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**
PLEASE CHECK BACK SOON
Download the files above while you wait.







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: 1768551
Sex: F
Age: 43
State: PA

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

Lab Data:

Allergies: NA

Symptom List: Dysphagia, Epiglottitis

Symptoms: Massive full body pain all joints, all muscles. 101.1 fever last from 10 pm 10/4/21-@12:00AM 10/6/21

Other Meds: Levoxyl Levothyrinine Sertraline Omeprazole Vit D

Current Illness: NA

ID: 1768552
Sex: F
Age: 32
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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Systemic: Fainting / Unresponsive-Mild, Additional Details: fainted after admin of fist dose of modern vaccine. recovered quickly. ems arrived and checked her out. she was fine

Other Meds:

Current Illness:

Date Died: 10/06/2021

ID: 1768554
Sex: M
Age: 87
State:

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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: death E87.1 - Hyponatremia

Other Meds:

Current Illness:

ID: 1768555
Sex: F
Age: 45
State: TX

Vax Date: 09/08/2021
Onset Date: 09/15/2021
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:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Systemic: Allergic: Rash (specify: facial area, extremeties)-Medium, Systemic: Numbness (specify: facial area, extremities)-Medium, Systemic: Tingling (specify: facial area, extemities)-Medium, Additional Details: ~1.5 weeks after administration, patient had delayed numbness/tingling that came and went in left arm. At about 2 weeks out, she also had a swollen, red rash (no itching) at site of injection. Tylenol, Advil, Benadryl provided no relief.

Other Meds:

Current Illness:

ID: 1768556
Sex: F
Age: 51
State: MN

Vax Date: 03/31/2021
Onset Date: 05/01/2021
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 to date, I have an appointment for tomorrow 10/08/2021.

Allergies: Benzocaine Seafood Sulfonamide Antibiotics

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

Symptoms: The 1st is an abnormally yellow-green vaginal discharge. There is no odor, no burning, no itching, and no abdominal/pelvic pain. It occurs 2-3 times a week and has the consistency and color or phlegm when I have a cold/flu. I was worried and went to Planned Parenthood and got an STI workup and that all came back negative. The 2nd is I am experiencing chronic full body pain in my joints and ligaments. It started very mild and intermittent but over time since May has become worse and more consistent. There has also been some joint swelling that comes and goes. I am almost 52 and do have some bouts of pain that I associate with age but this is more pronounced and sudden in onset since the vaccine in April.

Other Meds: albuterol sulfate 90 mcg/actuation 2 PUFF inhaled every 4 hours as needed for shortness of breath ascorbic acid (vitamin C) PO daily aspirin (Adult Aspirin Regimen) 81 mg 81 MG orally daily calcium carbonate-vitamin D3 (Calcium 600 with V

Current Illness: None

ID: 1768557
Sex: M
Age: 19
State: OK

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

Allergies: None

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

Symptoms: Wrong vaccine given. Monitored patient for additional time, no sxs reported at that time.

Other Meds: N/A

Current Illness: None

ID: 1768558
Sex: F
Age: 78
State: IA

Vax Date: 09/17/2021
Onset Date: 10/03/2021
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: ct scan, Mri, labs and was given the TPA drug, and hospitalized for Oct 3 to the 5th now wearing a heart monitor for 30 days

Allergies: sulfa, levaquin, liptor, bactrim, zorcor, cipro

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: loss control of my right arm, said it was a mini stroke was treated with TPA shot

Other Meds: none at the time

Current Illness: I have copd

ID: 1768559
Sex: M
Age: 89
State:

Vax Date: 02/27/2021
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: Patient is oriented to person and place; but not to time. He is febrile here at 39.6 degrees Celsius. The patient has a difficult time participating in history but endorses a cough, shortness of breath, diarrhea and fever that all began within the past day. 3rd vaccine 09/28/2021.

