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: 1782500
Sex: F
Age: 52
State: GA

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

Lab Data: Going to the Er today. 10/13/21 No doctors office will see me and have instructed me to go to the ER

Allergies: NA

Symptom List: Dysphagia, Epiglottitis

Symptoms: It started with extreme cramping in my stomach and then broke out in a rash with white little bumps in the rash on the inside of both legs and private area that is blood red and feels like it's on fire. I also experienced 3 bumps around the vaccine area and it itches badly.

Other Meds: Hydrochlorizide- 25mg 1 x daily Celexa- 40mg 1 x daily Advil

Current Illness: None

ID: 1782501
Sex: F
Age: 51
State:

Vax Date: 02/13/2021
Onset Date: 08/29/2021
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: 1782502
Sex: F
Age: 69
State: CA

Vax Date: 09/25/2021
Onset Date: 10/10/2021
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: pt came in to the pharmacy saying she had cough body aches no fever or congestion just feeling like flu like symptoms. These symptoms would come on and off for a couple days now and asked if she needs to go see a doctor she said no she will get better and not worried. She does not want to take a covid test and just want to get better on her own. She only has a little cough now. Pt got the fluzone hd on 9/25 and it is 10/12 when she reported this to us today.

Other Meds:

Current Illness:

ID: 1782503
Sex: F
Age: 33
State: TN

Vax Date: 09/24/2021
Onset Date: 09/26/2021
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: N/A

Allergies: NKA

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Started as mild rash on left hip on Sunday (2 days after injection) Spread for several days until it was intolerable on Monday 10/4/21. It had become very large on my left hip/flank area, spread to both arms, my chest, and lower back. Spoke to infection control nurse at work on Monday 10/4. She recommended I be seen. Went to ER physician. He said it was a systemic reaction to vaccine. My throat felt odd that night and worsened the next morning. Started Prednisone and antihistamine Tuesday 10/5 AM.

Other Meds: Nurtec 75mg PO every other day, mirtazipine 30mg PO QHS, cyclobenzaprine 5mg PO QD PRN

Current Illness: N/A

ID: 1782504
Sex: F
Age: 34
State:

Vax Date: 12/23/2020
Onset Date: 09/04/2021
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: COVID 19

Other Meds:

Current Illness:

ID: 1782505
Sex: F
Age: 11
State: TX

Vax Date: 07/16/2021
Onset Date: 07/16/2021
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: NKA

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

Symptoms: ONLY 11 YEARS OLD NOT ELIGIBLE FOR VACCINE.

Other Meds: NONE REPORTED

Current Illness: NONE REPORTED

ID: 1782506
Sex: F
Age: 61
State: MI

Vax Date: 01/29/2021
Onset Date: 06/01/2021
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: yes

Allergies: no

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Having trouble eating, diarrhea, nausea called her Oncologist and a blood clot of found in her pelvic

Other Meds: eutal acetamin cf, topiramate, carbamazepine, anastrozole, omeprazole, trastuzumab, prolia, ondansetron, melatonin, compro, pibanieine

Current Illness:

ID: 1782507
Sex: M
Age: 62
State: NV

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

Lab Data: None

Allergies: None

Symptom List: Pharyngeal swelling

Symptoms: Sore, throbbing pain in left knee. I had no activity prior to this event. 7pm..On phone..Simply sitting in chair and laying on bed. Symptoms grew so bad by 11pm could barely bend knee and almost impossible to walk.

