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: 1785378
Sex: F
Age: 71
State: IA

Vax Date: 10/06/2021
Onset Date: 10/07/2021
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: None

Allergies: Food allergies: peach, strawberry (many fruit drinks result in hives)

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient bled rather severely at administration due to likely hitting a blood vessel during administration. Patient reports one day after vaccination: fatigue, profuse sweating, very low-grade fever, cold sweats, low temperature. This progressed several days to day 4 (Sunday evening) fire department responded to patient reported unable to recognize surroundings and severe fatigue. They surveyed house for CO2 poisoning and did not find evidence of that. Patient declined hospitalization. Symptom improvement by 10/12/21 (got flu shot on 10/13/21 so must have felt much better).

Other Meds:

Current Illness: nothing notable

ID: 1785379
Sex: M
Age: 41
State: CA

Vax Date: 09/30/2021
Onset Date: 10/02/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data: CT brain(Normal) Electrocardiogram (Normal) Electrolytes (Normal) White Cell (Normal) Red Cell (Normal) Neurological Exam (Normal)

Allergies: None

Symptom List: Anxiety, Dyspnoea

Symptoms: I received the Covid booster shot at 9/30/2021. , After that, I experienced headaches the next 2 weeks. On Saturday 8, a week after Covid booster, I had a very bad day. I was sweating a lot and I got dehydrated. I am almost pass out. I had short memory lost. After that day, it has been very difficult to feel completely recovered. I ended up in the emergency room on Sunday 9. I was with headaches , dizziness and chills. Today, I am doing better but not totally recovered. I am still having headaches.

Other Meds: None

Current Illness: None

Date Died: 10/06/2021

ID: 1785380
Sex: M
Age: 76
State: TX

Vax Date: 03/11/2021
Onset Date: 09/13/2021
Rec V Date: 10/14/2021
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: Positive COVID-19 test on 9/19/2021 using the Abbott ID Now Platform using nucleic acid amplification technology.

Allergies: Amlodipine (Swelling), Sulfa (Nightmares)

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

Symptoms: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 2/11/2021 and 3/11/2021. Presented to ED on 9/19/2021 with a 6 day history of cough and worsening shortness of breath. On admission was hypoxic on room air that improved with 5 L of oxygen via nasal cannula. Patient was treated with dexamethasone, remdesivir, and baricitinib. Ultimately had progressive hypoxemia requiring mask BiPAP making it difficult to eat or drink and on the evening of 9/30 was intubated. Over the next 7 days he continued to deteriorate with worsening hypoxemia requiring prone ventilation strategy. Despite maximization of ventilator efforts he never improved. Moreover, he developed persistent hypotension and renal failure with minimal urine output ultimately with acidosis and hyperkalemia. Palliative care was involved with family discussions. He was transitioned to DNR status and expired on 10/6/2021.

Other Meds: Albuterol MDI prn, Apixaban 5 mg BID, Aspirin 81 mg QD, Atorvastatin 20 mg QD, Azelastine Nasal BID, Carvedilol 12.5 mg BID, Lotrisone Lotion BID, Dorzolamide Ophth 1 drop both eyes BID, Doxycycline 100 mg BID, Dronedarone 400 mg BID, Flov

Current Illness:

ID: 1785382
Sex: F
Age: 35
State: CA

Vax Date: 10/07/2021
Onset Date: 10/08/2021
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: I?ve made a doctor appointment for her.

Allergies: No

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: I am still breastfeeding. I experienced typical symptoms (dhiarrea, tiredness, soreness, etc) for 72 hours after the vaccine; however my 12/13 month old baby who is breastfeeding 4-6 times a day/night still experienced many Covid symptons. After 24 hours, she had dhiarrea followed by fever, stuffy and runny nose, sleeplessness, loss of appetite, cough, and thick green mucus). She is on day 6 of all of these symptoms. I haven?t taken her to get tested yet but will of her symptoms continue. She is not teething as she got all of her molars just last month.

