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: 1753763
Sex: M
Age: 73
State: MO

Vax Date: 02/26/2021
Onset Date: 07/08/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: CRP iflammatory Marker 11.4 mg/L and ESR28mm/hr

Allergies: Lodine, and Clindamycin. Food intolerance for mild, pork, yeast, and soy products

Symptom List: Dysphagia, Epiglottitis

Symptoms: Diagnosed with Polymyalgia Rheumatica. Being treated with Prednisone 20 mg.

Other Meds: Hydrochlorothiazide---- 25 mg Rosuvastatin---------------10 mg Cetirizine------------------- 10 mg PRN Famotidine---?10 mg Duloxetine----------------- 30 mg Alfuzosun HCL ER----------10 mg Metoprolol-----------------25 mg Allegra (fexofenad

Current Illness: none

ID: 1753764
Sex: M
Age: 15
State: FL

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: EMS called and transported to hospital.

Allergies: no known

Symptom List: Anxiety, Dyspnoea

Symptoms: Pt had hives rash to face 17 min following injection, rash did see spread to neck, back and abdomen. Epinephrine 0.3 mg ( EPI PEN) administered IM to left thigh. O2 applied , VS were stable.

Other Meds: none

Current Illness: none

ID: 1753765
Sex: F
Age: 45
State: WI

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 10/01/2021
Hospital: Y

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: EKG, Chest X-ray (results normal) and blood work (waiting results)

Allergies: Doxycycline

Symptom List: Chest discomfort, Dysphagia, Pain in extremity, Visual impairment

Symptoms: About hour I started feeling shaky and high heart rate. I stopped at a friends house she is a nurse checked my BP 183/125. She suggested I go to the ER took about 1 hour to get there. I got EKG, Chest X-ray and blood work stayed for observation for 3 hours. As of today I don't feel but regular symptoms such as sore arm and tired.

Other Meds: Sumatriptan

Current Illness: UTI 2 weeks prior

ID: 1753766
Sex: F
Age: 40
State: CT

Vax Date: 08/25/2021
Onset Date: 09/28/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: EKG TROPONIN D DIMER CBC CMP CT chest ( ECHO was performed on 9/2/21 which was my first visit for chest pain that was normal )

Allergies: NKDA

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: 8/25/21 - already submitted severe reaction 9/28/21 - Was at ED for severe burning chest pain and dyspnea - Pericardial fluid noted on CT chest - diagnosed with pericarditis

Other Meds: Vitamin D

Current Illness: 8/25/21 - 40 minutes after vaccination - dyspnea chest pain laryngeal spasms bradycardic and hypotensive

ID: 1753767
Sex: F
Age: 79
State:

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/01/2021
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: Booster dose of Pfizer COVID 19 vaccine given. Patient had previously received Moderna for first two doses. No adverse reactions noted.

Other Meds:

Current Illness:

ID: 1753768
Sex: F
Age: 88
State: CA

Vax Date: 06/08/2021
Onset Date: 09/02/2021
Rec V Date: 10/01/2021
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: Urgent Care: -COVID negative result -Bloodwork - was really good too -Chest x-ray - no signs of pneumonia or bronchitis;

Allergies: Doxycycline

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

Symptoms: Coughing in September 2 or so - she was having a deeper cough (then usual and more often) with clear phlegm and Urgent Care. They gave her antibiotics (Amoxicillin 500 mg) - and Benzoate - 100 mg. It seemed to help. The cough is still kind of there but it's at a lesser degree (not as often and not as deep). Sept 1st or so - I noticed she had developed a growth on the back of her head. She probably had it sometime in August. She still needs to be determined as to what it is. She has had this three years ago - and at that time we took her took to the doctor for it. They burned it off. It was called Saboric Keratosis (three years ago). I am assuming that this is what it is again. We had an over the phone doctor's appt due to COVID - but it's still not determined. She is to go in on October 11 to get the doctor to look at it closer to see what it is and what kind of treatment to receive. Note: August 26, 2021 she received her TDAP vaccine.

Other Meds: Zyrtec; baby aspirin; Memantine - for dementia; Levothyroxine; Fosamax; Omeprazole; Donzipil - for dementia; Atorvastatin; every now and then: Tylenol PM for pain or to aid in sleeping or melatonin for sleeping.

