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: 1776295
Sex: F
Age: 34
State: KY

Vax Date: 07/02/2021
Onset Date: 09/20/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Tested Positive for Covid

Other Meds:

Current Illness:

ID: 1776296
Sex: F
Age: 42
State: FL

Vax Date: 10/08/2021
Onset Date: 10/08/2021
Rec V Date: 10/11/2021
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: on 10/08/2021 around 10PM at the vaccine administration site, developed left arm pain, continues to have left arm pain, developed swollen area under left axilla, noticed swelling to left armpit/throbbing pain 10/08/2021, reports on 10/09/2021 left axilla lymph node swelling continued to increase in size. Reports she also developed chills, fever, left arm nerve pain, heart palpation around 24 hours after vaccine. Reports all other symptoms including heart palpations resolved except left arm pain and swollen lymph node to left axilla. Reports she took ibuprofen and applied ice pack to left arm/armpit for her symptoms.

Other Meds: Camaese Birth Control

Current Illness: none

ID: 1776297
Sex: F
Age: 34
State: ID

Vax Date: 10/09/2021
Onset Date: 10/10/2021
Rec V Date: 10/11/2021
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: N/A

Allergies: Shell fish

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

Symptoms: 1. Redness, itching, swelling at the injection site. 2. Armpit swelling and pain/tenderness

Other Meds: OTC Flonase, Generic allergy pill

Current Illness: None

ID: 1776298
Sex: F
Age: 31
State: MS

Vax Date: 07/01/2021
Onset Date: 07/01/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data: No tests or laboratory tests were run.

Allergies: Cefuroxime, Ceclor, Keflex

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: I received the shot at approximately 6:00 PM on 7/29/2021. Within 1 hour I had a mild headache. Within 6 hours I had fever and chills that last until the next morning. I suffered from severe headaches on and off since the date of injection for approximately 4 weeks. I do not regularly suffer from severe headaches. Two of these headaches (8/5/2021 and 8/12/2021) were the worst headaches of my life.

Other Meds: Spironolactone, Synapsin, Cholestyramine Probiotics, Vitamin D, Magnesium, Turmeric, Fish Oils, DIM

Current Illness: None

ID: 1776299
Sex: F
Age: 20
State: FL

Vax Date: 10/03/2021
Onset Date: 10/03/2021
Rec V Date: 10/11/2021
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: The needle did not enter the patients muscle entirely, about 3/4 of the 1 inch needle made it into the deltoid muscle. The safety for the needle prevented the full entry. Thus the shot may have entered subcutaneous tissue instead of muscular tissue.

Other Meds:

Current Illness:

ID: 1776300
Sex: F
Age: 59
State:

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/11/2021
Hospital:

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: received 3rd dose of Pfizer vaccine on 10/7/21. Reports she had generalized itching on 10/7/21 and 10/8/21. Took Benadryl 10/8/21. Symptoms resolved 10/8/21.

Other Meds:

Current Illness:

ID: 1776301
Sex: F
Age: 37
State: PR

Vax Date: 06/21/2021
Onset Date: 06/21/2021
Rec V Date: 10/11/2021
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: N/A

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient in area of observation had left arm cold, excessive sleepiness, right side neck red. P 75 Sat 99% BP 125/80 Dxt 109 was in observation for 1hr.

Other Meds: Unknown

Current Illness: Gastritis

ID: 1776302
Sex: F
Age: 64
State: KY

Vax Date: 04/02/2021
Onset Date: 10/06/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Tested Positive for Covid

Other Meds:

Current Illness:

ID: 1776303
Sex: M
Age: 51
State: AZ

Vax Date: 09/01/2021
Onset Date: 09/01/2021
Rec V Date: 10/11/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Increased heart rate, chest pains, out of breath, bloody nose

Other Meds: Fenofibrate 200 MG 1 daily Atorvastatin 20 Mg 1 Daily Metformin 500 mg 1 daily 81 mg low dose aspirin Lisinopril 10 mg 1 daily

Current Illness: None

ID: 1776304
Sex: M
Age: 39
State: PA

Vax Date: 10/05/2021
Onset Date: 10/05/2021
Rec V Date: 10/11/2021
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: None

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Abdominal swelling and pain around the belly and back. Pain Similar to after effects of passing kidney stone. Loss of appetite due to this. Abdominal swelling subsided after 48 hours.

