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: 1735386
Sex: F
Age: 43
State: MA

Vax Date: 09/02/2021
Onset Date: 09/02/2021
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: I?ve had multiple blood panels done by my primary care physician and my cardiologist, I?ve had sed rate tested (it was high) WBC was high. I have had two ekgs and I will have to wear a holtor monitor.

Allergies: NSAIDs, opiates, iv contrast, levaquin, vancomycin, gadolinium

Symptom List: Dysphagia, Epiglottitis

Symptoms: Immediate response: hives, rash flushing, tachycardia Menstrual responses: period was a week early, extremely heavy, lots of large clots. I actually had a colonoscopy during that time period and the doctors and nurses all noted how extremely heavy my period was. Prolonged response: tachycardia and hypertension

Other Meds: Benadryl, gastrocrom, ketotifen, singulair, linzess, b12, d3, quercitin

Current Illness: Kidney stone

ID: 1735387
Sex: F
Age: 50
State: MI

Vax Date: 03/23/2021
Onset Date: 08/17/2021
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: I had the PCR Covid test on August 17 and the test was positive. I had no other medical tests or lab results.

Allergies: Bactrim, Tofranil, sulfa products, adhesives No food allergies

Symptom List: Anxiety, Dyspnoea

Symptoms: I had only a mid effect immediately following the vaccine. But on August 17, I began having severe congestion and sinus pressure headaches. I was very fatigued and stayed home from work. I had a PCR Covid test at work and it was a positive diagnosis. I met with the health center nurse practitioner and she told me to treat the symptoms as they happened. She gave me Vitamin C, Vitamin D, zinc Glycinate, Quercetin with Bromelain, and NAC Amino Acids to take daily. A nasal spray helped a lot with the congestion. I took Ibuprofen as needed for the headaches and muscle aches. I took Benadryl and Claritin for the congestion. I was quarantined from August 17 to 27 and was not able to work except from home. For those weeks and some following, I was mostly very tired and felt like I had a bad cold. I also had "fuzzy" head where I could not focus or concentrate. I was easily distracted. I felt more anxious and needed to sleep a lot. It got better over time, but even now I don't feel like I have all of my energy and stamina back. I still have times when I can't think very well.

Other Meds: Trileptal Geodon Simvastatin Synthroid Multivitamin Hydroxyzine Pamoate Melatonin

Current Illness: None

ID: 1735388
Sex: F
Age: 56
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 Moderana.

Other Meds:

Current Illness:

ID: 1735389
Sex: U
Age: 14
State: GA

Vax Date: 08/18/2021
Onset Date: 08/18/2021
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:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1735390
Sex: M
Age: 53
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: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth

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

Other Meds:

Current Illness:

ID: 1735391
Sex: F
Age: 59
State: VA

Vax Date: 02/25/2021
Onset Date: 02/26/2021
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: None

Allergies: Penicillin And Ampicillin

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

Symptoms: The shot was given in my upper left arm but lower than normal. It was very sore for a week or more and I had a large bruise that stayed for a week or more. I also received the 2nd dose in March 26, 2021. On 4/1/21 I went for a physical at my doctors office and they drew bloodwork. The results were abnormal for me. I have always been very healthy with no known issues except overweight. My bloodwork showed several issues. My red blood cell count was elevated and my hemoglobin. I have never had that problem! I asked if this could be due to the vaccine and my doctor said no, but do we really know for sure? I think the person that gave me the vaccine gave it too low and possibly in my blood vessel instead of the muscle. The bruise was not a normal side effect of the vaccine and it lasted a long time. My blood is still very thick. I had blood drawn this week on 9/24/21 and the technician had a hard time getting blood out of my finger. It would start to clot after a few minutes. This is scary and unusual for me. They have never had problems getting blood from me before I got the Moderna vaccine.

