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: 1731260
Sex: F
Age: 56
State: OH

Vax Date: 03/11/2021
Onset Date: 04/01/2021
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:

Allergies: N/A

Symptom List: Dysphagia, Epiglottitis

Symptoms: Ear pain/pressure following vaccination-ongoing at time of submission

Other Meds: Multivitamin and Claritin

Current Illness: N/A

Date Died: 09/11/2021

ID: 1731261
Sex: F
Age: 77
State: KY

Vax Date: 04/01/2021
Onset Date: 09/11/2021
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: POSITIVE COVID19 ON 8/23/21

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: PRESENTED TO ED WITH DYSPNEA, TESTED COVID19 POSITIVE. DEVELOPED ACUTE RESP FAILURE AND DIED 9/11/21

Other Meds:

Current Illness:

ID: 1731262
Sex: F
Age: 55
State:

Vax Date: 04/06/2021
Onset Date: 09/08/2021
Rec V Date: 09/24/2021
Hospital: Y

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: Hospitalization. Treated with dexamethasone 6 mg IV daily.

Other Meds:

Current Illness:

ID: 1731263
Sex: M
Age: 79
State: CA

Vax Date: 01/07/2021
Onset Date: 09/23/2021
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: Sonogram

Allergies: none

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Venous thrombosis right leg

Other Meds: hydroxychloroquine, retacrit, levo-thyroxine

Current Illness:

ID: 1731264
Sex: F
Age: 31
State: TX

Vax Date: 08/27/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data: none

Allergies: none

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

Symptoms: BREAST FED BABY EXHIBITED SIGNS OF LETHARGY FOR ABOUT 12 HOURS. My baby slept, and slept, and slept, and slept. He was 3 months old, typically waking every 2 hours to feed still, he did not do this the night of my vaccine. I felt as if his body was also going through something. I exhibited fatigue, tinnitus, and a sore arm. All of it cleared. Dose 2 of Pfizer was taken 9/17/21. I experienced a DROP IN MILK SUPPLY 4 days post-second shot. I went from pumping 8 oz to 2 oz. There was no change in diet and no other medications taken during this time.

Other Meds: post natal vitamin

Current Illness: none

ID: 1731265
Sex: M
Age: 66
State:

Vax Date: 06/01/2021
Onset Date: 07/01/2021
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:

Allergies:

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

Symptoms: Chronic fatigue starting a few weeks after administration of the vaccine which has lasted and is ongoing. Patient needs to take 1-2 naps per day to maintain function

Other Meds:

Current Illness:

Date Died: 08/01/2021

ID: 1731266
Sex: M
Age: 67
State: AK

Vax Date: 08/08/2021
Onset Date: 08/10/2021
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: Pyrexia, White blood cell count decreased

Symptoms: Deceased. Heart attack. 24-48 hours after 2nd injection.

Other Meds:

Current Illness:

ID: 1731267
Sex: F
Age: 47
State: GA

Vax Date: 09/08/2021
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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: ?Moderna COVID-19 Vaccine EUA? PATIENT GIVE EXPIRED VACCINE - TWO DAYS POST EXPIRATION

Other Meds:

Current Illness:

ID: 1731268
Sex: M
Age: 91
State:

Vax Date: 02/05/2021
Onset Date: 09/23/2021
Rec V Date: 09/24/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series

Other Meds:

Current Illness:

ID: 1731269
Sex: M
Age: 40
State: CT

Vax Date: 08/30/2021
Onset Date: 09/10/2021
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: no test were performed.

Allergies: none

Symptom List: Diarrhoea, Nasal congestion

Symptoms: According to the recipient, there were rash developed on both side of his body, happened in one ad half weeks after the vaccination. He was not sure either it's the side effect from the vaccine or they are from his Eczema flare up. The rash was getting better in the 3rd week. The recipient reported the rash on the appointment day of the 2nd dose.

Other Meds: N/A

Current Illness: n/a

ID: 1731272
Sex: F
Age: 33
State:

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

Allergies: None

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

Symptoms: Increased frequency in migraines (increased from 1 per 6 months to over 3 events weekly). Vaginal spotting outside of menstrual cycle. (Continual spotting that has not stopped since vaccine).