Other Meds: None

Current Illness: None

ID: 1776305
Sex: M
Age: 39
State: VA

Vax Date: 03/10/2021
Onset Date: 03/11/2021
Rec V Date: 10/11/2021
Hospital: Y

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

Lab Data: There was a CT scan with contrast. The results were normal.

Allergies: I do not have any allergies.

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

Symptoms: The day after receiving my second dose, I felt really fatigued. The following day, I woke up and was experiencing pain in my stomach and ibuprofen and Tylenol did not help ease the pain. My wife and I took a trip and I started experiencing vomiting, diarrhea and continuous pain. The next morning I had to go to the hospital. I cannot remember the name of the hospital, but I had to spend the night one night. The doctor performed a CT scan with contrast to rule out any problems. I was given prednisone and fluids and I was released the next day.

Other Meds: Vitamin D; Mercaptopurin; Allegra for allergies.

Current Illness: I did not have any illness.

Date Died: 09/16/2021

ID: 1776306
Sex: M
Age: 57
State: KY

Vax Date: 03/13/2021
Onset Date: 08/23/2021
Rec V Date: 10/11/2021
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: COVID PCR positive for covid on 8/23/21 and 9/10/21

Allergies: pregabalin buspirone metformin NSAID prednisone

Symptom List: Rash, Urticaria

Symptoms: On 09/10/21: Patient is a 57 y.o. male with recent COVID infection, HFpEF, NASH cirrhosis, CKD IIIb, and IDDM2 who presented to ED via EMS post-code after PEA arrest. According to patient's wife, he developed acutely worsening shortness of breath early this morning. Wife called EMS after his shortness of breath did not improve upon resuming his home oxygen 3L NC which he had discontinued two days prior due to subjective improvement. Family estimates he stopped breathing less than 5 minutes prior to EMS arrival. EMS reports patient was apneic and in wide-complex PEA on arrival. He was coded for 20 minutes before ROSC. He arrived intubated and on levophed. Cardiogenic etiology considered due to transient hypoxia; however troponins without significant delta, EKG did not show ST abnormalities concerning for ischemia, or MI. Bedside echo without concerning findings. Infectious workup negative. Aggressively diuresed patient with minimal renal recovery. On exam patient was lacking gag reflex and pupils unreactive. Due to concern for severe anoxic encephalopathy and PVS, all sedation was stopped. Patient remained without any purposeful movement, without gag reflex, and without reactive pupils after >48 hours of complete cessation of sedating agents. Poor prognosis discussed with wife (NOK) and daughter. They both stated he has previously said he would not want to continue with current measures in this type of situation. Wife (NOK) ultimately decided to withdrawal care and pursue comfort care. Patient was terminally extubated and discharged to inpatient hospice

Other Meds: carvedilol metolazone torsemide

Current Illness: On 8/23/21: 57-year-old male with PMHx of NASH cirrhosis, CKD, type 2 diabetes with peripheral neuropathy, and hypertension presented as a direct admission from outpatient cardiology appointment. He was admitted to medicine for management of volume overload suspected secondary to chronic kidney and liver disease. On initial admission he required up to 6 liters NC to maintain SPO2 greater than 88%. His resp decline was felt to be multifocal related to both his COVID infection as well as to pulmonary edema secondary to his known NASH cirrhosis, CKD, and HFpEF. He completed a five day course of remdesivir (stop date 8/29/21) and will continue dexamethasone for a total of ten days (stop date 9/3/21). Respiratory: Positive for cough and shortness of breath. Cardiovascular: Positive for leg swelling. Negative for chest pain. Discharge Disposition/Condition on 9/1/21 Disposition: Home with Home Health Condition: Stable (s/sx potential problems absent or manageable)

ID: 1776307
Sex: F
Age: 64
State: IN

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data:

Allergies: Steroids latex flu shot Augmentin hydrocodone skin allergies

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

Symptoms: Mental mouth, sore arm, Vertigo very bad weakness fever up to 101 for about 50 hours chilling sweating profusely then my soreness went down into my armpit and to the side of my boob and it got hard now after 75 hours I?m itching where this site where I had the injection finally got better about 60 hours in

