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: 1730957
Sex: M
Age: 21
State:

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

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

Lab Data: None

Allergies: NKDA

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient received second dose of Moderna 15 days prior to second dose due date.

Other Meds: NONE

Current Illness: NONE

ID: 1730958
Sex: M
Age: 67
State: OH

Vax Date: 03/06/2021
Onset Date: 09/23/2021
Rec V Date: 09/24/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient developed breakthrough COVID-19 requiring hospitalization

Other Meds:

Current Illness:

ID: 1730959
Sex: M
Age: 36
State: NY

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

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

Symptoms: Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium, Additional Details: patient fainted and fell and scraped his face, given glucose tabs and water, become responsive seconds after falling, was sweating. Pharmacist made the patient sit for 30 minutes and patient stated feeling much better. Pharmacist walked patient to car to insure stability on feet and was okay. No other intervention was necessary. Fully recovered with minor scratches on face. Pharmacist advised patient to come accompanied for second dose and make pharmacist aware of incident.

Other Meds:

Current Illness:

ID: 1730960
Sex: M
Age: 60
State: FL

Vax Date: 09/10/2021
Onset Date: 09/15/2021
Rec V Date: 09/24/2021
Hospital:

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

Lab Data: None

Allergies: NONE

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: I don't want to make a big deal about this BUT - I am 60, a heavy smoker, In very good health for my age. I have developed a Tic - a very small area - almost right betwwen my eyes , above the bridge of my nose , closer to wear my right eyebrow starts by my nore , has a thobbing sensation - like a "Tic". It vibrates off and on for lack of a better description. I can see it when it occurs - like the nerves are twitchinng just under the skin. I have zero history of "Tics" or any involuntary Muscle or Nerve Movements. I do not suffer from anxiety or any other disorder that I have ever been aware of. I have some COPD (100yr smoker) and the "tic" is prevalent immediatley after I cough - which is smoething I do a lot. It lasts only a few seconds then goes away. I can Palpate the area during the "tic" and feel the movement under the skin - it feels like a really fast pulse sort of. I have not notified any medical personnel and do not feel that it is a serious matter - just kind of uncomfortable. There is no pain or discomfort associated with it - It just feels funny to me. I rarely go to the Doctor , I am as normal as it gets and tough as a nail. I just felt like I should say something - this started a few days after my 2nd shot - I have never experianced anything like this before in my life. I am Pre Hypertensive 135/88-90 , slightly overweight and a heavy smoker and Moderate drinker. I have felt the "Tic" approx 7 times in the time it took me to type this up. Thank You.

Other Meds: NONE

Current Illness: NONE

ID: 1730961
Sex: F
Age: 15
State: MD

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/24/2021
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: Systemic: Dizziness / Lightheadness-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Mild, Systemic: Hyperventilation-Medium, Systemic: Nausea-Medium, Systemic: Visual Changes/Disturbances-Mild, Systemic: Vomiting-Medium, Systemic: Weakness-Medium

Other Meds:

Current Illness:

ID: 1730962
Sex: M
Age: 20
State:

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

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: None

Allergies: NKDA

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

Symptoms: Patient received second dose of Moderna 15 days prior to second dose due date.

Other Meds: NONE

Current Illness: NONE

ID: 1730963
Sex: F
Age: 49
State: OH

Vax Date: 01/11/2021
Onset Date: 09/23/2021
Rec V Date: 09/24/2021
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: Pyrexia, White blood cell count decreased

Symptoms: Patient developed breakthrough COVID-19 requiring hospitalization

Other Meds:

Current Illness:

ID: 1730964
Sex: F
Age: 61
State: CA

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

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Site: Itching at Injection Site-Severe, Systemic: Allergic: Difficulty Breathing-Severe, Systemic: Allergic: Itch (specify: facial area, extremeties)-Medium, Systemic: Allergic: Itch Generalized-Medium, Systemic: Allergic: Rash (specify: facial area, extremeties)-Medium, Additional Details: the patient started with hives and rash on 9/21/21 and progressed to difficulty breathing where she went to er. She is picking up benadryl. difficulty breathing is resolving on its own slowly

Other Meds:

Current Illness:

