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: 1735697
Sex: F
Age: 55
State: TX

Vax Date: 05/15/2021
Onset Date: 05/15/2021
Rec V Date: 09/26/2021
Hospital:

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

Lab Data: N/A -Televisit resulted in Prednisone RX and Allergy meds for a week

Allergies: Levoquin

Symptom List: Dysphagia, Epiglottitis

Symptoms: Sharp brief pain in chest, face flush, eyes burning, and facial swelling for several days.

Other Meds:

Current Illness: Migraine

ID: 1735698
Sex: M
Age: 49
State: IL

Vax Date: 09/20/2021
Onset Date: 09/22/2021
Rec V Date: 09/26/2021
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: TIGHTNESS IN CHEST

Other Meds:

Current Illness:

ID: 1735699
Sex: M
Age: 53
State: AZ

Vax Date: 02/13/2021
Onset Date: 04/07/2021
Rec V Date: 09/26/2021
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: None

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

Symptoms: Ringing in ear..high pitch

Other Meds: None

Current Illness: None

ID: 1735700
Sex: M
Age: 57
State: CA

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 09/26/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1735701
Sex: F
Age: 83
State: TN

Vax Date: 02/27/2021
Onset Date: 09/17/2021
Rec V Date: 09/26/2021
Hospital: Y

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

Lab Data: 9/12/21 COVID-19 = DETECTED

Allergies: ACCUPRIL, CODEINE,METHADONE, PENICILLIN, SULFONAMIDES

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

Symptoms: 9/17/21 SEEN AT MEDICAL CENTER ER REPORTED COVID POSITIVE ON 9/12/21 COMPLAINS OF INCREASE WEAKNESS AND SOB, MILD CHEST WALL PAIN. DX; WITH PNEUMONIA DUE TO COVID 19 VIRUS. OXYGEN IN TH EUPPER 80S REQUIRING O2. ADMITTED TO INPATIENT STATUS. DISCHARGED ON 9/22/21 HOME WITH HOME HEALTH SERVICES.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1735702
Sex: F
Age: 26
State: CA

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 09/26/2021
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: NKA

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

Symptoms: 1st dose was given on 09/11/21. Gave vaccine on 09/25/21. During billing realized that vaccine was given 7 days early.

Other Meds:

Current Illness:

ID: 1735703
Sex: M
Age: 59
State:

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 09/26/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

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

Other Meds:

Current Illness:

ID: 1735704
Sex: M
Age: 59
State:

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 09/26/2021
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 Moderna.

Other Meds:

Current Illness:

ID: 1735705
Sex: F
Age: 51
State:

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 09/26/2021
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: 1735706
Sex: F
Age: 89
State:

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 09/26/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

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

Other Meds:

Current Illness:

ID: 1735707
Sex: M
Age: 46
State: CO

Vax Date: 09/05/2021
Onset Date: 09/06/2021
Rec V Date: 09/26/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Patient feels extremely tired, with a lot fatigue and overall just feels flu like even 21 days after first dose

Other Meds: None

Current Illness: None

ID: 1735708
Sex: F
Age: 51
State: CA

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 09/26/2021
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: 1735709
Sex: F
Age: 54
State: FL

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/26/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: AFTER SECOND SHOT, SHE NOTICED SWELLING AND REDNESS ON YOUR ARM. SHE PUT ICE ON IT, LOOKED LIKE A MOSQUITO LUMP. ITS TENDER, RED AND SWOLLEN. LAST NIGHT SHE FELT A LUMP IN HER NECK. THIS MORNING THE LUMP IS BIGGER. NO TROUBLE BREATHING, SWELLING OF FACE, NO SWELLING OF TONGUE. IF SHE TOUCHES THE LUMP, ITS PAINFUL. HER ARM IS SENSITIVE TO TOUCH. Referred patient to PCP .

