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: 1715535
Sex: F
Age: 0
State: VA

Vax Date: 09/20/2021
Onset Date: 09/20/2021
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: LA

Lab Data: N/A

Allergies: Unknown

Symptom List: Dysphagia, Epiglottitis

Symptoms: Client was administered an expired doses of Rotarix vaccine. This was the second dose in the vaccine series. Notified mother of client and contact the vaccine manufacturer.

Other Meds: Unknown

Current Illness: Unknown

ID: 1715536
Sex: F
Age: 13
State: CT

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

Lab Data: not sure

Allergies: none listed

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient fainted. She had pulse and was breathing. She was in and out (eyes opening and closing). Customer nearby was an EMT and assisted before 911 arrived. Patient was shaking for a few seconds. She also vomited.

Other Meds: none listed

Current Illness: none listed

ID: 1715537
Sex: F
Age: 13
State: TX

Vax Date: 09/09/2021
Onset Date: 09/12/2021
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: Blood glucose level came back in normal range, Covid test came back negative

Allergies: none

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

Symptoms: At about 6 AM on 9-12-21, my daughter woke me up saying she had a sore throat, headache, ear ache, and excessive thirst. When I touched her skin it was cool and clammy but the injection site was warm. I also noted she had sore lymph nodes on her throat when lightly touching them. I took her to Urgent Care and the doctor told me she was sure it was Covid and had nothing to do with the vaccination. She was tested for blood glucose levels, due to the thirst issue, and Covid and sent home with instructions to just take acetaminophen and ibuprofen as needed.

Other Meds: Zyrtec, ibuprofen, albuterol inhaler

Current Illness: none

Date Died: 09/04/2021

ID: 1715538
Sex: U
Age: 62
State: TN

Vax Date: 08/03/2021
Onset Date: 08/20/2021
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: po2-46

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient had diabetes, breast cancer and hypertension. Presented to the ED with a fever of 104, productive cough, shortness of breath, loss of taste, fatigue, and low oxygen saturations. She was diagnosed with COVID one week ago. Patient was admitted with COVID PNA and was placed on a ventilator on 8/22/2021. Patient developed significant bradycardia due to COVID myocarditis. She had only received her first dose of Moderna 8/3/2021. She continued to deteriorate and family chose to terminally extubate her and she expired on 9/4/2021.

Other Meds:

Current Illness:

ID: 1715539
Sex: F
Age: 57
State: NV

Vax Date: 02/14/2021
Onset Date: 05/12/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: Skin biopsy performed 7/27/21 Hepatic Panel completed 8/31/21 Results within normal range

Allergies: PCN Erythromycin Macrodantin Bactrim

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

Symptoms: Developed a chronic skin rash, which biopsy revealed to be Lichen Planus. May have developed sooner but I didn't notice until mid-May. Initially began on wrists, hands, and ankles. Rash proceeded to spread over all extremities, shoulders, spine, and is the worst on the anterior bilateral upper thighs. Rash is small, raised red/purplish color. Only itches when it is newly spread. Then it doesn't itch. Treated with Fluocinonide 0.05% topical ointment 7/27/21. Then added Pimecrolimus 1% on 9/7/21 due to continues to spread. Also prescribed Triamcinolone cream 0.1% to use after supply of Fluocinonide is gone.

Other Meds: Levothyroxine Protonix Lexapro Hydroxizine with Pepcid (as needed) [idiopathic hives]

Current Illness: Hashimotos Disease Hypothyroid

ID: 1715540
Sex: M
Age: 35
State: NY

Vax Date: 08/19/2021
Onset Date: 08/19/2021
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: no

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

Symptoms: Pfizer vaccine was diluted with NS 0.9% Bacteriostatic which is not recommended for use with this vaccines. Reported to Pfizer and CDC. As per recommendation from CDC, affected dose should be repeated. Pt was notified and all questions answered. Pt refused to repeat dose 1 due to side effects he experienced with the vaccine.