Other Meds: Carbomazepene

Current Illness: None

ID: 1782508
Sex: M
Age: 32
State:

Vax Date: 02/19/2021
Onset Date: 09/05/2021
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: 1782509
Sex: M
Age: 57
State:

Vax Date: 08/16/2021
Onset Date: 08/23/2021
Rec V Date: 10/13/2021
Hospital: Y

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

Lab Data:

Allergies: NKA

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient has experienced approximately 2 months worsening bilateral lower extremity and bilateral upper extremity paresthesias and fasciculations. Patient states that he received the Johnson & Johnson vaccine first dose on 8/16/2021. He states that over the next week he developed numbness and tingling in his bilateral feet. He states that his symptoms progressively ascended to his bilateral thighs. He also reports numbness and tingling in his hands that have ascended to his proximal biceps bilaterally. He states that the muscle fasciculations are worse in his calves bilaterally and that he can see his muscles twitching. Denies any weakness to his lower extremities or upper extremities. Patient presented to hospital with these symptoms and a neurology consult has been obtained. No medication therapies have been used at this time.

Other Meds: Sildenafil 100mg daily as needed for erectile dysfunction Fenugreek unknown dose

Current Illness:

ID: 1782510
Sex: F
Age: 31
State: OH

Vax Date: 10/08/2021
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:

Allergies:

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

Symptoms: Soreness, redness, swelling

Other Meds: Ocrevus infusion

Current Illness:

Date Died: 10/12/2021

ID: 1782511
Sex: F
Age: 91
State: MN

Vax Date: 03/31/2021
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: SYR
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Patient died 10/12/2021, not a covid related death

Other Meds:

Current Illness:

ID: 1782513
Sex: M
Age: 43
State: WI

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

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

Lab Data:

Allergies: No known allergies

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

Symptoms: Pt received one dose of the Pfizer COVID-19 vaccine series on 9/22/2021. Pt tested positive for COVID on 10/2/2021 during an ER visit. Pt returned to hospital 10/6/2021 and was admitted with a primary diagnosis of COVID.

Other Meds: None

Current Illness:

ID: 1782515
Sex: F
Age: 51
State: NY

Vax Date: 10/01/2021
Onset Date: 10/02/2021
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: 10/4/2021: Dexamethasone and Epinephrine 10/5/2021: Prednisone and Epinephrine injection 10/6/2021: Meclizine 10/11/2021: X-ray and ekg irregular heartbeat 10/12/2021: chest X-ray and ekg: irregular heartbeat

Allergies: None known

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

Symptoms: Dizziness Swollen tongue Difficulty breathing Swollen inner mouth Blisters all over lips Chest pains Blisters in right nostril

Other Meds: Vitamin D Excedrin Migraine

Current Illness: Migraine

ID: 1782516
Sex: F
Age: 44
State: CA

Vax Date: 10/07/2021
Onset Date: 10/08/2021
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: Compuzine and Reglan

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

Symptoms: Wide spread itchy rash

Other Meds: B12, Biotin, Wellbutrin and Melatonin

Current Illness:

ID: 1782517
Sex: F
Age: 6
State: MD

Vax Date: 10/09/2021
Onset Date: 10/09/2021
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: patient developed some slight swelling that evening which had doubled in size next day

Other Meds:

Current Illness:

ID: 1782518
Sex: F
Age: 42
State: GA

Vax Date: 04/05/2021
Onset Date: 04/19/2021
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: Hayfever, dustmites, pollen

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

Symptoms: After shot - normal arm pain for a few days. But the big adverse event after my shot - my period was only 1 day. And it was insanely painful. Then I didn't have my period for several months. I'm back on track (past two months) - but it was scary. Went to my gynecologists, endocrinologist, allergist, even medicine -- All levels were normal and I'm not in pre-menopause - and I don't have abnormal stress The only outling factor was the vaccine. And my periods are back to normal - back to the days they need to be - but they are also way more painful now.

Other Meds: Levothyroxine 125 mcd daily

Current Illness: nothing

ID: 1782519
Sex: F
Age: 92
State: VT

Vax Date: 10/09/2021
Onset Date: 10/11/2021
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: none

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Her arm became very red and swollen and she also broke out in hives.

Other Meds: Eliquis

Current Illness: na

ID: 1782520
Sex: F
Age: 12
State: CA

Vax Date: 10/10/2021
Onset Date: 10/11/2021
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: No

Allergies: No

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Around 4PM horrible migraine her toes were itchy, swollen, red & hurting and also had swelling fingers and hands mom gave tylenol on the following day her feet were swollen and purple she wasn't able to walk on her feet she was walking on her hills. Went to the ER and was diagnosed with COVID toes.