ID: 1730965
Sex: F
Age: 44
State: PA

Vax Date: 09/07/2021
Onset Date: 09/08/2021
Rec V Date: 09/24/2021
Hospital:

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

Lab Data:

Allergies: Allergic to Bactrim

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Intense joint swelling, most significant at knees and elbows with some involvement of the wrists, ankles, and fingers. Arm rash that spread to upper left chest

Other Meds: Levothyroxine, Metformin, Meloxicam, Atorvastatin

Current Illness:

ID: 1730966
Sex: F
Age: 24
State: CA

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

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Systemic: blurred vision-Medium, Additional Details: pt had blurred vision after shot, no other adverse reactions, checked blood pressure 126/93, called advice nurse at clinic where pt goes, she was advised to go to emergency room

Other Meds:

Current Illness:

ID: 1730967
Sex: F
Age: 33
State: CA

Vax Date: 09/16/2021
Onset Date: 09/16/2021
Rec V Date: 09/24/2021
Hospital:

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

Lab Data: NKA

Allergies: NKA

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

Symptoms: Wheal on injection site (4cmx3cm), low grade fever, chills, nausea

Other Meds: Prenatal tablet, Herbal supplement for lactation ( Mother's milk tea, Fenugreek, Moringa capsules)

Current Illness: NKA

ID: 1730968
Sex: M
Age: 73
State: CA

Vax Date: 09/08/2021
Onset Date: 09/09/2021
Rec V Date: 09/24/2021
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: Site: Bruising at Injection Site-Severe, Site: Redness at Injection Site-Medium

Other Meds:

Current Illness:

ID: 1730969
Sex: F
Age: 54
State: MA

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/24/2021
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: Systemic: Dizziness / Lightheadness-Mild, Systemic: Tingling (specify: facial area, extemities)-Mild, Additional Details: Arm was feeling tingling, fingers tingling. Seemed to resolve before she left site. Also complained of being a little lightheaded after vaccine. monitored patient for 60 to 70 minutes until she felt better.

Other Meds:

Current Illness:

ID: 1730970
Sex: F
Age: 13
State: VA

Vax Date: 09/21/2021
Onset Date: 09/22/2021
Rec V Date: 09/24/2021
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: Systemic: mouth swelling and painful after 24 hours of having the shot-Mild

Other Meds:

Current Illness:

ID: 1730971
Sex: F
Age: 12
State: MI

Vax Date: 09/17/2021
Onset Date: 09/17/2021
Rec V Date: 09/24/2021
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: Given 7 days early

Other Meds:

Current Illness:

ID: 1730972
Sex: F
Age: 88
State: LA

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/24/2021
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: Error: Wrong Dose of Vaccine - Too High-

Other Meds:

Current Illness:

ID: 1730973
Sex: F
Age: 73
State: FL

Vax Date: 02/10/2021
Onset Date: 02/14/2021
Rec V Date: 09/24/2021
Hospital:

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

Lab Data: Two punch biopsy , 08/10/2021 and 05/05/2021

Allergies: Vioxx, indocin, percodan

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

Symptoms: Pyoderma gangrenosum, onset 2/14/2021 to the present. had to go to clinic to specialist in pyoderma.

Other Meds: Eliquis, Dicylomine, Carvedilo, clobetasol, fenobitate, folic acid, levothroid, lisinopril, prednisone, cosentyx, temazepam, tramadol, venlafaxine, zinc, vitaminB12,vitamin d, vitamin c, multi vitamin

Current Illness: Psoriasis, psoriatic arthritis, osteoporosis,

ID: 1730974
Sex: M
Age: 74
State: NY

Vax Date: 07/01/2021
Onset Date: 07/01/2021
Rec V Date: 09/24/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-

Other Meds:

Current Illness:

ID: 1730975
Sex: F
Age: 60
State: NY

Vax Date: 07/30/2021
Onset Date: 07/30/2021
Rec V Date: 09/24/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Error: Booster Given Too Early-

Other Meds:

Current Illness:

ID: 1730976
Sex: M
Age: 33
State:

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

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

Lab Data: 9/20/2021: chest xray, ECHO, EKG, troponin, CBC, BMP, magnesium, phosphorus, Lipase, C-reactive protein, SED rate, COVID PCR,

