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: 1785010
Sex: M
Age: 59
State: FL

Vax Date: 08/30/2021
Onset Date: 09/01/2021
Rec V Date: 10/14/2021
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: Ototoxic to all pharmaceuticals

Symptom List: Dysphagia, Epiglottitis

Symptoms: 1. Tinnitus, increase in intensity, rest, no change in intensity, no resolution/permanent. 2. Heart Palpitations, increased form occasional to ~100 episodes per day. Rest and oral fluids. Sx continued for ~4 weeks and have slowly decreased to ~10 episodes per day.

Other Meds: Pantoprozole Amlodipine

Current Illness: None

ID: 1785011
Sex: F
Age: 78
State: CA

Vax Date: 09/26/2021
Onset Date: 10/03/2021
Rec V Date: 10/14/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: Blood clot in right lung

Allergies: Penicillin and Adhesive tape

Symptom List: Anxiety, Dyspnoea

Symptoms: Some pain in arm

Other Meds: Triamterne-HCTZ75-50, Benicar, Dexilant, Peroxetine, Synthroid, Allopurinol, Amlodipine, Sinvastatin, Trospium, Vitamin D3, Vitamin B12, pro Air, Breo.

Current Illness: None

ID: 1785012
Sex: F
Age: 56
State: MO

Vax Date: 07/15/2021
Onset Date: 07/18/2021
Rec V Date: 10/14/2021
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: Several test preformed - deep vein thrombosis was diagnosed

Allergies: None

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

Symptoms: A few days after the first shot, I developed a tachycardia for the first time in my life, I was alarmed and hoped it was a unique thing and would go away. I had 4 or 5 more incidents of this before I got my 2nd Moderna shot. August 18, I had the 2nd dose. Within just a few days of that, I developed edema for the first time in my life. The swelling in my legs continued off and on for the next month, and I scheduled a doctors appointment for October 5. On 9/30, the swelling in my leg was so bad that my husband and I decided we could not wait, and I reported to the ER at Medical Center. I was diagnosed with a blood clot in my lower left leg

Other Meds: None

Current Illness: None

ID: 1785013
Sex: M
Age: 55
State: FL

Vax Date: 09/20/2021
Onset Date: 09/21/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: -Sunburn sensation on back and chest, tingling/numbness in fingers on both hands, tingling/numbness on ball of both feet (started at ~4PM on 9/21/2021) -Sunburn subsided at 8 AM on 9/22/2021- -Numbness in hands and feet is on-going

Other Meds: Blood pressure

Current Illness: None

ID: 1785014
Sex: M
Age: 23
State: NY

Vax Date: 10/01/2021
Onset Date: 10/03/2021
Rec V Date: 10/14/2021
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: 23 year old patient who took Johnson and Johnson COVID-19 vaccination on Friday 10/1/21 because of school requirements for vaccination. Subsequent day on Saturday, he developed muscle aches of the extremities from the site of injection to other extremities. On Sunday, he began to have dark color urine. Admission into hospital, baseline CK over 300,000 on 10/7/21, - Admission ALT 538, AST 2012. Abdomen ultrasound "Unremarkable right upper quadrant ultrasound." Patient only reported 2 acetaminophens at home since Johnson and Johnson vaccine - 10/13/21: Patient continues to be on IV fluids. The creatinine kinase is 13,691 and AST/ALT 397/335 which are both substantial improvements from admission labs - Discharged 10/14

Other Meds:

Current Illness:

Date Died: 08/24/2021

ID: 1785015
Sex: F
Age: 59
State: GA

Vax Date: 06/15/2021
Onset Date: 08/18/2021
Rec V Date: 10/14/2021
Hospital:

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1785016
Sex: F
Age: 47
State: ND

Vax Date: 05/18/2021
Onset Date: 06/01/2021
Rec V Date: 10/14/2021
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: Seasonal allergies

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Menstrual cycle changes since fully vaccinated. First break through bleeding, then early menstrual cycle and now late menstrual cycle. Menstration has not been normal since fully vaccinated with Moderna vaccine. Other side effects included body aches, fatigue, fever etc. for 2-3 days post vaccine.

