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: 1722943
Sex: F
Age: 50
State: WA

Vax Date: 02/25/2021
Onset Date: 02/26/2021
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

Symptom List: Dysphagia, Epiglottitis

Symptoms: Swollen lymph node in my left armpit after the second vaccination. It happened again when I received the Shingles vaccine too. All vaccines were given in my left arm. The swelling went down after 10 days the after the Covid vaccine and it took over 2 weeks for the swelling to go down after the Shingle vaccine.

Other Meds: Lisinopril Zytrec Singular

Current Illness: none

ID: 1722944
Sex: M
Age: 26
State: MO

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: N/A

Allergies: NKDA

Symptom List: Anxiety, Dyspnoea

Symptoms: 2nd Dose of Moderna Vaccine administered on 9/6/21 from Lot #011A21A expired 8/16/21. *Site leadership consulted with the Moderna Medical Safety Department and received the below confirmation: * If the dose given in error is the first dose, a second dose should be administered 28 days later. If this dose is the second dose, the series is complete and no additional doses are needed.

Other Meds: N/A

Current Illness: No

ID: 1722945
Sex: M
Age: 77
State: VA

Vax Date: 03/18/2021
Onset Date: 09/07/2021
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: COVID test and referred for monoclonal antibody treatment.

Allergies: No

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

Symptoms: Patient felt unwell on 09/07/2021; chills, cough, mild flu, illness was persistent and he sought medical treatment on 09/09/2021 and was diagnosed with COVID and referred for monoclonal antibody treatment on 09/12/2021.

Other Meds: Multivitamin

Current Illness: No

ID: 1722946
Sex: M
Age: 46
State: TX

Vax Date: 09/22/2021
Onset Date: 09/22/2021
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: N/A

Allergies: N/A

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: ADMINISTRATION ERROR : Pt. states that 1st dose of Moderna given 08/30/2021 and 2nd dose 09/22/2021 (Blurry Vision)

Other Meds: N/A

Current Illness: N/A

ID: 1722947
Sex: F
Age: 31
State: FL

Vax Date: 08/31/2021
Onset Date: 09/03/2021
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: D Dimer Test -- Fluid levels were high CBC - Low Blood Pressure (89/53) T4 - Normal

Allergies: Penicillin Peg (ingredient in the vaccine)

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

Symptoms: I experienced exhaustion at work the following week, started losing weight, muscle fatigue/weakness, extreme headaches , dizziness, and has to go to the hospital on 09/12/2021 and they prescribed me a muscle relaxer which help relieve the chest pains. I was released after they performed a D-Dimer test because they didn't know what was happening to me. I still continue to have issues and did not have any prior to the vaccine and am started to have issues concentrating or resting and none of the Doctors can determine why I'm continuing to have so many issues. I'm on disability leave until further notice awaiting on additional test results.

Other Meds: No

Current Illness: No

ID: 1722948
Sex: F
Age: 66
State: TX

Vax Date: 08/16/2021
Onset Date: 08/30/2021
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: MRI- showed I had sinus polyps ( that test was many years ago)

Allergies: cheese give me a severe headache

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

Symptoms: About 2 weeks after the vaccination, 08/30/2021, I wake up with a headache everyday. But not every day is severe when I wake up. As the day goes on, it wears down, its not that bad, it's mild. The headache is there all day. I have learned to live with it, because I don't want to take medicine, the medicine does not help. I have not recovered from the adverse event. I still continue to have headaches. I have had headaches prior to taking the Pfizer Dose 2, but they have gotten worse. The headaches are more constant now.

Other Meds: omeprazole 20 mg od lisinopril 5 mg bd HCTZ 25 mg as need if my blood pressure is elevated at night Xanax 0.25 mg at night as needed melatonin 30 mg at night mevcor 20 mg once at night latanoprost 0.005% eye drops 1 eye drop at night

Current Illness: no

ID: 1722949
Sex: F
Age: 51
State: IL

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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Covid test 09/18/2021- positive.

