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: 1761407
Sex: U
Age: 49
State: NH

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

Allergies:

Symptom List: Dysphagia, Epiglottitis

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

Other Meds:

Current Illness:

ID: 1761408
Sex: M
Age: 78
State: NY

Vax Date: 03/25/2021
Onset Date: 10/01/2021
Rec V Date: 10/05/2021
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: Sulfur

Symptom List: Anxiety, Dyspnoea

Symptoms: Rash/ blisters on arm at vaccine point frist start on Oct 1 as a red spot with many small blisters. Today not as red but with large blisters.

Other Meds: Tamsulosin .4mg Amlodipine 2.5mg Finasteride 5mg

Current Illness: none

ID: 1761409
Sex: M
Age: 37
State: NJ

Vax Date: 04/11/2021
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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Ptosis of left eye

Other Meds: Atorvastatin 10 mg / daily

Current Illness: None

ID: 1761410
Sex: F
Age: 41
State: NY

Vax Date: 10/01/2021
Onset Date: 10/04/2021
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:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: tinnitus in left ear starting 3rd day after vaccine

Other Meds: Tri Femynor

Current Illness:

ID: 1761411
Sex: F
Age: 64
State: CO

Vax Date: 10/04/2021
Onset Date: 10/04/2021
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: None required.

Allergies: Unknown

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

Symptoms: I administered the Fluzone high dose to the patient and she is 64 years of age. There was no adverse outcomes.

Other Meds: Unknown

Current Illness: Unknown

ID: 1761412
Sex: M
Age: 67
State: MN

Vax Date: 03/30/2021
Onset Date: 09/28/2021
Rec V Date: 10/05/2021
Hospital: Y

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: Coronavirus 2 PCR Detect, V symptomatic POSITIVE

Allergies: Cefaclor

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

Symptoms: NO record of vaccine in chart, patient reports he received both vaccines in March 2021. Brand not in medical record. Patient reports to the ED with c/o cough, chest pain, shortness of breath, and weakness since yesterday morning. Patient reports that he has a "compromised immune system" and so he called the nurse line and was told to report to the ED. Patient denies fevers but reports some chills. Patient in no obvious distress, airway intact.

Other Meds:

Current Illness:

ID: 1761413
Sex: M
Age: 63
State: OR

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

Lab Data:

Allergies: unknown

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Client came to Covid vaccine clinic and attested on consent form that he has never received a Covid Vaccine before. Client provided a dose of Janssen on 9/30/21, and later it was determined that client had already received a dose of Janssen on 5/6/2021.

Other Meds: unknown

Current Illness: unknown

ID: 1761414
Sex: M
Age: 30
State: NJ

Vax Date: 10/04/2021
Onset Date: 10/05/2021
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:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: chills, weakness, and mild nausea

Other Meds:

Current Illness:

ID: 1761415
Sex: F
Age: 34
State: OH

Vax Date: 10/04/2021
Onset Date: 10/04/2021
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: N/A

Allergies: None.

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Intermittent arm numbness in left arm post vaccination. Patient contacted me later that day and reported that it subsided at around 5 pm on 10/04/2021

Other Meds: None.

Current Illness: None that I was aware of.

ID: 1761417
Sex: F
Age: 29
State: MN

Vax Date: 07/06/2021
Onset Date: 09/14/2021
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: Positive PCR test on 09/18/2021

Allergies: Guaifenesin-dm Cr Mucinex Guaifenesin Pseudoephedrine Base Hypertension

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient tested positive for COVID on 09/18/2021. Symptoms started on 09/14/2021. She had congestion, runny nose, cough, left ear pain.

Other Meds: Vitamin D, Antivert, ciprodex, mycostatin, robaxin, humira, indocin, sympicort, prilosec, yasmin, albuterol, proventil.

Current Illness: None

ID: 1761418
Sex: F
Age: 30
State: MI

Vax Date: 03/30/2021
Onset Date: 04/01/2021
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: Lab work, Thyroid, Electrolytes, many tests, micro hormone levels, CT scan.

