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: 1703954
Sex: F
Age: 34
State: DC

Vax Date: 01/29/2021
Onset Date: 01/31/2021
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: TSH October 2020 2.29 TSH February 24 2021 4.5 TSH June 21 2021 3.4 (5 weeks pregnant)

Allergies: Quinalones, topical iodine

Symptom List: Dysphagia, Epiglottitis

Symptoms: Accelerated progression of hypothyroidism increasing TSH from baseline of 1.8 to 2.3 up to 4.5 in February 2021. Severe symptoms of hypothyroidism including fatigue, coldness, brittle nails and hair, stiff muscles and joints, tinnitus, unexplained weight gain of 8-12 pounds, and difficulty losing weight since. Possible connection between TSH and first trimester miscarriage which took place around 9-11 weeks in late July to early August 2021.

Other Meds: Claritin, probiotics, multivitamin

Current Illness: N/a

ID: 1703955
Sex: F
Age: 68
State: PA

Vax Date: 09/14/2021
Onset Date: 09/14/2021
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:

Allergies: Cashews, macadamia nuts, penicillin, Plavix

Symptom List: Anxiety, Dyspnoea

Symptoms: I had the typical sore arm and achy feeling, but I also was nauseous. I got up to use the bathroom in the middle of the night and passed out. I fell and now have a huge bruise on my left thigh where I hit something hard, probably the toilet. My whole left side of my thigh is tender and swollen where it is black and blue.

Other Meds: Synthroid, Cytomel, Topamax, Prolia, multivitamin

Current Illness: none

ID: 1703956
Sex: M
Age: 63
State: OR

Vax Date: 08/19/2021
Onset Date: 08/30/2021
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: nonr

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

Symptoms: Rash

Other Meds: none

Current Illness: none

ID: 1703957
Sex: M
Age: 52
State:

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

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: hospitalization

Other Meds:

Current Illness:

ID: 1703958
Sex: F
Age: 65
State: MI

Vax Date: 03/13/2021
Onset Date: 07/01/2021
Rec V Date: 09/16/2021
Hospital: Y

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

Lab Data: July 28, 2021 CT scans, MRI of brain, chest x-ray, echocardiogram, blood tests, ultrasound of eyes,

Allergies: none

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

Symptoms: Dizziness, weakness, nausea, difficulty walking, shaking, sweating, burning pain down left side of spine and into neck, dead feeling in left arm. happened at 3:30am when tried to get out of bed, last hour or so until went back to sleep, lightheaded the rest of the day, sudden vision disturbances and severe headaches few days later for 3 out of 4 days. Had a similar episode in December of 2020.

Other Meds: Estradiol, Glucosamine Chondroitin Sulfate, Ibprofen, Magnesium, Vitamin C, Vitamin A, Fish Oil, Biotin with Keratin,

Current Illness: none

ID: 1703959
Sex: F
Age: 70
State:

Vax Date: 03/05/2021
Onset Date: 09/15/2021
Rec V Date: 09/16/2021
Hospital: Y

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:

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

Symptoms: hospitalization

Other Meds:

Current Illness:

Date Died: 09/15/2021

ID: 1703960
Sex: M
Age: 30
State: PA

Vax Date: 08/30/2021
Onset Date: 09/15/2021
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: No Known Drug Allergies

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Bilateral leg pain, history of venous thrombosis.

Other Meds: Unknown

Current Illness: Personal history of Venous Thrombosis

ID: 1703961
Sex: F
Age: 17
State: WA

Vax Date: 08/01/2021
Onset Date: 09/02/2021
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: None

Symptom List: Pharyngeal swelling

Symptoms: Halle has had regular periods for over four years. Since receiving the vaccine she has not had a. And is over two weeks late. She is not sexually active and there is no other reason for this to occur. She?s extremely distraught and concerned about her personal health and is scared of taking the second vaccine now

