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: 1704007
Sex: M
Age: 57
State: TX

Vax Date: 03/11/2021
Onset Date: 08/11/2021
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: IM
Vax Site: LA

Lab Data: ABG, CBC, CMP, CXR, EKG, Cardiac profile, rapid COVID

Allergies: NKDA

Symptom List: Dysphagia, Epiglottitis

Symptoms: Low O2 saturation, SOB

Other Meds: amlodipine, crestor, furosemide, glipizide,metoprolol, pioglitazone

Current Illness:

ID: 1704008
Sex: F
Age: 33
State: UT

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

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Woke up the morning after my second vaccine with swollen lymph nodes on the right side of my neck and near my right collar bone. Right arm is also very sore, slightly swollen.

Other Meds:

Current Illness:

ID: 1704009
Sex: F
Age: 60
State: NY

Vax Date: 09/10/2021
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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Low grade temperature the day after. 38 hours after pt. collapsed and was not coherent for a short period of time. After I was able to lay here down she was noticeably sweating on her face and body. We had her pulse taken by an EMS worker who was at the event the time of occurrence.

Other Meds:

Current Illness:

ID: 1704010
Sex: F
Age: 76
State: KY

Vax Date: 04/16/2021
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: Moderna 3/19 and 4/16. Positive on 9/15

Other Meds:

Current Illness:

ID: 1704011
Sex: F
Age: 70
State: FL

Vax Date: 03/15/2021
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: echocardiogram 9/2/2021

Allergies:

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

Symptoms: Rapid heart rate

Other Meds: Blood Pressure medications , nerve medication

Current Illness:

ID: 1704012
Sex: F
Age: 69
State: OH

Vax Date: 08/27/2021
Onset Date: 08/28/2021
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: urinalysis

Allergies: Macrodantin, Benzoyl Peroxide

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

Symptoms: 24 hours later, I noticed swelling of my lymph nodes in my neck and right axilla. They were swollen and painful. It took 2 days for that to resolve. I did take Tylenol. On 9/8/2021, I developed symptoms of urinary infection of burning, urgency and frequency. I went to Urgent Care that day. They did an urinalysis and I was treated with antibiotics Keflex. I am currently still on Keflex.

Other Meds: Tylenol

Current Illness: non Hodgkin lymphoma, leukemia

ID: 1704013
Sex: M
Age: 49
State: KY

Vax Date: 04/08/2021
Onset Date: 09/15/2021
Rec V Date: 09/16/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Pfizer 3/18 and 4/8. Positive on 9/9

Other Meds:

Current Illness:

ID: 1704014
Sex: F
Age: 23
State: KS

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:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKDA

Symptom List: Pharyngeal swelling

Symptoms: 48 hours after vaccination, developed Nausea with vomiting, migraine like headache, chills, hot flashes. Seen in clinic 24 hours into symptoms, 72 hours after vaccine. Was seen in clinic. Suspect future outcome is she will be OK.

Other Meds: None

Current Illness: None

ID: 1704015
Sex: F
Age: 38
State: PA

Vax Date: 08/28/2021
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: shoulder xray ordered

Allergies: tramadol, morphine, naprosyn, topamax

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: muscle spasms, shoulder stiffness, neck pain for 2 weeks following COVID vaccination.

Other Meds: multivitamin, vitamin C

Current Illness: unknown

Date Died: 08/24/2021

ID: 1704016
Sex: M
Age: 79
State:

Vax Date: 06/22/2021
Onset Date: 08/18/2021
Rec V Date: 09/16/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: presented with pneumonia due to COVID, respiratory failure, acute kidney injury, discharged to hospice where he died

Other Meds:

Current Illness:

ID: 1704017
Sex: M
Age: 55
State: NC

Vax Date: 05/07/2021
Onset Date: 05/11/2021
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: No labs, only physical test done by Neorologist. Follow-up with Neuro on Sept 17

Allergies: Penicillin

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

Symptoms: 1. May 7 - 2nd dose 2. May 8 - Lymph Node swelled to golf ball size day after vaccine. 3. May 11 - Top of feet and lower legs started to burn and eventually spread to lower half of upper leg. Same sensation in forearms from time to time, but not as severe as in legs. Legs are constant. Exacerbated by heat (outside temp, shower, etc.) 4. June 10 - Saw primary pyhsician (referred to Neurologist) 5. June 29 - Neurologist ruled out Neuropathy and said should pass over time 6. Still ongoing as of Sept 16 with no let-up

Other Meds: Multi VIt, VIt C, Vit E, Selenium, Baby Aspirin

Current Illness: NA

ID: 1704018
Sex: F
Age: 33
State: IL

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: 9-13-21. CBC, CMP, Ferritin. All within normal limits. H&H on very low end of normal.

