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: 1782396
Sex: M
Age: 58
State: NJ

Vax Date: 10/09/2021
Onset Date: 10/11/2021
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:

Allergies: None.

Symptom List: Dysphagia, Epiglottitis

Symptoms: Abdominal and back pain, hives, swelling of lips and eyes.

Other Meds: None.

Current Illness: Bronchitis.

ID: 1782397
Sex: M
Age: 35
State: NY

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

Lab Data: N/A

Allergies: None

Symptom List: Anxiety, Dyspnoea

Symptoms: I started feeling a scratchy/sore throat around 1h30min after taking the 3rd dose, which gradually worsened throughout the day. In the evening, the pain became very intense, and my throat felt swollen. I woke up at night feeling like my throat might close, but I was still able to breathe. I woke up at a different point choking on my own saliva, and coughing profusely as a consequence. Today upon waking up my throat was red and looked somewhat swollen; my uvula in particular looked somewhat edematous (perhaps the soft palate as well, but I could not tell).

Other Meds: None

Current Illness: None

ID: 1782398
Sex: F
Age: 58
State: NJ

Vax Date: 09/09/2021
Onset Date: 09/09/2021
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: tinidazole

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

Symptoms: stiff neck, headache, closed sinuses, injection site pain, fever, body aches, chills, sweats. Fever as high as 102 CIDP Neuromuscular symptoms WAY WORSE with 2nd shot. Hands very numb and tingling Hand tremors exaggerated. Pinky fingers keep pulling away. No grip, no movement control. Balance WAY WORSE. Leg muscle trembling & weakness, collapsing. Had to use walker CAUTIOUSLY. Burning painful feet and legs. Dizzy and odd head feelings. Eyesight weird, like it was faded.

Other Meds: Propranolol 80mg four times daily Estradiol10mcg insert 2x week Pantoprazole 40mg daily AM Famotidine 40mg daily PM Calcium Carbonate 500mg, twice a day Vitamin D3 1000iu daily Zinc 10mg daily Krill oil 1000mg daily B-Complex time releas

Current Illness: autoimmune, CIDP

ID: 1782399
Sex: F
Age: 40
State: NH

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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient arrived in the ER today, 10/13, post-Janssen vaccination. This individual arrived feeling very flushed after being vaccinated. They presented with tachycardia and hypertension post-vaccination and ER doctor diagnosed an allergic reaction due to the Janssen COVID-19 vaccination. Treatment: Famotidine 40mg/20mL X1 IV Methylprednisone 125mg/2mL x1 IV Vital Signs Monitoring Q30min Individual will be discharged from our care.

Other Meds:

Current Illness:

ID: 1782400
Sex: F
Age: 52
State: FL

Vax Date: 04/10/2021
Onset Date: 08/19/2021
Rec V Date: 10/13/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: 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: Admission to critical care hospital with COVID-19 diagnosis on admission

Other Meds:

Current Illness:

ID: 1782401
Sex: M
Age: 51
State: IA

Vax Date: 09/30/2021
Onset Date: 09/30/2021
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:

Allergies:

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

Symptoms: Patient presented to the pharmacy to get a covid vaccine and told this reporter that he hadn't been vaccinated yet. It turns out that he had already received a dose of the Janssen vaccine at a different pharmacy. Therefore the vaccination on 9/30/21 was unnecessary.

Other Meds:

Current Illness:

ID: 1782403
Sex: M
Age: 1
State: VA

Vax Date: 10/05/2021
Onset Date: 10/10/2021
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: None

Allergies: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Fever and red, bumpy rash covering legs and abdomen

Other Meds: None

Current Illness: None

ID: 1782404
Sex: F
Age: 70
State:

Vax Date: 02/10/2021
Onset Date: 08/23/2021
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:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: COVID 19

Other Meds:

Current Illness:

ID: 1782405
Sex: F
Age: 78
State: NC

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: LA

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient administered Moderna vaccine 2 days past the expiration date. MFR date of 03/10/2021

Other Meds:

Current Illness:

ID: 1782406
Sex: F
Age: 52
State: IN

Vax Date: 03/10/2021
Onset Date: 09/26/2021
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: Hospital has all records.

Allergies: Erythromycin

Symptom List: Diarrhoea, Nasal congestion

Symptoms: began having shortness of breath and chest pain in September 2021. Went to ER and had both lungs with Pulmonary Emboli. Client had covid virus October 2020.

