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: 1704109
Sex: M
Age: 51
State: PA

Vax Date: 08/18/2021
Onset Date: 08/24/2021
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: Platelet Counts: 8/24 183 THO/uL. 9/7 73 THO/uL. 9/16 149 THO/uL.

Allergies: ibuprofen and zyrtec.

Symptom List: Dysphagia, Epiglottitis

Symptoms: My platelet count has been trending downward with each shot. My 1st result was on 8/24 was 183 THO/uL. On 9/7, it was 173 THO/uL. This morning , 9/16 the result returned 149 THO/uL. This places me at thrombocytopenia technically. I am waiting for direction from Hematology and my PCP.

Other Meds: amlodipine, lisinopril, HCTZ, flonase.

Current Illness: no

ID: 1704110
Sex: F
Age: 57
State: KS

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

Lab Data: N/A

Allergies: unknown

Symptom List: Anxiety, Dyspnoea

Symptoms: No adverse reactions as of yet. Client in to walk in clinic requesting FIRST dose of Moderna. She denied getting any other covid vaccines on her paperwork and reported this as her first dose. Once she was vaccinated and a profile was created in out system, the state registry reported that she has had a dose of Janssen on 4/6/2. We asked her if that was indeed true, she said yes and then said her doctor was encouraging her to get the Moderna series since she had "only had the J&J". I explained to her that we would not be giving her the second Moderna and that it goes against the current recommendations and processes here with the Health Department. She left prior to her 15 minutes but did not verbalize or show any adverse reactions during the time she was here.

Other Meds: unknown

Current Illness: unknown

Date Died: 09/15/2021

ID: 1704111
Sex: M
Age: 66
State: TN

Vax Date: 03/23/2021
Onset Date: 08/20/2021
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: lisinopril, iodine based contrast

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

Symptoms: Patient had known recent covid infection on 8/20/21. Admitted to hospital on 9/7/21 with SOB, abdominal distension and nausea, vomiting and diarrhea. Paracentesis was performed on 9/8 and 9/13 for continued abdominal swelling. Increasing need for 02 supplement due to swelling/volume overload. Chest xray worsening. Was being treated with combivent nebs and symibcort for COPD exacerbation and zosyn. Continued to decline with multiorgan compromise. Elected transition to comfort care and passed on 9/15.

Other Meds:

Current Illness: hepatocellular carcinoma, COPD, hepatitis C

ID: 1704112
Sex: F
Age: 57
State: OH

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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data: none

Allergies: shellfish allergy

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Approximately 45 minutes after the injection, I developed a little tongue itching and a single hive on my tongue, but it resolved and I was fine. I was fine until later that evening (Friday Sept 3) at about 11PM when I had a syncopal episode- I felt very lightheaded and I suspect my bp dropped. I had an itchy rash that extended down the (left) arm in which I received the vaccine. This was followed by bouts of severe vomiting until about 4AM, as well as severe headache, fever and chills. I am a board-certified allergist and I would consider this a delayed anaphylactic reaction.

Other Meds: atorvastatin

Current Illness: none

ID: 1704113
Sex: F
Age: 54
State: WI

Vax Date: 08/20/2021
Onset Date: 08/26/2021
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: NKDA

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

Symptoms: Transverse myelitis

Other Meds:

Current Illness:

ID: 1704114
Sex: F
Age: 44
State: MN

Vax Date: 03/02/2021
Onset Date: 09/14/2021
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: 9/15/21 SARS/COV-2, NAAT, Positive

Allergies:

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

Symptoms: Breakthrough COVID

Other Meds:

Current Illness:

ID: 1704115
Sex: M
Age: 1
State: NC

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: IM
Vax Site: LA

Lab Data: none

Allergies: none

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Provider states to only give patient half (0.25ml) of the licensed dose (0.5ml). 0.25ml was given to patient on 9/14/21. Immunization department was contacted 9/16/21 when I was made aware of. They advised patient should come back in and receive full 0.5ml dose, there is no interval time to receive this dose. Patient should return 4 weeks after or the second dose. I have advised staff on correction plan and to notify parent to bring child in.

