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: 1764667
Sex: F
Age: 56
State: MN

Vax Date: 10/04/2021
Onset Date: 10/05/2021
Rec V Date: 10/06/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Dysphagia, Epiglottitis

Symptoms: Fever and severe upper body aches/pain

Other Meds: lisinopril

Current Illness: none

ID: 1764668
Sex: M
Age: 72
State: GA

Vax Date: 02/03/2021
Onset Date: 08/12/2021
Rec V Date: 10/06/2021
Hospital: Y

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

Lab Data: 08/12/2021 PCR+ COVID-19 test; 08/31/2021 PCR+ COVID-19 test

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Asymptomatic breakthrough COVID-19 case. Hospitalized 8/30/2021 to 9/4/2021

Other Meds:

Current Illness:

ID: 1764669
Sex: M
Age: 22
State: SC

Vax Date: 10/01/2021
Onset Date: 10/04/2021
Rec V Date: 10/06/2021
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: POC CK-MD: 2.6 POC Myoglobin: 96.0 POC Troponin I: <0.05 Troponin I: 0.20 (H)

Allergies: Morphine

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

Symptoms: Patient awoke at 4:00 AM on October 4th with complaints of sharp, stabbing pain localized to the left side of his chest. No radiation of pain. Pain made worse with movement and deep inspiration. No fevers, cough, SOB, abdominal pain, nausea, vomiting, anosmia, aguesia. Played soccer the day prior.

Other Meds: No known meds

Current Illness: Major depressive disorder, anxiety

ID: 1764670
Sex: F
Age: 34
State: KY

Vax Date: 01/25/2021
Onset Date: 08/21/2021
Rec V Date: 10/06/2021
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: Tested Positive for Covid

Other Meds:

Current Illness:

ID: 1764671
Sex: M
Age: 29
State: DE

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 10/06/2021
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: n/a

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

Symptoms: Pt reported that he felt faint and found himself to be shaking approx 10 min after receiving vaccine; pt was brought back and placed on abed; EMS was activated and pt was transferred to nearest ER

Other Meds: n/a

Current Illness: n/a

ID: 1764672
Sex: F
Age: 83
State: OH

Vax Date: 05/04/2021
Onset Date: 10/05/2021
Rec V Date: 10/06/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: unknown

Other Meds:

Current Illness:

ID: 1764673
Sex: F
Age: 58
State: TX

Vax Date: 04/23/2021
Onset Date: 05/24/2021
Rec V Date: 10/06/2021
Hospital:

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

Lab Data: Blood work: nothing came back abnormal aside from slightly low iron

Allergies: No

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Everything started in the month of May. I would wake up in the morning and my arm had a tingling feeling like numbness and my arm muscle would contract on its own. I also had a feeling of pressure as if someone was squeezing my arm. My arm was also weak. It feels like it does not have the strength it had before. I am unable to open things. Each symptom would come and go every 3 minutes. It happened every day for 2.5 months before it went down to 3-4 times a week. Then in July it went down to every other day. In August it decreased to once a week. I went to a doctor but wasn?t given any medications for it. In September, everything died down. It was very sporadic I was unable to keep track. September has been the best moth so far because I noticed it dies down. I haven?t experienced an episode in 2 weeks. The weakness in my arm is still present. I tried using green rubbing alcohol and warm and cold compress interchangeably. This helped with the symptoms.

Other Meds: Blood pressure medication, thyroid medication and potassium (these are all long term. I have been on them for over 10 years)

Current Illness: No

ID: 1764674
Sex: M
Age: 46
State: NJ

Vax Date: 10/04/2021
Onset Date: 10/05/2021
Rec V Date: 10/06/2021
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: None

Symptom List: Pharyngeal swelling

Symptoms: The second evening after receiving the vaccine I have noticed a small, sore, inflamed lump near my collar bone on my left side which is the side I received the vaccine on.