Other Meds: None

Current Illness: None

ID: 1731273
Sex: F
Age: 38
State: AL

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

Symptom List: Rash, Urticaria

Symptoms: One of the hospitals in my city offered a booster clinic for Moderna for immuocompromised and any individuals that were 8 months out from their Moderna series. I was very ill following the injection. I had fever, chills, body aches, nausea, vomiting, and fatigue. Two weeks after my booster injection, I began having systemic itching and occasional rashes. It began on 9/22 and is continuing even now. It varies from my neck, scalp, hands/wrists, feet, groin. The itching is intense and only relieved with Benadryl. The main rash was on my neck. I have not eaten anything different. I have not changed detergents or soaps. I have had no illnesses. The itching pops up at different times and can go away and come back in a different area. Majority of the time there is no rash but redness due to scratching because of the severe itching. I am not sure if this could be due to the booster vaccine. But I have no other causes that I can come up with.

Other Meds: None

Current Illness: None

ID: 1731274
Sex: M
Age: 15
State: GA

Vax Date: 07/12/2021
Onset Date: 07/12/2021
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: Patient was administered Moderna 0.5 mL IM. Patient was monitored for 15 minutes after immunization. Patient had no abnormal signs or symptoms. Patient discharged.

Other Meds:

Current Illness:

ID: 1731275
Sex: F
Age: 53
State: TX

Vax Date: 04/01/2021
Onset Date: 07/01/2021
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: I am scheduled for MRI.

Allergies: Tylenol and Ibuprofen

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

Symptoms: I developed occular migraines first, then my left eye started twitching and now the whole left side of my face twitches all night and during the day some also. I have seen 2 neurosurgeons. It keeps me up a lot at night. It is terrible and embarrassing. They asked if I had had Bell's Palsy. One neurosurgeon thinks that for some reason all of the sudden I am having hemifacial spasms.

Other Meds: Multi food based chewable Vitamin, Omega 3-6-9, pre/probiotic

Current Illness: none

ID: 1731276
Sex: F
Age: 37
State: NY

Vax Date: 09/24/2021
Onset Date: 09/24/2021
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: seizure, MS relapse. pt was hospitalized for a week and then in rehab for a month. hospital notes not received as of yet. tx not known at present. currently back to baseline

Other Meds:

Current Illness:

ID: 1731277
Sex: F
Age: 43
State: IL

Vax Date: 04/07/2021
Onset Date: 04/30/2021
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: no

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

Symptoms: None day of vaccine

Other Meds: zyrtec - as needed

Current Illness: no

ID: 1731278
Sex: M
Age: 65
State: WI

Vax Date: 09/21/2021
Onset Date: 09/22/2021
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:

Allergies: Pencillin and Epoxy

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

Symptoms: Patient had severe pain in left arm, unable to move it around, down to left elbow. Interesting he didn't have pain at injection site, but just distal to. Redness and swelling, adding nearly and inch in diameter to his arm circumference (by patient measurement at home) with erythema. Most of the redness and swelling was medial surface just of arm proximal to elbow. By 9/23, it was improving but still present. Treating with OTC pain mediations, ice and heat were also suggested 9/24 seen in office and some residual erythema to medial arm just above elbow but had significantly improved. Normal ROM present

Other Meds: Omega 3 fatty acid supplement

Current Illness: unknown hyperkalemia in work up, otherwise nothing

ID: 1731279
Sex: M
Age: 84
State:

Vax Date: 01/21/2021
Onset Date: 09/19/2021
Rec V Date: 09/24/2021
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: Vaccine breakthrough, symptomatic. Inpatient admit 9/21 to present,

Other Meds:

Current Illness:

ID: 1731280
Sex: M
Age: 59
State: MA

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

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

Lab Data: CSF protein 41, WBC 0

Allergies: No known allergies

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Per notes, Probable Guillain-Barr? syndrome/CIDP related to Covid vaccination. Patient came in with tingling and numbness, weakness in arms and legs, some difficulty swallowing

Other Meds: Labetalol, trazodone, Lexapro, doxazosin

Current Illness: alcohol abuse, depression, enlarged prostate, HTN

ID: 1731281
Sex: M
Age: 49
State: MO

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

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

Lab Data: N/A

Allergies: PCN, Propranolol, Metoprolol.