Other Meds: vitamins

Current Illness: N/A

ID: 1785017
Sex: F
Age: 29
State: TX

Vax Date: 10/11/2021
Onset Date: 10/12/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

Symptom List: Pharyngeal swelling

Symptoms: swollen lymph node under/in armpit

Other Meds: Adderall, Cymbalta, Flonase, Atorvastatin, Trulicity

Current Illness:

ID: 1785018
Sex: F
Age: 68
State:

Vax Date: 09/30/2021
Onset Date: 10/05/2021
Rec V Date: 10/14/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: breakthrough COVID-19 case

Other Meds:

Current Illness:

ID: 1785019
Sex: M
Age: 47
State: TX

Vax Date: 10/04/2021
Onset Date: 10/05/2021
Rec V Date: 10/14/2021
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:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Chest discomfort/pressure around the heart area began within 24 hours of the injection and has persisted through day 10 post injection.

Other Meds:

Current Illness:

ID: 1785020
Sex: M
Age: 20
State: MI

Vax Date: 10/10/2021
Onset Date: 10/11/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Fever, 101-102.7, a headache, cough, runny nose, sweating, shivering, sore throat, body aches.

Other Meds: Siezure disorder

Current Illness:

ID: 1785021
Sex: M
Age: 46
State: VA

Vax Date: 10/14/2021
Onset Date: 10/14/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data: No

Allergies: None

Symptom List: Rash, Urticaria

Symptoms: Into about 10 minutes after receiving the Pfizer COVID-19 vaccine, patient fell on the floor and passed out briefly for about 5 seconds, EMS called immediately, V/S at 1030 BP 111/70 HR 52 O2 SAT 99% RA. At 1032, V?S BP 123/74 HR 57 O2 SAT 99% RA, at 1035 V/S 117/81 HR 60 O2 SAT 99@ RA, at 10/40 V/S 108/76 HR 60 O2 SAT 99% RA, EMS arrived 1042, patient passed out again briefly for about 5 seconds, BP was 129/73. ER Doctor was on site from the beginning of the incident. Patient transported to Hospital ER for further evaluation.

Other Meds: Vitamin

Current Illness: No

ID: 1785022
Sex: F
Age: 41
State: TX

Vax Date: 10/08/2021
Onset Date: 10/09/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data: CBC w/ diff, Sed rate, D-Dimer and C-reactive protein quantitative

Allergies: No known allergies

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

Symptoms: 10/08/2021 Patient developed dizziness and burning sensation to both legs after vaccination, on 10/09/2021 developed rash on both knees, on 10/10/2021 rash spread below both knees up to ankles and developed whelps on both legs, on 10/11/2021 the patient was assessed by PCP and received a steroid injection and medication for dizziness, and on 10/12/2021 patient developed bruising on both legs.

Other Meds: None

Current Illness: None

ID: 1785023
Sex: F
Age: 67
State:

Vax Date: 03/18/2021
Onset Date: 10/06/2021
Rec V Date: 10/14/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: breakthrough COVID-19 case

Other Meds:

Current Illness:

ID: 1785024
Sex: F
Age: 60
State: WI

Vax Date: 10/11/2021
Onset Date: 10/14/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Called and left voicemail for patient. Awaiting call back to see if she is experiencing any signs/symptoms.

Other Meds:

Current Illness:

ID: 1785025
Sex: M
Age: 46
State: AL

Vax Date: 07/29/2021
Onset Date: 07/30/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data: August 3 (all visits) Urgent Care facility analysis (with subsequent referral to ultrasound analysis) Ultrasound analysis (led to immediate emergency room referral) Emergency room visit Result: DVT/blood clot

Allergies: Avelox Ceftin

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

Symptoms: Intense pain in my right calf muscle

Other Meds: Vitamin D Lyrica Tadalafil

Current Illness:

ID: 1785026
Sex: F
Age: 82
State: IL

Vax Date: 09/20/2021
Onset Date: 09/21/2021
Rec V Date: 10/14/2021
Hospital:

Vax Type: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data: spent 10 hrs. in the ER on 9/22/2021 , had CT scan that was normal . Felt better 09/23/21 and Tylenol helps a little but continues to have headache that gets better but never goes away completely, Has seen several Doctors including ENT but continues to be in pain.

