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: 1785539
Sex: M
Age: 26
State:

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: ADMINISTERED 2 DAYS PAST EXPIRATION DATE. NO ADVERSE REACTION.

Other Meds:

Current Illness:

ID: 1785540
Sex: M
Age: 72
State:

Vax Date: 02/11/2021
Onset Date: 10/14/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: breakthrough case

Other Meds:

Current Illness:

ID: 1785541
Sex: F
Age: 59
State: FL

Vax Date: 05/21/2021
Onset Date: 05/22/2021
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: MRI C spine 6/23/21showing moderate spinal stenosis at C4 ? 5, C5 ? 6, C6 ? 7 with degenerative disc disease at those levels. 8/20/21 EMG and nerve conduction studies: denervation in median and ulnar innervated muscles, as well as other muscles innervated by lower trunk of brachial plexus. there was no entrapment at the elbow. 8/20/21 labs normal ESR, CRp, copper, TSH, sjogrens ab, immunoglobulins, MAG Ab, RF, ANA, B12, folate, GM1 ab, CK, CBC, CMP, immunofix serum, paraneoplastic Ab. 9/10/21 MRI brachial plexus : long segment hyperintensity of the right C8 root, no enhancement. moderate lower cervical spondylosis.

Allergies: none

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

Symptoms: malaise, flu like symptoms x 10 days followed by severe Right interscapular area pain on 6/12/21. Developed progressive weakness of the Right upper extremity over weeks. Pain improved in a few days. Developed right hand atrophy.

Other Meds: venlafaxine, bupropion, omeprazole

Current Illness:

ID: 1785542
Sex: M
Age: 38
State:

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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: ADMINISTERED 2 DAYS PAST EXPIRATION DATE. NO ADVERSE REACTION.

Other Meds:

Current Illness:

ID: 1785543
Sex: F
Age: 40
State: AK

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: 10/2/21: cbc, D-Dimer, Comprehensive metabolic panel, liver enzymes, CRP high sensitivity, Creatinine Kinase, TSH 10/4/21 NT-proBNP, lower extremity venous duplex scan, 10/5/21 CBC, NT-pro BNP, Comprehensive metabolic panel, liver enzymes, urine microalbumin random, urine creatinine random, microalbumin/creatinine ratio 10/7/21 pelvic ultrasound

Allergies: Gabepentin

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

Symptoms: She developed significant lower extremity edema within 24 hours of COVID vaccination #3. She also had lymphadenopathy in her groin, and this was considered reactive from immunizaton and the primary cause of edema, as all other factors were excluded including DVT, heart and liver disease

Other Meds: Valacyclovir, topirimate, tizanidine, spirnolactone, cosentyx, topical salicylic acid, pramipexole, ondansetron, botox, hydroquinone topical, flucinolone topical, ferrous gluconate, ethinyl estradiol-northeindrone, escitalopram, colace, vit

Current Illness: none

ID: 1785544
Sex: F
Age: 69
State: ME

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

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

Symptoms: Local histamine based reaction with in 5 minutes of dose and resolved in 30 minutes with benadryl

Other Meds: gabapentin, b12, vitamin d, calcium, glucosamine, multi vitamin

Current Illness:

ID: 1785545
Sex: F
Age: 36
State: FL

Vax Date: 09/06/2021
Onset Date: 10/05/2021
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: Pyrexia, White blood cell count decreased

Symptoms: Patient seen at Clinic 10 days after administration of Moderna vaccine. Vaccine given at pharmacy and as per patient symptoms of SOB/Chest discomfort started 2 to 3 days after second dose of vaccine 10/5/2021 and has not improved. Patient was instructed to follow up at Emergency room for re-evaluation of her symptoms.

Other Meds:

Current Illness:

ID: 1785546
Sex: F
Age: 65
State: WI

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: UNK
Vax Route: IM
Vax Site: LA

Lab Data: Rapid Test - POSITIVE PCR - NEGATIVE

Allergies: None.

Symptom List: Pharyngeal swelling

Symptoms: 10 hours after receiving shot - low grade fever, sore arm, extreme fatigue, no smell or taste.

Other Meds: None.

Current Illness: None.

