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: 1714138
Sex: M
Age: 50
State: GA

Vax Date: 08/22/2021
Onset Date: 08/22/2021
Rec V Date: 09/19/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1714139
Sex: F
Age: 57
State:

Vax Date: 09/11/2021
Onset Date: 09/12/2021
Rec V Date: 09/19/2021
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: Themersol

Symptom List: Anxiety, Dyspnoea

Symptoms: Intermittent chest pressure and headaches

Other Meds: Lisinopril-HCTZ 20/12.5 mg, multivitamin

Current Illness: N/A

ID: 1714140
Sex: M
Age: 75
State: IL

Vax Date: 01/13/2021
Onset Date: 09/10/2021
Rec V Date: 09/19/2021
Hospital: Y

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: 9/10/21 chest xray: Area of opacification left lower hemithorax described above likely mixture of consolidation with pleural effusion. Findings likely reflect underlying pneumonia. Underlying malignancy not excluded on the basis of this exam. Clinical correlation and follow-up recommended. 9/10/21 CTA chest: No acute pulmonary thromboembolic disease is identified. Associated consolidation adjacent to the effusion at the left lung base, favored predominantly if not entirely round atelectasis. Mild bilateral ground-glass pulmonary opacities could represent COVID-19 pneumonia. 9/13/21 chest xray: Continued opacification left lower lung suggesting pneumonia.

Allergies: none

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

Symptoms: a long-term nursing home resident, who has been fully vaccinated against COVID-19 about 7 months ago, comes to emergency room complaining of sudden onset of temp substernal chest pain with no associated shortness of breath, cough, fever. His workup in the ER showed a normal CMP. His CBC was within normal limits excepting a hemoglobin of 8.8 with a baseline being around 11.2. Patient denies any epistaxis, hemoptysis, hematemesis, melena, hematochezia, hematuria, and his stool for occult blood was indeed negative; however, his COVID-19 screen came back as positive. Chest x-ray was raising possibility of infection or malignancy, so a CT angio of the chest was done which shows no PE, but shows bilateral ground-glass opacity, especially in the upper lobes consistent with COVID-19. There is some bilateral mucus plugging as well and some small complex left loculated pleural fluid, empyema versus sequelae of old hemothorax. An ABG was ordered and then the hospitalist service was called for admission. Please note, the pulmonologist is also being called for further workup. At this point of time, it appears prudent to have the patient admitted as an observation to our COVID-19 unit. I am starting the patient on some vitamin D, vitamin C, and Mucinex. We will await his ABG results to see if he would benefit for any Decadron or not. Please note, the patient's temperature was 100.1 when he came in. His influenza swab was negative. Because of possibility of empyema, I might start him on Zosyn at this point of time and have Pulmonary see him in the morning with a possible consult to IR to see if his loculated pleural effusion even needs to be drained or treated empirically.small left complex loculated effusion with pleural thickening , empyema vs sequela of hemothorax was suggested on CT scan report 09/10/21. He had positive COVID 19 on admission 09/10/21 ( apparently fully vaccinated 7 months ago) . He was started on zosyn, I discharged him on augmentin . Patient was initially on room air , and then 2 L NC , but back to room air. I started decadron and Remdesivir when he was using oxygen , but now doing well on RA. Both cardiology and pulmonary medicine were consulted by admitting physician. Patient was evaluated by pulmonary medicine in course of hospitalization with plan for outpatient follow up . Patient does not want any surgical procedures for left pleural effusion at this time , but ok for follow up appointment with pulmonary medicine. I corresponded with case management who arranged a referral to facility with Dr. EKG and trop on admission did not show acute changes suggestive of ACS . Cardiology recommended medical management , patient was started on Carvedilol , Amlodipine . He also has iron deficiency anemia and started on Ferous sulphate 325 mg BID upon discharge.

