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: 1741094
Sex: F
Age: 78
State:

Vax Date: 04/26/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

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: 1741095
Sex: F
Age: 63
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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

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

Other Meds:

Current Illness:

ID: 1741096
Sex: F
Age: 41
State: GA

Vax Date: 08/23/2021
Onset Date: 09/15/2021
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: I have covid now

Other Meds:

Current Illness: Never been sick

ID: 1741097
Sex: F
Age: 22
State: MI

Vax Date: 08/25/2021
Onset Date: 09/18/2021
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: EKG Echo (pending)

Allergies: Keflex Amoxicillin

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Pericarditis 3 weeks post vaccine. Sharp pleuritic chest pain which started on 9/18 - worse with inspiration. Seen in ED, other causes of chest pain ruled out.

Other Meds: Zoloft, Vyvanse, Vit D, Novolog (insulin pump), Mirena IUD in place

Current Illness:

ID: 1741098
Sex: F
Age: 23
State: NE

Vax Date: 09/28/2021
Onset Date: 09/28/2021
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: Penicillin

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

Symptoms: Vaccine was drawn up 9-27-21 at 1710, exp time 2310. Vaccine was given 9-28-21 at 915a. Talked with Pfizer 9-28-21 at 945a, was advised if vaccine was stored in the refrigerator for less than 24 hours between 2-30 C vaccine did not need to be repeated

Other Meds: etonogestrel/ethinyl estradiol 0.12-0.015 mg/24 hr Insert 1 ring vaginally and keep it in place for 3 weeks (21 days). Remove the ring for a 1-week break (7 days).

Current Illness: none

ID: 1741099
Sex: F
Age: 24
State: NC

Vax Date: 09/22/2021
Onset Date: 09/24/2021
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:

Allergies: amoxicillin, bermuda grass

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

Symptoms: The first hour after receiving the first dose of Pfizer-BioNTech vaccine, I developed a headache, body aches, and lower abdominal cramping. Two days following the vaccine, my milk supply decreased by 8oz. My infant, who is exclusively breastfed, became irritable, restless, and unable to pass a bowel movement for two day. Excluding the headache that alleviated 48 hours after first dose, all symptoms are still present at the time of this report.

Other Meds: Prenatal vitamins

Current Illness:

ID: 1741100
Sex: F
Age: 86
State:

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

Lab Data:

Allergies: morphine

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: 87-year-old female, vaccinated with Pfizer x2 doses on 2/2021, with a past medical history of Afib, dementia, HTN, HLD, CKD, gout, and anemia presented to the ED with cough, SOB, sputum production, x 4 days, presented to the ED with worsening fatigue and SOB. Daughter is the historian. She reports brother was sick Sunday and then 3 days later patient developed intermittent headaches, shortness of breath, and fatigue First vaccine 1/25/2021

Other Meds:

Current Illness:

ID: 1741101
Sex: M
Age: 51
State: MA

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Headache, ache in arm, neck, abdomen, and chest, head fogginess.

Other Meds:

Current Illness:

ID: 1741102
Sex: F
Age: 74
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: LA

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1741103
Sex: M
Age: 71
State: OK

Vax Date: 09/03/2021
Onset Date: 09/04/2021
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: CT scan at hospital on 9/14/21 Pt also states cancer treatment is going to change

Allergies: Metformin Quinine

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Pt has know squamous cell carcinoma in neck area, one day after vaccine he felt increased swelling in neck area, this continued to worsen every day following, he was seen by oncology and a stat CT scan was ordered of soft neck tissue, which revealed a significant increase in size of cancer compared to previous scan done on 7/23/2021

Other Meds: Chemo-Keytruda, carboplatin, Pacitaxel Hydroxyzine Zofran Albuterol Sulfate ASA Spironolactone Prochlorparazine Maleate Betamethasone Dipropinate Lactobacillus Vit D Amitripline ACL Finasteride Lyrica omeprazole Vit C Actos Terozosin Cre

Current Illness: Squamous cell carcinoma head/neck

ID: 1741104
Sex: F
Age: 70
State: PA

Vax Date: 03/25/2021
Onset Date: 03/25/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data:

Allergies: Penicillin; Dye Contrast

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

Symptoms: I started the night after the vaccine with chills, fever of 102, headache and weakness and aches those lasted about 2-3 days. My arm started to swell after those symptoms went away. The swelling started to swell all the way down where you bent the arm. I contacted the doctor and she advised to go to the emergency room. I went the emergency room at hospital. The doctor came and the looked at it they were unsure of what was causing the swelling. The looked like it could have been a reaction or infection. It was beat red and warm to the touch. They gave me an antibiotic and Benadryl. They also told me to take Pepcid AC. He drew a line where the swelling was, and it should not go past that line. The next morning it was swollen all the way to my wrist. I did go back to the emergency room and took pictures and they told me to keep doing what I was doing. I got an appointment with my PCP a few days later and she took me off the antibiotic and put me on a sulfur drug. I took a good month for the swelling to go down. I kept comparing it to my other arm. I also was experiencing nausea, extreme fatigue, and headaches during that time as well. I also got shingles about two months ago and I have had the original vaccine and the recent vaccine as well.

Other Meds: Zocor; Xanax; Cymbalta

Current Illness:

ID: 1741105
Sex: F
Age: 67
State: OR

Vax Date: 08/14/2021
Onset Date: 08/14/2021
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: EKG was unchanged from prior at time of exam on 09/21/2021. Holter Monitor ordered.

Allergies: Erythromycin

Symptom List: Rash, Urticaria

Symptoms: Patient described an immediate sensation of the shot going to the heart. Since vaccine, she has noted that she has had an increase in heart palpitation sensation (states that frequency has doubled since vaccine), some dull chest pain, causing it to be uncomfortable to lie on left side. Some noted SOB since vaccine.

Other Meds: Letrazole, iodine, ibuprofen, mistletoe, Vitamin B12, Vitamin D3, Aspirin, Vitamin C, MVI, WP Thyroid

Current Illness: Breast Cancer, Muscle weakness, Facial twitching, facial itching. hip pain.

ID: 1741106
Sex: F
Age: 70
State: FL

Vax Date: 09/26/2021
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 known Allergic to latex if I wear it

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

Symptoms: 2:00 am - headache, abdominal cramping; 7:00 am - cont. headache, diarrhea, fatigue; 7:00 am - 10:00 pm - cont. headache, fatigue; unable to eat or drink; slept most of day; 10:00 pm - cont. headache; lost muscle control and slowly fell (landing on back, but, don't believe I lost consciousness); diarrhea; 10:00 - went to bed and slept throughout the night until 7am; woke up feeling better; not wanting food or drink

Other Meds: Amlodipine Besylate - 5 mg; Benazepril - 10 mg; Atorvastatin - 40 mg; Montelukast - 10 mg; Estradiol - .5 g Vitamin B12, Vitamin D3; Women's One-a-Day Vitamin; Calcium; 5 g Fiber; Docusate Sodium

Current Illness: None

ID: 1741107
Sex: M
Age: 22
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: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1741108
Sex: F
Age: 81
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1741109
Sex: F
Age: 91
State: PR

Vax Date: 09/07/2021
Onset Date: 09/15/2021
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: Patient will make appointment with her primary doctor

Allergies: Gentamicin; Iodine; Aspirin; Neomycin; Penicillin

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

Symptoms: Female patient 91 year old oriented X3 in wheelchair accompanied by her son, she reports 8 days after receiving her first dose vaccine PFIZER with pain, inflammation and "numbness" in the joints. Patient reports pain in the neck, arms, wrists, knees and in the left lower limb, it radiates to the ankle.

Other Meds: Patient reports taking prescription medication: Losartan

Current Illness: NONE

ID: 1741110
Sex: F
Age: 46
State: MD

Vax Date: 03/01/2021
Onset Date: 04/01/2021
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: April21- xray of lungs- no issue May- ultrasound of neck- enlarged lymph node June- cardiologist visit- no findings follow up scheduled June- routine blood work- no issues August- er visit- ct scan- enlarged abdominal lynph node Aug- blood work/urinalysis normal Sept 7- pcp- follow up- appt scheduled with oncologist and gastroenterologist

Allergies: None

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

Symptoms: Continued enlarged lymphs nodes in right side of torso. Repeated for 5 months, different lymph nodes each time for approx 1-2 weeks each episode. In abdomen, neck, left armpit, left upper back. Lymph nodes will painfully enlarge then graddually decrease in size when another will enlarge. First symptoms beg or April continuing to today.

