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: 1772087
Sex: F
Age: 72
State: MD

Vax Date: 09/25/2021
Onset Date: 09/25/2021
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

Symptom List: Dysphagia, Epiglottitis

Symptoms: Symptoms started in evening of date received- fatigue, soreness injection site. During the night i woke with high severe shaking interfered with ability to walk without holding onto the wall. I was afraid to go downstairs to take my temp for fear of falling down the stairs. Went back to bed, awoke later - still had a fever but was able to walk properly. After take my temp 101.6 and taking ibuprofen I went back to bed, awoke around 7 am had a temp of 99.6 throughout the day, had a slight headache which remained through the weekend. Monday I felt well enough to go to the gym for a Tai Chi class. Each shot has had a worse reaction. If there is a 4th booster, I will NOT be getting it if this is what I have to look forward to.

Other Meds: Synthroid, tramadol, amlodipine, candesartan, Zoloft, fluvastatin, gabapentin, vitamin D

Current Illness: none

ID: 1772088
Sex: F
Age: 31
State: MD

Vax Date: 09/21/2021
Onset Date: 09/29/2021
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: I started to experience paresthesia in my hands the day after receiving the 3rd dose/booster dose. I also experienced very vivid dreams and was unable to wake easily. The paresthesia lasted about 5 days.

Other Meds: Hydroxychloroquine, once a day

Current Illness: None

ID: 1772089
Sex: M
Age: 76
State: FL

Vax Date: 05/21/2021
Onset Date: 05/22/2021
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:

Allergies: tetanus reclast lisinopril

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

Symptoms: blurry vision for 3 weeks chest pressure upon waking for 10 days ringing in ears for 3 weeks Extreme fatigue - continuous -still experiencing

Other Meds: plavixx diclofenac exitimber

Current Illness: none

ID: 1772090
Sex: F
Age: 67
State: OR

Vax Date: 03/11/2021
Onset Date: 09/21/2021
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:

Allergies: NKDA

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: breakthrough COVID infection in fully vaccinated individual

Other Meds: LEVETIRACETAM PHENYTOIN

Current Illness: none

ID: 1772091
Sex: F
Age: 53
State: MT

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:

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

Symptoms: Symptoms of body aches and chills then felt like throat was closing partially for a couple of hours, now breathing fine

Other Meds:

Current Illness:

ID: 1772092
Sex: M
Age: 66
State: TN

Vax Date: 04/01/2021
Onset Date: 04/01/2021
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: I had a x-ray that did not show any bone issues.

Allergies: none

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

Symptoms: Soreness never abated. Now, months later, I have limited mobility in my right arm. I can't sleep on my right side due to shoulder/arm pain. I have significant limited mobility in the arm and pain when I try to force typical motion.

Other Meds: Lisinopril

Current Illness: none

ID: 1772093
Sex: M
Age: 11
State: WI

Vax Date: 06/08/2021
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: None

Allergies: None listed

Symptom List: Pyrexia, White blood cell count decreased

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 the child's actual birthdate id 09/15/2009

Other Meds: Unknown

Current Illness: None listed

ID: 1772094
Sex: F
Age: 28
State:

Vax Date: 04/09/2021
Onset Date: 04/09/2021
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: NKA

Symptom List: Pharyngeal swelling

Symptoms: Pt reports SOB, hives after initial Moderna vaccination at the Vaccination clinic. After 5-10 minutes, she experienced a numbing, tingling, cold sensation in her throat and her throat swelled up. After 15 minutes, her tongue was visibly swollen. Able to swallow water and talk. Was given a shot of diphenhydramine at the vaccination site. Was transported to the ER via ambulance. Notes she felt dizziness and had increased blood pressure. Did not pass out. Had some tingling and coldness in her extremities. She was treated with diphenhydramine 50 IV in the ambulance and diphenhydramine 25 mg in the ER. No epinephrine. Was monitored in the ER for an hour. After she was discharged, patient felt a cold sensation and took cetirizine.

Other Meds: Medications: sertraline (ZOLOFT) 50mg Tab 1 tab (50mg) daily metFORMIN 24Hr-XR (GLUCOPHAGE XR) 500mg Tab Take 500 mg by mouth daily with breakfast Indications: 4 tablet daily by mouth.

Current Illness:

ID: 1772095
Sex: F
Age: 23
State: WI

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

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

Lab Data: 10/8/21 - CMP showed WNL on relevant parameters

Allergies: none

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Day after receiving second dose of moderna covid vaccine patient had syncopal episode and presented to urgent care. Patient was admitted to floor for less than 24hours for observation and was discharged.

