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: 1756695
Sex: F
Age: 40
State: PR

Vax Date: 01/26/2021
Onset Date: 01/26/2021
Rec V Date: 10/02/2021
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: Allergy to Mites and Dairy

Symptom List: Dysphagia, Epiglottitis

Symptoms: 40 year old female patient reports having had a reaction minutes after her first dose of the COVID-19 PFIZER Biotechnic vaccine. Signs after the vaccination: Patient refers that at the moment of observation, once the vaccinated, she began with chest pain, dizziness was observed for 30 minutes. The patient refers that it was at the moment and that there was no consecutive duration between chest pain and dizziness. Patient suffers from panic attacks, argues that after vaccinations she had to undergo surgery actions for 7 stones in the kidneys which she did not know at the time. Patient presented nodules in the neck area for a week on the of the same vaccination day. Doctor authorized the patient to obtain 2nd dose after passing the entire operation process.

Other Meds: None

Current Illness: Angiomas in the liver

ID: 1756696
Sex: F
Age: 43
State: TX

Vax Date: 09/30/2021
Onset Date: 10/02/2021
Rec V Date: 10/02/2021
Hospital:

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

Lab Data: None

Allergies: None

Symptom List: Anxiety, Dyspnoea

Symptoms: resting Tachycardia 10/1 hr 120 Swollen lymph nodes right side 10/2 armpit and next. Painful and large to palpate

Other Meds: None

Current Illness: Flu

ID: 1756697
Sex: F
Age: 62
State: CA

Vax Date: 04/21/2021
Onset Date: 05/04/2021
Rec V Date: 10/02/2021
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: Hearing test= results ok check for wax in ear = no wax MRI check for abnormal brain = no tumors. The doctor does not know the cause.

Allergies: peniccilin

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

Symptoms: Ringing in the ear(left) condition was unreported until I saw something in the news about others reporting ringing in the ear after vaccination. As a side note, the ringing is not as intense as before, it appears it's slowly going away.

Other Meds: nexium,hydroxyurea,mycardis

Current Illness: Graves disease

ID: 1756698
Sex: F
Age: 17
State: WA

Vax Date: 04/11/2021
Onset Date: 04/11/2021
Rec V Date: 10/02/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: There was no adverse reaction. This was an administration error as the patient was underage at the time of vaccination.

Other Meds:

Current Illness:

ID: 1756699
Sex: M
Age: 62
State: FL

Vax Date: 09/16/2021
Onset Date: 09/16/2021
Rec V Date: 10/02/2021
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: Mild chemical smell and taste intermittent over 4 day period, believed to be vaccine.

Other Meds: rosuvastatin

Current Illness:

ID: 1756700
Sex: M
Age: 40
State: GA

Vax Date: 08/01/2021
Onset Date: 08/09/2021
Rec V Date: 10/02/2021
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: TBD

Allergies: NA

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

Symptoms: Tightening of heart, seeing spots, left arm goes numb.

Other Meds: Blood pressure

Current Illness: NA

ID: 1756701
Sex: F
Age: 17
State: WA

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 10/02/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: There was no adverse reaction. This was an administration error as the patient was underage at the time of vaccination.

Other Meds:

Current Illness:

ID: 1756702
Sex: F
Age: 51
State: AZ

Vax Date: 09/21/2021
Onset Date: 09/22/2021
Rec V Date: 10/02/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Pharyngeal swelling

Symptoms: Lymph nodes swollen in neck for over a week , extreme spine pain, muscle pain in arms bilateral, extreme joint pain in bilateral hips , fatigue

Other Meds: NA

Current Illness: None

ID: 1756703
Sex: F
Age: 27
State: WA

Vax Date: 09/10/2021
Onset Date: 09/21/2021
Rec V Date: 10/02/2021
Hospital:

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

Lab Data:

Allergies: Pineapple, passion fruit, guava, cipro, flagyl and off brand versions of flagyl, latex

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: First my period was late by 5 days, cause my migraine with auras to pick up frequently, and now a week after getting off my period I?m now on my period again

Other Meds: Magnesium, progesterone, CBD vape.