Allergies: Peanuts, Tree Nuts, Latex, Adderall, Clindamycin, Keflex, erythromycin, hydrocortisone, generic of Synthroid, Butran patch, Augmentin, Pepcid, generic version of Claritin, and MANY others.

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

Symptoms: I had some symptoms the day of I just felt tired and then a headache but then Within 48 hours I?ve been very exhausted for months now. I've been to doctors, and I've been to urgent cares. They've done every test in the book. It's been this extreme fatigue with joint pain, but I don't know if it's related, and it comes and goes. I've seen urgent care, primary care, endocrinology, neuroendocrinology, allergist, immunology and none of them have been able to help. I had kidney stones and I had a severe UTI 2 weeks after I got shot and they did a CAT Scan and the CAT Scan showed a nodule on my lung and a stone on my kidney which they thought was strange because I've had tons of scans prior, but they figured they'd just repeat the scan and my insurance has to approve it so I had to reschedule it for October 12. I?m still dealing with fatigue.

Other Meds: Ritalin, Trileptal, Xanax, Allegra, 5 htp, hcu ez caps, Benadryl, Insulin, Humalog

Current Illness: Anaphylactic reaction a couple of weeks prior.

ID: 1761419
Sex: M
Age: 57
State: ID

Vax Date: 08/05/2021
Onset Date: 08/06/2021
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: none

Symptom List: Rash, Urticaria

Symptoms: Came down with Cough, Sinus, Congestion that lasted about 3 weeks. No Fever just got very sick. My right arm was very sore, and I could not move my arm no higher then 3 feet. Tested negative on COVID 4 times before and after first and second injection.

Other Meds: Benazpril high blood pressure 1/2 dose

Current Illness: none

ID: 1761420
Sex: M
Age: 37
State: TN

Vax Date: 04/01/2021
Onset Date: 04/26/2021
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: Doctor did some blood and urine tests and wanted to do an mRI - but he has no insurance.

Allergies: Pertussis vaccine

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

Symptoms: ran fever (101 degrees) after receiving vaccine but doesn't believe he had still had fever still at the time of the seizure, no treatment; he then felt better, but seizures started again in June. He saw the doctor and was put on Topamax. He had no seizures for a period of time. Then they returned. Still having seizures - some days 3 or 4 big and small.

Other Meds: Adderall

Current Illness: had fever and felt terrible after receiving the vaccine, but OK before

Date Died: 10/03/2021

ID: 1761422
Sex: F
Age: 35
State:

Vax Date: 03/04/2021
Onset Date: 09/14/2021
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: Covid + 9/16/2021

Allergies: No Known

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

Symptoms: Breakthrough Covid + 35 year old female with a Past Medical History of Evans Syndrome, Immune Deficiency Disorder, Lymph Node Abscess, B-cell Lymphoma, Cytomegalovirus, Pneumonia, Pneumothorax, Bone Marrow Biopsy, Port, and Lymph Node Biopsy. Admitted to Medical PCU for Low Grade Fever, COVID19, B-Cell Lymphoma, Evans Syndrome, Pneumonia, Splenomegaly, Elevated LFT's, Elevated Bilirubin, Dehydration, Hypoxemia, Tachycardia, Leukopenia, Anemia, Pancytopenia, Elevated Blood Glucose, Hyponatremia, Hypokalemia, and Questionable Small Lesions within the Liver. Patient was admitted to the hospital for shortness of breath cough and fever. Symptoms have been progressively getting worse over last 1-2 days.

Other Meds:

Current Illness:

ID: 1761423
Sex: F
Age: 68
State: GA

Vax Date: 10/04/2021
Onset Date: 10/05/2021
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: EES, Codeine, Doxycycline

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

Symptoms: Injection site pain, Chills, Fever 100.7, Muscle pain, Joint pain, Feeling unwell, Tiredness, Decreased appetite

Other Meds: Levothyroxine 50 mcg po QD Vit C 1000 mg po QD Vit D 2000 iu po QD

Current Illness: None

ID: 1761424
Sex: M
Age: 69
State: MA

Vax Date: 09/27/2021
Onset Date: 09/29/2021
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: Reported to physician, no tests or medical visit

Allergies: Furesamide Bee stings Pollen allergies

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

Symptoms: Vertigo, mild headache, mild nausea. Sudden onset, subsided after 30 minutes. Some remains after several days.

