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: 1782921
Sex: F
Age: 39
State: AZ

Vax Date: 04/11/2021
Onset Date: 05/23/2021
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: July 28 Ultrasound - inconclusive Gynecologist visit - did not determine anything

Allergies: Tree Nut Allergies; Seasonal Allergies

Symptom List: Dysphagia, Epiglottitis

Symptoms: I didn't get my period after the second dose of the COVID vaccine. I have always had regular periods so it was very strange to not get one like I expect. My husband and I are trying to get pregnant so there's no chance. So after about 6 weeks it did start, and I had a lot of tenderness and bleeding. There was many more heightened symptoms as usual, back pain swelling. As soon as it started, it just kept going. I usually have a 6 day period and it went on for 6 weeks. I sought medical care after I ended up getting a stomach bug and so I was at the doctor for that. And I told them at that point I had my period with a month. And so they prescribed with progesterone. And it was a 10 day course of progesterone. So it's June 28th, I did 10 days of progesterone, and then my period started again after 3 days. It would continue by then. The end of May now through the end of June. So my doctor referred me to a gyno for a consultation at that point. And so I scheduled with her and saw her in the beginning of July and I had a July 28 ultrasound. They didn't understand why I was still experiencing a period at that point. There was a thickening of the lining but it was considered normal. They prescribed me to go on progesterone for 3 months to reset my cycle. I took it for a week but it made me so tired that I was unable to function. I couldn't work, I needed to take naps in the middle of the day. So I called my doctor and said I needed to stop the progesterone and the doctor that looked at my ultrasound said I could come in and surgically implant an IUD to stop taking oral medication to be sleepy, and I declined. Now I'm 5 months out and I use a tracking app for my periods, I'm currently at 41 day cycle with a 12 day period. It has been getting better. It was 6 weeks and then it was 3 ? week, then 12 days, and now 8-10 days. But the variations are still not the same as what I'm used to. Also added a recommended biopsy and I declined.

Other Meds: Sertraline 25mg daily; Claritin as needed

Current Illness: N/A

ID: 1782922
Sex: F
Age: 82
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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: BinaxNow Rapid Test

Allergies: ACE inhibitors; Clindamycin; Lisinopril; Losartan; Magnesium; PCN; Magnesium Containing Compounds; Erythromycin

Symptom List: Anxiety, Dyspnoea

Symptoms: fatigue, loss of taste, congestion, head cold symptoms

Other Meds: unknown

Current Illness: unknown

ID: 1782923
Sex: F
Age: 77
State: FL

Vax Date: 10/06/2021
Onset Date: 10/07/2021
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: n/a

Allergies: soy diary

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

Symptoms: Approximately 14 hours after administration, patient began to experience intense itching, selling and pain. Bright red. Patient did not seek medical attention . Self medicated with Benadryl and topical steroids. Symptoms subsided after approximately 3 days.

Other Meds: meloxicam 15mg hydrochlorothiazide 12.5 glucosamine chondroitin vitamin-D

Current Illness: n/a

ID: 1782924
Sex: F
Age: 31
State: GA

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: none

Allergies: toradol tramadol reglan

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: patient was accidentally given 2 flu doses.

Other Meds: hydrochlorothiazide hydrocodone buspirone levothyroxine terazosin pantoprozole metoprolol larin vitamind d3 larin celexa symbicort

Current Illness: chronic pain high blood pressure anxiety depression

ID: 1782925
Sex: U
Age:
State:

Vax Date: 01/27/2021
Onset Date: 10/08/2021
Rec V Date: 10/13/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
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: Hospitalized due to covid

Other Meds:

Current Illness:

ID: 1782926
Sex: F
Age: 51
State: TX

Vax Date: 09/29/2021
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: None other than COVID-19 testing 10/1/2021

Allergies: Phentermine, Qsymia?All non-allergic reaction, mostly intolerance to the medication

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

Symptoms: Patient had loss of taste, loss of sense of smell after getting the vaccine. She also started having headaches from 9/30/2021?10/11/2021. Patient had difficulty sleeping and felt really ill despite intake of Motrin, Advil, Excedrin. She noted blood pressure to be high at 141/91. She was tested for COVID-19 10/1/2021 and resulted negative. Reaction was severe enough that patient could not go to work for that entire time. She was able to go back to work 10/12/2021.