Other Meds: Zyrtec, Multi-Vit., Vit. D, Vit. B, Red Yeast Rice, Fish Oil, Probiotic, Zync-Magnesium.

Current Illness: None

ID: 1764675
Sex: F
Age: 43
State: MN

Vax Date: 05/04/2021
Onset Date: 10/03/2021
Rec V Date: 10/06/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Tested PCR positive for COVID 10/3/21 after being fully vaccinated.

Other Meds:

Current Illness:

ID: 1764676
Sex: M
Age: 35
State: KY

Vax Date: 06/02/2021
Onset Date: 08/26/2021
Rec V Date: 10/06/2021
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: Tested Positive for Covid

Other Meds:

Current Illness:

ID: 1764677
Sex: M
Age: 62
State: SC

Vax Date: 04/13/2021
Onset Date: 04/14/2021
Rec V Date: 10/06/2021
Hospital: Y

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

Lab Data: hospital did a cat scan and found no bleeds, no sign of stroke and no UTI. 4/16/2021

Allergies: Penicillin

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

Symptoms: Pt woke up that morning and could not sit up, stand or walk.

Other Meds: Prescriptions

Current Illness: Difib/pacemaker surgery

ID: 1764678
Sex: M
Age: 64
State: CO

Vax Date: 10/06/2021
Onset Date: 10/06/2021
Rec V Date: 10/06/2021
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 two of the same vaccine - Pfizer dose 3 (booster). Patient intended to receive one COVID booster and one influenza vaccine, but after getting the first vaccine he sat down at another COVID vaccine table instead of the influenza table.

Other Meds:

Current Illness:

ID: 1764680
Sex: F
Age: 61
State: MN

Vax Date: 01/07/2021
Onset Date: 10/05/2021
Rec V Date: 10/06/2021
Hospital:

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

Lab Data: 10/5/21 SARS/COV-2, NAAT, Positive

Allergies:

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

Symptoms: Breakthrough COVID

Other Meds:

Current Illness:

ID: 1764681
Sex: F
Age: 13
State: TX

Vax Date: 09/17/2021
Onset Date: 10/03/2021
Rec V Date: 10/06/2021
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: CBC with mild elevation in percentage of eosinophils Normal CMP

Allergies:

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

Symptoms: Pruritic Scattered macular papular rash throughout the body

Other Meds:

Current Illness: Impetigo diagnosed 9-24-2021 treated with bactrim through 10-1-2021

ID: 1764682
Sex: F
Age: 52
State: MD

Vax Date: 06/23/2021
Onset Date: 07/20/2021
Rec V Date: 10/06/2021
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: Sulfa

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

Symptoms: Lump on Arm near injection sight of 2nd Moderna Covid 19 vaccination that appeared approximately 30 days after 2nd injection. While the arm does not feel like Covid Arm, each day it feels like I have had a shot given to me.

Other Meds: Zyrtec, Vitamin D, Lexapro, Losartin, Levythyroxine

Current Illness: No

ID: 1764683
Sex: F
Age: 29
State: KY

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 10/06/2021
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: None

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

Symptoms: Injection site swollen, red, itchy and painful to the touch. Redness has not went away it periodically will change between painful and itchy. So far its been a little over a week and been consistently.

Other Meds: Famotide, venlafaxine, labetalol

Current Illness: None

ID: 1764684
Sex: F
Age: 32
State: NY

Vax Date: 09/30/2021
Onset Date: 10/02/2021
Rec V Date: 10/06/2021
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: Diflucan Macrobid Bactrim

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

Symptoms: Starting the Thursday night of the date of administration I started feeling normal side effects reported such as headache, arm pain, and nauesa. However, starting on the Saturday after administration, my milk supply while breastfeeding my child began to decrease and has continued to do so since then. Nothing else has changed besides receiving the vaccine.

