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: 1736288
Sex: M
Age: 36
State: FL

Vax Date: 08/10/2021
Onset Date: 09/27/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data: None

Allergies: None that I know of

Symptom List: Dysphagia, Epiglottitis

Symptoms: The night of second Covid vaccine I fainted after urinating, fell on my face and tried to stand up 2 times but couldn't, my ears where ringing and I felt like vomiting right before. About 2 days after the vaccine I'm having panic attacks and bad anxiety that isn't going away and I'm continuing to have done then. I started taking Lexapro and Xanax to help but the anxiety still persist and not getting any relief.

Other Meds: None

Current Illness: None

ID: 1736289
Sex: M
Age: 38
State: WA

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 09/27/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: Urgent care: 9/26/2021 at 7:50 pm:

Allergies: None known

Symptom List: Anxiety, Dyspnoea

Symptoms: Morning flu vaccination given at vaccination site: Covid-19 Vaccinator for 2021 Flu Vaccine (without Covid-19 shot) on Saturday, Sep 25, 2021 at 10:00 AM. By evening facial swelling, the next day more extreme swelling, and evening urgent care appointment for Bells Palsy. A recurrence from four years prior, also potentially linked to flu vaccine (around the same time of year). Steroids (prednisone) prescribed at urgent care Sunday night at 8 pm.

Other Meds: Ketoconazole - topological

Current Illness: None

ID: 1736448
Sex: F
Age: 45
State: CO

Vax Date: 09/13/2021
Onset Date: 09/22/2021
Rec V Date: 09/27/2021
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: EKG, troponin level, d-dimer, chest x-ray, bedside echocardiogram

Allergies:

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

Symptoms: Pericarditis, no myocardial involvement, no effusion, treated with NSAIDs and colchicine

Other Meds:

Current Illness:

ID: 1736449
Sex: M
Age: 45
State: FL

Vax Date: 01/20/2021
Onset Date: 01/31/2021
Rec V Date: 09/27/2021
Hospital: Y

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

Lab Data: extensive imaging and basic labs other than a comprehensive autoimmune workup has not been performed

Allergies: none

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: chronic dyspnea now, atrial fibrillation, paresthesias

Other Meds: Approximately 2.5 weeks after vaccination, I developed chronic sob to this day requiring ER visit on Feb 18, 2 months after that neurologic symptoms similar to MS requiring hospitalization and then ER visit for eye pain and visual change

Current Illness: none

ID: 1736450
Sex: F
Age: 19
State: VT

Vax Date: 04/20/2021
Onset Date: 05/10/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data: Blood/Urine work (multiple times) Cat Scan Upper Endoscopy Small Bowel Follow Through/ Upper GI

Allergies:

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

Symptoms: Constant severe nausea, severe abdominal burning and cramping, vomiting, loss of appetite, weight loss, severe lymph node pain in arm, neck, shoulder leading to nerve pain in arm.

Other Meds: Omeprazole Northethindrone Acetazolamide

Current Illness:

ID: 1736451
Sex: M
Age: 82
State: OH

Vax Date: 02/25/2021
Onset Date: 09/20/2021
Rec V Date: 09/27/2021
Hospital: Y

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

Lab Data:

Allergies: avelox

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

Symptoms: hospitalized with covid

Other Meds: unknown

Current Illness: unknown

ID: 1736452
Sex: F
Age: 73
State: CO

Vax Date: 09/26/2021
Onset Date: 09/27/2021
Rec V Date: 09/27/2021
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: Keflex

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Mild headache, nausea

Other Meds: Lots

Current Illness:

ID: 1736453
Sex: F
Age: 62
State: NY

Vax Date: 05/03/2021
Onset Date: 05/09/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data: Elevated D Dimer 550 ng/ml FEU 9/24/21

Allergies: None

Symptom List: Pharyngeal swelling

Symptoms: Chest pains 2 incidents one 6 days after and one 20 weeks later Elevated D Dimer CT scan clear Reason for chest pains undetermined further testing to be performed