Current Illness: no

ID: 1753769
Sex: F
Age: 31
State: VA

Vax Date: 09/30/2021
Onset Date: 10/01/2021
Rec V Date: 10/01/2021
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: N/A

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Fatigue causing to miss work, low grade fever

Other Meds: Low dose hormonal birth control, Adderall XR

Current Illness: N/A

ID: 1753770
Sex: F
Age: 28
State: MN

Vax Date: 02/02/2021
Onset Date: 09/25/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: Covid-19 test.

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: The employee tested positive for Covid-19 after being fully vaccinated.

Other Meds:

Current Illness:

ID: 1753771
Sex: F
Age: 34
State: MO

Vax Date: 09/22/2021
Onset Date: 09/23/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: Increased blood pressure was high (120/96) compared to my normal. Blood pressure on 10/1 was checked and was 100/60.

Allergies: penicilin

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: lymph node under right arm swollen 9/23-9/29. Chest pressure 9/23-9/24 with increased blood pressure.

Other Meds: none

Current Illness: none

ID: 1753772
Sex: M
Age: 12
State: WI

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 10/01/2021
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: Pfizer 2nd dose was given @ 1540 , Dose expired @ 1500.

Other Meds:

Current Illness:

ID: 1753773
Sex: F
Age: 60
State: KY

Vax Date: 03/01/2021
Onset Date: 09/25/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: 27 Sep Rapid strep- neg

Allergies: Sulfa, iodine, seasonal allergies

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

Symptoms: Tested pos for Sars cov2 on the 27th. Symptoms started on the 26th w headache. Sore throat and stuffy nose

Other Meds: Cardizem, Lipitor, flonase, albuterol

Current Illness: None

ID: 1753774
Sex: F
Age: 85
State: FL

Vax Date: 09/18/2021
Onset Date: 09/18/2021
Rec V Date: 10/01/2021
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: shellfish, chocolate, nuts, penicillin, bee stings, Aleve, accupril, amitriptyline, aspirin, butane, copra, codeine doxycycline, flatly, iodine, reflex, levaquin, macrobid, nsaids, soma, sulfa

Symptom List: Rash, Urticaria

Symptoms: 101 fever (8hours after injection), severe chills so bad they felt like seizures , bladder infection, vomiting , golf ball size lump under right arm, double vision, bloody mucos in nose, headache, earache, sore throat

Other Meds: Lisonipril,low dose aspirin, vitamin d3 1000, trazadone, metoprolol , cholestoff, magnesium 250

Current Illness: none

ID: 1753775
Sex: M
Age: 59
State: CA

Vax Date: 09/20/2021
Onset Date: 09/27/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: None so far.

Allergies: None

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

Symptoms: Tinnitus so loud it wakes me up when I am sleeping. The tinnitus is heard whenever I am awake. It is miserable and makes it very hard to concentrate.

Other Meds: None

Current Illness: None

ID: 1753776
Sex: F
Age: 76
State: GA

Vax Date: 03/26/2021
Onset Date: 09/17/2021
Rec V Date: 10/01/2021
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:

Allergies:

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

Symptoms: Received faxed medical record from IP at hospital. Pt is a 76 yo fully vaccinated patient who presented to the ED after a fall. Pt c/o of weakness, fever. Symptoms started about a week ago. Pt had some confusion. Pt presented due to persistent fever, lethargy, confusion and generalized weakness with falls.

Other Meds:

Current Illness:

ID: 1753777
Sex: F
Age: 81
State: KY

Vax Date: 09/16/2021
Onset Date: 09/17/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: unknown

Allergies: none

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

Symptoms: Right leg discolored and swollen

Other Meds: unknows

Current Illness: unknown

ID: 1753778
Sex: F
Age: 38
State: CA

Vax Date: 09/03/2021
Onset Date: 09/04/2021
Rec V Date: 10/01/2021
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: Augmentin

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

Symptoms: Fever, body aches, fatigue

Other Meds:

Current Illness:

ID: 1753779
Sex: M
Age: 25
State: RI

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: NA

Allergies: NKDA

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

Symptoms: Patient was given expired vaccine.

