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: 1722469
Sex: M
Age: 29
State:

Vax Date: 09/01/2021
Onset Date: 09/01/2021
Rec V Date: 09/22/2021
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: No allergies

Symptom List: Dysphagia, Epiglottitis

Symptoms: About 2 days after receiving the vaccine, I started having a headache that comes and go and it is still happening even though it's been almost 2 weeks.

Other Meds: None

Current Illness: No illnesses

ID: 1722470
Sex: M
Age: 88
State: MI

Vax Date: 02/17/2021
Onset Date: 09/10/2021
Rec V Date: 09/22/2021
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: COVID-19 test positive on 9/10/2021.

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient presented to emergency department on 9/10/2021 after falling at his home. He was found to be tachypneic and hypoxic at home and was transported to emergency department. He was admitted previously from 8/25/21 to 9/3/21 for COPD exacerbation. Patient was found to be COVID-19 positive and in a. fib. He was admitted for further management. He was treated with remdesivir and dexamethasone. He was discharged to an extended care facility on 9/21/2021.

Other Meds: albuterol (VENTOLIN HFA) 108 (90 BASE) MCG/ACT HFA inhaler albuterol (VENTOLIN) (2.5 mg/3 mL) 0.083% nebulizer solution apixaban (ELIQUIS) 2.5 MG TABS tablet donepezil (ARICEPT) 5 MG tablet DULoxetine (CYMBALTA) 30 MG DR capsule famotidine

Current Illness: None known

ID: 1722471
Sex: M
Age: 54
State: OH

Vax Date: 09/17/2021
Onset Date: 09/20/2021
Rec V Date: 09/22/2021
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: shellfish

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

Symptoms: swollen right arm, "rock hard", "hot to the touch", from shoulder down to elbow, erythematous, painful to touch. Patient called his PCP on 09/20/21 who told him he had "COVID arm" and advised antihistamine and ibuprofen. He took "generic" antihistamine and ibuprofen, significantly improved within 1.5 days. Still "hot to the touch".

Other Meds: Propanolol

Current Illness: no

ID: 1722472
Sex: F
Age: 70
State: MA

Vax Date: 03/20/2021
Onset Date: 04/02/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data: Doc was concerned about the sudden increase in blood pressure. Saw a kidney specialist who ordered a 24-hour BP monitor. Primary care ordered a 30-day heart monitor. Neither test showed results warranting further studies. Follow-up visits with primary care doc showed marked improvement in blood pressure and on 8/27/2021, all BP medications were removed. My blood pressure remains within normal range currently.

Allergies: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Headache and elevated blood pressure, first recorded on 4/2/2021, but might have been prior. Saw primary care doc on 5/12/21 with headache, palpitations, and faintness. BP was 199/81. Doc put me on 2 BP meds.

Other Meds: Claritin, B-12, ibuprofen

Current Illness: None

ID: 1722473
Sex: F
Age: 44
State: OH

Vax Date: 06/18/2021
Onset Date: 09/21/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient just called 9/21/2021 stating that she had an injury to her RIGHT arm, and that her doctor told her it was common from a vaccine. She stated that the doctor told her this type of thing keeps happening etc. I asked her if she had gotten any other vaccines since 6/18/2021 and she said no. I informed her the paperwork stated we administered in the left arm, she was very adamant that we did her right arm. I did review video to verify information on the paperwork and it looks like she did receive it in her Left arm as shown on the VAR. She claimed the injury was "frozen shoulder syndrome". She also stated her doctor believes she will now need surgery.

