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: 1703896
Sex: M
Age: 46
State: NY

Vax Date: 09/13/2021
Onset Date: 09/14/2021
Rec V Date: 09/16/2021
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: Mod to severe headache fatigue chills nausea. One of the worst illness I've ever felt. Lasted only 1 day but same intensity. Very concerning. I did have same side effects after first but mild compared to this. Could not function. I feel good now but I do not want to go through that again.

Other Meds: Multivitamin

Current Illness: None

ID: 1703897
Sex: F
Age: 12
State: NY

Vax Date: 08/20/2021
Onset Date: 08/22/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data: 8/27/21 CBC and complete metabolic panel were normal

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: redness and rash upper arm

Other Meds:

Current Illness:

ID: 1703898
Sex: F
Age: 43
State:

Vax Date: 03/01/2021
Onset Date: 03/01/2021
Rec V Date: 09/16/2021
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: Chirizo

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

Symptoms: Heavy painful period (not due) 1 hour after vaccine and now every 2 weeks since

Other Meds:

Current Illness: Fibromyalgia

ID: 1703899
Sex: F
Age: 21
State: KY

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

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

Lab Data: EMS was called and arrived at around 9:50 AM. EMS performed all necessary evaluations, patient recovered and felt better, but weak when released by EMS. Someone drove the patient home and she was advised to follow up with her family physician, but patient did state she had not eaten anything since 9:00 PM last night.

Allergies: None.

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient was administered vaccine at 7:40AM. At 7:45 AM patient reported she wasn't feeling well with loss of color, dizziness, syncope episode, nauseous, blurred vision and slow to recover. Patient never passed out, but heart rate dropped to 32. Oxygen remained normal the entire time. 911 was called and arrived around 7:50 and performed a full evaluation on the patient. The patient refused to be transported and was released after recovering, but had someone drive her home.

Other Meds: None.

Current Illness: None.

ID: 1703900
Sex: F
Age: 26
State: ME

Vax Date: 08/27/2021
Onset Date: 08/30/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data: echo, troponin, CRP

Allergies: Amoxicillin

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

Symptoms: Chest pain/tightness, dyspnea on exertion

Other Meds: Oral contraception

Current Illness:

ID: 1703902
Sex: F
Age: 36
State: WI

Vax Date: 09/12/2021
Onset Date: 09/13/2021
Rec V Date: 09/16/2021
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 FORMAL MEDICAL TESTS BUT KNOWLEDGE OF MEDICAL CONDITIONS AND SYMPTOMS FROM EXPERIENCE AS A PARAMEDIC.

Allergies: MILD SENSITIVITY TO OXYCODONE

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

Symptoms: HEART PALPITATIONS, FREQUENT PVCs - USUALLY COMES IN WAVES OF 4-8 PER MINUTE THAT LASTS FOR AN HOUR OR MORE THEN DECREASES TO 0-2 PER MINUTE AND REPEATS - NO NOTICABLE PATTERN OTHERWISE, MILD BACK ACHE LESSENING EACH PASSING DAY, PAIN, CONTUSION, AND MUSCLE HARDNESS AT INJECTION SITE - NO IMPROVING MUCH OVER FIRST THREE DAYS, STIFF MUSCLES - PARTICULARLY IN LEGS AND FEET

Other Meds: ELINEST

Current Illness: NONE

ID: 1703903
Sex: M
Age: 15
State: NY

Vax Date: 09/15/2021
Onset Date: 09/16/2021
Rec V Date: 09/16/2021
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: Aches all over the body.