Allergies: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: I started having abdominal pain, cramping, nausea, frequent urination. The next day I had extreme fatigue, headache, joint pain, and low-grade fever 99.8. No cough until Sunday 09/19/2021. I had chest tightness and increase cough and SOB. I spoke with my doctor on 09/20/2021. I got a Covid test on Tuesday 09/18/2021 because I was going to have an outpatient colonoscopy on Tuesday. I thought these symptoms were just my body reacting to the vaccine. I have trying over the counter medications, Tylenol, Ibuprofen, Oscillococcimum, increasing vitamin D, multi vitamins. I was positive to Covid. My husband and son were positive too. I am fatigued.

Other Meds: Levothyroxine

Current Illness: None

ID: 1722950
Sex: F
Age: 34
State: IL

Vax Date: 09/22/2021
Onset Date: 09/22/2021
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:

Allergies: None

Symptom List: Pharyngeal swelling

Symptoms: Dizziness, Brain Fog, Immediate Menstruation (25 min post shot).

Other Meds: Nuvaring, Ashwagandha, ACV Gummies, Melatonin, Cranberry Pills, Women's Probiotic

Current Illness: None

ID: 1722951
Sex: M
Age: 28
State: FL

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: EKG 9/18 - Minor Arrhythmia, No major signs of distress Blood Panel 9/18 - No abnormalities Xray 9/18 - No abnormalities

Allergies: None

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient Described Symptoms: Severe Chest Pain, Irregular Heartbeat, Palpitations, Difficulty Breathing, Shortness of Breath, Tingling Extremities, Swollen feet, Cold Sweats/Chills, Weakness, Dizziness, Crushing sensation in chest, Lightheaded, Extreme Fatigue. Discharged Referral to Cardiologist

Other Meds: None

Current Illness: None

ID: 1722952
Sex: M
Age: 51
State: CA

Vax Date: 09/20/2021
Onset Date: 09/21/2021
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: None

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Headache, fever, stomach pain, joint pain. Still have a headache, rest of symptoms have subsided.

Other Meds: Prozac, Prilosec, metformin, Lipitor, lisinopril.

Current Illness: None

ID: 1722953
Sex: M
Age: 60
State: WV

Vax Date: 06/27/2021
Onset Date: 08/22/2021
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: Patient undergoing further testing, but vaccine assumed to be potential cause.

Allergies: NA

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

Symptoms: Stroke of the eye

Other Meds: Zanaflex, Tramadol, Lexapro, Atripla

Current Illness: HIV, Anxiety/Depression, Pain

ID: 1722955
Sex: M
Age: 28
State: MO

Vax Date: 09/06/2021
Onset Date: 09/06/2021
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: N/A

Allergies: Codeine

Symptom List: Rash, Urticaria

Symptoms: 2nd Dose of Moderna Vaccine administered on 9/6/21 from Lot #011A21A expired 8/16/21. *Site leadership consulted with the Moderna and received the below confirmation: * If the dose given in error is the first dose, a second dose should be administered 28 days later. If this dose is the second dose, the series is complete and no additional doses are needed.

Other Meds: Prescription: Albuterol Inhaler

Current Illness: No

ID: 1722956
Sex: M
Age: 48
State: TX

Vax Date: 09/13/2021
Onset Date: 09/14/2021
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: Sulfa

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

Symptoms: Fever and chills the night after the vaccine. Followed by prolonged stiffness and soreness of all joints, especially knee and ankle joints. Periodic headaches and cloudy head. The sore joints have persisted for at least 9 days, and were actually noticed prior to the 2nd dose of the vaccine.