Current Illness:

ID: 1756704
Sex: F
Age: 57
State: TX

Vax Date: 10/02/2021
Onset Date: 10/02/2021
Rec V Date: 10/02/2021
Hospital:

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

Lab Data: N/A

Allergies: None

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Dizziness, pressure on back of neck, flushed. EMS attended and cleared patient.

Other Meds: Hormone patch

Current Illness: None

ID: 1756705
Sex: M
Age: 28
State: TX

Vax Date: 10/02/2021
Onset Date: 10/02/2021
Rec V Date: 10/02/2021
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: Shrimp

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

Symptoms: Around 10:28, client expressed tingling in the throat and wheezing. EMS attended. Vitals BP 134/87, O2 99%. EMS released customer at 10:33, which he wanted to remain under observation for 30 minutes more. Client stated he was fasting.

Other Meds: None

Current Illness: None

ID: 1756706
Sex: F
Age: 17
State: WA

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 10/02/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: There was no adverse reaction. This patient received an extraneous dose of Moderna after already having received two Pfizer doses.

Other Meds:

Current Illness:

ID: 1756707
Sex: F
Age: 28
State: HI

Vax Date: 09/11/2021
Onset Date: 09/11/2021
Rec V Date: 10/02/2021
Hospital:

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

Lab Data: pls see #18

Allergies: BenzaClin, Spironolactone, Scented lotions detergents

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

Symptoms: 9/20/2021: 27-year old female who was seen in our clinic after her ED visit at Medical Center ED on 9/11/2021 for chest pain s/p her 1st shot of pfizer covid vaccine. Was sent to ER from the vaccine clinic. 12-lead ekg => NSR. CXR => no acute cardiopulmonary disease. Patient was d/c home from the ED with prednisone 50mg 1 tab PO daily for 5 days, diphenhydramine 25mg 1 cap PO q6hr PRN itching, famotidine 20mg 1 tab PO BID and epinephrine (epipen) 0.3mg/0.3mL inject 0.3mL into the muscle as needed for allergic emergencies (anaphylaxis). States, "At night, I feel like my heart is coming out of my chest". When bending her back backwards, it worsens the pain. Resting or leaning forward help to relieve the pain. Denies any dyspnea, dizziness, lightheadness, palpitations, abdominal pain, n/v. 9/30/2021: Patient feels better after taking OTC ibuprofen PRN pain. No chest pain at this time. Has been taking OTC ibuprofen PRN pain with full relief of chest pain. CXR and 12-lead EKG in the ED were normal. Labs were ordered and reviewed. Trop - neg, CRP - stable, TSH - stable, ESR - normal. Echocardiogram => normal EF 65%. There is mild pulmonic stenosis with calcification. Patient's cardiac workup is unremarkable. Patient's chest pain is most likely costochondritis. Patient to take OTC tylenol BID PRN pain or OTC ibuprofen PO BID with food PRN pain. Patient may take her 2nd Pfizer vaccine completion. Patient saw Cardiology Dr a few days ago Patient to f/u with Cardio for pulmonic stenosis follow-up.

Other Meds: Prednisone 50mg 1 tab PO daily x 5 days, Famotidine 20mg 1 tab PO BID, Benadryl 25mg 1 cap PO q6hr prn allergies, PRN epi-pen => all prescribed by Emergency Department. Patient is also on Vitamin D3 5000 1 cap PO daily

Current Illness: Hypertension, vitamin D deficiency, UTI, CKD2

ID: 1756708
Sex: F
Age: 21
State: TX

Vax Date: 08/30/2021
Onset Date: 08/30/2021
Rec V Date: 10/02/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Swollen lips, itchy body, red skin but mainly big lips and swollen face

Other Meds:

Current Illness:

ID: 1756709
Sex: F
Age: 36
State: CA

Vax Date: 09/18/2021
Onset Date: 09/20/2021
Rec V Date: 10/02/2021
Hospital:

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

Lab Data: Hospital cardiac monitoring

Allergies: Gluten intolerant Phenergan

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

Symptoms: Cardiac issues. I have been consistently having severe palpitations. PVC's in clusters on cardiac monitors at hospital. Shortness of breath. Daily since 2 days after 2nd dose of Pfizer.

Other Meds:

Current Illness: None.

