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: 1731825
Sex: F
Age: 68
State: FL

Vax Date: 07/22/2021
Onset Date: 08/05/2021
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: Covid test, lab work, cxr.

Allergies: NKA

Symptom List: Dysphagia, Epiglottitis

Symptoms: Pt came to ER c/o weakness, nausea, vomiting onset 2 weeks prior.

Other Meds:

Current Illness:

ID: 1731826
Sex: M
Age: 48
State: NJ

Vax Date: 09/20/2021
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: none

Symptom List: Anxiety, Dyspnoea

Symptoms: patient received 2nd dose of covid 19 Pfizer vaccine on 9/20/2021 - 3 days later presented to ED with crushing chestpain radiating to left arm and jaw accompanied by shortness of breath; admitted to hospital with NSTEMI; of note - patient has brother who had MI at 46 years old

Other Meds: none

Current Illness: none

ID: 1731827
Sex: F
Age: 58
State: FL

Vax Date: 09/05/2021
Onset Date: 09/07/2021
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: CT Scan Brain; CT Scan Lower Back; Bloodwork

Allergies: Codeine; eggs; wheat; milk

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

Symptoms: It started with a numbness tingling in my left big toe and the pain moved to the rest of my toes in my left foot and then to my whole foot. The pain then moved to my right ankle and the right side of my body. My whole body was burning, it felt like an electrical shock. I went to the ER/Urgent Care where I had a CT of brain/lower back and bloodwork. My whole body just burns and the limbs of my body just feel heavy and dead. Its really miserable.

Other Meds: Tylenol

Current Illness: N/A

ID: 1731828
Sex: F
Age: 60
State: CA

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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies: Keflex : anaphylaxis

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Pruritus at the site on Injection , started a few minutes after the shot was given her vaccine , this is her 2nd shot, she had no reaction to the 1st Moderna vaccine. Pt was given Benadryl 50mg and Solu-medrol 125mg IM Symptoms resolved

Other Meds: Tylenol Extra Strength 500 mg tablet Gabapentin 400 mg capsule Ropinirole 1 mg tablet Aspirin 81 mg Amlodipine 5 mg tablet Irbesartan 300 mg tablet Lasix 20mg

Current Illness:

ID: 1731829
Sex: F
Age: 60
State: VA

Vax Date: 05/11/2021
Onset Date: 05/11/2021
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: Penicillin

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

Symptoms: Since the second shot, my left arm muscle is very sore. The soreness is still there. I cannot lay on that side to sleep without pain, have limited movement in the arm when I hold it over my head, still have to take aspirin everyday to help with the pain. Never had any issues with my arm before, the shot.

Other Meds: None

Current Illness: None

ID: 1731830
Sex: F
Age: 59
State: MI

Vax Date: 09/03/2021
Onset Date: 09/09/2021
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: Latex, aspirin, Sudafed

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

Symptoms: My left arm in great deal of pain all the way down through hand. Severe fatigue. Much greater than normal. Not being able to do normal activities for me. Feeling nauseous a great deal of the time.

Other Meds: Cymbalta, trazadone, tramadol, Thyroid Arm

Current Illness: Fibromyalgia

ID: 1731831
Sex: F
Age: 55
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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1731832
Sex: M
Age: 57
State: FL

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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1731833
Sex: F
Age: 42
State: NC

Vax Date: 09/03/2021
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: none

Allergies: Penicillin allergy

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Menstrual changes: 2 day delayed start, lighter flow, shorter cycle

Other Meds: oral birth control pills, OTC MultiVitamin and Cetirizine 10mg

Current Illness: none

ID: 1731834
Sex: F
Age: 68
State: FL

Vax Date: 03/15/2021
Onset Date: 08/04/2021
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: Covid test, lab work, cxr.

Allergies: NKA

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Pt came to ER c/o SOB, fatigue, diarrhea, fever. Onset 10 days.

