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: 1782237
Sex: M
Age: 75
State: WI

Vax Date: 03/17/2021
Onset Date: 03/19/2021
Rec V Date: 10/13/2021
Hospital:

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

Lab Data: Advocate has records.

Allergies: Metoprolol seems to increase inflammation. Cold weather therapy of amoxicillin caused such to stop for the future.

Symptom List: Dysphagia, Epiglottitis

Symptoms: slightly sore arm for a week, then temporary relapse through this complaint time, especially sensitive after napping rest, weight lifting weakness with exercise. Patient had adverse reaction to right arm after Pfizer #2, RE2613, GPWIMF, Mar 17, 2021. Prior history 15 years of window washing with tense right arm. My employer, had major injection to left head by dope addiction group, claiming percussion tap sensitivity to tooth #12. Skipped fake urgent root canal to #12, to do left poison injection that made left foot, ear, and left elbow sensitive Associates July 10, 2003, for quite some time. Patient is still getting weak sensitive right arm after Mar 17, 2021, thru my complaint Oct 13. 2021, including right shoulder bursitis. Note the has a history of crashing into major electric transmission lines, like modern winds, and was moved. Patient suspects a type of current. Labor strike going on. Patient had right arm and foot stroke symptoms May 2011.

Other Meds: Lisinopril, clopidogrel, stopped metoprolol. vitamins, etc.

Current Illness: Sciatica right leg. Youth head neck injury.

ID: 1782238
Sex: M
Age: 66
State:

Vax Date: 03/10/2021
Onset Date: 08/17/2021
Rec V Date: 10/13/2021
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: COVID 19

Other Meds:

Current Illness:

ID: 1782239
Sex: F
Age: 70
State: CA

Vax Date: 10/12/2021
Onset Date: 10/12/2021
Rec V Date: 10/13/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Error: Shoulder Joint Injury (prolonged pain, tingling, etc.)-

Other Meds:

Current Illness:

ID: 1782240
Sex: F
Age: 73
State: IN

Vax Date: 10/11/2021
Onset Date: 10/12/2021
Rec V Date: 10/13/2021
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: Headache Nausea Tiredness

Other Meds: Metoprolol, lisinopril, aspirin, ezetimibe, devastation, citracal, omeprazole

Current Illness:

ID: 1782241
Sex: F
Age: 16
State: TX

Vax Date: 10/03/2021
Onset Date: 10/03/2021
Rec V Date: 10/13/2021
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: Excessive bleeding, tingling and soreness in arm, bruising still present after 9 days

Other Meds:

Current Illness:

ID: 1782242
Sex: M
Age: 83
State: NJ

Vax Date: 10/06/2021
Onset Date: 10/07/2021
Rec V Date: 10/13/2021
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: None

Allergies: None

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

Symptoms: *Unsure of the brand of vaccine he was given.* Tremendous pain in joints, unable to walk.

Other Meds: Adalimumab 40 mg (once daily) Amlodipine 5mg (once daily) Atorvastatin 80mg (once daily) Flecainide 50mg (twice daily) Metoprolol Succinate 25mg (once daily) Omeprazole 10mg (once daily) Xarelto 20 mg (once daily) Valsartan (once daily)

Current Illness: None

ID: 1782243
Sex: M
Age: 75
State: MA

Vax Date: 10/11/2021
Onset Date: 10/11/2021
Rec V Date: 10/13/2021
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: Pyrexia, White blood cell count decreased

Symptoms: Error: Incorrect Reconstitution-

Other Meds:

Current Illness:

ID: 1782244
Sex: M
Age: 17
State: FL

Vax Date: 09/03/2021
Onset Date: 09/30/2021
Rec V Date: 10/13/2021
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: None

Symptom List: Pharyngeal swelling

Symptoms: So I took my second dose got sick as usual then took Tylenol for the 2 days I was sick with chills,fever,headache everything I expected. Then after I felt better I had gotten parosmia/foul smell right after and it mainly affects my food taste and smell, but on some other items it?s just smell like some soaps/dog food/laundry detergent and etc.

