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: 1782864
Sex: F
Age: 29
State: NY

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

Lab Data:

Allergies: N/A

Symptom List: Dysphagia, Epiglottitis

Symptoms: Fatigue, feeling flush (w/ no fever) - started AM following evening dosages

Other Meds: Tri-lo-sprintec (birth control), probiotics

Current Illness: N/A

ID: 1782865
Sex: F
Age: 88
State: MO

Vax Date: 09/29/2021
Onset Date: 10/01/2021
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: NA

Allergies: none

Symptom List: Anxiety, Dyspnoea

Symptoms: Shingles

Other Meds: Lisinopril atorvostatin colpidigrel amlodipine levothyroxin

Current Illness: none

ID: 1782866
Sex: F
Age: 58
State: OR

Vax Date: 08/28/2021
Onset Date: 09/07/2021
Rec V Date: 10/13/2021
Hospital: Y

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

Lab Data: Sept 7 CAT scan, found blood clot. Sept 8 MRI, no signs of additional clots. Sept 9 or 10 ultra sound of heart, heart and surrounding area looks good.

Allergies: Latex

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

Symptoms: On the afternoon of Tuesday, Sept 7, 2021, 10 days after my second dose of the COVID vaccine, I started feeling dizzy, nausea, slurred speech, was taken to ER by ambulance, cat scan was done and a blood clot was found at the base of the brain stem. Was given tPA and admitted into the hospital. I was diagnosed as having a stroke. I was in the hospital for 2 weeks, for observation and therapy. I was discharged on Sept 21 and currently continuing outpatient, physical and occupational therapy. The stroke effected my balance and have double vision.

Other Meds: Atorvastatin 10mg Escitalopram 20mg Euthyrox 25mg Multivitamin 1 tablet Calcium w/ vitamin D 1 table

Current Illness: None

ID: 1782867
Sex: F
Age: 75
State: NC

Vax Date: 02/07/2021
Onset Date: 10/06/2021
Rec V Date: 10/13/2021
Hospital: Y

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

Lab Data: cycle threshold of 20.6 on 10/6

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Hospitalization due to COVID 19 Reported per Moderna COVID-19 Vaccine EUA

Other Meds:

Current Illness:

ID: 1782868
Sex: F
Age: 65
State: CO

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

Lab Data:

Allergies: Sulfur

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

Symptoms: Upper female lip swell to maximum capacity. Did not report to work on Tuesday, October 12, 2021. Treated with ice packs and Tylenol every four hours until swelling subsided.

Other Meds: Benazepril HCL

Current Illness: N/A

ID: 1782869
Sex: F
Age: 30
State: MT

Vax Date: 09/24/2021
Onset Date: 09/25/2021
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: Milk products, onions, zithromax, sulfa antibiotics, adhesive tape

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

Symptoms: Migraine headache, light acne sound sensitive, sense of taste greatly diminished

Other Meds: Cetirizine, cranberry supplement, prenatal, famotidine, docusate, vitamin d3 2,000iu

Current Illness: Lactating mother, post partum

ID: 1782870
Sex: M
Age: 65
State: CT

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: IM
Vax Site: LA

Lab Data: None that we know of.

Allergies: NKA

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: The patient made an appt for the J&J vaccine (only vaccine we were giving on 10/11/21), but meant to make an appt for his Pfizer booster. He was inadvertently given a J&J vaccine instead of the Pfizer booster he was looking for. He did not have symptoms, but happened to have an appt with his physician for a rash (totally unrelated to the vaccines). The physician called the pharmacy and informed us of what happened. I talked to the patient. He feels fine, is just concerned about whether the J&J will work as a booster or if he should still get a Pfizer booster shot.

Other Meds: Not sure

Current Illness: Patient was previously experiencing a rash, totally unrelated to the vaccine

ID: 1782871
Sex: F
Age: 29
State: PA

Vax Date: 08/09/2021
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: LA

Lab Data:

Allergies: none

Symptom List: Pharyngeal swelling

Symptoms: I was 8 weeks pregnant when I had a miscarriage on September 7th. Estimated due date was April 22. This was my second pregnancy. 1st pregnancy had no complications during pregnancy and birth, had a healthy baby boy on July 23, 2020.

Other Meds: Pre natal vitamin, 250 mg magnesium and 100 mg CoQ10

Current Illness: none. Relating to Item 8: I was 8 weeks pregnant when I had a miscarriage on September 7.