Other Meds: Pre- natal Vitamin Sunflower Lecithin

Current Illness: None

ID: 1764685
Sex: F
Age: 49
State:

Vax Date: 05/01/2021
Onset Date: 09/18/2021
Rec V Date: 10/06/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Pt got vaccinated then contracted COVID

Other Meds:

Current Illness:

ID: 1764686
Sex: F
Age: 35
State: WI

Vax Date: 09/01/2021
Onset Date: 09/30/2021
Rec V Date: 10/06/2021
Hospital:

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

Lab Data: 10/4 examined in urgent care

Allergies: none

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: diagnosed Pityriasis rosea widespread rash followed with extreme fatigue, chills, diarrhea,

Other Meds: aurovela 1.5mg acetaminophen 650mg

Current Illness: none

ID: 1764687
Sex: F
Age: 44
State: MO

Vax Date: 08/10/2021
Onset Date: 08/30/2021
Rec V Date: 10/06/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

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

Symptoms: One day prior to my second Covid shot I started feeling very off. I had major vertigo. I went to urgent care the morning or 8/31/21, the day I was to get my second shot, and was told I did have a double ear infection. I was given an antibiotic and was told I still could receive my second shot. I now an 5 weeks and 2 days from the start of the vertigo with no relief. I found that this could be a side effect of the Covid shot.

Other Meds: Sertraline 100Mg Enskyce .15mg

Current Illness: Found out 8/31 I did have an ear infection

ID: 1764688
Sex: M
Age: 27
State: NC

Vax Date: 08/01/2021
Onset Date: 08/05/2021
Rec V Date: 10/06/2021
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: Auditory test

Allergies: None

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

Symptoms: Sporadic episodes of vertigo. It started 3-4 days after vaccine. I went to ENT and they prescribed steroids for about a week or two. It is now 2 months after the shot and the vertigo has returned. I have been dizzy for the past 3 days. Am going to schedule another appt with ENT.

Other Meds: Adderall

Current Illness:

ID: 1764689
Sex: M
Age: 29
State:

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 10/06/2021
Hospital:

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

Lab Data: Moderna contacted, all handling details given, Moderna tested viability of vaccine lot beyond expiration and found it maintained the activity necessary to protect against Covid 19 at the time of administration.

Allergies:

Symptom List: Unevaluable event

Symptoms: Moderna first Dose Vaccine give 09/23/2021. Lot later found to have expired 09/22/2021. Moderna contacted, all handling details given, Moderna tested viability of vaccine lot beyond expiration and found it maintained the activity necessary to protect against Covid 19 at the time of administration. No adverse reactions related to this to patient found.

Other Meds:

Current Illness:

ID: 1764690
Sex: M
Age: 62
State: KY

Vax Date: 03/05/2021
Onset Date: 08/25/2021
Rec V Date: 10/06/2021
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: Tested Positive for Covid

Other Meds:

Current Illness:

ID: 1764691
Sex: F
Age: 40
State: TX

Vax Date: 06/26/2021
Onset Date: 08/08/2021
Rec V Date: 10/06/2021
Hospital:

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

Lab Data: None

Allergies: Penicillin

Symptom List: Injection site pain, Pain

Symptoms: Shortness of breath, Fatigue, Left side chest wall pain

Other Meds: Simvastatin, Methotrextate

Current Illness: None

ID: 1764692
Sex: F
Age: 65
State: OH

Vax Date: 06/04/2021
Onset Date: 06/08/2021
Rec V Date: 10/06/2021
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: Hydrocodone, Gadalivian, Insect Stings, Latex, Gluten

Symptom List: Injection site pain, Menorrhagia

Symptoms: Pt. states that after receiving the 2nd dose of Phizer 06/07/2021, started experiencing symptoms 06/08/2021 of Blood in the Urine, fever (100.5), ER visit recommended observation. 06/15/2021 rash across the face, scalp, and left arm. (Still continuing), Dermatologist Appt. 09/21/2021 recommended topical steroids. No Noted Primary visit.