Other Meds: None

Current Illness: None

ID: 1703962
Sex: F
Age: 60
State: FL

Vax Date: 03/16/2021
Onset Date: 09/14/2021
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:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: 61-year-old female patient with past medical history of asthma, pulmonary hypertension, on home oxygen, COVID-19 infection, bilateral pedal ureteral stent placement, UTI and BSI with ESBL E coli who was being treated at home for recent UTI and BSI infection on Invanz daily. Home health care visit found fever of 101 and was advised to come to the emergency room. While in the emergency room her fevers of 100 complaining of increased shortness of breath and feels her lungs are feeling again. Continues to complain of bilateral flank pain from her recent kidney stone and stent placements. Patient did receive her COVID-19 vaccination in April 2021. Patient did receive remdesivir on previous visit. CT of the abdomen shows borderline hydronephrosis on the right, with a decompressed system on left. Bilateral ureteral stents in appropriate position. No ureteral stones. Mild nonspecific peri red will impair renal fat stranding edema. Correlate with urinalysis. Also stable known restrictive umbilical hernia containing transverse colon, small bowel and omental fat. CT of the chest shows no pulmonary emboli, shows bilateral ground-glass infiltrates. Has been on BiPAP but now has been weaned down to 4 L hemo to 5 oxygen. Discussed with nursing. States has been evaluated by Urology and plans for removal of stents tomorrow. Will continue vancomycin and meropenem, await blood and urine cultures. Monitor O2 requirements and chest x-rays repeat procalcitonin level and continue to follow. Thank you for the opportunity to assist with the care and treatment of this patient.

Other Meds:

Current Illness:

ID: 1703963
Sex: M
Age: 12
State: TX

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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: EGG

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient given 1.8 ml of Pfizer vaccine instead of the recommended 0.3 ml dose.

Other Meds:

Current Illness:

ID: 1703964
Sex: F
Age: 29
State: MA

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:
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: No

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

Symptoms: Right after injection arm felt warm to the touch and face became slightly flushed. The next morning injection site was red warm and slightly swollen and tender to the touch. Injection may have been given to low on arm

Other Meds: Birth control daily

Current Illness: No

ID: 1703967
Sex: M
Age: 45
State: MO

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: SYR
Vax Site: RA

Lab Data:

Allergies: NSAIDs and seasonal allergies

Symptom List: Rash, Urticaria

Symptoms: 8 hours after getting the vaccine i started having aggressive body aches, chills and body literally shaking out of control like I was possessed and 102 fever. The pain and stiffness moved around my body starting at my shoulders and back then my hips. I finally broke the fever after 4 hours of shaking and aching. I woke up this morning with no fever but feel tired and achy with a headache front to back.

Other Meds: Cosentyx Lisinipril Atvortistatin

Current Illness:

ID: 1703968
Sex: F
Age: 29
State: NJ

Vax Date: 04/03/2021
Onset Date: 04/09/2021
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: None

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

Symptoms: Intense period pains and cramps, much worse than I have ever experienced, during my period following the vaccination.

Other Meds: None

Current Illness: None

ID: 1703969
Sex: M
Age: 58
State: TX

Vax Date: 09/13/2021
Onset Date: 09/15/2021
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: SYR
Vax Site: LA

Lab Data: none

Allergies: NKDA

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

Symptoms: sore arm, with swelling and tenderness to axillae, sore throat, sore muscles in the right neck and shoulder,

Other Meds: aripiprazole, amlodipine, sertraline

Current Illness: none

ID: 1703970
Sex: F
Age: 39
State: WV

Vax Date: 09/01/2021
Onset Date: 09/06/2021
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: Flaygel antibiotic

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

Symptoms: My hands feet legs and arms was burning numb and tingling like they have pins and needles in them the left side of my face was doing the same thing my heart rate is staying up high and it felt like someone had 2 fingers on each side of my throat squeezing it together this all didn?t start till day 5 up till then I felt fine ?..I went to my dr and he said to keep and eye on it?.. I?m feeling some what better note hands are what?s staying numb with pins and needles now my legs and feet do it every now and again but my heart rate is still staying up high so he?s doing a ekg on me in a few days and sending me to a heart doctor

Other Meds: None

Current Illness: None

ID: 1703971
Sex: M
Age: 17
State: VI

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

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

Lab Data:

Allergies: none

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

Symptoms: Recipient did not experience an adverse reaction. He inadvertently received the Moderna vaccine before 18 years old. He was 17 years 6 months at the time of vaccination.

