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: 1735800
Sex: F
Age: 62
State: FL

Vax Date: 09/22/2021
Onset Date: 09/26/2021
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:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient called stating that she received her flu vaccine and today experiencing chills, headache and runny nose. Advised patient to follow up with doctor. Per patient she is seeing her doctor tomorrow.

Other Meds:

Current Illness:

ID: 1735801
Sex: M
Age: 17
State: TX

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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

Symptom List: Anxiety, Dyspnoea

Symptoms: Dizzy, sweaty and tingling in both hands.

Other Meds: None

Current Illness: None

ID: 1735803
Sex: F
Age: 19
State: NC

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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Patient was conscious enough to tell me what she was experiencing. We sat her up on a chair and gave her water and checked to make sure she was improving and vitals stable. She said she had experienced this one or two other times in the past when she gave blood. It was explained that giving an Epipen is an option, but this was denied and the patient and her patient decided to wait and continue to drink cold water. Calling 9-1-1 was offered but this was denied and she said she would go to a nearby urgent care if anything. After sitting for another 15 minutes and drinking water, her symptoms did improve. Her sigh was back to normal, no more sweating, and her hearing eventually came back to normal. She was able to stand and walk out on her own and looking visably better. Later on, it was reported that she is doing fine and it seemed to be a short episode post vaccine.

Allergies: no allergies

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

Symptoms: Patient fainted for approximately 1-2 minutes, then regained consciously slowly back to a normal state. She was sweating profusely (visably), lost eye sight briefly when fainting, and had ringing in her ears that lasted while she was regaining full consciousness. She was pale with whitish lips.

Other Meds: none listed

Current Illness: none listed

ID: 1735804
Sex: F
Age: 63
State: NY

Vax Date: 03/21/2021
Onset Date: 03/21/2021
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: none

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Body aches, muscle pain, headaches that continue to this day, fatigue that continues to this day, high fevers (103.7 - 103.9) for 4 days, temperatures of 101 for 2 days, shaking chills and night sweats for 3 weeks, lips and mouth full of sores for 2 weeks.

Other Meds: none

Current Illness: none

ID: 1735805
Sex: M
Age: 44
State: CA

Vax Date: 04/10/2021
Onset Date: 04/18/2021
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: Blood tests show no abnormalities. Blood pressure is normal in all situations except when standing at which time spikes in blood pressure and heart rate are recorded. Dr. recommendations were to hydrate additionally which has not changed any of the side effects which are still ongoing 6 months later.

Allergies: none

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

Symptoms: Ongoing dizziness and elevated heart rate when standing up. Multiple episodes of losing vision during light headlines. Near miss with multiple episodes of loss of consciousness.

Other Meds: none

Current Illness: none

ID: 1735806
Sex: M
Age: 15
State: IN

Vax Date: 09/24/2021
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: NKDA

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

Symptoms: Mom reports a large swollen armpit ("hard knot") on the left (vaccine) side, accompanied by fever/aches/headache. Unsure if lymph node/axilla swelling is related to vaccine but the other symptoms were expected while the swelling not at vaccine site was not

Other Meds: None

Current Illness: NOne

ID: 1735807
Sex: F
Age: 74
State: WA

Vax Date: 01/28/2021
Onset Date: 04/04/2021
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: Ultrasound, D-Dimer, CBC, Electrolytes

Allergies: Scallops

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Deep vein thrombosis left calf

Other Meds: Levothyroxine, anastrozole, amlodipine, rosuvastin, hydrochlorthiazide, multivitamin, turmeric, calcium

Current Illness: None

ID: 1735808
Sex: F
Age: 69
State: FL

Vax Date: 09/20/2021
Onset Date: 09/21/2021
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: none

Symptom List: Pharyngeal swelling

Symptoms: red swollen arm

Other Meds:

Current Illness:

