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: 1732629
Sex: M
Age: 23
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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: none

Allergies: none

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient sat on the bench after receiving the Pfizer vaccine and passed out on the floor without any injuries to the body. He woke up ten seconds later and proceeded to vomit. He refused any further help and denied emergency services. We asked him to sit longer so we could continue to monitor. After 20 minutes, the patient was walking out on his own with his family.

Other Meds: not to our knowledge

Current Illness: not to our knowledge

ID: 1732631
Sex: F
Age: 70
State: MD

Vax Date: 03/03/2021
Onset Date: 03/04/2021
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: Not applicable

Allergies: Penicillin; cipro; mole

Symptom List: Anxiety, Dyspnoea

Symptoms: I experienced extreme fatigue, headaches, and body aches. The symptoms started the next days and lasted for 3 days.

Other Meds: Levothyroxine; lansoprazole; and meloxicam; vitamin d (liquid); liposomal glutathione; mitochondrial de; TMG; Digestzymes; Berberime; Methylsolate plus; chromium; antioxidant formula; Omegavail hi-po; Serrapeptase; Galt immune; Macuhealth;

Current Illness: No

ID: 1732632
Sex: M
Age: 54
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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1732633
Sex: M
Age: 45
State: MD

Vax Date: 09/01/2021
Onset Date: 09/18/2021
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: 9/22- strep, covid, flu, and lyme, all negative at Union Hospital ER.

Allergies: N/A

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Within a couple hours of getting the vaccine, I felt like I had been hit by a truck. I continued to get worse, very tired, severe muscle and joint pain, severe head pain and burning eyes. Extreme exhaustion. I got a fever on Monday, barely remember Tuesday, symptoms continued. Went to the ER at union hospital on Wednesday the 22nd. They tested me for covid, flu, lyme disease, and strep throat, all were negative. Continued being sick. Thursday the 23rd overnight was the worst so far. Fever 102.7. Excruciating pain in my right shoulder. Worst pain I've ever felt. Took tylenol at 2 am and went back to sleep, woke up at 8 am still sick still had fever. Called Doctor and had a telehealth appt. She said I need a full panel bloodwork but I can't go to a lab because I have covid symptoms. She said if I continue to be sick, go back to the ER. Now it's Friday night at 8 pm and I took tylenol around 6. I feel very tired and achy but I don't have a fever when I have tylenol in me. It is almost 7 days since I got the vaccine. I can't stay awake for more than a couple hours, my joint pain and body aches are horrible and I am not getting better, this was the first vaccine.

Other Meds: Multivitamin, omega 3, vitamin d with k, turmeric.

Current Illness: N/A

ID: 1732634
Sex: M
Age: 69
State: CA

Vax Date: 09/01/2021
Onset Date: 09/17/2021
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: Went into ER. - thought I was having a heart attack. They did the normal work up ? chest X-ray and 2 traponin tests?. No evidence of a heart attack

Allergies:

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

Symptoms: Horrible heart pain

Other Meds: Xarelto, plavix, fenofibrate

Current Illness: None

ID: 1732778
Sex: F
Age:
State:

Vax Date: 08/16/2021
Onset Date: 08/16/2021
Rec V Date: 09/24/2021
Hospital: Y

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: Edema Quincke's; This case was received via Regulatory Authority (Reference number: FR-AFSSAPS-NC20214076) on 17-Sep-2021 and was forwarded to Moderna on 17-Sep-2021. This regulatory authority case was reported by a physician and describes the occurrence of ANGIOEDEMA (Edema Quincke's) in a 53-year-old female patient who received mRNA-1273 (Spikevax) for COVID-19 vaccination. No Medical History information was reported. On 16-Aug-2021, the patient received first dose of mRNA-1273 (Spikevax) (Intramuscular) 1 dosage form. On 16-Aug-2021, after starting mRNA-1273 (Spikevax), the patient experienced ANGIOEDEMA (Edema Quincke's) (seriousness criteria hospitalization and medically significant). At the time of the report, ANGIOEDEMA (Edema Quincke's) had resolved. For mRNA-1273 (Spikevax) (Intramuscular), the reporter did not provide any causality assessments. Patient has a past medical history of HTA. No relevant concomitant medications were reported. No treatment information was provided. Company Comment: This case concerns a 53 year old female patient with medical history of HTA who experienced the unexpected event of angioedema. The event occurred on the same day after the first dose of the Moderna COVID-19 vaccine.. The rechallenge is not applicable as it is the first dose. The event is considered related to the product per the reporter's assessment. The event is consistent with the current understanding of the mechanism of action of the vaccine. The benefit-risk relationship of the Moderna COVID-19 vaccine is not affected by this report.; Sender's Comments: This case concerns a 53 year old female patient with medical history of HTA who experienced the unexpected event of angioedema. The event occurred on the same day after the first dose of the Moderna COVID-19 vaccine.. The rechallenge is not applicable as it is the first dose. The event is considered related to the product per the reporter's assessment. The event is consistent with the current understanding of the mechanism of action of the vaccine. The benefit-risk relationship of the Moderna COVID-19 vaccine is not affected by this report.

