:

Allergies:

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

Symptoms: Patient received dose 2 on day 21 instead of day 28.

Other Meds:

Current Illness:

Date Died: 07/16/2021

ID: 1694281
Sex: M
Age: 74
State: TX

Vax Date: 05/04/2021
Onset Date: 05/07/2021
Rec V Date: 09/13/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: death

Other Meds:

Current Illness:

ID: 1694282
Sex: M
Age: 51
State: SC

Vax Date: 09/11/2021
Onset Date: 09/11/2021
Rec V Date: 09/13/2021
Hospital:

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

Lab Data: None

Allergies: None

Symptom List: Injection site pain

Symptoms: Sore arm at injection site - lasted from 5 hours after injection til more than 46 hours after injection) fever (101 F) - lasted from 8 hours after injection til 30 hours after injection) headache - lasted from 14 hours after injection til 28 hours after injection)

Other Meds: Buproprion Atorvastatin Vitamin D Fish Oil

Current Illness: None

ID: 1694283
Sex: F
Age: 31
State: IL

Vax Date: 09/10/2021
Onset Date: 09/11/2021
Rec V Date: 09/13/2021
Hospital:

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

Lab Data: None

Allergies: None

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

Symptoms: Redness, edema, warmth, pain around injection site roughly the size of a large pear. Rash on bilateral arms and scattered on rest of body. Only treated with Tylenol.

Other Meds: None

Current Illness: None

ID: 1694284
Sex: F
Age: 18
State: TX

Vax Date: 04/21/2021
Onset Date: 04/22/2021
Rec V Date: 09/13/2021
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:

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

Symptoms: Myocarditis, trouble breathing, extreme body ache, high fever, chills, no appetite for 1 week

Other Meds:

Current Illness:

ID: 1694285
Sex: M
Age: 19
State:

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

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

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: Patient received dose 2 on day 21 instead of day 28.

Other Meds:

Current Illness:

ID: 1694286
Sex: F
Age: 84
State: NY

Vax Date: 08/09/2021
Onset Date: 08/29/2021
Rec V Date: 09/13/2021
Hospital: Y

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

Lab Data: ECG (8/31/21): Atrial fibrillation, right bundle branch block, inferior infarct age indeterminate. Transthoracic echocardiogram (8/31/21): Left ventricle cavity size normal. Left ventricle systolic function in the normal range with an ejection fraction 55-70%. Left ventricle moderate hypertrophy. Abnormal LV diastolic function. Right ventricular cavity normal. Right ventricular systolic function mildly reduced. TAPSE 10mm. Trivial circumferential pericardial effusion. Severe biatrial enlargement.

Allergies: Quinolones, lisinopril

Symptom List: Erythema, Pruritus

Symptoms: On 8/31, 21 days after first dose of Moderna COVID-19 vaccine, patient experienced new-onset dyspnea and chest pain at restChronic heart failure, atrial fibrillation, sick sinus syndrome, hypertension, COPD, cirrhosis, arteriosclerosis, asthma, nontoxic thyroid nodule, atherosclerosis of right carotid, vascular claudication. Patient was hospitalized from 8/31/2021-9/4/2021 for atrial fibrillation with RVR and acute CHF secondary to afib.

Other Meds: Metoprolol Tartrate, Warfarin Sodium, Levalbuterol, Vitalizer Gold vitamin senior tabs, vitamin D, irbesartan, potassium chloride, ventolin, alpha-lipoic acid-biotin, diltiazem, Furosemide, Lipitor

Current Illness: Atrial fibrillation

ID: 1694287
Sex: M
Age: 11
State: PR

Vax Date: 06/04/2021
Onset Date: 06/24/2021
Rec V Date: 09/13/2021
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: UNKNOWN

Allergies: UNKNOWN

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

Symptoms: INADVERTENTLY VACCINATED BEFORE 112 YEARS OF AGE.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1694288
Sex: M
Age: 42
State: IL

Vax Date: 03/03/2021
Onset Date: 09/03/2021
Rec V Date: 09/13/2021
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: COVID positive 9/7/21

