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: 1750068
Sex: M
Age: 33
State: VA

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 09/30/2021
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: none

Symptom List: Dysphagia, Epiglottitis

Symptoms: Pt received shot and walked to monitoring area. Pt felt lightheaded so he motioned for staff to help. Nurse arrived as pt had syncopal episode. Pt had an assisted fall out of the chair. Pt awoke within 1 minute. Vital signs at 1527 were BP 159/82 HR 90 97%O2, 18 resp. An employee was called. Pt A7O x3, no difficulty breathing, on floor with legs elevated. RRT arrived at 1529. Repeat vitals at 1529 BP185/113 HR89 98%O2 18 resp. Pt brought to ED for evaluation.

Other Meds: fish oil

Current Illness: none

ID: 1750070
Sex: F
Age: 33
State: MN

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

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

Lab Data: 9/30 SARS/COV-2, NAAT, Positive

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Breakthrough COVID

Other Meds:

Current Illness:

ID: 1750071
Sex: F
Age: 40
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/30/2021
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: Pt received vaccine at 12:27pm. Pt C/O chest tightness / tingling and lightheadedness at 12:43pm. Pt took 2 puffs of home inhaler. BP 168/70 HR 96 SPO2 100%. Pt then c/o itchiness at 12:45pm. No wheezing or stridor noted. Pt instructed to take her own EPi Pen. Epi Pen administered at 12:45pm. RRT called, pt escorted to ED with RRT team.

Other Meds:

Current Illness:

ID: 1750072
Sex: F
Age: 56
State: OK

Vax Date: 03/31/2021
Onset Date: 04/01/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: med center gave shot for hives; subsequent follow-up with GP ran multiple tests--no other cause/issue/origin determined

Allergies: penicillin, some molds, freshly cut grass, kiwi fruit, feathers,

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Developed hives within 24-48 hours of 2d covid shot. Hives were over entire body (not just limited to arm.) Went to med center and was given shot and continued to take medicine for hives for about 2 weeks; subsequent follow-up with GP because reaction seemed to also lead to stomach issues, diarrhea, nausea for multiple weeks following; lost 12 pounds during nausea time frame. Overall seems to have significantly improved (months later) but am concerned about another dose.

Other Meds: daily multi-vitamin

Current Illness: none known

ID: 1750073
Sex: M
Age: 65
State: MD

Vax Date: 09/29/2021
Onset Date: 09/30/2021
Rec V Date: 09/30/2021
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: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Woke up with vertigo about 12 hours after injection, which led to nausea but not vomiting. Vertigo eventually gave way to unsteadiness, which is now moderating at 24 hours post-injection. No treatment except rest and low level of activity.

Other Meds: baby aspirin and 40 mg atorvastatin daily

Current Illness: None

ID: 1750074
Sex: M
Age: 29
State: IL

Vax Date: 05/17/2021
Onset Date: 09/26/2021
Rec V Date: 09/30/2021
Hospital: Y

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: 9/28/21: COVID19 positive 9/28/21 CT abdomen: Evidence of acute pancolitis, favored infectious or inflammatory.

Allergies: None

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

Symptoms: Comes to the emergency room on 9/27/21, complaining of 1 day of mid abdominal pain with accompanying nausea, vomiting, and diarrhea. Says he might have thrown up a little bit of blood also this morning. Has not eaten anything outside and has not eaten anything unusual. No family members at home are sick, either. He had been fully vaccinated against COVID-19 a couple of months ago. He denies any fever, chills. No chest pain or shortness of breath. No urinary symptoms. He does smoke marijuana on and off. Does smoke cigarettes and occasionally drinks alcohol. Last drink being on Saturday. Workup in the ER revealed a normal white cell count, a normal CMP with a normal lipase. However, CT abdomen and pelvis was showing changes consistent with acute pancolitis. Patient was started on Levaquin and Flagyl, and then the hospitalist service was called for admission. When I saw the patient, his symptoms had significantly improved. He will be admitted as an observation for now with a consult to GI in the morning. Patient has no personal or family history of inflammatory bowel disease or colon cancer.A GI consult was requested. Recommendations appreciated. Supportive care with bowel rest, IV fluid hydration, analgesics and antiemetics as needed were offered. His symptoms resolved and so patient's diet was advanced. He tolerated well. He was ultimately discharged home in stable condition. He will follow up with his PCP within 1 week and with GI as scheduled.