Other Meds:

Current Illness:

ID: 1722474
Sex: F
Age: 14
State:

Vax Date: 08/13/2021
Onset Date: 08/29/2021
Rec V Date: 09/22/2021
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:

Allergies: Sulfa Tree nuts Roaches Bee venom

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

Symptoms: Patient with development of chest pain and small pericardial effusion ~ 2 weeks post vaccination. Chest pain reported as early as 3 days post vaccination

Other Meds: Mirena IUD Lorazepam 0.5mg 1-2 times daily PRN Propranolol 10mg daily Escitalopram 10mg daily Cetirizine 10mg daily Nitrofurantoin 50mg daily

Current Illness:

ID: 1722475
Sex: M
Age: 73
State: GA

Vax Date: 05/13/2021
Onset Date: 05/01/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data: 5/13- EKG, labs, physical assessment, CT/chest W/contrast, emergency workup: cbc, chem, troponin /cardiac markers, medication administration 5/24 pacemaker insertion

Allergies: codeine, lisinopril, PCN, Sulfa

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: This is what the patient verbally reported to me. Shortly after he received his Moderna shot. The patient became short of breath, this shortness of breath started becoming worse. He told his sister he wanted to be taking to the emergency department. On May 13, 2021- the patient presents with difficulty breathing and dizziness, dyspnea, weakness. Denies CP. Had the first moderna covid 19 vaccination today at 10:30 - then 50 min later had these symptoms, felt throat tightness and closing. This has gotten better with laying down. no rash, and no burning. The onset was 6 hours ago. The course/duration of symptoms is improving. Degree at onset moderate. Degree at present mild. The Exacerbating factors is exertion. The Relieving factors is rest. Risk factors consist of chest pain, age. Associated symptoms: denies chest pain, denies fever, denies chills, denies cough, denies nausea and denies vomiting. CARDIAC: cardiology after noting complete heart block at home. Recently started wearing event monitor which alerted the doctor today that he appeared to be in transient three degree block yesterday. D-Dimer elevation doctor reviewed and confirmed and advised the patient to come to the ER. Patient had a pacemaker placed on 5/24/2021. He states ever since than, his condition has been going down hill. .

Other Meds: Clonzpam 1mg, finasteride 5mg, turmeric, coq10, fish oil1000, Prozac, b complex, tamsuloin, b12, aspirin 325.

Current Illness: Cirrhosis, hepatitis, stomach/intestinal ulcers, anxiety/depression, arthritis, HLD, osteoporosis, chronic pancreaitis

ID: 1722476
Sex: M
Age: 11
State: PR

Vax Date: 06/16/2021
Onset Date: 06/16/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data: UNKNOWN

Allergies: UNKNOWN

Symptom List: Pharyngeal swelling

Symptoms: INADVERTENTLY VACCINATED BEFORE AGE 12 YRS OLD.INFO COULD NOT BE CLARIFIED.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1722477
Sex: F
Age: 85
State: MN

Vax Date: 02/19/2021
Onset Date: 09/19/2021
Rec V Date: 09/22/2021
Hospital: Y

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

Lab Data: Positive SARS-CoV-2 by PCR 9/20/21

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: This case meets vaccine breakthrough criteria review. SxS include fever and weakness, SOB, loss of appetite

Other Meds:

Current Illness:

ID: 1722478
Sex: M
Age: 16
State:

Vax Date: 09/15/2021
Onset Date: 09/15/2021
Rec V Date: 09/22/2021
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:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: This vaccine was given before the nurse realized that the refrigerator thermometer was broken. The vaccine's temperature had been out of range. Pfizer was contacted and the remaining vaccine needed to be wasted. The patient had to be notified that the dose he received was not valid and has to be repeated. No side effects noted.

Other Meds:

Current Illness:

ID: 1722479
Sex: F
Age: 38
State: NC

Vax Date: 08/19/2021
Onset Date: 09/04/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data: NONE

Allergies: none

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

Symptoms: ARM SWELLING, ITCHING AND RASH

Other Meds: none

Current Illness: none

ID: 1722480
Sex: M
Age: 8
State: PR

Vax Date: 06/04/2021
Onset Date: 06/04/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data: UNKNOWN

Allergies: UNKNOWN

Symptom List: Rash, Urticaria

Symptoms: INADVERTENTLY VACCINATED BEFORE AGE 12 YRS OLD. INFO COULD NOT BE CLARIFIED. WRONG DATA ENTRY SUSPECTED.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1722481
Sex: M
Age: 48
State: NC

Vax Date: 08/31/2021
Onset Date: 09/08/2021
Rec V Date: 09/22/2021
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: Intermittent shooting pain in legs, arms, and chest (both sides). The pain mainly persists in my arms. Some days are better than others.