Other Meds:

Current Illness:

ID: 1732790
Sex: F
Age: 25
State: NC

Vax Date: 09/23/2021
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: None

Allergies: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: My right arm where I had the injection has a baseball size lump. It is painful and extremely sore. I can?t lift my arm.

Other Meds: None

Current Illness: None

ID: 1732791
Sex: M
Age: 37
State: CA

Vax Date: 09/05/2021
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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Patient reported experiencing severe pain in the whole arm. It continues even more than two weeks after vaccination. Patient also has swelling in the arm. No fever reported. Patient took over-the counter Tylenol and Ibuprofen; also trying Voltaren gel and Lidocaine cream per his doctor's advise.

Other Meds:

Current Illness:

ID: 1732792
Sex: M
Age: 21
State: HI

Vax Date: 04/28/2021
Onset Date: 09/23/2021
Rec V Date: 09/24/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: fully vaccinated and tested positive for COVID 19

Other Meds:

Current Illness:

ID: 1732793
Sex: F
Age: 44
State: LA

Vax Date: 08/14/2021
Onset Date: 09/13/2021
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: Shingles outbreak.

Other Meds: None

Current Illness: None

ID: 1732794
Sex: F
Age: 50
State: NY

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: SYR
Vax Site: LA

Lab Data: They did a rapid strep it came back negative only one stripe and insisted I had strep I don?t even have tonsils.

Allergies: Penicillin

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

Symptoms: Severe swollen glands and lymph nodes in my neck under my ears and back of my head. They can be seen without touching my skin and they were very painful

Other Meds: Zyrtec and rosuvastatin

Current Illness: None

ID: 1732795
Sex: F
Age: 52
State: MN

Vax Date: 03/24/2021
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: SYR
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: sore throat, fever, headache, body aches, cough, chills, nausea, abdominal cramping, nasal congestion, rhinorrhea starting on 9/20/21

Other Meds: Prascion 1 1 tablet Oral once at night Amitriptyline HCl 10 MG Tablet 1 tablet at bedtime Orally Once a day Daily Multi - Tablet 2 tablets Orally once a day Gabapentin 400 MG Capsule 1 capsule Orally once a day Nasacort AQ Ne

Current Illness: none

ID: 1732796
Sex: F
Age: 66
State: CA

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

Lab Data: none

Allergies: none

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

Symptoms: Arthrus reaction, swelling, erythema, extreme soreness

Other Meds: Butalbital, Famotidine

Current Illness: none

ID: 1732798
Sex: M
Age: 29
State: CA

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

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

Symptoms: Patient came to get 2nd Moderna shot on 07/19/21, patient forgot his immunization card, patient stated Pfizer on consent and release form. He ended up getting the Pfizer vaccine. Patient came back 09/24/21 saying if we can fill out the card because he forgot to bring it back that day 07/19/21 to have filled out because he didn't have it with him initially. So I filled lot number and date he received Pfizer shot. So patient ended up getting 2nd Pfizer somewhere else and came today to have initial filled out. Patient didn't complain of any reaction or problem. Patient just wanted card filled out. 't

Other Meds:

Current Illness:

ID: 1732799
Sex: M
Age: 40
State: CA

Vax Date: 03/03/2021
Onset Date: 08/20/2021
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: Covid tests, chest X-rays , given inhaler and antibiotics

Allergies: None

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

Symptoms: Was diagnosed with Covid august 20th 2021- cough, loss of taste smell, weak, trouble breathing

Other Meds: Descovy as prep, One a Day Vitamin , fiber

Current Illness: Had a regular cold 30 days prior

ID: 1732800
Sex: F
Age: 50
State: FL

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

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

Lab Data:

Allergies:

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

Symptoms: Patient Received 2nd dose of Moderna at Day 21. Patient did not experience any problems at of 9/24/2021.

