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

Date Died: 09/22/2021

ID: 1736661
Sex: M
Age: 67
State: KY

Vax Date: 01/29/2021
Onset Date: 09/06/2021
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: IM
Vax Site: LA

Lab Data: COVID 19 + on 9/6

Allergies: Eggs/Egg derived products Fish-derived products

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient brought in by EMS admitted from the ED with difficulty breathing, altered mental status and severe hypoxemia. Pt intubated in ED and found to have bilateral basilar infiltrates - testing + for COVID 19 on PCR. Pt treated for COVID 19 from 9/6-9/13 when his medical team and family agreed that comfort care was the best option. Patient pass on 9/22.

Other Meds: Tamsulosin 0.4 mg daily MVI daily Phenytoin 50 mg (200 mg) BID Thiamine 100 mg daily Atorvastain 40 mg daily Benztropine 0.5 mg BID Donepazil 10 mg daily Memantine 10 mg BID Risperidone 1 mg BID Lorazepam 0.5 mg BID Zonisamide 100 mg daily

Current Illness:

ID: 1736662
Sex: F
Age: 76
State: KY

Vax Date: 05/20/2021
Onset Date: 05/22/2021
Rec V Date: 09/27/2021
Hospital: Y

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

Lab Data:

Allergies: Penicillian

Symptom List: Anxiety, Dyspnoea

Symptoms: LIGHT HEADED, DIZZY, COULDN'T STAND BY HERSELF, SLEPT A LOT DURING THE DAY COULDN'T TELL WHEN SHE HAD TO GO TO THE BATHROOM, COULDN'T GET OUT OF BED BY HERSELF, SOMEONE HAD TO STAY WITH HER AROUND THE CLOCK, SHE GOT A UTI IN AUGUST 2021 PUT HER IN HOSPITAL FOR 2 WEEKS AND NOW IN A NURSING HOME FOR 2 WEEKS AND SHE STILL CAN'T WALK OR STAND WITHOUT ASSISTANCE. HER SHORT TERM MEMORY STARTED THE NEXT DAY AFTER THE SHOT, AND IT STILL HASN'T RETURNED, EVEN AFTER 4 MONTHS, SEVERAL CT SCANS MRI SCANS DURING THAT 4 MONTHS AND NOTHING THAT WOULD EVEN THINK SHE HAS ANYTHING WRONG WITH BRAIN. SHE DOESN'T EVEN KNOW HOW TO ANSWER THE PHONE NOW.

Other Meds: Vitamin D, E, B-12, B-6, Co-Q10, Multi Vitamin, baby aspirin,

Current Illness: none

ID: 1736663
Sex: F
Age: 31
State: AL

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

Allergies: Sulfa antibiotics, Keflex, Rocephin, latex, rubbing alcohol, hydrocodone, burn cream, citrus, peppers, tomatoes, nickel

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

Symptoms: PT RECIEVED COVID VACCINE AROUND 1325, AFTER STATING THAT HER DOCTOR, TOLD HER TO COME HERE TO RECIEVE IT, PREVIOUS HX OF ANAPHYLAXIS QUESTIONED AND PT STATED HAD EXPIRED EPIPEN IN CAR, PT ADVISED OF S/S R/T ALLERGIC REATION TO MAKE STAFF AWARE OF WHILE WAITING FOR HER 30MIN WAITNG PERIOD. PT CAME TO THIS NURSE AFTER 10-15 MIN FOLLOWING INJECTION STATING SHE WAS FEELING ITCHY, HAD PT SIT ON BED WHILE CALLING FOR HELP, HUSBAND AT BEDSIDE, NP CAME OVER RIGHT AWAY, BEGAN TREATING PT, AROUND 1340-NP GAVE BENADRYL 50MG GIVEN TO R DELTOID, PEPCID 20MG GIVEN R DORSOGLUTEAL, SOLUMEDROL 125MG GIVEN L DORSOGLUTEAL, ALL INJECTION AREAS PREPPED WITH BETADINE PRIOR D/T PT ALLERGY TO ALCOHOL, PT STATED FELT BETTER THEN AFTER ABOUT 2/3 MIN BEGAN COUGHING, C/O CHEST TIGHTNESS, O2 APPLIED 15L VIA NASAL CANNULA, NP GAVE EPIPEN-0.3MG AT 1400, L VASTUS LATERALIS PREPPED WITH BETADINE, FOLLOWING PT WORSENING SYMPTOMS, VS AFTER INJECTION BP-SYS 120-TAKEN MANUALLY BY NP, O2-99%, HR 98-102, OXYGEN TURNED DOWN TO 2 L, PATIENT CALLED AMBULANCE TO TAKE PT TO ER, PT ALERT, AWAKE, ORIENTED UPON AMBULANCE ARRIVAL AND ABLE TO MOVE OVER TO STRETCHER WITHOUT ASSISTANCE