Other Meds: cetirizine (ZYRTEC) 10 MG tablet Take 10 mg by mouth daily as needed for allergies. Informant: Patient, Last Dose: Unknown at Unknown time TodayYesterdayPast WeekPast MonthMore Than A MonthUnknown at famotidine (PEPCID) 20 MG

Current Illness: none

ID: 1772096
Sex: F
Age: 23
State: NV

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

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Several hours after first injection of Moderna I began to have a fever of 103 and my heart started to race as if I was having a heart attack. My body had extreme aches and as well as a severe pain in my left arm that I cannot even describe. Following that I began to vomit and blacked out. The fever/vomiting/body aches lasted for 2 weeks. I am now left with shortness of breath and grey mark where my injection site was. My hair has begun to fall out as I am assuming it is from this vaccine as well.

Other Meds:

Current Illness:

ID: 1772097
Sex: F
Age: 70
State: WI

Vax Date: 02/19/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies: Bee Stings - Swelling, Hives Lisinopril - Dry Cough

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

Symptoms: Patient contracted COVID after being fully vaccinated. Headache, Sweating, congestion, muscle aches, brain fog, loss of smell Booster shot Pfizer on 10/1/2021

Other Meds: calcium carbonate 2000mg daily chlorthalidone 25mg daily cholecalciferol 2000IU daily epinephrine 0.3mg prn for anaphylaxis famotidine 10mg BID losartan 50mg daily metoprolol 12.5mg BID multivitamin daily rosuvastatin 10mg M,W,F

Current Illness: None documented

ID: 1772098
Sex: F
Age: 33
State: FL

Vax Date: 08/30/2021
Onset Date: 10/08/2021
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: Cardiac mri and biopsy

Allergies: Bactrim and lorabid

Symptom List: Rash, Urticaria

Symptoms: Pericarditis. 9/14/2021

Other Meds: Tacrolimus, sirolimus, cellcept, aciclavir, zinc, prevastatin, norvasc, calcium, ambien, Xanax, Benadryl, tops max, keppra

Current Illness: Post successfull heart transplant 4/1/2021

ID: 1772099
Sex: F
Age: 26
State: AZ

Vax Date: 10/02/2021
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: CXR, Chest CT W/ and W/O, Echocardiogram, D-dimer, ESR, CRP, troponin panel

Allergies: None

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

Symptoms: Chest pain, Body aches, headache, fatigue

Other Meds: None

Current Illness: None

ID: 1772100
Sex: F
Age: 27
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: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Post injection, pt was observed to have "slight convulsing", clammy, sweaty hands. HR and SpO2 WNL., BP normal. Denied dizzyness, chest pain, nausea. at 10:10 pt noted to show improvement in skin conditions. Pt ate granola bar, drank juice and water, tolerated well. She ambulated without difficulty, steady gait. At 10:40 pt left clinic, denied SOB, pain, dizziness. She was accompanied by her mother.

Other Meds:

Current Illness:

ID: 1772101
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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: N/A

Allergies: NONE

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

Symptoms: PATIENT WAS ADMINISTERED COVID-19 VACCINE MODERNA WITH THE LOT # MENTION ABOVE, AFTER MA NOTICED THE VACCINE VIAL THAT WAS ADMINSITERED WAS EXPIRED ALREADY ON 10/04/2021. PATIENT DID NOT SHOWED 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: 1772102
Sex: F
Age: 26
State: MA

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

Lab Data: none

Allergies: none

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

Symptoms: Patient experienced slight pain and some swelling in her lymph nodes the day after her flu vaccine.

Other Meds: did not specify

Current Illness: none listed

ID: 1772103
Sex: F
Age: 14
State: UT

Vax Date: 10/06/2021
Onset Date: 10/06/2021
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: None

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

Symptoms: Hives over whole body

Other Meds: None

Current Illness: None

ID: 1772104
Sex: M
Age: 55
State: CA

Vax Date: 04/05/2021
Onset Date: 08/07/2021
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: Blood test, swallowing test.

