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: 1765306
Sex: F
Age: 78
State: MT

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: very itchy rash, swelling and redness at site of injection

Other Meds:

Current Illness:

ID: 1765307
Sex: F
Age: 66
State: AR

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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient received expired vaccination.

Other Meds:

Current Illness:

ID: 1765308
Sex: M
Age: 68
State: MA

Vax Date: 01/12/2021
Onset Date: 01/27/2021
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: 1/26/21 - COVID positive at outside facility. 1/27/21 - COVID positive at our institution (Of not had been screened q2 weeks prior to this date and was negative)

Allergies: Exenatide microspheres

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

Symptoms: Patient presents with recent positive COVID-19 test, fatigue, cough, shortness of breath, admitted and managed with Regeneron on investigational study

Other Meds: aspirin, acetaminophen, vitamin d, jardiance, nexium, famotidine, gabapentin, humalog, metformin, cellcept, pirfenidone, ramipril, rosuvastatin, testosterone

Current Illness: None known (but does have known IPF/ILD too early for lung transplant per notes)

ID: 1765309
Sex: M
Age: 19
State: NC

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient received Moderna Vaccine on 10/5/2021. The shelf life expired on 10/03/2021. The vaccine expiration date 10/10/21.

Other Meds:

Current Illness:

ID: 1765310
Sex: F
Age: 43
State: WV

Vax Date: 10/02/2021
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: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Systemic: Tingling (specify: facial area, extemities)-Mild.

Other Meds:

Current Illness:

ID: 1765311
Sex: F
Age: 48
State: HI

Vax Date: 04/24/2021
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: As above.

Allergies: Soy, Demerol, Sulfa, Morphine.

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

Symptoms: She got her vaccine, had no reaction other than a little fatigue. She went to her PCP for routine yearly exam, he did blood work and called yesterday stating that he found out that she had positive ANA markers for autoimmune disease were 160. She had a negative lab work 12 years ago. Other lab work is all normal other than this. She now has an appointment to see a Rheumatologist to see what type of autoimmune disease she has. She did have her flu vaccine on 9/28/21.

Other Meds: Oxycodone, Lyrica.

Current Illness: Had a URI at the time of the vaccine.

ID: 1765312
Sex: F
Age: 46
State: NJ

Vax Date: 03/11/2021
Onset Date: 09/29/2021
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: September 30, 2021 at Labcorp. Positive for Herpes simplex virus type-2. Typing was confirmed by monoclonal antibody microscopic immunofluorescence.

Allergies: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: First ever genital herpes outbreak during Rheumatoid Arthritis flare. Blister on genitals, fatigue and all over body pain in joints RA/muscles. Never had any symptoms of Herpes before. Medical practitioner mentioned that the vaccine could possibly awaken dormant viruses. I am immuno suppressed.

Other Meds: Enbrel 50mg/ml sureclick Methotrexate 20mg 1x/wk Sertraline 50mg/day Wellbutrin HCL XL 300mg/day Rosuvastatin 10mg/day Folic acid 1mg/day Fluticasone nasal Women?s Multi vitamin 1/day Vitamin C 500mg/day Fish oil 1000mg 1x/day D3 25mcg-1

Current Illness:

ID: 1765314
Sex: F
Age: 22
State: KY

Vax Date: 07/25/2021
Onset Date: 09/20/2021
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: LA

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Covid19.

Other Meds:

Current Illness:

ID: 1765315
Sex: F
Age: 36
State: WA

Vax Date: 08/14/2021
Onset Date: 08/14/2021
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: vicodin

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: About 5-6 hours after the vaccine, my face developed raised, red bumps that severely itched.

Other Meds: levothyroxine, eskoloft (herbal)

Current Illness: none

ID: 1765316
Sex: F
Age: 70
State: FL

Vax Date: 09/20/2021
Onset Date: 09/20/2021
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: N/A

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Arm pain, headache, low grade temp, congestion, excessive mucus, cough, coughing up mucus. When I had my first Covid shot in January, I had these reactions for close to 3 weeks. Every since then, I have excessive mucus and the doctor diagnosed post nasal drip. Now, after years of flu shots, I have had a very similar reaction after the flu shot.

