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: 1762190
Sex: F
Age: 54
State: FL

Vax Date: 04/14/2021
Onset Date: 04/28/2021
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: 05/10/2021 Ophthalmology Evaluation: alternating esotropia, imaging ordered. 05/19/2021 Neurology Evaluation: Right 6th nerve palsy. CT Brain WNL MRI Brian with and without contrast, no acute intracranial abnormality. Foci of T2 flair hyperintensity within the right frontal subcortical white matter, nonspecific. All tests below were WNL: Striated muscle ab with reflex to titer Acetyl Choline receptor modulating ab ESR CRP Musk ab CBC WNL BMP WNL except for glucose 105 Ophthalmology:

Allergies: NKDA

Symptom List: Dysphagia, Epiglottitis

Symptoms: Right 6th nerve palsy 2 wks post vaccination, Neuro Evaluation

Other Meds: Omeprazole 20 mg daily Rosuvastatin 10 mg daily

Current Illness:

ID: 1762191
Sex: F
Age: 30
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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: Blood tests, fecal tests, ekg tests, colonoscopy & endoscopy. 24h blood pressure holter. Platelet tests. Multiple trips to the ER. Doctors don't find unusual results in tests. Endoscopy seemed to show infection but results of biopsy turn out normal.

Allergies: No

Symptom List: Anxiety, Dyspnoea

Symptoms: Weakness dizziness chills confusion irritability fever muscle aches back ache headache neck pain fatigue. About a month after the 2nd dose of the vaccine I also experienced unusual symptoms (symptoms which are not regular for me, I have never experienced such symptoms before) including blood clots on legs, behind knee and by my ankle. Unexplained exhaustion and chest pain lasting for over a month. Diarrhea lasting on a constant basis for 3 months, which later calmed down and became fluctuations between constipation and diarrhea- lasting until today.

Other Meds: No

Current Illness: No

ID: 1762192
Sex: F
Age: 15
State: CA

Vax Date: 09/25/2021
Onset Date: 09/25/2021
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: LAB WORK ONLY 09/29/2021 URINE TEST 09/29/2021 EVERYTHING WAS NORMAL

Allergies: EGGS, PEANUTS

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

Symptoms: MY DAUGHTER STARTED WITH ARM PAIN PULSING ON VACCINE SITE A FEW HRS AFTER RECEIVING THE VACCINE. SHECONTINUED LIKE THAT FOR THE REAT OF THE DAY. ON SUNDAY HER ARM WAS STILL SORE AND ARM PAIN HAD RADIATED TO LEFT UNDERARM. PULSING WAS STIILL PRESENT, BUT NOW IT WAS RADIATING TO LOWER ARM, TO THE ELBOW. ON MONDAY SHE WAS STILL COMPLAING OF PAIN AND SHE WAS NOW FEELING A KIND OF VIBRATION ON HER ELBOW AREA. IT WAS CONTINIOUSLY, IT WOULDN'T STOP. TUESDAY SHE WOKE UP WITH A STRONGER VIBRATION FEELING ON HER ARM, NOT JUST THE ELBOW AREA. BY THE EVENING HER ARM WAS HAVING A TIC/ UNCONTROLABLE SHAKING. WEDNESDAY HER ARM WAS SHAKING UNCONTROLABLY AND NOW IT WAS VERY NOTICIBLE. THAT IS WHEN I TOOK HER TO THE ER.

Other Meds: NONE

Current Illness: NONE

ID: 1762193
Sex: F
Age: 66
State: MD

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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: The patient developed cellulitis. Warm, redness and fever that radiated down her arm.

Other Meds:

Current Illness:

ID: 1762194
Sex: F
Age: 34
State: IN

Vax Date: 09/29/2021
Onset Date: 09/30/2021
Rec V Date: 10/05/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Bad back and neck pain. Right deltoid muscle pain still after 6 days

Other Meds:

Current Illness:

ID: 1762195
Sex: F
Age: 44
State: IL

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

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

Lab Data:

Allergies: N/A

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

Symptoms: Patient reported cramping and a ruptured ovarian cyst post vaccination

Other Meds: N/A

Current Illness:

ID: 1762196
Sex: F
Age: 36
State: MN

Vax Date: 01/27/2021
Onset Date: 10/01/2021
Rec V Date: 10/05/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Employee Health Services was notified that employee was Positive for COVID-19 10/02/2021, MDH requires us to report to VAERS breakthrough cases.