Other Meds: Aspirin fish oil Claritin morning blend collagen hey TORVASTATIN 10 mg, CITALOPRAM 20 mg

Current Illness: Flu shot

ID: 1776309
Sex: F
Age: 37
State: IL

Vax Date: 02/11/2021
Onset Date: 02/12/2021
Rec V Date: 10/11/2021
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: Tetanus

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

Symptoms: 0100- fever 0200- fatigue, muscle aches, headache 0400- rapid heart rate 130 bpm, extreme fatigue, feeling of surroundings being 'cloudy'

Other Meds:

Current Illness:

ID: 1776310
Sex: F
Age: 61
State: ID

Vax Date: 09/02/2021
Onset Date: 09/21/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data: COVID test

Allergies: Food allergies

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

Symptoms: Had an outbreak of COVID after being fully vaccinated and having the booster dose. I had the antibody infusion on 09/26/2021

Other Meds: Daily medications

Current Illness: No

ID: 1776311
Sex: F
Age: 64
State: KY

Vax Date: 02/10/2021
Onset Date: 09/16/2021
Rec V Date: 10/11/2021
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: Tested Positive for Covid

Other Meds:

Current Illness:

ID: 1776312
Sex: F
Age: 21
State: KY

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 10/11/2021
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:

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

Symptoms: Patient stated that this was her first COVID vaccine and requested the Johnson and Johnson vaccine. Patient received a Johnson and Johnson vaccine on 9/23/2021. After receiving Johnson and Johnson vaccine, it was noted in the system that patient had received a Pfizer vaccine on 08/24/2021. When patient was confronted about the Pfizer vaccine, she stated that " I felt the Pfizer vaccine did not work effectively for me, so I wanted to get the J&J."

Other Meds:

Current Illness: None known

ID: 1776313
Sex: M
Age: 28
State: WI

Vax Date: 10/08/2021
Onset Date: 10/10/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data:

Allergies: No

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Woke up second day after vaccine and notice lump under right arm in armpit area. Went to a quick care locally and was told most likely a Lymph Node

Other Meds: Vyvanse and Serteline

Current Illness: No

ID: 1776314
Sex: F
Age: 35
State: GA

Vax Date: 10/10/2021
Onset Date: 10/11/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data:

Allergies: NKA

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Large swelling (larger than golf ball, smaller than a tennis ball) in Right Axillary. No redness. Some tenderness. Right deltoid appropriately sore.

Other Meds: Deblitane 0.35mg QHS

Current Illness: None

ID: 1776315
Sex: M
Age: 77
State: KY

Vax Date: 02/03/2021
Onset Date: 09/15/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Tested Positive for Covid

Other Meds:

Current Illness:

ID: 1776316
Sex: F
Age: 58
State: MI

Vax Date: 10/09/2021
Onset Date: 10/09/2021
Rec V Date: 10/11/2021
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: Latex Sulfa Chlorhexidine

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

Symptoms: -started feeling generally sick within three hours -fever over 101 within six hours -fever over 102 by evening and not controlled well with fever reducer -shakes -chills -back ache

Other Meds: Multi vitamin Vit c Magnesium Probiotic DHEA Biotin B12 Fish oil Prescription-progesterone

Current Illness:

ID: 1776317
Sex: F
Age: 49
State:

Vax Date: 04/22/2021
Onset Date: 04/22/2021
Rec V Date: 10/11/2021
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: Anaphylaxis reported to patient's primary care provider by patient From past ED visit BWMC 5/3- Past medical history relevant for lupus who presents to the emergency department with facial tingling. The patient states that about five days ago she started with a rash around the injection site of her second Moderna COVID-19 vaccine, and three days ago began with lip tingling which has progressively radiated up the right side of the face and a headache. The patient has no history of numbness or tingling accompanying her previous migraines and states that the rest of her family received the same vaccine without similar side effects. Her lupus has been well-managed without prednisone at home and she has outpatient follow-up with an allergist and rheumatologist through. History is from the patient Old records reviewed. Per review of old records the patient was evaluated in the AAMC ED 4/22/2021 following her second Moderna COVID-19 vaccine, ten minutes after which she started with left-sided facial tinging and throat swelling, at which time she was given IM epinephrine and PO Benadryl by EMS en route to the ED. Her mental status had deteriorated en route and she had an MRI brain which was fairly unremarkable. The patient's symptoms improved in the ED and she was felt appropriate for discharge home.