Allergies: None

Symptom List: Rash, Urticaria

Symptoms: First covid shot on 8-25-21. On 8-28-21 started another menstrual cycle 1 week after finishing regular cycle. Daily headaches and intermittent migrains for 8 days starting day of injection. Persistent fatigue. Second dose on 9-15-21. Approximately 6 hours after injection started to develop stomach ache. Just before midnight started to vomit/ dry heave for 2 hours followed by 1 hour of severe abdominal cramping and chills. 9-16-21 persistent headache and sore abdominal muscles. Injection site soreness.

Other Meds: None

Current Illness: None

ID: 1704019
Sex: F
Age: 42
State: FL

Vax Date: 09/03/2021
Onset Date: 09/03/2021
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: Right Leg Ultrasound to check for blood clots/DVT's (nothing found) 9/15/2021

Allergies: Levaquin Injections - Hives

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

Symptoms: Numbing/Tingling/Burning in Right Thigh Saw family doctor on SEP 15, 2021 as symptoms were causing a limp along with the pain No Blood Cot (Ultrasound was performed), will revisit doctor in 30 days if not better

Other Meds: Klonopin 0.5mg Cymbalta 60mg Seroquel 100mg Ambien 10mg Low Dose Aspirin daily

Current Illness: N/A

ID: 1704020
Sex: F
Age: 55
State: CT

Vax Date: 02/10/2021
Onset Date: 02/10/2021
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: No further tests seemed necessary at the time. However, after 2nd dose in my right arm, within days I had the same type of reaction. This time, my right foot toes have numbness and my left big toe. I am currently scheduled to see a neurologist and will have a nerve study completed.

Allergies: Sulfa medication

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

Symptoms: Within a few minutes of getting the vaccine, I had numbness in my toes. In my left foot it was all my toes and my right foot it was my big toe. Spoke to some of the volunteers present, they had never heard of this type of reaction. I stayed there for 20 minutes, and nothing more happened. They recommended that if it continues to see my physician. The numbness came and went for several days and eventually went away then.

Other Meds: lisinopril and flexeril

Current Illness: none

ID: 1704021
Sex: F
Age: 36
State: NC

Vax Date: 02/26/2021
Onset Date: 02/26/2021
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: None.

Allergies: None.

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

Symptoms: It started 5:30 day of shot when my Covid symptoms came back and stayed for about three weeks. I had shortness of breath, and I couldn't walk around. They said that wasn't a typical reaction. I filled out forms online and they said that wasn't an expected reaction to the shot. I had a few others at time and they said those were to be expected, except the shortness of breath. Shortness of breath lasted for about until the 2-3 weeks before 2nd vaccine. It didn't happen immediately after vaccine with shortness of breath.. It was intermittent and I was able to sit down and catch my breath and it just felt like Covid.

Other Meds: Clomid fertility medicine (unsure of I was on it at that time).

Current Illness: Tested for Covid on January 20.

ID: 1704022
Sex: M
Age: 44
State: GA

Vax Date: 02/27/2021
Onset Date: 03/01/2021
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: Egg (including flu vaccine)

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

Symptoms: Persistent (i.e., 24/7 but fluctuates in degree of severity) chest pain (believe it was more concentrated in center of chest early but appears to have migrated a bit to upper left side of chest) dating back from around the time of vaccinations (did not immediately connect the two - and only perhaps linking the pain to the vaccinations now as a result of seeing publicity about the potential for heart inflammation - as pain was very mild early on). Have taken some anti-heartburn OTC medication at medical professional's direction, but that has not been an effective solution as pain has continued. Not overwhelmingly crippling pain, just persistent and concerning. Have not had a chance to see a specialist for full-blown evaluation/diagnosis yet.

Other Meds: Novolog; statin

Current Illness: N/A

ID: 1704023
Sex: F
Age: 30
State: NY

Vax Date: 09/14/2021
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: My vitals were checked at hospital. Vitals and EKG were normal and baby was still moving and had a heartbeat.

Allergies: None

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

Symptoms: I am pregnant and due on 10/31. Received 2nd shot on 9/14 at 4:30pm at 33 weeks pregnant. On 9/15 at 1:00pm I began having severe chest pains. I've never had chest pains before and the pain was so bad it prompted me to go to the Emergency Room.

