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: 1761678
Sex: F
Age: 32
State:

Vax Date: 08/25/2021
Onset Date: 10/04/2021
Rec V Date: 10/05/2021
Hospital: Y

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

Lab Data:

Allergies: NKA

Symptom List: Dysphagia, Epiglottitis

Symptoms: breakthrough C19 infection and hospitalization

Other Meds: no medications noted on admission med rec

Current Illness:

ID: 1761679
Sex: M
Age: 28
State: OK

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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: EKG- sinus tach MRI brain w/ and w/o contrast- wnl CMP/CBC- WNL

Allergies: NKA

Symptom List: Anxiety, Dyspnoea

Symptoms: Pt notes that he had LE numbness (dead feeling) and heaviness 30 min after vaccination and then the Fri afterwards started to feel muscle stiffness which has resolved but he also has been having pretty steady lack of discriminatory sensation in the toes, he has intermittent periods of time where he has numbness and tingling that rapidly involves the upper body and face as well but is intermittent. these episodes last for 30 minutes. He had decreased sharp/dull in the ED in the toes, neuro was consulted and rec MRI which was normal, pt declined LP at that time, distant fam hx of MS potentially. Denies vision changes, HA, chest pain, SOB, wheezing.

Other Meds: preworkout, protein

Current Illness: none

ID: 1761680
Sex: F
Age: 33
State: NY

Vax Date: 09/14/2021
Onset Date: 09/14/2021
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: Observation for test.

Allergies: Peanut; Almond Allergies; and Environmental Sessional Allergies.

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

Symptoms: 09/14/2021 evening felt fatigue (3 days), chills (1 day). Hives came on 09/22/2021 itchy, raised, ears, back, all over body from head, scalp, to toes and in between toes. Thursday 09/23/2021. Treated with Steroid injection at urgent care 09/23/2021 - AM then the allergist to received another treatment 09/23/2021 PM.

Other Meds: No

Current Illness: No

ID: 1761681
Sex: F
Age: 15
State: GA

Vax Date: 09/05/2021
Onset Date: 09/05/2021
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:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1761682
Sex: F
Age: 56
State: TX

Vax Date: 02/03/2021
Onset Date: 06/23/2021
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: Pathology report shows invasive mammary carcinoma infiltrating in linear cords and thin nests. Rare tubule formation is seen.

Allergies:

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

Symptoms: abnormal mammogram 6-23-21

Other Meds:

Current Illness:

ID: 1761683
Sex: F
Age: 67
State: CA

Vax Date: 09/26/2021
Onset Date: 09/28/2021
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: None needed.

Allergies: sensitivities to amoxycillin, corticosteroids

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

Symptoms: 42 hours after my Pfizer Covid19 Booster shot, my right arm developed a large red swollen diamond-shaped rash (possible "COVID ARM"?). No heat or fever. This rash started to dissipate in the next 2 days and was gone altogether by the 5th day. I e-mailed my doctor's office. They told me that I should report this event to you.

Other Meds: multivitamins, coq10, probiotics, digestive enzymes, joint supplements

Current Illness: none

ID: 1761684
Sex: M
Age: 67
State: WI

Vax Date: 04/06/2021
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: Brewer's yeast - throat swelling mold - throat swelling

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient contracted COVID after being fully vaccinated Runny nose/Congestion

Other Meds: acetaminophen 1000mg BID prn for pain aspirin 81mg daily atorvastatin 20mg daily cholecalciferol 1000IU daily duloxetine ferrous sulfate 325mg daily gabapentin 600mg TID multivitamin daily naproxen 500mg BID Fish Oil 1000mg BID pantoprazo

Current Illness: None documented

ID: 1761685
Sex: F
Age: 57
State: MN

Vax Date: 02/24/2021
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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Tested NAAT positive for COVID 10/1/21 after being fully vaccinated.

