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: 1771823
Sex: F
Age: 56
State: NJ

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

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

Lab Data: none

Allergies: unknown

Symptom List: Dysphagia, Epiglottitis

Symptoms: Employee was administered Fluzone "high dose" Quadrivalent Flu vaccine by 11-7 Supervisor on 10/5/21. Employee under 65 years of age. Currently, employee has not reported any adverse reactions.

Other Meds: unknown

Current Illness: unknown

ID: 1771824
Sex: F
Age: 45
State: VA

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

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

Lab Data: Doctor only performed strength tests in house and refereed me to a neurologist that has not scheduled an appointment with me yet.

Allergies: None

Symptom List: Anxiety, Dyspnoea

Symptoms: Numbness on complete left side of body. No strength problem and no weakness just jump. Bottom of left foot has pins and needles. Left side of have including left side of lips and tip of tongue numbness. 30 minutes after shot the numbness started on the tip of tongue and lips and then woke up next morning and whole left side of body was topically numb to touch. Now 3 days post shot and slight numbness moving to right side of face and arm.

Other Meds: Ambien Vacyclavir Xanax Hydroxizine Melloxicam

Current Illness: Herpes outbreak cleared about 3 days prior to vaccine Bee sting 2 days prior to vaccine

ID: 1771825
Sex: F
Age: 21
State: CO

Vax Date: 09/15/2021
Onset Date: 09/15/2021
Rec V Date: 10/08/2021
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: N/A

Allergies: latex, morphine, NSAIDs, sulfa, pineapple

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

Symptoms: Mother of Patient reports the following: within 24 hours of receiving the vaccination, pt experienced a fever of 102.8F, her O2 sats dropped to 73%, and her resting HR was 224 bbp. reports that she called Hospital and arranged to take her via ambulance to the ER but waited it out and symptoms resolved after 2 days. She gave supplemental oxygen, acetaminophen, and ibuprofen. She stated it was reminscent of when pt was hospitalized with COVID in November 2020.

Other Meds: Active prescriptions per patients medication chart: Dasetta (OCP), Proair, Tenex, vyvanse, gabapentin, levothyroxine, lorazepam, venlafaxine

Current Illness: Comorbidities per patient's medical chart: ADHD, asthma, chronic idopathic thrombocytopenic purpura, dpression, eczema, gastritis, hx of Lyme disease, hx of spelenctomy, hypothyroidism, impetigo, insomnia, mixed receptive-expressive language disorder (mild), neuropathy, nocturnal hypoxia, obesity, hx of COVID-19 (November 2020), personality disorder

ID: 1771826
Sex: F
Age: 21
State: AZ

Vax Date: 03/31/2021
Onset Date: 09/05/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: Positive Covid-19 from an urgent care, unknown type.

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: C/O cough, sore and scratchy throat, and headache,

Other Meds:

Current Illness:

ID: 1771827
Sex: F
Age: 29
State:

Vax Date: 12/29/2020
Onset Date: 10/02/2021
Rec V Date: 10/08/2021
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: PATIENT HAD PFIZER VACCINE 12/29/2020 and 01/27/2021, AND TESTED POSITIVE TO COVID.

Other Meds:

Current Illness:

ID: 1771828
Sex: M
Age: 47
State: CO

Vax Date: 09/01/2021
Onset Date: 09/01/2021
Rec V Date: 10/08/2021
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:

Allergies: NKA

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

Symptoms: Swelling in right arm, hand, neck and cheek within one hour of receiving vaccine.

