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: 1731416
Sex: F
Age: 31
State: CA

Vax Date: 09/17/2021
Onset Date: 09/19/2021
Rec V Date: 09/24/2021
Hospital: Y

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

Lab Data: Troponin I elevated to 0.08 with chest pain localized to left side

Allergies: N/A

Symptom List: Dysphagia, Epiglottitis

Symptoms: Developed myocarditis and had to be hospitalized during pregnancy.

Other Meds: Prenatal Vitamins, Iron Supplement, Baby Aspirin

Current Illness: N/A

ID: 1731417
Sex: M
Age: 40
State: GA

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

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

Lab Data:

Allergies: Allergic to Penicillin

Symptom List: Anxiety, Dyspnoea

Symptoms: Chronic Headaches/migraines everyday sometimes debilitating. Never had headaches.

Other Meds:

Current Illness:

ID: 1731418
Sex: F
Age: 25
State: CA

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: N/A

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

Symptoms: Nausea, pain in injection site, loss of appetite. Sleepiness, numbness in mouth.

Other Meds: N/A

Current Illness: N/A

ID: 1731419
Sex: F
Age: 86
State: WI

Vax Date: 02/12/2021
Onset Date: 09/06/2021
Rec V Date: 09/24/2021
Hospital: Y

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

Lab Data:

Allergies: environmental (mold, dust), sertraline, onion.

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Pt received both doses of the Pfizer COVID-19 vaccine, on 1/22/2021 and 2/12/2021 respectively. Pt tested positive for COVID on 9/6/2021, presented to ED same day and was admitted for stroke-like symptoms. Over the course of her hospitalization, she developed symptoms of severe COVID, with pneumonia and acute hypoxic respiratory failure. She was discharged back to her ALF on 9/15/2021.

Other Meds: acetaminophen, combivent respimat, alendronate, aspirin, atorvastatin, budesonide inhaler, cholecalciferol, diltiazem, fluticasone nasal spray, breo ellipta inhaler, furosemide, ipratropium-albuterol (neb), melatonin, montelukast, nystatin

Current Illness:

ID: 1731421
Sex: M
Age: 56
State: FL

Vax Date: 05/21/2021
Onset Date: 07/06/2021
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: none

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

Symptoms: Woke up on the morning of July 6 and felt big lumps under my arm pits then noticed them on my neck and now as time goes by more are appearing all over me 3 months dealing with this 3 doctors been to nobody now's nothing unreal that this happening to me

Other Meds: none

Current Illness: none

ID: 1731422
Sex: M
Age: 64
State: MI

Vax Date: 09/17/2021
Onset Date: 09/19/2021
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: yes Occasional edema swelling of the face or toungue

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

Symptoms: On friday 9/17/21 I recieved the first dose of the shingrix vaccine at approximately 12:45pm. little or no side effects. saturday 9/18/21 Arm was sore (hard) at injection site. Felt achy all day but managed to do some chores around the house. About 10:00 pm decided to take 3 - 200 mg ibrupropen (600mg total) due to sore joints and arm. Sunday 9/19/21 5:00 am Awoke with tongue swelled filling my entire mouth. Breathing thru my nose was not effected. Eventually took 2 - 50mg benadryl. By 3pm the swelling had reduced considerably, allowing me to eat. Monday 9/20/21 6:00 am Left hand ring finger was swollen and itchy. I removed my wedding ring. As the morning progressed my left hand swelled considerably but I managed to do some outside chores.Tuesday 9/21/21 Swelling in my left hand had reduced. All seemed better. As the day progressed the left side of my throat became quite sore along with my left ear. By 9:00 pm it became more difficult to swallow. Wednesday 9/21/21 6:00 am Woke up with a very painful sore throat. I could not swallow due to the pain. By 10:00 am I managed to drink a little coffee thru a straw. The pain eased up as the day went on but swallowing was difficult due to ear and throat pain. About noon the bottom of my right foot started swelling. the edema was a hacky-sac size bubble of fluid near my heel. walking was difficult due to floating fluids in the skin. Around 7:00 pm the bottom of my left foot started swelling. this seemed to cover the entire botttom of my foot. The swelling causes severe itching across the bottom and toes. I eventually took 1 -25 mg benadryl to ease the itching. Thursday 9/23/21 6:00 am Both feet are still swelled up and nearly impossible to walk on. My throat was still sore but getting better. Still very painful to swallow. spent the day off my feet. by 9:00 pm the swellling had reduced considerably. My left ear was still infected causing pain swallowing. Friday 9/24/21 6:00 am throat and ear are much better. Both right and left wrists are red and itchy. Left side of tonque is slightly swollen but swallowing pain is minimal. My feet have returned to normal with the exception of some itching. My experiance with the second Moderna covid vaccine had similar reactions. About day 4 the bottom of my feet swelled for two days with bubbles of fluid traveling from heel to toe as the day progressed. I also had typical reactions such as sore arm and fever on day two .