Other Meds:

Current Illness:

Date Died: 09/15/2021

ID: 1703904
Sex: M
Age: 83
State: TN

Vax Date: 02/22/2021
Onset Date: 09/15/2021
Rec V Date: 09/16/2021
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: COVID RELATED DEATH; FULLY VACCINATED

Other Meds:

Current Illness:

ID: 1703905
Sex: F
Age: 32
State: AR

Vax Date: 06/01/2021
Onset Date: 09/15/2021
Rec V Date: 09/16/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Covid-19 after complete vaccination

Other Meds:

Current Illness:

ID: 1703907
Sex: F
Age: 26
State: NY

Vax Date: 09/13/2021
Onset Date: 09/13/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data: None

Allergies: None

Symptom List: Diarrhoea, Nasal congestion

Symptoms: The patient consented to Jansen COVID-19 vaccination. Patient was given Pfizer 1st dose in error by the nurse. Patient did not experience any adverse reactions from the Pfizer vaccine. Patient was informed of the benefits and risks of both the pfizer and Jansen vaccination. Patient was informed of the efficacy of pfizer and Jansen and the warning associated with Jansen from ages 18-49. Patient was informed that a 2nd dose of pfizer is needed to complete the entire vaccination series. Patient agreed with receiving the 2nd dose of the Covid-19 vaccine. Patient was informed that she received the 1st dose of pfizer instead of Jansen.

Other Meds: None

Current Illness: None

Date Died: 09/15/2021

ID: 1703909
Sex: F
Age: 46
State: NY

Vax Date: 09/15/2021
Onset Date: 09/15/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data: None

Allergies: None

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

Symptoms: Patient received vaccine about 130pm on 9/16/21. After the vaccine, the patient waited in the pharmacy for 15 minutes to make sure she did not have a reaction. After that time, she went next door to the restaurant for lunch. About 7pm, the fire marshall came into the pharmacy requesting information about the patient. He was aware that she had just received the vaccine at our pharmacy and was inquiring because she went into cardiac arrest while at restaurant. After life-saving measures by EMT, patient was brought in to Medical Center and shortly after, passed away

Other Meds: Tradjenta, Ferrocite, Aripiprazole, Bupropion SR, Carvedilol, Oxybutynin ER, Medroxyprogesterone, Simvastatin, Clonidine, Myrbetriq, Valsartan, Duloxetine

Current Illness: None

ID: 1703910
Sex: M
Age: 1
State:

Vax Date: 12/02/2014
Onset Date: 12/02/2014
Rec V Date: 09/16/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Child had muscle spasms in arm that would not stop. Taken to ER twice in one day after doctor's office stated they did not have the means to help. First time ER sent child home, but spasms continued so was brought back. When treated with Keppra, spasms stopped. Followed up with neuro and continued Keppra for additional two years after vaccine was received. Charts notate that child was having seizure activity. Child has not received a flu shot since incident.

Other Meds:

Current Illness:

ID: 1703911
Sex: M
Age: 59
State: FL

Vax Date: 03/29/2021
Onset Date: 04/15/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data: RFA Ablation pulse with steroids L and R LFC nerves. 7/22/21

Allergies: None known

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

Symptoms: I had spine surgery 2 weeks following 2nd injection. Woke up left arm paralyzed elbow down but I also got Meralgia Paresthetica bi-lateral and the thighs burning and nerve pain has not subsided nor responded to any treatments. Could be the vaccine did some sort of nerve damages to my body.

Other Meds: Lotensin 20mg Rousouvastatin 10mg prilosec

Current Illness: Herniated discs L-4 L-5 S-1

ID: 1703912
Sex: M
Age: 55
State: OH

Vax Date: 05/05/2021
Onset Date: 09/16/2021
Rec V Date: 09/16/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: PCR + 9/16/2021

Allergies: nka

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

Symptoms: breakthrough covid case w/ dyspnea, cough, malaise

Other Meds: amlodipine, ASA, atorvastatin, glipizide, insulin glargine, insulin lispro, losartan, metformin

Current Illness: no

ID: 1703913
Sex: F
Age: 39
State: NH

Vax Date: 03/16/2021
Onset Date: 04/21/2021
Rec V Date: 09/16/2021
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: Prednisone, Corti-steroids, Codeine, Gluten, Dairy, Betadine

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

Symptoms: After I received the first dose, I woke up with a rash on my left shoulder and went up my left shoulder. I went to the DR (my dermatologist) and they gave me an anti-viral medication for 7 days, 2x a day. Valtrex is what they put me on. The shingles lasted about 3 weeks, I still have nerve damage to this day on my neck.