Other Meds: unknown

Current Illness: none

ID: 1736664
Sex: F
Age: 29
State: NY

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/27/2021
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: PATIENT REPORTED BACK TO VACCIEN CLINIC WITHIN 20 MINUTES WITH NUMBNESS IN THE LEFT ARM (SIDE USED FOR VACCCIANTION), ITCHING, UTICARIA, AND BURNING SENSATION. PATIENT ESCORTED TO ER TO BE SEEN.

Other Meds:

Current Illness:

ID: 1736665
Sex: M
Age: 34
State:

Vax Date: 08/24/2021
Onset Date: 08/25/2021
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: Chest radiograph: 9/24/2021.

Allergies:

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

Symptoms: Chronic cough onset first-day post-vaccination. Confirmed serious bronchitis. Potentially unseen atypical pneumonia.

Other Meds:

Current Illness:

ID: 1736666
Sex: F
Age: 50
State: FL

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

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

Lab Data: None, my primary doctor has not responded to any information that I have provided to him.

Allergies: Same as reported on VAERS ID: 1675629 / E-Report: 636305

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

Symptoms: September 27, 2021 New nervous system reaction: Over 20 years ago, I was diagnosed with RSD (Reflex Sympathetic Dystrophy) in my left knee. I spent over 2 years rehabbing and have had no signs of this nervous system disease until Tuesday, September 21, 2021, about 1:15 pm. While I was sitting at my desk working, sharp stabbing nerve pains in my left knee began to happen. These pains were milder than my original episode over 20 years ago and only lasted until Sunday, September 26, 2021, 10:30 am. This episode, happened quickly, like flipping a light switch on and ended quickly like, turning off a light. At this time, Monday, September 27, 2021, there is no sign of this episode. During those few days, of this episode, I reverted to treatments that I had done to help the RSD. I was even able to work out normally this morning. I have no idea if it has gone dormant again or if it will return any time soon, but I did feel it was necessary to add to my previous report (VAERS ID: 1675629 / E-Report Number: 636305). Both of these incidents have been reported to my Primary Doctor with no response. I am definitely disappointed in the no response and terrified of another injection. Thank you again for your time and I hope this information can be helpful for the future.

Other Meds: Same as reported on VAERS ID: 1675629 / E-Report: 636305

Current Illness: Same as reported on VAERS ID: 1675629 / E-Report: 636305

ID: 1736667
Sex: U
Age:
State: FL

Vax Date: 12/28/1972
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: Pyrexia, White blood cell count decreased

Symptoms: lip swelling

Other Meds:

Current Illness:

ID: 1736669
Sex: F
Age: 12
State: MI

Vax Date: 08/24/2021
Onset Date: 08/24/2021
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: LA

Lab Data: none

Allergies: none

Symptom List: Pharyngeal swelling

Symptoms: gave Meningococcal B to early, no treatment needed, no other symptoms recorded.

Other Meds: none

Current Illness: none

ID: 1736670
Sex: F
Age: 50
State: AR

Vax Date: 08/11/2021
Onset Date: 09/12/2021
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: None

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Fever, chills, sweats, sore arm, brain fog, extreme fatigue, headaches

Other Meds: Phentermine

Current Illness: Effects from having had COVID over a year ago - shortness of breath

ID: 1736671
Sex: F
Age: 32
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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Monitored my vitals and used an alcohol wipe to wake me up, made sure I ate something before releasing me and walked me out of the hospital vaccine site. The did not want to send me to the ER but they did call a rapid code initially.

