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: 1709195
Sex: M
Age: 13
State: GA

Vax Date: 09/17/2021
Onset Date: 09/17/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Administered covid vaccine, pt had already had first two in series.

Other Meds:

Current Illness:

ID: 1709196
Sex: M
Age: 24
State: OH

Vax Date: 09/17/2021
Onset Date: 09/17/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: none

Allergies: none

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient received a first dose of the pfizer covid shot in his left arm. About 5 minutes or less after receiving his vaccine he reported he was very dizzy. I had the patient sit down and gave him a bottle of water. He complained he was still very dizzy and had difficulty breathing. I offerred to call ED but patient declined. Patient went to the bathroom and came back and stated he felt better. He then left the store.

Other Meds: none

Current Illness: none

ID: 1709197
Sex: F
Age: 47
State: TX

Vax Date: 09/15/2021
Onset Date: 09/17/2021
Rec V Date: 09/17/2021
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: None

Allergies: No

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

Symptoms: Sore and swollen armpit and tricep

Other Meds: None

Current Illness: None

ID: 1709198
Sex: F
Age: 60
State: PA

Vax Date: 08/06/2021
Onset Date: 08/20/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient reports redness (approximately the size of a baseball) and swelling around injection site. Began about 2 weeks after dose and lasted around 8 days. Reports that it did not bother her nor did it require treatment.

Other Meds:

Current Illness:

ID: 1709199
Sex: F
Age: 45
State: MI

Vax Date: 09/12/2021
Onset Date: 09/12/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: going into ER again on 9/17/2021 requesting ultrasound testing

Allergies: none

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

Symptoms: burning instanly in shoulder. after couple hours severe shoulder pain. Immobility of the arm, nerve sensation and excruciating pain. Pain has persisted in its 5th day as of report. Seen in an ER. DIagnosed as muscle nerve pain

Other Meds: none

Current Illness: none

ID: 1709200
Sex: M
Age: 22
State: CA

Vax Date: 09/16/2021
Onset Date: 09/16/2021
Rec V Date: 09/17/2021
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: NONE

Allergies: NONE

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

Symptoms: ADMINISTERED EARLIER THAN THE RECOMMENDED 21 DAY INTERVAL. DOSE ONE OF PFIZER/BIONTECH (LOT # FF2587) WAS ADMINISTERED TO PATIENT ON 09/01/2021 (LEFT ARM, DELTOID, IM). PATIENT HAD NO ADVERSE REACTION. VAERS REPORT SUBMITTED TO RECORD EARLY VACCINATION.

Other Meds: UNKNOWN

Current Illness: NONE

ID: 1709201
Sex: F
Age: 60
State:

Vax Date: 09/14/2021
Onset Date: 09/14/2021
Rec V Date: 09/17/2021
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: Pt reports NKA.

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: "Pt PMH not available to this writer besides a hx of DM. Pt reports NKA. 9mins post vaccination pt c/o chest tightness. Vitals: @11:25 BP 113/61, HR 65, RR 18, Temp 98.1F, SpO2 96-100% -- > @11:45 103/59, 64, 17, 98.2, 100% -- > 12:08 101/59, 58, 18, 99% Stated that she was nervous coming to the vaccination site as she put wrong directions in her navigation. Denies numbness / tingling sensation in the left arm .Denies N/V/D/C. Denies having any other symptoms.Denies blurred vision.Denies slurred speech.Denies radiating pain to any other body part. Denies headache/dizziness. Denies having any h/o heart problems/family h/o heart problems. Patient states that she has borderline DM controlled well with diet. Pt given water, juice, and graham crackers. Pt was given a surgical mask to replace her KN95 mask to help her breathe easier. @11:25 pt reports that chest tightness improving now 4/10 down from 8/10 originally. @11:45 chest tightness 3/10 @12:08 Pt reports being symptom free. @12:11 pt stable and NAD pt ambulated out of facility accompanied by RN."