Allergies:

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

Symptoms: Patient admitted to Hospital with worsening shortness or breath, hypoxic at home. COVID positive 9/7/21

Other Meds:

Current Illness: Diabetes

ID: 1694289
Sex: M
Age: 59
State: VT

Vax Date: 09/12/2021
Onset Date: 09/12/2021
Rec V Date: 09/13/2021
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

Allergies: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Onset of the following events beginning 6 hours post injection - headache, fatigue, fever 101.2, shivering, nausea - took 500mg Tylenol every 4 hours. Fever began to drop after 20 hours, shivering subsided after 17 hours, headache responds to Tylenol, reduced fatigue continues at 24 hours

Other Meds: FEOSOL iron supplement, Omeprazole 40mg, tadalafil 2.5mg,, Diltiazem 240mg (budesonide 3mg to 9mg - to treat small intestine ulcers - last taken 45 days prior)

Current Illness: Small intestine ulcers with bleeding , treating with Budesonide but currently off Budesonide

ID: 1694290
Sex: M
Age: 37
State: VA

Vax Date: 03/11/2021
Onset Date: 03/11/2021
Rec V Date: 09/13/2021
Hospital:

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

Lab Data: Ultrasound; Mammogram biopsy.

Allergies: Penicillin; Aspirin; Provicaine

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

Symptoms: 5 hours after getting the 2nd dose, I felt like my sugar was dropping and felt shaky and lightheadedness. That evening I spiked a fever 102, body aches, joint pains which lasted about 12 hours and resolved. About 3 days later, my lymph nodes in my left arm pit became swollen. I consulted with my doctor and he advised to wait and see. They lymph node continued to get bigger. Around the middle of July 2021, I did finally get an ultrasound. The results of the ultrasound was "suspicious" and I was ordered to get another ultrasound with mammogram. In August 2021, I did another ultrasound and mammogram. The ultrasound showed the lymph nodes had become even larger and the mammogram was normal. The doctor now wants to do a biopsy which I did in Sept 2021 and I am waiting on the results of the biopsy.

Other Meds: Dexilant; Gabapentin; Imitrex

Current Illness: None

ID: 1694291
Sex: M
Age: 52
State: MN

Vax Date: 04/16/2021
Onset Date: 09/08/2021
Rec V Date: 09/13/2021
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: COMPREHENSIVE METABOLIC PANEL LAB ONLY-COMPLETE BLOOD COUNT WITH DIFFERENTIAL LIPASE SARS-COV-2, INFLUENZA A+B, AND/OR RSV NUCLEIC ACID TESTING PANEL CT ABDOMEN PELVIS WITH CONTRAST

Allergies:

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

Symptoms: Nausea and vomiting, intractability of vomiting not specified, unspecified vomiting type Diarrhea, unspecified type Right lower quadrant abdominal pain Elevated liver enzymes IMPRESSION: 1. There is inflammation and small amount of free fluid in the right upper quadrant adjacent to the gallbladder neck, right lobe of the liver and hepatic flexure of the colon. The gallbladder appears to be distended with associated mucosal hyperenhancement and question of gallbladder folds versus stones in the region of the gallbladder neck. This could represent findings of early acute cholecystitis. Recommend right upper quadrant ultrasound to better assess. Other causes of inflammation in the right upper quadrant such as diverticulitis, colitis or duodenitis are considered less likely. 2. Moderate urinary bladder wall thickening, which seems slightly greater than expected for incomplete distention with relatively normal size of the prostate gland. Recommend correlation with urinalysis to assess for possible cystitis. 3. Normal appendix. 4. Diffuse fatty infiltration of the liver.

Other Meds:

Current Illness:

ID: 1694292
Sex: F
Age: 62
State: KS

Vax Date: 03/08/2021
Onset Date: 05/29/2021
Rec V Date: 09/13/2021
Hospital:

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

Lab Data: Blood test Dermatologist exam

Allergies: None

Symptom List: Pain in extremity

Symptoms: Continued Significant hair loss ?

