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: 1741556
Sex: F
Age: 48
State: WA

Vax Date: 09/11/2021
Onset Date: 09/11/2021
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: LA

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient called us 9/28/21 to report that she had developed a lump and bruise at the injection site shortly after administration. About a week later the bruise went away, but a lump was still present and the lump was painful with sharp shooting pains, so she went to her primary care doctor. She said her doctor instructed her to wait and watch. She says as of 9/28/2021 she hadn't improved and was messaging her doctor about the situation.

Other Meds:

Current Illness:

ID: 1741557
Sex: F
Age: 38
State: AZ

Vax Date: 09/04/2021
Onset Date: 09/19/2021
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: 09/19/21: CBC, CMP, troponins, d-dimer

Allergies: N/a

Symptom List: Anxiety, Dyspnoea

Symptoms: Tachycardia, chest pain/tightness, afib reported x 2 on home ecg device. HR up to 160

Other Meds: Daily multivitamin

Current Illness: N/a

ID: 1741558
Sex: M
Age: 40
State: NY

Vax Date: 09/26/2021
Onset Date: 09/26/2021
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: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-

Other Meds:

Current Illness:

ID: 1741559
Sex: M
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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

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

Other Meds:

Current Illness:

ID: 1741560
Sex: F
Age: 46
State: MN

Vax Date: 02/08/2021
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:

Allergies:

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

Symptoms: Tested PCR positive for COVID on 9/28/21 after being fully vaccinated.

Other Meds:

Current Illness:

ID: 1741561
Sex: M
Age: 65
State:

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

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

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

Other Meds:

Current Illness:

ID: 1741562
Sex: F
Age: 16
State: AL

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: none

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: severe dizziness morning after vaccine, had to leave school and go home and still dizzy in afternoon

Other Meds: na

Current Illness: none

ID: 1741563
Sex: M
Age: 46
State: TN

Vax Date: 04/07/2021
Onset Date: 04/07/2021
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: Tetracycline, shellfish

Symptom List: Pharyngeal swelling

Symptoms: Immediate pain followed by numbness in left arm for 5 days. Loss of taste of certain foods for 5 days.

Other Meds: Adderall, Ambien

Current Illness: None

ID: 1741564
Sex: M
Age: 73
State: KY

Vax Date: 01/04/2021
Onset Date: 09/24/2021
Rec V Date: 09/28/2021
Hospital: Y

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

Lab Data: COVID 19 pcr 9/22

Allergies: Streptomycin-syncope sulfa-rash

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: COVID 19 infection with hypoxic respiratory failure and bilateral pneumonia

Other Meds: acetaminophen aspirin escitalopram iron gluconate lisinopril simvastatin vitamin B-12

Current Illness:

ID: 1741565
Sex: M
Age: 62
State: NJ

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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient is under 65 years old and was given FLUAD which is the 65 and older vaccine. This was done at an off site clinic at a senior living center. Patients nurse and doctor were on site and notified and will monitor patient, didnt think any harm was done to patient.

Other Meds:

Current Illness:

ID: 1741566
Sex: M
Age: 69
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: SYR
Vax Site: LA

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1741567
Sex: F
Age: 53
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: SYR
Vax Site: RA

Lab Data:

Allergies: None reported

Symptom List: Rash, Urticaria

Symptoms: At approximately 1100, patient reported to Lead Nurse she received a 1st dose of Moderna. Patient received her first dose of Moderna (LOT# 042L20A) on 01/17/2021 in left arm. Patient reported a first dose reaction. One day after her vaccination, patient noted left arm redness and swelling at the injection site. Patient immediately went to urgent care. Urgent care doctor advised patient to go to the emergency room. Patient was hospitalized for one night in the emergency room and reported hives all over the body. Lead nurse elevated to supervisor. Supervisor elevated to medical consult team. Medical consult team advised patient to receive a single dose of Janssen Covid vaccine. At 1342, patient received a single dose of Janssen (LOT# 211A21A, exp. 12/14/2021) in right arm. Patient advised to wait in observation for 30 minutes. Lead Nurse educated patient on signs/symptoms of when to seek emergency care, to follow up with primary care provider, and to sign up on v-safe. At approximately 1412, patient left facility with unlabored respirations and steady gait.