Other Meds: Atenolol Vitamin D3 Losartan Centrum Senior

Current Illness: None

ID: 1736454
Sex: M
Age: 65
State: TX

Vax Date: 06/15/2021
Onset Date: 06/15/2021
Rec V Date: 09/27/2021
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: Error: Booster Given Too Early-

Other Meds:

Current Illness:

ID: 1736455
Sex: M
Age: 60
State: TX

Vax Date: 07/03/2021
Onset Date: 07/03/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Error: Booster Given Too Early-

Other Meds:

Current Illness:

ID: 1736456
Sex: F
Age: 13
State: TX

Vax Date: 08/04/2021
Onset Date: 08/04/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Error: Booster Given Too Early-

Other Meds:

Current Illness:

ID: 1736457
Sex: F
Age: 27
State: CA

Vax Date: 09/26/2021
Onset Date: 09/26/2021
Rec V Date: 09/27/2021
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: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-

Other Meds:

Current Illness:

ID: 1736458
Sex: F
Age: 48
State: TX

Vax Date: 07/09/2021
Onset Date: 07/09/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Error: Booster Given Too Early-

Other Meds:

Current Illness:

ID: 1736464
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/27/2021
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: Test Name: Oxygen saturation; Result Unstructured Data: never below 96

Allergies:

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

Symptoms: SUSPECTED CLINICAL VACCINATION FAILURE; SUSPECTED COVID-19 INFECTION; This spontaneous report received via social media from a 65 year old patient of unspecified sex, race and ethnicity. The patient's height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown, Expiry: Unknown) 1 total, dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date (reported as 3 months after getting vaccinated), the patient got the virus (suspected clinical vaccination failure) and because of the vaccine, patient didn't end up in the hospital. The patient reported of having mild symptoms (suspected covid-19 infection). Laboratory data (dates unspecified) included: Oxygen saturation (not provided) never below 96. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the suspected clinical vaccination failure and suspected covid-19 infection was not reported. This report was serious (Other Medically Important Condition).; Sender's Comments: V0. 20210946648-COVID-19 VACCINE AD26.COV2.S- Suspected clinical vaccination failure. This event is considered not related. The event has an compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the events than the drug. Specifically: SPECIAL SITUATIONS

Other Meds:

Current Illness:

ID: 1736465
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/27/2021
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:

Allergies:

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

Symptoms: SWOLLEN LEG; UNABLE TO WALK; This spontaneous report received from a patient via company representative concerned a female of unspecified age, race and ethnicity. The patient's height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown, Expiry: Unknown) 1 total, dose not reported, start therapy date were not reported for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date, patient was hospitalized (date unspecified) for 9 days immediately after receiving the Janssen Covid-19 vaccine with swollen leg and was unable to walk. The patient reports that she will be receiving physical therapy to help her recover. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the swollen leg and unable to walk was not reported. This report was serious (Hospitalization Caused / Prolonged).; Sender's Comments: V0: 20210946668-covid-19 vaccine ad26.cov2.-swollen leg, unable to walk. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).

Other Meds:

Current Illness:

Date Died: 09/01/2021

ID: 1736466
Sex: M
Age:
State:

Vax Date:
Onset Date: 09/01/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: DEATH; .This spontaneous report received from a consumer via a company representative via social media concerned a male of unspecified age. The patient's height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown, expiry date; Unknown) dose was not reported, 1 total administered, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On SEP-2021, the patient experienced death from unknown cause. Reporter stated that "attending a funeral this Saturday for a fully vaccinated man". It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender's Comments: V0: 20210946753-covid-19 vaccine ad26.cov2.s-death. This event(s) is considered unassessable. The event(s) has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH

Other Meds:

Current Illness:

ID: 1736467
Sex: F
Age:
State: OH

Vax Date:
Onset Date: 09/23/2021
Rec V Date: 09/27/2021
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: EXPIRED VACCINE ADMINISTERED; This spontaneous report received from a health care professional concerned a 58 year old female. The patient's height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 202A21A, and batch number: 202A21A expiry: 21-SEP-2021) dose was not reported, administered on 23-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 23-SEP-2021, the patient experienced expired vaccine administered. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of expired vaccine administered was not reported. This report was non-serious.