Other Meds: Advair Diskus, albuterol, levothyroxine, montelukast, pantoprazole, Xyzal

Current Illness:

ID: 1782927
Sex: F
Age: 34
State: AL

Vax Date: 10/11/2021
Onset Date: 10/13/2021
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: Amoxicillin, sulfa, gluten, dairy

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Chest pains

Other Meds: None.

Current Illness: None

ID: 1782928
Sex: M
Age: 36
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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

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

Other Meds:

Current Illness:

ID: 1782929
Sex: M
Age: 18
State:

Vax Date: 08/18/2021
Onset Date: 08/25/2021
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: LA

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: COVID 19

Other Meds:

Current Illness:

ID: 1782930
Sex: F
Age: 83
State: WI

Vax Date: 04/16/2021
Onset Date: 08/25/2021
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:

Allergies: celecoxib - unknown cephalexin hydrochloride - diarrhea codeine - unknown diclofenac - unknown rofecoxib - unknown tramadol - palpations vicodin - unknown vioxx - swelling

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient contracted COVID after being fully vaccinated Unknown - done at facility where patient stays

Other Meds: acetaminophen 1000mg daily 650mg prn for pain/fever amitriptyline 10mg HS apixaban 2.5mg BID atorvastatin 10mg HS bacitracin topical prn for wounds betamethasone topical 0.1% topical BID calcium vitamin D 600mg-10mcg BID cholecalciferol 25m

Current Illness: None documented

ID: 1782931
Sex: F
Age: 72
State:

Vax Date: 01/04/2021
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: 1782932
Sex: M
Age: 24
State:

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

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

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: COVID 19

Other Meds:

Current Illness:

Date Died:

ID: 1782933
Sex: F
Age: 90
State: FL

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

Lab Data:

Allergies: NIACIN, PENICILLAMINE

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

Symptoms: DEATH

Other Meds: TRAMADOL,ESCITALOPRAM,ATORVASTATIN,AMLODIPINE,METOPROLOL

Current Illness:

ID: 1782934
Sex: F
Age: 57
State: MN

Vax Date: 01/10/2021
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: 10/12 SARS/COV2, NAAT, Positive

Allergies:

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

Symptoms: Breakthrough COVID

Other Meds:

Current Illness:

ID: 1782935
Sex: F
Age: 63
State: ID

Vax Date: 04/10/2021
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: N/A

Allergies: N/A

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

Symptoms: Second dose was worse, sore arm.

Other Meds: Thyroid medicine, apex Supplements.

Current Illness: N/A

ID: 1782936
Sex: F
Age: 51
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: 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 WAS GIVEN MODERNA VACCINE WITH AN EXPIRATION DATE OF 8/31/2021 ON 9/02/2021.

Other Meds:

Current Illness:

ID: 1782937
Sex: M
Age: 70
State:

Vax Date: 03/12/2021
Onset Date: 10/09/2021
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: Hospitalized due to covid Hospitalized in local HCP

Other Meds:

Current Illness:

ID: 1782938
Sex: M
Age: 37
State: ME

Vax Date: 05/05/2021
Onset Date: 06/10/2021
Rec V Date: 10/13/2021
Hospital: Y

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

Lab Data: see item 18

Allergies: none

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Subject: Patient VAERS: Myopericarditis June 10, 2021 and July 10, 2021 patient experienced severe chest pain & fatigue, this was relieved within 24 hours with bedrest and Advil. On September 11, 2021 patient reports sudden severe left side chest pain, back pain, shortness of breath, severe fatigue, and Dyspnea. EKG showed ST elevation at a local medical clinic. patient was sent to Medical Center ER where he was admitted from Sept. 14-Sept. 16,2021 with a diagnosis of Myopericarditis. EKG ST elevation in multiple leads, echocardiogram, chest x-ray, cardiac MRI w contrast, elevated troponin levels and elev. CRP levels we?re consistent with Myopericarditis. Treatment: bedrest, medication?s Colchicine & high-dose ibuprofen. discharge plan: cardiologist ordered no work for 3 months and continued treatment w high dose Colchicine & ibuprofen, activity restriction As this 37-year-old male has no known cardiac history and no risk factors for CAD, was active, and employment includes a very physical job it is suspicious and concerning that 8 weeks after his Pfizer vaccine (2nd dose) he Experienced his first chest pain & his first Cardiac symptoms with subsequent hospitalization for Myopericarditis. Please contact me with any questions: Practitioner Please confirm your receipt of this vaccine adverse event report by email to (private) Thank-you

Other Meds: Zoloft Clonazepam

Current Illness: Healthy 37 yo

ID: 1782939
Sex: M
Age: 54
State: CA

Vax Date: 03/16/2021
Onset Date: 03/19/2021
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: Bloodwork Ultrasound cT MRI

Allergies: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Constant, daily headaches; dizziness; vertigo; disorientation; brain fog Vestibular rehab - ongoing, medication (so far ineffective, CT, MRI, bloodwork, ultrasound

Other Meds: Metformin, humulin-n, metropolol, statin, lisinprol

Current Illness: None

ID: 1782940
Sex: F
Age: 52
State: TX

Vax Date: 10/06/2021
Onset Date: 10/06/2021
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: went to ER and had cbcs, chemistry done potassium was low er said she had paresthesia

Allergies:

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

Symptoms: numbness in head 1 hour after vax, couldnt swallow, numbness throughout whole body, high anxiety

Other Meds: Ferrous sulfate melatonin calcium d3 20

Current Illness:

ID: 1782941
Sex: F
Age: 45
State: NC

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: pollen

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

Symptoms: Patient was administered vaccine after expiration date of 9/28/21. No adverse effect noted.

Other Meds: Losartan 100mg

Current Illness: none reported

ID: 1782942
Sex: M
Age: 19
State: TX

Vax Date: 09/03/2021
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: EKG 9/3/21 Stress test 10/05/21

Allergies:

Symptom List: Unevaluable event

Symptoms: Chest pain that doesn't go away

Other Meds:

Current Illness:

ID: 1782943
Sex: M
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: 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: PATIENT WAS GIVEN MODERNA VACCINE WITH AN EXPIRATION DATE OF 8/31/2021 ON 9/02/2021

Other Meds:

Current Illness:

ID: 1782944
Sex: F
Age: 33
State: RI

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: While patient was sitting in observation area after receiving her vaccine she said she began to feel faint and was seeing black spot across her vision. She was given a bottle of water and cold compresses for her neck and wrists and was feeling back to normal by the time the ambulance arrived. Patient said that she felt as though it was a panic attack and not directly related to the vaccine administration. EMS checked her vitals and they were within range so she drover herself home.

Other Meds:

Current Illness:

ID: 1782945
Sex: M
Age: 24
State: KY

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: SYR
Vax Site: LA

Lab Data: None

Allergies: tomato, cherry, cinnamon

Symptom List: Injection site pain, Menorrhagia

Symptoms: Pain around the injection site following vaccination. Approximately 2 days later, patient began experiencing pain, tightness, and slight tingling in forearm. Patient also experiencing episodes of sweating only in the hands with no relief. Patient has received ibuprofen 800mg which has helped somewhat with the hands but not the forearm.

