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: 1768447
Sex: F
Age: 49
State: AZ

Vax Date: 03/20/2021
Onset Date: 08/10/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: Positive COVID-19 test 8/10/21.

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Fully vaccinated individual became symptomatic for COVID-19 on 8/9/2021 and tested positive on 8/10/21.

Other Meds:

Current Illness:

ID: 1768448
Sex: F
Age: 33
State: TX

Vax Date: 08/17/2021
Onset Date: 09/15/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: 9/15/21- CBC, CMP, Troponin, EKGx3, CTA, D-dimer- all normal 9/23/21- stress test- abnormal due to peak HR reached at 5 minutes. Echo- normal

Allergies: Amoxicillin

Symptom List: Anxiety, Dyspnoea

Symptoms: 9/15/21 began experiencing sharp left side chest pain that would radiate up left shoulder and neck, accompanied with shortness of breath upon mild exertion. Was evaluated at the ER that night for pulmonary embolism and MI. All test at hospital were normal. was referred to cardiologist and diagnosed with pericarditis on 9/29/21. symptoms began to improve on 9/28/21 and have resolved on 10/1/21.

Other Meds: Orthotricyclen lo

Current Illness: none

ID: 1768449
Sex: U
Age: 17
State:

Vax Date: 08/30/2021
Onset Date: 08/30/2021
Rec V Date: 10/07/2021
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: Pt given expired vaccine. Pfizer contacted, awaiting guidance

Other Meds:

Current Illness:

ID: 1768450
Sex: F
Age: 61
State: CO

Vax Date: 04/14/2021
Onset Date: 06/01/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: I have had blood work and X-rays conducted.

Allergies: No

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Sudden onset of inflammation and arthritis. I never had a pain in my life regarding arthritis. I can feel the injection sites in my left arm.

Other Meds: Atorvastatin, Lisinopril. Sertraline

Current Illness: None

ID: 1768451
Sex: F
Age: 94
State: TX

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: Vitals: BP 123/68 98.1 Oral Glucose-148 EKG Sonic Rhythm

Allergies: n/a

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

Symptoms: Patient received the vaccine and became hot, dizzy, and had a headache. The nurse attended and took the patients vitals and glucose. EMS arrived at 11:40 am and checked vital signs and 12 lead EKG. Patient became more alert as nurse was asking questions. EMS and On-site nurse suggested to transport to hospital but patient refused.

Other Meds: High blood pressure medication

Current Illness: n/a

ID: 1768452
Sex: F
Age: 66
State: TX

Vax Date: 09/14/2021
Onset Date: 09/15/2021
Rec V Date: 10/07/2021
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: Bloodwork - sodium level was good. covid - Negative Chest Xray -ok EKC - ok

Allergies: no

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

Symptoms: Patient went doctor, he indicated that I was low sodium from bloodwork. It was a follow up doctor's visit. The doctor didn't have 3rd dose and I went to the pharmacy to get it. The next day ,I felt sick bad headache and body aches , fever 100.4. Went to ER and I was worried about my sodium level. Meds were given through IV.

Other Meds: mycophenolate - 500 milligrams 2 tablets twice a day, gabatenpin - 400 milligram 2capsules , 3 times a day , Oxcarbazepin - 450 milligram 3 times a day, nisedpine - 30 mg er 1 tablet/2 a day, omeprazole , 40 milligrams 1 a day am, Alenv

Current Illness: no

ID: 1768453
Sex: F
Age: 20
State: OH

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: administered Pfizer 48 hours after refrigeration expiration

Other Meds:

Current Illness:

ID: 1768454
Sex: M
Age: 71
State: MI

Vax Date: 02/06/2021
Onset Date: 10/06/2021
Rec V Date: 10/07/2021
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: Pharyngeal swelling

Symptoms: Positive covid test in hospitalized patient

Other Meds:

Current Illness:

ID: 1768455
Sex: M
Age: 14
State: MO

Vax Date: 07/12/2021
Onset Date: 07/12/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient may have potentially received an expired dose of vaccine after the 6 hours after being reconstituted.