Other Meds:

Current Illness:

ID: 1722482
Sex: F
Age: 50
State:

Vax Date: 09/14/2021
Onset Date: 09/14/2021
Rec V Date: 09/22/2021
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: This vaccine was given before the nurse realized that the refrigerator thermometer was broken. The vaccine's temperature had been out of range. Pfizer was contacted and the remaining vaccine needed to be wasted. The patient had to be notified that the dose she received was not valid and has to be repeated. No side effects noted.

Other Meds:

Current Illness:

ID: 1722483
Sex: F
Age: 43
State: KY

Vax Date: 09/09/2021
Onset Date: 09/10/2021
Rec V Date: 09/22/2021
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: Naproxen

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

Symptoms: Extreme joint/muscle pain. Musculoskeletal flare. Back, bilateral hip, neck and bilateral shoulder pain. Pain in knees, toes, ankles and wrists. Joints felt like they were on fire. Severe myalgia in back, legs and shoulders. Muscles hurt to touch. Neuropathy in hips and legs. Hurt to walk, sit, bend and lay down. Symptoms lasted for 8 days. Physician prescribed Prednisone to treat symptoms. Unable to work for several days.

Other Meds: Humira, Diclofenac, Cetirizine, Vitamin D

Current Illness:

ID: 1722484
Sex: F
Age: 0
State: PR

Vax Date: 04/13/2021
Onset Date: 04/13/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data: UNKNOWN

Allergies: UNKNOWN

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

Symptoms: INFO COULD NOT BE CLARIFIED. WRONG DATA ENTRY SUSPECTED.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1722485
Sex: F
Age: 37
State: SD

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

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

Lab Data: Had a Covid 19 test to see if I had Covid and the result was negative.

Allergies: None

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

Symptoms: Migraine began 15 minutes after shot and lasted 24 hours. Shaking, chills, extreme body aches and fever of 101.5 with Tylenol occurred 16 hours after injection. Cough, chest tightness, had to leave work. Extreme exhaustion, mental fog, diaphoresis, blurry vision, dizziness, swollen lymph nodes, extreme pain I the injected arm, sore throat. Had to leave work and take Tylenol and Motrin to get fever down and pain under control. The next morning work up with continued sweating and mild headache.

Other Meds: None

Current Illness: None

ID: 1722486
Sex: F
Age: 66
State: NY

Vax Date: 04/29/2021
Onset Date: 04/29/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data: N/A

Allergies: PENICILLIN

Symptom List: Ear pain, Hypoaesthesia

Symptoms: EXHAUSTION, MIGRAINE HEADACHE, SHORTNESS OF BREATH, ONE WEEK DURATION.

Other Meds: QUERCETIN, ZINC, BLOOD PRESSURE PILLS

Current Illness: N/A

ID: 1722487
Sex: F
Age: 41
State: IN

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

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

Lab Data: n/a

Allergies: Morphine, PCN, Celexa, Celexbrex

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Red raised knot at injection site Armpit is very sore to touch and feels swollen

Other Meds: none

Current Illness: none

ID: 1722489
Sex: M
Age: 35
State:

Vax Date: 04/07/2021
Onset Date: 09/21/2021
Rec V Date: 09/22/2021
Hospital: Y

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: hospitalized 9/12/21. On 9/16/2021 with what he felt was a sinus infection. On Saturday the patient developed a migraine headache accompanied by low-grade temperature elevation (99F) chills and a cough. Patient visited our ED and was tested for COVID-19 which returned positive. Patient was discharged home but has since felt more lethargic with nausea (and some retching), continued cough with clear sputum production, anosmia and new diarrhea. Immunocompromised on Ocrevus.