Other Meds: Hydrochlorothiazide 12.5, Aspirin 81mg, Pepcid 21mg, Multi-Vitamin

Current Illness: N/A

ID: 1764693
Sex: M
Age: 52
State: TN

Vax Date: 09/17/2021
Onset Date: 09/18/2021
Rec V Date: 10/06/2021
Hospital:

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

Lab Data: have not sought medical attention at this time.

Allergies: none

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

Symptoms: heart beating is much more pronounced and at times accelerated. occasional chest pressure. slight shortness of breath.

Other Meds: none

Current Illness: none

ID: 1764696
Sex: F
Age: 42
State:

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 10/06/2021
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: . Moderna contacted, all handling details given, Moderna tested viability of vaccine lot beyond expiration and found it maintained the activity necessary to protect against Covid 19 at the time of administration.

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Moderna first Dose Vaccine give 09/23/2021. Lot later found to have expired 09/22/2021. Moderna contacted, all handling details given, Moderna tested viability of vaccine lot beyond expiration and found it maintained the activity necessary to protect against Covid 19 at the time of administration. Client found to have no adverse reaction to lot expiration. ** Patient meets 3 rd dose due to Immune compromised patient

Other Meds:

Current Illness:

ID: 1764697
Sex: F
Age: 82
State: GA

Vax Date: 03/12/2021
Onset Date: 08/12/2021
Rec V Date: 10/06/2021
Hospital: Y

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

Lab Data: 08/12/2021 PCR+ CPVID-19 test at health care facility

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Breakthrough COVID-19 case with unknown symptom onset date: shortness of breath/difficulty breathing. Hospitalized 8/21/2021 for unknown duration

Other Meds:

Current Illness:

ID: 1764698
Sex: M
Age: 39
State: WA

Vax Date: 01/08/2021
Onset Date: 01/09/2021
Rec V Date: 10/06/2021
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: none

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

Symptoms: The following morning and for the next three days, I experienced severe SOB, chest pain and rapid heart rate. Once those symptoms started subsiding, I had extreme nausea and diarrhea for 2 more days, and subsequently spent the next 3 weeks with lethargy, palpitations and intermittent tachycardia.

Other Meds: none

Current Illness: none

ID: 1764699
Sex: F
Age: 42
State: DE

Vax Date: 09/19/2021
Onset Date: 09/19/2021
Rec V Date: 10/06/2021
Hospital:

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

Lab Data:

Allergies: minocycline

Symptom List: Nausea

Symptoms: severe migraine that has not gone away since first inection

Other Meds: vitamin d, vitamin c, iron

Current Illness: none

ID: 1764700
Sex: M
Age: 38
State: KY

Vax Date: 03/05/2021
Onset Date: 08/28/2021
Rec V Date: 10/06/2021
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

Other Meds:

Current Illness:

ID: 1764702
Sex: F
Age: 59
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 10/06/2021
Hospital:

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

Lab Data: Moderna contacted, all handling details given, Moderna tested viability of vaccine lot beyond expiration and found it maintained the activity necessary to protect against Covid 19 at the time of administration.

Allergies:

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

Symptoms: Moderna first Dose Vaccine give 09/23/2021. Lot later found to have expired 09/22/2021. Moderna contacted, all handling details given, Moderna tested viability of vaccine lot beyond expiration and found it maintained the activity necessary to protect against Covid 19 at the time of administration. No adverse reations found by client related to expiration date.