ID: 1735809
Sex: F
Age: 40
State: WI

Vax Date: 09/20/2021
Onset Date: 09/20/2021
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: Albuterollocal swelling Bupropion HclOther - see Comments Entecavirheadache/dizziness Tiotropiumlocal swelling Tramadol-acetaminophenOther - see Comments Acetaminophennausea/vomiting Alginate [Alginic Acid]pruritic/watery eyes Amitriptylineheadache/dizziness Codeinenausea/vomiting Doxycyclinenausea/vomiting Erythromycinlocal swelling, Other - see Comments Ibuprofennausea/vomiting Neomycin-polymyxin-dexamethlocal swelling Nsaidsdiarrhea/abdominal cramping Prednisolonepruritic/watery eyes Prochlorperazinenausea/vomiting Tobramycinhives/rash/itching Topiramateheadache/dizziness, hives/rash/itching Trazodoneheadache/dizziness Atropine Sulfate Bactrim [Sulfamethoxazole-trimethoprim]Other - see Comments Benadryl [Diphenhydramine Hcl] Cyclobenzaprinemuscle aches Diphenhydramine GadoliniumOther - see Comments Hydrocodone HyoscyamineOther - see Comments Iodinated Diagnostic Agents Metrizamide Neurontin [Gabapentin] Tessalon [Benzonatate]muscle aches Zolpidem Belladonna Alkaloids Duloxetine Hcl Mirtazapine

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: hypokalemia, myalgia, severe lightheadedness/dizziness, nausea and vomiting

Other Meds: Tylenol, Ciprofloxacin, Gabapentin, Ibuprofen, Zofran,

Current Illness: Coag and Thromboembolic Superficial thrombophlebitis ENT Pain, dental Eye Unqualified visual loss, both eyes Clinical anophthalmos, bilateral Congenital glaucoma Eye pain, right Ocular inflammation Endocrine and Metabolic Vitamin D deficiency Thyroid enlarged Gastrointestinal and Abdominal Hepatitis B carrier Gastroesophageal reflux disease Hemorrhoids Hepatitis B virus infection Genitourinary and Reproductive History of hysterectomy Retention of urine Hypokalemia Infectious Diseases Oral herpes Mental Health Anxiety Bipolar I disorder Borderline personality disorder Drug-seeking behavior History of opioid abuse Depressive disorder Posttraumatic stress disorder Suicidal ideation Opioid use disorder Musculoskeletal and Injuries Right shoulder pain Articular cartilage disorder of right knee Pain of both shoulder joints Neuro Exacerbation of multiple sclerosis Epileptic seizure Chronic pain Ataxic gait Pulmonary and Pneumonias Pulmonary emphysema Recurrent aspiration pneumonia Symptoms and Signs Acute pain Abnormal drug screen Dizziness

ID: 1735810
Sex: M
Age: 64
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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: The patient received his primary series of Pfizer covid-19 vaccines on 04/01/2021 and 04/22/2021. He denied receiving any Covid-19 vaccine prior to the date of immunization on 9/26/2021. He received his booster dose less than six months after he received his primary series.

Other Meds:

Current Illness:

ID: 1735811
Sex: F
Age: 56
State: VA

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

Lab Data:

Allergies: Welbutrin Viibryd

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

Symptoms: Severe headache, shaking chills, fever (103), diuresis, moderate local pain at injection site, body aches. I have migraines yet the headache experienced was like no other headache I've had. The pain was intense squeezing pressure deep in the center of head where pressure was felt in cheekbones, jaw and upper neck. I also felt like I was delirious and couldn't concentrate.

Other Meds: atorvastatin aspirin

Current Illness: none

ID: 1735812
Sex: F
Age: 28
State: WA

Vax Date: 09/25/2021
Onset Date: 09/26/2021
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: None. Emergency room visit with visual exam

Allergies: CT contrast dye

Symptom List: Rash, Urticaria

Symptoms: Throat swelling. Delayed 11 hours after vaccine

Other Meds: Full spectrum CBD 25mg gummies

Current Illness: None

ID: 1735813
Sex: M
Age: 17
State: OH

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

Symptoms: 17 year and 8 month old male patient was inadvertently given the Flublok vaccine instead of the Fluarix vaccine. No immediate reaction noted. Attempted to call patient/parent to follow up, but unable to reach at this time.

Other Meds:

Current Illness:

ID: 1735814
Sex: F
Age: 88
State: IL

Vax Date: 03/06/2021
Onset Date: 08/16/2021
Rec V Date: 09/26/2021
Hospital: Y

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: Pt received Pfizer x2. Pt tested COVID + on 8/16/21 and admitted to hospital for COVID on 8/16/2021. Pt was on room air and did not receive remdesivir or dexamethasone. Pt was enrolled in hospice on 8/22/2021.

