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: 1741043
Sex: M
Age: 73
State:

Vax Date: 04/05/2021
Onset Date: 09/23/2021
Rec V Date: 09/28/2021
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: Codeine

Symptom List: Dysphagia, Epiglottitis

Symptoms: 73 y/o male with hx hypertension, hypothyroidism, history of CVA without any residual deficits, morbid obesity, on chronic systemic steroids/hydrocortisone due to unknown reason probably history of adrenal insufficiency, COPD, rectal adenocarcinoma status post port placement with neoadjuvant radio/chemotherapy for T3 N1 disease. Came to ER with severe weakness and fall. Was not able to walk. ER W/U showed Hypokalemia. Admitted for replacement of K and PT to ambulate. Tested positive on 9/23/2021. 73 year old male with hx hypertension, hypothyroidism, history of CVA without any residual deficits, morbid obesity, on chronic systemic steroids/hydrocortisone due to unknown reason probably history of adrenal insufficiency, COPD, rectal adenocarcinoma status post port placement with neoadjuvant radio/chemotherapy for T3 N1 disease. Came to ER with severe weakness and fall. Was not able to walk. ER W/U showed Hypokalemia. Admitted for replacement of K and PT to ambulate. Routine Corona virus test + however he is asymptomatic.

Other Meds:

Current Illness:

ID: 1741044
Sex: M
Age: 57
State: AZ

Vax Date: 03/29/2021
Onset Date: 03/30/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data: my Dr has left the family practice but ordered ultrasound and scan but I have not gone. My dad had a stroke, and I have not had the time.

Allergies: Penicillin

Symptom List: Anxiety, Dyspnoea

Symptoms: Swelling of my fingers, could not close my hand. Still after 6 months I can not close middle 2 fingers - middle and ring. Dr did indicate there has been clotting issues so I have been taking low dose aspirin.

Other Meds: Vitamin C

Current Illness: none

ID: 1741045
Sex: M
Age: 66
State: TN

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/28/2021
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: Patient called Health Dept. requesting 2nd dose of Pfizer vaccine to be administered in home due to disability. Pt states received 1st dose on 8/14/2021 @ Rehabilitation Center. No records found in Tenniis. Later that same day, RN drove pt. Pt unable to locate vaccine card upon arrival. RN administerd Pfizer vaccine in left deltoid. New vaccine card made. Before leaving home, pt found vaccine card which states received Moderna on 8/17/2021.

Other Meds:

Current Illness:

ID: 1741046
Sex: F
Age: 55
State: NM

Vax Date: 06/24/2021
Onset Date: 06/28/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data: too many to list

Allergies: none

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: woke with distorted vision doctors have no idea why I presented with advanced posterior and anterior uveitis I did not have health insurance and had to wait until july 17 to get my eye checked

Other Meds: none

Current Illness: none

ID: 1741047
Sex: F
Age: 60
State: MO

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
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 erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Administration error mixed series mRNA vaccination Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1741048
Sex: F
Age: 32
State: MD

Vax Date: 02/19/2021
Onset Date: 03/26/2021
Rec V Date: 09/28/2021
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: Ultrasound, DUTCH test

Allergies: Pollen

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

Symptoms: Irregular menstrual cycles following vaccine (March 2021 through present) - have had 43-90 day cycles after several years of regular 28-30 day cycles. Rapid weight gain associated with anovulation/PCOS. In September a ruptured ovarian cyst after no previous history of ovarian cysts (despite PCOS diagnosis).

Other Meds: Vitamin D

Current Illness: NA

ID: 1741049
Sex: F
Age: 61
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1741050
Sex: M
Age: 38
State:

Vax Date: 05/10/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
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: Pharyngeal swelling

Symptoms: -this is a 38-year-old male with no significant past medical history. Came to the hospital with a chief complaint of progressive worsening shortness of breath over the last 8 days. Initially the symptoms started on Sunday the week before. Initially the symptoms were intermittent fevers, chills, cough,. Few days after this the patient started having some shortness of breath which progressively got worse over the course of the last 3-4 days. Due to worsening shortness of breath the patient decided come to the emergency room. He was prescribed some empiric antibiotic 9/25/2021 tested positive