Other Meds: Tylenol

Current Illness: None

ID: 1782245
Sex: F
Age: 70
State:

Vax Date: 05/03/2021
Onset Date: 08/18/2021
Rec V Date: 10/13/2021
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: COVID 19.

Other Meds:

Current Illness:

ID: 1782246
Sex: M
Age: 55
State: MT

Vax Date: 05/01/2021
Onset Date: 05/01/2021
Rec V Date: 10/13/2021
Hospital:

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

Lab Data: None.

Allergies: None.

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Loss of approximately 90% of taste. Always. All foods and beverages. Everything has a slight metallic taste.

Other Meds: None.

Current Illness: None.

Date Died: 09/24/2021

ID: 1782247
Sex: M
Age: 81
State: GA

Vax Date: 02/17/2021
Onset Date: 08/31/2021
Rec V Date: 10/13/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Patient was hospitalized for heart problems. Patient died due to COVID-19. Patient was fully vaccinated.

Other Meds:

Current Illness:

ID: 1782248
Sex: M
Age: 53
State:

Vax Date: 06/03/2021
Onset Date: 08/10/2021
Rec V Date: 10/13/2021
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: COVID 19

Other Meds:

Current Illness:

ID: 1782249
Sex: F
Age: 23
State: GA

Vax Date: 10/12/2021
Onset Date: 10/12/2021
Rec V Date: 10/13/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Systemic: Allergic: Anaphylaxis-Medium, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Medium, Systemic: Chills-Mild, Additional Details: tightness started 30 minutes after reaction--pt received epi 3 minutes after reaction. Tightness gradually emerged, pt felt very cool. Sx subside after epipen given. Pulse read 98 bpm, pt has anxiety and started to feel anxious. Called 911--paramedic accessed. After assessment recommend to transport through ambulance but patient refused.

Other Meds:

Current Illness:

ID: 1782250
Sex: M
Age: 56
State:

Vax Date: 06/07/2021
Onset Date: 08/12/2021
Rec V Date: 10/13/2021
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: COVID 19.

Other Meds:

Current Illness:

ID: 1782251
Sex: F
Age: 88
State: KY

Vax Date: 02/02/2021
Onset Date: 10/01/2021
Rec V Date: 10/13/2021
Hospital:

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

Lab Data: Antigen Test administered on 10/02/2021 at Nursing Home.

Allergies: Unknown

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

Symptoms: Patient Contracted COVID-19.

Other Meds: Unknown

Current Illness: Unknown

ID: 1782252
Sex: M
Age: 84
State: MA

Vax Date: 10/11/2021
Onset Date: 10/11/2021
Rec V Date: 10/13/2021
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: Error: Incorrect Reconstitution-

Other Meds:

Current Illness:

ID: 1782253
Sex: F
Age: 68
State: FL

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 10/13/2021
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: No adverse event occurred. However, the vaccine was given after expiration. Expiration date 09/21/21. Vaccine given 09/30/21.

Other Meds:

Current Illness:

ID: 1782254
Sex: M
Age: 56
State:

Vax Date: 06/24/2021
Onset Date: 08/13/2021
Rec V Date: 10/13/2021
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: COVID 19.

Other Meds:

Current Illness:

ID: 1782255
Sex: M
Age: 49
State: KY

Vax Date: 02/22/2021
Onset Date: 10/09/2021
Rec V Date: 10/13/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Tested Positive for Covid

Other Meds:

Current Illness:

ID: 1782256
Sex: M
Age: 66
State: NJ

Vax Date: 09/13/2021
Onset Date: 09/17/2021
Rec V Date: 10/13/2021
Hospital:

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

Lab Data: None, will be admitting to the hospital.

Allergies: No known

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

Symptoms: Headaches, fatigue, muscle weakness, numbness hands and feet, abnormally high blood pressure, Worsening flu like symptoms, loss of weight. Tightness in chest, lower back pain, upper back pain.

Other Meds: None

Current Illness: CIDP, RA, PN Autoimmune

ID: 1782257
Sex: F
Age: 54
State: FL

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 10/13/2021
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: No adverse event occurred. However, the vaccine was given after expiration. Expiration date 09/21/21. Vaccine given 09/30/21.

