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: 1694814
Sex: M
Age: 66
State: WA

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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: none

Allergies: none

Symptom List: Dysphagia, Epiglottitis

Symptoms: Tinnitus. Significant, constant tinnitus started 6 hours after my second dose of covid-19 vaccination. It has been 6 months and there has been no relief. The tinnitus is in both ears. The volume level is about 2 sones.

Other Meds: Losartan, 25mg Rosuvastatin, 20mg

Current Illness: none

ID: 1694815
Sex: F
Age: 49
State: TX

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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: PCR test; rapid test; x-rays of the chest; infusion (shots).

Allergies: Codeine

Symptom List: Anxiety, Dyspnoea

Symptoms: At 10:30pm on 03-11-2021, started to feel a migraine headache coming on. I started to take Tylenol arthritis and I had something warm to drink thinking that could settle it down. I had a bad reaction where it was about 36 hours where I could not get out of bed. The tip of nose and earlobes did not hurt. All my muscles and bone hurt. I also had really bad headache. My arm hurt really bad it was red and tender. On the first vaccine one, my left arm was tender for more than two weeks. I also did a rapid test and PCR test done on 08-17-2021. I had PCR first done by County then my rapid test was negative. Participant also states she contracted Covid. Today I still have my symptoms, I had infusion done (was 4 shots hurt real bad still have lingering pain and mostly the shot on my right side I still wake up in the night and I am also having some strange muscle spasms and wide spread pain everywhere) and x-rays of the chest because my breathing was difficult. My brain fog is really bad as well. When I received my positive Covid test, there was a nurse practitioner that prescribed initially a Z-pack for me to take. They are doing some harvesting, I started to feel congestion, and had a real weird cough and there was a burn in my throat and this was unusual cough feeling. I just did not feel good and had really bad headaches where I needed to take my migraine medication it was (Butal-acet-cheff 50-325-40mg). I also would take the generic Flexeril 10mg and Alprazolam 1mg. I felt really uncomfortable and I instead took Excedrin tension medication. At that same time, my brain fog is like I have never had before in my life and since then it has gotten much worse. I started out on a 5 day Z-pack and prednisone 20mg and this prednisone I had to take once a day which causes me hot flashes. They asked me to take the prednisone medication in half. I was also put on ivermectin medication and this was all a televisit call and I was asked if I had asthma, I said no one has ever told me that I do, the nurse practitioner said along the line putting me on an inhaler and I said ok, I also asked about Singulair. When I went to pick up my prescriptions there was no inhaler and this was on 08-20-2021. I am still on the Singular today and I took all of my Z-packs and I was coughing while I had Covid. I could say three sentences easily, also had really bad fatigue and confusion. I am coughing and this was exacerbating things. I called the practice the next day, maybe I needed an inhaler. and they said they did call in an inhaler for me. Pharmacy apologized for the error on their part. They did have one for me in another pharmacy which was in stock for me. I started my televist with a nurse practitioner and she brought up Regeneron and was typing up a referral to go. She also said I had to get chest x-rays to rule out pneumonia and make sure we do not need oxygen to your house and this really scared me. Thank God there was no pneumonia. The other really strange symptom was diarrhea, upset stomach out of the blue. I still have diarrhea today. I also contacted my neurologist due to my wide spread pain. They told me to take Tramadol but it did not work. He told me this was not unusual and glad that I had the moderna vaccine. I had a tele visit on 09-10-2021 with a PA , and told me to wait to not get the flu shot yet. What we are trying to do now is calm my body know, the energy should return and the brain fog should clear. They have me on gabapentin medication and Baclofan medication. The nurse practitioner said that they are trying to introduce a new protocol to settle my symptoms and muscle spasms down. I also take Fluticaconeproprionate and salmeterol (inhalation powder 113mg/14mcg) taken in the morning and evening. The SOB have definitely have not gone away. The brain fog is very concerning to me. I also get hot, occasionally I did have a low grade fever which my temperature is never normal, like 99.9F or 100F. The nurse practitioner that prescribed the inhaler said that I need to get the booster but I have to wait for 3-4 months before I receive it.

