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: 1774942
Sex: F
Age: 58
State: NY

Vax Date: 10/06/2021
Onset Date: 10/07/2021
Rec V Date: 10/09/2021
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: latex

Symptom List: Dysphagia, Epiglottitis

Symptoms: pruritis, periorbital edema

Other Meds: asa, statin, plaivx, flonase, zestoretic, claritin, metformin, toprol xl,

Current Illness: none

ID: 1774943
Sex: F
Age: 44
State: WA

Vax Date: 09/24/2021
Onset Date: 09/25/2021
Rec V Date: 10/09/2021
Hospital:

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

Lab Data: Covid Test @ Medical Center 9/29 Negative Result on 9/30

Allergies: Lisinopril - have not taken for years

Symptom List: Anxiety, Dyspnoea

Symptoms: Fri, 9/24 - Vaccine injection #2 (no symptoms) Sat, 9/25 - Headache, fatigue/exhaustion, dizzy, sore/achy joints, nausea & swollen glands (in my throat) Sun, 9/26 - Headache, fatigue/exhaustion, dizzy, sore/achy joints, burning throat (felt like it was on fire) Mon, 9/27 - Headache, fatigue/exhaustion, dizzy w/exertion, dry cough + wheezing + SOB/short-of-breath (all with exertion) Tues, 9/28 - Headache, fatigue, dry cough with dizziness, wheezing and SOB (had to call off/miss work) Wed, 9/29 - Headache, dry cough with dizziness, wheezing & SOB & inhaler use (had to call off/miss work & get Covid test) Thurs, 9/30 - Headache, dry cough with dizziness, wheezing & SOB & inhaler use (Covid Test resulted negative) Fri, 10/1 - Headache, dry cough with dizziness, wheezing & SOB & inhaler use (attempted to go to work, wheezing and SOB worse & used inhaler multiple times to get through shift) Sat, 10/2 - Headache, dry cough with dizziness, wheezing & SOB Sun, 10/3 - Dry cough with dizziness, wheezing & SOB Mon, 10/4 - Dry cough with dizziness, less wheezing, SOB

Other Meds: Losartan-HCTZ, Fluoxetine, Famotidine, Zyrtec

Current Illness: None

ID: 1774944
Sex: F
Age: 52
State: CT

Vax Date: 07/01/2021
Onset Date: 08/01/2021
Rec V Date: 10/09/2021
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: Penicillin, almonds, hazelnuts, biaxin

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

Symptoms: Difficulty with gait/balance. Balance off when walking. Also foot pain, heel, right foot.

Other Meds: None

Current Illness: None

ID: 1774945
Sex: F
Age: 33
State: NC

Vax Date: 09/19/2021
Onset Date: 09/20/2021
Rec V Date: 10/09/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Extreme heart pain, chest pains, heart papulations, anxiety, breathing issues, numbness on right side of body

Other Meds:

Current Illness:

ID: 1774946
Sex: M
Age: 23
State: SD

Vax Date: 06/29/2021
Onset Date: 09/16/2021
Rec V Date: 10/09/2021
Hospital:

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

Lab Data: X-rays 09/27/2021

Allergies: Dog and Cat hair

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

Symptoms: Bad pain in my neck, shoulder, and spine. Currently undergoing 12-18 weeks of physical therapy. So far has done some good, but also hasn't really done to much to alleviate the pain.

Other Meds: DHEA

Current Illness:

ID: 1774947
Sex: M
Age: 58
State: VA

Vax Date: 09/18/2021
Onset Date: 09/28/2021
Rec V Date: 10/09/2021
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: Went to see a doctor on 10/8/2021, and ECG shows likely normal. The doctor advised taking Ibuprofen.

Allergies:

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

Symptoms: Pfizer 1st dose on 9/18/2021. Mild to medium chest pain on 9/28/2021. The chest pains are on and off.

Other Meds: Multivitamin

Current Illness:

ID: 1774948
Sex: F
Age: 43
State: NE

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

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

Lab Data: No I called the ER and they don't have a protocol for this except to wait it out especially me tasting this medicine. I do not wish this on anyone.