Other Meds: No medications

Current Illness:

ID: 1750075
Sex: M
Age: 79
State: WI

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

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

Lab Data: N/A

Allergies: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient received Pfizer Covid 19 "booster" although he did not qualify for this administration because his original series was Moderna. Booster dose should not have been administered.

Other Meds: Aspirin, cetirizine, cholecalciferol, metoprolol

Current Illness: N/A

ID: 1750076
Sex: M
Age: 61
State: IL

Vax Date: 09/27/2021
Onset Date: 09/30/2021
Rec V Date: 09/30/2021
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: Pfizer vaccine temperature excursion. The vaccine was placed in the freezer for 3 weeks then removed and placed in the fridge for a week. After that the vaccine was administered,

Other Meds:

Current Illness:

ID: 1750077
Sex: F
Age: 40
State: VA

Vax Date: 02/09/2021
Onset Date: 09/30/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: No test or labs.

Allergies: Kiwi

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Immediately after had a warm chill, swelling, and soreness at injection site. On the next day after taking medicine to sleep and for pain, stayed painful and annoying. Sleepiness and tired all the time (napped multiple times during the day) Flu like symptoms started without temp. OTC treatment self care. 2-3 weeks and only small issues for a week more after that.

Other Meds: Lamictal; Zoloft; Kroger gummies Women's Multivitamin; D3; Allegra; Mirena; Flonase; Ibuprofen; Tylenol; Excedrin Migraine; Fioricet

Current Illness: None

ID: 1750078
Sex: F
Age: 44
State: CO

Vax Date: 08/06/2021
Onset Date: 08/06/2021
Rec V Date: 09/30/2021
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: zithromax

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Pt received Moderna doses on 3/5/21 and 4/2/21 at another location. She came to the pharmacy on 8/6/21 and reported that she was here for her first dose of Covid vaccine and would like the Pfizer one. She received the Pfizer for her booster dose.

Other Meds: Eliquis, Folic acid, MTX, Prednisone, gabapentin, Rituxamab

Current Illness:

ID: 1750079
Sex: F
Age: 23
State: WI

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

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

Lab Data:

Allergies: Tree nuts and seasonal allergies

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

Symptoms: One hour after vaccine, left arm swollen and sore. Progressively got worse with extreme pain and hives on arm and shoulder. Also experienced headache, dizziness, sore eyes. Took Benadryl and Tylenol. Symptoms improving.

Other Meds:

Current Illness:

ID: 1750080
Sex: F
Age: 75
State: CA

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: None

Allergies: None

Symptom List: Rash, Urticaria

Symptoms: When I got home around 11:45 am I felt pressure in my heart for a short time (less than 1 minute). After I felt like the vaccine is flowing into my heart. I felt heavy. My breathing was not as easy as usual. I felt heavy in my chest.

Other Meds: Metroprolol er succinate 25 mg Synthroid 0.075 mg

Current Illness: None

ID: 1750081
Sex: M
Age: 54
State: PA

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 09/30/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Headache Fever Body aches

Other Meds: Vitamin D Telmisartan 80 mg Metformin 20 mg

Current Illness: High blood pressure

ID: 1750082
Sex: M
Age: 72
State: NC

Vax Date: 03/26/2021
Onset Date: 06/27/2021
Rec V Date: 09/30/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: See item 18

Allergies: None

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

Symptoms: Minor heart attach and stent inserted on 6/27/2021 while visiting our son.

Other Meds: Metformin Glimepiride Amlodipime Benazepril Levothyroxine

Current Illness: None

ID: 1750083
Sex: M
Age: 60
State: WI

Vax Date: 06/19/2021
Onset Date: 09/28/2021
Rec V Date: 09/30/2021
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: betadine - Burning pain cephradine - unknown latex - rash penicillins - hives

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

Symptoms: Patient contracted COVID after being fully vaccinated. Presented to the ER for CVA previously was sick with fatigue

Other Meds: aspirin 81mg daily bethamethasone topical BID levothyroxine 100mcg daily multivitamin daily olmesartan 20mg daily omeprazole 20mg daily triamcinolone topical daily

Current Illness: Nothing documented

ID: 1750084
Sex: M
Age: 48
State: VA

Vax Date: 05/16/2021
Onset Date: 08/07/2021
Rec V Date: 09/30/2021
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 - physical in person diagnosis was only thing necessary.