Allergies: n/a

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

Symptoms: 33 year old male with no past medical history received second dose of moderna shot 9/20/21 AM. Started feeling short of breath a few hours later. By the evening, patient experienced chest pain causing patient to seek medical attention at nearest emergency department. Patient was given 4 aspirin and pain was relieved. Troponin on arrival was 1.4 and peaked at 2.4. EKG NSR, ECHO normal. Chest xray normal. Pt diagnosed myocarditis and was admitted to hospital overnight for monitoring

Other Meds: n/a

Current Illness: n/a

ID: 1730977
Sex: M
Age: 85
State: TN

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/24/2021
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: Site: Bruising at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Additional Details: Followed up with patient 4-6hrs after and he said no changes reported and he feels fine, I iced the injection site for about 2-3mins and kept checking on him. He didn't report any pain or discomfort, just bruising and swelling

Other Meds:

Current Illness:

ID: 1730978
Sex: F
Age: 75
State: CA

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/24/2021
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: Error: Wrong Dose of Vaccine - Too High-

Other Meds:

Current Illness:

ID: 1730979
Sex: M
Age: 0
State: FL

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/24/2021
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: EKG at hospital was clear. They did not order blood work gave me more fever relief medications and put me on fluids because there was an electrolyte deficiency.

Allergies: No

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

Symptoms: Around 7:30 I began to have chills and slight back ache. In the hour following both got worse and I had full body aches. By 10:30pm after I had taken ibuprofen my temperature was 105.6 degrees and had a constant heart rate over 160bpm. I felt fatigued and shaky and had someone take me to hospital.

Other Meds: No

Current Illness: No

ID: 1730980
Sex: F
Age: 68
State:

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 09/24/2021
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:

Symptom List: Injection site pain, Pain

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1730982
Sex: F
Age: 59
State: MN

Vax Date: 01/30/2021
Onset Date: 09/20/2021
Rec V Date: 09/24/2021
Hospital:

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

Lab Data: 9/22/21 SARS/COV-2, NAAT positive

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Breakthrough COVID

Other Meds:

Current Illness:

ID: 1730983
Sex: F
Age: 39
State: IN

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 09/24/2021
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: Feeling ill by the time I returned home after receiving the Covid shot. Upset stomach, nausea, loss of appetite weakness, chills, sweats, shaking, headache, soreness and aching in back and neck, tingling, numbness, sensation of cold in arm that received the injection, pain, loss of strength. 24 hours bed rest. Increased fluids, acetaminophen, naproxen. Still sore, achy, feeling weak nearly 48 hours after receiving the shot.

Other Meds: None

Current Illness: None

ID: 1730984
Sex: F
Age: 25
State:

Vax Date: 05/01/2021
Onset Date: 05/28/2021
Rec V Date: 09/24/2021
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: I did facial swabs and a slight fungal infection was found on my neck, chest and face but this has changed and become even more disruptive. the doctors don't know what else to suggest

Allergies: None

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: I am still suffering from major skin irritation and allergies I don't even know what from. My skin is spotty, itchy, red, hot, burning, dry/oily and super sensitive

Other Meds: None

Current Illness: None

ID: 1730985
Sex: M
Age: 64
State: PR

Vax Date: 08/26/2021
Onset Date: 08/27/2021
Rec V Date: 09/24/2021
Hospital:

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

Lab Data: CBC on 9/13/2021, mycoplasma detected & antibiotics prescribed for 3 days. Doctor recommended follow up visit.

Allergies: none

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Extreme body aches, all joints & muscles; tired, very weak for the first 5 days, as well as fluctuating B/P .Day 6 & 7 felt normal again. On day number 8 pain & aches began again to a lesser degree lasting another 5 days. By day 14 still very tired & weak with body aches only at the right knee & shoulder. 9/17/21 Slight sour throat at this point & a shooting pain form the right shoulder to the right side of the head, this last only a few seconds & has happened only twice. .Energy levels still not 100% , some what tired but functional today 9/24/2021. The tiredness comes & goes & seems to be diminishing.