Other Meds:

Current Illness:

ID: 1741051
Sex: M
Age: 40
State: PA

Vax Date: 05/24/2021
Onset Date: 05/26/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data:

Allergies: Bactrim

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Tinnitus

Other Meds: None

Current Illness: None

ID: 1741052
Sex: F
Age: 61
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1741053
Sex: F
Age: 83
State: OH

Vax Date: 01/07/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
Hospital: Y

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

Lab Data:

Allergies: Latex, Cephalexin, Gabapentin, Nickel, some adhesive tapes

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

Symptoms: Patient developed breakthrough COVID-19 requiring hospitalization

Other Meds:

Current Illness: N/A

ID: 1741054
Sex: F
Age: 41
State: LA

Vax Date: 09/24/2021
Onset Date: 09/25/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data: N/A

Allergies: Codeine; Toradol

Symptom List: Rash, Urticaria

Symptoms: I experienced a little nausea and soreness into my left arm. I also had a headache.

Other Meds: Omeprazole; Celexa; Vistaril; Methscopolamine

Current Illness: N/A

ID: 1741055
Sex: F
Age: 31
State: NM

Vax Date: 03/08/2021
Onset Date: 05/01/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data:

Allergies: Allergic to shellfish and iodine

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

Symptoms: About 2 week after the shot I began to get a rash on both arms and legs. The rash was very red and bumpy. It would last a week, go away for about 3 weeks and then return. This went on from April to about August. I would also feel a tightening in my heart. It felt as if someone was squeezing it; this happened about twice a month from May to July. My menstrual cycle has changed drastically. A month and a half now goes by between each cycle. I know that it is the vaccine because I have been on my current birth control for two years now.

Other Meds: Benadryll Anti-Itch cream

Current Illness: none

ID: 1741056
Sex: M
Age: 14
State: NY

Vax Date: 08/25/2021
Onset Date: 08/25/2021
Rec V Date: 09/28/2021
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: N/A

Allergies: no

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

Symptoms: Pt is under age at 14 yrs old. He complained of generalized body aches for the first two days

Other Meds: none

Current Illness: none

ID: 1741057
Sex: F
Age: 31
State: NJ

Vax Date: 09/27/2021
Onset Date: 09/28/2021
Rec V Date: 09/28/2021
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: No

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

Symptoms: All my symptoms are WORSE than when I had covid. My chills and aches are worse. Terrible headache. This CANNOT be safe for me to feel worse than I felt when I had COVID. my hands are going intermittently numb, as are other parts of my body. I am sore everywhere. This is wrong.

Other Meds: Amoxicillin (person who administered vaccine said it was ok because I had no fever- it was my last day and prescribed for a sinus infection); birth control pill; topamax; Wellbutrin

Current Illness: Sinus infection

ID: 1741058
Sex: F
Age: 78
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1741059
Sex: F
Age: 75
State: NY

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/28/2021
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: Penecillin, Keflax, Vancomycin

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

Symptoms: Pain at the injection site, extreme fatigue, headaches, body aches

Other Meds: Desvenlasasxine 100 mg, Clopigogrel 75 mg,

Current Illness: None

ID: 1741060
Sex: M
Age: 56
State: NJ

Vax Date: 09/02/2021
Onset Date: 09/03/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data: Tx Medrol dose pack from 9/22/21 to 9/27/21 Blood work indicated elevated ESR=52 and CRP = 21.5

Allergies: Contrast Dye Shellfish

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Fatigue, low grade fever, myalgia surrounding back, shoulder, elbows, hands, knees, hips and feet, arthralgia, severe am stiffness, difficulty straightening arms, difficulty walking, abrupt response to Medrol pack 2-3 days after taking pain 80-90% improved. Currently symptoms persist worse in am and when sleeping prior to steroids unable to sleep due to unretractable shoulder and elbow pain.