Other Meds: None

Current Illness: None

ID: 1741111
Sex: M
Age: 30
State: ME

Vax Date: 09/24/2021
Onset Date: 09/24/2021
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: none- I spoke with our pharmacist and Dr and my supervisor to report. Patient had no adverse reaction.

Allergies: none

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient was Janssen Covid 19 vaccine that had expired on 9/21/21

Other Meds: none

Current Illness: none

ID: 1741112
Sex: M
Age: 47
State: AL

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

Allergies: no known allergies

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: pt received the Pfizer Covid vaccine for first dose in the series. Received Moderna Covid vaccine as second IM injection. no adverse reaction noted during 15 minute observation period.

Other Meds: not known

Current Illness: high cholesterol

ID: 1741113
Sex: M
Age: 65
State:

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

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1741114
Sex: F
Age: 35
State: IL

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: 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: After a few minutes receiving injection, associate c/o pounding HA, slight fatigue, and chills. Associate was had no fever - associate was highly anxious per her words and had a previous vertigo spell/panic attack with first dose. Associate was able to verbalize and maintain consciousness, had no vertigo spell and declined water. Was able to leave under own power, steady gait,.

Other Meds:

Current Illness:

ID: 1741115
Sex: F
Age: 22
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 system on 9/25/2021, and vaccine was given 9/27/21. No expiration on Moderna box or vials

Other Meds: metformin, norethindrone

Current Illness: none

ID: 1741116
Sex: M
Age: 41
State: AZ

Vax Date: 05/24/2021
Onset Date: 05/24/2021
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: LA

Lab Data: Have been to Urgent Care Have been to Family Dr Have been to clinic Have been to physical therapy X-ray done Steroid injection done Still on going therapy

Allergies: Penicillin

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

Symptoms: Pain in shoulder at site of injection

Other Meds: No

Current Illness: No

ID: 1741117
Sex: M
Age: 88
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: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

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

Other Meds:

Current Illness:

Date Died: 09/24/2021

ID: 1741118
Sex: M
Age: 56
State: TN

Vax Date: 09/01/2021
Onset Date: 09/24/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Injection site pain, Menorrhagia

Symptoms: Admitted on 9/7/2021 with COVID-19 and sever hypoxia. Known COVID contact several days prior. Treated with remdesivir, dexamethasone, ceftriaxone, and azithromycin. Also started on barictnib on 9/9 but stopped due to ARF. Echocardiogram showed EF of 25-50% with moderately severe LV function. Started on heparin and continued throughout hospital stay. DVT in right lower leg. Seen by infectious disease and continued on cefepime and levofloxacin for 14 days. Underwent cryo-amputation of right ischemic lower extremity and then BKA by vascular surgery. Prognosis poor and not improving. Family elected comfort care.

Other Meds:

Current Illness:

ID: 1741119
Sex: F
Age: 67
State: KY

Vax Date: 04/14/2021
Onset Date: 09/25/2021
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: 9/25/21-SARS-CoV-2 PCR - IPOC Detected

Allergies: Aspartame, Aspartame and phenylalanine, codeine, hydrocodone/acetaminophen, ciprofloxacin, Nsaids

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

Symptoms: 9/25/21-Episode onset: 5 days ago. The problem occurs hourly. The problem has not changed since onset.The cough is productive of sputum. There has been no fever. Associated symptoms include chills, headaches, rhinorrhea, myalgias, shortness of breath (increased from baseline) and pleuritic pain (left). Pertinent negatives include no chest pain, no sweats, no ear pain, no sore throat and no wheezing Exposure to covid through a child at her grandsons sporting event Positive for chills and malaise/fatigue. Negative for fever. HENT: Positive for congestion and rhinorrhea. Negative for ear pain and sore throat. Respiratory: Positive for cough, sputum production and shortness of breath (increased from baseline). Negative for wheezing. Cardiovascular: Negative for chest pain. Gastrointestinal: Positive for diarrhea. Negative for abdominal pain, nausea and vomiting. Musculoskeletal: Positive for myalgias. Neurological: Positive for headaches. Negative for sensory change. Covid positive today. No evidence of pneumonia on chest x-ray per my review however patient with increased shortness of breath, pleuritic pain, productive cough so will treat from a preventive standpoint as patient is very high risk for developing pneumonia. Patient does meet criteria for Regeneron infusion. Discussed with patient who is agreeable to have infusion. Discussed CDC isolation guidelines and advised to follow. Encouraged to continue supportive care. Patient advised to go to the emergency room for any worsening symptoms which were discussed in detail. Patient verbalizes understanding and agrees with treatment plan. 9/26/21-Regeneron infusion

