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: 1772035
Sex: F
Age: 28
State: PR

Vax Date: 05/18/2021
Onset Date: 05/18/2021
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: N/A

Allergies: unknown

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient with topical reaction in the area of the arms, abdomen and neck. VS 140/80, P 125, Sat 99%. Paramedic did not have an Antihistamine. Doctor recommended BENADRYL 25mg, then reaction decreased.

Other Meds: unknown

Current Illness: unknown

ID: 1772036
Sex: M
Age: 55
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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: none

Allergies: none

Symptom List: Anxiety, Dyspnoea

Symptoms: none at this time

Other Meds: Patient came in to get COVID vaccination. He was asked multiple times if he had received a COVID vaccine in the past. He stated No and also answered No on the Consent form. We checked the NCIR data base and his information could not be fou

Current Illness: none

ID: 1772037
Sex: F
Age: 58
State: MO

Vax Date: 10/06/2021
Onset Date: 10/06/2021
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: Was seen at ER on 10-7-21 and treated for nausea /vomiting.

Allergies: Many antibiotics and H1 blockers

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

Symptoms: Approximatly 1 hour and 15 min tinnitus began and hasn't stoppen . I have had occasssional tinnitus in the past that would cease. The tinnitus has not stopped yet. I also had vomiting within 17 hours of the vaccine.

Other Meds: Cuvitru, Azythromycin, Synthroid, digestive enzymes, probiotics, multi-vitamin

Current Illness:

ID: 1772038
Sex: M
Age: 64
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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data: NA

Allergies: NA

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Pt. received 4th dose of Jansen. Previous doses on 9/25/21; 8/31/21; 8/5/21

Other Meds: NA

Current Illness: NA

Date Died: 10/02/2021

ID: 1772039
Sex: F
Age: 75
State: TN

Vax Date: 05/28/2021
Onset Date: 09/16/2021
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: Case vaccinated with Janssen on 5/28/2021. Tested positive for COVID on 9/16/2021. Admitted to Hospital on 9/21/2021 and expired on 10/02/2021 while still hospitalized.

Other Meds:

Current Illness:

ID: 1772040
Sex: F
Age: 36
State: CA

Vax Date: 09/15/2021
Onset Date: 09/16/2021
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: Ct scan blood work. No MRI. No X-ray to check fir Myocardial issue

Allergies: Apples

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

Symptoms: Hives around injection site after 24 hours. Body shaking after 3 days. We have been to the ER 6 times in 4 weeks for uncontrolled body shakes, High blood pressure, Nausea and vomiting. Muscle soreness in arm and difficulty talking. Painful migraine like headache Heart rate elevated. This is a nightmare for my wife as the ER doctors just throw painkillers at her. The second dose has changed my wife. Please. Please help

Other Meds: Tylenol. Birth control.

Current Illness: Allergies

ID: 1772041
Sex: M
Age: 49
State: KY

Vax Date: 06/22/2021
Onset Date: 06/22/2021
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:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Pt was given Moderna as first Covid vaccine on 5/25/21, and then was given Pfizer in error as second dose on 6/22/21 by provider in clinic, NP.

Other Meds:

Current Illness:

ID: 1772042
Sex: F
Age: 47
State:

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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: was taken to medical facility - unknown outcome

Other Meds:

Current Illness:

ID: 1772043
Sex: F
Age: 38
State: NY

Vax Date: 02/05/2021
Onset Date: 02/06/2021
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: LA

Lab Data: None

Allergies: red dyes- all (rxn due to this allergy: liquid valium only x 1, and the orange chloroprep), dilaudid (itching/rash-- side effect vs allergy) other reactions to meds were known side effects

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: on day 2 : loss of smell - continued/longstanding, permanent? unknown - #20 and 21 below - not resolved yet and unknown regarding permanency within 1st 72 hours: loss of appetite, nausea, vomiting, diarrhea, shaking chills with teeth chattering, fever, pain in left arm and then intense body wide pain even to light touch, fatigue, mild chest tightness, loss of smell. - #20 below - resolved

Other Meds: Wellbutrin, propranolol, lamotrigine, Zyrtec, EnBrace HR/MF prenatal vitamin, magnesium, psyllium fiber prn - maybe - unable to remember: lorazepam, Prilosec, naproxen prn - not taken within a few days before or after: albuterol, Reglan,

Current Illness: mild respiratory infection in beginning of Jan 2021- 4 negative COVID tests anxiety/depression migraine- within that month is probable- I can't remember

ID: 1772044
Sex: F
Age: 51
State:

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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Provider mistakenly pulled J and J vial and gave a 0.3ml dose as a 3rd dose booster of a previous 2 dose Pfizer series. No adverse reaction reported by the individual who received the incorrect dose and brand for the booster.