Other Meds:

Current Illness:

ID: 1782258
Sex: F
Age: 81
State: KY

Vax Date: 04/02/2021
Onset Date: 09/28/2021
Rec V Date: 10/13/2021
Hospital:

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

Lab Data: Antigen Test administered on 09/28/2021 at Health Center.

Allergies: Unknown

Symptom List: Unevaluable event

Symptoms: Patient Contracted COVID-19

Other Meds: Unknown

Current Illness: Unknown

ID: 1782259
Sex: M
Age: 31
State:

Vax Date: 08/06/2021
Onset Date: 08/15/2021
Rec V Date: 10/13/2021
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: COVID 19

Other Meds:

Current Illness:

ID: 1782260
Sex: M
Age: 49
State:

Vax Date: 08/24/2021
Onset Date: 08/25/2021
Rec V Date: 10/13/2021
Hospital:

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

Lab Data:

Allergies: Nil

Symptom List: Injection site pain, Pain

Symptoms: sore arm for one day

Other Meds: Nil

Current Illness: Nil

ID: 1782261
Sex: M
Age: 76
State: NY

Vax Date: 03/08/2021
Onset Date: 10/11/2021
Rec V Date: 10/13/2021
Hospital:

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

Lab Data: Patient went to see his PCP and was referred to an ophthalmologist.

Allergies: prednisone, environmental allergies

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient is having blurry vision and double vision in the afternoons. Patient was not able to read the LOT number.

Other Meds: hydropside from high blood pressure, Claritin as needed, Tylenol as needed

Current Illness: no problem , feeling fine . 100% okay

ID: 1782262
Sex: M
Age: 47
State: TX

Vax Date: 09/16/2021
Onset Date: 09/17/2021
Rec V Date: 10/13/2021
Hospital:

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

Lab Data:

Allergies: None.

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

Symptoms: Got extremely red eye. Believe it was pink eye. It was draining clear and white thick fluids for 3 to 4 days. It wasn't personally noticeable until my spouse stated approximately 8 to 10 hours after 1st Pfizer Covid 19 Vaccination was administered that it was.

Other Meds: None.

Current Illness: N/A.

ID: 1782263
Sex: F
Age: 33
State: KY

Vax Date: 04/29/2021
Onset Date: 09/21/2021
Rec V Date: 10/13/2021
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: SARS CoV + SARS CoV2 Antigen Positive on 9/23/2021.

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Breakthrough case after Covid vaccination. Dose #1 3/31/21 Dose #2 4/29/21. C/O fever, headache, and cough. Onset 9/21/2021.

Other Meds:

Current Illness:

ID: 1782264
Sex: F
Age: 75
State: MA

Vax Date: 10/11/2021
Onset Date: 10/11/2021
Rec V Date: 10/13/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Error: Incorrect Reconstitution-

Other Meds:

Current Illness:

ID: 1782266
Sex: F
Age: 53
State: CA

Vax Date: 08/30/2021
Onset Date: 08/31/2021
Rec V Date: 10/13/2021
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: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: Systemic: blood blisters on lips and heels-Mild, Systemic: Tinnitus-Medium, Additional Details: blisters resloved ,but ringing in the ear is ongoing

Other Meds:

Current Illness:

ID: 1782267
Sex: F
Age: 52
State: NY

Vax Date: 10/10/2021
Onset Date: 10/13/2021
Rec V Date: 10/13/2021
Hospital:

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

Lab Data: n/a

Allergies: KNA.

Symptom List: Nausea

Symptoms: Red itchy rash on chest.

Other Meds: Lipitor, progesterone, mulivitamin, D3, C.

Current Illness: N/A.

ID: 1782268
Sex: F
Age: 73
State: MN

Vax Date: 04/01/2021
Onset Date: 10/12/2021
Rec V Date: 10/13/2021
Hospital: Y

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: Injection site pain

Symptoms: Hospitalization due to COVID in a fully vaccinated individual: Vaccinated on 4/1/21 and 3/7/21 with Moderna vaccine.