Other Meds: Unknown

Current Illness:

ID: 1771829
Sex: F
Age: 24
State: CA

Vax Date: 10/05/2021
Onset Date: 10/05/2021
Rec V Date: 10/08/2021
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: Fever, chills, headache the night of injection, fatigue every day and then fever, chills, and sore throat again on Thursday night

Other Meds: Fluconazole

Current Illness:

ID: 1771830
Sex: M
Age: 85
State: ID

Vax Date: 02/09/2021
Onset Date: 02/15/2021
Rec V Date: 10/08/2021
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: Severe rash over entire back ,chest pain with fever, extreme fatigue , loss of appetite, swelling in both legs

Other Meds: Eliquis,Lipitor,Vit D, Decadron,Fish oil,Omeprazole,PreserVision, Revlimid,

Current Illness: Multiple Myeloma Cancer

ID: 1771831
Sex: F
Age:
State: PA

Vax Date: 09/21/2021
Onset Date: 09/21/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: All services were performed on 09/21/2021 EKG Vital IV bolus administration of Zofran intravenously and an oral medication that I cannot remember

Allergies: PCN Levoquin Morphine Dilaudid Bees

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Received vaccine, everything was fine at first. I sat down to wait 15 minutes. All of a sudden I was extremely dizzy and started vomiting. My heart ate was extremely elevated. I was given an fluid bolus, Zofran and another medication that I cannot remember in the emergency room. I was monitored for a few hours and then sent home. Dizziness continued throughout the entire next day, and intermittently throughout the few days that followed, dizziness accompanied with nausea and some vomiting.

Other Meds: Multi-Vitamin Xyzal

Current Illness: none

ID: 1771832
Sex: F
Age: 70
State: CA

Vax Date: 04/03/2021
Onset Date: 09/17/2021
Rec V Date: 10/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Covid-19 Test - Tested Negative

Allergies: None

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Chills Running Nose Extreme Tiredness

Other Meds: Garlic Pill Vitamin D Omega 3 Magnesium Thyroid Pills

Current Illness: None

ID: 1771833
Sex: M
Age: 66
State: GA

Vax Date: 10/06/2021
Onset Date: 10/07/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: None

Allergies: None

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

Symptoms: Itchiness of hands, fingers, feet, ankles, lower arms. Ongoing as of 10/8/2021. Used Cortizone 10 which helped some. Itching can be intense at times. Non painful, though very annoying. Am going to try Calamine lotion.

Other Meds: Carvedilol Amlodipine Losartin

Current Illness: Post nasal drip

ID: 1771834
Sex: F
Age: 32
State: TX

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 10/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data: N/A

Allergies: NKDA

Symptom List: Rash, Urticaria

Symptoms: 1st vaccination was Moderna back on 12/24/2020. Another employee was misinformed about the length of time between injections and proceeded to give the client a Pfizer vaccine. She said she was advised that if the client exceeded a certain number of days between vaccinations, the client would be considered non-vaccinated. Client did not exhibit any signs or symptoms.

Other Meds: Unknown

Current Illness: Unknown

ID: 1771835
Sex: F
Age: 56
State: WI

Vax Date: 04/07/2021
Onset Date: 04/08/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: April 8, 2021: X-ray- showed a possible blood clot in lung; CAT scan-showed that there was no blood clot in my lungs.

Allergies: Sulfa drugs; lisinopril; cilantro

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

Symptoms: I woke up with a fast heart rate around 120 BPM and a fever of 102 degrees. I had lower oxygen which I haven't had in a while. I felt as bad as when I had Covid. In the morning I still had a fever. April 8th I went to an urgent care at the Hospital and Medical Center because my oxygen was still low around 89 or 82. The doctors listened and they heard crackling sounds. They did an X-ray and saw something on my lungs. They was scared I had a blood clot in it. I got sick and started throwing up. They transferred me to the ER at that same facility. In the ER they did a CAT scan, and it showed that I did not have a blood clot. They came to the conclusion that it was just a reaction to the vaccine.

Other Meds: Heart medication; antidepressant medication

Current Illness: Severe Covid back in 12/2021

ID: 1771836
Sex: M
Age: 28
State: UT

Vax Date: 10/06/2021
Onset Date: 10/07/2021
Rec V Date: 10/08/2021
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: NA

Allergies: None

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

Symptoms: Pain or uncomfortable pressure in left armpit noticed around 2:00pm next day after vaccine was given. Pain 5 out of 10. The pain feels like a constant ache or pressure in the left armpit feels slightly relieved by propping up my left arm and exposing my left armpit but aches when I have my left arm completely at rest dwon my side. A research showed that similar symptoms have been related to swollen lymph nodes following covid vaccine. The pain is still persisting to the time of this report.

