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: 1771929
Sex: F
Age: 20
State: NC

Vax Date: 10/07/2021
Onset Date: 10/08/2021
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: none reported

Symptom List: Dysphagia, Epiglottitis

Symptoms: body aches and headache

Other Meds: none reported

Current Illness: none reported

ID: 1771930
Sex: F
Age: 33
State: GA

Vax Date: 10/04/2021
Onset Date: 10/08/2021
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: N/A

Allergies: unknown

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient complains of headache since time of vaccination, and nausea/dizziness/blurred vision 5 days later. Patient has never gotten covid before to their knowledge.

Other Meds: unknown

Current Illness: unknown

Date Died: 08/31/2021

ID: 1771931
Sex: F
Age: 71
State: GA

Vax Date: 03/01/2021
Onset Date: 08/26/2021
Rec V Date: 10/08/2021
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: 08/26/2021 PCR+ COVID-19 test

Allergies:

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

Symptoms: Breakthrough COVID-19 case with unknown symptom status. Hospitalized 8/26/2021-8/31/2021. Death 8/31/2021. Vital Records data not available yet.

Other Meds:

Current Illness:

ID: 1771932
Sex: F
Age: 78
State: WV

Vax Date: 04/09/2021
Onset Date: 10/02/2021
Rec V Date: 10/08/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient was hospitalized with COVID-19 symptoms after receiving the vaccination.

Other Meds:

Current Illness:

ID: 1771933
Sex: F
Age: 37
State: DC

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

Lab Data: None.

Allergies: NKDA

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

Symptoms: Patient had influenza vaccine on 10/02 on right arm. She then had a Pfizer COVID-19 dose #3 booster vaccine on right arm on 10/05. Mostly painless swelling of right axillary lymph nodes. No systemic side effects. - She was advised to take Advil 600 mg TID with food and ice/cool compresses. - She had a video visit on 10/07 and followed up in the office on 10/08.

Other Meds: Flonase.

Current Illness: No.

ID: 1771934
Sex: F
Age: 49
State: AR

Vax Date: 09/29/2021
Onset Date: 09/30/2021
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: sulfur, bactrum

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

Symptoms: next day got severe chills, 104 fever, voice left from coughing, barely could walk, severe headache, eyed hurting, and wheezing: sinusitis, pharyngitis

Other Meds:

Current Illness:

ID: 1771935
Sex: M
Age: 65
State: TX

Vax Date: 09/12/2021
Onset Date: 09/23/2021
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: Covid-19 test -09/29/29-postiive

Allergies: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: 09/23/2021- felt as if I had a sinus headache, nauseas-over several days that progressed day to day, lasted about a week, went to urgent care and there was not test, but since my family did-the Dr told it was Covid. Tested on a later date and it was positive.

Other Meds: Naproxen

Current Illness: No

ID: 1771936
Sex: F
Age: 38
State: MN

Vax Date: 01/11/2021
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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Tested PCR positive for COVID 10/7/21 after being fully vaccinated.

Other Meds:

Current Illness:

ID: 1771937
Sex: F
Age: 62
State: GA

Vax Date: 08/20/2021
Onset Date: 08/20/2021
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: Sensitivity to all grains.

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Severe chills with violent trembling, could hardly walk, used 7 blankets Achy Extreme fatigue for 3 days Headache, low fever Nausea OK after 5 days

Other Meds: Fish oil, calcium, magnesium, vitamin D Prolia for osteoporosis, taken last March 2021.

Current Illness: Headache on August 12, 2021.

ID: 1771938
Sex: F
Age: 53
State: TX

Vax Date: 10/04/2021
Onset Date: 10/05/2021
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:

Allergies: No

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Circular area of approximately 1 - 1/2 inches around injection site red, swollen, and painful. Armpit of same arm swollen approximate size of grapefruit and painful. Lasted 4 days.