Other Meds: Prenatal vitamin, vitamin D, vitamin C, probiotic pearls complete

Current Illness: None

ID: 1704024
Sex: M
Age: 74
State: MI

Vax Date: 02/21/2021
Onset Date: 09/14/2021
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: Hematicrate low nuetriphill Hight monocite low lymphocyte low Blood urine High Carbon diocide low Creatinine High potassium high sodium low

Allergies: No Known Allergies

Symptom List: Ear pain, Hypoaesthesia

Symptoms: pt was Admitted 09/14/2021 expeirening S.O.B fatigue weakness and a fever. Upon admission Temp was 96.2 tested positive at an outside facility and presenting S.O.B. Pt was given monocolnal antibodies Pt was given o2, Ramdesiver Rivaroxaban, Zinc, Ascarbic acid, and dexomelozone. Pt is still currently admitted.

Other Meds: Unknown

Current Illness: Unknown

ID: 1704025
Sex: M
Age: 12
State: MA

Vax Date: 07/30/2021
Onset Date: 07/30/2021
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:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Pharmacist failed to dilute the vaccine prior to administering to my 12 yr old son with Down Syndrome.

Other Meds: 75mcg Levothyroxene

Current Illness:

ID: 1704026
Sex: F
Age: 56
State: TX

Vax Date: 03/11/2021
Onset Date: 08/14/2021
Rec V Date: 09/16/2021
Hospital: Y

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

Lab Data: CBC, CT Abdomen, CMP,

Allergies: codeine, erythromycin

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

Symptoms: lower abdominal pain

Other Meds: buspirone, venlafaxine, metoprolol, letrozole, meloxicam,folic acid, Flovent ivermectin, azithromycin

Current Illness:

ID: 1704027
Sex: F
Age:
State: IL

Vax Date: 09/11/2021
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: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies: Tedral

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

Symptoms: Within a minute after I had the vaccine, I had prickling feelings all over. I had big aches. Body aches and joint aches. I had pain that was in the arm and chest area. The more severe lasted a couple of hours while I was driving. What worries me is that they said side effects are more severe with the second dose than with the first dose. I really don?t want to experience something worse than what I had with the first one. I might have a better result with the Moderna. I was unvaccinated until the 9/11/2021 and I have not have Covid. I have followed all the guidelines and I have not gotten Covid. So getting the vaccine isn?t really much for me as it is for other people. I am worried to see that it works for me and if I cant get somebody to listen to me about this, I would not rather have another Pfizer vaccine, I would rather have the Moderna vaccine but if I can?t, then I will not get the second Pfizer vaccine. I will go to the doctor today because my PCP does not accept my insurance so I am going to another one. I have only called the pharmacies and doctor's offices and nobody has helped me.

Other Meds: None

Current Illness: None

ID: 1704028
Sex: M
Age: 60
State: MN

Vax Date: 04/11/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data: POSITIVE SARS-COV-2 BY PCR 9/15/21

Allergies:

Symptom List: Unevaluable event

Symptoms: This case meets vaccine breakthrough criteria review. Presented to ED with SOB, cough, congestion, body aches, headache, and neck pain for 7-10 days PTA.

Other Meds:

Current Illness:

ID: 1704029
Sex: F
Age: 65
State: NE

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

Lab Data: none

Allergies: Remicade, loversol, Raloxifene, idodine, contrast media, calcitonin.

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

Symptoms: Vaccine was expired at 3:15 p.m. after being drawn up for 6 hours. Vaccine was kept in refrigerator after being drawn up. Injection given at 4:30 p.m. Pt experienced no adverse symptoms

Other Meds:

Current Illness: none known

ID: 1704030
Sex: F
Age: 60
State: GA

Vax Date: 09/02/2021
Onset Date: 09/01/2021
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:

Allergies: Radiology contrast dye

Symptom List: Injection site pain, Pain

Symptoms: I also have an auto immune disease that was in remission and brought them all back to flare up after receiving my second dose. The symptoms that flared up GI symptoms, Chron's disease problems with elimination. It flared up the Crohn's disease, also I have fibromyalgia and flared up all the pain I have and increased my fatigue. Brain fog, chills (these were so severe that my teeth were actually chattering and I could not control the movements of my body.) Now, I have a rash that is covering my whole body except below the knees that I am having to take Benadryl for the rash and I am now on day 3 of taking Benadryl. I also basically had the symptoms for my first vaccine.

