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: 1779357
Sex: F
Age: 69
State: WI

Vax Date: 02/28/2021
Onset Date: 10/04/2021
Rec V Date: 10/12/2021
Hospital:

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

Lab Data: CMP, CRP Inflammation, Flu Swab Chest Xray

Allergies: No known allergies

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient contracted COVID after being fully vaccinated Chills, dizzy, anorexia, fever, congestion, cough, headache, fatigue

Other Meds: acetaminophen 650mg prn for pain or fever ascorbic acid 250mg BID aspirin 81mg daily atorvastatin daily biotin daily cholecalciferol 2000IU daily cyanocobalamin 1000mcg daily fenofibrate 160mg daily fluocinonide topical BID insulin glargine

Current Illness: None documented

ID: 1779358
Sex: F
Age: 16
State: OR

Vax Date: 04/14/2021
Onset Date: 10/12/2021
Rec V Date: 10/12/2021
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: n/a

Symptom List: Anxiety, Dyspnoea

Symptoms: no adverse events the only issue is vaccine given at a not recommended age, patient age at the time 17 yrs old and vaccine age recommended at 18 yrs old.

Other Meds: n/a

Current Illness: n/a

ID: 1779359
Sex: F
Age: 37
State: GA

Vax Date: 09/24/2021
Onset Date: 09/28/2021
Rec V Date: 10/12/2021
Hospital: Y

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: EKG(results normal), CT scan (blood clots results normal)

Allergies: No

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

Symptoms: On 924/2000 within 24 hrs I exp headache, muscle pain, dizziness lay down in bed. Then on 9/28/2021 other severe symptoms started chest pain, chest tightness, palpitations, dizziness continued through 10/1/2021/ It started for a couple days get better. On 10/6/2021 I started back having headaches, difficulty breathing again. Later that evening on 10/7/2021 went to ER had a EKG, blood test and given Aspirin. The ER doctor recommend me to see the Cardiologist. I have seen my PCP got a CT scan done for blood clots. As of today I'm still exp the same symptoms and have to scheduled for a Cardiologist appt.

Other Meds: No

Current Illness: No

ID: 1779360
Sex: M
Age: 75
State: MN

Vax Date: 10/07/2021
Onset Date: 10/08/2021
Rec V Date: 10/12/2021
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: Lot # given to patient was discovered to be associated with last years flu vaccine (2020-2021). No other ADRs have been reported with situation.

Other Meds:

Current Illness:

ID: 1779361
Sex: F
Age: 63
State: IL

Vax Date: 04/26/2021
Onset Date: 10/07/2021
Rec V Date: 10/12/2021
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: No known allergies

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

Symptoms: Patient presents to the ED for worsening edema of lower extremities and admitted to the hospital. Patient noticed both legs appeared swollen since the end of August and her PCP started her on Furosemide 20 mg daily. Patient with mild exertional dyspnea when she ambulates.

Other Meds:

Current Illness:

ID: 1779362
Sex: M
Age: 46
State: NJ

Vax Date: 09/28/2021
Onset Date: 10/01/2021
Rec V Date: 10/12/2021
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: nkda

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

Symptoms: Pfizer-BioNTech COVID-19 Vaccine EUA: Vaccine recipient was vaccinated on 9/28/2021. Around bedtime on 10/1/2021, he noticed symptoms of numbness on the right side of his face. On 10/2/2021., he woke up and was unable brush his teeth. he noticed that his right face was numb and he could not close his right eye. He then went to urgent care and they diagnosed him with Bell's Palsy. He is currently going to physical therapy. He currently cannot close is right eye completely at all. He has to sleep with an eye patch at night, sometimes he eye burns from keeping it open all the time. He was out of work for 1 week and returned to work on 10/12/2021.

Other Meds: metformin, glipizide, amlodipine, omeprazole

Current Illness:

ID: 1779363
Sex: F
Age: 32
State: MN

Vax Date: 01/18/2021
Onset Date: 10/10/2021
Rec V Date: 10/12/2021
Hospital:

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

Lab Data: 10/11/21 SARS/COV-2, NAAT, Positive

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Breakthrough COVID.

Other Meds:

Current Illness:

ID: 1779364
Sex: F
Age: 27
State: GA

Vax Date: 09/09/2021
Onset Date: 09/09/2021
Rec V Date: 10/12/2021
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: Patient received 2 doses

Other Meds:

Current Illness:

ID: 1779365
Sex: M
Age: 16
State: VT

Vax Date: 10/12/2021
Onset Date: 10/12/2021
Rec V Date: 10/12/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Vision sift then passed out, for a few seconds, water @1212, ambulatory at 1219.

