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**
PLEASE CHECK BACK SOON
Download the files above while you wait.







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: 1714963
Sex: M
Age: 31
State: IN

Vax Date: 08/26/2021
Onset Date:
Rec V Date: 09/20/2021
Hospital: Y

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

Lab Data: Ct Angiogram Chest for PE Duplex US venous EXT Low bilateral Duplex Venous ext Upper Rt Chest X-ray CMP CBC D-dimer Troponin PT C-reactive protein BNP

Allergies: NKA

Symptom List: Dysphagia, Epiglottitis

Symptoms: Acute deep vein thrombosis (DVT) of axillary vein of right upper extremity Bilateral Pulmonary Embolism

Other Meds: Atorvastatin clotriamzole-betamethasone cream lisinopril venlafaxine

Current Illness: Wound infection to achilles tendon

ID: 1714964
Sex: F
Age: 88
State: MI

Vax Date: 03/15/2021
Onset Date: 09/17/2021
Rec V Date: 09/20/2021
Hospital: Y

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: Hospitalization - hypomagnesemia, macrocytic anemia, external hemorrhoid, failure to thrive in adult, acute kidney injury

Other Meds:

Current Illness:

Date Died: 08/16/2021

ID: 1714965
Sex: M
Age: 65
State: LA

Vax Date: 01/22/2021
Onset Date: 02/12/2021
Rec V Date: 09/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NA

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

Symptoms: A few days after the first covid vaccine patient started to experience left ear fullness and slight tinnitus. This lasted for approximatley 2-3 weeks. He was told he may have fluid in his ears and was treated with OTC medications for allergies, reported by patient to myself. After his second vaccine he developed tinnitus in the left ear. He went see his physician and they were unsure what the corelation was but he was then treated for stress and placed on Wellburtrin. After this trail and the tinnitus not getting anybetter, he stopped taking his Wellburtrin and began seeing a serious of ENT/ Audiologist - all could not determine the cause of tinnitus (they rule out MRI/neck/HL etc.). After a month of seeing ENTs/ PT he reported to me for severe tinnitus. He was wearing a HA at this time and we used sound enrichment and counseling to help cope with the onset of tinnitus. However, even after working with him for 7 months, referring to specialist along the way, attending counseling, PT, TMJ, etc. He ended his life by suicide due to the tinnitus on 8/16/21.

Other Meds: NA

Current Illness: NA

ID: 1714966
Sex: F
Age: 42
State: KY

Vax Date: 09/04/2021
Onset Date: 09/13/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: 09/15/2021 had a positive Covid 19 antigen test

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Started feeling worse on 9/13/2021 with cough and muscle aches, lost taste and smell, headache, fatigue, nausea and diarrhea.

Other Meds:

Current Illness: diagnosed with bronchitis and sinus infection the week before

ID: 1714967
Sex: F
Age: 70
State: FL

Vax Date: 09/10/2021
Onset Date: 09/16/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: Brain mri-9/17 Ct scans-9/16 Us carotid artery?s-9/17

Allergies: None known

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

Symptoms: Stroke 6 days after vaccine

Other Meds: Vitamin d3, calcium, culturally pre/probiotic, move free, Flonase, Pepcid

Current Illness: None

ID: 1714968
Sex: F
Age: 60
State: MS

Vax Date: 06/11/2021
Onset Date: 06/11/2021
Rec V Date: 09/20/2021
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: NKDA

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

Symptoms: Dose #2 given Left deltoid @ 9:04am. 3 welps noted on Right deltoid approx. 15 minutes later at site of previous dose. Denies shortnes of breath no facial of lip swelling. No other s/s Denies food of drug allergies observed 30 minutes no other s/s

Other Meds: none

Current Illness: NONE

ID: 1714969
Sex: F
Age: 63
State: MI

Vax Date: 04/30/2021
Onset Date: 07/01/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: None

Allergies: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Constant bruise like pain at injection site beginning a few months after second dose. Sometimes pain extends down arm. Usually mild, but at times bad enough that I take Advil for relief.