Allergies: severe dust; pet dander, egg sensitivity, pollen/environmental

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Immediately I started to feel lightheaded, dizzy, nauseated. I started dry heaving, hyperventilating, had a hard time breathing, felt like I couldn't catch my breath, they tried to have me move to a different chair and when I stood up I almost collapsed. They needed to use an alcohol wipe under my nose to keep my from going unconscious. There were no vitals available, and they had to monitor me for an hour. Felt very fatigued the rest of the day, to the point where I was made to lay down at work and then sent home, and had severe headaches, slept for over 3 hours as soon as I got home. Shot was administered around 7:45 am, was monitored for an hour, was home by 12 pm from my shift, home by 12:30 and was asleep until almost 4-5 pm. Had chest pains the following few days vaccine. Have felt very weak and not myself ever since, constantly fatigued irregular hr and bp.

Other Meds: Topamax, multivitamin, probiotic

Current Illness: TBI/post concussion syndrome, tinnitus

ID: 1736672
Sex: F
Age: 80
State: OH

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

Lab Data: None

Allergies: Demerol ? beef?grass?pollen?grass & trees ? macrobid ? milk ? mold

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

Symptoms: Back ache- nausea-diarrhea (black)-sweats-chills

Other Meds: Tylenol 3 with codeine ? synthroid ? metoprolol? chlorathalidone ?lorazepam ? protonix tabs amiodipine ? magnesium oxide?potassium

Current Illness: Ademna in legs

ID: 1736673
Sex: F
Age: 74
State: PA

Vax Date: 02/17/2021
Onset Date: 09/25/2021
Rec V Date: 09/27/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Weakness. Lung and Bone Cancer. Admitted 9/25/21

Other Meds:

Current Illness:

ID: 1736674
Sex: M
Age: 56
State: KY

Vax Date: 05/11/2021
Onset Date: 09/13/2021
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: 9/13 - Covid swab + for COVID 19

Allergies: Cephalexin Levofloxacin Bactrim

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

Symptoms: Pt with hx of cirrhosis , SBP dx on 8/7 and recent dx of hepatocellular carcinoma found during admission on 7/14. Pt d/c on 8/7 with hospice and then returned to ED with increased abdominal discomfort, N/V; found to have COVID 19 + respiratory swab during routine testing. Pt was already current with hospice upon admission - admitted for symptom control and palliative care.

Other Meds: ALdactone 100 mg daily Bumex 2 mg daily Rifaxamin 550 daily Zinc 220 ER daily Lactulose 30 mL daily Levocarnitine 330 mg TID Levothyroxine 88 mcg daily MVI daily Nitroglycerin 0.4 mg SL PRN Trental 400 mg ER TID Propranolol 20 mg BID SErtra

Current Illness: SBP Pleural effusion

ID: 1736675
Sex: F
Age: 36
State: MD

Vax Date: 05/24/2021
Onset Date: 06/12/2021
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:

Allergies: Augmentin

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

Symptoms: Experienced chronic urticaria on hands and feet for 3 months after the second vaccine.

Other Meds: Modaphinal Xyzal

Current Illness: n/a

Date Died: 09/02/2021

ID: 1736676
Sex: M
Age: 68
State: GA

Vax Date: 05/24/2021
Onset Date: 08/16/2021
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: 08/12/2021 PCR+ COVID-19 test at HCF. 08/16/2021 PCR+ COVID-19 test at the Medical Center

Allergies:

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

Symptoms: Breakthrough COVID-19 case with symptom onset 8/16/2021: Fever, Shortness of breath/difficulty breathing, Nausea/Vomiting, Cough. Hospitalized 8/16/2021 to 9/2/2021. Death 9/2/2021. From Vital Records = SEPTIC SHOCK, COVID-19 PNEUMONIA, Per vital records, Codes include: Not yet coded ; Other Significant Conditions include: None listed. Place of death: HOSPITAL-INPATIENT, MEDICAL CENTER; certified by: HCP, PRONOUNCING AND CERTIFYING PHYSICIAN; occ/ind: .