Other Meds: None reported

Current Illness: None reported

ID: 1741568
Sex: F
Age: 59
State: UT

Vax Date: 09/17/2021
Onset Date: 09/17/2021
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: Milk, Penicillin, Keflex, Aspirin, NSAIDS, Macrodantin, Sulfa medications, Poly-mixin eye drops

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

Symptoms: Neck pain radiating into head starting at 2300. By 2330 full body ached, severe pain, chills, nausea, and temperature of 101.4. Took 1000mg of Tylenol and 200mg of Celebrex but nothing touched the pain. This lasted until September 18, 2021 at 0400. Nausea continued through the day of September 18, 2021

Other Meds: Effexor, Estradiol, Celebrex, Synthroid, Ditalizam, Omeprazole, Multi-vitamin, Biotin, Vitamin B-12, Calcium w/Vitamin D

Current Illness: None

ID: 1741569
Sex: F
Age: 23
State:

Vax Date: 01/29/2021
Onset Date: 09/24/2021
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: Patient had a positive COVID test on 9/24/2021

Other Meds:

Current Illness:

ID: 1741570
Sex: F
Age: 49
State: NJ

Vax Date: 01/20/2021
Onset Date: 03/01/2021
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: MRI, nasal scope, hearing tests not sure of dates

Allergies: PCN, Sulfa, Avapro, propofol

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

Symptoms: The day I received vaccine I became extremely sick, fever chills, terrible body aches lasted 24 hours. Felt better, Then a few weeks later I started to develop humming in my ears, tremendous pain in my inner ear. Ruled out every acute illness. Diagnosed with neuralgia. Now on seizure medicine, still getting work up (MRI, Pain management)

Other Meds: Synthroid, hct, protonix, melatonin, Vyvanse, vitamin D, Vitamin B12

Current Illness:

ID: 1741572
Sex: M
Age: 24
State: NY

Vax Date: 04/26/2021
Onset Date: 05/02/2021
Rec V Date: 09/28/2021
Hospital: Y

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

Lab Data: - Cardioechogram May 3rd - EF of 35% - CHEST CT w/without contrast May 4th - Chest XRAYs - Stress Test - Blood Test CardioEcko Aug 27th - EF of 46% Too many tests to describe.

Allergies: None.

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

Symptoms: Me and my family have no prior cardiac history, I am able-bodied, in great shape, and routinely exercise at time of the vaccine. 5 days after receiving the first dose of the Pfizer vaccine. I woke up in the middle of the night with intense palpitations, heart tremors, and chest pain. The following day, I saw a cardiologist to conduct a cardio-echogram at the office. I was informed that I had a cardiomyopathy with a reduced ejection fraction of 35%. The following day I was admitted to the Hospital, Heart Failure unit where I stayed for 3 days for treatment. Within my MRI's, heart inflammation was found within the imaging. Since then, I've been on a salt/exercise/alcohol restriction and have incurred thousands of dollars in medical expenses. I've taken numerous prescriptions on a daily basis with no end in sight. I'm now 25 years old. This has taken from me far more than I can begin to express. I may be on these medications for the rest of my life, however long that may be dependent on my condition. I need answers. Please someone reach back out to me. My doctors have told me it is impossible to say for certain, but there is reasonable possibility this stemmed as a reaction from the vaccine. I'm still waiting to hear back from Pfizer.

Other Meds: None.

Current Illness: None.

ID: 1741573
Sex: F
Age: 43
State: WA

Vax Date: 03/28/2021
Onset Date: 08/30/2021
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: Bloodwork - Anemia; EKG - normal; Chest x-ray - no phenomena; COVID-19 - 4th Sep 2021 positive.

Allergies: Keflex

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

Symptoms: In March after the vaccine, I had flu symptoms, joint pains and low grade fever. Which went off the next day. It started as congestion on 30Aug2021, I have general not feeling well, sinus pain, fever, cough, headache, fatigue, aches, lost of taste and smell and chills. Did tele doctor and went to ER on 13 Sep2021, because I was having chest pressure and difficult to breathe.

Other Meds: Vitamin C; Calcium; Lexapro; Multivitamin; Pantoprazole

Current Illness: No

ID: 1741574
Sex: M
Age: 65
State: GA

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

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Error: Incorrect Reconstitution-

Other Meds:

Current Illness:

ID: 1741575
Sex: M
Age: 58
State: FL

Vax Date: 03/23/2021
Onset Date: 04/23/2021
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: On labs, 6/2/21 show fasting blood glucose of 331, and hemoglobin A1c of >14.0%, and eGFR of 97.

Allergies: no allergies to medications or food

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Patient is a 58 year old man with recently elevated glucose levels after his second dose of his Pfizier COVID-19 vaccine and 10 days after began with polyuria, polydipsia, blurry vision, and then diagnosed with type 2 diabetes. On labs, 6/2/21 show fasting blood glucose of 331, and hemoglobin A1c of >14.0%, and eGFR of 97.