Other Meds:

Current Illness:

ID: 1782269
Sex: F
Age: 30
State: KY

Vax Date: 05/21/2021
Onset Date: 09/24/2021
Rec V Date: 10/13/2021
Hospital:

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

Lab Data: PCR Test administered on 9/24/2021.

Allergies: Unknown

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

Symptoms: Patient Contracted COVID-19

Other Meds: Unknown

Current Illness: Unknown

ID: 1782270
Sex: M
Age: 82
State: MN

Vax Date: 02/05/2021
Onset Date: 10/02/2021
Rec V Date: 10/13/2021
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: 10/2/2021 Coronavirus 2 PCR Detect, V symptomatic POSITIVE

Allergies: Lisinopril

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

Symptoms: CHIEF COMPLAINT/REASON FOR VISIT Chest Pain HISTORY OF PRESENT ILLNESS Pt is a COVID positive 83-year-old male with an extensive past medical history significant for CAD status post PCI of, heart failure with reduced ejection fraction most recent EF on 10/4 was 31%, atrial fibrillation status post pacemaker placement (not on anticoagulation due to recent history of GI bleed), mantle cell lymphoma on chemotherapy (recent history of tumor lysis syndrome during hospitalization from 09/21-9/30), who presents today with generalized weakness and mild central chest discomfort. Of note, he was recently hospitalized from October 2nd through October 7th on the Cardiology Service for COVID-19 infection with acute o

Other Meds:

Current Illness:

ID: 1782271
Sex: M
Age: 17
State: CA

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 10/13/2021
Hospital:

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

Lab Data: NA

Allergies: NA.

Symptom List: Tremor

Symptoms: Reporting an administration error. Moderna was accidentally given to 17 yr old. Parents were contacted and informed. Choose not to complete the series.

Other Meds: NA-this was an administration error in giving it under age 18.

Current Illness: NA.

ID: 1782272
Sex: F
Age: 81
State: FL

Vax Date: 10/12/2021
Onset Date: 10/12/2021
Rec V Date: 10/13/2021
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: Erythema, Pruritus

Symptoms: Patient stated that last night she had chills, and shakes. Also stated she had headaches, insomnia, and high temp. Was also having trouble with balance and walking. Patient has taken Tylenol, Tylenol broke fever and fever is now down to 100.4. Still having headaches.

Other Meds: High blood pressure meds, blood thinning meds.

Current Illness: NONE.

ID: 1782273
Sex: F
Age: 52
State: MA

Vax Date: 10/05/2021
Onset Date: 10/05/2021
Rec V Date: 10/13/2021
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: None

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

Symptoms: About 3 hours after I received the shot, I started having pain deep in my left armpit. Pain in armpit became worse as the night progressed, making it very difficult to sleep on left side. The next day I awoke with continued pain in my armpit and with swelling present in my armpit. 2 days post shot, deep armpit pain remained and swelling became worse. It is now 8 days post shot, swelling remains but at about 25% of what it was. Pain in armpit is still present but could be defined as slight. Ibuprofen had decent effect on armpit pain but did not decrease swelling.

Other Meds: None

Current Illness: None

ID: 1782274
Sex: F
Age: 52
State: PR

Vax Date: 07/01/2021
Onset Date: 07/01/2021
Rec V Date: 10/13/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: Vaccine administration was at 4:20 pm, 2nd dose with nurse, she got pale for a moment, sweaty, disoriented, dizziness, and urinary incontinence. Ambulance came at 5:00pm, Vital signs: BP 130/80, P 80, DX 218.

Other Meds: N/A

Current Illness: N/A

ID: 1782275
Sex: F
Age: 32
State: MI

Vax Date: 10/06/2021
Onset Date: 10/06/2021
Rec V Date: 10/13/2021
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: PAin, swelling, redness to the site. generalized itching that started soon after the injection. Pt visited Urgent care and was prescribed an antibiotic. pain and swelling decreased after three days, however, patient started to feel numbness in the arm going down to the fifth digit. PCP prescribed predisone for a potential pinched nerve from the swelling

Other Meds:

Current Illness:

ID: 1782276
Sex: F
Age: 54
State: GA

Vax Date: 10/11/2021
Onset Date: 10/12/2021
Rec V Date: 10/13/2021
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: none

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

Symptoms: I have a great pain in my left hip joint. I am having trouble walking and just sitting down the pain is still there. To touch the area hurts. I did not have this pain before the shot.