Other Meds:

Current Illness:

ID: 1732801
Sex: F
Age: 28
State: MN

Vax Date: 08/26/2021
Onset Date: 08/28/2021
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: Ultrasound was performed on abscess to determine if there was fluid. Fluid was present.

Allergies: None that I am aware of

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

Symptoms: Moderna COVID-19 Vaccine EUA Noticed an abscess on my left leg that appeared suddenly on 8/28 at night after receiving the shot 8/26 in the late afternoon. Visited urgent care on 8/29 where it was lanced and I was prescribed antibiotics. On September 20th noticed two more abscesses on my left leg and was prescribed antibiotics again.

Other Meds: Prescription for albuterol but haven't used it for over a year

Current Illness: Asthma?

ID: 1732802
Sex: M
Age: 28
State:

Vax Date: 09/08/2021
Onset Date: 09/13/2021
Rec V Date: 09/24/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Pt said he felt he was losing his hearing in his left ear. recommended to go see a physician. Pt goes to urgent department and gets a rx for antibiotic ear drops. Called back to check on pt, but no answer

Other Meds:

Current Illness:

ID: 1732803
Sex: F
Age: 50
State: OH

Vax Date: 04/06/2021
Onset Date: 06/30/2021
Rec V Date: 09/24/2021
Hospital:

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

Lab Data: Lab tests pending for hair loss. Recent blood tests showed elevated markers for inflammation. Additional testing pending. X-ray for shoulder showed no gas entrapment - antibiotics as preventative measure.

Allergies: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: 1. Patchy hair loss noted two months after second dose (the date provided on this form). 2. Significant adverse reaction to recent DPAT immunization. No history of vaccination reactions. Chills, nausea, significant swelling of entire outer bicep, swelling over clavicle on injection side, swelling on shoulder blade at day two. Prescribed antibiotics and steroids. Advised to increase Benadryl dosing and use Tylenol. Some clearing of symptoms at Day 4.

Other Meds: Multi vitamin, vitamins D and C

Current Illness: None

ID: 1732804
Sex: F
Age: 63
State: CA

Vax Date: 09/24/2021
Onset Date: 09/24/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1732805
Sex: M
Age: 38
State:

Vax Date: 09/20/2021
Onset Date: 09/21/2021
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: X-ray of my chest & blood samples drawn on the night of the adverse reaction in the emergency room (21 SEP 2021).

Allergies: BEE STINGS

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

Symptoms: Monday 20 SEP 2021 at 1500(L) GMT, against my will, I had my first dose of the fPizer vaccine. 28x hours later (21 SEP 2021) I began to vomit and feel very unwell. I was about to go in for a 12.5 hour night shift for work, when at 2000(L)GMT, my body collapsed, and I started to go into a state of paralysis. My fists clinched shut, my jaw seized shut, my speech was slurring, face dropping, and my body was all seized up and I was shaking uncontrollably. My wife raced me to the hospital, where I had to be lifted out of the car and onto a stretcher. The doctors performed tests for hours, they thought I may have had, or had been close to having had a stroke. I am a healthy 38 year old by the way; They hooked me up to an IV and continually kept adding different drugs to it and after hours, my muscles started to relax and body slowly started to stop shaking. I was released the next morning (22 SEP 2021), as the hospital E.R. waiting room area was full, and after doing chest X-rays to check for blood clotting, they said that there was nothing further that they could do. The doctor said "oh, I doubt it was the vaccine that did this, no, we checked and you are low on potassium, so just eat a banana or, two every day"...This was NOT from my lack of eating bananas, and I am now certain that the hospitals just don't want any bad reporting or, slandering of the vaccines. In fact, earlier in the week I had made a huge banana bread pudding for my mother in law to try, so I am not buying the doctor's lack of potassium excuse. My body was nearly going into shock, as they even had the EKG sticky pads on my chest. The nurse at my bed side said that he had not seen a reaction this bad to the vaccine. Today is Friday (24 SEP 2021), I still feel very unwell (nauseous, headache and unable to focus, with very low energy) but, knew that I had to gain the strength to write this email for your situational awareness and for the records.