Other Meds: Tylenol PRN, aspirin, docusate PRN, levetiracetam, memantine ER, miralax, nystatin cream, triamcinolone cream, vitamin D3

Current Illness:

ID: 1714141
Sex: M
Age: 59
State: GA

Vax Date: 08/06/2021
Onset Date: 08/06/2021
Rec V Date: 09/19/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1714142
Sex: F
Age: 23
State: CA

Vax Date: 08/13/2021
Onset Date: 08/17/2021
Rec V Date: 09/19/2021
Hospital:

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

Lab Data: N/A

Allergies: None

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

Symptoms: My skin turned red. The rash spread all over my body and there were bumps all over my skin. There was swelling around my lips, eyes, and nose. I took Benadryl. Then I went to the doctor. I was diagnosed with urticaria hives. I was given a prescription of Cetirizine.

Other Meds: None

Current Illness: None

ID: 1714143
Sex: F
Age: 16
State: TX

Vax Date: 09/14/2021
Onset Date: 09/14/2021
Rec V Date: 09/19/2021
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: Vaccinated with expired vaccine by 09/14/2021. No adverse reactions noted.

Other Meds: None

Current Illness: None

ID: 1714144
Sex: F
Age: 17
State: MD

Vax Date: 09/19/2021
Onset Date: 09/19/2021
Rec V Date: 09/19/2021
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: n/a

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: About 10 minutes post vaccination, patient started experiencing labored breathing, headache and slight chest pain. Mother of patient also stated patient has history of anxiety.

Other Meds: albuterol hfa inhaler

Current Illness: n/a

ID: 1714145
Sex: M
Age: 19
State: GA

Vax Date: 08/15/2021
Onset Date: 08/15/2021
Rec V Date: 09/19/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1714146
Sex: F
Age: 19
State: VA

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 09/19/2021
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: Moderna vaccine (NDC--8077-0273-99, lot # 048C21A) was received at a store on 7/16/2021 and placed under refrigerated temperature. 3 vials were transferred to another store where 20 doses were administered beyond use date.

Other Meds:

Current Illness:

ID: 1714147
Sex: M
Age: 26
State: GA

Vax Date: 08/03/2021
Onset Date: 08/03/2021
Rec V Date: 09/19/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1714148
Sex: F
Age: 31
State: GA

Vax Date: 09/14/2021
Onset Date: 09/16/2021
Rec V Date: 09/19/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Hives started at the vaccine injection site then wide spread over entire body

Other Meds: Metformin

Current Illness: no

ID: 1714149
Sex: F
Age: 24
State: FL

Vax Date: 08/15/2021
Onset Date: 08/17/2021
Rec V Date: 09/19/2021
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: None

Symptom List: Rash, Urticaria

Symptoms: Extreme joint pain around injection site and entire left side of my body. Shingles along my right side torso

Other Meds: None

Current Illness: None

ID: 1714150
Sex: F
Age: 42
State: GA

Vax Date: 08/23/2021
Onset Date: 08/23/2021
Rec V Date: 09/19/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1714151
Sex: F
Age: 69
State: OK

Vax Date: 09/14/2021
Onset Date: 09/15/2021
Rec V Date: 09/19/2021
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: NA

Allergies: Macrodantin, Darvon

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

Symptoms: Developed 3-4" diameter very hot red marking approximately 3" below injection site that persisted for several days despite use of hydrocortisone ointment as treatment. Almost gone at 6 days post injection.

Other Meds: Atorvastatin, Pepcid, Multi-Vit, Calcium-D

Current Illness: None

Date Died: 09/19/2021

ID: 1714152
Sex: F
Age: 80
State: IL

Vax Date: 01/25/2021
Onset Date: 09/08/2021
Rec V Date: 09/19/2021
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: 9/8/21 COVID19: positive 9/13/21 chest xray: Mild patchy opacification interstitial prominence demonstrated. Some of this may be atelectatic, some which may be infectious/inflammatory. 9/14/21 CTA chest: Findings compatible with COVID pneumonia. Right lower lobe airspace disease may relate to COVID pneumonia or potentially to a superimposed community or hospital-acquired pneumonia 9/16/21 US: negative 9/16/21 chest xray: Findings compatible with COVID pneumonia with interval worsening. The potential of developing diffuse alveolar damage/ARDS is considered.