Other Meds: unknown

Current Illness: none

ID: 1735710
Sex: M
Age: 69
State:

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 09/26/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1735711
Sex: M
Age: 72
State:

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 09/26/2021
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: 1735712
Sex: F
Age: 65
State: IL

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

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

Lab Data: none

Allergies: none

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

Symptoms: body aches, chills, fatigue, rosy cheeks

Other Meds: none

Current Illness: none

ID: 1735713
Sex: M
Age: 74
State:

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 09/26/2021
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: 1735714
Sex: F
Age: 44
State: AR

Vax Date: 08/31/2010
Onset Date: 09/01/2021
Rec V Date: 09/26/2021
Hospital: Y

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: A few days after vaccine patient developed chest pain. Had heart attack at doctors visit on 9/21 and is currently in hospital due to heart attack.

Other Meds:

Current Illness:

ID: 1735715
Sex: M
Age: 73
State: NE

Vax Date: 09/10/2021
Onset Date: 09/21/2021
Rec V Date: 09/26/2021
Hospital:

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

Lab Data: none

Allergies: Codeine Niacin

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Approximately 17 days after shot I am having very bad pains in my shoulder, neck and back. Similar to typical flu symptoms. Loss of balance very often since shot and VERY TIRED. No nausea, headaches as yet.

Other Meds: Aspirin-low dose daily Carvedilol-6.25mg-daily CitaLopram-40 mg tab-1/2 tablet daily Ezetimibe-10mg tab-daily Fluticasone Propionate 50mg spray-daily Furosemide 40mg tab (Lasix) -daily Gabapentin 600mg tab--2X daily Losartan 50mg tab-daily

Current Illness: NONE

ID: 1735716
Sex: F
Age: 55
State: TX

Vax Date: 08/14/2021
Onset Date: 08/15/2021
Rec V Date: 09/26/2021
Hospital:

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

Lab Data: 8/20/21 negative test for covid 9/8/21 Foot Dr appt - Nerve Sensory Test on Foot 9/22/2 Labs, and Nerve Sensory Test

Allergies: Levaquin Dexamethosone

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

Symptoms: Two weeks of Flu like symptoms, with extreme bone and joint pain, fatigue, vomiting and headache. Random sharp stabbing pain in random places. Can last for a few seconds or an hour. Tested negative for covid. At end of two weeks, left foot has started going numb in the bottom left side and is spreading. Still extremely tired and feel like upper body strength has decreased.

Other Meds:

Current Illness: migraine

ID: 1735717
Sex: F
Age: 35
State: NY

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/26/2021
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: Patient called the pharmacy to report hives. Post vaccination she felt that her arm was a little itchy. The next day she broke out in hives and does not report any difficulty breathing. She will follow up with doctor.

Other Meds:

Current Illness:

ID: 1735718
Sex: F
Age: 89
State: CA

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 09/26/2021
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: 1735719
Sex: F
Age: 33
State: CA

Vax Date: 09/24/2021
Onset Date: 09/25/2021
Rec V Date: 09/26/2021
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: Pain at injections sight and swelling to shoulder. 2 lumps on collar bone tender to touch and pain. Swelling.

Other Meds:

Current Illness:

ID: 1735720
Sex: M
Age: 71
State:

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 09/26/2021
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: 1735721
Sex: M
Age: 57
State:

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 09/26/2021
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:

ID: 1735722
Sex: M
Age: 59
State:

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 09/26/2021
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: 1735723
Sex: M
Age: 73
State: TN

Vax Date: 03/24/2021
Onset Date: 09/10/2021
Rec V Date: 09/26/2021
Hospital: Y

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

Lab Data: 9/10/21 COVID -19 PCR = DETECTED

Allergies: BRILINTA

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: 9/10/21 SEEN IN THE ER HYPOTENSIVE, COUGH, SOB AND VOMITING. PATIENT ADMISSION TO HOSPITAL. 9/12/21 LEAVES 9/14/21 RETURNS TO ER AT . ADMITTED TO HOSPITAL WITH FOOT INFECTION. REPORTS BREATHING HAS IMPROVED . PATIENT DISCHARGED ON 9/22/21 TO HOME

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1735724
Sex: F
Age: 53
State: AR

Vax Date: 04/05/2021
Onset Date: 08/01/2021
Rec V Date: 09/26/2021
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: Patient developed shingles around 3 months after vaccine

Other Meds:

Current Illness:

ID: 1735725
Sex: M
Age: 54
State: NC

Vax Date: 02/22/2021
Onset Date: 03/17/2021
Rec V Date: 09/26/2021
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: MRI, CT scan, ENT hearing test, blood tests, trigger injections from pain clinic. All this is first 3 months.

