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: 1744988
Sex: M
Age: 62
State: TX

Vax Date: 01/11/2021
Onset Date: 06/02/2021
Rec V Date: 09/29/2021
Hospital:

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

Lab Data: Cardiac event monitor, CXR, full labs including extensive autoimmune labs, brain, c-spine, thoracic spine, lumbar and pelvic MRI's, all unremarkable. Vestibular testing in process. Spinal tap, physical exam and EMG all consistent with the diagnosis.

Allergies: Rosuvastatin

Symptom List: Dysphagia, Epiglottitis

Symptoms: Asymptomatic until June 2, 2021. Developed symptoms of dysautonomia, dizziness, facial vasomotor symptoms, and near syncope. Full lab and cardiac work-up was negative, except for relative bradycardia at rest and during hard exercise. Fast-forward 5+ weeks, developed sudden onset of lower extremity proximal muscle weakness, and wasting. Diagnosis is AIDP/Guillain-Barre. Scheduled for IVIG therapy this week

Other Meds: Toprol XL, ASA 81 mgs

Current Illness: None

ID: 1744990
Sex: M
Age: 47
State: CA

Vax Date: 08/31/2021
Onset Date: 09/16/2021
Rec V Date: 09/29/2021
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: Gillian Barre Syndrome. Onset of neuropathy of left arm started circa 9/16. Numbness . Tingling . Radiating pain to left triceps, trapezius and armpit . Ongoing for two weeks. Loss of range of motion and severe immobilizing pain when move body in certain position. Symptoms aggravated or relieved by position of neck. Symptoms aggravated by pressure.

Other Meds: Ibuprofen, naproxen; Influenza

Current Illness:

ID: 1744991
Sex: M
Age: 77
State:

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 09/29/2021
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: Administration error mixed series mRNA vaccine Pfizer and moderna

Other Meds:

Current Illness:

ID: 1744993
Sex: F
Age: 69
State:

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 09/29/2021
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: 1744994
Sex: F
Age: 50
State: CA

Vax Date: 05/04/2021
Onset Date: 05/05/2021
Rec V Date: 09/29/2021
Hospital:

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

Lab Data: CT Scan of face. Performed 09/27/2021

Allergies: Gluten intolerance

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

Symptoms: Metal taste in mouth the next day following the first vaccine. Last about 4 weeks. Dislike of some foods, especially coffee, since first shot. Still present. Facial nerve pain about 2 months post vaccine. Still occurring intermittently.

Other Meds: None

Current Illness: None

ID: 1744995
Sex: M
Age: 54
State: GA

Vax Date: 09/05/2021
Onset Date: 09/15/2021
Rec V Date: 09/29/2021
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: unable to seek medical care . Homeless and unemployed

Allergies: Geodome codeine

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

Symptoms: Reaction on left side of chest and arm . feels like bee sting . Very painful.

Other Meds: no

Current Illness:

ID: 1744996
Sex: F
Age: 91
State:

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 09/29/2021
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: 1744997
Sex: M
Age: 60
State: NM

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 09/29/2021
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: sensitive to versed (delirium) previous similar reaction to flu vaccine about 20 years ago (triggers asthma)

Symptom List: Pharyngeal swelling

Symptoms: Awakened from sleep at 10:30 p.m. with sense of nervousness, slight tightness in chest, and an increase in effort to breathe. This is the sensation I get when my asthma has been triggered. It is NOT of cardiac origin. Took 2 puffs of albuterol inhaler with relief of chest tightness and able to breathe easier.. When asthma is triggered, I also have a very difficult time sleeping. I have a RX for ambien for such occasions. I took a half a ambien, and was able to fall asleep. I did need the inhaler again in the morning. No chest tightness but the sense of needing to breathe easier. I took 2 puffs of albuterol which enhanced my breathing effort. I plan to keep my inhaler readily available over the next few days to use prn. I had this same reaction about 20 years ago with the flu vaccine. I have had the COVID (Pfizer vaccine) and did not have any respiratory issues, which is why I thought I would try the flu vaccine again. I know that if I keep my asthma triggers well controlled, my asthma remains well controlled. Consequently, I am proactive to anything that may trigger my asthma to prevent any exacerbation of my symptoms.

Other Meds: OTC multivitamin for eyes, tincture "deep stress", iron aupplement

Current Illness: none

ID: 1744998
Sex: M
Age: 28
State: MN

Vax Date: 09/08/2021
Onset Date: 09/09/2021
Rec V Date: 09/29/2021
Hospital:

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

Lab Data:

Allergies: Sulfa drugs

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Fever of 100 degrees. Chills & sweating. Headache. Achiness, weakness, and fatigue.