Other Meds: Synthroid, Effexor, low dose aspirin, multi vitamin, calcium with D

Current Illness: None

ID: 1714970
Sex: M
Age: 66
State: KY

Vax Date: 04/11/2021
Onset Date: 09/13/2021
Rec V Date: 09/20/2021
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: Covid positive contact with friend

Other Meds:

Current Illness:

ID: 1714971
Sex: M
Age: 79
State: FL

Vax Date: 04/13/2021
Onset Date: 04/14/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: Did see dentist who took X rays and investigated and advised see an ENT. Saw ENT doctor who scanned sinus cavities, all OK. Trigeminal diagnosis is from symptoms by my regular doctor.

Allergies: Epinephrine

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Had initial reaction in arm, felt tired and achy. Reason reporting now is shots increased my nerve sensitivity, and peaked 1 month later. I now have Trigeminal nerve sensitivity and lower back nerve pains. It is getting better (5 months since last shot), and hopefully will disappear. I have heard of other legitimate cases.

Other Meds: Lisinopril, Sotalol, Atorvastatin, 325 Aspirin

Current Illness: None

ID: 1714972
Sex: M
Age: 73
State: CA

Vax Date: 03/17/2021
Onset Date: 03/24/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: blood work

Allergies: Lisinopril

Symptom List: Diarrhoea, Nasal congestion

Symptoms: A week after the second dose I had pain around my heart and under my left breast. Which lead me to go to the ER. Still have this pain.

Other Meds: Yes, daily medications. Lasortin, Metoprolol, Atorvastatin

Current Illness: No

ID: 1714973
Sex: F
Age: 16
State: MD

Vax Date: 09/16/2021
Onset Date: 09/16/2021
Rec V Date: 09/20/2021
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: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: Patient received her 2nd dose of Moderna despite being 15 years old. This is because for her 1st shot (RX 7614085) she received Moderna erroneously. To maintain continuation of care the CDC recommends she receive another dose of Moderna.

Other Meds:

Current Illness:

ID: 1714974
Sex: M
Age: 56
State: NJ

Vax Date: 03/19/2021
Onset Date: 03/20/2021
Rec V Date: 09/20/2021
Hospital: Y

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

Lab Data: 03/20/2021- Ekg, cat scan and ultrasound- Pericardia Infusion was prescribed Lancet Diagnosis with Amyloidosis

Allergies: None

Symptom List: Rash, Urticaria

Symptoms: 03/20/2021- Shortness of breath

Other Meds: I was taking Eliquis, Metoprolol.

Current Illness: None

ID: 1714975
Sex: M
Age: 26
State: WI

Vax Date: 02/01/2021
Onset Date: 08/09/2021
Rec V Date: 09/20/2021
Hospital: Y

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

Lab Data: Blood Work (numerous times August-September) Full body MRI (3 1/2 hours worth - August) EMG (August 10, 2021)

Allergies: None

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

Symptoms: Subacute Degeneration of the Spinal Column; Chronic Idiopathic Axonal Polynueropathy; Change in taste; inability to feel many bodily nerves; constantly in pain and numbness.

Other Meds: Losartan Alprozalam Temazepam Duloxitine Pantoprazole

Current Illness: High Blood Pressure

ID: 1714977
Sex: F
Age: 54
State: KY

Vax Date: 04/08/2021
Onset Date: 09/15/2021
Rec V Date: 09/20/2021
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:

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

Symptoms: Covid positive household contact

Other Meds:

Current Illness:

ID: 1714978
Sex: F
Age: 37
State: TX

Vax Date: 09/10/2021
Onset Date: 09/11/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: Chest xray, routine labs plus cardiac labs

Allergies: Penicillin, amoxicillin, ceclore, augmenton, z-pack, erythromycin, shellfish, navy beans, nickel, cobalt, iodine, and CT contrast.

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

Symptoms: Severe headache, shortness of breath, severe increase in chest pain, positive POC troponin

Other Meds: Xarelto, Lasix, Nitroglycerin, Protonix, Vitamins multi and B-12, Zoloft, and Xanax

Current Illness: Multiple coronary and pulmonary arterio-venous malformations.