Allergies: No

Symptom List: Ear pain, Hypoaesthesia

Symptoms: I had to J/J on 04/05/2021 around the end of June beginning of July I was having heart muscle pinching. It would last for 30 seconds, and it happened off and on. After a week it resolved. Prior to 08/07/2021 I had been taking Abilify for the past 10 years. I was on Abilify, I would go without medication for 2 or 3 months. About a week before on 08/07/2021, I had stopped taking the Abilify. On 08/07/2021 I began having shortness of breath, a hard time swallowing, and could not even drink water. It happened gradually through 08/09/2021. It was not getting better. On 08/11/2021, I was hospitalized at medical center. From 08/11/2011- 08/17/2021, for 6 days. I have withdrawn from Abilify and reduced my dosage in the past, without ever having any problem with swallowing. After the Johnson and Johnson, when I withdrew from the Abilify, I started having the problem with swallowing. In the past 10 years I have withdrew from Abilify twice and I had never these adverse reactions, of swallowing. I have recovered from the AE's with the administration of Abilify. I was put back on the Medication.

Other Meds: Abilify

Current Illness: No

ID: 1772105
Sex: F
Age: 39
State:

Vax Date: 09/30/2021
Onset Date: 09/30/2021
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: Left eye pain x 8 days and going

Other Meds:

Current Illness:

ID: 1772106
Sex: F
Age: 34
State: OR

Vax Date: 10/05/2021
Onset Date: 10/07/2021
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: Sulfa based antibiotics (rash)

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

Symptoms: I was 5 weeks 1 day pregnant at the time of vaccination. On Tuesday, I got flu and third covid vax at the same time. Thursday afternoon I started getting an itchy red rash bilaterally on my neck/shoulder. By evening it had spread down my chest to my stomach. It felt itchy/hot. I took half a unison pill, slept 11 hours and woke to see it about 80% improved. I still feel flushed but not as itchy. I don?t know if it is related to vaccination but can?t think of another likely cause.

Other Meds: Prenatal vitamin

Current Illness: None

ID: 1772107
Sex: M
Age: 16
State: CA

Vax Date: 07/08/2021
Onset Date: 07/08/2021
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:

Allergies:

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

Symptoms: Patient Fainted for 3-5 seconds,Vital signs bp 109/66, pulse 74, O2 98%, Head to toe assessment done. No found injury, no head hitting noted. Patient transferred to gurney and gave him water. Mother stated he had history of faintness and he skipped breakfast. Today he did not eat anything since the morning. Snack provided, patient stayed extra 30 minutes for observation. Patient feels better after 30 minutes. Advised mother to consult with primary care provider of patient and give more fluids. No dizziness or pain reported Vital after 15 minutes BP 110/78, pulse 66

Other Meds:

Current Illness:

ID: 1772108
Sex: F
Age: 32
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: N/A

Other Meds:

Current Illness:

ID: 1772109
Sex: F
Age: 15
State: NH

Vax Date: 09/01/2021
Onset Date: 09/02/2021
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: LA

Lab Data: Doctor visit to assess the lymph node and prescribe the antibiotic

Allergies: Tree Nuts

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

Symptoms: Swollen Lymph Nodes in armpit on left arm. After a month of swollen nymph node and pain, Patient was put on Augmentin and switched to Amoxicillian antibiotics. Continues to swell, pain and bruising. No resolution as of today

Other Meds: None

Current Illness: None

Date Died: 09/27/2021

ID: 1772110
Sex: F
Age: 96
State: TN

Vax Date: 02/26/2021
Onset Date: 09/16/2021
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:

Symptom List: Injection site pain, Pain

Symptoms: Case fully vaccinated with Pfizer. Last dose on 2/26/2021. Tested positive for COVID on 9/16/2021. Admitted to Hospital on 9/11/2021. Expired while still hospitalized on 9/27/2021.

Other Meds:

Current Illness:

ID: 1772111
Sex: F
Age: 63
State: WA

Vax Date: 03/04/2021
Onset Date: 03/25/2021
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: n/a

Allergies: NKDA

Symptom List: Injection site pain, Menorrhagia

Symptoms: Sore shoulder starting 3 weeks after vaccine given, when raising arm (i.e. to put on a shirt or jacket) and resolves shortly after lowering arm

Other Meds: levothyroxine 0.075 mg daily

Current Illness: Hypothyroidism

ID: 1772112
Sex: F
Age: 16
State: CT

Vax Date: 09/01/2021
Onset Date: 09/01/2021
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: None

Allergies: None

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

Symptoms: Administration error- patient was 16 years old when she received her second dose. The first dose was given on 05/06/2021 and was reported to VAERS. The second dose was given in accordance with CDC recommendations. Adverse reaction- (dose administered in day 0) Sore arm and headache on day 1. On day 2 and afterward, patient felt fine and engaged to her usual activities.