Other Meds:

Current Illness:

ID: 1761686
Sex: M
Age: 31
State: OR

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: 1
Vax Route: IM
Vax Site: LA

Lab Data: None as of yet

Allergies: Unsure

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: I was trying to sleep last night after drinking a glass of water before bed, which is my usual routine. After going to bed, I woke up with my body vigorously shaking, starting from the location of the injection site. I had to hold onto my neck oh the left side for support due to all the muscles, spreading from the injection site, wanting to vigorously contract and pull hard towards the injection location. My heart rapidly beat and I had to take the time to try and calm the body by doing deep breathing exercises. When it got to a comfortable time to move, I went to use the restroom and had to drink lots of water due to feeling a temperature, light sensitivity, a head ache, and body fatigue. This pattern happened throughout the night several times to the point where I felt sick. After my body calmed mostly down, I called the pharmacist at Genoa to share my experience. They mentioned how it was normal and to take a Tylenol to help with the symptoms. I also had to call in sick to work and request a substitute teacher to help with my classes today.

Other Meds: Propranolol 10mg (one in morning), Escitalopram 10mg (one in morning), Garden of Life Raw Enzymes Men, Garden of Life Vitamin Code Raw D3 2000IU

Current Illness: Ear infection. I finished taking the antibiotics for it three days ago.

ID: 1761687
Sex: F
Age: 46
State: IL

Vax Date: 08/21/2021
Onset Date: 08/26/2021
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:

Allergies: sulpha containing medications Penicillin (not true allergy, but causes puritis) Armour thyroid (porcine derived)

Symptom List: Diarrhoea, Nasal congestion

Symptoms: I obtained a Moderna booster vaccine due to innate IGG subclass immune deficiency. For 5 days after the vaccine shot, I was extremely nauseated and tired. On the 5/6th day a strong, body-wide itching began under my skin, so badly I couldn't sleep for 3 days, despite being on antihistamines. Delayed reactions to medicines are typical for me. After 3 sleepless nights, I called Dr, who advised taking 4 Xyzal per day and the maximum amount of Benadryl and Singulair each day. He also agreed that I should use Diflucan and antifungal creams to treat for a systemic yeast infection. The maximum antihistamines and antifungals controlled the itching enough to get some sleep. Still, with treatment, the itching persisted for more than 14 days. I had felt this body-wide under-skin itching sensation before when I was allergic to a medication or, more mildly, when I had a yeast infection. We believe the full dose of the Moderna booster diverted my weak immune system entirely away from the usual task of keeping yeast in check, thus letting a body-wide yeast infection take hold. Given the outcome, it may be worth halving the dose of Moderna boosters for immune compromised individuals in order to avoid overwhelming the limits of a curtailed immune systems, allowing other opportunistic infections to take hold.

Other Meds: Hyqvia Subcutaneous IGG therapy Tirosint levothyroxine Symbicort asthma inhaler Spiriva asthma inhaler QVar asthma inhaler Singulair Xyzal

Current Illness: IGG subclass deficiency fibromyalgia Hashimoto's hypothyroidism mild asthma

ID: 1761688
Sex: U
Age: 63
State: GA

Vax Date: 09/05/2021
Onset Date: 09/05/2021
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:

Allergies:

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

Symptoms: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1761689
Sex: M
Age: 78
State: OK

Vax Date: 09/27/2021
Onset Date: 09/27/2021
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: SYR
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Patient admitted ~48-72 hours post vaccination with back pain and urinary retention

Other Meds:

Current Illness:

ID: 1761690
Sex: M
Age: 71
State: GA

Vax Date: 05/21/2021
Onset Date: 09/11/2021
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: LA

Lab Data: 09/11/2021 PCR+ COVID-19 test at Medical Center

Allergies:

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

Symptoms: Breakthrough COVID-19 case with unknown symptom status. Hospitalized 9/11/2021 for unknown duration

Other Meds:

Current Illness:

ID: 1761691
Sex: U
Age: 62
State: GA

Vax Date: 09/05/2021
Onset Date: 09/05/2021
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:

Allergies:

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

Symptoms: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1761692
Sex: F
Age: 28
State:

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:

Allergies: Gluten and lactose intolerant

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

Symptoms: Not positive on the exact Influenza shot I received so I selected the first option. Yesterday I received the flu shot in my right arm and had the typical sore arm for the night. This morning it feels like a pulled muscle under the right arm going from my armpit down the side of my chest. Starting late this morning, my whole body aches and I have the chills. My head has also been pounding since I woke up feeling almost like a migraine and feeling nauseous.

