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: 1737147
Sex: M
Age: 77
State: NV

Vax Date: 02/19/2021
Onset Date: 07/25/2021
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: IM
Vax Site: LA

Lab Data:

Allergies: Gabapentin Lyrica

Symptom List: Dysphagia, Epiglottitis

Symptoms: 77 y.o. male with past medical history of lymphoma, atrial fibrillation, chronic anticoagulation, hypertension, who presents to the Emergency Department with chief complaint of as mentioned above. Patient was exposed to his friend who was tested positive for Covid. He has been sick for the last 4 days with cough, sore throat and shortness of breath. The patient presented to ER yesterday and had a negative chest x-ray. He was not hypoxic. The viral panel was positive for COVID-19. The patient was given Regeneron monoclonal antibody and was discharged home. The patient symptom is getting worse with more shortness of breath, productive cough with white color sputum; therefore, he came back to ER. He has no chest pain, vomiting, diarrhea, leg edema, calf tenderness. Onset of his condition was gradual with moderate symptoms. There is no aggravating factors. Oxygen helps In the ER today, patient was hypoxic with O2 sat of 88%. He requires a couple liters of oxygen. The patient this point is being admitted for COVID-19 infection, hypoxic respiratory failure, failure of outpatient treatment

Other Meds: none

Current Illness: Obesity (BMI 30-39.9) RBBB Systolic ejection murmur Osteoarthritis involving multiple joints on both sides of body H/O arthroplasty Chronic pain of right knee Lumbar pain . Genital herpes simplex Other male erectile dysfunction . Acute URI Atrial flutter PAF (paroxysmal atrial fibrillation) Mixed simple and mucopurulent chronic bronchitis . Mucopurulent chronic bronchitis . COPD exacerbation . Dependent edema Pressure injury of right buttock, stage 2

ID: 1737148
Sex: F
Age: 61
State: FL

Vax Date: 09/13/2021
Onset Date: 09/20/2021
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:

Allergies: Sulfa Drugs, IVP dye, Barium, Papaya, Latex

Symptom List: Anxiety, Dyspnoea

Symptoms: Pain with thyroid started one week after receiving vaccine. Have MD appointment next week.

Other Meds: None

Current Illness: None

ID: 1737149
Sex: F
Age: 78
State: MT

Vax Date: 03/05/2021
Onset Date: 09/19/2021
Rec V Date: 09/27/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Diagnosed and hospitalized with COVID

Other Meds:

Current Illness:

ID: 1737150
Sex: M
Age: 48
State: PA

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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data: N/A

Allergies: N/A

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Severe Flu-like symptoms (fever, fatigue) for 48 hours

Other Meds: Wellbutrin XL, Modafanil, mometasone nasal spray

Current Illness: None

ID: 1737151
Sex: F
Age: 72
State: MN

Vax Date: 08/25/2021
Onset Date: 09/05/2021
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 work; urine sample; Covid-19 test

Allergies: Penicillin; SOFIA; Scallop; nickels

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

Symptoms: I had a fever, chills, serve fatigue, and a dry cough. The fatigue was the worst. I had some discomfort around the injection site for about 12 hours. I went to the doctor about this. They did a complete blood work and a urine sample. Everything came out normal. I also did a Covid-19 test on Sept 13th, which came back negative.

Other Meds: Multi vitamins; vitamin D3

Current Illness:

ID: 1737152
Sex: F
Age: 37
State: WI

Vax Date: 06/29/2021
Onset Date: 07/01/2021
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

Allergies: None

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

Symptoms: Profuse sweating on slight exertion, enough to wet hair and clothing, dripping onto the floor. This began on the date noted, and has continued through the present date. The sweating is all over my body, such that even my phone in my pants pocket becomes wet, and sweat streams down my face and neck. It happens any time I am standing in one place, walking, cleaning, and even in cool weather, although hot weather makes it worse.

Other Meds: Escitalopram, Vyvanse, doxylamine succinate

Current Illness: None

ID: 1737153
Sex: F
Age: 34
State: MN

Vax Date: 06/09/2021
Onset Date: 09/22/2021
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: 9/24/21 SARS/COV-2, Naat positive

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Breakthrough COVID

Other Meds:

Current Illness:

ID: 1737154
Sex: F
Age: 68
State: IL

Vax Date: 05/09/2021
Onset Date: 09/21/2021
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: 9/21/21 COVID NAAT + 9/22/21 COVID PCR = Detected

Allergies: Codeine

Symptom List: Pharyngeal swelling

Symptoms: Patient received 3 Moderna COVID vaccinations per records 5/9/21, 6/6/21 and 8/18/21 - patient admitted 9/21/21 to hospital with anemia and hypotension - found to be COVID + in ER.