Other Meds:

Current Illness:

ID: 1768560
Sex: F
Age: 32
State: TN

Vax Date: 03/09/2021
Onset Date: 03/09/2021
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: No known allergies

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: I received my first dose of Pfizer and went to the allotted room where I had to sit for 30 minutes to ensure there was no adverse reaction. Within 10 minutes of me receiving the vaccine, I experienced a very distinct sensation that my throat was getting swollen. It was localized to my throat and felt as if my throat was getting "thicker". I spent the entire 30 minutes in the room and then left hoping that fresh air would help me to feel better. I ended up sitting outside of the emergency room for an hour before I was sure enough that my throat was not going to close completely, requiring emergency treatment. My throat had the sensation of feeling swollen for several hours after the vaccination. I knew if I mentioned this to the vaccination team, they would require me to go to the emergency room and I did not want to be responsible for an ER bill unless if it were absolutely necessary. I mentioned this event to my OB-GYN a few weeks later and she advised me that it would not be safe to get the second dose.

Other Meds: Prenatal Vitamin

Current Illness: None

ID: 1768561
Sex: F
Age: 62
State: CA

Vax Date: 08/26/2021
Onset Date: 08/29/2021
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: Chest Xray (pending results): 10/7/2021 Rapid COVID-19 Test: unknown location (School, rapid, negative) patient did not have information on hand and could not remember.

Allergies: KNDA, NKFA, NKEA

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Developed a chronic cough 3 days after receiving vaccine. Did not have this symptom with prior doses of vaccine.

Other Meds: Atorvastatin 40mg Qnightly, Calcium/ Vit D 200/500 units BID, Metformin 500mg BID.

Current Illness: Denies any URI symptoms prior to vaccine.

ID: 1768562
Sex: M
Age: 85
State:

Vax Date: 02/19/2021
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: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: presents after a fall at home in the setting of lightheadedness and weakness, now with confirmed positive COVID-19 infection. Fortunately, his vital signs have been stable and he is saturating well on room air. However, weakness in the setting of the infection likely resulted in the fall.

Other Meds:

Current Illness:

ID: 1768563
Sex: F
Age: 26
State: MA

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: Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Nausea-Medium, Additional Details: Patient stated they felt like they were going to pass out and felt very nauseous, was also visibly sweating a lot. Called 911 and rescue treated patient on scene, patient walked out of store with EMTs after being monitored/treated for around half an hour.

Other Meds:

Current Illness:

Date Died: 10/05/2021

ID: 1768564
Sex: F
Age: 69
State:

Vax Date: 04/14/2021
Onset Date: 10/02/2021
Rec V Date: 10/07/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: death J96.90 - Respiratory failure J96.01 - Acute respiratory failure with hypoxia

Other Meds:

Current Illness:

ID: 1768565
Sex: M
Age: 61
State: VA

Vax Date: 04/07/2021
Onset Date: 04/08/2021
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: SYR
Vax Site: LA

Lab Data: CT scan-blood clot in the lung CBC-blood clot indication Ultrasound-blood clot in the leg

Allergies: Lisinopril

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

Symptoms: The next day my arm at the injection site got a little sore which lasted about 24hrs. About 2 weeks ago I noticed a blood clot in my lower left leg that somehow detached and made its way to my lower left lobe of my right lung causing me to not to feel well. On Sat 9/11 it felt as my Trapezoid muscle in my right shoulder had a stabbing pain the pain was so bad that I went to the ER and was placed on blood thinners because the CT scan did show clots and was admitted in the hospital hours later on 9/12. The blood clot was from the groin area to the knee of my left leg. I was monitored and various test were performed and I was released after 3 days. I have an appointment on 10/18 with the Cardiologist because they suspect the blood clot in the lung caused a lot of inflammation and put excess pressure on the right side of my heart. I have an appointment tomorrow with the Pulmonologist for further treatment regimen.

Other Meds: Metoprolol-HCTZ, Potassium Citrate, C4

Current Illness: no

ID: 1768566
Sex: M
Age: 77
State: WI

Vax Date: 02/08/2021
Onset Date: 10/05/2021
Rec V Date: 10/07/2021
Hospital: Y

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

Lab Data:

Allergies: None

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

Symptoms: Pt Presented with Chronic S.O.B And Chronic cough. Pt was treated with Asperin, Azithromycin, Cestriaxone. Pt Still hospitalized.