Other Meds: Took 5 mg of melatonin evening after vaccine to help fall asleep for bed. Daily Herbal supplements include basic multi-vitamin pill, magnesium and calcium pill, 750 mg of ashwagandha, 500mg of collagen.

Current Illness: None

ID: 1771837
Sex: F
Age: 84
State: CA

Vax Date: 10/04/2021
Onset Date: 10/04/2021
Rec V Date: 10/08/2021
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: NONE

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

Symptoms: EXTREME HEADACHE, BODY ACHE

Other Meds: NONE

Current Illness: NONE

ID: 1771838
Sex: F
Age: 40
State: AZ

Vax Date: 01/18/2021
Onset Date: 09/09/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: Positive Covid-19 test of unknown type.

Allergies:

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

Symptoms: C/O elevated temperature and loss of taste/smell

Other Meds:

Current Illness:

ID: 1771839
Sex: M
Age: 55
State: AZ

Vax Date: 06/09/2021
Onset Date: 06/09/2021
Rec V Date: 10/08/2021
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: Latex

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

Symptoms: Constant pain in my left shoulder area. Pain has increased from a mild dull pain, similar to a Charlie horse. to a sharp throbbing pain in the upper arm/shoulder area.

Other Meds: Melatonin, Multi-vitamin,

Current Illness: None

ID: 1771840
Sex: F
Age: 63
State: AZ

Vax Date: 01/12/2021
Onset Date: 09/13/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: Positive Covid-19 PCR Test

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: C/O sore and scratchy throat, and headache

Other Meds:

Current Illness:

ID: 1771841
Sex: F
Age: 31
State: TX

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

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

Lab Data: N/A

Allergies: NKDA

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: The patient received 1st vaccine on 01/28/2021, 2nd vaccine on 07/14/2021, and 3rd vaccine on 08/05/2021. The facility could not provide accurate records to prove that the client had already received her completed series and was under the impression that she was unvaccinated. The client did not have any reported adverse reactions or symptoms.

Other Meds: Unknown

Current Illness: Unknown

ID: 1771842
Sex: F
Age:
State: WA

Vax Date: 10/07/1921
Onset Date: 10/08/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: None

Allergies: Penicillin, azithromycin

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

Symptoms: Fever, chills, headache, dizziness, stabbing roving body pain, nausea

Other Meds: Multivitamins

Current Illness: No

ID: 1771843
Sex: F
Age: 74
State: VA

Vax Date: 08/21/2021
Onset Date: 09/13/2021
Rec V Date: 10/08/2021
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: 9/16 Blood work - WBC 2.4 to 1.9; Neutrophils 1.4 ? 0.9; 10/6 Blood work - WBC ? 2.3; Neutrophils 1.38

Allergies: Penicillin; Sulfa allergies

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

Symptoms: Extreme fatigue, weakness around 3 weeks after getting the shot. I was walking over a mile at least 3 times a week prior to the booster. I have not been able to do that since around the 13 of Sept. I have a lot of muscle pain, aches, I have horrendous diarrhea. I've had headaches, not bad just occasional, nausea. I'm just worn out. I went to the Dr. last Friday October 1st for telehealth. Basically, he ran a battery of lab tests if there was anything currently different than what they were previously. Taking IMODIUM for the diarrhea. Trying to get my energy back, immune system was shot. Nausea has been gone. A test related to symptoms for the medication for hypothyroidism was done. No relation. I got my vitamin D increased because levels were low. Being referred to the Oncologist at the end of November.