Other Meds:

Current Illness:

ID: 1736678
Sex: F
Age: 53
State: FL

Vax Date: 03/23/2021
Onset Date: 07/19/2021
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: COVID-19 positive; EKG; Chest X-ray.

Allergies: Sulfa

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

Symptoms: I had excruciating headache, stuffy nose, mild cough and immediately after day of symptoms no sense of taste and smell. A week later I woke up with difficulty breathing and went into MD Now was tested. They gave me toradol for headache. My heart rate was low and my BP was low.

Other Meds: Hormone patch estradiol

Current Illness:

ID: 1736679
Sex: M
Age: 57
State: FL

Vax Date: 08/21/2021
Onset Date: 09/02/2021
Rec V Date: 09/27/2021
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: See hospital records

Allergies: None

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

Symptoms: First week in September, started feeling fatigued and sluggish. Gradually getting worse to the point of being winded when walking to the car at work. Sunday, September 19th taken to the emergency room for shortness of breath, heart rate at 40. 4:30 am on Monday, September 20th, code blue called for heart stopping. Rushed into CCU for a pacemaker, had to be transported to put in a temporary pacemaker due to vitals being unstable. Tuesday, September 21st, had pacemaker installed.

Other Meds: None

Current Illness:

ID: 1736680
Sex: F
Age: 47
State: CA

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

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Swollen lymph node, This was my 3rd shot

Other Meds: Hydrochlorothiazide, Alprazolam

Current Illness:

ID: 1736681
Sex: F
Age: 51
State: TX

Vax Date: 01/05/2021
Onset Date: 01/20/2021
Rec V Date: 09/27/2021
Hospital: Y

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

Lab Data: Had CT scan

Allergies: penicillin

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Woke up in the morning with severe chest pain. Went to ED and diagnosed with pericarditis. After second shot had same symptoms starting and started taking colchecine which I was prescribed after the first incident

Other Meds: lexapro, plaquinil, warfarin, baby aspirin, mvi, magnesium, CoQ10

Current Illness: none

ID: 1736682
Sex: M
Age: 67
State: TX

Vax Date: 04/09/2021
Onset Date: 07/23/2021
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: none

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

Symptoms: First occurrence of a-fib

Other Meds: 08/30/2021 - ONENOTE * indicates meds taken at night * amlodipine 5mg tablet /night [NORVASC] @BLOOD PRESSURE aspirin 81 mg * atorvastatin 40 mg tablet 1/night [LIPITOR] @CHOLESTEROL * carvedilol 25 mg tablet 2/day [COREG] @BLOOD

Current Illness:

ID: 1736683
Sex: M
Age: 71
State:

Vax Date: 02/11/2021
Onset Date: 09/14/2021
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:

Allergies:

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

Symptoms: Breakthrough covid case per PCR test on 9/24/2021

Other Meds:

Current Illness:

ID: 1736685
Sex: M
Age: 71
State: MN

Vax Date: 04/27/2021
Onset Date: 09/24/2021
Rec V Date: 09/27/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: Dose 2 COVID Pfizer, given 4/27/21, Dose 1 Pfizer given ER8733

Other Meds:

Current Illness:

ID: 1736686
Sex: M
Age: 83
State: MI

Vax Date: 03/18/2021
Onset Date: 09/18/2021
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: COVID-19 test positive on 9/18/2021.

Allergies: Ramipril (swelling)

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

Symptoms: Patient presented to emergency department on 9/18/2021 with a sore throat and dry cough. He was found to be COVID-19 positive and was admitted for further management. Patient was treated with dexamethasone. He was discharged home on 9/26/2021.

Other Meds: allopurinol (ZYLOPRIM) 300 MG tablet aspirin low dose 81 MG chew tablet atorvastatin (LIPITOR) 10 MG tablet carvedilol (COREG) 6.25 MG tablet diphenhydrAMINE (BENADRYL) 25 MG capsule loratadine (CLARITIN) 10 MG tablet multivitamin/beta caro

Current Illness: None known

ID: 1736687
Sex: F
Age: 45
State: FL

Vax Date: 09/22/2021
Onset Date: 09/22/2021
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: None

Symptom List: Injection site pain, Pain

Symptoms: Fever 102.3, chills, body aches, nausea, headache, fatigue.