Other Meds: OTC Mucinex, Caltrate

Current Illness: None

ID: 1735392
Sex: M
Age: 17
State: GA

Vax Date: 08/18/2021
Onset Date: 08/18/2021
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: 1735393
Sex: F
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:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

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

Other Meds:

Current Illness:

ID: 1735394
Sex: F
Age: 43
State: WA

Vax Date: 04/24/2021
Onset Date: 04/25/2021
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: Labs done to check blood cells Ultrasound on neck

Allergies: Eggs, soy, CT contrast dye

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Swollen lymph node on left neck, heavy legs and shooting pain through veins from the growing down to my toes on left side.

Other Meds: Irbesartan 300mg 1-daily Pantroprazole 40mg 1-daily Cetirizine Hydrochloride 10mg 1-daily

Current Illness:

ID: 1735395
Sex: M
Age: 58
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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

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

Other Meds:

Current Illness:

ID: 1735396
Sex: F
Age: 16
State: CA

Vax Date: 09/25/2021
Onset Date: 09/25/2021
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: no allergies.

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

Symptoms: -12:13- patient received COVID-19 vaccine and grew very anxious after receiving it. Staff recommended patient to lie down on the cot to relax and do some deep breathing. Parents stated she is taking a prescribed medication to help with anxiety, but did not remember the name of it. -12:15- patient had a panic attack and was very worried, anxious and scared and stated "my heart hurts, its beating fast." Vital signs taken: Blood pressure 163/86, HR 145, Sp02 99%. We called 911 and requested EMS. About 3 minutes later, the patient felt nauseous and stated "I feel sick, I need to throw up" and patient threw up in trash can. We provided continued to monitor the patient closely, water and deep breathing techniques to help relax the patient. -12:23- EMS arrived, handoff report provided and EMS took vitals signs and was provided consent by patient's parents to transport the patient to the Hospital.

Other Meds: Anxiolytic, name of prescribed medication unknown.

Current Illness: Very anxious after vaccinated, patient started getting very anxious and scared about the vaccine.

ID: 1735397
Sex: M
Age: 51
State: IL

Vax Date: 09/25/2021
Onset Date: 09/25/2021
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: Systemic: Allergic: Difficulty Breathing-Severe, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Tingling (specify: facial area, extemities)-Medium, Additional Details: Patient was in the observation phase and stated he was not feeling well, that he felt a little bit of tingling. We asked if he had had any issues with the first dose he recieved on 9/3/21. He said he did not asked him to stay for an additional observation for at least 30 minutes. He began to say he was having difficulty swallowing - HCP told him we were calling 911 and to please sit next to the pharmacy. I called 911, came back to the patient. ambulance came admin epipen and took to ER

Other Meds:

Current Illness:

ID: 1735398
Sex: M
Age: 50
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

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

Other Meds:

Current Illness:

ID: 1735399
Sex: U
Age: 29
State: GA

Vax Date: 08/18/2021
Onset Date: 08/18/2021
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:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1735400
Sex: U
Age: 17
State: GA

Vax Date: 08/13/2021
Onset Date: 08/13/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1735401
Sex: F
Age:
State: IL

Vax Date:
Onset Date:
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: Penicillin

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

Symptoms: Around 11:00pm the night of the injection I started to not feel well and so went to bed. That night I was in and out of sleep and was very feverish. Around 3:00 my 12 month old daughter woke up to nurse. I felt so insanely horrible that I opted not to breastfeed, and rather to give her a bottle (which literally quite never happens). Until probably 6:30am, I remained awake, tossing and turning? writhing in pain. My head felt like it was absolutely going to explode and I was having the worst chills. I literally was crying I was in so much pain and was out of my mind with what I was enduring. I was grasping on to my poor husband for warmth and making meek sounds of utter despair while tossing and turning, feeling as if God?s wrath was striking down on me. I birthed two babies with no epidural and the pain in my head was comparable, if not more than that. I got probably an hour and a half of sleep around 0600 and my husband noted that I was ?ablaze? and so put cold washcloths on my forehead and gave me a smoothie, ibuprofen, and water and let me rest . Around the afternoon time I had started to feel a little better, but started to get febrile and not feeling well come ~7:30, and so went to bed early. I felt better on Sunday.

