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: 1775153
Sex: M
Age: 72
State:

Vax Date: 10/06/2021
Onset Date: 10/06/2021
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: bedside ultrasound

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: 72-year-old male status post covid vaccine 3 days ago presenting with right axilla pain and swelling. Tender nodule and ultrasound showing small edema around reactive lymph node. Patient states that immediately after the vaccine he felt very lightheaded, everything went dark and felt like he was going to pass out. Patient denied chest pain or shortness of breath. Suspect pericarditis or myocarditis.He has had pain in the right arm (deltoid) where the shot was given, radiating to his neck , axilla, and right pectoral region. No signs of cellulitis or abscess. He was given medications for pain management and will follow up for repeat evaluations by his PCM in the next 2-3 days.

Other Meds:

Current Illness:

ID: 1775154
Sex: F
Age: 41
State: MN

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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient reports a rash around her belly button a couple hours after receiving the vaccination

Other Meds:

Current Illness:

ID: 1775155
Sex: F
Age: 59
State: MA

Vax Date: 03/09/2021
Onset Date: 03/10/2021
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: At ER: Chest CT, Abdominal CT and blood work (results=pelvic fluid) F/u with GI and immunology: ? hypersensitive reaction vs F/u with GI: no findings Cytokine long covid test: several cytokine markers high Pending consult with GI, allergist, neurologist

Allergies: celebrex, birth control patch, Buspirone, percocet, some antibiotics, dairy, gluten

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

Symptoms: (2nd vaccine injection) Significant bleeding from L arm during injection, that evening developed severe abdominal pain, diarrhea, chest pain and heart racing. Went to the ER. Symptoms continued to worsen with difficulty swallowing, after diarrhea became constipated (no motility), tinnitus, spinal chills,and joint pain, L inguinal pain. Several months later and still having difficulty - neuro problems developing

Other Meds: Plaquinel, Prednisone

Current Illness: none

ID: 1775156
Sex: F
Age: 26
State: OH

Vax Date: 10/07/2021
Onset Date: 10/08/2021
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: None

Allergies: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Dizzy, lightheaded, fever, shakes, soreness in injection sights and aches in my lower body

Other Meds: None

Current Illness: Soy

ID: 1775157
Sex: F
Age: 36
State: NY

Vax Date: 08/02/2021
Onset Date: 08/03/2021
Rec V Date: 10/09/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Severe daily headaches

Other Meds: None

Current Illness: None

ID: 1775158
Sex: F
Age: 36
State: CA

Vax Date: 10/08/2021
Onset Date: 10/08/2021
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: advised patient to follow up with primary care doctor.

Allergies: Nsaids

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

Symptoms: patient complains of itching inside throat and need to keep clearing throat soon after receiving 2nd dose of vaccine. symptoms relived few minutes after Benadryl 50 mg IM dose given. at 1800 patient was discharged home symptoms free in stable condition. boyfriend with patient. follow-up care instructions given to both.

Other Meds: Benadryl 50 mg IM

Current Illness: none reported by patient

ID: 1775159
Sex: F
Age: 59
State: AR

Vax Date: 09/15/2021
Onset Date: 09/16/2021
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: Moraphen

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: All lymph nodes on the side I received the vaccine in, my left size, were sore and swollen. There was pain, throbbing, severe soreness and knots you could feel. The largest knot burst and I received some relief. There is still soreness deep in my left breast. I received my second dose today, 10/9/21, and it is beginning to feel like before only quicker.

Other Meds: Prozac, ambien, gabepentine. Vitamins C,D and zinc.

Current Illness: Covid 19

ID: 1775160
Sex: F
Age: 64
State: MA

Vax Date: 10/03/2021
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: UNK
Vax Route: IM
Vax Site: LA

Lab Data: none

Allergies: Penicillin Sulfa IVP contrast dye Nickel shrimp

Symptom List: Pharyngeal swelling

Symptoms: left jaw tingling and numbness x 2 lasting 15-20 minutes each time headache stabbing/pinching pains in finger tips and toes. thigh pain muscle and joint pain fever 100.9 fatigue left arm swelling and redness at injection site lasted 7 days

Other Meds: Metformin 1000 mg Glimepiride 6 mg Lisinopril -HCTz 10-12.5 mg x 2

Current Illness: none

ID: 1775161
Sex: F
Age: 36
State: TN

Vax Date: 06/11/2021
Onset Date: 06/18/2021
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-ray done at walk in clinic. Nothing was broken. 07/29/21

Allergies: N/a

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Muscle pain in upper left arm. I can hardly lift it. It?s getting worse with time.