Other Meds: None

Current Illness: None

ID: 1736688
Sex: M
Age: 65
State: WI

Vax Date: 09/23/2021
Onset Date: 09/23/2021
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: None

Symptom List: Injection site pain, Menorrhagia

Symptoms: Fatigue starting 6 hours after receiving vaccine, followed by vomiting and diarrhera that continuing until 1:00AM. Fatigue continued through the following day.

Other Meds: calcium+D3, Acetaminophen, Tamsulosin, Avorvastatin, Fenofibrate, Synthroid, Omeprazole, Prednisone, Testosterone, Asprin 81

Current Illness: None

ID: 1736689
Sex: F
Age: 47
State: IN

Vax Date: 09/24/2021
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: Penicillin

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

Symptoms: 24Sept2021: I received my first dose of Pfizer COVID 19 vaccine at 1:00 pm in my left arm intramuscular. Later that night, I experienced chills and slight headache. On 25Sept2021: I was very fatigued, chills, injection site soreness, headache and nausea that resulted to one episode of vomiting. I took ibuprofen and aleve to help with injection site soreness and headache. On26Sept2021: Headache, nausea (with no vomiting), and lymph node swelling and pain under left armpit. The swelling is tennis size and very sore to touch. 27Sept2021: I reported my AEs but still have nausea and lymph node swelling and pain under left armpit.

Other Meds: None

Current Illness: No

ID: 1736690
Sex: F
Age: 36
State: KY

Vax Date: 03/08/2021
Onset Date: 09/23/2021
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:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Moderna on 2/5 and 3/8. Positive on 9/11

Other Meds:

Current Illness:

ID: 1736691
Sex: F
Age: 83
State: GA

Vax Date: 02/11/2021
Onset Date: 09/15/2021
Rec V Date: 09/27/2021
Hospital: Y

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

Lab Data: 09/15/2021 PCR+ COVID-19 case at St Josephs Hospital Atlanta

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Breakthrough COVID-19 case with symptom onset 9/15/2021: Runny Nose/Congestion, Loss of smell or taste. Hospitalized with diarrhea 9/15/2021, admitted for at least 6 days.

Other Meds:

Current Illness:

ID: 1736693
Sex: M
Age: 56
State: AL

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:

Allergies: None

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

Symptoms: Back ache, fatigue, fever, nausea

Other Meds: None

Current Illness: None

ID: 1736694
Sex: F
Age: 55
State: KY

Vax Date: 04/22/2021
Onset Date: 09/24/2021
Rec V Date: 09/27/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: Pfizer on 4/1 and 4/22. Positive on 9/23

Other Meds:

Current Illness:

ID: 1736697
Sex: M
Age: 66
State: KY

Vax Date: 03/25/2021
Onset Date: 09/24/2021
Rec V Date: 09/27/2021
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: Pfizer on 2/25 and 3/25. Positive on 9/24

Other Meds:

Current Illness:

ID: 1736698
Sex: M
Age: 77
State: PA

Vax Date: 02/17/2021
Onset Date: 09/24/2021
Rec V Date: 09/27/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Patient tested positive on 9/24/21

Other Meds:

Current Illness:

ID: 1736699
Sex: M
Age: 56
State:

Vax Date: 03/04/2021
Onset Date: 09/24/2021
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:

Allergies:

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

Symptoms: Breakthrough covid case per PCR test on 9/24/2021

Other Meds:

Current Illness:

ID: 1736700
Sex: F
Age: 27
State: NC

Vax Date: 09/24/2021
Onset Date: 09/25/2021
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: No

Symptom List: Tremor

Symptoms: 3rd dose: Swollen underarm started about 24 hours after vaccine given, worsened at 48 hours, and still lasting on 9/27 (likely swollen lympth nodes; Ibuprofen does help the pain)--Unsure how long this will last. Noticed fever at about 24 hours after vaccine given and lasted <24 hours after 3rd shot (booster given ~7 months after 2nd dose). No Nausea.