Other Meds: ATORVASTATIN; CHLORTHALIDONE

Current Illness: NA

ID: 1753780
Sex: F
Age: 50
State: IN

Vax Date: 04/12/2021
Onset Date: 04/15/2021
Rec V Date: 10/01/2021
Hospital: Y

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

Lab Data:

Allergies: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: I got the 1st Pfizer Injection on April 12th. I was feeling very bad after the vaccine. Dizziness and lethargic but I just pressed on thinking this was normal. Friday night I was feeling particularly bad and went to bed early. I woke up Saturday morning with partial vision loss to my left eye and was diagnosed with ocular stroke. I still have vision loss although a small amount of my vision returned. Or maybe did not return but light filters through, but still lower inner peripheral vision loss remains. I went to on call eye doctor over the weekend and received the dx of ocular stroke. It was devastating. Then on the next Wedndesday my neurological issues had gotten so much worse I was in the hospital for 5 days. They started working me up for auto-immune issues that could cause vision loss but nothing was checking out. I went home from the hospital feeling slightly better but I believe I felt better from the high-dose steroids they had started me on. I then later got worse and my face swelled. I had horrible pain moving around my body and at one point into my spine. I thought I was dying. The only thing I can say is I had been having undiagnosed symptoms over the last 5 years (not related to vision) but my doctor kept telling me things checked out. I voiced the symptoms to other physicians. All told me I was fine. When I kept getting sicker after the vaccine my PCP finally realized he had never checked my B12 level although I had low vitamin D persistent despite treatment. We checked my B12 and it was under 200. I have since started B12 injections and some of my neuro symptoms have improved but not all of them. I am still having tremors and dizziness at times so debilitating I have to lay down. None of the doctors believe the ocular stroke is related to the B12 deficiency. I saw a functional doctor later and he did not feel ocular stroke was from low B12 either, but he did say the COVID vaccine might have been the thing that pushed my immune system over the edge when I had already been symptomatic for years from the low B12 and chronic issues. My functional doctor is not anti-vaccine but told me I should not unnecessarily stress my immune system while we work to get me better. My functional doctor said he could not entirely rule out the vaccine causing some of my neuro symptoms though along with the ocular stroke and that it could be a combination of both causing the issues. I am now on quality supplements and B12 injections weekly until my neuro symptoms stop improving. I have improved on the numbness and burning in my feet, improved numbness in my hands. My heart palpitations are almost gone. My Shortness of breath I had been suffering from is greatly improved. I have not had a migraine since starting the B12 injections. I am still suffering from debilitating dizziness and tremors. I still have the blind spot in my eye. Since none of the doctors feel the ocular stoke can be explained by B12 deficiency I am reporting the ocular stroke as a potential adverse reaction post COVID vaccine since I have read that others had blood clots related to the vaccine.

Other Meds: Imitrex, zofran

Current Illness: None that I was aware of other than chronic conditions I was following doctor for. Migraines and GI issues post whipple

ID: 1753781
Sex: M
Age: 14
State: OR

Vax Date: 01/22/2021
Onset Date: 01/22/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Patient was underage when received the vaccine.

Other Meds:

Current Illness:

ID: 1753782
Sex: M
Age: 8
State: IN

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/01/2021
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: No adverse event. Reporting administration error in that child was too young to receive vaccine.

Other Meds: Unknown

Current Illness: None

ID: 1753783
Sex: M
Age: 34
State: NJ

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data:

Allergies: clarithromycin (hives), cefaclor (hives)

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

Symptoms: Patient reported that within seconds of getting the vaccine (1st dose), he had immense pain and rush to back of head with swelling. Could only walk 10 feet before getting short of breath and lightheaded. Noted throat swelling. Sharp sensation in arms, numbness and tingling in hands. Noted tachycardia until next day. Continues to have lower abdominal pain that started evening after his injection.

Other Meds: omeprazole 20mg

Current Illness: unknown

ID: 1753784
Sex: M
Age: 66
State: IL

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 10/01/2021
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: no

Symptom List: Unevaluable event

Symptoms: approximately 3-4 hours after injection severe pain developed in right deltoid muscle site of injection, Pain severity about 9 on scale 1-10.Unable to move arm due to pain. Swelling developed measuring about 3x5 inches extending from 1 inch below top of the shoulder tpo about 3 inches above elbow, The swelling was hot to touch, but minimal redness was observed. Sensation of flushing (all over but mostly face) started increasing at 5-7 hours (temp was rising at that time and was 100.2) and reached peak at 12 hours after injection, accompanied by chills and severe shivering. Max temperature measured was 101.9 (oral) at 12 hours after injection. Profuse sweating during the night. Treatment started at 5 hours after injection: cold compresses to the arm Tylenol 1 gram every 6 hours x 2 days (4 doses total) Cetirize HCL 20 mg every 24 hrs x 2 doses total Ibuprofen 800 mg q 12 hrs Dexamethazone p.o. 6 mg at once and then 6 mg 12 hours later. Symptoms started to improve 24-36 hrs after the injection and almost all symptoms resolved at 48 hrs, mild residual pain in right deltoid area remaining. without impact on the range of motion.

