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: 1764947
Sex: F
Age: 32
State: CA

Vax Date: 09/07/2021
Onset Date: 09/07/2021
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: Denies

Symptom List: Dysphagia, Epiglottitis

Symptoms: Client received covid vaccine @ 2:15pm in left arm, complained of tingling in same arm down to elbow @ 2:20 pm. Client denies any shortness of breath, tightening of throat, chest pain. Denies itching, no swelling or redness noted at site. Client denies any medical conditions, not taking medication, denies allergies. Vital signs assessed, all within normal limits. Client advised to continue with observation. At 2:42 pm, client reports tingling has resovled, states she needs to leave at this time. Client advised to complete observation, also educated to follow up with primary care and ER precautions given. Vital signs stable, client leaves with steady gait @ 2:45 pm.

Other Meds: Denies

Current Illness: Denies

ID: 1764948
Sex: M
Age: 25
State: CA

Vax Date: 04/01/2021
Onset Date: 04/02/2021
Rec V Date: 10/06/2021
Hospital:

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

Lab Data: 06/09/2021

Allergies: Doxycycline, sulfa based medications

Symptom List: Anxiety, Dyspnoea

Symptoms: Rashes, severe body itch. Almost hive like, come and go, only started after second vaccine, still have it to this day, I have these itchy rash spots from my legs, scrotom, thighs, arms stomach

Other Meds: None

Current Illness:

ID: 1764949
Sex: F
Age: 67
State: MO

Vax Date: 10/04/2021
Onset Date: 10/04/2021
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: Patient was given 3rd dose of Covid-19 vaccine, had said she had Pfizer with prior 2 doses. After receiving immunization, RN noted on vaccine card that patient had received Moderna vaccine for first 2 doses. RN called Pfizer to advise, was instructed no further action to be taken. Patient has been notified.

Other Meds:

Current Illness:

ID: 1764950
Sex: F
Age: 73
State: LA

Vax Date: 09/30/2021
Onset Date: 09/30/2021
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: N/A

Allergies: Antihistamines

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Pt. states that after receiving the 3rd dose Booster of Moderna 09/30/2021, started experiencing symptoms 09/30/2021 of fever (103.0), Chills, nausea, vomiting, dry cough, congested, loss of appetite, and fatigue. No noted Primary visit. Still continuing to experience fatigue and loss of appetite.

Other Meds: Multi-Vitamin, Elaquix, Vitamin D

Current Illness: N/A

ID: 1764951
Sex: F
Age: 37
State: PA

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:

Allergies: eggs, amidoamine, gold sodium thiosulfate, neomycin sulfate, nickel sulfate, tomatoes

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

Symptoms: Bodyaches, fever, headache, nausea (loss of appetite), extreme fatigue, chills, sweating, swelling at injection site, redness at injection site, warmth on the injection site

Other Meds: Zyrtec, Fish Oil, Multi Vitamin, Sertraline

Current Illness: none

ID: 1764952
Sex: F
Age: 42
State: AL

Vax Date: 01/27/2021
Onset Date: 08/01/2021
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: Brain CT - 9/13/21 Multiple eye scans - various, but most recent at Dr on 9/30/21 Blood draws - 8/20/21 and 9/8/21

Allergies: Percocet

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

Symptoms: I have had three doses of Moderna. Second on 2/24/21 (Lot#042L20A), third on 8/19/21 (Lot#017E21A). This effect began approximately around the first week of August. I noticed that i could not see the signs in the grocery store. My vision was blurred and hazy. I had Lasik surgery 8 years ago, and usually have 20/10 vision. I went home and used lubrication drops, and it cleared up. It happened two or three more times over the next two weeks, but again, the drops cleared it up. Within a day or two of having the third shot, the drops no longer worked, and my vision began deteriorating very quickly. I could no longer read car tags or road signs while driving. It was hard to see the TV. I saw my optometrist on 8/20 for the first visit. I have subsequently seen him approximately five more times. I have also seen the Nurse Practitioner at my GP's office and ophthalmologist. I have had a CT scan of my brain, which was unremarkable. I had had my A-1C and glucose checked twice, both fine. My blood pressure has been monitored. I have had multiple eye scans. Approximately two weeks ago, I woke up one morning and my close vision was also gone. The night before I could read my phone, books, etc, reasonably well, and by the next day it was completely blurry and hazy. This has continued. My visions shifts constantly now throughout the day, and is not stable. I am wearing one contact in one eye and reading glasses. I believe this is the fourth prescription I've had since this began.