Other Meds: Larin Fe 1/20 Dexilant Atenolol Duloxetine Celecoxib Zolpidem Atorvastatin Diltiazen Cyclobenzaprine Tylenol 3

Current Illness: None

ID: 1771939
Sex: M
Age: 68
State: KY

Vax Date: 06/01/2021
Onset Date: 08/21/2021
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:

Allergies:

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

Symptoms: Tested Positive for Covid

Other Meds:

Current Illness:

ID: 1771940
Sex: F
Age: 91
State: FL

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

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

Lab Data: SENT TO ER

Allergies: NKA

Symptom List: Rash, Urticaria

Symptoms: CARDIAC

Other Meds: OMEPRAZOLE,GLIPIZIDE,SIMVASTATIN,HCTZ,METFORMIN,FLUOXETINE,VITAMIN C ,LUTEIN,PRESERVISION,ASP LOW

Current Illness: NO KNOWN

ID: 1771942
Sex: M
Age: 29
State: NC

Vax Date: 10/07/2021
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: IM
Vax Site: LA

Lab Data: none

Allergies: none

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

Symptoms: chills headaches nausea and syncope

Other Meds: none

Current Illness: none

ID: 1771943
Sex: F
Age: 26
State: VA

Vax Date: 10/01/2021
Onset Date: 10/04/2021
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: EKG 10/7, Echo 10/8

Allergies: Dapsone, Xolair, Methotrexate, plaquenil, and amoxicillin, severe beef and severe pork.

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

Symptoms: Severe shortness of breath while peak flow was 470 and O2 was 98%. Sharp chest pain on the left side on october 4 which has continued but become an ache.

Other Meds: Xyzal twice daily, 40mg pepcid BID, 2000 Vitamin D, Iron, Flovent, Dynamist 1 spray BID, singulair at bedtime, and zoloft daily.

Current Illness: General cold two weeks prior. Shortness of breath from pre-existing condition.

ID: 1771944
Sex: F
Age: 30
State: WV

Vax Date: 09/24/2021
Onset Date: 09/24/2021
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: Patient arrived for second dose of COVID-19 vaccination (Pfizer). During review of pre-vaccination CDC checklist, patient admitted to having a reaction to the first dose. She understood the risk of a possible reaction to the second dose. Patient said "I am in the last three months of nursing school and will be kicked out of the program if I don't get the second shot. I have fought with them about it since August and they don't care. I have to get this." Patient was adamant about proceeding with second dose even after the risks were explained. 12:05 pm: Patient moved to medical area where emergency medication and monitoring equipment were available. A employee health nurse was also present for the entire encounter. 12:14pm: Patient was breathing rapidly, pulse and blood pressure were elevated. Upon auscultation, lungs were clear. No wheezing noted. The lead RN was notified of patient symptoms and the employee health nurse was still monitoring the patient. 12:18pm: Inspiratory wheezing could be heard from 5 feet away. Significant expiratory stridor were also noted. Patient was clearly in distress. Per protocol, 0.3mg of Epinephrine was given at this time and 911 was called. RN stayed with the patient and continued to monitor. Shaking and elevated pulse noted. Patient complained of heaviness in her chest. Lungs were clear and with good air exchange. Upon EMS arrival report was given and patient was transported.

Other Meds:

Current Illness:

ID: 1771945
Sex: F
Age: 35
State: NE

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

Allergies: none

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

Symptoms: About 5 hours after the shot I developed sore arm, headache, fatigue, muscle aches, small red spot at injection site, chest pain. Everything but the chest pain went away within 48 hours. Shortness of breath and chest pain continued, shortness of breath was mostly only noticeable with excess movement. As the days went on it got worse. I saw my doctor on day 8, she said I had inflammation in my chest. I was told to take 800mg of ibuprofen every 8 hours for 2 weeks. After the first dose of ibuprofen I got stomach cramps so I started taking 600mg after that. On Day 8 in the evening I noticed a large red spot at my injection site. It was warm to the touch and slightly itchy but no pain. It has been slowly fading since. I am now at Day 10 after the vaccine and My chest pains and shortness of breath are worse, ibuprofen do not seem to be helping. I now get pains in my back between my shoulder blades.

Other Meds: oral birth control, women's daily vitamin, Celexa, zyrtec, flonase

Current Illness: none

ID: 1771946
Sex: M
Age: 68
State: FL

Vax Date: 08/16/2021
Onset Date: 08/26/2021
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: CBC, Chemistry Profiles all negative. MRI of brachial plexus, Cervical Spine, elbow and thoracic spine are unremarkable except for evidence of spinal fusion. EMG also performed.