Other Meds:

Current Illness:

ID: 1779366
Sex: F
Age: 58
State: KY

Vax Date: 04/07/2021
Onset Date: 09/30/2021
Rec V Date: 10/12/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Covid positive contact unknown

Other Meds:

Current Illness:

ID: 1779367
Sex: F
Age: 79
State: FL

Vax Date: 09/24/2021
Onset Date: 09/27/2021
Rec V Date: 10/12/2021
Hospital:

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

Lab Data:

Allergies: Latex?

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

Symptoms: Three days after vaccine Booster, I experienced very severe cramping/spasms in lower abdomen. It felt like my body was trying to eliminate toxins from my system. This lasted approximately 48 hours, gradually subsiding after approximately 10 days. I was also extremely fatigued, and more susceptible than usual to warm temperatures.

Other Meds: Magnesium, Calcium, B-complex, Cinnamon, Vit. D-3, Vit. E, Turmeric, Ginger

Current Illness: None

ID: 1779368
Sex: F
Age: 66
State:

Vax Date: 10/08/2021
Onset Date: 10/09/2021
Rec V Date: 10/12/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Arm was swollen, fever, nausea, "cloudy mind", headache, weakness, fatigue; lasting at least 4 days

Other Meds:

Current Illness:

ID: 1779370
Sex: M
Age: 54
State: IN

Vax Date: 06/17/2021
Onset Date: 06/21/2021
Rec V Date: 10/12/2021
Hospital: Y

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

Lab Data: See above.

Allergies: penicillin

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

Symptoms: Patient developed Guillain-Barre syndrome within a week of J&J vaccination. Progressive numbness and weakness. Initially attributed to diabetes but subsequently diagnosed as GBS w/ nerve conduction studies and EMG. Lumbar puncture is planned.

Other Meds: aspirin, atorvastatin, bisoprolol-HCTZ, glimepiride, insulin glargine, metformin, semaglutide

Current Illness:

ID: 1779371
Sex: F
Age: 23
State:

Vax Date: 01/27/2021
Onset Date: 09/15/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: tested because of exposure not because of symptoms

Other Meds:

Current Illness:

ID: 1779372
Sex: F
Age: 60
State: KS

Vax Date: 10/05/2021
Onset Date: 10/05/2021
Rec V Date: 10/12/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Client received the Fluzone High Dose Quadrivalent instead of the regular Fluzone Quadrivalent which should of been administered due to her being under 65 years of age. No adverse reactions noted from client at this time.

Other Meds:

Current Illness:

ID: 1779373
Sex: M
Age:
State: NJ

Vax Date: 10/05/2021
Onset Date: 10/10/2021
Rec V Date: 10/12/2021
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: None

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

Symptoms: Patient reported on 10/12/21 complaining of bruising/hematoma/soreness at location of Fluzone HD vaccine. He said the symptoms were first noticed on 10/10/21. The patient has used warm compresses. The bruise is approximately 1.5 inches in diameter.

Other Meds: None

Current Illness: None

ID: 1779374
Sex: M
Age: 58
State: ME

Vax Date: 10/08/2021
Onset Date: 10/08/2021
Rec V Date: 10/12/2021
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: No known allergies

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

Symptoms: Patient given third (booster) dose of Pfizer, but original series (#1/#2) given with Moderna.

Other Meds: Unknown

Current Illness:

ID: 1779375
Sex: F
Age: 45
State: NJ

Vax Date: 10/12/2021
Onset Date: 10/12/2021
Rec V Date: 10/12/2021
Hospital:

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

Lab Data:

Allergies: Latex

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Pfizer-BioNTech COVID-19 Vaccine: About 10 minutes of sitting post her vaccine, she?not well.? Within 3 minutes of that statement she became nauseous and feeling hot. Code 10 (Employee/Visitor Event) was called. was given ice water and a cool cloth for her neck. is on chemo treatment and took one of her own Zofran pills. had no rash, itching or signs of angioedema. We encouraged to go with the ER personnel to the ER to be observed and treated if needed. She agreed.