Other Meds: Baby ASA Claritan Crestor 5 mg Tribenzor 40/10/25

Current Illness: HTN CRI S/P Left Adrenalectomy secondary to Aldosteronoma

ID: 1741061
Sex: F
Age: 57
State: MI

Vax Date: 03/12/2021
Onset Date: 09/20/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data: Swabbed positive on admission 9.20.21

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Patient needed lap chole

Other Meds: Celexa, trazodone, prinzide, lopid

Current Illness:

ID: 1741062
Sex: F
Age: 29
State: GA

Vax Date: 09/17/2021
Onset Date: 09/20/2021
Rec V Date: 09/28/2021
Hospital:

Vax Type: RV1
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: ROTAVIRUS (ROTARIX)
Lot:
Dose Series: 1
Vax Route: PO
Vax Site: MO

Lab Data: 9/20/2021 CT scan, blood test, urine test

Allergies: None

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

Symptoms: Dizziness, light headedness, shortness of breath, resting pulse not lower than 120 (monitored for 45 minutes), migraine for 3 days

Other Meds: None

Current Illness: Menorrhagia caused by first dose

ID: 1741063
Sex: F
Age: 62
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1741064
Sex: F
Age: 62
State: ID

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
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: Unevaluable event

Symptoms: Moderna lot number 038B21A expired in facility system on 9/25/2021, and vaccine was given 9/27/21. No expiration on Moderna box or vials

Other Meds: Vitamin C, biotin 1 mg, combigan, flexeril, voltaren, synthroid, mag-ox, multivitamin, travatan, verapamil, vitamin D

Current Illness: none

ID: 1741065
Sex: F
Age: 88
State: MO

Vax Date: 03/20/2021
Onset Date: 09/11/2021
Rec V Date: 09/28/2021
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: unknown

Allergies: unknown

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

Symptoms: Fever, SOB, fainting

Other Meds: unknown

Current Illness: unknown

ID: 1741066
Sex: F
Age: 55
State: MA

Vax Date: 09/16/2021
Onset Date: 09/16/2021
Rec V Date: 09/28/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: A patient may have received an additional dose of the Moderna covid vaccine during administration. She was notified immediately and educated that she may experience more intense side effects from the vaccine. She experienced the common vaccine side effects, including sore arm, which resolved.

Other Meds:

Current Illness:

Date Died: 09/23/2021

ID: 1741067
Sex: M
Age: 80
State: KY

Vax Date: 02/03/2021
Onset Date: 09/23/2021
Rec V Date: 09/28/2021
Hospital: Y

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

Lab Data: Confirmed PCR positive

Allergies: Unknown

Symptom List: Injection site pain, Menorrhagia

Symptoms: Pt died after contracting COVID-19 in Sep 2021. Pt developed COVID pneumonia

Other Meds: Unknown

Current Illness: Unknown

ID: 1741068
Sex: F
Age: 69
State: IL

Vax Date: 09/26/2021
Onset Date: 09/26/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data: NONE

Allergies: None

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

Symptoms: DIZZINESS NAUSEATED THREW UP

Other Meds: None

Current Illness: None

ID: 1741069
Sex: F
Age: 28
State: KY

Vax Date: 01/29/2021
Onset Date: 09/25/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data: 9/27/21 SARS-COV-2 PCR - Detected

Allergies: Percocet

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Sinus congestions and post nasal drip for several days (5-6). Has been doing neti pot, tylenol and ibuprofen, and afrin. Vapor inhaler was making her nose burn and drying it out. Afrin x2 days. Cough from post nasal drip, tenderness in the frontal sinuses. Denies fevers, body aches or chills Mild loss of taste and smell due to nasal congestion. Has had has COVID vaccines. Has had 2021 Flu shot 09/28/21-Patient received Regeneron infusion

Other Meds: cholecalciferol (VITAMIN D3) 1.25 MG (50000 UT) capsule TAKE 1 CAPSULE BY MOUTH ONE TIME PER WEEK ? doxylamine succinate (UNISOM) 25 MG tablet Take 1 tablet by mouth nightly as needed (Nausea). ? fluticasone (FLONASE) 50 MCG/ACT nasal

Current Illness: None

ID: 1741070
Sex: M
Age: 52
State:

Vax Date: 04/26/2021
Onset Date: 04/26/2021
Rec V Date: 09/28/2021
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: Intermittent left arm pain at area of 1st COVID Moderna shot for almost 6 months after injection. Initially had localized reaction and swelling of his arm but still has pain at times even 6 months after. No radiculopathy.