Other Meds: N/A

Current Illness: Overweight, prediabetes

ID: 1741577
Sex: F
Age: 82
State: AR

Vax Date: 03/25/2021
Onset Date: 09/22/2021
Rec V Date: 09/28/2021
Hospital: Y

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

Lab Data:

Allergies: hydromorphone hcl and codeine

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

Symptoms: hospitalization with covid after being fully vaccinated

Other Meds: unknown

Current Illness: unknown

ID: 1741578
Sex: F
Age: 48
State: PA

Vax Date: 05/07/2021
Onset Date: 09/03/2021
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: No

Allergies: No

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

Symptoms: Since receiving the second Covid 19 shot on June 4, it has changed my menstrual cycle. Starting in September I started menstruating every two weeks and the cycle last much longer than normal. I am 48 years old. I began my menstrual cycle at age 13 and I have always been regular. My cycle has always been about every 28 days. I do not have a history of any cycle changes or missed periods.

Other Meds: No

Current Illness: No

ID: 1741579
Sex: F
Age: 65
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: Unevaluable event

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

Other Meds:

Current Illness:

ID: 1741580
Sex: F
Age: 71
State: IL

Vax Date: 08/17/2021
Onset Date: 08/18/2021
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: None

Allergies: Naproxen, avocado, scallops & latex.

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

Symptoms: The day after vaccinated, I started getting large red bumps on both of my legs. I went to an immediate care clinic located outside of my hospital. He said it could be anything as it's that time of year for "biting" bugs. and that he wasn't a Dermatologist. I was able to get into my Dermatologist's office soon after this. After six days on August 23, I was able to get an appointment with my Dermatologist, Dr. gave me triamcinolone acetonide 0.1% topical ointment to put on these spots 2 x a day for 2-4 weeks. It is now September 28 and I am still getting these red spots. She wanted to put me on Prednisone but I have latent tb and cannot take this drug so she put me on Allegra since Monday, I believe September 20. I'm still getting these red spots and I am going to another Dermatologist regarding this on October 5.

Other Meds: Baby Aspirin/80 mg, Amitriptyline/5 mg tab, Emgality injection, Nadolol 20 mg tab, Omeprazole 20 mg tab, Probiotic capsules, Calcium 650 mg, Multiitamin chewable - mens, Docusate Sodium 100 mg 2 capsules, Vitamin D3 - 2000 IU, Magnesium 250

Current Illness: None

ID: 1741581
Sex: F
Age: 26
State:

Vax Date: 01/13/2021
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: Patient had a positive COVID test on 9/27/2021

Other Meds:

Current Illness:

ID: 1741582
Sex: F
Age: 26
State: MN

Vax Date: 01/26/2021
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: SYR
Vax Site: LA

Lab Data: 9/27 SARS/COV-2, NAAT Positive

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Breakthrough COVID

Other Meds:

Current Illness:

ID: 1741583
Sex: F
Age: 66
State:

Vax Date: 02/12/2021
Onset Date: 02/12/2021
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:

Allergies:

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

Symptoms: none

Other Meds:

Current Illness:

ID: 1741584
Sex: M
Age: 63
State: NC

Vax Date: 02/27/2021
Onset Date: 02/27/2021
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: LA

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: 63 year old who reports that he often feel faint when he gets shots. he received his vaccine and asked if he could immediately lie down.

Other Meds:

Current Illness:

ID: 1741585
Sex: F
Age: 63
State: GA

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: RA

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Error: Incorrect Reconstitution-

Other Meds:

Current Illness:

ID: 1741586
Sex: F
Age: 56
State: OH

Vax Date: 09/08/2021
Onset Date: 09/08/2021
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: 9/10/2021 and 9/17/2021

Allergies: N/A

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

Symptoms: Within 2 hours of receiving the vaccine my blood pressure increased to 187/97. I couldn't sleep overnight due to difficulty breathing. The next day I went to work and felt dizziness, weakness, muscle pain, tiredness and joint pain. The same symptoms the next 1/2 day followed by chest pain, shortness of breath. Feeling of having a fast-beating, heartburn and pounding heart. Around 4.30 PM I have called Dr.'s office asking for advice. I was advised to take Tylenol and Ibuprofen and if the symptoms persist to go to ER. Around 6.00 PM I went to ER and was checked having blood work and EKG. I was released 4 hours later and followed up a week after. At the time of visit I was checked up and had blood work again. I was advised to go again for more testing since I still had difficulty breathing.