Other Meds: multivitamins, vitamin B 3, fish oil, probiotics, vitamin c, Allegra, Flonase, Pepcid, Eliquis, lisinopril

Current Illness:

ID: 1782407
Sex: F
Age: 45
State:

Vax Date: 05/14/2021
Onset Date: 08/29/2021
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:

Allergies:

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

Symptoms: COVID 19

Other Meds:

Current Illness:

ID: 1782408
Sex: F
Age: 24
State: IN

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: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Symptoms: Fever, chills, chronic migraine( last -2 days), cough, fatigue, sore arm at injection site, ring around the injection site, and sore throat.

Other Meds:

Current Illness:

ID: 1782409
Sex: M
Age: 65
State:

Vax Date: 01/21/2021
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: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: change in behavior

Other Meds:

Current Illness:

ID: 1782410
Sex: F
Age: 42
State:

Vax Date: 08/06/2021
Onset Date: 08/10/2021
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: My menstrual cycle was impacted after taking the vaccine. My cycle had just ended on 07/27/2021 and I started my cycle again on 08/10, 4 days after receiving the first dose of the vaccine. It was extremely heavy and lasted for 4 days. Several blood clots which is abnormal for my cycle. My cycle is normally 21 days.

Other Meds:

Current Illness:

ID: 1782411
Sex: M
Age: 49
State:

Vax Date: 05/17/2021
Onset Date: 08/21/2021
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: COVID 19

Other Meds:

Current Illness:

ID: 1782412
Sex: F
Age: 47
State: CA

Vax Date: 04/09/2021
Onset Date: 09/10/2021
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: COVID - test swab - maybe on the 7th day of my illness

Allergies: codeine

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

Symptoms: Felt flu-ish- stayed in my jammies for an entire week. Couldn't do anything. I had a horrible headache. super tired; (was exposed to COVID); I was fatigued and super hot and couldn't cool down. After my fifth day of feeling horrible, We were having a huge spike in COVID cases when I was experiencing this and so my friends in the doctor office - said to stay at home and quarantine. Had a Parking lot - COVID nasal test - swab in the very front and I tested negative - they couldn't go all the way to the back because of my bleeding disorder. He went maybe a quarter of an inch in my nostril. My son, 13, started experiencing the same symptoms. I took Excedrin Extra strength and also Nyquil both day and night time to help me feel better. I had the symptoms probably 7-10 days total. We had such a huge uptake of cases here and I called the County and they said there were no testing sites available even. They were all full. They said if I experienced shortness of breath to go to the hospital.

Other Meds: no

Current Illness: no

ID: 1782413
Sex: F
Age: 69
State: GA

Vax Date: 04/23/2021
Onset Date: 08/31/2021
Rec V Date: 10/13/2021
Hospital: Y

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: PUI had a moderate to severe illness. She had to be hospitalized. She was diagnosed with COVID 19 pneumonia. PUI is fully vaccinated and believes based on the doctors advice it saved her.

Other Meds:

Current Illness:

ID: 1782414
Sex: F
Age: 43
State: FL

Vax Date: 03/29/2021
Onset Date: 03/30/2021
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: xrays on 8/23/21

Allergies: none

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Arm was sore. Soreness did not go away as expected, but worsened. It moved up into my shoulder. Eventually the pain was constant and increased with movement. I lost motion in my arm. I went to an orthopedist on 8/23/21. She seemed skeptical that the injury was related to the vaccine and refused to examine the area. She did a series of shoulder xrays and diagnosed me with rotator cuff tendinitis and gave me a cortisone injection. Her treatment made my condition worse. I saw a second orthopedist on 9/30/21. He diagnosed me with frozen shoulder related to covid vaccine. He gave me a cortisone injection in a different location and prescribed physical therapy. My pain has improved somewhat with his treatment, however, I still do not have range of motion.

Other Meds: topamax

Current Illness: none

ID: 1782415
Sex: F
Age: 58
State: OH

Vax Date: 09/29/2021
Onset Date: 09/30/2021
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: PCN, sulfa, tamiflu, azithromycin

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Within 1 day, developed polyarthralgia, tinnitus. These have not improved in 2 weeks.

Other Meds: Multivitamin, Vitamin D, B12, Cytomel, Levothyroxine, Claritin, Metoprolol

Current Illness:

ID: 1782416
Sex: M
Age: 25
State:

Vax Date: 03/06/2021
Onset Date: 08/31/2021
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:

Allergies:

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

Symptoms: COVID 19

Other Meds:

Current Illness:

ID: 1782417
Sex: F
Age: 44
State: SC

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: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: PCN

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

Symptoms: Client was given 2nd dose 10 days early. The donor was given her first dose on 09/03/2021, her vaccination card was misread as 09/30/2021 by admin staff and vaccinator. It was not noticed when they were in system either. The client had no complaints and no sign of any problems. The APRN was contacted by Team Lead, she instructed me to inform client that at this time, there is no need to restart the series, or get another dose. Client was informed.