Date Died: 10/07/2021

ID: 1782872
Sex: M
Age: 69
State: NY

Vax Date: 03/29/2021
Onset Date: 09/14/2021
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: COVID positive 9/14/21

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Respiratory distress, Intubation, death

Other Meds:

Current Illness:

ID: 1782873
Sex: F
Age: 48
State: MA

Vax Date: 09/23/2021
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: Laboratory blood work and urine collected on 10/8/21

Allergies: Penicillin, sulfa, bactrim

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Pain and swelling of joints related to knuckles of both hands and right anterior ankle; no injury to either of these sites.

Other Meds: citalopram 20 mg at bedtime

Current Illness: Urinary tract infection

ID: 1782874
Sex: M
Age: 52
State:

Vax Date: 07/27/2021
Onset Date: 07/29/2021
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: -Pressure/tightness in chest during several runs and any exertion above 170bpm for 2-3 weeks following 1st dose. -Tightness/Numbness left arm and hand day 10-21 following first dose -Headache, lightheaded and dizzy, visual focus off, and general 'off' feeling day 2-15 following 1st dose -Numbness lip and chin area thru week 4 following 1st dose -Dexterity/Tactile issues in hands for 2-4 weeks following 1st dose

Other Meds:

Current Illness:

ID: 1782875
Sex: F
Age: 35
State: KS

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: SYR
Vax Site: RA

Lab Data:

Allergies: sulfa

Symptom List: Rash, Urticaria

Symptoms: itchy eyes during the first 15 minutes post vaccine. took 50mg benadryl - didnt help. itchy face, hands, and throat to follow with closing of throat of shortness of breath

Other Meds:

Current Illness:

ID: 1782876
Sex: F
Age: 54
State: MA

Vax Date: 09/25/2021
Onset Date: 10/01/2021
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: Hydrochlorothiazide

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

Symptoms: Patient reports chest pain last week, that has now resolved. Was seen by PCP as well. Currently reporting bilateral calf cramping that radiates to ankles, and difficulty ambulating as a result. Tenderness to ankle decreased with acetaminophen. Patient also reported R hand cramping and numbness. Patient encouraged to go to emergency room.

Other Meds:

Current Illness:

ID: 1782877
Sex: M
Age: 13
State: VA

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: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: No

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

Symptoms: At appx. 8:00 am on 10/12/21 patient began to have diarrhea and continued having diarrhea all day long and stopping at approximately 9:30 pm. At appx 1:45 am on 10/13/21 Patient vomited alot. But no more vomiting after the one time.

Other Meds: Vitamins B,C,D

Current Illness: No

ID: 1782878
Sex: M
Age: 68
State: KY

Vax Date: 03/03/2021
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: SARS Antigen test (positive)

Allergies: Unknown

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

Symptoms: Tested Positive on 10/13/2021.

Other Meds: Unknown

Current Illness: None

ID: 1782880
Sex: F
Age: 18
State: MI

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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies: None

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

Symptoms: Dose given to patient from vial kept in refrigerator 35 days after taken from ultra cold storage

Other Meds: Levothyroxine

Current Illness:

ID: 1782881
Sex: F
Age: 12
State: NC

Vax Date: 08/27/2021
Onset Date: 08/30/2021
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: See timeline provided earlier. Work-up is ongoing. Suspect that vaccine is not the cause of her symptoms but I am reporting due to temporal relationship to her vaccine.

Allergies: amoxicillin

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

Symptoms: See timeline provided earlier.

Other Meds: Cetirizine

Current Illness: 10/7/2020 Saw VP for poss. periorbital cellulitis. Was sent to ED. Sx improved with clindamycin. F/u visit with myself on 10/14 with normal exam. 4/30/2021 Presented for diffuse, flat, splotchy rash on dorsal forarms and anterior thighs. ? polymorphic light rxn 5/3/2021 Persistent rash, now lacy and diffuse. Mom reported red cheeks prior to appt. IgM for Parvovirus19 + 5/5/2021 f/u phone call, pt feeling much better 8/18/2021 Tdap, Menveo, and Gardasil9 administered 8/27/2021 Received Pfizer Covid19 vaccine #1 (never received #2) 9/2/2021 phone call from mom re: vomiting daily since 8/30 9/3/2021 Saw VP for vomiting nightly (and once during school). VP noted scalp lesion at occiput. No other rash. 9/7/2021 Seen by myself for continued vomiting. Ordred CMP and lipase, this was WNL. Also ordered h.pylori but this was never collected. Labs WNL, vomiting stopped after mom had patient's class changed when she was having difficulty with a teacher. 9/15/2021 Saw VP for sore throat. Covid and strep negative 9/17/2021 Seen by myself for painful and itchy rash on left side of face at hairline. Excoriated papules and patches involving left hairline and left ear. Consistent with contact dermatitis and tx with TAC. 9/27/2021 Saw VP for sore throat, covid and strep negative. 10/4/2021 Call from PA at urgent care. Patient had presented with a painful rash on face, arms, legs. PA stated that the rash was very unusual in appearance and that the entire rash wiped off with saline and gauze. She stated th

