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: 1764833
Sex: F
Age: 74
State: MI

Vax Date: 03/31/2021
Onset Date: 10/05/2021
Rec V Date: 10/06/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient received Pfizer vaccine with 1st dose on 03/11/2021 and 2nd dose on 03/31/2021. Patient Covid + on 10/05/2021 and hospitalized. Per H & P: Patient is 75-year-old female she has a past medical history significant for hypertension hyperlipidemia diabetes mellitus chronic kidney disease gastroesophageal reflux disease patient has been complain of generalized weakness fatigue cough for decreased appetite diarrhea and abdominal pain no blood in the stool did not have any dysuria frequency hematuria she has been complain of cough no hemoptysis no dyspnea exertion no orthopnea she become more fatigued and weak she was brought to the hospital was found to have COVID-19 positive patient previously vaccinated for COVID-19 her chest x-ray showed diffuse peripheral lower opacities suggestive of atypical pneumonia CAT scan abdomen pelvis peripheral groundglass opacity lung base consistent with viral pneumonia right lower pole nonobstructing 9 mm renal stone no hydronephrosis cholelithiasis without cholecystitis patient was admitted to hospital for further evaluation treatment Assessment and plan 1. Abdominal pain and diarrhea, COVID-19 viral pneumonia 2. 9 mm nonobstructive stone 3. Cholelithiasis without cholecystitis 4. Diabetes mellitus type 2 non-insulin-dependent 5. Acute kidney injury chronic kidney disease stage III monitor BUN/creatinine 6 hypertension uncontrolled continue monitor, hyperlipidemia 7. Patient was started on IV steroid IV fluid hydration monitor BUN/creatinine monitor inflammatory markers physical therapy occupational therapy DVT GI prophylaxis

Other Meds:

Current Illness:

ID: 1764834
Sex: M
Age: 68
State:

Vax Date: 08/21/2021
Onset Date: 10/05/2021
Rec V Date: 10/06/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

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: 1764835
Sex: M
Age: 33
State: KY

Vax Date: 04/04/2021
Onset Date: 08/26/2021
Rec V Date: 10/06/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Tested Positive for Covid

Other Meds:

Current Illness:

Date Died: 10/06/2021

ID: 1764836
Sex: M
Age: 72
State: KY

Vax Date: 01/20/2021
Onset Date: 09/07/2021
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: BECAME SYMPTOMATIC AND TESTED COVID POSITIVE 8/13/21. DIED 9/7/21

Other Meds:

Current Illness:

ID: 1764838
Sex: F
Age: 38
State: CT

Vax Date: 10/03/2021
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: no

Allergies: yes

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

Symptoms: burning, Itching, Throat closing, chest pain and heart palpitation. I have been taking Benadryl since Sunday

Other Meds: none

Current Illness: none

ID: 1764839
Sex: M
Age: 68
State: MN

Vax Date: 09/22/2021
Onset Date: 09/22/2021
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: None

Allergies: Statins

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

Symptoms: Incorrect immunization given to patient. Patient was given HPV (Gardasil 9) instead of PPSV 23.

Other Meds: Atorvastatin

Current Illness: None

ID: 1764840
Sex: F
Age: 14
State: WI

Vax Date: 06/24/2021
Onset Date: 08/16/2021
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: + covid NAAT test 8/16/2021

Allergies: n/a

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Covid 19 break-through infection 08/16/2021

Other Meds: n/a

Current Illness: n/a

ID: 1764841
Sex: F
Age: 47
State: MD

Vax Date: 04/15/2021
Onset Date: 04/19/2021
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: See above for labs, CT results