Other Meds: None

Current Illness: None

ID: 1782946
Sex: F
Age: 46
State: IL

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

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

Lab Data:

Allergies:

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

Symptoms: patient was administered the vaccine 26 hours after it was removed from the fridge

Other Meds:

Current Illness:

ID: 1782947
Sex: F
Age: 15
State: KY

Vax Date: 06/14/2021
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Antigen test administered on 10/12/2021 at the local Walk-In Clinic

Allergies: Unknown

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient Contracted COVID-19

Other Meds: Unknown

Current Illness: Unknown

ID: 1782948
Sex: F
Age: 33
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: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

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

Other Meds:

Current Illness:

ID: 1782949
Sex: F
Age: 41
State: AK

Vax Date: 10/08/2021
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: RA

Lab Data:

Allergies:

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

Symptoms: painful and swollen lymph under left armpit, a day or second day after Pfizer booster shot, and moderate to severe painful arm at site of injection.

Other Meds:

Current Illness:

ID: 1782950
Sex: F
Age: 63
State:

Vax Date: 01/28/2021
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: RA

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: COVID-19.

Other Meds:

Current Illness:

ID: 1782951
Sex: M
Age: 69
State: TX

Vax Date: 02/19/2021
Onset Date: 02/19/2021
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: DENIES

Symptom List: Injection site pain

Symptoms: RECEIVED FIRST DOSE MODERNA LOT# 041L20A ON 1/25/2021 RECEIVED SECOND DOSE PFIZER ON 2/19/2021 LOT # UNKNOWN AT TIME OF THIS REPORT

Other Meds: NONE REPORTED

Current Illness:

ID: 1782952
Sex: F
Age: 30
State:

Vax Date: 06/17/2021
Onset Date: 09/01/2021
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:

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

Symptoms: COVID 19

Other Meds:

Current Illness:

ID: 1782953
Sex: M
Age: 30
State: MI

Vax Date: 09/14/2021
Onset Date: 09/15/2021
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: na

Allergies: Unknown

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

Symptoms: Upon arriving a line was already forming for workers to get the Pfizer vaccine(some first dosers, some second dosers). I completed Registration, scheduled the appt, check-in, inserted vaccine order in Athena, filled out vaccine card, and risked informed consent. Worker reconstituted and administered the Pfizer vaccine. Since there was a line, he drew up each vaccine 1 by 1. After completing the 4th vaccine, he informed me that he only was able to draw up 4 vaccines, and there was none left in the vial. I instructed him to reconstitute the new vial and draw up all 6 before administering. Once again, he only was able to have enough mixture to draw up 4. We clarified that 1.8ml of diluent needed to be added to the vial. Worker stated that he only added 0.8 to the last batch (as well as this one). We reinserted all 4 of the drawn up syringes back into he vial and added 1ml of additional diluent (totaling 1.8 ml of diluent) and then we were able to draw up 6, syringes of the Pfizer vaccine. No more issues were noted. Follow up phone call: Pt has had head aches for 2 weeks post vaccination. Patient has seen his PCP and was given Ibuprofen for the HA and has a return appointment on Oct. 22, 2021. Pt was tested for both Flu and Covid because of the HA. Both test came back negative. Pt said he appreciated the update.

Other Meds: Unknown

Current Illness: NKDA

ID: 1782954
Sex: F
Age: 34
State: UT

Vax Date: 04/26/2021
Onset Date: 04/26/2021
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: Normal chest x-ray, Normal echocardiogram, Abnormal Cardiac MRI showing myocarditis.

Allergies: None

Symptom List: Tremor

Symptoms: Excessive chest pain for 2 days and then chest pain off and on for the next 4 months.