ID: 1782883
Sex: F
Age: 29
State: OR

Vax Date: 04/13/2021
Onset Date: 04/27/2021
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: I did an uptake scan, to scan my thyroid. I had about 10 different blood works. An ultrasound on my thyroid.

Allergies: I'm allergic to Benadryl.

Symptom List: Ear pain, Hypoaesthesia

Symptoms: I had nausea, fatigue, weight loss, heart palpitations, increased heart rate, tremors, muscle loss, hair loss and occasional vomiting. I underwent radioactive iodine treatment. I had to take a radioactive pill i131. I had to isolate for 3 days. I was also prescribed beta-blockers for my heart and tremors. I couldn't take them during my radioactive treatment.

Other Meds: The only thing I was taken was a prenatal multivitamin once a day. I take two capsules a day.

Current Illness: None at the time.

ID: 1782884
Sex: M
Age: 16
State: NY

Vax Date: 04/03/2021
Onset Date: 04/03/2021
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: na

Allergies: N.K.D.A

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: vaccine given to client under recommended age

Other Meds: Albuterol Sulfate (2.5 MG/3ML) 0.083% Nebulization Solution

Current Illness: J45.20 Mild intermittent asthma without complication

ID: 1782885
Sex: F
Age: 54
State: FL

Vax Date: 04/12/2021
Onset Date: 07/28/2021
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: 08/10/2021 Covid test- positive

Allergies: Pollen

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

Symptoms: On 07/28/2021 I woke up with a sore throat. On 07/29/2021 it presented like a sinus infection, my sore throat was not as significant, it was mostly my nose which was really stuffed up. I felt like I was having a really bad sinus infection. By that evening I went to a walk-in clinic, I was given Dexamethasone 6 mg one time a day for 4 days, Augmentin 875 1.25 mg 2 times daily for 10 days. On Friday 07/30/2021 I realized I lost all taste and smell. I was getting worried about the Dexamethasone running out because I was not getting better. My oxygen levels were at 96-97. I could not breathe through my nose. I called back to the walk-in clinic and asked what I could do. They said to keep taking it. By Monday I started to feel a little bit better. On 08/01/2021 my oxygen levels were at 99 which is normal for me. On 08/03/2021 I was able to smell and taste a little. That day my husband started not feeling well. He had a fever and started vomiting and he went to the walk-in clinic. They tested him for Covid on 08/04/2021 and the results came back on 08/09/2021 positive. On 08/10/2021 I went back to the walk-in clinic and I tested positive as well. When I tested positive, I was already 15 days in and I was already recovering. It took about 21 days to fully recover. That first week I was sick I was in bed just resting. I had already completed a full year of menopause where I did not have any periods but since I had the Pfizer vaccine it caused me to have a period 3 times. One time it was a light period for 4-5 days, another time it was just one discharge.

Other Meds: Multi vitamin, vitamin D, nasal saline runs, Flonase

Current Illness: None

ID: 1782886
Sex: F
Age: 72
State: WI

Vax Date: 10/13/2021
Onset Date: 10/13/2021
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: Patient received two doses of Moderna vaccine and requested a booster. Pharmacist did not look as vaccine administration card before administering dose of Pfizer.

Other Meds: Glimperide, Hydrochlorothiazide, Amlodipine, Benazepril, Simvastatin, Metformin

Current Illness:

ID: 1782888
Sex: F
Age: 49
State:

Vax Date: 08/27/2021
Onset Date: 08/30/2021
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: 1782889
Sex: M
Age: 92
State: NJ

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

Lab Data:

Allergies:

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

Symptoms: The Vaccine was diluted with 1.4 ml instead of 1.8ml. Patient was called by provider and explained to call with any adverse reactions .

Other Meds:

Current Illness:

ID: 1782890
Sex: F
Age: 11
State: MN

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Patient falsified DOB when registering for vaccination by stating the minor was born 08/10/2009. Guardian consented to the vaccination. Verified with statistical records that the patient's actual DOB is 08/10/2010, which made the vaccine a contraindication. No known adverse reactions noted.