Other Meds: lisinopril, zolpidem

Current Illness: none

ID: 1722957
Sex: M
Age: 65
State: OK

Vax Date: 08/03/2021
Onset Date: 09/15/2021
Rec V Date: 09/22/2021
Hospital: Y

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-19

Other Meds:

Current Illness:

Date Died: 08/17/2021

ID: 1722958
Sex: F
Age: 65
State: TN

Vax Date: 04/09/2021
Onset Date: 08/05/2021
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: COVID-19 Quad collected 8/9/2021, CBC, XR Spine Lumbosacral8/9, Chest 8/9, CT chest8/9, Glucose level 8/10-74, BMP 8/10

Allergies: Penicillin

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

Symptoms: Began 8/5/2021 non-productive cough, nausea, vomiting, 8 lbs. weight loss in last 2 months, dyspnea, deconditioning, lower extremity weakness COVID Quad collected 8/9/2021 that was positive for COVID-19. She expired 8/17/2021

Other Meds: Albuterol inhaler, budesonide inhaler, calcium carbonate, Zyrtec, Prozac, gabapentin, gemfibrozil, ipratropium, Montelukast, omeprazole

Current Illness: Right sided lung mass, T 12 superior endplate compression fracture and 8 mm focus of abnormal anterior spinal cord signal and enhancement at the T4 level primary neoplasm and metastatic disease are differential, difficulty walking, dysphagia

ID: 1722959
Sex: F
Age: 68
State: NM

Vax Date: 08/24/2021
Onset Date: 08/25/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: rash and shortness of breath

Other Meds:

Current Illness:

ID: 1722960
Sex: F
Age: 54
State: GA

Vax Date: 05/01/2021
Onset Date: 05/04/2021
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: LUMBAR MRI 5/13/21 EMG 5/21/21 NERVE CONDUCTION STUDY 5/21/21 CERVICAL MRI 6/24/21 STANDING LUMBAR MRI 8/12/21

Allergies: NONE

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

Symptoms: SEVERE BILATERAL NERVE PAIN IN LEGS THAT STARTED 4 DAYS AFTER INJECTION THAT STILL CONTINUE. BILATERAL NERVE PAIN IN BOTH ARMS THAT STARTED APPROXIMATELY 30 DAYS AFTER INJECTION STILL CONTINUE.

Other Meds: TRAZADONE, ESTRADIAL, VALACYCLOVIR, TYLENOL, MAGNESIUM, GLUCOSAMINE/CHONDRONTIN

Current Illness: NONE

ID: 1722961
Sex: F
Age: 75
State:

Vax Date: 04/15/2021
Onset Date: 09/03/2021
Rec V Date: 09/22/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Presented to ED with shortness of breath, cough, 90% oxygen. Heart failure exacerbation was also present. Was given oxygen, rocephin, azithromycin, decadron, vitamin D, zinc, melatonin. Later became hypotensive and was given dobutamine Wad discharged home

Other Meds:

Current Illness:

ID: 1722962
Sex: F
Age: 56
State: IL

Vax Date: 08/20/2021
Onset Date: 08/31/2021
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: Primary suggested I see an allergist. Saw allergy doctor on 9/15 who reviewed rash and pictures and recommended that I DO NOT receive second dose as the reaction could be worse. He suggested wait until I can get J and J once cross vaccination is approved. No testing was done.

Allergies: Shellfish Cefuroxime Kenalog injections

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Same day and next day of injection - had some itchy, roughness on roof of mouth and lips. 11 days (8/31) after the injection had about a 3 inch oval around welt like spot at injection site that was red, puffy, warm and itchy. 4 days after that (15 after injection - 9/3) broke out in extremely itchy rash mostly on both arms but some on stomach and legs. The itchiness on roof of mouth and lips started again. Applied ice to injection site and took Benadryl - no immediate relief but went away after about 6 days. Rash - Benadryl did not help - applied rubbing alcohol for some itch relief. Still have rash on arms as of 9/22 but itchiness improved and starting to dry up.