Other Meds: Unknown

Current Illness: Unknown

ID: 1768567
Sex: M
Age: 89
State:

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

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: presents with fever and shortness of breath, found to have COVID-19 infection patient received his 3rd vaccine on 10/6/2021

Other Meds:

Current Illness:

ID: 1768568
Sex: F
Age: 26
State: OK

Vax Date: 10/06/2021
Onset Date: 10/06/2021
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:

Allergies:

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

Symptoms: Site: Bruising at Injection Site-Mild, Systemic: Fainting / Unresponsive-Mild

Other Meds:

Current Illness:

ID: 1768569
Sex: M
Age: 22
State: PR

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

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

Lab Data:

Allergies: N/A

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Male patient alert x3 with stable at 98 sat, 96 pulse, 36.3 temp, 100/70 HBP. Patient reports having head pain scale 1 to 10 and indicates an 8 pain level. Patient is in observation for 10 additional minutes. After the 10 minutes we asked if he was feeling better and he reports feeling the same. Patient reports taking Panadol 10 minutes before reporting to staff feeling head pain. The patient is asked if he wants to go to the hospital and indicates that he will go to his preferred room and his sister indicates that they will take him later. Patient leaves alert x3 in his car with his 2 sisters.

Other Meds: N/A

Current Illness: N/A

Date Died: 10/04/2021

ID: 1768570
Sex: M
Age: 82
State:

Vax Date: 02/27/2021
Onset Date: 09/24/2021
Rec V Date: 10/07/2021
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: death I63.9 - Acute CVA (cerebrovascular accident)

Other Meds:

Current Illness:

ID: 1768571
Sex: M
Age: 19
State: ND

Vax Date: 10/07/2021
Onset Date: 10/07/2021
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: unknown

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

Symptoms: Administered a vaccine after it expired. Was opened at 9:00 am 10/6 and administered at 12:30 on 10/7.

Other Meds: unknown

Current Illness: none reported

ID: 1768572
Sex: M
Age: 39
State: GA

Vax Date: 09/30/2021
Onset Date: 10/02/2021
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: none

Allergies: NKA

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

Symptoms: Patient presents to clinic on 10/07/2021 and states that he would like to make a report about his symptoms after the second dose of Pfizer COVID-19 vaccine on 09/30/2021. States that he has had fatigue and abdominal pain two days after the second dose and has not had any relief, but has not followed up with a PCP. States that he has not been able to go to work since the second dose. States that his supervisor told him to make a report at the place where he received his COVID 19 vaccines.

Other Meds: None

Current Illness: None

ID: 1768573
Sex: F
Age: 77
State: GA

Vax Date: 09/14/2021
Onset Date: 09/14/2021
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: Unevaluable event

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: 1768574
Sex: M
Age: 37
State: FL

Vax Date: 02/01/2021
Onset Date: 09/25/2021
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: CBC w/dif, CMP, D-dimer, Troponin, COVID PCR, Lipid Pannel, Glycohemoglobin profile EKG, Cath lab, Chest X-ray, CTA Chest.

Allergies: Aspirin

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

Symptoms: 9-26-2021 2100 Left upper chest pain. Felt like I layed on my arm wrong. Took 1gm tylenol and a warm bath. Pain Resolved. 9-27-2021 0330 Pain returned took 1gm Tylenol and 400mg Ibuprofen pain did not resolve. 0430 Pain began to radiate down left arm went to Hospital. Triage took EKG that showed Inferior MI. Sat in waiting room pain resolved. After 1 hour left facility to seek help at another facility. Pain returned EKG showed STEMI Troponins + d-dimer+. Sent to Cath Lab at medical center. No occlusions found. Diagnossed with Focal Myocarditis.

Other Meds: Symbicort, Albuterol, Tylenol, Ibuprofen

Current Illness: N/A

ID: 1768575
Sex: F
Age: 29
State: FL

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: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Mild, Additional Details: I gave vaccine and watched for 15 minutes. Patient was wearing a mask so couldnt see but later she came back in like 30 minutes and showed me her swollen tongue. I gave her immediately 2 benadryls and water and she came back before she left store to show me swelling went down. shw was with a friend and counseled her not to drive because drowsiness from benadryl. she was ok before she left.