Other Meds:

Current Illness:

ID: 1782891
Sex: F
Age: 22
State: VA

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: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Oct 13, 2021: 22 year old female patient received her second COVID 19 vaccine. Patient stated before the vaccine was administered that she had no previous issue with the first dose. Patient was told to report to the patient observation area for 15 minutes. Patient however had reported to the vaccination waiting area with no one observing. Admin clerk reported the reaction at 14:33 and called for assistance. patient reported feeling dizzy and lethargic and pale and diaphoretic. Patient began to lose consciousness; Epinephrine was administered via left thigh. patient vitals were then taken with BP 95/67 sp02 99 HR 79. Patient then requested to be laid down on the ground for comfort where an ice pack was administered to posterior neck. Patient stated having a vasovagal reaction to the previous flu shot. Vital signs were Within Normal Limits. Patient taken to the Emergency Room based off hospital protocol.

Other Meds:

Current Illness:

ID: 1782892
Sex: F
Age: 37
State: FL

Vax Date: 05/03/2021
Onset Date: 05/03/2021
Rec V Date: 10/13/2021
Hospital:

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

Lab Data: Ongoing visits with primary care to check on condition, no labs were done to date

Allergies: Artificial sweeteners, doxycycline, Azithromycin, perfumes, dyes

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

Symptoms: Numbness in face, lips and tongue, all over body rash and hives, high fever

Other Meds: NP thyroid, zyrtec, Flintstone daily vitamin

Current Illness: None

ID: 1782893
Sex: F
Age: 18
State: SC

Vax Date: 09/15/2021
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: None

Allergies: NKA

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Dull pain, 4/10, X1-2 days, located in chest radiating to neck and back, arms (biceps/shoulder) b/l, lateral knees (b/l). Treated with Tylenol and Ibuprofen (alternating) and medication use instructions, increase hydration, and RTC precautions.

Other Meds: None, however, patient has had migraines since 5 years old and most recently has been prescribed Sumatriptan. Patient reports taking 2 tabs once per month PRN.

Current Illness: None

ID: 1782895
Sex: F
Age: 45
State: NJ

Vax Date: 09/01/2021
Onset Date: 09/02/2021
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: Have Not been tested.

Allergies: No allergies known before vaccination.

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Covid Rash and hives, for over 30 days. Elevated blood pressure and blood glucose levels ( when tested on meter regularly for 3 weeks since September 1st 2021). Please call to discuss further.

Other Meds: I take medication DAILY for diabetes management Metformin&Glimeperide 2X A DAY; blood pressure management Losartan; Cholesterol management Pravastatin. I also take OTC Dietary supplements vitamin D3, garlic bulb, omega 3, etc. and Zrytec fo

Current Illness:

ID: 1782897
Sex: F
Age: 60
State: OH

Vax Date: 03/29/2021
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: 1
Vax Route: IM
Vax Site: RA

Lab Data: (ophtho) and (opthal) on April 28, and first week of May. neuro. 5/25. MRI= May 23 Echo= 6/24. MRA' and MRI= July 25 Dr. again on July 29 numerous eye Dr. appts all summer

Allergies: seasonal hay fever (to dead grasses) and allergic to cats.

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

Symptoms: I initially reported terrible muscle aches that lasted for a few days. What I did not think to report until later this summer are the neurological effects that I had: a loss of vision on April 28, which happened to be the same day I received the 2nd covid shot. Throughout the summer I faced numerous instances of severe, momentary 'woziness' where my head tipped unvoluntarily to the left, and I had a swoon-like/woozy experience (the room did not spin). I had faced less of these as time has passed, but there were enough of these experiences to warrant going to a Neurologist and having numerous tests done (MRI's, MRA, Echocardiogram etc).

Other Meds: singulair; fluoxetine; multi-vitamin; iron; vit D, zinc; baby aspirin;

Current Illness: none

ID: 1782898
Sex: F
Age: 76
State: WY

Vax Date: 01/20/2021
Onset Date: 01/21/2021
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 have been done.

Allergies: None known

Symptom List: Nausea

Symptoms: 01/21/2021 - Rash and itching of left upper arm and left shoulder blade for about 3 months. About 07/15/2021 - start of tingling of hands progressing to numbness then to loss of blood flow to hands resulting in white cold hands (this occurred in feet also but was not as bad). It has not yet improved and is sometimes quite painful. Symptoms I think are identical to Raynaud's or cold agglutinins.