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

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: Miconazole, Lipitor, carbidopa/levodopa/terazosin, Testosterone oil, artificial tears, Ibuprofen, Prilosec, Tums.

Current Illness: No

ID: 1731282
Sex: F
Age: 36
State: CO

Vax Date: 09/10/2021
Onset Date: 09/10/2021
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: none

Allergies: no

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

Symptoms: Vomiting, Diarrhea, Pain in right side of neck

Other Meds: Birth Control Lexapro

Current Illness: no

ID: 1731283
Sex: M
Age: 32
State:

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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: Moderate headache and fatigue

Other Meds:

Current Illness:

ID: 1731284
Sex: M
Age: 37
State: NM

Vax Date: 08/30/2021
Onset Date: 09/09/2021
Rec V Date: 09/24/2021
Hospital: Y

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

Lab Data: Cat scan, x-rays, bloodwork, diagnosed with vasculitis

Allergies: Macadamia nuts

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

Symptoms: Rash and blisters all over body, pain, weakness, swelling/inflammation, several urgent care/e.r. visits, 1 hospital stay for 4 days, diagnosed with vasculitis, prescribed steroids, antibiotics and pain meds.

Other Meds: None

Current Illness: None

ID: 1731285
Sex: F
Age: 14
State: MI

Vax Date: 06/16/2021
Onset Date: 06/24/2021
Rec V Date: 09/24/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: CAT, ultrasounds, hospitalization, follow-up with gastroenterologist, primary doctor, blood tests .

Allergies: none

Symptom List: Injection site pain, Pain

Symptoms: Inflammation of pancreas - pancreatitis and liquid in lungs

Other Meds: none

Current Illness: none

ID: 1731286
Sex: F
Age: 57
State: MA

Vax Date: 05/28/2021
Onset Date: 09/24/2021
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: Ophthalmologist and retina specialist. Ophthalmologist of Boston . Brain mri no clot in brain and carotid artery ultrasound no clots noted . Awaiting a echocardiogram of heart scheduled for sept 30 th . Now have vision loss in left eye due to damage from clot to retina .

Allergies: Codiene pencillian

Symptom List: Injection site pain, Menorrhagia

Symptoms: Blood clot behind left eye

Other Meds: Zoloft , topomax , aspirin , fish oil , magnesium, zinc , probiotics,

Current Illness: None

ID: 1731287
Sex: F
Age: 70
State: NC

Vax Date: 03/12/2021
Onset Date: 04/12/2021
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: TSH - very low.

Allergies: No

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

Symptoms: 1st dose on 12 Feb2021 and 12APr2021, annual check up and bloodwork. TSH very low. 12Jul it was even lower and had to follow with specialist on 8/23/2021 and count was coming up again. The doctor may have inflamed my thyroid. After 2nd dose, I couldn't move like a rock and laid down for 12 hours. It hurt to move.

Other Meds: No

Current Illness: No

ID: 1731288
Sex: M
Age: 75
State: GA

Vax Date: 02/02/2021
Onset Date: 06/14/2021
Rec V Date: 09/24/2021
Hospital: Y

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

Lab Data: 06/14/2021 PCR+ COVID-19 test

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Breakthrough COVID-19 case. Asymptomatic. case was sent to the hospital on 06/14 and admitted to ICU because of suspected renal failure. Hospitalized for unknown duration

Other Meds:

Current Illness:

ID: 1731289
Sex: F
Age: 40
State: GA

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

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: PATIENT WAS PROVIDED 0.1 ML INSTEAD OF THE REQUIRED 0.5 ML; PATIENT IS SCHEDULED FOR 9/23 TO RECEIVE FULL DOSE ?Moderna COVID-19 Vaccine EUA?

Other Meds:

Current Illness:

ID: 1731290
Sex: F
Age: 38
State: TX

Vax Date: 08/01/2021
Onset Date: 09/01/2021
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: None

Allergies: Penicillin

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

Symptoms: Tremors or shaking in the arm/hand/fingers. This did not occur until after the shot and was also noticed in my 13yr old who also had the same vaccine.