Other Meds: cetirizine (ZYRTEC) 2.5mg Daily

Current Illness: none

ID: 1704116
Sex: F
Age: 70
State: IL

Vax Date: 06/30/2021
Onset Date: 07/11/2021
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: Penicilloin

Symptom List: Pharyngeal swelling

Symptoms: I woke up with a slight temperature, headache in forehead, arm red and hot swollen arm and felt lethargic. I slept all day. On July 12 didn' feel better. Called Health department and was told to call my doctor. his office recommended Benadryl, Tylenol and ice packs. By July 17 red and heat gone

Other Meds: Levothyroxine, Elmiron, Triamterene, Lispinopril, Red Yeast Rice, Ocuvite 50+

Current Illness: none

ID: 1704117
Sex: F
Age: 15
State: NY

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

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

Lab Data: no

Allergies: no

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: wrong Diluent used . was diluted with bacteriostatic sodium chloride . not sodium Chloride supplied with vaccine

Other Meds: no

Current Illness: no

ID: 1704118
Sex: F
Age: 11
State: FL

Vax Date: 08/12/2021
Onset Date: 08/01/2021
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: N/A

Allergies: No reported allergies

Symptom List: Diarrhoea, Nasal congestion

Symptoms: The patient is an 11-year-old female who received the COVID-19 Pfizer vaccine on 8/12/2021. At this time, there are no reported symptoms by the patient or guardian.

Other Meds: No medication reported.

Current Illness: N/A

ID: 1704119
Sex: F
Age: 36
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:
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: shrimp, dust mites

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

Symptoms: Tinnitus in both ears

Other Meds: Multi Vitamin, Zinc, Calcium, Magnesium, Vitamin D

Current Illness:

ID: 1704120
Sex: F
Age: 62
State: MN

Vax Date: 03/25/2021
Onset Date: 09/12/2021
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: Sulfa drugs; Morphine; Demerol; Plaquenil; black dye; adhesive tape; seafoodl acetermra; flomax; arava

Symptom List: Rash, Urticaria

Symptoms: sore throat, and was feeling poorly. She has had fatigue, fits of dry cough, and laryngitis in the morning along with body aches starting 9/12 and 9/13/21

Other Meds: Rosuvastatin; Omeprazole; Methotrexate; Folic acid; Cyclobenzaprine; Vimpat; Potassium Citrate; Hydrochlorothiazide; Metamucil, Prednisone, Oxycodone; Methocarbamol

Current Illness: Did test COVID positive on 4/16/21, received second Moderna dose on 4/27/21

ID: 1704121
Sex: M
Age: 26
State: WA

Vax Date: 09/12/2021
Onset Date: 09/13/2021
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: LA

Lab Data: TTE with EF 40% and global hypokinesis, cardiac CT angiography with patent vessels, Troponin elevation peaking at 32, chest pain

Allergies: nkda

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

Symptoms: Myocarditis with EF 40% diagnosed 9/15

Other Meds: erythromycin ointment left eye qid

Current Illness: denies

ID: 1704122
Sex: F
Age: 59
State:

Vax Date: 03/23/2021
Onset Date: 09/15/2021
Rec V Date: 09/16/2021
Hospital: Y

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

Lab Data: 09/15/21 SARS-CoV-2 (COVID-19) by NAA - DETECTED

Allergies:

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

Symptoms: "This is a 60y.o. female with a PMH of pneumonia, partial lung resection, asthma, GERD, Hepatitis C, and bladder mass presented to EC with c/o worsening shortness of breath over past week associated with cough, fever, diarrhea, headache, body aches and loss of taste & smell."; admitted on 09/15/21.

Other Meds:

Current Illness:

ID: 1704123
Sex: F
Age: 19
State: WV

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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Pet dander

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

Symptoms: Beginning the night I got my vaccine I began to get a headache. The headache is still continuing to this day. Acetaminophen and ibuprofen don?t seem to alleviate the symptom.

Other Meds: Doxycycline (acne)

Current Illness: n/A

ID: 1704124
Sex: F
Age: 51
State: PA

Vax Date: 02/10/2021
Onset Date: 02/18/2021
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: Sulpher and penicillin

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

Symptoms: Itching without a rash for approx. 6 to 8 weeks

Other Meds: None

Current Illness: Na

ID: 1704125
Sex: F
Age: 58
State: CA

Vax Date: 08/20/2021
Onset Date: 08/20/2021
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: had a covid test on 9/10/2021 - negative.