Other Meds: None

Current Illness: None

ID: 1772114
Sex: F
Age: 75
State: TX

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

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Pt is fully vaxed for moderna and went to get a flu shot and was given a pfizer shot

Other Meds:

Current Illness:

ID: 1772115
Sex: F
Age: 73
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:
Dose Series: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: nut allergies; I get sleepy if I eat too many. That is my only reaction to them.

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Booster at 10 am: by 9pm I started getting very very cold and arm was aching and tender where injection was. By 10pm I was in bed shaking, cold; every part of my body hurt terribly. Around 11pm I took an Advil so I could sleep. Took an hour to take the edge off my symptoms but only barely. Slept until 4am & then got up. Still ached from head to toe; very very cold; took Tylenol throughout day and again it barely took the edge off. Miserable 24 hours of symptoms. Started clearing up after 24 hours; still cold, still achy for the next 24 hours. Then very very tired. By today, 10/8, I'm feeling almost normal.

Other Meds: none

Current Illness: none

ID: 1772116
Sex: F
Age: 55
State: SC

Vax Date: 07/01/2021
Onset Date: 08/02/2021
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: Contacted cardio surgeon and was put back on heart meds. Metoprolol

Allergies: N/A

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

Symptoms: Was given 1st moderna injection 3 days later had Afib attack, chest pain. Had cardio ablation 6/2019 to stop Afib and had no problems until after vax

Other Meds: Motrin, Claratin D, Multi vitamin

Current Illness: N/A

ID: 1772117
Sex: F
Age: 59
State: FL

Vax Date: 05/11/2021
Onset Date: 05/14/2021
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: May 14 Doctor as my foot swelled, said lets watch it come back in a feet evalate it May 28 Did an x-ray and said to have an mri June 16 Mri to look into why not repairing and why swollen and sent me to a speicalist June 24Specialist for the foot said i need to see a vascular doctor he thinks i have blood clots June 24 Confirmed by ultersound -acute occlusive venous thrombosis involving the right peroneal and posterior tibial veins. July 30-Put me on xarelto Oct 5 still have clots still on Xarelto

Allergies: none known

Symptom List: Nausea

Symptoms: I have never had blood clots. I was in a boot cast and noticed my foot extemely swollen. I had been going to the doctor every week but after the shot , my foot swelled and had lots of purple and redish marking. I went to a specialist who did an ultersound and it was said I had gotten blood clots. They put me on Xarelto.

Other Meds: Losartan 100 Mg Tablet once a day, 50 mcg D3, 2500 B12, Folic Acid 1000mcg, calcium 750Mg

Current Illness: I fractured my ankle on a jog, so i was on crutches and in a boot cast.

ID: 1772118
Sex: M
Age: 82
State: IL

Vax Date: 09/01/2021
Onset Date: 09/02/2021
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: None

Symptom List: Injection site pain

Symptoms: Vertigo. Severe. Caused me to fall. Lasted five minutes.

Other Meds: Eliquis Triamterene

Current Illness: Neuropathy

ID: 1772119
Sex: F
Age: 71
State: GA

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

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

Lab Data:

Allergies: SULFA, PENICILLIN, MANY "MYCINE" ANTIBIOTICS, KEFLEX,

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

Symptoms: That evening I woke up around midnight with 103 degree temperature and kept temperature for five (5) days. Fever ranged from 102 - 104 degrees over the 5 days. Tylenol was somewhat effective in that temperature would reduce a little. On the fifth day, the temperature subsided. Two weeks later high fever returned, and I ended up in hospital.

Other Meds: CALCIUM WITH D PRESERVISION AREDS 2 PRELIPID

Current Illness: NONE

ID: 1772121
Sex: M
Age: 21
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: RA

Lab Data:

Allergies:

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

Symptoms: 10 seconds after vaccination, pt's body tensed, he became pale and unresponsive. Arms and body became flexed and stiff. He was placed on floor, 911 called, Ammonia inhalant used with immediate response. VS stable, pt continued to be responsive. Skin was pale and diaphoretic. Denied headache, chest pain, SOB, nausea. No rash noted on skin, lungs clear, no wheezing. Pt improved, took sips of water and ate a snack. Tolerated well, no emesis. Medics arrived, assessed pt, offered transport to hospital but pt refused. Medics provided instruction to seek medical attention if symptoms return or worsen. Pt monitored for 30 minutes post event, no further symptoms. Ambulated without assist, steady gait to car.