Allergies: Vicodin, sunlight, topical meds, flu shot

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: 15 min after receiving the shot I could taste it meaning I could literally taste the medicine in my mouth. A couple hours later I experienced itching throughout my body more on my arm back and neck. I thought these things would go away and this morning I can still taste the vaccine. It tastes bitter. It tastes mediciney like saline mixed with something which in turn is making me nauseated because I can't get this taste out of my mouth. I can taste foods n things just fine but it's like the medicine is absorbed through my skin or something. I am also itching everywhere. My back on the right side mainly but also other parts of my body but it kind of hurts and burn a little on that whole right side kinda like hives but no red rash on the backside just injection site. I also am experience headaches. I went to work at 6:40 am and my head was pounding. I rarely have headaches but I was completely healthy before this. I was living my best health life before this. This vaccine was not made for me. This is also causing me to lose hours because I can't think if I'm in this much turmoil behind it.

Other Meds: At time of vaccination no prescription was taken 2 weeks prior.

Current Illness: None I was perfectly fine before I had this mandated vaccine that I never would have got if I wasn't coerced and forced.

ID: 1774949
Sex: M
Age: 44
State: NC

Vax Date: 09/19/2021
Onset Date: 09/22/2021
Rec V Date: 10/09/2021
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: Heart pain, Shooting chest pains, breathing issues, sever allergies, body numbness on left side,

Other Meds:

Current Illness:

ID: 1774950
Sex: F
Age: 33
State: FL

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

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

Lab Data:

Allergies: no

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: axilar adenomegaly and swelling, mild pain

Other Meds: Levothyroxine Multivitaminas

Current Illness: no

ID: 1774951
Sex: F
Age: 56
State: NC

Vax Date: 10/09/2021
Onset Date: 10/09/2021
Rec V Date: 10/09/2021
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: Penicillin, Sulfa

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient complained of itchiness on face around right eye - patient also admitted that she was nervous. Slight redness on tip of nose and chin - possibly from wearing a mask, Patient denied any itching or swelling of tongue or lips. patient is alert and oriented

Other Meds:

Current Illness:

ID: 1774953
Sex: F
Age: 55
State: FL

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

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

Lab Data:

Allergies: No

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

Symptoms: Adenomegaly axilar, pain, tenderness in underarm

Other Meds: Omega 3 Multivitamins Lorazepam Nucleotidos

Current Illness: No

ID: 1774954
Sex: F
Age: 49
State: IN

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/09/2021
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

Allergies: None

Symptom List: Rash, Urticaria

Symptoms: Started with a severe headache Thursday evening then added fever, chills, fatigue, and muscle aches all day yesterday. Slight improvement this morning.

Other Meds: Copaxone and Meloxicam

Current Illness: None

ID: 1774955
Sex: F
Age: 53
State: KY

Vax Date: 09/28/2021
Onset Date: 09/30/2021
Rec V Date: 10/09/2021
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:

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

Symptoms: Severe soreness throughout entire right arm, so strong that I was unable to use it for a full 24 hours. Followed by itching, bad itching at injection site and left shoulder that lasted around 36 hours.

Other Meds:

Current Illness:

ID: 1774956
Sex: F
Age: 66
State: OH

Vax Date: 10/06/2021
Onset Date: 10/07/2021
Rec V Date: 10/09/2021
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: None

Allergies: Penicillin

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

Symptoms: Sore/swollen arm, chills, joint pain, headache, muscle ache, sweating profusely Treated with Tylenol and alkaselzer plus.

Other Meds: Lantus, metformin, glipizide, farxiga, celexa, estimbe/simvastatin, plavix, lisinopril, omeprazole, Allegra, multivitamin, omega 3 fish oil

Current Illness: None

ID: 1774957
Sex: F
Age: 60
State: TX

Vax Date: 09/28/2021
Onset Date: 10/07/2021
Rec V Date: 10/09/2021
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: Hydrocodone Sulfa drugs

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

Symptoms: On day 7 my injection site became slightly painful. It broke out in a rash and began to swell and was very itchy. The next day the rash spread and the swelling was still there and still itches. Today the swelling is not as bad but the itching is still there. It now appears to be getting better.