Other Meds: Albuterol Ascorbic acid Aspirin 81mg Atorvastatin Exemestane Flonase Flovent HFA Folic Acid Ketoconazole Meloxicam Potassium chloride Pravastatin

Current Illness: Melena

ID: 1737155
Sex: F
Age: 26
State: TX

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

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Site: Pain at Injection Site-Mild, Additional Details: PATIENT IS GIVEN EMPTY SYRINGE BEFORE SHE WAS GIVEN 0.3 ML OF PFIZER COVID 19 VACCINE. WHEN THE INCIDENT TOOK PLACE, I INFORMED HER THAT THE SYRINGE WAS EMPTY AND I HAD TO RE-STICK HER AGAIN WITH VACCINE. MOM CALLED AN HOUR LATER AND WANTED A REPORT DONE.

Other Meds:

Current Illness:

ID: 1737156
Sex: M
Age: 41
State: NY

Vax Date: 12/31/2020
Onset Date: 01/10/2021
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: VNG testing was performed by Albany medical center hospital revealing brain involvement in vertigo. No eveidencenof inner ear involvement

Allergies: Penicillin, sulfa

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Flu like symptoms were experienced but extreme vertigo flare up resulted. Vertigo experienced after head injury had been under control utilizing epling maneuvers. Vertigo that was constant and unrelenting was experience for 6 months after 2nd dose

Other Meds: Astelin nasal spray

Current Illness: None

ID: 1737157
Sex: F
Age: 20
State: OK

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

Lab Data: None yet. Will be going in to see Dr if symptoms are still here at the one week mark.

Allergies: None

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

Symptoms: After my second dose of Pfizer when I woke up the next morning, I had regular symptoms (body aches) which were eased my ibuprofen. However, I also had low circulation in my left leg. This continued for a few days, and resulted in pain in my left calf, and some in my hamstring. There is no redness or swelling, but my calf muscle hurts when flexed or stretched. I continue to have circulation issues. It feels like the blood is having a difficult time flowing through. Symptoms are worse when lying down or sitting. I have not seen a Dr about this yet.

Other Meds: None

Current Illness: None

ID: 1737158
Sex: F
Age: 44
State: MS

Vax Date: 09/13/2021
Onset Date: 09/14/2021
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: Saw NP on 9/17/2021. Blood work revealed Bacterial infection

Allergies: No known allergies

Symptom List: Rash, Urticaria

Symptoms: Swollen lymph nodes and pain under left arm and base of neck. Breast tenderness.

Other Meds: Norvasc, Buspirone, fluoxetine, Mylan

Current Illness: No inown

ID: 1737159
Sex: F
Age: 38
State: UT

Vax Date: 01/29/2021
Onset Date: 01/31/2021
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: None

Allergies: none

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

Symptoms: I started my period two days after my second dose of the Pfizer vaccine. This was way several weeks off-cycle for me and I am usually fairly regular. I also had a very large flare up of genital herpes which I usually manage with Valcyclovir. But, it came on so suddenly I didn't have the typical warning and I wasn't sure about taking the medication.

Other Meds: Stool softeners, Loratadine

Current Illness: none

Date Died: 09/26/2021

ID: 1737160
Sex: F
Age: 74
State: MT

Vax Date: 02/23/2021
Onset Date: 09/21/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Diagnosed, hospitalized and expired from COVID

Other Meds:

Current Illness:

ID: 1737161
Sex: M
Age: 28
State: NY

Vax Date: 09/13/2021
Onset Date: 09/20/2021
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: Systemic: Joint Pain-Severe, Systemic: Vomiting-Severe, Additional Details: Had pain in his knee a week after the shot, so sharp and severe that it put him off balance and made him throw up. Pain lasted about a week, even with ibuprofen.