Other Meds: Tylenol

Current Illness: My underlying issue is fibromyalgia

ID: 1694816
Sex: F
Age: 34
State: MN

Vax Date: 04/21/2021
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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Patient tested positive for covid after completing covid series

Other Meds:

Current Illness:

ID: 1694817
Sex: M
Age: 43
State: MA

Vax Date: 08/01/2021
Onset Date: 08/29/2021
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: PCR test and rapid test administer on 9/2/21.

Allergies: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: When the dose was administered the syringe exploded. The clinic tech said this happens from time to time and should be nothing to worry about. I however think some of the dose went into my arm. Then when they made a second attempt with a new syringe I ended up with a 110-115% dose. I ended up getting very sick for 2 weeks. Major symptoms were fatigue, coughing, fever, difficulty breathing, and muscle aches. I went to urgent care 6 days after the dose of vaccine and tested positive via PCR test for COVID. Prior to the vaccination I felt fine and didn?t exhibit any symptoms of CoVID. I?m convinced I got it from the vaccine.

Other Meds: Multi vitamin, Vitamin D, Fish oil

Current Illness: None

ID: 1694818
Sex: F
Age: 19
State:

Vax Date: 08/11/2021
Onset Date: 08/19/2021
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: none

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

Symptoms: Patient had extremely heavy period after receiving the vaccine in August. Bleeding was so bad that she was going through one pad an hour. This lasted two days. The next month (September) patient started her period one week early and had the same extremely heavy bleeding as she did in August. Patient bled through one pad an hour for 48 hours. Prior to receiving vaccine, patient had very light periods, lasting only 2-4 days. Now, periods are VERY heavy for the first two days and are lasting 5-7 days. Extremely abnormal and this only changed after receiving the vaccine.

Other Meds: none

Current Illness: none

ID: 1694819
Sex: F
Age: 49
State: SC

Vax Date: 07/30/2021
Onset Date: 08/01/2021
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: My doctor has ordered an MRI to rule out stroke. I am in the process of scheduling it.

Allergies: Penicillin, seasonal allergies

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

Symptoms: I initially became ill with fever, body aches and general malaise. This lasted two days. On the third day, my right eye felt swollen and dry. It became weepy and then started twitching. The twitching continued and then I developed uncontrolled dystonic muscle firing in my face. It would start on the right and go across to the left side of my face. I had mouth and nose twitching and firing as well. The right side of my face and tongue were numb and tingling. Eventually it progressed to left facial dropping. I have some sharp shooting pains in my head and symptoms similar to those I feel with migraines. I have eye pain, seeing spots in my eye and phantom sensations in my right arm.

Other Meds: Fish Oil, Dhea, Ezetimibe,Red Yeast Rice, Synthroid, Zyrtec, Flonase

Current Illness:

ID: 1694820
Sex: F
Age: 38
State: WI

Vax Date: 09/13/2021
Onset Date: 09/13/2021
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: not applicable, patient escorted to ED for further evaluation by provider

Allergies: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Chest pain, left arm tingling, rash, dry mouth, diaphoretic, flushed-

Other Meds:

Current Illness: None

ID: 1694821
Sex: F
Age: 32
State: IL

Vax Date: 05/13/2021
Onset Date:
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: allergic to eggs, and in general has skin allergy like body rash

Symptom List: Pharyngeal swelling

Symptoms: Skin rash over the body esp. around the legs. Treatment: Calming body lotion

Other Meds:

Current Illness:

ID: 1694822
Sex: F
Age: 38
State: CT

Vax Date: 05/10/2021
Onset Date: 05/11/2021
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: Ultra sounds, blood work, a biopsy, and a D&C scraping.

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: I had chills, aches and tiredness. Then I was heavy menstrual bleeding clots. My doctor thought I had endometriosis, polyps, cancer, I had 3 ultrasounds, a D&C scraping. I was passing out at work , I was weak, they were keeping an eye on my blood counts because I was losing blood, excessively bleeding. I was recommended to take Iron supplements. I had horrible cramps, excessive back pain.