Other Meds:

Current Illness:

ID: 1762197
Sex: F
Age: 30
State: CA

Vax Date: 08/17/2021
Onset Date: 08/24/2021
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: bloodwork was taken -

Allergies: Propofol; ASA's; Cephalexin; Codeine; Mesalamine; Aspirin; Sulfas; Amoxicillin; Doxycycline

Symptom List: Pharyngeal swelling

Symptoms: A week after the dose, I got a cholangitis infection in liver: Increased nausea and pain and fever. Increased jaundice and so I contacted the doctor - teleheath visit with Hematologist; had labs drawn; elevated Liver enzymes and treated with Cipro Antibiotic. The antibiotic helped with the symptoms. Has recovered from the acute infection. This was something that happened each dose of the vaccination but I didn't realize the correlation to the Liver until the 3rd time.

Other Meds: Multivitamin; Calcium supplement; Alopurinol; Mercaptopurine; Gabapentin; Hydroxyzine; Zofran

Current Illness: no

ID: 1762198
Sex: F
Age: 61
State: KY

Vax Date: 02/07/2021
Onset Date: 08/16/2021
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: Negative for COVID19

Allergies: none

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: I woke up with a sore throat, slight cough, stuffy nose. I contacted my doctor to be tested, even though the sore throat seemed like drainage. My husband had cold symptoms too and felt worse. We both got tested. I was negative for the C. Virus but my husband tested positive. I tested 6 days later when they released him and was still negative in my Covid test.

Other Meds: Statin, Vitamin D, Vitamin C, Iron, Calcium, multi-vitamin, flaxseed

Current Illness: none

ID: 1762199
Sex: M
Age: 50
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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1762200
Sex: M
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: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1762202
Sex: F
Age: 56
State: IA

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: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: patient received 4 doses of COVID vaccine. dose 1-2 back in December and January. received a moderna doe in March and we administered the 3rd Pfizer (4th total) dose 9/30/21 unaware of the moderna dose.

Other Meds:

Current Illness:

ID: 1762203
Sex: F
Age: 69
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1762204
Sex: F
Age: 60
State: MI

Vax Date: 04/07/2021
Onset Date: 04/08/2021
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: Fever of 102.5 for about 18 hours, did not respond to Tylenol. Post herpatic neuralgia in head for about 72 hours after vaccine. Missed one day of work because of high fever.

Other Meds:

Current Illness:

ID: 1762205
Sex: F
Age: 44
State: DC

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

Lab Data: None

Allergies: Shrimp Almonds

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

Symptoms: Had chills/fever and was very, very tired all day on 10/2...unable to perform regular activities. Headache and slight tiredness (no fever/chills) on 10/3. Redness and swelling of injection started 10/3 and continue...but redness and swelling is typical for me with most shots. Notable that I received the flu shot on the same day, in opposite arm.

Other Meds: Pulmicort Inhaler Allegra Flonase Systane Moisturizing Eye Drops Vitafusion Women's Multivitamin

Current Illness: None

ID: 1762206
Sex: M
Age: 33
State: MN

Vax Date: 04/05/2021
Onset Date: 09/30/2021
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: Cats. Pollen.

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

Symptoms: I got kidney stones. I went to the ER that morning and they did a CT scan, as well as draw blood and urine test. They gave me pain meds and told me I have to wait until it passes. As I noted on the app, I don't think it is related to the shot, but it is a major enough event to document in case there is a connection.

Other Meds: Zertec. Flonase.

Current Illness:

ID: 1762207
Sex: M
Age: 69
State: FL

Vax Date: 09/27/2021
Onset Date: 09/28/2021
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:

Allergies:

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

Symptoms: I developed a rash on my right shoulder that has spread to my neck and upper arm area. Started on that Tuesday after the vaccine on Monday. Progressively got worse. Went to my dermatologist on Monday October 4th and was diagnosed with shingles. Dr said was likely an effect from the stress of the flu vaccine on my body. I am not medicating for the shingles.

Other Meds:

Current Illness:

ID: 1762208
Sex: M
Age: 23
State:

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

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: myocarditis, elevated trop - hospitalization 10/5/2021- current

Other Meds:

Current Illness:

ID: 1762209
Sex: F
Age: 58
State: TX

Vax Date: 09/22/2021
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: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Neuralgia left groin area to left buttock on October 2, 2021. On October 5, 2021 morning red, itchy, hot, rash on left groin, mons pubis, and left buttock. Diagnosed with Shingles.

Other Meds: Synthroid, Crestor, Aspirin, Estrogen patch, Estring

Current Illness: None

ID: 1762210
Sex: F
Age: 66
State: IN

Vax Date: 09/17/2021
Onset Date: 09/18/2021
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: no

Allergies: no

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

Symptoms: Arm became very large and hurtful. Since then she has become dizzy.

