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: 1700354
Sex: F
Age: 71
State: FL

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: I waited for everything to settle down and did not go to the doctor.

Allergies: Sodalol, Benicar, Latex, Niacin, Nutrasweet,

Symptom List: Dysphagia, Epiglottitis

Symptoms: Shot 9/3 at 1:20 pm by 6 pm became very sleepy. I woke the following day at 6 am ; then could not stay awake slept til 3 pm. Was very sleepy/groggy. After taking a shower I went to take evening pills. Had such brain fog I could not remember which were my evening pills so I skipped them. I just stared at them which is not normal. Brain cleared 2 days later. I am better now.

Other Meds: Synthroid, eliquist, cozier, diltiazem 24 hr, D3, K2, fish oil

Current Illness: none

ID: 1700355
Sex: M
Age: 40
State: TX

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 09/15/2021
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: NA

Symptom List: Anxiety, Dyspnoea

Symptoms: The adverse event was that an expired Janssen COVID-19 Vaccine has been administered to the patient. There were no adverse event, symptoms or any health related issues regarding the patient after the vaccine dose was given. Only that the vaccine has been given after the expiration date, nothing else.

Other Meds: NA

Current Illness: NA

ID: 1700356
Sex: F
Age: 68
State: TX

Vax Date: 07/13/2021
Onset Date: 07/29/2021
Rec V Date: 09/15/2021
Hospital: Y

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: Upper respiratory panel, CBC, CMP, ABGs, EKG, CT chest

Allergies: NKDA

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

Symptoms: Hypoxemia, diarrhea

Other Meds: metformin, glimipiride ,atorvastatin

Current Illness:

ID: 1700357
Sex: F
Age: 30
State: NH

Vax Date: 09/10/2021
Onset Date: 09/12/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Reports chest tightness and difficulty taking deep breaths, starting on 9/12/21.

Other Meds:

Current Illness:

ID: 1700358
Sex: M
Age: 44
State: TX

Vax Date: 09/13/2021
Onset Date: 09/13/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data:

Allergies: NA

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

Symptoms: The adverse event was that an expired Janssen COVID-19 Vaccine has been administered to the patient. There were no adverse event, symptoms or any health related issues regarding the patient after the vaccine dose was given. Only that the vaccine has been given after the expiration date, nothing else.

Other Meds: NA

Current Illness: NA

ID: 1700359
Sex: F
Age: 1
State: SC

Vax Date: 08/03/2021
Onset Date: 08/04/2021
Rec V Date: 09/15/2021
Hospital:

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: cashew, pistachio allergies

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

Symptoms: large swelling and induration at vaccination site

Other Meds:

Current Illness:

ID: 1700360
Sex: F
Age: 59
State: IL

Vax Date: 09/08/2021
Onset Date: 09/08/2021
Rec V Date: 09/15/2021
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: sulfa

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Within 3 minutes of the injection, I felt neck stiffness, then neck soreness. I felt a warm pressure sensation going up the base of my skull and over my head with pressure behind both eyeballs. After 48 hours of fever, chills, nausea, all body muscle aches, intense night sweating, a lymph node on the left side of base of my skull became enlarged ,swollen, and painful. This lasted 48 hours. It took an entire week until side effects subsided.

Other Meds: NONE

Current Illness: NONE

ID: 1700361
Sex: F
Age: 23
State: FL

Vax Date: 09/15/2021
Onset Date: 09/15/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Patient was given Pfizer for the second dose, instead of Moderna.

Other Meds:

Current Illness:

ID: 1700362
Sex: M
Age: 12
State: FL

Vax Date: 09/05/2021
Onset Date: 09/08/2021
Rec V Date: 09/15/2021
Hospital: Y

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

Lab Data:

Allergies: No allergies

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Received second Pfizer Covid vaccine on 9/5/21. On 9/8 in the morning patient experienced shortness of breath and chest pain described as his heart "feeling heavy." Was taken to the ED and transferred to pediatric cardiac ICU with concerns for myocarditis. Troponin peaked at 0.12. On 9/9 ECHO was done which showed normal function. ECHO was limited due to patient being uncooperative. Troponin 0.10. Due to troponin trending down and improvement in chest pain, patient was discharged with instruction to follow up with cardiology in one week.