Other Meds: None

Current Illness:

ID: 1741071
Sex: F
Age: 51
State: WV

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 09/28/2021
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: Tdap Sulfa

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

Symptoms: Vaccine administered at 9am. Tongue felt "itchy". Felt like a "hotdog" in throat. Vision changes began. Benadryl administered at 09:15am. Patient monitored for 15 more minutes. No improvement. Taken to ER.

Other Meds: Benadryl 50mg by mouth

Current Illness: N/A

ID: 1741072
Sex: M
Age: 42
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
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: Nausea

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1741073
Sex: F
Age: 58
State: IL

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
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: Injection site pain

Symptoms: Patient was given 3rd covid vaccination when she was not eligible yet. 2nd dose Moderna was received 4/21/21, patient checked yes to being immunocompromised even though she is not.

Other Meds: metronidazole 0.75% cream topical

Current Illness: none

ID: 1741074
Sex: F
Age: 40
State:

Vax Date: 09/22/2021
Onset Date: 09/23/2021
Rec V Date: 09/28/2021
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: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: On the evening after vaccination, patient had chills, headaches, and body aches. The next morning she woke up with left eye pain, left ear pain and inability to move the left side of her face. Left sided facial paralysis diagnosed as bell's palsy

Other Meds: none

Current Illness: none

ID: 1741075
Sex: M
Age: 49
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1741076
Sex: M
Age: 36
State: FL

Vax Date: 05/13/2021
Onset Date: 05/13/2021
Rec V Date: 09/28/2021
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 - No one is reporting anything.

Allergies: None

Symptom List: Tremor

Symptoms: Left numb, heart pain, confusion, and fever.

Other Meds: None

Current Illness: None

ID: 1741077
Sex: M
Age: 56
State: MI

Vax Date: 04/07/2021
Onset Date: 09/20/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data: positive for covid on admission

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: SOB

Other Meds: Albuterol, methocarbamol, metoprolol,

Current Illness:

ID: 1741079
Sex: M
Age: 65
State: CA

Vax Date: 01/13/2021
Onset Date: 01/31/2021
Rec V Date: 09/28/2021
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: Doctor visit followed by 10 lab tests on 03/17/2021.CYCLIC CITRULLINATED PEPTIDE IMMUNOGLOBULIN G M.D. Mar 17, 2021 HLA (HUMAN LEUKOCYTE ANTIGEN) B27 TYPING M.D. Mar 17, 2021 WHITE BLOOD CELL DIFFERENTIAL M.D. Mar 17, 2021 HEPATITIS C VIRUS (HCV) RNA QUANTITATION M.D. Mar 17, 2021 SERUM RHEUMATOID FACTOR M.D. Mar 17, 2021 ANTINUCLEAR ANTIBODY M.D. Mar 17, 2021 ERYTHROCYTE SEDIMENTATION RATE (ESR) M.D. Mar 17, 2021 CBC (COMPLETE BLOOD COUNT) WITH DIFFERENTIAL M.D. Mar 17, 2021 URIC ACID M.D. Mar 17, 2021 C-REACTIVE PROTEIN M.D. Mar 17, 2021

Allergies: None

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

Symptoms: Soreness at the injection site (right arm) beginning at the time of administration. Soreness in the shoulders, lower back, pelvic area begging at the onset of the adverse reaction and increasing since that time. Soreness severe band limited body movement and function.

Other Meds: Hydrochlorothiazide 12.5 MG, Doxazosin 4 MG.

Current Illness: None

ID: 1741080
Sex: M
Age: 73
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1741081
Sex: F
Age: 65
State: TX

Vax Date: 09/17/2021
Onset Date: 09/22/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data: 9/24/21-CMP, Lipid Panel, CBC, PT, PTT, ANA screen, CRP, Protein S, Protein C, Iron and TICB, Hgb A1C, DS DNA, Iron Sat%, CCP Ab, CCP Ab IgG,Sed Rate, Rheumatoid Factor, TSH, Free T4, Cardiolipin AB (IGA, IGG, IGM), 9/27/2021Carotid Doppler, 9/28/2021 (scheduled) Echocardiogram with "bubble flow study".

