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: 1713260
Sex: F
Age: 76
State: OR

Vax Date: 02/11/2021
Onset Date: 03/11/2021
Rec V Date: 09/18/2021
Hospital:

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

Lab Data: Covid test - results neither positive or negative 8/20

Allergies: none known

Symptom List: Dysphagia, Epiglottitis

Symptoms: I had no adverse reaction to the vaccine. This summer I developed a sinus infection. Because of the Covid scare, I finally decided to go to the doctor to make sure I wasn't a mildly asymptomatic vaccinated person. The doctor did a covid test and unfortunately the results were inconclusive (something the doctor said she had never experienced) - neither positive or negative. I stayed isolated for 10 days, treated with Sudafed and all symptoms went away. No one around me ever got sick.

Other Meds: multivitamin

Current Illness: none

ID: 1713261
Sex: M
Age: 34
State:

Vax Date: 12/19/2020
Onset Date: 12/30/2020
Rec V Date: 09/18/2021
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: Reyaud's like symptoms, e.g. easily cold, then red and painful feet, managed supportively, avoiding cold, changing socks frequently

Other Meds:

Current Illness:

ID: 1713262
Sex: F
Age: 56
State: WI

Vax Date: 08/18/2021
Onset Date: 09/01/2021
Rec V Date: 09/18/2021
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: office observation

Allergies: Penicillin

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

Symptoms: Hives, hands itchy, tongue swollen and feels burnt

Other Meds: Escitalopram 20mg, Furosemide 20mg, Losartan 50mg, Multi vitamin

Current Illness: none

ID: 1713263
Sex: F
Age: 59
State: CO

Vax Date: 08/28/2021
Onset Date: 08/28/2021
Rec V Date: 09/18/2021
Hospital:

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

Lab Data: None

Allergies: Bactrim

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Elevated heart rate as high as 150bpm at rest for 24-36 post administration

Other Meds: Lisi opril Cardizem Cymbalta Omepraze Zyrtec Metformin

Current Illness: None

ID: 1713264
Sex: F
Age: 45
State: FL

Vax Date: 09/17/2021
Onset Date: 09/18/2021
Rec V Date: 09/18/2021
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: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Got a nose bleed this morning. Never do ordinarily. So far. Super tired like the flu. Just thought you should know ..so far

Other Meds: None

Current Illness: None

ID: 1713265
Sex: F
Age: 64
State: TX

Vax Date: 09/16/2021
Onset Date: 09/17/2021
Rec V Date: 09/18/2021
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: Entire Left upper arm very red, swollen, sore, rash with itching

Other Meds: Levoxyl, tramadol, Osphena

Current Illness: None

ID: 1713266
Sex: F
Age: 26
State: WI

Vax Date: 09/15/2021
Onset Date: 09/16/2021
Rec V Date: 09/18/2021
Hospital:

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

Lab Data: EKG on 9/16: Sinus tachycardia, 113 bpm.

Allergies: Intolerance to adhesive - rash with prolonged use

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Common side effects of vaccination including low grade fever, chills/hotflashes, and intense body/bone aches began approximately 9/15 at 2300. I awoke at 0600 noting my heart rate to be at 122 bpm via radial manual pulse, my smart watch, and pulse oximetry; after walking short distance to kitchen, my heart rate was then 140 bpm. I figured maybe I just need to take my metoprolol. I do have a history of tachycardia for unknown reasons at this time but my rates have been controlled between 80-90 or less... even with activity usually my heart rate stays below 120 bpm now. At that time, I took my metoprolol; the day before I had taken it at approximately the same time given that is when I had gotten up for work. I was able to fall back asleep within an hour. I woke up again approximately 120 bpm... I could feel instantly that my heart rate still felt elevated. I checked my watch and pulse oximetry again to find my heart rate was still around 120 bpm just having woke up, still laying in bed. This is quite uncommon for me given my rates have been well-controlled for months now. I ended up discussing with employee health at my workplace who urged me to seek care so I went to the Urgent Care. Heart rate documented at 127 bpm and other vital signs within normal limits. EKG was completed showing sinus tachycardia at 113 bpm. End result was to increase metoprolol dosage until symptoms passed; if they did not improve, pursue ER care. Taking an additional 25 mg on top of my 50 mg ER metoprolol brought my heart rate down for the remainder of the day to 90-100... still elevated from my normal but tolerable. The following day as common symptoms improved so did my heart rate. I understand this reaction is likely due to my bodies response to creating antibodies; however, elevated heart rate was not listed as possible side effect which is drastically important for someone like me who has these issues being managed chronically. Expecting tachycardia as a response would have changed possibly which vaccine I received as well as my medical treatment. Provider at Urgent Care stated that none of their provider's were aware of tachycardia as a common reaction.