Allergies: none

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

Symptoms: Diagnosis of Bells Palsey Aug 16. Was prescribed steroids and an antibiotic. No other treatment since first round of medications. Slack facial features, head pain behind ear, as of 30 Sep 2021 still cannot close right eye - sleeps in eye patch with eye taped shut. Right side of mouth still affected.

Other Meds: 5 mg lisinopril 20 mg simvistatin

Current Illness: none

ID: 1750085
Sex: F
Age: 37
State: LA

Vax Date: 07/29/2021
Onset Date: 09/30/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: Rapid covid - negative

Allergies: Iodine contrast, latex

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

Symptoms: Fever, headache, Upper respiratory congestion, Fatigue, bodyaches.

Other Meds: Cymbalta, adderall, tizanadine, lunesta, vit c, omega10, gnc women, b12, magnesium

Current Illness: None

ID: 1750086
Sex: F
Age: 66
State: MO

Vax Date: 03/23/2021
Onset Date: 03/23/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: Stress Test Pulminary Test Chest Exray & CT Scan

Allergies: Sulpha Benadryl

Symptom List: Ear pain, Hypoaesthesia

Symptoms: 3 days of 104 fever, 6 months of body aches & inflimation that won't go away even with a modified diet, exercise, physical therapy & anti-inflamatory medication

Other Meds: Combipatch

Current Illness: None

ID: 1750087
Sex: F
Age: 49
State: WI

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

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

Lab Data:

Allergies: Biaxin intol Doxycycline intol Flagyl intol Protonix, capsasin

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Severe right arm pain within about 30 min, right medial elbow pain, right lateral chest wall pain, bilateral foot numbness, tongue and lip numbness, Lingering burning right arm continues as of 9-28-2021

Other Meds: Claritin D, Advair 250/50, Tumeric Supp, VIt E 400IU, Vit D 2000, Flonase, Pepcid, Progesterone only OCP, Tylenol as needed non 48 hours prior to shot, albuterol as needed

Current Illness: Seasonal allergies

ID: 1750088
Sex: F
Age: 54
State: MO

Vax Date: 05/15/2021
Onset Date: 09/17/2021
Rec V Date: 09/30/2021
Hospital: Y

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

Lab Data: unknown

Allergies: unknown

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

Symptoms: developed back pain on 9/17/2021. Admitted to hospital on 9/19 through 9/25. Denies any fever, cough or SOB. Has now been discharged to home and has no symptoms.

Other Meds: unknown

Current Illness: unknown

ID: 1750089
Sex: M
Age: 85
State: LA

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 09/30/2021
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: NKDA

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

Symptoms: Patient's wife brought him to get third shot because she feels he is immunocompromised due to his age. They were informed patient was getting a Moderna shot and patient/wife signed the waiver. After he was given the shot, the nurse was given the COVID vaccine card and saw his previous two shots were Pfizer shots. The couple was told he has now received a Moderna shot and to notify the office if he does poorly.

Other Meds: Amlodipine Besylate, Fluocinonide, levetiracetam, Tamsulosin, allopurinol

Current Illness: BPH, Diverticulosis, HTN, Hyperlipidemia

ID: 1750090
Sex: F
Age: 64
State: OH

Vax Date: 02/01/2021
Onset Date: 09/15/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: Procedure EKG Provider Not in System Sep 16, 2021 Imaging ECG 12-LEAD Sep 16, 2021 Imaging CT HEAD OR BRAIN WO CONTRAST Sep 16, 2021 Lab CBC AND DIFFERENTIAL Sep 16, 2021 Lab BASIC METABOLIC PANEL Sep 16, 2021 Lab CBC W/ AUTO DIFFERENTIAL Sep 16, 2021 Lab TROPONIN Sep 16, 2021 Lab POC GLUCOSE - RALS Sep 16, 2021

Allergies: tomatoes

Symptom List: Unevaluable event

Symptoms: poor speech, drooling, drooping of left side of face, blurred vision Prescribed Prednisone

Other Meds: Vitamin D, probiotic

Current Illness: NONE

ID: 1750091
Sex: F
Age: 33
State: NC

Vax Date: 02/25/2021
Onset Date: 08/31/2021
Rec V Date: 09/30/2021
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: Covid test, Flu test, Strep test all on September 3, 2021. Only positive for Covid and received results on September 5, 2021.