Other Meds: None

Current Illness: None

ID: 1744999
Sex: F
Age: 74
State: DC

Vax Date: 03/26/2021
Onset Date: 07/09/2021
Rec V Date: 09/29/2021
Hospital: Y

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

Lab Data: ekg, blood panel, ultrasound, echocardiogram, I don't remember all the test they did.

Allergies: codeine

Symptom List: Diarrhoea, Nasal congestion

Symptoms: I went to the ER because I had fallen on my knee and my knee was fine, while I was there in waiting room they noticed I had a very rapid heart beat. They found I had A FIb, I did not even realize my heart rate was high. I had no symptoms. I was hospitalized for 4 days and they put me on Eliquis and metoprolol . I'm going to have an ablation on Friday October 1, 2021.

Other Meds: levothyroxine, atorvastatin, Citalopram, Vitamin D, Zyrtec, calcium,

Current Illness:

ID: 1745000
Sex: M
Age: 92
State:

Vax Date: 03/06/2021
Onset Date: 09/24/2021
Rec V Date: 09/29/2021
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:

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

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: 1745001
Sex: M
Age: 60
State: IN

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 09/29/2021
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:

Symptom List: Rash, Urticaria

Symptoms: vaccine given after expiration date

Other Meds: vaccine given after expiration date

Current Illness:

ID: 1745002
Sex: M
Age: 71
State: NE

Vax Date: 03/25/2021
Onset Date: 08/16/2021
Rec V Date: 09/29/2021
Hospital: Y

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

Lab Data: 25th of August - Hospital ER - they put some dye in me and went up my wrist up one of my arteries and used a balloon to open up an artery that was starting to clog up. I was awake but 1/2 groggy through the process. They said there may be a couple of things that I made need to do in the future but this is all for now.

Allergies: none

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

Symptoms: The 15th, we moved son to location, I started having gas pains. My family doctor - I've been having problem with digestive system a little. Doctor had said that I maybe might have had a hiatal hernia (before all the gas symptoms started in August). The gas would come and go - last a 1/2 day and then go away and eventually it was all day and got to a point I could not sleep for 30 hours. I went to ER - they checked my heart and said I was having a heart attack. 18 session rehab - I go in and they hook me up to a box and sticky things and I do 3 exercises for about 40 minutes and the lady looks at a machine and there is a lecture every time. I do it every Monday, Wed, Friday and I am half way through. Their object is to tell me where I stand when I'm done with the 18 sessions.

Other Meds: Sulfasalazine - 500 mgs - I take either two-six of these every day to prevent colitis; arthritis in hands: Etodolac - I take twice a day - 500 mg; Simvastatin - 80 mg once a day

Current Illness: no

ID: 1745003
Sex: F
Age: 14
State: IL

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/29/2021
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: COVID-19 PCR, negative RSV, negative Influenza, negative chest xray, congestion albuterol neb given with decrease in symptoms

Allergies: nka

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

Symptoms: Pt c/o chest tightness and difficulty breathing after received 2nd dose Pfizer Covid vaccine last night. Appears fatigued but it alert and oriented, awakens easily. Reports some nausea and feeling shaky.

Other Meds: unk

Current Illness: na

ID: 1745004
Sex: F
Age: 36
State: SC

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

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

Lab Data: In progress - cardiovascular assessments

Allergies: NA

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

Symptoms: Rapid heart rate of 160 while resting, tachycardia, myocarditis symptoms, fever, fatigue, brain fog, insomnia

Other Meds: NA

Current Illness: NA

ID: 1745005
Sex: M
Age: 65
State:

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 09/29/2021
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: 1745006
Sex: M
Age: 82
State: FL

Vax Date: 04/28/2021
Onset Date: 09/17/2021
Rec V Date: 09/29/2021
Hospital: Y

Vax Type: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: Soma, Tramadol, Statins, Toradol, Dilaudid, Lipitor

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

Symptoms: Admission to critical care hospital with COVID-19 diagnosis on admission

Other Meds:

Current Illness:

ID: 1745007
Sex: F
Age: 33
State: MI

Vax Date: 09/20/2021
Onset Date: 09/21/2021
Rec V Date: 09/29/2021
Hospital:

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

Lab Data:

Allergies: sulfa, penicillin, latex

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Vaginal bleeding; still spotting 8 days after shot.