Allergies: Oxycodone; Percocet

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

Symptoms: On August 26th developed acute excruciating pain starting initially in left elbow which over 24 hours radiated up into axilla, left infrascapular area and down into hand with paresthesia and decrease motor function of 4th and 5th fingers. Initially received methylprednisolone 24mg daily and 14 days with NSAIA with no improvement. Saw Rheumatologist, Hand/Arm orthopod and eventually neurologist. Diagnnosis of Parsanage-Turner Syndrome occurred and presently on course of high dose IV steroids 1 gram followed by 250mg Iv daily for 3 days along with intravenous immunoglobulins IV for 3 days 2mg/kg.

Other Meds: Valsartan 40mg daily; Myrbetriq 25mg daily; Cimzia 400mg monthly; Prednisone 5mg daily; Flomax 0.4mg BID; Omeprazole 20mg daily; Celebrex 200mg daily; Morphine Sulfate ER 15mg q12h; Multivitamin daily, Vitamin D 1500mg daily; Colace 250mg H

Current Illness: none

ID: 1771947
Sex: F
Age: 36
State: MN

Vax Date: 05/01/2021
Onset Date: 09/30/2021
Rec V Date: 10/08/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: This case meets criteria for vaccine breakthrough review. SxS include cough, SOB, chills, fever, chest pain, myalgia, wheezing.

Other Meds:

Current Illness:

ID: 1771948
Sex: F
Age: 50
State: NE

Vax Date: 10/05/2021
Onset Date: 10/05/2021
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: haven not gone in just still tired 3 days later

Allergies: Sulfa and Bactrium

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: 5:30 that evening, foggy, chills, but hot couldn't get warm, full body muscle aches couldn't hardly touch anything everything hurt including my bones had a headache and fully exhausted.

Other Meds: Musinex, allergy shots, OHM allergy pil, magnesium, Vit E, A, C, B12, E, Zinc

Current Illness: Just a lot of sinus infections

ID: 1771950
Sex: F
Age: 78
State: GA

Vax Date: 03/24/2021
Onset Date: 08/25/2021
Rec V Date: 10/08/2021
Hospital: Y

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

Lab Data: 08/25/2021 Antigen+ COVID-19 test at Urgent Care; 09/03/2021 PCR+ COVID-19 test at Medical Center

Allergies:

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

Symptoms: Breakthrough COVID-19 case with symptom onset 8/25/2021: Fever, Shortness of breath/difficulty breathing, Fatigue or tiredness, Chills, Cough. Hospitalized 9/3/2021-9/6/2021. Pt was seen in the ED in late August with a positive Covid test. Pt was d/c home and told to come back if she felt worse. Xray was normal at that time. Pt was admitted when she came back to the ED on 09/03/2021. Pt then had a positive chest Xray for pneumonia

Other Meds:

Current Illness:

ID: 1771951
Sex: F
Age: 54
State:

Vax Date: 08/23/2021
Onset Date: 10/05/2021
Rec V Date: 10/08/2021
Hospital: Y

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: Positive COVID-19 PCR Nasopharyngeal

Allergies:

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

Symptoms: Breakthrough symptomatic COVID-19 infection- onset 10/5/21, positive PCR 10/7/21 Respiratory failure, cough, chills, nausea, vomiting, diarrhea, and myalgias

Other Meds:

Current Illness:

ID: 1771952
Sex: F
Age: 28
State: WA

Vax Date: 10/07/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data: n/a

Allergies: none

Symptom List: Unevaluable event

Symptoms: Change to menstrual cycle: Mild cramping began the evening of receiving the shot. Heavy vaginal bleeding (period) began day after receiving the shot, initiating bleeding about 2 weeks earlier than regular menstrual cycle.

Other Meds: none

Current Illness: none

ID: 1771953
Sex: M
Age: 65
State: GA

Vax Date: 09/08/2021
Onset Date: 09/10/2021
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:

Allergies: None

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

Symptoms: Pt reports numbness and tingling in hands and feet that started 2 days post-vaccination. Pt reports numbness and tingling is still ongoing, 1 month post-vaccination. Pt reports PCP prescribed Gabapentin, which is helping with pain and sensations, but reports sensation is still there.

