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: 1761243
Sex: F
Age: 56
State: NJ

Vax Date: 09/08/2021
Onset Date: 09/08/2021
Rec V Date: 10/05/2021
Hospital:

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

Lab Data: none

Allergies: none

Symptom List: Dysphagia, Epiglottitis

Symptoms: I very quickly began having flu like symptoms which increased dramatically as the day went on. I received the vaccine at 12:30 and began feeling progressively worse to the point where by 8 PM I had a fever of 104 which lasted throughout the night. I went from having a normal temperature to having the 104 fever in a span of 30 minutes. Horrific shaking and chills accompanied the fever. We were using a Forehead thermometer Wand which is approved for accuracy. The fever lasted throughout the night and was only mildly and temporarily reduced with tylenol. I continued to feel lousy the next day although the fever and shaking had largely subsided. 48 hours after receiving the vaccine I felt pretty muc recovered.

Other Meds: multi vitamin, calcium, vitamin D

Current Illness: none

ID: 1761244
Sex: F
Age: 78
State: PA

Vax Date: 02/17/2021
Onset Date: 10/03/2021
Rec V Date: 10/05/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient tested positive 10/3/21

Other Meds:

Current Illness:

ID: 1761245
Sex: M
Age: 48
State: VA

Vax Date: 08/13/2021
Onset Date: 08/13/2021
Rec V Date: 10/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKA

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

Symptoms: Major cramping and pain in the right foot and concentrated pain in right big toe at 30 minutes after shot. At 90 minutes major deep pain started in the right arm, with major pain concentrated at the right elbow. Neck pain started occurring immediately after arm. After two weeks, toe pain subsided. The elbow pain has not subsided. Neck pain has not subsided.

Other Meds: Nexium 40 mg, was second dose

Current Illness: None

ID: 1761246
Sex: F
Age: 66
State: OK

Vax Date: 02/04/2021
Onset Date: 02/05/2021
Rec V Date: 10/05/2021
Hospital:

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

Lab Data:

Allergies: Sulfa

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Shingles right arm the day after (Friday Feb 5) 2nd injection. Went to Dr on Monday was given valacyclovir. Beginning in July fingers of both hand became very sensitive to any kind of touch, a burning sensation and palm and fingers peel. First 2 times Dr gave antiviral and prednisone and cleared up although sensitivity and burning remains. The 3rd incident that is occurring now I did not seek medical attention and is going on 2 weeks with no sign of improvement.

Other Meds: Naproxen,omeprazole

Current Illness:

ID: 1761248
Sex: F
Age: 55
State:

Vax Date: 01/16/2021
Onset Date: 09/28/2021
Rec V Date: 10/05/2021
Hospital:

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

Lab Data: 9/28/2021, tested positive.

Allergies:

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

Symptoms: patient tested positive for COVID-19 > 14 days after vaccine series

Other Meds:

Current Illness:

ID: 1761249
Sex: F
Age: 54
State: NH

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 10/05/2021
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:

Allergies:

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

Symptoms: Patient was administered dose that expired on 9/21/2021.

Other Meds:

Current Illness:

ID: 1761251
Sex: F
Age: 26
State: OH

Vax Date: 08/23/2021
Onset Date: 09/20/2021
Rec V Date: 10/05/2021
Hospital:

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

Lab Data: None

Allergies: N/A

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Three days after the second vaccination I woke up with very bad tinnitus. I tried to ignore it, but a few days after that the pressure in my ears hurt so bad that I had to go to an urgent care. I thought that I might have an ear infection. She looked in my ears and saw fluid in one ear, but said that they didn't look infected. This was almost 2 weeks ago. The ringing in my ears is non-stop and louder than ever since then.

Other Meds: Tirosint 137mcg, Apri birth control, selenium, b12, vitamin D, and zinc.

