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: 1729009
Sex: F
Age: 0
State: NY

Vax Date: 06/03/2021
Onset Date: 06/26/2021
Rec V Date: 09/23/2021
Hospital:

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

Lab Data: ANA TITER reporting on 06/26/2021 high on the 1:640 H from my blood work, just weeks before receiving the 1rst dose of the Pfizer on 6/3/21

Allergies: No

Symptom List: Dysphagia, Epiglottitis

Symptoms: Weeks after I went to the dermatologist office, and was diagnose with my auto immune system inflamed with my ANA TITER reporting on 06/26/2021 high on the 1:640 H from my blood work, the physician assistant said that this is a possibility I may have different kinds of Lupus.

Other Meds: No, Just vitamin D supplements.

Current Illness: None.

ID: 1729010
Sex: F
Age: 52
State: AK

Vax Date: 08/27/2021
Onset Date: 08/29/2021
Rec V Date: 09/23/2021
Hospital:

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

Lab Data: None

Allergies: None

Symptom List: Anxiety, Dyspnoea

Symptoms: Severe night sweats for 20 days Rash on both arms, face, and right arm pit

Other Meds: Progesterone

Current Illness: None

ID: 1729011
Sex: F
Age: 40
State: TX

Vax Date: 01/15/2021
Onset Date: 02/11/2021
Rec V Date: 09/23/2021
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: I don't recall the dates of appointments with my EP doctor however, he is implanting a heart monitor next Monday to try to get a better idea of what is happening. I had an ER visit on Feb. 11 as a result of one of the cardiac events. I have yet to have my annual exam with my OBGYN to discuss the extreme bleeding that I am now experiencing since receiving the vaccine.

Allergies: Shellfish, penicillin, iodine

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

Symptoms: 1. Extremely heavy periods since vaccination resulting in being able to soak a super tampon and a 10-hour pad in a couple of hours and also soil underwear. This has happened more than once. 2. I also have a previous history of heart arrhythmia (SVT and AVNRT) that was treated in 2018 and well managed since then until two weeks after vaccination when the arrhythmia returned and I am now being treated for re-emergence of the problems with my EP doctor.

Other Meds: Daily women's multivitamin, calcium

Current Illness: None

ID: 1729012
Sex: F
Age: 82
State: WI

Vax Date: 06/21/2021
Onset Date: 06/24/2021
Rec V Date: 09/23/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: On July 24, 2021, three days after her vaccination, pt fell to the floor in the family room of her home and was unable to sit up or stand. Paramedics took her to the emergency room at. She was given a series of tests that revealed a major infection - possibly life threatening. The doctors could not immediately identify the source of the infection. She was admitted to the hospital, and tests were continued throughout the night. Early the next morning, an MRI scan revealed that her appendix was about to burst. She was rushed into surgery where her appendix was removed via laparoscopic surgery. (Continued on continuation page)The diagnosis of appendicitis was very surprising. She never had any abdominal pain from the appendicitis. People her age seldom get appendicitis, but there have been some reports of a slight increase in appendicitis after receiving a Covid19 vaccination. Her primary care physician did not know if her appendicitis was caused by the vaccination, but other physicians have said that coming down with appendicitis 3 days after her vaccination was too much of a coincidence to not blame the vaccination. After 9 days in the hospital, she was transferred on July 2, 2021, to a Post-Acute Care facility. At this point her infection had been cured, but she had difficulty walking, even with the aid of a walker. She also suffered from urinary and bowel incontinence. Unfortunately, a resident in a nearby room, came down with the Delta variant of Covid19. Therefore, the entire facility was placed in lockdown. Pt had a miserable time at the facility. During the lockdown, patients were confined to their rooms. No visitors were allowed. The facility became vastly understaffed. and members of the staff were unable to attend to her urinary and bowel movement needs in a timely manner. The food service deteriorated to the point where many meals were almost inedible. The one good thing about her stay at the facility was the physical therapy staff. They were excellent. Although they could not take patients to their physical therapy gym, they worked with pt in her room. Her ability to walk around with the aid of a walker improved significantly. Several things needed to be done to prepare for her return home. Toilet handlebars and a raised toilet seat were added to the bathroom. It was also necessary to prepare a first-floor room with sleeping facilities for her. This involved a clearing out the room and adding a wardrobe closet, a set of drawers, lamps, and a new bed and mattress. Pts insurance ended its partial coverage partial coverage of nursing home expenses ended after 3 weeks, and she had to pay the entire cost of her final week there. However, she did get her second dose of the Covid19 vaccine during that extra week. She returned home on July 31, 2021. She felt like she had just returned to Earth from outer space. At this point, she no longer had the incontinence problem and could walk reasonably well with a walker. Today she can do some limited walking without the walker.