Other Meds: Accu-Chek Softclix Lancets lancets Use. ? albuterol (PROVENTIL HFA;VENTOLIN HFA) 108 (90 BASE) MCG/ACT inhaler Inhale 2 puffs into the lungs every 6 (six) hours as needed for Wheezing ? allopurinol (ZYLOPRIM) 100 MG tablet ? a

Current Illness: No known illnesses

ID: 1741121
Sex: F
Age: 92
State:

Vax Date: 02/24/2021
Onset Date: 09/27/2021
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:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: hospitalization

Other Meds:

Current Illness:

ID: 1741122
Sex: F
Age: 72
State: VA

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

Lab Data: N/A

Allergies: Ativan

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Pt. states that after receiving the 3rd dose of Moderna Booster 09/24/2021, started experiencing symptoms 09/25/2021 of severe chills, fever (100.5), fatigued, knot swollen at injection site with rash, and severe pain throughout the left arm. Self-Treated with extra-strength Tylenol, Symptoms lasting until 09/27/2021. Knot at injection site still remains and self-treated area with Topical Creams. No noted Primary visit.

Other Meds: Lipitor, Tekturnahct, Bystolic, Prevacid, Plazix, Aspirin, Inspra

Current Illness: N/A

ID: 1741123
Sex: M
Age: 88
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:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1741124
Sex: M
Age: 57
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: 1741125
Sex: F
Age: 29
State: TX

Vax Date: 09/28/2021
Onset Date: 09/28/2021
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:

Allergies:

Symptom List: Injection site pain

Symptoms: Pt. stated that she felt nauseated. Applied cold compress to her neck. BP 142/94, P 68, R20 equal bilateral unlabored, O2 Sat 99% on . Pt stated that she had not eaten today. Gave pt. a bottle of water. Pt. said that she felt better. Stated no more nausea. Pt. cleared and sent home at 10:55. BP 133/87, P56, R 20, O2 Sat 99% RA. Lung sounds clear, no shortness of breath. Instructed to go to local ER if nausea or any adverse reactions occur off site after discharge. Cleared by RN.

Other Meds:

Current Illness:

ID: 1741126
Sex: F
Age: 52
State: RI

Vax Date: 09/22/2021
Onset Date: 09/22/2021
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: LA

Lab Data: all test and results are in my medical record all i was told was my labs were all within normal limits on both 9-22-21 as well as the next day on 9/23/21. they told me my xray was fine without any concers and my ekg had returned to normal

Allergies: amoxicillin, clarithromycin, tetracyline, atrificial sweetners, soy products

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

Symptoms: Aproximately 3hrs after recieving vaccine for covid my heart rate spointaniously jumped into the 180 and stayed rapid tachycardiac for about 12 hous . i went to a walkin in and was sent by emt"s to hospital. had blood tests multiple ekgs and a chest xray. administer fluids and vit k as well as diltiazem. and at some point my heart rate just flipped back to a normal sinus rythem. was admitted for 24 hrs then discharged to follow up with my pcp and a cardioligist

Other Meds: vitiamins D and C and zinc

Current Illness: none

ID: 1741127
Sex: M
Age: 56
State: WI

Vax Date: 03/18/2021
Onset Date: 09/20/2021
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: IM
Vax Site: RA

Lab Data: COVID PCR 9/14/21 Positive Chest CT 9/20/21 1. Organizing pattern of lung injury consistent with known Covid infection. 2. No pulmonary embolism or acute aortic syndrome.

Allergies: None

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

Symptoms: Patient completed COVID-19 vaccination on 3/18/21. Pt was admitted to the reporting hospital on 9/20/21 with complaint of fever, sore throat, body ache, and respiratory symptoms for over a week. Admission diagnosis was Acute hypoxic respiratory failure due to COVID-19. Patient did travel to (Withheld) 2 weeks prior to diagnosis. PCR testing was positive on 9/14/21. Patient was discharged after 5 days on 9/25/21.