Other Meds: Prenatal vitamins and DHA

Current Illness:

Date Died: 05/09/2021

ID: 1735402
Sex: F
Age: 91
State: VA

Vax Date: 04/19/2021
Onset Date: 04/30/2021
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: Sulfur

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

Symptoms: Patient vaccinated 4/19/2021. Patient became immobile 4/30/2021. Patient died 5/9/2021.

Other Meds: Warfarin, Donepezil, Levothyroxine Sodium, Memantine Hydrochloride, Tylenol, and Colace

Current Illness: dementia, survivor of open heart surgery from 2013 and poor circulation in legs. With these illnesses, pt still have a form of mobility. Shortly after 2nd vaccine, pain increased and on the 30th became so limited that hoyer lift was needed at a doctor's appointment. At previous appoint weeks prior, that was not the situation. Pt died on May 9, 2021. 11 days after vaccine, pain set in and inability to move without pain. Within days became unresponsive or able to communicate.

ID: 1735403
Sex: M
Age: 54
State: GA

Vax Date: 08/13/2021
Onset Date: 08/13/2021
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: 1735404
Sex: M
Age: 44
State: GA

Vax Date: 08/14/2021
Onset Date: 08/14/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1735405
Sex: U
Age: 39
State: GA

Vax Date: 08/18/2021
Onset Date: 08/18/2021
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:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1735406
Sex: M
Age: 62
State: HI

Vax Date: 04/02/2021
Onset Date: 04/26/2021
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: No medical insurance at this time. Expired in June 2021.

Allergies: None.

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

Symptoms: No effects after 1st shot. After second shot was sick for approximately 18 hours. Then took Acetaminophen and felt better in two hours. Patient feels tinitis got worse after vaccination.

Other Meds: multi vitamins, fish oil . No meds.

Current Illness: None.

ID: 1735407
Sex: M
Age: 18
State: GA

Vax Date: 08/13/2021
Onset Date: 08/13/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1735408
Sex: U
Age: 17
State: GA

Vax Date: 08/13/2021
Onset Date: 08/13/2021
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: 1735409
Sex: F
Age: 56
State: MA

Vax Date: 08/14/2021
Onset Date: 08/14/2021
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: No allergy

Symptom List: Injection site pain, Pain

Symptoms: Intermittent headache, sometimes severe. Take Advil ibuprofen tablet by myself, relieved. While some days later, the headache came again.

Other Meds: No other pills else taken on that vaccination day, while vitamins on the other days

Current Illness: No, while cholesterol shows high in previous physical examination, with hyperlipidemia

ID: 1735410
Sex: F
Age: 59
State: AZ

Vax Date: 09/13/2021
Onset Date: 09/18/2021
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: none

Allergies: Eggs, Almonds, Horse serum, surgical glue, sulfa antibiotics

Symptom List: Injection site pain, Menorrhagia

Symptoms: I started with stomach cramping lasting a week then, I got a severe rash starting on my knee where I previously has meniscus surgery and prior to that had viscosupplementation, prior to that cortisone shots. The rash moved out into my legs and upper thigh. The rash is now in my groin feet and hands. I contacted my Physician who has given me a prescription for prednisone and antibiotics.