Other Meds:

Current Illness: none

ID: 1703972
Sex: F
Age: 86
State: GA

Vax Date: 09/15/2021
Onset Date: 09/15/2021
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: NKDA

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

Symptoms: FEVER, CHILLS AND BODY ACHES

Other Meds: SIMVASTATIN, MELOXICAM, LISINOPRIL, LEVOTHYROXINE, TRAMADOL, AMLODIPINE

Current Illness: NOT KNOWN

ID: 1703973
Sex: M
Age: 64
State: MI

Vax Date: 04/05/2021
Onset Date: 09/07/2021
Rec V Date: 09/16/2021
Hospital: Y

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

Lab Data: COVID positive test 9/7/21

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: COVID vaccine breakthrough case

Other Meds:

Current Illness:

ID: 1703974
Sex: F
Age: 61
State: CO

Vax Date: 04/03/2021
Onset Date: 04/03/2021
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: None

Allergies: Sulfa drugs, Percocet, articaine

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Headache, body aches, racing heart, pain in heart, passing out (once), sweating, nausea, pain in arm where received injection

Other Meds: Resveratrol, metropolol, Coumadin, armory thyroid, baby aspirin, bioidentical HRT, multivitamin/mineral, CoQ10, Vit D,

Current Illness: None

ID: 1703975
Sex: F
Age: 33
State: WV

Vax Date: 04/05/2021
Onset Date: 04/05/2021
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:

Allergies:

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

Symptoms: II have always had on time monthly menstration cycles after the shot I have not had a cycle

Other Meds:

Current Illness:

ID: 1703976
Sex: F
Age: 74
State: PA

Vax Date: 08/20/2021
Onset Date: 08/21/2021
Rec V Date: 09/16/2021
Hospital: Y

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: Testing done in the Hospital.

Allergies: Latex, Ampicillin, Cipro, Aspirin, Morphine, Codeine, Caines with Epinephrine, Contrast Dye, Adhesive

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

Symptoms: Had all symptoms of COVID except Respiratory and loss of taste and smell. Had 3 COVID tests which were all negative including the PBR test.. Low BP. Was admitted to hospital

Other Meds: Atenolol, Diltiazem, Vasotec, Lasix, Gabapentin, Plavix, Pravastatin, Allopurinol, Tramadol, Prilosec, Zofran, Vitamin D3, Calcium

Current Illness: None

ID: 1703977
Sex: M
Age: 50
State: NC

Vax Date: 08/23/2021
Onset Date: 08/23/2021
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: Blisters on back side of arm down to wrist and raise in blood pressure for about a week.

Other Meds: Gilenya Atorvastain Metoprlol Cymbalta Baclofen

Current Illness:

ID: 1703978
Sex: F
Age: 56
State: MI

Vax Date: 03/18/2021
Onset Date: 03/18/2021
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:

Allergies: Ciprofloxacin, Levofloxacin, Mupirocin, Clarithromycin, Codeine, Exenatide, Hydrocodone bitartrate, Iron dextran complex, latex, Phytonadione, promethazine, quinacrine, rofecoxib

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

Symptoms: Hives all over body 3 hours after shot, lasted for 5 days Felt Hot, Low grade temp for 2 days Headache, Could not think, lasted for 3 1/2 weeks Short of breath for 5 or 6 days, had to use asthma inhalers Cough Extreme fatigue 3 1/2 to 4 weeks, in bed 12-14 hrs per day Unsteady - not vertigo, it was different Large golf ball lump at vaccine site - still sore

Other Meds: Albuterol, losartan Hydrochlorothiazide, Metoprolol succination, Mometasone-formoterol, Furosemide, Ozempic, Cosentyx, Insulin Glargine (Lantus solostar), Insulin Lispro, Valacyclovir, Cetirizine, Cyanocobalamin, Doxycycline, Tramadol

Current Illness:

ID: 1703979
Sex: F
Age: 72
State: MD

Vax Date: 09/09/2021
Onset Date: 09/11/2021
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: none

Allergies: none

Symptom List: Injection site pain, Pain

Symptoms: red warm swollen itching at injection site and surrounding arm area. Appeared 48 hours post injection. This was third dose. No such reaction with doses 1 or 2.

