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: 1754020
Sex: F
Age: 43
State: NJ

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

Allergies: none

Symptom List: Dysphagia, Epiglottitis

Symptoms: I have been bleeding vaginally ever since I got the vaccine - today is day 8. I had had my menstrual period the Sunday-Thursday prior to the vaccine.

Other Meds: none

Current Illness: none

ID: 1754021
Sex: F
Age: 41
State: OR

Vax Date: 08/01/2021
Onset Date: 08/01/2021
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: I have an appointment to get my labs drawn and im waiting to hear from dr.'s office for approval of a head CT from my insurance.

Allergies: Eggs, dairy, gluten, protein, sucrose and fructose

Symptom List: Anxiety, Dyspnoea

Symptoms: With the 1st dose of Moderna I had a fever, chills, muscle aches, pain, nausea, vomiting, fatigue, headaches, redness and swelling. All of the side effects cleared up except the fatigue and headaches. The headaches were manageable with Excedrin and ibuprofen. The headaches have not gone away, and with the 2nd dose of the Moderna vaccine the headaches have turned into migraines and I?ve become dizzy and shaky with the 2nd dose of the Moderna vaccine. I?m still very fatigued and the dr. Noted my blood pressure was abnormally high for me from my past visits.

Other Meds: Multi vitamin once a day.

Current Illness: None

ID: 1754022
Sex: M
Age: 31
State: CA

Vax Date: 07/20/2021
Onset Date: 07/28/2021
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: ER visit, labs, MRI , EGD , video fluroscopy

Allergies: none

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

Symptoms: dysphagia , eosinophilic esophagitis

Other Meds: none

Current Illness: none

ID: 1754023
Sex: F
Age: 66
State: TX

Vax Date: 03/06/2021
Onset Date: 07/30/2021
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: None

Allergies: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Sinus drainage, chest congestion, loss of taste and smell. Used Musinex for congestion and Flonase for drainage. Still cannot smell or taste

Other Meds: Sertraline, multi vitamin , baby aspirin, aleve , calcium, glucosamine, vitamin D

Current Illness: None

ID: 1754024
Sex: M
Age: 76
State: FL

Vax Date: 08/30/2021
Onset Date: 09/18/2021
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: Skin rash and itching

Other Meds:

Current Illness:

ID: 1754025
Sex: M
Age: 66
State: AL

Vax Date: 03/26/2021
Onset Date: 05/01/2021
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: August 19, 2021- mammogram - results no cancer

Allergies: Indomethacin; seasonal allergies; grass pollen; tree pollen

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

Symptoms: In early May 2021, I was itching from head to toe. The itching was very severe. I was causing myself to bleed from itching so much. I went to my dermatologist she diagnosed it as unspecified/ nonspecific dermatitis. She prescribed a cream, Triamcinolone acetonide cream 0.1% to use. I have not had to use the cream as much. But in June, July and August I was using it on a daily basis. The itching has subsided but the swelling has not. 6 or 8 weeks ago, I had swelling on my left breast. I went to see my doctor on 08/19/2021. I had a mammogram. They did not find cancer. I still have the swelling now. I did hit myself hard on my chest, so it may not be associated with the vaccine, but I do not know.

Other Meds: Losartan; MAXZIDE; carvedilol; LIPITOR; turkey tail mushroom tinctures extracts; lions mane's mushrooms tinctures extracts

Current Illness: 2 months prior I recovered from having COVID -19, 12/08/2020 - Tested positive for COVID-19

ID: 1754026
Sex: F
Age: 72
State: AL

Vax Date: 06/17/2021
Onset Date: 06/26/2021
Rec V Date: 10/01/2021
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: CT Scan 6/26/21 - Ischemic / Dry Stroke

Allergies: codeine

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Ischemic Stroke on 6/26. Within 7 days she couldn't speak, walk or eat. She is currently residing in a nursing home.