Other Meds: unk

Current Illness: unk

ID: 1715541
Sex: F
Age: 57
State: MN

Vax Date: 09/16/2021
Onset Date: 09/17/2021
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: na

Allergies: Hazelnuts Latex Lacinaprel (RX) Seasonal allergies

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: 3rd shot: sore arm same day & next day next day chills & headache

Other Meds: metoprolol succinate 25 MG 24 hour extended-release tablet albuterol HFA 108 (90 Base) MCG/ACT inhalation aerosol traZODone 50 MG tablet omeprazole 20 MG delayed-release capsule FLUoxetine 10 MG capsule azaTHIOprine 50 MG tablet eletriptan

Current Illness: NA

ID: 1715542
Sex: M
Age: 51
State: KY

Vax Date: 03/22/2021
Onset Date: 09/10/2021
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 household member

Other Meds:

Current Illness:

ID: 1715543
Sex: M
Age: 62
State: MI

Vax Date: 09/20/2021
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:

Allergies: None

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: This nurse looked at the wrong paper in the refrigerator to check the expiration date, as the paper needed to verify was under the envelope that was on top. The vaccine had expired on 9/19, and was administered on 9/20. Contacted Janssen to get further guidance. They sent information on current studies, but stated the validity of the dose would have to go off of our own professional judgment. Our medical director was contacted, and he stated the dose was a valid dose and did not need to be repeated. That if the client was concerned for effectiveness he could receive another dose or a dose of mRNA in 4 weeks to improve efficacy. Notified patient of situation. He was feeling fine after administration. He felt if our team felt it was still a valid dose, then he trusted the professional judgment. He did not feel a need to get another, or to get a dose of the mRNA. He did request to be notified at a later date if evidence came out that it was not effective, and he would get another for the efficacy.

Other Meds:

Current Illness: None

ID: 1715545
Sex: M
Age: 43
State: NJ

Vax Date: 04/09/2021
Onset Date: 04/09/2021
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: None.

Allergies: None.

Symptom List: Diarrhoea, Nasal congestion

Symptoms: He got his vaccine, he felt fine. He went home, and told his wife he was vaccinated, and gradually throughout the day he started to feel sick. He felt nauseous, throwing up, diarrhea, stomach pain, extremely cold. The next day he was bedridden all day, and also for the next 3-4 days, and also had vertigo. He took Tylenol, Advil, cold/flu medicine. He was feeling better about 2 weeks later, vertigo for a week and a half (never had this before). He went to the UC who told them there was nothing he could do, rest and take some OTC medicine and to just fight it off, stay hydrated.

Other Meds: None.

Current Illness: None.

ID: 1715546
Sex: F
Age: 47
State: GA

Vax Date: 08/31/2021
Onset Date: 08/31/2021
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: Dilaudid, Clindamycin

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

Symptoms: At the injection site, shortly after vaccination, the site became swollen and red with bumps. Day 2 symptoms of diarrhea, racing heart, high blood pressure (resting 121-130), loss of appetite, nausea and vomiting. Morning of day 3 she woke up with a swollen tongue, face, and throat, loss of sleep due to being scared and worried. Day 4 swelling was still prevalent. On Sep 1st, when the reaction was noticed, the patient called her family care doctor. They said that it was normal and it's nothing to worry about. Eating solid food was attempted but only apple sauce could make it past the tongue. This went on for about 5 days, the doctor's office gave an appointment via telemedicine with the assistant. No advice was given during the consultation. A follow up was done on 15 Sep with the attending doctor. This is when they explained that the pharmacy where the shot was administered would need to be told about the reactions. The Pharmacy said the patient would have to fill out the form on the website. The patient is now doing fine but during the reaction no one was trying to get her in touch with VAERS. This caused a delay in reporting and added more confusion to the situation.

Other Meds:

Current Illness: None

ID: 1715547
Sex: M
Age: 38
State: TX

Vax Date: 03/14/2021
Onset Date: 05/20/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data:

Allergies: Aspirin Milk thistle

Symptom List: Rash, Urticaria

Symptoms: Hives

Other Meds: None

Current Illness: None

ID: 1715548
Sex: M
Age: 46
State: FL

Vax Date: 09/15/2021
Onset Date: 09/15/2021
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: Home glucose levels running in excess of 300

Allergies: Cortisone

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

Symptoms: Elevated blood Glucose levels for approximately 4 days with no change in activity levels or caloric intake. Resulted in double to triple the insulin intake.