Other Meds: Valsartan, atorvastatin, levothyroxine, metFORMIN, Vitamin D, Vitamin C, quercetin, zinc, Elderberry and Zyrtec (as needed)

Current Illness: none

ID: 1722963
Sex: F
Age: 43
State: WI

Vax Date: 08/20/2021
Onset Date: 08/21/2021
Rec V Date: 09/22/2021
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: none

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

Symptoms: The day after my first shot i got my period. I am regular as clockwork. My period came a full week early. I have a short cycle, so it was late when it came the day before my second COVID shot. I am past child bearing years and do not want children, so reproduction is not a concern for me. But i know a lot of women who are in child bearing years and are concerned about their reproductive health with the vaccine. Many women i know have had their periods fluctuate due to vaccination. from what i have read, this is just beginning to be looked into. Unfortunately, this should have been looked into in the very first trials performed. But i can understand how hard that would be to find women willing to do a trial that could potentially cause them to not be able to conceive. Only time will tell how the vaccine truly affects women's reproductive health. But what i can tell you is there will not be a large increase in women getting vaccinated until this issue has been shown to actually be throughly reseached. Just saying there appears to be no problems is not good enough when women talk and know there are problems. There needs to be legitimate scientific study done to show that while the vaccine disrupts a cycle short term it has no long term effects. until that can be proven there will be continued vaccine hesitancy.

Other Meds: multi-vitamin, vitamin D3, acid reflux prescription

Current Illness: none

ID: 1722964
Sex: M
Age: 60
State: WI

Vax Date: 03/12/2021
Onset Date: 04/14/2021
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: APRIL AND MAY

Allergies: SEASONAL

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

Symptoms: ROUGHLY A MONTH AFTER VACCINE HAD A SERIES OF SINUS INFECTIONS AND STILL STRUGGLE WITH A TON OF SINUS PROBLEMS

Other Meds: LISONPROL, XARELTO , NAUBOTEME

Current Illness: NONE

ID: 1722965
Sex: F
Age: 46
State:

Vax Date: 03/09/2021
Onset Date: 08/20/2021
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:

Allergies:

Symptom List: Unevaluable event

Symptoms: Presented with shortness of breath, weakness, fatigue, fever, chills, vomitting, diarrhea, and hypoxic. Patient has history of COPD and asthma Been ill for about a week Oxygen saturation at 96% then dropped to 83% requiring oxygen support Was given dexamethasone and remdesivir, symbicort, vitamin D, zinc, and melatonin Discharged with a heart monitor and home oxygen.

Other Meds:

Current Illness:

ID: 1722966
Sex: M
Age: 54
State: KY

Vax Date: 08/24/2021
Onset Date: 08/24/2021
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: na

Allergies: NKA

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

Symptoms: Patient received Moderna vaccine first dose on 7-27.21. Returned to clinic on 8-24-21 for second dose and confirmed he was getting Pfizer vaccine. COVID card was not available to provider at the time of the injection. Patient received second dose as Pfizer vaccine. No treatment given. No signs or symptoms. No adverse reactions.

Other Meds: no

Current Illness: No

ID: 1722967
Sex: F
Age: 48
State: NY

Vax Date: 09/10/2021
Onset Date: 09/18/2021
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: PCN, Rocephin

Symptom List: Injection site pain, Pain

Symptoms: Large, raised, welt like rash between scapula and radiating up to back of neck. Rash synonymous with burning sensation and painful

Other Meds: Tamoxifen Effexor XR Vitamin D3

Current Illness: None

ID: 1722968
Sex: F
Age: 80
State:

Vax Date: 05/06/2021
Onset Date: 09/03/2021
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: Presented with headache, fever, cough, congestion, nausea, memory problems. Was given dexamethasone, vitamin C, zinc, remdesivir, oxygen Patient improved and was discharged

Other Meds:

Current Illness:

ID: 1722969
Sex: F
Age: 32
State: SC

Vax Date: 09/20/2021
Onset Date: 09/22/2021
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: nka

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

Symptoms: pt called stating that she had a golf ball size lump on her arm approximately 2 days after injection

Other Meds: nka

Current Illness:

Date Died: 09/14/2021

ID: 1722970
Sex: F
Age: 47
State:

Vax Date: 05/07/2021
Onset Date: 08/29/2021
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: Nausea, Pain in extremity, Pyrexia

Symptoms: Presented to the ED with shortness of breath, cough, fever, myalgias, and fatigue. Tested positive for COVID 5 days ago, 70% O2 sat Was given oxygen, decadron prednisolone, zinc, vitamin D, melatonin, remdesivir, budesonide Became unresponsive and died