Other Meds: none

Current Illness: none

ID: 1730986
Sex: F
Age: 40
State: CA

Vax Date: 08/29/2021
Onset Date: 08/30/2021
Rec V Date: 09/24/2021
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: NA

Allergies: NA

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

Symptoms: I developed muscle twitching in both legs beginning the day after injection. It has remained consistent for a month now. Additionally, I may experience muscle twitching in my arms, eye, back, or abdomen.

Other Meds: Multi-Vitamins

Current Illness: NA

ID: 1730987
Sex: F
Age: 71
State: WV

Vax Date: 02/05/2021
Onset Date: 09/18/2021
Rec V Date: 09/24/2021
Hospital: Y

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

Lab Data: MRI, PET scan, Biopsy of 1 mass for tissue dx. Started on prophylactic Keppra IV

Allergies: Amoxicillin

Symptom List: Nausea

Symptoms: Patient came in on 9/18/21 "I feel tired, sleepy also time and very forgetful": New Diagnoses: 1 acute metabolic encephalopathy 2 brain mass (multiple on MRI = multiple enhancing masses in the left parietal, temporal, and occipital loves which are connected by mass-like T2 FLAIR signal abnormality. Findings are concerning for multifocal glioblastoma. Largest mass extends along the ependymal lining of left lateral ventricle. 3 memory impairment History of Present Illness: memory impairment for several weeks, worsening. Admitted to ICU, PET scan, neurologist consult. Biopsy of 1 mass for tissue dx. Started on prophylactic Keppra IV. Neuro checks. Neurosurgery consult. Complaints of tiredness, forgetfulness, sleepiness. Describes symptoms as being off balance and lacking equilibrium. Associated Nausea and vomiting. Reports being up-to-date on CA screenings, colonoscopy was 5 days ago, mammogram in January. Nonsmoker, non-drinker.

Other Meds:

Current Illness: Diabetes Mellitus type 2, HTN, benign right breast mass, pulmonary emboli, thyroid nodule, heartburn, PONV, cataract

ID: 1730988
Sex: M
Age: 59
State: MA

Vax Date: 08/05/2021
Onset Date: 08/08/2021
Rec V Date: 09/24/2021
Hospital:

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

Lab Data: None

Allergies: None

Symptom List: Injection site pain

Symptoms: Ear ringing.

Other Meds: Avastatin

Current Illness:

ID: 1731135
Sex: F
Age: 28
State: GA

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

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

Lab Data:

Allergies: Mild allergy to radishes and mangoes

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

Symptoms: Experiencing itchy skin rash on left side of neck and small spots in a few other places. Began on September 20 and still present September 24. Received vaccine on 33W+2D pregnant. Uncomplicated pregnancy thus far.

Other Meds: Prenatal vitamin, fish oil supplements

Current Illness:

ID: 1731136
Sex: M
Age: 55
State: CA

Vax Date: 05/04/2021
Onset Date: 05/04/2021
Rec V Date: 09/24/2021
Hospital:

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

Lab Data: Many labs completed, you have my permission to access any and all from Health Center

Allergies: na

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

Symptoms: Right arm swelling, pain and redness at injection site. Slight fever, slept for several hours. When I awoke, I noticed edema of both lower legs. This got progressively worse over the following weeks. Without any symptoms of arthritis prior, I now had it in every joint in my body. Each morning I wake it's a new spot that's decided to hurt the worst, that day. It appears that the reconstruction work done on my knees has disappeared or been wiped out. My hands, which never had pain or swelling, are starting to deform and every finger now triggers from the sudden onset of arthritis. I did not notice it at the time of the first injection, but my heart rate began running 100-120 BPM, and my BP from 215/113 to about 180/105. We have had some luck with LISINOPRIL-HCTZ, FUROSIMIDE, CLINORIL. It appears to be getting the BP down a bit, but still in the range of 170-180/100-110

Other Meds: B Complex

Current Illness: Long COVID

ID: 1731137
Sex: M
Age: 60
State: MD

Vax Date: 08/07/2021
Onset Date: 08/11/2021
Rec V Date: 09/24/2021
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: N/A