Other Meds: Metoprolol, bupropion, and finished dose of flagyl

Current Illness: just finished medication course for yeast infection and BV

ID: 1713267
Sex: M
Age: 50
State: NV

Vax Date: 04/11/2021
Onset Date: 07/01/2021
Rec V Date: 09/18/2021
Hospital:

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

Lab Data: Lyme test - negative

Allergies: none

Symptom List: Pharyngeal swelling

Symptoms: Bells Palsey

Other Meds: none

Current Illness: none

ID: 1713268
Sex: M
Age: 78
State: TX

Vax Date: 09/09/2021
Onset Date: 09/10/2021
Rec V Date: 09/18/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Severe Bruising on the upper arm

Other Meds: Plavix (Clopidogrel)

Current Illness: unknwon

ID: 1713269
Sex: F
Age: 50
State: NY

Vax Date: 09/09/2021
Onset Date: 09/16/2021
Rec V Date: 09/18/2021
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: Peanuts, tree nuts, Ibuprofen

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Right arm redness, rash, and itching at injection site

Other Meds: Vitamin C Once a Day

Current Illness: None

ID: 1713270
Sex: F
Age: 42
State: AZ

Vax Date: 09/16/2021
Onset Date: 09/16/2021
Rec V Date: 09/18/2021
Hospital:

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

Lab Data: None yet

Allergies: None

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

Symptoms: Severe abdominal pain, fever, nausea, vomiting, diarrhea, headache, myalgia. Symptoms have remained severe since onset and now for 48hrs since vaccine. Tx?Zantac 360mg bid, peptobismol q6hrs, omeprazole 40mg.

Other Meds: Armour Thyroid 30mg Estradiol 2mg Progesterone 100mg

Current Illness: None

ID: 1713271
Sex: F
Age: 68
State: GA

Vax Date: 03/10/2021
Onset Date: 03/18/2021
Rec V Date: 09/18/2021
Hospital:

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

Lab Data: Blood rests, echo gram Mri and x-rays

Allergies:

Symptom List: Rash, Urticaria

Symptoms: sore arm , dry cough, hard to breathe, can't sleep head ache and high blood pressure

Other Meds:

Current Illness:

ID: 1713272
Sex: M
Age: 34
State: TX

Vax Date: 09/16/2021
Onset Date: 09/16/2021
Rec V Date: 09/18/2021
Hospital:

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

Lab Data:

Allergies: Some foods but it happens rarely

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

Symptoms: Around 05 pm the pain and fever slowly started and by around 10 pm i started to have cold and hot fever, joint pain, lower back pain and followed by cramping and stomach uncomfortably and a serious pain. Medicine used for treatment: stomach such as omeprazole and anti acids, nausea tabs and pain and fever relievers but really nothing worked because of the nuasea

Other Meds: Nausea medicine, pain and fever relievers and digestive or stomach medicine

Current Illness: None

ID: 1713273
Sex: F
Age: 19
State: KS

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 09/18/2021
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:

Allergies: Apples

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

Symptoms: Patient states history of vasovagal syncope and felt dizzy. Patient observed for 25 minutes and released to leave after stating she felt better.