ID: 1714979
Sex: F
Age: 40
State: VA

Vax Date: 07/22/2021
Onset Date: 07/23/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: Pregnancy test done at Urgent Care in early August 2021 - negative Antibody test done on the same day - positive for antibodies.

Allergies: Penicillin, Pecans

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

Symptoms: 7/22/2021 - received first Pfizer (FA7484) vaccine in right arm at 8:00PM. By the next morning the lymph nodes on my left side of my neck had swollen and a hard lump had formed. I was scheduled to have my period a few days later and I have not had one yet. It is now 9/20/2021. My second shot was on 8/19/2021 at 8:30PM again Pfizer (FC3180). No side affects from that except a headache and still no period. Starting to become concerned. Five pregnancy tests are negative along with one done at Urgent care. I am having massive pain in my lower stomach and nothing helps to relive it. Along with gaining 10 pounds since July. I have yet another appointment on 9/22/2021 to see what the problem is.

Other Meds: Seed Probiotic, Collagen powder, Manes tail powder

Current Illness: Zero

ID: 1714980
Sex: F
Age: 15
State: MD

Vax Date: 09/16/2021
Onset Date: 09/16/2021
Rec V Date: 09/20/2021
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: Patient received her 2nd dose of Moderna despite being 15 years old. This is because for her 1st shot (RX 7614085) she received Moderna erroneously. To maintain continuation of care the CDC recommends she receive another dose of Moderna.

Other Meds:

Current Illness:

ID: 1714981
Sex: M
Age: 76
State: AL

Vax Date: 04/01/2021
Onset Date: 05/01/2021
Rec V Date: 09/20/2021
Hospital: Y

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

Lab Data: Cat-Scan 05/2021 Chest X-Ray (Unknown) Biopsy (Unknown) Ultrasound (Unknown) EKG (Unknown)

Allergies: N/A

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Pt.'s Daughter states that after her Father received the 2nd dose of Moderna 04/2021, her Father started experiencing symptoms 05/2021 of fatigue, high heart rate, Covid-Like symptoms, and shortness of breath. Hospital originally admitted (7 days). Discharged with Oxygen and Medications (Unknown) still experiencing symptoms. ER (Medical Center) /Primary visits noted (unknown dates) finally admitted to Hospital currently (5 weeks). Still continuing to experience symptoms.

Other Meds: Daily Vitamins

Current Illness: N/A

ID: 1714982
Sex: M
Age: 77
State: KY

Vax Date: 03/26/2021
Onset Date: 09/06/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Covid positive family member

Other Meds:

Current Illness:

ID: 1714983
Sex: M
Age: 29
State: NJ

Vax Date: 09/16/2021
Onset Date: 09/16/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: None

Allergies: No known allergies

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

Symptoms: None

Other Meds: Loratadine 10 mg daily Prazosin 1mg each pm Seroquel 100 mg each pm Buprenorphine 8 mg daily

Current Illness: None

ID: 1714984
Sex: F
Age: 74
State: NH

Vax Date: 03/18/2021
Onset Date: 05/01/2021
Rec V Date: 09/20/2021
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: Lab test

Allergies: None

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

Symptoms: I became super fatigue, hip pain, stiff neck, on June 22 I couldn't get out of bed. On the 25th of June I was diagnosed with polymyalgia rheumatica.

Other Meds: Diclofemac; Omeprazole HTTTZ; Losartin; Vitamin D3; Ciltrate; Centrium Multivitamin, Pressure Vison; AReds2; Aspirin, B12.