Other Meds:

Current Illness:

ID: 1737162
Sex: M
Age: 55
State: TN

Vax Date: 08/16/2021
Onset Date: 09/17/2021
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: MRI brain no stroke consutation with retinal specialists

Allergies: none

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

Symptoms: one day after vaccine patient suffered acut retinal artery occlusion due to embolus resulting in total and permanent unilateral vision loss

Other Meds: lisinopril, clopidegril, aspirin,pravastatin, ezetimibe,

Current Illness: atherosclerosis and coronary artery disease

ID: 1737166
Sex: M
Age: 64
State: PA

Vax Date: 04/29/2021
Onset Date: 09/22/2021
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:

Allergies:

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

Symptoms: Patient tested positive 9/22/21

Other Meds:

Current Illness:

Date Died: 08/26/2021

ID: 1737167
Sex: F
Age: 93
State: GA

Vax Date: 02/11/2021
Onset Date: 08/19/2021
Rec V Date: 09/27/2021
Hospital: Y

Vax Type: HIBV
Manufacturer: MERCK & CO. INC.
Vax Name: HIB (PEDVAXHIB)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data: 08/19/2021 PCR+ COVID-19 test

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Breakthrough COVID-19 case with symptom onset 8/19/2021: Cough. Hospitalized 8/19/2021 for unknown duration. Death 8/26/2021. Vital records COD = ACUTE HYPOXIC RESPIRATORY FAILURE, COVID-19. Per vital records, COD ICD Codes include: Not yet coded ; Other Significant Conditions include: BRONCHIECHIECTASIS PULMONARY EMBOLUS; Place of death: HOSPITAL;

Other Meds:

Current Illness:

ID: 1737168
Sex: M
Age: 71
State: NV

Vax Date: 03/18/2021
Onset Date: 03/20/2021
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:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: rash on face

Other Meds: aporvaspadin

Current Illness:

ID: 1737169
Sex: M
Age: 57
State: MI

Vax Date: 04/07/2021
Onset Date: 09/20/2021
Rec V Date: 09/27/2021
Hospital: Y

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: Patient fell, was admitted swabbed positive on admission, asymptomatic

Other Meds: Tumeric, gabapentin, glucosamine,

Current Illness:

ID: 1737170
Sex: F
Age: 53
State: CA

Vax Date: 09/27/2021
Onset Date: 09/27/2021
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: Penicillin Bee venom

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

Symptoms: Patient arrived to COVID vaccine clinic around 9 am on 9/27. She was very nervous to get her shot and verbalized this to other patients while waiting in line. About 15 minutes into her 30-minute observation (allergic to Penicillin and bee venom) a staff member was grabbing an emesis bag for the patient, so I went to assess her. As I approached, the patient slumped over onto the desk and became unresponsive. Patient began shaking all over. I lowered her to the ground and held her head for the duration of the seizure for safety. Another patient came over stating she is a nurse and checked the patient?s pulse, stating it was very fast and weak. Patient was unresponsive and shaking for 1-2 minutes. When the shaking ended, she opened her eyes and was able to ask where she was. After another minute or so, we assisted patient onto the gurney and patient was able to help by using her legs to push up from the floor. We took patient to the ED for evaluation. Patient remained lethargic but was responsive to voice while en route to the ED

Other Meds:

Current Illness:

ID: 1737171
Sex: F
Age: 26
State: TX

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

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: Site: Pain at Injection Site-Mild, Additional Details: PATIENT WAS STICK WITH AN EMPTY SYRINGE BEFORE SHE WAS GIVEN 0.3 ML PFIZER COVID19 VACCINE. WHEN THE INCIDENT TOOK PLACE, I INFORMED HER THAT I STICKED WITH AN EMPTY SYRINGE AND I HAD TO RE-STICK HER WITH PFIZER COVID19 VACCINE. MOM CALLED AN HOUR LATER AND WANTED ME TO REPORT THE INCIDENT.

Other Meds:

Current Illness:

ID: 1737172
Sex: M
Age: 34
State: WI

Vax Date: 09/24/2021
Onset Date: 09/25/2021
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: augmentin, ceclor

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

Symptoms: pt called monday 9/27/21 stating he was admitted to the hospital over the weekend and diagnosed with myocarditis and stayed for 2 nights.

Other Meds:

Current Illness:

ID: 1737173
Sex: F
Age: 66
State: NY

Vax Date: 03/25/2021
Onset Date: 08/19/2021
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: Pap test, Aug 19, 2021

Allergies: Amoxicillin Septra

Symptom List: Injection site pain, Pain

Symptoms: I had a positive test on a Pap smear. I don't think it's related, but it's new in August. Atypical squamous cells of undetermined significance.