Allergies: ethambutol, gabapentin

Symptom List: Pharyngeal swelling

Symptoms: Received Moderna COVID-19 vaccine on 4/15. She felt well for 2-days after vaccine with no symptoms but then developed severe chills, fatigue, malaise, and myalgias. Was not able to get out of bed due to pain/fatigue and cough was significantly worse with significant sputum production. This lasted about 48-hours and she had persistent lethargy and did nothing for 1-week due to fatigue. Cough remained significant and similar to a severe flare of MAC-IRIS. Seen in clinic on 4/28 and appeared clinically stable but with severe cough. CRP increased from 5 to 102. Remained on anti-mycobacterial antibiotics without change and prednisone. Two days later, fevers recurred to 101 and had severe pleuritic chest pain similar to IRIS flares. Presented to ED on 4/30, and no specific intervention performed as labs were overall stable. At follow-up on 5/3 in clinic, CRP was 134 and CT scan showed increased mediastinal lymphadenopathy with greater atelectasis in right middle lobe. Was started on prednisone 80mg daily at this time for possible IRIS flare. Had improvement in fevers and CRP to 34 but cough and chest pain persisted. Therefore, received dose of infliximab on 5/6 as this has been used to treatment MAC-IRIS symptoms previously. Symptoms dramatically improved over the next 48 hours and continued to do well. Her underlying disease still requires immune suppression with infliximab.

Other Meds: azithromycin, minocycline, rifabutin, Descovy, dolutegravir, moxifloxacin, Advair, loratadine, prednisone 10mg daily

Current Illness: HIV with disseminated MAC and persistent IRIS requiring continued prednisone and intermittent doses of infliximab

ID: 1764842
Sex: F
Age: 47
State: IN

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

Allergies: N/A

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Dizziness, severe full body aches, fever, diarrhea

Other Meds: Labetalol

Current Illness: N/A

ID: 1764843
Sex: F
Age: 41
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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies: None

Symptom List: Diarrhoea, Nasal congestion

Symptoms: I woke up at 3:30am (8 hours exactly after injection) and had severe chills. Around 5am I began vomiting. My entire body ached, my head hurt and I had a fever of 101.8. Around 7am I was able to keep a piece of bread down and take Advil. The fever started to go away but I was sweating the rest of the day. Body aches continued all day, into the night and stopped the next day.

Other Meds: Multivitamin, Vitamin D3+K2 (125mcg), Rabepraxzole 20mg, Airborne

Current Illness: None

ID: 1764844
Sex: F
Age: 71
State: KY

Vax Date: 02/09/2021
Onset Date: 09/01/2021
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:

Allergies:

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

Symptoms: Tested Positive for Covid

Other Meds:

Current Illness:

ID: 1764845
Sex: M
Age: 61
State: WI

Vax Date: 03/31/2021
Onset Date: 10/02/2021
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: SYR
Vax Site: RA

Lab Data:

Allergies: None

Symptom List: Rash, Urticaria

Symptoms: Patient is a 62 y.o. male hx etoh cirrhosis and prior varices has been sober for several months who presents with melena. This started last night. In the ER had one episode of coffee ground emesis. Denies chest pain. He is vaccinated for covid, was diagnosed w/ covid 9/26. Has been having myalgias, sore throat, dysgeusia, cough. Denies dyspnea. In the ER he was not hypoxic. Hgb 9.3 which is essentially at his recent baseline. No tachycardia, one BP of 83/51 but subsequently 119/55. Afebrile.

Other Meds: naltrexone, nortriptyline, Omeprazole, polyethylene glycol, propranolol, sulfamethoxazole-trimethoprim

Current Illness:

Date Died: 03/31/2021

ID: 1764846
Sex: M
Age: 73
State: GA

Vax Date: 02/25/2021
Onset Date: 03/19/2021
Rec V Date: 10/06/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Fever, Runny Nose/Congestion, Sore Throat, Cough recent diagnosis of lung cancer on the left side. He had a left lung biopsy yesterday. Last night he developed shortness of breath. He is very dyspneic. He normally is on oxygen from 2-4 L. On 4 L he was in the mid 70s on EMS arrival. They placed him on oxygen but his oxygen status was still low and he was tachypneic. He was placed on CPAP with improvement. He also received steroid, Solu-Medrol as well as breathing treatments. No chest pain. No abdominal pain. No nausea vomiting. No fever. patient reports having his 2nd dose of COVID vaccine 2 weeks ago In ER, patient was noted to be in AFib with RVR. The per patient and wife was at bedside, he does not have any history of atrial fibrillation. Death on 3/31/2021