Other Meds: None

Current Illness: None

ID: 1774958
Sex: M
Age: 42
State: WV

Vax Date: 10/01/2021
Onset Date: 10/02/2021
Rec V Date: 10/09/2021
Hospital:

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

Lab Data: 10/2/21 routine vital signs including pulse oximetry, pulse, temperature, bp completed

Allergies: None

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

Symptoms: Approx. 1 AM on 10/2/21 noticed throat was itching and tongue felt full. Self administered 2 benadryl and went back to sleep. Awakened at 3 am with lip, tongue and throat swelling and called for assistance. Epinephrine 0.3 mg IM administered and prednisone 60 mg orally administered with improvement of throat swelling /tongue swelling . Lip swelling improved however continued to be mild for an additional 8 hours. Patient given prednisone taper and benadryl q4 hours along with certirizine 10 mg bid and famotidine 20 mg bid prescribed for 1 week. By approx 6 pm on 10/2/21 all symptoms had resolved .

Other Meds: Venlfaxine 150 mg daily, xyzal 5 mg daily, melatonin 5 mg daily

Current Illness: None

ID: 1774959
Sex: F
Age: 37
State: NY

Vax Date: 02/01/2021
Onset Date: 02/24/2021
Rec V Date: 10/09/2021
Hospital:

Vax Type: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data: None

Allergies: No

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

Symptoms: Pain to left arm, numbness, tingling. Heavy periods and often 2x a month.

Other Meds: Spironolactone

Current Illness: No

ID: 1774960
Sex: F
Age: 46
State: OK

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

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

Lab Data: Cbc, metabolic panel, urinalysis

Allergies: Hay fever, demoral, sulfa, pcn, ibuprofen, liquibid-d, codiene, keflex, cipro, tcn, cleocin, erythromycin, macrobid

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Itching, headache, red blotches on skin, raised heart rate, swelling throat

Other Meds: Amlodipine Lipitor

Current Illness:

ID: 1774961
Sex: F
Age: 69
State: NJ

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

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

Lab Data: Office exam. Steroids, aspirin and hydroxychloroquin were prescribed

Allergies: Grass, trees, ragweed, mold, dust, apples, peaches, tomato, onion, gluten

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Extreme chills, nausea with dry heaving, extreme fatigue, persistent headache, numbness in feet, weakness in leg muscles with aching, slowed pupilary reflex response to light, slowed overall motor reflexes, aggravated bronchial congestion and sinus congestion

Other Meds: Breo Ellipta

Current Illness: None

ID: 1774962
Sex: F
Age: 65
State: CA

Vax Date: 09/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/09/2021
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: Ampicillin none

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

Symptoms: Sore arm next day with redness. About 5 days later memory problems. Can't find things I just had in my hand or forgot where I put it. Go to get something and totally forget what I was looking for. Being asked to do something. Then being asked if I had done it. And can't remember that I was even asked. Left one item in food cart after shopping. Continue to have small episodes of forgetfulness . But have not seen doctor yet.

Other Meds: Questran Premarin

Current Illness:

ID: 1774963
Sex: M
Age: 72
State: LA

Vax Date: 10/07/2021
Onset Date: 10/08/2021
Rec V Date: 10/09/2021
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:

Allergies: nka

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

Symptoms: Patient came in pharmacy 10/8/21 (evening) complained of feeling as if something was in his left eye and wanted an eye wash. After questioning patient, had patient take blood pressure (171/94). Patient said sight was blurry in left eye. Advised patient and spouse to seek medical attention. Patient started having trouble with speaking and standing. Patient's wife brought to hospital. Called patient's wife to inquire status on 10/9/21. Patient had a stroke and is still in hospital.

Other Meds:

Current Illness:

ID: 1774964
Sex: F
Age: 58
State: MN

Vax Date: 04/27/2021
Onset Date: 10/04/2021
Rec V Date: 10/09/2021
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: Unevaluable event

Symptoms: cough on 10/4/21 That lasted a couple of days, and has nearly resolved. She has some nasal congestion and decreased smell as a result of congestion. She was with her brother 10 days ago, and afterward he ended up getting sick and being diagnosed with COVID-19.