Other Meds: Tirosint, Liothyronine, Fish Oil,

Current Illness: hypothyroid

ID: 1735411
Sex: U
Age: 51
State: GA

Vax Date: 08/14/2021
Onset Date: 08/14/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1735412
Sex: F
Age: 16
State: GA

Vax Date: 08/10/2021
Onset Date: 08/10/2021
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: 1735413
Sex: M
Age: 18
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:
Dose Series: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1735414
Sex: M
Age: 33
State: NC

Vax Date: 07/02/2021
Onset Date: 07/02/2021
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: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-

Other Meds:

Current Illness:

ID: 1735415
Sex: M
Age: 51
State: GA

Vax Date: 08/03/2021
Onset Date: 08/03/2021
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: 1735416
Sex: U
Age: 19
State: GA

Vax Date: 08/13/2021
Onset Date: 08/13/2021
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: 1735417
Sex: M
Age: 60
State: GA

Vax Date: 09/02/2021
Onset Date: 09/02/2021
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 induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1735418
Sex: F
Age: 61
State: GA

Vax Date: 08/07/2021
Onset Date: 08/07/2021
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:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1735419
Sex: F
Age: 26
State: GA

Vax Date: 08/07/2021
Onset Date: 08/07/2021
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: 1735420
Sex: F
Age: 50
State: GA

Vax Date: 08/14/2021
Onset Date: 08/14/2021
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: Incorrect Reconstitution-

Other Meds:

Current Illness:

ID: 1735421
Sex: U
Age: 14
State: GA

Vax Date: 08/18/2021
Onset Date: 08/18/2021
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:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1735422
Sex: F
Age: 27
State: SC

Vax Date: 09/05/2021
Onset Date: 09/18/2021
Rec V Date: 09/25/2021
Hospital: Y

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

Lab Data: SARS-CoV-2 virus RNA, 9/19/2021, 9/22/2021: Positive Covid 2 IgG spike protein, 9/20/2021: Positive, 22.9 AU per mL CT angiogram of her chest, 9/19/2021: Notable for mild atelectasis but no pulmonary infiltrates

Allergies: No known allergies

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

Symptoms: Patient meeting case definition for MIS-A with evidence of myocarditis. She is 27 weeks pregnant, Estimated fetal weight 1116g Patient proceeded to progress to cardiogenic shock requiring inotropes and vasopressors. Her hospital course has been complicated by a ventricular fibrillation related cardiac arrest and acute respiratory failure from which she recovered and was successfully extubated. She was treated with aspirin 162 mg, 2.5 mg/kg of IVIG, 400 mg of Tocilizumab, 6 mg twice daily of dexamethasone followed by 1 mg/kg of methylprednisolone.

Other Meds: Ferrous Sulfate

Current Illness: COVID-19

ID: 1735423
Sex: M
Age: 59
State: TX

Vax Date: 04/10/2021
Onset Date: 08/25/2021
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: Ct scan of lungs and pelvis RLE ultrasound MRI of right leg

Allergies: n/a

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: adverse reaction-Right leg DVT and bilateral pulmonary emboli. Symptoms- right leg pain and shortness of breath Time- over 3 weeks Treatment- anticoagulant Outcome- dischrged from hospital. Still on medications for 6 months to a year

Other Meds: benicar, norvasc, metoprolol

Current Illness: n/a

ID: 1735424
Sex: M
Age: 51
State: GA

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: 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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1735425
Sex: M
Age: 54
State: GA

Vax Date: 08/05/2021
Onset Date: 08/05/2021
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:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1735426
Sex: F
Age: 45
State: WI

Vax Date: 06/10/2021
Onset Date: 06/11/2021
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: Pain in extremity

Symptoms: Started period a full week early

Other Meds: Pilocarpine Naproxen Cyclobenzaprine

Current Illness: None

ID: 1735427
Sex: M
Age: 17
State: GA

Vax Date: 08/18/2021
Onset Date: 08/18/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1735428
Sex: F
Age: 54
State: NY

Vax Date: 04/04/2021
Onset Date: 04/04/2021
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: N/A

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

Symptoms: Ears clogged, Right Ear is still clogged and now I have tinnitis

Other Meds: VitD, VitC, Magnesium

Current Illness: N/A

ID: 1735429
Sex: M
Age: 2
State: NY

Vax Date: 09/22/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
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: Had only a chemistry drawn at Hospital on Friday September 25th which per MD was benign but parent never saw results

Allergies: None

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

Symptoms: Had live influenza vaccine Wednesday Sept 22 and had two febrile seizures requiring hospitalization on Friday the 25th of September Temps still high now and breath smells of urine. Fever blisters on tongue decreased appetite and fluid intake.