Other Meds: Has auto immune disease and takes medication

Current Illness:

ID: 1704031
Sex: M
Age: 82
State: MN

Vax Date: 01/21/2021
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:

Symptom List: Injection site pain, Menorrhagia

Symptoms: pt is positive for covid after being fully vaccinated

Other Meds:

Current Illness:

ID: 1704032
Sex: F
Age: 68
State: MO

Vax Date: 03/04/2021
Onset Date: 05/09/2021
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: No

Allergies: Stimate (had a reaction years ago), rashes after pneumonia

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

Symptoms: I got shingles; it broke out on my calf. It was like a cluster of blisters. I went to the doctor where I was put on an antiviral. It began spreading up my leg but did not hurt. This was my first incident of shingles. On July 5th, I woke up with and earache and headache. I had a bump behind my ear. I went to the doctor where they treated me with steroids and an antibiotic because they thought I was a bug bite. It got worse and my doctor said it was shingles. I was treated with gabapentin, but it did not do well with me. It was very painful I had bumps in my scalp and body. I currently still have nerve pain that comes and goes. It is getting better but I know it's there.

Other Meds: Restasis; calcium

Current Illness: No

ID: 1704033
Sex: M
Age: 14
State: MA

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

Lab Data:

Allergies: NKDA, NKA

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Approximately 10-15 minutes after injection was administered, pt. had episode of syncope. Pt's. father sat pt. up in chair, pt. was alert but reported lightheadedness. Nursing and provider arrived and vitals were taken - initial BP 74/44. Laid pt. on the floor for 3-4 minutes. Pt. then sat up for a minute. BP increased to 104/67. Pt. reported feeling better, provider reinforced teaching to pt. and father that vasovagal syncope can be common with HPV vaccination.

Other Meds: N/A

Current Illness: N/A

ID: 1704034
Sex: F
Age: 20
State: MN

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:
Dose Series: UNK
Vax Route: IM
Vax Site: RA

Lab Data: Immediate physical exam after episode was WNL.

Allergies: none

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Fainted 5 minutes after administration of Gardasil vaccine. No injury. No fall. Laid head onto arm on table.

Other Meds: none

Current Illness: none

ID: 1704035
Sex: F
Age: 65
State: AZ

Vax Date: 01/23/2021
Onset Date: 01/01/2021
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: RA

Lab Data: none

Allergies: bee stings, cidein, tremadol, aspirin , zpak

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

Symptoms: LOSS OF SMELL , sick for 2 weeks, severe pain in arm for2 weeks,

Other Meds:

Current Illness:

ID: 1704036
Sex: M
Age: 33
State: TX

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: The patient is in the emergency room now getting tested.

Allergies:

Symptom List: Nausea

Symptoms: The patient had facial paralysis on one side of their face. And has went to the emergency room to have tests done.

Other Meds:

Current Illness:

ID: 1704037
Sex: M
Age: 34
State: MN

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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

Symptom List: Injection site pain

Symptoms: Dose injected into shoulder versus deltoid. Shoulder is very painful and limited with motion

Other Meds: Daily Multivitamin omeprazole

Current Illness: none

ID: 1704038
Sex: M
Age: 61
State: NY

Vax Date: 08/13/2021
Onset Date: 08/13/2021
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: none

Allergies: No

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

Symptoms: Wrong diluent was used . did not use sodium chloride supplied with vaccine but used sodium chloride bacteriostatic.

Other Meds: No

Current Illness: No

Date Died: 09/16/2021

ID: 1704039
Sex: M
Age: 79
State: TN

Vax Date: 04/05/2021
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:

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

Symptoms: COVID RELATED DEATH; FULLY VACCINATED

Other Meds:

Current Illness:

ID: 1704040
Sex: F
Age: 74
State: MI

Vax Date: 03/17/2021
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: CT scan Covid-19 blood work urine sample

Allergies: oxycodone, erythromycin , Cofilin, Levaquin

Symptom List: Tremor

Symptoms: I had a low-grade fever and chills. I had SOB, increased fatigue, changes in my taste and smell. I went to the ER. I also have a pneumonia in both of my lower lungs that showed up on the CT scan. They did a Covid-19 test, negative. They did blood work and a urine sample, which show that I had a UTI. I also had a kidney stone. I also was having abdomen pain as well.