Other Meds: cymbalta and wellbutrin

Current Illness: no

ID: 1762211
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: 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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1762212
Sex: F
Age: 75
State: IN

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: none

Allergies: egg yolk

Symptom List: Unevaluable event

Symptoms: Soreness in arm where shot given. The next day, extreme fatigue that lasted throughout the day.

Other Meds: carvedilol, isosorbide, losartan, 80 mg aspirin, vitamin D,

Current Illness: none

ID: 1762213
Sex: F
Age: 83
State: CT

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

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

Lab Data:

Allergies:

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

Symptoms: Patient stated that her arm was very sore and swollen - she called the pharmacy and informed us of this approximately 4 days after the vaccines were administered

Other Meds: Acyclovir 200mg Metoprolol 50mg ER Alendronate 70mg KCl 10 MEQ Furosemide 20mg

Current Illness:

ID: 1762214
Sex: M
Age: 45
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: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Fever, Chills, Body aches

Other Meds:

Current Illness:

ID: 1762215
Sex: M
Age: 32
State: UT

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: SYR
Vax Site: LA

Lab Data: Vitals taken several times.

Allergies: None known

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient reported he was going to "blackout." He was conscious and able to answer all questions correctly. Patient moved to medical; then to the infirmary for further care. In the infirmary, under the care of a doctor, patient received 1.5L of NS, and low-flow O2 nasal cannula at 2L/min. Patient was bradycardic and hypotensive initially. After the treatment, (about 3 hours), patient felt much better and vitals were with in normal limits. Patient never reported any typical allergic reactions, such as airway swelling or difficulty breathing.

Other Meds: Clindamycin, Ibuprofen

Current Illness: None known

ID: 1762216
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: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1762217
Sex: F
Age: 69
State: MI

Vax Date: 01/29/2021
Onset Date: 08/15/2021
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: xrays found all of these that i did not have before

Allergies: niacin,avelox,latex CTdye

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: nodules inleft arm ,nodule in throid, nodule in sleen

Other Meds: metformin,glimepiride,losartan,topiramate,lansoprasole,D3,omega3acid,depakote,claritin,januvia,rosuvstatin, levalbuterol inhaler , asmanex inhaler

Current Illness: no

ID: 1762218
Sex: F
Age: 62
State: FL

Vax Date: 09/15/2021
Onset Date: 09/16/2021
Rec V Date: 10/05/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Generalized weakness, fatigue, malaise, paresthesia, arm pain x 3 weeks

Other Meds:

Current Illness:

ID: 1762219
Sex: F
Age: 63
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: RA

Lab Data:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1762220
Sex: M
Age: 61
State: NY

Vax Date: 09/08/2021
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: RA

Lab Data: eye dilated, puff test, and all basic eye tests 9/28/21. retinal specialist did a sonogram and repeat of basic eye tests, 09/29/21. retinal specialist did a sonogram and basic eye test again. scheduled for an exam on 10/21/21 to see if blood has cleared or will have surgery

Allergies: none

Symptom List: Nausea

Symptoms: loss of vision in left eye began on 9/28/21. Went to ophthalmologist on 9/28/21 . He sent me to a retinal specialist on on 9/29/21. returned to retinal specialist on 10/05/21. waiting for blood to clear from left eye. Until blood clears will not know if it is an artery, vein, blood clot, or a tear.

Other Meds: multi-vitamin

Current Illness: none

ID: 1762221
Sex: F
Age: 29
State: MN

Vax Date: 04/30/2021
Onset Date: 10/02/2021
Rec V Date: 10/05/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Tested positive for COVID 10/2/21 after being fully vaccinated.

Other Meds:

Current Illness:

ID: 1762222
Sex: F
Age: 77
State: NV

Vax Date: 02/25/2021
Onset Date: 08/10/2021
Rec V Date: 10/05/2021
Hospital: Y

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

Lab Data:

Allergies: NKA

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

Symptoms: Progressive weakness poor appetite and falling HISTORY OF PRESENT ILLNESS:Patient is a 77 y.o. female with past medical history of peripheral artery disease, oxygen dependent COPD, hypertension and depression, who presents to the Emergency Department with chief complaint of as mentioned above. The patient reportedly has been progressively ill for about a week. Reportedly her husband brought her in by private vehicle to the ambulance bay tonight due to her declining condition. Husband has left by the time I interviewed the patient. Reportedly patient was reluctant to come to the emergency department. Her emergency evaluation showed marked abnormalities including signs of sepsis with a high fever, marked leukocytosis and lactic acidosis. In addition she tested positive for Covid and was noted to be anemic and in acute renal failure with heme positive stools. Intent was to transfer the patient to a higher level of care for critical care services, however all area hospitals have no bed availability so the patient is being admitted in the ICU here. The patient states she does not feel well. She has mild shortness of breath. She has had very poor appetite and has been weak. She said she is fallen several times this week. She has had some mild abdominal pain and also describes some mild dysuria. She is unaware that she has had a fever. She said she has been drinking water. She said she has had some diarrhea but denies seeing any blood in her stool and her stool has not been particularly black.

