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: 1738280
Sex: M
Age: 43
State: WA

Vax Date: 08/31/2021
Onset Date: 09/02/2021
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: not sure

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: 2 days after vaccination pt started having ringing in the ears. it is still happening. He went to the dr (not sure which dr) and he said to have me do a VAERS form. not sure why the md did not do it

Other Meds:

Current Illness:

ID: 1738281
Sex: F
Age: 21
State: TN

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

Lab Data: None

Allergies: Sulfa drugs

Symptom List: Anxiety, Dyspnoea

Symptoms: -moderate-severe back pain, what I can describe as "bone pain." My spine was hurting so bad I couldn't bear to sit up on my couch and had to lie in bed; lasted until about 24 hours after the vaccine -chest pain- lasted about 24 hours after the vaccine -lethargy/fatigue- I was so tired I slept most of the day.lasted about 24 hours after the vaccine -general weakness- lasted about 3 days after the vaccine -Sore left deltoid muscle (injection site) lasted about 3-4 days after the vaccine -swollen left deltoid muscle- lasted about 48 hours after the vaccine -nasal inflammation- lasted about 24-48 hours after the vaccine. No drainage noted, only inflammation -decreased appetite- about 3-4 days after the vaccine. I forced myself to eat one meal a day and almost threw up after -nausea after eating/food aversion -3-4 days after the vaccine -Feeling feverish/having chills- I could not check my temp to see if I had an actual fever, but my body felt hot, I had chills, and on the second day, I woke up in a sweat and felt as if a fever had "broke." -a sense of impending doom/something wasn't right -difficulty breathing/pain when inhaling- made it difficult to speak, was winded from walking up my stairs in my apartment. Lasted about 24 hours after the vaccine. -Sore throat-- lasted about 24 hours after the vaccine

Other Meds: Equate women's one a day multivitamin, annovera ring

Current Illness: None

ID: 1738282
Sex: U
Age:
State:

Vax Date:
Onset Date:
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:

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

Symptoms: Shooting pains up and down injection arm for a week. Since day of vax- Forearm twitching in both arms daily. Numerous headaches with light sensitivity.

Other Meds:

Current Illness:

ID: 1738283
Sex: F
Age: 65
State: CT

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: N/A

Allergies: Shellfish; iodine

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Facial swelling on right side of mouth and lips; took 3 benadryl 25mg liquid capsules at 9:00 pm.

Other Meds: Metoprolol, estrogen, progesterone

Current Illness: None; except, Aug 26, 2021 had an idiopathic swelling of lips in VT that required emergency room treatment at the hospital.

ID: 1738284
Sex: F
Age: 59
State: PA

Vax Date: 01/18/2021
Onset Date: 01/18/2021
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: several visits to PCP, visit to allergy/immunology specialist, appointment forthcoming with neurology (took 10 months to get appointment)

Allergies: codene, codaine, adhesive tape

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

Symptoms: 25 min post administration- pain, pins and needles shot through arm to wrist and pinky and ring fingers in left arm/arm that received shot. 35 min post administration- pins and needles and numbness in arm, fingers, face, lips, and throat. Lasted 6 hrs, with a period of hearing loss for about 10-15 min. Day1- present (9 months +2 weeks post administration) ulnar nerve pain continues from neck to finger tips with periodic pins and needles in fingers and wrist, and headache. Pain deep in bicep area of left arm. August 2021, develop trigger finger in left middle finger (next to fingers effected by vaccine).

Other Meds: none

Current Illness: none

ID: 1738285
Sex: F
Age: 31
State:

Vax Date: 09/23/2021
Onset Date: 09/25/2021
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:

Allergies: N/A

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

Symptoms: Breastfeeding infant had fever at 99-100.5 for 24 hours, extreme irritability/fussiness, decreased appetite and eczema flare up on ankles, wrists, bends of elbows and shoulders.