Other Meds: Lipitor 10mg, Restasis, Cymbalta 60mg, Lisinopril 10 mg, Aleve 220mg, Dayquil

Current Illness: Hypertension and hyperlipidemia

ID: 1741128
Sex: M
Age: 57
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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1741129
Sex: F
Age: 77
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: Erythema, Pruritus

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

Other Meds:

Current Illness:

ID: 1741131
Sex: F
Age: 35
State: TX

Vax Date: 03/24/2021
Onset Date: 03/29/2021
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: US of the kidneys MRI of the kidneys

Allergies: Amoxicillin; Levaquin; Feathers

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

Symptoms: I developed an UTI that lasted three months. It started on 03-29-2021 and it cleared up about the beginning of July. I had MRI of the kidneys as well as an ultrasound of the kidneys were performed at Hospital because they could not explain why this was happening to me. The UTI is now gone and I am left in inflamed urethra that I have to take Myrbetriq 50mg medication for. I also had a cystoscopy performed. I am currently seeing a Doctor, due to my inflamed urethra.

Other Meds: Advil; Allegra Medication

Current Illness: None

ID: 1741132
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: 1741133
Sex: M
Age: 20
State: TX

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

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient started to feel nauseous and lightheaded. He said he also had ringing in ears. He looked pale and muscles in arms were tensed up. I advised he keep his head down and keep breathing. 911 was called when he said his muscles were tensing up. However in the middle of the call he said he was starting to feel better and for the EMT not to come out. He sat down for another 20 mins and left cause he said he was much better and did not have the symptoms anymore.

Other Meds:

Current Illness:

ID: 1741134
Sex: F
Age: 75
State: IL

Vax Date: 03/20/2021
Onset Date: 07/19/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data: Immediate symptoms after the vaccine were: I got not only very tired and felt miserable. I had to be off of work for the day. I can't remember exactly what the symptoms were because I felt unbelievably miserable. I didn't want to eat or do anything. It lasted for a day. In July, I noticed cold symptoms and I thought I had a bad sinus infection. Nose running, congestion and then I began coughing. I had one episode when I was coughing when I couldn't breathe for 10 seconds. I got through that episode and then I went to Urgent Care. They gave me steroids - for about five days and I quarantined. That helped with my symptoms. I started feeling better within a couple of days but I quarantined until August 2 when I went back to work.

Allergies: no

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

Symptoms: Immediate symptoms after the vaccine were: I got not only very tired and felt miserable. I had to be off of work for the day. I can't remember exactly what the symptoms were because I felt unbelievably miserable. I didn't want to eat or do anything. It lasted for a day. In July, I noticed cold symptoms and I thought I had a bad sinus infection. Nose running, congestion and then I began coughing. I had one episode when I was coughing when I couldn't breathe for 10 seconds. I got through that episode and then I went to Urgent Care. They gave me steroids - for about five days and I quarantined. That helped with my symptoms. I started feeling better within a couple of days but I quarantined until August 2 when I went back to work.

Other Meds: Trimederen; Levothyroxine

Current Illness: no

ID: 1741135
Sex: F
Age: 49
State: TX

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: Employee calling to report a reaction after receiving a COVID-19 vaccine. Vaccine Name - Pfizer Vaccine Date - ? 9/27/2021 Is this your first or second dose- 3rd (booster) Date of symptom onset - ? 9/27/2021 Symptoms - ? body aches, headache, and nausea Last day of work and shift - ? NA Home remedies-NA Any improvement-NA Recommendation- Advised employee to take Tylenol or Ibuprofen per pack instructions for pain. Employee voiced understanding Employee of information ? Yes Employee voiced any concerns ? No Employee?s questions answered to employee?s satisfaction -Yes

Other Meds:

Current Illness:

ID: 1741136
Sex: F
Age: 77
State:

Vax Date: 02/21/2021
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: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pain in extremity

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: 1741137
Sex: F
Age: 19
State: TX

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:
Dose Series: 2
Vax Route:
Vax Site:

Lab Data: Pt requested a Benadryl 25mg capsule.

Allergies:

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

Symptoms: Patient reported feeling a bit of chest pain after receiving her covid Pfizer vaccine. Did not report any trouble breathing or redness/ itching.