Other Meds: N/a

Current Illness: N/a

ID: 1775162
Sex: M
Age: 57
State: CA

Vax Date: 02/16/2021
Onset Date: 03/26/2021
Rec V Date: 10/09/2021
Hospital: Y

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

Lab Data: Blood, MRI, spinal tap, xray, etc

Allergies: None

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Gillian-Barre Syndrome (GBS)

Other Meds: None

Current Illness: None

ID: 1775163
Sex: F
Age: 56
State: NV

Vax Date: 09/27/2021
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: none

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

Symptoms: Chest pain and palpitations

Other Meds: Vit B12 and Calcium

Current Illness: none

ID: 1775164
Sex: F
Age: 57
State: FL

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

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

Lab Data: sugar extremely high 300

Allergies: chlorohexidine , Iodine

Symptom List: Rash, Urticaria

Symptoms: I woke up with dizziness - huge dizziness also, my sugar was extremely high in the 300

Other Meds: metformin, labetalol, aspirin, vitamin D3

Current Illness: Diabetes

ID: 1775165
Sex: M
Age: 0
State: FL

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

Lab Data: none

Allergies: no

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

Symptoms: seizure for 10-20 seconds right the the shot

Other Meds: none

Current Illness: no

ID: 1775166
Sex: F
Age: 33
State: AZ

Vax Date: 09/25/2021
Onset Date: 10/06/2021
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: Pregnancy test- negative. Not on birth control pills

Allergies:

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

Symptoms: Menstruation delay from October 5.

Other Meds:

Current Illness:

ID: 1775167
Sex: F
Age: 60
State: MD

Vax Date: 04/20/2021
Onset Date: 06/09/2021
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: primary doctor performed a first blood test to rule out Lyme Disease - end of July I still need to check if I need a second blood test I ended up seeing my primary doctor 2x and the dermatologist 1x in order to obtain appropriate medication for resolving the traveling rash. I had a fourth visit for a blood test and will have visit #5 to confirm the results of visit #4. I am enrolled in the Federal COVID vaccine monitoring program and received a phone call that I asked me to compete a VAERS report.

Allergies: bleomycin, pollen

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

Symptoms: 1) itching reaction to bug bite lead to an itchy rash that traveled intermittently around the body: bite site on back of L leg; back of hands, right arm, back 2a) Primary physician treated with hydroxyzine hcl (itch) tablet and cephalexin (oral antibiotic) with Lotrimine, presumed dx fungus ("ring worm") and staph infection (no testing) 2b) dermatologist considered Lyme Disease, but felt that I had had a chemical exposure to a substance on school bleachers where I had sat close to the ground: treated with antibiotic and topical steroid/fungicide, diagnosed inflammatory response "to something unknown" 3) first blood test ruled out Lyme Disease.

Other Meds: lamotrigine, Pulmicort HFA, vitamin D, calcium + mg + D, melatonin

Current Illness: bug bite 06/06/2021 just prior; subsequent test for Lyme was negative co-incident to recall of Respironics bipap

ID: 1775168
Sex: F
Age: 49
State:

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

Lab Data:

Allergies:

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

Symptoms: Patient developed hives on arms and hands minutes after immunization. Treated with diphehydarmine and began to improve.

Other Meds:

Current Illness:

ID: 1775169
Sex: F
Age: 35
State: TX

Vax Date: 03/18/2021
Onset Date: 04/08/2021
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:

Allergies: none

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

Symptoms: Migranes every single day some so painful I can't function on some days. Can't concentrate or remember alot of things, no energy, I'm so tired. My chest always feels tight and heart rate is very high.