Other Meds: Birth control

Current Illness: N/A

ID: 1761693
Sex: F
Age: 73
State: WI

Vax Date: 05/26/2021
Onset Date: 05/28/2021
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: IR BIOPSY HEMOGRAM PROTHROMBIN TIME AGGRESSIVE B CELL LYMPHOMA FISH RFLX,TISSUE IGH BCL2 FUSION BY FISH SURGICAL PATHOLOGY PROCEDURE

Allergies: N/A

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

Symptoms: Swelling of Lymphnode in chest/shoulder near injection site. Within 2 days it was visible swelling (large). Within 30 days the enlarged lymphnode caused 2 fractures in shoulder/arm at swelling site (also near injection site). Diagnosed with diffuse large B-cell lymphomas (DLBCL). PET Scan showed majority of cancer was at injection site but did spread into other lymphnodes as well.

Other Meds: Multi-Vitamin Losartan 100mg Tab Blood Pressure Medication

Current Illness: N/A

ID: 1761694
Sex: F
Age: 29
State: NY

Vax Date: 08/22/2021
Onset Date: 08/29/2021
Rec V Date: 10/05/2021
Hospital: Y

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

Lab Data: numerous tests done

Allergies:

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

Symptoms: felt weak/dizzy, fainted , cant see well, couldnt walk or stand up , left side of body was numb

Other Meds:

Current Illness:

ID: 1761695
Sex: F
Age: 60
State: VA

Vax Date: 08/30/2021
Onset Date: 09/02/2021
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:

Allergies: Penicillin, Neomycin, Gold Au 198, Bacitracin

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Swelling in left arm lasting from (9/02/2021- present). Burning, aching sensation on back left-side starting (09/15/2021- present).

Other Meds: None

Current Illness: None

ID: 1761696
Sex: F
Age: 34
State:

Vax Date: 09/24/2021
Onset Date: 09/25/2021
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: Sonogram showing baby inside of uterus with heartbeat on 09/25. Then, 09/26 morning I had a miscarriage.

Allergies: No

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Slight fever and chills. Spotting. Miscarriage.

Other Meds: No

Current Illness: No

ID: 1761697
Sex: M
Age: 17
State: NJ

Vax Date: 03/20/2021
Onset Date: 10/03/2021
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: PCR for Covid + 10/3/2021

Allergies: none known

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

Symptoms: Client was fully vaccinated with Pfizer vaccines for Covid on March 20 and April 20, 2021. Received booster dose of Pfizer on October 1, 2021. Client high risk as he has arthritis and takes methotrexate and other immune-compromising medications. Symptoms started on 10/3 - nasal congestion, headache, fever 100.1. Tested + with PCR for Covid on 10/3.

Other Meds: methotrexate

Current Illness: none known

ID: 1761698
Sex: F
Age: 70
State: GA

Vax Date: 09/13/2021
Onset Date: 09/13/2021
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:

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

Symptoms: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1761699
Sex: F
Age: 77
State:

Vax Date: 09/30/2021
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 broke out in hives on the legs, arms, and neck. Patient was given Benadryl, she is getting better now. Was taken to Urgent care on 10/4/21

Other Meds:

Current Illness:

ID: 1761700
Sex: M
Age: 19
State: PA

Vax Date: 10/05/2021
Onset Date: 10/05/2021
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: none

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

Symptoms: Patient experienced syncope while exiting the store. He fell over and suffered the skin on his chin split open

Other Meds: unknown

Current Illness: none

ID: 1761701
Sex: M
Age: 88
State: KY

Vax Date: 01/28/2021
Onset Date: 10/04/2021
Rec V Date: 10/05/2021
Hospital: Y

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

Lab Data: covid19 positive test - 10/4/202

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: altered mental status, increased oxygen requirements

Other Meds:

Current Illness:

ID: 1761702
Sex: M
Age: 64
State: TX

Vax Date: 08/20/2021
Onset Date: 08/21/2021
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: 9/3/2021 ? Echocardiogram, and 12-lead ECG, office visit, and placing of the 7-day monitor to check PVC percentages. Note: The echocardiogram was done post ablation procedure, but not before the vaccine was administered, so there is no post ablation/pre-vaccine baseline to reference. 9/13/2021 ? Cardiac MRI test administered to compare against pre-ablation baseline to assess for any additional scar tissue. 10/4-2021 ? Office visit to discuss test results and re-do the 12-lead ECG. 7-day monitor revealed PVC?s at a rate of approximately 9%, so 4.5 times the rate pre-vaccination, and other test revealed these are new PVC?s originating from a different area, not a return of the previous PVC?s. Dr. wants to check for heart inflammation (myocarditis) and has ordered a heart PET scan, date to be determined, before proceeding further, but is at this point is of the opinion that another ablation procedure may be necessary if the PVC?s persist. Proceeding with caution but says there is no immediate danger of catastrophic heart failure and I can continue with my workout routines and outdoor physical activities. Note: Dr. has not dismissed the correlation between the vaccine and the PVC rate reversal, and in fact has another PVC patient with similar issues post vaccine, though the other patient received the Pfizer injection. I told him I intentionally skipped the due date the 2nd shot for now, he did not object or advise that I should get the 2nd shot, at least for now.

Allergies: none

Symptom List: Injection site pain, Menorrhagia

Symptoms: See # 12 above. The PVC condition had been monitored for several years, but over time had grown in frequency (approximately 25%) and echocardiogram history began to show a diminished percentage of lower chamber output. After consultation with Dr. a decision was made to do a heart ablation procedure to attempt to significantly reduce the PVC frequency. The procedure was successfully performed on June 30, 2021. A few weeks after the procedure a 7-day monitor was worn to measure the post procedure PVC results. At the follow up visit on August 16, 2021, the test results revealed the PVC?s had been reduced to less than 2% in frequency, and it was assumed that the heart function percentage likely had increased as well, so to confirm this result a follow up echocardiogram was put on the schedule for September 9th. At that time I was encouraged by Dr. to go ahead and get the covid-19 vaccine. The covid vaccine (Moderna) was taken on Friday afternoon (8/20) and by Saturday morning (8/21) I noticed the PVC?s had returned at a much higher rate. I assumed this would probably diminish after a few days and did not even monitor it for about a week or so. Self-monitoring the PVC rate varied but averaged about 12-13%. When it persisted I contacted the Doctors office and they advised me to come in earlier for the echocardiogram, a 12-lead ECG, and an office visit. To date, the symptoms have not diminished and PVC rate has been monitored and remains above 9%.

Other Meds: Atorvastatin 10 ml, one a day Daily multi-vitamin Baby aspirin, one a day

Current Illness: none

ID: 1761703
Sex: F
Age: 32
State: OK

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: 025J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: None

Allergies: Sulfa drugs

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

Symptoms: SOB; throat tightening; hypertension; sweating

Other Meds: LoLoEstrin Fe-Birth Control

Current Illness: None

ID: 1761704
Sex: F
Age: 65
State: GA

Vax Date: 09/05/2021
Onset Date: 09/05/2021
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: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1761705
Sex: F
Age: 81
State:

Vax Date: 02/24/2021
Onset Date: 10/03/2021
Rec V Date: 10/05/2021
Hospital: Y

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

Lab Data:

Allergies: trazodone

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: breakthrough C19 infection + hospitalization

Other Meds: albuterol sulfate HFA 108 (90 Base) MCG/ACT inhaler Inhale 2 puffs Every 4 (Four) Hours As Needed for Wheezing. amLODIPine (NORVASC) 5 MG tablet Take 1 tablet by mouth once daily aspirin 81 MG EC tablet Take 1 tablet by mouth daily. choleca

Current Illness:

ID: 1761707
Sex: M
Age: 27
State: GA

Vax Date: 09/06/2021
Onset Date: 09/06/2021
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: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1761708
Sex: F
Age: 73
State: GA