Current Illness: None

ID: 1714985
Sex: F
Age: 42
State: OR

Vax Date: 06/16/2021
Onset Date: 08/20/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: POSITIVE COVID 19 TEST ON 8/26/21

Allergies: Allergic to asparagus - food allergy Phenergan - anti nausea medicine

Symptom List: Unevaluable event

Symptoms: JANSSEN LOT# 202A21A SITE OCC ON 6/16/21

Other Meds: none

Current Illness: none

ID: 1714986
Sex: M
Age: 67
State: OH

Vax Date: 02/17/2021
Onset Date: 02/24/2021
Rec V Date: 09/20/2021
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: yes

Allergies: no

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

Symptoms: loud ringing ands chirping noises in ears still happening today. muscle pain

Other Meds: yes heart medication

Current Illness: no

ID: 1714987
Sex: F
Age: 28
State: MN

Vax Date: 06/04/2021
Onset Date: 09/17/2021
Rec V Date: 09/20/2021
Hospital: Y

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

Lab Data: POSITIVE COVID TEST UPON LABOR AND DELIVERY ADMISSION 9/17/2021

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: ASYMPTOMATIC

Other Meds:

Current Illness:

ID: 1714988
Sex: F
Age: 35
State: KY

Vax Date: 01/20/2021
Onset Date: 09/12/2021
Rec V Date: 09/20/2021
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: Covid positive link unknown

Other Meds:

Current Illness:

ID: 1714989
Sex: F
Age: 45
State: GA

Vax Date: 03/16/2021
Onset Date: 09/07/2021
Rec V Date: 09/20/2021
Hospital: Y

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: Patient fully vaccinated and hospitalized due to Covid. Patient started feeling sick on 9/4/21 with fatigue, shortness of breath, cough, congestion, body aches and loss of smell. Patient was in the hospital for 4 days, she was not in ICU or on a ventilator.

Other Meds:

Current Illness:

ID: 1714990
Sex: F
Age: 49
State: NY

Vax Date: 09/16/2021
Onset Date: 09/17/2021
Rec V Date: 09/20/2021
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: blood work was taken at the hospital on 9/18/2021

Allergies: lisinopril, tetracycline, metoprolol, spironolactone

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: low blood pressure, lightheadedness started 9/17/20201 on about 10:00 am, On Saturday 9/18/2021 between 2 2:30 I went to urgent care the doctor said that because my blood pressure was low and because I was having palpitations that I needed to be seen in the Emergency dept. While there they did and EKG, Chest X-Ray, checked my blood pressure lying down, sitting and standing, which was still low when lying down and sitting , they also did blood work.., they still weren't able to tell me why my blood pressure was low and why I was lightheaded

Other Meds: atenolol, hydralazine, hydrochlorothiazide, amlodipine, spironolactone

Current Illness:

ID: 1714991
Sex: M
Age: 26
State: PA

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: Self monitoring of heart rate, blood pressure, and blood oxygen level

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Chest pain and feeling like I had to constantly take deep breaths that both began within 5 minutes of receiving the first COVID vaccine by moderna. Symptoms lasted approximately 24 hours and then resolved.

Other Meds: Birth control pill

Current Illness: None

ID: 1714992
Sex: M
Age: 20
State: NY

Vax Date: 09/18/2021
Onset Date: 09/18/2021
Rec V Date: 09/20/2021
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: Blood glucose taken at site by EMS, resulting 126. BP, P, SpO2 also taken at site by EMS.

Allergies: None reported.

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

Symptoms: Vaccine clinic was held at the center on 9/18/2021. Pt received J&J vaccine at approximately 12:38 pm. Was instructed to sit at vaccination station for 15 minutes with staff after receiving vaccine. Pt stood up after receiving vaccination and began to talk with a person near chair where he was to sit. Pt girlfriend was present. Within one to two minutes of talking to person, pt fell to ground near recovery chairs/vaccine tent. EMS was close to clinic tent at time of event and one EMT witnessed fall. Writer and several EMTs responded to patient. Pt turned onto side. Eyelids were noted to be quivering for approximately 30 seconds. One EMT reported she saw his eyes turn up into his sockets. Within approximately 1-2 minutes patient gained consciousness and began talking. EMT asked him name, dob, location which he was able to answer appropriately. EMT took BP, P, SpO2, and BG, and assessed patient. Pt given cool, damp cloth and began to talk more, then stated he was beginning to lose vision. He talked through this episode with staff present. Within approximately 30-60 seconds he began to regain vision. Pt again able to state name, dob, and location appropriately. The ambulance then took this patient to Hospital for further evaluation. Writer unable to obtain any further detailed information about patient.