Other Meds:

Current Illness:

ID: 1764847
Sex: M
Age: 78
State: OH

Vax Date: 03/11/2021
Onset Date: 09/20/2021
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: SYR
Vax Site: LA

Lab Data: PT tested positive 9/20/21 prior to arrival 10/3/21. Symptoms begin 9/24/21.Received monoclonal antibodies on 9/29/21.SARS-COVID-19 resulted positive 10/3/21

Allergies: Dilaudid

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

Symptoms: Covid monitoring documentation. PT is 78 yom admitted 10/3/21 for sob, known covid infection. IPT tested positive 9/20/21, symptoms begin 9/24/21, received monoclonal antibodies on 9/29/21. PT reports fevers (resolved), coughing, sob, fatigue, malaise, chills, nausea, diarrhea, poor appetite. Inpatient was vaccinated with Janssen 3/11/21, Lot 1802068. SARS-COVID-19 resulted positive 10/3/21. This was reported to VAERS 10/6/21.

Other Meds: BETAMETHASONE VALERATE 0.1 % TOPICAL CREAM Topical TRICOR 145 MG TABLET Oral CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % LOTION Top LISINOPRIL 5 MG TABLET Oral tablet MULTIVITAMIN TAB Oral FLUOXETINE 20 MG T

Current Illness:

ID: 1764848
Sex: F
Age: 45
State: TX

Vax Date: 02/18/2021
Onset Date: 02/18/2021
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: Seizures. . Had a nerve needle test, EEG and other tests done with Neurologist?s office. Neurology; Dr. MRI, Ct etc.

Allergies: Betamethazone, penicillin, codeine, morphine, tape

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

Symptoms: Arm swelled, fatigue, nausea, pain in muscles, joint pain;then major pain in hips both sides, and started having tremors in both hands. The tremors joint pain and hip pain have not gone away. Have increased falls. I would consider this permanent damage.

Other Meds: Gabapentin, fiorecet, atovistatin, hzrt, tramadol, topomax, albuterol, can?t? remember the rest.

Current Illness: Peripheral neuropathy, migraines

ID: 1764849
Sex: F
Age: 60
State: NJ

Vax Date: 09/25/2021
Onset Date: 09/25/2021
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: EKG 9/28 /21 was normal Echocardiogram on 9/30 was normal

Allergies: Bactrim DS, Ciprofloxacin, Moxifloxacin(gave me palpitations), mild casein allergy, mild egg allergy

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

Symptoms: Around 4pm on 9/25 became fatigued, woke up on 9/26 around 6am with mild headache, fatigue, mild chills and mild body aches, pain at injection site which started after the injection. Later on Sunday the 26th towards the afternoon noticed shortness of breath with exertion such as walking, mild palpitations and increased pulse rate. During the night while sleeping would wake up with palpitations and could feel heart pounding. Monday 9/27 the fatigue continued as well as mild headache. Shortness of breath, palpitations, heart pounding and increased pulse was more noticeable and I had to stop multiple times while showering and getting myself dressed. In the afternoon while speaking with my Doctor I took my blood pressure which was 139/93 (high for me), pulse rate in the 90's (also high for me). I was up from 2:30 am to 4am Tuesday morning with palpitations. On Tuesday my symptoms started to diminish and slowly get better. It took until 10/4 for palpitations to disappear.

