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: 1762139
Sex: F
Age: 54
State: CA

Vax Date: 08/20/2021
Onset Date: 08/20/2021
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: AZTHROMYCIN & SULFA DRUGS

Symptom List: Dysphagia, Epiglottitis

Symptoms: PATIENT RECEIVED THE VACCINE FROM EITHER LOT # 024C21A OR # 007C21A. IT IS NOT KNOWN WHICH LOT. BOTH LOTS WERE OUT OF THE FREEZER FOR 4 TO 18 DAYS MORE THAN THE RECOMMENDED 30 DAYS. MODERNA EXPECTS VACCINES TO HAVE REMAINED SUFFICIENTLY EFFICACIOUS. PATIENTS DID NOT HAVE ANY NEGATIVE OUTCOMES SO FAR..

Other Meds: UNKNOWN

Current Illness: NONE

ID: 1762140
Sex: M
Age: 73
State: NJ

Vax Date: 09/19/2021
Onset Date: 09/19/2021
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:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1762141
Sex: M
Age: 46
State: MA

Vax Date: 07/23/2021
Onset Date: 08/01/2021
Rec V Date: 10/05/2021
Hospital: Y

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

Lab Data: COVID 19 PCR 7/29/21 Positive 7/29/21 - CXR with diffuse b/l mixed interstitial alveolar infiltrates 7/29/21 - CTA extensive B/L ground glass opacities

Allergies: Pencillin

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

Symptoms: Patient developed ARDS with ICU admission (initial presentation at outside hospital and then transferred to another medical facility

Other Meds: None

Current Illness: Illness started day after J&J vaccine.

ID: 1762142
Sex: M
Age: 48
State: CA

Vax Date: 08/20/2021
Onset Date: 08/20/2021
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: None

Allergies: NKDA

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient received the vaccine from either lot #024C21A or #007C21A. It is not known which lot. Both lots were out of the freezer for 4 to 18 days (more than the recommended 30 days). Moderna expects vaccines to remain sufficiently efficacious. Patients did not have any negative outcomes so far.

Other Meds: Unknown

Current Illness: None

ID: 1762143
Sex: F
Age: 74
State: NJ

Vax Date: 09/19/2021
Onset Date: 09/19/2021
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 erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1762144
Sex: M
Age: 25
State: CA

Vax Date: 08/20/2021
Onset Date: 08/20/2021
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

Allergies: NKDA

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

Symptoms: PATIENT RECEIVED THE VACCINE FROM EITHER LOT # 024C21A OR # 007C21A. IT IS NOT KNOWN WHICH LOT. BOTH LOTS WERE OUT OF THE FREEZER FOR 4 TO 18 DAYS MORE THAN THE RECOMMENDED 30 DAYS. MODERNA EXPECTS VACCINES TO HAVE REMAINED SUFFICIENTLY EFFICACIOUS. PATIENTS DID NOT HAVE ANY NEGATIVE OUTCOMES SO FAR..

Other Meds: UNKNOWN

Current Illness: NONE

ID: 1762145
Sex: F
Age: 37
State: OR

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

Lab Data:

Allergies: none

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: About an hour after the vaccine my tongue became swollen, numb and I lost my sense of taste

Other Meds: none

Current Illness: none

ID: 1762146
Sex: F
Age: 51
State: CA

Vax Date: 08/20/2021
Onset Date: 08/20/2021
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: NONE

Allergies: PCN

Symptom List: Pharyngeal swelling

Symptoms: PATIENT RECEIVED THE VACCINE FROM EITHER LOT # 024C21A OR # 007C21A. IT IS NOT KNOWN WHICH LOT. BOTH LOTS WERE OUT OF THE FREEZER FOR 4 TO 18 DAYS MORE THAN THE RECOMMENDED 30 DAYS. MODERNA EXPECTS VACCINES TO HAVE REMAINED SUFFICIENTLY EFFICACIOUS. PATIENTS DID NOT HAVE ANY NEGATIVE OUTCOMES SO FAR..