ID: 1756710
Sex: F
Age: 50
State: MT

Vax Date: 09/06/2021
Onset Date: 09/27/2021
Rec V Date: 10/02/2021
Hospital:

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

Lab Data: Multiple IVIG infusions as treatment - from Feb - October

Allergies: None

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

Symptoms: All three doses (2+ booster) of the Moderna Covid-19 vaccine caused significant relapse/resurgence of symptoms from CIDP - numbness, weakness, difficulty in mobility. Reporting because people with demylenating illnesses were excluded from vaccine trials so might be helpful for some patients to know.

Other Meds: IVIG

Current Illness:

ID: 1756711
Sex: M
Age: 40
State: UT

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

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

Lab Data: None

Allergies: Allergy to wasps and bees. Contact dermatitis allergy to Avagard.

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

Symptoms: Lightheaded, hypotensive, Tingling / cold feeling up the side of my neck, into my face and down the other side of my neck. Feeling of impending doom.

Other Meds: None

Current Illness: None

ID: 1756712
Sex: F
Age: 51
State: PR

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 10/02/2021
Hospital:

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

Lab Data:

Allergies: Crustacean, Lactose, Gluten, Medication-Percocet

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Symptoms: fever, left armpit pain, sore throat, headache, joint pain, chills, burning when urinating, nausea. Two days in bed. Total rest. Day 3 (today) I feel better. Still slight armpit pain, inappetent, confused. I understand that by the nature of the new variants the dose is stronger. I just wanted to be part of the documentation. Thanks

Other Meds: Paxil, Ativan, Wellbutrin, Neurontin, Ambien, Relafen, Rosuvastatin, Topamax, Nexin, Aspirin 81, Biotin, Vit B12, Vit D, Vit E, Multivitamins

Current Illness: Arthritis, Fibromyalgia, fatty liver, sleep apnea, lumbar and cervical affected, migraines

ID: 1756713
Sex: F
Age: 27
State: FL

Vax Date: 10/01/2021
Onset Date: 10/02/2021
Rec V Date: 10/02/2021
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: Headache, achy joints, chills, Fatigue, Weakness Injection site tenderness

Other Meds: Prazosin, Lamotrigine, Hydroxyzine, Sertraline, Quetiapine, Melatonin

Current Illness:

ID: 1756714
Sex: F
Age: 83
State: CO

Vax Date: 09/29/2021
Onset Date: 09/30/2021
Rec V Date: 10/02/2021
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: penicillin, sulfa ciprofloxacin,

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

Symptoms: Local redness and itching at the injection site

Other Meds: levothyroxine, multivitamin, calcium

Current Illness: none

ID: 1756715
Sex: F
Age: 34
State: CT

Vax Date: 08/30/2021
Onset Date: 09/03/2021
Rec V Date: 10/02/2021
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: 9/29/2021 urgent care and ER EKG chest xray labs

Allergies: Norvasc, gadolinium

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

Symptoms: Pericarditis, chest pains dyspnea

Other Meds: Metoprolol, humulin,lisinopril,metformin,atorvastatin,gabapentin

Current Illness:

ID: 1756716
Sex: M
Age: 83
State: MO

Vax Date: 03/29/2021
Onset Date: 03/31/2021
Rec V Date: 10/02/2021
Hospital:

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

Lab Data: I have had too many blood tests and neurology tests to lists and give results here. Pages long which I can scan and e-mail if needed

Allergies: none known

Symptom List: Unevaluable event

Symptoms: Day 2, started fatigue, hypoglycemia, leg muscle weakness and pain, hypoglycemia every day for about 6 weeks, still get it on occasion (haave been diagnoses with it for several years) primary care physician sent me to orthopedic specialist, he said I needed to exercise my legs(have done for several weeks but no change in weakness). referred me to a neuromuscular neurologist, he diagnosed as having mild neuropathy, he refered me to hematoligist/oncologist and has diagnosed MGUS, monoclonal gammaprotein of unknown significance, To return for more test in 6 months. No one has helped with leg weakness issues.

Other Meds: pravastatin, simbrinza, latanoprost, low dose aspirin, multiple vitamin, vatamin D3, Omega-3

Current Illness: none

ID: 1756718
Sex: F
Age: 25
State: CT

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 10/02/2021
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: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: Systemic: Allergic: Rash (specify: facial area, extremeties)-Mild, Systemic: Allergic: Rash Generalized-Mild

Other Meds:

Current Illness:

ID: 1756719
Sex: F
Age: 48
State: CA

Vax Date: 01/20/2021
Onset Date: 03/01/2021
Rec V Date: 10/02/2021
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: Diflucan allergy, wheat intolerance, lactose intolerance. Dust allergies.