Other Meds: T3-13.5mcg and T4-57mcg, Progesterone 100mg at bedtime, XHANCE nasal spray, Singular, Claritin, Multi-vitamin, Vitamin B12 supplement, Vitamin C, Vitamin D

Current Illness: Hashimoto's Thyroiditis, Chronic sinusitis

ID: 1764850
Sex: F
Age: 42
State: MN

Vax Date: 10/01/2021
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:

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

Symptoms: Intense pain and swelling of armpit and neck.

Other Meds:

Current Illness:

ID: 1764851
Sex: F
Age: 78
State: MI

Vax Date: 08/25/2021
Onset Date: 09/25/2021
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: N/A

Allergies: Latex

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Severe bone pain, 101.1 fever for 2 days after vaccination

Other Meds: Ibrance 75 mg-21 days on, 7 days off Semara 2.4 mg-1x a day Linopril 10mg-1x a day Chlorthalindone 25mg-1 half per day Vitamin B12 liquid-1000mcg-every other day Biotin 2.5mg-1x a day Aspirin .81mg-1x a day

Current Illness:

Date Died:

ID: 1764852
Sex: F
Age: 89
State: MN

Vax Date: 01/26/2021
Onset Date: 09/04/2021
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: COVID-19 test positive - fully vaccinated/breakthrough case. NOTE: Patient has since died, unknown cause of death by this reporter; patient had other co-morbidities.

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: 9/4 Pt had various symptoms last week prior to ED visit, Nausea, no vomiting, cough for last 4-5 days, generally felt poorly and weak for the last two to three weeks. Pt had exposure to family member who was COVID positive about 3 days prior . She was fully COVID vaccinated. Denies SOB and was not hypoxic.

Other Meds:

Current Illness:

ID: 1764853
Sex: M
Age: 71
State:

Vax Date: 02/03/2021
Onset Date: 10/05/2021
Rec V Date: 10/06/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: 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: 1764854
Sex: M
Age: 38
State: OH

Vax Date: 03/31/2021
Onset Date: 07/05/2021
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: No

Allergies: None

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

Symptoms: I saw a flare-up of red boils on the right side of my chest, upper side. I thought it as heat bubbles and I waited. It started to look like it had fluid in them. I went to the pharmacy for diagnosis. I met with a Registered Nurse and who looked at it, and she inspected it and was pretty sure it was Shingles. Gave me over the counter medicine for a week and prescribed something for 1-2 weeks. It took it's time in resolving. I had it for at least 2 weeks and then resolved on its own. I have marks on my chest right now but shingles are completely gone. It affected my ability to be productive, for a couple days or so. If a cloth were even to touch it, it would be insanely painful.

Other Meds: B12 supplement; vit D3

Current Illness: No

ID: 1764855
Sex: F
Age: 58
State: MA

Vax Date: 01/12/2021
Onset Date: 08/06/2021
Rec V Date: 10/06/2021
Hospital: Y

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

Lab Data: 8/17/21 - COVID PCR positive at our facility Previously tested and treated with MABs

Allergies: nkda

Symptom List: Unevaluable event

Symptoms: first tested positive for COVID-19 on August 6th. He received monoclonal antibodies at an outside facility on 8/12, and felt generally well until two days before admission. The morning of admission he began experiencing body aches, HA, sweats, fevers, and cough, and vomiting

Other Meds: amlodipine, atorvastatin, jardiance, lisinopril, metformin, ozemipic, terbinafiney, tizanidine

Current Illness: NA

Date Died: 09/22/2021

ID: 1764856
Sex: M
Age: 70
State: KY

Vax Date: 01/14/2021
Onset Date: 09/22/2021
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: Unknown

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

Symptoms: Pt died after contracting COVID-19 in early August 2021.

Other Meds: Unknown

Current Illness:

ID: 1764857
Sex: F
Age: 26
State: MI

Vax Date: 09/05/2021
Onset Date: 09/06/2021
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:

Allergies: None.

Symptom List: Injection site pain, Pain

Symptoms: I broke out with hives all over my body which I have the pictures to prove and my muscles in my leg makes me feel like my legs are giving out on me I wasn?t having these problems until I took the shot it is abnormal for me and I?m scared.