ID: 1785547
Sex: M
Age: 28
State:

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:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: ADMINISTERED 2 DAYS PAST EXPIRATION DATE. NO ADVERSE REACTION.

Other Meds:

Current Illness:

ID: 1785548
Sex: M
Age: 33
State: FL

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

Lab Data: EKG, Chest X-ray, blood work

Allergies: No

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Immediate palpitation and shortness of breath upon second dose. One day after I went to the hospital for extreme palpitations, and slow heart rate under 59bpm. Very high anxiety since vaccination. Also headache and brain fog.

Other Meds: Fish oil, multivitamin, ashwagandha, b complex

Current Illness: Anxiety, palpitations, sleep apnea

ID: 1785549
Sex: F
Age: 57
State: NJ

Vax Date: 03/10/2021
Onset Date: 03/10/2021
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 sure tests done at ER

Allergies: none

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

Symptoms: high temperature 102.5, body aches, chills, headache, nausea, dehydration, Went to ER the next morning as could not hydrate myself. Got pain meds and IV fluids , went home Illness repeated itself twice over the next two days, each time less severe than the time before. All well after three days

Other Meds: Duloxetine, Bystolic, One a day vitamin

Current Illness: none

ID: 1785550
Sex: F
Age: 28
State: PA

Vax Date: 04/10/2021
Onset Date: 05/01/2021
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: Left breast ultrasound which found a cyst as mentioned above.

Allergies: Amoxicillin

Symptom List: Rash, Urticaria

Symptoms: Some time within a few weeks to a month after my 2nd vaccine my left breast began to hurt very badly. I would have random sharp pains near my nipple all throughout the day and my entire breast was sore. Any movement, accidental bump, etc. was very painful. After several weeks I decided to see my OBGYN. I knew to wait at least 6 weeks after my vaccination. A small lump was found in that breast near my nipple. An ultrasound was completed and they are claiming it is a cyst but they did not perform a biopsy which I'm considering demanding as the pain is not as strong but it is still there and I worry it could turn cancerous. I did get swollen lymph nodes that began the same day as my vaccine and lasted several days. The doctor confirmed that my lymph nodes were NOT swollen at the time that I had the lump evaluated.

Other Meds: Cryselle-28 and Escitalopram

Current Illness: None

ID: 1785551
Sex: M
Age: 54
State:

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:

Allergies:

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

Symptoms: ADMINISTERED 2 DAYS PAST EXPIRATION DATE. NO ADVERSE REACTION.

Other Meds:

Current Illness:

ID: 1785552
Sex: F
Age: 50
State: ND

Vax Date: 02/19/2021
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: none

Allergies: Sulfa

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

Symptoms: CT heart score completed and incidental finding of Small pericardial effusion

Other Meds: lisinopril

Current Illness: none

ID: 1785553
Sex: F
Age: 46
State: NM

Vax Date: 10/12/2021
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: none

Allergies: AMPICILLIN, PROMETHAZINE

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

Symptoms: swollen area in left clavicule with painful lump .

Other Meds: IBUPROFEN 400 MG (10/13/21)

Current Illness: NONE

ID: 1785554
Sex: F
Age: 28
State: MN

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

Lab Data:

Allergies: Most trees and grasses, especially birch trees and Timothy grass. Cherrys, redness reducer in eyedrops, dust, pollen, animal dander

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

Symptoms: Extremely heavy period symptoms. I have my second mirena IUD and have been using this method of birth control for the last 7 years. I stopped having periods all together. I would still get irritated and slightly more emotional during my cycle, but I would only spot once every 6 months or so. Since getting my first dose of phizer 2 days ago now I have had a significant amount of discharge (not blood) extremely severe abdominal cramping, that almost made me go into the ER (and I typically avoid that place like the plague) extreme emotional swings, increased depression and self harm urges, and mood swings.

Other Meds: Vitamins, Xyzal allergy,

Current Illness: No

ID: 1785555
Sex: M
Age: 80
State:

Vax Date: 01/29/2021
Onset Date: 10/12/2021
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:

Allergies:

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

Symptoms: breakthrough case

Other Meds:

Current Illness:

ID: 1785556
Sex: M
Age: 41
State: CA

Vax Date: 09/30/2021
Onset Date: 09/30/2021
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: NKA

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient unintentionally received a dose of Moderna Covid vaccine 35 days after, it is believed, completing the Pfizer series in August 2021 (#1- 8/5 or 8/6 #2- 8/26/21) at another facility. Per current medical consultant - patient did not experience any adverse effects associated with the Moderna vaccination.