Other Meds: N/a

Current Illness: n/a

ID: 1703914
Sex: F
Age: 59
State:

Vax Date: 09/14/2021
Onset Date: 09/15/2021
Rec V Date: 09/16/2021
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: Soy allergy

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

Symptoms: Headache, muscle aches, nausea, fatigue, pain and redness at injection site, chills. Most were gone by noon on 9/15, headache persisted all day 9/15, pain and redness still there on 9/16.

Other Meds: Multi-vitamin, excedrin, zyrtec

Current Illness: None

ID: 1703915
Sex: M
Age: 67
State: OH

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 09/16/2021
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: None

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

Symptoms: Very itchy rash on upper chest, lower neck, upper back, and b/l armpits, b/l medial thighs, perianal area that appeared 2 days after second moderna vaccine and has improved with topical triamcinolone

Other Meds: Baby aspirin Calcium B12 Osteo billed Magnesium malate Men 50+ MVI from members mark Collagen Potassium Viagra prn

Current Illness: None

ID: 1703916
Sex: F
Age: 48
State: GA

Vax Date: 03/30/2021
Onset Date: 04/25/2021
Rec V Date: 09/16/2021
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: Menstrual cycle completely stopped after second dose of vaccine on 3/31/21. I have not resumed menstrual cycle at this time.

Other Meds: none

Current Illness: none

ID: 1703917
Sex: F
Age: 43
State: VA

Vax Date: 09/02/2021
Onset Date: 09/06/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data: EKG normal CAT Scan with contrast normal

Allergies: none

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Three days after second Pfizer shot, extreme chest pain, tightness. PCP Seen and PCP sent to cardiologist for full workup. EKG normal. Patient sent for urgent CAT scan with contrast to check for pulmonary emboli. None found. Results normal, but patient on day 10 of severe chest pain and tightness. Doctor suggested it is inflammation brought on by vaccine.

Other Meds: Xarelto 20 mg

Current Illness: none

ID: 1703918
Sex: F
Age: 42
State: NY

Vax Date: 01/12/2021
Onset Date: 02/01/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data: blood work, ultrasounds

Allergies: No

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

Symptoms: A month after the second dose my menstrual cycle became irregular. I had my cycle in February and no again until April 27,2021 but it was irregular. May was also irregular and very heavy. July is when my period started back being normal.

Other Meds: Prenatal vitamin

Current Illness: No

ID: 1703920
Sex: F
Age: 51
State: NC

Vax Date: 09/15/2021
Onset Date: 09/15/2021
Rec V Date: 09/16/2021
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: No Known allergies

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

Symptoms: Patient was administerd Covid Pfizer vaccine IM. While still in vaccine booth patient stated her tongue was feeling numb. She was moved to a recliner and given water to sip. Her breathing rate started to increase, she bacome diaphoretic and pale. She stated her left arm was numb. Her pulse felt rapid. a monitor was placed on the pt. at 2:05pm- Pulse 108, p02 100%, Resp 20, 2:10pm Pulse 120, p02 100%, respirations 24. Rapid response called, advised to call adult medical emergency. Vitals at 2:15pm Pulse 133, p02 100% Respirations 28. Rapid response team arrived, assessed patient and Patient transferred immediately by wheelchair to the Emergency Dept.

Other Meds: N/A

Current Illness: No Known

Date Died: 09/15/2021

ID: 1703921
Sex: F
Age: 85
State: TN

Vax Date: 01/28/2021
Onset Date: 09/15/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: COVID RELATED DEATH; FULLY VACCINATED

Other Meds:

Current Illness:

ID: 1703922
Sex: F
Age: 54
State: NC

Vax Date: 09/01/2021
Onset Date: 09/03/2021
Rec V Date: 09/16/2021
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: Bloodwork, 25th