Other Meds:

Current Illness:

ID: 1731835
Sex: F
Age: 54
State: MI

Vax Date: 12/28/2020
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: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: tested positive for covid on binax rapid antigen test 9/23/21- sx cough, congestion

Other Meds:

Current Illness:

ID: 1731836
Sex: F
Age: 70
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: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1731837
Sex: M
Age: 73
State: FL

Vax Date: 03/12/2021
Onset Date: 04/15/2021
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: EKG

Allergies: None

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

Symptoms: Costochondritus. Pain in rib cage.

Other Meds: Flucticasone Propionate, Pantoprazole, Losartan, Tamsulosin, amiLodipine, avorstatin

Current Illness:

ID: 1731838
Sex: F
Age: 71
State: WI

Vax Date: 03/17/2021
Onset Date: 09/19/2021
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: No known allergies

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

Symptoms: Patient contracted COVID after being fully vaccinated Fatigue, congestion, cough, sore throat, headache, diarrhea, chills

Other Meds: Vitamin C Calcium Carbonate Vitamin B12 Vitamin D Hydroxyquinoline topical 0.025% metoprolol 50mg daily

Current Illness: None documented

ID: 1731839
Sex: F
Age: 22
State: TX

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

Lab Data: NA

Allergies: None reported

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

Symptoms: Approximately 8 minutes after vaccine administration, the recipient reported feeling nauseous and dizzy. The patient threw up. After, she reported still feeling dizzy and experiencing some blurred vision. Within a 45 minute time span, the recipient threw up 2 additional times and reported persistent dizziness and weakness upon standing. The recipient did report resolution of blurred vision.

Other Meds: None reported

Current Illness: None reported

ID: 1731840
Sex: F
Age: 65
State: RI

Vax Date: 09/18/2020
Onset Date: 09/28/2020
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: I had many tests some of which were Blood work ,MRI, Spinals, a CT scan and finally Immunoglobulin infusion treatments, which were four treatments each 3 hours long .

Allergies: none

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

Symptoms: I started feeling intense pain in my legs about ten days after the Shingrix vaccine which went on for several days . I spoke to my doctor and by the fourth day and a emergency room visit I was no closer to a diagnosis . I finally saw a neurologist and he sent me to the hospital. They determined it was Guillain -Barre Syndrome.

Other Meds: Metoprolol 25mg low dose aspirin 81mg calcium = D3 multivitamin

Current Illness: none

ID: 1731841
Sex: M
Age: 66
State: PA

Vax Date: 09/23/2021
Onset Date: 09/23/2021
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: None yet

Allergies: Shellfish

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

Symptoms: Pain in the left armpit and left chest that has persisted, and pain in the rectum for 18 hours now.

Other Meds: Lisinopril 10mg Metformin 1000mg

Current Illness: NA

ID: 1731842
Sex: F
Age: 45
State: MI

Vax Date: 08/20/2021
Onset Date: 08/30/2021
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: none reported

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient called today. Said on Aug 30th she started to develop a rash. On September she saw a physician and was diagnosed and treated for Shingles.

Other Meds: unknown

Current Illness: unknown

ID: 1731843
Sex: M
Age: 63
State:

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: 1731845
Sex: M
Age: 37
State: CA

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

Allergies: Sulfur drugs

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

Symptoms: After the second shot I was told I would get pain at the vaccination site headaches etc. Here I am 3 months later and my elbow and wrist are in chronic pain. It feels like I have tennis elbow in both of them that has prevented me from doing many physical activities I used to be able to. In general I try to stay physically fit with cardio and weight lifting. I have been unable to do any kind of heavy lifting with my right arm since my second dose without pain. Even small amounts of light movement will cause pain over time.

Other Meds: none

Current Illness: none

Date Died: 05/05/2021

ID: 1731846
Sex: F
Age: 81
State:

Vax Date: 01/20/2021
Onset Date: 04/29/2021
Rec V Date: 09/24/2021
Hospital: Y

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: 04/29/21 SARS-CoV-2 (COVID-19) by NAA - DETECTED

Allergies:

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

Symptoms: On 04/29/21 pt. presented to EC in respiratory distress via EMS; "Hx of CHF, NSCLC with mets to brain"; subsequently admitted to ICU; Palliative extubation was carried out on 05/05/21, which is when patient diet.