Other Meds: Stelara (injectable every 12 weeks) ? Crohn?s Dicyclomne 10 mg (4-6/day) ? Crohn?s Mesalamne DR 1.2 GM (4/day) ? Crohn?s Nortriptyline HCL 25 mg (1/day) ? Crohn?s Pantoprazole SOD 40 mg (1/day) ? Crohn?s Colesevelam 625 mg (1/day) ? Crohn?s

Current Illness:

ID: 1764953
Sex: F
Age: 44
State: GA

Vax Date: 10/05/2021
Onset Date: 10/06/2021
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: NONE

Allergies: NKDA

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: PATIENT REPORTS RASH BILATERAL ARMS AND LEGS THAT STARTED AT 0400 AFTER HER THRID DOSE. RASH HAS SLIGHT REDNESS WITH SWELLING, BUT PATIENT DENIES ITCHING. SHE REPORTED SAME RASH AFTER HER FIRST AND SECOND DOSE. DENIES SHORTNESS OF BREATH OR CHEST PAIN. EDUCATATED PATIENT THAT RASH MAY OCCUR AFTER THE VACCINE. ADVISED PATIENT TO TAKE OTC BENADRYL FOR RASH AND ACETAMINOPHEN FOR PAIN. PATIENT DENIES EMERGENCY AND WILL CONTINUE TO MONITOR.

Other Meds: VITAMINE D3

Current Illness: DENIES

ID: 1764954
Sex: F
Age: 21
State: KY

Vax Date: 09/10/2021
Onset Date: 09/12/2021
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: Chest xray 9/12/21 Chest angiograph 9/12/21 BMP D dimer Troponin EKG

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: New onset chest pain.

Other Meds:

Current Illness:

ID: 1764955
Sex: F
Age: 39
State: MA

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:

Allergies: Dairy

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Fever, body aches, chest pain, chills

Other Meds: Omeprazole

Current Illness:

ID: 1764956
Sex: F
Age: 45
State: WI

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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: not applicable

Allergies: not applicable

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Vaccine was reconstituted with less than the required amount of sterile dilutant. Patient was given the vaccine at a higher concentration than recommended.

Other Meds: not applicable

Current Illness: not applicable

ID: 1764957
Sex: M
Age: 20
State: KS

Vax Date: 09/26/2021
Onset Date: 10/01/2021
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: After the second Vacc i got Problems

Other Meds:

Current Illness:

ID: 1764958
Sex: F
Age: 52
State: AZ

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

Lab Data:

Allergies: none

Symptom List: Rash, Urticaria

Symptoms: Extremely swollen lymph nodes in right arm pit. Same arm that I received the vaccination. This occurred within 8 hours of getting the vaccination. My entire right arm is in pain, I cannot use my arm normally without causing extreme pain in my arm pit. Also within 8 hours of receiving the shot, my joints in my entire body hurt. I had nothing wrong with me, no pain anywhere when I went to get the vaccination.

Other Meds: Birth control pills

Current Illness: none

ID: 1764959
Sex: M
Age: 69
State:

Vax Date: 09/01/2021
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:

Allergies:

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

Symptoms: blood clot in lung within 30 days of vaccine booster

Other Meds:

Current Illness:

ID: 1764960
Sex: F
Age: 40
State: MN

Vax Date: 01/27/2021
Onset Date: 09/30/2021
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:

Allergies:

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

Symptoms: Fully vaccinated employee became symptomatic and tested positive for Covid-19.