Other Meds:

Current Illness:

ID: 1754027
Sex: F
Age: 36
State: CA

Vax Date: 09/01/2021
Onset Date: 09/01/2021
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: None

Allergies: Keflex

Symptom List: Pharyngeal swelling

Symptoms: Swelling,hives,blisters in mouth, swelling lasted 4 days. I had to take Benadryl for the 4 days

Other Meds: Lyvothyroxine 125mcg, vitamin D3 5000 iu, lisinopril 10mg

Current Illness: Hypothyroidism hashimoto thyroiditis,hypertension

ID: 1754028
Sex: F
Age: 31
State: CA

Vax Date: 08/28/2021
Onset Date: 08/29/2021
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:

Allergies: No

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: The second night after my 2nd Pfizer vaccine, my left upper arm hurts, but then there was radiating numbness to my forearm and all the way to the left hand ring finger. I was scared because all of a sudden I didn't have strength, and it hurts to put my hand in a fist and I couldn't squeeze dishwasher soap. It went on the second day, and my right arm felt numbing too. Occasionally, now it's once in awhile with weakness.

Other Meds: The second night after my 2nd Pfizer vaccine, my left upper arm hurts, but then there was radiating numbness to my forearm and all the way to the left hand ring finger. I was scared because all of a sudden I didn't have strength, and it hu

Current Illness: Occasionally, felt slight numbing on the arm.

ID: 1754029
Sex: M
Age: 33
State: WA

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

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: My head is burning up with a fever while my arms and legs are freezing and getting chills. Soft and green colored stool. Joints are stiff and sore. Arm where the injection was administered hurt and bruised.

Other Meds:

Current Illness: Sinus congestion over a week ago, but I was feeling just fine

ID: 1754030
Sex: F
Age: 34
State: AK

Vax Date: 09/07/2021
Onset Date: 09/07/2021
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: During 8 days of symptoms ( September 20th - 27th, 2021) Patient visited emergency room twice, with no abnormal findings. Diagnostics included,: Radiograph of Thorax, EKG, CBC & Chemistry, CT scan with and without contrast.

Allergies: Elimination diet for Wheat and Milk due to eosinophilic esophagitis (resolved at time of vaccination)

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

Symptoms: Full body flushing & tingles, numbness in face, feeling faint, dizzy, weak legs and arms, cold feet, head felt heavy, felt spacy, headaches, slight nausea. Normal heart rate, normal breathing. Lasted 1 day post first vaccination on August 9, 2021 and lasted 3 days post second vaccination on September 7th, 2021. Then ALL the same symptoms returned exactly 2 weeks post 2nd vaccination and lasted for 8 days ( September 20th - 27th, 2021). Patient is still dealing with headaches, some flushing and dizziness today Oct 1st, 2021

Other Meds: esomeprazole, Vitamin C, Daily multivitamin

Current Illness: none

ID: 1754031
Sex: F
Age: 37
State: WY

Vax Date: 08/20/2021
Onset Date: 08/21/2021
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: Blood pressure elevated.

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Reports fluttering in chest, chest pressure, lightheaded, dizziness, increased blood pressure increasing throughout day. On 8/21/2021, the day after receiving vaccine, reported symptoms continued through the weekend, client reports the symptoms felt intense at times, reports symptoms did get better on 8/24/21, client did go to her doctor, and doctor offered an ekg and holter monitor which client refused at this time.

Other Meds:

Current Illness:

ID: 1754032
Sex: F
Age: 100
State: NJ

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

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

Lab Data: None

Allergies: Amoxicillin, Sulfacet-R, Sulfanomides

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

Symptoms: Vomiting, hypoxemia, elevated temperature

Other Meds: Aspirin 81 mg, Atenolol 25 mg, Azelastine HCI Solution, Lexapro 10 mg, Lisinopril 2.5 mg, Peniaic Solution, Pentasa 500 mg, Predisolone Suspension, Remeron 15 mg, Xanax 0.25 mg

Current Illness:

ID: 1754033
Sex: M
Age: 42
State: ND

Vax Date: 09/07/2021
Onset Date: 09/09/2021
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: SYR
Vax Site: LA