Other Meds: Prenatal vitamin

Current Illness: None

ID: 1738287
Sex: F
Age: 67
State: WA

Vax Date: 05/06/2021
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: bees peanuts

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: After both vaccines I experienced numbness on the left side of my face. On 9/15/21 and 9/25/21 my face started twitching uncontrollably for maybe 15 minutes

Other Meds: bupropion methylphenidate

Current Illness: none

ID: 1738484
Sex: F
Age: 23
State: NJ

Vax Date: 08/18/2021
Onset Date: 09/18/2021
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: No

Symptom List: Pharyngeal swelling

Symptoms: I have petechiae all over my right thigh and some on my right arm as well as bruising very easily. Not sure if it?s related to the vaccine but it is concerning me as I?ve never had petechiae on my body in my whole life.

Other Meds: No

Current Illness: No

ID: 1738485
Sex: F
Age: 37
State: NY

Vax Date: 08/18/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data: ANA positive, RF positive, ESR elevated; RNP, Sm antibody positive;

Allergies: NONE KNOWN

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient reports fatigue, joint pains, joint stiffness and joint warmth for 1 month

Other Meds: NONE

Current Illness: NONE

Date Died: 09/14/2021

ID: 1738486
Sex: F
Age: 82
State: NY

Vax Date: 03/17/2021
Onset Date: 08/12/2021
Rec V Date: 09/27/2021
Hospital: Y

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

Lab Data:

Allergies: Keflex, atorvastatin, niacin, penicillin

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient experienced breakthrough COVID infection despite getting vaccine. She passed away on 9/14/21.

Other Meds: Albuterol, amlodipine, insulin, vitamin D, Advair, levothyroxine, lisinopril, melatonin, metoprolol, omeprazole

Current Illness:

ID: 1738487
Sex: M
Age: 41
State: OH

Vax Date: 08/11/2021
Onset Date: 08/11/2021
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: Allergy to fragrance.

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

Symptoms: I experienced powerful psychedelic hallucinations almost immediately after being injected with the vaccine. 1st with my imagination and then with my vision. After that the auditory hallucination started. After that I blacked out in the chair. I dropped the magazine that I was holding. I don't know how long I lost consciousness. When I came to, confused, I realized I had dropped the magazine on the floor. When I looked down, I saw it on the floor and picked the magazine up. After that, I went into hardcore sweating all over my body. I was soaking up the sweat off of my face and neck with the jacket that I brought with me. After that, I experienced some pretty severe nausea but no vomiting. I was extremely confused when I left, possibly in shock. I called for several days afterwards to try to report my symptoms but they never picked up at the pharmacy. I was on hold over 10 minutes at least 3 days in a row. I did however meet in person with the pharmacist and discussed all of this with him. The reason it took me so long to report this is because I didn't even know this was a thing. My sister told me about your website today. Is is there any way you can get me a copy of the security footage from my vaccination?

Other Meds: I have a cannabis license.

Current Illness: None.

ID: 1738488
Sex: M
Age: 15
State: MA

Vax Date: 08/27/2021
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: SYR
Vax Site: RA

Lab Data: none

Allergies: none

Symptom List: Rash, Urticaria

Symptoms: Chest pain, sore throat, nasal congestion, fatigue, sore right arm, loss of appetite. Normal cardiac exam with no friction rub or pain when leaning forward. Treatment included aspirin 81 mg QD and rest., avoid sports. Patient recovered by 9/21/21 (13 days).

Other Meds:

Current Illness: none

ID: 1738489
Sex: F
Age:
State:

Vax Date:
Onset Date:
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: 3 ecgs done - 09/25/2021 Ultrasound done - 09/25/2021 Blood work done - 09/25/2021

Allergies:

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

Symptoms: Chest pains, difficulty breathing, minor heart attack, cold sweats, dizziness

Other Meds:

Current Illness:

ID: 1738490
Sex: F
Age: 16
State: SC

Vax Date: 09/25/2021
Onset Date: 09/27/2021
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: none

Allergies: Amoxicillin Peanut Tree nut

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

Symptoms: 48 hours past injection pt has edema of the upper left arm, erythema of the injection site, pain with touch a palpable area of induration and pain when lifting the arm. Edema resolved with ice and ibuprofen. PT examined 7 hours later approximately 3 cm area of induration surrounding injection site. very faint erythema about 2mm at injection site itself. No streaking redness, no fluctuant mass. PT is able to move her arm with normal ROM but is hesitant due to pain

Other Meds: tretinoin 0.025%

Current Illness: n/a

ID: 1738491
Sex: M
Age: 69
State: CA

Vax Date: 02/24/2021
Onset Date: 02/26/2021
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: Doctor prescribed clobetasol 2 week treatment; not effective.