Other Meds: Topical clindamycin and topical tretinoin (both on face for acne)

Current Illness: No

ID: 1736701
Sex: F
Age: 46
State: KY

Vax Date: 03/29/2021
Onset Date: 09/23/2021
Rec V Date: 09/27/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Pfizer on 3/8 and 3/29. Positive on 9/23

Other Meds:

Current Illness:

ID: 1736702
Sex: F
Age: 33
State: AR

Vax Date: 09/14/2021
Onset Date: 09/14/2021
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: Urinalysis

Allergies: Vicodin

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

Symptoms: About an hour after the vaccine, My throat started to really hurt, nose was sneezing and coughing. I took Allegra D and Flonase. I also had a bad headache,full body aches, ear pain, and still neck. I had no fever. My symptoms continue to worsen. My nerve disorder also flared. The symptoms of my flare up includes tingling in my legs, feeling cold or very hot, creepy crawling sensations, and restless legs. I did go see the doctor (virtual md) and was initally prescribed muscle relaxer Cyclobenzaprine for my stiff neck. I then went to a 2nd doctor (in person visit) and I was prescribed Methylprednisolone, Amoxicillin, and Fluconazole. The medications are helping and I am feeling much better. I was against taking the vaccine but my employer has mandated it.

Other Meds: Zoloft; Wellbutrin; Iron; Synthroid; Adderall

Current Illness: None

ID: 1736703
Sex: F
Age: 46
State: VA

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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: N/A

Allergies: Penicillin, Microdantin, Macrobid

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

Symptoms: Broke out in hives one day following 2nd injection of Moderna. Hives started on neck and chest and continue to move upwards towards my right and left side of neck, and down the right side of my arm (side the injection was given).

Other Meds: Zyrtec

Current Illness: None

ID: 1736704
Sex: F
Age: 65
State: FL

Vax Date: 09/17/2021
Onset Date: 09/19/2021
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: recommended patient reach out to her pcp on Monday

Allergies: no

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Left arm as warm red area around injection site

Other Meds: unknown

Current Illness: none

ID: 1736705
Sex: M
Age: 93
State: KY

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 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: Janssen on 3/9. Positive on 9/23

Other Meds:

Current Illness:

ID: 1736706
Sex: M
Age: 12
State: SD

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

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: none

Allergies: none

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

Symptoms: pt inadvertently given Moderna even though Moderna is not approved for ages 12 and over. Moderna company contacted, patient is not at and increased risk of side effects or adverse events. Per their information emailed to nurse: "If given at age 12 to 17 years as the first dose, may administer the second vaccine dose 28 days later even though it is considered off-label use."

Other Meds: none

Current Illness: none

ID: 1736707
Sex: F
Age: 58
State: MN

Vax Date: 03/05/2021
Onset Date: 04/02/2021
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: Pain in extremity

Symptoms: Patient tested positive for COVID 9/25/21

Other Meds:

Current Illness:

ID: 1736710
Sex: M
Age: 20
State: NJ

Vax Date: 09/16/2021
Onset Date: 09/17/2021
Rec V Date: 09/27/2021
Hospital: Y

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

Lab Data: 20 September: MRI (negative) 23 September: Spinal tap (elevated protein in CSF)

Allergies: None

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

Symptoms: Patient presented to clinic at approximately 0615 the morning of 17 September 2021 complaining of diplopia in both eyes. Denied any headache, vertigo, nausea, vomiting, or pain associated with diplopia. Physical exam findings were unremarkable and patient was observed for approximately one hour before being released with return precautions and artificial tears for comfort. Patient returned to clinic approximately 4 hours later complaining of increased frequency of diplopia without any associated systems. Provider boarded patient on facilities Patient Care Unit for observation. Patient had no further complaints until the afternoon of 19 September where he began to complain that his diplopia was now constant with associated headache and vertigo. Patient transported to local hospital and was admitted for observation. Subsequent MRI on 20 September was negative for any abnormalities but patient began to lose Ocular Motor function later that day. Spinal tap on 23 September showed elevated protein levels in CSF and a subsequent diagnosis of Miller Fisher Syndrome was given. He was started on IgG therapy and currently remains at the inpatient unit with an anticipated discharge date of 28 September.