Other Meds: None

Current Illness: None

ID: 1782955
Sex: F
Age: 62
State:

Vax Date: 08/24/2021
Onset Date: 08/29/2021
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: COVID 19

Other Meds:

Current Illness:

ID: 1782956
Sex: F
Age: 42
State: GA

Vax Date: 04/08/2021
Onset Date: 04/15/2021
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: blood work was normal, EEG was normal, MRI was normal except for some black matter that has been there forever

Allergies: Penicillin, Erythromycin, Cetril, Cymbalta, Celexa, Effexor, Singulair

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

Symptoms: I had a full grand mal seizure on the 15th. I followed up with my PCP who referred me to neurology immediately. The neurologist ran tests and autoimmune tests. The blood work was normal. EEG was normal. MRI was normal except for some black matter that has been there forever. They put me on antiepileptic drugs because I have had 2 seizures since then. I am still having some seizures and I am still on medication, which seem to be helping but it has not resolved entirely.

Other Meds: Escitalopram, Atorvastatin, Quiatitin, Lisinopril

Current Illness: None

ID: 1782957
Sex: F
Age: 40
State:

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:

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

Symptoms: Patient was given the vaccine accidentally 27 hours after it was removed from the fridge instead of before 24

Other Meds:

Current Illness:

ID: 1782958
Sex: M
Age: 63
State:

Vax Date: 04/15/2021
Onset Date: 06/07/2021
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: 1782959
Sex: F
Age: 58
State: MN

Vax Date: 01/26/2021
Onset Date: 10/09/1921
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: 10/12 SARS/COV-2, NAAT, Positive

Allergies:

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

Symptoms: Breakthrough COVID.

Other Meds:

Current Illness:

ID: 1782960
Sex: M
Age: 79
State: GA

Vax Date: 03/04/2021
Onset Date: 09/15/2021
Rec V Date: 10/13/2021
Hospital: Y

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: PUI was hospitalized from 09/15/2021 to 09/21/2021 and then he has been staying at a Senior Care facility. Normally, the Isolation Timeframe is 09/11/2021 to 09/21/2021. However, it would be extended due to PUI's severe illnesses, preexisting conditions, and hospitalization. Patient is fully vaccinated.

Other Meds:

Current Illness:

ID: 1782961
Sex: M
Age: 52
State:

Vax Date: 02/01/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: COVID 19

Other Meds:

Current Illness:

ID: 1782962
Sex: F
Age: 82
State: OH

Vax Date: 03/02/2021
Onset Date: 09/26/2021
Rec V Date: 10/13/2021
Hospital: Y

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

Lab Data: SARS-CoV-2 Antigen specimen collected 10/5/21 and 2019 Coronavirus RNA specimen collected 10/7/21

Allergies:

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

Symptoms: Hospitalized for covid; symptoms include subjective fever, cough, nausea/vomiting, fatigue, and myalgia

Other Meds:

Current Illness:

ID: 1782963
Sex: M
Age: 24
State:

Vax Date: 03/03/2021
Onset Date: 09/07/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: COVID 19

Other Meds:

Current Illness:

ID: 1782964
Sex: M
Age: 77
State:

Vax Date: 04/05/2021
Onset Date: 09/13/2021
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:

Allergies:

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

Symptoms: COVID 19

Other Meds:

Current Illness:

Date Died: 01/27/2021

ID: 1782965
Sex: F
Age: 77
State: NJ

Vax Date: 01/20/2021
Onset Date: 01/26/2021
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: See above.