Other Meds: none stated

Current Illness: recently released from rehab for ETOH abuse

ID: 1782418
Sex: M
Age: 56
State:

Vax Date: 06/02/2021
Onset Date: 09/03/2021
Rec V Date: 10/13/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: COVID 19

Other Meds:

Current Illness:

ID: 1782419
Sex: F
Age: 44
State: MD

Vax Date: 10/05/2021
Onset Date: 10/06/2021
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: fever 104, severe nausea, frequent vomiting/heaving, headache, muscle aches, exhaustion, malaise, dizziness, arm pain at injection site, lymph node swelling on same side as injection site. Vomiting controlled after 5 hours with 8mg zofran. Acute symptoms resolved with zofran and OTC ibuprophin in 24 hours. Arm pain and lymph node swelling resolved in 7 days.

Other Meds:

Current Illness:

ID: 1782420
Sex: F
Age: 51
State: MA

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

Lab Data: no

Allergies: no

Symptom List: Injection site pain, Pain

Symptoms: About an hour after the vaccine I developed a jolting pain in my right leg and it felt as if swelling developed in my mouth feeling as if I was having problems swallowing. I went to the ER but nothing was done and was advised it was a heightened immune response to the vaccine and released.

Other Meds: Keppra, Baclofen, Lasix, Potassium

Current Illness: no

ID: 1782421
Sex: F
Age: 47
State: IN

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: 1
Vax Route: SYR
Vax Site: LA

Lab Data: NONE

Allergies: none

Symptom List: Injection site pain, Menorrhagia

Symptoms: HARD KNOT, RED AROUND AREA OF VACCINE, WARM TO TOUCH

Other Meds: Metformin, Januvia, Jardiance, Amlodipine, Losartan, Baby ASA

Current Illness: none

ID: 1782422
Sex: F
Age: 74
State:

Vax Date: 04/07/2021
Onset Date: 08/28/2021
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:

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

Symptoms: COVID 19

Other Meds:

Current Illness:

Date Died: 10/11/2021

ID: 1782423
Sex: M
Age: 62
State: OH

Vax Date: 04/07/2021
Onset Date: 10/05/2021
Rec V Date: 10/13/2021
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: Coronavirus RNA PCR specimen collected 9/30/2021

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Hospitalized and death; symptoms include fever, rhinorrhea, sore throat, cough, shortness of breath, chest pain, headache, fatigue, diarrhea, congestion, and loss of taste/smell.

Other Meds:

Current Illness:

ID: 1782424
Sex: F
Age: 45
State: SC

Vax Date: 03/04/2021
Onset Date: 06/11/2021
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: Hearing tests showing partial hearing loss, MRI, CT scan

Allergies: Sulfa

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Partial hearing loss, fullness and tinnitus in right ear beginning in June 2021, recurring again in August 2021 and continues on and off

Other Meds: synthroid, B12, Iron, Effexor, Zinc, Vitamin D, Vitamin C

Current Illness:

ID: 1782425
Sex: M
Age: 44
State:

Vax Date: 04/09/2021
Onset Date: 09/16/2021
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: COVID 19

Other Meds:

Current Illness:

ID: 1782427
Sex: F
Age: 49
State:

Vax Date: 03/25/2021
Onset Date: 09/25/2021
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:

Allergies:

Symptom List: Nausea

Symptoms: COVID 19

Other Meds:

Current Illness:

ID: 1782428
Sex: M
Age: 80
State: MA

Vax Date: 10/12/2021
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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: no

Symptom List: Injection site pain

Symptoms: Woke up the next morning after taking the shot his face is all red and itchy

Other Meds: mucinex

Current Illness:

ID: 1782429
Sex: F
Age: 47
State: MA

Vax Date: 02/11/2021
Onset Date: 03/01/2021
Rec V Date: 10/13/2021
Hospital: Y

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

Lab Data: I had blood drawn, an EKG, a chest x-ray, a stress test w/o nuclear medicine, a stress test with nuclear medicine and an echocardiogram. The chest x-ray came back normal, but the other tests had abnormalities.

Allergies: I am allergic to citalopram hydrobromide.