Other Meds: D3, Calcium, Melatonin, B12 Betamethasone Dipropionate Cream

Current Illness: None

ID: 1737174
Sex: F
Age: 41
State: NC

Vax Date: 09/07/2021
Onset Date: 09/10/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data: None

Allergies: None

Symptom List: Injection site pain, Menorrhagia

Symptoms: Headaches, cycle started and it should not have, cycle was heavy and abnormal, continues to spot

Other Meds: None

Current Illness: None

ID: 1737175
Sex: M
Age: 12
State: KY

Vax Date: 09/01/2021
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: Covid positive school

Other Meds:

Current Illness:

ID: 1737176
Sex: F
Age: 56
State: NY

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

Lab Data: None (yet).

Allergies: None

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: 1. Uncontrollable shaking right hand and leg (on and off/mostly when being still). 2. Pain in veins (especially the wrist) on the right side (from shoulder to the palm of my hand). 3. Burning/tingling sensation in soles of feet and palms of both hands.

Other Meds: None

Current Illness: Mild Sore Throat

ID: 1737177
Sex: F
Age: 57
State: MD

Vax Date: 05/12/2021
Onset Date: 05/12/2021
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: Error: Shoulder Joint Injury (prolonged pain, tingling, etc.)-

Other Meds:

Current Illness:

ID: 1737178
Sex: F
Age: 20
State: CT

Vax Date: 04/12/2021
Onset Date: 06/22/2021
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: Labs done on 6/22/2001. In addition to pediatrician, can also check with endocrinologist for blood test results before and after vaccine.

Allergies: Seasonal allergies

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

Symptoms: High cholesterol detected in next bloodwork. Bloodwork was run a second time with same results. Referred to dietician, but diet was already good. No other treatments. Condition persists so far. Patient is 20 yrs old, slim, athletic, with healthy diet. Gets bloodwork done multiple times per year, has never had high cholesterol before.

Other Meds: levothyroxine charlotte 24 fe benedryl

Current Illness: None

ID: 1737179
Sex: M
Age: 50
State: LA

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

Lab Data:

Allergies: sulfa allergy

Symptom List: Nausea

Symptoms: Immediate metallic taste in mouth; Less than 10 minutes in, a tightening of the throat

Other Meds: none

Current Illness: none

ID: 1737180
Sex: M
Age: 43
State: CA

Vax Date: 03/01/2021
Onset Date: 08/05/2021
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: NKA

Symptom List: Injection site pain

Symptoms: Patient is a 44 y.o. male with past medical history of WPW, who presents to the Emergency Department with chief complaint of as mentioned above. Patient dates that he has been ill for about 10 days with flulike symptoms including a cough, headaches, diffuse myalgias and generalized weakness. About 5 days ago he was diagnosed with COVID-19 after testing positive at pharmacy. He has been self isolating at home. His sister who is a nurse had sent him a pulse ox and warned him to monitor for hypoxia. The patient has admitted that he has been very weak and mostly just lying in bed. He has very poor appetite. He has had low-grade fevers and chills. He endorses dyspnea with exertion. He was seen in the emergency department yesterday and was not hypoxic. He returns today with worsening shortness of breath and noted that his oxygen saturations were dropping into the 80s. The emergency room he was indeed found to be hypoxic with an x-ray consistent with Covid pneumonia and is being admitted to hospital for further evaluation and treatment. Incidentally, the patient completed his Pfizer Covid vaccination in March 2021

Other Meds: fluoxetine (PROZAC) 40 MG capsule atenolol (TENORMIN) 50 MG Tab

Current Illness: Pneumonia due to COVID-19 virus Bronchoconstriction

ID: 1737181
Sex: M
Age: 71
State: OK

Vax Date: 02/12/2021
Onset Date: 09/22/2021
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: hospitalization

Other Meds:

Current Illness:

ID: 1737182
Sex: M
Age: 96
State: MN

Vax Date: 03/04/2021
Onset Date: 09/26/2021
Rec V Date: 09/27/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: 9/26/21 patient presented to the ED hypoxic about 5 days after onset of URI symptoms, tested positive for covid-19 and was admitted to the hospital, currently hospitalized with covid-19 pneumonia

Other Meds:

Current Illness:

ID: 1737183
Sex: M
Age: 52
State: KY

Vax Date: 05/27/2021
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:

Allergies:

Symptom List: Tremor

Symptoms: Covid positive concert

Other Meds:

Current Illness:

ID: 1737184
Sex: F
Age: 66
State: ID

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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies: Darvon

Symptom List: Erythema, Pruritus

Symptoms: Chills, headache, earache, body aches, nausea, chest pain, tiredness. Began at 12:30 am on Sept 24, lasted all day. No appetite. By the night of the 24th the symptoms were chest pain, mild nausea, mild body aches, sore eyes (felt dry), and tiredness. On Sept 25 the only remaining symptoms were chest pain and tiredness. By the morning of the 26th all symptoms were resolved, other than mild chest pain, which was probably attributable to my ongoing vasospastic angina.

Other Meds: Warfarin, Amlodipine, levothyroxin, Hyoscamine, Prilosec, Tylenol, Vit B12, Vit D3

Current Illness: None

ID: 1737185
Sex: F
Age: 47
State: NY

Vax Date: 03/29/2021
Onset Date: 04/05/2021
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: June 1, 2021- results of surgery are on file Eye and Ear HCF.

Allergies: Sulfa

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

Symptoms: I experienced a macular hole in my left eye four days after I received my second injection of Moderna. This required emergency surgery and has a long term effect on my vision. I had to miss 3 months of work due to poor vision.

Other Meds: Lamitrogine

Current Illness: N/A

ID: 1737186
Sex: F
Age: 63
State: TX

Vax Date: 09/24/2021
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: IM
Vax Site: LA

Lab Data: LOTS OF BLOOD TEST; OXYGEN; IV MEDS; ORAL MEDS

Allergies: CODEINE ; KEFLEX; vancomycin; minocycline

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

Symptoms: AMBULANCE RIDE TO HOSPITAL COULD NOT BREATH HARD CHEST PAINS; FAINT; DIZZY; NAUSEA STARTED ABOUT 2PM HOSPITAL ADMINISTERED SEVERAL TREATMENTS HEART RATE WAS OVER 200 STAYED AT 134 TILL ABOUT 1:40 AM SUNDAY MORNING

Other Meds: DULOXETINE 30 MG ELIQUIS 5 MG SPIRONOLAETONE 50MG SYNTHOID .150MG ISINOPRIL 10MG METOPROLOL 50MG OMERPRAOLE 40MG VIT D CACIUM 600 W/D-3 TYMALOS INJ NIGHTLY

Current Illness: A-FIB

ID: 1737187
Sex: F
Age: 64
State:

Vax Date: 04/11/2021
Onset Date: 09/26/2021
Rec V Date: 09/27/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series

Other Meds:

Current Illness:

ID: 1737188
Sex: F
Age: 60
State: MN

Vax Date: 02/04/2021
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: SYR
Vax Site: LA

Lab Data: SARS COVID-19 NASAL SWAB 9/27/21: POSITIVE

Allergies: AMOXICILLIN, CODEINE

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

Symptoms: 9/26/21: RUNNY AND STUFFY NOSE, COUGH, HEADACHE

Other Meds: ESTRADIOL. LEVOTHYROXINE, LORATADINE, PROGESTERONE, NASOCORT, OMEPRAZOLE, PRO AIR, TRAZODONE, TOPRAMATE

Current Illness: UPPER RESPIRATORY SYMPTOMS

ID: 1737189
Sex: F
Age: 49
State: OR

Vax Date: 03/24/2021
Onset Date: 03/24/2021
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: x-rays- normal