Other Meds:

Current Illness:

ID: 1736468
Sex: F
Age: 14
State: NV

Vax Date: 09/26/2021
Onset Date: 09/26/2021
Rec V Date: 09/27/2021
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: Systemic: Headache-Severe, Systemic: Nausea-Severe, Systemic: Vomiting-Severe, Additional Details: advised pt mom to get tylenol and emetrol. if problems persist, recommended to go to urgent care

Other Meds:

Current Illness:

ID: 1736469
Sex: F
Age: 39
State:

Vax Date: 09/17/2021
Onset Date: 09/24/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data: Myoglobine : 21 (25-28) 1st Troponine T ultrasensible: 18 ( <14) 2nd Troponine T ultrasensible:4

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: I had very strong left arm and hand pain with very strong heart pain. Still have heart and left arm and hand pain, especially at the midnights. Sometimes I have headche also. 3 days ago at the midnight I waked up with high blood pressure with red flushing face. Normally my blood pressure is low. My face is usually red since from 5 or 6 days. At the emergency center they made some tests. My troponine t level was 18 which was supposed to be under 14 but at the second test it was normal. And myoglobin level was 21 which is supposed to be over 25. Normally I?m healthy, I don?t have any immune issue or heart disease problem. I have only histamine intolerance but I obey to histamine diet and sometimes using daosin enzyme. I have Th1 dominance. My il2, il6 are high. Because of that I had ivig serum but I still had miscarriage 3 weeks ago. And the doctor performed anti D injection, it was 2 weeks ago before pfizer vaccination.

Other Meds:

Current Illness:

ID: 1736470
Sex: F
Age: 61
State: NC

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 09/27/2021
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: Systemic: Allergic: Anaphylaxis-Mild, Systemic: Chest Tightness / Heaviness / Pain-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Shakiness-Medium, Systemic: Tachycardia-Medium, Additional Details: 5 min post vaccine pt stated she felt hot all over. Gave her a cold bottle of water. 10 min post vaccine pt stated she felt like her heart was beating rapidly. Gave her Benadryl and told her she would have to wait 30 minutes. 20 min post vaccine pt said she felt her chest was getting tight. I called EMS and was about to administer Epiephrine but they arrived before I gave it. They examined her and ask if she wanted to go to the hospital to be seen by doctor. Pt ok today 9/26/21

Other Meds:

Current Illness:

ID: 1736471
Sex: M
Age: 14
State: MA

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 09/27/2021
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: COVID and Strep negative

Allergies: none

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

Symptoms: hives started on elbows saturday afternoon. When he woke up Sunday his feet, elbows, knees and hands were covered with hives. Started taking Benadryl Q6hr, seen by pediatrian. Had Covid and strep test both negative. Sunday afternoon hives on ears, neck and face.

Other Meds: Nutropen (growth hormone) Minocycline (acne) Adderrall (did not take on day of vaccine)

Current Illness: none

ID: 1736472
Sex: F
Age: 28
State: FL

Vax Date: 08/30/2021
Onset Date: 08/31/2021
Rec V Date: 09/27/2021
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: Augmentin, all grains, dairy, legumes, soy, high-oxalate plant foods

Symptom List: Unevaluable event

Symptoms: Approximately 6 hours after receiving the vaccine I experienced the typical chills, followed by fever (around 9pm). Then, I experienced pulsating muscle pain that radiated out of my lower back; it was excruciatingly painful. Then, I experienced migraines that were on & off the entire night. In the morning around 4am, since I was unable to sleep more than 4 hours, I had difficulty walking. Not only did I feel weak, but my legs began feeling numb. Within 24 hours, those symptoms went away (praise God), but I almost became paralyzed. I could not stop crying with how much pain I was in. In addition, for 3 weeks after the vaccine, I would get a headache each morning upon waking. I do not have a history of any of these symptoms.