Other Meds:

Current Illness:

ID: 1735815
Sex: F
Age: 11
State: HI

Vax Date: 06/01/2017
Onset Date: 06/01/2017
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: only clinic visit as we were traveling

Allergies: red dye

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

Symptoms: sore arm after vaccine, fever onset the next day. cough after a few days with worsening. no resolution for 5-6 days after antibiotics started (zpack). presumed pneumonia

Other Meds: none

Current Illness: none

ID: 1735816
Sex: M
Age: 37
State: AZ

Vax Date: 12/29/2020
Onset Date: 03/01/2021
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: None

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

Symptoms: Tinnitus. Symptoms began and worsened over the course of several months.

Other Meds: None

Current Illness: None

ID: 1735817
Sex: F
Age: 79
State: IL

Vax Date: 02/28/2021
Onset Date: 08/22/2021
Rec V Date: 09/26/2021
Hospital: Y

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: Pt received Pfizer x2. Pt tested COVID + on 8/22/21 and admitted to hospital for COVID on 8/22/2021. Pt received remdesivir and dexamethasone.

Other Meds:

Current Illness:

ID: 1735819
Sex: M
Age: 52
State: IL

Vax Date: 03/11/2021
Onset Date: 08/26/2021
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: Pt received J&J. Pt tested COVID + on 8/26/21 and admitted to hospital for COVID on 8/26/2021. Pt received remdesivir x3 doses and dexamethasone.

Other Meds:

Current Illness:

ID: 1735820
Sex: F
Age: 61
State: MA

Vax Date: 05/01/2021
Onset Date: 06/06/2021
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 to date, Physical Therapy scheduled

Allergies: Sulfer

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Muscle pain site of injection, muscle fatigue, Tricep and bicep reduction, upper body pain across shoulder blades, loss of strength in upper body

Other Meds: Levothyroxine, vitamin D, calcium, B complex

Current Illness: None

ID: 1735821
Sex: F
Age: 59
State: WA

Vax Date: 08/10/2021
Onset Date: 08/10/2021
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:

Allergies: Codeine, Metformin, aspirin

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

Symptoms: Patient states she has had swollen arm, redness, some difficulty breathing. States that she has an "invasion of her body"

Other Meds: Fish Oil, Glucosamine/Chondrointin

Current Illness:

ID: 1735822
Sex: M
Age: 81
State: IL

Vax Date: 03/12/2021
Onset Date: 08/26/2021
Rec V Date: 09/26/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Pt received Pfizer x2. Pt tested COVID + on 8/26/21 and admitted to hospital for COVID on 8/26/2021. Pt received remdesivir x4 doses and dexamethasone.

Other Meds:

Current Illness:

ID: 1735823
Sex: F
Age: 32
State: TX

Vax Date: 08/20/2021
Onset Date: 09/09/2021
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: n/a

Symptom List: Unevaluable event

Symptoms: Ringing in my ears

Other Meds: n/a

Current Illness: n/a

ID: 1735824
Sex: F
Age: 40
State: FL

Vax Date: 09/05/2021
Onset Date: 09/08/2021
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: We do not have this information

Allergies: not known

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

Symptoms: Patient stated that 3 days after getting the Pfizer vaccine that she blew her nose and had clots. This caused her concern and so she went to the ER seeking medical care. They ran test and ruled out other possibilities of what could have caused the clots and came up with the vaccine as the main cause of the clots. She stated that they did a brain scan and said that she was fine. Her md is aware of what happened and wanted her to receive the second shot which was given today on 9/26/21, but since she had COVID already as well that she will not need to get a 3rd dose. We have only given her vaccine and have not filled any regular medications for her so we do not have her medical md on file.

Other Meds: na

Current Illness: not known

ID: 1735825
Sex: F
Age: 54
State: OR

Vax Date: 08/13/2021
Onset Date: 08/13/2021
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: None

Allergies: Mango, wintergreen

Symptom List: Injection site pain, Pain

Symptoms: I am allergic to wintergreen. I have full body aches and pain for three days if I come in contact with it, even through my skin. My reaction to this vaccine felt like I was injected with wintergreen oil. I felt like I had been hit by a truck. Breathing hurt, moving hurt, speaking hurt. The feeling of anything touching my skin was painful. I was light sensitive. I was able to get through it by taking Benadryl for three days, and by the end of the third day I felt mostly back to normal enough to function. But it felt like my blood was on fire for most of the three days following the vaccination. Because I was able to handle the symptoms using benadryl, I did not seek medical attention. But when I spoke about it to my

Other Meds: None

Current Illness: None

ID: 1735826
Sex: F
Age: 30
State: TX

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: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Right after giving her the vaccination while she was waiting the 15 minutes, she had nausea. She got up and walked around and felt better. She said she was ok.