Other Meds: UNKNOWN

Current Illness: NONE

ID: 1762148
Sex: F
Age: 59
State: MN

Vax Date: 01/23/2021
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:

Allergies: none

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Sore throat, chills, fatigue, runny nose. 7 days into illness-rash on torso, starting on 9/27/21

Other Meds: multi vitamins

Current Illness: none

ID: 1762149
Sex: F
Age: 39
State: MN

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

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

Lab Data: 10/5 SARS/COV-2, NAAT, Positive

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Breakthrough COVID

Other Meds:

Current Illness:

ID: 1762150
Sex: M
Age: 38
State: CA

Vax Date: 08/20/2021
Onset Date: 08/20/2021
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: NKDA

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

Symptoms: PATIENT RECEIVED THE VACCINE FROM EITHER LOT # 024C21A OR # 007C21A. IT IS NOT KNOWN WHICH LOT. BOTH LOTS WERE OUT OF THE FREEZER FOR 4 TO 18 DAYS MORE THAN THE RECOMMENDED 30 DAYS. MODERNA EXPECTS VACCINES TO HAVE REMAINED SUFFICIENTLY EFFICACIOUS. PATIENTS DID NOT HAVE ANY NEGATIVE OUTCOMES SO FAR..

Other Meds: UNKNOWN

Current Illness: NONE

ID: 1762151
Sex: M
Age: 46
State: HI

Vax Date: 06/01/2021
Onset Date: 08/03/2021
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: COVID hospitalization after vaccination.

Other Meds:

Current Illness:

ID: 1762152
Sex: F
Age: 38
State: MA

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:

Allergies: Dairy Allergy-Egg Sensitivity- hives

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

Symptoms: Angioedema of right eyelid, approximately 9hrs post injection of vaccine

Other Meds: Synthroid 125mg daily po

Current Illness: Hashimotos

ID: 1762153
Sex: M
Age: 31
State: CA

Vax Date: 08/20/2021
Onset Date: 08/20/2021
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: NONE

Allergies: NKDA

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

Symptoms: PATIENT RECEIVED THE VACCINE FROM EITHER LOT # 024C21A OR # 007C21A. IT IS NOT KNOWN WHICH LOT. BOTH LOTS WERE OUT OF THE FREEZER FOR 4 TO 18 DAYS MORE THAN THE RECOMMENDED 30 DAYS. MODERNA EXPECTS VACCINES TO HAVE REMAINED SUFFICIENTLY EFFICACIOUS. PATIENTS DID NOT HAVE ANY NEGATIVE OUTCOMES SO FAR..

Other Meds: UNKNOWN

Current Illness: NONE

ID: 1762154
Sex: F
Age: 75
State: NJ

Vax Date: 09/20/2021
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:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1762155
Sex: F
Age: 49
State: SC

Vax Date: 09/02/2021
Onset Date: 09/03/2021
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: Normal Lupus bloodwork on 10/1/21. All labs are normal.

Allergies: Body does not tolerate some antibiotics well (cipro, augmentim and others)

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

Symptoms: In addition to the normal side effects that lasted for several days for me, I also had significant increase in hair loss that began in the days after the vaccine and has continued to the present day (almost 5 weeks post injection); increased fatigue; joint pain and the feeling of swelling in joints and in particular hands and feet. This was a problem in the past with lupus but has not been an issue for many years and it just started again after the vaccine. I have not received the second injection yet due to these lingering symptoms

Other Meds: zyrtec, tumeric, multi vitamin, vitamin d, biotin, omega 3, fibercon, omeprazole, famitodine

Current Illness: none

ID: 1762156
Sex: F
Age: 66
State: OK

Vax Date: 09/01/2021
Onset Date: 10/05/2021
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: None to date

Allergies: No

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

Symptoms: I began to feel very nauseated and dizzy, headache and chills about 12 hours after receiving the PFIZER booster. I went to the restroom to regurgitate but couldn't and ended up fainting. I don't know how long I laid on the floor but came to and went back to bed. I have been dizzy since Oct 1 and it is now Oct 6. I also took a flu shot at the same time I got the Booster which I did not mark on your above form as I do not know the quadrivalent. I was able to get my shots at Health Clinic. I have never fainted in my life. The dizziness is bothersome to me and while it has lessened, it is concerning, and I hope it eventually subsides. I got sicker with this 3rd dose more so than the other 2 and I doubt I will take any more in the future. It's very scary to wake up on the floor after passing out, alone and wondering how you got there. I had a goose egg on the left side of my head for a couple of days, but it has gone down.