Lab Data: Cardiac workup ER multiple dates ----Clinic workup---- 9/20/21 RBC 5.93, RDW 14.7, Monocyte 4.3%, Hgb 17.4, WBC 7.2, Platelets 230. Glucose 109, ALT 54.0, HgbA1C 5.9, globulin 3.5, CMP otherwise normal with creatinine 1.0, total cholesterol 237.0, HDL 46.0, LDL 143, Triglycerides 242 Urinalysis trace lysed blood with 100 protein, 0-3 RBCs no WBCs, trace mucous Vitamin D 14.6 --- 9/24 TSH 3.49, drug toxicology negative, CK total 98, 100 protein in urinalysis,0-4 WBC in urine, 0-3 RBCs, ANA Ab Pattern 2 speckless, ANA Ab pattern homogenous, AnA Ab screen positive, ANA Ab titer 1 and 2 positive (High), Hepatitis A /B/C and HIV negative ESR 9/30/21 is 2.

Allergies: Iodine, Shellfish

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

Symptoms: ER visit 9/10/21 Left chest soreness started 2 days after vaccine progressively worsening, significant fatigue, body aches, shortness of breath,. ER visit 9/13/2021 Primary care visit 9/13/21 Primary care visit 9/14/21 Primary care visit 9/24/21 Low vitamin D, proteinuria - weakness, fatigue, chest pain intermittently, difficulty breathing, cough, acid reflux. About 2 weeks after vaccine bilateral cheek rash Primary caare 9/30/21 10/1/21 Today Persistent fatigue, body aches

Other Meds: Amlodipine 10 mg daily Lisinopril 40 mg daily Allopurinol 300 mg daily Epinephrine only for emergencies.

Current Illness: Bilateral foot pain

ID: 1754034
Sex: F
Age: 78
State: VA

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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Xrays today, 10/01/2021, did not show damage. If I do not experience significant improvement wIthin 6 weeks, the dr wii order an MRI. ,

Allergies: Sulfa drugs Doxycycline

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

Symptoms: Injection was made into my shoulder capsule, not my arm. The injection itself was very painful. For 2.5 hours, I had no further pain. At approximately 2.5 hours after the injection, I experienced severe pain in my shoulder and upper arm. Now 3 days later, I have limited arm movement and continuing pain. My orthopedist believes that the injection was made directly into the rotator cuff. Treatment will entail anti-inflammatories, which I am not generally supposed to take because of CKD, physical therapy, and 6-8 weeks if I?m lucky.

Other Meds: Pepcid for GERD

Current Illness: None

ID: 1754035
Sex: F
Age: 60
State: KY

Vax Date: 03/12/2021
Onset Date: 09/24/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Tested Positive for Covid

Other Meds:

Current Illness:

ID: 1754036
Sex: M
Age: 45
State: MI

Vax Date: 03/13/2021
Onset Date: 09/18/2021
Rec V Date: 10/01/2021
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: NKDA