Other Meds: Unknown

Current Illness: None

ID: 1771954
Sex: F
Age: 56
State: WI

Vax Date: 09/14/2021
Onset Date: 09/15/2021
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: Doctor was seen for pain and numbness in right arm on 9/24/21 at 9:45 am, ultrasound was done on injection site in right upper arm checked for hematoma, no hematoma noticed

Allergies: Sulpha

Symptom List: Injection site pain, Pain

Symptoms: I had received 1st covid shot on 9/14/21 , had little pain in upper right arm at injection site in the evening. Woke up on 9/15/21 pain radiated down right arm and right hand and fingers numb as if hand is asleep. It is now 10/8/2021 and I am still having pain in upper right shoulder , in right elbow, down arm and my hand and fingers are still numb and cold to touch.

Other Meds: Vitamin D

Current Illness:

ID: 1771955
Sex: F
Age: 65
State: MO

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: SYR
Vax Site: LA

Lab Data:

Allergies: penicillin and morphine

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient had pain and stiffness in the arm of the injection site on the first day after the vaccine and then on the 2nd day her upper left arm was red with swelling and the patient felt nodules on her underarm. No red streaks noted by pharmacists when she visited pharmacy on 10/8/21 to report adverse effects. Patient stated that the symptoms had improved. The patient was advised to continue observing and to notify pharmacy if the redness and swelling became worse instead of continuing to improve.

Other Meds:

Current Illness:

ID: 1771956
Sex: F
Age: 40
State: CO

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

Lab Data:

Allergies:

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

Symptoms: per patient: "Hi I don?t know if your keeping track of any adverse immune reactions to the booster. I wanted to let the pharmacy know that I develop a painful rash on my arm at the injection sport. I guess it?s called ?covid arm?. The rash is very painful and uncomfortable. My arm feels like it?s on fire. I also had fever for three days. The rash seems to be growing. I read that this covid arm goes away after a week. I am treating it with OTC pain relief cream and antihistamine. If my rash is not better by Monday I will go see my doctor. "

Other Meds:

Current Illness:

ID: 1771957
Sex: F
Age: 37
State: MO

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

Lab Data: N/A

Allergies: fish allergies & unknown preservative

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Cough, felt throat tightening, tachy post administration. Adm 50mg diphenhydramine po @ 0840. BP 160/70, HR 147. Patient did not want epi administered. Patient's condition did not improve, EMS contacted.

Other Meds: none

Current Illness: none

ID: 1771958
Sex: F
Age: 85
State: WV

Vax Date: 01/08/2021
Onset Date: 09/30/2021
Rec V Date: 10/08/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient hospitalized with COVID-19 symptoms after receiving the vaccination.

Other Meds:

Current Illness:

ID: 1771959
Sex: F
Age: 87
State: FL

Vax Date: 10/04/2021
Onset Date: 10/04/2021
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: CODEINE,PENICILLIN

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

Symptoms: FACIAL SWELLING

Other Meds: POTASSIUM,TRAMADOL,LEVOTHYROXINE,BUPROPION,ZOLPIDEM,DOC SOD,LISINOPRIL,VITMIN B,FISH OIL,OMEPRAZOLE,ASP LOW,GABAPENTIN,CARVEDILOL,MIRTAZIPINE

Current Illness:

ID: 1771960
Sex: M
Age: 35
State: IL

Vax Date: 10/07/2021
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: 1
Vax Route: IM
Vax Site: RA

Lab Data: N/A

Allergies: N/A

Symptom List: Nausea

Symptoms: At 1:15-1:30am the next day (about 8 hours after injection) woke up with extremely hot/swollen/itchy feet and toes.

Other Meds: Escitalopram, Bupropion HCL XL, Amlodipine Besylate

Current Illness: N/A

ID: 1771961
Sex: M
Age: 85
State: KY

Vax Date: 09/30/2021
Onset Date:
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: Injection site pain

Symptoms: Patient presented for third COVID19 vaccine. Patient had received Moderna for doses 1 and 2, however received Pfizer vaccine, in error.