Other Meds: bystolic, lisinopril, crestor mulitvivtamins, cranberry probiotic

Current Illness: surgical removal of ovarian tumor. Angiomyolipoma renal

ID: 1703980
Sex: F
Age: 37
State:

Vax Date: 04/07/2021
Onset Date: 04/12/2021
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: Chest x-ray showed no abnormality; CBC was normal

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Extreme shortness of breath, which last for approximately 4 days. Patient had no history of shortness of breath and has had no recurrence.

Other Meds: Zyrtec, Flonase

Current Illness:

ID: 1703981
Sex: F
Age: 8
State: FL

Vax Date: 06/30/2021
Onset Date: 06/01/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data: N/A

Allergies: No Known allergies

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

Symptoms: The patient is an 8-year-old female who received the COVID-19 Pfizer vaccine on 6/30/2021. At this time, there are no reported symptoms by the patient or guardian.

Other Meds: No medication reported

Current Illness: N/A

ID: 1703982
Sex: F
Age: 28
State: PR

Vax Date: 09/01/2021
Onset Date: 09/01/2021
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:

Allergies: Crustacean

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Strong heart beat during bed time for about 2 minutes.

Other Meds: None medications

Current Illness: None

ID: 1703983
Sex: F
Age: 60
State: NH

Vax Date: 03/10/2021
Onset Date: 07/06/2021
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: Echo cardiogram 31 day event monitor

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Heart palpitations

Other Meds:

Current Illness:

ID: 1703984
Sex: F
Age: 42
State: IL

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: None

Allergies: Sulfa

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

Symptoms: Redness and swelling of right arm Nausea Fever of 100.0-101.0 Severe chills

Other Meds: Ibuprofen as needed

Current Illness: None

ID: 1703985
Sex: F
Age: 79
State:

Vax Date: 02/27/2021
Onset Date: 09/15/2021
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: Patient was brought here by her daughter for altered mental status. She could only answer questions yes, no or okay. The patient was in the Hospital 8/17/2021 for dehydration and had similar presentation. 2 weeks prior she was in the Hospital once again for urinary tract infection.

Other Meds:

Current Illness:

ID: 1703986
Sex: M
Age: 62
State: TX

Vax Date: 03/20/2021
Onset Date: 09/05/2021
Rec V Date: 09/16/2021
Hospital: Y

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

Lab Data: COVID+ PCR test on 9/15/21

Allergies:

Symptom List: Injection site pain

Symptoms: COVID breakthrough. Patient recently returned from vacation and began having symptoms for COVID on 9/5/21 such as cough, chills, and fatigue. He presented to the hospital on 9/14/21 with ongoing symptoms and decreased oxygen saturation. He tested positive in the hospital on 9/15/21.. He is currently on 5L of Oxygen.

Other Meds:

Current Illness:

ID: 1703987
Sex: M
Age: 85
State:

Vax Date: 02/27/2021
Onset Date: 09/15/2021
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:

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

Symptoms: Patient was brought here by her daughter for altered mental status. She could only answer questions yes, no or okay. The patient was in Hospital 8/17/2021 for dehydration and had similar presentation. 2 weeks prior she was in Hospital once again for urinary tract infection.

Other Meds:

Current Illness:

ID: 1703988
Sex: M
Age: 36
State: WI

Vax Date: 09/13/2021
Onset Date: 09/15/2021
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: None

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

Symptoms: Chest pain

Other Meds: None

Current Illness: None

ID: 1703989
Sex: F
Age: 8
State: FL

Vax Date: 04/05/2021
Onset Date: 04/01/2021
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: N/A

Allergies: No known documented allergies

Symptom List: Tremor

Symptoms: The patient is an 8-year-old female who received the COVID-19 Moderna vaccine on 4/05/2021. At this time, there are no reported symptoms by the patient or guardian.