Other Meds: no

Current Illness: none

Date Died: 06/03/2021

ID: 1775170
Sex: M
Age: 64
State: FL

Vax Date: 01/22/2021
Onset Date: 05/23/2021
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:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Chest pain, shortness of breath, Acute Myocardial Infarction

Other Meds:

Current Illness:

ID: 1775171
Sex: M
Age: 22
State: NY

Vax Date: 10/09/2021
Onset Date: 10/09/2021
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: N/A

Allergies: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Near Syncope, Blurry Vision

Other Meds: Multi-vitamin

Current Illness: None

ID: 1775172
Sex: M
Age: 16
State:

Vax Date: 09/29/2021
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:

Allergies: None

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

Symptoms: Intermittent chest pain beginning 10/1 and continues to present

Other Meds: None

Current Illness: Sinus infection

ID: 1775173
Sex: F
Age: 43
State: FL

Vax Date: 10/08/2021
Onset Date: 10/09/2021
Rec V Date: 10/09/2021
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: none yet

Allergies: only to pollen and other unknown...somewhat severe

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

Symptoms: severe headache, fever of 103

Other Meds: none

Current Illness: she had a cold that ended approximately 2 weeks prior

ID: 1775174
Sex: F
Age: 52
State: AL

Vax Date: 04/17/2021
Onset Date: 07/01/2021
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:

Allergies:

Symptom List: Unevaluable event

Symptoms: July: both legs swole and turned purple lasting until present October. September: hospitalized September 16- diagnosed with two blood clots in lungs, blood clots in two separate chambers of the heart, and double pneumonia

Other Meds:

Current Illness:

ID: 1775175
Sex: F
Age: 81
State: FL

Vax Date: 10/06/2021
Onset Date: 10/06/2021
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:

Allergies:

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

Symptoms: "Moderna Vaccine EUA" Stiffness in right arm, swollen and painful with pain and discoloration in fingers

Other Meds:

Current Illness:

ID: 1775176
Sex: F
Age: 14
State: WI

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: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: unknown result but was awake and stable. believed to be transported out of caution

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Patient was given vaccination as usual and vaccine was confirmed and accurate. No previous reactions were reported prior to administration. Patient expressed the vaccine hurt more on her arm that dose 1 as she was returing to her mother in the waiting area. She began to state she was passing out as she reached her chair in which her mother was attending to her and had her in chair safe. Pharmacist was alerted immediately and patient was moving and responsive when he arrived but past out shortly after arrival. technician retrieved blanket and bottle of water as patient was safely lowered to ground by pharmacist and mother after assessing she was safe but unconscious. patient was responsive to name and mom state

Other Meds: Clindamycin/BPO gel topical

Current Illness:

ID: 1775177
Sex: F
Age: 13
State: CA

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

Lab Data: n/a

Allergies: penicillin V

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient was given 1st dose of Moderna vaccine, Lvn supervisor Monitored patient for 45 minutes after injection in lobby. no side effects noted. Supervisor informed mother of vaccine administration and will follow up in the upcoming days and set up a follow up appt. with PCP. Informed mother if patient begins to have any adverse reactions to the vaccine do not hesitate to go to urgent care or local hospital.

Other Meds: None stated.

Current Illness: none stated

ID: 1775178
Sex: F
Age: 70
State: MS

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

Lab Data: None

Allergies: Penicillin, codeine

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

Symptoms: Fever began night of injection (Thursday) and went up to 101.8 degrees. Treated with Tylenol. Shingrix injection site began to swell and redden overnight. Fever continued all the following day (Friday, 10/08/2021) being about 99.8 with Tylenol. General malaise and sleepiness all day diminishing by about 8pm Friday night. Redness at Shingrix injection site increased to 3"x1" with hard knot, heat, and swelling; some itchiness. Red, hard, hot, swelling lasted at least thru Saturday 10/09/2021. (time of this report, so probably will last another day or more)

Other Meds: Muro128 ointment, Quercetin, Vit D, Zinc, Multi-vitmins.