Other Meds:

Current Illness:

ID: 1741138
Sex: F
Age: 82
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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1741139
Sex: M
Age: 47
State:

Vax Date: 09/28/2021
Onset Date: 09/28/2021
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: 1741140
Sex: F
Age: 70
State: NJ

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

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

Lab Data:

Allergies: None

Symptom List: Vomiting

Symptoms: In the afternoon following the second Moderna dose on 3/11/2021 I began to feel extremely tired. By early evening I had a headache, felt extremely nauseous, and had extreme chills. I skipped dinner, went to bed but was unable to sleep due to the chills and nausea. In the morning I still felt slightly nauseous but was able to eat some broth. I felt better as the day went on and was able to eat a small meal at dinnertime and felt normal by evening. Seven days after my first Moderna dose on 2/6/2021 a rectangular red patch appeared on my left arm just below the injection site. It was moderately and intermittently itchy. It lasted 5 days and disappeared. My doctor said it's called "Covid arm".

Other Meds: Montelukast 10 mg, Prolia, Albuterol 90 mg, Fish Oil 1200 mg, Vitamin C 500 mg, Vitamin E 400 IU, Vitamin D 2000 IU, Citracal, Acidophilus, Culturelle (generic form), Fiber powder

Current Illness: None

ID: 1741141
Sex: F
Age: 79
State: OH

Vax Date: 09/25/2021
Onset Date: 09/26/2021
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:

Allergies: Penicillin, sulfa, erythromycin

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Sore arm then 24 hours later muscle and joint pains lasting 7 hours with 1.5 degree temperature above normal. Then a day later, the same reaction, lasting 8 hours. Arm is red, puffy, and warm and itches.

Other Meds: Premarin, lovastatin, vitamin D, multi vitamin

Current Illness: None

ID: 1741142
Sex: M
Age: 70
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:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1741144
Sex: F
Age: 58
State: NJ

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

Allergies: Vitamin D, latex, IV contrast

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient reports that she noticed right lower abdominal discomfort about 30 minutes after receiving the vaccine. She decided to take Famotidine to try to relieve her discomfort. She reports that the pain continued on and off for one week and continued as of Mon 9/27/21 at 3:34 PM. Reports that the pain is a dull ache and feels like pain she had prior to getting her gallbladder removed. Patient also reports persistent left anterior arm pain and difficulty raising arm over head and behind her back. No swelling or redness. No shoulder joint pain. Reports that she feels that the arm pain and limitation in movement is about 50% better than it was at the onset. No history of left arm or shoulder problems.

Other Meds: Vitamin C, Folic Acid

Current Illness: Celiac disease, lightheadedness/ low blood pressure

ID: 1741145
Sex: F
Age: 63
State: MN

Vax Date: 04/30/2021
Onset Date: 09/25/2021
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: none

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

Symptoms: diarrhea, cough. headaches starting on 9/25/21

Other Meds: Excederin; Duloxetine; Vitamin D; C; B12; Omeprazolel Fluticason; Fenofenadine; Rizatriptan; Gabapentin

Current Illness: none

Date Died: 09/25/2021

ID: 1741146
Sex: M
Age: 36
State: TN

Vax Date: 09/22/2021
Onset Date: 09/22/2021
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: No medical or lab tests were done by the Death Investigator. An autopsy was ordered and the body was sent to the State Medical Examiner for an autopsy.

Allergies: NKA

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

Symptoms: Parents reported to Death Investigator that patient complained of body aches, severe headache, and pain in his lower extremities on the evening of 9/22/21 (thee date he received the vaccine). He was taking Tylenol for his symptoms per his parents. On Thursday, 09/23/21, he continued with the above symptoms and felt worse per parents. Mother asked him if he needed to go to the doctor and he said no. On Friday, 09/24/21, he felt better than the day before but still had symptoms. Parents last talked with him around 2230 Friday night. They went to wake him up at 1100 on Saturday, 09/25/21 and found him deceased in the bed. EMS was called and he was transported to Hospital Emergency Department DOA.

Other Meds: Unknown

Current Illness: None reported by individual - Parents told EMS and Death Investigator that he had been "sick a few weeks ago". He was last tested for COVID-19 for his job on 8-16-21 and was negative. It was a PCR test.

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am