Other Meds: NONE

Current Illness: NONE

ID: 1732806
Sex: M
Age: 66
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Unevaluable event

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

Other Meds:

Current Illness:

ID: 1732807
Sex: F
Age: 32
State: AR

Vax Date: 08/09/2021
Onset Date: 08/23/2021
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: LA

Lab Data:

Allergies:

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

Symptoms: Red painful rash around the injection site that lasted approximately 2 weeks

Other Meds:

Current Illness:

ID: 1732808
Sex: F
Age: 74
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: 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: 1732809
Sex: M
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:
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

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

Other Meds:

Current Illness:

Date Died: 08/24/2021

ID: 1732810
Sex: M
Age: 64
State: WV

Vax Date: 04/21/2021
Onset Date: 04/22/2021
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: SYR
Vax Site: LA

Lab Data: Medical staff was not interested in discussing side effects.

Allergies: nuts

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

Symptoms: breathing, chest pain, and severe pain within joints.

Other Meds: n/a

Current Illness: n/a

ID: 1732811
Sex: M
Age: 46
State: CA

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

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

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

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

Other Meds:

Current Illness:

ID: 1732812
Sex: F
Age: 17
State: NE

Vax Date: 08/27/2021
Onset Date: 08/28/2021
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: Separate Bill. Haven't rec'd this yet. Not sure what they all performed.

Allergies: none

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Severe chest pains the night following vaccination. We thought they would get better, but continued to get worse. Vaccine was on Friday afternoon at 4:00. Went to primary doctor on Monday afternoon. Referred to Heart facility for further testing.

Other Meds: none

Current Illness: none

ID: 1732813
Sex: F
Age: 70
State: CA

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

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

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1732814
Sex: M
Age: 60
State: MN

Vax Date: 03/25/2021
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: RA

Lab Data:

Allergies: none

Symptom List: Nausea

Symptoms: URI symptoms for 1-2 days.sore throat, Headache, low energy, cough. includes seasonal allergies, antibiotics 3 weeks ago for tooth infection. Exposures reported: patient was around a person whos secretary was positive but friend was not tested, he was around them on sat and sun.

Other Meds: Claritin 10 MG Tablet 1 tablet Orally Once a day Glucosamine 750 MG Tablet 1 tablet Orally once a day Multi For Him - Tablet 1 tablet Orally once a day Tumersaid - Tablet 1 tablet Orally once a day Flonase Allergy Relief 50 MCG/

Current Illness: none

ID: 1732815
Sex: M
Age:
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:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKDA

Symptom List: Injection site pain

Symptoms: FAINTED, UNRESPONSIVE SNORING SOUNDS CPR

Other Meds: BASAGLAR INSULIN SIMVASTATIN GLIPIZDE NORTRIPYLINE NORCO TRAMADOL LISINOPRIL LEVOTHYROXINE

Current Illness:

ID: 1732816
Sex: F
Age: 64
State: AK

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

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

Lab Data: Testing POSITIVE for Covid for six weeks (since I was vaccinated)

Allergies: penicillin and sulfa

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

Symptoms: Testing POSITIVE for Covid for six weeks (since I was vaccinated)

Other Meds: bladder control medicine

Current Illness: none

ID: 1732817
Sex: F
Age: 84
State: FL

Vax Date: 08/26/2021
Onset Date: 09/12/2021
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:

Allergies: No known allergies.

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

Symptoms: For the past two weeks, PT has had a problem that does not resolve. Received third Moderna dose (100 micrograms) on 8/26/21 in left arm. The only noticeable side effect was stronger arm pain than after the previous doses, and this went away after about 12 hours. About two weeks later, on 9/12/21, she awoke with extreme dizziness/vertigo, vomiting, and incapacitating muscle ache in left shoulder and left side of neck. This pain shifted after several days to all of neck. Around 9/15/21, she tried the Epley maneuver for the dizziness, but this made the dizziness worse. PT spoke to her doctor on the phone on 9/17/21. GP prescribed a prednisone regimen that will end on 9/27/21. She also went in to the doctor's office on 9/20/21. Prednisone has resolved the pain problem. But the dizzy spells remain. Every night when getting up during the night and every morning when arising is dizzy and unstable enough to need help walking anywhere. The dizziness disappears by noon or early afternoon. After that, she feels just about normal and steady on legs, able to take a 30-minute walk. Yesterday, 9/23/21, she even ran a bit, optimistic that problems were over. On the contrary, the dizziness this morning, 9/24/21, was even worse than before. Prior to 9/12/21, Pt was a very active person who played tennis, swam, walked, and/or ran for several hours a day. The persistent dizziness over the past 2 weeks has forced her to change her lifestyle significantly. Questions include: 1) Could this be a delayed reaction to the Moderna 100-microgram 3rd dose?; 2) If so, what might be the best treatment for continued severe dizziness that has been most pronounced in the morning?; and 3) How long might such a reaction last? Thank you very much.