Other Meds: Abilify 2 mg q hs and Intuiv 1 mg ER bid

Current Illness:

ID: 1700363
Sex: F
Age: 57
State: ME

Vax Date: 09/14/2021
Onset Date: 09/14/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: right side of face swollen, heachache, tiredness, blurred vision, confusion

Other Meds:

Current Illness:

ID: 1700364
Sex: F
Age: 26
State: OR

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: N/A

Allergies: Sulfa Penicillin Amoxicillin Iodine Latex Monistat Azithromycin Misoprostol

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

Symptoms: Recurring symptoms: I've been experiencing facial numbness and tingling on the left side of my face & arm. Also, a week and a half after taking the vaccine, I've been dealing with breakthrough bleeding with my menstrual cycle, even though I use the Mirena IUD. I've been getting severe headaches and migraines, which is very abnormal for me since I usually don't get these at all. I've been given a steroid shot to deal with some of my symptoms. I've been to referred to an Allergist and Neurologist.

Other Meds: None

Current Illness: None

ID: 1700365
Sex: F
Age: 60
State: CA

Vax Date: 01/15/2021
Onset Date: 02/19/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: Hospital x-ray, blood test, EKG, cardiologist

Allergies: Penicillin

Symptom List: Rash, Urticaria

Symptoms: Lymph node swelling around collar bone, dizziness within hour of receiving, fever & fatigue.

Other Meds: Blood pressure; Advil

Current Illness: None

ID: 1700366
Sex: F
Age: 66
State: NY

Vax Date: 04/10/2021
Onset Date: 06/25/2021
Rec V Date: 09/15/2021
Hospital: Y

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

Lab Data: Blood test cardiac enzyme was 16000, blood test will be done 09/16/2021

Allergies: No

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

Symptoms: On 06/25/2021, chest pain. I went to the ER, Hospital, they admitted me because I was having a heart attack. Within an hour, at 1:16pm I had a series of blood test, the 2nd series of blood test, it showed the cardiac enzyme were at 16000. They did an Emergency catherization. They called it NSTEMI Heart attack. They told me I was lucky because I had no heart damage, they could not do anything to repair it. Treatment: Aspirin 80 mg, Lipitor 40 mg. I just had to rest. A small artery that suddenly broke as though somebody came and cut with some scissors. The doctor monitors me to take my heart pressure. This morning I took it 4 times and it was bad. I have a follow up with the doctor, Dr., on 09/20/2021. I look fine, but there are days my blood pressure is bad, but I feel fine.

Other Meds: Atacama; Toprol; calcium; magnesium; vitamin B-12; vitamin C; vitamin D, K, & E

Current Illness: No

ID: 1700367
Sex: F
Age: 24
State: MD

Vax Date: 09/09/2021
Onset Date: 09/15/2021
Rec V Date: 09/15/2021
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:

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

Symptoms: Sharp chest pain on the left side, constant

Other Meds:

Current Illness:

ID: 1700368
Sex: M
Age: 40
State: NY

Vax Date: 08/30/2021
Onset Date: 08/31/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: N/A

Allergies: N/A

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

Symptoms: Pt. states that after receiving the 1st dose of Phizer 08/26/2021, started experiencing symptoms of hives, numbness throughout the body, heaviness in the chest, and shortness of breath. Lasting 2 1/2 weeks, Primary recommendations to not receive the 2nd dose of Phizer due to symptoms.

Other Meds: N/A

Current Illness: N/A

ID: 1700369
Sex: F
Age: 21
State: MD

Vax Date: 09/14/2021
Onset Date: 09/14/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: unknown

Allergies: unknown

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

Symptoms: - few minutes after administering vaccine Patient passed out (syncope) - lay her flat on the floor and she came around - called 911 and was checked by Emt and released

Other Meds: unknown

Current Illness: none according to screening questionnaire

ID: 1700370
Sex: M
Age: 52
State: TX

Vax Date: 09/13/2021
Onset Date: 09/13/2021
Rec V Date: 09/15/2021
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: NA

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

Symptoms: The adverse event was that an expired Janssen COVID-19 Vaccine has been administered to the patient. There were no adverse event, symptoms or any health related issues regarding the patient after the vaccine dose was given. Only that the vaccine has been given after the expiration date, nothing else.