Other Meds: REVLIMID; metformin; AMARYL; CYMBALTA; baby aspirin; levothyroxine; pantoprazole; FOSAMAX; vitamin B12 injection; ZETIA; allopurinol; ZYRTEC; FLONASE; IMODIUM; ZOFRAN; magnesium lactate; vitamin D3; krill oil; B complex; multivitamin; calci

Current Illness: MDS - Bone marrow cancer

ID: 1771844
Sex: F
Age: 37
State: WA

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

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

Lab Data: EKG, Labs, CXR

Allergies:

Symptom List: Unevaluable event

Symptoms: Chest pain, elevated cardiac enzymes, myocarditis

Other Meds: Zyrtec

Current Illness: no

ID: 1771845
Sex: F
Age: 35
State: CA

Vax Date: 04/02/2021
Onset Date: 09/21/2021
Rec V Date: 10/08/2021
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: COVID and Strep tests - at Urgent Care

Allergies: No

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

Symptoms: In Sept - I had a really sore throat that started on one side and migrated to whole throat; really bad congestion. Sinus pressure; ear congestion; and kind of cloudy feeling and lethargy. I did go and get tested for COVID and they also did a Strep test on throat but everything was negative. They thought it was some other viral thing going on. No treatment except for home remedies. Lasted about five days. Also, I had a ridiculous amount of snot.

Other Meds: Birth control pill; daily women's supplements; loratadine - allergy medication; albuterol inhaler for asthma (take occasionally)

Current Illness: No

ID: 1771846
Sex: F
Age: 66
State: WA

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 10/08/2021
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: Bee venom protein

Symptom List: Injection site pain, Pain

Symptoms: Patient first received Moderna COVID vaccine on 2/11/21 and 3/11/21. On 9/22/21, patient received Moderna COVID vaccine dose #3 even though she's not moderately/severely immune suppressed and the criteria used for rationale of giving the patient a third dose was age>65. This is an error as we are not yet giving third booster doses to non immune suppressed patients and Moderna has not been approved for booster doses. No adverse event to the patient.

Other Meds: Premarin, hydrochlorothiazide, Provera, nifedipine ER

Current Illness:

ID: 1771847
Sex: M
Age: 42
State: TX

Vax Date: 04/20/2021
Onset Date: 04/21/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: September 18th 2021 EKG @ Emergency Room detected A-Fib First heart issue ever.

Allergies: N/A

Symptom List: Injection site pain, Menorrhagia

Symptoms: A-Fib, fatigue, anxiety.

Other Meds: N/A

Current Illness: N/A

ID: 1771848
Sex: F
Age: 73
State: TX

Vax Date: 09/17/2021
Onset Date: 09/17/2021
Rec V Date: 10/08/2021
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: sulfa and penicillin

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

Symptoms: Patient developed a lump in her arm.

Other Meds: n/a

Current Illness:

ID: 1771849
Sex: F
Age: 39
State: AZ

Vax Date: 01/08/2021
Onset Date: 09/12/2021
Rec V Date: 10/08/2021
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: Positive Covid-19 test of unknown type.

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: C/O cough, elevated temperature, runny nose and congestion, malaise.

Other Meds:

Current Illness:

ID: 1771850
Sex: F
Age: 81
State: CA

Vax Date: 09/24/2021
Onset Date: 10/04/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: NONE

Allergies: NONE

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: EXTREME HEADACHE RADIATED TO THE BACK AND NECK

Other Meds: NONE

Current Illness: NONE

ID: 1771851
Sex: F
Age: 55
State: FL

Vax Date: 03/29/2021
Onset Date: 08/19/2021
Rec V Date: 10/08/2021
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: CT Scans, X-rays, Blood Work

Allergies: Demecycline; Mucinex; Adhesive Tape

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

Symptoms: COVID symptoms started on the evening of 08/19/2021 when I had a 102 degree fever. I tested negative for COVID on 08/20/2021 and then I went the whole weekend and they had given me antibiotics anyways and then on 08/25/2021 I tested positive. I experienced only the fever thus far. I went to get the infusion on 08/28/2021 and they couldn't do it because my oxygen was low and they said it was low enough to go to the ER. I went to the ER and was hospitalized and I don't remember a whole 3 days. I was hospitalized for 10 days and they had to put me on a BiPap Machine. I had gotten pneumonia, a DVT in right leg, and I got a PE in my left lung. Since they let me go I have been sitting at home on oxygen. I did get my booster and flu vaccine though. I also had no taste whatsoever.