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

Symptoms: Hospitalized (9.24.21 - present); COVID-19 positive (9.18.21); fully vaccinated Principal Problem: Pneumonia due to COVID-19 virus Active Problems: Acute respiratory failure with hypoxia History of Present Illness Patient is a 46 y.o. male who presents to ER today with c/o severe worsening cough, fever, increasing SOB. Patient has a 14 yo son that was recently sick with Covid. He is in school and unmasked and has completed his isolation. Patient's spouse is also sick with Covid 19. Patient has not been able to sleep the last two nights due to severe cough. His cough is productive at times with greenish/yellow secretions. Patient denies wheezing, chest pain, edema, orthopnea. He does snore sometimes. He denies OSA. Patient has been alternating taking acetaminophen and ibuprofen at home for his fevers and myalgias. Patient reports that he is having watery diarrhea about 2 to 3 in last 24 hours. Patient has a PMhx of psoriatic arthritis, hyperthyroid, h/o light tobacco use. Patient follows with endocrinology and rheumatology. Covid vaccination Janssen on 3/13/21. Patient was ill last October and thought this may have been due to Covid. Covid 19 IGG antibody in Dec was negative. ER evaluation today Fever 38.4, 87% sats on RA, HR 105, RR up to 22. 2L oxygen w/sats up to 93%. CXY bilateral lung opacities consistent w/covid pneumonia +Covid 9/18/21. Patient was prescribed albuterol inhaler and tessalon perles 2 days ago. Na 131, AST 86, ALT 77, WBC 3.5, lymphopenia In the ER patient was given dexamethasone 6 mg IV, tessalon perles, albuterol MDI and acetaminophhen. Patient is being admitted for acute hypoxia due to Covid pneumonia w/sepsis. Notes from 10.1.21: SUBJECTIVE: Significant events in the last 24 hours: intubated 9/27; tolerated prone positioning; slight negative fluid balance; tol heparin gtt no evidence of bleeding. CHIEF COMPLAINT: Pneumonia due to COVID-19 virus Length of Stay: 7 days Assessment/Plan ASSESSMENT / PLAN: * Pneumonia due to COVID-19 virus Assessment & Plan S/p remdesivir S/p Dexamethasone 6mg -> 20 9/27 Worsening hypoxia Acute Respiratory Failure with hypoxia - secondary to ARDS from COVID-19 pna; worsening COVID-19 pneumonia - dx 9/18; admitted 9/24 -Intubated 9/27 -sedation for vent synchrony - RASS -5 -NMRB - trial holding today --lung protective ventilation - goal pplat < 30 driving pressure < 15 -daily prone positioning for p/f < 150 - 16 hours minimum per 24 hrs. -empiric abx -remdesivir -dexamethasone - 20mg daily x5 days then 10mg daily x 5 days -corpak - I/o goal even to - 500 DVT - LE/ U/s w/ peroneal dvt 9/28 -heparin gtt Psoriatic arthritis - h/o immunosuppression Hyperthyroidism - methimazole; free T4 nml Proph GI- H2B VTE- heparin gtt VAP- Chlorhexadine Full Code

Other Meds: albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler benzonatate (TESSALON) 100 MG capsule ibuprofen (MOTRIN) 200 MG tablet leflunomide (ARAVA) 20 MG tablet meloxicam (MOBIC) 7.5 MG tablet methIMAzole (TAPAZ

Current Illness: COVID-19 positive 9.18.21

ID: 1754037
Sex: F
Age: 35
State: AZ

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

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

Lab Data: N/A

Allergies: Pseudophedrine

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Menstrual cycle started 7-10 days ahead of time.

Other Meds: Vitamin D, Vitamin B

Current Illness: None

ID: 1754038
Sex: M
Age: 70
State: NE

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

Allergies: nka

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: not in CDC guidlines

Other Meds: Zofran, Compazine, Lidocaine oral rinse, Radiation,

Current Illness: Cancer

ID: 1754039
Sex: F
Age: 4
State: CT

Vax Date: 10/01/2021
Onset Date: 10/01/2021
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: None

Allergies: NKA

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

Symptoms: Patient develop redness and a rash on the face almost immediately. Patient was administered 7.5 mL Benadryl

Other Meds: None

Current Illness: None

ID: 1754040
Sex: F
Age: 68
State: MN

Vax Date: 03/01/2021
Onset Date: 09/22/2021
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: CXR, Chest CT no PE.

Allergies:

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

Symptoms: Patient c/o symptoms starting around 9/22 with chest pain, cough, and back pain in left upper back. COVID test 9/23 Positive. Hx of RA, Asthma, Hyperlipidemia, and COPD on 2 L of Oxygen.

Other Meds:

Current Illness:

ID: 1754041
Sex: F
Age: 66
State: OH

Vax Date: 04/30/2021
Onset Date: 05/01/2021
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: Covid test negative.