Other Meds: ADVIL, 0.81 mg Aspirin, Vitamins, Move Free, Citracal Calcium

Current Illness:

ID: 1729013
Sex: F
Age: 30
State: CA

Vax Date: 08/13/2021
Onset Date: 08/13/2021
Rec V Date: 09/23/2021
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: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Symptoms the night of seemed normal. Fever, headache, body sores, etc. Those lasted about two-three days. But now, 6 weeks later, I am still experiencing headaches on and off. I have never experienced headaches like this prior to the COVID vaccine. I also still feel weakness and dullness in the muscle injected.

Other Meds: NONE

Current Illness: NONE

ID: 1729014
Sex: M
Age: 51
State: MI

Vax Date: 04/07/2021
Onset Date: 09/06/2021
Rec V Date: 09/23/2021
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:

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

Symptoms: COVID positive, seen in ED for treatment. Fully vaccinated April 2021.

Other Meds:

Current Illness:

ID: 1729015
Sex: F
Age: 63
State:

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

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1729016
Sex: M
Age: 59
State: WA

Vax Date: 09/17/2021
Onset Date: 09/19/2021
Rec V Date: 09/23/2021
Hospital:

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

Lab Data: lab results 09/23/2021 RBC 3.02, Hemoglobin 10.5, HCT 31.1%, MCV 103.0, Platelet Count 108, Alkaline Phosphatase 157, ALT 141, AST 84, Bilirubin Total 4.2, BUN/Creatinine 11, Iron 38, Ferritin 704.9, Iron Saturation 12!

Allergies: none

Symptom List: Pharyngeal swelling

Symptoms: Kidney pain, chills, extreme vomiting for several hours starting around 1:30 AM.

Other Meds: Zinc 50mg qd

Current Illness: none

ID: 1729017
Sex: F
Age: 60
State: MO

Vax Date: 09/15/2021
Onset Date: 09/15/2021
Rec V Date: 09/23/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Employee given expired flu vaccination. Expiration date of 06/30/21. No signs or symptoms reported thus far.

Other Meds:

Current Illness:

ID: 1729018
Sex: M
Age: 64
State: TX

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

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

Lab Data:

Allergies: penicillin

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Pt woke up the next morning and his lips were very swollen. He had a small patch of itch rash on his leg but not all over his body. He did not complain of difficulty breathing. His swelling has diminished with allergy medication. His physicians office offered no advice.

Other Meds:

Current Illness:

ID: 1729019
Sex: F
Age: 35
State: FL

Vax Date: 08/04/2021
Onset Date: 08/04/2021
Rec V Date: 09/23/2021
Hospital:

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

Lab Data: Nones

Allergies: Cinnamon allergy

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

Symptoms: After first dose Leg pain after about 1 hour on the side shot was given. Same thing happened on the second dose pain on the leg where the shot was given. Been having headaches once or twice a weeks since the second shot.