Other Meds: NA

Current Illness: NA

ID: 1700371
Sex: F
Age: 25
State: WI

Vax Date: 03/01/2021
Onset Date: 04/01/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data:

Allergies: mildly allergic to amoxicillin (got a rash)

Symptom List: Ear pain, Hypoaesthesia

Symptoms: a few weeks after getting the vaccine, I started getting rashes. Started off on my hands, but then progressed up my arms, neck, and upper torso, and feet. It was intermittently present.. so sometimes it's fine, and sometimes it's horrible. Can't figure out the trigger for it. Doctor said I could take zyrtec in higher doses to help them, so I did that. Then, I started getting hives everywhere. The rash was also still intermittently there. Eventually, I had to take prednisone. That helped, but could only take it a few days. Eventually, the rash returned. I've been dealing with it off and on all summer.

Other Meds: occassional zyrtec for allergies, and a daily multivitamin

Current Illness: none known

ID: 1700372
Sex: M
Age: 68
State: NJ

Vax Date: 03/12/2021
Onset Date: 07/04/2021
Rec V Date: 09/15/2021
Hospital: Y

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

Lab Data: Numerous blood tests, scans, echo cardiogram.

Allergies: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: atrial fibrillation, emergency room visit, overnight hospital stay. Condition normalized and has not returned. I have no history of AF, other heart conditions or other health issues. I am a runner and exercise regularly. I have returned to my normal routines.

Other Meds: Multi-vitamin, vitamin C, fish oil, Calcium, saw palmetto, low dose Aspirin

Current Illness: None

ID: 1700373
Sex: F
Age: 36
State: OK

Vax Date: 09/10/2021
Onset Date: 09/12/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: Performed COVID 19 testing at PCP office, results pending

Allergies: codeine

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

Symptoms: Erythema at injection site; URI symptoms (body aches, non-productive cough, and nasal congestion)

Other Meds: None

Current Illness: none

ID: 1700374
Sex: F
Age: 69
State: PA

Vax Date: 08/20/2021
Onset Date: 08/21/2021
Rec V Date: 09/15/2021
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: Patient states her arm hurts really bad even a few weeks after vaccine. Was told by her doctor to take tylenol and ibuprofen.

Other Meds: N/A

Current Illness: N/A

ID: 1700375
Sex: F
Age: 95
State: FL

Vax Date: 01/19/2021
Onset Date: 08/18/2021
Rec V Date: 09/15/2021
Hospital: Y

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

Lab Data: SARS COV2 COVID 19 PCR 08/18/2021

Allergies: Levaquin

Symptom List: Unevaluable event

Symptoms: The patient presents with Right sided weakness, onset 1400 this afternoon. Pt coming was noted to be experiencing worsening symptoms. EMS services were called and pt was noted to be febrile with a HR of 140 at arrival. Pt denies headache, altered vision, dizziness, chest pain, shortness of breath, urinary symptoms, and all other symptoms. The onset was 1400 today. Associated symptoms: denies chest pain, denies abdominal pain, denies nausea, denies vomiting, denies shortness of breath, denies chills, denies headache, denies dizziness and denies back pain. Patient was tested 2 days ago for COVID-19 and tested negative. ? CVA--Covid incidental finding asymptomatic

Other Meds: Multivitamin, Metamucil, Losartan, Metoprolol, Tylenol, NTG, MEDS: Coumadin, AMlodipine, Iron, Simvastatin, Systane, Vitamin D3, Isosorbide mononitrite,

Current Illness: unknown

ID: 1700376
Sex: M
Age: 76
State: VA

Vax Date: 08/17/2021
Onset Date: 08/28/2021
Rec V Date: 09/15/2021
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: Biopsy done 08/31/21 with the results "interface dermatitis" which would fit the picture of viral exanthem / post-vaccine reaction

Allergies: NKDA

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

Symptoms: Morbilliform, itchy rash all over his body starting 10 days after his 3rd Covid booster vaccine

Other Meds: B complex, Chondroitin Sulfate, Vitamin B-12, Vitamin C, Flonase, Aspirin, Centrum Silver, Eliquis, Glucosamine, Nexium, Tylenol, Vitamin D3, Amoxicillin, Krill Oil, Metoprolol succinate, Rosuvastatin, Tamsulosin, Valsartan

Current Illness: None

ID: 1700377
Sex: M
Age: 82
State: FL

Vax Date: 03/15/2021
Onset Date: 09/03/2021
Rec V Date: 09/15/2021
Hospital: Y

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

Lab Data: 09/03/21 SARS COV2 COVID 19 PCR (DETECTED)