Vax Date: 09/13/2021
Onset Date: 09/13/2021
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:

Symptom List: Nausea

Symptoms: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1761709
Sex: M
Age: 63
State: TX

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

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Patient admitted for biliary drain leakage (per notes pre-existed vaccine dose)

Other Meds:

Current Illness:

ID: 1761710
Sex: M
Age: 28
State: GA

Vax Date: 09/06/2021
Onset Date: 09/06/2021
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: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1761711
Sex: M
Age: 45
State: OR

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: RA

Lab Data:

Allergies: None

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

Symptoms: Head aches, body aches, pain on my finger joints and hands.

Other Meds: Metoprolol and atorvastatin

Current Illness: None

ID: 1761712
Sex: M
Age: 35
State: NJ

Vax Date: 09/13/2021
Onset Date: 09/13/2021
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: N/A

Allergies: n/a

Symptom List: Tremor

Symptoms: Approx 48 hours of headaches, chills, muscle aches, fatigue, low grade fever

Other Meds: sertraline

Current Illness: n/a

ID: 1761713
Sex: F
Age: 35
State: FL

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:

Allergies: NA

Symptom List: Erythema, Pruritus

Symptoms: Nauseous, vomiting, diarrhea

Other Meds: NA

Current Illness: NA

ID: 1761714
Sex: F
Age: 50
State: WA

Vax Date: 10/02/2021
Onset Date: 10/02/2021
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: Yes, food allergies

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

Symptoms: ~ 1300 notified that patient, was experiencing a scratchy and itchy throat. Patient had just prior received a J&J vaccine in her right deltoid. First BP attempt was unsuccessful. Anterior oropharynx and tongue had no swelling noted on exam. Pt having increased anxiety. Second attempt BP 180/120 HR ~110. No difficulty breathing, diaphoresis, pallor or urticaria noted. Oropharynx and tongue remained unchanged. Patient was clearing throat with increased frequency and breathing shallowly and fast. Anxiety present. No stridor noted, LS clear bilaterally, no urticaria noted. Notified pt that 911 was being called for evaluation. ~1306 BP 180/125 HR 110?s. Pt reporting increased difficulty breathing. I discussed the use of epinephrine and the risks with an elevated BP and HR. Pt stated ?do you want to use mine or yours.? Pt carries an epi pen for anaphylaxis from food allergies and has had to use it in the past. I asked the pt if she was sure she wanted epi and she stated ?yes?. No stridor noted, LS clear bilaterally, no urticaria noted, no diaphoresis, A&O, still clearing throat and taking shallow breaths. 0.3mg of epinephrine administered by RN via pt?s own pen in the left lateral thigh. EMS arrived ~ 3 minutes after administration of epinephrine. EMS evaluated patient and discharged her at the location. Patient remained at location for ~ 15 more minutes with RN at her side. She stated her throat was starting to feel better. Throat clearing decreased. Smiling and conversing with no distress noted. She walked out of the location in stable condition.

Other Meds:

Current Illness:

ID: 1761715
Sex: F
Age: 51
State: GA

Vax Date: 09/06/2021
Onset Date: 09/06/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1761716
Sex: F
Age: 57
State: MN

Vax Date: 02/24/2021
Onset Date: 10/01/2021
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:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Tested positive for COVID 10/1/21 after being fully vaccinated.

Other Meds:

Current Illness:

ID: 1761717
Sex: F
Age: 72
State: GA

Vax Date: 09/14/2021
Onset Date: 09/14/2021
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: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1761718
Sex: F
Age: 31
State: WA

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: Patient received Pfizer booster shot accidentally after receiving 2 dose series with Moderna. Patient was not eligible to receive Pfizer booster shot. No adverse reactions occurred.