Current Illness: N/A

ID: 1761252
Sex: F
Age: 60
State: MD

Vax Date: 09/29/2021
Onset Date:
Rec V Date: 10/05/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Whole body aches, goosebumps, malaise, painful joints, headache

Other Meds:

Current Illness:

ID: 1761253
Sex: M
Age: 43
State: NH

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 10/05/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient received vaccine dose that expired on 9/21/2021

Other Meds:

Current Illness:

ID: 1761254
Sex: F
Age: 63
State: PA

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 10/05/2021
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: NKDA

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Headache,Nausea,Extreme weakness,,Fatigue,,soreness at injection site

Other Meds: No OTC

Current Illness: No

ID: 1761255
Sex: M
Age: 27
State: NC

Vax Date: 08/15/2021
Onset Date: 08/15/2021
Rec V Date: 10/05/2021
Hospital:

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

Lab Data: n/a

Allergies: n/a

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

Symptoms: Pt presented at community event requested 1st dose. The county was offering 100$ gift cards for 1st doses. The patient was vaccinated with J&J as requested. Once Mass Event Registration form was entered into database, it was noted the patient had already received his 1st dose of MODERNA on January 6, 2021.

Other Meds: n/a

Current Illness: n/a

ID: 1761256
Sex: F
Age: 38
State: TN

Vax Date: 10/02/2021
Onset Date: 10/02/2021
Rec V Date: 10/05/2021
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: Z-pack

Symptom List: Rash, Urticaria

Symptoms: Rash, redness, swelling, and itching at injection site (2" diameter) within 2 hours after injection and continues 3 days after. Chest pains within 1 hour of injection and continued for 1 day.

Other Meds: Tylenol, Ibuprofen, Zyrtec, Flonase, Macrobid 100mg

Current Illness:

ID: 1761257
Sex: F
Age: 48
State: NH

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 10/05/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Patient received expired dose of vaccine. Vaccine expired 9/21/2021

Other Meds:

Current Illness:

ID: 1761258
Sex: F
Age: 71
State: IL

Vax Date: 03/31/2021
Onset Date: 07/01/2021
Rec V Date: 10/05/2021
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: Bloodwork - normal

Allergies: Cefaclor

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

Symptoms: Jul2021 my legs started hurting, it progressively got red and sore and blistery, I went immediate care and got medicine, didn't work, then went to ER on18 Aug2021 and then 23Aug2021, and went to dermatologist. tomorrow vein test 10/6/2021. Diagnosed with Venous Stasis Dermatitis in Aug2021. Got flu shot 3 weeks ago

Other Meds:

Current Illness: no

ID: 1761259
Sex: M
Age: 70
State: NH

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 10/05/2021
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: Patient received vaccine dose that expired on 9/21/2021.

Other Meds:

Current Illness:

ID: 1761260
Sex: F
Age: 41
State: VA

Vax Date: 04/24/2021
Onset Date: 04/24/2021
Rec V Date: 10/05/2021
Hospital:

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

Lab Data: various blood tests; neuro-psychological exam; neurology exam

Allergies: intolerance to tree nuts and stone fruits

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

Symptoms: Chronic headaches and migraines 4-6 per week; "brain fog", dizzy spells; forgetfulness and difficulty focusing; eyes extremely sensitive to light

Other Meds:

Current Illness:

ID: 1761261
Sex: F
Age: 44
State: AR

Vax Date: 09/24/2021
Onset Date: 09/25/2021
Rec V Date: 10/05/2021
Hospital:

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

Lab Data: 9/28/2021 went to get tested

Allergies: none

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

Symptoms: Swelling under armpits both found active lymph nodes

Other Meds: blood pressure medicine, Norvasc, Labetalol, Hyzarr, Probiotic, Fish Oil, Multivitamin

Current Illness: Sinus infection

ID: 1761262
Sex: M
Age: 38
State: VA

Vax Date: 10/04/2021
Onset Date: 10/05/2021
Rec V Date: 10/05/2021
Hospital:

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

Lab Data: None

Allergies: NASIDS

Symptom List: Ear pain, Hypoaesthesia

Symptoms: First Shot: Mild fatigue Second Shot: Mild fatigue and approximately 10 hours later convulsions with fever reaching over 100 degrees per oral testing.