Other Meds: Unknown

Current Illness:

ID: 1709202
Sex: F
Age: 44
State: NM

Vax Date: 09/09/2021
Onset Date: 09/10/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: none

Allergies: pineapple

Symptom List: Pharyngeal swelling

Symptoms: deep tender pain that extended down the arm for four days, diarrhea for three days and The next day post vaccine I began to have muscle spasms-twitching and in r arm and in various body locations, such as R rib muscles and bilateral buttocks, lower back muscles and r arm bicep and Forearm intermittently for up to 5 days and also had moderate to severe cramping intermittent of leg muscles R /L buttocks hamstrings and calves, charlie-horse like at times, and overall body aches these symptoms lasted for 5 days. The mild sore throat and moderate headache for two days. *** Missed several days of work.

Other Meds: tylenol ibuprofen and multivitamin

Current Illness: none

ID: 1709203
Sex: M
Age: 71
State: CO

Vax Date: 01/13/2021
Onset Date: 09/09/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: weakness and somnolence

Other Meds:

Current Illness:

ID: 1709204
Sex: F
Age: 39
State: KS

Vax Date: 04/07/2021
Onset Date: 04/07/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Nurse gave patient covid vaccine even though pt received monoclonal antibody therapy for Covid within the last 90 days

Other Meds:

Current Illness:

ID: 1709205
Sex: F
Age: 54
State: PA

Vax Date: 09/17/2021
Onset Date: 09/17/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: BP checked >200/140

Allergies: None

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

Symptoms: High blood pressure that started immediately after giving shot, 5 minutes after shot patient said face was warm and did not feel right.

Other Meds: Meclizine, lamotrigine

Current Illness: None

ID: 1709206
Sex: M
Age: 33
State: NC

Vax Date: 03/05/2021
Onset Date: 03/07/2021
Rec V Date: 09/17/2021
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

Symptom List: Rash, Urticaria

Symptoms: Feelings of having a fast-beating, fluttering, or pounding heart. Most typical in the evening when laying down to rest / sleep. Lasted 1-2 weeks after both doses of vaccine. Dismissed after the first dose as a fluke, but occurred again after the second dose. Last 1-2 weeks as well. Both doses were Pfizer (EN6202 and ER8727). Second dose administered on March 31 2021. No adverse symptoms now several months later.

Other Meds: None

Current Illness: None

ID: 1709207
Sex: M
Age: 36
State: NY

Vax Date: 06/26/2021
Onset Date: 06/27/2021
Rec V Date: 09/17/2021
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: Had severe swelling under the left arm pit that lasted for about 1 week, and a lump roughly the size of a plum. After the lump subsided, then severe joint pain ensued. Pain has been chronic ever since. Sometimes effecting the ability to walk. Pain is mainly centered around hips and knees. On certain days the pain is all over, especially in joints. The joint pain has not gone away. Treating with Ibuprofen and CBD oil, and other anti-inflammatories. I absolutely DID NOT have any of this prior to receiving the Covid-19 vaccine.

Other Meds: CBD oil for Tourette's Syndrome

Current Illness: none

ID: 1709208
Sex: F
Age: 41
State: AZ

Vax Date: 04/01/2021
Onset Date: 05/01/2021
Rec V Date: 09/17/2021
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: None

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

Symptoms: Menstrual cycle changed to 21 days , with increase in flow and pain

Other Meds: Hcg diet supplements Lexapro Ambien Lorazepam Melatonin

Current Illness: None

ID: 1709209
Sex: F
Age: 58
State: KS

Vax Date: 03/25/2021
Onset Date: 03/25/2021
Rec V Date: 09/17/2021
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: Advil contrast dye has epi pen

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

Symptoms: 1405 pt complains of SOA unable to speak. Epi pen administered 1412-1416 seizure activity 1418 EMS arrived 1419 verbal and A&O

Other Meds: unknown

Current Illness: unknown

ID: 1709210
Sex: F
Age: 12
State: KS

Vax Date: 08/25/2021
Onset Date: 08/25/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: BP-94/67, P80, 02-95% P88, 02-99%

Allergies: NKA

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

Symptoms: After vaccine was administered, patient felt dizzy, vision was a little blurry. Patient sat on cot and ice pack was applied to back of neck. Vitals taken. Patient sat in EMS room approx 12 minutes until stated feeling better. Had patient stand to check balance and dizziness. Patient stated she felt good. Walked with patient and her mother to exit.