Other Meds: Metoprolol Losartan Amlodipine Atorvistatin

Current Illness: Arthritis

ID: 1762157
Sex: M
Age: 19
State: CA

Vax Date: 08/20/2021
Onset Date: 08/20/2021
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: NKDA

Symptom List: Ear pain, Hypoaesthesia

Symptoms: PATIENT RECEIVED THE VACCINE FROM EITHER LOT # 024C21A OR # 007C21A. IT IS NOT KNOWN WHICH LOT. BOTH LOTS WERE OUT OF THE FREEZER FOR 4 TO 18 DAYS MORE THAN THE RECOMMENDED 30 DAYS. MODERNA EXPECTS VACCINES TO HAVE REMAINED SUFFICIENTLY EFFICACIOUS. PATIENTS DID NOT HAVE ANY NEGATIVE OUTCOMES SO FAR..

Other Meds: UNKNOWN

Current Illness: NONE

ID: 1762158
Sex: F
Age: 96
State: FL

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

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: PATIENT HAD STATED THAT SHE HAD RECEIVED MODERNA AS A FIRST DOSE AND WAS DUE FOR THE SECOND DOSE, PATIENT COULD NOT FIND HER VACCINATION CARD, MODERNA VACCINE SECOND DOSE WAS ADMINISTERED, LATER THE CARD WAS FOUND AND IT INDICATED THAT SHE HAD RECEIVED PFIZER AS A FIRST DOSE, CDC WAS CONTACTED AND AS PER THEIR RECOMMENDATION NO OTHER DOSE WAS NEEDED, PATIENT WAS OBSERVED FOR THE TIME REQUIRED AND DID NOT HAVE ANY ADVERSE EVENT AFTER ADMINISTRATION OF THE VACCINE. PATIENT IS TO CONTACT CDC REGARDING FUTURE RECOMENDATION FOR ANY FURTHER REQUIRED DOSES.

Other Meds:

Current Illness:

ID: 1762159
Sex: F
Age: 43
State: CA

Vax Date: 10/01/2021
Onset Date: 10/02/2021
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: none

Allergies: none

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

Symptoms: On 10/2 the next day after receiving my pfizer booster vaccine, I experienced muscle pain, chills, joint pain, feeling unwell, swollen lymph nodes under my left arm (arm pit), left arm pain followed by numbness. It is now 10/5 and the left under arm swelling has not resolved and I continue to experience numbness in my left arm. I notified my doctor and I am waiting for a response.

Other Meds: iron gluconate daily vitamin melatonin

Current Illness: None

ID: 1762160
Sex: M
Age: 56
State: CA

Vax Date: 04/01/2021
Onset Date: 04/15/2021
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: CT scan 2 MRIs of head- clear bloodwork- showing signs of lupus

Allergies: none

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

Symptoms: After receiving the vaccine I initially started with having headaches. Those headaches intensified and became more regular through the May 2021. From the month of May till now the headaches have been 24/7. They are very intense ranging from a 4 to 9 pain level. Now I have a problem speaking, communicating, and remembering things. I also have body aches are that are 24/7 now. I am having trouble sleeping because of the intensity of the headaches when they come in the evening at night. I've seen multiple doctors and neurologists. My new doctor said it was possibly vaccine induced. I was prescribed Topamax for the headaches, but it isn't working. I have also tried over the counter medications, but those don't work either. I am scheduled to do a nerve test in two weeks.