Other Meds: Multivitamin

Current Illness:

ID: 1713274
Sex: F
Age: 56
State: KY

Vax Date: 04/01/2021
Onset Date: 04/15/2021
Rec V Date: 09/18/2021
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: Multiple: Labs X rays Cat Scans of chest Pulmonary function test

Allergies: Ambien Penicillin

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

Symptoms: Multiple Er visuals, 9 day hospitalization, slept (pretty much comatose) for 4 days, persistent cough, problems breathing, vomiting, body aches from head to toes, tired, exhausted, weakness (legs feel like noodles), loss of appetite, can?t get enough sleep, dry mputh, excessive thirst, cough & problems breathing continues months later as well as exhaustion and weakness , dehydration,

Other Meds: Pristiq Doxipen Vitamin B 12 Prazosin Diazepam Ibuprofen

Current Illness: None

ID: 1713275
Sex: M
Age: 15
State: TX

Vax Date: 09/06/2021
Onset Date: 09/06/2021
Rec V Date: 09/18/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Administered expired vaccine by 6 days. No adverse reaction.

Other Meds: None

Current Illness: None

ID: 1713276
Sex: F
Age: 33
State: OH

Vax Date: 08/28/2021
Onset Date: 09/01/2021
Rec V Date: 09/18/2021
Hospital:

Vax Type: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data: 9/4/21-EGK, Chest x ray, labs 9/7/- 21EKG, Chest x ray 9/14/21- EKG, chest x ray, labs 9/23/21 - heart ultrasound and holter monitor

Allergies: none

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

Symptoms: 8/28/21 - covid vaccine pfizer 9/1/21- 9/4/21 - symptoms began - Shortness of breath hard to swallow, feeling of throat closing 9/4/21 - Emergency Room 9/6/21 - 9/7/21 - shortness of breath, chest pain, heart palpitations, Numb Left Arm 9/7/21- Urgent Care symptoms continue... except for L arm is tingly, not numb 9/14/21 - Back at ER with chest pain and heart palpitations. referred to cardiology 9/15/21 - cardiology appt. Dr wants to test for pericarditis. 9/23/21 - Ultrasound of heart and holter monitor will be placed

Other Meds: escitalopram, losartum potassium, levothroxine

Current Illness: none

ID: 1713277
Sex: F
Age: 46
State: FL

Vax Date: 08/25/2021
Onset Date: 08/26/2021
Rec V Date: 09/18/2021
Hospital:

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

Lab Data: Nothing done yet, just taking Motrin

Allergies: Sulfa, late

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Horribly painful muscle and joint aches and pains.

Other Meds: Synthroid, Zoloft

Current Illness: None

ID: 1713278
Sex: M
Age: 13
State: OH

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

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

Lab Data: N?A

Allergies: NKDA

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: 13 Year-old administered the Moderna vaccine. No side effects reported by patients mother or patient

Other Meds: None

Current Illness: None

ID: 1713279
Sex: F
Age: 32
State: MD

Vax Date: 08/01/2021
Onset Date: 09/01/2021
Rec V Date: 09/18/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Secondary insomnia. Every night since receiving vaccination I wake up between 4-5 AM.

Other Meds: None

Current Illness: None

ID: 1713280
Sex: F
Age: 36
State: OK

Vax Date: 09/09/2021
Onset Date: 09/09/2021
Rec V Date: 09/18/2021
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: Fetal monitoring- normal 9/9/21

Allergies: No known allergies

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

Symptoms: 10/25/21 was 33.3 weeks pregnant on day of vaccine administration Within 15-20 minutes of vaccine administration patient began experiencing slurred speech, vision changes, headache, and low blood pressure. Was evaluated in ER. Resolved in 3 hours.

Other Meds: Prenatal vitamin Aspirin 81 mg

Current Illness: None

ID: 1713281
Sex: M
Age: 44
State: KS

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 09/18/2021
Hospital:

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

Lab Data:

Allergies: NKA

Symptom List: Unevaluable event

Symptoms: Patient presented to clinic requesting 2nd dose of Pfizer 5 days prior to approved date. 1st dose-03/17/2021, 2nd due 04/07/2021. Dose given to patient and patient will advise if any adverse effects.