Other Meds:

Current Illness:

ID: 1722971
Sex: M
Age: 27
State: MO

Vax Date: 09/06/2021
Onset Date: 09/06/2021
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: N/A

Allergies: NKDA

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: 2nd Dose of Moderna Vaccine administered on 9/6/21 from Lot #011A21A expired 8/16/21. *Site leadership consulted with the Moderna Medical Safety Department and received the below confirmation: * If the dose given in error is the first dose, a second dose should be administered 28 days later. If this dose is the second dose, the series is complete and no additional doses are needed.

Other Meds: Prescription: Loratadine, Tums

Current Illness: No

ID: 1722972
Sex: F
Age: 24
State: TX

Vax Date: 01/18/2021
Onset Date: 09/13/2021
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: Ultrasound confirming no heartbeat

Allergies: None.

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

Symptoms: I got a positive pregnancy test on 07/22/21. I had my first ultrasound on 8/18/21 everything was good, baby had a heartbeat. At my second visit on 9/13/21 my baby no longer had a heartbeat. I started bleeding on 9/12/21 the process ended on 9/14/21.

Other Meds: Estarylla Tablets 28s

Current Illness: None.

ID: 1722973
Sex: M
Age: 50
State: CA

Vax Date: 09/15/2021
Onset Date: 09/16/2021
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:

Allergies: Allergic to bee venom

Symptom List: Nausea

Symptoms: I get a muscle spasm in my right thigh about 4 times a day that lasts for 3 minutes.

Other Meds: Multi vitamins

Current Illness: None

ID: 1722974
Sex: F
Age: 75
State:

Vax Date: 03/07/2021
Onset Date: 08/31/2021
Rec V Date: 09/22/2021
Hospital: Y

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: Presented to ED from nursing home with cough and shortness of breath with O2 saturation of 60% and hypotensive. Was given decadron, singulair, vitamin D, zinc, melatonin, Later developed seizure and was very frightened and hallucinated Later tested negative for COVID-19 Discharged back to nursing home

Other Meds:

Current Illness:

Date Died: 09/15/2021

ID: 1722975
Sex: M
Age: 63
State:

Vax Date: 04/06/2021
Onset Date: 09/12/2021
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 induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Patient came to ED and reported that he was diagnosed with COVID a few weeks ago. Patient presented with chest pain, fever, and shortness of breath. He was also having acute kidney injury and diabetic ketoacidosis. Patient tried taking ivermectin at home with orange juice. Started on decadron, pulmicort, then redemsivir and oxygen as he got worse. He was also given tylenol. Suddenly deteriorated with a respiration rate of 40 breaths per minute and dropping blood pressure with a 105F fever. He was intubated. Patient was transferred to hospice and passed away.

Other Meds:

Current Illness:

ID: 1722976
Sex: F
Age: 34
State: TN

Vax Date: 09/02/2021
Onset Date: 09/03/2021
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: Bloodworks -

Allergies: no

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

Symptoms: 5aug 1st dose, 14 aug 2021 positive for covid, 27 aug2020 out quarantine. didn't hold off. The pharmacy got my second dose 2 September 2020. You mentioned fever and mentioned that I was out off quarantine. next day 105 fever, chills, couldn't walk and couldn't get out bed. doctor on 4sep2021, bad reaction on the arm. Supposed to wait 90days. My teeth was rattling, my fingers were cold, I couldn't open my eyes and couldn't feel my knees. Been going to Psychical Therapy. I cant work right right . Pins and needles in my body

Other Meds: no

Current Illness: covid

ID: 1722978
Sex: M
Age: 60
State:

Vax Date: 03/11/2021
Onset Date: 08/26/2021
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: Presented to the ED with shortness of breath, body aches, cough, congestion, fever, hypertertensive, and hypoxic 56% Chest X ray showed bilateral multifocal pneumonia Started on decadron and remdesivir, BiPAP, combivent, pulmicort, albuterol, zinc, vitamin D, melatonin, Discharged home with decadron, amoxicillin, and azithromycin