Other Meds:

Current Illness:

ID: 1722490
Sex: F
Age: 43
State: GA

Vax Date: 09/18/2021
Onset Date: 09/18/2021
Rec V Date: 09/22/2021
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: NKA

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

Symptoms: Lillian felt nauseated at 10:52am after receiving the Pfizer vaccination, dose 1 at 10:45am. We took her blood pressure, it was 138/72. She was given some electrolyte fluids and she felt better. Her blood pressure repeat was 182/86 at 11:00am. She voiced that is normal for her and that she takes medication for high BP. She disclosed no other medical history to us. She did voice that she did not eat that morning or take her medication. After feeling better she was escorted to her car and her family member drove her home.

Other Meds: unknown

Current Illness: hypertension

ID: 1722491
Sex: M
Age: 29
State: AZ

Vax Date: 09/19/2021
Onset Date: 09/21/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data:

Allergies: Nickle

Symptom List: Unevaluable event

Symptoms: Nausea, vomiting, diarrhea, bloating, severe intestinal cramping, chills, lightheaded, lethargy, splotchy skin on face.

Other Meds: Losartan potassium

Current Illness:

ID: 1722492
Sex: F
Age: 17
State: NE

Vax Date: 08/05/2021
Onset Date: 08/05/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: No adverse event. Patient was 17 years old at the time of vaccination and it's indicated for age 18 and older.

Other Meds:

Current Illness:

ID: 1722493
Sex: F
Age: 47
State: IN

Vax Date: 09/13/2021
Onset Date: 09/21/2021
Rec V Date: 09/22/2021
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: None

Symptom List: Injection site pain, Pain

Symptoms: On September 21 around 5:00 pm I noticed a knot at the injection site that was itchy and hot to touch went to bed got up September 22 at 8:30 and had a another bump much larger that was itchy and its hot to touch and has my muscle sore.

Other Meds: None

Current Illness: None

ID: 1722494
Sex: M
Age: 67
State:

Vax Date: 03/30/2021
Onset Date: 09/21/2021
Rec V Date: 09/22/2021
Hospital: Y

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: hospitalized 9/21/21 with generalized weakness, confusion and poor p.o. intake. SARS-COV-2 positive. Noted to be hypoxic on ABG. However not noted to have pneumonia on CT angiogram and did not have a PE. PMH ITP, T2DM, history of follicular thyroid cancer, status post thyroidectomy, history of malignant melanoma and history of pituitary adenoma.

Other Meds:

Current Illness:

ID: 1722495
Sex: F
Age: 66
State: NY

Vax Date: 05/25/2021
Onset Date: 05/25/2021
Rec V Date: 09/22/2021
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: PENICILLIN

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

Symptoms: EXHAUSTION, MIGRAINE HEADACHE, SHORTNESS OF BREATH

Other Meds: QUERCETIN, ZINC, BLOOD PRESSURE PILLS

Current Illness:

ID: 1722496
Sex: M
Age: 46
State: MA

Vax Date: 09/02/2021
Onset Date: 09/03/2021
Rec V Date: 09/22/2021
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: Sulfa

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: At around 4 am on 9/3/21, I woke up with severe itching and swelling at the injection site in the rear of my right arm, a strong headache and tingling around my mouth and neck. I took 1000 mg of Acetaminophen and 50 mg of Benadryl. The strong headache persisted for several days, but was relieved with acetaminophen. The Benadryl seemed to help the itching and sensation around my mouth and neck, but I did have to take an additional 50 mg around 5pm that afternoon as the symptoms had returned. By the morning of 9/5, only the local arm irritation, itching and headache persisted. I continued to alternate with Tylenol and Motrin for approximately the next 3 days, after which the headache and local irritation in my arm seem to have improved.

Other Meds: Losartan, Atorvastatin, Omeprazole, Amitriptyline, Vitamin D

Current Illness: None

ID: 1722497
Sex: F
Age: 53
State: KY

Vax Date: 07/27/2021
Onset Date: 07/27/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data: none

Allergies: Flu Vaccine, CT Dye, Versed, Amoxicillian, Immodium,

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: That evening started sweating profusely and face was flushed. Bp and heart rate remained normal. Lasted for a 2 days. For 7 weeks now, I still keep having daily episodes of profuse sweating. They come at night and once or twice during the day, along with the facial flushing.