Other Meds:

Current Illness: Cancer on chemotherapy

ID: 1779376
Sex: M
Age: 47
State: FL

Vax Date: 10/08/2021
Onset Date: 10/08/2021
Rec V Date: 10/12/2021
Hospital:

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

Lab Data: Neuro physical tests by Provider upon return to clinic. Declined blood work and MRI although asked what I should look out for in the event I needed to go to ER.

Allergies: Not aware of any

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Received J&J Covid vaccine in left shoulder--no blood after needle or next day upon removing bandaid. After 15 min observation period, felt tingling and numbness in left hand fingers. As I drove home, numbness and tingling moved to the left side of my head, changing nerve feelings randomly from ear, to cheek, to jaw, to gums. These symptoms were told to be expected, and thankfully greatly diminished upon awaking the next morning, although still not 100% gone a few days later. Also, upon going to bed, would feel random crawling feelings on ears, face and scalp. Side effect that was reported to be potentially serious in waiver was unusual bruishing. 24-36 hours after shot, I noticed red horse shoe shaped squiggle on inside of left bicep. No overly tender and could not feel bumps. Turned to bruise. Followed literature side effect precaution so returned to clinic on Monday afternoon and was given neurological tests by provider. At this time, I just hope no further symptoms present and experience dissapates as literature indicates should occur.

Other Meds: Vitamin C, Zinc, Lysiene

Current Illness: Not aware of any

ID: 1779377
Sex: F
Age: 45
State: PR

Vax Date: 02/19/2021
Onset Date: 03/08/2021
Rec V Date: 10/12/2021
Hospital:

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

Lab Data: Mammogram with Doctor a breast imaging Fellow. Gynecologist recommended to do a second study.

Allergies: UNKNOWN

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

Symptoms: Patient refers to her experience with her two vaccines and explains her reaction to the first vaccine. Due to her health history, the patient suffers from a rare cancer, she has her annual check ups. A mammogram was performed it showed the following, bilateral need replaced sonography normal axillary lymph node are seen. Prominent right axillary lymph are recognized measuring 0.9 and 1.6 cm, most likely associated to COVID vaccination.

Other Meds: UNKNOWN

Current Illness: Cancer not very common

ID: 1779378
Sex: M
Age: 41
State:

Vax Date: 06/09/2021
Onset Date: 09/01/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Fever, muscle aches, runny nose, sore throat, loss of taste and smell, headache, fatigue, cough, chest pains, diarrhea

Other Meds:

Current Illness:

ID: 1779379
Sex: M
Age: 68
State: OH

Vax Date: 10/11/2021
Onset Date: 10/12/2021
Rec V Date: 10/12/2021
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: Soreness in arm, treated with Tylenol. duration of adverse event approx. 36 hours

Other Meds: Omeprazole, Finasteride, Pravastatin

Current Illness: Bladder Cancer

ID: 1779380
Sex: M
Age: 78
State: IL

Vax Date: 03/04/2021
Onset Date: 10/01/2021
Rec V Date: 10/12/2021
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:

Allergies: ragweed

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

Symptoms: hospitalizaton w/AMS

Other Meds: N/A

Current Illness: N/A

ID: 1779381
Sex: M
Age: 4
State: MN

Vax Date: 10/07/2021
Onset Date: 10/08/2021
Rec V Date: 10/12/2021
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: Severe skin reaction near injection - red area and warmth that persisted for 2 days. Appeared within 24 hours of injection. Photos can be provided if needed

Other Meds: None

Current Illness: None

ID: 1779382
Sex: M
Age: 60
State:

Vax Date: 04/06/2021
Onset Date: 08/20/2021
Rec V Date: 10/12/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Shortness of breath; was tested because of COVID exposure

Other Meds:

Current Illness:

ID: 1779383
Sex: M
Age: 43
State: OH

Vax Date: 10/08/2021
Onset Date: 10/09/2021
Rec V Date: 10/12/2021
Hospital: Y

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

Lab Data: 10/11/2021 Covid +

Allergies: None

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

Symptoms: Pt developed Cough, Congestion on Saturday, 10/9/2021 Developed SOB on Monday, 10/11/2021. COVID + and admitted to hospital for Oxygen.

Other Meds: Unknown

Current Illness: URI the week prior. Resolved per patient

ID: 1779384
Sex: F
Age: 45
State: VA

Vax Date: 04/06/2021
Onset Date: 04/09/2021
Rec V Date: 10/12/2021
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: Lab work, leg ultrasound, physical therapy. Many doctor appointments. Slowly getting better.

