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: 1734419
Sex: M
Age: 60
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1734420
Sex: M
Age: 15
State: GA

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 09/25/2021
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:

Symptom List: Anxiety, Dyspnoea

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1734421
Sex: F
Age: 71
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
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: 1734422
Sex: F
Age: 47
State: WI

Vax Date: 09/14/2021
Onset Date: 09/15/2021
Rec V Date: 09/25/2021
Hospital:

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

Lab Data:

Allergies: Avelox, Aciphex, Zithromycin, Imitrex

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: HSV2 outbreak the day following the vaccine administration

Other Meds: Zoloft, lamotrigine, spironalactone, alprazolam, Norco, levothyroxine, liothyronine, Naprosyn, ibuprofen, acetaminophen, multivitamin, phentermine, vitamins C, D, B2, B12, biotin, chromium

Current Illness: None

ID: 1734423
Sex: F
Age: 75
State: GA

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 09/25/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1734424
Sex: M
Age: 50
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
Hospital:

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

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1734425
Sex: F
Age: 55
State: GA

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 09/25/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1734426
Sex: M
Age: 47
State: KY

Vax Date: 08/03/2021
Onset Date: 09/21/2021
Rec V Date: 09/25/2021
Hospital:

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

Lab Data: they did an echocardiogram , chest xray, blood work , ekg all on 09/21/2021

Allergies: no

Symptom List: Pharyngeal swelling

Symptoms: after second vaccine arm had alot of swelling, but swelling subsided in approx a week, then i started to have tightness in chest and also broke out in a rash from waist up to neck, then started experiencing a constant dull ache in top left portion of back, i took ibuprofen at home but as time went on the pain and chest tightness intensified, so on 9/21/2021 i ended up goin to where i was diagnosed with myocarditis and pericarditis i was released on colchicine 0.6mg twice daily 60 tabs famotidine 20 mg 3x per day ibuprofen 800 mg 3 times per day 30 tabs losartan 25 mg one time per day

Other Meds: i was taking no prescription medications at time of vaccination, only dietary supplement i was taking was vitamin d 25mcg once a day and vitamin c once a day

Current Illness: none

ID: 1734427
Sex: M
Age: 69
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1734428
Sex: F
Age: 29
State: GA

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 09/25/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1734429
Sex: M
Age: 72
State: GA

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 09/25/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1734430
Sex: F
Age: 59
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
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: 1734431
Sex: M
Age: 66
State: GA

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 09/25/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1734432
Sex: F
Age: 25
State: NC

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 09/25/2021
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: Penicillin Mold

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

Symptoms: Headache Sharp pain radiate in arm and belly Loss taste and smell then it came back

Other Meds:

Current Illness:

ID: 1734433
Sex: F
Age: 74
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1734434
Sex: F
Age: 25
State: GA

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 09/25/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1734435
Sex: M
Age: 58
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1734436
Sex: F
Age: 14
State: GA

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 09/25/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1734437
Sex: F
Age: 71
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
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: 1734439
Sex: F
Age: 37
State: GA

Vax Date: 08/28/2021
Onset Date: 09/08/2021
Rec V Date: 09/25/2021
Hospital:

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

Lab Data: (9/8/21)Day 11, appt w urologist, ruled out uti , xray and ct scan to rule out kidney stones, all negative, positive for blood in urine. 9/13- CBC & CMP all normal 9/15 saw PCP , exam, lab work, ekg. All normal.

Allergies: Pcn, bactrim, cefdinir, omnicef, keflex, vancomycin, gentamycin, clindamycin latex mango

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

Symptoms: Starting Day 11, started experiencing 3 days of gross hematuria. Day 12- bilateral weakness in upper and lower extremities. Day 13, migraine, internal jitteriness, bilateral weakness in muscles, tingly feet, burning finger tips omn Day 14- heart rate while sitting fluctuating from 150s- 50s.

Other Meds: Vitamin D, E, C, Zinc, folic acid Ivermectin 0.2mg/kg (12mg twice a week)- prophylaxis prescribed regimen

Current Illness: none

ID: 1734440
Sex: F
Age: 39
State: IN

Vax Date: 08/13/2021
Onset Date: 09/16/2021
Rec V Date: 09/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Systemic: Headache-Mild, Additional Details: Went to MD about headaches that appeared after vaccine. Has had CT scan 09/22/2021. Awaiting results. May not be related.

Other Meds:

Current Illness:

ID: 1734441
Sex: M
Age: 65
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
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: 1734442
Sex: M
Age: 61
State: GA

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 09/25/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1734443
Sex: F
Age: 72
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
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: 1734444
Sex: F
Age: 27
State: SC

Vax Date: 09/01/2021
Onset Date: 09/01/2021
Rec V Date: 09/25/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1734445
Sex: M
Age: 68
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1734446
Sex: F
Age: 47
State: GA

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 09/25/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1734447
Sex: M
Age: 59
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1734448
Sex: F
Age: 22
State: GA

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 09/25/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1734449
Sex: F
Age: 47
State: CA

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/25/2021
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: Nausea

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1734450
Sex: M
Age: 17
State: GA

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 09/25/2021
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: Injection site pain

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1734451
Sex: M
Age:
State: OH

Vax Date: 04/01/2021
Onset Date: 04/29/2021
Rec V Date: 09/25/2021
Hospital:

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

Lab Data: none

Allergies: none

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

Symptoms: after shot #2. 8 hours after shot began to feel funny. went to bed at 7:00pm. fever, chills, heart palpitations, weak, unable to walk, woke up 22 hours later and then felt 95% OK 3 hours. later. since second shot my digestive system has been abnormal. eating amount was reduced, stomach was bloated, BM were spermatic, started an over the counter Probiotic in september 2021 and it is helping