Other Meds: Metropolol

Current Illness:

ID: 1761425
Sex: F
Age: 6
State: TX

Vax Date: 09/29/2021
Onset Date: 09/29/2021
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: Dr. provided orders for a food allergy test. Walnuts was the allergy present on the results which the patient has not had that day.

Allergies: Allergy to Walnuts No known drug allergies

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

Symptoms: Patient had a routine flu vaccine at 10:24 am. The mother reported after a few hours of leaving the clinic the patient's lips began to swell. The lips gradually continued to swell so the mother brought her back to the clinic for evaluation at 12:30 pm where she was given prednisone.

Other Meds: None

Current Illness: None

ID: 1761426
Sex: F
Age: 52
State: WI

Vax Date: 09/23/2021
Onset Date: 09/23/2021
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: dicloxacillin - rash

Symptom List: Ear pain, Hypoaesthesia

Symptoms: started within hours of immunization - swelling, redness, and pain from shoulder to elbow. Swelling and redness resolved after a few days, but the pain has continued since as of today (10/5/21). Pain is about 30% better from beginning. No restricted ROM.

Other Meds:

Current Illness: none

ID: 1761427
Sex: M
Age: 56
State: AS

Vax Date: 09/02/2021
Onset Date: 09/02/2021
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: ultrasound

Allergies: none

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Chest pains first 3 days. Sept 4th back ache starts. Back ache surges with pain down left leg. Sept 15th visit to Dr for anti-inflamatories and back adjustment. Sept 17th excessive back and nerve pain Sept 18th high fever started at noon, peaked 102 - 103 that evening, on and off for 3 days of fevers. Setp 19th went to urgent care. Hot spot on thigh identified as "dermal infection starting". sent to ultrasound to check for blood clots, none. skin rash starts to spread down left leg over next day 9/20.. Can barely walk now, pain in leg and back. Bed rest all day with fever. Sept 21 able to slowly walk, red patch on lower left leg deepens in color. A doctor in the family suggests maybe shingles. PEr internet research - yes symptoms match Shingles nerve pain, but no blisters. Pain level can be very high all of sudden with sitting down, moving a certain way. etc. Dr. visit on 9/24: Skin infection is not shingles. Swelling is of more concern, could mean pulmanary issues. Blood draw taken for blook tests. Dr. visit on 9/27: blood test results show very high earlier covid antibodies, so conclusion is he had covid earlier and already had natural immunity. The shot met with great resistence. 10/4/21 update - lower leg and foot remain swollen, back still aches potentially from inflammation, upper left leg still hurts internally.

Other Meds: Rosuvastatin calcium 10 mg tab; Lisinopril 10 mg

Current Illness: none

ID: 1761429
Sex: M
Age: 67
State:

Vax Date: 10/04/2021
Onset Date: 10/04/2021
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:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1761430
Sex: M
Age: 59
State: NJ

Vax Date: 03/19/2021
Onset Date: 09/01/2021
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: Blood work negative, full blood work 9/2021.

Allergies: None

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

Symptoms: Severe shingles like pain throughout entire abdomin area.

Other Meds: Metformin, Glipacide, Prevacid.

Current Illness: Diabetes

ID: 1761431
Sex: M
Age: 50
State: MI

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

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: patient received a pfizer bioNtech booster shot at mobile vaccine clinic. Patient did not have vaccine card on him and there was no access on site. His original series was Moderna. Patient was asked prior to receive the booster and he mentioned he took pfizer.