Other Meds: None

Current Illness: No

ID: 1785383
Sex: F
Age: 48
State: NC

Vax Date: 09/24/2021
Onset Date: 09/24/2021
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: Saw my doctor who conducted test to rule out stroke in her office. 9/24/2021.

Allergies: Medication - Compazine, IV Contrast, Vicodin, Dexamethasone, Prednisone Foods - Banana, Orange, Soy, Sage,

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

Symptoms: Johnson & Johnson shot this was not on the list. Hemiplegic reaction. Caused a stinging headache which then caused my entire right side to go numb and lose feeling from face to foot. Caused 6 hours of vomiting. Face and right arm are still numb to the touch. Lost 1 of the 3 nerve feelings on my right side.

Other Meds: Metoprolol ER 25mg 1XDay - prescription Low Dose Asprin 81mg 1XDay - over the counter Probiotic 10 - 1XDay - over the counter Krill Oil 500mg - 1XDay - over the counter Organics Daily Liquid Vitamins - 2 TBS 1XDay - over the counter

Current Illness: none

ID: 1785384
Sex: M
Age: 65
State: CA

Vax Date: 05/22/2021
Onset Date: 05/22/2021
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: None. However, I have strong reason to believe I got SARS-CoV in early March 2020, but media coverage and CDC info suggested Covid-19 was accompanied by fever, and I had no fever, so I did not seek to be tested. In fact, unless I had become acutely ill enough to go to the ER, I could not get tested in local area at that time. It was several months before the PCR test was made available in my local area outside of the hospital, and I tested negative. However, just over 4 weeks after I first became sick (with what I now am sure was Covid-19) I had an acute two-hour period when I struggled to get enough oxygen through my lungs, and feared I would die. I did have 'long haul' symptoms for ~1.5 years.

Allergies: none

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

Symptoms: 7 out 10 pain at injection site, with noticeable soreness 50 hours later; headache and body ache; chills, fever (24 hours later: 101.7F); swollen glands; extreme fatigue: spent most of next 30 hours in bed; intermittently light headed; loss of appetite; elevated pulse. All symptoms appeared within several hours, and resolved within 2-3 days. Except that about a week or two later I noticed that my right nostril fills with mucous (snot) 10-20 times a day, ongoing for past 5 months.

Other Meds: none

Current Illness: none

ID: 1785385
Sex: M
Age: 48
State: PA

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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: cipro and ct dye

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: started with like a vertigo event for hours, then violent headache and lights were making it worse? slept, woke up, confusion, headache, nausea and now diarrhea where i have nothing left but water coming out. general weakness and lack of motivation for anything

Other Meds:

Current Illness:

ID: 1785386
Sex: F
Age: 65
State: TX

Vax Date: 02/24/2021
Onset Date: 02/24/2021
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: NONE

Allergies: YES TO ALLERGIES BUT NOT SPECIFIED ON CONSENT

Symptom List: Pharyngeal swelling

Symptoms: CLIENT RECEIVED MODERNA VACCINE 1/21/2021. THEN RECEIVED PFIZER VACCINE ON 2/8/2021 AND SECOND PFIZER DOSE PREMATURLY ON 2/24/2021, ONLY 16 DAYS APART.

Other Meds: NOT RECORDED

Current Illness: NOT REPORTED

ID: 1785387
Sex: M
Age: 70
State: OR

Vax Date: 04/10/2021
Onset Date: 04/11/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data: COVID test - positive

Allergies: N/A

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: No treatment. Both my wife and son were sick and then I got sick. I kinda guessed it was COVID because I got the same strange headache when I got the vaccine. So I decided to get myself tested and I came back positive. Before that my gums left really strange. And I thought I had a sinus infection that went up to my eyes. And that was my initial guess. then I went to the doctor for that and got tested for COVID and got came back positive. My wife also got sick and we took her to the hospital and she was positive. She was given medication Regeneron injection. We thought my son had it too but he didn't get tested. I wasn't as bad as they were. I was down for about 2 or 3 days. I wasn't really bad but I didn't wanna do anything and I got really lethargic and bad headaches mainly.