Other Meds:

Current Illness:

ID: 1731847
Sex: M
Age: 62
State: MD

Vax Date: 09/14/2021
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: I have scheduled a doctors visit for 9/30/21

Allergies: no

Symptom List: Unevaluable event

Symptoms: cold symptoms including headaches for a couple of days in the beginning and now a week later my chest/lungs feels heavy as though I am not getting a good breath.

Other Meds: Amlodipine, Valsartan, Fenofibrate, CoQ10, Omega3, vitamin D, magnesium, zinc

Current Illness: no

ID: 1731848
Sex: M
Age: 79
State: FL

Vax Date: 03/04/2021
Onset Date: 06/26/2021
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: Ct abdomen and pelvis- June 27,2021 CTA chest- June 27,2021 Bronchoscopy- July 28, 2021

Allergies: None

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

Symptoms: Developed lower extremity weakness and swelling. Work up discovered lung cancer with metastatic spread to the spine 3 months after vaccine. Prior healthy and active still working as handyman while retired

Other Meds: Synthroid, Triamterene/HCTZ Meloxicam

Current Illness: Hypertension

ID: 1731849
Sex: F
Age: 73
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: 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: 1731850
Sex: M
Age: 22
State: KY

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

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

Lab Data: 2 EKG, Chest Xray, blood drawn

Allergies: None

Symptom List: Injection site pain, Menorrhagia

Symptoms: Acute chest pain, heart pain, shortness of breathe

Other Meds: None

Current Illness: No

ID: 1731851
Sex: M
Age: 45
State: FL

Vax Date: 07/23/2021
Onset Date: 07/24/2021
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: None

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

Symptoms: Tinnitus: Ringing in the ears

Other Meds: None

Current Illness: None

ID: 1731852
Sex: F
Age: 45
State: FL

Vax Date: 01/05/2021
Onset Date: 08/04/2021
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: Covid test.

Allergies: NKA

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Pt came to ER c/o headache and fatigue. Onset one day prior.

Other Meds:

Current Illness:

ID: 1731853
Sex: F
Age: 53
State: TX

Vax Date: 05/06/2021
Onset Date: 05/06/2021
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: None

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient got her second shot of Moderna (COVID vaccine) on 5/6/2021 ar 11 am. When she woke up the next morning on 5/6, she had a blister and pain on her right deltoid where the vaccine was administered . Her deltoid was red and warm to touch. Pt had limited movement on the affected side. The band aid had been left on the vaccine administration site and the pt had an adverse reaction not only to vaccine but to the adhesive/ band aid. The band aid was imbedded in the blister. When attempting to slowly remove the Band-Aid the blister popped. It drained clear fluid. I cleansed the area with saline, applied antibiotic ointment and a nonstick dressing. Pt was advised to take OTC Bendryl and keep area clean. Pt was contacted after 2-3 days and her symptoms had resolved completely Pt reports to clinic on 9/24/2021 states that she has had soreness ever since she got her vaccine. When she makes certain movements with her right shoulder its painful. She denies any weakness, numbness or popping in the affected joint. The pain usually occurs more when she is reaching over her head. She was advised to call and get appt with local ortho to evaluation right shoulder

Other Meds: Diovan daily

Current Illness: None

ID: 1731854
Sex: F
Age: 36
State:

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:

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

Symptoms: ration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1731855
Sex: F
Age: 70
State: MI

Vax Date: 03/05/2021
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: RA

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: Patient received 2 doses of the Moderna COVID-19 vaccine, one in Feb 2021 and one in Mar 21, and tested positive for COVID-19 on 9/23/2021

Other Meds:

Current Illness:

ID: 1731856
Sex: M
Age: 57
State: NY

Vax Date: 09/15/2021
Onset Date: 09/15/2021
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: 09/18/2021: CPK 69,589; CK-MB 27.8; Troponin peak value 7.41; creatinine 1.57; urine large blood with no RBC visible on microscopy.