Other Meds: 1) metoprolol 1xday 25 mg 2) calcium 1200 units/day 3) vitamin D3 2000 IU/day 4) magnesium 250 mg/day

Current Illness: None.

ID: 1732818
Sex: M
Age: 49
State: CA

Vax Date: 04/30/2021
Onset Date: 05/04/2021
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: On May 17, 2021, I saw my primary care physician who took my pulse and who asked me a series of questions. It was his conclusion that there did not seem to be anything to be too concerned about regarding my heart palpitations. However, he referred me to see a cardiologist. On July 30, 2021, I saw a cardiologist (information listed in this questionnaire). He placed an EKG and took my pulse. He asked me a series of questions. He told me he did not believe there was any cause for concern.

Allergies: None

Symptom List: Tremor

Symptoms: The first dose of the vaccine was given to me on April 2, 2021. The second dose was given to me on April 30, 2021 (at 9:00am). On May 4, 2021, at approximately 9:00pm, I noticed that my heart skipped a beat several times beginning at this hour. The following day, it happened several times again throughout the day. Then it continued to happen multiple times a day on most days lasting for approximately until mid-August 2021. Beginning in late July I had begun taking magnesium citrate supplements to try to abate the heart palpitations. By mid-August until today's date, the palpitations seemed to have now gone away.

Other Meds: None

Current Illness: None

ID: 1732819
Sex: F
Age: 39
State: WA

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: IM
Vax Site: LA

Lab Data:

Allergies: Amoxicillin, penicillin, sulfa

Symptom List: Erythema, Pruritus

Symptoms: Server onset migraine within 25mins of shot that isn't cured by medicine. Nausea

Other Meds: None

Current Illness: None

ID: 1732820
Sex: F
Age: 17
State: TX

Vax Date: 09/11/2021
Onset Date: 09/11/2021
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: Ciprofloxacin, Trace Metals (hives)

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

Symptoms: Patient complains of left arm numbness, shortness of breath with exertion and at rest, and chills after 2nd dose of Pfizer vaccine.

Other Meds:

Current Illness:

ID: 1732821
Sex: F
Age: 54
State: FL

Vax Date: 07/21/2021
Onset Date: 07/28/2021
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: n/a

Allergies: None

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

Symptoms: Patient stated Menstrual bleeding started 7 days after the vaccine and continued for 18 days. It stopped for 4 days then continued 7 more days.

Other Meds: None

Current Illness: None

ID: 1732822
Sex: M
Age: 14
State: FL

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

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

Lab Data: Bloodwork 9/13/21 & 9/17/21 : two ER visits on 09/09 & 09/10 Admitted to hospital for testing on 09/23: lumbar puncture and spine MRI

Allergies: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Numbness and tingling in extremities ,coldness in hands and feet

Other Meds: None

Current Illness: Respiratory infection on 08/12treated with omnicef

ID: 1732823
Sex: F
Age: 34
State: CA

Vax Date: 08/20/2021
Onset Date: 08/20/2021
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: None

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

Symptoms: The symptoms happened while in the waiting room waiting the 15 minutes they tell you to wait sitting. I got very loud ringing in my ears, I felt very weak and lightheaded, had cold sweats, shortness of breath, chills, fast heart beat.

Other Meds: None

Current Illness: None

ID: 1732824
Sex: M
Age: 69
State: TN

Vax Date: 09/12/2021
Onset Date: 09/13/2021
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:

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

Symptoms: Patient received first dose of vaccine on Sunday 9/12/21, and states that his face felt "hot, warm, and red." On Monday 9/13/21 he said his face was still "warm and hot" and his shoulder, and "middle back to upper shoulder" was aching. Patient thought he developed a rash on his left wrist that "looked like poison ivy, but went away after a while." Patient also said he was feeling weak, but felt fine when he reported these events to the pharmacy.

Other Meds: atorvastatin, sildenafil, venlafaxine

Current Illness:

ID: 1732826
Sex: F
Age: 51
State: NY

Vax Date: 09/15/2021
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: Na

Allergies: NKA

Symptom List: Pain in extremity

Symptoms: Itching and swelling in eyes, lips swelling, red raised rash on arms, stomach.