Other Meds: -Qvar 50mcg once daily -Spiriva 80mcg (guess) once daily

Current Illness: N/A

ID: 1785388
Sex: F
Age: 93
State: GA

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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Error: Incorrect Reconstitution-

Other Meds:

Current Illness:

ID: 1785389
Sex: M
Age: 43
State: OH

Vax Date: 09/17/2021
Onset Date: 09/24/2021
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: N/A

Allergies: N/A

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

Symptoms: Patient stated after receiving the 1st dose of Pfizer on 09/17/2021, symptoms of burning in the lungs and heartburn (lasting 7 days then subsided) developed on 09/24/2021. Primary communications recommendation delay of 2nd vaccination.

Other Meds: N/A

Current Illness: N/A

ID: 1785390
Sex: F
Age: 69
State: IL

Vax Date: 09/16/2021
Onset Date: 09/18/2021
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: SYR
Vax Site: RA

Lab Data: Bloodwork, catscan Surgery to remove appendix. 09-18-2021

Allergies: Darvon. Not made anymore

Symptom List: Rash, Urticaria

Symptoms: Fever, not felt well. Temp elevated each hour. Went to urgent care. 9-18-2021 Admitted to hospital, Perforated appendix, appendectomy 09-18-2021

Other Meds: None

Current Illness: None

ID: 1785391
Sex: M
Age: 34
State: CT

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

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

Symptoms: Left anterior shoulder pain that is not improved with NSAID's. Began a few hours after administration of vaccine and has persisted since

Other Meds: None

Current Illness: None

ID: 1785392
Sex: M
Age: 93
State: MI

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

Lab Data: N/A

Allergies: NKDA, NKFA

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

Symptoms: Patient received a concentrated dose related to an error in drawing. Received a dose of 1.3 versus a dose of 0.3 post reconstitution of the 1.8mL of Sodium chloride.

Other Meds: Analgesics for recent Hip replacement (09/29/2021)

Current Illness: Right Hip replacement.

ID: 1785393
Sex: F
Age: 50
State: WI

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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies: Seasonal

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

Symptoms: Fever, Chills, night sweats, severe pain in armpit area radiating into lymph nodes and breast adjacent to vaccination site.

Other Meds: Levothyroxine

Current Illness: None

ID: 1785394
Sex: M
Age: 73
State: MN

Vax Date: 01/22/2021
Onset Date: 10/13/2021
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: POSITIVE COVID TEST 10/13/21

Allergies: Amoxicillin-Pot Clavulanate Diatrizoate Iodinated Diagnostic Agents

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

Symptoms: FEVER, COUGH, SOB

Other Meds: acetaminophen (TYLENOL) 500 MG tablet budesonide (PULMICORT) 0.25 MG/2ML nebulization suspension ALBUterol (PROAIR RESPICLICK) 108 (90 Base) MCG/ACT inhalation powder atorvastatin (LIPITOR) 20 MG tablet loratadine (CLARITIN) 10 MG table

Current Illness:

ID: 1785395
Sex: M
Age: 50
State: PA

Vax Date: 04/27/2021
Onset Date: 05/26/2021
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: none to date.

Allergies: none

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

Symptoms: Constant pain at injection site persists. Arm losing muscular strength and pain when arm is engaged in any physical activity. Losing grip strength in hand.

Other Meds: none

Current Illness: none

ID: 1785396
Sex: M
Age: 45
State: MN

Vax Date: 10/14/2021
Onset Date: 10/14/2021
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:

Allergies: no

Symptom List: Ear pain, Hypoaesthesia

Symptoms: This patient lied to the technician about this being their first shot of Covid. He did get a Jassen, but it did not come up in immunization records right away. He only shows up on immunization records when search Patients name. (this was found after he was given the shot.) the patient claimed that he needed a first dose pfizer shot. Before giving the shot he was asked again if this was his first shot, he said yes. He lied, after giving the shot he mentioned about Janssen shot. Then he said he was mistaken and he did not get it. But searching a little harder immunization records after, it looks like he did get the shot. He is informed he cannot get a second pfizer shot.