Other Meds: None listed

Current Illness: N/A

ID: 1713283
Sex: M
Age: 54
State: NC

Vax Date: 09/03/2021
Onset Date: 09/04/2021
Rec V Date: 09/18/2021
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: None

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

Symptoms: vasovagal syncope with loss of consciousness for unknown length of time (est. 10-30min), resulting in forehead laceration from fall severe fever, sweats, chills for 60min flu-like symptoms for 24hrs

Other Meds: None

Current Illness: None

ID: 1713284
Sex: M
Age: 60
State: OR

Vax Date: 09/15/2021
Onset Date: 09/16/2021
Rec V Date: 09/18/2021
Hospital:

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

Lab Data: None.

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Body temperature increased 1.1 degrees, aches and pains, lethargy. Took Advil. Recovered by next morning.

Other Meds: LisinopriL 20 mg PO daily; Glucosamine sulfate 500mg PO 3x/daily; Red yeast Rice 600 mg 2 PO 2xdaily; Omega-3 acid ethyl esters 1 gm PO 2x/daily; Loratadine 10 mg PO daily; Guaifenesin 1200 mg PO 1 or 2x/day; Centrum Silver multivitamin PO

Current Illness:

ID: 1713285
Sex: F
Age: 52
State: GA

Vax Date: 09/15/2021
Onset Date: 09/17/2021
Rec V Date: 09/18/2021
Hospital:

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

Lab Data: Ekg

Allergies: Sulfa penicillin and clindamycin

Symptom List: Injection site pain, Menorrhagia

Symptoms: 40 hours after vax dose 1 at 8:30 am fingers got tingling sensation and spread quickly up my arms like when your foot goes to sleep felt awful had to call 911. When at drs got ekg and then Got a vitamin IV from my dr at 2:00 symptoms. I think the cdc should cover my ambulance and the 250 dollars getting the vitamin infusion. I am VERY apprehensive on getting 2nd dose considering it could be worse.

Other Meds: Zinc C D

Current Illness: None

ID: 1713286
Sex: F
Age: 25
State: OK

Vax Date: 09/17/2021
Onset Date: 09/18/2021
Rec V Date: 09/18/2021
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: Chills Very sore arm Tired Aches

Other Meds:

Current Illness:

ID: 1713287
Sex: U
Age: 35
State: KS

Vax Date: 03/30/2021
Onset Date: 03/30/2021
Rec V Date: 09/18/2021
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: Vitals at 1402- BP 120/78, P 83, 02 98%

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient c/o face swelling "like allergy" face is red. 1415 patient resting in chair; cheeks red; states face feels "a little hotter." Will continue to moniter. RN administered benadryl 25mg po at 1425. Per supervisor, patient is stable and ok to leave. Patient states going to mom's house which is "6 minutes away." Patient told to follow up with PCP and verbalized understanding.

Other Meds:

Current Illness:

ID: 1713288
Sex: F
Age: 40
State: VA

Vax Date: 09/13/2021
Onset Date: 09/14/2021
Rec V Date: 09/18/2021
Hospital:

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

Lab Data:

Allergies: none disclosed on form

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: non- itching rash covering entire body about 24 hours after administration only marginally responded to benadryl after 3 days patient started on steroids and it did respond to that

Other Meds: not known

Current Illness: none disclosed on form

ID: 1713289
Sex: F
Age: 14
State: TN

Vax Date: 09/17/2021
Onset Date: 09/17/2021
Rec V Date: 09/18/2021
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:

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

Symptoms: Bled after receiving vaccine and warm to touch (mom called and complained of this).

Other Meds:

Current Illness:

ID: 1713290
Sex: F
Age: 32
State: PA

Vax Date: 03/14/2021
Onset Date: 03/14/2021
Rec V Date: 09/18/2021
Hospital:

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

Lab Data: Basic Metabolic Panel 5/6/21 CBC w/PLT/DIFF AUTO 5/6/21 CBC w/ diff 6/2/21 Comp. Met 6/2/21 HBA1C 6/2/21 CBC with Diff 4/21/21 Comp Met 4/21/21 THS with Reflex 4/21/21 Iron panel 4/21/21 Venipuncture 5/6/21 MRI 7/15/21 CT Head unehanced 5/6/21 CT Head W/WO COn W/Recon 5/6/21 Endoscopy Nasal Diagostic 7/15/21

Allergies: Amoxicillin

Symptom List: Nausea

Symptoms: Migraines, headache almost every day since March 14, 2021.