Allergies: Penicillin

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

Symptoms: Upper torso rash. Hot-to-touch with white blotches. Right upper chest raised red rash 5" in diameter that keeps coming back off and on.

Other Meds: Metoprolol, Amlodipine, Buprenorphine-Naloxone

Current Illness: NA

ID: 1738492
Sex: F
Age: 80
State: MT

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

Lab Data:

Allergies:

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

Symptoms: Pt received Pfizer Covid-19 vaccine instead of Moderna Covid vaccine

Other Meds:

Current Illness:

ID: 1738493
Sex: F
Age: 27
State:

Vax Date: 12/22/2020
Onset Date: 12/29/2020
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: About a week later large lymph node in axilla

Other Meds:

Current Illness:

ID: 1738494
Sex: F
Age: 51
State: SC

Vax Date: 09/01/2021
Onset Date: 09/17/2021
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: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Severe welts every night. Very painful and itchy.

Other Meds: Prozac, phentermine, lumpen, latanaprost

Current Illness: None

ID: 1738495
Sex: F
Age: 86
State: CA

Vax Date: 09/10/2021
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: NA

Allergies: PENICILLIN

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: PATIENT COMPLAINT OF DIFFICULTY BREATHING 2 WEEKS AFTER VACCINATION. PATIENT WAS ADVISED TO SEEK MEDICAL CARE ASAP. (URGENT CARE OR EMERGENCY DEPARTMENT)

Other Meds: NA

Current Illness:

ID: 1738496
Sex: M
Age: 35
State: PA

Vax Date: 04/30/2021
Onset Date: 04/30/2021
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: Can be furnished by my PCP

Allergies: N/A

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

Symptoms: I was perfectly healthy when I arrived at the pharmacy with my wife. I recieved my Pfizer covid shot and sat down on the chair in the observation waiting area. I felt a light tingling sensation in my arm (in which I got the shot) but didn't think much of it (as I assumed the vaccine is stored at sub zero temperature). I started using my phone while waiting for my wife to get her shot next. About 5 mins has elapsed, that I fell off my chair. My wife was there and panicked. As described to me by wife (who observed me first hand) my face turned green as I fell face down from my chair. My body was having jerky movements (involuntary spasms), I had passed out, my body temperature was rising, I lost control of my bladder also (it was basically all the manifestations of a seizure). The pharmacist panicked and have me an EPIPEN injection in my thigh (thinking I'm having an allergic reaction). They had also called 911 in the meanwhile. An ambulance arrived and took me to the ER. There they only did an ECG which was normal. They did not preform any blood tests and released me saying that it was "vasovagal syncope". However I spoke with a few family doctors to get opinions and multiple told me that is all signs of a seizure & not syncope. The ER doctor did tell me to make a follow up general checkup appointment with a PCP which I did a couple of weeks later. The PCP requested a full blood palette test which came out normal.