Allergies: none known

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

Symptoms: Severe headache described as "brain freeze" when drink something cold

Other Meds: Cardiac Medications has pacemaker , no blood thinners

Current Illness: none

ID: 1785027
Sex: M
Age: 28
State:

Vax Date: 06/03/2021
Onset Date: 06/28/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data: blood work mri on brain NORMAL

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: 3 weeks later, panic attack episodes, eyes sensitve to light, light headed/dizzy, shortness of breath, eye flutters, inflammation in the eye, Intermediate uveitis

Other Meds:

Current Illness:

ID: 1785028
Sex: F
Age: 71
State: LA

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

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

Lab Data: NA

Allergies: NONE REPORTED

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: PT WAS ADMINISTERED EXPIRED VACCINE. MODERNA EXPIRED ON 10/11/21. IT WAS ADMINISTERED ON 10/13/21.

Other Meds: UNKNOWN

Current Illness:

ID: 1785030
Sex: M
Age: 60
State: CT

Vax Date: 09/30/2021
Onset Date: 10/01/2021
Rec V Date: 10/14/2021
Hospital: Y

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

Lab Data: Basic serum tests, a Head CT, and an EEG were normal.

Allergies: Percocet, cod fish

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

Symptoms: irregular tremor like movements that started the day after vaccination and worsened a few days later. They responded to benzodiazepines and he was discharged from the hospital. The clinical impression was that these movements were psychogenic.

Other Meds: Vit B complex, Vit D, Welchol, Nexium, Zetia, metformin, lovaza

Current Illness: none

ID: 1785031
Sex: F
Age: 55
State:

Vax Date: 08/03/2021
Onset Date: 10/11/2021
Rec V Date: 10/14/2021
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:

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

Symptoms: breakthrough COVID-19 case

Other Meds:

Current Illness:

ID: 1785032
Sex: F
Age: 45
State: CA

Vax Date: 10/08/2021
Onset Date: 10/09/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data: none

Allergies: NKA

Symptom List: Unevaluable event

Symptoms: A bump developed behind right knee, and itching at injection site. Has since resolved.

Other Meds: none

Current Illness: none

ID: 1785033
Sex: M
Age: 75
State:

Vax Date: 05/07/2021
Onset Date: 10/11/2021
Rec V Date: 10/14/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: breakthrough COVID-19 case

Other Meds:

Current Illness:

ID: 1785034
Sex: M
Age: 72
State: WI

Vax Date: 10/11/2021
Onset Date: 10/14/2021
Rec V Date: 10/14/2021
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: Unknown. Unable to get in touch with patient. Patient does not have a phone number or e-mail on file. Called contact on file who stated I had the wrong number.

Other Meds:

Current Illness:

ID: 1785035
Sex: F
Age: 33
State: WI

Vax Date: 10/11/2021
Onset Date: 10/14/2021
Rec V Date: 10/14/2021
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: Mold, ragweed

Symptom List: Injection site pain, Menorrhagia

Symptoms: Swelling of Left supraclavicular lymphnode

Other Meds: Domperidone, goats rue, blessed thistle, prenatal vitamin, birth control (for 1st vax only)

Current Illness: None

ID: 1785036
Sex: M
Age: 83
State: GA

Vax Date: 01/28/2021
Onset Date: 08/30/2021
Rec V Date: 10/14/2021
Hospital: Y

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: PUI is a symptomatic resident of a LTCF currently in outbreak. PUI tested positive on 8/30/2021 by PCR. Symptoms as indicated above. PUI was admitted to hospital on 8/30/2021-9/7/2021. PUI was not admitted to ICU. PUI is a breakthrough case. Received Pfizer dose @1-1/5/2021 and dose #2 1/28/2021.

Other Meds:

Current Illness:

ID: 1785037
Sex: F
Age: 33
State: GA

Vax Date: 09/14/2021
Onset Date: 09/18/2021
Rec V Date: 10/14/2021
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: I experienced nothing but a sore and swollen arm on September 15th but on Saturday the 18th of September I started experiencing tightening of my thigh, calf, and leg muscles. The tightening is persistent and is most uncomfortable when I'm trying to relax and especially after I wake up after being sleep for several hours. I'm still experiencing this daily.