Other Meds:

Current Illness:

ID: 1761432
Sex: M
Age: 63
State: PA

Vax Date: 03/01/2021
Onset Date: 03/24/2021
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: CBC and differential - STAT CBC auto differential - Once Comprehensive metabolic panel - STAT Magnesium - STAT TSH - STAT Troponin I To be done STAT ECG 12-lead: HOSPITAL or TEST FACILITY Once Palpitations X-ray chest 1 view cardiac monitor for 30 days EEG

Allergies: no

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

Symptoms: My heart was racing uncontrollably & I had to go to emergency room, where I was told that I had a "mild heart attack". I then went to the doctor. Topic, a cardiologist who checked me out. I told her I thought the vaccine caused this problem because previously I had NO problems with my heart at all. Dr stated that it was possible.

Other Meds: clonodine.01mg, Tamsulosin

Current Illness: none

ID: 1761433
Sex: M
Age: 85
State: GA

Vax Date: 03/01/2021
Onset Date: 08/11/2021
Rec V Date: 10/05/2021
Hospital: Y

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

Lab Data: 08/11/2021 PCR+ COVID-19 test at Hospital

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Breakthrough COVID-19 case with symptom onset 8/11/2021: cough and headache. Hospitalized 8/11/2021 for unknown duration

Other Meds:

Current Illness:

ID: 1761434
Sex: M
Age: 48
State: NE

Vax Date: 09/20/2021
Onset Date: 09/21/2021
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: Emergency Room tested for blood clots, heart attack, pulminary embolism. They provided IV fluids and a shot of Ativan to try to calm my heart rate. They then sent me home.

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Injection site soreness (first 72 hours); Severe Headache (within first 12 hours), caused a day of missed work; Body aches, extreme fatigue (starting about 72 hours after vaccine and continues to Present (Oct 5th)); Cold Sore (appeared 1 week after vaccine); Nausea (appeared 8 days after vaccine); Extreme body aches, fatigue, nausea, diarhea (ramp up at 9 days after vaccine); Missed work days 9-11 after vaccine. Rapid heart rate (appears 10 days after vaccine.); Visited ER on day 12. No sleep/insomnia (nights 10 and 11 after vaccine).; Chest pain (appears day 11 after vaccine); Visited ER on day 12.

Other Meds:

Current Illness:

ID: 1761435
Sex: M
Age: 58
State: MI

Vax Date: 04/07/2021
Onset Date: 09/25/2021
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: SYR
Vax Site: LA

Lab Data: Unknown

Allergies: No Known Drug Allergies, Citrus

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

Symptoms: Cough, SOB with worsening SOB in the last 24 hours, fever and congestion, had nausea. Possible vomiting unsure.

Other Meds: Unknown

Current Illness: Unknown

ID: 1761438
Sex: F
Age: 47
State: CA

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

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1761439
Sex: F
Age: 66
State: MI

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

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

Lab Data: COVID positive test

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: COVID vaccine breakthrough case

Other Meds:

Current Illness:

ID: 1761440
Sex: F
Age: 47
State: CA

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:
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: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1761441
Sex: F
Age: 41
State: OH

Vax Date: 03/19/2021
Onset Date: 10/01/2021
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: PCR test collected on 10-4-2021, resulted positive

Allergies:

Symptom List: Nausea

Symptoms: Headache, dizziness, loss of taste and smell, severe sinus pressure, jaw pain, muscle aches, nausea, cough.

Other Meds:

Current Illness:

ID: 1761442
Sex: F
Age: 65
State: AL

Vax Date: 04/01/2021
Onset Date: 08/30/2021
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: 08/30/2021 Covid, strap, and flu- all negative 08/30/2021 chest x-ray- normal 3 more Covid tests- negative

Allergies: Seasonal

Symptom List: Injection site pain

Symptoms: After the second shot I was very tired for one day. I had some soreness and redness in my arm. I didn?t feel like doing anything. I just rested. After that I was perfectly fine. In August my husband had fever and he was not feeling well. We gave it a day before we went to the doctor. I was pretty sure he had Covid because of his symptoms and he was not vaccinated. We had both been exposed directly to Covid. On Tuesday 08/30/2021 we went to urgent care. We both tested negative for Covid, strap, and flu. We both had sinus issues. Mine was worse. I had congestion. They also did a chest x-ray because I was having some chest pain. It came back normal. 2 days later my husband tested positive for Covid. I tested 4 times negative for Covid. I took some antibiotics and a shot of cortisone and I am fine now.