Other Meds: flue shot 600mg ibrupropen at 10:00pm 09/18/2021

Current Illness: none

Date Died: 08/21/2021

ID: 1731423
Sex: F
Age: 81
State:

Vax Date: 01/27/2021
Onset Date: 08/16/2021
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: presented to ED with c/o dyspnea, confusion, known bronchitis (on a Z pack), hypoxic; positive COVID -19 test; severe acute hypoxic respiratory failure; pt intubated; condition worsened where patient died in the hospital; hx of HTN, HL, NIDDM

Other Meds:

Current Illness:

ID: 1731424
Sex: F
Age: 37
State: MI

Vax Date: 04/30/2021
Onset Date: 09/22/2021
Rec V Date: 09/24/2021
Hospital: Y

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

Lab Data: Of note patient was retested x 2 by PCR for COVID after the initial positive - once outside of hospital and once onsite. Both results were negative.

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: a 37y.o. at 37w3d gestation admitted to hospital for planned C-section due to transverse spine down presentation. Patient asymptomatic tested prior to surgical procedure and delivery per protocol. No known history of previous positive test. Patient managed on isolation while in the hospital. Infant required NICU care on delivery O2 stats in the 70's-80's. Deep suctioning performed and oxygen administration performed. BW Weight: 3330 g. Infant being managed in NICU for needed care and on isolation per protocol pending COVID testing x2 at 24 and 28 hr - both which have resulted negative at the time of this reporting

Other Meds:

Current Illness:

ID: 1731425
Sex: F
Age: 73
State: AZ

Vax Date: 09/15/2021
Onset Date: 09/15/2021
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: No testing done at PIMC, pt was seen in hospital, records have not been received at time of report.

Allergies: amitriptyline- anxiety, codeine- reaction not documented, gabapentin- drowsy, delirium, dry eyes, feeling agitate, penicillin-rash

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Pt received a 3rd dose of Pfizer vaccine since HIV/AIDS, 73 years old and multiple co-morbidities, at high risk for adverse outcomes due to COVID19. Vaccination dates 1/12/21, 2/2/21 and 9/15/21. Pt left a voicemail on 9/15, sounded inadvertent, where can hear family say "mom, if you don't eat, I'm going to take you to the hospital". Attempted to call pt back but unable to reach. After additional calls pt finally spoke with RN, approx 17:00 on 9/15/21. reported was in a hurry to pick up grandchildren at school and didn't wait the 15 min observation time. She became short of breath and felt she couldn't breath while driving. At the school, the staff called 911 and she was transferred to hospital by EMS. She was given oxygen and this improved all symptoms. After feeling better, pt left AMA because of concerns for out of pocket expenses. At time of phone call, pt was feeling better and at home. Additional follow-up the next day, spoke with patient's daughter. She said her mom was doing ok, "almost back to normal", some soreness in her ribs and tired. The patient came to phone, asked if she had been on anxiety medication previously, felt she had a panic attack after the vaccine. Pt still has unpaid hospital bills from prior situations so was concerned about money. Pt was scheduled with Dr., internal medicine and psychiatry, to determine if needs intervention for possible anxiety/panic attack on 9/21/21, pt did not keep this appointment.