Allergies: Penicillin

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

Symptoms: Tinnitus began 3 weeks after my second dose. Although the tinnitus is minimized today, it was quite bad in my left ear for 3 months. I still have it to this day but not as bad. When I first got the side effect it was intolerable.

Other Meds: Lisinopril Multivitamin Levothyroxine

Current Illness: High blood pressure Acid reflux Thyroid issue

ID: 1735726
Sex: M
Age: 45
State: MI

Vax Date: 07/26/2021
Onset Date: 08/24/2021
Rec V Date: 09/26/2021
Hospital: Y

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

Lab Data: Ultrasound,CTA and emergency surgery

Allergies: None

Symptom List: Nausea

Symptoms: DVT and multiple pulmonary embolisms

Other Meds: Norco Lisinopril Tramadol

Current Illness: None

ID: 1735727
Sex: F
Age: 54
State:

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 09/26/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1735728
Sex: M
Age: 74
State: CA

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 09/26/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1735729
Sex: F
Age: 34
State: CA

Vax Date: 07/24/2021
Onset Date: 09/01/2021
Rec V Date: 09/26/2021
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: I have noticed that my menstrual cycle went from 28 days to 24 days. And period last about 10 days when it use to be 6 days. My cramps are more severe as well.

Other Meds:

Current Illness:

ID: 1735730
Sex: F
Age: 55
State:

Vax Date: 02/25/2021
Onset Date: 02/25/2021
Rec V Date: 09/26/2021
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: pt felt her throat was closing and was observed for 30 minutes, this was followed by lightheadedness. symptoms went away after 1 hour and patient left the hospital symptom free

Other Meds:

Current Illness:

ID: 1735731
Sex: M
Age: 76
State: CA

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 09/26/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

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

Other Meds:

Current Illness:

ID: 1735732
Sex: M
Age: 18
State: DE

Vax Date: 09/26/2021
Onset Date: 09/26/2021
Rec V Date: 09/26/2021
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: unknown at this time

Allergies: no known allergies

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

Symptoms: Patient lost consciousness and had seizure activity. Upon regaining consciousness, patient became somewhat alert and reported loss of vision, which returned after a few minutes. He then reported hallucinations, numbness over whole body, and chest tightness. Could not find a radial pulse, but patient was breathing and fingernails remained pink. Patient was sweating through his shirt. 911 was called, responding within 10 minutes. Patient was transferred to a stretcher and taken to the hospital.

Other Meds: None

Current Illness: None

ID: 1735733
Sex: F
Age: 29
State:

Vax Date: 02/25/2021
Onset Date: 02/25/2021
Rec V Date: 09/26/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: itchiness in bilateral arms and neck, pt refused Benadryl, pt verbalized feeling better in 10 minutes and left hospital symptom free

Other Meds:

Current Illness:

ID: 1735734
Sex: F
Age: 56
State: TX

Vax Date: 03/13/2021
Onset Date: 04/03/2021
Rec V Date: 09/26/2021
Hospital:

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

Lab Data: Endoscopy on 6/7/2021 Esophagus, GE junction, Eosinophilic esophagitis Up to 25 intraepithelial eosinophils per high power field present

Allergies: Gluten (celiac disease) no wheat, barley, rye or contaminated oats

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Exactly three weeks after my vaccine, I experienced a food impaction in my throat, also started having a lot of acid reflux. I was woken up with a severe heartburn attack in April. I got in to see my GI in June and was able to get an endoscopy. The results showed I had Eosinophilic esophagitis, EOE. My Eosinophilic number was 25. I was put on an elimination diet, no dairy, eggs, nuts, seafood, along with already being gluten free. I was also sent to an allergist and am now doing three shots twice weekly. I have never, ever, had an issue with these foods before or had swallowing issues.