Other Meds:

Current Illness:

ID: 1722980
Sex: F
Age: 17
State: TX

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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: N/A

Allergies: N/A

Symptom List: Erythema, Pruritus

Symptoms: Minor received the 2nd dose of Pfizer COVID Vaccine on 9/21/21. Initial 1st dose of Pfizer COVID Vaccine was administered on 9/16/21

Other Meds: N/A

Current Illness: N/A

ID: 1722981
Sex: F
Age: 40
State: NY

Vax Date: 03/31/2021
Onset Date: 04/01/2021
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: Went to de told to wait 6 months after the shot

Allergies: Penicillin

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

Symptoms: Arm hurts - can?t pick up heavy objects anymore. Trouble breathing and Pains Bones ache and arm hurts keeps me up at night Swollen lymph node in my neck

Other Meds: Sertaline

Current Illness:

ID: 1722982
Sex: F
Age: 57
State: FL

Vax Date: 08/01/2021
Onset Date: 08/03/2021
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: EKG x2 Bloodwork Now referred to cardiologist

Allergies: Iodine, Codeine, Shellfish

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

Symptoms: Immediate negative taste in the mouth Within 2 minutes pounding searing headache lasted 6+ weeks Within 15 minutes heart started to flutter and lasted 5 days Same night rash on torso and neck. Lasted 3 weeks Same night urinary burning started. Constant for 3 weeks (all tests came back neg) and now is intermittent Severe lethargy - was unable to function for 2 weeks Now confirmed I experienced a heart attack and have heart issues that I did not have 4 months ago or 1 year ago (EKG confirmed)

Other Meds: Sigulair, Vit D, Vit B

Current Illness: None

Date Died: 09/04/2021

ID: 1722983
Sex: M
Age: 74
State:

Vax Date: 03/18/2021
Onset Date: 08/23/2021
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:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Arrived at hospital with shortness of breath, cough, fever, weakness, and diarrhea O2 sat 68%. History of COPD Was given rocephin, decadron, remdesivir, alubuterol, pulimicort, ceftriaxone, azithromycin, and BIPAP No improvement after receiving maximum treatment with uncontrolled muculoskeletal pain. Passed away

Other Meds:

Current Illness:

ID: 1722984
Sex: F
Age: 66
State: MI

Vax Date: 10/06/2020
Onset Date: 10/07/2020
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:

Allergies: No known allergies

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

Symptoms: Patient reported significant muscle pain in the left arm after receiving the first dose of Shingrix. Over time she says the pain has lessened somewhat, but still bothers her. She has subsequently received the second dose, also in the left arm, which did not affect the pain whatsoever. At rest she reports no pain, however, when extending her left arm she feels a pain level of 6 out of 10.

Other Meds: Bupropion XL 150mg Lisinopril 20mg Lovastatin 40mg Metformin 500mg

Current Illness:

ID: 1722985
Sex: M
Age: 63
State:

Vax Date: 08/04/2021
Onset Date: 08/24/2021
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:

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

Symptoms: Presented to ED with shortness of breath, chills, productive cough, nausea, vomitting, diarrhea, and weakness. Started on Decadron, remdesivir, combivent, albuterol, Vitamin D3, ZInc, melatonin, and oxygen Discharged home with decadron, singulair

Other Meds:

Current Illness:

ID: 1722986
Sex: M
Age: 87
State:

Vax Date: 02/24/2021
Onset Date: 09/16/2021
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:

Allergies:

Symptom List: Pain in extremity

Symptoms: Presented to the ED with complaints of increased shortness of breath and fever. Tested positive for COVID-19 recently Prior to presenting at the ED, was given monoclonal antibody infusion Was given dexamethasone, insulin, rocephin, and zithromax Got better on room air. Awaiting discharge

Other Meds:

Current Illness:

ID: 1722987
Sex: M
Age: 35
State: IN

Vax Date: 09/20/2021
Onset Date: 09/21/2021
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: None

Allergies: Non

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

Symptoms: Stating from the morning after the day got the shot , I have been experiencing mild pain in my scrotum, most especially the right sack.