Allergies: Beef, nuts, tomatoes, latex, onions, iodine, zofran

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: After a couple days leg pain increased to neuropathy. Extreme leg pains and eventually very difficult to walk. Took months to walk again and many medical appointments. Also had lower abdominal pain and diarrhea. Headache on day one. Slowly getting better.

Other Meds: Claritan, tagamet

Current Illness: Mast cell disease, vulvodynia

ID: 1779385
Sex: M
Age: 17
State: OR

Vax Date: 04/12/2021
Onset Date: 10/12/2021
Rec V Date: 10/12/2021
Hospital:

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

Lab Data: n/a

Allergies: n/a

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: no adverse event, vaccine given at a not recommended age. patient 17yrs old when vaccine is recommended at 18yrs old.

Other Meds: none

Current Illness: n/a

ID: 1779386
Sex: M
Age: 76
State: GA

Vax Date: 08/18/2021
Onset Date: 09/16/2021
Rec V Date: 10/12/2021
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: Nuclear stress test- no clogged arteries Blood work Echocardiogram- no blood clots Thoracic echocardiogram- didn't have any blood clots

Allergies: none

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

Symptoms: I had no reaction from vaccine, but roughly 2 or 3 weeks later I developed atrial fibrillation. I have never had heart issues before, and no one in my family history has had it as well. I was in the hospital for 3 days. They did the cardioversion to get my heart back on a normal rhythm. After that I left the hospital and I was just on medications. About two weeks later the atrial fibrillation came back. Today I went into the hospital for nuclear stress test to make sure I don't have any clogged arteries. I am now in the process of getting a cardiac ablation. I am usually active, but now I am more exhausted and tired since being diagnosed with atrial fibrillation.

Other Meds: Telmisartan 40mg, 1xday Atorvastatin 40mg, 1xday Multivitamin

Current Illness: none

ID: 1779387
Sex: F
Age: 71
State:

Vax Date: 04/07/2021
Onset Date: 08/15/2021
Rec V Date: 10/12/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: headache, cough

Other Meds:

Current Illness:

ID: 1779388
Sex: F
Age: 40
State: TX

Vax Date: 10/02/2021
Onset Date: 10/03/2021
Rec V Date: 10/12/2021
Hospital:

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

Lab Data: Strep test. Flu test. COVID test, Rapid PCR.

Allergies: Egg; sulfa antibiotics

Symptom List: Injection site pain

Symptoms: Headache, fatigue, chills, fever, swollen lymph nodes, sore throat.

Other Meds: Bupropion; vitamin d; fish oil; b complex

Current Illness: None

ID: 1779389
Sex: F
Age: 46
State: KY

Vax Date: 03/19/2021
Onset Date: 10/04/2021
Rec V Date: 10/12/2021
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 induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Covid positive contact unknown

Other Meds:

Current Illness:

ID: 1779390
Sex: F
Age: 69
State: IL

Vax Date: 03/27/2021
Onset Date: 10/02/2021
Rec V Date: 10/12/2021
Hospital: Y

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

Lab Data:

Allergies: Codeine, Papaver

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

Symptoms: Patient presents to the ED and admitted to the hospital for evaluation of fever, chills, body aches, abdominal pain, nausea, and decreased appetite. Symptoms ongoing for the past few days. Patient states her mother tested positive for COVID-19 one week ago, and her mother currently lives with her.

Other Meds:

Current Illness:

ID: 1779392
Sex: F
Age: 55
State: TN

Vax Date: 10/05/2021
Onset Date: 10/05/2021
Rec V Date: 10/12/2021
Hospital:

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

Lab Data: 10/11/2021 negative for COVID, influenza, strep 10/11/2021 CBC, CMP unremarkable

Allergies: Latex

Symptom List: Tremor

Symptoms: Symptoms started 4-6 hours post vaccination. Chills, sinus pressure, headache, fatigue, itching to soles of feet. Symptoms progressed over next several days to include fever 102.3, sore throat, dry cough, laryngitis. Symptoms still present today, 7 days post vaccination. No treatment except for supportive measures to include pushing oral hydration, and alternating Tylenol and Advil.