Other Meds: Benztropine 1mg BID, haloperidol decanoate 100mg IM q4weeks, olanzapine 10mg po HS

Current Illness:

ID: 1785557
Sex: F
Age: 35
State:

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

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: ADMINISTERED 2 DAYS PAST EXPIRATION DATE. NO ADVERSE REACTION.

Other Meds:

Current Illness:

ID: 1785558
Sex: F
Age: 24
State:

Vax Date: 10/14/2021
Onset Date: 10/14/2021
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: ADMINISTERED 2 DAYS PAST EXPIRATION DATE. NO ADVERSE REACTION.

Other Meds:

Current Illness:

ID: 1785559
Sex: F
Age: 33
State: MO

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: 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: Vaccine given 3 days past vial expiration date

Other Meds:

Current Illness:

ID: 1785560
Sex: M
Age: 31
State:

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:

Allergies:

Symptom List: Unevaluable event

Symptoms: ADMINISTERED 2 DAYS PAST EXPIRATION DATE. NO ADVERSE REACTION.

Other Meds:

Current Illness:

ID: 1785561
Sex: F
Age: 69
State: KY

Vax Date: 10/02/2021
Onset Date: 10/03/2021
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: LA

Lab Data: None

Allergies: Flu shot; blue dye; a lot of additives put in generic drugs

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

Symptoms: Tiredness and a sore arm.

Other Meds: None

Current Illness: None

ID: 1785562
Sex: M
Age: 61
State: KY

Vax Date: 10/08/2021
Onset Date: 10/08/2021
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: None

Allergies: Sulfa

Symptom List: Injection site pain, Pain

Symptoms: Patient's first and second dose of Covid vaccine was Pfizer. Third dose ordered as Moderna in error. No symptoms. Pt feels well. No treatment needed.

Other Meds: Albuterol Lipitor Cipro eye drops Farxiga Trulicity Gabapentin IBP Lisinopril/HCTZ Metformin Actos Revatio

Current Illness: PVD

ID: 1785563
Sex: M
Age: 31
State:

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: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: ADMINISTERED 2 DAYS PAST EXPIRATION DATE. NO ADVERSE REACTION.

Other Meds:

Current Illness:

ID: 1785564
Sex: M
Age: 73
State: MN

Vax Date: 03/01/2021
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: SYR
Vax Site: LA

Lab Data: POSITIVE COVID TEST 10/12/21

Allergies:

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

Symptoms: SHORTNESS OF BREATH, WEAKNESS.

Other Meds: Aspirin 81 mg oral enteric coated tablet Atorvastatin (LIPITOR) 80 mg oral tablet Calcium 500 mg, 1250 mg,-vitamin d 200 units (OSCAL-D) oral tablet Celexa 20mg tablet Insulin glargine (LANTUS) 100 unit/mL SubQ vial

Current Illness:

ID: 1785565
Sex: F
Age: 43
State: VA

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: Nausea, Pain in extremity, Pyrexia

Symptoms: weakness all over body, unsteady, leg buckling, trouble walking in straight line, trouble going down stairs, trouble speaking, headache, trouble with word finding

Other Meds:

Current Illness:

ID: 1785566
Sex: F
Age: 49
State: IN

Vax Date: 04/22/2021
Onset Date: 04/27/2021
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: ER visit 4/30/21-5/1/21: EKG, blood tests, chest x-rays, chest CT scan with IV contrast;

Allergies: Dermabond, Lamictal, Elavil, Nuclear scan dye, Tetracyclines, Beyaz, Zithromax

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Five days after 2nd dose of Moderna, I had some pain in bottom of right lung. By early the next morning, I had severe pain on the whole right side of my chest, particularly when trying to take a breath. Pain was worse when lying down. I went to ER 2 days later and was diagnosed with multiple pulmonary embolisms in both lungs and a pulmonary infarct in the lower lobe of the right lung. I was instructed to discontinue the birth control pills I was taking. Doctors could not say for certain if the vaccine was a factor in causing the clots. I'm now prescribed an anticoagulant medication. I now have a pulmonologist. Current status of clots unknown.