Current Illness: none

ID: 1775179
Sex: F
Age: 65
State: FL

Vax Date: 09/29/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data: none

Allergies: sulfa, occasional rash with eggs- mild

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: patient presented with a red spot at injection site about 4x4 area. She stated also having rash on back ,legs, and breast that itches. She stated that she has gotten dizzy also. Patient has taken Zyrtec and applied ice to area. Pharmacist suggested benadrylas it is a better choice for itching and can bring down swelling of arm and to continue using ice.

Other Meds:

Current Illness:

ID: 1775181
Sex: F
Age: 66
State: CT

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

Lab Data: 10/09/21 BP 138/79 PULSE 67

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: AFTER 15 MINUTE WAITING PERIOD PATIENT STATED HER ARM FELT VERY ITCHY AND LIKE IT WAS SWELLING, ALSO FELT A LITTLE LIGHT HEADED. GAVE 25MG BENADRYL AND MONITORED ADDITIONAL 30 MINUTES. TOOK BLOOD PRESSURE, PULSE, AND HAD PATIENT STAND WITH ME PRIOR TO LEAVING. BP AND PULSE NORMAL, PATIENT COHERENT AND ABLE TO STAND WITHOUT DIZZINESS, LIGHTHEADED, OR FAINTING.

Other Meds:

Current Illness:

ID: 1775182
Sex: F
Age: 72
State: TN

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

Allergies: No

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

Symptoms: Patient had a allergic reaction to her 2nd Pfizer vaccine. She experienced ichiness all over her hand, arm, back and stomach.

Other Meds: No

Current Illness: No

ID: 1775183
Sex: F
Age: 52
State: CA

Vax Date: 09/15/2021
Onset Date: 09/18/2021
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: RA

Lab Data: Unknown medical tests. Was informed that she had a massive stroke and a blood clot in her brain stem.

Allergies: Penicillin and azithromycin

Symptom List: Nausea

Symptoms: When she received the vaccine shot on Wednesday, the 15th of September of 2021 she experienced the usual symptoms typical of a vaccine. However, each day her symptoms became more unusual and of concern. She was experiencing severe diarrhea, chronic coughing up of mucous, and dehydration. Then by the 18th she was experiencing the loss of control over her bowels and urine. Then it escalated to paralysis and was rushed to the hospital.

Other Meds: Unknown. She was taking meds for her high blood pressure and heart condition.

Current Illness: She has been diagnosed with Hypertension, congestive heart failure, and diabetes.

ID: 1775184
Sex: F
Age: 43
State: GA

Vax Date: 09/16/2021
Onset Date: 09/17/2021
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: Head CT in ED and then a follow up head MRI with contrast. Bloodwork in ED also.

Allergies: None

Symptom List: Injection site pain

Symptoms: Vomiting x1 day after, next day had a drooping eyelid and difficulty chewing/swallowing. Four days after vaccine had aphasia and then went to ED. Diagnosed with Bell's palsy.

Other Meds: atorvastatin, losartan, meloxicam, hydroxyzine, tylenol, gabapentin, oxybutin

Current Illness: None

ID: 1775185
Sex: M
Age: 15
State: VA

Vax Date: 09/13/2021
Onset Date: 09/13/2021
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: See prior information about allergist visit.

Allergies: As a result of allergic reaction to vaccine, taken to see allergist the following week (9/20/21). From skin and blood tests, determined to be allergic to tree nuts, shellfish.

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

Symptoms: Pt. experienced dizziness, tired and lethargic, migraine, burning inside his body, mild fever, numbness, itchy. Reaction took place one hour after vaccination. Was taken out of school & given Benadryl (day 1) and rested. Next day went to school and same reactions took place only this time the nurse gave him an epinephrine injection (Epipen) and he was taken by ambulance to the nearest emergency room. The doctor only gave fluids and monitored since the Epipen was what helped address the adverse/allergic reactions.