Other Meds: Clonidine; Triamterene-HCTZ

Current Illness: none

ID: 1774965
Sex: F
Age: 27
State: GA

Vax Date: 04/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/09/2021
Hospital: Y

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

Lab Data: CT BRAIN, MRI BRAIN, CT VENOGRAM BRAIN

Allergies: NONE

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

Symptoms: PATIENT WAS ADMITTED TO HOSPITAL WITH HEADACHE AND VISUAL IMPAIRMENT, ULTIMATELY DIAGNOSED WITH CEREBRAL VENOUS THROMBOSIS

Other Meds: NONE

Current Illness: NONE

ID: 1774966
Sex: F
Age: 69
State: SC

Vax Date: 10/03/2021
Onset Date: 10/05/2021
Rec V Date: 10/09/2021
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: None

Symptom List: Injection site pain, Pain

Symptoms: Dizziness followed by swelling of lips

Other Meds: Daily vitamin, D3 2000

Current Illness: None

ID: 1774967
Sex: F
Age: 32
State: FL

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

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

Lab Data:

Allergies: N/A

Symptom List: Injection site pain, Menorrhagia

Symptoms: At 5 weeks pregnant dose 1 was administered at 8 weeks a complete spontaneous miscarriage occurred

Other Meds: Pre natal vitamins

Current Illness: N/A

ID: 1774968
Sex: M
Age: 62
State: CA

Vax Date: 04/09/2021
Onset Date: 06/18/2021
Rec V Date: 10/09/2021
Hospital:

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

Lab Data: CT Scan, MRI, EKG, stress test, multiple visits to Urgent care, E/R, and family practice Doctor over the last 4 months.

Allergies: None

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

Symptoms: Multiple subsegmental pulmonary emboli, which turned into heart palpatations.. One emboli traveled to my brain and caused me to collapse at work, where I was taken by ambulance to Emergency Room.

Other Meds: None

Current Illness: None

ID: 1774969
Sex: F
Age: 72
State:

Vax Date: 06/27/2021
Onset Date: 06/27/2021
Rec V Date: 10/09/2021
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: Visited doctor and reported these events. He did not recommend tests, but told me to report it to the VAERS site.

Allergies: Sulpher, sulphite drugs

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Pain and swelling at the site, left upper arm and shoulder blade, lasting 2 weeks Loss of full range of motion in left arm continuing today (4 months) Left upper arm continues to feel bruised (4 months) Chills, fever, body aches, multiple hallucinations lasting 2 days Fatigue, lethargy continuing today (4 months) Daily Multiple silent migraines lasting two months Severe cramps all over body - neck, legs, arms, abdomen (4 months)

Other Meds: Lisinopril (blood pressure) Spironolactone (potassium sparing water pills)3

Current Illness:

ID: 1774971
Sex: F
Age: 55
State: KS

Vax Date: 05/28/2021
Onset Date: 05/28/2021
Rec V Date: 10/09/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: At 1425, patient was in the observation area and complained of "being hot and dizzy." Patient reported that "I feel like I was blacked out for a second and then I see you." Escorted patient to EMS room. BP: 120/62, P:80, O2 SAT= 98% on RA. Patient reported that she had panic attack sometimes, and she took Lorazepam 1 mg at 1320 at home. RN offered snack and water to patient. Applied cold compress to her neck. After 20 minutes visiting with patient in the EMS room, patient reported she was feeling much better. RN escorted patient to the car at 1445.

Other Meds: Lorazepam

Current Illness:

ID: 1774972
Sex: M
Age: 48
State: KS

Vax Date: 07/26/2021
Onset Date: 08/09/2021
Rec V Date: 10/09/2021
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: Ultrasound done 9-9-21

Allergies: NKDA

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

Symptoms: Pt developed left axillary lymphadenopathy/mass approx 2 weeks after receiving the vaccine in his left arm. The swelling cont to incr. He had a ultrasound done that showed concern for lipoma vs inflamed tissue. The mass continued to increase in size. Pt saw a surgeon who thought it should be removed. The day of surgery, (9/23/21) the mass was about the size of a grapefruit. Pathology showed lymph node with adipose tissue. Post op, the area continued to swell and remains swollen. Pt is being observed for now. The area remains tender to touch and is affecting his ADLs due to pain and swelling.