Other Meds: None reported.

Current Illness: None reported.

ID: 1714993
Sex: M
Age: 43
State: MI

Vax Date: 05/10/2021
Onset Date: 09/19/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: positive covid test 9/19/21

Allergies:

Symptom List: Nausea

Symptoms: tested positive for COVID 9/19/2021 at Hospital- asymptomatic for covid- went to hospital r/t kidney stones

Other Meds:

Current Illness:

Date Died: 08/14/2021

ID: 1714994
Sex: M
Age: 74
State: GA

Vax Date: 02/03/2021
Onset Date: 08/01/2021
Rec V Date: 09/20/2021
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: Fever, cough, shortness of breath, difficulty breathing, Chest pain, fatigue. Death: 8/14/2021

Other Meds:

Current Illness:

ID: 1714995
Sex: M
Age: 89
State: MI

Vax Date: 04/13/2021
Onset Date: 09/07/2021
Rec V Date: 09/20/2021
Hospital: Y

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

Lab Data: COVID-19 test positive on 9/7/2021

Allergies: Sulfa drugs (itching)

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

Symptoms: Patient presented to emergency department on 8/26/2021 with weakness and leaking for urinary catheter. Patient was discharged on the same day from skilled nursing facility and son reported patient was very weak and could not stand or walk. Upon screening for discharge to facility, patient was found to be COVID-19 positive. Patient remained asymptomatic with COVID-19 infection during admission. He was discharged on home hospice on 9/17/2021.

Other Meds: acetaminophen (TYLENOL) 325 MG tablet ferrous sulfate (FEOSOL, 65 FE,) 325 (65 FE) MG tablet HYDROcodone-acetaminophen (NORCO) 7.5-325 MG tablet lidocaine-prilocaine (EMLA) 2.5-2.5 % topical cream LORazepam (ATIVAN) 0.5 MG tablet Methoxy PE

Current Illness: None known

ID: 1714996
Sex: M
Age: 15
State: WV

Vax Date: 09/15/2021
Onset Date: 09/16/2021
Rec V Date: 09/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: Visual exam given by urgent care 9/20/2021 at approximately 9am

Allergies: None

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

Symptoms: Red itchy rash on torso, groin, inner elbows on both arm, back of knee on both legs, fingers, chin line, along neck/chin line. Large (approximate circumference of 1-1/2 size of a silver dollarraised lump with blister ring surrounding lump on front side of ankle

Other Meds: None

Current Illness: None

ID: 1714997
Sex: F
Age: 58
State:

Vax Date: 01/22/2021
Onset Date: 09/17/2021
Rec V Date: 09/20/2021
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: Breakthrough case confirmed covid positive with PCR test on 9/18/2021

Other Meds:

Current Illness:

ID: 1714998
Sex: M
Age: 59
State: IA

Vax Date: 04/22/2021
Onset Date: 04/26/2021
Rec V Date: 09/20/2021
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: too many to list

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: I had a stroke ni the early morning of 4/26/21

Other Meds: Lisinopril , Allertec, Nasonex

Current Illness:

ID: 1714999
Sex: F
Age: 13
State: ID

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 09/20/2021
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: Patient is age 13 and received MODERNA vaccine instead of Pfizer.