Other Meds: N/A

Current Illness: N/A

Date Died: 09/21/2021

ID: 1736473
Sex: M
Age: 88
State: KY

Vax Date: 02/25/2021
Onset Date: 09/21/2021
Rec V Date: 09/27/2021
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:

Allergies: None

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

Symptoms: Weakness, achy, increased signs of dementia, fatigue, confusion, stomach pain, headaches (which he had never had his whole life). About 6 months later, developed pneumonia, tested positive for COVID-19. Death on 9/21/2021.

Other Meds: Lotrel, one-a-day multivitamin

Current Illness: None

ID: 1736474
Sex: F
Age: 17
State: TX

Vax Date: 09/05/2021
Onset Date: 09/06/2021
Rec V Date: 09/27/2021
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: Systemic: Chest Tightness / Heaviness / Pain-Mild, Additional Details: Patient had some chest pain & dyspnea the day after the shot. It was sporadic throughout the whole day & came in waves. She had COVID a year ago & experienced moderate chest pain & dyspnea back then. Recent chest pain wasn't as bad as the COVID pain. All symptoms resolved the following day. Chest pain lasted 1 day.

Other Meds:

Current Illness:

ID: 1736475
Sex: M
Age: 22
State: CA

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

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Error: Incorrect Reconstitution-

Other Meds:

Current Illness:

ID: 1736476
Sex: M
Age: 24
State: TN

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 09/27/2021
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: Systemic: Numbness (specify: facial area, extremities)-Medium, Additional Details: numbness in middle and ring finger on left arm

Other Meds:

Current Illness:

ID: 1736477
Sex: F
Age: 35
State: CA

Vax Date: 09/08/2021
Onset Date: 09/09/2021
Rec V Date: 09/27/2021
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: Systemic: Abdominal Pain-Medium, Systemic: Diarrhea-Medium, Systemic: Fever-Medium, Systemic: Vomiting-Severe

Other Meds:

Current Illness:

ID: 1736478
Sex: F
Age: 62
State: FL

Vax Date: 09/20/2021
Onset Date: 09/24/2021
Rec V Date: 09/27/2021
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: Systemic: Allergic: Rash Generalized-Medium, Additional Details: patient reports that has head to toe rash. refused to take benadryl as says give vertigo. recommended to take an anithistamine asap and if no improvement seek the attention of a doctor

Other Meds:

Current Illness:

ID: 1736479
Sex: F
Age: 36
State: NH

Vax Date: 09/23/2021
Onset Date: 09/18/2021
Rec V Date: 09/27/2021
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: Many foods/Linalool/Fragrance

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

Symptoms: Breakthrough bleeding and clotting mid cycle

Other Meds: NA

Current Illness: Hypothyroidism

ID: 1736480
Sex: F
Age: 40
State: SC

Vax Date: 09/21/2021
Onset Date: 09/26/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data:

Allergies: Penecilin sensitivity only known allergy besides seasonal allergies

Symptom List: Nausea

Symptoms: Period/cycle came 5 days after the second dose. Cramping started within 48 hours of the shot along with irritability.

Other Meds: None

Current Illness: None

ID: 1736481
Sex: M
Age: 54
State: NY

Vax Date: 08/30/2021
Onset Date: 08/31/2021
Rec V Date: 09/27/2021
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: Systemic: Allergic: Rash Generalized-Medium

Other Meds:

Current Illness:

ID: 1736482
Sex: F
Age: 61
State: NC

Vax Date: 08/30/2021
Onset Date: 08/30/2021
Rec V Date: 09/27/2021
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: Site: Pain at Injection Site-Medium, Additional Details: PAtient has been complaining of signigicant pain in her left arm. Unable to lift over her head. Has been on going since vaccination. Recommended to patient to see MD. She states that is feels like there is "another muscle" on her arm as well

Other Meds:

Current Illness:

ID: 1736483
Sex: F
Age: 48
State: AZ

Vax Date: 09/22/2021
Onset Date: 09/23/2021
Rec V Date: 09/27/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: NONE

Allergies: Allergic to Levaquin, CT Scan Dye, and Shellfish

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

Symptoms: I had/have swollen glands in my arm pits that sill is persisting on 9/27/21. The glands hurt when being touched as well as when when not.