Other Meds:

Current Illness:

ID: 1768456
Sex: F
Age: 32
State: UT

Vax Date: 10/05/2021
Onset Date: 10/06/2021
Rec V Date: 10/07/2021
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: seasonal allergies, lidocaine

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Received shot in left arm at the end of her shift. By the time she got home she was having pain and tingling in that arm. Went to bed and when she awoke in the am she had an extreme headache her cheek and eye were swollen, she was diaphoretic and nauseated. She took Ibuprophen at the time and still has some swelling today.

Other Meds: Sertaline

Current Illness: none

ID: 1768457
Sex: F
Age: 16
State:

Vax Date: 08/28/2021
Onset Date: 08/28/2021
Rec V Date: 10/07/2021
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: The client arrived to vaccine site for second dose in the vaccination series. Client is a 16 year old female and had received Moderna as initial dose despite being a minor. Registered nurse explained the CDC recommendations for vaccine administration errors and deviations that if client is age 12 to 17 and has received Moderna as initial dose that the second dose may be administered as off-label use. The client is accompanied by her father and both patient and parent consented to receiving second dose and acknowledged the CDC recommendations.

Other Meds:

Current Illness:

ID: 1768458
Sex: M
Age: 72
State: NY

Vax Date: 10/06/2021
Onset Date: 10/06/2021
Rec V Date: 10/07/2021
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: Pt received above vaccine @ 13:55, stated that he felt "pins and needles sensation top of right hand at 1530. 10/06/2021. Stated that "pins and needles " sensation top of right hand worsening morning of 10/07/2021 . Pt stated additionally that right hand now lightly tight . Pt stated that "tingling" sensation is now extending from top of right hand to right wrist area.. Pt states he does not have pain at this time

Other Meds:

Current Illness:

ID: 1768460
Sex: M
Age: 73
State: OH

Vax Date: 10/06/2021
Onset Date: 10/06/2021
Rec V Date: 10/07/2021
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: unknown

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

Symptoms: Janssen erroneously administered instead of Pfizer.

Other Meds: unknown

Current Illness: unknown

ID: 1768461
Sex: U
Age: 15
State:

Vax Date: 08/30/2021
Onset Date: 08/30/2021
Rec V Date: 10/07/2021
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: Pt given expired vaccine. Pfizer contacted, awaiting guidance

Other Meds:

Current Illness:

ID: 1768462
Sex: F
Age: 62
State: CA

Vax Date: 02/03/2021
Onset Date: 08/02/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: No

Allergies: No

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

Symptoms: Covid

Other Meds: No

Current Illness: No

ID: 1768463
Sex: F
Age: 53
State: CT

Vax Date: 08/28/2021
Onset Date: 08/28/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: 09/22/2021- went to the doctor and was told to take benadryl, pepcid, labs were done for immunity.

Allergies: I have allergies to aspirin, penicillin, lanolin, mercury, corn, potatoes, celery, shrimp

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

Symptoms: 08/28/2021- Everything started swelling, neck swelling, throat swelling, hives, nerve pain, fever, nerve pain rapid heart beat, low oxygen level, headaches, eye pain and tendonitis

Other Meds: I take Synthroid, rescue inhaler, nebulizer treatment, prednisone, Epi Pen

Current Illness: None

ID: 1768464
Sex: M
Age: 42
State: RI

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

Vax Type: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data: none

Allergies: NKDA

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

Symptoms: Pt called office this afternoon to alert nurse that he woke up this morning with vomiting and sweats. Denies any fever, states he does feel weak, fatigued and did have chills last night. Also states he started with left sided chest pain last night that has continued to be on and off. Advised pt that because of the chest pain he is having it is advised he go to the ER for further evaluation. Pt in agreement and is self transporting to local ER.

Other Meds: Zyrtec, Fluticasone nasal spray, Ibuprofen

Current Illness: none

ID: 1768465
Sex: M
Age: 63
State: MI

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

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

Lab Data: rapid covid

Allergies: Penicillins

Symptom List: Ear pain, Hypoaesthesia

Symptoms: positive covid

Other Meds: atorvastatin, amlodipine, hydrochlorothiazide, metformin, rosuvastatin

Current Illness: morbid obesity

ID: 1768466
Sex: U
Age: 17
State:

Vax Date: 08/20/2021
Onset Date: 08/30/2021
Rec V Date: 10/07/2021
Hospital:

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: Pt given expired vaccine. Pfizer contacted, awaiting guidance

Other Meds:

Current Illness:

ID: 1768467
Sex: F
Age: 66
State: OH

Vax Date: 10/04/2021
Onset Date: 10/04/2021
Rec V Date: 10/07/2021
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: PATIENT RECEIVED THE MODERNA VACCINE FOR DOSES 1 AND 2 AND THEN RECEIVED A BOOSTER OF PFIZER

Other Meds:

Current Illness:

ID: 1768468
Sex: F
Age: 14
State: GA

Vax Date: 09/19/2021
Onset Date: 09/28/2021
Rec V Date: 10/07/2021
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: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1768469
Sex: F
Age: 40
State: AZ

Vax Date: 01/12/2021
Onset Date: 08/23/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: Positive COVID-19 PCR test 8/23/21.

Allergies:

Symptom List: Unevaluable event

Symptoms: Fully vaccinated person became symptomatic for COVID-19 on 8/23/21 and tested positive on 8/23/21.

Other Meds:

Current Illness:

ID: 1768470
Sex: F
Age: 71
State: CA

Vax Date: 03/31/2021
Onset Date: 09/20/2021
Rec V Date: 10/07/2021
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: 71F with HTN, HLD, OSA, asthma, ILD, hypersensitivity pneumonitis, chronic hypoxemic failure (normally 2-3L home O2), HFpEF, CKD (creat 1.4) and DM2 who present with shortness of breath ongoing x 2 weeks. Increased lasix to 40mg daily 9/14. Covid postive on 9/16 during visit to the oxygen clinic. Developed chills, dry cough, chest tightness, and increased SOB on 9/19 and came to the ED on 9/20. Noted to have O2 sat 64%, BNP 805. Acute on chronic respiratory failure due to HFpEF, ILD and covid - admitted directly to ICU and managed with tocilizumab x 1 9/20, solumedrol 100mg IV BID (9/20-22), then 250mg IV q6hr (9/22-24), iNO given on 9/23 with some improvement in hemodynamics. HF component managed with IV lasix and spironolactone. Not given remdesivir due to renal function. Per I/O documentation she has diuresed a total of 18.8L. Weight down to 174lbs at discharge. (last clinic weight 195lbs on 8/16/21). CRP/Ddimer low so unclear how much covid is contributing to hypoxia. FiO2 returned to baseline 2 lpm. Received empiric cefepime 9/22-25. Solumedrol was weaned to prednisone 40mg daily 9/26 with plan to decrease by 10mg every 5 days. Lasix switched to PO on 9/27. PTA atenolol and losartan were continued at lower doses than home and amlodipine was stopped (bradycardia and low BP). Continued on PTA wixela and prn albuterol. Referral sent to follow up in pulmonary clinic. DM - managed with NPH/lipsor with ongoing titration. BS's were elevated and labile due to ongoing titration of steroids. Transitioned back to lantus for discharge. CKD - creatinine has improved with diuresis and is below recent basleine Mediastinal adenopathy - seen on CTA, f/u CXR in 6 weeks OSA - on CPAP q HS Primary Procedures: None Secondary Procedures: None Reason for Hospital Admission (Admitting Diagnosis): CHF, ILD, covid, acute on chronic respirtory failure

Allergies: Hydrochlorothiazide -makes gout worse Salonpas-hot ---Rash Simvastatin - Nausea/Vomiting Tetracycline - Vomiting

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

Symptoms: Date of Admission: 9/20/2021 Date of Discharge: 9/28/2021

Other Meds: ASPIRIN 81 MG ORAL TBEC DR TAB Sig: TAKE 1 TABLET ORALLY DAILY Albuterol (PROAIR/PROVENTIL/VENTOLIN) 90 mcg/actuation Inhl HFAA Sig: Inhale 2 puffs by mouth every 4 hours as needed for quick relief of asthma symptoms . 100 days suppl

Current Illness:

Date Died: 09/10/2021

ID: 1768471
Sex: M
Age: 67
State: OK

Vax Date: 01/07/2021
Onset Date: 01/15/2021
Rec V Date: 10/07/2021
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: weekly blood work draws on fridays

Allergies: He had an allergy to sulfur

Symptom List: Injection site pain, Pain

Symptoms: after shot on thursday, on friday his white blood cell count moved up just a little when he did his routine weekly blood work on fridays. the wbc count went up dispite the fact that he had been doing weekly xarixo shots (white blood cell boosting shots) from may 2020 - jan 2021 and the wbc did not move even after this time. and for the first time it went up after his 1st covid shot. WBC count slowly started going up and never stopped and continued to go up and when he got his 3rd shot in august it went up an accelerated rate in the 3 weeks and then he died. I noticed before his aug shot, he was at 700 at his wbc count and was at 100k on his august shot and 3 wks later at nearly 400K after that shot.