Allergies: Zomig Metformin Celebrex

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

Symptoms: Severe Swelling of injection site(Baseball size) Deep Redness at Injection site Very Sore/ Painful at Injection Site Very High Fever(104) prolonged Severe Nausea Severe Vomiting Extreme Fatigue Dehydration Severe Body Aches Diarrhea Extreme Body Aches Weightloss Worsening OrthoStatic Hypotension Syncope Low blood/ox Still In The Hospital at 16 days since 3rd vaccine much Doctors Can't Find How, When, What, How longer I Need to be treated and kept in the hospital. I'm still in the Hospital I'm still sick, swollen arm, fever, Fatigue, nausea, vomiting

Other Meds: Eliquis pantoprazole Gabapenten Lipitor Phenergan Mirtazapine fluticasone fludricortizole Zanaflex Effexor Bentyl

Current Illness: None

ID: 1703923
Sex: F
Age: 37
State: NY

Vax Date: 08/23/2021
Onset Date: 08/30/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data: Ultrasound done on lower right leg for blood clot diagnostics on 09/08/2021; negative results.

Allergies: penicillin, lactose, cats, dogs and grass

Symptom List: Injection site pain, Pain

Symptoms: Constant soreness and intermittent pain in right leg (back of knee); tingly sensations in lower right leg, primarily on shin; numb toes and right foot numb (without sitting on it etc.) 4 times in one week; unable to workout because of right leg weakness. Numbness in right hand several times in one week. As of week 3, blurriness in eyes during morning and evening, and light pressure on forehead.

Other Meds: Vitamin C

Current Illness: none

Date Died:

ID: 1703924
Sex: F
Age: 80
State: KY

Vax Date: 02/22/2021
Onset Date: 09/01/2021
Rec V Date: 09/16/2021
Hospital: Y

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: DEVELOPED COVID19 WITH SYMPTOM ONSET 8/19 (MUSLCE ACHES, WEAKNESS, SORE THROAT, CHEST PAIN) AND DIED

Other Meds:

Current Illness:

ID: 1703925
Sex: F
Age: 62
State: IN

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

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

Lab Data: n/a

Allergies: sensitive to vaccines

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

Symptoms: Patient reported that she had itching eyes the afternoon of the vaccine that lasted till 09/13/2021... also felt very cold the same day she received the shot... injection site was red and itching

Other Meds: Blood pressure med Thyroid med

Current Illness: none

ID: 1703926
Sex: F
Age: 64
State: KY

Vax Date: 03/05/2021
Onset Date: 04/13/2021
Rec V Date: 09/16/2021
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: MRI and two hearing tests

Allergies: Lactose

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: I developed Tinnitus during the second week of April 2021. Thinking it could be related to the Meloxicam I was taking, I stopped taking this drug, however, the Tinnitus has continued. I have seen an ENT doctor and was told I have hearing loss. I also went to see an audiologist and was fitted for a hearing aid.

Other Meds: Meloxicam, Vitamin D3, Vitamin B12

Current Illness:

ID: 1703927
Sex: F
Age: 39
State: NH

Vax Date: 05/24/2021
Onset Date: 06/16/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data: N/A

Allergies: Prednisone, Corti-steroids, Betadine, Codeine, Gluten, Dairy

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: I woke up about 3 weeks after the second dose with a lot of jaw pain and pressure in my jaw. I went to my PCP and they gave me antibiotic thinking that it was sinus pressure. It did not help and I see a dentist in a couple weeks, I still have a lot of jaw pain.

Other Meds: N/A

Current Illness: N/A

ID: 1703928
Sex: F
Age: 34
State: CA

Vax Date: 09/14/2021
Onset Date: 09/15/2021
Rec V Date: 09/16/2021
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: Minocycline

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

Symptoms: Swollen left armpit.