Other Meds: No medication reported

Current Illness: N/A

ID: 1703990
Sex: M
Age: 32
State: TN

Vax Date: 05/25/2021
Onset Date: 06/01/2021
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:

Allergies: none

Symptom List: Erythema, Pruritus

Symptoms: A WEEK OR SO AFTER GETTING THE J&J VACCINE I STARTED EXPIERENCING ISSUES WITH SMELL AND TASTE. I NOTICED THIS FIRST WITH DRINKING MT DEW. IT TASTED RANCID AND METALLIC LIKE. THEN AT DINNER EATING FOOD IT HAD A AWFUL METALLIC TASTE AND SMELL. THIS IS STILL PRESISTING TO HAPPEN AS OF TODAY.

Other Meds: Phentermine 37.5mg taken once daily Ibuprofen 800 taken when needed Fluoxetine 20mg taken once daily

Current Illness: none

ID: 1703991
Sex: M
Age: 61
State: TX

Vax Date: 03/11/2021
Onset Date: 08/06/2021
Rec V Date: 09/16/2021
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: CXR, CBC, CMP, upper respiratory panel

Allergies: sulfa

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

Symptoms: Developing congestion and cough, got tested at PCP office. Antibiotics given.

Other Meds: amlodipine, losartan

Current Illness:

ID: 1703992
Sex: F
Age: 69
State: OH

Vax Date: 03/15/2021
Onset Date: 03/15/2021
Rec V Date: 09/16/2021
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: All results normal

Allergies: Percocet, Vicodin, statin (aggravated colitis)

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

Symptoms: After dinner I started feeling dizzy, weak and tired. I laid down and tried to sleep. As I closed my eyes, the dizziness got worse. I then started vomiting. I went to the ER, where they gave me a shot and the dizziness and vomiting went away. I also have tachycardia now. This is something I have never had before. I was hospitalized for this last month

Other Meds: budesonide (3mg, 2x/daily), valacyclovir (500mg, 3x/week), vitamin D3 (1000 iu) ezetimibe 10mg, amlodipine (10mg, 1x/day), losartan (100mg, 1x/day), potassium chloride

Current Illness: None

ID: 1703993
Sex: F
Age: 67
State: VI

Vax Date: 04/06/2021
Onset Date: 05/19/2021
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: blood, ekg, cardiac monitor, caradid doppler

Allergies: Pennicillin

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Beginning 5/19/2021 experienced rapid heat beat lasting about an hour. About a week later experienced the same but several times a day. Saw cardiac as it continued to happen in late August. Wore cardiac monitor for one week diagnosis Arterial flutter possibly due to vaccine. Have been prescribed Eliquist to prevent clots and Metroprolol to try and regulate. Doctor says these medicines should be taken until after the booster dose of the covid 19 vaccine and then I should be reevaluated.

Other Meds: anastrozol, losartin, d, cal/mag/d/zinc, aspirin, omego 3

Current Illness: none

ID: 1703994
Sex: F
Age: 55
State: CA

Vax Date: 09/14/2021
Onset Date: 09/14/2021
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: N/A

Allergies: Tylenol, Ibuprofen

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

Symptoms: Pt. states that after receiving the 1st dose of Phizer 09/14/2021, started experiencing symptoms that evening of Pressure in the chest, pain in right arm to neck, vomiting, nausea, fever 102.0, chills, right arm swollen at injection site, headaches, lack of sleep, still continuing experiencing symptoms, Primary recommendations not to receive the 2nd dose, Primary refuses to sign any HR forms.

Other Meds: N/A

Current Illness: N/A

ID: 1703995
Sex: F
Age: 28
State: OK

Vax Date: 09/14/2021
Onset Date: 09/14/2021
Rec V Date: 09/16/2021
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: unknown

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

Symptoms: Vaccine given 44 minutes after open vial discard time.

Other Meds: unknown

Current Illness: unknown

ID: 1703996
Sex: F
Age: 42
State: FL

Vax Date: 08/31/2021
Onset Date: 09/01/2021
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: 6-Sept-2021 - chest xray - EKG - blood tests All in normal limits; however white blood count was elevated, per doctor

Allergies: no

Symptom List: Pain in extremity

Symptoms: chest pain (dull/pressure) - pain severity 3/4 out 10; intermittent daily pain started on 01-Sept-2021 (day following 2nd dose) by 5-Sept-2021 length of pain was lasting longer and by 6-Sept-2021 pain was constant albeit still dull/pressure feeling. Went to ER the evening of 6-Sept-2021.