Other Meds: Multivitamin

Current Illness: None

ID: 1779393
Sex: F
Age: 82
State: TN

Vax Date: 10/11/2021
Onset Date: 10/12/2021
Rec V Date: 10/12/2021
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: UNKNOWN

Symptom List: Erythema, Pruritus

Symptoms: PATIENT'S HUSBAND CALLED CLINIC TODAY, 10/12/2021 AT 12:50 AND STATED THAT HIS WIFE CAME TO MEDICAL CENTER YESTERDAY FOR HER PFIZER COVID BOOSTER SHOT. HE STATES THAT HE JUST WENT INTO THE KITCHEN WHERE HIS WIFE "ABOUT PASSED OUT". HE STATES HE SAT HER IN A CHAIR. HE REPORTS HER BLOOD PRESSURE IS 140/86, PULSE IS 119, AND HER BLOOD GLUCOSE IS 110. INSTRUCTED PATIENT'S HUSBAND TO EITHER CALL PATIENT'S PCP OR CALL 911 FOR EVALUATION. I CALLED PATIENT TO CHECK ON HER AT 1:40 AND NO ANSER, I LEFT VOICEMAIL THAT I WAS CHECKING ON HER STATUS. AT 2:41 PATIENT'S SPOUSE CALLED BACK AND STATES HE CALLED 911 AND PATIENT WAS TRANSPORTED TO MEDICAL CENTER ER IN IN A NDIFFERENT CITY. HE STATES THE DOCTOR HAS SAID HE THINKS THE PATIENT LIKELY HAS VERTIGO. PATIENT'S HUSBAND STATES HAS HAD VERTIGO IN THE PAST.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1779394
Sex: F
Age: 76
State: KY

Vax Date: 10/11/2021
Onset Date: 10/11/2021
Rec V Date: 10/12/2021
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: none

Allergies:

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

Symptoms: no adverse events, the patient received a Pfizer booster and had the moderna vaccine in the original series.

Other Meds:

Current Illness:

ID: 1779395
Sex: M
Age: 57
State: SD

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/12/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Booster was given before prescreen paperwork was filled out. Pfizer vaccine was going to expire in 4 minutes. After the patient received the pfizer booster it was then realized that the patient just got Regen-COV on 8/28/21.

Other Meds:

Current Illness:

ID: 1779396
Sex: M
Age: 67
State:

Vax Date: 08/03/2021
Onset Date: 08/13/2021
Rec V Date: 10/12/2021
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: fever, chills, loss of taste and smell, headache, fatigue, cough

Other Meds:

Current Illness:

ID: 1779397
Sex: M
Age: 70
State: AR

Vax Date: 04/15/2021
Onset Date: 04/15/2021
Rec V Date: 10/12/2021
Hospital:

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

Lab Data: Pt did not conduct a pulse ox, but states his color remained normal during the week of wheezing symptoms. Pt states he conducted exercise to try to strengthen his breathing, but states wheezing symptoms were worsened by periods of exercise.

Allergies: Pt reports allergies to: MSG Salicylates Biaxin Penicillins Naprosyn

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

Symptoms: Pt reports fatigue and wheezing beginning four hours post vaccination. Pt describes wheezing as "daily cyclical" Pt states fatigue lasted up to two weeks. Pt states wheezing lasted up to one week.

Other Meds: None

Current Illness: None

ID: 1779399
Sex: F
Age: 86
State: MN

Vax Date: 10/12/2021
Onset Date: 10/12/2021
Rec V Date: 10/12/2021
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: unknown

Allergies: nka

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

Symptoms: The patient shopped for an hour and a half after receiving the vaccine. She then fainted in the store. She hadn't had anything to eat or drink that day. She was slurring her speech and agreed to allow the ambulance to take her to the hospital.

Other Meds: unknown

Current Illness: none

ID: 1779400
Sex: M
Age: 81
State:

Vax Date: 03/03/2021
Onset Date: 10/11/2021
Rec V Date: 10/12/2021
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: Pain in extremity

Symptoms: Email address

Other Meds:

Current Illness:

ID: 1779401
Sex: M
Age: 42
State: CA

Vax Date: 09/27/2021
Onset Date: 09/29/2021
Rec V Date: 10/12/2021
Hospital:

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

Lab Data: 10/12/21 - Hearing Test

Allergies: none

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

Symptoms: Two issues. First - day after shot I noticed hives over my entire upper body but followed my clothing line. I did last wash prior to this use a common washer /dryer at an air bnb and may have had contamination with detergent or other alergens. Second - about a week later ears felt full and hearing was hard... used OTC ear wax removal and did remove some heavy black wax in each ear. However hearing never recovered. After a week - neither recovered so went to Urgent care on 10/11/21 for the appooint noted above. Today 10/12/21 I had a hearing test and it was confirmed i have suddon hearing loss.