Other Meds:

Current Illness:

ID: 1761719
Sex: F
Age: 18
State: NH

Vax Date: 06/01/2021
Onset Date: 07/01/2021
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: LA

Lab Data: Lumbar Puncture Electromyelography MRI

Allergies: NKA

Symptom List: Pain in extremity

Symptoms: Patient developed difficulty swallowing and then difficulty speaking in July of this year. She had multiple medical visits for this and saw a neurologist for extensive workup. In September, she developed lower extremity weakness which progressed to upper extremity weakness. Her weakness worsened, and progressed to include difficulty breathing, for which she was intubated. After intubation, the patient was diagnosed with Myasthenia Gravis. After several days of treatment with IVIG, her strength improved and she was able to be extubated.

Other Meds:

Current Illness:

ID: 1761720
Sex: F
Age: 56
State:

Vax Date: 09/16/2021
Onset Date: 09/30/2021
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:

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

Symptoms: Intestinal upset - diarrhea/constipation alternately. Migraine headache, nausea, fatigue and injection site pain.

Other Meds:

Current Illness: Head cold

ID: 1761721
Sex: M
Age: 5
State: FL

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

Lab Data:

Allergies:

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

Symptoms: Vomiting, diarrhea

Other Meds:

Current Illness:

ID: 1761722
Sex: F
Age: 37
State: FL

Vax Date: 03/15/2021
Onset Date: 04/12/2021
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: Confirmed Shingles, my Dr's office prescribed cortizone and ibuprofen but after the reaction increased they ordered steroid tablets to calm it down and recommended to continue with the cortizone and keep skin well moisturized.

Allergies: None

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

Symptoms: Adverse event: I had shingles one week after I received my first shot Actions: After the second day to have the first reactions I set up an appointment with my family doctor and when I went they told me that I had shingles as a reaction. Outcome; - Originally had 4 shingles on my face, after the 4-5 day was spread all over my face, neck (front and back), behind the ears, torso (including chest), back, (upper and lower), legs, glutinous, genitals, everywhere. They were many. - The front neck area was full of shingles, that they even connected with each other. - Swollen body More actions after spread; - Took cold showers and baths almost every hour for around 35 hrs. of constant pain - Use Cortizone, aloe vera, Calamine, Cooling itch relief spray and creams. - Did not sleep well for 2 nights - My body is all swollen and I needed anti-inflammatory, other than Ibuprofen. Started around 3/29 and ended in 4/28 - Still have marks all over the body and my front neck skin became flexible and aged significantly

Other Meds: None

Current Illness: None

ID: 1761723
Sex: U
Age: 12
State: GA

Vax Date: 09/06/2021
Onset Date: 09/06/2021
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: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1761724
Sex: F
Age: 68
State:

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

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

Lab Data:

Allergies: lisinopril

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: breakthrough C19 infection and hospitalization

Other Meds: cyclobenzaprine (FLEXERIL) 10 MG tablet Take 1 tablet by mouth 3 (Three) Times a Day As Needed for Muscle Spasms. Sleepiness precautions Fluticasone-Umeclidin-Vilant (Trelegy Ellipta) 100-62.5-25 MCG/INH inhaler Inhale 1 puff Daily. gabapen

Current Illness:

ID: 1761725
Sex: M
Age: 38
State: GA

Vax Date: 09/06/2021
Onset Date: 09/06/2021
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: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1761726
Sex: M
Age: 36
State: ND

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: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Throat tightness, headache, severe sweating

Other Meds:

Current Illness:

ID: 1761727
Sex: M
Age: 70
State: WI

Vax Date: 10/05/2021
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: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Patient was given a booster vaccine of Pfizer. His first 2 doses were Moderna. This was caught before the patient left the clinic. He was informed and was having no symptoms or signs of a reaction.

Other Meds:

Current Illness:

ID: 1761728
Sex: F
Age: 82
State: TN

Vax Date: 10/03/2021
Onset Date: 10/03/2021
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: RA

Lab Data:

Allergies: get allergy shots, can not take benadryl

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

Symptoms: patient had red rash going down arm that she said showed up the day she got her flu vaccine. it did not hurt but it was warm to the touch still even 2 days later. she did mention that she also had an allergic reaction to her covid shot she got this year as well but has never had that reaction to a flu shot in the past. her doctor would not give her her allergy shot today because of the rash

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am