Other Meds: prednisone

Current Illness: Urgent Care diagnosis of Pityriasis Rosea (14-Aug-2021). Prednisone was prescribed by Urgent Care physician to treat the condition.

ID: 1703997
Sex: F
Age: 63
State: MD

Vax Date: 04/02/2021
Onset Date: 04/15/2021
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: Hospitalization for infection - Blood Tests - MRI, CT

Allergies: Dust mites, ragweed, hickory tree, pecan tree, elm tree, mountain cedar tree, maple tree, Cobalt dichloride, nickel sulfate, thimerosal, propolis

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

Symptoms: Increased genital herpes outbreaks. Extreme increase in genital herpes outbreaks. High White Blood Count - Infection, vertigo and extreme dizziness.

Other Meds: None

Current Illness: None

ID: 1703998
Sex: F
Age: 11
State: FL

Vax Date: 06/23/2021
Onset Date: 06/01/2021
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: N/A

Allergies: No known disclosed allergies

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

Symptoms: The patient is an 11-year-old( at the time of vaccine administration) female who received the COVID-19 Pfizer vaccine on 6/23/2021. At this time, there are no reported symptoms by the patient or guardian.

Other Meds: NO medication reported

Current Illness: N/A

ID: 1703999
Sex: F
Age: 68
State: NH

Vax Date: 08/31/2021
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: sulfa

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

Symptoms: Sept 15 Severe VERTIGO

Other Meds:

Current Illness:

ID: 1704000
Sex: F
Age: 11
State:

Vax Date: 09/14/2021
Onset Date: 09/14/2021
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:

Symptom List: Vomiting

Symptoms: mom reported daughter was 12 years old for pfizer vaccine and wrote 12 years old on consent form but birthday in patients profile does not match patients reported age. received second pfizer vaccine on 9.14.2021

Other Meds:

Current Illness:

ID: 1704002
Sex: F
Age: 83
State:

Vax Date: 03/20/2021
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: Ceftin (Diarrhea), sulfa antibiotics (Hives)

Symptom List: Headache, Limb discomfort, Nasal congestion

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

Other Meds: acetaminophen/diphenhydramine, alendronate, ascorbic acid, benzonatate, Symbicort, calcium carbonate, cetirizine, cholecalciferol, dexamethasone, famotidine, fluticasone, multivitamin, rivaroxaban

Current Illness:

ID: 1704003
Sex: F
Age: 32
State: NC

Vax Date: 09/02/2021
Onset Date: 09/11/2021
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: Hcg blood test 9/13/21 Ultrasound 9/13/21

Allergies: Sulfa allergy

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

Symptoms: Miscarriage; tested positive for pregnancy on 9/4/21 and 9-9/21. Began cramping and bleeding 9/11/21, miscarriage confirmed 9/13/21.

Other Meds:

Current Illness:

ID: 1704004
Sex: F
Age: 70
State: MN

Vax Date: 08/26/2021
Onset Date: 08/01/2021
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:

Allergies: Shellfish,penecillin, statins, sprices

Symptom List: Injection site swelling, Limb discomfort

Symptoms: little finger of left hand numb

Other Meds: levothyrroxine

Current Illness:

ID: 1704005
Sex: M
Age: 72
State:

Vax Date: 03/21/2021
Onset Date: 08/15/2021
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:

Allergies:

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

Symptoms: painful swollen testicals

Other Meds:

Current Illness:

ID: 1704006
Sex: M
Age: 45
State: OK

Vax Date: 07/17/2021
Onset Date: 09/15/2021
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: 09/15/21: POSITIVE POC SARS COVID RAPID ANTIGEN (QUICKVUE)

Allergies: NKA

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

Symptoms: COUGH, SOB, CHILLS, FATIGUE, SORE THROAT, HEADACHE

Other Meds: LAMOTRIGINE, HYDROXYZINE, ALBUTEROL, NICOTINE PATCH, TRAZODONE, MELATONIN, DICLOFENAC GEL

Current Illness: NONE

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am