Other Meds: Zyrtec, Fish Oil, and Ambien. Monthly Allergy shots

Current Illness: Seasonal Allergies

ID: 1761263
Sex: F
Age: 63
State: NY

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/05/2021
Hospital:

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

Lab Data:

Allergies: latex penicillin egg

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: numbness in face,ear,neck throat closing fever chills upset stomach headache swollen lymph nods throbbing pain in arm

Other Meds:

Current Illness:

ID: 1761264
Sex: F
Age:
State: TN

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

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

Lab Data:

Allergies: Penicillin

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

Symptoms: Sore and swollen underarm on left arm (vaccine administered) Lacy rash on left side of chest Fatigue Wrist pain on right side

Other Meds: Levoxl

Current Illness: None

ID: 1761265
Sex: F
Age: 46
State: MO

Vax Date: 10/04/2021
Onset Date: 10/04/2021
Rec V Date: 10/05/2021
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: Latex, Benadryl, ASA, Lidocaine,Nuts

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

Symptoms: Nausea , Headache, Chills, Body aches, skin pain, kidney pain, back pain, coughing, fever, joint and muscle pain,

Other Meds: Metoprolol. Thyntroid. vitamin b,

Current Illness: none

ID: 1761266
Sex: F
Age: 48
State: MI

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 10/05/2021
Hospital:

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

Lab Data:

Allergies: None.

Symptom List: Unevaluable event

Symptoms: Muscle pain, diagnosed with viral syndrome, inflammation on spine, weakening of muscles, groin pain on right side, injection side has tingling sensation, chest pain. platelet levels high. GF factors abnormal, blood surfaces to skin, headaches.

Other Meds: Xanax, Zoloft.

Current Illness:

ID: 1761267
Sex: M
Age: 64
State: IN

Vax Date: 10/01/2021
Onset Date: 10/02/2021
Rec V Date: 10/05/2021
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: Bioxen

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

Symptoms: Body / bone joint aches

Other Meds: None

Current Illness: None

ID: 1761268
Sex: F
Age: 26
State:

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

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: MYOCARDITIS

Other Meds:

Current Illness:

ID: 1761269
Sex: M
Age: 41
State: TN

Vax Date: 09/30/2021
Onset Date: 10/02/2021
Rec V Date: 10/05/2021
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: None

Symptom List: Injection site pain, Menorrhagia

Symptoms: Herpes Zoster

Other Meds: None

Current Illness: None

ID: 1761270
Sex: M
Age: 12
State: LA

Vax Date: 09/25/2021
Onset Date: 09/26/2021
Rec V Date: 10/05/2021
Hospital:

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

Lab Data: Seen at after hours clinic over the weekend, Had a strep screen on 10/4 - negative

Allergies: Doxycycline

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

Symptoms: Patient began with fever 12 hours prior to receiving the COVID 19 vaccine (9/26/21). Then patient then began with joint swelling, joint pain and rash, on 9/29/2021 hives and swollen lymph nodes.

Other Meds: Clindamycin-benzoyl peroxide gel, minocycline, Retin-A

Current Illness: None

ID: 1761271
Sex: F
Age: 33
State: VA

Vax Date: 06/18/2021
Onset Date: 07/09/2021
Rec V Date: 10/05/2021
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: All 7/9/21: CBC WITH AUTO DIFF BASIC METABOLIC PANEL ALPHA-GAL PANEL

Allergies: No food. Macrobid and Geodon

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: 10AM Initial reaction of mild swelling in neck and throat area at work. Coughing due to throat irritation, then low wheezing. ED Provider Notes MD at 7/9/2021 11:02 AM HPI: Patient presents for evaluation of allergic reaction. Initial history limited due to her significant respiratory distress. She is stridorous and moving poor air. She can speak only a few words at a time. History initially provided by her significant other. He states she called him from her work this morning stating she was having trouble breathing. He went to her place of employment to pick her up and bring her here. While in route in his car, her breathing became more difficult. This prompted her to administer her EpiPen in her right thigh. He notes there is quite minimal appearance of improvement in her condition. She still seemed labored in her breathing and her breathing was quite loud. Upon arrival here she was immediately brought to an ED room where I assessed her. 11:05 AM After receiving 0.3 mg 1-1000 IM epi here in the ED, she improved within minutes. Stridor resolved. Work of breathing normalized. Lungs clear. Able to speak to me with ease now in full sentences. She tells me that she felt some throat tightness this morning actually before work, prompting her to take p.o. Benadryl. Total patient critical care time required for stabilization and resuscitation of anaphylaxis was 35 minutes and includes direct patient care at bedside, medical decision making, lab/x-ray interpretation, historical review, coordination of care and discussion with consultants and family. This is separate from other procedures listed and performed. She has received 2 doses of epi thus far for quite significant stridor/ respiratory distress. We discussed the option of admission to the ED observation unit. She is amenable to this. Discussed with ED observation unit provider Dr., who will evaluate the patient for admission.