Other Meds: No

Current Illness: No

ID: 1731291
Sex: M
Age: 58
State: CT

Vax Date: 08/01/2021
Onset Date: 09/01/2021
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: No test performed

Allergies: none

Symptom List: Nausea

Symptoms: The recipient reported " someone punched him in the chest ", it happened a couple of time at night after the first dose of Pfizer Covid - 19 vaccine. No other side effect noted.

Other Meds: n/a

Current Illness: n/a

ID: 1731292
Sex: M
Age: 65
State: PA

Vax Date: 02/19/2021
Onset Date:
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: Tested on Aug. 30 2021, received positive test resultes on Sept 1, 2021

Allergies:

Symptom List: Injection site pain

Symptoms: Contracted Covid19. Symptoms started on Aug. 28, 2021

Other Meds:

Current Illness:

ID: 1731293
Sex: M
Age: 56
State: MN

Vax Date: 09/24/2021
Onset Date: 09/24/2021
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 induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Accidentally gave patient their second dose 1 week before it was due. Patient received 1st dose 9/3/21 & 2nd was given 9/24/21. Their vaccination card looked like it said 1st dose 8/3/21 & the patient stated the facility told him the 2nd was due in 3 weeks. Patient was alerted of the mistake & did not seem overly concerned.

Other Meds:

Current Illness:

ID: 1731294
Sex: M
Age: 44
State: MO

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

Allergies: Pork, Iodine

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

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: Docusate Sodium, Analgesic Balm, Naproxen.

Current Illness: No

ID: 1731295
Sex: F
Age: 32
State:

Vax Date: 09/17/2021
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: None

Allergies: None

Symptom List: Tremor

Symptoms: Headache for a week, cramps in stomach, breast are swollen.

Other Meds: None

Current Illness: None

ID: 1731296
Sex: M
Age: 28
State: FL

Vax Date: 09/18/2021
Onset Date: 09/18/2021
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: Will be getting blood test on 09/25/2021

Allergies: Penicillin

Symptom List: Erythema, Pruritus

Symptoms: Vomiting, fatigue but can't sleep, foggy brain, forgetting information feeling like I lost time and space for days, headaches, panic attacks, chest pains feels like my heart is swelling and rapid heart beat.

Other Meds: Metformin

Current Illness:

ID: 1731297
Sex: M
Age: 67
State: MD

Vax Date: 09/23/2021
Onset Date: 09/23/2021
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:

Allergies: None.

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

Symptoms: Headache, pain at injection site, chills, fatigue, muscle pain.

Other Meds: None.

Current Illness:

Date Died: 09/24/2021

ID: 1731299
Sex: M
Age: 81
State: IA

Vax Date: 05/14/2021
Onset Date: 09/20/2021
Rec V Date: 09/24/2021
Hospital: Y

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

Lab Data: Labs, imaging, EKG 9-20 through 9-24.

Allergies: Erythromycin

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

Symptoms: Fully vaccinated individual, hospitalized on 9-20-21 for COVID. Passed away 9-24-21.

Other Meds: unknown

Current Illness: unknown

ID: 1731300
Sex: M
Age: 57
State: GA

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: none

Allergies: none

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Pt received Moderna vaccine for second shot instead of Pfizer

Other Meds:

Current Illness:

ID: 1731301
Sex: M
Age: 26
State: AR

Vax Date: 08/30/2021
Onset Date: 09/21/2021
Rec V Date: 09/24/2021
Hospital:

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

Lab Data: ECG

Allergies: None

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

Symptoms: "Pfizer Covid19 Vaccine was administered 8/30/21 at Hospital. Body aches began the next day only lasting about 24 hours, three days of dizziness were followed afterwards, chest pain began around four or five days after first dose and has continually increased, chest feeling tight, heavy, burning and shortness of breath throughout each day, and possible heart palpations. I went to receive my second dose of the Pfizer Covid19 vaccine 9/20/21 and was instructed by nursing staff, who spoke with occupational health, to not receive my vaccine due to concern. I later spoke with occupational staff including Dr. who instructed me to make an appointment to get checked out. I have since had other problems such as swollen ankles and leg pain. The next day I went to an appointment at the Center where and ECG shown possible left atrial enlargement and a referral was made to see a cardiologist as soon as I could. I have updated occupational health since the appointment."