Other Meds:

Current Illness:

ID: 1764961
Sex: F
Age: 53
State: TX

Vax Date: 01/08/2021
Onset Date: 02/09/2021
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: 4/9/2021- ecg, ct scans, bloodwork

Allergies: None

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

Symptoms: Heart enlargement causing dizzy and fainting daily. Treatments, rest and stay off get. Still active.

Other Meds:

Current Illness: None

ID: 1764962
Sex: M
Age: 73
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

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

Other Meds:

Current Illness:

ID: 1764963
Sex: M
Age: 28
State: CA

Vax Date: 03/29/2021
Onset Date: 09/15/2021
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: No - visual exam

Allergies: milk

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

Symptoms: I basically got pretty massive ear infection in left ear that I just never get. It was also coupled with a lot of fatigue. It was significant fatigue. I went to Urgent Care and the Doctor prescribed ear drops - steroid antibiotic. That helped a bit with the symptoms. I still have it. I followed up with my doctor. He said there is no remaining infection but there is still tinnitus. The tinnitus in left ear is still there. I still have to finish off the medicine and I'm doing that. Immediate - health event after the vaccine was received - I reacted pretty badly at first. It was a significant immune response. I got pretty sick for three days. Enough to not be able to go to work. And then those were gone after that time as expected.

Other Meds: Zoloft - 100 mg; Bentyl - 10 mg; ibuprofen - I take it somewhat more than occasionally 400 mg; Loratadine 10 mg; Multi-Vitamin every day

Current Illness: no

ID: 1764964
Sex: M
Age: 70
State:

Vax Date: 10/05/2021
Onset Date: 10/05/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1764965
Sex: F
Age: 70
State: WA

Vax Date: 03/19/2021
Onset Date: 03/20/2021
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: Blood tests; ENT tests: audiogram, Tympanogram; MRI

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: 1st Shot: Swelling which spread down arm. Lasted 10 days 2nd Shot: Severe dizziness; brain fog; severe ear pain

Other Meds: Organic vitamins

Current Illness:

ID: 1764966
Sex: M
Age: 49
State:

Vax Date: 04/11/2021
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: 1764967
Sex: F
Age: 36
State: ND

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: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Patient was escorted to the ER for observation. Per patient, EKG and labs came out negative. Follow up appointment was made with her PCP for today.

Allergies:

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

Symptoms: Fast heart rate, chest discomfort about 5 minutes after the shot was given.

Other Meds:

Current Illness:

ID: 1764968
Sex: F
Age: 41
State: AZ

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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Nka

Symptom List: Unevaluable event

Symptoms: Swelling noted under left axillary, tenderness developed, still swollen and tender 2 days later, low grade fever.

Other Meds: Tylenol otc

Current Illness: None

ID: 1764969
Sex: F
Age: 50
State: IL

Vax Date: 09/07/2021
Onset Date: 09/10/2021
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: LA

Lab Data:

Allergies: NA

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

Symptoms: strange feeling back of left thigh starting on 9/10/21 @ 1015am traveled to calf. called PCP office, they instructed patient to go to ER for US to rule out blood clot. patient arrived with Full Code Stroke symptoms @ 12:45pm with left side paralysis. administered tPA within time window. residual VITT symptons.

Other Meds: phenobarbital, naproxen, losartan

Current Illness: NA

ID: 1764970
Sex: F
Age: 80
State: CO

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

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

Lab Data: FLUVID test: Positive for COVID-19 on 10/3/2021 (negative for influenza A, influenza B, and RSV on test panel).

Allergies: Patient has an allergy to iodinated contrast media (reports throat swelling).

Symptom List: Injection site pain, Pain

Symptoms: Patient required inpatient admission to hospital with COVID-19 on 10/2/2021 (presented with cough, shortness of breath, and sore throat for the past week per provider notes). As of 10/6/2021, the patient remains admitted to the hospital for treatment of COVID-19 infection.