Other Meds: N/A

Current Illness: N/A

ID: 1738497
Sex: M
Age: 19
State: WA

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: none

Allergies: unknown

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

Symptoms: PT here for Johnson and Johnson shot, received at 1841. Immediately after vaccination, PT presented with pallor and diaphoresis, reported his vision was starting to be blurry/go black. No LOC noted. SPO2 was 95% RA and HR was 52 sitting in chair. Unable to obtain BP at this time. PT was able to transfer to WC and assisted to lay down on cot with feet elevated, reported that he felt much better lying down. VS at 1849 were: BP 104/60 laying, HR 63, SPO2 99% RA. PT was offered and consumed 2 juice boxes, reported that he felt to be to baseline. At 1854, PT sat at edge of cot without difficulty, reports that this happens every time he gets an injection. VS at 1858: Sitting BP 122/84, HR 78, SPO2 98% RA. PT educated on vasovagal reactions, encouraged to notify future healthcare workers of this history prior to vaccination. PT verbalized understanding. VS at 1904: BP 129/68 sitting, HR 64, SPO2 98% RA. PT was able to stand without difficulty and with appropriate balance. VS at 1908: BP 118/72 standing, HR 64, SPO2 98% RA. PT was able to walk a short distance with steady gait, denies further dizziness, vision changes, reports he feels ?normal?. PT?s demeanor was affable and appropriate. VS at 1911: BP 130/68 standing. PT exited facility at 1913, will be at home with his mother.

Other Meds: unknown

Current Illness: unknown

ID: 1738498
Sex: M
Age: 18
State: AZ

Vax Date: 08/02/2021
Onset Date: 08/02/2021
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: Unevaluable event

Symptoms: PATIENT RECEIVED VACCINE AT 10:30AM AND WITHIN 5 TO 10 MINS HE BECAME FLUSHED AND NAUSEATED AND BEGAN TO SWEAT. PHARMACY CALLED 911 AND IN THE TIME BETWEEN CALL AND ARRIVAL OF EMS, THE PT BEGAN TO RETURN TO NORMAL. HE WAS CHECKED OUT BY FIRE DEPT AND DECLINED GOING TO HOSPITAL. PHARMACIST CALLED PATIENT AT 1:00PM AND HE STATED HE WAS DOING FINE.

Other Meds:

Current Illness:

ID: 1738500
Sex: F
Age: 69
State: FL

Vax Date: 09/01/2021
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Morphine

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

Symptoms: Headache, muscle pain, shortness of breath, fever

Other Meds: None

Current Illness: None

ID: 1738501
Sex: F
Age: 70
State: NC

Vax Date: 09/24/2021
Onset Date: 09/27/2021
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: nothing currently

Allergies: aspirin,codeine, hydromorphone, morphine penicilin

Symptom List: Injection site pain, Pain

Symptoms: Her should was swelled up as a large bump probably the size of a baseball, no treatment as of yet, told to take ibuprofen for inflammation

Other Meds: not sure

Current Illness: no

ID: 1738502
Sex: F
Age: 12
State: CA

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: SYR
Vax Site: LA

Lab Data:

Allergies: Ibuprofen - Face swelling.

Symptom List: Injection site pain, Menorrhagia

Symptoms: The client's mother alerted EMT that the client was "breathing funny." EMT responded to the client. The client denied any shortness of breath or any other s/s of anaphylaxis. RN responded. The following was obtained with RN intermittently translating between languages. The client's mother stated that the client's "breathing was not normal." The client's mother said she noticed the client was "sweating and taking deep breaths." The client reported pain over the left area of her abdomen, under her rib cage. Vitals obtained by EMT at 5:56PM were as follows: BP 114/89, HR 85, O2 99%. Capillary refill was < 2 seconds on the client's left middle finger. The client's mother reported the client has a history of facial swelling after taking ibuprofen. The client has a history of appendicitis. The client's mother denied any other chronic conditions or medications. RN observed a bruise over the right upper arm that appeared to be healing. RN inquired about the bruise, and the client's mother reported the bruise was a result of the client practicing Taekwando. The client's mother explained the specific Taekwando move that caused the bruise. The client reported the pain under her left ribs with inhalation and exhalation. The client rated the pain at a 6 on a 10 point scale and described the pain as "shooting." The client's mother stated the client tolerated the first COVID vaccine Pfizer well and denied any s/s of anaphylaxis. RN offered to activate EMS at 5:59PM and the client's mother declined. RN recommended the client and her mother stay in the observation area until the symptoms resolve. RN provided education to the client regarding when to seek EMS. The client's mother voiced understanding of this education. The client's mother said she wanted to monitor the client at home since they had already waited 30 minutes in the observation area. The client's mother stated she wanted to leave against medical advice. The client ambulated unassisted with a steady gait out of the observation area at 6:02PM.