Allergies:

Symptom List: Unevaluable event

Symptoms: Reported various symptoms such as fatigue, diarrhea, headache, nausea, sweats, chills, and cough following the vaccine. These lasted several weeks and turned into wheezing, coughing, and pneumonia.

Other Meds:

Current Illness:

ID: 1754042
Sex: M
Age: 72
State: IN

Vax Date: 09/29/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Several hours after injection I spiked a fever of 100.9. All joints and muscles ached. Felt awful!

Other Meds: Elioqis, diamipsan, synthroid

Current Illness: Afib, chronic kidney disease, Pulmonary Hypertention

ID: 1754043
Sex: M
Age: 27
State: AZ

Vax Date: 09/10/2021
Onset Date: 09/22/2021
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: None

Allergies: None

Symptom List: Injection site pain, Pain

Symptoms: Muscle weakness and face numbness in right arm, right leg, right side of face, and left calf and foot.

Other Meds: None

Current Illness: None

ID: 1754044
Sex: F
Age: 52
State: OR

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

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

Lab Data:

Allergies: None

Symptom List: Injection site pain, Menorrhagia

Symptoms: Breakthrough infection following full vaccination.

Other Meds: LEVOTHYROXINE

Current Illness: None

ID: 1754045
Sex: F
Age: 27
State:

Vax Date: 09/28/2021
Onset Date: 09/29/2021
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: PINEAPPLE

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

Symptoms: RASH ON FEET AND HANDS, WENT TO URGERNT CARE AND THEY DIDN'T DO ANYTHING. HAND TREMORS, HAVING A HARD TIME DOING MY WORK WITHOUT MY HANDS SHAKING.

Other Meds: NONE

Current Illness: NONE

ID: 1754046
Sex: F
Age: 37
State: IL

Vax Date: 08/06/2021
Onset Date: 08/06/2021
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:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Lymphadenopathy and high blood pressure including heart rate. Metoprolol tartrate 25mg, metoprolol succ er 25mg. Unable to work since received 2nd dose of vaccine. Currently under Drs care.

Other Meds: Norethindrone tablets .35mg

Current Illness:

ID: 1754047
Sex: M
Age: 53
State: OH

Vax Date: 04/30/2021
Onset Date: 05/01/2021
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: RA

Lab Data: Negative covid test

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient reported several symptoms the days and weeks following vaccination. These included fatigue, diarrhea, headache, nausea, sweats, chills and cough. These persisted for 3 weeks.

Other Meds:

Current Illness:

ID: 1754048
Sex: M
Age: 30
State: NY

Vax Date: 10/01/2021
Onset Date: 10/01/2021
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:

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

Symptoms: Approximately 30 minutes after my first vaccination I briefly fainted

Other Meds:

Current Illness:

ID: 1754049
Sex: F
Age: 66
State: OH

Vax Date: 02/12/2021
Onset Date: 02/15/2021
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:

Allergies: No

Symptom List: Nausea

Symptoms: By the 15th, I had discomfort under my ribs which I thought might be a UTI. By the 16th, I was really hurting. I went to the doctor on the 18th. The rash from the shingles was prominent by then. The doctor was able to look at me and already diagnose it. I was given a steroid pack and gabapentin for nerve pain. I also had a urinary tract infection which I was given antibiotics for. I took the medication for about a week. The shingles lasted for 3-4 weeks but 2 weeks was extremely painful.

Other Meds: Standard Process:Thytrophin, Ligaplex II, Parotid PMG, Boswellia complex, Black Currant Seed Oil, Zypan, Magnesium Lactate, Drenamin, Gastrex, Ashwagandha, Rehmannia, Echinacea Premium Probiotic, Fish oil, Zyflamend, eleuthero , cordaceps,

Current Illness: No

ID: 1754050
Sex: M
Age: 77
State: MA

Vax Date: 03/25/2021
Onset Date: 04/09/2021
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: covid positive test on 4/9. Chest x ray on 4/9 representing covid 19 pneumonia