Other Meds: No

Current Illness: No

ID: 1782521
Sex: M
Age: 55
State:

Vax Date: 09/03/2021
Onset Date: 09/04/2021
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: 1782522
Sex: M
Age: 36
State: NC

Vax Date: 10/08/2021
Onset Date: 10/12/2021
Rec V Date: 10/13/2021
Hospital: Y

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: Midazolam

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

Symptoms: Myopericarditis requiring hospitalization. Chest pain symptoms started 4 days after patients COVID Pfizer booster. Initial vaccination series was 12/17/2020 and 1/8/2021. Patient's substernal chest pressure, positional with improvement sitting forward as well as EKG changes showing diffuse ST elevations all support pericarditis. Chest pain improve with colchicine and ibuprofen.

Other Meds:

Current Illness: None

ID: 1782523
Sex: F
Age: 61
State: MO

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: none

Symptom List: Unevaluable event

Symptoms: severe chills, body aches, headache, fever.

Other Meds: synthroid, calcium, calcitriol

Current Illness: none

ID: 1782524
Sex: F
Age: 51
State: NY

Vax Date: 10/06/2021
Onset Date: 10/09/2021
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: CT Scan 10/09/2021 Blood Work 10/09/2021 EKG 10/09/2021 Ultrasound 10/09/2021

Allergies: Pennicillin, Strawberries

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

Symptoms: Pt. states that after receiving the 1st dose of Phizer 10/06/2021, started experiencing symptoms 10/09/2021 of full body spasms, Blood Sugar +300, chest pain, and passing out spells. Biting of the tongue during spell (similar to Seizure) Emergency Room visit 10/09/2021 CT Scan, Blood Work, EKG, and Ultrasound. Diagnosed with Vertigo and follow-up with Neurologist. Appt. with Neurologist 01/2021, still experiencing symptoms with High Blood Sugar readings continuing.

Other Meds: Ravipril, Thorcimide, Atorvastatin

Current Illness: N/A

ID: 1782525
Sex: F
Age: 37
State: SC

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

Lab Data: none at this time. Appointment scheduled with my PCP on 10/27/2021

Allergies: Ceclor

Symptom List: Injection site pain, Pain

Symptoms: The same evening around 5 hours after receiving the vaccine I started having fever, chills and body aches. The following day, I started having swelling above my clavicle area on the same side of the arm where the vaccine was given. The swelling caused me not to be able to raise my arm at all. It was very panful to the point I could not turn my neck. This lasted for a week before the swelling decreased. I have also been experiencing an increased resting heart rate since I received the Covid vaccine. I received my flu shot on 10/06/2021 in the same arm that I received the Covid vaccine. The following day I started swelling in the same clavicle region. It's been a week now and the swelling is worse and sending shooting pains down into my left breast and up the left side of my neck.

Other Meds: Synthroid and Lexapro

Current Illness: none

ID: 1782526
Sex: M
Age: 77
State: SC

Vax Date: 09/21/2021
Onset Date: 10/07/2021
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: CRT'S, CAT SCANS, MRI, BLOOD TESTS (8), XRAY'S RESULTS AVAILABLE FROM HCF

Allergies: NONE

Symptom List: Injection site pain, Menorrhagia

Symptoms: STROKE

Other Meds: atorvastatin 40 mg tablet, MULTI-VITAMINS, EYE CARE HERBAL,

Current Illness: NONE

ID: 1782527
Sex: F
Age: 53
State: NM

Vax Date: 05/02/2021
Onset Date: 09/15/2021
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: N/A

Allergies: N/A

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

Symptoms: I had No symptoms

Other Meds: Daily Vitamin Supplement, Omega 3s Calcium, iodine, dim, Vitamin ADK, Primrose, Lactobacillus gasseri, MSM.