Other Meds: Tylenol, Acyclovir, Prilosec, Prolia, Vit.D, Calcium, SloMag,

Current Illness: Hiatal hernia, GERD, Osteopenia

ID: 1782899
Sex: F
Age: 17
State: NY

Vax Date: 05/08/2021
Onset Date: 05/08/2021
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: Injection site pain

Symptoms: Patient was 17yrs old at the time of her first dose of Covid vaccine and received Moderna.

Other Meds:

Current Illness:

ID: 1782900
Sex: M
Age: 90
State: OK

Vax Date: 01/12/2021
Onset Date: 10/02/2021
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: BinaxNow Rapid Test

Allergies: Zoloft; Clonazepam; lyrica; gabapentin

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

Symptoms: Tested positive for Covid-19 on 10/2/2021

Other Meds: unknown

Current Illness:

Date Died: 10/12/2021

ID: 1782901
Sex: F
Age: 82
State: NY

Vax Date: 03/27/2021
Onset Date: 10/06/2021
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: COVID positive 10/7/21

Allergies:

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

Symptoms: Cough, pneumonia, COVID

Other Meds:

Current Illness:

ID: 1782903
Sex: M
Age: 58
State:

Vax Date: 04/15/2021
Onset Date: 08/25/2021
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: 1782904
Sex: M
Age: 72
State: PA

Vax Date: 10/04/2021
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: CT, CTA's on 10/10

Allergies: atorvastatin, rosuvastatin, cefadroxil, glimepiride, PCN, metoprolol

Symptom List: Erythema, Pruritus

Symptoms: 72yoM presented to the ED on 10/10 with acute painless L monocular blindness. Prior day prior, he reported having L eye pain but without vision loss and has no eye pain on day of presentation to ER. Neurology evaluated the patient and believes the left eye vision loss is related to retinal ischemia. Patient left prior to completion of MRI or optho evaluation.

Other Meds: metformin, Pepcid, aspirin, amlodipine, allopurinol

Current Illness:

ID: 1782905
Sex: M
Age: 55
State:

Vax Date: 06/02/2021
Onset Date: 08/30/2021
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:

Allergies:

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

Symptoms: COVID 19

Other Meds:

Current Illness:

ID: 1782906
Sex: M
Age: 73
State: AR

Vax Date: 02/25/2021
Onset Date: 10/12/2021
Rec V Date: 10/13/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 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: Patient is a 73-year-old male with a past medical history of ESRD m/w/f, Crohn disease, neuropathy presents to the ED due to shortness of breath and altered mental status that started about a week ago. Upon arrival to the ED patient was originally confused and confusion resolved by the time I saw the patient and was able to provide history. Patient reports he recently tested positive of COVID-19 10/2/21 at urgent care and that his sister who care for him periodically also tested positive for COVID-19. Patient stats that he his vaccinated. Patient reports headache, fever, chills, shortness of breath, confusion, weakness and body ache, vomiting, diarrhea. Patient reports he ambulates with walker. Admitted to hospital 10/12/2021.Patient reports he ambulates with walking cane and he has had frequent fall, over the past 6 months he has fell twice without hitting his head, last fall was 2 months ago. Patient complains of back aching pain onset 2 months ago after fall, that radiates to the abdomen, intensity 7/10, no associated symptoms, alleviating factors include rest, aggregative factors include movement. Patient also has history of ESRD, and reports that his sister drove him to dialysis yesterday. Patient reports he lives by himself in an apartment and his sister comes over to assist him periodically. Patient denies chest pain, urine changes, loss of consciousness, dizziness, and any head trauma. ED course: Vital: WNL except BP 105/69 Lab: Creatinine 4.4, BUN 23.7, procalcitonin 8.64, lactic acid 2 UA wnl CXR: Chronic markings with right bibasilar opacity possibly representing focal infiltrate. CT head or brain without contrast: No acute findings BC pending cefepime, vancomycin. ESRD m/w/f Cataract crohn Anemia Neuropathy GERD

Other Meds:

Current Illness:

ID: 1782907
Sex: M
Age: 78
State: MN

Vax Date: 02/10/2021
Onset Date: 10/12/2021
Rec V Date: 10/13/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient tested positive for COVID 19 on 10/12/21. No vaccine lot information available on database.