Allergies: tetanus

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

Symptoms: Arrived to ER on 9/13/2021. Patient is an 81-year-old female with advanced dementia, diabetes, hypertension, tested positive for COVID on 09/08/2021. Was vaccinated approximately 7 months ago with Pfizer. Has not been eating. Has episodes of desaturation below 90% on room air. Patient unable to provide any history whatsoever. Admitted to hospital on 9/13/21. She started on decadron, keep oxygen above 90%. I covered her with abx due to possible superimposed bacterial GNR PNA. She was tested positive for COVID on 09/08/2021. She was vaccinated approximately 7 months ago with Pfizer. Was started her on remdesivir 9/14; started on doxycycline and ceftriaxone. CTA confirmed Covid-19 PNA and possible superimposed RLL PNA GNR; no signs of PNA. Pt developed acute hypoxic respiratory failure with increasing oxygen requirement on 9/15. She is now on HFNC 60 liters. Niece is aware of deterioration. Ct with supportive measures. Due to worsening of respiratory status. Talked with POA the niece and patient placed on comfort on 9/18. She was on IV prn morphine and IV ativan prn. She passed away on 9/19/21 01:02AM

Other Meds: Tylenol PRN, aspirin, refresh tears, vitamin D3, vitamin B12, donepezil, ferrous sulfate, levothyroxine, memantine ER, multivitamin, pantoprazole, pravastatin, quetiapine, sertraline

Current Illness:

ID: 1714153
Sex: F
Age: 25
State: GA

Vax Date: 08/06/2021
Onset Date: 08/06/2021
Rec V Date: 09/19/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1714154
Sex: F
Age: 60
State: FL

Vax Date: 09/17/2021
Onset Date: 09/17/2021
Rec V Date: 09/19/2021
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: Sulfa, Amitriptyline, all Statins, latex, Ivory soap, Bandage adhesive

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

Symptoms: Sore arm, fever, swollen lymph glands under arm, shoulder and neck

Other Meds: Trulance, Evamist, Multivitamin, Vitamin D3, Calcium, Zolipdem, Melatonin, Tramadol, Duloxetine, Famotidine, Tumeric, Fiberwell gummies

Current Illness:

ID: 1714155
Sex: F
Age: 14
State: TX

Vax Date: 09/14/2021
Onset Date: 09/14/2021
Rec V Date: 09/19/2021
Hospital:

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

Lab Data: None

Allergies: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Vaccinated with expired vaccine by 09/14/2021. No adverse reactions noted.

Other Meds: None

Current Illness: None

ID: 1714156
Sex: F
Age: 22
State: KY

Vax Date: 08/27/2021
Onset Date: 08/28/2021
Rec V Date: 09/19/2021
Hospital:

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

Lab Data:

Allergies: None (Maybe lactose)

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Itching and burning rash on both thighs. Stared the day after administration (8-28-21) and continued for 2-3 days after.

Other Meds: None

Current Illness: None

ID: 1714157
Sex: F
Age: 12
State: GA

Vax Date: 08/05/2021
Onset Date: 08/05/2021
Rec V Date: 09/19/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1714158
Sex: F
Age: 24
State: GA

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 09/19/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1714159
Sex: M
Age: 44
State: IL

Vax Date: 01/21/2021
Onset Date: 09/11/2021
Rec V Date: 09/19/2021
Hospital: Y

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

Lab Data: 9/14/21 CT abdomen: Acute cholecystitis 9/14/21 Chest xray: Shallow inspiration with right basilar subsegmental atelectasis.