Other Meds: Valtrex, Blio-Fi, Omneprazole, Amolodipine

Current Illness: NONE

ID: 1736484
Sex: F
Age: 53
State: NY

Vax Date: 09/26/2021
Onset Date: 09/26/2021
Rec V Date: 09/27/2021
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: Site: Swelling at Injection Site-Severe, Additional Details: arm very swollen - entire length arm. no other side effects.

Other Meds:

Current Illness:

ID: 1736485
Sex: M
Age: 67
State: IN

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 09/27/2021
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: Sulfa

Symptom List: Erythema, Pruritus

Symptoms: Extreme fatigue, digestive -stomach upset, chills, gas

Other Meds: Allopurinal, diprydimal, statin, sodium bicarbonate,thyroid med,

Current Illness: Allergies

ID: 1736486
Sex: M
Age: 40
State: NC

Vax Date: 07/25/2021
Onset Date: 07/25/2021
Rec V Date: 09/27/2021
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: Booster Given Too Early-

Other Meds:

Current Illness:

ID: 1736487
Sex: F
Age: 27
State: IL

Vax Date: 09/26/2021
Onset Date: 09/26/2021
Rec V Date: 09/27/2021
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: Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Mild, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Mild, Systemic: Numbness (specify: facial area, extremities)-Mild, Systemic: Tingling (specify: facial area, extemities)-Mild, Additional Details: Pt recieved flu then covid vaccine, said she didnt feel good and fainted. LOC for 6 seconds, woke up with nausea. Pt given juice and water and ice pack. Pt felt better after 15 minutes. Pt reported N/V, tinginling in fingers, flushing of face, loss of color to face, and ears felt on fire.

Other Meds:

Current Illness:

ID: 1736488
Sex: M
Age: 55
State: FL

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data: None

Allergies: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: This was the 2nd shot of the 2-shot MODERNA regimen. I received the expected headache and sore arm within a few hours after the injection, they were expected. What began happening about 24 hours after the injection was this: I could literally feel the vaccine move through my kidneys, then my lungs, then down my spine over the course of about 8 hours with inflammation and a fever. What happened next was frightening, it felt as if 10,000 knives were being thrust in to my chest and back. Breathing was difficult and painful. This went on for a few hours. I was unable to find my phone to call anyone or emergency help. Over the course of 48 hours during all this I lost 8 pounds from sweating. It was after about 48 hours that the fever broke and all pain subsided.

Other Meds: Aripiprazole, Bupropion, Lamotrigine, Pravastatin, Omeprazole

Current Illness: None

ID: 1736489
Sex: M
Age: 69
State: FL

Vax Date: 03/05/2021
Onset Date: 03/06/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data: CT of head 4/9/2021 at Clinic Various bloodwork and labs via PA

Allergies: Darvocet, morphine cause nausea, vimiting

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

Symptoms: Chronic severe headache continuing to present; stiff neck causing inability to turn head; red rash on left side of head and in left ear canal with extreme pain and tenderness; swollen lymph nodes left side; extreme weakness continuing to present; light headedness continuing to present; shortness of breath; feeling of anxiety and nervousness; fever immediately following injection and lasting for 4 days

Other Meds: Metformin 500mg Famotidine 40mg

Current Illness:

ID: 1736490
Sex: M
Age: 90
State: KY

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

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: hospitalization (non-ICU)

Other Meds:

Current Illness:

ID: 1736491
Sex: F
Age: 27
State: OH

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/27/2021
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: Bee pollen

Symptom List: Pain in extremity

Symptoms: Adverse event: Severe bilateral hip joint pain and inflammation that left me unable to walk and unable to conduct normal life functions without severe pain for approximately 38 hours. Treatment: Over the counter pain relief, heating pad, ice packs, laying flat on my back. Outcomes: At around 38 hours after the onset of the severe bilateral hip joint pain and inflammation that left me unable to walk and unable to conduct normal functions without severe pain the pain subsided.