Allergies: No known allergies

Symptom List: Injection site pain, Pain

Symptoms: 09/03/21 The patient presents with SOB with unknown onset. Per nurse, Pt who was brought in by EMS for SOB with exertion and noted he has COVID-19 and is fully vaccinated. Reports that pt came in with 2 liters of nasal canula and his pulse ox rests in the 90s. HPI limited due to being a poor historian 2/2 dementia . The onset was unknown. The course/duration of symptoms is unknown. Degree at onset unknown. Degree at present unknown. The Exacerbating factors is unknown. The Relieving factors is unknown. Risk factors consist of COVID-19. Therapy today: none. Associated symptoms: denies chest pain, denies fever, denies chills, denies cough, denies nausea, denies vomiting, denies abdominal pain,

Other Meds: Acidophilus, ASA, Atorvastatin, BIofreeze, Breo Ellipata,

Current Illness: Unknown

ID: 1700378
Sex: F
Age: 56
State: TX

Vax Date: 06/26/2021
Onset Date: 06/27/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: Chest x-ray, bloodwork, auto-immune 9/01/2021, 09/04/2021, 09/11/2021

Allergies: Sulfa

Symptom List: Injection site pain, Menorrhagia

Symptoms: Diarrhea, vomiting, nausea, headache, light sensitivity, fever, chills, fatigue, brain fog, restless legs, rashes, blurred vision, whole body aches, no energy, no smell or taste, cough, hard to breathe/shortness of breath, sore throat, congestion/bad allergy/runny nose, pressure in chest and throat.

Other Meds: None

Current Illness: None

ID: 1700379
Sex: M
Age: 30
State: PA

Vax Date: 09/08/2021
Onset Date: 09/08/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: NA

Allergies: NA

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

Symptoms: I had a reaction to the vaccine less then 5 minutes after getting it. I experience profuse sweating, arm concussions, vomiting & tunnel vision / fitness. This results in the EMTs being called on my behalf the pharmacist whom note a drop in blood pressure and heart rate. Please see attached for EMT report and vaccination card.

Other Meds: NA

Current Illness: NA

ID: 1700380
Sex: F
Age: 62
State: IL

Vax Date: 04/01/2021
Onset Date: 09/07/2021
Rec V Date: 09/15/2021
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: 9/14/2021 COVID-19 Rapid Molecular Positive,

Allergies: Tessalon, Ceclor

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: HPI: Patient is a 63-year-old female with multiple medical problems who presents to the emergency department chief complaint of cough, abdominal pain, diarrhea, nausea, headache, back pain, and fevers. Patient states that she has had her symptoms for approximately 9 days. She was tested on 9/9 for COVID-19 and was negative. Patient states that she has been having some diarrhea and vomiting but it temporarily improved

Other Meds: Advair inhaler, Albuterol inhaler, Lipitor, Tessalon (prn), OSCAL-D, Vitamin D, Vitamin B-12, Flexeril, Colace, FLONASE nasal spray, Gabapentin, Glimepiride, Ibuprofen, Synthroid, METANX, Losartan, Antivert, Singulair, Fish oil, Protonix,

Current Illness:

ID: 1700381
Sex: F
Age: 17
State: NC

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: NONE

Allergies: NO KNOW ALLERGIES

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient given 1 dose of moderna prior to turning the approved date of 18 years of age. Second dose due one week prior to 18th birthday. Will be given following birthday.

Other Meds: NO KNOWN MEDS

Current Illness: NONE

ID: 1700382
Sex: F
Age: 72
State: OR

Vax Date: 09/13/2021
Onset Date: 09/13/2021
Rec V Date: 09/15/2021
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

Allergies: None

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

Symptoms: excessive fatigue and weakness, shivering and chills, severe headache, swelling and tenderness where shot was given, lasted 36 hours

Other Meds: Vitamin B, Lysine, Zinc, Vitamin D3, Quercetin, Melatonin

Current Illness: None

ID: 1700383
Sex: F
Age: 66
State: FL

Vax Date: 09/05/2021
Onset Date: 09/14/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data:

Allergies: Penicillin: rash

Symptom List: Nausea

Symptoms: 9 days following vaccination pt developed 5cm x 5cm localized redness, swelling, warmth, induration, tenderness and pruritis of vaccination site

Other Meds: Amiloride-hydrochlorothiazide 5-50 mg tablet daily, Xanax 1mg PRN

Current Illness: None

ID: 1700384
Sex: M
Age: 42
State: SC

Vax Date: 09/14/2021
Onset Date: 09/15/2021
Rec V Date: 09/15/2021
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: Dizziness and Vertigo. Began upon waking and has continued throughout the day.