Other Meds: Amlodipine 2.5mg 1xday Losartan 12.5 1xday

Current Illness: none

ID: 1762161
Sex: F
Age: 71
State: NJ

Vax Date: 09/20/2021
Onset Date: 09/20/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1762162
Sex: M
Age: 43
State: TX

Vax Date: 03/21/2021
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: LA

Lab Data: Pcr test positive

Allergies: None

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

Symptoms: Tested positive for covid August 28th. Stuffy head and headache and achy body

Other Meds: None

Current Illness: None

ID: 1762163
Sex: M
Age: 47
State: CA

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: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: VITALS ONLY

Allergies: BEE STING AS A CHILD

Symptom List: Injection site pain, Pain

Symptoms: PATIENT HAD FIRST PFIZER VACCINE 11:58A. AFTER ABOUT 15 MINUTES IN OBSERVATION, PATIENT STATED HIS THROAT WAS DRY. RN GAVE PATIENT WATER. MINUTES LATER, PATEINT SAID HE FELT LIKE IT WAS HARD TO SWALLOW. RN CALLED (12:15P) AND: 12:17P - PROCEEDED TO TAKE BP AND SPO2. VITALS 120/86, 96%, HR 92. 12:20P - RT ARRIVED 12:20P - 130/83, 97%, HR 92 12:21P - Doctor arrived 12:25P - TRANSDERRED TO ER PER doctor

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1762164
Sex: M
Age: 62
State: MT

Vax Date: 09/23/2021
Onset Date: 09/24/2021
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: PCN

Symptom List: Injection site pain, Menorrhagia

Symptoms: Pt describe that he had debilitating "kidney pain" for two days after recieving first dose of Moderna shot. He states that he nearly went to the ED because it was so intense.

Other Meds: albuterol, aspirin, Lipitor, ergocalciferol, flonase, gabapentin, protonix, potssium choloride, primidone, Pembrolizumab, heparin port flush

Current Illness: COPD, Neuropathy, PVD, heartburn

ID: 1762165
Sex: F
Age: 19
State: MI

Vax Date: 10/01/2021
Onset Date: 10/03/2021
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:

Allergies: None.

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

Symptoms: Magnets and coins stick near injection site.

Other Meds: None.

Current Illness:

ID: 1762166
Sex: M
Age: 79
State: NJ

Vax Date: 09/20/2021
Onset Date: 09/20/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1762167
Sex: F
Age: 81
State:

Vax Date: 05/19/2021
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:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series

Other Meds:

Current Illness:

ID: 1762168
Sex: F
Age: 5
State: ND

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: Injection site started to get red, firm and warm to touch the evening of 10/4/2021, mother took pictures, area was about 2 inches by 2 inches morning of 10/5/2021. As of 1540 on 10/5/2021 the area has become more swollen, still warm to the touch and red as well as approximately 6 inches by 6 inches. Pt reports some pain but is able to still play. Instructed mother to apply a cold/ice compress and childrens Benedryl to help with swelling as well as monitor it and if it continues to get worse then see the local clinic.

Other Meds:

Current Illness:

ID: 1762169
Sex: F
Age: 62
State: NJ

Vax Date: 09/20/2021
Onset Date: 09/20/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1762170
Sex: F
Age: 28
State: AZ

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

Lab Data:

Allergies: None

Symptom List: Injection site pain

Symptoms: Menstrual cycle much heavier than usual

Other Meds: None

Current Illness: Strep throat prescribed penicillin on 9/14/21

ID: 1762171
Sex: F
Age: 65
State: WI

Vax Date: 08/24/2021
Onset Date: 08/26/2021
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: Chest x-ray, CBC CMP, Covid testing 8/24 and 8/27.

Allergies: None

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

Symptoms: Fever, increased Sob. Labs and chest x-ray normal. Hypoxia. Treated with Z-pack and prednisone 40 mg qd x 5 days. 3 Days later, symptoms worsened, seen in ER and admitted with hypoxia. Treated with IV Prednisone, antibiotics.

Other Meds: Stiloto, Flovent, Prednisone, Duoneb, Norvasc, losartan, citalopram calcium/vit d

Current Illness: None

ID: 1762172
Sex: F
Age: 43
State:

Vax Date: 01/21/2021
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: RA

Lab Data:

Allergies:

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

Symptoms: PATIENT HAD PFIZER VACCINE DOSES ON 01/21/2021 and 02/11/2021, AND TESTED POSITIVE TO COVID.

Other Meds:

Current Illness:

ID: 1762173
Sex: F
Age: 62
State: CA

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:

Allergies: none

Symptom List: Tremor

Symptoms: Started with fever 99+, body aches, fatigue less than 8 hours after shot with symptoms lasting over 36 hours . Also started coughing about 10 hours after shot. Dry continuous cough still going on 3 weeks past the vaccine.