Other Meds: None

Current Illness: No illnesses but have 2 abdominal hernias

ID: 1729020
Sex: F
Age: 50
State:

Vax Date: 08/24/2021
Onset Date: 08/24/2021
Rec V Date: 09/23/2021
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:

Symptom List: Rash, Urticaria

Symptoms: pt called to report that she suffer from asthma attack-like symptoms such wheezing, coughing up phlegm about 30 minutes after receiving prizer vaccine on 08/24/21, per pt her symptoms resolved after using a rescue inhaler. Per pt she has a history asthma but had not had an attack in over 10 years and had not had one since. she thinks it is related to the vaccine and is concern about getting the second dose.

Other Meds:

Current Illness:

ID: 1729021
Sex: M
Age: 52
State:

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 09/23/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1729022
Sex: M
Age: 18
State: CA

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/23/2021
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: N/A

Allergies: N/A

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

Symptoms: AFTER ADMINISTERING THE VACCINE THE PATIENT WALKED OUT AND WITHIN MINUTES HE PASSED OUT FELL DOWN HIT HIS HEAD AND DIDN'T KNOW WHERE HE WAS HE WAS CONFUSED SWEATING WE CALLED EMS THEY WERE HERE WITHIN FEW MINUTES AND WORKED ON HIM THE PATIENT REFUSED TO GO TO ER AFTER A WHILE 1/2 HOURS OR SO HE CLAIMED HE WAS GETTING BETTER AND HE WENT TO HIS CAR WAITING FOR HIS FATHER TO GIVE HIM A RIDE

Other Meds: N/A

Current Illness: N/A

ID: 1729023
Sex: F
Age: 46
State: MI

Vax Date: 04/07/2021
Onset Date: 09/06/2021
Rec V Date: 09/23/2021
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:

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

Symptoms: Seen in ED for COVID 19 symptoms and positive test. Fully vaccinated April 2021.

Other Meds:

Current Illness:

ID: 1729024
Sex: F
Age: 51
State: NC

Vax Date: 09/17/2021
Onset Date: 09/23/2021
Rec V Date: 09/23/2021
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: Pt contacted Pharmacy on Thursday, 9/23/2021 to inquire about potential adverse effects following her second dose of the COVID-19 Pfizer vaccine. The vaccine was given on Friday, 9/17/2021. She stated her are was sore following the injection and the arm felt swollen and like there was a hard knot at the injection site. On Thursday, 9/23/2021 around 4AM the arm became red and hot to the touch and she began having pain below the injection site in the area of her bicep. She described the pain as a deep ache.

Other Meds:

Current Illness:

ID: 1729025
Sex: M
Age: 41
State:

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

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

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1729026
Sex: F
Age: 60
State: CA

Vax Date: 04/01/2021
Onset Date: 04/01/2021
Rec V Date: 09/23/2021
Hospital:

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

Lab Data: I went to local clinic Doves urgent care asked for xrays I thought I broke something. They xrayed ( nothing). I established a primary there after 3 days off work. Dr said this is yr shoulder (wk comp injury) rhomboid spasms written off work 3 weeks. Kept asking if I ever had heart problems (no); chalked High BP n pulse to pain. THIS IS WHY IM REPORTING: My daughter (had both vaccines and sent her breast milk to cedars) did NOT want ME to get vaccinated because we believe I have DNA/mitochondrial damage from the Cipro. And I did first vac anyway then wound up in real bad shape like when I was floxed. I promised her I wouldn't get 2nd shot

Allergies: Serious allergy to FQs! Cipro disabled me for a year 2008-09. Allergic to many rx, some mineral allergies, dyes: skin reactions

Symptom List: Ear pain, Hypoaesthesia

Symptoms: At the 12 minute wait mark a mushroom of pain exploded/bloomed in top of L arm. It eased off to soreness The next day my left underarm lymph swelled/painful, the day after that R underarm lymph joined in. Then groin lymph joined in for a few more days. My right scapula started hurting and the area of bra strap across back had fiery pain (like the fire pain when I was floxed from cipro) My heart was racing for weeks also.