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

Symptoms: On 03/06/2021, I experienced a sharp left chest pain. I had never experienced chest pain before. That night, I felt like a needle was poking me in my chest. I contacted my doctor, on 03/11/2021, and was told to go to the ER at Hospital for a chest x-ray. I went to the ER and had to wait four hours to be taken to the back. They performed an EKG and noticed that the test was abnormal. My blood work came back abnormal also. I also had a stress test w/o nuclear medicine, a stress test with nuclear medicine and an echocardiogram. The chest x-ray came back normal, but the other tests had abnormalities. I stayed in the hospital for 3 days for observation and was never diagnosed with anything. After leaving the hospital, I couldn't resume my daily activities. I needed to spend extra time resting because I would have shortness of breath easily. It took about two weeks before I started to feel like myself again.

Other Meds: I was not taking any medications.

Current Illness: I was not experiencing any illness.

ID: 1782430
Sex: F
Age: 83
State: WI

Vax Date: 03/06/2021
Onset Date: 10/09/2021
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:

Allergies: Cefazolin, Fish Derived, Ondansetron Hcl, Ibuprofen

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

Symptoms: Patient admitted as inpatient on 10/10/21 due to Pneumonia due to COVID-19 virus. Patient was tested for COVID-19 and was positive on 10/9/21.

Other Meds: alendronate, aspirin, atorvastatin, calcium carbonate/vitamin, furosemide, metoprolol succinate, mirtazapine

Current Illness:

ID: 1782431
Sex: M
Age: 51
State:

Vax Date: 04/12/2021
Onset Date: 09/18/2021
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: Tremor

Symptoms: COVID 19

Other Meds:

Current Illness:

ID: 1782432
Sex: F
Age: 60
State: NJ

Vax Date: 06/16/2021
Onset Date: 06/16/2021
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: Erythema, Pruritus

Symptoms: Post nasal drip

Other Meds:

Current Illness:

ID: 1782433
Sex: M
Age: 83
State: FL

Vax Date: 04/09/2021
Onset Date: 08/30/2021
Rec V Date: 10/13/2021
Hospital: Y

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: No Known Allergies

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

Symptoms: Admission to critical care hospital with COVID-19 diagnosis on admission

Other Meds:

Current Illness:

ID: 1782434
Sex: M
Age: 84
State:

Vax Date: 03/04/2021
Onset Date: 10/11/2021
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: LA

Lab Data:

Allergies:

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

Symptoms: asymptomatic

Other Meds:

Current Illness:

ID: 1782435
Sex: F
Age: 24
State:

Vax Date: 02/19/2021
Onset Date: 09/21/2021
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: covid 19

Other Meds:

Current Illness:

ID: 1782436
Sex: F
Age: 39
State: LA

Vax Date: 09/23/2021
Onset Date: 09/23/2021
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: Blood work X ray Ekg All negative, all on 10/10/21

Allergies: None

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

Symptoms: Dizziness from day of injection. 2 weeks later nausea, chest heaviness and left arm pain, numbness/hallow feeling. Feeling like fainting or passing out. Feels like falling at times. Started 2 weeks ago and was sporadic. Constant since Sunday, 10/10/21. Another dr appointment scheduled 10/13/21.

Other Meds: Zoloft 50ml, Multivitamin, Steroid

Current Illness: Sinus/allergies

ID: 1782438
Sex: F
Age: 47
State: WV

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: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: N/A

Allergies: Unknown

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

Symptoms: Patient received Moderna COVID-19 on 1/14/21 and 2/10/21 for their primary series of COVID-19 vaccines. Patient did not report what vaccine they received for their primary series and presented to receive a booster dose of the Pfizer-BioNTech COVID-19 vaccine. It was discovered when entering into the statewide system that the patient received Moderna for their primary series. Patient has not reported any ADRs as of the time of the report.

Other Meds: Unknown

Current Illness: Unknown

ID: 1782439
Sex: F
Age: 15
State: PR

Vax Date: 07/11/2021
Onset Date: 07/11/2021
Rec V Date: 10/13/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Pain in extremity

Symptoms: After administering the vaccine PFIZER, patient became unresponsive, appears sweaty and pale. The patient mother reports that at 11 years of age, patient had a similar reaction to another vaccine but patient responded quickly. Patient is with paramedic since she was not responding. Vitals are taken BP 90/60, dex 113, pulse 61, oxi 99, patient is placed on a superior position and the ambulance is called. Patient responded to time and place, but can not move extremities or speak. By nodding her head and asking her she indicates no pain but can not move her limbs but she does have sensation.

Other Meds: N/A

Current Illness: N/A

ID: 1782440
Sex: M
Age: 76
State:

Vax Date: 04/05/2021
Onset Date: 09/20/2021
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:

Allergies:

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

Symptoms: COVID-19.