Other Meds: Oral contraceptive

Current Illness:

Date Died: 09/06/2021

ID: 1703929
Sex: M
Age: 75
State: FL

Vax Date: 03/23/2021
Onset Date: 09/03/2021
Rec V Date: 09/16/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: This is a 76-year-old Laotian male with reported cirrhosis of the liver, whom we are consulted on for septic shock. All history was obtained from the ICU RN & from the chart, given the patient is intubated. Was driving down to another State. He presented to the ER on 9/3 with generalized weakness and abdominal pain. In the ER, he was hypotensive & confused. CT C/A/P demonstrated cirrhosis of the liver & suspected gastric bleeding. GI was consulted for an EGD, however, the patient was too unstable to undergo endoscopy, hence this procedure had to be canceled. Initial Hgb was 9.7. Unknown baseline. He was transfused. Placed on pressors. He was intubated for respiratory distress.

Other Meds:

Current Illness:

ID: 1703930
Sex: F
Age: 66
State: OH

Vax Date: 09/01/2021
Onset Date: 09/14/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data: n/a I suffered through it

Allergies: nsnaids, CORTISONE, VOLTARAN, ROMOSOZUMAB

Symptom List: Injection site pain

Symptoms: Injection site pain, overall physical pain, especially joint pain, loss of appetite, no energy, slight fever

Other Meds: ACETAMINAPHIN, STATIN FOR CHOLESTEROL

Current Illness:

ID: 1703931
Sex: M
Age: 79
State: OH

Vax Date: 03/12/2021
Onset Date: 09/07/2021
Rec V Date: 09/16/2021
Hospital: Y

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

Lab Data: + COVID19 9/7/21

Allergies:

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

Symptoms: Patient received Moderna vaccination on 2/8/21 and 3/12/21 to become fully vaccinated. Patient tested positive for COVID19 on 9/7/21 and was admitted 9/15/21. Patient is still currently admitted for treatment.

Other Meds:

Current Illness:

ID: 1703932
Sex: F
Age: 22
State: PA

Vax Date: 09/15/2021
Onset Date: 09/16/2021
Rec V Date: 09/16/2021
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: Allergic to percocet and oxycotton

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

Symptoms: I developed a redness around the injection site. The Employee Health nurse took a look at it this morning and upon analysis noticed a bump formed.

Other Meds: Birth control

Current Illness: none

ID: 1703933
Sex: M
Age: 31
State: CA

Vax Date: 09/15/2021
Onset Date: 09/15/2021
Rec V Date: 09/16/2021
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 injected with Moderna vaccine at approximately 1100 on 09/15/21. Approximately 15 minutes after injection the patient began to complain of numbness in the right arm from deltoid to antecubital region. No redness, swelling loss of motion. Fingers were warm and had full ROM. No distress noted. No breathing difficulties noted. Patient reported feeling moderately anxious. Approximately 30 minutes after injection the patient began complaining of a burning sensation in the right arm from deltoid to antecubital region. Patient was encouraged to go to his own provider or to go to the emergency room. Patient called his wife to pick him up. at approximately 1200 the patient left the facility for the emergency room.

Other Meds:

Current Illness:

ID: 1703934
Sex: F
Age: 13
State: TN

Vax Date: 06/27/2021
Onset Date: 07/01/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data: No tests. I informed her doctor via message and she didn't seemed worried and didn't think the vaccine caused the issue.

Allergies: none

Symptom List: Erythema, Pruritus

Symptoms: Once patient received her second shot, her periods for the past 3 months have been irregular. They were never irregular before. She would have a period every two weeks and then go over a month without one. They are still not regular at this point.

Other Meds: none

Current Illness: none

ID: 1703935
Sex: F
Age: 31
State: CO

Vax Date: 09/11/2021
Onset Date: 09/12/2021
Rec V Date: 09/16/2021
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: 9/16- CMP

Allergies: None

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

Symptoms: 9hrs after-site soreness, fever 100.9, body aches 24hrs after- site sorness, fever 101, body aches, extreme fatigue 48hrs after- temp 99.8, fatigue, extreme headache, nausea, extremely lightheaded and dizzy 72hrs and 96hrs after- temp fluctuation 99-101, mild fatigue, mild headache, extremely lightheaded and dizzy

Other Meds: None

Current Illness: None

ID: 1703937
Sex: M
Age: 38
State: GA

Vax Date: 04/07/2021
Onset Date: 08/01/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: I?m experience erectile dysfunction and swollen testicles. I?ve never experienced these symptoms before. They suddenly appeared some months after taking my vaccine shot. I?ve been healthy otherwise until now.