Other Meds: Synthroid Levothyroxine 50mg daily, Vit D

Current Illness:

ID: 1694823
Sex: F
Age: 79
State: IL

Vax Date: 08/17/2021
Onset Date: 09/11/2021
Rec V Date: 09/13/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient presented to ED on on 9/11/21 after experiencing 3 days of abdominal pain, diarrhea, and confusion. Patient denied any respiratory symptoms and was not found to be hypoxic. A CT abdomen/pelvis showed inflammatory changes suggesting portal colopathy/rectal varices vs proctitis, signs of cirrhosis, and a hypodense lesion in the spleen. A COVID test was done in the ED on 9/11/21, and it came back positive. Patient is fully vaccinated for COVID (s/p 3 doses of Pfizer vaccine on 2/3/21, 2/24/21, and 8/17/21). Patient was admitted for further work-up and remdesivir was started because her MD believed the diarrhea was mainly due to COVID. Lovenox was also started as VTE prophylaxis. Patient is currently on day 2 of hospitalization and is still saturating well on room air.

Other Meds:

Current Illness:

ID: 1694824
Sex: M
Age: 50
State: PR

Vax Date: 05/19/2021
Onset Date: 05/19/2021
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: N.C.D.A.

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

Symptoms: Moderna Vaccine is administered first and later Pfizer.

Other Meds: Unknown.

Current Illness: Unknown.

ID: 1694825
Sex: F
Age: 68
State: TN

Vax Date: 03/20/2021
Onset Date: 09/10/2021
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: 9/10/2021 chest x ray cardiomegaly with vascular congestion an interstitial edema/heart failure

Allergies: Glyburide, Amoxicillin, Metformin, Glimepiride,Pioglitazone

Symptom List: Rash, Urticaria

Symptoms: Ongoing Hospitalization, currently day 4 in ICU. Shortness of breath during dialysis treatment, given supplemental oxygen and admitted to intensive care unit. Placed on BiPAP for hypoxia, then Vapotherm 25L and 75% FiO2. 5 ays of remdesivir, dexamethason

Other Meds: Unknown

Current Illness: Unknown

ID: 1694826
Sex: M
Age: 51
State: MN

Vax Date: 04/09/2021
Onset Date: 09/06/2021
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: POSITIVE SARS-COV-2 BY PCR

Allergies:

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

Symptoms: This case meets vaccine breakthrough criteria . SXS INCLUDE GENERAL MALAISE, FEVER, MUSCLE PAINS, COUGH, SOB

Other Meds:

Current Illness:

ID: 1694827
Sex: M
Age: 52
State: MD

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

Lab Data: None

Allergies: None

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

Symptoms: Numbing and swelling at the site of injection.

Other Meds: None

Current Illness: None

ID: 1694828
Sex: M
Age: 66
State: TX

Vax Date: 03/04/2021
Onset Date: 08/02/2021
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: drainage - pseudomonas covid tests- negative EKG- negative blood work- negative chest x-ray- pneumonia

Allergies: None

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

Symptoms: I started with a cough. I went to the ENT and she took some drainage and it was an infection, pseudomonas. I started taking antibiotics for that. I still have pseudomonas and I am taking more antibiotics. I went to the ER because I had fever and my chest was hurting, I had 2 covid tests and they were both negative. They did a chest x-ray, EKG, blood work- they were all negative, except the chest x-ray which said I had pneumonia.

Other Meds: Singulair, Pantoprazole, Flonase, Azelastine spray, zinc, vitamin C, vitamin D3, vitamin B complex, Centrum silver, fish oil, Mucinex, meloxicam, Montelukast, Fluoxetine

Current Illness: None

ID: 1694829
Sex: M
Age: 50
State:

Vax Date: 06/26/2021
Onset Date: 06/26/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Restricted bronchial inhalation on two occasions occurring on day one and day three following injection. Skin lesions appearing to be a rash that occurred on day two then again on day six.