Allergies:

Symptom List: Injection site pain

Symptoms: Severe muscle pain from rhabdomyolysis. The muscle pain began on 9/15/21, the evening of the vaccination. Presented to the ER on 9/18/21, treatment was initiated and he was transferred to an ICU bed at Hospital for ongoing management.

Other Meds:

Current Illness:

ID: 1731857
Sex: F
Age: 72
State: WA

Vax Date: 09/04/2021
Onset Date: 09/05/2021
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: Sulfa, macrobid, codeine

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

Symptoms: Woke at 3am (9/5) feeling achy & cold so added a blanket. Woke at 5am with body aches(whole body, from toes to head), uncontrollable shakes & vomiting (only one episode with numerous vomits of bile) & temperature of 101. Took 2 ibuprofen for aches + 2 Tylenol to reduce my temperature. Returned to bed, slept until 10:30am, waking hungry & temperature down to 98.7. Continued taking ibuprofen/Tylenol according to bottle directions. Woke at 5am(9/6) with my left arm, beneath the injection site, red/swollen/itchy/hot & temperature at 99.8. Took 2 Benadryl & continued according to Direction. Arm remained like this until 9/11. Slowly going pink.

Other Meds: Estradiol, mag/cal, potassium, lysine

Current Illness: None

ID: 1731858
Sex: M
Age: 28
State: IL

Vax Date: 05/13/2021
Onset Date: 05/14/2021
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: echocardiogram, ekg, CBC, BMP, stress test

Allergies: none

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

Symptoms: Chest tightness, short of breath, regurgitation in two heart valves

Other Meds: none

Current Illness: none

ID: 1731860
Sex: F
Age: 27
State: SC

Vax Date: 09/22/2021
Onset Date: 09/23/2021
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: Tremor

Symptoms: Started to develop some chest pain in the middle of my chest. It's almost like a precordial catch that won't go away. Haven't seen a Dr yet but plan to if symptoms didn't pass.

Other Meds: None

Current Illness: None

ID: 1731861
Sex: U
Age: 80
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: 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: 1731862
Sex: U
Age: 10
State: MN

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

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

Symptoms: Patient parent signed consent form verifying and misrepresenting patients age, then upon verbal verification misrepresented a second time

Other Meds:

Current Illness:

ID: 1731863
Sex: F
Age: 22
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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: PATIENT WAS GIVEN 0.1 ML INSTEAD OF 0.5 ML OF MODERNA; PATIENT CONTACTED TO RESCHEDULE FOR FULL DOSE; STAFF WERE ALL PROVIDED ADDITIONAL TRAINING ?Moderna COVID-19 Vaccine EUA?

Other Meds:

Current Illness:

ID: 1731864
Sex: F
Age: 68
State: FL

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

Lab Data: none

Allergies: Penicillin-- Rash; swelling of tongue and face; Cefdinir -- throat tightening, inability to swallow, difficult talking, swelling of tongue, discomfort in chest; dizziness, headache; Keflex -- Throat tightening, inability to swallow, swelling of tongue, extreme dizziness needed ER. Celebrex -- swelling of face, Naproxen -- swelling of face, Codeine -- Dizziness, disorientation Quinolones -- Tendon Damage sulfonamides - difficulty swallowing, swelling of throat and face Valtrex --Extreme Dizziness and disorientation Clindamycin - difficulty swallowing, swelling of throat Monovisc -- swelling of entire limb Erythromycin Filmtab -- Severe Dizziness, disorientation, vomiting ZPAC-- problematic, cannot recall specifics Nasacort Nose Spray 24 hour -- throat tightness Minocycline - throat tightness, difficulty swallowing; Arestin - dose dependent 1 vile ok; 2nd Vile = throat tightness, chest pounding, heart racing with repeatability on 3 different occasions Latex -- Rash and skin breakdown Vaseline/Petroleum -- Rash and skin breakdown Bacitracin -- rash and skin breakdown Blue Sutures -- blistering of skin, bloody discharge redness; swelling; inability for wound to close. sudafed Sinus Congestion -- With repeatabili

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: sudden sore throat; quickly escalated to a tightness in the throat and escalating further super difficulty swallowing and talking lasting several hours.