Other Meds: Adderal 20mg

Current Illness: None

ID: 1732827
Sex: M
Age: 52
State: AR

Vax Date: 08/14/2021
Onset Date: 08/14/2021
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: numbness to Left pinky and ring finger

Other Meds: lisinopril

Current Illness: none

ID: 1732829
Sex: F
Age: 57
State: CA

Vax Date: 09/05/2021
Onset Date: 09/05/2021
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: ECG 12 lead, VAS leg venous doppler

Allergies: plaquenil

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

Symptoms: abdominal rash, trunk hives, severe right thigh pain, burning skin, chest pressure

Other Meds: alendronate

Current Illness:

ID: 1732830
Sex: F
Age: 48
State: NY

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: IM
Vax Site: LA

Lab Data: 199/102 blood pressure with pulse of 96. 15 minute follow-up 198/101 blood pressure with a pulse of 100

Allergies: aspirin, himilyan salt

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

Symptoms: heart was racing and she felt dizzy. upon evaluation from EMS medical care, they reported that it was not from the vaccine. Patient declined going to the hospital afterwards

Other Meds: Unknown

Current Illness: Unknown

ID: 1732832
Sex: M
Age: 68
State: MN

Vax Date: 03/27/2021
Onset Date: 09/13/2021
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: latex

Symptom List: Vomiting

Symptoms: Patient called into clinic to report symptoms started 9/13/21, and tested positive 9/20/21.

Other Meds: Chlorthalidone; Sildenafil; daily Vitamin; Triamcinolone; Clobetasol

Current Illness: none

ID: 1732833
Sex: M
Age: 48
State: NM

Vax Date: 08/08/2021
Onset Date: 08/09/2021
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. They would not believe me.

Allergies: Had allergic reaction to pain shots Milk Seasonal allergies

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Tachycardia High Blood pressure

Other Meds: Metformin Atorvastatina

Current Illness: Pre diabetic Back problems High cholesterol

ID: 1732834
Sex: F
Age: 32
State: CA

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

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

Lab Data:

Allergies:

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

Symptoms: Extreme sore throat started within 24 hours of receiving the first shot of Pfizer

Other Meds:

Current Illness:

ID: 1732835
Sex: F
Age: 72
State: AZ

Vax Date: 07/03/2021
Onset Date: 07/20/2021
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: Chest XR - Enlarged heart.

Allergies: Codeine

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Approximately 1-2 weeks after receiving 1st dose Moderna Covid-19 vaccine patient developed productive cough - frothy sputum, dizziness, swelling to legs. Symptoms persistent x 2 months. Seen in urgent care 9/24/21 for complaint of cough x 2 months. Chest XR shows very enlarged heart. Referred to ER for labs, further testing, and treatment for congestive heart failure. Patient denies history of heart failure - had a-fib/a-flutter that was treated with ablation in March of 2021.

Other Meds: Eliquis, Clonidine, dicyclomine, flecainide, hydrochlorothiazide, lisinopril, metoprolol, nifedipine, omeprazole, oxybutynin, promethazine.

Current Illness: None

ID: 1732836
Sex: M
Age: 39
State: PA

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: RA

Lab Data: None

Allergies: none known

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

Symptoms: less than 5 minutes after the shot, patient had a vasovagal response that included his eyes rolling back like a seizure and sliding down a chair. The event was over in 10-15 seconds but paramedics were already called. he did not go to hospital and called back to the pharmacy an hour later saying he was fine and that the same reaction occurred when he was a teen after the Tdap shot and again when he got eye drops.

Other Meds: None known

Current Illness: none known

ID: 1732837
Sex: M
Age: 53
State: CA

Vax Date: 05/15/2021
Onset Date: 05/23/2021
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: About a 3 weeks ago, as symptoms were not going away : Basic Metabolic, Count, Iron, EKG. Several values were elevated, or off when compared to prior tests. Specifically Iron, Platelets, and a few others. I also have noticed other anomalies. I am scheduled to see 3 specialists as a result of this

Allergies: Steroids

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

Symptoms: Initially: Arm Pain Slight Temperature Very strong abdominal/ GI pain, had to go see a GI doctor, he was not able to understand the correlation to this vaccine because it was something he was familiar with, or able to comprehend. Persistent, these issues have not resolved: Chronic Headache, forehead area pressure, insomnia as I wake up with headache regularly, Joint Pain, Chest Pain (Heart Area) , unexplained pain (intermittent), Fatigue, Less frequent: Difficulty breathing Least frequent: hypersensitivity to temperatures (warm water seems very hot)

Other Meds: Diovan

Current Illness: None

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am