Other Meds: levothyroxine (SYNTHROID) 100 MCG Tab traZODone (DESYREL) 50 MG Tab escitalopram (LEXAPRO) 20 MG tablet atorvastatin (LIPITOR) 80 MG tablet

Current Illness: COPD (chronic obstructive pulmonary disease) Insomnia Hypothyroidism Overview ICD-10 transition Dyslipidemia Ulcerative colitis . Spinal stenosis, lumbar Altered mental status Essential hypertension CKD (chronic kidney disease) stage 3, GFR 30-59 ml/min Peripheral vascular disease . Nephrolithiasis Hydronephrosis . GI bleed Elevated troponin A-fib Former smoker Alcohol abuse, daily use Acute-on-chronic kidney injury . Elevated LFTs Lactic acidosis Hyponatremia . Hyperkalemia Thrombocytosis Presence of other vascular implants and grafts Nonrheumatic aortic valve stenosis

ID: 1762223
Sex: F
Age: 68
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: RA

Lab Data:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1762224
Sex: M
Age: 32
State: TX

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

Lab Data: None

Allergies: NA

Symptom List: Tremor

Symptoms: 11$0am Patient completed getting vaccine and walked to Post observation. Patient sat down and right after he sat down, he immediately felled head first on the floor. Nurse sat patient up and vital signs were taken. AOX3. B/P 120/78. P86. Patient was cold, clammy and sweating. Assess patient noted left bruise on head, posterior left side abrasion of head. Pt. stated that he has not eaten today. History of fainting. Pt. continued to sit on floor and evaluated for additionally twenty minutes. Gave patient protein bars and water. Pt. stood up upon completed time and states he will make appointment with doctor.

Other Meds: NA

Current Illness: NA

ID: 1762225
Sex: F
Age: 38
State:

Vax Date: 01/13/2021
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: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: PATIENT HAD PFIZER COVID VACCINE ON 01/13/2021 and 02/03/2021, AND TESTED POSITIVE TO COVID.

Other Meds:

Current Illness:

ID: 1762226
Sex: F
Age: 72
State: OK

Vax Date: 09/16/2021
Onset Date: 09/18/2021
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: No labs or tests as of yet. My primary care doctor wanted me to go to the hospital for an EKG but am hesitant to go because that is where the Covid is. I've know to many people who have gone in healthy and come out with COVID. Advised my Thyroid doctor of my problem but she referred me back to my Primary Care doctor. Problem still persists but I think previous prescriptions are helping. Still plan a doctor appointment of consultation.

Allergies: Lisinopril - dizziness and blackouts Propranolol - strong heart palpitations, squeezing of chest, cannot move, heart attack feelings, cannot breath well

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

Symptoms: strong heart palpitations beginning the evening of the 2nd day after vaccination, weakness, some dizziness, sore arm at injection sight, lots of tightness in chest lots of , heaviness in chest, tenderness at injection sight.. pain across shoulders from left arm across shoulders to right arm and shoulder happened on the 8th day after. The sixth day left arm became stiff in the morning. My current prescriptions have helped me get thru the day with little palpitations, but they come back in early evening and some during the night.

Other Meds: Prescriptions: Atenolol 25mg 1 and ? pill per day Amlodipine Besylate 2.5mg ? pill per day Atorvastatin Calcium 80 mg 1 pill per day Methimazole 5mg 1 and ? pill per day Vitamins: Bone Up ? 6 capsuls per day supports Bone density and provi

Current Illness: no other illness

ID: 1762227
Sex: M
Age: 24
State: MA

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

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

Lab Data:

Allergies: None

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

Symptoms: Patient received second dose of murderer vaccine on October 1. That night he developed low-grade fevers, chills, body aches, which resolved after 2 days. However on the morning of October 5, he woke up with acute onset chest pain. He presented to the hospital with persistent chest pain and significant troponin elevation. EKG with nonspecific findings. Echocardiogram is still pending. Chest pain resolved spontaneously while in the emergency department. Awaiting echocardiogram and cardiac MRI results.