Other Meds: N/A

Current Illness: N/A

ID: 1709211
Sex: F
Age: 46
State:

Vax Date: 09/15/2021
Onset Date: 09/15/2021
Rec V Date: 09/17/2021
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:

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

Symptoms: Burning at injection site and around the arm, fever, swollen lymph node.

Other Meds:

Current Illness:

ID: 1709212
Sex: F
Age: 49
State: OH

Vax Date: 08/18/2021
Onset Date: 08/23/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data:

Allergies: metronidazole

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Severe constipation followed by severe diarrhea 3-5 days after the constipation. Shortness of breath and chest pain when exercising or walking up steps. Worsening of arthritis. Severe fatigue

Other Meds: Dicyclomine, Advair, metoprolol, singulair

Current Illness:

ID: 1709213
Sex: M
Age: 30
State: CA

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 09/17/2021
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: ADMINISTERED EARLIER THAN THE RECOMMENDED 21 DAY INTERVAL. DOSE ONE OF PFIZER/BIONTECH (LOT #EW0187) WAS ADMINISTERED TO PATIENT ON 08/27/2021 (LEFT ARM, DELTOID, IM). PATIENT HAD NO ADVERSE REACTION. VAERS REPORT SUBMITTED TO RECORD EARLY VACCINATION.

Other Meds: UNKNOWN

Current Illness: NONE

ID: 1709214
Sex: F
Age: 56
State: CA

Vax Date: 09/13/2021
Onset Date: 09/13/2021
Rec V Date: 09/17/2021
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, MD office messaged through website today.

Allergies: Morphine products, Oranges, Vicodin,Percocet,Dilaudid,Cipro,Tramadol,Norvasc,Levaquin, Latex. Codeine derivatives,Fentanyl, Oxycodone

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

Symptoms: Fever post injection , about 3 hours. Continued for 2 days with chills, headache and general malaise. The arm is swollen at injection site with itching . An edematous pocket below the injection area about an inch. The edematous spot below the injection site is growing, initially the width of my index finger, now the size of three fingers with increased itching and warmth . Both areas are red.

Other Meds: Cardia, Benicar, Zyrtec, Rouvastin,Singulair.

Current Illness: Migraine

ID: 1709215
Sex: F
Age: 58
State: NH

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 09/17/2021
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: None

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

Symptoms: body aches, headaches different than regular migraines that would come on without warning, nausea, fatigue,

Other Meds: Adderall, Celcept, Amitryptiline, Medrol, O2, Albuteral, Spiriva, Omeprazole, Bactrim/Spectra, Simbacort, Gabapentin, Valtrex, Imitrex, Emgality, Lorazepam, Oxycodone, Mirtazapine

Current Illness: none

ID: 1709216
Sex: F
Age: 20
State: CA

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 09/17/2021
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: NONE

Symptom List: Unevaluable event

Symptoms: ADMINISTERED EARLIER THAN THE RECOMMENDED 21 DAY INTERVAL. DOSE ONE OF PFIZER/BIONTECH (LOT #EW0187) WAS ADMINISTERED TO PATIENT ON 08/27/2021 (LEFT ARM, DELTOID, IM). PATIENT HAD NO ADVERSE REACTION. VAERS REPORT SUBMITTED TO RECORD EARLY VACCINATION.

Other Meds: UNKNOWN

Current Illness: NONE

ID: 1709217
Sex: M
Age: 25
State: CA

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 09/17/2021
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: NONE

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

Symptoms: ADMINISTERED EARLIER THAN THE RECOMMENDED 21 DAY INTERVAL. DOSE ONE OF PFIZER/BIONTECH (LOT #EW0187) WAS ADMINISTERED TO PATIENT ON 08/27/2021 (LEFT ARM, DELTOID, IM). PATIENT HAD NO ADVERSE REACTION. VAERS REPORT SUBMITTED TO RECORD EARLY VACCINATION.