Symptom List: Tremor

Symptoms: Posterior vitelline detachment

Other Meds: Indomethacin prn Vitamin C Vitamin D

Current Illness: N/A

ID: 1731138
Sex: M
Age: 84
State: MI

Vax Date: 03/12/2021
Onset Date: 09/20/2021
Rec V Date: 09/24/2021
Hospital: Y

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

Lab Data: SARS CoV-2 RNA (NAAT)= Detected

Allergies: penicillin

Symptom List: Erythema, Pruritus

Symptoms: 85-year-old male presents emergency department by private automobile in mild distress. He is tremulous. Patient has a history of COPD and tremors. He is currently being treated for lung cancer with metastasis to the brain as well. He is on antibiotics for a diagnosis of pneumonia on Monday. He started feeling sick on Monday with cough and congestion. He was seen by his doctor and placed on antibiotics. Today his tremors got worse and he was increasingly short of breath. He has home oxygen but only wears it occasionally. They checked his O2 saturation at home and it was 78%. He does not complain of any chest pain. He is mildly confused. No nausea or vomiting.

Other Meds: Current Home Medications 1. Aspir 81 oral delayed release tablet : 1 tab(s) orally once a day 2. levoFLOXacin 500 mg oral tablet : 1 tab(s) orally every 24 hours 3. metoprolol tartrate 25 mg oral tablet : 1 tab(s) orally once a day 4. potas

Current Illness: unknown

ID: 1731139
Sex: F
Age: 32
State: MN

Vax Date: 05/22/2021
Onset Date: 09/22/2021
Rec V Date: 09/24/2021
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: 9/22 SARS/COV-2, NAAT positive

Allergies:

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

Symptoms: Breakthrough COVID

Other Meds:

Current Illness:

ID: 1731140
Sex: F
Age: 56
State: MI

Vax Date: 08/23/2021
Onset Date: 09/01/2021
Rec V Date: 09/24/2021
Hospital:

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

Lab Data: Haven't gone to the doc for it. Hoping it would go away. Will call to make appointment.

Allergies: Penicillin Raw onions and heavy garlic in any form really bother my mouth and stomach.

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

Symptoms: Pounding and rushing of heart has been ongoing in the weeks after I got the shot. Feels like my heart is too big for my chest cavity. A little shortness of breath.

Other Meds: I had used birth control as a hormone/menopause management med until June 2021. Use ibuprofen once a day for foot pain.

Current Illness: None

ID: 1731141
Sex: F
Age: 29
State: NJ

Vax Date: 09/19/2021
Onset Date: 09/19/2021
Rec V Date: 09/24/2021
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: NKDA

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient returned call and stated that vaccine site (Covid Vaccine) on her arm had "been red and swollen". Patient states swelling has decreased and pain has subsided. Patient states "my mother told me to take a benadryl and I used cold compresses". Offered patient appointment to come for evaluation. Patient states "I am feeling much better but will call if I need to come in or if symptoms do not improve.

Other Meds: None

Current Illness: None

ID: 1731142
Sex: M
Age: 73
State: MI

Vax Date: 01/27/2021
Onset Date: 09/21/2021
Rec V Date: 09/24/2021
Hospital: Y

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

Lab Data: SARS-CoV-2 by NAA was positive for COVID-19

Allergies: none

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

Symptoms: Pt received Moderna vaccines in January and February. Pt presented to the ED with complaints of respiratory distress. Upon EMS arrival to pt's facility, pt was found to have a room air saturation of 64% and was placed on 15L nonrebreather. After arrival to the ED, pt was intubated and found to be COVID positive.

Other Meds:

Current Illness:

ID: 1731143
Sex: F
Age: 28
State: MD

Vax Date: 08/22/2021
Onset Date: 08/26/2021
Rec V Date: 09/24/2021
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: Primary care provider sent her for MRI which she brought to (neurologist) which was normal. Neurologist thought she had "inflammation" and needed to rest.

Allergies: fish oil

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

Symptoms: Day after vaccine had fever, headache. Then 3 days after vaccine she felt dissociated- felt out of her body, didn't know what time it was or day of the week. Then on the 4th day after the vaccine, she went for a walk and got loss and had major short memory loss for a week starting on that day. She has had "brain fog" since then although it is very slowly improving and her short term memory is better but not back to baseline.