Other Meds: None

Current Illness: None

ID: 1700385
Sex: F
Age: 43
State: TX

Vax Date: 08/28/2021
Onset Date: 08/28/2021
Rec V Date: 09/15/2021
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: Flagyl

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

Symptoms: Patient talking to, LVN prior to vaccine administration stated her daughter had Covid and it was rough on the family as she had been on the vent. After administering the vaccine client became non-responsive, clammy and pale immediately. Client moved to obervation via chair. Client asked what was wrong she stated she just didn't feel well. V/S taken B?P 120/78 P-78 R-28. Asked client if she had eaten anything she stated no , snack given with water. Client begins to shake upper and lower extremeties uncontrollably advised we need to lay you on floor she refused. V/S 139/98 P-84 R-28 she states she is hot, cold compress applied to back of neck and fan turned directly facing her. Her color begins to return and she is drinking water and eating snack. V/S 124/98 78 24 states she is beginning to feel better. she is no longer shaking extremeties and no longer clammy. V/S 124/98 74 24 states I feel so much better. Advised we will keep her a while longer to make sure she does not have any other reactions. V/ 124/98 74 24 no complaints voiced states her husband is sitting outside waiting on her. Advised her of postcare if she should have SOB, heart palpitations or rash over entire body she should contact EMS. V/S 120/9472 20 continues to observe and monitor no complaints voiced. V/S 110/78 72 20 advised to stand slowly states no dizziness advised to rest today and if she should have any distress or any of the reactions previously reviewed to go to emergency room. Escorted to car without complaints or problems

Other Meds: Vraylor

Current Illness: none

ID: 1700386
Sex: M
Age: 30
State: TX

Vax Date: 09/14/2021
Onset Date: 09/14/2021
Rec V Date: 09/15/2021
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: NA

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

Symptoms: The adverse event was that an expired Janssen COVID-19 Vaccine has been administered to the patient. There were no adverse event, symptoms or any health related issues regarding the patient after the vaccine dose was given. Only that the vaccine has been given after the expiration date, nothing else.

Other Meds: NA

Current Illness: NA

ID: 1700387
Sex: M
Age: 73
State: FL

Vax Date: 08/15/2021
Onset Date: 09/03/2021
Rec V Date: 09/15/2021
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: 09/04/2021 SARS COV2 COVID 19 (NOT DETECTED) 09/05/2021 SARS COV2 ANTIBODY (REACTIVE)

Allergies: No Known Allergies

Symptom List: Tremor

Symptoms: 09/03/21 The patient presents with 73 year old male with history of HTN and DM presents via EMS with malaise, fatigue, cough, occasional chest pain, and mild shortness of breath.Patient was diagnosed with COVID-19 x10 days ago. Patient informs he was seen by PCP earlier this week, he was prescribed ABX and steroids, he received Regeneron on 09/02. Sts he was seen by his PCP today and given a shot but unsure what it was. Wife informs the patient has a DNI and DNR but she does not have a hardcopy of the documents at this time, she sts the patient's PCP will call the ED with additional information. . The onset was 10 days ago.

Other Meds: ASA, Lotril, Amlodipine, HCTZ, Dosazosin, Losartan, Sildenafil

Current Illness: UNKNOWN

ID: 1700388
Sex: F
Age: 68
State: OR

Vax Date: 09/03/2021
Onset Date: 09/04/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: None

Allergies: No known

Symptom List: Erythema, Pruritus

Symptoms: The morning after the 2nd Pfizer, her left eye was very puffy and her face was red and she had a bad headache. The headache persisted for 10 days. The second morning she had pain in her teeth and gums and it hurt to brush and floss for 10 days.