Allergies: Codeine (hyper/jittery feeling , insomnia)

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

Symptoms: Started showing symptoms of Covid on August 31, 2021. Tested positive for Covid on September 3, 2021. Symptoms began with scratchy throat and stuffy nose. Continued for days with stronger productive cough and congestion. These symptoms lessened by September 5, 2021 but remained for a few weeks (only minimum cough and stuffyness). Loss of taste and smell on September 5, 2021 which continued for two weeks or so. Smell still is not fully recovered. The tiredness and brain fog became more present on September 6, 2021 and continued for days. By the 10 days of quarantine on September 10, 2021, the symptoms were mostly minimum but a few weeks before I felt fully recovered.

Other Meds: None

Current Illness: None

ID: 1750092
Sex: M
Age: 42
State: OH

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 09/30/2021
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: None

Symptom List: Injection site pain, Pain

Symptoms: Dizziness and weakness, Shortness of breath, chest pain, and mild headache. The dizziness started around 2:00 pm on September 30th and around 3 PM the same day the weakness, shortness of breath, chest pains, and mild headache started. I did take Acetaminophen at 3:30 PM for pain and the headache started to go away a little around 4 PM. The other symptoms are still present. I have called my primary care physician and am waiting on her response back.

Other Meds: Olemsartan Medoxomil 40mg, Flueoxetine HCL 40mg

Current Illness: None

ID: 1750093
Sex: F
Age: 82
State: MA

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data:

Allergies: codeine

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient inadvertently received a Pfizer COVID 19 vaccine as a single dose booster and after administering the vaccine we realized that the patient had received Moderna as a primary series

Other Meds:

Current Illness:

ID: 1750094
Sex: M
Age: 32
State:

Vax Date: 09/07/2021
Onset Date: 09/07/2021
Rec V Date: 09/30/2021
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: Heart palpitations while sitting at desk lasting about 3 minutes one hour post vaccination Sharp, stabbing pain in chest about 5 days, 13 days and 19 days post vaccination. These all lasted less than one minute.

Other Meds:

Current Illness:

ID: 1750095
Sex: M
Age: 33
State: AR

Vax Date: 09/15/2021
Onset Date: 09/30/2021
Rec V Date: 09/30/2021
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: 09/27/2021 Glucose 701, Sodium 127

Allergies: None

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Developed malaise and frequent urination~10 days after second Moderna. Lab done revealed glucose 701. New onset diabetes mellitus.

Other Meds: None

Current Illness: None

ID: 1750096
Sex: M
Age: 32
State: AZ

Vax Date: 09/09/2021
Onset Date: 09/09/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Throat swelling; difficulty swallowing (lasted 6-8 hours).

Other Meds: None

Current Illness: None

ID: 1750097
Sex: M
Age: 37
State: MS

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 09/30/2021
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: BP 103/82 post incident

Allergies: denied on form, oral

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

Symptoms: Pt presented 1100 for Pfizer Covid #1. Form filled out online. RPh reviewed form online (all answers no) before orally confirming in booth prior to injection. Injection given at 1110 am, discussed possible side effects, etc with patient for couple of minutes, pt was seated in waiting area for 15 minutes prescribed period , and was visually checked by RPh every couple of minutes. At 1131 another customer waved and informed us patient had fainted in chair (no fall). 2 pharmacists responded with rescue kit and bp monitor as pt was awakening. bp was taken, pupils, skin temp, peripheral blood flow, etc. Patient reported he felt a bit nausea and dizzy but very relaxed. Was surprised but not upset. One pharmacist stayed with patient the required extra 15 minutes + and provided pt with water while repeatedly checking vitals. At 1147am pt was past the 15 minutes and felt he was ready to go. Rph verified patient stability and reflex before pt left.