Other Meds: Effexar otezla zyrtec amitryptiline

Current Illness:

ID: 1713291
Sex: M
Age: 41
State: FL

Vax Date: 09/18/2021
Onset Date: 09/18/2021
Rec V Date: 09/18/2021
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: None

Symptom List: Injection site pain

Symptoms: While patient was waiting in the post vaccination area (after receiving Pfizer COVID-19 vaccine), he started feeling cold and his face was pale. He was sweating a lot (his clothes were all wet covered in sweat). Patient never had difficulty breathing nor any sign of allergy. He was conscious at all time. I took his blood pressure and it was 114/77 and his pulse was 83. We monitored the patient and called 911.

Other Meds: None

Current Illness: None

ID: 1713292
Sex: M
Age: 19
State: OK

Vax Date: 09/14/2021
Onset Date: 09/14/2021
Rec V Date: 09/18/2021
Hospital:

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

Lab Data: Labs were drawn in the ED but I am not sure what labs were drawn

Allergies: NKDA

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

Symptoms: Severe abdominal cramping & pain that worsened so much from 9pm to midnight that I had to go to the local ER and receive IV medication. After I received one dose of IV Zofran and one dose of IV Toradol the pain decreased to a manageable level and I was able to be discharged.

Other Meds: Biktarvy

Current Illness: none

ID: 1713293
Sex: M
Age: 23
State: NJ

Vax Date: 08/21/2021
Onset Date: 08/22/2021
Rec V Date: 09/18/2021
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: Vertigo.

Other Meds:

Current Illness:

ID: 1713294
Sex: F
Age: 45
State: KS

Vax Date: 03/30/2021
Onset Date: 03/30/2021
Rec V Date: 09/18/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: Patient states "am I supposed to feel funny?" Patient states she is lightheaded. Patient brought to cot; denies nausea or other symptoms. Patient was provided water.

Other Meds:

Current Illness:

ID: 1713295
Sex: F
Age: 58
State: MA

Vax Date: 04/30/2021
Onset Date: 08/01/2021
Rec V Date: 09/18/2021
Hospital:

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

Lab Data: Examination by my Dermatologist on 9/15/2021

Allergies: None

Symptom List: Erythema, Pruritus

Symptoms: In early August, 3 months after my second vaccine dose, I noticed unusually increased hair shedding. This continued so I saw my dermotologist on September 15, 2021. My dermatologist diagnosed me with Telogen Effluvium. I understand it is often the result of an adverse event 3 months prior. There really was no change in my life except having the vaccine at that time. I wonder if there could be a connection. My dermatologist did not believe so.

Other Meds: None

Current Illness: none

ID: 1713296
Sex: F
Age: 43
State:

Vax Date: 03/14/2021
Onset Date: 09/13/2021
Rec V Date: 09/18/2021
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: tested PCR positive on 9/13/2021

Allergies:

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

Symptoms: Patient is fully vaccinated as on 03/14/2021 with Janssen vaccine and contracted COVID, tested positive on 9/13/2021

Other Meds:

Current Illness:

ID: 1713297
Sex: F
Age: 44
State: MT

Vax Date: 09/15/2021
Onset Date: 09/17/2021
Rec V Date: 09/18/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Swollen, painful lymph nodes in left armpit (same side as vaccine).

Other Meds:

Current Illness:

ID: 1713298
Sex: M
Age: 18
State:

Vax Date: 07/26/2021
Onset Date: 07/26/2021
Rec V Date: 09/18/2021
Hospital:

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

Lab Data: The hospital ran bloodwork to check for anything else that may be going on. But, nothing else showed in the blood work. It was an adverse reaction to the covid-19 vaccine. Patient's PCP was notified of the severe adverse reaction.

Allergies: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient had a seizure within one minute of Johnson & Johnson Covid-19 vaccine administration. His eyes rolled back in his head, he was convulsing, incoherent, and arms were uncontrollably moving. His blood pressure plummeted; he became pale, was profusely sweating, and passed out a couple different times. He was given an epipen shot in the thigh shortly after these symptoms and was taken to the hospital via ambulance. Patient is a very healthy 18 year old with no prior seizures, diseases, autoimmune disorders, allergies or other health ailments.