Other Meds: Rosuvastatin 5mg daily Armodafinil 250 daily Famotidine 20 mg daily Myrbetriq (brand) 5mg daily Ibuprofen 600 mg prn Bupropion XL 450 mg daily

Current Illness: periodontitis

ID: 1753785
Sex: F
Age: 48
State: WA

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 10/01/2021
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: Yes, unknown to what

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

Symptoms: 15 minutes after vaccination patient became hypertensive, tachy, RR increased and she felt "itchy". 50mg PO benadryl was administered and patient was put in a supine position. After 1 hour her vitals normalized and itchy feeling subsided. Provider assessing attributed event to anxiety.

Other Meds: Unknown

Current Illness: Unknown

ID: 1753786
Sex: F
Age: 36
State: TX

Vax Date: 04/23/2021
Onset Date: 04/24/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: No tests.

Allergies: Rocephin

Symptom List: Injection site pain, Pain

Symptoms: Awoken the next day with my skin from head to toe feeling as if it were on fire. The feeling of pinpricks all over my skin. Nerve pain all over my body. Joint pain even in my ribs. Radiating pain from my right arm across my back, neck, and down my left arm.

Other Meds: zyrtec, Miyo-Chiro Insitol, Women's daily vitamin.

Current Illness: none

ID: 1753787
Sex: F
Age: 59
State: CA

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: None.

Allergies: Sulfa drugs

Symptom List: Injection site pain, Menorrhagia

Symptoms: Soreness at injection site onset 9/29/21, persists through the time of this report (11:00M 10/1/21). Fever up to 100.8* F on 9/30/21 (the day after the injection), resolved by 5:00AM on 10/1/21. Chills starting 9/29/21 7:30PM, resolved by 1:00PM on 09/30/21. Body aches, resolved by 10:00AM on 10/1/21.

Other Meds: CALCIUM; IRON; VITAMIN C

Current Illness: None

ID: 1753788
Sex: M
Age: 17
State: NJ

Vax Date: 09/14/2021
Onset Date: 09/14/2021
Rec V Date: 10/01/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1753789
Sex: F
Age: 48
State: WI

Vax Date: 04/13/2021
Onset Date: 09/28/2021
Rec V Date: 10/01/2021
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: erythromycin - upset stomach

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient contracted COVID after being fully vaccinated Cough, Congestion, Sore throat

Other Meds: albuterol 90mcg cholecalciferol 3000IU daily fexofenadine 180mg daily fluticasone nasal daily ibuprofen 800mg prn levothyroxine 112mcg daily magnesium oxide 500mg daily omeprazole 20mg daily oxybutynin 2.5mg daily rosuvastatin 10mg HS sertr

Current Illness: None documented

ID: 1753790
Sex: M
Age: 83
State:

Vax Date: 04/01/2021
Onset Date: 09/30/2021
Rec V Date: 10/01/2021
Hospital: Y

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: 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: 1753791
Sex: F
Age: 85
State:

Vax Date: 02/17/2021
Onset Date: 09/28/2021
Rec V Date: 10/01/2021
Hospital: Y

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

Lab Data: Cycle threshold 29.9 on admission.

Allergies:

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

Symptoms: Patient admitted to the hospital for COVID 19. Reporting per Moderna COVID vaccine EUA.

Other Meds:

Current Illness:

ID: 1753792
Sex: F
Age: 58
State: AL

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 10/01/2021
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:

Symptom List: Nausea

Symptoms: Vaccine expired on September 28, 2021. Administered September 29, 2021.

Other Meds:

Current Illness:

ID: 1753793
Sex: F
Age: 79
State:

Vax Date: 08/28/2021
Onset Date: 08/30/2021
Rec V Date: 10/01/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Presented to ED for shortness of breath. Patient had IV placed, labs and CXR imaging performed. On attempt to ambulate the patient, after only a couple of steps she becomes quite hypoxic dropping her sats into the 80s and tachycardic. It is unclear to me the cause of her symptoms, however due to her persisted hypoxia upon exertion and oxygen requirement she will be admitted to the hospital for ongoing management.