Allergies: 2 medications but I do not remember their names

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

Symptoms: When I first got the shot I had immediate pain at the area and my shoulder. I had a rash on top of my shoulder. It lasted for about an hour or 2. The rash went away but the pain was still there. I had swelling in my armpit. The pain went down to my elbow and fingers. I had tingling in my fingers. It was a few weeks of extreme pain. I called the doctor to let them know about the pain I was having, and they told me to take Tylenol so I did. Probably about a week and so I was in such pain so I called again. They did urgent care online and I explained what was going on. They told me to continue with Tylenol. They wanted to do prednisone but I got so sick when I took it that we had to stop. About a week later or so I was able to get in with my PCP. We did a telehealth visit. She was shocked about what was going on. She wanted to actually see me. I went in the next day. She said my armpit had swelling like lumpy like. She said I had frozen shoulder from not moving it. I was not able to move it without having quite pain. I had to have a mammogram early so she did not want me to take the second shot until I got the results. Everything looked good. I was referred to orthopedics. It was probably a few months until I saw him. I was feeling a little bit better. I explained him everything. He recommended a cortisone shot but we opted not to do anything there because I was feeling better. He said just to monitor it. They think they have given me the shot in the wrong area. It is started to get worse again. They are getting me in to see the orthopedist next week. I am also seeing a physical therapist. They did some x-rays and they said it was fine but I think we need to do more tests to see if everything is ok on the inside of my arm. The amount of pain has been at an 8 or 9 out of 10. I am upset that it is wearing me out and I am unable to do normal things. My first dose and second dose were 52 days in between because we were trying to figure out why that happened to me. Now I have a lot of back shoulder area pain, which is new, the swelling under my armpit went away but it came back. The injection site its an itchy area, it comes and goes.

Other Meds: Gabapentin, Singulair, Clonazepam, Wellbutrin, Lamictal, Loratadine, vitamin D, Senna

Current Illness: None

ID: 1737190
Sex: F
Age: 59
State: CA

Vax Date: 09/09/2021
Onset Date: 09/15/2021
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: no

Allergies: sulfa, epinephrine, codeine aspirin lidocaine latex lots of food allergy

Symptom List: Pain in extremity

Symptoms: On September 15injection site developed a rash . Rash spread to hand .

Other Meds: no

Current Illness: no

ID: 1737191
Sex: M
Age: 70
State: GA

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

Allergies:

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

Symptoms: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-

Other Meds:

Current Illness:

ID: 1737192
Sex: M
Age: 74
State: OH

Vax Date: 09/07/2021
Onset Date: 09/08/2021
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: covid 19 negative

Allergies: nka

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

Symptoms: 1 week sinus drainage/ congestion/ low grade fever/ flu like symptoms

Other Meds: dilt xr / losartan

Current Illness: none

ID: 1737193
Sex: F
Age: 49
State: CA

Vax Date: 09/02/2021
Onset Date: 09/02/2021
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: BLOOD WORK TAKEN SEPT 17 - RESULTS PROVIDED ON SEPT 21 - ALL CLEAR

Allergies: NKDA

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

Symptoms: ON DAY OF - EXTREME EXHAUSTION DAY AFTER - FEVER, NAUSEA, VOMITING, EXHAUSTION, FATIGUE, HEADACHE 2 DAYS AFTER - FATIGUE, HEADACHE, NAUSEA 3 DAYS AFTER - PRONOUNCED HEARTBEAT AND INCREASED HEARTRATE LASTING FOR EIGHT HOURS SPORADICALLY SINCE THEN - DAYS OF PRONOUNCED HEARTBEAT LASTING FOR HOURS

Other Meds: SUBOXONE

Current Illness: NONE

ID: 1737194
Sex: F
Age: 57
State:

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

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

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series

Other Meds:

Current Illness:

ID: 1737195
Sex: F
Age: 55
State: VA

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: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: none

Allergies: none

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Fever up to 102.2/ chills/headaches/ body aches/ Fatigue/myalgia and arthralgia x 3 days.

Other Meds: omeprazole.

Current Illness: none

ID: 1737196
Sex: F
Age: 32
State: MD

Vax Date: 09/24/2021
Onset Date: 09/26/2021
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: None

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

Symptoms: Currently 15 weeks pregnant Swollen area and lymph node right above right clavicle...very tender to touch

Other Meds: None

Current Illness: None

ID: 1737197
Sex: F
Age: 57
State: TN

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: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: cipro, statins, amitiza

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Swelling around R eye and cheek

Other Meds:

Current Illness: none

ID: 1737198
Sex: F
Age: 29
State: FL

Vax Date: 09/13/2021
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: RA

Lab Data: n/a

Allergies: NKDA

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

Symptoms: Vial was diluted with 0.8 mL. Patient present for follow-up appointment on Sept 23, 2021. No adverse effects noted.

Other Meds: Vitamin D Clonazepam

Current Illness: myalgia, HA

ID: 1737199
Sex: F
Age: 75
State: MI

Vax Date: 02/22/2021
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: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: PT presented with cough and shortness of breath for over a week; Inpatient; PT is on Remdesvir, Aspirin, Medrol, vitamin C and D

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am