Other Meds: 1350mg daily Lithium, Discovy, Allegra, Emergen-C

Current Illness: none

ID: 1779402
Sex: F
Age: 65
State: MD

Vax Date: 10/08/2021
Onset Date: 10/08/2021
Rec V Date: 10/12/2021
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: Shell fish allergies

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

Symptoms: Patient arrived for second dose, told the immunizer that she was there for her second dose of Pfizer, the immunizer got the patient registered and went through the pre vaccination checklist questions. The Pfizer dose was given, and the patient pulled out her card and realized that she had actually gotten moderna as her first dose. The patient stayed for 15 minutes for observation with no obvious reaction.

Other Meds: Unk

Current Illness: Unk

ID: 1779403
Sex: M
Age: 73
State: IL

Vax Date: 10/04/2021
Onset Date: 10/05/2021
Rec V Date: 10/12/2021
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: NONE

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

Symptoms: low fever chills headache muscle pain light headed sore throat

Other Meds: Valsartan 160 mg Metoprolol 25 mg Aspirin 81mg Amlodipine 5 mg Rosuvastatin 40 mg

Current Illness: NONE

ID: 1779405
Sex: F
Age: 56
State: TX

Vax Date: 04/12/2021
Onset Date: 07/01/2021
Rec V Date: 10/12/2021
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: N/A

Symptom List: Vomiting

Symptoms: I got a UTI in the last part of July 2021. There is no reason for me to get a UTI and I have had them in the past but not like this one. I went to the emergency room for the UTI. Urgent care. They prescribed antibiotics. I got another about a month after that and it has gone away.

Other Meds: N/A

Current Illness: N/A

ID: 1779406
Sex: F
Age: 74
State: CA

Vax Date: 10/06/2021
Onset Date: 10/06/2021
Rec V Date: 10/12/2021
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: Bluish square at the injection site

Other Meds:

Current Illness:

ID: 1779407
Sex: M
Age: 71
State: WI

Vax Date: 09/23/2021
Onset Date: 09/30/2021
Rec V Date: 10/12/2021
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:

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

Symptoms: Patient was seen in the regulatory authority for a one week follow up on 9/23/21. He was asked if he would like to receive a third dose of the covid vaccine as he is eligible based on being immunocompromised. The patient stated he wanted to receive the vaccine. Medical Assistant asked all of the screening questions prior to administration. Patient said Yes to ever having a positive Covid-19 test. Patient said No to convalescent plasma or monoclonal antibody infusion in the past 90 days. Dose of Moderna Covid vaccine was administered on 9/23/21. Patient returned to the clinic on 9/30/21 for another 1 week follow up. During this appointment, he stated that he doesn't think he should have received this third vaccine last week because he received a monoclonal antibody infusion. Upon chart review, patient received casirivimab-imdevimab on 8/31/21. Medical Oncologist was notified and stated no intervention was needed. Clinical Research Associate was notified as this patient is currently on a clinical trial and CRA stated no intervention was needed from a clinical trial standpoint. Nurse Supervisor was notified of the error. Patient was aware of all of this.

Other Meds:

Current Illness:

ID: 1779408
Sex: M
Age: 76
State: IL

Vax Date: 04/07/2021
Onset Date: 10/01/2021
Rec V Date: 10/12/2021
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: No known allergies

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient presents for evaluation of worsening confusion. Patient comes from nursing home facility with confusion and worsened from from yesterday, along with worsening weakness.

Other Meds:

Current Illness:

ID: 1779409
Sex: M
Age: 50
State: KY

Vax Date: 04/01/2021
Onset Date: 10/03/2021
Rec V Date: 10/12/2021
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: Patient developed Covid

Other Meds:

Current Illness:

ID: 1779410
Sex: F
Age: 42
State: WA

Vax Date: 09/29/2021
Onset Date: 10/03/2021
Rec V Date: 10/12/2021
Hospital:

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

Lab Data: D dimer, troponin, CMP, CBC., EKG, CXR and CT angio.

Allergies: No known drug allergies

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

Symptoms: Patient had left sided chest pain and was seen. Had lab work done and prescribed Naproxen and Tramadol. Diagnosed with pleuritic chest pain and told to follow up with PCP for suspected myocarditis. Seen for follow up visit.

Other Meds: None

Current Illness: None known

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am