Other Meds: no

Current Illness: no

ID: 1785397
Sex: F
Age: 54
State: MN

Vax Date: 08/03/2021
Onset Date: 10/12/2021
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:

Allergies: none

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Symptoms began 2 days ago with mildly productive cough and sinus congestion starting 10/12/21

Other Meds: Tylenol 325 MG Tablet 1 tablet as needed Orally every 4 hrs Ibuprofen 200 MG Tablet 2 tablets with food or milk as needed Orally every 6 hrs Tums 500 MG Tablet Chewable 1 tablet Orally Once a day be for bed as needed Aspirin Adult

Current Illness: none

ID: 1785398
Sex: F
Age: 71
State: GA

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

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

Lab Data:

Allergies:

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

Symptoms: Error: Incorrect Reconstitution-

Other Meds:

Current Illness:

ID: 1785399
Sex: M
Age: 69
State: IA

Vax Date: 10/06/2021
Onset Date: 10/07/2021
Rec V Date: 10/14/2021
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: None

Allergies: NKA

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

Symptoms: 1 day post vaccination: severe fatigue, nausea, sweating, cold sweats, low-grade fever. Loss of 29 lbs in 1 week. Hallucinations, fire department responded to both he and his wife not being aware of surroundings and did CO2 house check. No signs of carbon monoxide poisoning. Patient refused hospitalization.

Other Meds:

Current Illness: none notable

ID: 1785400
Sex: F
Age: 57
State: NY

Vax Date: 10/06/2021
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: LA

Lab Data:

Allergies: Cow's Milk Protein

Symptom List: Unevaluable event

Symptoms: I received the vaccine on 10/6/21. In the early morning of 10/7/21 I woke up with nausea. I walked to the bathroom, then the kitchen holding onto walls and counters due to dizziness. When I reached the kitchen, vertigo began and I fell over as the room continued to spin. My spouse found me on the floor and helped me return to bed. During the day I experienced body aches, fever of 101.1, nausea, dizziness, headache, and extreme fatigue. It is now 8 days since the vaccine, and I still have intermittent dizziness, headache, and fatigue. (I did not experience any adverse effects from the first COVID vaccine, and I only experienced soreness at the injection site and a mildly elevated temperature, 99, from the second vaccine.)

Other Meds: Sertraline - 150mg/day Trazodone - 50mg/day Multivitamin Vitamin D Fish Oil

Current Illness: None

ID: 1785401
Sex: M
Age: 72
State: GA

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: LA

Lab Data:

Allergies:

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

Symptoms: Error: Incorrect Reconstitution-

Other Meds:

Current Illness:

ID: 1785402
Sex: M
Age: 69
State: MN

Vax Date: 02/26/2021
Onset Date: 03/01/2021
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: I experienced hives

Other Meds:

Current Illness:

ID: 1785403
Sex: M
Age: 18
State: CA

Vax Date: 08/20/2021
Onset Date: 08/27/2021
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: Not reported

Allergies: None

Symptom List: Injection site pain, Menorrhagia

Symptoms: Chest tightness Shortness of nreath

Other Meds: Vitamins C D Multi

Current Illness: None

ID: 1785404
Sex: M
Age: 24
State: OH

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

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

Lab Data: Ultrasound confirmed blood clot (9/11/2021)

Allergies:

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

Symptoms: Blood clot formation in left calf 4 days after receiving first dose of the Covid shot. Started as pain in the left calf and progessivley got worse between Monday 9/6/2021 and Friday 9/10/2021. Went to the ER on 9/11/2021. Currently on Eliquis for 3 months. I do not have a history of any blood related issues. I have always had good blood pressure.