Other Meds:

Current Illness:

Date Died: 10/04/2021

ID: 1768576
Sex: M
Age: 52
State:

Vax Date: 04/23/2021
Onset Date: 10/02/2021
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: death E87.1 - Hyponatremia

Other Meds:

Current Illness:

ID: 1768577
Sex: M
Age: 79
State: GA

Vax Date: 09/14/2021
Onset Date: 09/14/2021
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:

Allergies:

Symptom List: Arthralgia, Chills, Headache, Mobility decreased, 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: 1768578
Sex: F
Age: 12
State: MN

Vax Date: 09/29/2021
Onset Date: 09/29/2021
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:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Error: Patient Too Young for Vaccine Administered-

Other Meds:

Current Illness:

ID: 1768579
Sex: M
Age: 59
State: OH

Vax Date: 09/28/2021
Onset Date: 10/04/2021
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: 10/7/21 COVID-19, rapid: positive CBC: platelets 133; HBG 13.4; lymphocytes 15 Sed rate: 62 Chest X-ray: right lateral mid-field opacity; bibasilar opacities d-dimer: 1.37 Pro-BNP: 1137 CMP: sodium 130; potassium 3.6; AST 49; albumin 3.4 CRP: 129.7 Procalcitonin: 0.14 troponin (high sensitivity): 36 Chest CT: bilateral opacities

Allergies: NKA

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: On approximately 10/4/21 the patient began experiencing nausea and vomiting, cough, and shortness of breath. On 10/7/21 the patient began feeling associated dizziness and lightheadedness with his shortness of breath. Per EMS report, the patient's O2 sats were in the high 80s with bilateral wheezing when they arrived. The patient received a Duoneb treatment in the field. Patient was found to have A-fib with RVR in ED (HR in the 150s on initial presentation) and patient has no known history of A-fib. Patient was febrile to 103 F. Patient was started on anticoagulation, fluids, and a diltiazem drip. Patient is requiring high flow O2. Patient is positive for COVID-19 by rapid test. The patient will be admitted to ICU.

Other Meds: Aspirin, clopidogrel, Advair, lisinopril, metoprolol succinate, simvastatin

Current Illness:

Date Died: 10/04/2021

ID: 1768580
Sex: M
Age: 76
State:

Vax Date: 04/04/2021
Onset Date: 09/25/2021
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: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: death N17.9 - AKI (acute kidney injury)

Other Meds:

Current Illness:

ID: 1768581
Sex: F
Age: 66
State: FL

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: RA

Lab Data: **see above Husband was evaluated at ER

Allergies:

Symptom List: Nausea

Symptoms: Skin rash of bright red, raised dots on abdomen & arms. My husband had the same vaccine at pharmacy on 9/29/21 and broke out in the same rash (which he still has) on his trunk, legs & feet. He was evaluated at the ER on 10/06/21, and they felt it could be vaccine related. He is treating the itching with Benadryl cream. We also both had the Pfizer COVID booster shot at the same pharmacy location on 9/25/21.

Other Meds: Citracal Magnesium Atorvastatin (every other day)

Current Illness:

ID: 1768582
Sex: M
Age: 43
State: KY

Vax Date: 04/30/2021
Onset Date: 09/10/2021
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: Bio Q Nasal Antigen Positive on 9/15/2021

Allergies:

Symptom List: Injection site pain

Symptoms: Breakthrough case after Covid vaccination. Dose #1 4/2/2021 Dose #2 4/30/2021. C/O runny nose, fatigue, cough, chest pain, and diarrhea/ onset 9/10/2021

Other Meds:

Current Illness:

ID: 1768583
Sex: F
Age: 65
State: IA

Vax Date: 04/22/2021
Onset Date: 04/25/2021
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: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Patient experienced a severe migraine 3 days later (never having had one previously) and went to ER, had a CAT scan which was negative for anything. Treated at home with Tylenol, eventually with continued migraines was prescribed Axert.

Other Meds:

Current Illness:

ID: 1768584
Sex: F
Age: 84
State: WA

Vax Date: 03/13/2021
Onset Date: 09/01/2021
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: Multiple blood tests, X-Rays and Scans while in ER on Sept 7, 2021

Allergies: none

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

Symptoms: Started having difficulty breathing and severe breathing when stressed early September. Taken to Emergency Room at Hospital, Sept. 7 with O2 sats in the 80's. Was in ER for multiple tests to determine cause of breathing issue. Scan and blood tests ultimately revealed massive clotting in lungs and heart. Put on IV Heparin and hospitalized for 1 week.