Other Meds: Gabapentin, Diazepam (as needed), Meloxicam

Current Illness: None

ID: 1761272
Sex: F
Age: 73
State: MN

Vax Date: 09/28/2021
Onset Date: 10/02/2021
Rec V Date: 10/05/2021
Hospital:

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

Lab Data: None

Allergies: Amoxicillin-pot clavulavte, codeine, ezetimibe, gluten,dust mite,lactose,opioids, penicillin, some perfumes, most statins, tobrsmycin

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Extreme muscle soreness and stiffness

Other Meds: Synthroid 75 mcg, spironolactone 50 mg,, losartan 200mg, q-var,Tylenol, fish oil, vit d, baby aspirin, rosuvastin 5 mg, magnesium citrate 200 mg,

Current Illness: Recent back surgery

ID: 1761273
Sex: F
Age: 68
State: MA

Vax Date: 09/30/2021
Onset Date: 10/01/2021
Rec V Date: 10/05/2021
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: Lisinopril

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

Symptoms: Red, Hard, itchy, painful, and swollen at the injection site. Going to see PCP today

Other Meds: losartan Vit D

Current Illness:

ID: 1761274
Sex: F
Age: 65
State: TX

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 10/05/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Nausea

Symptoms: Chills, weakens, and high fever for 36 hours. Temp ran from 101 to over 103 for 36 hours.T emp perked at over 103 for 5 hours. Took tylenol for this.

Other Meds: Bystolic, Tekturna, Synthroid

Current Illness: none

ID: 1761276
Sex: F
Age: 40
State: AL

Vax Date: 09/17/2021
Onset Date: 09/17/2021
Rec V Date: 10/05/2021
Hospital:

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

Lab Data: N/A

Allergies: EGG FLU VACCINE

Symptom List: Injection site pain

Symptoms: SEVERE SWEATING RIGHT AFTER ( LASTED 2 DAYS), HEADACHE , NAUSEA ,VOMITTING, FEVER 102.8, BODYACHES, CHILLS,FEELING SHAKY, OFF BALANCE , SCRATCHY THROAT(LASTED 4 DAYS) . HEADACHE IS STILL PRESENT. IT COMES AND GOES BUT IS PRESENT 4 OUT OF 7 DAYS A WEEK. THEY ARE MODERATE TO SEVERE.

Other Meds: N/A

Current Illness: N/A

ID: 1761277
Sex: F
Age: 42
State: IA

Vax Date: 07/23/2021
Onset Date: 07/26/2021
Rec V Date: 10/05/2021
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: Within a few days of the first Pfizer vaccine, I developed ringing in the ears. It has persisted to this day over two months later with no diminishment in intensity. The ringing has impacted my quality of life and it makes it very difficult to sleep at night.

Other Meds:

Current Illness:

ID: 1761278
Sex: F
Age: 29
State: NY

Vax Date: 08/16/2021
Onset Date: 08/17/2021
Rec V Date: 10/05/2021
Hospital:

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

Lab Data: REFLEX TO MULTIPLE TESTS ANTI-DSDNA ANTI-SMITH ANTIBODY (BIOREF) ANTICARDIOLIPIN AB, IGA, QN CBC WITH DIFFERENTIAL AND PLATELETS COMP METABOLIC PANEL CREATINE PHOSPHOKINASE, TOTAL (CPK) ESR (SED RATE) *ABOVE-LISTED TESTS ORDERED 10/4/2021

Allergies: NKDA

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

Symptoms: Periorbital dermatitis and rash on arms/legs. Placed on Prednisone and Benadryl PO. Consult to Rheumatology

Other Meds: None

Current Illness: None

ID: 1761279
Sex: M
Age: 73
State: MA

Vax Date: 04/03/2021
Onset Date: 04/04/2021
Rec V Date: 10/05/2021
Hospital:

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

Lab Data: Ultrasound on clot, superficial, between 04/03/2021 to 04/11/2021

Allergies: Bactrim; cephalexin; oxycodone

Symptom List: Tremor

Symptoms: I got what they refer to as COVID ARM. I got it from the infection site, down to my elbow. I had a fever from 99 to 102 as well as very strong flu-like symptoms. I got a superficial blood clot in the shot arm as well. Those lasted about, I'd say 4-5 days. I went to my PCP when I noticed the shot arm was getting worse, they treated it with an antibiotic.