Other Meds: None (does not want to list any at this time)

Current Illness: None

ID: 1771852
Sex: M
Age: 63
State: TX

Vax Date: 04/12/2021
Onset Date: 04/29/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: 28 APR 2021 Labs at 05 JUL 2021 at 28 SEP 2021 at 01 OCT 2021 at

Allergies: sulfa

Symptom List: Nausea

Symptoms: I have had low platelets, in the 50's, after the J&J shot, it went down to 38/41, and recently now down to 25. For Cirrhosis of the liver, this is abnormal it should fall not below 40 and perhaps coincidental, but suspect the J&J shot contributed to the the further decline in what was otherwise a somewhat stable 50 or so platelets I had achieved for some time. The J&J I have read in journals and other media suggest possibility that it may have contributed to further decline of my platelets. I wen to the ER as the Navy doctor ordered me after I indicated I had been tasting blood in the back of my thought for day.

Other Meds: Hydrochlorothiazide, pantoprazole,

Current Illness: Liver Disease, thrombocytopenia

ID: 1771853
Sex: M
Age: 55
State: CO

Vax Date: 09/19/2021
Onset Date: 10/08/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: CT Scan 10/10/21

Allergies: None

Symptom List: Injection site pain

Symptoms: Acute viral Bronchitis following second Moderna vaccines

Other Meds: Methotrexate, Simponi, Metformin, Curcumin, NAC

Current Illness: None

ID: 1771854
Sex: F
Age: 56
State: NJ

Vax Date: 10/05/2021
Onset Date: 10/05/2021
Rec V Date: 10/08/2021
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: unknown

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

Symptoms: Employee administered Fluzone "high dose" Quadrivalent by 11-7 Supervisor on 10/5/21. Employee under 65 years of age. Currently employee reports no adverse reactions.

Other Meds: unknown

Current Illness: unknown

ID: 1771856
Sex: M
Age: 17
State: CA

Vax Date: 10/08/2021
Onset Date: 10/08/2021
Rec V Date: 10/08/2021
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: NONE

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

Symptoms: UPON WITHDRAWAL OF THE INJECTION NEEDLE FROM THE LEFT DELTOID AREA, PATIENT DEVELOPED VASOVAGAL SYNCOPY. PATIENT WAS PLACED IN SUPINE POSITION WITH HIS LOWER EXTREMITY SLIGHTLY ELEVATED. PATIENT RECOVERED WITHOUT LOOSING CONCIOUSNESS. BP 123/83, HR 55. PATIENT VERBALIZED THAT HE DID NOT HAVE BREAKFAST BEFORE VACCINATION. PROVIDED WATER AND ORGANIC APPLE SAUCE. PATIENT LEFT CLINIC FEELING WELL.

Other Meds: NONE

Current Illness: NONE

ID: 1771857
Sex: F
Age: 26
State:

Vax Date: 08/02/2021
Onset Date: 08/30/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: N/A

Allergies: none

Symptom List: Tremor

Symptoms: On the day following the second dose of my Moderna vaccination, I experienced flu-like symptoms, including fatigue, fever, and chills. The symptoms started out mild in severity and worsened throughout the day. I also experienced sharp headaches throughout the rest of the night, along with the flu-like symptoms. Those symptoms resolved the next day, however I noticed two days later around September 2nd, the development of canker sores and inflamed gums that were not related to any lifestyle related activities. I treated the sores with hydrogen peroxide and it took about 1 to 2 weeks for the symptoms to fully resolve. I also noticed irregularities in my menstrual cycle as I had expected my cycle on the week of September 5th, however did not get a menstrual period until September 21st. My cycle was around 5 days long which was the expected average, and I had not experienced an irregular period in years prior to receiving the vaccination. This irregularity had not been experienced with previous vaccinations either, such as the yearly influenza or any required vaccination I had received. I will continue to monitor for any changes or irregularities in my menstrual cycle to determine how long the effects last.