Other Meds: Esomeprazole 40mg, MVI, Lexapro 20mg, Claritin 10mg, Hydromorphone 4mg, Crestor 5mg, Flexeril 10mg prn, Trazadone 50mg prn

Current Illness: None

ID: 1774973
Sex: F
Age: 56
State: VA

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

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

Lab Data: None

Allergies: None

Symptom List: Nausea

Symptoms: Chills, body aches, lethargy,

Other Meds: Allegra, probiotic, magnesium, vitamin D

Current Illness: None

ID: 1774974
Sex: F
Age: 29
State: MN

Vax Date: 05/01/2021
Onset Date: 10/04/2021
Rec V Date: 10/09/2021
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: productive cough, sore throat, headache/heavy feeling, runny, chest congestion, chest tightness, shortness of breath, fatigue, diarrhea-3 times/no blood in stool, sinus congestion, nasal congestion,. starting 10/4/21

Other Meds: Vitamin D

Current Illness: none

ID: 1774975
Sex: M
Age: 68
State: MI

Vax Date: 10/01/2021
Onset Date: 10/02/2021
Rec V Date: 10/09/2021
Hospital:

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

Lab Data: Tested positive for Covid a week later

Allergies: Penicilin

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

Symptoms: This was my third vaccination. That night felt a little sick. Lost sense of smell

Other Meds: Elequist. Norco Advanostatin Hydroclorothidizide

Current Illness: Arthritis

ID: 1774976
Sex: M
Age: 41
State: MO

Vax Date: 10/08/2021
Onset Date: 10/08/2021
Rec V Date: 10/09/2021
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: Administration error, mixed series mRNA vaccines Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1774977
Sex: F
Age: 54
State: FL

Vax Date: 10/01/2021
Onset Date: 10/06/2021
Rec V Date: 10/09/2021
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: Quinolines

Symptom List: Tremor

Symptoms: ?Covid arm?

Other Meds: Na

Current Illness: Na

ID: 1774978
Sex: M
Age: 74
State: MO

Vax Date: 10/08/2021
Onset Date: 10/08/2021
Rec V Date: 10/09/2021
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: Administration error, mixed series mRNA vaccines Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1774979
Sex: F
Age: 65
State: MO

Vax Date: 10/08/2021
Onset Date: 10/08/2021
Rec V Date: 10/09/2021
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 vaccines Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1774980
Sex: F
Age: 47
State: NC

Vax Date: 09/26/2021
Onset Date: 09/27/2021
Rec V Date: 10/09/2021
Hospital:

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

Lab Data: 09/30/21

Allergies: Clarithromycin, zoloft, simbicort, Advair HFA, Morphine

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

Symptoms: Began with slight headache, chills , injection site soreness. palpitations, light headed and dizzy . Unable to get up from bed that monday morning , very dizzy as if the room was spinning. nausea , lightheaded palpitation that came and went. loss of appetite. Took 2 500 mg Tylenol which helped with the soreness and headache. Tuesday symptoms continued, seemed to be milder through out the day palpitations continued more frequently and felt clammy throughout my body. (no fever what so ever ) . Wednesday morning , woke up feeling well. attempted to work and the dizziness came full force along with nausea. unable to continue to work . I laid down for the rest of the morning . started to feel better . I went to the store with my son and while in the store felt as if I was going ton pass out. when I arrived home , ate and rested . As I was sitting in the recliner, palpitations and dizzy feeling began again and this time lasted longer. I decided to go to the ER at this time. seen at ER where and EKG , labs and CT scan were performed. per provider all results were normal. DX: dizziness, Palpitations, and Middle ear effusion. prescribed Prednisone 50mg tablets 1 by mouth for 7 days, Diphenhydramine 25mg 3 x a day and Meclizine 25 mg

Other Meds: budesonide inhalant suspension- 0.25mg/2ml , Vitamin C 1000mg , Pataday once daily relief eye allergy itch relief (eye drops as needed ) xoponex inhaler as needed Azelastine nasal drop hcf 0.1%

Current Illness: sinus pressure headache a week prior to vaccination

ID: 1774981
Sex: F
Age: 54
State: MO

Vax Date: 10/08/2021
Onset Date: 10/08/2021
Rec V Date: 10/09/2021
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: Administration error, mixed series mRNA vaccines Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1774982
Sex: F
Age: 68
State: MO

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

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

Lab Data:

Allergies:

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

Symptoms: Administration error, mixed series mRNA vaccines Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1774983
Sex: F
Age: 77
State: LA

Vax Date: 02/02/2021
Onset Date: 03/18/2021
Rec V Date: 10/09/2021
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: Full labs, cardiac labs, Chest X-Ray, EKG