Other Meds: Xarelto; methotrexate; L-arginine; sildenafil

Current Illness: N/A

ID: 1761280
Sex: F
Age: 59
State: CA

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

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

Lab Data: May 2021: visit to emergency room for cardiac symptoms. Had chest X-ray, labs, EKG, cardiac monitoring for 2 hours; a basic cardiac work up that did not show any acute cardiac events. Between May 2021 and September 2021, I have had several follow up visits with my primary care physician, and a cardiologist. I have worn a continuous cardiac monitor for a month, had an echocardiogram , and additional lab work. I am scheduled this month (October 2021) for an evaluation in pulmonary medicine, and pulmonary function tests. I am an extremely healthy person overall, have no significant health issues, eat a great diet, and cycle 50-75+ miles per week. I had none of these health issues previous to my Covid vaccines.

Allergies: Ampicillin, walnuts, melons

Symptom List: Erythema, Pruritus

Symptoms: Within a few weeks of the second Moderna Covid vaccination, I began to have heart palpitations, irregular heart rate, chest pressure/pain, shortness of breath, exacerbation of my previously mild asthma symptoms, and fatigue. These became progressively worse over time, resulting in a visit to the emergency room in May 2021, as the palpitations, irregular heart rate, and chest pressure made me unable to sleep, and worried that I was having a heart attack or other cardiac event.

Other Meds: Levothyroxine, omeprazole, estradiol, progesterone, testosterone.

Current Illness: None

ID: 1761281
Sex: M
Age: 59
State: NH

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 10/05/2021
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: Patient received expired vaccine dose. Vaccine expired 9/21/2021

Other Meds:

Current Illness:

ID: 1761282
Sex: F
Age: 34
State: KS

Vax Date: 09/18/2021
Onset Date: 09/19/2021
Rec V Date: 10/05/2021
Hospital:

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

Lab Data: None at this time, though she is contacting her primary care provider.

Allergies:

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

Symptoms: Patient states the day after her booster dose (she states she is immuno-comprimised) her arm was sore, which she expected. She states that after a couple days it went away- but that after a day or so of being fine, the soreness has returned, and has now affected her entire arm and neck. She states it is difficult to move, and she has extreme weakness to where she struggles to lift or hold things with her left arm.

Other Meds:

Current Illness:

ID: 1761283
Sex: F
Age: 59
State: NH

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 10/05/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient received expired vaccine. Vaccine expired on 9/21/2021

Other Meds:

Current Illness:

ID: 1761284
Sex: F
Age: 80
State: MD

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/05/2021
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: She got up to go to the cash register about 5 minutes after receiving her vaccine. As she stood at the register she felt flushed from the top of her head down to her body. She felt hot and then felt pain down her body. She also felt nauseous. We gave her some water and had her sit down immediately. We then called 911 upon her request. Once the EMT's arrived she was feeling better. The EMT's stayed until her husband arrived. She stated she did not need to go to the emergency room and she was okay to go home. I followed up on 10/5 to see how she was and she stated she was doing well but felt maybe receiving the 65+ vaccine for the 1st time might have caused the reaction.

Other Meds:

Current Illness:

ID: 1761286
Sex: F
Age: 66
State: MI

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/05/2021
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: Patient signed up for pfizer booster through our pharmacy, went through process, when I gave shot told her she was getting pfizer booster, after the fact she showed us card she had gotten moderna as first two. Did not get first two doses at our facility. We told her to monitor side effects and let us know if any issues/adr.

Other Meds:

Current Illness:

ID: 1761287
Sex: F
Age: 18
State: NY

Vax Date: 09/26/2021
Onset Date: 09/30/2021
Rec V Date: 10/05/2021
Hospital:

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

Lab Data: Elevated Troponin T (417 ng/L)

Allergies: None

Symptom List: Pain in extremity

Symptoms: Myocarditis

Other Meds: None

Current Illness: None

ID: 1761288
Sex: F
Age: 62
State: NY

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

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

Lab Data:

Allergies: Patient doesn't know what she's allergic to.