Other Meds:

Current Illness:

ID: 1694830
Sex: M
Age: 50
State: AL

Vax Date: 08/01/2021
Onset Date: 08/01/2021
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: N/A

Allergies: N/A

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

Symptoms: Pt. states that after receiving the 2nd dose of Moderna 08/2021, started experiencing symptoms mid 08/2021 of intense arm pain and loss of motor skills throughout the hands. Still continuing to experience symptoms.

Other Meds: N/A

Current Illness: N/A

ID: 1694831
Sex: F
Age: 22
State: OH

Vax Date: 09/13/2021
Onset Date: 09/13/2021
Rec V Date: 09/13/2021
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: pt has known history of syncope with vaccinations. sts she has a temporal lobe abnormality that causes her to have syncopal episodes with any sharp touch. administered vaccination, pt awake and conversating 1 min after injection. pt loses concuiousness 1 min after injection (roughly 12:41PM) Hr 55. pt secure on exam table. pt regains conciousness within 15 seconds, reoriented to room. BO 110/62 at this time and HR 76. monitored patient for 30 min and felt well enough to leave at 1:25 PM. pt sts this was a normal episode for her. pt was escorted to car by her brother and he sts he is driving her home.

Other Meds: none

Current Illness: none

ID: 1694832
Sex: M
Age: 27
State: IL

Vax Date: 05/19/2021
Onset Date: 08/14/2021
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:

Allergies: Neosporin

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: I began having chest pain on the date indicated. The pain seems to be located nears the retrosternal area. I thought it maybe heartburn. However, one or two days later, I began having slight shortness of breath without exertion. The shortness of breath seemed to get worse upon laying down. The symptoms also seemed to be worse at night. The pain/SOB lasted a few weeks, then subsided. It has returned once again recently.

Other Meds: N/a

Current Illness: N/a

ID: 1694833
Sex: M
Age: 41
State:

Vax Date: 09/08/2021
Onset Date: 09/08/2021
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: EKG showed bradycardia without ACS or ectopy. Patient has history of Wolff-Parkinson-White with ablation.

Allergies: citalopram

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

Symptoms: chest and throat tightness

Other Meds: cephalexin, Norco, sildenafil, ibuprofen

Current Illness: urinary tract infection, receiving cephalexin at time of vaccine administration

ID: 1694834
Sex: F
Age: 30
State: MA

Vax Date: 09/13/2021
Onset Date: 09/13/2021
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: None

Allergies: None

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

Symptoms: The patient received her first dose of the Pfizer vaccine at 12:02PM. At 12:07, the RN checked on the patient to see how she was doing. The patient complained of feeling dizzy with a slight headache. She stated that she also felt nauseous. The patient stated she did not have any food or drink all day prior to vaccination. The treatment provided was giving the patient ice packs that she applied to the back of her neck and on her belly. She was encourage to drink water and was given crackers and a protein bar. Her BP was taken - 124/74, HR - 74. The patient remained in the observation area until 12:40pm when she was feeling better and felt safe to drive home.

Other Meds: None

Current Illness: None

ID: 1694835
Sex: M
Age: 79
State: MO

Vax Date: 01/04/2021
Onset Date: 08/25/2021
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: LA

Lab Data: Unknown

Allergies: Unknown

Symptom List: Unevaluable event

Symptoms: Patient went to the hospital for an infusion treatment after being diagnosed with COVID-19. Medical personnel admitted patient to the hospital on 08/30/2021.

Other Meds: Unknown

Current Illness: Diabetes

ID: 1694836
Sex: F
Age: 70
State: WA

Vax Date: 04/05/2021
Onset Date: 04/05/2021
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: EKG; Ziopatch

Allergies:

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

Symptoms: I experienced irregular heartbeat.

Other Meds: ARMOUR THYROID; liothyronine; propranolol

Current Illness:

ID: 1694837
Sex: U
Age: 35
State: MN

Vax Date: 02/09/2021
Onset Date: 09/07/2021
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:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Patient tested positive for covid after completing series

Other Meds:

Current Illness:

ID: 1694838
Sex: F
Age: 79
State: CA

Vax Date: 09/13/2021
Onset Date: 09/13/2021
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:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Swollen and redness at the site of reaction which was spreading. Patient was not feeling dizzy. She had no hives. Patient was observed for about 45minutes and she left the facility, No medication was administered.