Symptom List: Injection site pain, Pain

Symptoms: Intermittently in the weeks to months after the vaccination I would have days of increased joint pain and fatigue more than before the vaccine. I will occasionally feel fatigued and ill, as if I am going to have a moderate to severe viral infection, but will feel better after 1-2 days. This feels more intense than before the vaccine.

Other Meds: Copaxone 40 mg, fluticasone propionate nasal, Loratidine 10 mg, turmeric capsules, fish oil, vitamin D3 2000 IU, B-complex, calcium-magnesium-zinc, Macapause, Om chaga and lions mane powders, turmeric powder.

Current Illness: None

ID: 1756720
Sex: F
Age: 31
State: VA

Vax Date: 09/29/2021
Onset Date: 09/30/2021
Rec V Date: 10/02/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Site: Itching at Injection Site-Medium, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium

Other Meds:

Current Illness:

ID: 1756721
Sex: F
Age: 78
State: MN

Vax Date: 03/05/2021
Onset Date: 10/01/2021
Rec V Date: 10/02/2021
Hospital: Y

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: unaware of any concerns post vaccine - currently admitted to hospital with COVID 19 +

Other Meds:

Current Illness:

ID: 1756722
Sex: F
Age: 25
State: IN

Vax Date: 09/30/2021
Onset Date: 10/01/2021
Rec V Date: 10/02/2021
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: N/A

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Sore arm, headache, aches, chills, fever of 102.6.

Other Meds: Antibiotics

Current Illness: Cold, UTI

ID: 1756723
Sex: M
Age: 19
State: VA

Vax Date: 09/28/2021
Onset Date: 09/29/2021
Rec V Date: 10/02/2021
Hospital: Y

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

Lab Data: No access to the test or laboratory results performed in the hospital.

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Myocarditis. Chest pain started at 5am, approximately 19 hours after vaccination. Patient's symptoms mimicked those of a hear attack. Patient taken to the hospital on Thursday morning after shortness of breath developed. Pain was radiating down his arm and to his back. Patient was admitted on Thursday after being at the ER.

Other Meds: None

Current Illness: None

ID: 1756724
Sex: M
Age: 47
State: CT

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/02/2021
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: Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Medium, Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Hypertension-Severe, Systemic: Numbness (specify: facial area, extremities)-Severe, Systemic: Tingling (specify: facial area, extemities)-Severe, Additional Details: patient reported numbness immediatley following injection in shoulder neck and ear. he then report numbness moving across his face and throat and tongue. Patient then reported feeling very hot. Gave him 25 mg of benadryl and called 911 . Emt's reported hypertension (172/110) and sent him to hospital for treatment

Other Meds:

Current Illness:

ID: 1756725
Sex: M
Age: 16
State: VA

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

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

Lab Data:

Allergies:

Symptom List: Nausea

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

Other Meds:

Current Illness:

ID: 1756726
Sex: M
Age: 56
State: IN

Vax Date: 09/30/2021
Onset Date: 10/01/2021
Rec V Date: 10/02/2021
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:

Symptom List: Injection site pain

Symptoms: Headache, sore injection site, muscle cramps, sore muscles, tired Started about 24-30 hours after injection

Other Meds:

Current Illness:

ID: 1756727
Sex: F
Age: 28
State:

Vax Date: 09/30/2021
Onset Date: 10/01/2021
Rec V Date: 10/02/2021
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: N/A

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

Symptoms: Enlarged and painful axillary left node (left)

Other Meds: Lexapro

Current Illness: N/A

ID: 1756728
Sex: F
Age: 36
State: MI

Vax Date: 05/26/2021
Onset Date: 06/01/2021
Rec V Date: 10/02/2021
Hospital:

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

Lab Data: I'm switching doctors and insurance because no one is listening to me.