Other Meds:

Current Illness:

ID: 1772122
Sex: M
Age: 82
State: CT

Vax Date: 09/27/2021
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: 10/06/2021- ER visit for straight cath/foley placement 10/08/221- urology visit - dx with BPH, started on medication

Allergies: None known

Symptom List: Tremor

Symptoms: Acute urinary retention

Other Meds: Losartan, allopurinol

Current Illness: None

ID: 1772123
Sex: M
Age: 50
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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Patient experienced chest tightness, palpitations, tongue swelling. No shortness of breath. The nurse confirmed vitals were good, and that the patient was able to eat/drink/swallow. Nurse administered 25mg of Benadryl. BP was 110/70 and HR was 64. The patient noted he had a similar reaction to the first dose. Doctor spoke with the vaccinator and the patient. Patient is the school principal. The patient was discharged at 11:45am to the school nurse.

Other Meds:

Current Illness:

ID: 1772124
Sex: M
Age: 24
State: KY

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: EXPIRED/BEYOND USE DATE VACCINE

Other Meds:

Current Illness:

ID: 1772125
Sex: F
Age: 32
State:

Vax Date: 09/23/2021
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:

Allergies: Allergies: Fruit Extracts (nausea, vomiting, rash, problems breathing), NSAIDS (coagulopathy), Raw Vegetables (hives, itchy tongue4/mild asthma)

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

Symptoms: Spoke with patient. She developed an itchy rash started about 2 hours after first dose of Moderna vaccine. Started with one red and very itchy bump on her arm. Later that day and following days, developed more similar bumps. Pt took benadryl w/ no relief of symptoms. Bumps remain present constantly, do not come and go, are very itchy, do not look like insect bites. Total has about 4 on her arm and some on her legs. Lesions are very itchy. Given triamcinolone oint and hydroxyzine. Per allergy, pt should not get dose #2

Other Meds: Medications: Albuterol 90mcg/act 2inh PRN SOB

Current Illness:

ID: 1772126
Sex: F
Age: 43
State:

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

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

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Vaccine expired 10/2/21. Expired vaccine administered on 10/3/21. No adverse events. Error found on 10/4/21 and reported to Janssen.

Other Meds:

Current Illness:

ID: 1772127
Sex: M
Age: 75
State: MI

Vax Date: 02/08/2021
Onset Date: 10/03/2021
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: NKDA

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

Symptoms: Hospitalized (10.3.21); COVID-19 positive (10.3.21); fully vaccinated Admission Date: 10/3/2021 Discharge Date: Oct 5, 2021 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: COVID-19 [U07.1] HOSPITAL COURSE: This is a 75-year-old male with past medical history significant for coronary artery disease, paroxysmal atrial fibrillation, hypertension, hyperlipidemia, CVA and bladder cancer who presented to the emergency department with shortness of breath, cough and generalized weakness. In the emergency department, the patient was tachypneic with oxygen saturation stable on room air. He was found to be COVID-19 positive. CTA chest was performed and did not show PE but did show findings consistent with COVID-19. He received a dose of Decadron and was admitted for further management. Given lack of hypoxia, the patient qualified for monoclonal antibody therapy for which he received on 10/03. Further Decadron was held and the patient was monitor closely. The patient did have a small amount of hemoptysis, which was felt likely related to COVID in setting of aspirin and Pradaxa use. His hemoglobin remained stable. He did drop his O2 saturations to 89% while ambulating in room to bathroom without supplemental O2 but otherwise feels well and comfortable returning home today. No skilled needs on PT/OT evaluation.

Other Meds: acetaminophen (TYLENOL) 500 MG tablet amLODIPine (NORVASC) 5 MG tablet aspirin 81 MG chewable tablet atorvastatin (LIPITOR) 80 MG tablet finasteride (PROSCAR) 5 MG tablet levETIRAcetam (KEPPRA) 500 MG tablet metoprolol succinate-XL (TOPROL-

Current Illness: 9.29.21: ED - rectal bleeding, hemorrhoids, exhaustion

ID: 1772128
Sex: M
Age: 50
State: GA

Vax Date: 05/22/2021
Onset Date: 08/27/2021
Rec V Date: 10/08/2021
Hospital: Y

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

Lab Data: 08/27/2021 PCR+ COVID-19 test at Hospital

Allergies:

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

Symptoms: Breakthrough COVID-19 case with symptom onset 8/27/2021: Shortness of breath/difficulty breathing, chest pain, and brain fog. Patient states that he felt he couldn't breathe, so he called an ambulance to take him to the hospital. Patient was taken to Hospital and was admitted on August 27th. PUI was there until he was discharged on August 30th. Patient states he has no idea how he was exposed to COVID. Patient states he stays at home since he is retired. Patient states he has no pre-existing conditions.