Current Illness: N/A

ID: 1782528
Sex: F
Age: 88
State:

Vax Date: 01/04/2021
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:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Covid 19

Other Meds:

Current Illness:

ID: 1782529
Sex: F
Age: 63
State:

Vax Date: 03/09/2021
Onset Date: 09/07/2021
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: COVID 19

Other Meds:

Current Illness:

ID: 1782530
Sex: F
Age: 66
State: IL

Vax Date: 03/30/2021
Onset Date: 07/25/2021
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: COVID rapid test

Allergies: No

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

Symptoms: Had a sinus pressure, fatigue and chest congestion the 07/25/2021 and started taking Mucinex, sinus and Neti Pot, PCR test negative 08/01/2021. Test positive 08/06/2021 rapid test was contacted by her health department with directives for care and was contacted everyday during quarantine.

Other Meds: Allergy medicine over the counter; vitamin

Current Illness: No

ID: 1782531
Sex: F
Age: 16
State:

Vax Date: 08/24/2021
Onset Date: 09/09/2021
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: 1782532
Sex: M
Age: 53
State: PA

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

Lab Data: N/A as this is only day 3, post dose.

Allergies: Flexerill

Symptom List: Injection site pain

Symptoms: Experiencing intermittent mild burning and tingling in hands, feet, and forearms which is consistent with small fiber neuropathy, a clinically documented pre existing condition that I suffer from. However, the new symptoms have excabertared directly following my dose.

Other Meds: Flonase, Claritin, Vitamin C, B12, D, B complex, turmeric, echinacea, elderberry, milk thistle, probiotic

Current Illness: N/A

ID: 1782533
Sex: M
Age: 43
State: AZ

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: n/a

Allergies: n/a

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

Symptoms: Patient was supposed to get a flu shot but accidently got a covid shot. He had his 1 st pfizer vaccine on 03/20/21 and 2 nd on 04/13/21

Other Meds: n/a

Current Illness: n/a

ID: 1782534
Sex: F
Age: 17
State: OR

Vax Date: 04/09/2021
Onset Date: 04/09/2021
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: RA

Lab Data: n/a

Allergies: n/a

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

Symptoms: no adverse event, pt was 17yrs old when moderna vaccine is recommended at 18yrs old.

Other Meds: n/a

Current Illness: n/a

ID: 1782535
Sex: M
Age: 65
State:

Vax Date: 02/23/2021
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: 1782536
Sex: F
Age: 71
State: AZ

Vax Date: 03/07/2021
Onset Date: 03/01/2021
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: I have had a chest x-ray, a chest CT scan and both are negative. I have been tested for TB, valley fever both of which are negative. There is no fever nor any other symptoms. I am awaiting results on blood work for thyroid condition or anemia.

Allergies: None

Symptom List: Erythema, Pruritus

Symptoms: A dry cough developed in the same month as the vaccines. It is intermittent, but has lasted since March 2021. I have had a chest x-ray, a chest CT scan and both are negative. I have been tested for TB, valley fever both of which are negative. There is no fever nor any other symptoms. I am awaiting results on blood work for thyroid condition or anemia.

Other Meds: Losartin, Simvastatin, Hydrochlorothyazide, vitamin and mineral supplements

Current Illness: None

ID: 1782537
Sex: F
Age: 66
State: NY

Vax Date: 01/17/2021
Onset Date: 01/17/2021
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: ENT and audiologist found nothing wrong, but she still suffers from tinnitus

Allergies: PCN

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

Symptoms: After 1st dose, felt like she had lockjaw or tightness in her neck and jaw for the first half hour, then it went away. She reports that her arm was very sore for 5 days and she could hardly move it. She also noted that about one month later she started having ringing in her ears, similar to the sound of crickets chirping.