Other Meds: Biktarvy, celebrex, diclofenac, magnesium oxide, albuterol inhaler, aspirin 81mg, calcitrate/vit d, rosuvastatin, lisinopril, fexofenadine, diphenhydramine

Current Illness: allergic rhinitis

ID: 1731427
Sex: M
Age: 60
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: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1731429
Sex: F
Age: 36
State: IL

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: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Numbness developed 15 minutes after administration. Extends from site of injection to fingertips. Currently lasting 2 weeks and 1 day and ongoing.

Other Meds:

Current Illness:

ID: 1731430
Sex: F
Age: 11
State: MN

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: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Patient falsified DOB when registering for vaccination. Guardian, consented to the vaccination. Department of Health verified with statistical records that the patients actual DOB made the vaccine a contraindication. No known adverse reactions noted.

Other Meds:

Current Illness:

ID: 1731431
Sex: F
Age: 36
State: CA

Vax Date: 09/01/2021
Onset Date: 09/13/2021
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: No tests. Emailed my Healthcare team. They confirmed it was a side effect and I was told to take benadryl. Nothing else they can do. Not sure how long symptoms will last.

Allergies: None

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

Symptoms: Unbearable itchiness of the left breast and nipple. Tattoo in area raised and inflamed. Redness and pain from scratching uncontrollably.

Other Meds: Oral contraceptive, Welbuterin, 400 MG magnesium, vitamin D3, inhaler on occasion

Current Illness: None

ID: 1731432
Sex: M
Age: 11
State: MN

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: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Patient falsified DOB when registering for vaccination. Guardian consented to the vaccination. Department of Health verified with statistical records that the patients actual DOB made the vaccine a contraindication. No known adverse reactions noted.

Other Meds:

Current Illness:

ID: 1731433
Sex: F
Age: 62
State: IL

Vax Date: 03/20/2021
Onset Date: 08/19/2021
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: X-Ray of neck and upper back. Results showed arthritis and spurs in C2-C7. Recommended Physical Therapy.

Allergies: Latex

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

Symptoms: Severe pain on left side of neck, upper left back, and down left arm. Numbness in left fingers.

Other Meds: Lisinopril HCTZ Wellbutrin

Current Illness:

ID: 1731434
Sex: F
Age: 61
State: SC

Vax Date: 04/07/2021
Onset Date: 04/09/2021
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: Stress test heart rate went up to 250, Hart cath and found nothing, EKG showed nothing also

Allergies:

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

Symptoms: My arm swollen up very large and hurts and I have chest pain and was even hospitalized and they saw every thing was clear, Also out of breath and light headed

Other Meds: Tramadol as needed, diazepam, Lipitor, amlodipine

Current Illness: None

Date Died: 09/20/2021

ID: 1731435
Sex: M
Age: 76
State: TN

Vax Date: 02/18/2021
Onset Date: 02/18/2021
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:

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

Symptoms: Case fully vaccinated with Pfizer. Tested positive for COVID 19 @ 9/15/2021. Admitted on 9/15/2021 and expired on 9/20/2021 while still hospitalized.

Other Meds:

Current Illness:

ID: 1731436
Sex: F
Age: 44
State: AZ

Vax Date: 09/24/2021
Onset Date: 09/24/2021
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: None

Allergies: Amoxicillin-clavulanate, Ciproflaxacin, Clindamycin, Fluzone, Penicillins.

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient was administered Pfizer vaccination at 0740. 0748: Exhibited symptoms of allergic reaction. 0748: 50mg PO Benadryl administered, Epi (.3mg/.3mL) administered. Patient began vomiting, O2 2L Nasal Canula applied. 0751: Epi (.3mg/3mL) administered. 0752: Benadryl 50mg IM administered. 0755: EMS arrived. 0800: 8mg Decadron IM and 40mg Kenelog IM administered.

Other Meds: Unknown

Current Illness: None

ID: 1731437
Sex: F
Age: 74
State: CA

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

Other Meds:

Current Illness:

ID: 1731438
Sex: F
Age: 62
State: MO

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

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1731439
Sex: F
Age: 27
State: NY

Vax Date: 09/22/2021
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: none

Allergies: minocycline, miralax

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

Symptoms: aches, chills, headache began 12 hours after vaccination, treated with Advil and Tylenol at the 24 hour mark i began to have a 102 fever all continuing to treat with Advil and Tylenol. I am now roughly over the 36 hour mark and starting to feel better despite the exhaustion.