Other Meds: Tylenol, Ibuprofen

Current Illness: N/A

ID: 1741587
Sex: F
Age: 40
State: OR

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

Lab Data:

Allergies: Sulfa Antibiotics Hydroxychloroquine Sulfate Methotrexate Derivatives Diclofenac Nitrates, Organic Prednisone sensitivity Etonogestrel-Ethinyl Estradiol Acyclovir And Related Lactose Soybean/ Blueberry/Avocado/Rice/Hops Tolterodine Tartrate Valproic Acid Topiramate Gadolinium Derivatives Sulfa (Sulfonamide Antibiotics) Nitrates Tape, Occlusive Adhesive Adhesive Tape-Silicones Bee Venom Protein (Honey Bee) Iodinated Contrast Media Gadolinium-Containing Contrast Media

Symptom List: Nausea

Symptoms: EXTREME FATIGUE. MUSCLE & JOINT PAIN, NAUSEA & VOMITING and MIGRAINE HEADACHE

Other Meds: Meds oxycodone/acetaminophen Zofran Fluconazole Clotrimazole Lozenge Gabapentin Spironolactone Hydroxyzine Hcl Doxepin Metformin Trospium morphine montelukast Ketotifen Gastrocrom Cetirizine Buspar Venlafaxine MethylAssist Doxylamine Lorat

Current Illness: Mast cell activation EDS (Ehlers-Danlos syndrome) TMJ dysfunction Numbness Chronic right flank pain Nephrolithiasis Poor dentition Full Set of Dentures Costochondritis Bipolar 1 disorder, depressed Chronic migraine Polyarthropathy Vitamin B12 deficiency HLA-B27 positive Vitamin D deficiency Fibromyalgia syndrome Bunion, right foot Anxiety Hypothyroidism (acquired) Achilles tendinitis of left lower extremity Tendonitis, Achilles, left Urge incontinence of urine Chronic bilateral low back pain without sciatica Bladder irritation IUD (intrauterine device) in place-replace 1/2025 Urinary frequency Heterozygous MTHFR mutation C677T

ID: 1741588
Sex: F
Age: 58
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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain

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

Other Meds:

Current Illness:

ID: 1741589
Sex: F
Age: 63
State: NJ

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:

Allergies:

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

Symptoms: Patient is 63 years old and received FLUAD 65 and older vaccine, This was administered at an off site clinic patients nurse and doctor were on site and aware did not believe there was any harm and will monitor patient.

Other Meds:

Current Illness:

ID: 1741590
Sex: F
Age: 40
State: NC

Vax Date: 03/31/2021
Onset Date: 03/31/2021
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: seasonal

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

Symptoms: pt c/o light headed, dizzy. Pt has anxiety. Pt had panic attack prior to vaccine. Low fever 99.6, vital normal, after additional monitoring by ems pt was released no transport needed.

Other Meds: xanax

Current Illness: none

ID: 1741591
Sex: F
Age: 37
State: NC

Vax Date: 03/17/2021
Onset Date: 03/17/2021
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: walnuts, diflucan

Symptom List: Tremor

Symptoms: Rash to neck area, difficulty swallowing. Patient vitals are normal. Patient did wait her 30mins and had no reaction but once she started to leave the building she had symptoms return. Administered 50mg PO of Benadryl and monitored for additional 30 mins. Patient improved and declined transport and further care

Other Meds: none

Current Illness: none

ID: 1741592
Sex: F
Age: 64
State: CA

Vax Date: 03/10/2021
Onset Date: 03/10/2021
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: NONE

Allergies: OXYCODONE

Symptom List: Erythema, Pruritus

Symptoms: UPPER ARMS HURT A LOT, MASSIVE HEADACHES, CHILLS. I WAS REALLY TIRED AND SICK AND IT WENT ON FOR ABOUT 14 HOURS. FOR MY THIRD BOOSTER SHOT MY JOINTS WERE HURTING A LOT. MY ELBOW SHOULDER AND THE WHOLE BODY ACHED.

Other Meds: AREMIDA; ADOLA; LAMICTAL; CASTOR; MISLEIN; ZAMIK; CALCIUM; B12; VITAMIN D2; JOINT HELP

Current Illness: NONE

ID: 1741593
Sex: M
Age: 59
State:

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

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1741594
Sex: F
Age: 46
State: KS

Vax Date: 02/19/2021
Onset Date: 02/25/2021
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: None. Will be seeing my Endocrinologist in October for another test.

Allergies: Sulfa

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

Symptoms: Less than a week after my shot I started bleeding heavily with clots. I had already been on my period 2 weeks prior. I bled heavy for 8 days which is unusual. I have only had one period since then in this time span. I have hot flashes now and no period. I am like clock work. I also was just checked last year to make sure I was not in peri menapause as we may have to adjust my thyroid medication or treatment plan.. but I was not. My levels were WNL. I also have substantial bruising as well. Randomly on my body. I?m a RN and I actually didn?t know who to report these things too as there was no information given to me at the time of my vaccine.