Other Meds: none

Current Illness: none

ID: 1771858
Sex: M
Age: 42
State: TN

Vax Date: 10/08/2021
Onset Date: 10/08/2021
Rec V Date: 10/08/2021
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: NKDA

Symptom List: Erythema, Pruritus

Symptoms: Patient left vaccine clinic after waiting 15 minutes after injection of Pfizer. Patient re-entered building and notified staff member of chest pain with tightness. Blood pressure 180/102, O2 sat 98% on room air. EMS called and upon arrival, patient stated felt improvement. Pt declined transport to hospital.

Other Meds: "Multiple"

Current Illness: None.

ID: 1771859
Sex: M
Age: 50
State: WA

Vax Date: 10/07/2021
Onset Date: 10/08/2021
Rec V Date: 10/08/2021
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: Sulfa, Metformin, Penicillin, Amoxicillin

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

Symptoms: So far fever (99-102), discomfort in left arm at injection site.

Other Meds: Just the Johnson and Johnson vaccine

Current Illness: None

ID: 1771860
Sex: F
Age: 30
State: AL

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

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

Lab Data:

Allergies:

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

Symptoms: no adverse event, vaccine administered one day past BUD

Other Meds:

Current Illness:

Date Died: 10/04/2021

ID: 1771861
Sex: M
Age: 70
State: MD

Vax Date: 08/17/2021
Onset Date: 08/19/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: Cardiac echo 9/29/21 showed EF 40-45%. Repeat on 10/3/21 showed EF 10-15%.

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Chart review showed he received 2 Moderna COVID-19 mRNA vaccines on 7/20/21 and 8/17/21. Wife called PCP on 8/19/21 to report that he had developed loss of appetite and fatigue and appeared ill. PCP recommended ED eval, but pt did not go until 9/29. At that time he was found to have profound thrombocytopenia with platelets of 18000 and wbc 2700. Previous CBC on 7/21/21 showed wbc 6200 and platelets 150,000. INR initially 1.7 (9/29) then increased to 2.8 (10/3). PT 18 -- >27, PTT 45-- >62, Fibrinogen 110 then decreased to <80 mg/dl. Blood and urine cultures did not show any growth. CT C/A/P showed airspace opacities LLL/RUL/RLL and moderate right pleural effusion, hepatic cirrhosis, large ascites, NORMAL spleen. He was started on broad spectrum abx. ALso started on high dose dexamethasone per hem/onc for possible ITP. He received multiple platelet transfusions. He had chronic hep C, mRNA load 1209 mIU/mL. He developed hypotension refractory to IVF and had to be transferred to the ICU on 10/3/21 and subsequently passed on 10/4/21.

Other Meds:

Current Illness:

ID: 1771862
Sex: F
Age: 46
State: AK

Vax Date: 09/30/2021
Onset Date: 10/02/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: NONE YET.

Allergies: Penicillin

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

Symptoms: THE RING FINGER ON MY RIGHT HAND HAS DEVELOPED A CYST LIKE HARD BUMP AT THE BASE OF MY FINGER AND IT IS BECOMING PAINFUL.

Other Meds: Vitamin D, Iron

Current Illness: None

ID: 1771863
Sex: F
Age: 51
State: MA

Vax Date: 10/08/2021
Onset Date: 10/08/2021
Rec V Date: 10/08/2021
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 reported

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

Symptoms: healtcare worker came to our vaccine clinic for Pfizer COVID 19 vaccine booster and attested that they had Pfizer COVID 19 vaccine primary series at an outside facilty. we administered the Pfizer COVID 19 booster dose. after the fact the healthcare worker admitted that her primary series was Moderna COVID 19 vaccine.