Allergies: NKDA

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

Symptoms: This "adverse event" was reported directly to Public Health 6 months after it occurred. The patients husband was concerned about vaccines being "mandated". Patient is a 77yo F with an extensive medical history who presented on 03/18/21 with c/o chest pain and SOB for 2 days. She had been taking lasix for CHF, but hadn't taken a dose in several days. She was admitted, given multiple labs and tests. She was given several doses of Lasix, and improved significantly. She was diagnosed with an exacerbation of CHF, and released to home the next day. Her husband who made the report stated I received a call. He wanted to make a report warning about the side effects of the Pfizer vaccine. He received his last dosage of the vaccine in February, and he and his wife had severe complications due to the vaccine. He stated that he had blood clots in his brain and lungs, and his wife has been hospitalized five times since their last dosage. He disclosed that he was 81 years old, and believes that not everyone should not be mandated to take the vaccine. This is the only hospital record that he provided (his wife's).

Other Meds: Alprazolam, Amiodareone, Amlodipine, Ca+/VitD, Gabapentin, Isosorbide Dintrate, Lisinopril, Magnesium, Metformin, Metoprolol, Nitroglycerin, Januvia

Current Illness:

ID: 1774984
Sex: M
Age: 16
State: LA

Vax Date: 07/29/2021
Onset Date: 08/10/2021
Rec V Date: 10/09/2021
Hospital: Y

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

Lab Data: Extensive labs

Allergies: not known

Symptom List: Pain in extremity

Symptoms: Pediatric Multisystem Inflammatory Syndrome

Other Meds: not known

Current Illness:

ID: 1774985
Sex: M
Age: 60
State: MO

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

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

Lab Data:

Allergies:

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

Symptoms: Administration error, mixed series mRNA vaccines Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1774986
Sex: F
Age: 43
State: CA

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

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

Lab Data: MRI EMG- 5/17/21: Evidence consistent with partial brachial plexopathy (predominantly upper trunk involvement) with evidence of ongoing active denervation without evidence of reinnervation.

Allergies: none

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

Symptoms: Pain in neck and left shoulder and arm within 4 days of vaccination. Saw a doctor, and had several tests done including an MRI. The Neurologist confirmed Parsonage Turner syndrome. Several weeks later I had an EMG done, and the doctor again confirmed that diagnosis. I have limited ability to lift weight any weight over my head with my left arm. I have muscle loss showing in my shoulder and back. I have not regained any of my previous strength prior to the vaccine.

Other Meds: Ambian

Current Illness: none

ID: 1774987
Sex: M
Age: 17
State: LA

Vax Date: 07/13/2021
Onset Date: 07/28/2021
Rec V Date: 10/09/2021
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: Extensive labs

Allergies: not known

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

Symptoms: Pediatric Multisystem Inflammatory Syndrome following first dose of Pfizer vaccine

Other Meds: not known

Current Illness:

ID: 1774988
Sex: F
Age: 25
State: KS

Vax Date: 05/10/2021
Onset Date: 05/10/2021
Rec V Date: 10/09/2021
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: Patient was sitting in observation and complained of feeling light-headed. Taken to EMS room. After lying down and eating a snack, states she feels much better.

Other Meds:

Current Illness:

ID: 1774989
Sex: M
Age: 53
State: MO

Vax Date: 10/08/2021
Onset Date: 10/08/2021
Rec V Date: 10/09/2021
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 vaccines Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1774990
Sex: F
Age: 55
State: PA

Vax Date: 08/30/2021
Onset Date: 09/04/2021
Rec V Date: 10/09/2021
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: ANA + as above in September

Allergies: Avelox

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

Symptoms: Developed diffuse pruritic rash of trunk and intertriginous areas 1 week after booster dose. Diagnosed as dermal hypersensitivity reaction to vaccine by dermatologist. Also ANA + 1:80 nuclear dots and 1:320 speckled pattern

Other Meds: None

Current Illness: None

ID: 1774991
Sex: F
Age: 68
State: MO

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

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Administration error, mixed series mRNA vaccines Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1774992
Sex: F
Age: 37
State: MO

Vax Date: 10/08/2021
Onset Date: 10/08/2021
Rec V Date: 10/09/2021
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: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: Administration error, mixed series mRNA vaccines Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1774993
Sex: F
Age: 25
State: KS

Vax Date: 06/11/2021
Onset Date: 06/11/2021
Rec V Date: 10/09/2021
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: While in observation, patient felt faint/sweating. Patient did not fall. Patient alert and oriented. Given snack and water.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am