Allergies: None

Symptom List: Unevaluable event

Symptoms: He comes to the emergency room complaining of 2-3 days of right upper quadrant abdominal pain with nausea, vomiting, diarrhea, cough, body aches. He said he was immunized with COVID-19 in January and February of this year. He lives with his wife and children, none of whom are sick. He came to emergency room with these complaints. He tested positive for COVID-19. Also, his urinalysis was abnormal showing esterase 2+ and WBC 6-10. CT abdomen and pelvis is raising the possibility of acute cholecystitis for which the surgeon was called and will see the patient in the morning. Patient was saturating anywhere between 92% to 94% at rest, but when we did the ABG, his pO2 was only 66.% on room air. So, the patient was also started on Decadron and remdesivir. For his UTI and his COVID-19 status, he is already started on Zosyn. Admitted on 9/13/2021. Urine culture 09/13/21 E Coli . He had acute hypoxemic respiratory failure secondary to COVID 19 viral and suspected secondary bacteria pneumonia . Was on decadron , remdesivir , supportive oxygenation , CXR showed right basilar subsegmental atelectasis. Upon discharge , patient was not using oxygen. Discharged on 9/18/21

Other Meds: None

Current Illness:

ID: 1714160
Sex: M
Age: 29
State: NY

Vax Date: 05/05/2021
Onset Date: 06/01/2021
Rec V Date: 09/19/2021
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: EKG with slightly abnormal results, unremarkable lung x-ray, day of ER visit, early June 2021

Allergies: None

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

Symptoms: I believe I developed pericarditis from the second shot. Got COVID-19 in Feb 2020 and got my second shot May 5th, 2021 and within three weeks I had persistent and inexplicable chest pain and shortness of breath that sent me to the ER where they discovered an abnormality in my EKG. The doctor's diagnosis was pericarditis likely due to some kind of viral infection. No other cardiovascular issues, risks, or prior events. It went away shortly after but has come back this week. I don't have healthcare here in NY until Oct 1st 2021 so as soon as I can get in to see a doctor I will seek further treatment.

Other Meds: None

Current Illness: None

ID: 1714161
Sex: M
Age: 27
State: GA

Vax Date: 08/06/2021
Onset Date: 08/06/2021
Rec V Date: 09/19/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1714162
Sex: F
Age: 19
State: GA

Vax Date: 08/04/2021
Onset Date: 08/04/2021
Rec V Date: 09/19/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1714163
Sex: M
Age: 17
State: TX

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 09/19/2021
Hospital:

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

Lab Data: None

Allergies: None

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

Symptoms: vaccinated with expired vaccine by 10 days. No adverse reaction

Other Meds: None

Current Illness: None

ID: 1714164
Sex: F
Age: 44
State: IL

Vax Date: 06/18/2021
Onset Date: 06/18/2021
Rec V Date: 09/19/2021
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: 8/31/21: Physical

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Immediately upon vaccine injection I felt intense burning and shooting pain where it was injected. It was painful, almost like an electrical current, and I could feel the solution entering my arm and surrounding area. I told the pharmacists this injection was painful and she said it was normal. The injection was located at the lower front side of my upper arm and I do not believe the needle was inserted anywhere near the correct location, which I was told should be in the middle of your deltoid muscle. Since the minute the vaccine was injected, my right arm has been in severe pain. I went back to the pharmacy 11 days after injection to ask about the debilitating pain I have been experiencing since the vaccine and was told it was normal and that it should clear up within 2 weeks. One month after the vaccine I went back to the same pharmacy to ask again if the pain I have been experiencing should still be persisting 30 days after injection. I was again told that it is normal. Two months later I was back at the pharmacy asking about the pain and told AGAIN that it will go away. Every movement my right arm makes results in shooting pain at the injection site on my arm and down thru my arm to my right hand. I am unable to perform normal daily tasks, I cannot sleep on my right side or stomach, I'm not able to do perform any exercises with my right arm or hold heavy objects. It was only after I went to see my Doctor on 8/30/21 that I was officially diagnosed with an injury due to the vaccine. To date (9/19/21), my right arm has increasing gotten worse. Three months later and the mobility in my arm is less than it has ever been and extremely painful. I feel a constant burning sensation and numbness throughout my arm. I have also experienced disruption in my menstrual cycle since the vaccine.