Other Meds: omeprazole, flutacazone nasal spray, asteline nasal spray prn

Current Illness: NO

ID: 1782538
Sex: M
Age: 55
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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: N/A

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

Symptoms: WE OFFER PFIZER COVID-19 SERIES AND BOOSTERS. PATIENT STATED HE HAD NOT RECIEVED A COVID-19 VACCINATION YET AND FILLED OUT NECESSARY PAPERWORK. WHEN UPLOADING VACCINATION INFORMATION INTO IT WAS DICOVERED HE HAD BEEN GIVEN COVID-19 JANSSEN BY ANOTHER PROVIDER ON 6/7/21. WE ARE DOING OUR DUE DILIGENCE AND REPORTING THE VACCINE ERROR. NO ADVERSE REACTIONS/EVENTS WERE REPORTED BY PATIENT

Other Meds: N/A

Current Illness: NONE

ID: 1782539
Sex: F
Age: 59
State: OR

Vax Date: 05/23/2021
Onset Date: 05/24/2021
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: Brain MRI 7/1/21 c/w Bell's Palsy (per radiology) Several blood tests evaluating for cause of new neuropathy, unrevealing

Allergies: Seroquel

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: 12 hours after receiving vaccine dose, had L facial numbness. When sxs continued to worsen, brain MRI obtained and c/w Bell's Palsy. Since then, having worsening sxs which are bothersome to her. Now also having BUE numbness with mild weakness in addition to L leg numbness. The weakness is not so severe as to impair motor function, but sensory sxs are very distressing to her and impacting her mental health. Has seen neurology who did not have anything to offer, so have referred for second opinion as well as ordering EMG

Other Meds: amLODIPine (NORVASC) 5 mg tablet aspirin 81 mg EC tablet atorvastatin (LIPITOR) 80 mg tablet clonazePAM (KLONOPIN) 2 mg tablet clopidogreL (PLAVIX) 75 mg tablet gabapentin (NEURONTIN) 100 mg capsule gabapentin (NEURONTIN) 300 mg capsu

Current Illness: N/A - no acute illnesses prior

ID: 1782540
Sex: F
Age: 71
State: MI

Vax Date: 03/25/2021
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: SYR
Vax Site: LA

Lab Data: COVID positive test on 10/9/21

Allergies:

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

Symptoms: COVID vaccine breakthrough case

Other Meds:

Current Illness:

ID: 1782541
Sex: F
Age: 38
State: FL

Vax Date: 09/01/2021
Onset Date: 10/03/2021
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: EKG

Allergies: None

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

Symptoms: Left breast hurting, felt like a large lump. Went away after a few weeks. Heart and chest pains, pressure on heart, dull pain throughout the day

Other Meds: None

Current Illness: None

ID: 1782542
Sex: M
Age: 66
State: NC

Vax Date: 04/03/2021
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: Covid test- positive (9/14/2021)

Allergies: none

Symptom List: Pain in extremity

Symptoms: I first felt unconformable Friday. I was coughing more, and I felt pain in my chest. I steamed that night and the pain went away. The steam consisted of breathing in warm air for half an hour. I had congestion, sneezing, and coughing. I took my temperature on Monday and it was 100 degrees. I called to make an appointment with my doctor. They made an appointment for Tuesday morning. I went to the appointment, and I had tested positive for covid. The night before I had steamed for half an hour and repeated that for every 6 hours. Later, that had drained my head. My temperature on Tuesday was 98 degrees. I went into isolation at that point. I am convinced that the steaming helped me feel better. I didn't take any medication to help with covid. I only did the steaming, except for taking my normal blood pressure pill.