Allergies: Sulfa and hyper thyroid medication

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

Symptoms: Started with low grade fevers with headache late in the afternoon, almost daily. On 09/08/2021 around 1:00 pm I started getting the chills, headache increased, sore throat, body aches started and fever increased. 09/09/2021: I had 104 degree fever and it stayed around 101 through Saturday night. Chills, severe sore throat, extremely difficult to swallow, body aches and headache. By Sunday, 09/12/2021, my symptoms improved but had a serious non productive cough. Had to reach out to doctor to get prescription cough syrup because Cepacol and Robitussin were not helping.

Other Meds:

Current Illness:

ID: 1704126
Sex: M
Age: 21
State: FL

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

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Passed out for 15 seconds. Says he was dehydrated from PT from the (place of work), had not eaten and felt dizzy prior to passing out.

Other Meds:

Current Illness:

ID: 1704127
Sex: M
Age: 69
State: FL

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

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Severe Flu like symptoms. Soreness/aches in my neck, shoulder, chest, arm all on the left side. Fever-101.8, severe chills, tiredness, headache, Dizziness/weakness, weakness in arms and legs. Treatment: Tylenol Recovered in 36 hours

Other Meds: Losartan-hctz 100-25 mg Doxycycline Hyclate 75 mg

Current Illness: None

ID: 1704128
Sex: M
Age: 32
State: WA

Vax Date: 08/31/2021
Onset Date: 08/31/2021
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: None as of now, but do have a zoom appointment with a Primary Care Provider.

Allergies: Seasonal allergies, pet dander

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

Symptoms: At the time of the injection, I felt coldness run from my left shoulder into my left ear/ear lobe. Later that evening, I started feeling paresthesia in my left ear. Over the course of two weeks, I have had gradual worsening paresthesia in my left anterolateral neck, jaw, cheek bone, forehead and left skull. I am also starting to taste metallic like pennies in my mouth.

Other Meds: None

Current Illness: None

ID: 1704129
Sex: M
Age: 48
State: CA

Vax Date: 03/12/2021
Onset Date: 03/13/2021
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:

Allergies:

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

Symptoms: fever, muscle aches, diarrhea, headaches and nausea

Other Meds: mepformin

Current Illness:

ID: 1704130
Sex: F
Age: 54
State: MO

Vax Date: 08/05/2021
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: LA

Lab Data: NA

Allergies: Medication Allergies: Aspirin, Morphine, Penicillin Food Allergies: Watermelon, all melons, Tree Nuts, Peanuts, Wheat, Bananas, Plums Other Product Allergies: Adhesives

Symptom List: Unevaluable event

Symptoms: Chicken pox and/or random shingles rash spots all over hands, left upper arm, a few on chin and one on eye lid. Major right arm pain after shot. No fever, no other aches after first dose. The pox were red dot, filled with fluid, and popped after a week or so. Second dose given on September 2, 2021, right arm. Woke up to a burning type rash 2 days after second dose. Face was red and swollen, rash on both arms and hands felt hot. Rash went a little down my neck, but stopped. I took Benedryl [3 pills] and within 90 minutes, the rash went away. I had no fever, no aches or anything other than the extreme sore arm again after the rash went away.

Other Meds: Premarin 1.25mg daily; Ambien 10mg nightly

Current Illness: None

ID: 1704131
Sex: F
Age: 33
State: CA

Vax Date: 03/09/2021
Onset Date: 05/01/2021
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: Penicillin, Gadolinium

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

Symptoms: New symptom noticed since vaccination. I get sudden nosebleeds when my period starts. I can be sitting watching TV and my nose will suddenly pour out blood. I can quickly control the bleed. As of yesterday, during physical activity I had a sudden heavy nose bleed. The blood runs out quickly like a faucet. I was able to quickly get it under control.

Other Meds: None

Current Illness: None

ID: 1704132
Sex: F
Age: 86
State: FL

Vax Date: 09/13/2021
Onset Date: 09/14/2021
Rec V Date: 09/16/2021
Hospital: Y

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

Lab Data: EKG, T-dimmer and CTR

Allergies: n/a

Symptom List: Injection site pain, Pain

Symptoms: unable to speak, gray color, partial facial paralysis. Hospital test found new on-site heart irregularities after the vaccine. administration. Conditions did not exists prior to vaccine. Vaccine Johnson and Johnson. This was the second shot.