Other Meds: Multivitamin, Tumeric gummies, Vitamin D3, Women's probiotic

Current Illness: URI a month prior

ID: 1731144
Sex: M
Age: 28
State:

Vax Date: 04/05/2021
Onset Date: 04/15/2021
Rec V Date: 09/24/2021
Hospital: Y

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

Lab Data: See table in the publication https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.055891

Allergies:

Symptom List: Pain in extremity

Symptoms: Myocarditis. Hospitalized x 28 hours

Other Meds:

Current Illness: None

ID: 1731145
Sex: F
Age: 71
State: FL

Vax Date: 02/26/2021
Onset Date: 02/26/2021
Rec V Date: 09/24/2021
Hospital:

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

Lab Data: Had a visit with allergist after this episode

Allergies: tetanus toxoid, naprosyn penicillin, macrobid, minocin

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

Symptoms: hives, redness, fatigue, she has reported a case number, please connect this to 3/23/21 case filed by the patient

Other Meds: nothing except estradiol vaginal cream twice per week vaginally and one a day vitamin

Current Illness: normal health

ID: 1731146
Sex: F
Age: 29
State: NJ

Vax Date: 09/20/2021
Onset Date: 09/20/2021
Rec V Date: 09/24/2021
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: reglan

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

Symptoms: pt reported a few hours after vaccine was administered, she developed hives. Also felt sick and weak.

Other Meds:

Current Illness:

ID: 1731147
Sex: M
Age: 41
State: MN

Vax Date: 01/11/2021
Onset Date: 09/22/2021
Rec V Date: 09/24/2021
Hospital:

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

Lab Data: 9/22 SARS/COV-2, NAAT, Positive

Allergies:

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

Symptoms: Breakthrough COVID

Other Meds:

Current Illness:

ID: 1731148
Sex: F
Age: 26
State:

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 09/24/2021
Hospital:

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

Lab Data:

Allergies: UKN

Symptom List: Vomiting

Symptoms: A few hours after my first shot I became very nauseous, then my body hurt really bad, and I had a very bad headache. These symptoms last for about 2 days. I took Tylenol and vitamin C gummies to try and help with the side effects after getting the first dose. My arm was very sore and I could not really move it for the entire time I had the side effects.

Other Meds: Birth control

Current Illness: none

ID: 1731149
Sex: F
Age: 50
State: WI

Vax Date: 08/30/2021
Onset Date: 08/30/2021
Rec V Date: 09/24/2021
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: None

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Rash and bump which was hot to the touch and felt like it was stinging. Lasted a week. Three weeks later I still have a lump under the skin and faint purple coloring.

Other Meds: None

Current Illness: None

ID: 1731150
Sex: F
Age: 61
State: IL

Vax Date: 09/14/2021
Onset Date: 09/14/2021
Rec V Date: 09/24/2021
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: na

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

Symptoms: Slight nausea started around 9:00 PM on 9-14-21. An hour later, I developed a fever, body aches, and chills. These lasted throughout the night. By morning I had a headache, was fatigued, and had a slight fever. These symptoms lasted until the morning of 9-16-21. After that, I felt fine.

Other Meds: Welbutrin, Zrytec, Vitamin D

Current Illness: na

ID: 1731151
Sex: M
Age: 39
State: VA

Vax Date: 04/11/2021
Onset Date: 04/14/2021
Rec V Date: 09/24/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Please see web link

Allergies: NKDA

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Myocarditis resulting in hospitalization

Other Meds: None

Current Illness: None

ID: 1731152
Sex: M
Age: 50
State: GA

Vax Date: 09/01/2021
Onset Date: 09/02/2021
Rec V Date: 09/24/2021
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: Approximately 14-18 hours after the injection, client started feeling a funny feeling in his chest and checked his pulse. He stated it was 180. He called EMS and was transported to be checked out.

Other Meds:

Current Illness:

ID: 1731153
Sex: M
Age: 12
State: DC

Vax Date: 09/04/2021
Onset Date: 09/10/2021
Rec V Date: 09/24/2021
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 at this time. Will schedule follow up with his physician in the next few days.

Allergies: Cephalosporins

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

Symptoms: About two weeks following vaccination, my son started to complain of dyspnea on exertion, palpitations, and chest pain. It seems the complaints have gotten more frequent in the last 10 days.

Other Meds: Vitamin D, multivitamin, magnesium, DHEA

Current Illness: None

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am