Other Meds: None

Current Illness: Unknown

ID: 1738503
Sex: M
Age: 31
State:

Vax Date: 09/06/2021
Onset Date: 09/27/2021
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: patient states has been nauseous at times since first pfizer vaccine

Other Meds:

Current Illness:

ID: 1738504
Sex: F
Age: 43
State: CA

Vax Date: 03/06/2021
Onset Date: 03/30/2021
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.

Allergies: Adhesives

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: I have an IUD and have had it for at least 9 years. I rarely have spotting or any type of vaginal bleeding. Last week a had what seemed to be a full on period for 5 full days and spotting for an additional 2. I am very concerned. This is very abnormal for me and especially since I have an IUD.

Other Meds: Mirena IUD

Current Illness: None

ID: 1738505
Sex: F
Age: 45
State: AZ

Vax Date: 07/01/2021
Onset Date: 09/01/2021
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: Sulfa Flu vaccine

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Headache, extreme fatigue and generalized weakness to my upper arms. 2 weeks later I got my period?.I have been in menopause for 2 years. Documented labs to prove early onset menopause.

Other Meds: Progesterone 200mg Liothyronine sodium 5mcg

Current Illness: None

ID: 1738506
Sex: M
Age: 12
State: CA

Vax Date: 09/10/2021
Onset Date: 09/11/2021
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: None

Allergies: Bee stings

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

Symptoms: Started feeling weak, tired, sore throat, and headache in the morning after getting his second dose. Then he threw up. He laid down and started getting a fever in the afternoon, reaching 103.0 at one point. We started giving him Tylenol which reduced the fever, but it kept fluctuating the rest of the day. He had chills, and his left armpit hurt. He took over five naps that day, and more the next day with headaches continuing, but no more fever. After the first two full days, his only remaining symptom was the pain in his left armpit. It subside four days later.

Other Meds: Smarty Pants Multi-Vitamins

Current Illness: None

ID: 1738507
Sex: F
Age: 34
State: IL

Vax Date: 04/21/2021
Onset Date: 04/21/2021
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: Nausea

Symptoms: Persistent headaches since vaccination

Other Meds: estradiol, calcium and magnesium

Current Illness: none

ID: 1738508
Sex: F
Age: 26
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:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data: None conducted. Doctor expected decrease in rash with time. Rash on infant only increased in size.

Allergies: None

Symptom List: Injection site pain

Symptoms: Was breastfeeding, noticed rashes developing in my 4month old 1 week after receiving the vaccine. Baby was already on a supplemented diet of formula and only receiving 2-3oz of breast milk a day until 9/27/2021. Correlation with ingestion of Vaccine-Breastmilk was only noted change following perfectly healthy 4month Pediatric Appointment.

Other Meds: None

Current Illness: None

ID: 1738509
Sex: F
Age: 65
State: AZ

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:
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: PT GOT VACCINATION AT AROUND 3:00 ON 9-25-21 AND REPORTED TO RPH ON 9-27-21. SHE DEVELOPED SYMPTOMS OVER THAT EVENING AND NEXT DAY OF REDNESS AND SWELLING AROUND INJECTION SIGHT AND IN SPOTS 2 TO 3 INCHES BELOW INJECTION SITE. SHE ALSO HAD FACIAL FLUSHING AND PRESSURE IN HER HEAD. PT STATES THIMERISOL ALLERGY, MFR PKGE STATES PRESERVATIVE FREE. SHE SAYS SHE WILL CONTINUE TO MONITOR HERSELF (PT IS A DR)

Other Meds:

Current Illness:

ID: 1738510
Sex: F
Age: 51
State: HI

Vax Date: 08/11/2021
Onset Date: 08/13/2021
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: NKDA

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

Symptoms: Painless blistering over the injection site that developed two days following injection. Area was weeping clear fluid for one day.