Other Meds: none

Current Illness: none

ID: 1762174
Sex: F
Age: 77
State: NJ

Vax Date: 09/19/2021
Onset Date: 09/19/2021
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:

Symptom List: Erythema, Pruritus

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1762175
Sex: M
Age: 42
State: WA

Vax Date: 07/08/2021
Onset Date: 07/08/2021
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: Tests ordered on 10/5 : echo, ekg, cmp

Allergies: lillys

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

Symptoms: Palpitations that lasted 1 week, have improved but were occurring prior to the vaccines. Patient states palpitations increased after vaccine

Other Meds: n/a

Current Illness: none

ID: 1762176
Sex: M
Age: 84
State: MA

Vax Date: 04/01/2021
Onset Date: 08/10/2021
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: LA

Lab Data: 8/10/21 - COVID PCR positive

Allergies: NKDA

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

Symptoms: Patient brought in by EMS after complaints of dizziness at home. A&O on arrival

Other Meds: aspirin, D3, diclofenac gel, docusate, Nexium, glimepiride, jardiance, levothyroxine, gabapentin, losartan, hctz, metoprolol, oxybutynin, Creon, Crestor, Senna, Januvia, Tamsulosin, venlafaxine metformin

Current Illness: unknown

ID: 1762177
Sex: F
Age: 55
State: MD

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

Lab Data:

Allergies: Penicillin

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: I went into epileptic shock after receiving the vaccine. I was taken to the hospital by ambulance and I do not remember anything else. I am swollen and my body is painful to touch and feels something is crawling inside of me. I have seen many doctors. I saw an allergist Dr. today. I do not have lot# to provide. I also have SOB off and on. I am not been able to sleep. I was prescribed some medication to sleep which helps temporally with little relief.

Other Meds: Took my regular medications

Current Illness:

ID: 1762178
Sex: F
Age: 74
State:

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 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: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series

Other Meds:

Current Illness:

ID: 1762179
Sex: M
Age: 48
State: MN

Vax Date: 01/12/2021
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: Employee Health Services is required per policy to report all breakthrough cases of COVID-19 post vaccination.

Other Meds:

Current Illness:

ID: 1762180
Sex: F
Age: 69
State: NJ

Vax Date: 09/19/2021
Onset Date: 09/19/2021
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: Pain in extremity

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1762181
Sex: M
Age: 45
State: PR

Vax Date: 09/14/2021
Onset Date: 09/18/2021
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: He made a medical visit to Doctor. The Doctor ordered a series of laboratories which have not yet obtained results. He has a follow up appointment tomorrow October 6,2021.

Allergies: NKA.

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

Symptoms: Patient reports experiencing the following symptoms in a period after vaccination of 4 days. Body heat. Itching throughout the body. Tiredness. Pain when ejaculating (the pain prevails for a period of one hour).

Other Meds: Aspirin; Ibuprofen

Current Illness: No.

ID: 1762182
Sex: F
Age: 53
State: AR

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: Fever, loss of taste and smell, left arm pain, hand numbness on left side

Other Meds:

Current Illness:

ID: 1762183
Sex: F
Age: 46
State: UT

Vax Date: 03/06/2021
Onset Date: 04/02/2021
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: Latex

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

Symptoms: I was menstruating when I went to receive the 1st dose. My period continued normally for that week. When I went back to receive the 2nd dose I should have been menstruating again but was not. It has now been 7 months and I have not had another period. Nothing else in my life has changed and I am NOT pregnant. I am also not experiencing any of the symptoms of Menopause.