Other Meds: none

Current Illness: none

Date Died: 08/19/2021

ID: 1745008
Sex: M
Age: 64
State: FL

Vax Date: 06/04/2021
Onset Date: 08/06/2021
Rec V Date: 09/29/2021
Hospital: Y

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

Lab Data: Labs, covid test, cxr.

Allergies: NKA

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Pt came to ER c/o SOB, onset 4 weeks prior.

Other Meds:

Current Illness:

ID: 1745009
Sex: F
Age: 76
State: VA

Vax Date: 07/29/2021
Onset Date: 08/03/2021
Rec V Date: 09/29/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Patient reports persistent pain in deltoid region without loss of range of motion where vaccine administered, headaches, and chest congestion. Adverse reactions started 5 days after administration of dose #2 per patient.

Other Meds: Unknown

Current Illness: None

ID: 1745010
Sex: M
Age: 33
State: OK

Vax Date: 08/27/2021
Onset Date: 09/10/2021
Rec V Date: 09/29/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: none

Allergies: Kiwi - local swelling of the mouth

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

Symptoms: C/O muscle stiffness in the neck and upper back and shoulders for the past 4 weeks or so. Has been seen by PCP and put on antibiotic and steroid shot because they dx him with sinus infection but the medication did not help at all. Has not changed his daily routine. He states that "this is a different type of pain than I have ever had" "it won't go away and medications does not help"

Other Meds: Synthroid, Olmesartan, Propranolol, Singular, phentermine,

Current Illness: none

ID: 1745011
Sex: F
Age: 72
State: AL

Vax Date: 09/01/2021
Onset Date: 09/27/2021
Rec V Date: 09/29/2021
Hospital:

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

Lab Data:

Allergies: Sentsitive

Symptom List: Unevaluable event

Symptoms: At midnight of the same day of booster shot, I woke up with chills, diarrhea and my blood pressure was 150/90. I had shortness of breath and felt ill all night. Did not have this reaction with the other Pfizer shots, except for tiredness and headache.

Other Meds: Zimvastatin Calcium Magnesium Vitamin D

Current Illness: None

ID: 1745012
Sex: M
Age: 45
State: AR

Vax Date: 09/09/2021
Onset Date: 09/10/2021
Rec V Date: 09/29/2021
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: Codeine

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

Symptoms: Approximately 12 hours after injection, developed raised red rash in both axillae. Required medication intervention to resolve

Other Meds: Losartan, Xanax, contrave, metoprolol, atorvastatin, Aspirin

Current Illness: None

ID: 1745013
Sex: F
Age: 85
State:

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 09/29/2021
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:

ID: 1745014
Sex: F
Age: 53
State: NE

Vax Date: 07/16/2021
Onset Date: 07/19/2021
Rec V Date: 09/29/2021
Hospital:

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

Lab Data: Shot of steroid in the butt at doc office, and steroid cream to stop itch and burning. 2 days later, still spreading, got a dose pack of steroid pills.

Allergies: Penicillin Sulfa Quinolones

Symptom List: Injection site pain, Menorrhagia

Symptoms: After first dose I developed a rash on day 3 on my right arm, which continued to worsen and then appeared on left arm and then on both legs from the knees to ankles. Took 3 weeks to completely disappear.

Other Meds: B12Shot Baclofen famotidine omeprazole amalodopine Magnesium Fish oil Complex B Vitamin Vitamin D

Current Illness: none

ID: 1745015
Sex: F
Age: 58
State: CA

Vax Date: 03/31/2021
Onset Date: 03/01/2021
Rec V Date: 09/29/2021
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: No

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

Symptoms: Tinnitus, No Treatment, Ringing Persists Currently

Other Meds: Glimepiride and Trulicity

Current Illness: None

ID: 1745016
Sex: F
Age: 84
State: FL

Vax Date: 01/25/2021
Onset Date: 06/19/2021
Rec V Date: 09/29/2021
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: Penicillin, Sulfa drugs, Tramadol

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Admission to critical care hospital with COVID-19 diagnosis on admission

Other Meds:

Current Illness:

ID: 1745017
Sex: M
Age: 42
State: WA

Vax Date: 08/14/2021
Onset Date: 09/22/2021
Rec V Date: 09/29/2021
Hospital:

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

Lab Data:

Allergies: Mangos

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: I developed shingles about a month later

Other Meds: Bisoprolol

Current Illness: None

ID: 1745018
Sex: M
Age: 35
State: CA

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 09/29/2021
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: Severe headache, fever, chills, shaking, sweating, lack of sleep, nausea, achy body, and difficulty breathing.