Other Meds: None

Current Illness: None

ID: 1775186
Sex: F
Age: 16
State: NV

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

Lab Data:

Allergies:

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

Symptoms: patient started feeling light-headed after receiving the shot, she said she was fine at first and went to observation chair to sit. after 5 minutes, she did not feel better and laying down to the ground saying she feeling dizzy. pharmacist on duty came to check her and she said she didnt feel very well. after saying that, she went into seizure for 5-6 seconds. patient did not respond to her mom calling her. when she regained consciousness, she had no recollection of the event. pharmacist on duty, patient's mom and another customer also witnessed the event. 911 was called and arrived on scene. patient felt weak and could not walk so she was taken to ER to further evaluate. No family history of seizure confirmed with the mom.

Other Meds:

Current Illness:

ID: 1775187
Sex: F
Age: 58
State: IN

Vax Date: 10/02/2021
Onset Date: 10/02/2021
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: None

Allergies: No

Symptom List: Tremor

Symptoms: Ringing in ears. It sounded like a steam whistle. I thought something was on the stove. I had ringing in my ears with the second dose too but I didn?t think much of it and did not report it.

Other Meds: Metformin Vasepa Prilosec Pravastatin Lisinopril Lantus insulin Humalog insulin

Current Illness: None

ID: 1775188
Sex: M
Age: 30
State: CA

Vax Date: 10/05/2021
Onset Date: 10/05/2021
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: Patient presented to the vaccination site on 10/05/21. The client notified RN that he received a single dose of the (AstraZeneca) COVID vaccine on (5/29/21). RN submitted a medical consult via text message requesting to proceed with the COVID vaccine Janssen. Per CDC guidance, approval to proceed with COVID vaccine Janssen was obtained via text message. Client received COVID vaccine Janssen Lot# 211A21A on 10/05/2021. The client did not report any symptoms during the observation period. The client left the vaccination site at 1401.

Other Meds:

Current Illness:

ID: 1775189
Sex: F
Age: 40
State: LA

Vax Date: 09/13/2021
Onset Date: 09/13/2021
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: n/a I don't have health insurance

Allergies: latex

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

Symptoms: Starting within 30 minutes of receiving 2 dose of moderna vaccine I began to have intense sporadic migraine-like headaches, random fever & extreme photosensitivity & blurred vision which continues to this day. It is effecting my job since I work in an outdoor profession.

Other Meds: none

Current Illness: none

ID: 1775190
Sex: F
Age: 35
State: MD

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

Allergies: Morphine

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

Symptoms: Very high diastolic blood pressure and severe pressure in head, dizziness, and lightheadedness

Other Meds: Labetalol

Current Illness:

ID: 1775191
Sex: F
Age: 65
State: MO

Vax Date: 10/05/2021
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: None

Allergies: Demerol

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: vaccine 10/5/21 am, left arm ( pneumovax 23), right arm (quad 65+). 10/5 pm-rt arm sore. 10/6 am-rt arm large knot, swollen, red with heat; lft arm sore. 10/7 am-rt arm knot reducing; lft arm very sore, heat, nauseous, achy, very faint, slept most of day. 10/8 am-rt arm little tender; lft arm large knot, swollen, very red, alot of heat, extremely sore., finger tips numb. 10/9 am-knot gone, large red patch on full bicep, very sensitive to any touch, small amount of heat.

Other Meds: Norvasc 5mg Lexapro 20mg Xanax 0.5mg Fioricet 50/325/40

Current Illness: None

ID: 1775192
Sex: F
Age: 41
State: OH

Vax Date: 10/08/2021
Onset Date: 10/09/2021
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: Swelling, pain, red lump at injection site

Other Meds: Hydroxyzine, amoxicillin

Current Illness:

ID: 1775193
Sex: M
Age: 50
State: OH

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

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

Lab Data:

Allergies: Lactose intolerance

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

Symptoms: The evening I received the shot, I started experiencing pain / soreness around the injection site. The next day I felt very strange, with flu-like symptoms all day (fever, stuffy head, body aches)

Other Meds: Centrum, vitamins B, C, and D

Current Illness: N/A

ID: 1775194
Sex: F
Age: 60
State: CT

Vax Date: 08/19/2021
Onset Date: 08/20/2021
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: Lab tests pending

Allergies: Tree nut allergy

Symptom List: Pain in extremity

Symptoms: On 8/20/21, around 6:00 am, the morning after the vaccine, I had left arm numbness/tingling which resolved after about a minute. The following morning on 8/21/21, the same thing happened. On 8/23/21, at approximately 3:00 pm while sitting on the couch, my left foot started tingling. This tingling is continuous and has not stopped. On 9/9/21, my right foot started tingling but only temporarily. This happens only once in a while. On 9/13/21, I started to feel severely fatigued and this has continued. Since around 9/21/21, I have had decreased strength in my legs and am not able to walk as far as I used to.