Other Meds: None.

Current Illness: None.

ID: 1764858
Sex: M
Age: 67
State: WI

Vax Date: 03/30/2021
Onset Date: 04/13/2021
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:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: I developed severe lightheadedness and equilibrium problems approximately 14 days after my second vaccine dose. The symptoms have not ceased. I continue to be extremely lightheaded and off balance. I can no longer drive. I have seen multiple doctors/specialists, have had several hospital stays, and numerous tests/procedures. No cause has been identified for my symptoms. The only explanation left for my symptoms is the vaccine.

Other Meds:

Current Illness:

ID: 1764859
Sex: M
Age: 65
State:

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

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

Lab Data:

Allergies:

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

Symptoms: The patient is an immunocompromised host with multiple comorbidities, being admitted with COVID infection. He has mild hypoxia and a portable chest x-ray consistent with pneumonitis superimposed on scarring. Right middle lobe collapse could not be excluded, so will obtain a PA lateral and start remdesivir with dexamethasone and consult Transplant Infectious Disease for further recommendations

Other Meds:

Current Illness:

ID: 1764860
Sex: M
Age: 59
State: MN

Vax Date: 03/08/2021
Onset Date: 10/02/2021
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: penicillin; sulfa

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: headache, nonproductive cough, chills, shortness of breath, body aches, ear pain, sinus congestion, post nasal drainage, chest congestion, ear fullness, starting on 10/2/21, recent travel

Other Meds: Atorvastatin; Sildenafil; Tadalafil; Gabapentin; Propecia; Xanax; Cyclobenzaprine; Sertraline; Albuterol; Doxyclycline

Current Illness: none

ID: 1764861
Sex: M
Age: 63
State: GA

Vax Date: 05/26/2021
Onset Date: 05/27/2021
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: Per Hospital labs when admitted.

Allergies: zocor, lipitor, sulfa, mavacol, wool

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: PT presented to medical facility s/p "fainting." He was sent to hospital & admitted with a Pulmonary Embolism, treated, and released the next day, & placed on eloquis,

Other Meds: zetia, crestor, ntg, ecasa, flomax, xopenex, ibuprofen

Current Illness: None

ID: 1764862
Sex: F
Age: 69
State: WV

Vax Date: 09/30/2021
Onset Date: 09/30/2021
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: Lymphedema under the left arm - worst on day 2, and slowly resolving at day 6.

Other Meds: Letrozole, escitalopram, vitamin B complex, folic acid, diclofenac potassium, magnesium and calcium supplement, Centrum Silver one-a-day.

Current Illness: None

ID: 1764863
Sex: M
Age: 65
State:

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

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: The patient is an immunocompromised host with multiple comorbidities, being admitted with COVID infection. He has mild hypoxia and a portable chest x-ray consistent with pneumonitis superimposed on scarring. Right middle lobe collapse could not be excluded, so will obtain a PA lateral and start remdesivir with dexamethasone and consult Transplant Infectious Disease for further recommendations

Other Meds:

Current Illness:

ID: 1764864
Sex: M
Age: 84
State: MI

Vax Date: 03/02/2021
Onset Date: 03/02/2021
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: LA

Lab Data: SARS COV 2 lab

Allergies: ACE inhibitors

Symptom List: Injection site pain

Symptoms: Patient hospialized with COVID currently.