Other Meds: None

Current Illness: None

ID: 1713299
Sex: U
Age: 21
State: KS

Vax Date: 03/30/2021
Onset Date: 03/30/2021
Rec V Date: 09/18/2021
Hospital:

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

Lab Data: Vitals @ 1435-BP 102/74, P 81, 02 96%

Allergies:

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

Symptoms: At 1432 injection given to patient; patient stood and felt lightheaded and dizzy; patient taken to observation area in wheelchair. 1435 vitals taken; patient clammy and ice pack applied; patient lying on cot and states this has happened before. 1446 patient sitting up on cot and eating crackers and drinking water. 1448 patient states feeling "much better' and sitting in observation area for 30 minutes.

Other Meds:

Current Illness:

ID: 1713300
Sex: F
Age: 26
State: NM

Vax Date: 09/17/2021
Onset Date: 09/17/2021
Rec V Date: 09/18/2021
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: Migraine , sore throat , body aches , chills , fever , diarrhea, nausea, loss of appetite, fatigue

Other Meds: 100mg Zoloft , 5mg progesterone, fish oil , super B complex , prenatal, vitamin D3 , probiotic

Current Illness: Na

ID: 1713301
Sex: M
Age: 64
State: PA

Vax Date: 07/21/2021
Onset Date: 07/22/2021
Rec V Date: 09/18/2021
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: Pain in extremity

Symptoms: The day of the injection I was fine. The next morning approximately 4:00 am I awoke feeling as if my ribs were broken, (I've never broken a rib, but I imagine that it must feel that way), I could not breathe in or out without extreme pain in my left rib, upper abdomen area. I could not move in any direction, either up, down or sideways without extreme pain in the same area. There was nothing I could do to help alleviate the pain. I take morphine sulfate as part of a pain regimen for my power back and taking my regular daily dosage did nothing to help either. This went on the entire day after the injection, and into the following day as well. And it wasn't until the third day that the pain began to subside to a point to where I could function. The fourth day the pain and the feelings of broken ribs had completely subsided and was pretty much gone. My wife and I almost went to the emergency room the day after the injection when it was the worst, but I decided I wanted to wait it out to see if it would get better. Plus, I'm one that doesn't like hospitals if I can at all help it! Due to other reasons not related, I could not get my second injection. So it had to wait until yesterday 9/17/2021 at 1:00 pm. Also at a Pharmacy, but another store location. Today, 9/18/2021 I am having symptoms very similar to the last time, only I got the shot in my right arm yesterday, and the feelings are the same only very slightly

Other Meds: Lisinopril 1x20mg, Morphine Sulfate 2x100mg, Neurontin 3x600mg

Current Illness: None

ID: 1713302
Sex: F
Age: 15
State: TX

Vax Date: 09/18/2021
Onset Date: 09/18/2021
Rec V Date: 09/18/2021
Hospital:

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

Lab Data: none

Allergies: none

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

Symptoms: pt stated feeling dizzzy when standing, elevated heart rate and a little shaky. vitals at the time of the reaction: hr 98 o2 100% bp 130/85 Pt stated they felt better after 15 mins of siting. Pt was cleared to leave. Vitals after 15mins: hr 84 o2 100 bp 125/80

Other Meds: none

Current Illness: none

ID: 1713303
Sex: F
Age: 17
State: TX

Vax Date: 09/06/2021
Onset Date: 09/06/2021
Rec V Date: 09/18/2021
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: None

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

Symptoms: Administered expired vaccine by 6 days

Other Meds: None

Current Illness: None

ID: 1713304
Sex: F
Age: 35
State: MI

Vax Date: 09/17/2021
Onset Date: 09/18/2021
Rec V Date: 09/18/2021
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: Avelox Doxycycline

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

Symptoms: Chills, headache, muscle pain, nausea, feeling sick overall, arm pain down to my elbow, nasal congestion. Symptoms started this morning at 5 am and woke me up. I've taken one 500 mg tablet of acetaminophen, and I've not taken any of my prescription medications yet today.