Other Meds:

Current Illness:

ID: 1776318
Sex: M
Age: 73
State: NJ

Vax Date: 03/03/2021
Onset Date: 10/08/2021
Rec V Date: 10/11/2021
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: SARS-CoV-2 Antigen (++) on 10/8/2021

Allergies: NKDA

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

Symptoms: 74 yo male diagnosed with COVID 19 4 days prior presented for Monoclonal antibody infusion but found to have Pulse Ox 91% and disqualified for said therapy. Patient states he received series #2 Pfizer vaccine 03/24/2021. He has an intermittent non prodictive cough and reports having chills earlier. He denies having chest pain or shortness of breath. He denies having headache or abdominal pain. He reports having an episode of loose stools previous day.

Other Meds: allopurinol 100 mg Tablet Directions: 1 tablet oral daily (Active) aspirin (Aspirin Low Dose) 81 mg tablet,delayed release (DR/EC) Directions: 1 tablet oral daily (Active) hydrochlorothiazide 12.5 mg Tablet Directions: 1 tablet oral d

Current Illness:

ID: 1776319
Sex: F
Age: 75
State: PA

Vax Date: 10/08/2021
Onset Date: 10/09/2021
Rec V Date: 10/11/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: none

Allergies: none

Symptom List: Injection site pain, Pain

Symptoms: Pt went to ER with cellulitis in right arm. Was given cephalexin 500mg 1 bid x7days

Other Meds: albuterol MDI, allopurinol 100mg, tramadol 50mg, metformin er 500mg, carvediolol 3.125, montelukast 10mg,

Current Illness: none

ID: 1776320
Sex: F
Age: 67
State: VA

Vax Date: 10/04/2021
Onset Date: 10/04/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data: None.

Allergies: Percocet, Morphine, Medrol dose pack, Tramadol.

Symptom List: Injection site pain, Menorrhagia

Symptoms: She got her vaccine, had body aches, extreme chills to the point feeling like she was in an ice bucket and then extreme heat, headache, nausea all the time, felt like she was pregnant, extreme tiredness. She could only function to eat some crackers or water. She just slept which is not her normal. She did have fever, does not know what it measured. Whatever symptoms she read about she had. She had a sunburn type rash on her chest. She woke up sopping wet on Wednesday evening, she went to the bathroom and was feeling a little better, felt that her fever broke, and noticed the sunburn type burn. At one point her temp was 101.4, but she was not able to measure other times as was too weak to get out of bed. The rash then moved down her body, from her chest/breast area to her stomach, down to her thigh area and then it went down her back and went down the upper arms on the inside, craping type skin. Then the itching started when the color went away. It was not a blotchy rash, just a red rash. This rash lasted for a couple of days. She has had this reaction before with the other vaccines but not to this extent. She has also had similar reactions to the medications that she is allergic to. She is not sure if it is a fever type rash or what, as she does get it when she gets a fever. She did also get her flu vaccine on 9/14/21, does not know which one she got, just the regular flu vaccine. There is nothing regarding the sunburn rash in the reactions section of side effects, but would like people to know this does happen. It does not blister up, it's like a itchy blanket of sunburn.

Other Meds: Estradiol weekly, multivitamin, Vitamin D3, Brimonidine, Dorzolamide HCI-Timolol Maleate, Latanoprost Ophthalmic, calcium.

Current Illness: None.

ID: 1776321
Sex: F
Age: 28
State: PR

Vax Date: 06/22/2021
Onset Date: 06/22/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data: N/A

Allergies: N/A

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

Symptoms: Patient in the observation area reported that she felt dizzy and after that she vomited. The paramedics put her on a stretcher to stabilize her in the ambulance, they took her vitals. Initial pressure 80/60 (patient anemic, hypoglycemic, allergic to iodine) final pressure 100/80, 62 dextrose 94 sugar, 95 SAT, 85 pulse.