Other Meds:

Current Illness:

ID: 1735827
Sex: M
Age: 65
State: IL

Vax Date: 03/26/2021
Onset Date: 08/27/2021
Rec V Date: 09/26/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Pt received Pfizer x2. Pt tested COVID + on 8/16/21 and admitted to hospital for COVID on 8/27/2021. Pt received remdesivir x3 doses and dexamethasone.

Other Meds:

Current Illness:

ID: 1735828
Sex: F
Age: 61
State: MA

Vax Date: 03/17/2021
Onset Date: 09/17/2021
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: LA

Lab Data: 9/17 Home test 9/21 PCR test

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Tested positive for Covid19

Other Meds: omeprazole, vitamin d, flonase

Current Illness:

ID: 1735829
Sex: F
Age: 49
State: IA

Vax Date: 09/08/2021
Onset Date: 09/12/2021
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: Multiple blood test, EKG all results were good. Made appointment with my regular doctor. He increased my blood pressure meds to 20 mg and I have a follow up appointment on 9/27/21. Feel better after increase in medicine.

Allergies: penicillin and sulfa

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Began with dizziness, headache and neck pain on 09/12/2021 early evening. Took 1000 mg Tylenol to help with headache and 16 oz of water at 6 pm. Went to bed. Next day still felt dizzy and head pain, relaxed and took 1000 mg Tylenol every 8 hours to help. Went to bed around 9 pm and woke up 5 times to urinate. Each time was very dizzy, fell into the wall the 5th time (did not hit head), unstable. Heart was beating so hard I could feel it in my eyes. Head and neck pain continued. Took a neproxen and drank 6 oz of water and went back to bed. Woke up dizzy around 5:30 am and felt like I was having an out of body experience. Took blood pressure with an Advocate Model SPBP-04 with the following readings: 6:00 am 157/100, pulse 152. Drank a cold glass of water. 6:10 am 148/107, pulse 147. 6:30 am 140/98, pulse 152. Called doctor's office and they scheduled me to see a floating nurse. Nurse kept me until I could see Dr.

Other Meds: Allegra D - 24 hr; citalopram 10 mg; lisinopril 10 mg

Current Illness: none

ID: 1735830
Sex: M
Age: 60
State: IL

Vax Date: 04/14/2021
Onset Date: 08/27/2021
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: RA

Lab Data:

Allergies:

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

Symptoms: Pt received Pfizer x3. Pt tested COVID + on 8/23/21 and admitted to hospital for COVID on 8/27/2021. Pt received remdesivir and dexamethasone.

Other Meds:

Current Illness:

ID: 1735831
Sex: M
Age: 51
State: NJ

Vax Date: 09/06/2021
Onset Date: 09/09/2021
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: N/A because there is no health insurance at this time.

Allergies: N/A

Symptom List: Nausea

Symptoms: Dizziness, vomiting, and fever 3 days after the shot, starting 09/09/2021. Felt a little better the following week, (09/13/2021) then a little better this past week, (09/20/2021) with some Dizziness, light vomiting lingering. Second shot scheduled for 09/27/2021, was asked to hold off until seen by a doctor by the local department of health.

Other Meds: N/A

Current Illness: N/A

ID: 1735832
Sex: F
Age: 72
State: IL

Vax Date: 03/04/2021
Onset Date: 08/23/2021
Rec V Date: 09/26/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Pt received Pfizer x2. Pt tested COVID + on 8/22/21 and admitted to hospital for COVID on 8/23/2021. Pt received remdesivir and dexamethasone.

Other Meds:

Current Illness:

ID: 1735833
Sex: M
Age: 15
State:

Vax Date: 09/14/2021
Onset Date: 09/26/2021
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: CBC and CMP were within normal limits. D-Dimer was 4,764.75, CRP 42.9, respiratory viral panel was negative. CT with contrast was obtained which revealed 'near occlusive filling defect in distal right main pulmonary artery, concerning for PE...clot burden extends into the RUL, RML, and RLL arteries.'

Allergies: N/A

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

Symptoms: Patient reported to ED with 24 to 48 hour history of sudden onset chest pain and shortness of breath. On arrival patient was pale, diaphoretic, and hypoxic with O2 sats 60s-70s. Patient was placed on 15L HFNC. CT with contrast was obtained which revealed 'near occlusive filling defect in distal right main pulmonary artery, concerning for PE...clot burden extends into the RUL, RML, and RLL arteries.' Heparin infusion was initiated and patient was transferred to PICU for higher level of care.