Other Meds: levothyroxine 125mcg tablet, olmesartan 40 mg daily, HCTZ 12.5mg daily, pantoprazole 40mg daily, trazodone 50mg at bedtime, tropsium ER 60mg daily, D-Mannose twice a day

Current Illness: None

ID: 1700389
Sex: F
Age: 48
State: TX

Vax Date: 03/31/2021
Onset Date: 07/30/2021
Rec V Date: 09/15/2021
Hospital: Y

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: CBC,CMP, liver enzymes, EKG, antibiotic, COVID 19

Allergies: lidocaine, adhesives,bees, ants, paprika

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

Symptoms: right upper quadrant pain, tested positive for COVID 19.

Other Meds: sucralfate,dicyclomine, prednisone,gabapentin, corisoprodol, buspirone, duloxetine, ursodiol, diclofenac, protonix, eliquis, dilaudid, morphine

Current Illness:

ID: 1700390
Sex: M
Age: 81
State: FL

Vax Date: 03/11/2021
Onset Date: 09/01/2021
Rec V Date: 09/15/2021
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: 09/01/21 SARS COV2 COVID 19 PCR (DETECTED)

Allergies: No known allergies

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

Symptoms: 09/01/21 The patient presents with Possible COVID-19 symptoms x1 week. Pt who is fully vaccinated states he was tested for COVID-19 screening last week and was negative. However, pt is c/o SOB, cough, and loss of appetite and smell. Denies any other symptoms or complaints. The onset was 1 weeks ago.

Other Meds: Lisinopril, Metformin, Rosuvastatin, Jardiance, Midodrine

Current Illness: Unknown

ID: 1700391
Sex: F
Age: 53
State: SC

Vax Date: 09/09/2021
Onset Date: 09/11/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: 9/14/2021 saw doctor.

Allergies: Latex, PCN, Kiwi, IV Iron

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Moderna COVID-19 Vaccine EUA Fever 100.1, chills, entire body aches, injection site extreme pain - took Tylenol regularly under arm/breast area lump felt - Dr is having me apply ice and watch to see if it decreases because it occurred on same arm that I received the injection. Wants to wait until after 2nd dose to see if it goes away

Other Meds: Wellbutrin, Vitamin D, Flonase, Flovent HFA

Current Illness: Asthma, Fibromyalgia, DJD, Low Vitamin D, Sleep Apnea

ID: 1700392
Sex: F
Age: 63
State: MT

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: N/A

Allergies: Hay allergy

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

Symptoms: Developed tingling rash on inner thigh to above knee of left leg. Noticed odd looking rash about 6 hours after shot. Photo is available if needed. Rash gradually disappeared after about 12 hours. Felt mildly ill and had joint pain, slept for majority of next day and a half.

Other Meds: Multi vitamin, calcium, fish oil

Current Illness: None

ID: 1700393
Sex: M
Age: 79
State: CA

Vax Date: 09/01/2021
Onset Date: 09/02/2021
Rec V Date: 09/15/2021
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: Codeine

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

Symptoms: General weakness, diarrhea, loss of motor funtions and fever

Other Meds: Gabapentin, baclofen, dantrolene, baby aspirin, hydrochorlizide.

Current Illness: None

ID: 1700394
Sex: F
Age: 48
State:

Vax Date: 08/18/2021
Onset Date: 08/26/2021
Rec V Date: 09/15/2021
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: woke up and arm was swollen and hard(size of a baseball), chest pains and trouble breathing, went to cardiologist and was diagnosed with pericarditis, swollen lymph nods, joint pain, went to er after cardiologist and her level of inflammation on body was 35%

Other Meds: synthroid crestor fish oil tumeric

Current Illness:

Date Died: 08/29/2021

ID: 1700395
Sex: M
Age: 78
State: GA

Vax Date: 01/18/2021
Onset Date: 08/25/2021
Rec V Date: 09/15/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Hospitalization and death due to COVID-19

Other Meds:

Current Illness:

ID: 1700396
Sex: F
Age: 33
State: IL

Vax Date: 01/29/2021
Onset Date: 01/30/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: Will provide upon request

Allergies:

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

Symptoms: 12 hours after receiving shot spiked fever of 102, severe migraine body aches, chills, nausea, vomiting and diarrhea. By day 2 my shaking became so uncontrollable couldn?t sleep. Symptoms began to lesson after six days, but an exhaustion soon kicked in that had me drained and made every day activities difficult to impossible. By the 3 or 4th week I noticed the lumps in my breast and kept having specific point pain throughout various areas of my body. I was soon diagnosed with lymphadenopathy. My blood pressure has been recorded higher then normal as well as my heart rate. The lymphadenopathy is constant and at times debilitating. My migraines increased in frequency despite medication given to prevent them. Prednisone is given off and on to help with lymph node flare ups. Sometimes the exhaustion makes it hard to function and creates a fog. My mind will at times go black and I find myself almost ?lost?. Multiple scans, X-rays, CTs and blood work has been done and all I?m told is-it?s a side effect from the vaccine.