Allergies: None known

Symptom List: Vomiting

Symptoms: I am the epidemiologist reporting on behalf of 77-year-old female patient. According to records, patient was a 77 y/o woman with a hx of hypertension, hyperlipidemia, hx of tachycardia-induced cardiomyopathy (with normalization of LV function), chronic atrial fibrillation complicated by embolic renal infarction (on rivaroxaban), hx of rectal cancer, sacral decubitus ulcer, resident who had been positive for COVID19 since about a month prior to admission who presented to ED on 1/26 with substernal chest pain, where she was found to be in atrial fibrillation with bradycardia and to have an inferior STEMI. A transvenous pacer was emergently placed in the emergency room and patient was intubated because of hypoxia and unresponsiveness. Of note, COVID19 PCR was still positive. Emergent cardiac catheterization was done, which demonstrated a totally occluded RCA. PCI was performed and three drug eluting stents were placed in the RCA. The transvenous pacer was repositioned under fluoroscopic guidance. Vasopressor support was started in the cath lab. Upon ICU arrival, patient had rapidly escalating vasopressor requirements and persistent bradycardia, but the pacer was no longer capturing (despite maximal output). Echocardiography demonstrated severe systolic dysfunction. Mrs. Wightman had three consecutive cardiac arrests. TIMELINE: The patient tested positive for COVID-19 on 11/24/20 and 12/08/21 via PCR. The patient then received two doses of the Pfizer vaccine on 12/30/20 and 1/20/21. The patient tested positive for COVID-19 again on 1/26. The patient died on 1/27/21, one week after their second dose of Pfizer vaccine and one day after testing positive for COVID-19. The suspected cause of death is listed as ?cardiac arrest secondary to STEMI, cardiogenic shock?. I am reporting this case now because vaccination status was not considered to be a factor in cardiac arrest at the time this report was initially made.

Other Meds: Unknown

Current Illness: hypertension, hyperlipidemia, hx of tachycardia-induced cardiomyopathy (with normalization of LV function), chronic atrial fibrillation complicated by embolic renal infarction (on rivaroxaban), hx of rectal cancer, sacral decubitus ulcer, nursing home resident who had been positive for COVID19 since about a month prior to admission

ID: 1782966
Sex: F
Age: 35
State: OH

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

Lab Data: no

Allergies: unknown

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: This vaccine vial was punctured at 8:15 am and beyond use date as 6 hours after this time. the time then would be 2:15 pm. This vaccine was stored in out refrigerator at 40 degrees Fahrenheit. this vaccine then was administered at 3:30 pm making it out of the 6 hours use timeframe. this vaccine was labeled with the Beyond use label and the time of the 2:15pm. Assessed patient and there was no immediate reaction. contacted Janssen and spoke with the pharmacist. She emailed me an appendix with guidelines and did not have any other guidance.

Other Meds: unknown

Current Illness: unknown

ID: 1782967
Sex: F
Age: 61
State: MI

Vax Date: 10/07/2021
Onset Date: 10/07/2021
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: NOT KNOWN

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

Symptoms: patient said that she experienced shivering and she blacked out in her car while driving home and hit a car and ended up in Emergency

Other Meds: NOT KNOWN

Current Illness: NOT KNOWN

ID: 1782968
Sex: M
Age: 43
State:

Vax Date: 09/22/2021
Onset Date: 09/23/2021
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: COVID 19

Other Meds:

Current Illness:

ID: 1782969
Sex: M
Age: 46
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: RA

Lab Data: We did vital signs B/P 148/90, R 18, P 80, Pulse Ox 98%. Dr. gave him oral Benadryl and instructed him on taking it further s well as using his prescribed EpiPen if needed. Also referred him to his regular doctor to be evaluated for this event and also to determine if he can receive dose #2 and if so, he will probably have to receive it at his providers office. I am to follow up with him tomorrow. I also sent a note with him to work that if his symptoms worsen or do not resolve, he is to be sent to the nearest ER ASAP for continued treatment.

Allergies: ASA, IODINE, SHELLFISH, GRASS, DUST MITES, WHEAT

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

Symptoms: Patient left clinic after 30 minutes observation. Returned 40 minutes after receiving vaccine c/o numbness and tingling in his mouth and down his left side to his fingers. States this is the same reaction he has to his other allergies. ( he is prescribed an EpiPen but left it at his work)

Other Meds: UNKNOWN

Current Illness: DIABETES, HYPERTENSION

Date Died: 09/15/2021

ID: 1782970
Sex: M
Age: 59
State: GA

Vax Date: 04/12/2021
Onset Date: 09/14/2021
Rec V Date: 10/13/2021
Hospital: Y

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

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am