Other Meds: Multi vitamin, magnesium, Zyrtec, vitamin B12, calcium, CoQ10, baby aspirin, melatonin

Current Illness: None

ID: 1761443
Sex: F
Age: 90
State: CA

Vax Date: 10/04/2021
Onset Date: 10/04/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1761444
Sex: M
Age: 58
State: TN

Vax Date: 04/22/2021
Onset Date: 04/23/2021
Rec V Date: 10/05/2021
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: EKGs- I was in basically A- Flutter blood work ups

Allergies: penicillin

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

Symptoms: 24 hours after the vaccine, 04/23/201, tachycardia- my heartbeat jumped from 60 to 280 beat a minute. I called Medical Center, they told me to double up on my medication- Diltiazem , which lowered my heart beat from 130 to 140 beats per minute. , my typical is around somewhere to 60 beat per minute. For the remainder of that week, 04/30/2021, I went back to Medical Center --I had out-patient surgery- cardio version to get my heart shocked to get it back in rhythm at the end of that week . They diagnosed it as A-flutter 07/21-07/24 I was prescribed Tikosyn @ the Medical Center -they monitored me for 3 days, before they put me on that medication 07/23 they did another cardio version of the heart and I have been fine since, They got me back into to rhythm with the Tikosyn and I have been taking the Tikosyn ever since.

Other Meds: Xarelto 20 mg od diltiazem 240 mg od vitamin B-3 Vitamin C Zinc 50 mg

Current Illness: no

ID: 1761445
Sex: F
Age: 68
State: MN

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

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

Lab Data: Coronavirus 2 PCR Detect, V symptomatic POSITIVE

Allergies:

Symptom List: Tremor

Symptoms: Patient is a 68-year-old female who presented herself to the Emergency Department at the Health System. She was complaining of some difficulty breathing and abdominal pain and a general feeling of being unwell. She was noted to have significantly lower blood pressures. A CT scan of the chest, abdomen, and pelvis revealed a relatively large left lower quadrant intraabdominal abscess with perforation. There was also findings of free air into the diaphragm and free air tracking along the mediastinum. The facility did not have any beds available, and so she was transferred to the another facility for further management. Of note, the patient was admitted to Hospital

Other Meds:

Current Illness:

ID: 1761446
Sex: F
Age: 91
State: IL

Vax Date: 03/25/2021
Onset Date: 09/28/2021
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: CODEINE

Symptom List: Erythema, Pruritus

Symptoms: MD Notes: Chief Complaint This patient is a 91-year-old pleasant lady awake alert oriented x4 living independently in an apartment and assisted by 2 children high functioning cognitively physically was brought in after she was found to have been weak had loss of appetite cough fever and tested positive for COVID-19. History of Present Illness This patient has cough, dyspnea acute hypoxia fever loss of appetite low energy loss of taste and diarrhea. She has been having her children and caregivers provide food to her apartment. She stated that she has 2 children a son and a daughter. One of her frequent visiting caregiver had tested positive for COVID-19. She had symptoms of cough fever and diminished taste appetite diarrhea about 4 days ago. She has been hypoxic and has dyspnea. Outpatient testing came back positive for COVID-19. She had worsening symptoms of acute hypoxia, atrial fibrillation with rapid ventricular rate and patient being symptomatic elderly 91-year-old was brought and admitted for further evaluation and management of acute hypoxia, newly diagnosed COVID-19 associated. She denies any chest pain shortness of breath. She denies any orthopnea palpitations. She is volume depleted. She has been evaluated in the emergency room now brought into telemetry unit.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1761448
Sex: F
Age: 65
State: CA

Vax Date: 10/04/2021
Onset Date: 10/04/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1761449
Sex: F
Age: 43
State: CA

Vax Date: 09/02/2021
Onset Date: 09/05/2021
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: Papsmear and blood tests were normal. After the 2nd dose, I had pelvic ultrasound and found cyst in my ovary. I will have another pelvic ultrasound to follow up.