Other Meds: He was taking Allopurinol 300 mg, Lipitor 20mg, Protonix 40mg, Hydroxyurea

Current Illness: CMML (Chronic myelomonocytic) Leukemia

ID: 1768472
Sex: M
Age: 61
State: MI

Vax Date: 03/18/2021
Onset Date: 10/06/2021
Rec V Date: 10/07/2021
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: positive covid test

Other Meds:

Current Illness:

ID: 1768473
Sex: M
Age: 56
State: KY

Vax Date: 04/18/2021
Onset Date: 09/10/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: SARS CoV + SARS CoV 2 Antigen Positive

Allergies:

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

Symptoms: Breakthrough case after Covid vaccination, Dose #1 03/25/2021 Dose #2 04/18/2021. C/O loss of taste/smell and stuffy nose/ onset 9/10/2021

Other Meds:

Current Illness:

ID: 1768474
Sex: F
Age: 24
State: CA

Vax Date: 08/28/2021
Onset Date: 09/08/2021
Rec V Date: 10/07/2021
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: NA

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Chills, fatigue and body aches after the shot . An extreme change in menstrual period and symptoms . Nausea, lower back pain and really really bad cramps.

Other Meds: Junel birth control

Current Illness: N/A

ID: 1768475
Sex: F
Age: 52
State: MS

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 10/07/2021
Hospital: Y

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

Lab Data: I do not have access to her medical records, but she told me on the phone that they did MRI's and possible CT scans.

Allergies: unknown

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Pt called back to mobile clinic to report she had a swelling tongue and side of her face, 2 hours after injection. The staff she spoke to referred her to the nearest ER which was Medical Center. I called to check on her and she stated they had admitted her to their hospital for testing and she would call me when she had a clear idea of what was wrong. She also reported facial paralysis and neck and shoulder paralysis as well as a "knot that came up in a matter of seconds, the size of a golfball in her neck". She called back today 10/7/2021 to tell me she was discharged from hospital and was told she had suffered "a blood clot on the brain stem". She said she is better now. Not d/c home on any anticoagulants or new meds. Was told not to take another Covid vaccine.

Other Meds: unknown

Current Illness: unknown

ID: 1768476
Sex: M
Age: 52
State: FL

Vax Date: 04/01/2021
Onset Date: 06/01/2021
Rec V Date: 10/07/2021
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: Screening of a bladder - to get some of the cells to test. They tested the pieces of flesh that they took out - that came back as Cancer Grade 3 Stage PTA; Then they did the second surgery and took out more and it came back to PTA 1 Grade 3.

Allergies: mycardis; seasonal allergies

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

Symptoms: I was diagnosed with a bladder stone that they were going to go in and get and when they went to do it, it was attached to a tumor in the bladder. Dx'd with Bladder Cancer. Then they did some testing on that and I have had a couple of surgeries. They went in twice to do the TURB procedure. The first time, they didn't take enough to get to the muscle of the bladder so they had to do it again. I start BCG treatments - I start those the 12th of this month for six weeks, once per week.

Other Meds: Metformin 1000 mg; Hydrochlorothiazide - 12. 5 mg; Atorvastatin 10 mg; Losartan 100 mg; Carvedilol 12.5 mg; Pantoprazole 40 mg; Fluoxetine 40 mg; Potassium Chloride ER20; Tadalafal - 5 mg; Clonidine .1 mg; Amlodipine 5 mg; Vit D3; Zyrtec

Current Illness: no

ID: 1768477
Sex: M
Age: 47
State: AR

Vax Date: 09/30/2021
Onset Date: 10/01/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: high WBC count (15.98) RBC was slightly low at 4.26 platelets were *very* low at 24 (normal 150-450) PCP called at 10:00 PM last night (Wednesday) and urged to go to the ED immediately One thing the ED doc said was to monitor, especially in light of the low platelet count, is if have developed secondary immune thrombocytopenia

Allergies: Unknown

Symptom List: Nausea

Symptoms: very high fever of 103.4.