Other Meds:

Current Illness: None

ID: 1738511
Sex: F
Age: 27
State: IL

Vax Date: 09/19/2021
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:

Allergies: Gluten, Wheat, Dairy

Symptom List: Tremor

Symptoms: In less than 5 minutes I had facial flushing, increased/rapid heart rate, chest pain, shortness of breath (it felt like the air was taken out of my lungs)

Other Meds: Oral Contraceptive (Lo Loestrin Fe), Adderall, Prenatal, Omega 3-FA, Vitamin D3, Biotin

Current Illness: Thyroid cysts, abnormal enlarged lymph nodes

ID: 1738512
Sex: F
Age: 63
State: NY

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

Lab Data:

Allergies: Codeine. Sulfa drugs

Symptom List: Erythema, Pruritus

Symptoms: Tingling and numbness L arm L neck L face and ear to top of head L side since day after in am

Other Meds: Vitamins D. Vitamin C. Zinc. Magnesium Acidophilus. B complex Apple cider vinegar gummed LEVOXYL 75 MCG

Current Illness: Ob sleep apnea. MVP

ID: 1738513
Sex: M
Age: 48
State: KS

Vax Date: 12/18/2020
Onset Date: 01/01/2021
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: None

Allergies: None

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

Symptoms: Spontaneous but delayed urticaria days after injection.

Other Meds: None

Current Illness: None

ID: 1738514
Sex: F
Age: 44
State: PA

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

Lab Data:

Allergies: None

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

Symptoms: Lips/face tingly and numb within a hour. Extreme fatigue for 2 days. Baseball size lump in arm for 1 week. Reduced to half, hive/rash/pain/itch on injection arm nearly 3 weeks later, despite otc allergy medicine. Day 4 included throat squeezing sensation.

Other Meds: None

Current Illness: None

ID: 1738515
Sex: F
Age: 55
State: WA

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

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Injections slightly sore several hours after injection. Arm sore/stiff 7 hours after injection. 3"x4" area around injection site swollen/warm by 10AM day following injection. Arm very sore/stiff. Tire/slightly dizzy day following injection. Diminished apatite day following injection. 4"x5" area around injection site swollen/warm by 6pm day following injection. Arm sore/stiff. Body temp increase 1.5 degrees by 8pm day following injection. 5"x7" area around injection site swollen/warm 9am 2 days after injection. Slight reddening of area around injection site, very sore. Diminished apatite continues 2 days following injection. 400mg ibuprofen before bed 2nd day after injection. No change 3rd day after injection. Injection site still swollen/warm/sore and slightly reddened. Occasionally dizzy when walking/turning head, diminished apatite.

Other Meds:

Current Illness: Upper respiratory infection, multiple sties.

ID: 1738516
Sex: F
Age: 76
State: WI

Vax Date: 03/03/2021
Onset Date: 09/15/2021
Rec V Date: 09/27/2021
Hospital: Y

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

Lab Data: CT Scan, MRI

Allergies:

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

Symptoms: Adverse Event: Right side of face drooped, headache, ear pain. Treatment: Emergency room visit at Hospital Outcome: Diagnosed with Bell's Palsy

Other Meds: metFORMIN, calcium carbonate, metoprolol succinate XL, pantoprazole EC, rosuvastatin, Rybelsus, Vitamin D, Zinc,

Current Illness:

ID: 1738517
Sex: M
Age: 41
State: OH

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: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: N/A

Allergies: No known allergies

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

Symptoms: Patient passed out and looked like they went into a seizure about 3-5min after getting the vaccine. The patient was sitting in the chair waiting the 15min and I heard a crash and the patient fell off the chair. I attended the patient and his eyes were rolled in the back of his head and he is making muttering noises. Pt was like this for under a monitor then became conscious and didn?t know where he was at. I called 911 and we all accessed the patient and determined he was okay and he assisted to leave with his life.