Other Meds:

Current Illness:

ID: 1703938
Sex: F
Age: 47
State: WI

Vax Date: 05/07/2021
Onset Date: 05/09/2021
Rec V Date: 09/16/2021
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: Amoxicillin

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Swollen and painful lymph nodes in right armpit within 48 hours of vaccination. Pain, ache and tenderness in upper right arm, arm pit, right breast and upper right pectoral continues 4 months after vaccinations and has not resolved.

Other Meds: Lialda

Current Illness: None

ID: 1703939
Sex: F
Age: 73
State: NC

Vax Date: 03/05/2021
Onset Date: 08/23/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data: COVID test

Allergies: Yes

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

Symptoms: I contracted COVID-19 virus after being fully vaccinated.

Other Meds: Yes

Current Illness: No

Date Died: 08/19/2021

ID: 1703941
Sex: M
Age: 90
State: KY

Vax Date: 03/19/2021
Onset Date: 08/19/2021
Rec V Date: 09/16/2021
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:

Allergies:

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

Symptoms: DEVELOPED COVID19 (ONSET AND DETAILS UNKNOWN, LOST TO FOLLOWUP) AND DIED

Other Meds:

Current Illness:

ID: 1703942
Sex: F
Age: 86
State: MN

Vax Date: 02/25/2021
Onset Date: 09/09/2021
Rec V Date: 09/16/2021
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: Penicillins (confusion, hallucinations), Blood-group specific substance (unknown reaction)

Symptom List: Pain in extremity

Symptoms: Patient was admitted to the hospital on 9/14/21 with hypoxia due to pneumonia due to COVID-19.

Other Meds: Allopurinol, amlodipine, ascorbic acid, aspirin, calcium carbonate, darbepoetin, insulin aspart, isosorbide mononitrate, metoprolol tartrate, multivitamin, nitroglycerin prn, zofran, simvastatin, tamsulosin

Current Illness:

ID: 1703944
Sex: M
Age: 73
State: MN

Vax Date: 02/15/2021
Onset Date: 09/15/2021
Rec V Date: 09/16/2021
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: Dose 1 Moderna was on 1/18/2021, and Dose 2 Moderna was on 2/15/2021

Other Meds:

Current Illness:

ID: 1703945
Sex: F
Age: 58
State: FL

Vax Date: 04/11/2021
Onset Date: 09/11/2021
Rec V Date: 09/16/2021
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: he patient presents with 58-YEAR-OLD FEMALE HISTORY OF CHRONIC ALCOHOLISM, MELANOMA PRESENTS TO EMERGENCY DEPARTMENT WITH MULTIPLE COMPLAINTS. STATES APPROXIMATELY 5 MONTHS AGO SHE RECEIVED HER JOHNSON & JOHNSON CORONAVIRUS VACCINE AND SINCE THAT TIME HAS FELT FATIGUED WITH LITTLE ENERGY. STATES SHE ALSO HAS UNEXPECTED WEIGHT LOSS OF ABOUT 20 LB SINCE THIS YEAR. SHE SAW A DOCTOR AT THE CLINIC THIS MORNING WHO REFERRED HER TO THE EMERGENCY DEPARTMENT. STATES SHE DRINKS VODKA DAILY AND HAS BEEN CUTTING BACK TO 2 SERVINGS PER DAY. STATES SHE HAS TINGLING IN HER BILATERAL HANDS AND FEET AND FEELS NAUSEATED. NOTED TO BE TACHYCARDIC UPON ARRIVAL. HER DOCTOR SENT HER WITH A LETTER RECOMMENDING INPATIENT ALCOHOL DETOX. SHE DENIES ANY CHEST PAIN OR SHORTNESS OF BREATH, NO NECK PAIN OR STIFFNESS. NO AUDITORY VISUAL HALLUCINATIONS. NO BLACK OR BLOODY STOOLS. NO HEMATEMESIS OR ABDOMINAL PAIN.. The onset was chronic. The course/duration of symptoms is fluctuating in intensity. Location: SEE HPI. The character of symptoms is SEE HPI. The degree at onset was moderate. The degree at present is moderate. Risk factors consist of SEE HPI. Therapy today: see nurses notes. Associated symptoms: denies chest pain, denies headache and denies back pain. .