Other Meds: diabities medication and high blood pressure

Current Illness:

ID: 1704133
Sex: M
Age: 55
State: TN

Vax Date: 04/13/2021
Onset Date: 04/14/2021
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

Allergies: Insulin

Symptom List: Injection site pain, Menorrhagia

Symptoms: Shingles.

Other Meds: Yes

Current Illness: No

ID: 1704134
Sex: M
Age: 68
State: KY

Vax Date: 03/09/2021
Onset Date: 04/02/2021
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:

Allergies:

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

Symptoms: Staying in away from people release date 09/17/2021

Other Meds:

Current Illness:

ID: 1704135
Sex: F
Age: 45
State: RI

Vax Date: 09/11/2021
Onset Date: 09/12/2021
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: latex allergy and seasonal allergies

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: generalized muscle and joint aches/pains, chills, fever, nausea, significant fatigue and weakness, headache, inappetence; aches and pains started at 3am on 9/12/2021 and intensified throughout the following hours until their peak around 11am; approximately 7pm on 9/12/2021 is when the symptoms, other than headache and fatigue started to resolve.

Other Meds: Vit. C

Current Illness: none

ID: 1704136
Sex: F
Age: 98
State:

Vax Date: 01/30/2021
Onset Date: 09/06/2021
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: RA

Lab Data: COVID test for SNF transfer + 9/9/2021

Allergies: avelox IV, penicillins, shellfish, sulfadiazine

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: 98 y o woman with essential HTN, dementia, PVD brought to hospitat for concern of stroke with left facial droop. Since admission, BP initialy showed SBP of 215. Work up showed CT of brain confirming no acute process, chronic small vessel ischemia changes and diffuse cerebral atrophy. Working impression now is just TIA. As part of transfer eligibility, repeat COVID 19 pCR done and showed positive. Does not require oxygen supplementation and xray shows LLL atelectasis r/o new infiltrate. First dose 1/9/2021

Other Meds:

Current Illness:

ID: 1704137
Sex: F
Age: 49
State: MN

Vax Date: 01/18/2021
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:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: 9/15/21 SARS/COV-2, NAAT positive

Allergies:

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

Symptoms: Breakthrough COVID

Other Meds:

Current Illness:

ID: 1704138
Sex: F
Age: 49
State: OH

Vax Date: 07/27/2021
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: RA

Lab Data: None

Allergies: None

Symptom List: Nausea

Symptoms: Swollen lymph nodes right collar bone

Other Meds: Vit D, magnesium

Current Illness: None

ID: 1704139
Sex: F
Age: 50
State: PA

Vax Date: 04/08/2021
Onset Date: 04/11/2021
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: Telehealth visits on 4/16/21 and 4/29/21

Allergies: iodine

Symptom List: Injection site pain

Symptoms: Shingles- mild case

Other Meds: methimazole, vitamin B, vitamin D, iron supplements

Current Illness: none

ID: 1704140
Sex: M
Age: 37
State: ID

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: IM
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Immediately after vaccination emotional numbness set in and has not left since injection

Other Meds: None

Current Illness: None

ID: 1704141
Sex: F
Age: 93
State:

Vax Date: 02/06/2021
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: RA

Lab Data: 09/15/21 SARS-CoV-2 (COVID-19) by NAA - DETECTED

Allergies:

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

Symptoms: 9/15/2021 presented to EC with with shortness of breath, cough and fever with nausea.

Other Meds:

Current Illness:

ID: 1704142
Sex: F
Age: 67
State: TX

Vax Date: 09/03/2021
Onset Date: 09/07/2021
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: Reglan, ephedrine,

Symptom List: Tremor

Symptoms: 5-6 after vaccination, my mouth broke out in canker sores. all of mouth and tongue. I had added nothing new - no meds etc. It still hurts on 9-16 (a week after it started). Doctor told me to report it since vaccination/boosters after effects are still unknown.