Other Meds: Lamictal Cardizem Synthroid Metformin Vitamin D2

Current Illness: None

ID: 1736492
Sex: M
Age: 11
State: MI

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

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 2
Vax Route:
Vax Site:

Lab Data: none

Allergies: none

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

Symptoms: gave Meningococcal B vaccination to early, no symptoms, patient is doing well.

Other Meds: none

Current Illness: none

ID: 1736493
Sex: F
Age: 45
State: CO

Vax Date: 05/05/2021
Onset Date: 05/06/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data: September 2021 various routine blood tests including hormone and thyroid returned results within normal ranges

Allergies: Composine Sulfasalazine Wheat/gluten

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

Symptoms: Missed ovulation cycles followed by prolonged periods of heavy bleeding May 2021 - September 2021. .

Other Meds: None

Current Illness: None

ID: 1736494
Sex: M
Age: 30
State: PA

Vax Date: 09/25/2021
Onset Date: 09/26/2021
Rec V Date: 09/27/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: Fever of 103 degrees for roughly 3 hours followed by fever lowering to 100 degrees for roughly 16 hours with severe headache, nausea, and vomiting. Strong soreness in joints from shivering with fever.

Other Meds: Xyzal

Current Illness: None

Date Died: 09/22/2021

ID: 1736654
Sex: M
Age: 98
State: KY

Vax Date: 01/18/2021
Onset Date: 09/14/2021
Rec V Date: 09/27/2021
Hospital: Y

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

Lab Data: 9/14: Respiratory Panel PCR w/COVID-19(SARS-CoV-2) - + for COVID 19 and RSV by PCR

Allergies: None

Symptom List: Vomiting

Symptoms: Pt s/p fall on 9/6 and seen in ED. Pt is resident of assisted living facility. Returned on 9/14 with general body weakness, wheezing and dry cough x 5 days. Testing for RVP in the ED is positive for COVID 19 and RSV coinfection

Other Meds: Unknown

Current Illness: None

ID: 1736655
Sex: F
Age: 66
State: KY

Vax Date: 03/17/2021
Onset Date: 09/25/2021
Rec V Date: 09/27/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: hospitalization (non-ICU)

Other Meds:

Current Illness:

ID: 1736657
Sex: F
Age: 48
State: GA

Vax Date: 09/24/2021
Onset Date: 09/25/2021
Rec V Date: 09/27/2021
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: n/a

Allergies: Doxycycline and simvastatin

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

Symptoms: Red, warm, swollen vaccine site day after vaccine. Fever/chills/headache developed 2 days after vaccine.

Other Meds: Multivitamin

Current Illness: Cold about 3 weeks prior.

ID: 1736658
Sex: F
Age: 76
State: KY

Vax Date: 03/17/2021
Onset Date: 09/26/2021
Rec V Date: 09/27/2021
Hospital: Y

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: hospitalization (non-ICU)

Other Meds:

Current Illness:

ID: 1736659
Sex: F
Age: 28
State: KY

Vax Date: 08/01/2021
Onset Date: 08/27/2021
Rec V Date: 09/27/2021
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: patient presented to the ED with headache, fever, nausea and vomiting

Other Meds:

Current Illness:

ID: 1736660
Sex: M
Age: 59
State: KY

Vax Date: 09/01/2021
Onset Date: 09/27/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data: labs were done, however; the patient left AMA

Allergies:

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

Symptoms: Patient presented to the ED with chest pain that started one week after the vaccine.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am