Other Meds: Novolog Tresiba Simvastatin Metoprolol

Current Illness:

ID: 1715549
Sex: F
Age: 56
State: KY

Vax Date: 03/24/2021
Onset Date: 09/10/2021
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 member

Other Meds:

Current Illness:

ID: 1715551
Sex: M
Age: 64
State: AZ

Vax Date: 03/18/2021
Onset Date: 09/09/2021
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: COVID test.

Allergies: Ragweed, seasonal allergies

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

Symptoms: Contracted the COVID virus after being fully vaccinated. I went in to hospital and had the antibiotic infusion on 09/15/2021.

Other Meds: Yes

Current Illness: No

Date Died: 08/19/2021

ID: 1715552
Sex: F
Age: 87
State: GA

Vax Date: 02/15/2021
Onset Date: 08/06/2021
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: 08/04/2021 PCR+ COVID-19 test at Assisted Living

Allergies:

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

Symptoms: Breakthrough COVID-19 case with symptom onset 8/6/2021: Cough (new onset or worsening of chronic cough). Death 8/19/2021. From vital records: CONGESTIVE HEART FAILURE-UNSPECIFIED. Per vital records, Codes include: Not yet coded ; Other Significant Conditions include: HYPERTENSION DEMENTIA. Place of death: NURSING HOME-LONG TERM CARE FACILITY ASSISTED LIVING; PRONOUNCING AND CERTIFYING PHYSICIAN.

Other Meds:

Current Illness:

ID: 1715553
Sex: M
Age: 58
State: FL

Vax Date: 04/10/2021
Onset Date: 04/12/2021
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: None

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

Symptoms: One and Half days after taking the vaccine I have being facing a continuos ringing on my ears.

Other Meds: Crestor 5mg daily

Current Illness: None

ID: 1715554
Sex: M
Age: 62
State: MT

Vax Date: 08/30/2021
Onset Date: 08/31/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data:

Allergies: advair diskus - casuse heart palpitations

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient reports a rash at vaccination site, approximately 2 inches by 4 inches. He states he felt the needle "went high up on his arm". Also had pain in his bicep, and weakness to the point he couldn't pick up a coffee pot. Patient also states he had a fever starting the day after receiving the vaccine, in the range of 102 degrees for three days. He states he felt better by September 3rd, but felt sick again by September 7. He states he thought he had a "virus" and was seen for this on September 8th. He states that this visit was due to the virus, not because of the rash/arm pain.

Other Meds: Prednisone, Dexilant, alopurinol, amlodipine, atorvastatin, metoprolol, trelegy, aspirin (low dose), Vitamin D, calcium, albuterol

Current Illness:

ID: 1715555
Sex: M
Age: 80
State: MN

Vax Date: 02/18/2021
Onset Date: 09/18/2021
Rec V Date: 09/20/2021
Hospital: Y

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

Lab Data: 9/18- SARS-CoV-2 RNA by PCR Detected

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: admitted to the hospital for malaise, fever, unsteadiness, tested positive for COVID on admission.

Other Meds:

Current Illness:

ID: 1715556
Sex: F
Age: 63
State:

Vax Date: 09/17/2021
Onset Date: 09/20/2021
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:

Allergies:

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

Symptoms: Red and itchy localized reaction, below the vaccine injection site.

Other Meds:

Current Illness:

ID: 1715557
Sex: F
Age: 62
State: KY

Vax Date: 03/24/2021
Onset Date: 09/06/2021
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:

Allergies:

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

Symptoms: Covid positive household member

Other Meds:

Current Illness:

ID: 1715558
Sex: F
Age: 55
State: NH

Vax Date: 03/02/2021
Onset Date: 06/10/2021
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: mri, blood work

Allergies: sulpha

Symptom List: Unevaluable event

Symptoms: after a couple of months later i had heart racing randomly and then i went to the doctor because of my high blood pressure and they gave me a medicine. My blood pressure is increased and it's still the same.

Other Meds: VERAMAPIL, NERONTIN, VITAMINS, ASPRIN, DYSANIDE

Current Illness: none

ID: 1715559
Sex: M
Age: 15
State: NY

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

Allergies: no

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

Symptoms: Pfizer vaccine was diluted with NS 0.9% Bacteriostatic which is not recommended for use with this vaccines. Reported to Pfizer and CDC. As per recommendation from CDC, affected dose should be repeated. Made multiple attempts to reach the parent of the pt without success. Message was left to discuss the need to repeat pt's 1st dose.