Other Meds: N/A

Current Illness: History of passing out to prior vaccine

ID: 1738518
Sex: M
Age: 32
State: NM

Vax Date: 09/20/2021
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: IM
Vax Site: LA

Lab Data: negative for strep throat test taken on 9/26/21

Allergies: none

Symptom List: Pain in extremity

Symptoms: throat swelling , cant swallow ,anaphylaxis

Other Meds: none

Current Illness: none

ID: 1738519
Sex: F
Age: 33
State: MD

Vax Date: 09/19/2021
Onset Date: 09/21/2021
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: Labs, EKG, Trop

Allergies: NKDA

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

Symptoms: Continued CP and BLE Paresthesias

Other Meds: Vyvanse, Levoxyl

Current Illness:

ID: 1738520
Sex: M
Age: 20
State: WA

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

Lab Data: none

Allergies: none

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

Symptoms: Patient had first dose Moderna on 8/30. Returned on 9/27 to administer second dose and patient was mistakenly given a standard dose of Pfizer when he should have received Moderna.

Other Meds: unknown

Current Illness: unknown

ID: 1738587
Sex: F
Age: 46
State: MI

Vax Date: 06/16/2021
Onset Date: 06/18/2021
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: I did all the tests but nothing showing

Allergies: Non

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

Symptoms: Head's Hair falling, and bold spots at the front of my hair

Other Meds: E and C

Current Illness: Non

ID: 1738588
Sex: F
Age: 48
State: OR

Vax Date: 05/06/2021
Onset Date: 05/07/2021
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: None. I had hormone testing a couple months after the second vaccine dose and my results were normal (for a premenopausal woman).

Allergies: Penicillin

Symptom List: Vomiting

Symptoms: Fever (103 F) for two days, headache for 10 days, menstruated for 18 days in a row. I had begun my period before the second vaccine dose and it should have ended 3-4 days before my second vaccine dose but it did not. After the second vaccine dose on 5/6/21 my period became very heavy again and it lasted for a total of 18 days. I have had a few minor menstrual irregularities in the past but have never previously had a period that lasted longer than 8 days. After that incident my menstrual cycle has been normal.

Other Meds: No medications

Current Illness: None

ID: 1738589
Sex: M
Age: 68
State: ID

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

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Arm pain, fever, joint pains, muscle pain, fatigue, anorexia

Other Meds:

Current Illness:

ID: 1738590
Sex: M
Age: 52
State: TX

Vax Date: 08/18/2021
Onset Date: 08/18/2021
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: Had a full physical 03/2021 with no issues

Allergies: None

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

Symptoms: Metalic taste, 5 weeks and on going. Can't drink from aluminum cans or use metallic silverware. Makes my lips, tongue and mouth burn, go numb, along with strong metallic taste.

Other Meds: Zoloft 100mg

Current Illness: None

ID: 1738591
Sex: F
Age: 38
State: TX

Vax Date: 09/17/2021
Onset Date: 09/18/2021
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: Ekg, chest X-ray, bloodwork 09/23/2021 Ekg, bloodwork, ct PE protocol, ultrasound 09/24/2021

Allergies: Pertussis vaccine Dauladid Steri strips

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Chest pain, headache Currently still have symptoms Pcp dr and emergency room

Other Meds: None

Current Illness: None

ID: 1738592
Sex: F
Age: 48
State:

Vax Date: 07/01/2021
Onset Date: 07/01/2021
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: None

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

Symptoms: Immediate shooting pain down left arm and numbness and pain at left ear, left eye, left side of face and around mouth numb, nausea, dizziness, lightheaded Numbness lasted days

Other Meds: None

Current Illness: None

ID: 1738593
Sex: F
Age: 66
State: CA

Vax Date: 04/24/2021
Onset Date: 04/24/2021
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: No Tests for Hives, just reported to my primary internist. September 26th, while admitted to Hospital, they performed blood panel and Cat Scan to rule out stroke.

Allergies: Sulfa, Penicillin

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

Symptoms: Symptoms of sore arm for 2 days and hives for 3 days all over body about 1 1/2 hours noticed after shot extreme itching. Followed up with Benedryl and creme. Never felt well after but every once in a while felt feverish and achy. On September 20th I began feeling these symptoms again and on September 26th 10 AM my eye started to droop. By 12:00 I went to emergency room Hospital and was admitted with a diagnosis of Bells Palsy.

Other Meds: Enamapril, Atorvistatin, Vit D

Current Illness: none

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am