Other Meds: Nexium, Aspirin, Synthroid, Vitamin D3, Allegra

Current Illness: none

ID: 1722498
Sex: F
Age: 44
State: PA

Vax Date: 09/17/2021
Onset Date: 09/18/2021
Rec V Date: 09/22/2021
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: Basic vital signs completed on 09/22/2021, along with EKG on 09/22/2021.

Allergies: Sudafed

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

Symptoms: Patient reports she began experiencing Heart palpitations, Feelings of of being Jittery, Anxiety, Foggy headed, Headache, Cervical neck pain, Heavy head, Achy Muscles all over body and a cough at 11am the following day.

Other Meds: ASA 325MG, Motrin 200MG

Current Illness: None

ID: 1722499
Sex: F
Age: 0
State: PR

Vax Date: 12/23/2020
Onset Date: 12/23/2020
Rec V Date: 09/22/2021
Hospital:

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

Lab Data: UNKNOWN

Allergies: UNKNOWN

Symptom List: Nausea

Symptoms: INFO COULD NOT BE CLARIFIED. WRONG DATA ENTRY SUSPECTED.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1722500
Sex: F
Age: 71
State: NH

Vax Date: 03/21/2021
Onset Date: 04/18/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data: Blood Screen, Tick Borne Diseases, Thyroid, MRI, CAT scan, ANA, Troponin, Magnesium, Furritin, Metabolic, Covid, C-Reactive Protein, Home Sleep Study 05/10/2021-present All Normal

Allergies: Erythromycin, Blue Cheese

Symptom List: Injection site pain

Symptoms: Vertigo and vomiting 04/18/2021 Dizziness/Loss of Balance 05/07/2021 followed by ongoing light headedness, dizziness, muscle weakness, fatigue, loss of balance, sleep disruptions, internal shaking during the night and upon waking. Symptoms have been ongoing since 05/07/2021

Other Meds: Levothyroxine, Probiotic, Multi Vitamin

Current Illness: None

ID: 1722501
Sex: F
Age: 64
State: MN

Vax Date: 04/02/2021
Onset Date: 09/18/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data: C-REACTIVE PROTEIN (INFLAMMATION) COMPREHENSIVE METABOLIC PANEL LAB ONLY-COMPLETE BLOOD COUNT WITH DIFFERENTIAL SARS-COV-2, INFLUENZA A+B, AND/OR RSV NUCLEIC ACID TESTING PANEL Imaging Orders Placed Today Imaging Tests XRAY CHEST PA AND LATERAL

Allergies:

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

Symptoms: RSV (acute bronchiolitis due to respiratory syncytial virus) Cough

Other Meds:

Current Illness:

ID: 1722502
Sex: F
Age: 22
State:

Vax Date: 09/15/2021
Onset Date: 09/19/2021
Rec V Date: 09/22/2021
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: Migraine for over a week (still going) Chills Sweats Sore muscles Swollen eyes Swollen lymph nodes Extreme tiredness

Other Meds:

Current Illness:

ID: 1722503
Sex: F
Age: 91
State: KY

Vax Date: 03/29/2021
Onset Date: 09/21/2021
Rec V Date: 09/22/2021
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: Tremor

Symptoms: Pfizer on 3/8 and 3/29. Positive on 9/21

Other Meds:

Current Illness:

ID: 1722504
Sex: F
Age: 62
State: NC

Vax Date: 03/21/2021
Onset Date: 03/21/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data: Antibody test in August (5 months after J&J vaccine) which reported NO DETECTIBLE ANTIBODIES