Other Meds: None

Current Illness: Non

ID: 1722988
Sex: M
Age: 52
State:

Vax Date: 07/15/2021
Onset Date: 08/28/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: Diagnosed with COVID and came into the ED after a syncope episode. He also had fever, congestion, cough, diarrhea, nausea, myalgias Was given dexamethasone, remdesivir, barticinib, oxygen. Linezolid and ceftriaxone for possible bacteremia Discharged with oxygen

Other Meds:

Current Illness:

ID: 1722989
Sex: F
Age: 65
State: FL

Vax Date: 09/16/2021
Onset Date: 09/16/2021
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: Diarrhea, chills ,aches, really bad head aches, tightness in my chest, shooting Bain in my left breast, Last 3 days Headaches remain

Other Meds: Busprione

Current Illness: None

ID: 1722990
Sex: F
Age: 81
State:

Vax Date: 02/27/2021
Onset Date: 09/13/2021
Rec V Date: 09/22/2021
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:

Allergies:

Symptom List: Vomiting

Symptoms: Patient presented to the ED with cough, nausea, vomitting, weakness, confusion, with fever. She tested positive for COVID a few days before. Started on decadron, oxygen, and inhalers. Developed pancytopenia. Started on vancomycin for suspected blood infection Developed atrial fibrillation with rapid ventricular response. Was given lopressor, amiodarone, magnesium, lasix, and atrovent. Patient started to vomit and was given zofran. Remdesivir was given as renal function improved. Patient is still hospitalized as of this moment. Barticinib is being considered.

Other Meds:

Current Illness:

ID: 1722991
Sex: F
Age: 70
State: NC

Vax Date: 09/06/2021
Onset Date: 09/07/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data: N/a

Allergies: N/a

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: pt states that she had a rash the size of her palm, fever/chills, headache and loss of muscle control in her right arm

Other Meds: N/a

Current Illness: none

ID: 1722992
Sex: F
Age: 68
State: TX

Vax Date: 08/30/2021
Onset Date: 08/30/2021
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: None. Doctor just looked at the leg and said everything reported was expected.

Allergies: Penicillin; preservatives; food and environmental

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

Symptoms: Diarrhea, headache, upper back pain starting from right going left, swelling and soreness at injection site, bruised leg and clotted on inside of right leg outside. Diarrhea left yesterday.

Other Meds: Blood pressure

Current Illness: No

ID: 1722993
Sex: F
Age: 33
State: WI

Vax Date: 08/04/2021
Onset Date: 08/06/2021
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: Visited clinic on 9/17 and was "diagnosed" with unknown reason for rash - Pitariosis Rosea.

Allergies: no

Symptom List: Injection site swelling, Limb discomfort

Symptoms: 3 days after 1st vaccination - large area on skin under right arm began to peal/flake. 3 days after that appeared a full blown itchy, scaly rash appeared on arms, neck and torso.

Other Meds: Sertraline 50mg

Current Illness: no

Date Died: 09/06/2021

ID: 1722994
Sex: M
Age: 86
State:

Vax Date: 04/23/2021
Onset Date: 08/23/2021
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:

Allergies:

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

Symptoms: Presented to ED with fever, fatigue, shortness of breath, myalgias Was put on Bipap, treated with decadron Did not qualify for remdesivir and barticinib Developed sepsis, was given rocephin Developed cardiac arrythmia and ventricular fibrillation

Other Meds:

Current Illness:

ID: 1722995
Sex: F
Age: 16
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: NONE

Allergies: NO KNOWN

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

Symptoms: RASH DEVELOPED AROUND 1 HOUR AFTER IMMUNIZATION. PER GRANDMOTHER RASH STARTED AT SITE AREA AND JUST BELOW AND SPREAD UP PATIENT'S NECK. RASH STILL PRESENT TODAY.

Other Meds: BUSPIRONE, HYDROXYZINE

Current Illness: AUGUST 20, 2021 - COVID-19

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am