Other Meds: Unknown

Current Illness: Unknown

ID: 1764971
Sex: M
Age: 39
State:

Vax Date: 09/30/2021
Onset Date: 09/30/2021
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: shell fish

Symptom List: Injection site pain, Menorrhagia

Symptoms: dizziness, light headedness

Other Meds: blood thinner, tylenol, cholestrol

Current Illness:

ID: 1764972
Sex: F
Age: 59
State: MO

Vax Date: 05/13/2021
Onset Date: 06/01/2021
Rec V Date: 10/06/2021
Hospital:

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

Lab Data: Appointments: 8/27/21 Initial appointment - diagnosed Timnitus (continuous ringing in my ears started in June 2021 - after Pfizer covid vaccines) 9/27/21 Follow up appointment - still constant ringing in my right ear. Need to schedule a MRI. 10/11/21- MRI is scheduled to see what is going on in my ear.

Allergies: None

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

Symptoms: After 2nd shot, experienced constant ringing in my right ear. Saw an ENT, who diagnosed Tinnitus. Since ringing started after the second Pfizer shot, and I have never experienced these symptoms before, the doctor and I believe this is related to receiving the Pfizer covid vaccine.

Other Meds: None

Current Illness: None

ID: 1764973
Sex: M
Age: 46
State: NY

Vax Date: 03/09/2021
Onset Date: 03/17/2021
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: No known.

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Developed Tinnitus one week after receiving my second dose of the COVID vaccine.

Other Meds: Mesalamine Famotidine Paroxitine

Current Illness: None.

Date Died: 06/20/2021

ID: 1764974
Sex: M
Age: 15
State: NH

Vax Date: 06/14/2021
Onset Date: 06/20/2021
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: RA

Lab Data: Autopsy report 6/21/2021. Pertinent findings include: no external indication of scalp injury, with small subgaleal hemorrhage over the left occiput; normal epidural, subdural, and subarachnoid evaluations; mildly elevated cardiac mass 420 mg; normal pericardial appearance; normal coronary artery origins from the aorta and free of atherosclerosis; increased left ventricular wall thickness (1.8 cm) and normal right ventricular wall thickness (0.3 cm); normal gross appearance of the endocardium, myocardium, and cardiac valves; small foci of myocardial inflammation of the lateral wall of the left ventricle with myocyte necrosis; negative myocyte disarray; negative toxicology; negative SARS-CoV-2 RT-PCR; Ambry Genetics CardioNext analysis of 92 genes associated with inherited cardiomyopathies and arrhythmias negative for pathologic findings, positive for 2 variants of unknown significance.

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: He was in his usual state of good health. 5 days after receiving the vaccine, he complained of brief unilateral shoulder pain (unclear to family which shoulder), which the family attributed to a musculoskeletal source. No chest pains, shortness of breath, or palpitations. He was playing with 2 friends at a community pond, swinging from a rope swing, flipping in the air, and landing in the water feet first. He surfaced, laughed, told his friends "Wow, that hurt!", then swam toward shore, underwater as was his usual routine. The friends became worried when he did not re-emerge. His body was retrieved by local authorities more than an hour later.

Other Meds: None

Current Illness: None

ID: 1764975
Sex: F
Age: 31
State: MN

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: None at this point.

Allergies: Vancomycin

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

Symptoms: Felt pain as flu vaccine was being injected into my left deltoid (around 10:45). It was injected 1-1.5 fingers below my acromion process, seems higher than where it should've been administered. During and right after injection felt some tingling/numbness through my arm and hand. Throughout rest of day continued to feel dull pain and some pain/feeling of tightness through my left shoulder into my neck. Today (10/6) am still feeling some weakness in my left arm.

Other Meds: Stelara injections every 8 weeks, Mirena IUD implanted

Current Illness: No illnesses

ID: 1764976
Sex: F
Age: 20
State: WV

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

Lab Data: None

Allergies: Unknown

Symptom List: Nausea

Symptoms: The patient received Moderna for the first two doses of the COVID-19 vaccine series and presented to the pharmacy to receive a booster dose of Pfizer BioNTech COVID-19 vaccine. Patient received the Pfizer BioNTech COVID-19 vaccine for the 3rd dose, so this form is being submitted due to the error of not receiving the primary series of the Pfizer BioNTech COVID-19 vaccine prior to receiving the Pfizer BioNTech COVID-19 booster.