Other Meds: Lorantidine Ibuprofen

Current Illness: Not yet "permanent/stationary from busted shoulder 1/2020.

ID: 1729027
Sex: F
Age: 29
State: IL

Vax Date: 09/21/2021
Onset Date: 09/23/2021
Rec V Date: 09/23/2021
Hospital:

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

Lab Data:

Allergies: NONE

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: PATIENT PREGNANT WITH NO ESTIMATED DELIVERY DATE. EXPERIENCING STRONG HEART PALPITATIONS

Other Meds: NONE KNOWN

Current Illness: NONE

ID: 1729028
Sex: M
Age: 38
State: MD

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

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

Lab Data: Unknown

Allergies: NKA

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

Symptoms: Patient did not report any adverse event during administration or the 15 minute wait time. It was determine at 5:00pm that the patient was administered a Pfizer vaccine past the BUD/time. Administered at 3:18pm on 9/23 from a vial that remained in the IMZ room from the previous day which was mixed on 9/22 at 12:14pm . I observed the beyond use time of 6:14pm, however I did not verify the date. Contacted Pfizer and was informed that there is no protocol for after 24 hours outside of BUD/time. Consulting the Market Director and Clinical Services team for further guidance.

Other Meds: Unknown

Current Illness: None

ID: 1729029
Sex: F
Age: 59
State: MO

Vax Date: 09/15/2021
Onset Date: 09/15/2021
Rec V Date: 09/23/2021
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: Employee given expired flu vaccination. Expiration date of 06/30/21. No signs or symptoms reported thus far.

Other Meds:

Current Illness:

ID: 1729030
Sex: M
Age: 71
State:

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 09/23/2021
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: Unevaluable event

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1729031
Sex: F
Age: 74
State:

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 09/23/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1729032
Sex: F
Age: 53
State: NY

Vax Date: 09/11/2021
Onset Date: 09/12/2021
Rec V Date: 09/23/2021
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: ALeve, Anaprox, Aspirin, Motrin,latex gloves& black pepper etc

Symptom List: Injection site pain, Pain

Symptoms: SYMPTOMS: SEVERE HIVES >right/left arm >right/left leg > right/left thigh >buttocks >upper right side shoulder > right/left side of the chest >right top foot The above outbreak hives symptoms began September 12, 2021 and continue for about seven days. THe hives were treated by benedryl (pill) but unfortunately the symptoms continue progressing. Therefore, I had no choice but to seek medical attention on September 19, 2021 at a HCF. I was seen by ,PA-C and it was confirmed that my outbreak was due to the J&J COVID 19 vaccine. I am sharing my experience because these severe outbreak caused me to be very emotional and distressed. T

Other Meds: Before Vaccination-Tylenol

Current Illness:

ID: 1729033
Sex: M
Age: 24
State: TN

Vax Date: 07/21/2021
Onset Date: 07/21/2021
Rec V Date: 09/23/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Injection site pain, Menorrhagia

Symptoms: Trouble breathing in the 5 days after shot received. Felt like I couldn't take a full breath. It scared me so much that I decided not to proceed with my second vaccine shot. Turns out this may be a side effect of Myocarditis.. But I don't have this side effect anymore so maybe it wasn't that. It's not an extremely serious side effect by any means, but I felt I should report it because it caused me to decide not to go with the second shot.

Other Meds: Suboxone, Unisom/Doxylamine for sleep, Ibuprofen

Current Illness: N/A

ID: 1729034
Sex: M
Age: 12
State: CA

Vax Date: 09/14/2021
Onset Date: 09/14/2021
Rec V Date: 09/23/2021
Hospital:

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

Lab Data: N/A

Allergies: None

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

Symptoms: Moderna is not FDA approved for 18 age and under. Patient is 12 year-old and received the Moderna vaccine.