Other Meds: Synthroid, cytomel, metformin (not diabetic), Vit c and multi vitamin

Current Illness: None

ID: 1741595
Sex: F
Age: 67
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: Asthenia, Chills, Headache, Myalgia

Symptoms: none

Other Meds:

Current Illness:

ID: 1741596
Sex: M
Age: 11
State: NC

Vax Date: 08/16/2021
Onset Date: 08/16/2021
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: N/A

Allergies: NKDA

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

Symptoms: Underage patient received Pfizer vaccine. No adverse reactions noted. No problems at present or after first vaccine.

Other Meds:

Current Illness: None

ID: 1741597
Sex: M
Age: 34
State:

Vax Date: 08/06/2021
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: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Found to be Covid positive incidentally during admission for alcohol withdrawal

Other Meds:

Current Illness:

ID: 1741598
Sex: M
Age: 70
State: TN

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: Pain in extremity

Symptoms: Error: Wrong Dose of Vaccine - Too High-

Other Meds:

Current Illness:

ID: 1741599
Sex: F
Age: 72
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: 2
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1741600
Sex: M
Age: 11
State: NC

Vax Date: 08/16/2021
Onset Date: 08/16/2021
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: N/A

Allergies: NKDA

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

Symptoms: Underage patient received Pfizer vaccine. No adverse reactions noted. No problems at present or after first vaccine.

Other Meds:

Current Illness: None

ID: 1741601
Sex: F
Age: 76
State: CA

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: Not applicable

Allergies: Tramadol, Codeine, Metopropol, Pistachios, Eggpland

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

Symptoms: Sudden loss of energy during afternoon walk about 1.5 hrs. after shot - was walking only about 10-15 when occured Tired in evening 2:30 am - feeling washed out, stomach pains, nausea, very slight headache, sore arm, redness at shot site Feeling fatigued right now: 12:30 pm 09/28/2021 Not much of an appetite Otherwise improving

Other Meds: ES Tylenol, Mucinex , Claritin prn Daily: Vit D3, Biotin, Milk Thistle, Arthrocen, Vit B12; Melatonin 1/2 mg. at night Oral Rx: Buspar 7.5 mg daily

Current Illness: None

ID: 1741602
Sex: F
Age: 29
State: MA

Vax Date: 04/17/2021
Onset Date: 05/16/2021
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:

Allergies: Seroquel, Zyprexa, Gabapentin, Risperidone

Symptom List: Vomiting

Symptoms: myopericarditis

Other Meds: Ibuprofen Colchicine

Current Illness:

ID: 1741603
Sex: F
Age: 49
State: NY

Vax Date: 02/27/2021
Onset Date: 03/27/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data: Aug 28th test results

Allergies: Tree nuts, soy, etc.

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: DIAGNOSED with COVID-19: low grade fever, increased heart rate, loss of taste and smell, fatigue, body aches, diarrhea, sore throat, cough, congestion, chest pains, nausea, vomiting.

Other Meds: Valsartan & Valacyclovir

Current Illness: No.

ID: 1741604
Sex: F
Age: 32
State: MS

Vax Date: 08/01/2021
Onset Date: 08/01/2021
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: Doxycycline, Macrobid, Reglan, Bactrim, and contrast dye

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

Symptoms: The vaccine was given 8/24/2021 and the following month I experienced a big delay in menstruation. I am currently experiencing a delay in menstruation as well. My cycle is always on time and it has been many years since I experienced a delay in menstruation. I was completely unaware of this possible side effect until a relative mentioned it.

Other Meds: Lexapro

Current Illness: Anemia

ID: 1741605
Sex: F
Age: 47
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: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

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

Other Meds:

Current Illness:

ID: 1741606
Sex: F
Age: 63
State: PA

Vax Date: 03/18/2021
Onset Date: 08/23/2021
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: RA

Lab Data: xray of left hand 8/23/21 - the xray showed soft tissue swelling but nothing else abnormal

Allergies: iodine in xray dye

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

Symptoms: on 8/22/21 noticed that my left 'ring' 4th finger was swollen at base and purple in color. Was still bad the next morning so went to Dr on 8/23 who diagnosed it as a ganglion cyst. I have never had one before. note that I have no idea if it is associated with the vaccine or not.

Other Meds: Vitamins D3 (2000iu), Calcium, K1, K2, magnesium

Current Illness: none

ID: 1741607
Sex: F
Age: 32
State: MN

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: Error: Booster Given Too Early-

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am