Other Meds: N/A

Current Illness: N/A

ID: 1776322
Sex: F
Age: 85
State: NJ

Vax Date: 10/07/2021
Onset Date: 10/09/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Severe pain in right breast that lasted 20 hours.

Other Meds: baby aspirin, rosuvastatin 20mg, atenolol 25mg, calcium d , glucosamine chrondrotin with msn, melatonim 10mg, daily vitamin

Current Illness: none

ID: 1776323
Sex: F
Age: 27
State: IN

Vax Date: 10/06/2021
Onset Date: 10/06/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: fever, chills, shaking, SOB, chest pain, anxiety, muscle aches, back pain, leg weakness, difficulty standing and walking

Other Meds: N/A

Current Illness: N/A

ID: 1776324
Sex: F
Age: 29
State: NC

Vax Date: 04/05/2021
Onset Date: 06/19/2021
Rec V Date: 10/11/2021
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: participant got a full panel for THC for thyroid and participant says everything came back normal

Allergies: No

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

Symptoms: 2 months off of work. Participant says she started experience the extreme panic June. Participant delivered her baby in January, weekly therapy. Participant is on sleep medication seeing a PCP.

Other Meds: Synthroid

Current Illness: No

ID: 1776325
Sex: F
Age: 52
State: FL

Vax Date: 10/09/2021
Onset Date: 10/09/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Nausea

Symptoms: severe leg cramps, headaches, fever,

Other Meds: Tresiba

Current Illness: None

ID: 1776326
Sex: F
Age: 42
State: OH

Vax Date: 09/22/2021
Onset Date: 09/23/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data: ALLERGY SCREENING 2 WEEKS AFTER HAD BLOOD WORK DRAWN- PATIENT UNSURE OF WHAT WAS TESTED

Allergies: CODEINE, PCN, AZITHROMYCIN

Symptom List: Injection site pain

Symptoms: ONE DAY AFTER RECIEVING VACCINE, PATIENT DEVELOPED LARGE, RED, WELTS/HIVES FROM HEAD TO TOE, ITCHING. ANTIHISTAMINE, TOPICAL CREAM-HYDROCORTISONE, SHOT OF KENALOG

Other Meds: HYDROCHLOROTHIAZIDE, METOTOPROLOL, BENTYL

Current Illness: NONE REPORTED

ID: 1776328
Sex: F
Age: 62
State: TX

Vax Date: 09/27/2021
Onset Date: 09/28/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data: Flu test and Covid test came out negative. Bloodwork, showed below normal WBC . My white blood cell count was and is below normal range.

Allergies: No allergies

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

Symptoms: Severe headache, body aches, chest hurt. Tired. lasted for 7 days, took Advil and tynelol, went into the Dr. office on Monday Oct. 4, bloodwork, flu test along with Covid test, both came out negative. Still have headaches but not as severe. and get tired easily.

Other Meds: Vit. C, B12, Biotin

Current Illness: No illnesses prior

ID: 1776329
Sex: F
Age: 70
State: FL

Vax Date: 10/01/2021
Onset Date: 10/08/2021
Rec V Date: 10/11/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: None

Allergies: Aspirin and fresh clams.

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

Symptoms: Lymph nodes under injection arm became very tender and caused severe pain in the underarm area. This reaction happened 7 days after the vaccine and last for a little under 3 days.

Other Meds: None

Current Illness: None

ID: 1776330
Sex: M
Age: 23
State: NC

Vax Date: 09/17/2021
Onset Date: 09/27/2021
Rec V Date: 10/11/2021
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 as of yet.

Allergies: None

Symptom List: Tremor

Symptoms: Symptoms started 2 weeks after receiving the 2nd dose of the vaccine. The symptoms started as heart palpations that occurred at least once a day. The palpations have progressively become more frequent till they were occurring about 30-40 times a day. The palpations seem to occur more often with position changes but can, and do happen at any time. They occur when standing, walking, sitting, or laying.

Other Meds: None

Current Illness: None

ID: 1776331
Sex: F
Age: 32
State: NC

Vax Date: 10/08/2021
Onset Date: 10/09/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data: N/A

Allergies: Amoxicillin, cephalexin, sulfa, azithromycin, almonds, surgical adhesive

Symptom List: Erythema, Pruritus

Symptoms: Fever (Tmax 102.8), chills, joint and muscle aches, fatigue, headache, injection site tenderness. I've taken Tylenol for fever and pain control. Symptoms resolving but not entirely gone, now 3 days after booster dose.