Other Meds: Zoloft, Buspar, Topomax, Depakote ER, Atenolol, Flexeril, Lunesta, Methylphenidate, Flonase, Fexofenadine HCl, Nexium, Tylenol, Centrum multivitamin;

Current Illness: None besides chronic health conditions.

ID: 1785569
Sex: M
Age: 34
State: MN

Vax Date: 02/19/2021
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: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: Tested PCR positive for COVID 10/14/21 after being fully vaccinated.

Other Meds:

Current Illness:

ID: 1785570
Sex: F
Age: 73
State: CA

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: RA

Lab Data:

Allergies: Penicillin, Gabapentin, Percocet.

Symptom List: Nausea

Symptoms: Double vision, fatigue.

Other Meds:

Current Illness: None.

ID: 1785571
Sex: M
Age: 42
State:

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: LA

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: ADMINISTERED 2 DAYS PAST EXPIRATION DATE. NO ADVERSE REACTION.

Other Meds:

Current Illness:

ID: 1785572
Sex: F
Age: 54
State: FL

Vax Date: 08/01/2021
Onset Date: 08/26/2021
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: I went to my primary doctor and reported these side effects to him and his response was that my immune system is just probably reving up to protect me from the virus. He never recommended any test be done. I?m afraid to go to the E.R. For fear of catching the vaccine so I don?t know what to do now. I?m at a lost.

Allergies: None/Unknown

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

Symptoms: About two days after taking the vaccine my face was twisting up as if I was having a stroke. Then my vision became blurry, my face was swollen and I had headaches, now the left side of my face keeps twisting like the nerves are jumping in my face. My left eye and bottom left side of my face keeps jumping like something to do with my nerves.

Other Meds: Verapamill, Lisinopril, chlonozepham

Current Illness: Back pain, nerve pain, osteoarthritis

ID: 1785573
Sex: M
Age: 45
State: CA

Vax Date: 04/10/2021
Onset Date: 04/13/2021
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: RA

Lab Data: Cat-Scan 04/16/2021 Ultrasound 04/16/2021 Blood Work 04/16/2021

Allergies: Pennicillin, Bee Stings

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

Symptoms: Pt. states that after receiving the 1st dose of J&J 04/10/2021, started experiencing symptoms 04/13/2021 of abdominal pain, Emergency Room visit 04/16/2021 * (160) Blood Clots located in the Abdomen area. Cat-Scan, Ultrasound, Blood Work done. Loss of weight, clots located in bowel movements. Still continuing to experience symptoms, no Follow-Up with Treating Physicians.

Other Meds: N/A

Current Illness: N/A

ID: 1785574
Sex: F
Age: 12
State: NJ

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Tremor

Symptoms: About 10 minutes after the vaccine, the patient's arm went numb and then became painful. Patient got dizzy and had tunnel vision. This resolved after 5 minutes of sitting down. The next morning (Friday, 10/8), patient woke with a bad headache and remained home from school. Tylenol was taken throughout the day. Friday evening, patient complained that it was difficult to breathe and there was a pain in the center of her chest. Patient took 2 puffs of Albuetrol, which did not resolve the symptoms. After 30 minutes, patient took Benadryl. An hour later, breathing was better but patient indicated it felt like her chest was being squeezed. Saturday morning, patient woke with headache and a feeling of the chest being squeezed and not being able to get enough air. Doctor was consulted via phone and advised to give ibuprofen, to use a heating pad on the chest, and to limit activity. Ibuprofen would help with the pressure feeling but would need to be given every 4-5 hours to prevent the feeling. This continued all through Sunday and Monday (patient missed school again). On Tuesday, the patient woke with no headache but still had the uncomfortable pressure (which was slightly better). Patient returned to school after taking ibuprofen. Gradual improvement was seen Wednesday and Thursday. Patient is still taking ibuprofen as the pressure pain comes and goes. Patient indicated that there have been a couple of episodes of her vision getting blurry in school since returning.