Other Meds: None

Current Illness: None

ID: 1762228
Sex: F
Age: 76
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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1762229
Sex: F
Age: 24
State: PA

Vax Date: 08/20/2021
Onset Date: 08/24/2021
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: ALLERGY TO BACTRIM ANTIBIOTIC

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

Symptoms: THE NEXPLANON BIRTH CONTROL STOPPED MY PERIOD UNTIL I GOT VAXED AND NOW I HAVE IT AWFULLY LIKE IM NOT EVEN ON BIRTH CONTROL

Other Meds: NEXPLANON BIRTH CONTROL

Current Illness: N/A

ID: 1762231
Sex: M
Age: 73
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: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1762232
Sex: F
Age: 66
State: OH

Vax Date: 03/17/2021
Onset Date: 04/15/2021
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: EKG and echocardiogram done late April after symptoms began. Repeat echo and related blood work done upon admission to hospital May 3, 2021. Angiojet removal of heart clots done May 4.

Allergies: thimerosal and seasonal allergies

Symptom List: Pain in extremity

Symptoms: Extreme shortness of breath over several days about 3 weeks after vaccine. Blood clots found in rt calf, lungs and heart. Anticoagulants administered and heart clots removed mechanically. Outcome good.

Other Meds: metformin and glimperide

Current Illness: none

ID: 1762233
Sex: F
Age: 59
State: WA

Vax Date: 09/01/2021
Onset Date: 09/02/2021
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: None

Allergies: Sulfa; topical thimerasol; melons

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

Symptoms: I woke up at 4am on 9/2/2021 with a severe headache. Over the next 2-3 hours I developed head to toe, global body aches. I also suffered extreme fatigue and spent 21 of the next 24 hrs in bed, sleeping.

Other Meds: Effector XR 150mg qd; Micardis 80mg qd; HCTZ 10mg qd; Singulair 20mg qd; Eloquis 10mg bid; Fish Oil 1400mg qd; Quercetin/Zinc qd: Vit D 5000mg qd; Vit C 1200mg qd; Calcuum citrate 1000mg qd; Women's formula multivitamin qd; Ceterizine qd;

Current Illness: None

ID: 1762234
Sex: M
Age: 67
State: WV

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

Lab Data:

Allergies:

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

Symptoms: The patient was given a fourth dose of Pfizer vaccine. The patient had received a booster dose for being immunocompromised on 9/24 but the facility didn't have it documented so they requested us to given him his booster today 10/5. The nurse practitioner realized later that day that he had already received a booster dose and contacted us to let us know. The patient is tolerating well so far.

Other Meds:

Current Illness:

ID: 1762235
Sex: M
Age: 47
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1762237
Sex: F
Age: 19
State: TN

Vax Date: 09/03/2021
Onset Date: 09/04/2021
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: X-ray

Allergies: Dilated pain medication

Symptom List: Vomiting

Symptoms: Nausea and vomiting for 7 days straight, fever of 102 for 3 days, extreme chills and sweats to the point of vomiting more, headaches for all 7 days, went to ER on day 4 for dehydration and vomiting doctor took X-ray and gave nausea medicine.

Other Meds: N/A

Current Illness: N\A

ID: 1762238
Sex: M
Age: 11
State: WI

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: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: N/A

Allergies: NONE PER PARENT

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: APPOINTMENT MADE AND CONSENT / QUESTIONNAIRE FILLED OUT BY PARENT USING A DATE OF BIRTH. INSURANCE DID NOT REJECT FOR INCORRECT DOB AND COVID VACCINE WAS ADMINISTERED TO 11 YEAR OLD PT.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1762239
Sex: F
Age: 19
State: NY

Vax Date: 04/20/2021
Onset Date: 04/25/2021
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: n/a, I am a virgin so I knew that I wasn't pregnant. It's not unusual for me to miss a period but to miss 3 was definitely not normal. I was in the process of looking for a gynecologist in the area when I finally started my period. I didnt get any tests taken.

Allergies: penacillin

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

Symptoms: Missed period/ delayed menstrual cycle for 3 months. one long 20 day period/ menstruation. Also development on new nosebleeds.

Other Meds: ecitalopram, vivance, unithroid

Current Illness:

ID: 1762240
Sex: F
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: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1762241
Sex: F
Age: 51
State: WI

Vax Date: 09/14/2021
Onset Date: 09/15/2021
Rec V Date: 10/05/2021
Hospital:

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

Lab Data:

Allergies: NA

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

Symptoms: Really bad Chills, body aches, Terrible headache pain

Other Meds: NA

Current Illness: NA

ID: 1762242
Sex: M
Age: 50
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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am