Other Meds:

Current Illness:

ID: 1772046
Sex: F
Age: 33
State: NJ

Vax Date: 02/26/2021
Onset Date: 02/26/2021
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: Blood Work in approx April 2021

Allergies: Nickel

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

Symptoms: I have maintained a low to mid grade fever every single day since the date of my vaccine, ranging from 100.1 to 102.3 with an enlarged lymph node in my right armpit. I reported these findings to my primary care physician and underwent a blood test which overall, was unremarkable.

Other Meds: Norethindrone, Vitamin D (2000 ICU)

Current Illness: None

ID: 1772047
Sex: M
Age: 58
State: OH

Vax Date: 04/06/2021
Onset Date: 04/09/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: none yet

Allergies: aspartame ( aka nutra sweet )

Symptom List: Rash, Urticaria

Symptoms: First shot was just as said it would be, next day I would feel as if getting the flu or a cold. After to days I was good. Second shot wasn't right. Next day.chest was heavy stomach up set dizzy, then the migrain s started. Dont want to eat, just feel ill all the time. Chest, sometimes is hard to breath, sometimes I think I'm going to have a heart ache it will hurt so bad. I Don't have energy to do anything, no interest in doing anything. Sleep is a joke anymore. Joints ache, headaches. IT'S been FOUR MONTHS now,. When will this go away?

Other Meds: pravastatin 10mg once a day glimepiride ( subst for amaryl ) 4mg once a day tizanidine 4mg as needed rizatripan 10mg (subst for maxalt ) as needed garlic 100mg multi vitamin

Current Illness: nothing

ID: 1772048
Sex: F
Age: 32
State: VA

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

Lab Data: Pt to have Quantiferon lab drawn in place of PPD administration

Allergies: No known allergies

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

Symptoms: Pt presented to clinic for PPD administration. 0.1mL of undiluted Pfizer COVID vaccine given intradermally in L forearm in error by clinical staff member. Administration error was discovered once pt had left the clinic. Call placed to Pfizer to report error and receive guidance for pt. Pfizer reported that pt should be monitored and treated for any symptoms as required. Pt should be reassured that this is not harmful but that they may be more likely to experience pain in their injected arm and should be monitored for potential local and systemic adverse events. Called pt to inform of error and check on status. Pt states she is doing well and does have localized reaction with redness, itching, and swelling at injection site. Pt will continue to monitor and seek care if necessary. Pt was previously vaccinated with 2 doses of Moderna.

Other Meds: Nexplanon device in place

Current Illness: None

ID: 1772049
Sex: M
Age: 51
State:

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: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Provider mistakenly pulled J and J vial and gave a 0.3ml dose as a 3rd dose booster of a previous 2 dose Pfizer series. No adverse reaction reported by the individual who received the incorrect dose and brand for the booster.

Other Meds:

Current Illness:

ID: 1772050
Sex: M
Age: 85
State: IA

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: LA

Lab Data:

Allergies:

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

Symptoms: Patient received 3rd dose Pfizer but stated they lost their vaccination record card. Patient and caregiver confirmed patient did receive Pfizer for first two doses and that it had been atleast 6 months since the 2nd dose. Consulted database and there was no record of first two doses. Patient was administered Pfizer vaccine, and the pharmacy followed up with another agency to confirm dates and lot numbers. At that time, it was discovered the patient actually received Moderna for the first two doses.

Other Meds:

Current Illness:

ID: 1772051
Sex: F
Age: 56
State: NY

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

Lab Data: N/A

Allergies: N/A

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

Symptoms: Pt. states that after receiving the 1st dose of Moderna 10/05/2021, started experiencing symptoms 10/06/2021 of pain at injection site, headaches, fever (100.4), feeling of crawling in the face (left), and twitching in the face and left arm. Still continuing to experience symptoms. No noted Primary visit.