Other Meds: Synthroid 150 mcg Vagifem 10 mcg Vitamin D Probiotics Daily vitamin VisionShield eye vitamin, lutein & zeaxanthin

Current Illness:

ID: 1735735
Sex: M
Age: 69
State: CA

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 09/26/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1735736
Sex: F
Age: 33
State:

Vax Date: 03/02/2021
Onset Date: 03/02/2021
Rec V Date: 09/26/2021
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: pt had tachycardia @ 148, this decreased to 95 within 15 minutes then increased to 124. symptoms resolved within 25 minutes and patient left symptom free, advised to speak to obgyn for additional question

Other Meds:

Current Illness:

ID: 1735737
Sex: F
Age: 15
State: IL

Vax Date: 09/26/2021
Onset Date: 09/26/2021
Rec V Date: 09/26/2021
Hospital:

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

Lab Data: N/A

Allergies: NONE

Symptom List: Pain in extremity

Symptoms: Patient Passed out immediately after giving vaccine, patient's blood pressure was 68/47mmHg & pulse 52. Pt was sweating and hot. 911 was called and took her to the hospital for further check up.

Other Meds: NONE

Current Illness: NONE

ID: 1735738
Sex: M
Age: 41
State: NE

Vax Date: 09/26/2021
Onset Date: 09/26/2021
Rec V Date: 09/26/2021
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: Patient had vasovagal reaction. Fainted. Was able to communicate and give his mom's phone number. Nurse, pharmacist and customer physician tended to the patient. He was still faint after 10 minutes so 911 was called and the squad took over patient care at that time.

Other Meds:

Current Illness:

ID: 1735739
Sex: M
Age: 34
State: CA

Vax Date: 08/30/2021
Onset Date: 08/30/2021
Rec V Date: 09/26/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Janssen COVID-19 Vaccine EUA. 0900: patient reports dizziness 0903: BP 97/58, HR- 44, 02 RA 99%. syncopal episode occur. S/SX seizure/posture (15 seconds), diaphoretic. DOD aware, paramedics called 0905: AxOx4. BP 98/60, HR 60, O2 98% 0905: medics arrive to vaccine clinic. EKG done + STEMI. Patient transferred via gurney to ambulance for higher level of care, Allergy to COVID-19 vaccine documented in Allergies activity, Patient advised to discuss second dose considerations with a clinician Patient transferred via ambulance to ER 0940: patient arrival at ER. BMP, CBC w/auto Diff, Troponin I, ED EKG-CernerCV, Diagnosis: Syncope, Patient advised to follow up with primary care physician within 1-2 days

Other Meds: Triamcinolone Acetonide (TRIDERM) 0.5 % Top Cream

Current Illness: Atopic Dermatitis

ID: 1735740
Sex: F
Age: 57
State: CA

Vax Date: 09/26/2021
Onset Date: 09/26/2021
Rec V Date: 09/26/2021
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: Codine

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

Symptoms: Patient felt chills, Vitals were taken, Vitals within normal limits. Patient was in Obsveration for 60 mins, vitals still within normal limits, no chills/hot flashes, tingling sensation in mouth. Patient stated she has "cloudy" feeling. Patient able to tolerate foods and fliuds and able to communicate needs. NP visualize inside patients mouth/cleared. Patient was able to leave the clinc after 60 mins. patient is aware to follow up with MD if symtoms worsen.

Other Meds: Simvastation

Current Illness:

ID: 1735741
Sex: M
Age: 80
State: CA

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 09/26/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Vomiting

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

Other Meds:

Current Illness:

ID: 1735743
Sex: F
Age: 66
State: NC

Vax Date: 03/12/2021
Onset Date: 07/01/2021
Rec V Date: 09/26/2021
Hospital:

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

Lab Data: I had a stool sample test on September 20, 2021, to see if I had a bacterial infection (Helicobacter Pylori Antigen). Test was negative.