Other Meds:

Current Illness:

ID: 1782908
Sex: F
Age: 53
State: FL

Vax Date: 09/02/2021
Onset Date: 09/02/2021
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:

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

Symptoms: PATIENT WAS GIVEN MODERNA VACCINE WITH AN EXPIRATION DATE OF 8/31/2021 ON 9/02/2021

Other Meds:

Current Illness:

ID: 1782910
Sex: F
Age: 84
State: NJ

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:

Allergies:

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

Symptoms: covid Vaccine was diluted with 1.4 ml instead of 1.8ml, at this time no adverse reaction. Provider called patient to let them know of the error and to call back if any reactions.

Other Meds:

Current Illness:

ID: 1782911
Sex: F
Age: 46
State: WA

Vax Date: 04/07/2021
Onset Date: 09/17/2021
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- negative 9/17/2021 Covid test- positive 9/20/2021

Allergies: none

Symptom List: Pain in extremity

Symptoms: I woke up on 9/17/2021 with body aches, excruciating, head ache, lack of appetite, exhaustion, fog, irritable, and chills, but I never got a fever. I took a covid test and it was negative. I wasn't able to anything by 9/19/2021. I took another covid test on 9/20/2021 and it was positive. I felt those symptoms all the way until Thursday 9/23/2021. I feel normal now but I still do not have my taste or smell back.

Other Meds: Celebrex 100mg, 2xday Lamictal 50mg, 2xday Klonopine 0.5mg, 1xday

Current Illness: none

ID: 1782912
Sex: M
Age: 14
State:

Vax Date: 08/27/2021
Onset Date: 08/30/2021
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:

Date Died:

ID: 1782913
Sex: F
Age: 75
State: GA

Vax Date: 04/19/2021
Onset Date: 09/17/2021
Rec V Date: 10/13/2021
Hospital: Y

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

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

Other Meds:

Current Illness:

ID: 1782914
Sex: F
Age: 54
State: NC

Vax Date: 09/16/2021
Onset Date: 09/24/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: Multiple boils on skin

Other Meds: Naltrexone

Current Illness: None

ID: 1782915
Sex: F
Age: 18
State: CA

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: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: N/A

Allergies: No allergies

Symptom List: Vomiting

Symptoms: Within 5 minutes of administering the vaccine, patient became unconscious for 2-3 minutes and slowly became conscious and started responding to our questions.

Other Meds: N/A

Current Illness: No

ID: 1782916
Sex: F
Age: 43
State: SC

Vax Date: 03/09/2021
Onset Date: 03/14/2021
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: I have not seen a doctor for this yet. I am just pushing through it. I have not seen a doctor because I have a lot of other medical bills to pay for my children.

Allergies: none

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Chest pain that feels like what people might describe an anxiety attack. It can occur with or without a stressful event. It occurs intermittently and sometimes to the degree that the chest hurts for hours afterward. My upper back also hurts at times.

Other Meds: none

Current Illness: none

ID: 1782917
Sex: F
Age: 58
State: CA

Vax Date: 08/08/2021
Onset Date: 08/08/2021
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: N/A

Allergies: Codeine, Eggs, Opiod, Milk

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

Symptoms: Pt. states that after receiving the 1st dose of Phizer 08/08/2021, started experiencing symptoms 1hr later of frequent urinating. Strong urge to urinate lasting 24hrs. Clinic tested for UTI (Negative). No noted Primary visit. Symptoms has since subsided.

Other Meds: N/A

Current Illness: N/A

ID: 1782918
Sex: M
Age: 69
State: TX

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

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

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient with newly identified leptomeningeal tumor on imaging (imaging ordered prior to vaccine administration based on clinical exam during office visit). Admitted for pain control , acute cancer therapy, urinary retention. Unclear if patients symptoms acutely worsened post vaccination.

Other Meds:

Current Illness:

ID: 1782919
Sex: F
Age: 50
State: GA

Vax Date: 09/02/2021
Onset Date: 09/02/2021
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: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: PATIENT WAS GIVEN MODERNA VACCINE WITH AN EXPIRATION DATE OF 8/31/2021 ON 9/02/2021

Other Meds:

Current Illness:

ID: 1782920
Sex: F
Age: 36
State: IL

Vax Date: 09/12/2021
Onset Date: 09/14/2021
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: Heart scans did not show any damage (taken on 9/20/21), blood tests came back normal.

Allergies: N/A

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

Symptoms: Chest pains beginning two days after the shot, then shingles following one month after, lots of headaches and neck pain from the initial vaccination date.

Other Meds: Woman?s multivitamin, vitamins c and d, probiotics

Current Illness: N/A

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am