Other Meds:

Current Illness:

ID: 1764703
Sex: F
Age: 83
State: MI

Vax Date: 07/13/2021
Onset Date: 10/05/2021
Rec V Date: 10/06/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: COVID-19 infection; dehydration; elevated troponin

Other Meds:

Current Illness:

ID: 1764705
Sex: F
Age: 47
State: ND

Vax Date: 02/23/2021
Onset Date: 02/24/2021
Rec V Date: 10/06/2021
Hospital:

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

Lab Data: Labs at Medical Center, through my primary included 8/25/21 Sedimentation Rate 15 8/25/21Rheumatoid Factor negative 8/25/21 B12 391 9/7/21 EMG-NCS normal 9/7/21 XR Cervical Spine 2 or 3 VW normal 9/9/21 CT Cervical Spine WO Contrast normal 9/28/21 MRI Spine Cervical WO Contract normal 9/29/21 MRI Brain W/WO Contrast normal

Allergies: Wheat (gluten diet)

Symptom List: Tremor

Symptoms: After my second vaccine I had terrible joint pain starting 12 hours after the vaccine and lasted for about 36 hours. After that the pain was less surging but took a couple more days to settle down but just had dull joint aches after that. About 5 weeks later , the last week of April, I started getting the surges of joint pain again. All my joints hurt. I felt like I had the shot again. At this time, my right starting falling asleep from my elbow down to the my fingers mostly at night. Then as the weeks went by it would fall asleep any time of the day, many times a day. Over the summer months my left hand would fall asleep. The joint pain in my right elbow area was out of control. My joints hurt so bad in my body, I would drop things in my hands, couldn't grasp spray bottles to spray. I would surging stabbing pain in my arms, then it would turn to a burning pain and sometimes in the same timeframe I would have a cold sensation going through my joints. These episodes could last from several minutes to hours putting me tears. I finally had to go to the doctor.

Other Meds: Vivelle Dot Estrogen Patch Multi vitamin

Current Illness: none

ID: 1764707
Sex: M
Age: 61
State: AR

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/06/2021
Hospital:

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

Lab Data: None

Allergies: Cipro Wheat Gluten

Symptom List: Erythema, Pruritus

Symptoms: Dizziness, vomiting, partial loss of hearing starting around 5:00 pm. Uncontrollable shaking around 9:00 pm until around 10 pm. Tried to sleep but would wake up gasping for air which continued all night. Periodic vomiting, confusion until around 8:00 am. Still weak at this time.

Other Meds: Finesteride Tamsulosin

Current Illness: None

ID: 1764709
Sex: F
Age: 52
State: KY

Vax Date: 04/08/2021
Onset Date: 08/27/2021
Rec V Date: 10/06/2021
Hospital:

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data:

Allergies:

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

Symptoms: Tested Positive for Covid

Other Meds:

Current Illness:

ID: 1764711
Sex: M
Age: 52
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/06/2021
Hospital:

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

Lab Data: . Moderna contacted, all handling details given, Moderna tested viability of vaccine lot beyond expiration and found it maintained the activity necessary to protect against Covid 19 at the time of administration.

Allergies:

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

Symptoms: Moderna first Dose Vaccine give 09/23/2021. Lot later found to have expired 09/22/2021. Moderna contacted, all handling details given, Moderna tested viability of vaccine lot beyond expiration and found it maintained the activity necessary to protect against Covid 19 at the time of administration. No adverse effects noted by patient

Other Meds:

Current Illness:

ID: 1764712
Sex: M
Age: 14
State: VA

Vax Date: 09/19/2021
Onset Date: 09/26/2021
Rec V Date: 10/06/2021
Hospital: Y

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

Lab Data: Sunday 10/3, At the ED the patient underwent a broad workup: CXR, CT head, CT abdomen, and abdominal ultrasound (for appendicitis). Overall unremarkable, however, CT abdomen demonstrated tiny dense pulmonary nodule "incompletely imaged though highly likely benign", and a liver w/ "hepatic steatosis" (also seen on ultrasound). Outside hospital labs: Blood cultures drawn and no growth, procalcitonin 14, lactic acid 3.0, urinalysis was w/out signs of infection but with 20-50 WBC, BMP all WNL, COVID PCR negative, CBC: WBC 16, Hgb 16 Hct 42, plt 87, 84% neutrophils, hepatic panel w/ mildly elevated transaminases, lipase 132, and mono negative. Pt was given ibuprofen, acetaminophen, Mylanta, famotidine, ceftriaxone (at 1940) and clindamycin (most recently at 2238).