Other Meds: omeprazole

Current Illness:

ID: 1785405
Sex: F
Age: 49
State: TX

Vax Date: 04/09/2021
Onset Date: 08/21/2021
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: COVID test - positive

Allergies: no

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Friday, I felt like a sinus or bronchitis infection - though it was allergies bought COVID home test, that Saturday on 21AUG2021. I couldn't smell my pork chop dinner. Tested positive for COVID. Husband was negative, Went to Urgent care and was positive. Normally I do lose my taste and smell for all my sinus infection. It was like a common cold and no fever.

Other Meds: no

Current Illness: no

ID: 1785406
Sex: F
Age: 81
State: IN

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: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Error: Incorrect Reconstitution-

Other Meds:

Current Illness:

ID: 1785409
Sex: F
Age: 39
State: AZ

Vax Date: 08/27/2021
Onset Date: 09/03/2021
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: Headache Fatigue Blurry vision Watering eye Cloudy judgment

Other Meds: Sythroid, Valtrex, Minocycline, B12,

Current Illness: Thyroid

ID: 1785411
Sex: F
Age: 74
State: IN

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: RA

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: Error: Incorrect Reconstitution-

Other Meds:

Current Illness:

ID: 1785412
Sex: M
Age: 39
State: MO

Vax Date: 10/11/2021
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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NONE

Symptom List: Injection site pain

Symptoms: PATIENT WAS ADMINISTERED AN UNDILUTED DOSE (0.3 mL) OF PFIZER VACCINE BY EMT VOLUNTEER VACCINATOR FROM FIRE DEPARTMENT DURING OUTREACH CLINIC. HEALTH DEPARTMENT PROVIDED VACCINE AND SITE COORDINATION.

Other Meds: NONE

Current Illness: NO

ID: 1785413
Sex: F
Age: 84
State: AZ

Vax Date: 10/01/2021
Onset Date: 10/01/2021
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: lisinopril, naproxen, CHLOROXYLENOL, dexamethasone, nickel, tixocortol

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

Symptoms: Patient reports rash on groin initially that progressed to her ankles and later noted on her arms/both upper and lower. Described as a numerous small patches with red bumps on the surface. Non pruritic.

Other Meds: Tylenol, amlodipine, aspirin, calcium carbonate, cetirizine, b12, diphenhydramine-night before, docusate sodium, ergocalciferol high dose, fluticasone nasal spray, folic acid, losartan, MVI-AREDS2, Lutein/Zeanthin and additional MVI w/folat

Current Illness: none

ID: 1785414
Sex: F
Age: 48
State: MI

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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: N/A

Allergies: Nka

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

Symptoms: Red, itchy, red bumps on left arm. PT denies chest pain, shortness of breath and any other symptoms. Was given 25mg Benadryl and water. Remain in observation for 30 more minutes. Pt stated that her arm was no longer itchy.

Other Meds: None

Current Illness: None

ID: 1785415
Sex: F
Age: 66
State: WA

Vax Date: 09/28/2021
Onset Date: 09/28/2021
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: CBC; Urine test; Blood work

Allergies: Ampicillin; doxycycline; sulfa drugs; erythromycin; PREMARIN; ciprofloxacin; lidocaine; metronidazole; IV iodine; quinacrine; latex; hydroxychloroquine

Symptom List: Tremor

Symptoms: Sore arm; Underarm pain; Nausea; Headaches; Balance issues; Urinary frequency; Low-grade fever; Diarrhea; Body aches & pain; Shortness of breath. Recurring or worsening symptoms: Cramping in abdominal area; Abdominal pain; Stomach pain; Fatigue; Achiness.

Other Meds: Potassium; vitamin D

Current Illness: N/A

ID: 1785416
Sex: F
Age: 70
State: NC

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

Allergies: Nuts, Erythromycin and Codeine. Bee stings.