Other Meds:

Current Illness:

ID: 1694839
Sex: F
Age: 35
State: MA

Vax Date: 12/31/2020
Onset Date: 02/05/2021
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: Being done now. Donated blood with + AB test 5/31/21

Allergies: Bactrim, Doxy vomiting, PCN=myalgias

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

Symptoms: Day after first vaccine had extreme fatigue x 3 days napping and sleeping more then usual. After the 2nd vaccine noted tachycardia, chest tightness, and chest palpitations for a few months then started improving. Symptoms have since returned and having left chest tightness, intermittent dizziness, chest palpitations and syncopal event. Currently getting cardiac work up.

Other Meds: Singular 10mg daily, Lexapro 20mg daily, Wellbutrin 150mg daily, Claritin 10mg daily, albuterol 90mcg/inh 2 inh prior to exercise and PRN, omeprazole 20mg daily, MVI, vit D 1000 IU daily, progestin only mini pill, klonipin 0.5mg daily PRN

Current Illness: none

ID: 1694840
Sex: F
Age: 49
State: MO

Vax Date: 09/07/2021
Onset Date: 09/07/2021
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: Bloodwork CMP CBC UA CULTURE CT SCAN Low platelets high protein in urine I don't understand the rest

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Left side facial droop 20 minutes after Improved within one hour still doesn't look right six days later. Chest pain and Headache on the drive home still have at 6 days later. Dizziness fever of 104 left arm pain neck pain can't move my head lather knees buckle out from underneath me. Difficulty breathing facial rash

Other Meds: None

Current Illness: Urinary tracy infection one month prior

ID: 1694841
Sex: F
Age: 57
State: PA

Vax Date: 09/10/2021
Onset Date: 09/13/2021
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: none

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Severe vertigo and nausea. I wasn't able to move since the symptoms were so bad. Needed to call 911 since I was concerned I was going to pass out. I was treated with anti-nausea medication which helped relieve the symptoms after a couple hours. Have been feeling extreme fatigue the rest of the day.

Other Meds: none

Current Illness: none

ID: 1694842
Sex: F
Age: 37
State: GA

Vax Date: 09/11/2021
Onset Date: 09/11/2021
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: Ajovy injection 225mg/1.5 mL in left thigh on 10 SEP 2021 @ 1445.

Allergies: Latex, feathers, peanuts, tree nuts, melons, avocados

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

Symptoms: Migraine, swollen arm, pain at injection site, fatigue

Other Meds: Ajovy, Ubrelvy, Topiramate, Fiorcet, Sumatriptan, Fexofenadine, Montelukast, Ferosul, Vitamin D2, Epi-pen

Current Illness: Migraines

ID: 1694843
Sex: F
Age:
State: MO

Vax Date:
Onset Date:
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: Mri, ct scan, ultrasound, genetic testing, echogram, prolonged heart monitoring, ekg, antibiotics?

Allergies:

Symptom List: Nausea

Symptoms: Blood clot in left portal vein to liver, low blood pressure, slow heart rate

Other Meds: Levothyroxine, paroxatine, verapamil, metoprolol

Current Illness:

ID: 1694844
Sex: F
Age: 20
State: TX

Vax Date: 09/03/2021
Onset Date: 09/03/2021
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: Doctor's visit on September 7th, 2021 where he preformed the following tests: Neuro assessment COVID-19 Test: Negative

Allergies: Latex allergy

Symptom List: Injection site pain

Symptoms: On September 3rd 2021 I received the COVID vaccine. By lunch time I was running a fever, had body aches, severe arm pain at injection site, numbness in my fingers and lips, fatigue, nerve pain along the scalp neck and face, chills, dizziness when waking moving my neck or looking out of my peripheral vision. My fever broke Sunday morning. The body aches, severe pain at injection site and chills lasted until Wednesday September 8th. The numbness in fingers and lips lasted until Friday September 10th. The fatigue, nerve pain, dizziness upon moving, turning my head, or looking in my peripheral vision has lasted 10 days without relief.