Other Meds: None

Current Illness: None

ID: 1735430
Sex: F
Age: 61
State: FL

Vax Date: 01/27/2021
Onset Date: 01/27/2021
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: None Talked to Drs but no one can confirm that ringing is from the vaccine

Allergies: Penicilian

Symptom List: Vomiting

Symptoms: 1/27/21 -Fever chills-heart palpitations March 2021-intense ringing in both ears. Still have ringing as of today 9-25-2021

Other Meds: Azor Ambien Multi vitamin Celexa

Current Illness:

ID: 1735431
Sex: F
Age: 35
State: TX

Vax Date: 08/13/2021
Onset Date: 08/22/2021
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: Dr visit 08/31/21- ran labs and urine sample Ultrasound of abdomen 09/23/21

Allergies: None

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Pain, swelling, and pressure on right side of abdomen, sometimes on left as well. Started occurring about a week after vaccination with second dose.

Other Meds:

Current Illness: None

ID: 1735432
Sex: F
Age: 50
State: LA

Vax Date: 09/10/2021
Onset Date: 09/12/2021
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: Cbc normal x1. Potassium low x 1 Covid test negative x 2 Flu negative Rheumatoid factor negative Ana negative

Allergies: Sulfa Lortab Minocycline Cipro Imitrex

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

Symptoms: Headache for weeks now Joint pain/swelling for weeks now Muscle aches for days Stomach upset for two weeks Nausea for last week

Other Meds: Creator Bystolic Januvia

Current Illness:

ID: 1735433
Sex: F
Age: 29
State: GA

Vax Date: 09/20/2021
Onset Date: 09/21/2021
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: 3 lead heart rate monitor with print out of results

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: After receiving my second vaccine on Monday, (09/20/21) I had the usual symptoms of fever/chills/nausea/body aches for about 24 hours. I was forced to be out of work on Tuesday due to the symptoms but by Tuesday evening I was feeling pretty normal again. Beginning Tuesday morning, I did notice that my chest felt tight. I again felt like that this could be normal. I returned to work on Wednesday sept. 22nd. Wednesday morning I again felt chest tightness but throughout the morning/afternoon I would notice times where I would feel like my heart was racing. I work at a health place on a- hospital campus. Our building has Cardiac Rehab on our lower level. My co-worker convinced me to just go down and let them put the 3-lead monitor on me to make sure it was nothing serious. They did note some PAC?s and increased heart rate while just sitting at rest. My typical heart rate is low (50?s) when this was happening my heart rate would jump from 50?s to 100?s. I have never experienced any type of heart issue or ever felt this type of thing happening before. I am a runner and athlete so I am relatively aware of odd occurrences in heart beat/rhythm along with my normal bodily functions. I still felt these weird bouts that my heart was racing throughout Wednesday evening. I have since not felt this happening again. I was advised to contact you. My employer is a hospital system.

Other Meds: None

Current Illness: None

ID: 1735434
Sex: M
Age: 35
State: NY

Vax Date: 05/25/2021
Onset Date: 08/01/2021
Rec V Date: 09/25/2021
Hospital: Y

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

Lab Data: 08/20/2021 & more dates

Allergies: None

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

Symptoms: Blood clots (right toe) Essential Thrombocytes

Other Meds: None

Current Illness: None

ID: 1735435
Sex: F
Age: 58
State: TN

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: RA

Lab Data: None

Allergies: Tetracycline, Omnicef, Levaquin, Rocephin

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

Symptoms: Dizzy immediately after vaccine, burning sensations immediately after vaccine, periodic jerking muscle movements of face & jaw continues since vaccine, hoarseness starting a few hours after vaccine & continues on.

Other Meds: Myrbetriq, Lyrica, Memantine, Nortriptyline, Tizanidine

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am