Other Meds: Triamterene

Current Illness:

ID: 1785038
Sex: M
Age: 24
State: TX

Vax Date: 07/01/2021
Onset Date: 07/01/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data: NONE

Allergies: HIVES TO CHILDHOOD IMMUNIZATIONS

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: RECEIVED VACCINE AND RETURNED TO WORK. RETURNED TO CLINIC WITH C/O VOMITING AND CHILLS. VITALS: 169/90, 79, 97%, 20, DENIES PAIN. THEN C/O ANXIETY AND FEELING FLUSHED. EMS CALLED BY EMPLOYER. PATIENT REFUSED.

Other Meds: NOT REPORTED

Current Illness: NOT REPORTED

ID: 1785039
Sex: F
Age: 46
State: MT

Vax Date: 10/13/2021
Onset Date: 10/13/2021
Rec V Date: 10/14/2021
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: 2nd Dose Covid-19 administered 4 days after expiration date.

Other Meds:

Current Illness:

ID: 1785040
Sex: M
Age: 35
State:

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data: None

Allergies: None.

Symptom List: Nausea

Symptoms: Injection site soreness lasting about 48 hours Headache lasting about 3.5 days Fever (99.5 - 100.5 F) lasting about 3 days Nausea lasting about 2 days

Other Meds: None.

Current Illness: None.

ID: 1785041
Sex: M
Age: 60
State:

Vax Date: 04/20/2021
Onset Date: 10/08/2021
Rec V Date: 10/14/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: breakthrough COVID-19 case

Other Meds:

Current Illness:

ID: 1785042
Sex: F
Age: 47
State: IL

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

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

Lab Data: Unkown

Allergies: none known

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

Symptoms: Vaccine Administration Error: wrong vaccine administered. Patient had two previous doses for Moderna COVID -19 Vaccine. Patient originally wanted an influenza vaccine. Patient experienced fatigue, nausea, vomiting, dizziness, headache and fever. Patient was seen at HCF. Final outcome unknown at this time.

Other Meds: Tylenol

Current Illness: unknown

ID: 1785043
Sex: F
Age: 65
State: VA

Vax Date: 04/01/2021
Onset Date: 04/03/2021
Rec V Date: 10/14/2021
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: CT scans, MRI scans, MRA scans, vision field tests, tests for my retina and optic nerve, and blood tests - none resulted in determining a cause of the brain hemorrhage

Allergies: penicillin, sulfas

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

Symptoms: On April 3, I had a brain hemorrhage. I was doing my normal Saturday morning activities - ate breakfast, did a few simple things around the house, then was doing some light floor exercises. While doing my usual light exercises, I suddenly felt "off" then took a bath. While I was in the bath, I realized that something was wrong with my vision and I had someone take me to the emergency room. I had lost half of my vision as well as experienced significant memory loss, loss of fine and gross motor control, issues with my speech and use of language, unable to do simple math, could not remember or figure out how to use a cell phone, and severe balance and dizziness issues. I spent a week in the hospital, most of that time in the ICU. After being discharged from the hospital, I needed full-time care for over a month, then still needed a caregiver most of the time for several more months. I started intensive physical, occupational, and speech therapy at a specialized neurotherapy center, which has continued for 6 months. I have continued to see my neurologist, neuro-ophthalmologist, ophthalmologist, and primary care doctor on a regular basis. They have done numerous tests, including CT scans, MRI scans, MRA scans, vision field tests, tests for my retina and optic nerve, and blood tests. Through all of this testing, they were not able to determine a cause and I have none of the risk factors for having a brain hemorrhage. I am continuing to do therapy at home, including physical, occupational, speech, and vision therapies. I am not fully recuperated, still not able to work, and the doctors do not know if I will fully recuperate.

Other Meds: NP Thyroid, multivitamin, zinc, omega

Current Illness: cold

ID: 1785044
Sex: F
Age: 34
State: IL

Vax Date: 04/07/2021
Onset Date: 07/14/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data: blood test for immunocompromised disease- negative blood test

Allergies: Codeine Flu Vaccine

Symptom List: Tremor

Symptoms: I experienced 2 different symptoms. One was my feet was hurting very badly in the morning when I woke up. In the morning I was having very painful feet problems. Overtime the feet would loosen up. I had a blood test done for any immunocompromised disease I may have and it was negative. The problems I am having with my feet are still undiagnosed. I have also been experiencing dizziness all the time. I also had a blood test to see if anything showed up that could be related to the dizziness I am having. That blood test was negative for that, but it showed that I am low on Vitamin D. I was prescribed a high dose supplement of vitamin D. I am scheduled to see an ear, nose, and throat doctor tomorrow to see if there is any correlation with my ear and the dizziness.