Other Meds: 81 mg ASA

Current Illness: none

ID: 1768585
Sex: F
Age: 19
State: AK

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: IM
Vax Site: LA

Lab Data: none

Allergies: Amoxicillin

Symptom List: Tremor

Symptoms: Pt. received Moderna vaccine 03/24/2021. Pfizer vaccine was given 10/06/2021.

Other Meds: None

Current Illness: None

ID: 1768586
Sex: F
Age: 91
State: IA

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

Lab Data: none

Allergies: Sulfa

Symptom List: Erythema, Pruritus

Symptoms: Patient already received her 3rd (booster) dose on 9/30/21 at the facility she resides in- this was not know at the time of her appointment today or did the patient tell us she just received her boost dose. A 4th dose was given today, not knowing she just got it a week ago, it did not come up on our immunization history.

Other Meds: Tylenol, Norvasc, cranberry concentrate, aspirin, TUMS, Vit D3, cinnamon, ibuprofen, lisinpril, lysine, mag-ox, melatonin, metformin, omeprazole, miralax, K+, pravastatin, senokot, torsemide, tramadol

Current Illness: NA

ID: 1768587
Sex: F
Age: 64
State: GA

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

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

Date Died: 10/03/2021

ID: 1768588
Sex: M
Age: 73
State:

Vax Date: 03/10/2021
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: LA

Lab Data:

Allergies:

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

Symptoms: death N17.9 - AKI (acute kidney injury) (CMS/HCC) J96.01 - Acute respiratory failure with hypoxia (CMS/HCC)

Other Meds:

Current Illness:

ID: 1768589
Sex: M
Age: 16
State: CA

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: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Systemic: Confusion-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Additional Details: pt got pfizer covid shot on left arm and fluzone on right felt light headed and dizzy fainted fell and hit his chin and was unresponsive for a few minutes paramedics came to check pt out was fine

Other Meds:

Current Illness:

ID: 1768590
Sex: F
Age: 66
State: FL

Vax Date: 09/29/2021
Onset Date: 09/29/2021
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:

Allergies: Sulfa

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

Symptoms: Severe chills 8:15, sharp mid- back pain 8:45

Other Meds: Metformin, amlodipine, bupropion, citalopram, trazadone, levothyroxine Calcium, vit D, vit A, fish oil, B complex, iron

Current Illness: None

Date Died: 10/03/2021

ID: 1768591
Sex: M
Age: 77
State:

Vax Date: 02/16/2021
Onset Date: 09/28/2021
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: death G45.9 - TIA (transient ischemic attack)

Other Meds:

Current Illness:

ID: 1768592
Sex: F
Age: 29
State: AR

Vax Date: 10/02/2021
Onset Date: 10/03/2021
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: One side of her face feels itchy and numb. It started slightly the day after the shot but four days later she is still having symptoms.

Other Meds:

Current Illness:

ID: 1768593
Sex: M
Age: 80
State: NY

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:

Allergies:

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

Symptoms: Error: Wrong Dose of Vaccine - Too High-

Other Meds:

Current Illness:

ID: 1768594
Sex: F
Age: 51
State: SC

Vax Date: 08/01/2021
Onset Date: 08/29/2021
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: None. I did mention it to my PCP at regular physical on 9/13. I was encouraged to complete this form after receiving my 2nd dose (on 9/26).

Allergies: None

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

Symptoms: The evening after receiving the injection my head felt pressure and bilateral ears began ringing (tinnitus) this has been constant since the time of the first vaccine. No change after my second dose.

Other Meds: Synthroid, Tylenol , omeprazole

Current Illness: None

ID: 1768595
Sex: F
Age: 62
State: FL

Vax Date: 09/23/2021
Onset Date: 09/24/2021
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: none

Allergies: Sulfa drugs, erythromycin

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

Symptoms: No adverse effect for the first 12 hours, from 11am to 11pm. Fitfull sleeping at night - unable to sleep, achy body, beginning of fever. Day after shot: body aches, weak, severe fatigue, heavy arm, redness around site of shot ~ 2" x 5", fever of 100.8. Second day after shot: body aches lessening, fatigue, heavy arm, redness around site of shot ~ same size, fever of 99.8. Third day after shot: weakness, starting to feel closer to normal, redness around site of shot ~ 2" x 4", fever of 98.8. My body temperature is typically closer to 98. Fourth day after shot: feeling much better, no fever, just slight redness of arm and some stiffness. Not sure if this is related to the vaccine: low grade nauseous headache from 11th to 14th day after vaccine.