Other Meds: Unknown

Current Illness: Unknown

ID: 1764977
Sex: F
Age: 87
State:

Vax Date: 04/17/2021
Onset Date: 10/05/2021
Rec V Date: 10/06/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Injection site pain

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: 1764978
Sex: F
Age: 36
State: OH

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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: no

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

Symptoms: Chest started hurting. Feeling of heart fluttering and tiredness.

Other Meds: no

Current Illness: no

ID: 1764979
Sex: M
Age: 45
State: MN

Vax Date: 09/15/2021
Onset Date: 10/02/2021
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: RA

Lab Data: Troponin 0.05 (upper end of normal), CBC normal, CRP 14.5 (mildly elevated), Panel 12 mostly normal. CT of the head without contrast pending results.

Allergies: PCN, Bee stings, Amlodipine, epinephrine, Latex and Reglan

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

Symptoms: Severe headache and now today a tremor of the left hand and arm associated with weakness

Other Meds: Flomax, Levemir, Albuterol, Prednisone, Flexeril

Current Illness: Had not felt well since initial C19 shots

ID: 1764980
Sex: F
Age: 65
State: CA

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

Lab Data: No tests done

Allergies: None

Symptom List: Tremor

Symptoms: Extreme dizziness, nausea, headache. Vomiting.

Other Meds: Synthroid

Current Illness: Healthy

ID: 1764981
Sex: M
Age: 51
State: MN

Vax Date: 08/30/2021
Onset Date: 08/30/2021
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: Erythema, Pruritus

Symptoms: It was discovered after the vaccine was administered, that the lot used had a beyond use date of 8-19-21. Moderna was contacted for clinical information and stability guidance to help determine if the dose would be considered valid. The response received from Moderna's medical information department: The vaccine administered on August 30, 2021 from lot number 026A21A maintained the activity necessary to protect against the SARS-CoV-2 (COVID-19) virus at time of administration.

Other Meds:

Current Illness:

ID: 1764982
Sex: M
Age: 45
State: PA

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

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

Symptoms: Headache (3:30 PM day of booster) Chills (6:00 PM day of booster) Body Aches (4:00 AM day after booster)

Other Meds: Amlodipine Wellbutrin XR Klonopin Buspirone Levoxyl Lexapro Propranolol Xyzal

Current Illness: None

ID: 1764983
Sex: M
Age: 58
State: AZ

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

Allergies: penicillin

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

Symptoms: Arm felt like it had been punched lasted 4 days. Left side of chest hurt unable to isolate lasted 3 days. Severe headache lasted 2 days. Vision blurred started clearing on 5th day. E.D. still on going.

Other Meds: Lisinopril 20mg

Current Illness: none

Date Died: 08/30/2021

ID: 1764984
Sex: F
Age: 81
State: KY

Vax Date: 03/03/2021
Onset Date: 08/21/2021
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: COVID-19 PCR positive on 08/21/21

Allergies: Chlorhexidine Chlorhexidine Itching Medium Allergy 1/29/2018 Oxycodone-acetaminophen Oxycodone-acetaminophen Itching Medium Allergy 1/27/2018 Cephalexin Unknown reaction Low Allergy 3/7/2016 Doxycycline Unknown reaction Low Allergy 3/7/2016 Nafcillin Nafcillin Unknown reaction Low Allergy 3/7/2016