Symptom List: Erythema, Pruritus

Symptoms: She got her vaccine, she felt fine until that evening she started feeling bad, had 3rd booster, but during the night she was practically delirious When she woke up in the morning her temp was climbing 103.4, got it down with Tylenol, really bad headache. The worst problem was her heart, has a normal resting heart rate of 50, and it was going from 50-90, shooting up and plummeting. This went on all day. Went on all Monday, got some sleep Monday night. Woke up Tuesday, still had the headache. Her temp got down to normal during the day and finally felt better. By Wednesday she was OK. She called her PCP, cardiologist and her dermatologist. Her dermatologist told her not to take anything she didn't need to take. Her PCP told her to take Tylenol. Her Cardiologist told her to take it easy for the next two days, just lie around.

Other Meds: Eliquis, Losartan, metoprolol ER, Doxycycline around 3:30 PM that day.

Current Illness: None.

ID: 1785417
Sex: F
Age: 69
State: CA

Vax Date: 10/13/2021
Onset Date: 10/13/2021
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: Eggs, wheat, yeast, soy, Vicodin, cymbalta, latex

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

Symptoms: I got the chills, then hot flashes all night long. Also, by early morning hours a migraine with nausea developed. All-over muscle aches by morning.

Other Meds: Wixela, Flonase, dutasteride, estradiol, Zyrtec, GABA Amino acid

Current Illness: None

ID: 1785418
Sex: F
Age: 45
State: IL

Vax Date: 10/05/2021
Onset Date: 10/06/2021
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: CBC/CMP ordered

Allergies: Denies

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

Symptoms: 45-year-old female RN was received a flu shot and COVID shot on 10/05/2021. She reports she after the she developed pain with subsequent drowsiness and intense burning on the ventral surface of her proximal her upper extremities (in the proximity of the biceps brachi) and axilla?s She felt that she felt that her lymph nodes were swollen as well. She fells that he area is warm as well. She had not had reactions to immunizations previously. She tells me that she has been using Tylenol and Ibuprofen 800. She denies fevers or recent illness. She reports a Hx of Migraine headaches and uses Rrizatriptan, Emgality and drospirenone-ethinyl estradiol OCP. She denies possibility of pregnancy or allergies. She reports a 5/10 constant burning pain with no aggravating factors on the left and a 2/10 constant burning pain with no aggravating factors on the right.

Other Meds: Rrizatriptan, Emgality and drospirenone-ethinyl estradiol OCP

Current Illness: Denies

ID: 1785419
Sex: F
Age: 75
State: TX

Vax Date: 03/31/2021
Onset Date: 03/31/2021
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: NONE

Allergies: NKA

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: RECEIVED FIRST DOSE MODERNA COVID VACCINE 1/27/2021. RECEIVED SECOND DOSE PFIZER COVID VACCINE 3/31/2021

Other Meds: NOT RECORDED

Current Illness: NOT REPORTED

ID: 1785420
Sex: F
Age: 37
State: NC

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: 011J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: pcn

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

Symptoms: left arm and neck rash, throat itching, tongue felt "funny"

Other Meds:

Current Illness:

ID: 1785422
Sex: M
Age: 76
State: RI

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

Lab Data:

Allergies:

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

Symptoms: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-

Other Meds:

Current Illness:

ID: 1785423
Sex: F
Age: 48
State: WI

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:

Allergies: None

Symptom List: Pain in extremity

Symptoms: Body aches Headache

Other Meds: Spironolactone Omega 3 Multivitamin Calcium with vit D Cetirizine Flonase

Current Illness: A cold 2 weeks prior

ID: 1785424
Sex: F
Age: 43
State: TX

Vax Date: 10/14/2021
Onset Date: 10/14/2021
Rec V Date: 10/14/2021
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: Breast fed right after receiving vaccine. Baby immediately broke out with facial rash and signs of lethargy 0 labored breathing noted. Cleared by EMS.

Other Meds:

Current Illness:

ID: 1785425
Sex: F
Age: 82
State: IA

Vax Date: 02/08/2021
Onset Date: 02/16/2021
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: Patient had dementia, and presented for a Moderna COVID vaccine on 2/8/21 and 2/16/21, so she received her two doses only 8 days apart. Patient had no unusual outcome, but was told not to get another dose in February/March.