Other Meds:

Current Illness:

ID: 1745019
Sex: M
Age: 53
State:

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 09/29/2021
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: 1745020
Sex: F
Age: 74
State: MN

Vax Date: 03/01/2021
Onset Date: 09/17/2021
Rec V Date: 09/29/2021
Hospital:

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

Lab Data: CXR obtained,

Allergies:

Symptom List: Injection site pain

Symptoms: Pt developed symptoms on 9/17/21 and tested positive for COVID 19 as did her husband on 9/20/21. Patient presented to the ED on 9/25 with continued symptoms and wished to have evaluation and treatment.

Other Meds:

Current Illness:

ID: 1745021
Sex: M
Age: 67
State:

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 09/29/2021
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: Administration error mixed series mRNA vaccine Pfizer and moderna

Other Meds:

Current Illness:

ID: 1745022
Sex: M
Age: 76
State: NE

Vax Date: 09/07/2021
Onset Date: 09/28/2021
Rec V Date: 09/29/2021
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: Lab consisted on WBC of 42.1, CRP - 16.3, Proc. 2.06 , lactic acid of 3.4, PH 7.41, BNP of 594, K+ of 5.6, Cr of 1.7. EKG showed tachycardia. 9/28 - Covid PCR was negative, 09/28 - CXR showed left lower lobe pneumonia. Pt. was given IV fluids, calcium gluconate, lasix, and kayexalate. IV antibiotics of Vanco and Cefapime.

Allergies: Oxycodone

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

Symptoms: Pt. presents to ER on 09/28/2021 with temp of 101.5. Pt. reports that he had fallen out of bed and is uncertain as to why he had fallen out of bed, but thought that he was trying to get self to BR. Pt. reports that he was not able to get up off the floor and normally ambulates ad lib. At home pt. is dependent on O2 at 4L per cannula. Pt. when found by EMS was noted to have O2 sat. in the 60%. (Unsure if oxygenation was on RA or on O2). Pt. c/o non-productive cough. Pt. received his third covid vaccination, (booster) on 09/07/2021. Pt. in ER denied SOB, CP, HA, rash, abd. pain, diarrhea, constipation, dysuria, or confusion.

Other Meds: Valium, Lisinopril - HCTZ, Restoril, Zocar, Thera M, Toprol XL, ASA, Albuterol Sulfate HFA, Lasix, Norco

Current Illness: Unaware of any illness at time of vaccination or up to one month prior. Pt. received his booster Moderna vaccination on 09/07/2021. Pt. had received 2 previous Covid Moderna vaccinations and unaware of any reactions.

ID: 1745023
Sex: M
Age: 45
State: CO

Vax Date: 09/04/2021
Onset Date: 09/09/2021
Rec V Date: 09/29/2021
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: I experienced shingles.

Other Meds: Imuran; Azathioprine

Current Illness:

ID: 1745024
Sex: F
Age: 73
State: MI

Vax Date: 03/29/2021
Onset Date: 09/28/2021
Rec V Date: 09/29/2021
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: Covid test 9/28/21

Allergies: None

Symptom List: Erythema, Pruritus

Symptoms: Patient after 3 episodes of bloody diarrhea and non-productive cough over 10 days.

Other Meds: N/A

Current Illness: Unknown

ID: 1745025
Sex: F
Age: 70
State: NY

Vax Date: 05/03/2021
Onset Date: 05/27/2021
Rec V Date: 09/29/2021
Hospital: Y

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: Various Test Ran

Allergies: None

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

Symptoms: Shortness breath, claustrophobic feeling, fever. Was diagnosed with bronchitis. Diagnosed with a flutter from cardiologist. Has been back and forth to the doctor since the second vaccination.

Other Meds: None

Current Illness: None

ID: 1745026
Sex: M
Age: 46
State: CA

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 09/29/2021
Hospital:

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

Lab Data: Aug 9, 2021 - dr. appt to examine arm Review of Systems: Constitutional: negative for fever and negative for chills Musculoskeletal: no other joint pain. Skin: no redness nor warmth to the area. Neurological: no weakness per se, but pain w/ L shoulder use.

Allergies: none

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

Symptoms: I have had shoulder pain since the date of my COVID vaccination (April 8, 2021). At first I thought it was just a passing side effect of the vaccination, but the pain and discomfort have been persistent for the past 6 months. I have limited my activity with that arm/shoulder thinking it would help, but it has not. The pain in my shoulder is persistent and restrictive. The only time it does not hurt is when I attempt to immobilize it.