Other Meds: UNKNOWN

Current Illness: NONE

ID: 1709218
Sex: M
Age: 52
State: CA

Vax Date: 07/20/2021
Onset Date: 09/17/2021
Rec V Date: 09/17/2021
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:

Symptom List: Injection site pain, Pain

Symptoms: headache, cough, nasal congestion, fatigue, myalgias, and arthralgias.

Other Meds:

Current Illness:

ID: 1709219
Sex: M
Age: 19
State: CA

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: NONE

Allergies: NONE

Symptom List: Injection site pain, Menorrhagia

Symptoms: ADMINISTERED EARLIER THAN THE RECOMMENDED 21 DAY INTERVAL. DOSE ONE OF PFIZER/BIONTECH (LOT #EW0187) WAS ADMINISTERED TO PATIENT ON 08/27/2021 (LEFT ARM, DELTOID, IM). PATIENT HAD NO ADVERSE REACTION. VAERS REPORT SUBMITTED TO RECORD EARLY VACCINATION.

Other Meds: UNKNOWN

Current Illness: NONE

ID: 1709220
Sex: F
Age: 28
State: IN

Vax Date: 09/17/2020
Onset Date: 09/17/2021
Rec V Date: 09/17/2021
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: cephazolin

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

Symptoms: racing heart, tingling and numbness in nose, mouth and throat, difficult swallowing

Other Meds: none

Current Illness: none

ID: 1709221
Sex: F
Age: 28
State: NY

Vax Date: 09/15/2021
Onset Date: 09/16/2021
Rec V Date: 09/17/2021
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

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Chest tightness, chest tingling from mid sternum radiating to throat. Shortness of breath, labored breathing worsened with deep inspiration.

Other Meds: None

Current Illness: None

ID: 1709222
Sex: M
Age: 38
State: CA

Vax Date: 09/17/2021
Onset Date: 09/17/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: None

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Pt received shot at 1440, alerted staff at 1449 to difficulty breathing, globus, racing heartbeat. Pt given 1 Epi pen at 1449, second dose of epi given at 1455. Benadryl 50mg given at 1500. Patient transported 1508.

Other Meds: None

Current Illness: Rheumatoid Arthritis

ID: 1709223
Sex: M
Age: 38
State: CA

Vax Date: 09/17/2021
Onset Date: 09/17/2021
Rec V Date: 09/17/2021
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: not known

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

Symptoms: Patient became very light headed, started sweating and said felt faint. 911 was called. EMT staff evaluated and said he was ok t go home.

Other Meds: not known

Current Illness: not known

ID: 1709224
Sex: M
Age: 17
State: CA

Vax Date: 09/13/2021
Onset Date: 09/14/2021
Rec V Date: 09/17/2021
Hospital: Y

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

Lab Data: MRI brain as described above. CSF studies nonrevealing thus far.

Allergies: None

Symptom List: Nausea

Symptoms: Technically symptoms had started 1 mo prior to vaccination, but patient was admitted to hospital for workup and treatment of these symptoms AFTER vaccination. He and his mom denies worsening of his symptoms after vaccination. Symptoms-- intermittent diplopia, speech/word finding difficulties, and gait instability (but no falls). MRI brain on admission was abnormal for patchy/nodular densities in multiple parts of the brain. He was hospitalized 9/14 (1 day after vaccination) for workup, and on 9/15 after significant workup sent, started on a 5-day course of high dose steroids.

Other Meds: None

Current Illness: Symptoms had been happening for about 1 mo prior to admission to hospital (admission date 9/14). Symptoms were diplopia, word finding difficulties, and gait instability.

ID: 1709225
Sex: M
Age: 24
State: TX

Vax Date: 08/26/2021
Onset Date: 09/12/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: Clinic visit, prescribed Valacyclovir 3x per day for 7 days starting on 9/15/2021

Allergies: None

Symptom List: Injection site pain

Symptoms: Developed shingles on right posterior, right testicle, between legs. Followed by fever and consistent headache which have subsided, shingles still present. IMPORTANT: NEVER HAD CHICKEN POX Received chicken pox vaccination and booster as infant.