Allergies: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Received COVID-19 booster on 9/17/21, the Seasonal Flu vaccine on 9/17/21, then developed vision problems on 9/22/21. Was seen by retinal specialist on 9/22/21 and diagnosed with right branch retinal vein occlusion with macular edema. Received Lucentis 0.5 mg via intravitreal injection. Still have decreased visual acuity compared to non-affected eye. Am going through medical eval to rule out coagulopathy. Have appts to see Cardiology and attempted to set up appt. with hematology. Have had screening labs ordered via a Lab these are pending.

Other Meds: Losartan/HCTZ 100/25 daily, Synthroid 150 cmg daily, Carevedilol 6.25 mg BID, Cetirizine 10 mg daily, Centrum OTC vitamin daily, Vit D3, Calcium, Vitamin C

Current Illness: None

ID: 1741082
Sex: F
Age: 20
State: TX

Vax Date: 05/20/2021
Onset Date: 09/24/2021
Rec V Date: 09/28/2021
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: Leukemia patient hospitalized for COVID-19 illness.

Other Meds:

Current Illness:

ID: 1741083
Sex: M
Age: 48
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1741084
Sex: M
Age: 29
State: CA

Vax Date: 09/01/2021
Onset Date: 09/01/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data:

Allergies: No

Symptom List: Pain in extremity

Symptoms: Migraine, fatigue and chills

Other Meds: No

Current Illness: No

Date Died: 09/23/2021

ID: 1741085
Sex: M
Age: 53
State: AR

Vax Date: 03/06/2021
Onset Date: 09/20/2021
Rec V Date: 09/28/2021
Hospital: Y

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

Lab Data: 9/21/2021 SARS CoV RAP RNA (RT RNA) positive 9/23/2021 SARS CoV RNA (RT RNA) positive 9/23/2021 SARS CoV PAN (RT RNA) positive

Allergies: NKA

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

Symptoms: Developed Acute Respiratory Failure leading to intubation and death.

Other Meds: Unknown

Current Illness: Ulcerative colitis, Cellulitis of RLE CKD, Polycystic Kidney disease, Osteoarthritis, Hyperlipidemia, Post kidney transplant, Long term use of immunosuppressive drug, would of lower extremity, ESRD on dialysis, CVA, Immunosuppressed status,

ID: 1741086
Sex: F
Age: 75
State: ME

Vax Date: 03/12/2021
Onset Date: 09/24/2021
Rec V Date: 09/28/2021
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: CT HEAD W/O IV CONTRAST. CHEST 2 VIEWS FRONTAL/LATERAL, COVID test.

Allergies: Codeine, Morphine.

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

Symptoms: Symptoms: Cough, Altered Mental Status, chest congestion. Treatment: oxygen, remdesivir.ceftriaxone , nebulizer treatment and Spiriva Outcomes: still in the hospital 9/28/2021

Other Meds: aspirin, atorvastatin cephalexin donepezil memantine. aspirin ( pantoprazole tiotropium

Current Illness: Memory loss

ID: 1741087
Sex: M
Age: 51
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1741088
Sex: F
Age: 36
State:

Vax Date: 06/22/2021
Onset Date: 08/03/2021
Rec V Date: 09/28/2021
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: Routine lab work has been WNL except for a slightly low WBC of 3.0 on September 22, 2021. September 11th, MRI done which showed mass near lacrimal sac measuring 2.0 x 1.5 x 3.7 cm. Biopsy performed on September 14, 2021 with roughly 1cm x 1cm specimen sent to pathology was negative for malignancy but showed necrotic Granulomas and numerous acid fast bacilli. Specimen was sent to lab around September 13, 2021 for PCR testing to get speciation of the mycobacterium. The results are not back. Multiple cultures have been taken within the past couple weeks and have been negative for growth thus far.