Other Meds: Tylenol

Current Illness: none

ID: 1785045
Sex: F
Age: 80
State:

Vax Date: 02/17/2021
Onset Date: 10/12/2021
Rec V Date: 10/14/2021
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:

Symptom List: Erythema, Pruritus

Symptoms: breakthrough COVID-19 case

Other Meds:

Current Illness:

ID: 1785046
Sex: F
Age: 39
State: CO

Vax Date: 10/07/2021
Onset Date: 10/08/2021
Rec V Date: 10/14/2021
Hospital:

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data: none

Allergies: none

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

Symptoms: 10/7/21 ? received shot at 2:45 pm. Other than unconformable at injection site no issues. 10/8/21 1am woke up very thirsty and drank about 8 glasses of water in 30 minutes until thirst was quenched. Went back to bed and the headaches and muscle cramps and joint pain started. Extreme pain causing inability to get comfortable or sleep. Throat started getting tight also. No issues breathing or eating and drinking, just uncomfortable tightness in my throat. Assuming thyroids inflamed. By 5am had a mild fever of 100 degrees. Migraine type headache, sensitive to like and sound, extreme muscle and joint pain preventing me from wanting to move. Sitting up or standing caused dizziness and nausea. Very fatigued and week, had to use walls and tables for support when moving around. About 6am sweets and chills went with raised temperature, 100.5. Muscles would randomly spasm and cause pain. Spent the day laying down. Temp went to normal about 12:30pm. Was unable to eat most the day due to dizziness and nausea. Around 6pm dizziness and nausea subsided, and muscle pain was less. Was able to be in a sitting position in the afternoon. Around 10pm headaches subsided. Was able to get some sleep that night with little pain. Throat still tight. 10/9/21 joint pain, tight throat, mild headache, fatigue, mobility issues with left arm, pain at injection site. Around 10am had dizziness and limbs went tingly and numb. Had the shakes and felt very unsteady. Around 12:30pm dizziness and tingly/numb limbs went away. But still had fatigue, joint pain, tight throat, fatigue, and mobility issues with left arm. 10/10/21 joint pain, fatigue, tight throat, mobility issues with left arm, small red blister and pain at injection site. 10/11/21 joint pain, fatigue, tight throat, mobility issues with left arm, small red blister and pain at injection site. 10/12/21 joint pain, fatigue, tight throat, mobility issues with left arm, small red blister and pain at injection site. 10/13/21 fatigue, tight throat, small red blister at injection site. 10/14/21 fatigue, tight throat, small red blister at injection site. Received single Dose Janssen intermuscular lot#211A21A 10/7/21 2:45pm. Did not contact or seek any treatment. Assumed since no breathing issues not much anyone can do.

Other Meds: Le-Vel Thrive daily supplement vitamins

Current Illness: none

ID: 1785047
Sex: M
Age: 53
State: NC

Vax Date: 04/13/2021
Onset Date: 04/18/2021
Rec V Date: 10/14/2021
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: 5/3/2121 Primary Physician ? Respiratory Infection ? Respiratory Distress 5/3/2021 ED Visit - Low SPO2 5/3/2021 X-Ray Chest 5/3/2021 Hospital Admission - Diagnosis - Pneumonia 5/4/2021 Hospital Discharge 5/6/2021 Primary Physician - Acute Respiratory Distress 5/20/2021 Primary Physician - Acute Respiratory Distress 5/20/2021 CT Angiography Chest w/contrast 5/21/2021 Echocardiogram 5/21/2021 PFT 5/26/2021 Pulmonary Visit 5/27/2021 Bronchoscopy w/ Biopsy 5/27/2021 X-Ray Chest 6/2/2021 Pulmonary Assessment ? Referral ILD Specialist 6/21/2021 CT Chest w/o contrast 8/9/2021 PFT ? ILD Specialist Assessment 9/29/2021 CT Chest w/o contrast