Other Meds:

Current Illness:

ID: 1715000
Sex: F
Age: 58
State: KY

Vax Date: 09/01/2021
Onset Date: 09/02/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: None

Allergies: N/A

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

Symptoms: Shortness of breath, weakness, anxiety, diarrhea and nausea

Other Meds: Multivitamins, vitamin D3, Calcium with zinc and magnesium, tylenol

Current Illness: N/A

ID: 1715001
Sex: F
Age: 35
State:

Vax Date: 09/12/2021
Onset Date: 09/20/2021
Rec V Date: 09/20/2021
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: Asthenia, Chills, Headache, Myalgia

Symptoms: Headache, fever, muscle pain, fast heart rate, tiredness

Other Meds:

Current Illness:

ID: 1715002
Sex: F
Age: 54
State: IL

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

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

Lab Data: N/A

Allergies: None that I?m aware of

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

Symptoms: Extreme headache and all the other general side effects listed on site exempt vomiting. (Feeling of vomiting) Injection site reactions: pain, tenderness and swelling of the lymph nodes in the same arm of the injection, swelling (hardness), and redness General side effects: fatigue, headache, muscle pain, joint pain, chills, nausea and vomiting, and fever

Other Meds: Advair 100/50 Allega D took on Monday and 9.21.21 Nazacord

Current Illness: None

ID: 1715003
Sex: M
Age: 57
State: VA

Vax Date: 03/01/2021
Onset Date: 03/15/2021
Rec V Date: 09/20/2021
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: LAB TEST: ALL test were within normal limits CBC WITH DIFFERENTIAL AUTO, COMPREHENSIVE METABOLIC PANEL, MAGNESIUM SERUM, URINALYSIS POC IMAGING TEST:All test were normal CT CTA HEAD, NECK..EKG 12 LEAD..

Allergies: none

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

Symptoms: On Monday March 15th 2021 at 410pm I was getting off work. I was driving through the main gate and at the 2nd light I made a right turn. Travel about 12 feet after the turn and was hit with vertigo. I immediately pulled off the road over to the right and close my eyes for 15 minutes. It settle down enough for me to make it home. I arrived at my home a 420pm and the vertigo started up again to the point of me throwing up and not being able to walk straight. I never had vertigo before and I had to stay home from work the next couple of days hoping it would go away. Then on Thursday March 18th my fianc? took me to an URGENT CARE I was diagnose with Benign Paroxysmal Vertigo. I was prescribed meclizine 25mg tablet and given instructions on how to perform the Epley Maneuvers. On Saturday March 27th im still at home because of the vertigo. I'm to afraid to drive but the nausea has stop. My fianc? took me back to the urgent care clinic where they prescribe me Hydroxyzine HCI 25mg. On Tuesday April 13th im still at home because of vertigo and im afraid to drive. I was walking up my stairs and got extremely dizzy and fell down. My fianc? took me the Emergency Room. They diagnosed me with Benign Paroxysmal positional vertigo and conducted several test. The test were; LAB TEST: ALL test were within normal limits CBC WITH DIFFERENTIAL AUTO, COMPREHENSIVE METABOLIC PANEL, MAGNESIUM SERUM, URINALYSIS POC IMAGING TEST:All test were normal CT CTA HEAD, NECK..EKG 12 LEAD.. On Tuesday April 20th with the help of meclizine I was able to go back to work. My dizziness and vertigo is better when im sitting or laying down. My doctor referred me to Physical Therapy to have vestibule rehab done. I started my vestibule rehab on Wednesday September the 8th. Currently im still experiencing dizziness and vertigo.

Other Meds: Prescriptions and vitamins?Telmisartan 40mg, atorvastation 10mg, OMEGA 369, Vitamin D3 and C, MEGA Men 50 Plus, Glucosamine and Chondroitin.

Current Illness: none

ID: 1715004
Sex: F
Age: 26
State: PA

Vax Date: 09/16/2021
Onset Date: 09/20/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: Self monitoring of BP, HR, and SpO2. Will contact PCP if symptoms persist

Allergies: None

Symptom List: Pain in extremity

Symptoms: Abrupt onset of Dizziness and vertigo, unable to walk straight and feeling like I was going to pass out. Exactly 96 hours after second dose. No history of vertigo/ENT conditions or anything similar ever happening. Feeling that something is off is lingering, and dizziness is persisting.