Other Meds:

Current Illness:

ID: 1753794
Sex: F
Age: 10
State: AZ

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/01/2021
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: Systemic: Hyperventilation-Mild, Systemic: Nausea-Mild, Systemic: Vomiting-Mild, Additional Details: patient has had vasovagal response before and anxiety when it comes to shots. Mother said her aunt is the same way. Patient vomited shortly after receiving her flu shot. She felt nauseous and was hyperventilating. Mother, brother, and I were trying to calm her down to take deep breaths. Patient was able to get cleaned up and left for home. She was talking and walking out. ***PATIENT DID NOT RECEIVE COVID VACCINE. It was a required field for me to fill out this form.***

Other Meds:

Current Illness:

ID: 1753795
Sex: F
Age: 34
State: IL

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/01/2021
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: Asmanex

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

Symptoms: Significant swelling of injection site continues to this day (10/01/21), with area measuring 10cm wide by 6.5cm long. Area is inflammed, itchy, and sore. Neck, shoulders, and upper back pain making it difficult to sleep, daily headache, increased fatigue, decreased appetite. Tried Benadryl and naproxen for symptoms, with no improvement. Waiting for symptoms to subside on their own, since injection site swelling has stopped spreading.

Other Meds: Vitamin D3 2000 IU (daily), norethindrone 0.35mg (daily), cetirizine hydrochloride 10mg (daily), rizatriptan ODT 10mg (as needed).

Current Illness:

ID: 1753796
Sex: F
Age: 31
State: FL

Vax Date: 07/27/2021
Onset Date: 07/31/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: SARS-COV-2, NAA positive on 7/29/21

Allergies: NKDA

Symptom List: Tremor

Symptoms: Patient received the vaccine on 7/27/21 and symptoms began on 7/31/21. It started with swelling in her hands which would travel up her forearms. The swelling would go away after a few days but then swelling in a different body part would occur a couple of days later. Eventually, her lips and ears got swollen. Today, there is still residual swelling in her ears.

Other Meds: Tylenol

Current Illness: Anemia

ID: 1753797
Sex: M
Age: 18
State: NJ

Vax Date: 09/14/2021
Onset Date: 09/14/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1753798
Sex: F
Age: 40
State: CA

Vax Date: 07/29/2021
Onset Date: 08/16/2021
Rec V Date: 10/01/2021
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: URGENT CARE VISIT - Series of blood tests and exams 8/16/2021 ER VISIT - CT scan head 8/18/2021 ER VISIT - Full panel of blood work and exams 8/18/2021 ER VISIT - Blood work and exams 8/31/2021 MRI - brain and brain stem 8/26/2021 MRI - inner ear with and without contrast 9/22/2021

Allergies: levaquin

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

Symptoms: The following symptoms started on August 16, 2021: Positional vertigo, nausea, dizziness, ringing in ears, sensitivity to light, sensitivity to sound, difficulty focusing, loss of balance, vibrating head sensations, migraines, head pressure. These symptoms are persistent and have caused substantial disruption of my ability to conduct normal life functions.

Other Meds: none

Current Illness: none

ID: 1753799
Sex: F
Age: 26
State: NJ

Vax Date: 09/14/2021
Onset Date: 09/14/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1753800
Sex: M
Age: 62
State: IL

Vax Date: 03/30/2021
Onset Date: 08/03/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: Covid test - came positive on 6 Aug2021 - rapid test.

Allergies: No; seasonal allergies

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: - 1st week of Aug - sick for a week. 04 tested negative/6 Aug 2021 - positive; Sneezing, congestion, running nose, cough. fever, chills and aches - lasted about week at 102.7 temperature for 2 days. Sore throat and congestion went off 10 days. I still have loss of taste and smell.

Other Meds: No

Current Illness: No

ID: 1753801
Sex: F
Age: 59
State: OR

Vax Date: 09/16/2021
Onset Date: 09/16/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: Patient was administered IM epinephrine shortly after the onset of symptoms and fully recovered within approximately 10 minutes after administration of epinephrine

Allergies: Aspirin, loratadine, morphine, gabapentin and Lyrica

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

Symptoms: Shortly after administration of vaccination patient started to develop hoarseness of voice with associated coughing as well as the sensation of her throat closing up. Patient then developed dry heaves.