Other Meds:

Current Illness:

ID: 1714165
Sex: M
Age: 22
State: IL

Vax Date: 07/06/2021
Onset Date: 09/04/2021
Rec V Date: 09/19/2021
Hospital: Y

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

Lab Data: 9/04/21 COVID19: positive 9/15/21 chest xray: Borderline heart size. Otherwise, no acute cardiopulmonary disease.

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: This is a 22-year-old gentleman who is a student of a local college here who has been immunized against COVID-19 in August. Then about 10 days ago, he had to have a COVID-19 test done because he was exposed to somebody on his football team who had COVID-19 and he did test positive. He just came out of quarantine yesterday and had a long workout session for his football team, but was not drinking enough fluid, started to have abdominal cramps and then arms and leg cramps and therefore came to the emergency room where his creatinine was found to be 1.6, without a baseline in our system. Also, his CPK was 791, which after a L of fluid actually went to 832. The patient says he feels a whole lot better right now and his cramps are almost resolved. We will give him a couple more L of fluids and recheck his CPK and BMP in a few hours and then make a decision whether the patient can be discharged from the ER or be admitted for his possible AKI and elevated CPK. He also has a slight white count of 11.43, but he is denying any chest pain, shortness of breath or cough, fever or chills. No urinary s/s.. Mild leukocytosis with a recent COVID-19 infection. Checking chest x-ray and urinalysis. Patient denies any fever, chills, or cough or any urinary symptoms. No diarrhea either. Given fluids and discharged on 9/17/21

Other Meds: None

Current Illness:

ID: 1714166
Sex: F
Age: 72
State: DC

Vax Date: 09/09/2021
Onset Date: 09/09/2021
Rec V Date: 09/19/2021
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: The patient received Pfizer on 01/16/21 and 02/06/21, Moderna on 06/09/21 and Janssen on 09/09/21

Other Meds:

Current Illness:

ID: 1714167
Sex: F
Age: 17
State: TX

Vax Date: 09/14/2021
Onset Date: 09/14/2021
Rec V Date: 09/19/2021
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: Vaccinated with expired vaccine by 09/14/2021. No adverse reactions noted.

Other Meds: Topamax 150mg, Metformin 550mg, Trileptal 300mg

Current Illness: None

ID: 1714168
Sex: M
Age: 12
State: CA

Vax Date: 08/07/2021
Onset Date: 08/07/2021
Rec V Date: 09/19/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1714169
Sex: F
Age: 22
State: KY

Vax Date: 09/17/2021
Onset Date: 09/19/2021
Rec V Date: 09/19/2021
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 (maybe lactose)

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

Symptoms: Burning and itching rash on both thighs. Started 2 days after vaccination (today-9-19-21) I still have it, the same reaction happened with the first dose.

Other Meds: None

Current Illness: None

ID: 1714170
Sex: M
Age: 33
State: VA

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 09/19/2021
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: Moderna vaccine (NDC--80777-0273-99, lot # 048C21A) was received on 7/16/2021 and placed under refrigerated temperature. 3 vials were transferred to store where 20 doses were administered beyond use date.

Other Meds:

Current Illness:

ID: 1714171
Sex: F
Age: 30
State: GA

Vax Date: 08/03/2021
Onset Date: 08/03/2021
Rec V Date: 09/19/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1714172
Sex: F
Age: 34
State: MO

Vax Date: 08/08/2021
Onset Date: 08/16/2021
Rec V Date: 09/19/2021
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?ve had it biopsies and it?s an allergic reaction.

Allergies: Cipro Amoxicillin Penicillin Celphorporins Tramadol

Symptom List: Erythema, Pruritus

Symptoms: I?ve been breaking out in hives every 2-3 days. The original rash is still here a month later but now it?s gray.