Allergies:

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

Symptoms: Hands numb and painful. Didnt get period for months and I'm always on time. Then when I period it will not stop. I have been bleeding for 4 months. I've always had blood clots but now I lose so much blood I'm dizzy and cant even get up. I have 8 half dollar size or bigger per hour for 3 to four days. Before I would have one or two for one day. I thought I was dying from blood loss the other day and couldnt even get up.

Other Meds: Losarten

Current Illness:

ID: 1756729
Sex: F
Age: 42
State: CA

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 10/02/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: Systemic: Dizziness / Lightheadness-Mild, Systemic: Nausea-Mild, Additional Details: After the vacccine was administered, patient started feeling dizzy and faint. Patient never fainted, just felt faint and a bit nauseous. Recevied permission from patient to call 911 to have her closely monitored. Paramedics came and took vitals and spoke with her. They offered to take her in but patient refused and said she felt fine after vaccine was given and can go home on her own. Her husband came in afterwards and they left together.

Other Meds:

Current Illness:

ID: 1756730
Sex: F
Age: 29
State: TX

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/02/2021
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: Systemic: Dizziness / Lightheadness-Medium, Systemic: Nausea-Mild

Other Meds:

Current Illness:

ID: 1756731
Sex: F
Age: 32
State: VA

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/02/2021
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: Error: Wrong Dose of Vaccine - Too High-

Other Meds:

Current Illness:

ID: 1756732
Sex: F
Age: 30
State: CA

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/02/2021
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: Systemic: Chills-Medium, Systemic: Confusion-Mild, Systemic: Dizziness / Lightheadness-Medium, Systemic: Exhaustion / Lethargy-Mild, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Hypotension-Medium, Systemic: Shakiness-Medium, Systemic: Weakness-Mild

Other Meds:

Current Illness:

ID: 1756733
Sex: F
Age: 39
State: CA

Vax Date: 09/29/2021
Onset Date: 10/01/2021
Rec V Date: 10/02/2021
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: Bananas

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Soft, painful lump the size of tennis ball under left armpit.

Other Meds: Acyclovir

Current Illness: Prior to vaccination I had a pitting edema

ID: 1756734
Sex: F
Age: 13
State: FL

Vax Date: 09/28/2021
Onset Date: 09/30/2021
Rec V Date: 10/02/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Systemic: Lymph Node Swelling-Medium

Other Meds:

Current Illness:

ID: 1756735
Sex: M
Age: 54
State: FL

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/02/2021
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: Systemic: turned pale-Medium, Systemic: Hypotension-Medium

Other Meds:

Current Illness:

ID: 1756736
Sex: F
Age: 47
State: PA

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 10/02/2021
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: Site: Bruising at Injection Site-Medium, Site: Itching at Injection Site-Mild, Site: Pain at Injection Site-Mild, Additional Details: Patient still has bruising in the arm in which the vaccine was administered. It does not hurt, but covers a majority of the shoulder. Counseled to ice and use heat to reduce brusing as well as to apply lidocaine wound gel. Patient will follow-up with primary care physician.

Other Meds:

Current Illness:

ID: 1756737
Sex: F
Age: 44
State: OH

Vax Date: 03/04/2021
Onset Date: 04/01/2021
Rec V Date: 10/02/2021
Hospital:

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

Lab Data: Nuclear stress test Ct chest w cont Mri brain w so cont Mri thoracic spine w so cont Mri cervical spine w so cont X-ray cervical spine LABS: Copper, serum ESR C-reactive protein Rheumatoid factor ANAscreen w/reflex ANCA Angiotensin converting enzyme Anti Cardiolipin AB IGG IGA IGM Fourth generation HIV 1/2 AB/AG Vitamin B12 Folate Vitamin E Vitamin B6 Lyme total TSH w/reflex MOGFS MOG FACS serum NMOFS NMO AQP4 FACS

Allergies: Sulfa,bactrim, erythromycin

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

Symptoms: Sore arm and body aches after 1st dose. ALL problems started shortly after 2nd dose: Cervical cord lesion C2 Hemangioma T6 vertebrae body Neurocardiogenic syncope worsened Decreased sensation of lower extremity Pain and numbness of left upper extremity Ataxia Difficulty in walking Thoracic spine pain Muscle spasm of back Syringomyelia in thoracic spinal cord T3-T9 Brain single focus of signal abnormality in the right occipital periventricular region Early demyelination plaque possible