Other Meds:

Current Illness:

ID: 1771962
Sex: M
Age: 80
State: FL

Vax Date: 10/01/2021
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: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: about 15 hrs followiing the Covid booster shot, experienced heavy shacking of arms and lower legs, low grade temperature, fatigue, had to search for words, no chills, poor balance. Symtems lasted2- 3 days

Other Meds: ClonazePAM, Fish Oil, Niacin,Metatonin

Current Illness:

ID: 1771963
Sex: F
Age: 53
State: VA

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

Lab Data: Blood chemistry & hematology labs were all normal, ekg good. There were no other tests to address the numbness and tingling in my feet.

Allergies: Acyclovir, Aldomet, Contrast/IVP dye; Diphenhydramine; Flu Shot (not allergic to eggs); Latex; Lidocaine if sprayed in mouth or nose topical has given no reaction; Rizatriptan; Metoclopramide; Midodrine; Morphine; Esomeprazole; Omeprazole; Pantoprazole; Shellfish; banana; avacado; kiwi; strawberry; eggplant; apple, peach, cantaloupe; pecan; walnut; pine nuts; cashew

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

Symptoms: Received vaccine 10a.m. est on 10/6/21; approx 10:10 developed headached; approx 10:20 heart rate & bp spike but came back down fairly quickly; by 10:30 had dizziness, lightheaded about 10:45 started getting chills. Was monitored at facility until 10:45 and then went home. Between 12:00-12:30pm developed sudden numbness, tingling & pain in both feet. Around 8:00p.m. arm started to hurt; around 10p.m. was hit with profound fatigue. On 10/7/21 approx 6:50a.m. had syncopal episode. Went to Emergency room 10/7/21 about 7:30a.m because both feet and lower legs still numb, tingling and pain. Dr. said he thinks it's my dysautonomia but I respectfully disagree. I have dealt with dysautonomia for many years and have never had sudden numbness and tingling and pain in both feet at the same time.

Other Meds: Levoxyl; Pepcid AC; Metoprolol Tartrate; Vitamin B Complex, Vitamin C, Zofran

Current Illness: None

ID: 1771964
Sex: M
Age: 61
State: LA

Vax Date: 04/01/2021
Onset Date: 08/09/2021
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: COVID test

Allergies: Latex

Symptom List: Tremor

Symptoms: Participant contracted COVID virus after being fully vaccinated. Got antibodies.

Other Meds: Daily medications

Current Illness: No

ID: 1771965
Sex: F
Age: 33
State: MI

Vax Date: 10/07/2021
Onset Date: 10/07/2021
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: NO KNOWN ALLERGIES

Symptom List: Erythema, Pruritus

Symptoms: THE VACCINE EXPIRED ON 10/03/2021 AND WAS GIVEN ON 10/07/2021

Other Meds: N/A

Current Illness: N/A

ID: 1771966
Sex: F
Age: 33
State: TX

Vax Date: 10/05/2021
Onset Date: 10/05/2021
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: n/a

Allergies: None

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

Symptoms: No adverse symptoms; staff member received Moderna for first 2 doses

Other Meds: None

Current Illness: None

ID: 1771967
Sex: F
Age: 34
State: MN

Vax Date: 01/15/2021
Onset Date: 10/07/2021
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: Tested PCR positive for COVID 10/7/21 after being fully vaccinated.

Other Meds:

Current Illness:

ID: 1771968
Sex: F
Age: 64
State: OH

Vax Date: 10/01/2021
Onset Date: 10/06/2021
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: Aspirin, Cashews

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Pt. states that after receiving the 1st dose of J&J 10/01/2021, started experiencing symptoms 10/06/2021 of itchy face, rash across on the side of the right neck, sinus congestion, and puffy eyes. Self-treating with Benadryl, still continuing to experience symptoms. No noted Primary visit.

Other Meds: Multi-Vitamins

Current Illness: N/A

ID: 1771969
Sex: F
Age: 24
State: MI

Vax Date: 04/15/2021
Onset Date: 09/27/2021
Rec V Date: 10/08/2021
Hospital: Y

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

Lab Data:

Allergies: Morphine (hives)

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

Symptoms: Patient presented to emergency department on 10/1/2021 with worsening shortness of breath. She was found to COVID-19 positive at an outlying facility on 9/27/2021. She was admitted for further management of COVID-19 infection and sickle cell crisis. She was discharged home on 10/7/2021.