Other Meds: None

Current Illness: None

ID: 1729035
Sex: M
Age: 25
State: IL

Vax Date: 08/11/2021
Onset Date: 08/12/2021
Rec V Date: 09/23/2021
Hospital:

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

Lab Data: Blood work: 9/3/21 Heart inflammation confirmed Tests ongoing

Allergies: None

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Headache ranging from moderate to severe (9 days) pain for 37/43 days; Muscle pain ranging from moderate to severe (11 days) pain for 43/43 days; Fatigue ranging from moderate to severe (8 days) for 40/43 days; Dizziness ranging from moderate to severe (4 days) for 18/43 days; Joint pain ranging from moderate to severe (1 day) pain for 9/43 days; Muscle spasms ranging from moderate to severe (6 days) intensity for 43/43 days; Pain at injection site ranging from moderate to severe (9 days with one day in which I was unable to use my arm for the duration of the pain) pain for 29/43 days; Severe skin sensitivity ranging from moderate to prolonged (8 days) duration for 21/43 days; Heart inflammation 43/43 days.

Other Meds: Allegra-D; Aspirin

Current Illness: None

ID: 1729036
Sex: F
Age: 77
State: MI

Vax Date: 04/14/2021
Onset Date: 08/17/2021
Rec V Date: 09/23/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient admitted for GI bleed.

Other Meds:

Current Illness:

ID: 1729037
Sex: F
Age: 53
State: NY

Vax Date: 09/11/2021
Onset Date: 09/12/2021
Rec V Date: 09/23/2021
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: ALeve, Anaprox, Aspirin, Motrin,latex gloves& black pepper etc

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

Symptoms: SYMPTOMS: SEVERE HIVES >right/left arm >right/left leg > right/left thigh >buttocks >upper right side shoulder > right/left side of the chest >right top foot The above outbreak hives symptoms began September 12, 2021 and continue for about seven days. THe hives were treated by benedryl (pill) but unfortunately the symptoms continue progressing. Therefore, I had no choice but to seek medical attention on September 19, 2021. I was seen by PA-C and it was confirmed that my outbreak was due to the J&J COVID 19 vaccine. I am sharing my experience because these severe outbreak caused me to be very emotional and distressed.

Other Meds: Before Vaccination-Tylenol

Current Illness:

ID: 1729038
Sex: F
Age: 61
State: MO

Vax Date: 09/15/2021
Onset Date: 09/15/2021
Rec V Date: 09/23/2021
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: Nausea

Symptoms: Employee given expired flu vaccination. Expiration date of 06/30/21. No signs or symptoms reported thus far.

Other Meds:

Current Illness:

ID: 1729039
Sex: F
Age: 58
State: GA

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

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

Lab Data: CT Angiogram Head and Neck - Stroke VIZ LVO CT Head without IV Contrast - Stroke Protocol Electrocardiogram, 12 lead X-ray chest portable APTT CBC and differential Comprehensive Metabolic Panel POC Creatiinine w/GFR performed 2 times Protime-INR Troponin T Urinalysis

Allergies: None

Symptom List: Injection site pain

Symptoms: Approximately 15 minutes after injection my heart started racing and I experienced extreme Lightheadedness. I notified the nurse, who proceeded to take my pulse, then had me lie down. Approximately 10 minutes later, it became very difficult to speak. Although I could think, it became increasingly difficult to form words. At that point they called Rapid response, Over the next 20 minutes, it subsided, and I was able to think and speak coherently. Then it started all over again. I could think, but it was extremely difficult to keep my eyes open or to form words. At that point I was taken to the Emergency Department, where they did a complete stroke assessment.