Other Meds: amlodipine and levothyroxine

Current Illness: none

ID: 1753802
Sex: M
Age: 81
State: MA

Vax Date: 08/16/2021
Onset Date: 08/17/2021
Rec V Date: 10/01/2021
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: Blood draws including CBC AND Differential, frequent BP readings, Endoscopy

Allergies: Levofloxin, Ambien

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

Symptoms: Patient received the Pfizer third ("booster") vaccination on August 16, 2021, at @ 1:00 p.m. The following morning the patient was too weak to walk without help. The second day after the vaccination, August 16, 2021, the patient was admitted to the ICU. Blood analysis showed that the patient's Hemoglobin had dropped to 4.6, requiring the immediate transfusion of three (3) units of blood, and a three day regimen of IV Vasopressors for extremely low blood pressure. Initially, treating doctors surmised that the Hemoglobin drop was caused by bleeding in the GI tract. An endoscopy revealed that not to be the case. No explanation for the drop in Hemoglobin or extremely low blood pressure has been found by treating physicians and other medical providers. Patient was discharged on August 22, 2021. Patient does not know if treating physicians or Primary MD has reported this incident as a possible side effect of the third ("booster") Pfizer vaccination.

Other Meds: traMADoL 50 mg tablet every 6 hours predniSONE 1 MG tablet 4 3 mg daily omeprazole 20 MG tablet twice a day cholecalciferol (vitamin D3) 25 mcg (1,000 unit) capsule daily ferrous sulfate 325 (65 FE) MG tablet daily cyanocobalamin 1,000 mcg/

Current Illness: Pneumonia

ID: 1753803
Sex: F
Age: 63
State: NJ

Vax Date: 09/16/2021
Onset Date: 09/16/2021
Rec V Date: 10/01/2021
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, Improper Storage temperature.

Other Meds:

Current Illness:

ID: 1753804
Sex: F
Age: 49
State: CT

Vax Date: 09/28/2021
Onset Date: 09/29/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data:

Allergies: lamictal

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

Symptoms: 7 pm aching legs 12:30 am fever 102 12:30 twitching, teeth chattering, seizure like movements, 2:00am headache

Other Meds: aspirin,vit d

Current Illness: autoimmune

ID: 1753805
Sex: M
Age: 74
State: AL

Vax Date: 03/05/2021
Onset Date: 09/09/2021
Rec V Date: 10/01/2021
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: N/A

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

Symptoms: BREAKTHROUGH CASE : Covid + 09/09/2021

Other Meds: Aspirin, Metaphorim, Atorvastatin, Ometprosal, Genovia, Lisinopril, Ezetimide, Ampalodapine, Toparol, Laradien, Hydrochlorothiazide, Glipazide, Melatonin, Fish Oil

Current Illness: N/A

ID: 1753806
Sex: F
Age: 29
State: KY

Vax Date: 09/24/2021
Onset Date: 09/26/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: Went to urgent care and had a CT scan done

Allergies: NKDA

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

Symptoms: Facial swelling on one side of face

Other Meds: Unknown

Current Illness:

ID: 1753807
Sex: F
Age: 30
State: NJ

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: Site: Itching at Injection Site-Severe, Systemic: Allergic: Itch Generalized-Severe, Systemic: Allergic: Rash Generalized-Severe

Other Meds:

Current Illness:

ID: 1753808
Sex: F
Age: 38
State: NJ

Vax Date: 09/13/2021
Onset Date: 10/01/2021
Rec V Date: 10/01/2021
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: MACROBID

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: ACCORDING TO Doctor, THE PATIENT DEVELOPED TRIGEMINAL NEURALGIA.

Other Meds:

Current Illness:

ID: 1753809
Sex: F
Age: 30
State: NC

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 10/01/2021
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: Thimerosal Cocamidopropyl Betaine

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

Symptoms: Facial Rash-itch and swelling around 5-6pm after being given the vaccine at 2:02pm. Patient reported to the nurse on 09/30/2021 and stated there was no trouble breathing and that Benadryl was helping with the rash and swelling. Patient has allergy to thimersol so a prefilled syringe was needed. High dose was picked up and administered instead of appropriate dose for patient age.

Other Meds: Adderall XR 15mg

Current Illness: N/A

ID: 1753810
Sex: F
Age: 52
State: NJ

Vax Date: 09/14/2021
Onset Date: 09/14/2021
Rec V Date: 10/01/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1753811
Sex: F
Age: 74
State: FL

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: fever of 101 a few hours later

Allergies: none

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

Symptoms: patient received both vaccines in same arm, a few hours later she said she developed fever of 101, aches, diarrhea, soreness at inj site, extreme fatigue.

Other Meds: Tylenol, pedialyte and hydration fluids

Current Illness: mpme

ID: 1753812
Sex: M
Age: 79
State:

Vax Date: 02/11/2021
Onset Date: 09/18/2021
Rec V Date: 10/01/2021
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: Cycle threshold 25.7 on admission

Allergies:

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

Symptoms: Patient hospitalized for COVID 19. Reporting per Moderna COVID vaccine EUA.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am