Other Meds: Emgality- monthly injection D3 B2 Fish oil Dehist Cranberry suplement Fiber suplement Magnesium

Current Illness: None

ID: 1694845
Sex: F
Age: 30
State: NY

Vax Date: 09/08/2021
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: patient hospitalized and given bendryl and pepcid for symptoms

Allergies: penicilin,prednisone

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

Symptoms: Patient had hives and swollen lymph nodes.

Other Meds: na

Current Illness:

ID: 1694846
Sex: F
Age: 54
State: SC

Vax Date: 08/22/2021
Onset Date: 08/29/2021
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: EKG normal

Allergies: None

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

Symptoms: Pounding heart. Still ongoing but isn?t as bad as initially

Other Meds: Natures Bounty Hair Skin Nails vitamin

Current Illness: None

ID: 1694847
Sex: F
Age: 50
State: MO

Vax Date: 04/18/2021
Onset Date: 05/23/2021
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: NKDA

Symptom List: Tremor

Symptoms: Patient had numbness at tip of tounge and constant wax/wayne in intensity

Other Meds: Magnesium daily, Vitamin D3 1,000IU QD, Vitamin B12 2,500mcg QD, Zinc 50mg QD, Calcium Carbonate 600mg BID, Flax Seed Oil QD, Iron QD

Current Illness: N/A

ID: 1694848
Sex: F
Age: 59
State: MN

Vax Date: 01/20/2021
Onset Date: 09/07/2021
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: Erythema, Pruritus

Symptoms: completed series and tested positive for covid

Other Meds:

Current Illness:

ID: 1694849
Sex: F
Age: 38
State: CT

Vax Date: 04/12/2021
Onset Date: 04/13/2021
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:

Allergies:

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

Symptoms: I started bleeding excessively, clots, back aches and cramping.

Other Meds: Levothyroxine 50 mg daily, Vit d

Current Illness:

ID: 1694850
Sex: M
Age: 44
State: MN

Vax Date: 03/15/2021
Onset Date: 09/10/2021
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: POSITIVE SARS-COV-2 BY PCR

Allergies:

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

Symptoms: This case meets vaccine breakthrough criteria . SXS INCLUDE RIGORS, BODY ACHES, CONGESTION, SOB

Other Meds:

Current Illness:

Date Died: 09/12/2021

ID: 1694851
Sex: F
Age: 80
State: MI

Vax Date: 03/27/2021
Onset Date: 09/10/2021
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: COVID+ PCR on 9/10/21

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient presented to the hospital on 9/1/21 with weakness and dizziness. The patient developed a cough around 9/5/2021, although the patient stated that is a chronic cough. The patient had a fever on 9/6/2021 of 100.2. On 9/10/21 she tested positive for COVID. Her maximum Oxygen requirement was 5L on 9/10/21. On 9/12 the patient expired.

Other Meds:

Current Illness:

ID: 1694852
Sex: F
Age: 63
State: OH

Vax Date: 06/12/2021
Onset Date: 08/01/2021
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:

Allergies: Penicillin, sulfa, Percocet, Prilosec

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

Symptoms: After receiving the vaccine, I felt nothing. 2 ? months later, I had appendicitis. On 8/29, I had pain that got worse. I wen to the ER on 8/30 around 2:00. By 6:00am, my appendix was out and all is well. I am able to return to work tomorrow.

Other Meds: Yes, blood pressure medication, water pill, cholesterol medication, Tylenol, ibuprofen

Current Illness: No

ID: 1694853
Sex: F
Age: 57
State: CA

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: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies: Brazil nut allergy

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

Symptoms: Lethargy, muscle/joint soreness, fever, dizziness, nausea

Other Meds: Fluoxetine (60mg), levothyroxine (75mcg), Simvastatin (20mg), Buspirone (45mg), dextroamphetamine ER (20mg), Nature?s Bounty Women?s Multivitamin (50mg), Whole Foods N-Acetyl L-Cysteine (1500mg)

Current Illness: None

ID: 1694854
Sex: F
Age: 80
State: CT

Vax Date: 02/09/2021
Onset Date: 02/11/2021
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: Blood test.