Other Meds: Unknown

Current Illness: Unknown

ID: 1768478
Sex: F
Age: 83
State: GA

Vax Date: 09/23/2021
Onset Date: 09/28/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1768479
Sex: M
Age: 32
State: CA

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

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

Lab Data: None yet

Allergies: None

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

Symptoms: Morning following injection, I experienced extreme dizziness and brain discomfort. Dizziness was bad enough to make walking difficult and even created motion sickness. 5 months later the dizziness has eased but still present, flying, driving, elevators, anything seems to trigger some form of dizziness. Hights of about 10 feet give bad vertigo, I am a pilot and aircraft mechanic and this creates an issue working on jets and I do not want to possibly loose my pilots medical. Brain fog is also long lasting still and makes mental clarity difficult which was never an issue until the day after the shot. My heart has created irregular heart rhythms, I have physical stress and tire easily and my muscles will shake and twitch after minimal effort. Biggest concern is dizziness and clarity and loss of short term memory, talking in front of large audiences for work has become difficult since my cognitive skills seem to have diminished from the lasting brain fog.

Other Meds: None

Current Illness: None

ID: 1768480
Sex: M
Age: 49
State: MA

Vax Date: 09/20/2021
Onset Date: 10/01/2021
Rec V Date: 10/07/2021
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: ekg x 2, cbc, chem, 10 d-dimer, tsh, ctscan, echo, stress test

Allergies: none

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

Symptoms: on day 11 after the second vaccine purple fingers and toes started with some shortness of breath, by day 14 worsening shortness of breath worsening extremities discoloration and chest pain with breathing

Other Meds: multi vitamin, vicodin, losartan, abilify, celexa, levothyroxine, pantoprazole,

Current Illness: none

ID: 1768481
Sex: M
Age: 60
State: TX

Vax Date: 03/24/2021
Onset Date: 08/28/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: pulmonary exam 10/04/2021 - measurement of respiratory and volume of breathing

Allergies: banana allergy tree nuts

Symptom List: Tremor

Symptoms: On 08/28/2021, an extreme shortness of breath , constricted throat and inability to breath. It lasted about 15 minutes from onset to resolution. I have a rescue inhaler, I used it, I monitored and noticed subsequent use of the inhaler. Serious increase in my need for the inhaler for the next week and then I sought medical attention. On 09/27/2021- I saw Dr. - he examined me, listened to my respiration, and prescribed a pulmonary exam. And started me on new medication, Montelukast sod 10 mg od, and Qvar Redinhaler 40 mcg bd, and Albuterol sulfate HSA as needed. I have benefited from the new medication, but I still continue with frequent need to use my rescue inhaler.

Other Meds: lisinopril 20 mg od Benadryl 50 mg od cetirizine 10 mg bd hcl 25 mg od

Current Illness: no

ID: 1768482
Sex: F
Age: 78
State: SC

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/07/2021
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: codeine, oxycodone, sulfa, amlodipine, dilauded, ibuprofen

Symptom List: Erythema, Pruritus

Symptoms: Headache for 6 days lightheaded/dizzy

Other Meds: vitamin d, crestor, spironolactone valsartan

Current Illness: history of covid19. hypertension, osteoporosis, coronary artery disease, hyperlipidemia, prediabetes, vitamin d deficiency

ID: 1768483
Sex: M
Age: 16
State: CA

Vax Date: 03/14/2021
Onset Date: 10/07/2021
Rec V Date: 10/07/2021
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: N/A

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

Symptoms: Patient 16 years old at time of vaccine which Jansen Covid vaccine to be given to 18 years and older. Patient's date of birth on the covid card is incorrect.

Other Meds: N/A

Current Illness: N/A

ID: 1768484
Sex: M
Age: 52
State: CA

Vax Date: 08/17/2021
Onset Date: 08/27/2021
Rec V Date: 10/07/2021
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: Demerol

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

Symptoms: Started with an intense scratchy throat and then it completely closed up. This lasted about 5-seconds & the itchyness is not as intense but has never gone away.