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

Symptoms: Patient stated that she felt like her throat was going to close, injection site swollen, red and sore. Patient stated that she all through weekend and didn't start feeling better until this past Sunday.

Other Meds: High Blood pressure meds

Current Illness: NONE

ID: 1761289
Sex: F
Age: 35
State: IN

Vax Date: 03/12/2021
Onset Date: 04/01/2021
Rec V Date: 10/05/2021
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: none

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

Symptoms: Irregular menstrual cycles post vaccination. End of April 2021 cycle last 2 weeks and very heavy, May missed cycle, June late cycle lasting longer than usual, July missed cycle, August very heavy cycle lasting 3-4 dyas, end of September spotting x 2 days then cycle started again 3 days later in early October.

Other Meds: none

Current Illness: none

ID: 1761290
Sex: F
Age: 61
State: KY

Vax Date: 08/05/2021
Onset Date: 10/02/2021
Rec V Date: 10/05/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: hospitalization (non-ICU)

Other Meds:

Current Illness:

ID: 1761292
Sex: F
Age: 62
State: NC

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

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

Lab Data: n/a

Allergies:

Symptom List: Vomiting

Symptoms: No adverse event - reporting Covid vaccine error. Patient received Moderna vaccine for the first 2 doses. Came to facility requesting a booster shot. Patient indicated she had previously received Pfizer vaccine, but did not have her records. Staff did not check the NC State Vaccine system to verify previous records prior to administration of the booster shot. When recording the booster in the state system, nurse noticed that the patient had previously received Moderna. Patient was monitored, but there were no adverse effects. Patient instructed to call clinic with any problems.

Other Meds:

Current Illness:

ID: 1761293
Sex: F
Age: 48
State: PA

Vax Date: 09/01/2021
Onset Date: 09/01/2021
Rec V Date: 10/05/2021
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: allergies to monocryl

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Dizziness, imbalance, vision changes, painful tingling in finger tips the same day after the second covid pfizer vaccine

Other Meds: None

Current Illness: none

ID: 1761295
Sex: M
Age: 63
State: FL

Vax Date: 02/04/2021
Onset Date: 05/01/2021
Rec V Date: 10/05/2021
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: None

Allergies: None

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

Symptoms: Tardive Dyskinesia

Other Meds: HUMOLOG INSULIN AVERAGE 100 UNITS DAILY VIA PUMP METFORMIN 1,000 MG TWICE DAILY FARXIGA 10MG DAILY GLUCAGON EMERGENCY 1MG KIT FREESTYLE LIBRE 2 CGM ATORVASTATIN 40 MG DAILY LISINOPRIL 10MG DAILY HYDROCHLOROTHIAZIDE 12.5 MG ONCE DAILY ASP

Current Illness: Diabetics, Sarcoidosis, Asthma.

ID: 1761296
Sex: F
Age: 25
State: MD

Vax Date: 10/01/2021
Onset Date: 10/02/2021
Rec V Date: 10/05/2021
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: none

Allergies: Zithromax, Augmentin

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Persistent vomiting. Phenergan given by MD, symptoms still persist

Other Meds: None

Current Illness: None

ID: 1761297
Sex: F
Age: 84
State: KY

Vax Date: 01/12/2021
Onset Date: 09/30/2021
Rec V Date: 10/05/2021
Hospital: Y

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: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: hospitalization (non-ICU)

Other Meds:

Current Illness:

ID: 1761299
Sex: F
Age: 57
State: MN

Vax Date: 02/17/2021
Onset Date: 10/01/2021
Rec V Date: 10/05/2021
Hospital: Y

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

Lab Data:

Allergies: Omnipaque [Iohexol], Prochlorperazine, Iodinated Contrast Medi

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

Symptoms: Patient admitted as inpatient on 10/1 due to acute respiratory failure with hypoxia. Patient was tested for COVID-19 and was positive on 10/1.

Other Meds: acetaminophen, albuterol, atorvastatin, BENZOcaine-menthol, dexAMETHasone

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am