Other Meds: Not on VARIC or oral discussion

Current Illness: denied on form, oral

ID: 1750098
Sex: F
Age: 12
State: OH

Vax Date: 05/17/2021
Onset Date: 07/14/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: Ultrasound

Allergies:

Symptom List: Nausea

Symptoms: Approximately 6 weeks after initial COVID vaccine patient experienced her first menstrual cycle ever. 6 weeks after her 2nd dose of vaccine she was diagnosed with a 3x3 inch ovarian cyst via a visit to the emergency room. Since her first period in early July, she has only had a total of 2 periods (as of 9/30/21). The ovarian cyst is still present and latest ultrasound shows the cyst is not resolving. Surgery likely to resolve the cyst in November. Concern is the vaccine impacted her menstrual cycle and ovarian tissue.

Other Meds:

Current Illness:

ID: 1750100
Sex: F
Age: 55
State: CA

Vax Date: 09/26/2021
Onset Date: 09/27/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data:

Allergies: penicillin metrodzole

Symptom List: Injection site pain

Symptoms: Fever 102.3 lasted 24 hours , Headache 3 days . Head pressure when lowering head . Arm pit glands swollen and painful

Other Meds: Symbicort , Multi vitamin, calcium zinc , Vitamin D

Current Illness:

ID: 1750101
Sex: F
Age: 17
State: TN

Vax Date: 09/26/2021
Onset Date: 09/27/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: Bloodwork, covid test, mono test, chest x-ray, EKG All normal results

Allergies: N/A

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

Symptoms: Fatigue, nausea, headache, chills, shortness of breath, rapid heart rate at times, lymph nodes swollen under arm and breast area. Went to ER 09/28 to get chest X-ray and bloodwork. Everything was normal per ER doctor. She has continued to have shortness of breath. Other symptoms are not really an issue now, but the shortness of breath and rapid heart rate is an issue. Lymph nodes still swollen and sore. Following up with pediatrician tomorrow 10/01.

Other Meds: Prilosec, Align Probiotic, Aurovela 24 FE

Current Illness: She was diagnosed with a sinus infection a week before. 09/20

ID: 1750102
Sex: M
Age: 31
State: VA

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 09/30/2021
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: Sulfa, amoxicillin, versed

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

Symptoms: Incredibly sore arm starting a couple hours after shot. Malaise and fatigue along with chills that night and into the next day. Somewhat resolved by next afternoon (time of report). Worse than post-COVID shot and significantly worse than any flu shot to date.

Other Meds: None

Current Illness: None

ID: 1750103
Sex: F
Age: 38
State:

Vax Date: 02/01/2021
Onset Date: 02/01/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: I had xrays in March 2021.

Allergies: SMP Sulfa, Cipro

Symptom List: Tremor

Symptoms: Shortly after receiving the vaccine, I began having extreme pain in my opposing arm whenever I did small actions that involved moving my shoulder. For example buckling my children in their car sears was torturous. I saw a neurologist who recommended that I see an orthopedist who diagnosed vaccine-induced bursitis. He put me on a course of Meloxicam and gave me some shoulder exercises. After a month or so I felt fine.

Other Meds: None

Current Illness: None

ID: 1750104
Sex: M
Age: 65
State: MS

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 09/30/2021
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: NKA

Symptom List: Erythema, Pruritus

Symptoms: Patient presented to the Vaccine site to receive his first dose of Moderna. All of the questions were asked and the patient stated to the nurse that he had not received any dose of vaccine. When dose was being entered into the DATABASE, it was noted that the patient had received a dose of JANSSEN ON 04/05/2021. Spoke to patient today who reported no problems since receiving the vaccine. Told patient that

Other Meds: ASPIRIN 81 MG DAILY, ATORVASTATIN CALCIUM 80 MG QHS, COZAAR 100 MG DAILY, FARXIGA 10 MG DAILY, FUROSEMIDE 40 MG BID, MAGNESIUM OXIDE 400 MG TID, METOPROLOL SUCCINATE 50 MG, PANTOPRAZOLE SODIUM 40 MG DAILY, POLYETHYLENE GLYCOL 17 GM PRN DAIL

Current Illness: UNKNOWN

ID: 1750105
Sex: F
Age: 39
State: NC

Vax Date: 09/02/2021
Onset Date: 09/02/2021
Rec V Date: 09/30/2021
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: n/a

Allergies: no known allergies

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

Symptoms: Patient came in for second dose and upon asking how she did with the first dose she began to describe what appeared to be an allergic reaction. She described her reaction as occuring the same day as the vaccine. She states her arm became visibly swollen, red, and broke out into a rash. She described the rash as appearing like large welts. She states this rash went away after a few days but then came back and repeated in this way for the next 3 weeks. The pharmacist recommended the patient reach out right away to her primary care provider to discuss her reaction and whether they felt she should receive a second dose.