Other Meds: None

Current Illness: No

ID: 1768485
Sex: F
Age: 25
State: GA

Vax Date: 09/22/2021
Onset Date: 09/28/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1768486
Sex: F
Age: 64
State: NY

Vax Date: 04/26/2021
Onset Date: 05/26/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: not yet...appointment in Nov.

Allergies: None

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

Symptoms: Tinnitus.....beginning to affect ability to sleep...appointment has been made with specialist Nov 9, 2021

Other Meds: None

Current Illness: None

ID: 1768487
Sex: F
Age: 90
State: MN

Vax Date: 02/18/2021
Onset Date: 10/02/2021
Rec V Date: 10/07/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Patient was hospitalized with Covid 19

Other Meds:

Current Illness:

ID: 1768488
Sex: U
Age: 22
State: GA

Vax Date: 09/19/2021
Onset Date: 09/28/2021
Rec V Date: 10/07/2021
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: Pain in extremity

Symptoms: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1768489
Sex: F
Age: 78
State: OH

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

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

Lab Data: N/A

Allergies: unknown

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

Symptoms: J&J erroneously administered instead of Pfizer.

Other Meds: unknown

Current Illness: unknown

ID: 1768490
Sex: M
Age: 79
State: SC

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/07/2021
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: nkda

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

Symptoms: Headache for 6 days

Other Meds: aspirin, ergocalciferol, levothyroxine, rosuvastatin, tadalafil

Current Illness:

ID: 1768491
Sex: M
Age: 15
State: PR

Vax Date: 06/02/2021
Onset Date: 06/02/2021
Rec V Date: 10/07/2021
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: N/A

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

Symptoms: Minor male patient. At the time of being vaccinated he appeared sweaty, cold to touch. The vaccinator indicated that he was ventilating. Vital signs were taken. BP60/40, dextrose 79. He was given brown sugar and applesauce and in 10 minutes he was monitored again for vital signs. BP 70/40 and glucose was 110. He positioned himself semi-folded with his head down and oriented himself. According to him he was feeling better outside by raising his head. He positioned himself in semi-lumbar to help increase pressure. When the ambulance arrived for transfer to the nearest hospital he was stable.

Other Meds: N/A

Current Illness: N/A

ID: 1768492
Sex: F
Age: 47
State: CA

Vax Date: 10/04/2021
Onset Date: 10/04/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: no tests

Allergies: NKDA

Symptom List: Vomiting

Symptoms: itching, swelling and redness of the injection site within 4 hrs of injection; generalized hives within 12 hrs of injection

Other Meds: lisinopril

Current Illness: none

ID: 1768493
Sex: F
Age: 43
State: WI

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: 10/11 seen my primary for chest pains, headaches, feeling out of breath.

Allergies: Bee & seasonal

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Severe headaches, constant heart racing & feeling out of breath almost panic feeling, vomiting night of vaccine, body aches, very tired still, blood work affected along with my crohns.

Other Meds: Entyvio, vitamin D, Folic, multi vitamin

Current Illness:

ID: 1768494
Sex: F
Age: 84
State:

Vax Date: 03/27/2021
Onset Date: 10/06/2021
Rec V Date: 10/07/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: 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:

Date Died: 10/06/2021

ID: 1768495
Sex: F
Age: 79
State:

Vax Date: 08/25/2021
Onset Date: 10/05/2021
Rec V Date: 10/07/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: death - Acute intracranial hemorrhage

Other Meds:

Current Illness:

ID: 1768496
Sex: F
Age: 24
State: IN

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

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

Lab Data: N/a

Allergies: Codeine and Lexapro

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

Symptoms: Getting the covid vaccine was worse than having covid itself for me. I experienced flu like symptoms. Body aches, chills, profuse sweating without a fever, soreness in arm at the injection site occurring 20 minutes after injection and is still sore, and a headache. All symptoms started, besides left arm soreness, early morning on oct 6 around 6 AM and continued until I went to bed around 9pm on oct 6.

Other Meds: Vitamin C, daily multivitamin, fish oil, adderall, and Wellbutrin

Current Illness: None

ID: 1768497
Sex: F
Age: 47
State: AZ

Vax Date: 01/08/2021
Onset Date: 08/22/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: Home COVID-19 test resulted positive on 8/22/21.

Allergies:

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

Symptoms: Fully vaccinated person became symptomatic for COVID-19 on 8/22/21 and tested positive on 8/22/21.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am