Other Meds: None

Current Illness: None

ID: 1709226
Sex: F
Age: 38
State:

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 09/17/2021
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: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: constantly hot

Other Meds: methimazole, scironolactone

Current Illness:

ID: 1709227
Sex: M
Age: 75
State: CA

Vax Date: 01/27/2021
Onset Date: 09/06/2021
Rec V Date: 09/17/2021
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: Weak and lost his appetite. Fever cough and SOB

Other Meds:

Current Illness:

ID: 1709229
Sex: F
Age: 12
State: WI

Vax Date: 09/14/2021
Onset Date: 09/15/2021
Rec V Date: 09/17/2021
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: None

Symptom List: Tremor

Symptoms: Moderate headache, fatigue, upset stomach, nausea all lasting over two days.

Other Meds: None

Current Illness: None

ID: 1709230
Sex: F
Age: 47
State: TX

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: I have a schedule doctor appointment on 9/20/2021

Allergies: Almonds

Symptom List: Erythema, Pruritus

Symptoms: After 30 minutes of administration of injection my symptoms were headache, light headness, sore arm and throat felt very scratchy and felt like my throat was closing up. The symptoms lasted for two days. 5 days after injection I woke up with shooting pain, numbness, tingling from waist down down to my toes. I continue to have these symptoms that I cannot rest even at night. Lastly, I have had occurrences of scratchy throat as I have to clear my throat as if my throat is closing up.

Other Meds: No medications was taken at the time of the vaccination

Current Illness: None

ID: 1709231
Sex: F
Age: 57
State: CA

Vax Date: 09/02/2021
Onset Date: 09/02/2021
Rec V Date: 09/17/2021
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: none

Allergies: bees PCN

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

Symptoms: immediate swelling and hives followed by continued hives, itching, erythematous rash, periorbital edema x 2 weeks at time of presentation to Urgent Care

Other Meds: amlodipine indapamide repatha levothyroxine Good life MVI CoQ10

Current Illness: none

ID: 1709232
Sex: F
Age: 72
State: AZ

Vax Date: 03/08/2021
Onset Date: 03/08/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: I did not go to the hospital.

Allergies: Sulfur drugs; penicillin; LEVAQUIN; tiliquinol; tobramycin eye drops; azithromycin; tetracycline; etodolac; prednisone

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

Symptoms: My joints started feeling inflamed.

Other Meds: Sulindac; bupropion; rosuvastatin; flecainide; diltiazem; pilocarpine; montelukast; betamethasone cream; ICY HOT lidocaine patches; omeprazole; MUCINEX; COQ-10; aspirin; turmeric; melatonin; vitamin D3, B-complex vitamin; vitamin C

Current Illness: I am not sure

ID: 1709233
Sex: F
Age: 74
State: TN

Vax Date: 02/16/2021
Onset Date: 02/21/2021
Rec V Date: 09/17/2021
Hospital: Y

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

Lab Data: See hospital records at Physcians office

Allergies: Sulfa, Codeine

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Heart Palpitations; rapid heart rate; irregular heart beat; dizziness; After 2nd vaccine (Lot #010A21A - Modetma - experienced more & longer symptoms. In hospital- discovered pulmonary embolism; treated for all & treatments still ongoing.

Other Meds: Multi vitamin, biotin, Citracal, Vit D, Vit B2, , Aimovig, Generic Imitrrx as needed

Current Illness: Only migraine headaches

ID: 1709234
Sex: F
Age: 35
State:

Vax Date: 09/14/2021
Onset Date: 09/14/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data:

Allergies: NKDA

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

Symptoms: "Pt w/ PMH significant for Asthma. NKDA. Pt denies any medications. 7mins post vaccination, pt c/o feeling paint and hot. Pt denied N/V blurry vision, palpitations, itching or respiratory issues. Skin dry and VSS. Vitals: @11:15 BP 108/61, HR 60, RR 18, O2 Sat 99%. -- > @11:30 108/83, 57, 18 -- > @11:42 116/91, 57, 18. Pt notes that she has had previous needle anxiety. No known bradycardia hx. Last PCP visist a long time ago. Pt given apple juice, crackers, and ice pack. @11:25 pt reports feeling better @11:30 improving - mild dizziness. @11:48 Pt ambulated off unit, accompanied by family. Dizziness resolved. Pt stable and released from the vaccination site. Recommended the patient f/u w/ healthcare provider, f/u instructions provided."