Other Meds: Tizanidine

Current Illness: Dental work about 3 weeks prior

ID: 1700397
Sex: F
Age: 52
State: TX

Vax Date: 09/14/2021
Onset Date: 09/14/2021
Rec V Date: 09/15/2021
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: NA

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

Symptoms: The adverse event was that an expired Janssen COVID-19 Vaccine has been administered to the patient. There were no adverse event, symptoms or any health related issues regarding the patient after the vaccine dose was given. Only that the vaccine has been given after the expiration date, nothing else.

Other Meds: NA

Current Illness: NA

ID: 1700398
Sex: F
Age: 58
State: KY

Vax Date: 06/28/2021
Onset Date: 09/12/2021
Rec V Date: 09/15/2021
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:

Symptom List: Vomiting

Symptoms: Tested positive for COVID 19 9/12/2021

Other Meds:

Current Illness:

ID: 1700399
Sex: F
Age: 48
State: MA

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: When I went to the ER I had a X-Ray done on my chest and I got a COVID test done.

Allergies: None.

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: After the vaccine a hour later I had pain and swelling in my arm pit, breast, the side of my ear, and the side of my neck. All of this took place on the right side of my body. I still have constant migraines. Ear ringing on my right side, and loss of hearing. I had a very bad severe migraine after the vaccine. I had difficult breathing as well.

Other Meds: I was taking my prescribed medication for hormone replacement.

Current Illness: None.

ID: 1700400
Sex: F
Age: 41
State: MI

Vax Date: 09/01/2021
Onset Date: 09/03/2021
Rec V Date: 09/15/2021
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: Just the blood pressure check at my dentist office on Monday the 13th.

Allergies: lettuce, chocolate, coffee, soy, wheat, corn

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

Symptoms: It started with flushing, chest constriction, nausea and lightheaded. I am now 12 days out and I'm still feeling the same on and off. While at my dentist office my blood pressure was 155/95. I almost always run 118/78. I've been checking my blood pressure 3x day since my dentist appointment and it was consistently elevated. Today at my noon testing it was 153/92. I have never, in my life had high blood pressure. I'm wrought with more fatigue than normal, anxiety, and continued symptoms that I initially experienced.

Other Meds: progesterone, multivitamin, b complex, vitamin d

Current Illness: Lyme disease

ID: 1700401
Sex: F
Age: 65
State: WV

Vax Date: 09/10/2021
Onset Date: 09/11/2021
Rec V Date: 09/15/2021
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: N/A

Allergies: N/A

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Pt. states that after receiving the Booster 3rd dose of Moderna 09/10/2021, started experiencing symptoms 09/11/2021 of Low Blood Pressure (88/58), feeling of low blood sugar, and weakness lasting 48hrs. No noted Primary visit. Symptoms have subsided.

Other Meds: Ibranze, Letrazol

Current Illness: N/A

ID: 1700402
Sex: F
Age: 72
State: NJ

Vax Date: 08/14/2021
Onset Date: 09/14/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: none

Allergies: Moxifloxacin

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

Symptoms: I had a strong metallic taste in my mouth. The doctor said it could be thrush or an adverse reaction to the vaccine. I was prescribed an antifungal mouth rinse and after the 2nd day of user the taste was gone. I do believe I had thrush.

Other Meds: Orencia - 1xweekly Sulfasalazine- 1xdaily Nabumetone 1xdaily Atorvastatin 1xdaily Gabapentin 1xdaily Low Dose Aspirin 1xdaily Multi Vitamin 1xdaily Calcium with Vitamin D 1xdaily Probiotics 1xdaily

Current Illness: none

ID: 1700403
Sex: F
Age: 56
State: WA

Vax Date: 09/14/2021
Onset Date: 09/15/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: N/a

Allergies: Sulfa, Green and red peppers

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

Symptoms: I woke to pain in hands. I have cysts on right hand to third and fourth fingers on palm to left hand and on on right hand4th finger palm. Left arm pain.-

Other Meds: Metformin tumeric

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am