Other Meds: N/A

Current Illness: N/A

ID: 1772052
Sex: F
Age: 66
State: NY

Vax Date: 10/06/2021
Onset Date: 10/08/2021
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: Penn icilin

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

Symptoms: Fever, body aches, redness, pain and heat to the touch at injection site

Other Meds: synthroid, Wellbutrin, Zertec, diltiazem 120mg,rosuvastatin 5mg, metroprolo er 25mg ibuprofens

Current Illness:

ID: 1772053
Sex: M
Age: 37
State: NC

Vax Date: 06/16/2021
Onset Date: 06/16/2021
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:

Allergies: No known allergies

Symptom List: Ear pain, Hypoaesthesia

Symptoms: 37yo M with 6 days of diffuse, constant chest pain after receiving J&J vaccine on 16JUN. Patient reporting SOB and increased symptoms when laying flat. Patient hypertensive on exam, otherwise vitals wnl. CV/PULM exam unremarkable. EKG nsr. Concern for possible post vaccination pericarditis vs myocarditis vs much lower concern for PE. Patient counseled on findings and escorted to the ED for further evaluation and treatment. Patient will f/u after clearance from ED. Pt was sent to Medical Center. Pt was given a cardio referral. Had a full lab work up, and x-rays. Pt has been seen in clinic multiple times for follow up and continued chest pain. Pt also reports extreme fluid retention.

Other Meds:

Current Illness:

ID: 1772054
Sex: M
Age: 46
State:

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:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Provider mistakenly pulled J and J vial and gave a 0.3ml dose as a 3rd dose booster of a previous 2 dose Pfizer series. No adverse reaction reported by the individual who received the incorrect dose and brand for the booster.

Other Meds:

Current Illness:

ID: 1772055
Sex: F
Age: 48
State: WA

Vax Date: 10/04/2021
Onset Date: 10/05/2021
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. I did not seek medical intervention.

Allergies: Flu vaccine

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

Symptoms: ~12 hours after the injection, my left arm was numb and tingling from the mid-fore arm down through my hand and fingers. I was flushed and sluggish with tolerable nausea the nest morning. The second morning post vaccine, I had sharp pain that felt like a vice grip clamped over half my body radiating in an orb from the injection site. Sharp shooting pains through my chest most of the day, not helped by ibuprofen & acetaminophen. The second day I was so lethargic. I was unable to wake up to go to work. I had very little energy and took a long nap that afternoon. When I woke up I was still tired. Shot on Monday-side effects lasted through Thursday.

Other Meds: RX: escitalopram 10mg PO daily OTC: 81mg aspirin, calcium, magnesium, zinc

Current Illness: none

ID: 1772056
Sex: F
Age: 45
State: NJ

Vax Date: 09/27/2021
Onset Date: 09/28/2021
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: EKG, blood work, Chest X-ray - 9/30/21 ECHO- 10/8/21

Allergies:

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

Symptoms: Severe dizziness, shortness of breath, chest pain.

Other Meds:

Current Illness:

ID: 1772058
Sex: F
Age: 56
State: MI

Vax Date: 10/01/2021
Onset Date: 10/03/2021
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: Physical exam of the area

Allergies: doxycycline Catapress patch

Symptom List: Unevaluable event

Symptoms: Notice rash under Rt Breast on Sunday night , red itchy irritated. took Benadryl and use hydrocortisone cream to area, Monday morning rash was the same, Monday evening rash spread to my back on the right side. Tuesday Morning went to Doctors office and was Diagnosis with shingles.

Other Meds: Calcium Vitamin D Fiber supplement

Current Illness: None

ID: 1772059
Sex: F
Age: 22
State: OR

Vax Date: 09/22/2021
Onset Date: 09/22/2021
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: Cardiology referral, US echo, c-reactive protein, troponin, CK-mb, CMP, CBC, D-dimer. Some results still pending

Allergies: amoxicillin, penicillin

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

Symptoms: Facial nerve sensory disorder, palpitations, dyspnea. Treated with prednisone, treated in ER along with multiple labs and tests

Other Meds: IBU, magnesium, Vitamin D3, Zinc

Current Illness: none

ID: 1772060
Sex: M
Age: 11
State: WI

Vax Date: 05/18/2021
Onset Date: 10/07/2021
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: None

Allergies: None listed

Symptom List: Injection site pain, Pain

Symptoms: Parent/Guardian brought minor child to our covid-19 vaccination clinic. Completed vaccine administration form using birthdate of 09/15/2008. On 10/07/2021 we were informed that child's actual birthdate is 09/15/2009

Other Meds: Unknown

Current Illness: None listed

ID: 1772061
Sex: F
Age: 31
State: MN

Vax Date: 06/03/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Tested PCR positive for COVID 10/4/21 after being fully vaccinated.