Allergies: Latex

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient was transfer to ED from an outside hospital for concerns of hypotension likely secondary to MIS-C vs post-COVID vaccine myocarditis. Per family, symptoms started on Wednesday 9/29 with general malaise and some difficulty breathing. The patient was evaluated by the PCP where he received a COVID test, which was negative, and a Strep swab which was found to be positive. The patient was sent home with an Amoxicillin prescription. Thereafter, the patient experienced decrease in oral intake and diarrhea. Additional complaints included dizziness upon standing and ambulating. The patient was receiving acetaminophen and ibuprofen at home. There has been no recent travel and no new animal exposures. The patient recently received the second COVID vaccine 2 weeks prior. On Saturday, 10/2, symptoms persisted prompting a visit to an Urgent Care where he received IV fluids and IV steroids. At his time the antibiotics were switched to from amoxicillin to clindamycin. On (Sunday 10/3), the patient presented to an outside hospital ED after waking with chills, chest pain, and difficulty breathing. Per report, patient was in the process of being discharged when his blood pressures dropped into the 70s and 80s range. With new hypotension post receiving a total of 3 L of normal saline, the decision was made to transfer to ED for further treatment. In ED: Patient complained of chest pain and blood pressures were intermittently in the mid 80's. He was given 1L IVF via bolus and started MIVF. EKG normal, cardiology contacted who recommended epinephrine drip initiation for BP support. The patient was anxious and started on wall O2 via face-mask for comfort only. Lab work-up was repeated and significant for an inflammatory process with elevated Procalcitonin, D-dimer, and Fibrinogen. COVID IgG positive and COVID capsid positive, demonstrative of likely previous COVID infection and current immunized status. Thrombocytopenic to 81, leukocytosis to 18.

Other Meds: Amoxicillin, clindamycin, ondansetron

Current Illness: Wednesday 9/29 with general malaise and some difficulty breathing. PCP was seen, COVID test negative but Strep swab positive. Sent home with Amoxicillin . During this time, had decreased oral intake and diarrhea. Patient experienced dizziness upon standing and ambulating. He was receiving acetaminophen and ibuprofen at home. No recent travel. The patient received the second COVID vaccine 2 weeks ago prior, on 9/19/2021. Saturday, 10/2, symptoms persisted and the patient went to Urgent Care where he received IV fluids and IV steroids. Antibiotics for strep throat were switched from amoxicillin to clindamycin.

ID: 1764713
Sex: F
Age: 29
State: MN

Vax Date: 01/14/2021
Onset Date: 10/04/2021
Rec V Date: 10/06/2021
Hospital:

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

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

Allergies:

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

Symptoms: Breakthrough COVID

Other Meds:

Current Illness:

ID: 1764714
Sex: M
Age: 72
State: MI

Vax Date: 03/20/2021
Onset Date: 10/05/2021
Rec V Date: 10/06/2021
Hospital: Y

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: Pneumonia due to COVID-19 virus; acute respiratory failure due to hypoxia

Other Meds:

Current Illness:

ID: 1764715
Sex: F
Age: 56
State: NJ

Vax Date: 09/04/2021
Onset Date: 09/04/2021
Rec V Date: 10/06/2021
Hospital:

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

Lab Data:

Allergies: Cipro, daypro, flagyl, all fresh fruit and vegetables

Symptom List: Pain in extremity

Symptoms: Walking back to car moving arm left arm went numb, then left hip, then left leg. (Day of dose 1) Over the course of the last month SOB, occasional dizziness, one fall with weakness, mild aphasia and elevated blood pressures October 4 also both doses mild feelings of aggression days post injection up to 10 days