Other Meds: Zoloft, trazadone, Xanax, propranolol

Current Illness: none

ID: 1731440
Sex: F
Age: 49
State: MD

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: Blood pressure 121/90 temperature (oral) 97.8 degrees F pulse 95, respiration 16, oxygen said 99%

Allergies: None

Symptom List: Unevaluable event

Symptoms: Both feet and ankles swollen and painful so was unable to walk before getting to the ER. Back of right leg painful, place I was injected painful, backache, severe headache, fever

Other Meds: None

Current Illness: Tested positive -Covid 19 on Aug 9

ID: 1731441
Sex: F
Age: 24
State: WI

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

Allergies: none

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

Symptoms: large, hard, red, and hot welt the size of a baseball on the vaccination arm. Chills, nausea, fatigue, severe body aches, headache, no appetite

Other Meds: birth control (tri-sprintec)

Current Illness: none

ID: 1731442
Sex: M
Age: 53
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: 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: 1731443
Sex: M
Age: 69
State: MI

Vax Date: 02/14/2021
Onset Date: 09/22/2021
Rec V Date: 09/24/2021
Hospital: Y

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

Lab Data: Unknown

Allergies: Unknown

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient is asymptomatic but the ECF sent patient in as they are not allowed to keep COVID positive patients per ER note.

Other Meds: Unknown

Current Illness: Unknown

ID: 1731444
Sex: M
Age: 44
State: TN

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

Lab Data: NONE

Allergies: NO KNOWN ALLERGIES

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

Symptoms: PATIENT RECEIVED A PFIZER VACCINE INSTEAD OF A MODERNA FOR HIS SECOND DOSE.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1731445
Sex: F
Age: 58
State: MO

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

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

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

Other Meds:

Current Illness:

ID: 1731447
Sex: F
Age: 33
State: GA

Vax Date: 09/22/2021
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: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Nose Bleed

Other Meds: zoloft, labetol

Current Illness:

ID: 1731448
Sex: M
Age: 52
State: VA

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:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Unknown

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

Symptoms: Vaccine given on 9/23 and vaccine expired on 9/21, one day prior.

Other Meds: Unknown

Current Illness: Unknown

ID: 1731449
Sex: M
Age: 77
State:

Vax Date: 01/21/2021
Onset Date: 09/12/2021
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:

Allergies:

Symptom List: Nausea

Symptoms: Vaccine breakthrough, symptomatic. 9/12 Inpatient admit 9/17 to present,

Other Meds:

Current Illness:

ID: 1731450
Sex: F
Age: 66
State: PA

Vax Date: 03/10/2021
Onset Date: 04/17/2021
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: CT scan 4/22/21 Opthalmologist 4/26/21 Labs drawn 4/27/21

Allergies: NKA

Symptom List: Injection site pain

Symptoms: Bilateral blurring vision (30 minutes) followed by transient aphasia, difficult word finding(another 30 minutes). Entire episode lasted 1 hour, resolved with vision and speech returning to normal.

Other Meds: Armour Thyroid

Current Illness: none

Date Died: 08/24/2021

ID: 1731451
Sex: M
Age: 77
State:

Vax Date: 03/10/2021
Onset Date: 08/18/2021
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: LA

Lab Data:

Allergies:

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

Symptoms: pt tested positive for COVID on 8/18; presented to ED on 8/24 hypoxic with confusion, SOB, coughing; placed on BIPAP; pneumothorax occurred; condition worsened where patient died in hospital

Other Meds:

Current Illness:

ID: 1731452
Sex: F
Age: 32
State: AL

Vax Date: 04/09/2021
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: RA

Lab Data: Skin biopsy to test for psoriasis - taken 9/16/21. Results have not come back, yet.