Other Meds: unk

Current Illness: unk

ID: 1715560
Sex: M
Age: 12
State: VA

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: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies: None

Symptom List: Injection site pain, Pain

Symptoms: Patient developed urticaria at vaccination site and on arms, legs, and head. Hives resolved spontaneously within 2 days of both vaccinations.

Other Meds: No medications; reaction also occurred with the second dose of his Pfizer covid vaccine on 13-Sep-2021

Current Illness: unknown

ID: 1715561
Sex: F
Age: 79
State: OH

Vax Date: 03/15/2021
Onset Date: 06/04/2021
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: Eat testing for hearing and vertigo to confirm diagnosis.

Allergies: Sulfa, morphine

Symptom List: Injection site pain, Menorrhagia

Symptoms: Severe balance issues resulting in inability to walk without a cane or perform simple household or personal care activities. Referred to ENT specialist who have me exercises to dislodge crystals in inner causing situation. 90% effective and should resolve with additional time.

Other Meds: Levothyroxine .088 mg, Meloxicam 15 mg, Pravastatin 20 mg, Amlodipine Besylate 5 mg, Bromi idine Tertrate ophthalmic .2% eye drops. All are 1 tablet daily. Eye drops are twice daily.

Current Illness: None

ID: 1715562
Sex: M
Age: 54
State: PA

Vax Date: 05/04/2021
Onset Date: 06/25/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Shingles outbreak. Lasted 1 week. Took anti-viral. Resolved

Other Meds: none

Current Illness:

ID: 1715563
Sex: F
Age: 71
State: NC

Vax Date: 08/25/2021
Onset Date: 08/27/2021
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: Did not go to doctor or have any tests. Just monitored my pulse and BP at home. I have a Pulse ox and BP monitor. If either went too high I would have called EMS. I only wanted to report my symptoms. I did not call EMS, doctor, or have any tests. I only wanted to submit this as information to the Pfizer group.

Allergies: penicillin, sulfa

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: I did not contact my family doctor. I have had A Fib for over 10 years. 1 day after first vaccine, i began a fib but was very different than other episodes I have had. My pulse went into a fib but went up and down from high to low with stopping. It didn't go over 110 but not below 82. It just ran up and down. This started on August 26, 2021(day after shot) and didn't stop until Sept. 17, 2021 at 9:00 pm. I have never had something like this with A Fib. My BP remained low and I do not panic but rest and handle the A Fib. I did not take the second shot as I was afraid it might trigger another episode. I am fine now, a little tired is all. The person who gave me the first dose asked me to contact this site and report this.

Other Meds: ecotrin 81 mg, metoprolol 50 mg, slow release iron 45 mg, B12 1000mcg, all one time daily(mornings)

Current Illness: A-Fib, Fibromyalgia, anxiety(panic), anemia,

ID: 1715564
Sex: M
Age: 61
State: NH

Vax Date: 04/07/2021
Onset Date: 04/24/2021
Rec V Date: 09/20/2021
Hospital: Y

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

Lab Data: On 04/24/2021 a blood count was done and my platelets were 1,000 !! (Normal is 150,000 to 400,000). It was considered an immediate threat to my life and I was admitted. More blood counts were done and it took 4 days of medications for the platelet count to be high enough for me to safely go home. Blood counts continued over the next 5 weeks while I was treated to bring my platelet counts up to normal levels.

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Shortly after receiving the second vaccine shot a started to notice unusual bleeding (what I knew to be common to ITP) primarily I was getting more frequent nose bleeds that became more and more difficult to stop. On 04/24/2021 the bleeding seemed to be really bad so I contacted my hematologist and discussed the symptoms. He directed to to go to the nearest hospital and have my platelet count checked. I went to Hospital in.

Other Meds: Losartan 50mg once a day, Metoprolol Tartrate 100mg twice a day, Atorvastatin 40mg once a day, Metformin ER 750mgx2 once a day, Glipizide ER 10mg once a day, Jardiance 25mg once a day, Fiber Gummies 20g once a day

Current Illness: None

ID: 1715565
Sex: F
Age: 83
State: CO

Vax Date: 09/16/2021
Onset Date: 09/16/2021
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: N/A

Allergies: None

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

Symptoms: Beginning 2-3 hours after injection on September 16, arm became painful and I began to feel poorly. Basically went to bed for next 48 hours. First evening and next day suffered chills and temperature reached 100 degrees. By September 18 fever and chills had gone, but felt weak. By September 19, was feeling pretty good until mid-afternoon when I felt quite nauseous and rested the remainder of the day. OK today.