Other Meds: NONE

Current Illness: none

ID: 1731865
Sex: F
Age: 76
State: CA

Vax Date: 03/02/2021
Onset Date: 03/03/2021
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: CT scan - normal; Bloodwork - normal; chkg your thyroid, my iron levels was a little low.

Allergies: Gabapentin

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

Symptoms: My arm was sore, 3/3/2021 headache on top left and to behind my eye and between eyebrows and it was hurting bad, sharp pains on my head. Then the pain was on top of my head and below my eyes; Migraines. I never had this before. I saw my doctor in May or June2021.

Other Meds: No

Current Illness: No

ID: 1731866
Sex: F
Age: 49
State: OR

Vax Date: 09/10/2021
Onset Date: 09/17/2021
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: 1. Ultrasound of the right axillary node at OHSU Internal Medicine on 9/17. Findings: 1 reactive-looking lymphonode on exam. COVID-19 vaccine likely the cause. 2. Exam at OHSU Internal Medicine on 9/24. Findings: (1) herpes zoster (possible the stress of the COVID-19 vaccine caused this). (2) Inguinal lymphandenopathy (likely from Zoster, but can't be sure. If still present in 2 weeks, will proceed with ultrasound).

Allergies: Raw soy milk, raw hazelnuts

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

Symptoms: 1. Pain in the lymph node near the site of the injection (right axillary). It started a week after the vaccination and the symptoms lasted 4 days and resolved. 2. Shingles (herpes zoster) outbreak on the right upper buttock. This is accompanied by pain in the groin lymph node on the right side (side of the vaccination). Symptoms started 12 days after the vaccination and are still ongoing.

Other Meds: Sertraline, Singulair, Ambien, progesterone, Omega-3 oil, CoQ10, vitamin B complex, vitamin D, chromium, probiotic (HMF Forte), burdock root, chaste tree berry, green tea extract

Current Illness:

ID: 1731867
Sex: F
Age: 87
State: FL

Vax Date: 03/26/2021
Onset Date: 09/15/2021
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:

Allergies: NKA

Symptom List: Pain in extremity

Symptoms: Vaccinated patient hospitalized with COVID-19.

Other Meds:

Current Illness:

ID: 1731868
Sex: M
Age: 60
State:

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: 2
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: e Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1731869
Sex: M
Age: 76
State: GA

Vax Date: 02/17/2021
Onset Date: 02/18/2021
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: Troponin - 0.260, 0.240, 0.200 Echo (3/4/21) o LVEF is 62%. LV systolic function is normal. LV size is normal. Normal LV wall thickness. o Akinetic apical anterior, apical septal, apical inferior, apical lateral and apex LV wall. o RV mildly dilated. RV systolic function is normal. o LA mildly dilated. o Tricuspid aortic valve. Mild to moderate aortic regurgitation. No aortic valve stenosis. o Mitral valve normal. Mild mitral annular calcification. Mild mitral regurgitation. o Moderate tricuspid regurgitation. o Mild pulmonary hypertension. o Aortic root dilated. Ascending aorta dilated. o Ao Sinus s 4.17 cm Ao ST jnct s 4.08 cm Ao Asc s 4.5 cm o No pericardial effusion. o Compared to the prior examination in 2018 there is significant changes including regional wall motion abnormalities. CTA Coronary (3/5/21) 1. Total coronary artery calcium score is 65. Mesa percentile based on age, gender, and race is 25%. 2. There is a moderate stenosis visualized in the LAD due to mild diffuse partially calcified atherosclerosis. This will be further evaluated by FFR CT as below. 3. Akinetic LV apex. 4. The right RCA arises from the anterior aspect of the noncoronary cusp. The RCA takes normal course from there. 5. There is a fusiform aneurysm of the ascending aorta with a max dimension of 4.5 cm. FFR CT addendum: 6. The moderate stenosis in the proximal LAD as described above is unlikely to be hemodynamically significant with a FFR-CT of 0.94.