Other Meds: Topiramate, Valtrex, Amlodipine, Cyclobinzaprine, Femhrt, Nurtec, Probiotic, Lysine, Advil, Calcium, turmeric, Miralax

Current Illness: no

ID: 1782277
Sex: F
Age: 58
State: GA

Vax Date: 10/11/2021
Onset Date: 10/11/2021
Rec V Date: 10/13/2021
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: 2 hours after shot: headache, 12 hours after shot: intense relentless body pain, fever, sweating, 24 hours after shot: extreme body pain, chills, sweating, 36 hours after shot: significant body pain.

Other Meds:

Current Illness:

ID: 1782279
Sex: F
Age: 70
State: KY

Vax Date: 02/25/2021
Onset Date: 09/14/2021
Rec V Date: 10/13/2021
Hospital:

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

Lab Data: Antigen test administered on 09/14/2021.

Allergies: Unknown

Symptom List: Pain in extremity

Symptoms: Patient Contracted COVID-19

Other Meds: Unknown

Current Illness: Unknown

ID: 1782280
Sex: F
Age: 52
State: MN

Vax Date: 04/14/2021
Onset Date: 04/28/2021
Rec V Date: 10/13/2021
Hospital:

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

Lab Data: Checked patients thyroid levels and started back on medication.

Allergies: Zoloft.

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

Symptoms: 2 weeks after receiving vaccine had weakness, hunger and weight loss. Believed the vaccine triggered her hyperthyroidism to come back. Had to restart Methlmazole medication from her Endocrinologist.

Other Meds: Advair, Calcium, Multivitamin, Methlmazole.

Current Illness: None.

ID: 1782281
Sex: F
Age: 63
State: NY

Vax Date: 02/17/2021
Onset Date: 02/17/2021
Rec V Date: 10/13/2021
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: Fluoroquinolone,many antibiotics, codeine, morphine, shell fish.

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

Symptoms: Had fever of 101 for four days, body aches for four weeks, random shooting pains for eight weeks throughout my body, digestive issues (loose stools) for four weeks, insomnia for two weeks, flair up of arthritis pain for four weeks, total body inflammation for eight weeks, headaches for two weeks. to date still have random shooting pains in various parts of my body, inflammation, bouts of insomnia, and digestive issues.

Other Meds: Multi vitamin, vitamin D, probiotic.

Current Illness:

ID: 1782283
Sex: M
Age: 45
State: MI

Vax Date: 09/02/2021
Onset Date: 09/03/2021
Rec V Date: 10/13/2021
Hospital:

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

Lab Data: 10-11-21 Blood panel, hospital, GLUCOSE, THYROID, VITAMIN B12, D, ETC.

Allergies: Sulfa.

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

Symptoms: After the MODERNA booster, my 3rd shot I had the normal mild side effects for 1 day, fever, chills. But after 2 days I started developing numbness in my toes and feet, specifically the bottoms and pads of my feet and toes. It has grown debilitatingly worse. I contacted my family physicians and due to being overweight, they set up a blood panel for me to test my sugar, glucose, thyroid, vitamin D/ B12 etc. All tests came back normal. It's now been more than a month and I cannot feel my toes. It's very bad in the morning, total numbness and changes a bit throughout the day. it's been excruciating. I've also started having some random joint pain, hips, shoulders, elbows etc.

Other Meds:

Current Illness:

ID: 1782284
Sex: M
Age: 72
State: NJ

Vax Date: 02/01/2021
Onset Date: 05/07/2021
Rec V Date: 10/13/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: Brain MRI, CT-scans, exessive blood tests, spinal tap, eye exams. Test e]were performed at Eye Hospital. Had IVIG 3 times, taking Mastonis and steriods .

Allergies: None

Symptom List: Vomiting

Symptoms: Got double vision on May 7, 2021, uncontroled blasser around end of May 2021, later diagnosed with myasthenia gravis. Have double vision, difficulty swallowing, trouble catching my breath after exercise or walking, uncontrollable bladder functions.