Other Meds: unknown

Current Illness: unknown

ID: 1764866
Sex: F
Age: 24
State: FL

Vax Date: 10/05/2021
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:

Allergies: Ibuprofen, naproxen, Tramadol, Tylenol caplet

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

Symptoms: This is a 24-year-old female who is 37 weeks and 4 days' pregnant, who received her second COVID vaccine (manufacture: Pfizer) at 1452 today. She began experiencing throat itching and wheezing. She was given albuterol and a shot of Benadryl, and she noticed some improvement in her throat itching. She then received a dose of IV 125 mg Solu-Medrol, and then her hand started swelling. Right side of her face became hot and red. She began itching on her trunk, arms and legs. She says that she has a history of "being allergic to everything and has learned not to panic in these situations." She has a history of asthma since she was a child, and is currently on albuterol inhaler and a Qvar inhaler over the past 4 to

Other Meds: prenatal vitamins, Proairinhaler, Qvar inhaler

Current Illness: none

ID: 1764867
Sex: M
Age: 80
State:

Vax Date: 03/04/2021
Onset Date: 10/06/2021
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: 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: 1764868
Sex: M
Age: 30
State: VA

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: IM
Vax Site: LA

Lab Data:

Allergies: none

Symptom List: Tremor

Symptoms: pt received 3rd dose of covid 19 vaccine. Pt lost consciousness in chair and was placed on floor by 2 corpsmen. Feet were elevated. Pt woke up about 10 seconds later, A&O x4. Pt stated this has happened before with venipuncture but never a vaccine. VSS. RRT arrived and transported patient to ED in stable condition.

Other Meds:

Current Illness:

ID: 1764870
Sex: F
Age: 39
State: MT

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

Lab Data:

Allergies: PENN SULFA GLUTEN

Symptom List: Erythema, Pruritus

Symptoms: FATIGUE, FEVER OF GREATER THAN 101.5 FOR APPROX 9 HOURS, CHILLS, MUSCLE WEAKNESS

Other Meds: LEVOTHYROXINE PROZAC

Current Illness:

ID: 1764872
Sex: F
Age: 43
State: KY

Vax Date: 03/26/2021
Onset Date: 09/22/2021
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: COVID POSTIVE

Other Meds:

Current Illness:

ID: 1764874
Sex: F
Age: 54
State:

Vax Date: 10/03/2021
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: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: 10/4/21 @ 10 am she developed significant angioedema of her lips (and slightly to her left infraorbital region), but no other allergic reaction symptoms. Apparently she had filler injected into both her lips a couple weeks ago and less filler, longer ago to her left infraorbital region. We spoke with her plastic surgeon and came up with a plan to properly treat her reaction. No hospitalization required, but was seen by our emergency dept, Of note, the patient was not eligible for a third booster dose yet, and she was not immunocompromised and in otherwise good health. She is a healthcare professional.

Other Meds:

Current Illness:

ID: 1764875
Sex: F
Age: 61
State: OR

Vax Date: 08/16/2021
Onset Date: 08/17/2021
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: RD BLOOD COUNT IS HIGH. AS COMPARED TO LABS IN JULY. CONTAACT DR FOR REPORT, PLAQUE BUILD UP IN RT CAROTID ARTERY, UNKNOWN IF RELATED.

Allergies: opiates

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: VERY FATIGUED, LOSS OF APPETITE, CHILLS, HEADACHE, FEVER X 3 DAYS AFTER SHOT, VARIOUS OTHER JOINT SND MUSCLE PAINS SINCE. NOT ABLE TO BEAR WEIGHT ON RT LEG, KNEE HURTING WITH WEIGHT. ANKLE SWELLING ON RT SIDE. BACK NECK SPINE PAIN. INSOMNIA, 1SAT DAY AFTER SHOT, 1ST BOWEL MOVEMENT HAD RED BLOOD IN IT, NOW HAS MORE MUCUS THAN NORMAL.

Other Meds: metropolo tartrate 50mg daily

Current Illness: none

ID: 1764876
Sex: M
Age: 70
State: IL

Vax Date: 08/18/2021
Onset Date: 08/20/2021
Rec V Date: 10/06/2021
Hospital:

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

Lab Data:

Allergies: None.

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

Symptoms: Dizziness, nausea, ears constantly ringing.

Other Meds:

Current Illness: None.