Other Meds: Pt denies

Current Illness:

ID: 1709235
Sex: F
Age: 75
State: IN

Vax Date: 09/15/2021
Onset Date: 09/16/2021
Rec V Date: 09/17/2021
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:

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

Symptoms: PATIENT RECIEVED VACCINE ON 9/15/2021. ON 9/16/2021 THE PATIENT NOTICED A BRUISE DEVELOPING AT THE SITE OF VACCINATION, ABOUT 4 INCHES BELOW AND 6 INCHES WIDE THERE WAS A RED PATCH. THE PATCH WAS SLIGHTLY RAISED, FIRM, AND WARM TO THE TOUCH. PATIENT SAID THAT IT WAS IMPROVING SLIGHTLY AFTER 24 HOURS.

Other Meds:

Current Illness:

ID: 1709236
Sex: F
Age: 8
State: NH

Vax Date: 09/17/2021
Onset Date: 09/17/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: Approximately 5 minutes after immunization with flucelvax, patient briefly fainted. Pharmacist immediately assisted and provided an ice pack to wrist and back of neck of patient. Patient recovered quickly and quickly recovered awareness. Pharmacist asked if patient has ever had a problem with a vaccine in the past and patient's mother reported that she does not normally have any issues. Patient's mother also reported that the patient did not have very much to eat at lunch. Pharmacist provided supervision to patient for approximately 15 minutes and patient seemed back to normal as family left the pharmacy.

Other Meds:

Current Illness:

ID: 1709427
Sex: M
Age: 73
State: TN

Vax Date: 02/25/2021
Onset Date: 04/23/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: MRI of chest/lungs - 2 PE in upper left lobe, possibly 1 PE in lower left lobe Drug induced heart and blood vessel stress test with EKG - Good Ultrasound of veins in both legs - Clear

Allergies:

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

Symptoms: Pain in left chest on Thursday night but eased. Pain in left chest on Friday night and went to ER Blood thinner zarelto in hospital and for 6 months

Other Meds: Ezetimibe 10 mg Irbesartan 300 mg Claritin 1 tab/day Vitamin D3 5000 iu Multi-Vitamin CoQ10 100 mg Aspirin 81 mg - 4/week

Current Illness:

ID: 1709428
Sex: F
Age: 20
State: GA

Vax Date: 09/16/2021
Onset Date: 09/16/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Pt reported feeling dizzy 5 mins s/p vaccine administration. Pt was escorted to exam room for monitoring, VS taken, BP 112/70, HR 95, O2 sat 97% on RA. Pt given apple juice and monitored; no LOC. S/s resolved within 20-25 mins. Repeat vitals as follows: BP 112/73, HR 93, O2 sat 98% on RA. Pt ambulated out of clinic.

Other Meds:

Current Illness:

ID: 1709429
Sex: M
Age: 68
State: OR

Vax Date: 04/12/2021
Onset Date: 05/16/2021
Rec V Date: 09/17/2021
Hospital: Y

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

Lab Data: CT head, MRI with and without contrast plethora of labs (b1, b12, tsh, cbc, cmp, syphillis, etc) also LP which was nml.

Allergies: amoxicillin

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

Symptoms: initial sx which started a couple weeks after vaccination: repeating himself, mild short term memory loss sx escalated and peaked at full mania a couple months later: aggressive behavior, confusion, mania, irritability, inability to stay on task, inability to perform day to day tasks such as turning on water for shower or how to measure a board (he is a wood worker), psychomotor agitation (walked for 4 miles in he woods and injured himself in the night and called wife, then pusher her down on the ground at 3 am as he was 2 miles from home - lead to psych admission).