Allergies: No known allergies

Symptom List: Injection site pain

Symptoms: Patient presented to ED on 4/9/21 with weakness, fatigue, and SOB. Found to be covid positive after fully vaccinated. Patient was treated for covid 19 pneumonia during admission

Other Meds: Zyrtec, esoperazole, temazepam

Current Illness: Not applicable

ID: 1754051
Sex: F
Age: 12
State:

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:
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: Vaccine affected by temperature excursion administered to the patient

Other Meds:

Current Illness:

ID: 1754052
Sex: F
Age: 53
State: IL

Vax Date: 09/06/2021
Onset Date: 09/17/2021
Rec V Date: 10/01/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: Blood Work 09/18/2021

Allergies: Flagle

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

Symptoms: Pt.'s Husband states that after the Pt. received the 1st dose of Phizer 09/17/2021, started experiencing symptoms 09/17/2021 of fatigue, and stomach pains. (History of Liver Disease) ER visit 09/18/2021 blood work done (Ammonia elevated), confusion started 09/20/2021 difficulty speaking. 09/24/2021 Diagnosed with Brain bleed, scheduled procedure to relieve the pressure. Pt. fell into a Coma. Currently still Hospitalized with no improvements.

Other Meds: Pre-natal Vitamins

Current Illness: N/A

ID: 1754053
Sex: F
Age: 56
State: NJ

Vax Date: 03/08/2021
Onset Date: 03/09/2021
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: MRI

Allergies: NONE

Symptom List: Tremor

Symptoms: I had a fever I couldn't sleep and ringing in the ear and then I went to the ENT. They said it's just normal and then I tried a couple of medicines and it still didn't work and I couldn't sleep. I had the ringing in the ear and I did the hearing test and they said I don't need to worry about it and then in August I went to do an MRI and found a brain tumor. I just had the surgery to remove to the tumor.

Other Meds: HIGH BLOOD PRESSURE MEDICATION

Current Illness: NONE

ID: 1754054
Sex: M
Age: 43
State:

Vax Date: 09/01/2021
Onset Date: 09/01/2021
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: none

Allergies: NKDA

Symptom List: Erythema, Pruritus

Symptoms: muscle soreness at place of injection for 24 hours

Other Meds: Vitamin C, 1000mg; once daily Vitamin D-3, 2000 IU; once daily Red Yeast Rice, 2400mg; once daily Zinc, 50mg; once daily BAYER One-A-Day Men's Multivitamin; once daily

Current Illness: none

ID: 1754055
Sex: F
Age: 71
State:

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

Allergies:

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

Symptoms: Vaccine affected by temperature excursion administered to the patient

Other Meds:

Current Illness:

ID: 1754056
Sex: F
Age: 65
State:

Vax Date: 09/26/2021
Onset Date: 09/26/2021
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: Vaccine affected by temperature excursion administered to the patient

Other Meds:

Current Illness:

ID: 1754057
Sex: M
Age: 70
State: FL

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

Lab Data: none

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Feel I suffered a Silent Heart attack 3 hours after my booster shot.

Other Meds: Persugel Metoprolol Repatha atrovastatin ASA

Current Illness: Post MI

ID: 1754058
Sex: F
Age: 34
State: NY

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: 011J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: No known drug allergies

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

Symptoms: Patient was administered the vaccine per guidance and shortly after receiving the vaccine experienced an acute seizure. Patient was stabilized and sent to the local ER for further evaluation.

Other Meds:

Current Illness:

ID: 1754059
Sex: F
Age: 16
State:

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

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

Lab Data:

Allergies:

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

Symptoms: Vaccine affected by temperature excursion administered to the patient.