Other Meds: Kelnor Xanax Floreset

Current Illness:

ID: 1714173
Sex: F
Age: 65
State: GA

Vax Date: 08/16/2021
Onset Date: 08/16/2021
Rec V Date: 09/19/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1714175
Sex: M
Age: 65
State: FL

Vax Date: 09/11/2021
Onset Date: 09/11/2021
Rec V Date: 09/19/2021
Hospital:

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

Lab Data: na

Allergies: na

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

Symptoms: a horrible headache, which lasted for about 36 hours and sleeplessness legs felt like they weighed 200 lbs and felt like i was carrying weight on my back.. e

Other Meds: na

Current Illness: glaucoma

ID: 1714176
Sex: F
Age: 16
State: TX

Vax Date: 09/14/2021
Onset Date: 09/14/2021
Rec V Date: 09/19/2021
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: Pork

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Vaccinated with expired vaccine by 09/14/2021. No adverse reactions noted.

Other Meds: None

Current Illness: None

ID: 1714177
Sex: F
Age: 13
State: GA

Vax Date: 08/24/2021
Onset Date: 08/24/2021
Rec V Date: 09/19/2021
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:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1714178
Sex: M
Age: 64
State: IL

Vax Date: 08/31/2021
Onset Date: 09/01/2021
Rec V Date: 09/19/2021
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: raw eggs

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

Symptoms: Arm pain [ left arm injection ] on 8/22. Continued sensitivity and sensory issues exist (today 9/19). These extend down the arm into the forearm.

Other Meds: zinc

Current Illness: none

ID: 1714179
Sex: M
Age: 18
State: GA

Vax Date: 08/06/2021
Onset Date: 08/06/2021
Rec V Date: 09/19/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1714180
Sex: F
Age: 74
State: VA

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 09/19/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Moderna vaccine (NDC--80777-0273-99, lot # 048C21A) was received at store on 7/16/2021 and placed under refrigerated temperature. 3 vials were transferred to another store where 20 doses were administered beyond use date.

Other Meds:

Current Illness:

ID: 1714181
Sex: M
Age: 34
State: NC

Vax Date: 05/10/2021
Onset Date: 05/10/2021
Rec V Date: 09/19/2021
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: Penicillin

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

Symptoms: The patient is a mechanical engineer that came 8 years ago to attend graduate school. He had since moved and works as a mechanical engineer. The patient has previously been quite healthy with exception of some elevated blood pressure readings which he states run in his family. He has not been seeing a doctor on a regular basis. He reports no previous significant bowel issues. Patient states that he was in his usual state of health until 4 days ago when he got his second dose of Pfizer Covid vaccine. He reports the following day he did develop low-grade fever. Yesterday he reported that he felt almost completely back to normal with slightly decreased appetite and just feeling weak and run down. This morning he woke up with epigastric and bilateral upper quadrant abdominal pain associated with nausea. He vomited several times what appeared to be stomach contents without blood. He was evaluated at nearby urgent care center and from the referred to the emergency department. In the emergency department work-up is positive for moderately elevated blood pressures (only slightly above baseline), mildly elevated blood blood cell count of 11,000, normal platelet count and normal renal function electrolytes. Urinalysis showed only trace of protein. CT scan abdomen pelvis was obtained which showed acute celiac axis vasculitis involving the celiac artery, proximal hepatic artery, splenic artery. He was found to have large geographic area hypoechoic attenuation involving the spleen compatible with acute ischemia. After contacting rheumatology he was given dose of Solu-Medrol 125 mg intravenously. Patient was also given injection Lovenox subcutaneously. We are asked to see him for admission. Patient denies any headache, difficulty with vision, cough, difficulty breathing, hemoptysis. He reports no difficulty with bowel function. Patient has rash on the extensor surface of both legs but he reports this rash has been there for a long time and he felt that this was likely sequela from scratching his legs after falling (rash appears consistent with psoriasis). Patient reports no recent history of international travel in July, 2019. He traveled between May 3 and 6 this year. Reports that he has been quite diligent about wearing a mask and denies any sick exposures and known Covid exposure. Patient has never used tobacco. Drinks beer infrequently and in moderation. He is married, has no children. Patient was maintained on Solu-Medrol 125 mg every 8 hours for 2 days. He was initially started on clear liquid diet and diet was gradually advanced. He was seen in consultation with vascular surgery anticoagulation was recommended to prevent clotting of the affected vessels. Patient was maintained on Lovenox throughout the hospitalization and will be discharged on Xarelto. Abdominal symptoms completely resolved. Interestingly his sedimentation rate is normal and C-reactive protein is only mildly elevated. ANCA and ANA serology came back negative. Cryoglobulins are pending. Case has been discussed at length with rheumatology. He will follow the the patient closely after discharge. He will see the patient next 7 days. Please note that we did search to vaccine registry for similar cases of vasculitis after Covid vaccine. Were able to find only two reported cases but neither of those fit the presentation of this patient?one had ANCA associated vasculitis and the other one was IgA mediated appears to have skin manifestation which this case does not appear to have. Bottom line is patient has medium vessel abdominal vasculitis which may or may have not been related to his Covid vaccination. Likely will require gradual weaning of steroids with close monitoring. He will remain under care of rheumatologist and vascular surgeon after discharge. The plan at this point is to repeat his abdominal CT scan in 4 to 6 weeks and decide if to discontinue anticoagulation at that time.