Other Meds: Rosuvastatin 20mg, calcium with vitamin D

Current Illness: N/A

Date Died: 10/03/2021

ID: 1765317
Sex: M
Age: 77
State: WI

Vax Date: 09/30/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies: none

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

Symptoms: My dad had a physical 9/30/2021 and received a clean bill of health complete with lab work. He then received his second covid vaccine. sunday 10/3/2021 my dad got up went to the store..called my mother around noon had lunch and went back to work. two hours later he had an event and DIED. he was In perfect tip top health. he was taken from us way to soon

Other Meds: multi vitamin

Current Illness: none

ID: 1765318
Sex: F
Age: 81
State: MI

Vax Date: 09/28/2021
Onset Date: 10/01/2021
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: Site: Redness at Injection Site-Mild, Systemic: Allergic: Itch (specify: facial area, extremeties)-Medium, Systemic: Allergic: Rash (specify: facial area, extremeties)-Medium, Additional Details: Rash started 3 days after vaccination. Started in both upper extremities and spread to chest. Patient states severe itching that did improve slightly with hydrocortisone. On the 5th day rash is starting to recede.

Other Meds:

Current Illness:

ID: 1765319
Sex: M
Age: 42
State: OH

Vax Date: 08/25/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data: 2 Negative Home Pregnancy Tests

Allergies:

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

Symptoms: Delayed period of over 18 days (cycle has ALWAYS been 25-27... NEVER 45 days!).

Other Meds: NP Thyroid, FH Pro Multi, Ubiquinol, Alpha Lipidic Acid, NAC, Vitamin C, Fish Oil, Food Enzymes, Probiotic, Magnesium

Current Illness:

ID: 1765320
Sex: F
Age: 28
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: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: n/a

Allergies: Latex

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

Symptoms: Local, redness and swelling at injection approximately 3 inches across, slightly indurated, hot and itchy. Beginning 24 hours post vaccination, lymph pain and swelling to L axilla. Pain in axilla, shoulder/pec area. This report is being completed 48 hours post vaccination. At about 36 hours post vaccination, patient reports sharp chest pain localized to left side of chest lasting approximately 15 minutes.

Other Meds: n/a

Current Illness: n/a

ID: 1765321
Sex: F
Age: 55
State: KY

Vax Date: 03/29/2021
Onset Date: 09/08/2021
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: COVID POSTIVE

Other Meds:

Current Illness:

ID: 1765322
Sex: F
Age: 11
State: CT

Vax Date: 06/04/2021
Onset Date: 06/04/2021
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

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

Symptoms: this vaccine was given to a patient who was under the age of eligibility, no known side effect

Other Meds:

Current Illness:

ID: 1765323
Sex: F
Age: 57
State: MN

Vax Date: 04/12/2021
Onset Date: 09/16/2021
Rec V Date: 10/06/2021
Hospital: Y

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: Patient was hospitalized with Covid 19

Other Meds:

Current Illness:

ID: 1765324
Sex: F
Age: 64
State: CA

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: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-

Other Meds:

Current Illness:

ID: 1765325
Sex: F
Age: 77
State:

Vax Date: 08/09/2021
Onset Date: 10/05/2021
Rec V Date: 10/06/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: 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: 1765326
Sex: F
Age: 58
State: CA

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

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1765327
Sex: F
Age: 34
State: MN

Vax Date: 01/12/2021
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: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Fully Vaccinated employee began symptoms and tested positive for Covid-19.

Other Meds:

Current Illness:

ID: 1765328
Sex: M
Age: 83
State: PA

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: IM
Vax Site: LA

Lab Data: None

Allergies: None

Symptom List: Unevaluable event

Symptoms: Swollen injection site to this day; large(4 inch diameter) red patch which is itchy; listless for 5 days; slept 4 to 5 extra hours per day.; didn?t feel like eating. Felt certain it would go away each night, but it didn?t. Have pictures of site.