Other Meds: Apri oral contraceptives, omeprazole 20mg

Current Illness: Bronchitis (COVID-negative twice)

ID: 1776332
Sex: M
Age: 76
State: KY

Vax Date: 03/04/2021
Onset Date: 09/24/2021
Rec V Date: 10/11/2021
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: Tested Positive for Covid on 09/28/2021

Other Meds:

Current Illness:

ID: 1776333
Sex: M
Age: 62
State: WA

Vax Date: 08/16/2021
Onset Date: 08/25/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data: Dr visit for physical Mentioned vertigo feeling

Allergies: Steriods

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

Symptoms: Vertigo approximately 3 hours after shot

Other Meds: Crestor, Eztibe

Current Illness: None

ID: 1776334
Sex: M
Age: 48
State: OK

Vax Date: 10/05/2021
Onset Date: 10/05/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data:

Allergies: NONE

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: In the hours following injection I became febrile ( T- 101.6) and extremely achy with severe joint pain. Treatment consisted of acetaminophen and rest. Fever lasted for 48 hours. Body aches continued to through the 72 hour mark.

Other Meds: NONE

Current Illness: NONE

ID: 1776335
Sex: F
Age: 74
State: OH

Vax Date: 10/05/2021
Onset Date: 10/05/2021
Rec V Date: 10/11/2021
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: Patient woke up the following morning of her vaccine with redness, swelling, and warmth at the injection site. She reports that the swelling was greatest when she woke up and decreased slightly throughout the day. She came to the pharmacy to allow the pharmacist to examine her arm at about 8:50 pm on 10/5/21. The pharmacist confirmed that it appeared to be an injection site reaction and recommended she ice the area and take diphenhydramine. The patient returned to the pharmacy on 10/9/21 and stated that the reaction was completely healed.

Other Meds: Atenolol; Atorvastatin

Current Illness:

ID: 1776336
Sex: M
Age: 70
State:

Vax Date: 04/06/2021
Onset Date: 09/18/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Fever, chills, body and muscle aches, loss of taste and smell, headache, extreme fatigue, coughing, shortness of breath, nausea and vomiting

Other Meds:

Current Illness:

ID: 1776337
Sex: U
Age: 41
State:

Vax Date: 01/26/2021
Onset Date:
Rec V Date: 10/11/2021
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: None stated.

Other Meds:

Current Illness:

ID: 1776338
Sex: F
Age: 67
State: FL

Vax Date: 05/08/2021
Onset Date: 10/05/2021
Rec V Date: 10/11/2021
Hospital: Y

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: History of Present Illness Patient is a 68 years old white female who has past medical history significant for history chronic right upper extremity stricture and also has past medical history significant for history of alcoholic cirrhosis. Patient apparently also has past medical history significant for history of chronic constipation and previous cervical laminectomy and cholecystectomy and hysterectomy. Patient comes into the hospital from her nursing facility for the reason of abdominal wound with drainage. She was evaluated in the emergency room for the reason of 1 week history drainage from the right groin/right lower quadrant wall. She was noted to have cellulitic changes in the abdominal wall area and was evaluated with an ultrasound which showed a purulent collection and was recommended to come to the hospital where she was evaluated and was recommended admission. She denies any documented fevers. She denies any chest pain. She was currently on antibiotics in the form of Cipro and Bactrim. She denies any nausea or vomiting or diarrhea or any shortness of breath or cough. Worth mentioning is that she was recently diagnosed of COVID-19 and apparently was recovering in rehab for COVID-19.