Allergies: Naftifine - Itching Prozac - adverse reaction Xanax - adverse reaction Flagyl - nausea Reglan - nausea

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

Symptoms: Patient presented to hospital on 3/2/21 with decreased appetite, nausea and generalized weakness. Cardiac workup showed mildly elevated troponin (~ 0.260, 0.240, 0.200). Patient underwent an echocardiogram which showed preserved ejection fraction but regional wall motion abnormalities were present, mild to moderate aortic regurgitation, mild mitral regurgitation and dilated aortic root and ascending aorta. Patient underwent a CT coronary angiogram which showed a calcium score of 63 with moderate LAD stenosis (FFR 0.94), RCA 50% stenosis noted. Diagnosis presumed to be takotsubo cardiomyopathy and patient was treated with medical therapy. Repeat echo on 4/15/21 after discharge showed resolution of wall motion abnormalities.

Other Meds: Allopurinol (ZYLOPRIM) 100 mg tablet, Taking 300 mg by mouth daily Atorvastatin (LIPITOR) 40 mg tablet, Take 40 mg by mouth daily Colchicine 0.6 mg tablet, Take 0.6 mg by mouth daily as needed Furosemide (LASIX) 40 MG tablet, Take 1 tablet

Current Illness: Noted decreased appetite and unintentional weight loss starting in 1/2021

ID: 1731870
Sex: F
Age: 57
State: OH

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: valium, sulfa, penicillin, vancomycin, erythromycin, fluconazole, EE

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

Symptoms: -Patient received Pfizer vaccine on 9/23/21. Patient reports the following adverse reactions: facial swelling/redness and tingling. Tongue tingling and arm redness. No sob or difficulty swallowing. I did have pt wait 30 minutes after the vaccine was given. Vitals taken and recorded. Pt was given 25mg of Benadryl after she reported tongue tingling. Pt then returned to the office 30 minutes later with facial edema,redness and tingling. Pt was given another Benedryl 25mg -Pt was advised to continue to take Benadryl 25-50mg q 4-6 hours as needed. Pt will continue to monitor symptoms and will go to the ER if any difficulty breathing or chest tightness. Pt was advised to follow up with her PCP tomorrow. Covid Pfizer vaccine added to pt allergy list.

Other Meds: acyclovir, multivitamin

Current Illness:

ID: 1731871
Sex: M
Age: 65
State: FL

Vax Date: 03/04/2021
Onset Date: 08/04/2021
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: Covid test, chest CT, lab work.

Allergies: NKA

Symptom List: Vomiting

Symptoms: Pt came to ER c/o pain to left ribs with SOB.

Other Meds:

Current Illness:

ID: 1731872
Sex: F
Age: 35
State: WI

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: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: None done at the clinic.

Allergies: Morphine

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Within 15 seconds of receiving the vaccine patient started feeling hot and dizzy. This progressed to include nausea, tachycardia, and shortness of breath without hypoxia. Patient also stated it felt like she could not swallow and her throat felt tight. She was given an Epi pen and symptoms started to improve but after about 20 minutes symptoms started worsening again. At this time she was transported to the hospital ER for further evaluation and treatment. Patient reports some continued episodes that resolve with Benadryl and time in the 1-2 days since getting the vaccine.

Other Meds: Bupropion

Current Illness: None

ID: 1731873
Sex: F
Age: 38
State: KY

Vax Date: 03/04/2021
Onset Date: 09/20/2021
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: Tested positive for COVID 9/20/2021

Other Meds:

Current Illness:

ID: 1731874
Sex: F
Age: 59
State: MD

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: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: UNKNOWN.

Allergies: UNKNOWN

Symptom List: Injection site swelling, Limb discomfort

Symptoms: PATIENT RECEIVED THE WRONG VACCINE (PREVNAR 13) INSTEAD OF FLUARIX. PATIENT STATED THAT SHE ALREADY RECEIVED THE PREVNAR 13 IN THE PAST.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1731875
Sex: M
Age: 62
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:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1731876
Sex: F
Age: 49
State: NY

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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: None

Allergies: Seasonal allergies

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

Symptoms: Pain in right arm, fever of 102.4, numbness in left arm and tingling in pinky and ring finger, headache, heart palptations.

Other Meds: None

Current Illness: None

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am