Other Meds:

Current Illness:

ID: 1785426
Sex: F
Age: 27
State: WY

Vax Date: 09/08/2021
Onset Date: 09/13/2021
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: none

Allergies: none

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

Symptoms: Some food smells turned to skunk-like. I was 6 weeks pregnant at the time, and it was a few days after my 1st vaccine dose when some food smells turned very sour. I have been pregnant two times previously, and neither of those pregnancies resulted in modified taste or smell. I lost my taste and smell initially in May 2021 when I presumably had COVID-19, but I didn't ever test to confirm. Loss of taste and smell were the only symptoms. My taste and smell were recovering slowly when I became pregnant and received the 1st dose of the vaccine. I had not experienced a bad smell or taste up to that point. A few days later my smell started to turn sour. I have experienced some pregnancy related nausea and food aversions simultaneously. My estimated date of delivery is 05/08/2022.

Other Meds: Prenatal Vitamin

Current Illness: none

ID: 1785427
Sex: F
Age: 60
State: NJ

Vax Date: 10/12/2021
Onset Date: 10/12/2021
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: Systemic: Allergic: Itch Generalized-Severe, Systemic: Allergic: Rash (specify: facial area, extremeties)-Severe

Other Meds:

Current Illness:

ID: 1785428
Sex: M
Age: 18
State: TX

Vax Date: 01/12/2021
Onset Date: 10/12/2021
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: Respiratory panel with Covid PCR

Allergies: NKDA

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient tested positive for Covid-19 on 10-12-2021.

Other Meds:

Current Illness: Asthma

ID: 1785429
Sex: M
Age: 22
State:

Vax Date: 10/14/2021
Onset Date: 10/14/2021
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: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: GIVEN 2 DAYS EXPIRED; NO ADVERSE EVENT.

Other Meds:

Current Illness:

ID: 1785430
Sex: F
Age: 91
State: MD

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: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Codeine, Penicillin, Betadine, Shellfish.

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Administration error : On 05/03 patient received 1st dose of vaccination was Janssen, and received Pfizer vaccination on 10/14.

Other Meds:

Current Illness:

ID: 1785431
Sex: M
Age: 67
State: KY

Vax Date: 03/10/2021
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: RA

Lab Data: POSITIVE COVID-19 PCR TEST ON 10/02/2021

Allergies: NO KNOWN ALLERGIES

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

Symptoms: BREAKTHROUGH HOSPITALIZATION

Other Meds: clopidogrel 75 mg tablet 75 mg PO DAILY lisinopril 20 mg tablet 5 mg PO DAILY tab bisoprolol fumarate 10 mg tablet 5 mg PO DAILY tab aspirin 81 mg tablet,delayed release 81 mg PO DAILY tab allopurinol 100 mg tablet 100 mg PO

Current Illness: HYPERTENSIVE HEART DISEASE, ACUTE RESPIRATORY FAILURE, ACUTE COVID-19

ID: 1785432
Sex: F
Age: 57
State: TX

Vax Date: 10/12/2021
Onset Date: 10/12/2021
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: None

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

Symptoms: Approximately 3 hours after receiving the J & J vaccine I developed a bad headache. I took 2 Ibuprofen but still had a slight headache. On Wednesday, Oct. 13th, I still had a headache and as the day progressed it became more intense. At approximately 6 p.m. I started to feel achy and anxious. About an hour later a severe fever began. My body not only aches but I would rate the amount of pain at around an 8. My husband wanted to take me to the hospital but I did not think I could handle the trip and did not want to call an ambulance knowing that this was more than likely a response to the vaccine. This hell lasted for about 12 hours. I am writing this on the 14th of October. It is 2:00 p.m. and I am still running a slight fever with fatigue and headache. This struggle has been much more difficult than when I had Covid-19.

Other Meds: None

Current Illness: None

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am