Other Meds:

Current Illness:

ID: 1776339
Sex: F
Age: 61
State: FL

Vax Date: 02/26/2021
Onset Date: 03/10/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data: 4/23/2021- ct of abdominal area - kidney cysts unrelated to cause of diarrhea/ nausea/ pain 5-12-21 MRI- brain white matter spots Ent Arthritis dr more( no time left

Allergies: None

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

Symptoms: 2 weeks after second dose=dizziness, nausea, weakness in legs, high bp, heart palpitations, severe weight loss( 14 lbs in first 10 days) , vertigo, left ear pain, diarrhea constant at first, feeling faint, left side of face tingling, palpitations, skipped beats, now, after 7 months=vibrating in head, torso with heat in feet/back of hands and twitching random places every night like clock work. Feels like a seizure sometimes when the vibrating is on my left side of my head. This has been consistent for 4 months now and replaced the ?wave of motion, followed by nauseating ? in middle of the night. Tingling, heat in random areas, fatigue twitching and fatigue is still keeping me from living my life. I have no insurance and the hospital bills and ER, specialists have left me deep in debt without helping me

Other Meds: Bystolic, Amlodipine Bestylate, synthroid, hormone cream

Current Illness: None

ID: 1776340
Sex: F
Age: 63
State:

Vax Date: 03/29/2021
Onset Date: 09/24/2021
Rec V Date: 10/11/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: muscle aches, runny nose, headache, very weak with cough

Other Meds:

Current Illness:

ID: 1776341
Sex: F
Age: 46
State:

Vax Date: 10/08/2021
Onset Date: 10/09/2021
Rec V Date: 10/11/2021
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: REACTION TO 2ND DOSE OF MODERNA VACCCINE GIVEN ON 10/8/2021 @ 9:30AM, WOKE ON 10/9/2021 TO RIGHT ARMPIT SWELLING AND SORENESS ON SAME ARM AS THE INJECTION SITE, POSSIBLE LYMPH NODES SWELLING. HAVE BEEN TAKEN TYLENOL FOR PAIN REPORTED INJURY ON 10/11/2021 STILL HAVE SWELLING AND TENDERNESS UNDERARM PIT

Other Meds:

Current Illness:

ID: 1776342
Sex: F
Age: 81
State: MA

Vax Date: 09/17/2021
Onset Date: 09/17/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data: x ray showed nothing

Allergies: Niacin

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Starting on the day of the injection Extreme continuous pain from the site ,affecting shoulder, down my arm affecting my elbow joint , so painful was difficult bending and using arm from sept. 17th. until today only because the Orthopedic Dr. Prescribe a 6 day treatment of IC METHYLPREDISOLONE 4 MG. DOSEPK which seems to have quieted it down. I have 2 days more to take so I will wait to see if its completely gone. I have tried other treatments Naproxen,. Lidocain patches , advil and nothing touched it.

Other Meds: Advil

Current Illness: COPD

ID: 1776343
Sex: M
Age: 79
State: WV

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 10/11/2021
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: Shell fish

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

Symptoms: 8/30/21 6pm. Cold chills, shivering, temp. 100, weakness, uneasy on feet. 9/1/21 In bed all day, temp. 102, weak, uneasy on feet, lost taste, voice high pitched, hearing diminished, slept all day. 9/2/21 Feeling better, temp. 100.4, walking better, voice cleared up, hearing better, still showing signs of weakness

Other Meds: acetaminophen 500 mg Tablet Commonly known as: TYLENOL Learn more Take 500 mg by mouth Four times a day This medication isn't available for renewal at this time. ipratropium bromide 42 mcg (0.06 %) Spray, Non-Aerosol Commonly known as: A

Current Illness: None

ID: 1776344
Sex: F
Age: 66
State: MN

Vax Date: 03/25/2021
Onset Date: 10/04/2021
Rec V Date: 10/11/2021
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: Positive COVID test 10/8/21

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Fatigue, decreased PO intake, cough, low grade fever. "Urinating all the time"

Other Meds: amitriptyline (ELAVIL) 25 mg oral tablet

Current Illness:

ID: 1776345
Sex: F
Age: 56
State:

Vax Date: 04/12/2021
Onset Date: 09/25/2021
Rec V Date: 10/11/2021
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: loss of taste and smell, headache, diarrhea and coughing

Other Meds:

Current Illness:

ID: 1776346
Sex: F
Age: 84
State: MN

Vax Date: 03/19/2021
Onset Date: 07/01/2021
Rec V Date: 10/11/2021
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: not available at this time

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

Symptoms: Diagnosed on July 1 2021 with Bells Palsy

Other Meds: Not available at this time

Current Illness: no

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am