Other Meds: Multivitamin, Zinc, Vitamin D

Current Illness: None

ID: 1729040
Sex: M
Age: 55
State:

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 09/23/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1729041
Sex: M
Age: 43
State: MD

Vax Date: 04/12/2021
Onset Date: 04/22/2021
Rec V Date: 09/23/2021
Hospital:

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

Lab Data: June 10th Venous Doplar Scan (radiology), additional follow up at ER. Sept 22nd Venous Doplar Scan

Allergies: penicilin

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

Symptoms: DVT in R Leg from Ankle through Pelvis, Eliquis 10MG/day 6 months, rescan after 3 months no change. Changing dose to 20MG/day for 3 months

Other Meds: none

Current Illness: none

ID: 1729042
Sex: F
Age: 54
State: CT

Vax Date: 09/14/2021
Onset Date: 09/14/2021
Rec V Date: 09/23/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: Intense body aches. Temperature. Headache. Ear ache. Neck ache.

Other Meds: Armor thyroid

Current Illness:

ID: 1729043
Sex: F
Age: 30
State: CA

Vax Date: 04/16/2021
Onset Date: 04/16/2021
Rec V Date: 09/23/2021
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: None

Symptom List: Erythema, Pruritus

Symptoms: Fast heart rate, blood pressure of 180/98, dry mouth, weird taste, weakness, chest pains, chest pressure.

Other Meds: None

Current Illness:

ID: 1729044
Sex: F
Age: 25
State: TN

Vax Date: 09/18/2021
Onset Date: 09/19/2021
Rec V Date: 09/23/2021
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: Amoxicillin penicillin

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

Symptoms: The day after my vaccine I went to bed crying in pain from my lower body hurting so bad. That has continued every day since. The second day after my vaccine, I started bleeding vaginally and it has not stopped and I have bled an insane amount. I?ve had a heavy heavy flow before I was put on birth control but it was nothing compared to this. I?ve gotten dizzy nauseous and had headaches.

Other Meds: None

Current Illness: None

ID: 1729045
Sex: M
Age: 41
State: MO

Vax Date: 09/10/2021
Onset Date: 09/11/2021
Rec V Date: 09/23/2021
Hospital:

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

Lab Data: Bloodwork was normal. Doctor not able to explain cause of adverse events

Allergies: None known

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

Symptoms: Extreme weakness in legs and thighs (for approximately 7 days after vaccine) Unable to walk for short periods of times (for approximately 6 days after vaccine) Difficulty walking (13 days after vaccine and ongoing) Shooting pain in legs, thighs, and arms (for approximately 12 days after vaccine) Tingling feeling throughout body (for approximately 12 days after vaccine) Dizziness and lightheadedness (for approximately 9 days after vaccine)

Other Meds: Buspirone HCL 30 mg/day

Current Illness: None

ID: 1729046
Sex: F
Age: 79
State:

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 09/23/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1729047
Sex: F
Age: 35
State: MO

Vax Date: 09/15/2021
Onset Date: 09/15/2021
Rec V Date: 09/23/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Employee given expired flu vaccination. Expiration date of 06/30/21. No signs or symptoms reported thus far.

Other Meds:

Current Illness:

ID: 1729048
Sex: F
Age: 37
State: NC

Vax Date: 08/24/2021
Onset Date: 09/10/2021
Rec V Date: 09/23/2021
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: Doxycycline

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

Symptoms: Menstrual period two weeks late and very heavy with cramping. Period is normally always regular with barely any cramping.

Other Meds: Pre natal vitamins, slow fe, Flonase, citalopram 20mg

Current Illness: None

ID: 1729049
Sex: F
Age: 63
State: CA

Vax Date: 07/22/2021
Onset Date: 07/01/2021
Rec V Date: 09/23/2021
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: Pain in extremity

Symptoms: Bump the size of a quarter and I left at the injection site.

Other Meds: Ability, Wellbutrin, ambien, lamictal Vitamins c, d, zinc, tumeric

Current Illness: None

ID: 1729050
Sex: F
Age: 68
State: MI

Vax Date: 04/15/2021
Onset Date: 08/05/2021
Rec V Date: 09/23/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: patient presented to ED with COVID symptoms and positive test. Treated with Regeneron antibodies. Fully vaccinated in April 2021.