Other Meds:

Current Illness:

ID: 1754060
Sex: F
Age: 53
State: IA

Vax Date: 09/22/2021
Onset Date: 09/22/2021
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: Codeine, sulfa, tetracycline

Symptom List: Pain in extremity

Symptoms: Event: Received the Influenza vaccine on 9/22/21 in right shoulder, which hurt when received it. Later that night the pain became worse. Every day and night since has had to take Tylenol and ibuprofen alternating every 4 hours. Wakes during the night and has to take Aleve. Has used ice and heat. All therapies have helped with some relief. Describes pain as dull ache but when moves is a "pulls my muscle off bone - tearing feeling." Pain is felt in anterior and lateral portion of right shoulder. Rates pain a 3/10 but when moves it can be an 8/10. Tx: Will start meloxicam and tizanidine. May use tylenol every 4-6 hours as needed. Discussed use of ice/heat in addition to topical analgesics/patches.

Other Meds: None

Current Illness:

ID: 1754061
Sex: F
Age: 78
State:

Vax Date: 09/29/2021
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:

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

Symptoms: Vaccine affected by temperature excursion administered to the patient

Other Meds:

Current Illness:

ID: 1754062
Sex: F
Age: 56
State: WI

Vax Date: 09/23/2021
Onset Date: 09/24/2021
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 - negative; Influenzas A and B - all negative; RSV; Chest X-ray - Negative; AP and lateral; CBC - 20 tests done; CMPN - BP - 158/84 which is high normal; Creatine kinase

Allergies: Morphine

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

Symptoms: Flu and 2nd shot. I wasn't feeling well after the 1st dose, 2nd dose was increased fatigue, breathing got worse. Influenza P-free Quadrivalent vaccination on same day on 2nd dose. The next day, all my muscles and joint and feet hurts and painful to walk, headache and extreme fatigue and cough. Progressively worst the next day. I slept all weekend and didn't work. Breathing got worst. Had fever on weekends 100.3 after Tylenol. Tuesday called out sick and went to doctor. I was not improving. Tests shows nothing wrong. BP was high.

Other Meds: No

Current Illness: No

ID: 1754063
Sex: M
Age: 42
State: WA

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

Symptoms: Severe lethargy; severe back pain; headaches.

Other Meds:

Current Illness:

ID: 1754064
Sex: M
Age: 76
State:

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: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: Vaccine affected by temperature excursion administered to the patient.

Other Meds:

Current Illness:

ID: 1754065
Sex: M
Age: 27
State: RI

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

Allergies: NA

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Employer compelled me to take a third vaccine (took both shots in July, but doses were spaced lesser than 4 weeks) at the risk of losing my employment (doctoral student). Pharmacist strongly advised against it, but I persisted (to not lose my job). The first night (T+ 6-16 hours) I laid awake all night with severe myalgias, a 101 fever, body chills, and an intermittent headache. between T 16-48 I continued to experience moderate to severe myalgia and headache grew increasingly painful (6/10) but fever began to attenuate by +36 hours. Between T+ 48-72 hours I could barely get out of bed, but other symptoms slowly improved. Decided not to go to hospital at the suggestion of my PCP.

Other Meds: NA

Current Illness: NA

ID: 1754066
Sex: M
Age: 79
State:

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:

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

Symptoms: Vaccine affected by temperature excursion administered to the patient

Other Meds:

Current Illness:

ID: 1754067
Sex: F
Age: 73
State:

Vax Date: 09/25/2021
Onset Date: 09/25/2021
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: Vaccine affected by temperature excursion administered to the patient.

Other Meds:

Current Illness:

ID: 1754068
Sex: F
Age: 79
State: IL

Vax Date: 03/18/2021
Onset Date: 08/05/2021
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: I tested positive for Covid-19 on 08/05/2021.

Allergies: Penicillin, Benazepril, Erythromycin, Vancomycin

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

Symptoms: Breakthrough case: My symptoms included loss of taste & smell (which lasted for 6 weeks), tiredness, and brain fog (lasted for 4-5 days).

Other Meds: N/A

Current Illness: None

ID: 1754069
Sex: M
Age: 54
State: OR

Vax Date: 04/30/2021
Onset Date: 09/02/2021
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: RA

Lab Data:

Allergies:

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

Symptoms: Breakthrough infection after full vaccination.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am