Other Meds: Sambora 20mg, omeprazole40mg, Motorola 25mg, Aspirin 81mg, Celebrates, Ambulant 20mg, Gast ax 25mg, fish oil 1000mg, multi vitamin, Simvastatin 40mg, Cingular 10mg, Zyrtec 5mg , Amlodipine 10mg, codeine Bute 5mg,Varlas 1mg, nasal spray, e

Current Illness: bowel obstruction, laryngitis, kidney stones

ID: 1704041
Sex: M
Age: 47
State:

Vax Date: 09/10/2021
Onset Date: 09/14/2021
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: None

Allergies: None

Symptom List: Erythema, Pruritus

Symptoms: 4 days after I started having unbalance when getting up or rolling over. Two days later issue still present.

Other Meds: Flu vaccine

Current Illness: None

ID: 1704042
Sex: M
Age: 47
State: TN

Vax Date: 09/03/2021
Onset Date: 09/03/2021
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: N/A

Allergies: Shellfish

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

Symptoms: Pt. states that after receiving the 1st dose of Phizer 09/03/2021, started experiencing symptoms 20mins of tenderness in the testicles (more so the right) lasting 7-8hrs. No other noted symptoms. No Primary visit noted.

Other Meds: N/A

Current Illness: N/A

ID: 1704043
Sex: M
Age: 50
State: GA

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

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

Lab Data: SEPT 3, 2021 COVID 19 TEST- RESULT NEGATIVE SEPT 3, 2021 BLOOD LABS- RESULTS NORMAL

Allergies: SULFER DRUGS, YELLOW JACKET STINGS

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

Symptoms: SEPT 1ST, 2021- 4pm administered a home covid 19 test, it was negative, at 5pm: Received first dose of Pfizer at Pharmacy. Waiting 30 minutes, no immediate reactions. Sept 2nd, 2021 at 10:30pm: Relaxing at home with my dog. Started Coughing, Tachycardia (180+ BPM),O2 sat 97%, Hypertension (BP 220/135) less than 30 seconds (results via pulses/ox meter, Electronic arm BP cuff), shaking tingling-numbness in upper and lower extremities. Went two houses down to mom and dad's and called 911, Ambulance came and paramedics did a patient assessment and confirmed the above. Recommended transport to emergency room. I agreed and was transported to ER. In route paramedic started an IV, took BP and confirmed very high BP with tachycardia, but O2 sat were normal and stayed normal, EKG performed which showed normal heart sinus arrhythmia. Paramedic administered 1 dose Nitroglycerin under the tongue, 1 dose of Morphine via IV, 1 dose of Zopran via IV. This got my heart rate within normal limits and my BP down to a high normal, upon arriving at Emergency Room per the paramedic. Admitted to ER around 12:00am Sept 3rd, 2021. Nurse performed another EKG and confirmed normal heart sinus arrhythmia, heart rate normal, BP normal, O2 normal. ER doc ordered Covid 19 test and blood labs and 1 bag of saline solution with a dose of Ativan I believe. Covid 19 test was negative, blood work normal according to the ER doc. I was discharged around 5:30 am Sept 3rd, 2021. I didn't feel back to my normal self until Sunday, Sept 5, 2021. No other issues at this time. Heart rate and BP appear to be normal at this time. I have no history or diagnoses of any other medical issues other than hypertension. I am concerned with the possible short and long term effects this may have on my health and well being.

Other Meds: LOSARTAN POTASSIUM 25MG, ONE DOSE DAILY

Current Illness: NONE

ID: 1704044
Sex: F
Age: 50
State: WA

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: allergy to sulfa, penicillin, latex

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Migraine, extreme body chills, extreme ache in every bone and joint

Other Meds: None

Current Illness: none

ID: 1704045
Sex: M
Age: 72
State: ME

Vax Date: 03/23/2021
Onset Date: 04/08/2021
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: blood tests 06/08/2021

Allergies: none

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

Symptoms: constant twitching in muscles of arms and legs

Other Meds: omeprazole 40mg losartan 50mg osteo bi-flex one tabulate /day calm magnesium 2 teaspoons/day

Current Illness: blood level of vitamin D- 31

ID: 1704046
Sex: F
Age: 31
State: TN

Vax Date: 09/07/2021
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: None

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

Symptoms: Rash at injection site started 9-15-21 and swollen lymph node by left collar bone 9-14-21

Other Meds: None

Current Illness: None

ID: 1704047
Sex: F
Age: 22
State: NJ

Vax Date: 05/28/2021
Onset Date: 05/01/2021
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:

Allergies: Gluten, dairy, egg, peanuts Omnicef

Symptom List: Pain in extremity

Symptoms: Dizziness, headaches, extreme tiredness, losing vision and feeling dizzy when sitting up or standing

Other Meds: Citalopram , Magnesium-Calcium, Bio-Gest, Vitamin C, Vitamin D3, Melatonin

Current Illness: N/A

ID: 1704048
Sex: M
Age: 61
State: MI

Vax Date: 05/25/2021
Onset Date: 09/16/2021
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: Hospitalization - acute hypoxemic respiratory failure due to COVID-19

Other Meds:

Current Illness:

ID: 1704049
Sex: F
Age: 25
State: MS

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: NA

Allergies: NA

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

Symptoms: Employee came in requesting 2nd dose Moderna. The vaccine sheet was pulled and dose was prepared and given. Upon documenting the dose it was noted her first dose was given on 9/10/2021. When employee questioned, she stated she was told to return "today" (9/15/21) to get her second dose. Explained she was to wait 30 days between doses. Notified all necessary parties.

Other Meds: NA

Current Illness: NA

ID: 1704050
Sex: F
Age: 41
State: AR

Vax Date: 06/10/2021
Onset Date: 06/17/2021
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:

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

Symptoms: YEAST INFECTION 1 WEEK AFTER INJECTION AND MISSED 4 MENSTRUAL CYCLES

Other Meds:

Current Illness:

ID: 1704051
Sex: F
Age: 60
State: NJ

Vax Date: 08/04/2021
Onset Date: 08/01/2021
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: Pending

Allergies: None.

Symptom List: Vomiting

Symptoms: Left arm weakness for over 1 month each shot. Severe neck pain on left side to present day. Headaches till present day. Sharp stabbing pains running up from both ankles to mid calf.

Other Meds: At our Thyroid 90 mg.

Current Illness: Back pain, arthritis.

ID: 1704052
Sex: M
Age: 25
State: FL

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

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

Lab Data:

Allergies: nka, nkda

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient experienced Hives and a rash

Other Meds: none

Current Illness: none

ID: 1704053
Sex: F
Age: 71
State: AL

Vax Date: 07/26/2021
Onset Date: 07/29/2021
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: Was on vacation in another state so did not see a doctor until my ear felt like it was going to burst. saw a doctor at Clinic in city, state. She diagnosed inner ear infection and prescribed Z-Pack. I'm still experiencing extreme dizziness.

Allergies: Amoxicillin Bactrim Codeine Statins

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

Symptoms: Vomiting, headache, severe dizziness, ear pain, tinnitus, jaw pain, blood sugars uncontrolled, sore throat, itchy on palms and soles and ended up with inner ear infection. continuing to have dizziness and some ear pain.

Other Meds: Lisinopril Armour Thyroid

Current Illness: None

ID: 1704054
Sex: M
Age: 59
State: ID

Vax Date: 04/29/2021
Onset Date: 09/16/2021
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: NA

Allergies: Polyethylene glycol Polysorbates and polysorbate 80

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Severe hives and itching. Moderate wheezing. Discussed with Doc. He suggested pretreating with benadryl. I asked about sensitization with future shots and he didn't comment. He asked if I wanted the shingles vaccine. I asked if it had polyethylene glycol or polysorbates in it and he said he had no way of knowing so I declined for now.

Other Meds: Lisinopril, Omeprazole, Finasteride

Current Illness: None

ID: 1704055
Sex: F
Age: 90
State: TX

Vax Date: 01/13/2021
Onset Date: 08/13/2021
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: CBC, CMP, CXR, EKG, Cardiac profile

Allergies: amitriptyline, atorvastatin, bacitracin, celecoxib, clarithomycin, claritin,codeine, guaifenesin, alendronate, bee venom, dextromethorphan,escitalopram gramicidins, hydrocodone, neomycin

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

Symptoms: SOB at rest

Other Meds: tylenol, loperamide, aricept, gabapentin,pravachol, ocuvite, calcium,b complex, multi vitamin, amlodipine, b-12 tablet, plavix, protonix

Current Illness:

Date Died: 08/27/2021

ID: 1704056
Sex: M
Age: 74
State:

Vax Date: 02/09/2021
Onset Date: 08/11/2021
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: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: diagnosed with COVID on 8/11/21; went to hospital on 8/16/21 with SOB, weakness, fever, confusion; hx of chronic kidney disease, type 2 diabetes

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am