Other Meds: unknown

Current Illness: unknown

ID: 1771864
Sex: M
Age: 42
State: AL

Vax Date: 10/02/2021
Onset Date: 10/02/2021
Rec V Date: 10/08/2021
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: no adverse reaction, vaccine administered one day past BUD

Other Meds:

Current Illness:

ID: 1771865
Sex: M
Age: 68
State: NY

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

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

Lab Data: None

Allergies: GATIFLOXACIN - HIVES, URTICARIA, RASH SIMVASTATIN - ANXIETY, HEADACHE TRAZODONE - HEADACHE CHOCOLATE & BACON - CANKER SORES

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

Symptoms: Hives under arms and in groin area. Treated with Benadryl pill and cream

Other Meds: Atorvastatin 20mg, Quetiapine Fumarate 12.5 mg, Lamotrigine 50mg, Amlodipine Besylate 5mg, Dicyclomine 10mg, low dose aspirin

Current Illness: Diverticulitis

ID: 1771866
Sex: M
Age: 62
State: AZ

Vax Date: 01/08/2021
Onset Date: 09/11/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: Positive Covid-19 PCR test

Allergies:

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

Symptoms: C/O cough, nasal congestion and runny nose

Other Meds:

Current Illness:

ID: 1771867
Sex: F
Age: 38
State: NV

Vax Date: 06/10/2021
Onset Date: 06/10/2021
Rec V Date: 10/08/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: After I received my second vaccine I started my period and had extreme clotting. I just got off my period 2 weeks before and NEVER have 2 periods in the same month. It was extremely pain full, extremely heavy, and extreme clotting.

Other Meds: none

Current Illness: none

ID: 1771868
Sex: F
Age: 73
State: OH

Vax Date: 02/05/2021
Onset Date: 03/16/2021
Rec V Date: 10/08/2021
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: CAT scan, MRA, Neuropathy test.May through June 2021

Allergies: Wheat Formaldehyde

Symptom List: Vomiting

Symptoms: Following month lost balance often, fell, progressive, had stroke like event in June. 2 weeks in hospital, 3 months rehab. CAT scan MRA

Other Meds: Metformin Zyrtec Advair Proair Lutein SpirIr

Current Illness: week of Jan 1, fever, cough, achbreathin difficulty but not severe

ID: 1771869
Sex: F
Age: 32
State: NY

Vax Date: 10/05/2021
Onset Date: 10/05/2021
Rec V Date: 10/08/2021
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: Shellfish Macrobid Bactrim

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Pins and needles on tongue started mins after the vaccine was administered . Swollen tongue a few mins after and had to take benadryl for the allergic reaction. Fever for 3 days 102.3 being the highest. Pain on the left arm where vaccine was placed, pain on the left underarm and left breast. Shortness of breath and headaches.

Other Meds:

Current Illness:

ID: 1771871
Sex: M
Age: 62
State: AL

Vax Date: 10/02/2021
Onset Date: 10/02/2021
Rec V Date: 10/08/2021
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: no adverse event, vaccine administered one day past BUD

Other Meds:

Current Illness:

ID: 1771872
Sex: F
Age: 62
State: AZ

Vax Date: 01/12/2021
Onset Date: 09/15/2021
Rec V Date: 10/08/2021
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: Positive Covid-19 PCR test

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: C/O cough, elevated temperature, headache, and malaise

Other Meds:

Current Illness:

ID: 1771873
Sex: F
Age: 36
State: ID

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

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

Lab Data:

Allergies: Milk

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

Symptoms: Increased heart rate, night sweats

Other Meds: Lamictal Magnesium Turmeric Glutamate

Current Illness:

ID: 1771874
Sex: F
Age: 33
State: WI

Vax Date: 02/05/2021
Onset Date: 10/04/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: covid 19 positive test

Allergies: ibuprofen

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

Symptoms: got sick with covid 19 even after 2 vaccinations

Other Meds: metoprolol xl, diltiazem, calcitriol, famotidine, Lasix,

Current Illness: none

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am