ID: 1764877
Sex: F
Age: 45
State: VA

Vax Date: 07/16/2021
Onset Date: 07/18/2021
Rec V Date: 10/06/2021
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: Electrocardiogram Electrocardiogram Stress Test Echocardiogram

Allergies:

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

Symptoms: Pericarditis/chest pressure

Other Meds:

Current Illness:

ID: 1764878
Sex: M
Age: 67
State: VA

Vax Date: 02/09/2021
Onset Date: 02/23/2021
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: Dr note: I would continue the (ketoconazole shampoo, clobetasol solution as needed). Other options are : consider biopsy of rash but may not change our management or consider removal all potential allergens that may be affecting scalp (shampoos / conditioners any other things that contact the affected areas). An OTC shampoo/line of products that has very few irritating ingredients is Free and Clear shampoo. Scalp demmatitis

Allergies: none

Symptom List: Pain in extremity

Symptoms: Itching and scaling rash and lesions from waist line to scalp.

Other Meds: Clobetasol Propionate

Current Illness: none

ID: 1764879
Sex: F
Age: 41
State: WI

Vax Date: 03/26/2021
Onset Date: 09/29/2021
Rec V Date: 10/06/2021
Hospital:

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

Lab Data: + covid test 9/29/2021

Allergies: n/a

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

Symptoms: Covid 19 break-through case 9/29/2021

Other Meds: n/a

Current Illness: n/a

Date Died: 09/03/2021

ID: 1764880
Sex: M
Age: 81
State: KY

Vax Date: 03/24/2021
Onset Date: 09/03/2021
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:

Allergies: Unknown

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

Symptoms: Patient died after contracting COVID-19 in Aug 2021.

Other Meds: Unknown

Current Illness: Unknown

ID: 1764881
Sex: M
Age: 75
State:

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

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

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

Other Meds:

Current Illness:

ID: 1764882
Sex: M
Age: 56
State: KY

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

Symptom List: Vomiting

Symptoms: Moderna vaccine was administered to client on 10/05/2021, vaccine expired 10/01/2021.

Other Meds: unknown

Current Illness: none

ID: 1764884
Sex: F
Age: 82
State: OH

Vax Date: 09/24/2021
Onset Date: 09/25/2021
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: Morphine Demerol Amoxicilin Metformin

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient was tired, started running fever, shortness of breath, coughing, oxygen level drops when doing simple tasks. Patient is still running fever some days.

Other Meds: Insulin Thyroid meds Emetprozol Blood pressure meds Breo

Current Illness: NONE

ID: 1764885
Sex: F
Age: 35
State:

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

Allergies: Clonidine

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

Symptoms: patient previously received 2 doses of Moderna. patient came in for 3rd dose of Moderna and was inadvertently given Pfizer instead. the patient waited for 30 minutes and had no adverse effects. the doctor was informed and the patient was discharged to home.

Other Meds:

Current Illness:

ID: 1764886
Sex: F
Age: 57
State: MA

Vax Date: 04/06/2021
Onset Date: 09/12/2021
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: Hospital testing.

Allergies: Codeine.

Symptom List: Injection site swelling, Limb discomfort

Symptoms: I had a heart attack on 09/12/2021. I was feeling pressure in my chest and I just did not feel right. I went to the emergency room and they said I was having a heart attack. I had four stents placed and I was in the hospital for three days. I have never had any heart problems before this.

Other Meds: Tylenol.

Current Illness: N/A

ID: 1764887
Sex: F
Age: 50
State:

Vax Date: 10/05/2021
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: RA

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1764888
Sex: F
Age: 56
State: VA

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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: 911 called transport to hospital patient was released 2 hours later

Allergies: pineapple allegra latex shellfish nut coconut

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

Symptoms: Lot A2AK3 exp 6/30/22 felt tingling in tongue and throat after shot was given, treatment was epi pen and 25 mg benadryl

Other Meds:

Current Illness: none known of

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am