Other Meds: Oral birth control

Current Illness: None

ID: 1715005
Sex: M
Age: 29
State: MD

Vax Date: 08/05/2021
Onset Date: 08/06/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: Heart Stress Test EKG Ultrasound BloodWork

Allergies: None

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

Symptoms: A lot of brain fog and chest tightness the day after the vaccine. Brain fog has subsided partially and turned into chronic migraine headaches. Chest tightness gets very bad randomly.

Other Meds: None

Current Illness: Chest pressure from long covid

ID: 1715006
Sex: F
Age: 66
State: KY

Vax Date: 02/09/2021
Onset Date: 09/11/2021
Rec V Date: 09/20/2021
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: Covid positive work related

Other Meds:

Current Illness:

ID: 1715007
Sex: M
Age: 47
State: LA

Vax Date: 09/18/2021
Onset Date: 09/19/2021
Rec V Date: 09/20/2021
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: I get hives when I eat peanut butter when I take Cypro. I can take Cypro or eat peanut butter alone with no adverse reaction. Combined, I break out all over my body.

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

Symptoms: I got vaccine around 11am Saturday morning. When I woke up Sunday, I had a severe headache. I took two Tylenol, watched some TV then took a 2-hour nap around 4pm. I still had a headache when I awoke. I took two more Tylenol. When I woke up Monday morning I still have a pounding headache. I took two Advil. An hour later I still have a headache. I spoke to pharmacist and she advised me to report my symptoms.

Other Meds: NONE

Current Illness: NONE

ID: 1715008
Sex: M
Age: 64
State: NC

Vax Date: 09/16/2021
Onset Date: 09/16/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: None

Allergies: No known drug allergies

Symptom List: Vomiting

Symptoms: None

Other Meds: Gabapentin 100mg twice a day Aspirin 81mg daily Losartan 25 mg once in am Tamsulosin .4mg once in am Lisinopril 10 mg once in am Glipizide 5mg once in am Metformin 1000mg twice a day Lipitor 80mg once in am Imdur 30mg once in am

Current Illness: None

ID: 1715009
Sex: F
Age: 40
State: FL

Vax Date: 07/26/2021
Onset Date: 07/26/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: under current treatment

Allergies: none

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Immediate Chest pain/pressure Shortness of breath and tightness in chest

Other Meds: Prilosec Welburtrin XL

Current Illness: none

ID: 1715010
Sex: F
Age: 46
State: TX

Vax Date: 09/18/2021
Onset Date: 09/18/2021
Rec V Date: 09/20/2021
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: Employee calling to report a reaction after receiving a COVID-19 vaccine. Vaccine Name - Pfizer Vaccine Date - ? 09/182021 Is this your first or second dose- 1st Date of symptom onset - ? 09/18/2021 Symptoms - ? Severe fatigue, fever of 100.9, knot at site of injection the size of a walnut, itching, headache, body aches, and congestion Last day of work and shift - 09/19/2021? Home remedies- Ibuprofen for fever, soreness, and headaches and Benadryl for itching Any improvement- Employee stated the ibuprofen and Benadryl are helping Recommendation- Advised employee to continue take the ibuprofen and Benadryl per pack instructions for symptoms, monitor symptoms and if they worsen or new ones develop to follow up with PCP. Employee voiced understanding Employee of information ? Yes Employee voiced any concerns ? No Employee?s questions answered to employee?s satisfaction -Yes

Other Meds:

Current Illness:

ID: 1715011
Sex: F
Age: 30
State: IA

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 09/20/2021
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: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Extreme body aches, chills, fever of 102, severe migraine. Lasted for 20 hours.

Other Meds: None

Current Illness: None

ID: 1715012
Sex: M
Age: 68
State: KY

Vax Date: 03/24/2021
Onset Date: 09/11/2021
Rec V Date: 09/20/2021
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: Covid positive link unknown

Other Meds:

Current Illness:

ID: 1715013
Sex: F
Age: 38
State: WA

Vax Date: 09/18/2021
Onset Date: 09/19/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: N/A

Allergies: N/A

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

Symptoms: Left armpit lymph nodes swollen, and tender

Other Meds: Multivitamin

Current Illness: N/A

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am