Other Meds: Protonix 40 mg, Cardizem 120, Azo, multi Vitamin, Vitamin C, D, citracal and D3, instaflex, B6, B complex, probiotic, boswellia, red yeast rice,

Current Illness: none

ID: 1704143
Sex: F
Age: 43
State: MA

Vax Date: 04/27/2021
Onset Date: 04/30/2021
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: I did not get my period at the end of April and then not again at the end of May (after second shot). It resumed at the end of June. Significant concern over how the vaccine impacts puberty, especially if consideration about my 11 - year daughter to get the vaccine pre-puberty.

Other Meds: none

Current Illness: none

ID: 1704144
Sex: F
Age: 36
State: FL

Vax Date: 09/15/2021
Onset Date: 09/16/2021
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:

Allergies:

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

Symptoms: Heachache, chills, fever, muscle aches, fatigue, soreness at injection site

Other Meds: Vitamin D supplement

Current Illness:

ID: 1704145
Sex: F
Age: 53
State: GA

Vax Date: 03/10/2021
Onset Date: 07/20/2021
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: August 2021 saw family medicine...they treated for infection...no results...saw ent...had full ear test with sound...air blown in ear and monitered eye movement during tests

Allergies: None

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

Symptoms: Ear problems...feeling of fluid...some pain and noticeable dizziness

Other Meds: Metapropolol- bp med Zetia- cholesterol

Current Illness: None

ID: 1704146
Sex: F
Age: 30
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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: n/a

Allergies: unknown

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient indicated had not received covid vaccine before and requested moderna. Administered moderna and then found out upon processing she received 1 dose pfizer on 7/29/21.

Other Meds: unaware

Current Illness: unknown

ID: 1704147
Sex: F
Age: 58
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: 011J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: None

Allergies: Yes

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

Symptoms: Adverse event: Increasing difficulty breathing, swelling of throat and sinuses, dizziness Time: starting at 4:30pm Took Ventolin resulting in immediate reaction to Ventolin. extreme difficulty breathing, throat swelling and choking, heart racing, excessive nasal drip and saliva, Took 2 Capsules of Advil Cold and Sinus Extreme stmptoms, choking and unable to breath subsided after 45 minutes. Difficulty breathing, dizziness lasted until 10am the following morning.

Other Meds: Armour thyroid. Ventrolin HFA.

Current Illness: None

ID: 1704148
Sex: F
Age: 50
State: MN

Vax Date: 09/13/2021
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:

Allergies: Na

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

Symptoms: Mon@11-shot Mon by 8pm-every cell body hurts worse than ever experienced before, freezing to wringing wet all night, terrible migraine. Cannot sleep, cannot begin to get comfortable. Tues 12:. Slightly better can at least get rest but unable to productivity function Wed evening:. Finally feel human but still have terrible headache Thurs morning:. Headache, light headed, heart rate elevated

Other Meds: 10mg Lisinopril 10mg montelukast Multi vitamin Omega 3-6-9

Current Illness: Na

ID: 1704149
Sex: F
Age: 13
State: NY

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

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

Lab Data: no

Allergies: no

Symptom List: Pain in extremity

Symptoms: wrong Diluent used . was diluted with bacteriostatic sodium chloride . not sodium Chloride supplied with vaccine

Other Meds: no

Current Illness: no

ID: 1704150
Sex: M
Age: 52
State: FL

Vax Date: 08/04/2021
Onset Date: 08/04/2021
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: No known medication allergies

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

Symptoms: Dr states wanted this reported out as a vaccine related event that patient had reaction to his second pfizer shot and ended up with shingles. He had his first dose of the vaccine in April then contracted COVID and didn't get his second shot until 8/4/2021. Patient was admitted 8/25/21 for shingles to the face, Peri orbital Cellulitis, suspected superimposed bacterial infection. Corneal abrasion secondary to fiberglass 8/21/2021. He is currently on acyclovir IVPB x 14 days.

Other Meds: ascorbic acid, diclofenac tablet, furosemide, potassium chloride, zinc sulfate

Current Illness:

ID: 1704151
Sex: F
Age: 29
State: TN

Vax Date: 07/30/2021
Onset Date: 07/31/2021
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: No

Allergies: Celebrex

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

Symptoms: My asthma took a turn for the worse. I have had more headaches than I have had before. I am also more tired. My ability to focus has also decreased. I went to the doctor regarding my asthma. I was prescribed an allergy medication to deal with the asthma opposed to another inhaler. It has been a few days so I have not noticed a difference yet.