Other Meds: Synthroid 25mcg

Current Illness: Hypothyroidism, GERD

Date Died: 09/03/2021

ID: 1764717
Sex: M
Age: 81
State: GA

Vax Date: 02/02/2021
Onset Date: 08/18/2021
Rec V Date: 10/06/2021
Hospital: Y

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

Lab Data: 08/18/2021 Antigen+ COVID-19 test at Rehab; 08/28/2021 IGG+ COVID-19 t

Allergies:

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

Symptoms: Breakthrough COVID-19 case with symptom onset 8/18/2021: worsening confusion and loss of appetite. Hospitalized 8/26/2021-9/3/2021. Death 9/3/2021. Vital Records data not available yet

Other Meds:

Current Illness:

ID: 1764718
Sex: M
Age: 68
State:

Vax Date: 03/04/2021
Onset Date: 10/05/2021
Rec V Date: 10/06/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: breakthrough COVID-19

Other Meds:

Current Illness:

ID: 1764719
Sex: M
Age: 57
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/06/2021
Hospital:

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

Lab Data: Moderna contacted, all handling details given, Moderna tested viability of vaccine lot beyond expiration and found it maintained the activity necessary to protect against Covid 19 at the time of administration.

Allergies:

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

Symptoms: Moderna first Dose Vaccine give 09/23/2021. Lot later found to have expired 09/22/2021. Moderna contacted, all handling details given, Moderna tested viability of vaccine lot beyond expiration and found it maintained the activity necessary to protect against Covid 19 at the time of administration. No adverse reation noted by client related to expiration

Other Meds:

Current Illness:

ID: 1764720
Sex: F
Age: 55
State: NC

Vax Date: 08/13/2021
Onset Date: 08/20/2021
Rec V Date: 10/06/2021
Hospital:

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

Lab Data: None

Allergies: None

Symptom List: Vomiting

Symptoms: Patient started to experience stiffness and numbness across her neck, shoulder and upper arm about a week after the administration of the Moderna shot. The pain and stiffness was not experienced on the arm that was administered but on the opposite arm and shoulder. She went to a chiropractor to help with the pain but he said that it is too inflamed to do any work on the shoulder.

Other Meds: None

Current Illness: None

ID: 1764721
Sex: F
Age: 44
State: KY

Vax Date: 03/18/2021
Onset Date: 09/03/2021
Rec V Date: 10/06/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Tested Positive for Covid

Other Meds:

Current Illness:

ID: 1764722
Sex: M
Age: 87
State: MI

Vax Date: 03/25/2021
Onset Date: 10/05/2021
Rec V Date: 10/06/2021
Hospital: Y

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: Pneumonia due to COVID-19 virus; hypoxia; acute on chronic CHF, unspecified heart failure type; essential hypertension; coronary artery disease involving native coronary artery without angina pectoris; paroxysmal atrial flutter; elevated troponin; type 2 myocardial infarction

Other Meds:

Current Illness:

ID: 1764723
Sex: F
Age: 73
State:

Vax Date: 01/29/2021
Onset Date: 09/30/2021
Rec V Date: 10/06/2021
Hospital: Y

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: breakthrough COVID-19 after vaccination

Other Meds:

Current Illness:

ID: 1764724
Sex: F
Age: 22
State: IL

Vax Date: 04/22/2021
Onset Date: 05/18/2021
Rec V Date: 10/06/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Much heavier and crampier menstruation than normal. Debilitating and had to stay at home for multiple days until my period was over. During this cycle, I made no other changes in my routine, stress levels, diet/lifestyle. I am not on any birth control pill or other medications.

Other Meds: None

Current Illness: None

ID: 1764725
Sex: M
Age: 49
State: TX

Vax Date: 02/02/2021
Onset Date: 06/01/2021
Rec V Date: 10/06/2021
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: Difficulty focusing, minor distractions causing me to lost my train of thought completely, difficulty remembering things

Other Meds: Chondroitin/glucosamine/msm, vitamin D, fish oil, daily multivitamin, collagen

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am