Other Meds:

Current Illness:

ID: 1772062
Sex: M
Age: 56
State: KY

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

Other Meds:

Current Illness:

ID: 1772063
Sex: M
Age: 81
State:

Vax Date: 02/17/2021
Onset Date: 03/20/2021
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: None

Allergies: None

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: After the vaccination my left arm was weak, I have pain in my shoulders.

Other Meds: Heart medication; antibodies; acetaminophen

Current Illness: Fall injury

ID: 1772064
Sex: F
Age: 15
State: LA

Vax Date: 07/31/2021
Onset Date: 08/15/2021
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: RA

Lab Data: EKG - Normal Ultrasound of heart - Normal

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Loss of energy, dizziness, unable to stand or sit up for long period of time, vision becomes blurry, ears began ringing and will faint. Unable to attend school for over a month. Currently on a 14 day heart monitor.

Other Meds: None.

Current Illness:

ID: 1772065
Sex: F
Age: 75
State: FL

Vax Date: 02/24/2021
Onset Date: 02/25/2021
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: I am allergic to penicillin and aspirin

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

Symptoms: 02/25/2021- Very tired and weak and couldn't get out of bed.

Other Meds: I take alot of vitamins, CENTRUM.

Current Illness: None

Date Died: 09/27/2021

ID: 1772066
Sex: M
Age: 70
State: TN

Vax Date: 03/22/2021
Onset Date: 09/14/2021
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:

Symptom List: Nausea

Symptoms: Case fully vaccinated with Pfizer. Second dose received on 3/22/2021. Tested positive for COVID on 9/14/2021. Admitted to Medical Center on 9/20/2021. Expired on 9/27/2021 while still hospitalized.

Other Meds:

Current Illness:

ID: 1772067
Sex: F
Age: 53
State:

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Syncope, posturing, N/V, pallor

Other Meds:

Current Illness:

ID: 1772068
Sex: F
Age: 21
State: CA

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: LA

Lab Data: N/A

Allergies: NONE

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

Symptoms: PATIENT WAS ADMINISTERED COVID-19 VACCINE MODERNA WITH THE LOT # MENTION ABOVE, AFTER IT WAS NOTICED THE VACCINE VIAL THAT WAS ADMINSITERED WAS EXPIRED ALREADY ON 10/04/2021. PATIENT DID NOT SHOW OR HAD ANY SYMPTOMS OR SIDE EFFECTS TO THE VACCINE. PATIENT WAS MONITORED FOR 15 MINUTES IN THE EXAM ROOM THEN PATIENT WAS DISCHARGE HOME WITH NO COMPLAINTS.

Other Meds: NONE

Current Illness: NONE

ID: 1772069
Sex: M
Age: 79
State:

Vax Date: 03/12/2021
Onset Date: 09/12/2021
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: IM
Vax Site: RA

Lab Data: DC cardio conversion.

Allergies: Dust & Pollen, gluten sensitivity..

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

Symptoms: Afib.

Other Meds: Accupril, Amolodipine, Pravastatin, Tamsolusin, M2-K7, Cod Liver Oil, Ezetimibe, Lutein, D3?

Current Illness: None.

ID: 1772070
Sex: F
Age: 74
State:

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

Symptom List: Tremor

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

Other Meds:

Current Illness:

ID: 1772071
Sex: F
Age: 81
State: GA

Vax Date: 02/11/2021
Onset Date: 08/16/2021
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: 08/16/2021 Antigen+ COVID-19 test at Hospital

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Breakthrough COVID-19 case with unknown symptom onset date: Aches, Runny Nose/Congestion, Sore Throat, Nausea/Vomiting, Fatigue or tiredness, Cough. Patient reports that she went to the doctor a total of 3 times. She was tested for COVID-19 on the third doctor's visit. Patient had a fever, but cannot recall her temperature. She was on home O2 and has home health services. Patient has completed self isolation period. Her strength is diminished and she does not have energy. She said she gets tired easily. Tested at hospital but not admitted.