Other Meds: Crestor, Alendronate Sodium

Current Illness: Urinary infection - several weeks before

ID: 1715566
Sex: F
Age: 47
State: WV

Vax Date: 09/15/2021
Onset Date: 09/15/2021
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: Celiac disease

Symptom List: Nausea

Symptoms: My stomach started hurting I got nauseous next day I was lethargic sick and elevated temperature

Other Meds: Vit. D, C, mood, gerd, iron, colesterol, gabapentin

Current Illness:

ID: 1715567
Sex: F
Age: 44
State: KY

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:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Food Sensitives corn and wheat products and biproducts

Symptom List: Injection site pain

Symptoms: within a short time of injection throat started to swell, took Benadryl. In less than 1.5 hours Nausea and fatigue began. Benadryl caused me to sleep woke @ 1 am with internal shaking/quivering/sharp pains and the feeling of a blow torch heating up my insides. Cramping in female organs similar to body prepping for cycle when it is not time. No fever. Took more Benadryl. Went to physician this morning, 2 days post shot with now constant internal vibrations/shaking and fatigue

Other Meds: Vitamin d3, Vitamin B, Vitamin C and Tylenol

Current Illness: none

Date Died: 09/01/2021

ID: 1715568
Sex: F
Age: 87
State: OH

Vax Date: 01/19/2021
Onset Date: 09/01/2021
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: 2019 Novel Coronavirus RNA specimen collection on 8/19/2021

Allergies:

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

Symptoms: death

Other Meds:

Current Illness:

ID: 1715569
Sex: F
Age: 65
State: TX

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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Hydrocodone, morphine, latex

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

Symptoms: Patient presented to ED with fever, chills, and one episode of vomiting the day following her booster COVID19 vaccine. The patient was noted to have a drop in sodium and was given a dose of steess-dose steroids given her adrenal insufficiency. She also was given Ciprofloxacin empirically for a UTI, given positive leukocyte esterases in the urinary analysis, and discharged home.

Other Meds: Pembrolizumab, lorazepam, diphenhydramine, haloperidol, levothyroxine, acetaminophen, aspirin, vitamin D3, calcium carbonate, hydrocortisone, ondansetron, clotrimazole, fluticasone, triamcinolone ointment, valacyclovir PRN

Current Illness:

Date Died: 09/16/2021

ID: 1715570
Sex: M
Age: 83
State: KY

Vax Date: 02/05/2021
Onset Date: 09/16/2021
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: CBC, chemistry panel, lactate, ferritin, ABGs, Procalcitonin. CXR, blood cultures, CT head, PT/PTT

Allergies:

Symptom List: Tremor

Symptoms: 9/16/21 - patient sent to ED due to worsening confusion and hypoxemia. Recently tested positive for COVID-19 at his SNF. Determined to be in septic shock. Patient was palliatively extubated and expired shortly after.

Other Meds: At the time of admission: Tylenol, albuterol sulfate HFA, amlodipine, ascorbic acid, ASA, Lipitor, Dulcolax, Venelex ointment, Glutose prn, Plavix, Collagenase ointment, Pepcid, Amaryl, glucagon, hydralazine, Novolog, Lactobacillus, lisinop

Current Illness: At the time of 9/16/21 admission : HTN, Type II Diabetes, Dementia, H/O CVA x 2, Bilat pleural effusions, COVID-19, septic shock, BPH, H/O CAD with stent

Date Died: 08/18/2021

ID: 1715571
Sex: F
Age: 91
State: GA

Vax Date: 02/15/2021
Onset Date: 08/10/2021
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: 08/12/2021 PCR+ COVID-19 test