Other Meds: meloxicam, hydroxychloroquine, forteo, flonase, calcium, vitamin D

Current Illness: none

ID: 1768596
Sex: F
Age: 50
State: GA

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

Allergies:

Symptom List: Vomiting

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: 1768597
Sex: F
Age: 34
State:

Vax Date: 09/15/2021
Onset Date: 09/15/2021
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: None

Allergies: Unknown

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Pfizer vial was diluted with 1.5ml of diluent instead of 1.8ml. A vaccine was taken from the table before all doses had been drawn up and one dose was administer before the adverse event was realized. No other doses were administered. Patient was notified and the on-site provider consulted with the patient. Patient stated she experienced no symptoms or issues other then the normal headache experienced by other patients who were vaccinated with a correctly diluted vaccine.

Other Meds: Unknown

Current Illness: Unknown

ID: 1768598
Sex: F
Age: 20
State: FL

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

Allergies:

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

Symptoms: Systemic: Dizziness / Lightheadness-Medium, Systemic: Felt like she was going to faint-Medium, Systemic: Nausea-Medium

Other Meds:

Current Illness:

Date Died: 10/02/2021

ID: 1768599
Sex: M
Age: 45
State:

Vax Date: 04/28/2021
Onset Date: 09/18/2021
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 J18.9 - Pneumonia, unspecified organism J96.01 - Acute respiratory failure with hypoxia

Other Meds:

Current Illness:

ID: 1768600
Sex: M
Age: 51
State: CA

Vax Date: 08/16/2021
Onset Date: 08/17/2021
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: ER did xrays a bunch of bloodwork the 24th and 25th, and more was done this week. WBC was a touch high from standard, potsassium a touch low, no evidence of heart attack in the enzyms. I can not copy and paste the results, I tried

Allergies: Ibuprofin, ketoprifin, onion, carrot, gabapentimn, pollen

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

Symptoms: Severe fever and congestion as bad as when I had covid that lasted a week or so. Heart pressure began after a few days, radiating out from my sternum. The pressure came and went a few times, and though I resisted the first few opisodes, it ended up finally necessitating an ER visit. In the beginning I started taking sudafed (the kind they check ID for, that works) and tylenol and had electronic followup with my doctor vioa email. The fever and congestion broke about an hour after I was prayed for in our temple services Friday night (I'm not saying it is connected, but I am also not saying it is not. ;) ) The heart pressure continued to come and go in pules and episodic periods lasting an hour or two, except the last time on 9/24. I realize 9/24 is quite a while after the shot, however the problems started right after the shot and my heart has been checked regularly and never had any trouble before. It really has not gone away, by the way. I still have bits of radiating chest pressure here and there.

Other Meds: odanestron, triamcinolone, tacroklimus, hydrocoapap, lisinop, omeprazol, rosuvASTATIN, CL.indamycin, dicyclonmine, doxycycline, sildenafil, melatonin

Current Illness: herniated disks, irritable bowel, scar tissue in lungs and around pancreas, shattered heel, sciatic nerve, follicilitis,

ID: 1768601
Sex: F
Age: 81
State: IN

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

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

Lab Data: Head CT CBC CMP ferritin fibrinogen haptoglobin LDH UA troponin PTT prothrombin

Allergies: Floxin, Biaxin, doxycycline, penicillin, PC Tar

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

Symptoms: Patient got the Moderna vaccine 2 days ago this was her third shot. Last night after eating she noticed some sores in her mouth and this morning they got larger and were blisters. She also states she noticed some blood in both her urine and in her stool. Otherwise patient states she has been feeling well has no fevers. She had a mild headache this morning that has since resolved. No other new medications that she started recently no recent travel or tick bites. On examination patient has a sending petechiae to both legs extending up to her thighs. She states that these were not there when she put her socks on this morning at 9 AM.

Other Meds: aspirin 325mg QD; diltiazem ER 240mg QD; atorvastatin, 10mg; telmesartan 40mg QD; multivitamin; probiotic; Spiriva 18 mcg;; zantac 300mg; caltrate 300mg BIDi

Current Illness: none

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am