Other Meds: metamucil daily - 1 scoop

Current Illness: none

ID: 1709430
Sex: F
Age: 46
State: NY

Vax Date: 01/12/2021
Onset Date: 01/22/2021
Rec V Date: 09/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: 04/01/2021 Hearing test

Allergies: Fish; sulfa; Avelox

Symptom List: Vomiting

Symptoms: Ear clog and difficult to hear, medicine did not seem to help. With 2nd vaccination, worsening condition, loss of hearing, tinnitus (mostly left ear) lessened but has flare-ups. 01/31/2021 Astelin aerosol, Claritin, Sudafed for 5 days. 2/5/2021 PC gave antibiotics. Dizziness, vertigo, vomiting occurred after second dose. 2/23/2021 prednisone for 4 day, helped a little 04/01/2021 Hearing test, within normal limits but issues with high and low freq in left ear. Appointments pending w/ENT with specializing in ears. Symptoms are lessened as of 9/17/2021 it is ongoing.

Other Meds: Atorvastatin; famotidine; levothyroxine; metoprolol; Pulmicort; Culturelle; aspirin; Ritual multivitamin capsule

Current Illness: None

ID: 1709431
Sex: M
Age: 88
State: AL

Vax Date: 09/17/2021
Onset Date: 09/17/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: Paramedics took vitals. HR ranged from 130-160. Glucose ~94. BP (~ mid 70s SBP / ~ mid 50s DBP) - unsure of exact values.

Allergies: NKDA

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: About 10 minutes after receiving vaccine, pt began throwing up clear liquid (his wife later told me he hadn't eaten anything today). He was sitting in a motorized shopping cart hunched over, but conscious. He was sweating, but could communicate and tell me he was breathing ok. Was conscious the entire time. We called 911 and the paramedics arrived within minutes and moved him to gurney to take vitals. Pt left to go to the ER due to abnormal vitals.

Other Meds: Ranolazine, Ondansetron, Metoprolol, Losartan, Montelukast, Levothyroxine, Omeprazole

Current Illness: Unknown

ID: 1709432
Sex: F
Age: 70
State: OK

Vax Date: 04/08/2021
Onset Date: 07/30/2021
Rec V Date: 09/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

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

Symptoms: Started with intermittent tightness and cramping in back of calf x 3 days starting 7/30/2021, noticeable at bedtime. The cramping went away after 3 days. Felt a tightness in back of right calf but did not seem swollen and when measured never increased in size. After the cramping went away seemed like SOB getting worse on activity. Went to ER, on 8/6/2021 and diagnosed with Bilateral pulmonary embolism, acute deep vein thrombosis of proximal vein of right lower extremity, and exertional dyspnea, and was put on Rivaroxaban 15mg 1 po bid x 21 days and then Rivaroxaban 20 mg 1 po daily.

Other Meds: Protonix 40mg 1 daily; Calcium600 +D3 800iu 1tab bid;

Current Illness: no illness

ID: 1709433
Sex: M
Age: 69
State: CA

Vax Date: 03/28/2021
Onset Date: 09/09/2021
Rec V Date: 09/17/2021
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:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: no symptoms reported

Other Meds:

Current Illness:

ID: 1709435
Sex: M
Age: 26
State: OH

Vax Date: 08/19/2021
Onset Date: 08/20/2021
Rec V Date: 09/17/2021
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: Adverse event: Next day after vaccine administration (August 20, 2021) patient experienced "dull pain" in area of heart . He describes the pain as an "ache". On day 26 after receiving vaccine- he describes sensation of pressure in area of heart, hard to breathe and lightheadedness. He did not mention any treatment.

Other Meds:

Current Illness:

ID: 1709436
Sex: F
Age: 80
State: NJ

Vax Date: 08/18/2021
Onset Date: 08/20/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: None

Allergies: None

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

Symptoms: Swelling of lips & lower right jaw. Took 2 Benadryl & 6 hours took 2 additional. The swelling started to go down about 4 hours later, completely gone within 24 hours

Other Meds: Levothroxide,, simvastatin,amlodopine,hydrochlorozide,metoprolol

Current Illness: None

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am