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Breakthrough COVID-19 case with symptom onset 8/10/2021: Cough (new onset or worsening of chronic cough). Death 8/18/2021. From vital record cause of death: CARDIOPULMONARY ARREST, SENILE DEGENERATION OF THE BRAIN. Per vital records, Codes include: Not yet coded ; Other Significant Conditions include: None listed. Place of death: NURSING HOME-LONG TERM CARE FACILITY, ASSISTED LIVING; PRONOUNCING AND CERTIFYING PHYSICIAN

Other Meds:

Current Illness:

ID: 1715572
Sex: F
Age: 57
State: KY

Vax Date: 07/26/2021
Onset Date: 09/04/2021
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: Covid positive contact unknown

Other Meds:

Current Illness:

ID: 1715573
Sex: F
Age: 54
State: AZ

Vax Date: 09/11/2021
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: COVID 19 Test - Negative result on 9/15/21

Allergies: Erythromycin - upset stomach

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

Symptoms: Approximately 1.5 hours after receiving shot I felt a sore throat coming on. It continued to feel that way for the next few days. Then on the afternoon of 9/14/21 my mouth and throat started to blister and became very painful. I immediately started to drink ice water to help with the pain. The pain persisted for hours until I fell asleep. I woke up the next morning and the sores seemed to have resolved for the most part, but was unsure of whether or not to receive a second dose. I made an appointment with a doctor to look at and she stated most of it had resolved but noticed some irritation.

Other Meds: Lisinopril 40 mg Multi Vitamin Vitamin D Baby aspirin

Current Illness: None

ID: 1715574
Sex: F
Age: 33
State: VA

Vax Date: 09/11/2021
Onset Date: 09/14/2021
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: none

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient states that she is having a shooting nerve type pain in her right leg and right arm. She said it started a few days after receiving the vaccine.

Other Meds: none

Current Illness: none

ID: 1715575
Sex: F
Age: 56
State: AL

Vax Date: 05/12/2021
Onset Date: 05/13/2021
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: I SUFFERED IT OUT AT HOME AND DID NOT GO FOR ANY TESTING.

Allergies: HYDROCODONE

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

Symptoms: I RECEIVED THE SECOND SHOT WED. MAY 12, 2021. ON THURSDAY MORNING, I STARTED HAVING CHILLS, FEVER, BODY ACHES, FELT LIKE I HAD THE FLU. I WAS NOT ABLE TO GET OUT OF BED, AND I THOUGHT I MIGHT HAVE TO GO TO THE HOSPITAL. I AM PRETTY SURE I BECAME DEHYDRATED. I MISSED 2 DAYS FROM WORK AND CONTINUED FEELING TERRIBLE THROUGH THE WEEKEND. I REPORTED BACK TO WORK MONDAY MAY 17.

Other Meds: COZAAR FARXIGA METFORMIN LEXAPRO LIPITOR ASMANEX HYDORCHLOROTHIAZIDE

Current Illness: NONE

ID: 1715576
Sex: M
Age: 74
State: MN

Vax Date: 02/20/2021
Onset Date: 09/13/2021
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:

Allergies: none

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

Symptoms: exposure to COVID. Cough, sore throat, runny nose, fatigue starting 9/13/21. Wife tested positive on 9/17/21

Other Meds: Finasteride; HCTZ; Lisinopril, Metoprolol; Pradaxa; Tamsulosin; Amlodpine

Current Illness: none

ID: 1715577
Sex: F
Age: 15
State: NY

Vax Date: 08/24/2021
Onset Date: 08/24/2021
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: none

Allergies: no

Symptom List: Pain in extremity

Symptoms: Pfizer vaccine was diluted with NS 0.9% Bacteriostatic which is not recommended for use with this vaccines. Reported to Pfizer and CDC. As per recommendation from CDC, affected dose should be repeated. Pt was notified and all questions answered. Pt repeated dose on 9/15/21.

Other Meds: unk

Current Illness: unk

ID: 1715578
Sex: M
Age: 27
State: GA

Vax Date: 09/07/2021
Onset Date: 09/08/2021
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:

Allergies: Ceclor

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

Symptoms: 101 fever, chills, severe headache, elevated blood pressure that has not went back down

Other Meds: 25 mg Hydrochlorothiazide

Current Illness:

ID: 1715579
Sex: M
Age: 46
State: GA

Vax Date: 04/06/2021
Onset Date: 08/01/2021
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: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: As of 8/8/2021: Pui is currently hospitalized with no infusion and no date of being released. Pui has been diagnosed with pneumonia. Pui wife would not disclose place of employment, however did state that pui rarely goes anywhere besides work and home. Pui is asthmatic and started coughing on 08/04/2021.