Other Meds: Modafinil

Current Illness: None

ID: 1731302
Sex: M
Age: 44
State: TX

Vax Date: 03/09/2021
Onset Date: 09/12/2021
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:

Allergies: No

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

Symptoms: Positive Covid results.

Other Meds: XIGDUO; OZEMPIC; enalapril; rosuvastatin

Current Illness: No

ID: 1731303
Sex: F
Age: 57
State: KY

Vax Date: 03/27/2021
Onset Date: 07/19/2021
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: LABS

Allergies: NO

Symptom List: Pain in extremity

Symptoms: 07/19/2021 DURING WORK HOURS I STARTED SNEEZING THEN MY NOSE STARTED RUNNING CO WORKERS SAID "YOU HAVE ALLERGIES," BUT I DONT HAVE ALLERGIES 07/20/2021 I HAD FACIAL CONGESTION AND MY EARS WAS HURT ING I WENT TO THE DOCTOR AT 9 AM . I WAS TOLD I HAVE A SINUS INFECTION AND I WAS GIVEN ANTIOBIOTICS AND STERIODS. I HAD A COVID TEST DONE AS WELL. I LOST SMELL AND TASTE ON 07/21/2021 07/21/2021 MY COVID TEST RESULTS CAME BACK POSITIVE. 07/22/2021 I HAD A DETACHED RECTUM 07/23/2021 I HAD SURGERY FOR THE DETACHED RECTUM. I WAS GIVEN A REGENERON COCKTAIL INFUSION THROUGH IV I HAD TO STAY IN THE HOSPITAL FOR 1 DAY BECAUSE i WAS POSITIVE FOR COVID AND COULDN'T GO FOR A FOLLOW UP ON 07/24/2021 I WAS DISCHARGED 07/25/2021 WAS MY LAST DATE OF QUARANTINE 07/26/2021 I RETURNED TO MY NORMAL DAILY ROUTINE I WOULD LIKE TO KNOW WHAT VARIANT I HAD? IF POSSIBLE! FYI: I FEEL LIKE I WAS EXPOSED TO COVID AT WORK (WEEK PRIOR TO MY SYMTOMS, I WORK AT A SMALL LAW OFFICE TWO ATTORNEYS 07/13 AND 07/14 ONE OF ATTORNEY S WHO WAS NOT VACINNATED KEPT COUGHING MORE LIKE POST NASAL DRIP MONDAY, TUESDAY AND WEDNESDAY HE WAS COUGHING THURSDAY AND FRIDAY HE WAS SNEEZING. HE ENDING UP FINDING OUT ON THE 21ST OF JULY THAT HE WAS POSITIVE FOR COVID . HIS WIFE AND GROWN SON WAS POSITIVE AS WELL. HE WAS PLACED IN ICU AND HE DIED THE FOLLOWING TUESDAY. ) I WOULD LIKE TO KNOW IF COVID IMPACTED MY STAMINA

Other Meds:

Current Illness: NO

ID: 1731304
Sex: F
Age: 63
State: RI

Vax Date: 06/02/2021
Onset Date: 06/02/2021
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: none

Allergies: none

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

Symptoms: sharp needle like pains persist in left deltoid

Other Meds: lisinopril/hct

Current Illness: none

Date Died: 09/12/2021

ID: 1731305
Sex: F
Age: 87
State: GA

Vax Date: 01/25/2021
Onset Date: 09/08/2021
Rec V Date: 09/24/2021
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: 09/08/2021 Antigen+ COVID-19 test

Allergies:

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

Symptoms: Breakthrough COVID-19 case with unknown symptom status. Hospitalized 9/9/2021-9/12/2021. Death 9/12/2021. Death certificate not yet available

Other Meds:

Current Illness:

ID: 1731306
Sex: F
Age: 29
State:

Vax Date: 09/13/2021
Onset Date: 09/14/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: Myocarditis

Other Meds:

Current Illness:

ID: 1731307
Sex: M
Age: 58
State: WI

Vax Date: 04/13/2021
Onset Date: 06/01/2021
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: MRI; CT Scan; Hearing Test-significant hearing loss.