Other Meds: unknown

Current Illness: unknown

ID: 1750106
Sex: F
Age: 39
State: WI

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

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

Lab Data:

Allergies: none

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

Symptoms: Left arm swollen with 2 big hives, painful arm, itchy, red, and headache. Benadryl and Ibuprofen taken. Symptoms improving.

Other Meds:

Current Illness:

ID: 1750107
Sex: F
Age: 37
State: MN

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

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

Lab Data: NONE, referred to her primary care provider

Allergies: unknown

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Redness and warmth at injection, the size of a fist.

Other Meds: unknown

Current Illness: unknown

ID: 1750108
Sex: M
Age: 30
State: CA

Vax Date: 03/25/2021
Onset Date: 07/19/2021
Rec V Date: 09/30/2021
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: Dust

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

Symptoms: I woke up sometime in mid-July, roughly around 5 months since vaccination, when I woke up with intense vertigo and dizziness. The room was spinning and I couldn't sit or stand, I had to lie down in order to making the vertigo and dizziness stop. I was told by the ENT doctor that I had BPPV (Benign paroxysmal positional vertigo ), the treatment was Epley maneuver and I read online to take Calcium and Vitamin D3 supplements. I have never had this before in my life and it came out of no where. Even up to today, around 3 months, I get dizzy if my head is in a certain position, but it felt like I was on amend and could deal with the mild dizziness. Until the vertigo came back strong out of no where on 9/29/21 when I stood up from my desk, not as strong when I experienced it for the first time, but strong enough where it was making me nauseous and sweat. The day after, which is today (9/30) when I'm typing this, I feel better but I am dealing with the residual dizziness.

Other Meds: Multi-vitamin, fish oil, vitamin D3, magnesium, and creatine monohydrate

Current Illness: N/A

ID: 1750109
Sex: F
Age: 16
State: MN

Vax Date: 09/20/2021
Onset Date: 09/20/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: n/a

Allergies: None

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

Symptoms: Patient was administered the Moderna vaccine by nurse. Parent requested the vaccine to be given to her child even though she was a minor and outside of the age guidelines for this vaccine.

Other Meds: Unknown

Current Illness: Unknown

ID: 1750110
Sex: M
Age: 88
State: IL

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

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

Lab Data:

Allergies: n/a

Symptom List: Pain in extremity

Symptoms: Patient received high dose flu vaccine at pharmacy clinic. Following vaccination, I was entering information and identified that patient had already received High Dose Fluzone dose from physician clinic 8 days prior. Patient was notified and stated that he was unaware or did not remember that he had received the flu vaccine already. Stated that he is feeling fine and did not have any adverse side effects following flu vaccine admin.

Other Meds: n/a

Current Illness: n/a

ID: 1750111
Sex: M
Age: 71
State: CA

Vax Date: 02/08/2021
Onset Date: 02/22/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Started noticing symptoms of neuropathy on both legs and feet and mildly in both arms shortly after receiving the first Pfizer vaccine. Condition has gotten worse with numbness and tingling in both legs.

Other Meds: None

Current Illness: None

ID: 1750112
Sex: F
Age: 32
State: MN

Vax Date: 02/18/2021
Onset Date: 09/30/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: Positive COVID-19 RT-PCR Test

Allergies: Adhesives, Keflex

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

Symptoms: Positive COVID-19 Test while fully vaccinated.

Other Meds: Inderal, Cymbalta, Imitrex, Ativan

Current Illness: N/A

ID: 1750113
Sex: F
Age: 56
State: CA

Vax Date: 05/07/2021
Onset Date: 05/12/2021
Rec V Date: 09/30/2021
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: Allergy to dairy and fragrances.