Allergies: Penicillin

Symptom List: Pain in extremity

Symptoms: Had pain both arms, shoulders back of neck and thighs. Muscle pain. Diagnosed polymyalgia. Prescribed Prednisone by PCP. Sent to rheumatologist.

Other Meds: Calcium, Vitamin D3, Fish Oil, Biotene, Cranberry

Current Illness: None

ID: 1694855
Sex: F
Age: 50
State: KY

Vax Date: 02/23/2021
Onset Date: 09/08/2021
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:

Allergies:

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

Symptoms: Tested positive for COVID 19 09/08/2021

Other Meds:

Current Illness:

ID: 1694856
Sex: F
Age: 66
State: MD

Vax Date: 04/21/2021
Onset Date: 09/13/2021
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: Unk

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

Symptoms: Numbness that radiates from the ring finger and pinky finger on her right hand

Other Meds: Unk

Current Illness: unk

ID: 1694857
Sex: F
Age: 81
State: MO

Vax Date: 09/08/2021
Onset Date: 09/11/2021
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: Large amount redness and itching in left upper arm, also headache that started 09/11/21. 09/13/21 redness improving, continues to have headache and itching. Has not taken any meds for side effects.

Other Meds:

Current Illness:

ID: 1694858
Sex: F
Age: 30
State: TX

Vax Date: 08/27/2021
Onset Date: 09/13/2021
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:

Allergies: None

Symptom List: Vomiting

Symptoms: Initial symptoms were fever and chills immediately 24-48 hours from second vaccine. As of reporting date (today), I cannot see clearly and see spots in my vision. Bright colors and light is triggering it.

Other Meds: Birth Control, adderall as needed

Current Illness: None

ID: 1694859
Sex: F
Age: 39
State: AZ

Vax Date: 02/24/2021
Onset Date: 06/21/2021
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: See #18.

Allergies: Cephalexin

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: I developed a breast lump within a few months of receiving my second dose of the COVID-19 vaccine. The lump was discovered in mid-June 2021. I had a mammogram with ultrasound in July 2021 and a core needle biopsy on August 3, 2021. The result was a benign breast tumor called a Fibroadenoma. It does not need to be removed unless it grows in size.

Other Meds: Errin, Baclofen, Flovent, Vitamin D, Biotin, Joint Supplement

Current Illness: N/A

ID: 1694861
Sex: M
Age: 17
State:

Vax Date: 09/02/2021
Onset Date: 09/06/2021
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: Penicillin

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

Symptoms: palpitations and shortness of breath occurred 3 days after receiving 1st dose of vaccine. premature ventricular contractions visualized on cardiac monitor in ER.

Other Meds: None

Current Illness: none

ID: 1694862
Sex: M
Age: 27
State:

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

Lab Data:

Allergies: NKMA

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Moderna 2nd dose vaccine given 1 week early.

Other Meds:

Current Illness:

ID: 1694863
Sex: F
Age: 77
State: KY

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: RA

Lab Data: no

Allergies: no

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

Symptoms: couldn't move left arm, in alot of pain

Other Meds: Prilosec, metformin, mononit, triginta, atenolol, tentorial

Current Illness: no

ID: 1694864
Sex: F
Age: 22
State: LA

Vax Date: 09/13/2021
Onset Date: 09/13/2021
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: None yet

Allergies: Latex, Aleve, chloroprep

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

Symptoms: Right arm was throbbing, so I looked at it and noticed it was breaking out into a petechiae rash from just below the injection site down to my hand.

Other Meds: * Ketotifen 2mg twice daily (am/pm) * Diamox 125mg, once daily (pm) * Cardiamin once daily, multivitamin (pm) *Vitamin D3 100mcg (pm) * Zofran 4-8mg as needed * Famotidine 20mg once daily (am) * Diltiazem 90mg three times daily * Duloxetin

Current Illness: None

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am