Other Meds: Midodrine 10 mg Fludrocortisone .1 mg

Current Illness: None

ID: 1756738
Sex: M
Age: 57
State: IN

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

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

Lab Data:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1756739
Sex: F
Age: 75
State: NC

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/02/2021
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: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-

Other Meds:

Current Illness:

ID: 1756740
Sex: F
Age: 57
State: AZ

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

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

Lab Data: Urgent care said oxygen 95% didn't do tests

Allergies: Bad reaction to flu shot, 1st vax

Symptom List: Vomiting

Symptoms: Thu night serious chest pain, burning, up through neck into jaw. Thought it was the worst heartburn I'd ever had possibly a heart attack. Super bad for a week. Went urgent care finally. Better now but still an issue. Lightheaded, burning, weakness in thighs, circulation bad. Accidentally found myocarditis and that describes it. After bad reaction to first, much worse than covid was, I probably shouldn't have gotten it. I'm worried it won't heal. I want CDC to know so another like me can make an informed decision. I'm totally pro vax so I don't tell people online. I called after first vax for 2 weeks and requested the forms and they wouldn't take the info or send forms.

Other Meds: Zolpidem, percocet, singulair small amounts only

Current Illness: Asthma, possible breast concern

ID: 1756741
Sex: F
Age: 57
State: NC

Vax Date: 09/27/2021
Onset Date: 09/28/2021
Rec V Date: 10/02/2021
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: Penicillin. Vicoden chantex

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Headache, chills body aches fever

Other Meds: Crestor, omeprazol, metoporol, singular, omesartan, myrbetric, remron, fish oil, d3, aspirin, fibercon, super b, vit c, zinc, dicocyclin

Current Illness: Sinus infection, viral infection

ID: 1756742
Sex: M
Age: 57
State: CA

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/02/2021
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: Site: Bruising at Injection Site-Severe, Site: Swelling at Injection Site-Severe, Systemic: see additional details below-Severe, Additional Details: pt moved during injectin. when needle was retracted, visible raised bump the size of a nickel. tehnician gave the injection, notified rph on duty immediately, rph removed bandaid to inspect site, told pt will experience brusing and swelling, take ibuprofen and monitor. sit for 15 minutes, call pharmacy within next hour if site worsens. go to er if pain/fever/cannot feel arm.

Other Meds:

Current Illness:

ID: 1756744
Sex: M
Age: 19
State: MD

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/02/2021
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: Wrong Dose of Vaccine - Too High-

Other Meds:

Current Illness:

ID: 1756745
Sex: F
Age: 44
State: OR

Vax Date: 03/30/2021
Onset Date: 03/30/2021
Rec V Date: 10/02/2021
Hospital:

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

Lab Data: I had both my Acupuncturist look at it and my naturopath both who want me to see a physical therapist

Allergies: Coumadin/Warfarin Penicillin

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

Symptoms: Arm started swelling around 10hrs after vaccination but not like my partners or son. It was a one inch band around 3 inches long. The pain was severe. Couldn't sleep, touch roll over on that side, skin was raised and welted up in that band around my arm. My second vaccination in my left arm was sore, but a 2/3 on the pain scale which resolved in 3 days. This one got worse and peaked around the week mark and then held at that pain(8/9 on pain scale) I started losing mobility in my shoulder to raise my arm above my head, twisting, and reaching behind myself. At 3-4 weeks pain started to decrease. When I got to my 2nd vaccination the swollen red band had finally decreased to about 1/2 inch to 1 inch in diameter and the pain was around a 6/7 as long as I didn't reach up, behind, or bend my elbow(think like a arm behond head for a sit up). The swelling was gone by week 6-8 and now I am just left with the pain. Months later and still no improvement, Ibprofen helps more than prescription pain meds. The pain wakes me up every morning, and I am still losing more mobility.

Other Meds: oxycodone 5mg multi vitamin Vitamin D

Current Illness: N/A

ID: 1756746
Sex: F
Age: 49
State: AZ

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 10/02/2021
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: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Nausea-Mild, Systemic: Vomiting-Mild, Additional Details: Patient reported she had been fasting and was afraid of needles. She fainted briefly, then several minutes later vomited. Her bp and pulse were good. She stayed 45 minutes extra time, then told us she was feeling better and left.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am