Other Meds: high blood pressure medication 1xday

Current Illness: none

ID: 1782543
Sex: F
Age: 52
State: MO

Vax Date: 10/01/2021
Onset Date: 10/02/2021
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: Not Applicable

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

Symptoms: I was vaccinated on 10-1-21 with the Janssen 1822809. Since then I have blacked out twice and I am menstruating after seven years of no periods I am now! - heavy. and pain on top right foot which lasted two days Regarding black outs-My brother had called 911 the first time on 10-2-21 - responders came my sugar level was 90 and BP 126/72 We bought a monitor and my blood sugar has been in a normal range Second time I blacked out was 10-12-21. No changes in eating habits- still juicing in the am and high protein all day. Same diet as the last five years. Pain on right foot roughly two inches in circumphrence - no bruising Blood test ordered for 10-13-21

Other Meds: Multi Vitamin

Current Illness: Not applicable

ID: 1782544
Sex: F
Age: 75
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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Body aches on day 1 after vaccine. I took aspirin 26 hours after receiving the vaccine. It seemed to ease the symptoms. No adverse event on day 2 following vaccine.

Other Meds: Verapamil Omeprazole Fosinopril Atorvastatin Cranberry Vitamin D Probiotic

Current Illness: None

ID: 1782545
Sex: M
Age: 93
State: WI

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

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

Lab Data:

Allergies: Augmentin, Diclofenac

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

Symptoms: Patient admitted as inpatient on 10/10 due to acute respiratory failure with hypoxia. Patient was tested for COVID-19 and was positive on 10/10.

Other Meds: apixaban, artificial tears, cyanocobalamin, difluprednate , levothyroxine, metoprolol tartrate, nitroglycerin, rosuvastatin

Current Illness:

ID: 1782546
Sex: M
Age: 56
State: MN

Vax Date: 01/04/2021
Onset Date: 10/10/2021
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:

Allergies: none

Symptom List: Vomiting

Symptoms: sore throat, cough, chills, nasal congestion, post nasal drainage, sneezing. Had hives or bug bites on legs, have since cleared up. starting on 10/10/21

Other Meds: none

Current Illness: none

ID: 1782547
Sex: F
Age: 71
State: OH

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

Lab Data: NA

Allergies: NKDA

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: After Pneumovax was given in the left deltoid, the area around the injection site started to swell, bruise, and bleed. After a couple minutes, the swollen area felt hard. The patient did not complain of pain or any systemic side effects.

Other Meds: Unknown (patient does not fill prescriptions at this pharmacy)

Current Illness: Unknown

ID: 1782548
Sex: M
Age: 61
State: TN

Vax Date: 08/09/2021
Onset Date: 09/06/2021
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: RA

Lab Data: I do not know the tests or lab results.

Allergies: None

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

Symptoms: Patient developed Pericardial effusion after 3rd dose of Moderna vaccine

Other Meds:

Current Illness: None

ID: 1782549
Sex: F
Age: 71
State: MN

Vax Date: 09/26/2021
Onset Date: 09/27/2021
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: Referred for pych eval and ENT consult after being seen in the ED

Allergies: Sulfa. Mold

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient began having excessive salivation and haaring voices in her head telling them that they were going to harm her.

Other Meds: Hyzaar Synthroid

Current Illness: none

ID: 1782550
Sex: F
Age: 58
State: OK

Vax Date: 03/19/2021
Onset Date: 03/20/2021
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: Penicillin, Codeine

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

Symptoms: Early the next morning after the vaccine I woke up to my whole arm swollen with a very itchy rash that was down the whole arm. I was nauseated and ran a temp that never elevated over 101. I was super sleepy and tired. The lymph nodes under my are swole preventing me from getting my Mammogram until July. My Dr did a physical inspection and advised to keep it clean and take tylenol to help with the disconfort

Other Meds: Metformin, Meloxicam, Otorvorstatin, Abilify, Acetazolamide, Oxybutynin, Gabapentin, Zoloft, Hydroxyzine, Vit D, Claritin, Tylenol XS

Current Illness: no

ID: 1782551
Sex: M
Age: 49
State: AL

Vax Date: 04/09/2021
Onset Date: 08/30/2021
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: Ultrasound

Allergies: Shellfish, environment allergies, melons

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

Symptoms: I have been diagnosed with blood clots in both legs. I am a blood thinner medication now.

Other Meds: Fish oil, multivitamin

Current Illness: No

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am