Other Meds: None

Current Illness: None

ID: 1736711
Sex: M
Age: 82
State: GA

Vax Date: 02/07/2021
Onset Date: 09/05/2021
Rec V Date: 09/27/2021
Hospital: Y

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

Lab Data: 09/05/2021 Antigen+ COVID-19 test

Allergies:

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

Symptoms: Breakthrough COVID-19 case with symptom onset 9/5/2021: Shortness of breath/difficulty breathing. Hospitalized 9/5/2021-9/6/2021. Patient was admitted to the hospital the same day of testing positive at the facility. He was discharged the next day on 9/6 but then re-admitted the same day with bilateral pulmonary embolism. At time of hospitalization, noted to have pneumonia, abnormal chest x-ray, and acute respiratory distress.

Other Meds:

Current Illness:

ID: 1736712
Sex: F
Age: 20
State: MO

Vax Date: 03/22/2021
Onset Date: 03/23/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: Fever, body aches, chills, headache, and fainted

Other Meds: Lexapro, dirspirenone

Current Illness:

ID: 1736714
Sex: M
Age: 16
State:

Vax Date: 07/19/2021
Onset Date: 07/19/2021
Rec V Date: 09/27/2021
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: None

Symptom List: Vomiting

Symptoms: Extremely sharp heart t and chest pain - lasted 30 minutes about 4-5 hours after first dose

Other Meds: None

Current Illness: None

ID: 1736716
Sex: F
Age: 72
State: IL

Vax Date: 03/31/2021
Onset Date: 04/21/2021
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: COVID(+) 9/22/21

Other Meds:

Current Illness:

Date Died: 09/16/2021

ID: 1736717
Sex: M
Age: 75
State: TX

Vax Date: 01/30/2021
Onset Date: 09/15/2021
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: RA

Lab Data: COVID Positive on 9/15/2021; Chest X-ray revealed worsening diffuse bilateral pulmonary infiltrates on 9/15/2021

Allergies: No known allergies

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

Symptoms: MODERNA COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccines on 1/2/2021 and 1/30/2021. Patient previously hospitalized for for COVID pneumonia 8/26/2021 to 8/31/2021. Patient presented to ED on 9/9/2021 for shortness of breath. Patient was placed on BiPAP for worsening hypoxia. Patient received: methylprednisolone, zosyn, and vancomycin. Respiratory condition worsened and family decided to place patient on comfort care. Patient expired shortly after at 0953 on 9/16/2021.

Other Meds: Diltiazem 30 mg three times daily, apixaban 5 mg twice daily, ezetimbe 10 mg daily, xopenex 2 puffs every 6 hours as needed, lutein 10 mg daily, metoprolol 25 mg as needed, omega-3 fatty acids-fish oil (FISH OIL) 300-1,000 mg Capsule once d

Current Illness:

ID: 1736718
Sex: M
Age: 48
State: OH

Vax Date: 04/13/2021
Onset Date: 05/01/2021
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: IM
Vax Site: LA

Lab Data: blood work numerous times over July ,August , and September

Allergies: prior allergies to codine

Symptom List: Injection site swelling, Limb discomfort

Symptoms: autoimmune disease PMR

Other Meds: metropocol vitamin D

Current Illness: none

ID: 1736719
Sex: F
Age: 57
State: IN

Vax Date: 09/23/2021
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: RA

Lab Data:

Allergies:

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

Symptoms: fatigue, low grade temp, body aches

Other Meds:

Current Illness:

ID: 1736720
Sex: F
Age: 79
State: MN

Vax Date: 03/12/2021
Onset Date: 09/26/2021
Rec V Date: 09/27/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Patient had COVID vaccine on 3/12/21(Janssen), and is hospitalized now (admitted 9/26/21) with acute hypoxic rerspiratory failure secondary to COVID pneumonia (expected D/C is not for 3 or 4 more days)

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am