Allergies: N/A

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

Symptoms: Interstitial Lung Disease, Lung scaring , Reduced to 57% capacity - April 2021 through October 2021

Other Meds: N/A

Current Illness: N/A

ID: 1785048
Sex: M
Age: 82
State: IL

Vax Date: 09/20/2021
Onset Date: 10/02/2021
Rec V Date: 10/14/2021
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: was taken by ambulance to Hospital was admitted to R/O Aneurysm had CT scans, chest x-ray, abdominal scans

Allergies: none known

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: in the night awoke very diaphoretic states clothes wet, attempted to get up and got very lightheaded and fell back in the bed , legs very weak unable to walk and headache

Other Meds: blood pressure medication and Prilosec

Current Illness: none

ID: 1785049
Sex: M
Age: 77
State: GA

Vax Date: 02/17/2021
Onset Date: 09/06/2021
Rec V Date: 10/14/2021
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:

Allergies:

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

Symptoms: Patient hospitalized due to COVID-19. Patient had cough, SOB, chest pain, and fatigue. Patient is fully vaccinated.

Other Meds:

Current Illness:

ID: 1785050
Sex: F
Age: 76
State:

Vax Date: 02/10/2021
Onset Date: 10/13/2021
Rec V Date: 10/14/2021
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: Vaccine breakthrough 8/13/21

Other Meds:

Current Illness:

ID: 1785051
Sex: F
Age: 51
State: NY

Vax Date: 10/14/2021
Onset Date: 10/14/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data: transported to ED

Allergies: vancomycin, gentamicin

Symptom List: Pain in extremity

Symptoms: dizziness, feels like she will fall

Other Meds: metoprolol, gabapentin, ASA 81

Current Illness: depression

ID: 1785052
Sex: M
Age: 91
State:

Vax Date: 03/12/2021
Onset Date: 10/11/2021
Rec V Date: 10/14/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: admitted for PNA due to covid

Other Meds:

Current Illness:

ID: 1785053
Sex: F
Age: 42
State: UT

Vax Date: 09/21/2021
Onset Date: 09/21/2021
Rec V Date: 10/14/2021
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: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1785054
Sex: F
Age: 16
State: CA

Vax Date: 08/28/2021
Onset Date: 08/28/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data: Pediatrician and Allergest appointment

Allergies: Episode of beauty product allergy and cereal allergy. Specific allergy not known. Appointment with allergist today 10/14/21.

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

Symptoms: After about 30 mins of vavcine, Rash and redness to eyes then itchy throat. Started benadryl round the clock. Symptoms lasted x 3 days.

Other Meds: None

Current Illness: None

ID: 1785055
Sex: M
Age: 42
State: UT

Vax Date: 09/21/2021
Onset Date: 09/21/2021
Rec V Date: 10/14/2021
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:

Symptom List: Vomiting

Symptoms: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1785056
Sex: M
Age: 23
State: MT

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

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

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient administered 2nd Covid-19 vaccine 4 days after expiration date.

Other Meds:

Current Illness:

ID: 1785057
Sex: M
Age: 58
State: OH

Vax Date: 04/08/2021
Onset Date: 07/28/2021
Rec V Date: 10/14/2021
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: a1c > 10

Allergies: None

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

Symptoms: type 2 diabetes diagnosis. could very well be a coincidence.

Other Meds: None

Current Illness: None

ID: 1785058
Sex: M
Age: 82
State: NY

Vax Date: 09/27/2021
Onset Date: 09/30/2021
Rec V Date: 10/14/2021
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: None

Allergies: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Extreme Fatigue all day long

Other Meds: Colace Stool Softener

Current Illness: None

ID: 1785059
Sex: F
Age: 54
State: UT

Vax Date: 09/21/2021
Onset Date: 09/21/2021
Rec V Date: 10/14/2021
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: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1785060
Sex: F
Age: 29
State: PA

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

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

Lab Data:

Allergies:

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

Symptoms: Fever, chills, nausea, vomiting, headache, muscle soreness, chest pain, increased respiratory rate, shortness of breath, cough, diarrhea, difficulty concentrating, fatigue

Other Meds: Lamotrigine 200 mg; Xyzal (Levocetirizine); sertraline 75 mg

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am