Allergies: none

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

Symptoms: 2 days after the first vaccine, I had vaginal bleeding. I already had my period the week before the vaccine. I went to my primary doctor and all vaginal exam, including papsmear were normal. 2 days after the 2nd dose I started to have spotting again. This is different spotting I had experience prior to start of my menstrual period. Yesterday, 10/4/21, I noticed in the morning that my upper right arm was stiff and the injection site was tender. Everytime I move my right arm, the injection site hurts. The day of the 2nd dose, I also had mild fever and right arm severe pain and muscle pain/aches/sore. My right arm continues to be painful and feeling stiff where the injection site is. I am afraid of paralysis from the vaccine.

Other Meds: Tylenol

Current Illness: none

ID: 1761450
Sex: F
Age: 53
State:

Vax Date: 04/15/2021
Onset Date: 04/16/2021
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: chemo, adhesive, sulfur

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: waking up with abscess in mouth, prescribed antibiotics

Other Meds: ivib infusion

Current Illness:

ID: 1761451
Sex: M
Age: 0
State:

Vax Date: 04/17/2021
Onset Date: 10/02/2021
Rec V Date: 10/05/2021
Hospital: Y

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

Lab Data: Covid + 10/02/2021

Allergies: No Known

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

Symptoms: Breakthrough Covid + male presents to the ED with general malaise about 10 days ago and that over the past 2 days he has had a HA associated with N/V, unrelieved by taking tylenol around the clock. Pt states his sister tested positive for COVID-19 a few days ago and he was recently in contact with her.

Other Meds:

Current Illness:

ID: 1761452
Sex: M
Age: 77
State: CA

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: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1761453
Sex: F
Age: 35
State: FL

Vax Date: 09/28/2021
Onset Date: 09/29/2021
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: None

Allergies: Iodine

Symptom List: Pain in extremity

Symptoms: 24 hours after the vaccine vomited continuously could not eat. Received 2 IV bags of fluid along with Zofran and Tornadol. Had right ear Pain and neck pain. Also have vertigo with nystagmus and dizziness that is still present 1 week later. Not able to walk well without feeling off balance. Symptoms are improving slowly. Have a hard time driving.

Other Meds: Prenatal Vitamins

Current Illness: Was post c section and just delivered my baby 4 weeks ago

ID: 1761454
Sex: F
Age: 63
State: VA

Vax Date: 03/06/2021
Onset Date: 03/26/2021
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: 3/26/21 x-ray and bloodwork. 9/24/21 bloodwork.

Allergies: Aleve

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

Symptoms: 3/26/21 Vertigo with nausea and epigastric pain , went to local ER. 9/24/21 Vertigo with nausea and epigastric pain, after calling insurance nurse line, was advised to go to ER. 09/30/21 Follow up with physician at local Health Center, referral for physical therapy. 10/01/21 Physical therapy, which resulted in a positive test for benign paroxysmal positional vertigo.

Other Meds: none

Current Illness: none

ID: 1761455
Sex: F
Age: 39
State: IA

Vax Date: 09/10/2021
Onset Date: 09/10/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: Developed a rash 5 hours after dose to arms and neck. Continues with itching. Has dark skin where rash was present. Was seen by medical provider and put on 2 medications, but unsure of names.