Other Meds: n/a

Current Illness: n/a

ID: 1714183
Sex: M
Age: 15
State: TX

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 09/19/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: vaccinated with expired vaccine by 10 days. No adverse reaction noted.

Other Meds: None

Current Illness: None

ID: 1714184
Sex: F
Age: 17
State: GA

Vax Date: 08/14/2021
Onset Date: 08/14/2021
Rec V Date: 09/19/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1714185
Sex: U
Age: 17
State: TX

Vax Date: 09/14/2021
Onset Date: 09/14/2021
Rec V Date: 09/19/2021
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

Allergies: None

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Vaccinated with expired vaccine by 09/14/2021. No adverse reactions noted.

Other Meds: None

Current Illness: None

ID: 1714187
Sex: F
Age: 43
State: WA

Vax Date: 09/18/2021
Onset Date: 09/18/2021
Rec V Date: 09/19/2021
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: Balance test (good) checking ears, throat(Normal) checking vitals (normal)

Allergies: Benzol Peroxide, Dilaudid (Hydromorphone), Oxycodone

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

Symptoms: Dizziness (vertigo), it slowly resolves. Treatment: rest, more water intake & over the counters medication to help with the dizziness.

Other Meds: Fluoxetine HCL 10 MG

Current Illness: None

ID: 1714188
Sex: F
Age: 29
State: VA

Vax Date: 08/03/2021
Onset Date: 08/03/2021
Rec V Date: 09/19/2021
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: Error: Booster Given Too Early-

Other Meds:

Current Illness:

ID: 1714190
Sex: F
Age: 81
State: VA

Vax Date: 09/04/2021
Onset Date: 09/04/2021
Rec V Date: 09/19/2021
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: Moderna vaccine, lot # 048C21A) was received on 7/16/2021 and placed under refrigerated temperature. 3 vials were transferred to another store where 20 doses were administered beyond use date.

Other Meds:

Current Illness:

ID: 1714192
Sex: M
Age: 46
State: MA

Vax Date: 09/09/2021
Onset Date: 09/11/2021
Rec V Date: 09/19/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Systemic: arm has continuous "cold sensation" and a magnet sticks to arm-Medium, Systemic: Tinnitus-Medium, Additional Details: patient reports cold sensation at site of injection even 10 days later. also reports site of injection being "magnetic" where a magnet will stick to his arm

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am