Other Meds: None

Current Illness: None

ID: 1765329
Sex: M
Age: 82
State: PA

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: LA

Lab Data:

Allergies:

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

Symptoms: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-

Other Meds:

Current Illness:

ID: 1765330
Sex: F
Age: 53
State: KY

Vax Date: 06/30/2021
Onset Date: 09/02/2021
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:

Symptom List: Injection site pain, Pain

Symptoms: COVID POSTIVE

Other Meds:

Current Illness:

ID: 1765331
Sex: F
Age: 55
State: TX

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: SYR
Vax Site: LA

Lab Data:

Allergies: Sulfa Medication Garlic

Symptom List: Injection site pain, Menorrhagia

Symptoms: Nausea Dizziness Headache Weakness Exhaustion

Other Meds: B12

Current Illness:

ID: 1765332
Sex: F
Age: 36
State: MO

Vax Date: 08/18/2021
Onset Date: 08/25/2021
Rec V Date: 10/06/2021
Hospital:

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

Lab Data: 2 ultrasound tests on 2 separate visits.

Allergies: None

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

Symptoms: Painful cramping a few days after the 2nd shot, followed by miscarriage several days later, confirmed by 2 separate ultrasound doctor's visits. Baby died around 6 to 7 weeks into pregnancy.

Other Meds: None

Current Illness: None

ID: 1765333
Sex: M
Age: 41
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: LA

Lab Data: None

Allergies: NKA

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: After receiving booster, patient was sent to monitoring area. Approximately 5 min later patient described feeling sweaty, fast pulse, heavy breathing. Thought he was going to pass out. Patient admitted to have been drinking for past 6-7 days. Response team was called to assist. Two to three minutes later team arrived and patient had calmed. After approximately 10 more minutes after team arrived, patient decided to leave on own. Response team was comfortable with decision.

Other Meds: IBUPROFEN ACETAMINOPHEN

Current Illness: None

ID: 1765334
Sex: M
Age: 7
State: WA

Vax Date: 10/02/2021
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: UNK
Vax Route: IM
Vax Site: RA

Lab Data: Chemistry panel, ESR

Allergies: Pineapple - causes rash

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: 36 hours after receiving vaccine, patient felt alternating tingling sensation in his upper and lower extremeties. As of 3/5/2021, which is when I evaluated him, his symptoms were still present and unchanged. His reflexes and strength were normal.

Other Meds: None

Current Illness: No

ID: 1765335
Sex: F
Age: 67
State: WI

Vax Date: 02/08/2021
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: None

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

Symptoms: Patient admitted as inpatient on 10/05/2021 due to Cerebrovascular accident (CVA) due to thrombosis. Patient was tested for COVID-19 and was positive on 10/05/2021, asymptomatic.

Other Meds: calcium phosphate-vitamin D3, DULoxetine, levothyroxine, metFORMIN

Current Illness:

ID: 1765336
Sex: M
Age: 62
State: GA

Vax Date: 04/01/2021
Onset Date: 05/01/2021
Rec V Date: 10/06/2021
Hospital:

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

Lab Data: Ekg,stress test echo garam and chest x-rays

Allergies: Penicillin

Symptom List: Nausea

Symptoms: Shortness in breath

Other Meds: Trulicty,jardance,metformin,amlodipine,atorvastatin

Current Illness:

ID: 1765337
Sex: F
Age: 95
State: CA

Vax Date: 09/20/2021
Onset Date: 09/20/2021
Rec V Date: 10/06/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Systemic: Confusion-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: Headache-Medium, Systemic: Nausea-Severe, Systemic: Weakness-Severe, Additional Details: Patients daughter, reported to the pharmacy on 10/5/21 that patient experienced severe adverse reaction after receiving her moderna booster on 9/20/21. Patient developed flu-like symptoms on 9/21/21 along with nausea and reduced appetite. Patient subsequently developed dehydration and was admitted to the hospital on 10/4/21. Stated that patient was also in a state of confusion.