Allergies: None

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

Symptoms: I had a sinus infection about two weeks later, but as I have seasonal allergies, I'm sure that was not related. I also developed an eczema flare-up around 4/17/21 on my hands, stomach, arms, face, and neck that has not gone away. I have begun treatment with a dermatologist for the flare-up and am currently being tested for psoriasis. I did not have any eczema or psoriasis symptoms before. My dermatologist mentioned that they have seen previously dormant auto-immune disorders becoming active after the vaccine, and this was likely the case with me.

Other Meds: Zyrtec - once daily Flonase - once daily

Current Illness: Seasonal allergies

ID: 1731453
Sex: F
Age: 35
State: TX

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:

Allergies:

Symptom List: Tremor

Symptoms: One dose (0.5ml) of Janssen COVID-19 vaccine lot #203A21A with expiry date of 09/21/21 was administered to the patient on 09/22/21.

Other Meds:

Current Illness:

ID: 1731454
Sex: U
Age: 69
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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1731455
Sex: F
Age: 55
State: TX

Vax Date: 02/26/2021
Onset Date: 02/26/2021
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: NONE

Allergies: No

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

Symptoms: Dizziness and small tremors in my head.

Other Meds: CENTRUM

Current Illness: COVID

ID: 1731456
Sex: M
Age: 56
State: TX

Vax Date: 03/11/2021
Onset Date: 07/04/2021
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: LA

Lab Data: MRI of the brain with and without contrast. Seen by ophthalmology is ongoing.

Allergies: no

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

Symptoms: Woke up with bell's palsy July 4, 2021, took 2 baby aspirin and went immediately to Emergency Department at to receive evaluation and treatment. Condition has not improved as of this date, September 24, 2021. I still have complete paralysis of the left side of my face.

Other Meds: Lisinopril, Rosuvastatin calcium, Sitagliptin Phos, Metformin HCL

Current Illness: no

ID: 1731457
Sex: F
Age: 62
State: CO

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

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

Lab Data:

Allergies: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Heart palpitations Blood clot in my right wrist.

Other Meds: prednisone 1mg daily Methotrexate 2.5 mg 7 tabs weekly Folic acid 1 mg 3 tabs daily Vit d 2000 if daily B13 sub lingual 2500mcg

Current Illness:

ID: 1731458
Sex: M
Age: 42
State: NC

Vax Date: 07/19/2021
Onset Date: 07/24/2021
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:

Allergies: Allergic to nuts and fish

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

Symptoms: Had initial pain at injection site however about one week later I experienced Intense aching pain from left side of chest to fingers on left hand. This pain extended through my entire arm for several hours during the first event. This aching returned several times over the following two weeks. Each time extending through my entire arm and into the left side of my chest.

Other Meds: None

Current Illness: None

ID: 1731459
Sex: M
Age: 84
State: MT

Vax Date: 03/03/2021
Onset Date: 09/11/2021
Rec V Date: 09/24/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Hospitalized and diagnosed with COVID

Other Meds:

Current Illness:

ID: 1731460
Sex: U
Age: 79
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1731461
Sex: F
Age: 47
State: FL

Vax Date: 08/04/2021
Onset Date: 08/18/2021
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: Chest x-ray August 24 CT Scan August 31

Allergies: None

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

Symptoms: Day 12 after vaccine, started having chest tightness. Awaken on day 14 to shortness of breath, fatigue, sweating, excessive chest pain. This continued for 6 days and I called my internal medicine doctor, Doctor. She got me in on day 7 of symptoms increasingly more intense daily. She ordered chest x-ray, prescribed amoxicillin and albuterol inhaler. Day 8 chest x-ray results came back with small mass lung lower lobe, Dr. ordered a CT scan. Symptoms only increased with medicine. On day 10 had CT scan that showed Mass to be prior Scar Tissue possibly. Annual CT scan ordered for follow up. Also in CT scan of lungs, some bronchial inflammation. Doctor called me and we spoke of vaccine and she was unsure if it was that or some other exposure but upon my insistence, she called in a Breo steroid inhaler and prednisone 10-day regimen. I still had no relief oh, I only felt worth shortness of breath, bronchial and lung pain and chest tightness so I called back a few days later. I beg for something to be done and she called in a z-pack and gave me a referral to a lung specialist in case this was related to vaccine because she did not know what else to do. Because of backlog at lung specialist, I am waiting for four more weeks for an answer. However, I don't feel any better at all today, September 24th. I have had symptoms for over 5 weeks with no relief. It has now been nearly 60 days since vaccine. I never left house after vaccine and my husband never felt sick. Therefore, I do not believe this is anything other than an adverse reaction from the Johnson vaccine. I do not smoke, have not smoked, never had lung issues before.