Other Meds: acetaminophen (TYLENOL EXTRA STRENGTH) 500 MG tablet amitriptyline (ELAVIL) 50 MG tablet aspirin (HALFPRIN) 81 MG tablet cholecalciferol (VITAMIN D-3) 50000 UNIT capsule fentaNYL (DURAGESIC) 100 MCG/HR patch folic acid 1 MG tablet HYDROmorp

Current Illness: None known

ID: 1771970
Sex: F
Age: 44
State: CA

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

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1771971
Sex: F
Age: 74
State: AZ

Vax Date: 03/02/2021
Onset Date: 03/02/2021
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: No

Allergies: No

Symptom List: Pain in extremity

Symptoms: On 03/02/2021, I had no local symptoms from the injection. The evening of my vaccination, I started to get extreme fever somewhere between 100 and 101. I went to sleep and the next morning the tachycardia kicked in. I could not control it after an hour to 1 1/2 hours. That's when I went to the emergency room. At the Hospital, they gave me IV fluids and the tachycardia stopped on it's own.

Other Meds: Metoprolol; raloxifene

Current Illness: No

ID: 1771972
Sex: M
Age: 52
State: TX

Vax Date: 07/21/2021
Onset Date: 07/21/2021
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: In process.

Allergies: CIPRO.

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

Symptoms: Prior to receiving the Moderna vaccination, I have had ongoing pain in both knees due to a fall years ago. Post-vaccination, aside from experiencing soreness in upper left arm and other symptoms , I have began to notice less blood circulation in my lower extremities between my knees and ankles. I have also experienced rapid heart beats at times while performing my work duties. I realized CIPRO has at least one ingredient that is the same as what is in the other vaccines, to include the Moderna vaccine. I have hesitated receiving the second dose of the Moderna vaccination because of these concerns.

Other Meds: None.

Current Illness: None.

ID: 1771973
Sex: F
Age: 27
State: OH

Vax Date: 10/05/2021
Onset Date: 10/07/2021
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:

Allergies: None

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

Symptoms: Vaginal yeast infection beginning on day 3 after vaccine

Other Meds: None

Current Illness: None

ID: 1771974
Sex: F
Age: 31
State: NY

Vax Date: 08/19/2021
Onset Date: 08/21/2021
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: EKG, chest x-ray, blood tests, stress test and echocardiagram

Allergies: none

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

Symptoms: chest pain/tightness, tough to take deep breath, racing heart, out of breath more easily, constant fatigue

Other Meds: Birth control, spironolactone & adderall

Current Illness: none

ID: 1771975
Sex: F
Age: 71
State: CA

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/08/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1771976
Sex: M
Age: 56
State: CA

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

Symptom List: Headache, Limb discomfort, Nasal congestion

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

Other Meds:

Current Illness:

ID: 1771977
Sex: F
Age: 48
State: MI

Vax Date: 10/07/2021
Onset Date: 10/07/2021
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: none

Allergies: NO KNOWN ALLERGIES

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

Symptoms: Vaccine was administered 10/07/2021 and expired on 10/03/2021

Other Meds: N/A

Current Illness: NONE LISTED

ID: 1771978
Sex: F
Age: 48
State: TX

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: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: n/a

Allergies: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: No adverse events; staff member received Moderna for first 2 doses

Other Meds: None

Current Illness: None

ID: 1771979
Sex: F
Age: 49
State: OH

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

Lab Data: D-Dimer .62 Chest X-Ray - shows fluid in lower right lung CAT scan shows pulmonary embolism

Allergies: cefnidir & macrobid - GI issues

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

Symptoms: 10/4/2021 - Sudden stabbing pain in upper right chest. Radiates to neck and back, right side 10/5-10/6 - pain subsides, but coughing 10/7 - Stabbing pain in upper right chest more severe, scheduled appointment with PCP 10/7 - PCP (Primary Care Physician) did EKG, D-Dimer and Chest X-ray. D-Dimer positive; X-ray shows fluid in bottom of right lung. PCP orders CAT scan 10/8 CAT scan shows pulmonary embolism. EKG and other heart health tests come back normal. Sent home with 20mg/day apixaban (blood thinner). NOTE: no history of clotting, no risk factors for clotting.

Other Meds: 5 mg prednisone

Current Illness:

ID: 1771980
Sex: M
Age: 58
State: CA

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

Allergies:

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

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

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am