Other Meds:

Current Illness:

ID: 1765338
Sex: F
Age: 60
State:

Vax Date: 03/25/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

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: 1765339
Sex: M
Age: 64
State: WA

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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: administration error - shot given 7 days too early.

Other Meds:

Current Illness:

ID: 1765340
Sex: F
Age: 80
State: WA

Vax Date: 09/29/2021
Onset Date: 10/03/2021
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: 10/4 - head CT, CBC, CMP, ethanol, drug screen magnesium, UA

Allergies: bees, pcn, peanuts

Symptom List: Tremor

Symptoms: Patient had tonic-clonic seizure on evening of 10/3/21, post-ictal for 2 hours. Evaluation in ER was negative for blood work and head CT

Other Meds: HCTZ and armour thyroid

Current Illness: knee bursitis

ID: 1765341
Sex: F
Age: 26
State: NC

Vax Date: 09/21/2021
Onset Date: 09/22/2021
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: N/a

Allergies: None

Symptom List: Erythema, Pruritus

Symptoms: Chills, Fever, Achy, Small amount of chest discomfort

Other Meds: None

Current Illness: No

ID: 1765342
Sex: M
Age: 67
State: CA

Vax Date: 09/30/2021
Onset Date: 09/30/2021
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: Error: Wrong Dose of Vaccine - Too Low-

Other Meds:

Current Illness:

ID: 1765343
Sex: M
Age:
State: IL

Vax Date:
Onset Date: 09/23/2021
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: LA

Lab Data:

Allergies: None

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

Symptoms: hospitalization

Other Meds: N/A

Current Illness: N/A

ID: 1765344
Sex: F
Age: 38
State: MN

Vax Date: 10/01/2021
Onset Date: 10/03/2021
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: Pcn, latex

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Severe diarrhea developed on day 3 after vaccination and continues through day 5.

Other Meds: Effexor, Lisinopril, Wellbutrin, iron, prenatal, vitamin d

Current Illness: None

ID: 1765345
Sex: F
Age: 80
State: CA

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

Lab Data:

Allergies:

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

Symptoms: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-

Other Meds:

Current Illness:

ID: 1765346
Sex: M
Age: 42
State: IL

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: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: none

Allergies: none

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

Symptoms: Onset of radiating pain occurred immediately from the vaccination shot site on my left arm. It spread and enveloped the left chest, lungs, and heart area within minutes of the injection. A tingling sensation of the entire left chest area lasted for several hours. Elevated heart rate, heart palpitations, and heart pain occurred within minutes of injection and lasted for several hours. Fever of 99.6 degrees occurred approximately eight hours after injection and lasted for several hours. Tiredness and fatigue occurred approximately eight hours after injection and lasted throughout the night. Onset of extreme joint pain and stiffness occurred approximately eight hours after injection and lasted throughout the night. At night I experienced chills, night sweats, and a headache that prevented sleep for most of the night. Onset of tinnitus throughout the night. I could feel the pressure on my eardrums with every heartbeat.

Other Meds: none

Current Illness: none

ID: 1765347
Sex: F
Age: 74
State: VA

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

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

Lab Data: CTK, CRP, SED, EMG, nothing abnormal

Allergies: No

Symptom List: Pain in extremity

Symptoms: On 3/8/21, I had the vaccine. During that week I had sore muscles in my neck, upper arm shoulder and back I also had weakness in my legs. The pain is constant and is always somewhere in my body. In late March, I contacted my PCP, and asked if I should get the second shot. On 5/5/21, I had a doctor's visit where physical therapy was ordered for the pain. It was primarily for my shoulders and neck. On 7/7, I went to another doctor, and he discontinued alendronate thinking the soreness was a side effect from that. For 4 months I was off but no difference. 8/21, I went back to the doctor. I was told to double up on over-the-counter medication but that did not help. On 8/26, an MRI was ordered. The MRI showed mild arthritis in my neck. I was then referred to physicians rheumatology. On 10/4, I went for my first visit to another primary care doctor. Several lab tests were ordered. The results did not show abnormal inflammation. Today, I saw an NP who is treating the soreness and pain as polymyalgia. She has prescribed a high dose prednisone which I will taper off. I am severely restricted with what I can do. It interferes with my walking, standing, sleeping. The pain is currently at a 7.