Allergies: None

Symptom List: Vomiting

Symptoms: August 3rd 2021, 6 weeks after the COVID-19 vaccination administration, the patient (myself) started to experience symptoms of a blocked tear duct that evolved into dacryocystitis, which was resistant to PO and IV antibiotics and continued to worsen despite an I & D. At which time, September 11th 2021, an MRI was done which showed a mass near the lacrimal sac. Biopsy results showed necrotic Granulomas with numerous acid fast bacilli consistent with a mycobacterial infection. Currently speciation and sensitivities are unknown. Modified RIPE therapy had been implemented with the concern that IV antibiotics may also need to be used depending on PCR and culture results. I have yet to recover from this infection and have been out of work since 8/13. I have lost weight, suffer from right sided headaches, right eye pain, slightly blurred vision on the right side, and will have a facial deformity due to the I&D and surgery. I also suffer from fatigue and general malaise. I will still require at least one more surgery to reconstruct the lacrimal duct system. While I understand that one could argue that I am immunocompromised due to the medications I?m on for Crohn?s disease, I would argue that I do not have a history of infections, risky personal habits or travel. I am vegan, plant based and work out daily. With mycobacterial infections commonly known as opportunistic, I have to wonder if the vaccine altered my immune response, allowing for the mycobacterium to proliferate and cause a serious infection.

Other Meds: Remicade Imuran

Current Illness:

ID: 1741089
Sex: M
Age:
State: LA

Vax Date:
Onset Date: 09/02/2021
Rec V Date: 09/28/2021
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: NKDA

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Symptoms were similar to a pulled muscle on the left side of back, and lasted approximately 10 days

Other Meds: wellbutrin

Current Illness: no

ID: 1741090
Sex: M
Age: 64
State: CA

Vax Date: 04/14/2021
Onset Date: 04/24/2021
Rec V Date: 09/28/2021
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: Visit to urgent care on April 25th, Dr on April 27th, audiologist and Dr on June 11th.

Allergies:

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

Symptoms: I lost hearing in my right ear on April 24th, 10 days after my 2nd Pfizer vaccine. I went to urgent care, then saw Dr on April 27th. The cause of the problem and the urgency to correct it were not clear at the time. Unfortunately I had to wait 2 months to see an ENT who properly diagnosed the problem as Sensorineural Hearing Loss. I was prescribed a course of treatment with Prednisone, but this did not recover any hearing . I have permanently lost almost all the hearing in my right ear.

Other Meds:

Current Illness:

ID: 1741091
Sex: F
Age: 44
State: CA

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 09/28/2021
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 sample test. September 2, 2021.

Allergies: No

Symptom List: Injection site swelling, Limb discomfort

Symptoms: I felt really tired, and I had a fever, it started about 04:00pm. I tried to massage and exercise my arm (on injection site). Those lasted for two days. No treatment. I noticed that my right foot has been swelling up a lot ever since the vaccine or maybe since having COVID. I had COVID in December 2020. I recently went to the doctor (Sept 2) for the foot swelling and really bad back pain. I was diagnosed with kidney issues which I didn't have before. October, another doctor visit is coming up to determine treatment. Ongoing symptoms still for foot swelling and back pain is ongoing at this time until I get treatment.

Other Meds: No

Current Illness: No

ID: 1741092
Sex: M
Age: 40
State: FL

Vax Date: 09/16/2021
Onset Date: 09/17/2021
Rec V Date: 09/28/2021
Hospital: Y

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

Lab Data: Hospitalized for dizziness and nausea and chest pain and elevated blood pressure - 9-25-21 to 9-27-21

Allergies: penicillin

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

Symptoms: dizziness and balance issues, nausea, cloudy/muted hearing on side of vaccine (left ear), pain, fever, sweating, chest pain, elevated blood pressure

Other Meds: metoprolol succinate, glycine, byetta, vitamin d3, milk thistle, phosphatidylcholine, turmer, trimethylglycine, berberine, n-ac, nicotinamide mononucleotide, trans-pterostilbene, fish oil, cinnamon, chromium, benazepril, niacin, rosuvastati

Current Illness: None

ID: 1741093
Sex: M
Age: 39
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am