Other Meds: Clopidogrel, listinopril, metoprolol, atorvastinin, oxybutynin, metformin,

Current Illness: None

ID: 1782285
Sex: F
Age: 41
State: TX

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/13/2021
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: Asprin.

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Headache body hurt cant taste chills and chest pains.

Other Meds:

Current Illness:

ID: 1782286
Sex: F
Age: 32
State: MD

Vax Date: 10/08/2021
Onset Date: 10/08/2021
Rec V Date: 10/13/2021
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: None

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

Symptoms: 32-year-old female with no significant past medical history presents to ED today (10/08/2021) for evaluation of palpitations. Patient states that she got her second Covid vaccine earlier this morning, states that at the 12-minute mark during the observation period she started noticing that she was having palpitations. Had vital signs taken, her systolic blood pressure was in the 170s and her heart rate was at 127. States that she was sent here to the ED as protocol. States that it resolved on its own after about 10 minutes. States that she feels back to baseline at this time but does have some nausea. States that after her first Covid vaccine, she did have some swelling around her C-section site. Did not have palpitations after her first vaccination. Endorses mild headache at this time but also worked overnight and then order Covid vaccine. Denies dizziness, lightheadedness, chest pain, shortness of breath, vomiting or diarrhea. A/P Clinically well-appearing patient with stable vital signs presenting for evaluation of palpitations after receiving her second Covid vaccine. No associated chest pain, shortness of breath. States around 12 minutes during the observation period after she got the vaccinations, started having palpitations, elevated blood pressure and heart rate in the 120s. Normalized on its own by the time patient arrived to ED. Vital signs stable at this time. Palpitations at past, no active symptoms other than mild headache. Benign physical examination, EKG unremarkable. Likely COVID-19 vaccination side effect. Strict return precautions discussed. Patient agreeable discharge plan.

Other Meds: None

Current Illness: None

ID: 1782287
Sex: M
Age: 39
State: NY

Vax Date: 10/05/2021
Onset Date: 10/05/2021
Rec V Date: 10/13/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: At 11pm, 10/5/21 I woke up uncomfortable, achy and feeling cold and continued to progress throughout the night. By 5am 10/6/21, I woke up with severe chest and back pain, sweats and chills. When I stood up, I began to feel dizzy and light headed. I took 600mg of Motrin shortly after and symptoms started to subside after about 30-40mins. The morning of 10/6/21, I started having tingling sensations in my neck, upper to mid back, left tricep, left forearm and left hand. Tingling was intermittent throughout the day, along with Brain Fog. These symptoms lasted a few days and started to subside by Saturday 10/9/21, lingering symptoms only in left leg and foot and Brain Fog. Symptoms in left leg and foot continued until Monday 10/11/21, nearly 100% gone, still lingering discomfort in left big toe. Contacted Primary Care Physician on 10/11/21 to discuss these symptoms at 7:17pm. Dr. recommended to keep an eye on symptoms and to contact back if symptoms re-present themselves or worsen. As of 10/12/21, symptoms seem to be improving, continued feeling of brain fog and left foot/toe discomfort.

Other Meds:

Current Illness:

ID: 1782288
Sex: M
Age: 64
State: MN

Vax Date: 10/13/2021
Onset Date: 10/13/2021
Rec V Date: 10/13/2021
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: Patient came in for his booster shot - he had gotten his first two shots at the county. they were not entered in our medical record. He did not have his card with him. The shot was given and then immunizations were reconciled in the computer and found that he had recieved Moderna for his first two and not Pfizer.

Other Meds: none

Current Illness: none

ID: 1782289
Sex: F
Age: 48
State: KY

Vax Date: 04/12/2021
Onset Date: 09/10/2021
Rec V Date: 10/13/2021
Hospital:

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

Lab Data: Antigen Test administered on 09/11/2021 at the Urgent Care Center.

Allergies: Unknown

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

Symptoms: Patient Contracted COVID-19.

Other Meds: Unknown

Current Illness: Unknown

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am