Allergies: Vitakidin; Environmental Allergies

Symptom List: Vomiting

Symptoms: A couple months after the vaccine I developed a ringing in my left ear followed by hearing loss which I still have the loss to date. Was referred to an ENT who did an MRI and CT Scan but nothing was found on either as to the cause of the ringing and hearing loss. I had a constant bugging in my ear daily. The ENT specialist performed a hearing test and saw there was drastic hearing loss associated with the ringing in my ear but states there is nothing further they can do because they are unaware of what the cause is and suggested a hearing aid but does not know the cause.

Other Meds: Melatonin;Loratadine; Pravastatin; finasteride; Aspirin; Vitamin D3; Metformin; Tamsulosin; Stironolactone; Citalopram; Furosemide.

Current Illness: No

ID: 1731308
Sex: F
Age: 26
State: FL

Vax Date: 12/02/2020
Onset Date: 12/16/2020
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: Blood work Colonoscopy x 2

Allergies: none

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: 2 weeks after 2nd injection of the Pfizer mRNA vaccine, the patient developed bloody diarrhea and frequent bowel movements, which persist to this day (12-15 bowel movements on average). She denies any travel, or other contributing factors that may have caused this aside happening after the vaccination. After months of pain and intestinal spasms she ultimately got 2 colonoscopies to unveil the medical issue at hand. She was diagnosed with ulcerative proctitis a form of IBD (irritable bowel disease) and has been placed on Mesalamine and occasional steroids for flares ever since. Her former physician mentioned having seen this once before after this vaccination she states although uncertain of which manufacturer.

Other Meds: none

Current Illness: none

ID: 1731309
Sex: M
Age: 65
State: CT

Vax Date: 03/19/2021
Onset Date: 07/12/2021
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:

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

Symptoms: Patient developed a slightly productive cough around 7/9. He had associated symptoms of fatigue, myalgias low-grade temperature but no true fever, no associated chest pain or shortness of breath. Patient is on his ranch with a doctor who prescribed him a 5-day course of levofloxacin. He was tested for COVID-19 while at the time of his symptoms and 3 days ago. Lingering cough. He says he has a coughing fit approximately 2-3 times a day with not much productive sputum, but he feels that the cough is improving with each day. He denies any fevers, chills, headaches, rhinorrhea, sore throat, chest pain, shortness of breath, nausea, vomiting, diarrhea. Patient says the cough is not very bothersome and he is able to manage it at home.

Other Meds:

Current Illness:

ID: 1731311
Sex: F
Age: 34
State: OH

Vax Date: 08/23/2021
Onset Date: 08/23/2021
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: IM
Vax Site: LA

Lab Data:

Allergies: Codeine, Pertussis vaccine

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient received Pfizer Covid-19 vaccine in ED. Nurse received vaccine vial from Pharmacy, she reconstituted it, drew up entire contents of vial and noted to administer 2.1ml IM. She did scan the vial and EHR indicated dose due was 30mcg/0.3ml. Patient discharged. After few hours in discussion with colleagues regarding vaccine, she realized she gave too much to patient. Nurse was not aware it was a multiple dose vial. Risk management and physician tried to reach patient multiple times, left message with grandmother and sent letter to patient to address provided. No return calls from patient or family.

Other Meds: Brexpiprazole, buprenorphine-naloxone, escitalopram, multivitamin with folic acid, trazodone

Current Illness: Cough, chest congestion, runny nose

ID: 1731312
Sex: F
Age: 67
State: GA

Vax Date: 02/07/2021
Onset Date: 04/07/2021
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: 04/07/2021 PCR+ COVID-19 test

Allergies:

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

Symptoms: Breakthrough COVID-19 case with unknown symptom status

Other Meds:

Current Illness:

ID: 1731313
Sex: F
Age: 74
State: VA

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

Allergies: Celebrex, codeine, naproxen, penicillin, mushroom, lobster and chocolate

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

Symptoms: immediately after the shot her arm started to ache, pain became on and off depending on how she moves

Other Meds: amlodipine, latoprol, vit d2, vit d3, fenofibrate, probiotics, mag-oxide, Pepcid, Flovent inhaler

Current Illness: no

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am