Other Meds:

Current Illness:

ID: 1772072
Sex: M
Age: 51
State:

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

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

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

Other Meds:

Current Illness:

ID: 1772073
Sex: F
Age: 67
State: MI

Vax Date: 03/13/2021
Onset Date: 10/02/2021
Rec V Date: 10/08/2021
Hospital: Y

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

Lab Data:

Allergies: NKDA

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

Symptoms: Hospitalized (10.2.21); COVID-19 positive (10.2.21); fully vaccinated Discharge Provider: MD Primary Care Provider: MD Admission Date: 10/2/2021 Discharge Date: 10/4/21 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] Pneumonia due to COVID-19 virus [U07.1, J12.82] HOSPITAL COURSE: Patient admitted with COVID and hypoxia related to. She is status post vaccination with Moderna. Low volume oxygen is required during his hospital stay, but was wean off oxygen prior to discharge. She was found to have lower extremity DVT which is treated by Eliquis. She will be placed on Eliquis for 3 months. She will also be given dexamethasone for 10 day period. She did receive remdesivir here for 2 does. But was asymptomatic at time of discharge Patient will be on for 3 months. Vaccine would be recommended at that time if boosters indicated. Patient is recommended to have a 10 day isolation.

Other Meds: acetaminophen (TYLENOL) 500 MG tablet albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler apixaban (ELIQUIS) 5 MG tablet apixaban (ELIQUIS) 5 MG tablet aspirin 81 MG enteric coated tablet atenolol (TENORMIN

Current Illness: 10.2.21: Urgent Care visit - Medical Decision Making: Patient is ill appearing and diaphoretic. Her oxygen is at 95%, she does appear slightly short of breath, but no respiratory distress. She is wearing a sweat sure and wrapped in a blanket, as she has significant chills. Lungs are clear bilaterally. Her rapid COVID test was positive. She is vaccinated. I do, however, have concern for the right lower extremity redness, warmth, and calf pain. She was also recently traveling on a 10 day bus trip. She has a history a blood clot during pregnancy many years ago. Discuss her increased risk of blood clot with these risk factors and recommend further evaluation in the emergency department. Patient stated understanding and is agreeable. She prefers emergency department. We did offer wheelchair transfer, but patient prefers to drive her car around the parking lot. Pre arrival placed.

ID: 1772074
Sex: M
Age: 72
State: IN

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Headache tremors chills nausea fatigue cough

Other Meds:

Current Illness:

ID: 1772075
Sex: M
Age: 70
State:

Vax Date: 02/03/2021
Onset Date: 10/07/2021
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:

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

Symptoms: Hospitalized due to Covid

Other Meds:

Current Illness:

ID: 1772076
Sex: F
Age: 48
State: UT

Vax Date: 09/10/2021
Onset Date: 09/26/2021
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: NA

Allergies: sulpha, cardizem, latex.

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

Symptoms: As soon as I woke up in the morning I felt sick, my throat hurt my glands head and neck hurt, I had a severe headache body aches, chills, heat flashes more PVC then I normally have, weak and tired, super strong muscle pains, I took, motrin, xanax, flexxeril and alka selter sinus and chloraseptic for my throat pain , prn, I am due to have my 2nd booster shot today and I still have all the same symptoms but much milder now, but is seems to change constantly. I sure hope this next one causes no more side effects and I will have immunity to this virus.

Other Meds: toprol , paxil, lipitor, motrin,

Current Illness: seasonal allergies

ID: 1772077
Sex: F
Age: 13
State: TX

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:

Allergies: none

Symptom List: Pain in extremity

Symptoms: The patient fainted, about 1 minute after receiving her immunization. She expressed feeling nervous about "needles". She was in the lobby of the pharmacy, beginning her 15 minute post immunization observation period when the event occurred. No trauma resulted from, her fall to the floor which was slow, and assisted by her parent. She got up almost immediately and felt dizzy. She was clammy and pale. Within 10 minutes she reported feeling "fine". Her parent chose not to have medical attention at this time.

Other Meds: unknown

Current Illness: none

ID: 1772078
Sex: M
Age: 61
State: GA

Vax Date: 08/24/2021
Onset Date: 08/25/2021
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: COVID test; Labs were done, but nothing significant came of them

Allergies: Penicillin

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

Symptoms: The following morning, I had extreme dizziness. That persisted for days. There were other symptoms too I had a low-grade fever the 2nd day. It never got over 100.2. I had severe sinus congestion. My head felt stuffy. I felt in a state of confusion. I had extreme postnasal drip and sweating. I also experienced joint aches and nausea and headaches. I just had overall feeling if being unwell. I felt a fullness in my chest in my heart area. I had mucus draining from everywhere. About the 3rd day of feeling this way, I went to an urgent care. A COVID test that was done, came back negative. I was given a medication for inflammation but it was not helpful. The bulk of these symptoms lasted approx. 2 weeks. I am still dealing with dizziness. It is random and will come up out of nowhere. I had a tele visit with my PCP who suggested Mucinex D for help with the nasal drip. This helped but caused some heart palpitations. Also, my heart palpitations increased all while going through this. My heart does not feel healthy. It feels different now, it feels heavy.