Other Meds: Alendronate 70 mg, one time per week

Current Illness: None

ID: 1775196
Sex: F
Age: 14
State: WA

Vax Date: 10/09/2021
Onset Date: 10/09/2021
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: n/a

Allergies: n/a

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

Symptoms: None yet

Other Meds: n/a

Current Illness: n/a

ID: 1775197
Sex: F
Age: 39
State: TX

Vax Date: 10/08/2021
Onset Date: 10/09/2021
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: None

Allergies: Shellfish, pcn

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

Symptoms: Body aches, headache, chills, nausea, lethargy, Low grade fever (100.2 oral)

Other Meds: None

Current Illness: None

ID: 1775198
Sex: F
Age: 47
State: IL

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

Lab Data: None

Allergies: Fish/shellfish (anaphylaxis), tropical fruit, tree nuts

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

Symptoms: Muscle pain (back. arms. legs), skin pain/sensitivity, headache, fatigue, malaise, swollen lymph nodes (all moderate to severe, unable to work)

Other Meds: zyrtec, slynd

Current Illness:

ID: 1775199
Sex: F
Age: 38
State: OR

Vax Date: 07/26/2021
Onset Date: 09/08/2021
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: Penicillin, sulfas, latex, shellfish, dairy, eggs

Symptom List: Vomiting

Symptoms: Flu-like symptoms for 2 days. This started a few hours after vaccine. Long-term side effects started 9/08/2021 with extreme menstrual cramping before, during, and after menstruation. This never happened beforehand, and I think it?s related. I went to an obgyn and they didn?t have much of any information or help.

Other Meds: Xyzal 5mg

Current Illness:

ID: 1775200
Sex: F
Age: 23
State: IL

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: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: NA

Allergies: NKA

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: The Leur lock on the needle was not tightened and the needle detached from the syringe during administration and part of the dose was lost.

Other Meds: NA

Current Illness: No

ID: 1775201
Sex: M
Age: 57
State: WA

Vax Date: 04/22/2021
Onset Date: 05/20/2021
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:

Allergies: No

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

Symptoms: Moderna Covid-19 Vaccine EUA Headache since September 20th, 2021 Muscle ache since September 20th, 2021 Fatigue all days long Fever and chilly

Other Meds: No

Current Illness: No

ID: 1775202
Sex: F
Age: 47
State: CA

Vax Date: 09/29/2021
Onset Date: 10/04/2021
Rec V Date: 10/09/2021
Hospital: Y

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: N/A

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Sleep pattern is off, get 4 hours a night, Daily headaches after waking up, keeping forgetting or losing things, all symptoms started week after #2, 10/7 migraine all day, with pain from my left side temple, down my neck to my shoulder, 10/8 woke up with same migraine (maxalt prescribed not working) last all day, woke up at midnight trowing up every 30 ins to and hour until 4 am. no appetite and migraine still here

Other Meds: VIORELE B/C PILLS, DAILY VITAMINS

Current Illness:

ID: 1775203
Sex: M
Age: 18
State: CA

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: none

Allergies: none

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

Symptoms: While waiting for 15 minutes after the first covid vaccine, patient slumped down the chair but did not hit his head to the floor. Patient was awake the whole time and reported lightheaded as well as dizzy. Pharmacy called 911 and provided a bottle of water while monitoring patient closely. No signs and symptoms of allergic reactions. EMS arrived and checked patient's vitals which were all normal and released patient home with parents.

Other Meds: none

Current Illness: none

ID: 1775204
Sex: M
Age: 17
State: WA

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

Lab Data: n/a

Allergies: n/a

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

Symptoms: Patient was given vaccine under age approved

Other Meds: n/a

Current Illness: n/a

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am