Other Meds:

Current Illness:

ID: 1772130
Sex: F
Age: 17
State: IL

Vax Date: 04/27/2021
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: LA

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: to ER c/o sore throat, headache and nasal congestion x3 days. myalgias, cough

Other Meds:

Current Illness:

ID: 1772131
Sex: M
Age: 67
State: FL

Vax Date: 04/30/2021
Onset Date: 05/30/2021
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: Unknown

Allergies: N/A

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

Symptoms: Pt. states that after receiving the 2nd dose of Moderna 04/30/2021, started experiencing symptoms 05/30/2021 of chest pains, shortness of breath, and fatigue. Diagnosed with Pericarditis and lung infection. Still continuing to experience symptoms.

Other Meds: Losartan

Current Illness: N/A

ID: 1772132
Sex: F
Age: 33
State: NC

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

Lab Data: Ultrasound; CT Scan

Allergies: No

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

Symptoms: I had a ruptured ovarian cyst and an inflamed appendix. I have been taking over the counter medication. I went to the ER where they did an ultrasound and CT scan. I have some follow up appointments with a PCP, OB/GYN and a general surgeon as well as some imaging scheduled.

Other Meds: No

Current Illness: No

ID: 1772133
Sex: F
Age: 86
State: CO

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

Lab Data:

Allergies: NKA

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

Symptoms: Patient reports constant pain in/around injection site since receiving vaccine, and injection site reaction (redness) which lasted around 1 day, which she has not previously experienced with this vaccine

Other Meds:

Current Illness:

ID: 1772135
Sex: M
Age: 43
State:

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: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: HSCRP ESR d-dimer

Allergies:

Symptom List: Vomiting

Symptoms: flare of gout, elevated HSCRP>10, ESR 22, d-dimer 0.64

Other Meds:

Current Illness:

ID: 1772136
Sex: F
Age: 59
State: NM

Vax Date: 08/20/2021
Onset Date: 08/21/2021
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: Upcoming with Doctor - Appt within the next month.

Allergies: Opiates; sulfa drugs; Flagel - allergies; sensitivities: Diclofenac; Tylenol; Non Steroidal Anti-Inflammatory

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Severe fatigue - severe severe. It is still ongoing actually. I have gone from full-time with an overload to working part-time. Because of the other things going on, I don't have a way of knowing if it was vaccine related. A pretty big upkick in joint pain; muscle pain and stiffness (they call it Fibromyalgia); skin patches that look like psoriasis or eczema. I see all the doctors. I just a repeat endoscopy for the ulcers. Breast doc followed up as well. And I have an upcoming appt with a doctor. With my bone disease, I have very low Vit D levels so I have an appt with primary care to check in about the Vit D levels, etc. I went to part time work to help myself rest more.

Other Meds: Gabapentin; NEXIUM; ZRYTEC OTC

Current Illness: No -except in August I had: breast surgery for lumpectomy - benign and Endoscopy that found I had digestive tract was eroded from arthritis medication - 6 peptic ulcers - I just had a follow up this morning and they are gone

ID: 1772137
Sex: F
Age: 39
State: AZ

Vax Date: 01/12/2021
Onset Date: 08/21/2021
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: RA

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

Allergies:

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

Symptoms: Cough, chills, elevated temperature, sore/scratchy throat, Headache, runny nose/congestion, loss of taste and/or smell, myalgia, and malaise

Other Meds:

Current Illness:

ID: 1772138
Sex: M
Age: 37
State: MN

Vax Date: 05/21/2021
Onset Date: 09/17/2021
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 RT-PCR Test

Allergies: NKA

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Positive COVID-19 While fully vaccinated

Other Meds: Flonase, Sudafed, Motrin

Current Illness: N/A

ID: 1772139
Sex: M
Age: 81
State:

Vax Date: 02/28/2021
Onset Date: 09/06/2021
Rec V Date: 10/08/2021
Hospital: Y

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: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: hospitalization with covid pneumonia

Other Meds:

Current Illness:

ID: 1772140
Sex: F
Age: 59
State: PA

Vax Date: 01/06/2021
Onset Date: 01/06/2021
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: L arm itchy two weeks after injection. Deep muscle aches which settled into L thigh Vertigo Fever

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am