Other Meds: N/A

Current Illness: N/A

ID: 1735834
Sex: F
Age: 67
State: NV

Vax Date: 09/21/2021
Onset Date: 09/21/2021
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: NONE

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

Symptoms: Healthcare & Rehabilitation did not notify the pharmacist supervising the offsite-clinic that the patient already received the third (booster) vaccine. A fourth dose was given to the patient.

Other Meds: UNKNOWN

Current Illness: BEDRIDDEN

ID: 1735835
Sex: M
Age: 20
State: KY

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

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: Patient received his first dose of Moderna in his left deltoid muscle. There was some bleeding but nothing substantial (one cotton ball-full). Patient stood up and was fine. He spoke for approximately 2 minutes before he said, "Oh, I'm starting to feel it now." He then fainted against the wall and hit his head. He was alert but very out of it and began shaking. His father grabbed him and sat him up. The patient then vomited onto the ground. His father was able to raise him up in a chair. He felt lightheaded and said this has happened before. We called 911 and he left with EMS and his family.

Other Meds:

Current Illness:

ID: 1735836
Sex: F
Age: 20
State: PR

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:

Symptom List: Erythema, Pruritus

Symptoms: After the vaccine administration, when patient was about to go to the area of observation, she reports feeling dizzy and unable to get up. She reports her arm fell asleep.

Other Meds:

Current Illness:

ID: 1735837
Sex: F
Age: 45
State: FL

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

Allergies: latex, Levaquin, sulfa.

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

Symptoms: SINCE THE VACCINE CHILLS, FEVER SWEATING, HEADACHE, TIREDNESS, DIHARREA, DIZZINESS , TINGLING SENSATION BY FORHEAD , TEMPLES AND FACE , CEREBELUM UNTIL TODAY, PLUS EARLY PERIOD AND LOTS OF BLOOD DURING PERIOD PLUS PAINFULL AND LOTS OF CRAMPS THAT NEVER HAVE BEFORE . PLUS A PRESUSURE ON MY FRONT HEAD AND SOMETIMES FAST PALPITATIONS ON MY HEARTH, AND ON MY LEFT ARM WAS VERY PEAINFULL FOR 3 DAYS AND AT TIMES I SEE LIKE LITLE STARTS IF I MOVE MY HEAD AROUND, ANXIATY .

Other Meds: none meds

Current Illness: no illnesses

ID: 1735838
Sex: M
Age: 43
State: CA

Vax Date: 06/01/2021
Onset Date: 06/02/2021
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: Ranitidine

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

Symptoms: I woke up in the middle of the night with fever and profuse sweating. I took ibuprofen to lower the fever symptoms. I was weak for 48 hs after jab.

Other Meds: Omeprazole

Current Illness: None

ID: 1735839
Sex: M
Age: 46
State: AL

Vax Date: 02/01/2021
Onset Date: 02/05/2021
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: no

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: 46 y/o male with prior hx of vaccine related myocarditis following SPV in 2005 developed chest tightness, SOB, tachycardia 4-5 days after his second Moderna vaccine. Not seen by a medical provider until 3/25/21. EKG showed ST seg elevation V1-5. ECHO normal, CRP/ESR normal. No trop drawn. Continues with mild SOB with exertion. Placed on a beta blocker for tacycardia.

Other Meds: Tnzanidine

Current Illness: no

ID: 1735840
Sex: M
Age: 51
State: NY

Vax Date: 04/25/2021
Onset Date: 08/01/2021
Rec V Date: 09/26/2021
Hospital: Y

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

Lab Data: viral test, catscan, spinal tap, etc

Allergies: none

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

Symptoms: started having severe lower back pain, then my lower lip went numb, two days later lost all control of my legs and could not walk anymore ..was found to have Guillain Barre Syndrome

Other Meds: abilify, lexapro, gabapentin, suboxone

Current Illness: none

ID: 1735841
Sex: M
Age: 52
State: MI

Vax Date: 09/25/2021
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: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Patient was mistakenly adminstered a Fluad vaccine instead of Fluarix. He is under 65 and the prescription was typed and billed for the correct vaccine but the incorrect one was given. This error was discovered after the patient left on 9/25/21. I spoke to patient on 9/26/21 and informed him of the error. I described the differences between the two vaccines and that he should not expect any side effects different than that of the standard flu vaccine he was intended to receive. I corrected his prescription records and MCIR to match the immunization he received (Fluad).