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: 81 y.o. female with PAD s/p aortobifem bypass, Atrial fibrillation on xarelto who presents to Medical Center with COVID19. Spoke with patient and daughter briefly at bedside prior to emergent intubation. Patient and daughter report that patient tested positive for COVID19 about 10 days ago. Patient has been at home on nasal cannula. Patient reports that today she felt as though she could not breathe. Daughter reports that saturations had dropped at home. Patient reports that otherwise she has felt ok in the last ten days, has had diarrhea that has been bothering her more in the last few days prior to presentation. Of note patient is vaccinated with Pfizer. In the emergency room, patient was requiring HFNC. CTPE showed no pulmonary embolism and moderate bilateral airspace disease consistent with COVID19. Patient also has advanced emphysema. She has a past medical history of CHF (congestive heart failure), Chronic renal failure, Compression fracture of fourth lumbar vertebra with routine healing (11/2020), COPD (chronic obstructive pulmonary disease), Hyperlipidemia, unspecified, Hypertensive heart disease without congestive heart failure, PAD (peripheral artery disease), and Personal history of other diseases of the digestive system. #Acute Hypoxic Respiratory failure secondary to COVID19 infection - Patient's CTPE negative of PE, did show bilateral GGO c/w COVID and some concern for underlying lung disease. No concern for concurrent bacterial pneumonia. PLAN - DEXA ARDS started 8/23 - a.m. gas was borderline requiring proning- will reevaluate this afternoon - Ongoing ICU level care given hypoxic respiratory failure #Acute Hypoxic Respiratory failure secondary to COVID19 infection- worsened - Required increased PEEP for recruitment, paralytic, and increasing to FiO2 100% overnight. This a.m. remains hypoxic despite being on 100% FiO2. Differential includes PE, pneumonia, progression of COVID19 infection. Initially started antibiotics, however as goals are now to keep the patient alive until family arrives, are minimizing treatment to only what is sustaining her life for the next 24 hours. PLAN - Continue steroids - Not proning due to multiple comorbidity and poor prognosis - Cont vent settings. - Heparin drip for possible PE, will not pursue imaging to confirm Patient was unable to be weaned down on her ventilator settings despite dexamethasone and attempts to optimize patient's fluid status. Patient's family elected to have no escalation of care on 8/28, and ultimately decided on comfort care with terminal extubation on 8/30.

Other Meds: albuterol atorvastatin budesonide-formoterol calcitonin cefadroxil docusate furosemide hydrocodone-acetaminophen levothyroxine loratadine-pseudoephedine metoprolol tartrate pantoprazole rivaroxaban

Current Illness: N/A

ID: 1764985
Sex: F
Age: 71
State: CA

Vax Date: 02/05/2021
Onset Date: 02/06/2021
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: NONE

Allergies: LUVAKOX, PENICLIN,

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

Symptoms: VERY SORE ARM, STUFFY AND RUNNY NOSE

Other Meds: ATORVASTATIN, HIGH BLOOD PRESSURE MEDICINE, WATER RETENTION MEDCINE, SLEEPING MEDICATION, POTASSIUM, MULTIVITAMIN, VITAMIN C AND CALCIUM D AND VARFARIN, NEUROALIPTA, VENTALIN,

Current Illness: NONE

ID: 1764986
Sex: M
Age: 50
State: IN

Vax Date: 10/04/2021
Onset Date: 10/04/2021
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: No test performed on the day of the ER visit.

Allergies: NKDA

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

Symptoms: Service member had symptoms of an allergic reaction about 45 minutes after his first dose of Pfizer vaccine. He began having a sensation of swelling in the throat. His voice deepened, but did not had difficulty breathing nor with his air way, he did experience an increase amount of saliva in his mouth. EMS was called on the scene to access his vital and his air way, he later was transported to the hospital as precautioning measures. On arrival to hi did not appear to be in acute distress. He had some mild swelling over the uvula in the posterior pharynx. He had a feeling that his voice was deeper, he was anxious and with no.n toxic appearance and not in acute distress. The degree at onset was minimal, he was given Decadron 10mg, IV Push once, Pepcid 20mg IV push once, Diphenhydramine 25 mg. After the above treatment service member was feeling much better and was discharged from ER, with a follow up with his primary care physician .

Other Meds: Brilinta Aspirin Atorvastatin Lisinopril

Current Illness: Aortic Valve Disorder(Mild aortic insufficiency (AI) with normal aortic valve, asymptomatic, stable.