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

Symptoms: Deep fatigue, body aches, dizzy spells, shortness of breath lasting for 3-4 months. Arm pain at injection site was intermittent and lasted for several months. The dizzy spells were severe and were most acute within one month of the second dose; at one point I fainted. Nausea after the first several weeks of taking the second dose. I still don't feel as well as I felt before the vaccinations.

Other Meds: T3/T4 compounded thyroid medication

Current Illness: None

ID: 1750114
Sex: F
Age: 39
State: CA

Vax Date: 03/08/2021
Onset Date: 03/22/2021
Rec V Date: 09/30/2021
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: Pencillin

Symptom List: Vomiting

Symptoms: Patient received vaccine 03/08/2021 which was on her menses. Two weeks later the patient developed heavy bleeding which was unusual for this patient, she has never had mid cycle bleeding. Patient found out she was pregnant the middle of April, and then she had miscarriage at the end of April at home.

Other Meds: No

Current Illness: None

ID: 1750115
Sex: F
Age: 75
State: OH

Vax Date: 02/26/2021
Onset Date: 04/14/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: Blood work. No inflamation

Allergies: None

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Hip joint pain, some knee pain relieved with topical medication, I had some pain previously but not as intense, it got worse , dr had me stop my cancer med,(anastrozole) and pain decreased about 20%. About 2 weeks ago I started esteste Am trying to decide if pain has increased and why

Other Meds: Xaralto, lansoprazole, calcium, b12 complex, stool softener, d3, anastrole, senna

Current Illness: None

ID: 1750116
Sex: F
Age: 57
State: HI

Vax Date: 03/27/2021
Onset Date: 08/01/2021
Rec V Date: 09/30/2021
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: March-May 2021: Physical Therapy (started Sept 2020 for ulnar nerve but immediately after the 2nd vaccination, PT focus on neck/shoulder June 2021: nerve test, shows pinched ulnar nerve at the elbow and moderate carpal tunnel on right arm/hand July 5-Aug 10 2021: Mammogram, Ultrasound, Biopsy Sept 13, 14, 17: Ear, Nose, Throat specialist for continual nose bleeding and nose cautery treatments; Packing of nose from Sept 14-17 Sept 27 2021 -- Hearing and Balance testing; results pending

Allergies: Allergies to dust, mold, mites

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

Symptoms: March 29 to present (still occuring): back of neck tightness, stiff and soreness; contributing to ulnar nerve issues on right hand July 5-Aug 10: Left breast mass - intraductal papilloma & left breast - Fibrocystic change w/ductal epithelial hyperplasia usual type without stromal fibrsis and cyst formation Aug 31-Sept 2: Migraine headache; Sept 3 to present (still occuring) : Vertigo; Sept 12-17: left nose bleeds requiring nose cautery in 4 locations & nose packing Sept 27 to present (still occuring): nausea

Other Meds: Livalo, Amlodipine, Nexletol, Rybelsus, Nasonex, Olopatidine

Current Illness: Nose bleed (2/1/21) and ulnar nerve issues

ID: 1750117
Sex: F
Age: 39
State: WI

Vax Date: 09/08/2021
Onset Date: 09/08/2021
Rec V Date: 09/30/2021
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: O@ sat 100% at urgent care, HR normal

Allergies: Propranolol

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Within 5 minutes dizziness, right arm numb extend to digits, cold arm, then progressed to left arm, As walked to car perioral numbness and on tongue, Went to urgent care - Dizzy, head under water feel, Speech not making sense, lateral neck pain, sense of increased heart rate, tongue felt swollen, O2 100%, Treated with benadryl and felt better within 15 min., Legs tingly the next day with some dizziness and arm symptoms resolved after 2 days.

Other Meds: EMGEL and ELIDEL topical

Current Illness:

ID: 1750118
Sex: F
Age: 34
State: WI

Vax Date: 08/24/2021
Onset Date: 08/25/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data:

Allergies: N/A

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

Symptoms: Night sweats and cramping. felt much like menstrual cramps

Other Meds: N/A

Current Illness: N/A

ID: 1750119
Sex: F
Age: 72
State: KY

Vax Date: 01/28/2021
Onset Date: 09/30/2021
Rec V Date: 09/30/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: hospitalization (non-ICU) Vaccine lot numbers / sites of injection not documented.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am