Other Meds: Lialda, simvastatin, maxzide

Current Illness: None

ID: 1731462
Sex: M
Age: 43
State: NY

Vax Date: 04/13/2021
Onset Date: 05/09/2021
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: MRIs, CT Scans, Stress Test, Heart scans, brain scans, blood work, vascular scans

Allergies: None

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

Symptoms: I lost my speech one morning and much of the control of my right side. This was due to an Ischemic Stroke in the left brain from a blood clot. I had previously reported full body numbness from my first vaccination but now I realize that was a T.I.A. or Mini-Stroke. Which I unknowingly had a few of after receiving the first and second doses. I went to the emergency room and after some tests they admitted me. They then transferred me to see if the clot could be removed. It was too late and I then had to recover from the Stroke. I went to a speech therapist, occupational therapist, Neurologist, Hematologist, and Cardiologist. They all have no answer to why the stroke occurred and won't admit that it was from the vaccines.

Other Meds: None

Current Illness: None

ID: 1731463
Sex: F
Age: 47
State: NY

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

Lab Data: 9/23 labs drawn at urgent care

Allergies: Pcn Latex Flu vaccine Biaxin Seaweed Acetaminophen

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

Symptoms: First vaccine jist had sore arm for a day and metal taste for a few weeks. Also had a tingly tongue shortly after getting shot but wrote off as anxiety. Day of second vaccine 9/21, a few hours after got the normal sore arm and general unwell feeling and metal taste returned. No taste for a few hours. Next day 9/22 woke up around 9 am and couldn?t move from swollen and sever joint pain, extreme nausea and feverish. Slept all day. Got worse thru the day fever ranged from 99.8 to 102. The next day, 9/24 woke up feeling a little better but still had 99.4 which broke a few hours after waking. Noticed bruising when taking shower around noon and called employee Heath who recommended I get seen immediately. Was seen in urgent care and blood work was drawn. Received a call today 9/24 from the urgent care md that my hemoglobin is low and wbc is low but platelets were within normal range and to follow up with my primary. I still have joint pain and stiffness and general unwell feeling. No new bruising as of today.

Other Meds: Nurtec Botox Zofran prn Compazine prn Klonopin Ketorolac prn

Current Illness: No

ID: 1731464
Sex: U
Age: 64
State:

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: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

Date Died: 08/27/2021

ID: 1731465
Sex: M
Age: 87
State: GA

Vax Date: 02/18/2021
Onset Date: 08/21/2021
Rec V Date: 09/24/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient was hospitalized for unknown reasons. Patient was fully vaccinated. Died due to COVID.

Other Meds:

Current Illness:

ID: 1731466
Sex: M
Age: 34
State: OR

Vax Date: 09/21/2021
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:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Right axillary lymphadenopathy. 3-4 cm swollen node.

Other Meds:

Current Illness:

ID: 1731467
Sex: F
Age: 51
State: MO

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

Symptom List: Injection site swelling, Limb discomfort

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

Other Meds:

Current Illness:

ID: 1731468
Sex: M
Age: 67
State:

Vax Date: 03/04/2021
Onset Date: 09/17/2021
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:

Allergies:

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

Symptoms: Vaccine breakthrough, symptomatic. 9/17 Inpatient admit 9/17 to present,

Other Meds:

Current Illness:

ID: 1731469
Sex: M
Age: 63
State: MI

Vax Date: 04/20/2021
Onset Date: 09/22/2021
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: COVID+ test on 9/22/21

Allergies:

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

Symptoms: COVID breakthrough. Patient developed fever of 103 on 9/21/21 with labored breathing while hospitalized for other reasons. They tested positive on 9/22/21.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am