Other Meds: Losartan; XANAX; CIALIS

Current Illness: No

ID: 1772079
Sex: M
Age: 45
State: NY

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

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

Symptoms: HSV-2 exacerbation

Other Meds: Vitamin D, multivitamin

Current Illness: none

ID: 1772080
Sex: M
Age: 72
State: PA

Vax Date: 03/26/2021
Onset Date: 06/17/2021
Rec V Date: 10/08/2021
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: They did EKG; all the heart tests and blood work. They tried to do cardio version - to shock the upper heart back into rhythm but the cardio version did not work. Changed some medications - they gave him some stronger heart meds and later took him off of it and told him to take it easy - that wasn't a lot that they did. They talked about a Watchman Process but they didn't feel he was strong enough. He was in the hospital for 8 days at that time. And then three other hospital stays after that event for 43 or 44 days total. The second time he went in , he went in for a bleed - they tried to find the source of the bleed and switched med. Then he went back in for heart failure. This last time, he went into surgery and he went into heart failure while in surgery so they couldn't keep proceeding. He coded three times in surgery. He went into Dialysis September 7th, 2021.

Allergies: can't take Ibuprofen - because he has one kidney

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

Symptoms: On the 17th, he has a difibulator and we got word that he went into A-Fib. And he came into the room and said that he could barely breathe before I could tell him. He ended up going to the hospital that day. See below for other hospital visits.

Other Meds: Atorvastatin; Alopurinol; Bumix; Courig - generic for it; Finasteride; Fam - Pepcid (Generic for it); Tamsulosin; Imdur

Current Illness: no

ID: 1772081
Sex: M
Age: 15
State: ME

Vax Date: 10/01/2021
Onset Date: 10/01/2021
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: none

Allergies: none

Symptom List: Vomiting

Symptoms: Pt was inadvertently administered an expired dose of covid vaccine. Pt was fine, did not experience any untoward effects.

Other Meds: dextroamphetamine, fluoxetine, guanfacine, hydroxyzine

Current Illness: none

ID: 1772082
Sex: F
Age: 51
State: VA

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

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

Lab Data: COVID test

Allergies: Yes

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: I just woke up one day and I couldn't taste. All COVID test came back negative.

Other Meds: No

Current Illness: No

Date Died: 10/01/2021

ID: 1772083
Sex: M
Age: 81
State: TN

Vax Date: 02/26/2021
Onset Date: 09/21/2021
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:

Allergies:

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

Symptoms: Case fully vaccinated with Moderna. Last dose on 2/26/2021. Tested positive for covid on 9/21/2021. Admitted to Medical Center on 9/27/2021. Expired on 10/01/2021 while still hospitalized.

Other Meds:

Current Illness:

ID: 1772084
Sex: F
Age: 15
State: NH

Vax Date: 08/10/2021
Onset Date: 08/11/2021
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: none

Allergies: Tree Nuts

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Hives on face and neck, Swollen lymph node in armpit under left arm. Both continued for 7 days and resolved on their own

Other Meds: None

Current Illness: None

ID: 1772085
Sex: F
Age: 56
State: MI

Vax Date: 10/01/2021
Onset Date: 10/03/2021
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: Physical exam

Allergies: Doxycycline Catapres Patch

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

Symptoms: Noticed rash on right breast Sunday night when I was getting undress. It was only on my right breast . I took Benadryl and put hydrocortisone cream it the rash and went to sleep. Monday the rash was the same itchy and red. Monday night getting undressed noticed the rash has spread to my back on the right side only. it was red itchy and very painful. Tuesday Morning went to the Doctors office and was diagnosis with shingles.

Other Meds: Calcium Vitamin D Fiber Supplement

Current Illness: None

ID: 1772086
Sex: M
Age: 60
State: MO

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

Lab Data: No labs drawn related to the event. Was seen by primary care nurse practitioner the day after the event and advised of stretching exercises and electrolyte supplementation.

Allergies: N/A

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

Symptoms: Severe cramping /tetany of the left hand that occurred approximately 24 hours after vaccination. Symptom onset was immediate and lasted for 45 minutes before resolution.

Other Meds: Allopurinol, Lisinopril, Amlodipine

Current Illness: N/A

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am