Other Meds:

Current Illness:

ID: 1715580
Sex: M
Age: 70
State: TX

Vax Date: 02/28/2021
Onset Date: 03/03/2021
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: Ultrasound: Negative results, dates unknown (@ April, 2021)

Allergies: Metrocarbonal

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

Symptoms: I took my first shot of Pfizer on Feb. 02, 2021 and my second shot on Feb. 28, 2021. After two to three days (after the second shot) I experienced extremely severe shooting pain in my testicle region. The pain was severe enough to seek medical attention. My doctor ordered an ultrasound. Howerer, the ultrasound did not report any abnormalities and after about three weeks I did not experience any more pain the my testicular region.

Other Meds: Vitamin C

Current Illness: None

ID: 1715581
Sex: F
Age: 78
State: MN

Vax Date: 03/10/2021
Onset Date: 09/19/2021
Rec V Date: 09/20/2021
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: SARS CoV-2, PCR, Rapid, V Detected

Allergies:

Symptom List: Vomiting

Symptoms: Pt tested positive for COVID 9/19 and was admitted to the hospital with fever

Other Meds:

Current Illness:

ID: 1715582
Sex: F
Age: 62
State: PA

Vax Date: 09/17/2021
Onset Date: 09/17/2021
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:

Allergies: erythromicy, rantadine

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Exactly 7 hours after administration of the vaccine (4pm) I developed the following symptoms; Fever which reached 101 degrees, painful headache, fatigue and a slightly sore arm. The next morning 7:30am I was extremely fatigued and had a sensitivity to light and had a headache and was slightly nauseous. I took my morning medication and ate a small amount and returned to bed. My temperature was 100 degrees and continue to reduce through out the day I took another nap in the afternoon but felt better in the evening with a small amount of fatigue. On Sunday morning I woke up with a rash on my left arm and my arm was extremely hot but otherwise I felt fine. On Monday morning the rash on my arm had spread and continued to be hot and sensitive to the touch. I did not contact my doctor and did not feel the need to seek medical assistance.

Other Meds: Cortef, levothyroxine, metformin, glimepride, zegrid

Current Illness: none

ID: 1715583
Sex: F
Age: 43
State: KY

Vax Date: 02/08/2021
Onset Date: 09/08/2021
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: Covid positive household member

Other Meds:

Current Illness:

ID: 1715584
Sex: F
Age: 87
State: VT

Vax Date: 09/20/2021
Onset Date: 09/20/2021
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: N/A

Allergies: Carbocaine, ACE Inhibitors (cough), Procardia XL, Prazosin Clams and Swordfish

Symptom List: Injection site swelling, Limb discomfort

Symptoms: A few minutes after receiving the Fluad Quad 65+ vaccine, the patient had pain in her legs, back, and face. Her face felt flushed and she had a headache. It only lasted about 5-7 minutes and then she felt ok. The patient was monitored for 1 hour and she was given water.

Other Meds: Atenolol, Losartan/Hydrochlorothiazide, and Simvastatin Calcium, Centrum Silver 55 Plus, OsteoBiflex, Baby Aspirin

Current Illness: None

ID: 1715585
Sex: F
Age: 71
State: TX

Vax Date: 07/26/2021
Onset Date: 09/01/2021
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: RA

Lab Data: PCP office visit and prescribe anti anxiety medication that caused agitation and shaking.

Allergies: N/A

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

Symptoms: Extreme Anxiety Leading to Attempted Suicide per overdose of prescribed Tramadol.

Other Meds: Gabapentin-Atorvastatin-Pantroprazole-Metoprolol-Paroxetine-Hydroxyzine

Current Illness: seasonal allergies

Date Died: 02/22/2021

ID: 1715587
Sex: M
Age: 85
State: FL

Vax Date: 02/10/2021
Onset Date: 02/15/2021
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: RA

Lab Data: Covid test, labwork, cxr.

Allergies: NKA

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

Symptoms: Pt came to ER with SOB, no endurane, nausea. Recieved first dose of covid vaccine 2/10 unsure of manufacturer.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am