Other Meds: none

Current Illness: none

ID: 1745027
Sex: M
Age: 83
State:

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 09/29/2021
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: Administration error mixed series mRNA vaccine Pfizer and moderna

Other Meds:

Current Illness:

ID: 1745028
Sex: F
Age: 75
State:

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 09/29/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: ADMINISTRATION ERROR MIXED SERIES mRNA VACCINE PFIZER AND MODERNA.

Other Meds:

Current Illness:

ID: 1745029
Sex: F
Age: 28
State: NY

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 09/29/2021
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: Sulfa, Latex

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

Symptoms: I was diagnosed with Tachycardia.

Other Meds: Prednisone

Current Illness: No

ID: 1745030
Sex: F
Age: 78
State: CA

Vax Date: 02/12/2021
Onset Date: 09/20/2021
Rec V Date: 09/29/2021
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: Profound spinning sensation. Worse when she moves her head. Associated nausea vomiting. No acute severe headache or neck pain. No vision loss. No difficulty speaking or swallowing. No focal motor weakness. Not incoordinated.

Other Meds:

Current Illness:

ID: 1745031
Sex: M
Age: 35
State: WA

Vax Date: 03/27/2021
Onset Date: 08/02/2021
Rec V Date: 09/29/2021
Hospital:

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

Lab Data: COVID-19 test; X-ray.

Allergies:

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

Symptoms: I had a hard time breathing, coughing and had a fever. I felt like I had a cold or flu that did not get better after a week. I had a hard time keeping food down and I did vomit at times. My fever was about 100 to 101 at times. I called my doctor and he prescription me medicine that did not help. So, I call my doctor again and he told me to go to urgent care. They did a COVID-19 test and a x-ray, which came back negative and normal. They said I had a virial infection.

Other Meds: Metformin; Jardiance; Atorvastatin; Sertraline; Lavatory

Current Illness:

ID: 1745032
Sex: M
Age: 56
State: FL

Vax Date: 07/26/2021
Onset Date: 08/07/2021
Rec V Date: 09/29/2021
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: Labs, CT chest, cxr.

Allergies: NKA

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

Symptoms: Pt came to ER c/o URI onset 4 days prior. Known to be covid positive.

Other Meds:

Current Illness:

ID: 1745033
Sex: M
Age: 53
State:

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 09/29/2021
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: 1745034
Sex: M
Age: 65
State: IN

Vax Date: 09/27/2021
Onset Date: 09/28/2021
Rec V Date: 09/29/2021
Hospital:

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

Lab Data: none

Allergies: lactose intolerant

Symptom List: Vomiting

Symptoms: 103.7 temp, chills, headache, body aches - particularly severe at injection site, fatigue

Other Meds: Levothyroxine 75 mg, Pantoprazole 40 mg, Atorvastatin 40 mg

Current Illness:

ID: 1745035
Sex: F
Age: 49
State: TX

Vax Date: 08/11/2021
Onset Date: 08/11/2021
Rec V Date: 09/29/2021
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: tetracycline

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: headache chills nausea fatigue muscle aches

Other Meds:

Current Illness:

ID: 1745036
Sex: M
Age: 34
State: MN

Vax Date: 01/28/2021
Onset Date: 09/27/2021
Rec V Date: 09/29/2021
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: 9/28/21 SARS/COV-2, NAAT, Positive

Allergies:

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

Symptoms: Breakthrough COVID

Other Meds:

Current Illness:

ID: 1745037
Sex: F
Age: 50
State: CA

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/29/2021
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: cillins, cyclines, myacins

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Dose 2: forehead facial swelling, eye lid swelling within 5 minutes; itching within an hour; swelling still present 5 days later, painful Dose 1: forehead facial swelling, eye lid swelling within 30 minutes, itching next day; swelling present for 10 days, painful

Other Meds: None

Current Illness: None

ID: 1745039
Sex: M
Age: 2
State: TX

Vax Date: 09/27/2021
Onset Date: 09/28/2021
Rec V Date: 09/29/2021
Hospital:

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

Lab Data: none

Allergies: NKA

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

Symptoms: Abnormal movements, soreness and muscle ache. Fever and movements improving with time.

Other Meds: none

Current Illness: none

ID: 1745040
Sex: F
Age: 38
State: ID

Vax Date: 09/04/2021
Onset Date: 09/06/2021
Rec V Date: 09/29/2021
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: None

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

Symptoms: Pain in back of head at base of skull for 10 days. Had to take motrin and tylenol to relieve the pain. Ended after 10 days.

Other Meds: None

Current Illness: None

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am