Allergies: None

Symptom List: Erythema, Pruritus

Symptoms: Received the J&J vaccine March 21, 2021 Took an antibody test in August (5 months after J&J vaccine) which reported NO DETECTIBLE ANTIBODIES Advised by physician to begin a full course of Pfizer or Moderna vaccine Pfizer vaccine dose #1 given 08/17/2021 Pfizer vaccine dose #2 given 08/08/2021

Other Meds: Lisinopril; Jardiance; Trulicity; Rosuvastatin; Hydroxychloroquine

Current Illness: None

ID: 1722505
Sex: F
Age: 60
State: ME

Vax Date: 08/23/2021
Onset Date: 08/23/2021
Rec V Date: 09/22/2021
Hospital:

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data: None

Allergies: NKDA

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

Symptoms: Migraine headache and blurry vision.

Other Meds: Vericare 5mg PO daily

Current Illness: None

ID: 1722506
Sex: F
Age: 82
State: KY

Vax Date: 03/23/2021
Onset Date: 09/21/2021
Rec V Date: 09/22/2021
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:

Allergies:

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

Symptoms: Pfizer on 3/2 and 3/23. Positive on 9/17

Other Meds:

Current Illness:

ID: 1722507
Sex: M
Age: 42
State: TX

Vax Date: 08/24/2021
Onset Date: 08/28/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data: None

Allergies: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: I woke up and was feeling tingling all up and down the left side of my body. I felt nausea and got up to go to the bathroom in case I vomited. I was dizzy on my walk over there. When I got to the bathroom I decided instead to lie down on the floor. After about 20 minutes the feeling subsided. Since then I've noticed my blood pressure seems to fluctuate more than usual (30 points difference between systolic readings in the same week); this has abated somewhat but I still have to stand up more slowly (and breathe deeply several times) in order to prevent lightheadedness.

Other Meds: Buproprion and resveratrol

Current Illness: None

ID: 1722508
Sex: F
Age: 3
State: PR

Vax Date: 05/25/2021
Onset Date: 05/25/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data: UNKNOWN

Allergies: UNKNOWN

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

Symptoms: INFO COULD NOT BE CLARIFIED. WRONG DATA ENTRY SUSPECTED.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1722509
Sex: F
Age: 13
State:

Vax Date: 08/08/2021
Onset Date: 08/14/2021
Rec V Date: 09/22/2021
Hospital: Y

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: NKA

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

Symptoms: Patient presented to Emergency Department with sore throat, emesis, pharyngeal bleeding, and bruising. Admitted for observation. Worsening ecchymosis noted during hospital stay on left arm, and onto right arm. Palatal enanthams noted. EKG showed septal infarct; repeat EKG the following day WNL. Upon discharge patient still c/o headache, body aches, sore throat/mouth.

Other Meds: sertraline, zyrtec, flovent, albuterol, fluoxitine

Current Illness:

Date Died: 09/19/2021

ID: 1722510
Sex: M
Age: 37
State: NV

Vax Date: 09/15/2021
Onset Date: 09/18/2021
Rec V Date: 09/22/2021
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: Unknown

Symptom List: Pain in extremity

Symptoms: The decedent received his initial Pfizer vaccine on 07/29/2021; and the second Pfizer vaccine on 09/14/2021. On 09/18/2021, the decedent reported to his mother that he was vomiting blood. On 09/19/2021, the decedent was found deceased in his residence.

Other Meds: Pregabalin 75 mg; possible methamphetamine on scene

Current Illness: Two weeks prior to the death, the decedent reported that he was, "not feeling well." On 09/18/2021, the decedent was vomiting blood.