Other Meds:

Current Illness:

ID: 1735842
Sex: F
Age: 52
State: NY

Vax Date: 09/11/2021
Onset Date: 09/14/2021
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: None.

Allergies: Shellfish (Specific to Clam Only)

Symptom List: Pain in extremity

Symptoms: Disequilibrium, trouble reading and concentrating, lightheadedness and heart palpitations. Noticed in the afternoon while working at computer. I had to stop work and rest until symptoms eased about 2 hours later. These same symptoms repeated for several days before stopping. I have never had these symptoms before the vaccine.

Other Meds: Armour Thyroid

Current Illness: None

ID: 1735843
Sex: F
Age: 50
State: NY

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: No

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

Symptoms: Diarrhea

Other Meds: Vitamin D, magnesium, multivitamin, calcium, metoprolol, zoloft

Current Illness: None

ID: 1735844
Sex: F
Age: 42
State: PR

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

Lab Data:

Allergies:

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

Symptoms: Tachycardia

Other Meds:

Current Illness:

ID: 1735845
Sex: F
Age: 53
State: NY

Vax Date: 04/08/2021
Onset Date: 05/04/2021
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: Blood work 8/5/21 and MRI of right hand 8/25/21

Allergies: penicillin

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

Symptoms: By beginning of May, pain started in both feet (at the forefoot), moved up to both knees, both wrists, 2nd and 3rd PIP joints on right hand swelled up; both TMJ swollen making opening mouth difficult. In August, purple/red rash appeared on left arm around injection site, hot to the touch, sore and itchy. 2 weeks later rash appeared on side of face by left ear, also purple/red, itchy and warm. Smaller rash appearing on right side by ear now.

Other Meds: none

Current Illness: none

ID: 1735846
Sex: M
Age: 27
State: OH

Vax Date: 09/20/2021
Onset Date: 09/20/2021
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: unsure

Allergies: none

Symptom List: Vomiting

Symptoms: After receiving the vaccine, the patient was walking out of the room and collapsed hitting his face on the floor. He was breathing and had a pulse. Ems was called, he regained consciousness shortly after. Ems took him to the local hospital for evaluation.

Other Meds: unknown

Current Illness: none

ID: 1735847
Sex: F
Age: 63
State: CT

Vax Date: 04/01/2021
Onset Date: 05/01/2021
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:

Allergies: Sulfa

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Prior to my second Moderna vaccine I had a mild, localized case of granuloma annulare that was present mostly on my thighs and legs. A few weeks after the 2nd moderna vaccine my granuloma annulare became generalized and spread to my arms, trunk, neck and is covering my entire back.

Other Meds: Vitamins C, B, Calcium, Magnesium, Turmeric, D, Flonase for allergies

Current Illness:

ID: 1735848
Sex: F
Age: 73
State: CA

Vax Date: 03/16/2021
Onset Date: 06/15/2021
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: None

Allergies: Hard shellfish, such as clams, oysters. Anchovies, salmon. Sulfites cause asthema.

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

Symptoms: I had my second vaccine on March 16, 2021 and three months later, on June 15, 2021, I developed tinnitus that continues to this day (9/26/2021).

Other Meds: Levothyroxine 50 mg. at 5;45 AM; Zoloft 100 mg. at 8:00 AM

Current Illness: None

ID: 1735849
Sex: F
Age: 23
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: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None.

Symptom List: Injection site swelling, Limb discomfort

Symptoms: I went to go get my flu vaccine and was accidentally administered a Pfizer COVID vaccine. I already received my first two doses of Pfizer 02/12/2021 and 03/12/2021. Although I do not expect to have any major issues. This was an error.

Other Meds: Aurovela Fe 1/20

Current Illness: None.

ID: 1735850
Sex: M
Age: 53
State:

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

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1735851
Sex: F
Age: 33
State: GA

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

Lab Data: none

Allergies: none

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

Symptoms: Right after vaccine was given, patient started complaining of feeling nauseated. She then stated she wasn't feeling well and began to slump in the chair. Patient passed out. Ambulance was called. Patient was alert before the ambulance arrived and was coherent. EMTs took patient's vitals and determined issue was due to her not eating before getting vaccinated and having a normally low blood pressure. Vitals : bp - 112/78, pulse - 54 ( normal for patient), and oxygen - 99. EMTs observed patient until 12:22 pm and then advise patient to rest at home. I checked on patient at 6:45 pm. -- patient was feeling much better.

Other Meds: none

Current Illness: none

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am