Other Meds: Amlodipine 25MG Prenatal vitamins

Current Illness: None

ID: 1694293
Sex: M
Age: 17
State: OR

Vax Date: 09/12/2021
Onset Date: 09/12/2021
Rec V Date: 09/13/2021
Hospital:

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

Lab Data: None as of yet.

Allergies: Amoxicillan

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

Symptoms: Pain at injection site one hour after vaccine, bad headache, pain in arms and legs, 102 degree fever, periodic stomach cramps.

Other Meds: Ritalin, Lorazapan, Zyrtech

Current Illness: None.

ID: 1694294
Sex: F
Age: 84
State: MI

Vax Date: 03/10/2021
Onset Date: 09/08/2021
Rec V Date: 09/13/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: positive covid test as outpatient

Other Meds:

Current Illness:

ID: 1694295
Sex: F
Age: 17
State:

Vax Date: 08/27/2021
Onset Date: 08/27/2021
Rec V Date: 09/13/2021
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 Moderna Vaccine under the age of 18 years.

Other Meds:

Current Illness:

ID: 1694296
Sex: F
Age: 62
State: SC

Vax Date: 03/23/2021
Onset Date: 04/26/2021
Rec V Date: 09/13/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: CT head 08/20/2021 MRI brain 08/26/2021 EMG lower extremities 09/09/2021 pending ENT contsult as of this date

Allergies: ees latex Tramadol lanolin

Symptom List: Vomiting

Symptoms: fatigue, weakness lower extremities, burning both feet, dysphagia, pain feet , legs, back, impaired gait, impaired balance. impaired ability to perform all ADL. Ringing ears. high risk falls due to balance issue. started in April after second vaccination and is ongoing with current date.

Other Meds: alprazolam Zolpidem citalopram Tylenol

Current Illness: arthritis depression anxiety right hip replacement 01/20/2021

ID: 1694297
Sex: F
Age: 66
State: MO

Vax Date: 08/13/2021
Onset Date: 08/14/2021
Rec V Date: 09/13/2021
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: 1 inch diameter red rash around injection site that was unresolved at time of second covid-19 vaccine administration The patient described the reaction as a purple area around injection site after first injection and then improved to the red rash that I observed at second injection.

Other Meds:

Current Illness:

ID: 1694298
Sex: F
Age: 16
State: IN

Vax Date: 09/01/2021
Onset Date: 09/02/2021
Rec V Date: 09/13/2021
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: None at this time

Allergies: Aloe, Acacia tree

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

Symptoms: Next day reaction included fatigue and chest pain, chest pain continues multiple days when exerting body in physical activity

Other Meds: None

Current Illness: None

ID: 1694299
Sex: F
Age: 20
State:

Vax Date: 08/01/2021
Onset Date: 09/01/2021
Rec V Date: 09/13/2021
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: Extremely heavy (waking up to a pool of blood after 5 hours) menstrual cycle first period after the second dose.

Other Meds:

Current Illness:

ID: 1694300
Sex: F
Age: 48
State: OH

Vax Date: 05/03/2021
Onset Date: 09/11/2021
Rec V Date: 09/13/2021
Hospital: Y

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

Lab Data: Covid + 9.11, CXR: bilateral opacities and effusions

Allergies: nka

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

Symptoms: breakthrough Covid + w/ PNA and Sepsis requiring critical care admission

Other Meds: albuterol

Current Illness: PCP visit for ongoing eval of chronic CP, wheezing, cough, undergoing workup for COPD in setting of chronic tobacco use

ID: 1694301
Sex: F
Age: 45
State: MO

Vax Date: 06/16/2021
Onset Date: 06/16/2021
Rec V Date: 09/13/2021
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: Shingrix vaccine was delivered to immunocompetent patient under the age of 50. Prescription was entered into computer system by technician and checked by pharmacist and neither caught the patient age. Patient stated she had had shingles in the past and her doctor advised her to get the vaccine early. Pharmacy will hold off on administering second dose of vaccine until patient is 50 years old.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am