Other Meds:

Current Illness:

ID: 1729051
Sex: F
Age: 70
State:

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

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

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1729052
Sex: F
Age: 11
State: CO

Vax Date: 07/14/2021
Onset Date: 09/23/2021
Rec V Date: 09/23/2021
Hospital:

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

Lab Data: none

Allergies: no known allergies

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

Symptoms: No known negative outcomes have been reported. The patient indicated they were 12 years of age on the consent form, but was a week shy of turning 12 and came in to get her second dose of vaccine with her mother. The vaccine was administered, not knowing the patient had not turned the appropriate age of 12 yet.

Other Meds: unknown

Current Illness: no known illnesses

ID: 1729053
Sex: F
Age: 28
State: IL

Vax Date: 09/01/2021
Onset Date: 09/10/2021
Rec V Date: 09/23/2021
Hospital:

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

Lab Data: 9/11/2021: EKG, labs, chest xray, CTA of the chest

Allergies: none

Symptom List: Vomiting

Symptoms: On 9/10, 9 days after vaccination, I developed tightness in my chest mid morning as well as a mild sore throat. I left work. Went home, slept, woke up around 2:00 with persistent tightness in my chest and sore throat. I rested. That evening I woke up in the night, the left side of my mouth was swollen and my left eye was bloodshot. I put an ice pack on my face and went back to sleep. Next morning, I woke up (9/11), still had tightness in my chest and a sore throat and additionally my hands and feet were swollen. It was painful to walk and open and close my hands. I went to immediate care. They ran an EKG, labs, did a chest X-ray. EKG and chest xray came back clear but my labs revealed a d-dimer value of >3,800 (normal <400) which they said was indicative of me possibly having a pulmonary embolism, especially because I had just gotten the J&J vaccine. I was sent to the hospital immediately. They did additional blood work, EKG, and a chest CT which revealed no PE. I was told it was likely just a bad vaccine reaction and sent home. I followed up with my PCPs office on 9/20 who also believed it was an adverse vaccine reaction.

Other Meds: Birth control

Current Illness: none

ID: 1729054
Sex: F
Age: 46
State: MO

Vax Date: 09/15/2021
Onset Date: 09/15/2021
Rec V Date: 09/23/2021
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:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Employee given expired flu vaccination. Expiration date of 06/30/21. No signs or symptoms reported thus far.

Other Meds:

Current Illness:

ID: 1729055
Sex: M
Age: 59
State: MI

Vax Date: 04/15/2021
Onset Date: 08/22/2021
Rec V Date: 09/23/2021
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:

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

Symptoms: Patient admitted for COVID pneumonia. Fully vaccinated in April 2021.

Other Meds:

Current Illness:

ID: 1729056
Sex: F
Age: 46
State: CO

Vax Date: 09/15/2021
Onset Date: 09/16/2021
Rec V Date: 09/23/2021
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: None

Allergies: Sulfa Cipro Penicillin

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Very sore injection site with small lump for a week. The day after the vax my arm was hurting quite badly from my shoulder down to my hand, into my left shoulder blade, and around and under my arm just above the armpit. That is the part that was super painful to the point of tears. I couldn?t stand to move my arm or hand or lay on my back or on my left side.

Other Meds: Birth control pill Tumeric Fish oil Iron supplement Ferrofood

Current Illness: None

ID: 1729057
Sex: F
Age: 83
State:

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 09/23/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1729058
Sex: F
Age: 67
State: AZ

Vax Date: 09/20/2021
Onset Date: 09/20/2021
Rec V Date: 09/23/2021
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: Walnuts Morphine

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

Symptoms: Headache constant

Other Meds: Ibrance Valcylovir Venflaxine Gabbypentin

Current Illness: Cancer

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am