Allergies: Levaquin family of drugs; MSG; penicillin

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Stomach pains on left side, especially under the last rib, down into hip area and sometimes across abdomen to right side, about two months after being on Rosuvastatin.. Doctor stopped Rosuvastatin. I also stopped Omeprazole. Gastroenterologist PA put me back on Omeprazole on September 21, 2021 (Zoom appointment), 2X a day, and severe pain stopped although there are a few twinges. No mention was made of possible connection to the Moderna vaccine, only that the Rosuvastatin probably was irritating my stomach lining and intestines. I mentioned the stomach pains on my V-Safe Check-in just in case there was a connection.

Other Meds: 20 mg Omeprazole 10 mg Rosuvastatin 100mg Gabapentin 50mg Metoprolol ER Succinate 100mg Losartin 1.25mcg Spiriva Respimat inhaler (2x daily) 100mcg Arnuity inhaler QVAR (at the time, but no longer taking it; now taking Arnuity) 180mg Alleg

Current Illness: -0-

ID: 1735744
Sex: F
Age: 54
State: AZ

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 09/26/2021
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: see 2nd sheet

Allergies: Codeine,Flu Vaccine,Lamisil,terbina

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

Symptoms: PVC's, headaches,systemic reaction,inflammatory reaction,Joint pain,fatigue, vertigo, Arm pain,arm tingles,facial spasms RT side,hand spasms,neck pain,tinnitus,ears plugged,shortness of breath,chest pain,sinus pressure, head and neck pressure,muscle pain, hand & feet cramping, Since the Covid vaccine I have been diagnosed with Fibromyalgia, PVC's 15% of heart rate,migraine/headache disorder,Tinnitus, central sensitization. I have ongoing care on a weekly, monthly basis for an undetermined time frame. Have been told that the Fibromyalgia is a life long chronic illness with NO cure.

Other Meds: B-12 complex, VitaminD

Current Illness: NONE

ID: 1735746
Sex: M
Age: 39
State: GA

Vax Date: 09/11/2021
Onset Date: 09/11/2021
Rec V Date: 09/26/2021
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: I am employed and was coerced under threat to take these experimental vaccines, even though I already had natural immunity from prior infection. So, after I took it, some time at night after receiving the injection, I proceeded to have high fever, violent shivering and projectile vomiting. It lasted all night and me and my wife were not certain I'd make it through the night. The 2 weeks proceeding just left me drained and feeling like a cancer patient. I am now starting to slowly feel like my normal self. That is if no long-term side effects develop because these vaccines are experimental.

Other Meds:

Current Illness:

ID: 1735747
Sex: F
Age: 40
State: NC

Vax Date: 12/27/2020
Onset Date: 01/01/2021
Rec V Date: 09/26/2021
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: Penicillin, latex

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

Symptoms: Starting 4 days after receiving the first Covid vaccine, my daughter stopped wanting to breastfeed. She said that the milk tasted like plastic and that it didn't taste right. She said the same thing for several days in a row, at which point she stopped wanting to nurse. Within a month of the first vaccine, and ongoing ever since, my menstrual cycles have been irregular. The start date of my cycle varies up to a two week difference, which had been very regular before I received the vaccine. The bleeding is inconsistent, may be very heavy one month and light the next. I have frequent night sweats. The night sweats started in January, a week before my period started. This has changed over time, and I now have night sweats any time during the month. I also have frequent problems with constipation, a problem that I have never had before I received the vaccine. I now have frequent headaches, at least 3-4 per week. This was not an issue before the vaccine.

Other Meds: None

Current Illness: None

ID: 1735748
Sex: F
Age: 32
State: AZ

Vax Date: 08/11/2021
Onset Date: 08/18/2021
Rec V Date: 09/26/2021
Hospital:

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

Lab Data: Audio test: showed hearing loss MRI: nothing found

Allergies: None

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

Symptoms: 1 week after vaccination: left ear feeling of fullness and over all fatigue left ear still full went to urgent care and said there was fluid. Prescribed steroids 20mg for 5 days. During course of steroids no change. Week 2: ear still full, noticing hearing loss in ear. Goes to ent gets audio test and has noticeable hearing loss. Prescribed steroids 10days 40mg tapper. Week 3-4 : steroids helped and obvious inner ear inflammation has gone down. Hearing test again hearing has come back.

Other Meds: Nexplinon

Current Illness: None

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am