Other Meds: none

Current Illness: none

ID: 1734452
Sex: M
Age: 40
State: NY

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 09/25/2021
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

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

Symptoms: My left shoulder has been in pain from September 3rd till present (today is September 25) . Also I have noticed more swelling around a bump I have in the same arm . Also , I feel like the way I poop has changed . I feel like I poop smaller and less than before . (This has occurred from September 3rd till present )

Other Meds: No

Current Illness: No

ID: 1734453
Sex: F
Age: 13
State: GA

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 09/25/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1734454
Sex: M
Age: 16
State: GA

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 09/25/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1734455
Sex: F
Age: 31
State: GA

Vax Date: 09/23/2021
Onset Date: 09/25/2021
Rec V Date: 09/25/2021
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. Literature online says it should reduce in 7-10 days

Allergies: None

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

Symptoms: Left sided supraclavicular swollen lymph node

Other Meds: Nikki (birth control)

Current Illness: None

ID: 1734456
Sex: F
Age: 34
State: TN

Vax Date: 09/23/2021
Onset Date: 09/25/2021
Rec V Date: 09/25/2021
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: None

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

Symptoms: Upper lip swelling over 24 hrs after shot.

Other Meds: None

Current Illness: None

ID: 1734457
Sex: M
Age: 36
State: NJ

Vax Date: 09/23/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
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: Asthenia, Chills, Headache, Myalgia

Symptoms: Vaccine was given on 9/23/2021 and had expiration date of 9/21/2021. This was confirmed on 9/23/21. Health officer notified immediately, medical director notified immediately. Contacted Department of Health and was told to report to vaccine manufacturer. Those steps were completed by 8pm on 9/23/2021.

Other Meds:

Current Illness:

ID: 1734458
Sex: F
Age: 15
State: CA

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
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:

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

Symptoms: Systemic: Confusion-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Medium, Systemic: Hypotension-Medium, Systemic: Nausea-Medium, Systemic: Shakiness-Medium, Systemic: Visual Changes/Disturbances-Medium, Additional Details: about 5 min after vaccine pt stated feeling nauseous, vision loss, felt cold, body went limp, eyes rolled back and pt was found collapsed on the ground. She did no hit her head. 1st BP 83/66 HR 83, 10 min later 2nd BP 97/79 HR 80. After 30 min of monitoring pt stated feeling better and was able to leave with no side effects

Other Meds:

Current Illness:

ID: 1734459
Sex: F
Age: 29
State: IN

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/25/2021
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: None

Allergies: Keflex, Bactrim, erythromycin

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

Symptoms: Fever, chills, weakness

Other Meds: None

Current Illness: None

ID: 1734460
Sex: F
Age: 65
State: GA

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 09/25/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1734461
Sex: M
Age: 56
State: NJ

Vax Date: 09/23/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
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: Vaccine was given on 9/23/2021 and had expiration date of 9/21/2021. This was confirmed on 9/23/21. Health officer notified immediately, medical director notified immediately. Contacted Department of Health Vaccine Operations Dept. and was told to report to vaccine manufacturer. Those steps were completed by 8pm on 9/23/2021.

Other Meds:

Current Illness:

Date Died: 09/25/2021

ID: 1734462
Sex: M
Age: 79
State: FL

Vax Date: 08/21/2021
Onset Date: 09/25/2021
Rec V Date: 09/25/2021
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:

Allergies: Tetanus Toxoids - Nausea & Vomiting - reported 6/4/18

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

Symptoms: on Day 8 post vaccination, who presents to ED complaining of worsening shortness of breath for the past 4 days associated with cough and fever. Tested positive for COVID 8/29/21. Pneumonia, ARF, Septic Shock, AKF, Received CRRT from effects of Baricitinib, . Coded resulting in Death 9/25/21.

Other Meds: none

Current Illness:

ID: 1734463
Sex: F
Age: 85
State: GA

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 09/25/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1734464
Sex: F
Age: 62
State: GA

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 09/25/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1734465
Sex: M
Age: 62
State: GA

Vax Date: 08/15/2021
Onset Date: 08/15/2021
Rec V Date: 09/25/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1734466
Sex: M
Age: 62
State: GA

Vax Date: 09/15/2021
Onset Date: 09/15/2021
Rec V Date: 09/25/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1734467
Sex: F
Age: 32
State: WV

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
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: Systemic: Allergic: Anaphylaxis-Severe, Systemic: Allergic: Difficulty Breathing-Severe, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Severe, Systemic: Allergic: Itch (specify: facial area, extremeties)-Severe, Systemic: Allergic: Itch Generalized-Severe, Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Severe, Systemic: Bell's Palsy-Severe, Systemic: Body Aches Generalized-Severe, Systemic: Chest Tightness / Heaviness / Pain-Severe, Systemic: Confusion-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: Flushed / Sweating-Severe, Systemic: Hyperventilation-Severe, Systemic: Numbness (specify: facial area, extremities)-Severe, Systemic: Tingling (specify: facial area, extemities)-Severe, Additional Details: All muscles in limbs stiffened up within 10minutes. Lips turned blue. Patient reported rapid heart rated. Touble moving mouth, and couldn't talk. Jaw Stiffened and locked in place.

Other Meds:

Current Illness:

ID: 1734468
Sex: F
Age: 28
State: ND

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
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: Systemic: Chest Tightness / Heaviness / Pain-Mild, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Severe, Systemic: Hyperventilation-Medium

Other Meds:

Current Illness:

ID: 1734469
Sex: M
Age: 52
State: MA

Vax Date: 06/29/2021
Onset Date: 06/29/2021
Rec V Date: 09/25/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Error: Booster Given Too Early-

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am