Other Meds: Hydrochlorothiazide; prednisone; alendronate; vitamin D

Current Illness: No

ID: 1765348
Sex: M
Age: 31
State: CA

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: 2
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Additional Details: pt had to go to rest roomafter shot came back said he thought he past out with in 5 mins after the shot fell in bathroom he felt dizzy and past out hit back of head was red and had a bump was clammy and sweating gave pt water and something to eat like a granola bar and boost pt was hungry ambulance came in to check pt out told him ok to go was getting his color back but head hurt due to fall called pt 2 hrs later better

Other Meds:

Current Illness:

ID: 1765349
Sex: F
Age: 68
State: IL

Vax Date: 03/12/2021
Onset Date: 03/12/2021
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: X-Rays 07/15/2021

Allergies: Pennicillin, Sulfa, Antibiotics

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

Symptoms: Pt. states that after receiving the 1st dose of Phizer 03/12/2021, started experiencing symptoms of pain at injection site, with bruising. Primary visit 06/2021 with referral to Orthopedics (Appt. 07/15/2021 X-Rays preformed). Bruising lasting estimated 4 weeks and pain still continuing spreading down the Left arm. (Recommended it was possibly Tendonitis of the Rotator Cuff) Physical Therapy has been setup up.

Other Meds: N/A

Current Illness: N/A

ID: 1765350
Sex: F
Age: 77
State:

Vax Date: 10/05/2021
Onset Date:
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: 1765351
Sex: F
Age: 84
State:

Vax Date: 03/27/2021
Onset Date: 10/06/2021
Rec V Date: 10/06/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Vomiting

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: 1765352
Sex: M
Age: 54
State:

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

Other Meds:

Current Illness:

ID: 1765353
Sex: F
Age: 66
State: SC

Vax Date: 10/01/2021
Onset Date: 10/06/2021
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: Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Medium, Systemic: Fever-Mild

Other Meds:

Current Illness:

ID: 1765354
Sex: F
Age: 56
State: KY

Vax Date: 02/22/2021
Onset Date: 09/03/2021
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: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: COVID POSTIVE.

Other Meds:

Current Illness:

ID: 1765355
Sex: M
Age: 3
State: CA

Vax Date: 09/27/2021
Onset Date: 09/28/2021
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: Several. Low albumin 1.8 today, increased CRP 10/3 was 43 now 10/6 it was 95. CT abd/pelvis on 10/4 with severe small bowel inflammation/enhancement.

Allergies: Environmental allergy to dogs. +allergy to peanut, egg, tree nuts, sesame. Previously allergic proctocolitis (blood in the stool suspected to be related to egg and/or milk in the maternal diet, possibly soy and sweet potato). He also had suspected FPIES to rice but passed a rice challenge in the hospital in March 2020. He passed a sunflower seed oral food challenge in August 2019. He tolerates baked egg. The patient passed a cashew and an almond oral food challenge in Dec 2020

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

Symptoms: One day after vaccination, started w L leg/calf pain and was limping. That self-resolved within 2 days. He also then developed abdominal pain, then vomiting that proceeded to bilious vomiting. Admitted to the hospital after 3-4 days of vomiting for hydration, workup. He had fevers that started 3 days after the vaccine, low grade. Higher in the hospital 101, 102 but very sporadic, and self-resolved.

Other Meds: None

Current Illness: 2 wk prior, had viral croup.

ID: 1765356
Sex: M
Age: 52
State:

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

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am