Other Meds:

Current Illness:

ID: 1703946
Sex: F
Age: 61
State: MO

Vax Date: 03/11/2021
Onset Date: 09/08/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data: Positive Covid test.

Allergies:

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

Symptoms: Hit me in the sinuses and my eyes were hurting, It felt like a head cold a real bad head cold. I went to get checked they offered antibodies and I did not want to go to the hospital, a few days later it hit me hard I got really fatigued and broke out into sweats.

Other Meds: Zoloft; Celebrex; Pepcid

Current Illness:

ID: 1703947
Sex: M
Age: 53
State: VI

Vax Date: 09/11/2021
Onset Date: 09/11/2021
Rec V Date: 09/16/2021
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: No

Symptom List: Vomiting

Symptoms: Continuous Headaches. Taken Tylenol

Other Meds: Tylenol

Current Illness: None

ID: 1703948
Sex: M
Age: 86
State: KY

Vax Date: 05/28/2021
Onset Date: 09/10/2021
Rec V Date: 09/16/2021
Hospital: Y

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

Lab Data:

Allergies: chlorhexedine contrast dye fentanyl keflex morphine PCN vancomycin

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Pt had 1st moderna shot in 5/2021 - no second shot received. Now admitted to hospital with COVID 9/10/2021

Other Meds: unknown

Current Illness: unknown

ID: 1703949
Sex: F
Age: 19
State:

Vax Date: 09/02/2021
Onset Date: 09/15/2021
Rec V Date: 09/16/2021
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: Zithromax

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

Symptoms: Increased menstrual bleeding that soaks a overnight pad every 30 min for 24 hours. This is uncommon for her. Possible anemia.

Other Meds: None

Current Illness: None

ID: 1703950
Sex: F
Age: 24
State: CO

Vax Date: 04/01/2021
Onset Date: 07/01/2021
Rec V Date: 09/16/2021
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: CBC ordered 8/20/21 WBC 5.0, RBC 4.72, Hgb 14.4, Hct 42.7, MCV 90.5, mCH 30.5, MCHC 33.7, RDW 12.1, platelet 260, absolute neutrophil 2255, absolute lymphocytes 2145, absolute monocytes 410, absolute eosinophils 130, absolute basophils 60.

Allergies: NKDA

Symptom List: Injection site swelling, Limb discomfort

Symptoms: In July, patient noticed Right axillary lymphadenopathy. 3 lymph nodes were enlarged and nontender. No history of wounds, injuries, infections or illness. Pt endorsed good overall health. Denied fever, weight loss, chills, night sweats. No other lymphadenopathy noted. Patient received both Pfizer COVID19 injections in April, 3 weeks apart. Patient unsure of exact dates. Both injections were to the right deltoid.

Other Meds: synthroid 75 mcg po daily

Current Illness: N/A

ID: 1703951
Sex: M
Age: 13
State: IN

Vax Date: 09/14/2021
Onset Date: 09/15/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data: EKG showed sinus tachycardia and was otherwise normal.

Allergies:

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

Symptoms: Patient developed fever, myalgias, headache, and tachycardia the day after his vaccine. He was taken to the ED by his mother for concern about myocarditis. He was discharged in stable condition and followed up with me outpatient the next day. His symptoms were resolved when I saw him.

Other Meds:

Current Illness:

ID: 1703952
Sex: F
Age: 56
State: KY

Vax Date: 12/29/2020
Onset Date: 09/07/2021
Rec V Date: 09/16/2021
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: Positive COVID test

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am