Other Meds: Gabapentin Tramadol Orphenadrine Diazepam

Current Illness: I was sick with an unknown diagnosis, but my COVID PCR test was negative 2 weeks prior to getting my second COVID shot

ID: 1713305
Sex: M
Age: 17
State: NJ

Vax Date: 09/14/2021
Onset Date: 09/16/2021
Rec V Date: 09/18/2021
Hospital: Y

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

Lab Data: At ED on 9/17/21, his temperature was 37.7 C, BP 104/82 mmHg, HR 84, RR 18, SPO2 98% on room air. He was given a dose of motrin at 4:30 pm which alleviated his discomfort. ECG was normal with no ST changes, CXR showed clear lungs and no cardiomegaly. CK, electrolytes, and CBC were unremarkable. High sensitivity troponin was elevated to 92 prompting his transfer to another Hospital.

Allergies:

Symptom List: Vomiting

Symptoms: Patient presented with chest discomfort. No other symptoms.

Other Meds: none

Current Illness:

ID: 1713306
Sex: F
Age: 81
State: CA

Vax Date: 02/26/2021
Onset Date: 03/12/2021
Rec V Date: 09/18/2021
Hospital: Y

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

Lab Data: Many tests where taken during my time at Hospital from June 16th to June 25th.

Allergies: Pinicillin - codiene - morphine -

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: I started to have some rectal bleeding and it increased as time went by and I started to have loss stools. It turned out I had developed ulcerated colitus. I ended up in hospital from June 16th to June 25th. I am still under treatment for the problem.

Other Meds: Armour thyroid 60 mg - ubiquinol 100 mg - krill oil 500 mg.- DMG 125 mg - Taurine 500 - multi vitamin -

Current Illness: Diverticulouses - Hoshimotos

ID: 1713307
Sex: U
Age: 60
State: KS

Vax Date: 03/29/2021
Onset Date: 03/29/2021
Rec V Date: 09/18/2021
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:

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

Symptoms: Patient has history of anaphylaxis. Preventatively had patient frontline their own benadryl 50mg po 20 minutes prior to vaccine. Observed patient for 30 minutes; no injury to patient.

Other Meds: Benadryl 50mg

Current Illness:

ID: 1713308
Sex: F
Age: 39
State: NY

Vax Date: 09/17/2021
Onset Date: 09/17/2021
Rec V Date: 09/18/2021
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: None

Allergies: Mangos, chlorine, Kewi, seamoss Rash and hives with administration of Flu Vaccine

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Initially started itching within 20 minutes of injection. Then rashes developed on left forearm, buttocks, and upper back. Overnight had rash and hives, headache, bodyaches, and chills.

Other Meds: Prilosec, Multivitamin, Zyrtec

Current Illness: Gastritis, hiatal hernia

ID: 1713309
Sex: F
Age: 31
State: PA

Vax Date: 02/05/2021
Onset Date: 02/06/2021
Rec V Date: 09/18/2021
Hospital:

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

Lab Data: MRI of head in August 2021 due to ongoing headaches, no acutefindibfs

Allergies: None

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

Symptoms: 2/6/21 headache, muscle soreness, stiff neck, fever, earache 2/7/21 headache, fatigue, sore arm and neck 2/8/21 severe migraine, severe ear ache, Daily headaches and ear aches over the next 2-3 weeks. Intermittent ear pain and migraines since vaccination. No history of migraines or ear pain.

Other Meds: Postnatal vitamins

Current Illness:

ID: 1713310
Sex: F
Age: 53
State: PR

Vax Date: 09/16/2021
Onset Date: 09/16/2021
Rec V Date: 09/18/2021
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: Penicillines, sulfas, iodine, bethadine, kiwi, strawberry, latex

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

Symptoms: today is the 3rd day with persistent headache, mild nauseas, sore throat, malaise and tiredness. Relieved by Acetaminophen use 1000 mg every 8 hrs

Other Meds: Zyrtec 10 mg one tab daily Singulair 10 mg one tab daily Synthroid 150 mcg one tab daily

Current Illness: Asma, hypothyroidism

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am