Other Meds: Levoceterizine, famotadine, budesonide/fomoterol

Current Illness: None

ID: 1762184
Sex: M
Age: 68
State: NJ

Vax Date: 09/19/2021
Onset Date: 09/19/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1762185
Sex: F
Age: 42
State: CA

Vax Date: 07/24/2021
Onset Date: 07/25/2021
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: PCN, keflex, ranitidine, ketorolac, latex, shellfish

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Within 24 hours of vaccine, noted expected side effects of vaccine (mild soreness arm, fatigue, mild headache, low grade fever) but also noticed marked worsening of baseline dysautonomia, with HR to 120s and SBP to low 90s, dyspnea, orthostatic intolerance (whereas dysautonomia had been very well controlled at time of vaccine). Also noted surges of adrenaline and some irritability. Within 4-5 days, developed fevers to 101, sinus congestion, cluster headache with intense facial, jaw and teeth pain, and pervasive fatigue. These symptoms lasted for 8-9 days (possible URI vs vaccine side effect?; covid test neg), but despite resolution of discrete event, other symptoms continued to worsen. Cont'd. The tooth pain has never remitted, seems to be irreversible pulpitis in as many as 3 teeth, now likely needing root canal or extraction. Fatigue and dysautonomia worsened further over the subsequent 3 weeks with progressive loss of functional reserve consistent with a CFS/ME "crash" to point of mostly bedbound/difficulty doing ADLs/iADLs for 2-3 weeks, now still with significantly limited functional status over 8 weeks after vaccine (mostly housebound, dyspeic with iADLS, SBP dropping into low 80s). Not yet able to get second vaccine dose due to compromised functional status and unstable vital signs. Functional status remains far below pre-vax baseline. Also with intense bouts of retrosternal chest discomfort beginning 10 days after vaccine (attributed to CFS crash by PCP and workup deferred by PCP but unlike any other chest pain previously experienced and associated with marked sob even at rest/lying down, not overtly positional, nonpleuritic, not reproducible to palpation, associated with feeling of pounding heart/palpitations, often would awaken from sleep with discomfort) that lasted every day for over a week, almost all day, before resolving in the setting of multiple days of full bedrest. Pt not able to take NSAIDS, so no trial of anti-inflammatory in case of possible myocarditis. Conclusions: despite well-managed and improving CFS/ME and absent signs of dysautonomia prior to and at the time of vaccine, the vaccine seemed to trigger a functionally marked and debilitating CFS/ME 'crash' and functionally limiting dysautonomia (tachy, hypotension), moderate chest pain x 1+ weeks of unclear etiology (myocarditis not able to be ruled out), with enduring deficits almost 8+ weeks post-vaccine that limit self-care and preclude safe dosing of vaccine #2 given risk of further functional compromise and inability to care for self. Now, after 10 weeks, starting to have some improvement in dysautonomia and able to complete basic ADLs.

Other Meds: Naltrexone (low-dose), vit D, Vit A, iron, ca (low dose), Mg

Current Illness: CFS/ME, MCAS

ID: 1762186
Sex: F
Age: 41
State: IL

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: 1
Vax Route: IM
Vax Site: RA

Lab Data: None

Allergies: Acetaminophen, Aspirin, Ibuprofen, Shellfish, Gadolinium, Iron Sucrose. IV Contrast with Dye

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

Symptoms: Patient states after waiting 30 minutes after receiving vaccine she start to experience a headache and tingling to her lips. Patient states did is how she feels when she is about to have a reaction. APRN notified and informed LPN Nurse, to administer Diphenhydramine 25 mg capsule PO and to observe patient for 30 minutes more. After observing patient for 30 minutes, patient states tingling to lips subsided and only have a slight headache but is feeling better and is ok. APRN discharged patient and to follow up if needed. Patient verbalized understanding.

Other Meds: None

Current Illness: None

ID: 1762187
Sex: F
Age: 44
State: MN

Vax Date: 01/12/2021
Onset Date: 09/25/2021
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: 9/29 Home COVID test

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Breakthrough COVID

Other Meds:

Current Illness:

ID: 1762188
Sex: M
Age: 83
State: NJ

Vax Date: 09/19/2021
Onset Date: 09/19/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1762189
Sex: F
Age: 73
State: WA

Vax Date: 09/26/2021
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: RA

Lab Data: Not applicable

Allergies: Antibiotics

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

Symptoms: I experienced a herpes outbreak on my left hand (had it for about 13 years). It was an immune system reaction to the vaccine. My PCP confirmed that it was no doubt some inflammation or immune reaction to the vaccine. She prescribed medication to treat the adverse event.

Other Meds: I took my normal medications - Simvastatin and Levothyroxine.

Current Illness: No

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am