ID: 1722511
Sex: F
Age: 11
State: PR

Vax Date: 06/16/2021
Onset Date: 06/16/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data: UNKNOWN

Allergies: UNKNOWN

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

Symptoms: INADVERTENTLY VACCINATED BEFORE AGE 12 YRS OLD. INFO COULD NOT BE CLARIFIED. WRONG DATA ENTRY SUSPECTED.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1722512
Sex: F
Age: 46
State: MD

Vax Date: 09/11/2021
Onset Date: 09/13/2021
Rec V Date: 09/22/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: Swollen lips, migraine and nausea

Other Meds: Lisinopril

Current Illness: None

ID: 1722513
Sex: F
Age: 31
State:

Vax Date: 01/20/2021
Onset Date: 03/01/2021
Rec V Date: 09/22/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: Menstrual irregularities

Other Meds:

Current Illness:

ID: 1722514
Sex: M
Age: 61
State: PA

Vax Date: 08/24/2021
Onset Date: 08/27/2021
Rec V Date: 09/22/2021
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: zithromax, ragweed, dust

Symptom List: Vomiting

Symptoms: Hives in various places from 08/27/2021 to 09/01/2021.

Other Meds: atorvastatin, omeprazole, paroxetine, vitamin D

Current Illness: none

ID: 1722515
Sex: M
Age: 79
State: MI

Vax Date: 02/10/2021
Onset Date: 09/20/2021
Rec V Date: 09/22/2021
Hospital: Y

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

Lab Data: positive (SARS CoV-2 Detected) 9/21/21

Allergies: Allergy: - gabapentin; (Drug) - Lexapro; (Drug)

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: He is currently a resident at the medical care facility. Patient developed a cough and some mild shortness of breath over the last couple of days and tested positive for Covid this morning. His oxygen saturation is 95% on 3 L nasal cannula. Patient states he feels fine but does admit to some mild congestion and cough. He denies any shortness of breath beyond his normal state however does have some conversational dyspnea noted at rest.

Other Meds: Current Home Medications 1. atorvastatin 20 mg oral tablet : 1 tab(s) orally once a day (at bedtime) 2. bethanechol 25 mg oral tablet : 1 tab(s) orally 3 times a day 3. Calcium 600+D 600 mg-200 intl units oral tablet : 1 tab(s) orally once

Current Illness: unknown

ID: 1722516
Sex: F
Age: 75
State: OK

Vax Date: 03/13/2021
Onset Date: 05/07/2021
Rec V Date: 09/22/2021
Hospital: Y

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: Various allergies to medication

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

Symptoms: Itching arm for about two weeks after the injection. Was diagnosed with pneumonia. Diagnosed with lungs that were scarred up.

Other Meds: Prevagin (once daily) Digestive Advantage (once daily)

Current Illness: None

ID: 1722517
Sex: M
Age: 14
State: WI

Vax Date: 09/17/2021
Onset Date: 09/17/2021
Rec V Date: 09/22/2021
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: Bee venom, azithromycin, penicillins, amoxicillin

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Rash and throat closing.

Other Meds: Albuterol inhaler, adderal, Zyrtec, epi pen, fluoxetine.

Current Illness:

ID: 1722518
Sex: F
Age: 16
State: IA

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

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

Lab Data: n/a

Allergies: nka

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

Symptoms: Patient given Moderna vaccine and is only 16 years of age. No adverse reaction. Reporting a VAERS for improper age to receive this vaccine.

Other Meds: n/a

Current Illness: n/a

ID: 1722519
Sex: M
Age: 36
State: TN

Vax Date: 09/21/2021
Onset Date: 09/21/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data: Unknown as it was not provided by patient.

Allergies: Unknown as it was not provided by patient.

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

Symptoms: At 8:30am on 9.22.21, the patient called to speak to pharmacy staff to tell them what happened to him and what he should do. He explained to the pharmacist that around 8-8:30 pm on 9.21.21 he started to feel dizzy, headache, experienced arm soreness and "did not feel right in the head". He said at approximately 8.30 he woke up on his bathroom floor. Further into the conversation to go over his side effects, he then explained that his kids found him in the bathtub. When I asked him about the discrepancy, he exclaimed it was the floor of the bathtub. He explained he hasn't felt right since and is "woozy" headed. I counseled him that due to his side effects he is currently experiencing that I would suggest for him to seek medical treatment to err on the side of caution. I do not know if patient will due to him yelling profanity and discontinuing the phone call abruptly.

Other Meds: Unknown as it was not provided by patient.

Current Illness: Unknown as it was not provided by patient.

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am