Other Meds: albuterol

Current Illness: No

ID: 1704152
Sex: M
Age: 68
State: MN

Vax Date: 02/04/2021
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:

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

Symptoms: Tested positive for COVID-19 on 9/15/21

Other Meds:

Current Illness:

ID: 1704153
Sex: M
Age: 25
State: AL

Vax Date: 04/11/2021
Onset Date: 04/11/2021
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: N/A

Allergies: Iodine

Symptom List: Vomiting

Symptoms: When I took the first shot I had normal reactions. When I was given the second shot, I woke up in the middle of the night with a fever of 103.9, difficulty breathing, uncontrollable shaking, and headaches. I did not go to the doctors office not did I go to the hospital since it was the middle of the night, and I could not think straight at the time. I did dial 9-1 on my phone and did not complete the call because I thought I was feeling a little better and would be okay. I took some Motrin and put some ice packs in my armpits and neck. I do not know the exact time that I had a reaction. I had my first shot at a Medial Clinic Health Department. I got my second shot at another location.

Other Meds: trazodone

Current Illness: N/A

ID: 1704154
Sex: M
Age: 42
State: FL

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

Allergies: No

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient reported lip swelling at 11:30pm day of vaccine and resolved following day 9:30am

Other Meds: Unknown

Current Illness: unknown

ID: 1704155
Sex: F
Age: 62
State: GA

Vax Date: 08/25/2021
Onset Date: 09/13/2021
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: RA

Lab Data: none

Allergies: sulfa, one of the cancer meds - revlimid.

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

Symptoms: history of bells palsey on right side of face. Numbness and tingingling on right face - bells palsy returned. she is also a cancer patient (multiple myloma - currently in treatment) contacted MD - is going to receive steroid therapy. initially had numbness on right side of face the day following injection - droopiness, slurring of words began 3 weeks following 2nd injection.

Other Meds: darsalex (cancer drug), acyclovir, Pepcid, b/P med, unisom, vit c, curcumin, asa, calcium, zinc

Current Illness: multiple myloma,

ID: 1704156
Sex: M
Age: 55
State: CA

Vax Date: 04/01/2021
Onset Date: 04/03/2021
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: Treadmill EKG; calcium score; angiogram

Allergies: Nothing, but seasonal allergies to plants

Symptom List: Injection site swelling, Limb discomfort

Symptoms: The moment the shot was put into my arm, I had a very slight prick feeling in my heart and in a lymph node under my left arm (left arm was injected). It went away in less than a second. Two days later, I started getting a very strong, stabbing feeling in my lymph node and into my chest on my left side. This got worse for about 3 days, getting to the point where I could hardly exert myself. The pain came on with exertion and tamped down when I stopped. I also had terrible flu symptoms, including nausea. The flu symptoms went away after 3 days, but the feeling in my chest and lymph node continued. It has slowly gotten better. I hardly think about it now, but I had an angiogram due to the chest pain. I fully occluded coronary artery was found, but I had collateral vessels supplying blood around the blockage. I am a very active person and I do consistent exercise, most often, cycling. I still think the lymph node swells sometimes, but nothing like it had been.

Other Meds: Crestor, Amlodipine, Diazide, baby aspirin

Current Illness: None

ID: 1704157
Sex: F
Age: 82
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:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Patient began to have a severe reaction to the vaccine starting at 9pm. She became feverish, itchy and a headache. She was very congested and had difficultly breathing. She was gasping for air all night and not able to lie down to sleep. She has had a poor appetite and was very tired in the morning. The symptoms were mildly better in the morning. The patient is waiting to hear back from her primary care physician.

Other Meds:

Current Illness:

ID: 1704158
Sex: F
Age: 52
State: MN

Vax Date: 01/14/2021
Onset Date: 09/15/2021
Rec V Date: 09/16/2021
Hospital:

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

Lab Data: 9/15/21 Sars/Cov-2, Naat positive

Allergies:

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

Symptoms: Breakthrough COVID

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am