ID: 1764987
Sex: M
Age: 65
State: IL

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: 2 covid tests

Allergies:

Symptom List: Pain in extremity

Symptoms: has the flu, chills, sweat, fever, naseau

Other Meds:

Current Illness:

ID: 1764988
Sex: M
Age: 63
State: WY

Vax Date: 04/02/2021
Onset Date: 04/26/2021
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: None

Allergies: Bee sting

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

Symptoms: I was diagnosed with shingles

Other Meds: Atorvastatin, aspirin, Flovent, lisinop/HCTZ,

Current Illness: None

ID: 1764989
Sex: F
Age: 56
State: PA

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

Lab Data: Consultation with specialist (neurologist)

Allergies: No known drug allergies

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

Symptoms: Patient states she has been experiencing significant neuropathic pain in unilateral left arm after receiving Pfizer vaccine. Pain is described as burning and tingling extending from site of vaccination at the deltoid to the tips of the fingers on the left arm. Pain was not present for this patient prior to receiving 3rd dose booster vaccination.

Other Meds: duloxetine 30mg, lisinopril/hctz 20-12.5mg, baclofen 20mg, oxybutynin ER 5mg, pramipexole 0.125mg, gabapentin 300mg, diazepam 5mg, myrbetriq ER 25mg, kesimpta (specialty)

Current Illness:

ID: 1764990
Sex: F
Age: 45
State: IN

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

Lab Data:

Allergies: Sulfa Keflex

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

Symptoms: Fever 100.4- 5am on 10/5 thru 10p 10/5 Headache- onset 10/4 at 5p Extreme fatigue - onset 10p 10/4 though 5a 10/6

Other Meds: Hctz Multivitamin Vitamin d Probiotic

Current Illness:

ID: 1764991
Sex: M
Age: 58
State: WA

Vax Date: 04/01/2021
Onset Date: 09/07/2021
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: 9/7/2021: XR Chest 2 views: No acute cardiopulmonary pathology COVID-19 test: negative Troponin: negative BMP: normal BNP: normal CBC: normal other than elevated WBC (10.1) D-Dimer: 165 (reference range: 100-600) EKG: unremarkable

Allergies: sulfa

Symptom List: Vomiting

Symptoms: Covid-like symptoms - deep cough, runny nose. Treatment: none Diagnosis: Cough Outcome: treat symptoms

Other Meds: Eliquis 5mg 2/day Ezetimbe 10mg 1/day Atorvastatin 40mg 1/day Losartan 50mg 1/day Metoprolo Succ 50mg 1/day Aspirin 81mg 1/day

Current Illness:

ID: 1764992
Sex: F
Age: 66
State: NY

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: SYR
Vax Site: LA

Lab Data:

Allergies: she stated none at the time however her boyfriend said she has some allergies,

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: pt felt weak after about 5 minutes and was feeling like passing out. she then began to vomit.

Other Meds:

Current Illness: screws in head loose and needs surgery

ID: 1764993
Sex: M
Age: 37
State: MA

Vax Date: 09/10/2021
Onset Date: 09/10/2021
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:

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

Symptoms: Pt was given a vaccine past the 6 hour hold time after reconstitution. Pt had no signs or symptoms.

Other Meds:

Current Illness:

ID: 1764994
Sex: F
Age: 44
State:

Vax Date: 10/05/2021
Onset Date: 10/06/2021
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: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Within 24 hours felt nauseous, tinnitus in both ears, metal taste in my mouth

Other Meds:

Current Illness:

ID: 1764995
Sex: F
Age: 60
State: NC

Vax Date: 07/29/2021
Onset Date: 07/29/2021
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: Sulfa,

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

Symptoms: Welts on body, facial swelling,

Other Meds: Nexium

Current Illness:

ID: 1764996
Sex: F
Age: 55
State: IL

Vax Date: 08/20/2021
Onset Date: 08/22/2021
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: Dilaudid, chocolate, Vancomycin, Tetanus, anesthesia

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

Symptoms: Diarrhea, 101 temp; within the week, stomach issues-to see gastroenterologist; chest pains, high blood pressure; nausea Never hospitalized; waiting possible transfer to medical facility; kidney damage, lung damage, partial collapse, heart problems and stomach issues.

Other Meds: Gabapentin Remeron

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am