Other Meds:

Current Illness:

ID: 1782441
Sex: F
Age: 47
State: SC

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: none

Allergies: nkda

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

Symptoms: Tachycardia HR 118, elevated BP 185/120, flushed face, sweating, nausea - Treated with Benadryl 25mg IM and Famotidine 20mg po, symptom duration 30 minutes

Other Meds: Adderall 20mg daily

Current Illness: none

ID: 1782442
Sex: M
Age: 69
State:

Vax Date: 03/01/2021
Onset Date: 09/26/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: COVID 19

Other Meds:

Current Illness:

ID: 1782443
Sex: M
Age: 78
State: MN

Vax Date: 04/02/2021
Onset Date: 10/08/2021
Rec V Date: 10/13/2021
Hospital: Y

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

Lab Data: 10/12/2021 SARS CoV-2, PCR, Rapid, V Detected

Allergies:

Symptom List: Vomiting

Symptoms: CHIEF COMPLAINT Generalized malaise HISTORY OF PRESENT ILLNESS Patient is a 78 y.o. male with DM 2, CKD 4, atrial fibrillation, heart failure, ANCA vasculitis, DLD who presents with generalized malaise, decreased urinary frequency and acute on chronic AKI. He states that he was in his usual state of health until the past week or so. He hasn't had an appetite for the past 4-5 days. No nausea or vomiting. Did have some diarrhea 5 days ago but then took some Imodium and improved a little bit but he still had multiple episodes of watery diarrhea. This corresponded to when he didn't have an appetite. His wife also wasn't feeling well and had diarrhea. He hasn't been producing as much urine since de CHIEF COMPLAINT Generalized malaise HISTORY OF PRESENT ILLNESS Patient is a 78 y.o. male with DM 2, CKD 4, atrial fibrillation, heart failure, ANCA vasculitis, DLD who presents with generalized malaise, decreased urinary frequency and acute on chronic AKI. He states that he was in his usual state of health until the past week or so. He hasn't had an appetite for the past 4-5 days. No nausea or vomiting. Did have some diarrhea 5 days ago but then took some Imodium and improved a little bit but he still had multiple episodes of watery diarrhea. This corresponded to when he didn't have an appetite. His wife also wasn't feeling well and had diarrhea. He hasn't been producing as much urine since decreased oral intake. Doesn't have difficulty urinating but doesn't have as good of control as used to. He was recently being treated for osteomyelitis and underwent partial right great toe amputation on 09/17. He was started on cephalexin that does correlate with his increasing creatinine. He states that after the surgery he was not taking any further antibiotics but it appears that he was prescribed Keflex to go home with.. Able to get around the house ok without difficulty but still unable to drive.

Other Meds:

Current Illness:

ID: 1782444
Sex: M
Age: 42
State:

Vax Date: 09/12/2021
Onset Date: 09/15/2021
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:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: COVID 19

Other Meds:

Current Illness:

ID: 1782445
Sex: M
Age: 24
State: KY

Vax Date: 09/01/2021
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:

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

Symptoms: Tested Positive for Covid

Other Meds:

Current Illness:

ID: 1782446
Sex: F
Age: 54
State: NY

Vax Date: 09/30/2021
Onset Date: 09/30/2021
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: throat was closing and itchy had to take Benadryl for two days. Vomiting the whole weekend after the vaccine.

Other Meds: FLOVENT,

Current Illness: ASTHMA

ID: 1782447
Sex: M
Age: 49
State: HI

Vax Date: 09/15/2021
Onset Date: 09/15/2021
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: - EKG - negative for heart attack, damage - Heart enzyme test - negative for heart attack, damage - Will follow up with blood testing

Allergies: Allergy to penicillin.

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

Symptoms: - Pain at injection site (RT arm) and tightness in right side of neck and jaw - from time of injection through approx 8 Oct. (23 days). - Tightness in chest approx 72 hrs after injection and slowly subsiding through 15 days after - Dry cough, hard to take a deep breath from approx 72 hrs after injection through 7 days after - Exhaustion and brain fog approx 72 hrs after and subsiding through 7 days after

Other Meds: None

Current Illness: None

ID: 1782448
Sex: M
Age: 52
State: IL

Vax Date: 09/20/2021
Onset Date: 09/21/2021
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:

Allergies:

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

Symptoms: Fatigue, cold sweats, muscle twitches in arms, severe cramping in body, severe headache persisting up to this date of reporting adverse reactions (10/13/21).

Other Meds: Apidra insulin, Vitamin D and Calcium supplements, Levythyroxine 175 mcg daily

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am