Other Meds:

Current Illness:

ID: 1761456
Sex: F
Age: 39
State: NY

Vax Date: 09/24/2021
Onset Date: 09/24/2021
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: 9/29/21 ER: blood work (normal) including COVID PCR test (negative), chest x-ray, CT chest pulmonary angiography with IV contrast (no pulmonary embolus or other pathology)

Allergies: Latex, salicylic acid

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

Symptoms: Soreness and swelling at injection site (left arm) for over two days. Fever the night of the vaccine. Woke with sore neck and back and a headache. Day after the vaccine shortness of breath and increased hear rate began. For 9 days after the vaccine I was short of breath with increased heat rate doing anything but sitting or laying. I was out of breath walking across a room and gasping after going up stairs. Exhausted/ fatigued for 9 days after vaccine with increased sleep (naps, bed early) and speaking was slow and occasionally labored. Right eye was constantly twitching and both legs had tingles for several days after vaccine. Small, quick chest pains for 9 days.

Other Meds: None

Current Illness: None

ID: 1761457
Sex: M
Age: 62
State: CA

Vax Date: 10/04/2021
Onset Date: 10/04/2021
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:

Allergies:

Symptom List: Vomiting

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1761458
Sex: M
Age: 59
State:

Vax Date: 10/04/2021
Onset Date:
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:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1761459
Sex: F
Age: 66
State: MA

Vax Date: 09/28/2021
Onset Date: 09/28/2021
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: Oxycodone [Opioids-Morphine & Related] Penicillin Tetanus

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

Symptoms: Because of history of allergies, facility had me wait 1/2 hour after; several hours after jab administered, sore arm at injection site. Upon waking the next morning, I noticed a rash - diffuse red spots - developing : Abdomen to lower back, few spots on breasts, some on arms, some have white heads; headache; several hours later saw MD for rash; had fever of 101.1, headache worse, arm very painful, body aches; later that day into evening had chills and fatigue. Day 3 severe headache, body aches, bone pain, nausea diarrhea, fatigue, chills, arm pain. These continued into Day 4 with sweating and fatigue worsening. One week later I still have a dull headache, fatigue and intermittent sweating.

Other Meds: Vitamin D3, B complex, zinc, probiotic

Current Illness: none

ID: 1761460
Sex: M
Age: 38
State: WA

Vax Date: 01/26/2021
Onset Date: 01/26/2021
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: n/A

Allergies: No history

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient is a 38 y.o. male with history of obesity, HTN, hypogonadism who presents after his first COVID vaccine with sensation of throat tightness, nausea, and flushing of the arms which started about 25 minutes after the vaccination. Pt denies any history of asthma, allergies, or anaphylaxis. Upon arrival to our ED, patient is awake, alert, and answering questions appropriately. Normal HR, RR, and O2 sat. Hypertensive with SBP max in the 160s (never headache, vision change, chest pain). Physical exam notable for mild flushing but not hives over his right shoulder. Rest of exam with normal findings including no respiratory distress or visible oral swelling. He is tolerating his secretions well, no stridor, talking in full sentences, good breath sounds b/l. Initial ASAP score 4 - for flushing, nausea without vomiting, and sensation of tight throat. In discussion with the patient, given improvement in flushing/diaphoresis and no worsening of symptoms, patient received cetirizine and famotidine with plan to escalate care if symptoms worsened. Patient was observed in the emergency department for at least 2 hours. Patient clinically improved - resolution of throat symptoms and ASAP score to 1. He had residual mild nausea for which he received zofran and then was able to PO without issue and reported feeling much better and feels comfortable with discharge. Patient is safe to discharge home with supportive care instructions including s/s requiring return to the ED. Prescription for cetririzine and famotidine/ranitidine provided.

Other Meds: N/A

Current Illness: obesity, HTN, hypogonadism

ID: 1761461
Sex: F
Age: 91
State: NY

Vax Date: 09/27/2021
Onset Date: 09/27/2021
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: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: patient started having swelling of her tongue approximately 1 hours after the 3rd dose of Pfizer vaccine. Patient was treated with Benadryl, prednisone and epipen. Patient did not require hospitalization and patient recovered fully next day. Patient did report that she bit her tongue.

Other Meds:

Current Illness:

ID: 1761462
Sex: M
Age: 61
State:

Vax Date: 10/04/2021
Onset Date:
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: RA

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am