Other Meds: None

Current Illness: None

ID: 1785575
Sex: F
Age: 46
State: NM

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: The vaccine, Flublock Quadrivalent, was stored outside of the expected temperature range (36-46F) for 96 hours with a maximum temperature reaching 51.8F. The manufacturer, has reported that the product becomes invalid when stored in temperatures above 46F up to 72 hours or more. CDC recommendations are to have the employee re-vaccinate and may do so immediately, no need to wait. Employee notified of event. Unable to reschedule at this time, as our clinic is out of stock. To notify employee when restocked.

Other Meds:

Current Illness:

ID: 1785576
Sex: M
Age: 30
State: TX

Vax Date: 09/09/2021
Onset Date: 09/09/2021
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: no medical tests complete

Allergies: allergy to CECLOR

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

Symptoms: pt experienced itchiness, shortness of breath, headaches, blood in stool. pt was seen a local ER out in town. pt was given prednisone and famotidine.

Other Meds: FAMOTIDINE, PREDNISONE

Current Illness: NONE

ID: 1785577
Sex: F
Age: 31
State: MO

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: n/a

Allergies: Sulfa antibiotics - hives and vomiting

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

Symptoms: swollen and hot injection site, chills and nausea/vomiting

Other Meds: Advair, Vyvanse, Allegra, Escitalopram

Current Illness: none

ID: 1785578
Sex: M
Age: 39
State:

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: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: ADMINISTERED 2 DAYS PAST EXPIRATION DATE. NO ADVERSE REACTION.

Other Meds:

Current Illness:

ID: 1785579
Sex: M
Age: 43
State: IL

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: NKDA

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

Symptoms: Patient lost consciousness about 5 minutes after receiving vaccine. Called paramedics, when they arrived he was hypotensive. Patient was taken to hospital for obeservation. He was AOx3 while he was being transported.

Other Meds: N/A

Current Illness: N/A

ID: 1785580
Sex: F
Age: 34
State: OK

Vax Date: 09/20/2021
Onset Date: 09/22/2021
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: None

Allergies: None

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

Symptoms: Ringing of the ears several times a day almost every day or every other day. Ringing will last about 10-20 seconds and stop.

Other Meds: Prenatal vitamin, vitamin d3, fish oil

Current Illness: None

ID: 1785581
Sex: F
Age: 56
State: MI

Vax Date: 09/22/2021
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: Tuesday 10/05/21 9:00 am Covid test. Results negative

Allergies: none

Symptom List: Pain in extremity

Symptoms: Received shot 09/22/21 10:30 am Adverse effects: Friday 09/24/21 1:30 am - mild soreness in arm when lifting, mild fever, mild body aches, mild nasal congestion, fatigue Friday 09/24/21 8:00 am - mild soreness in arm when lifting, fever with increased feeling of fever in head and spine, mild body aches, nasal congestion, extreme fatigue Sunday 09/26/21 8:00 am - no soreness in arm, increased fever with feeling of increased fever in head, spine, and chest, body aches, nasal congestion, mild chest congestion but feeling of inability to expand lungs for full breaths, extreme fatigue Tuesday 09/27/21 8:00 am - fever with feeling of higher fever in head, spine, and chest, body aches, nasal congestion, increased but mild chest congestion with increased feeling of inability to expand lungs for full breaths, fatigue Tuesday 10/05/21 9:00 am much reduced head/chest congestion, low grade fever, mild inability to get full breaths, deep coughing especially in early morning. Saw pharmicist where I received shot. Pharmacist advised taking Tylonel severe cold and flu, rest, and drink lots of fluids. Purchased the medication and took one does in morning and a second in evening for 3 days (I've never taking any medications of any kind with the exception of one Motrin perscribed by a dentist around age 40 following a root canal) Tuesday 10/14/21 4:18 pm mild deep coughing usually in early morning, mild chest congestion

Other Meds: none

Current Illness: none

ID: 1785582
Sex: F
Age: 53
State: TX

Vax Date: 10/10/2021
Onset Date: 10/11/2021
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: N/A

Allergies: Wheat; gluten sensitive

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

Symptoms: I STARTED GETTING A LOT OF CONGESTION AND POST NASAL DRIP, CONGESTION IN CHEST AS WELL, P.A. SUGGESTED ALLERGY MEDICATIONS, EXPECTURANT TO COUGH OUT PHLEGM, DRINK FLUIDS AND TEA, AND TO SLEEP WITH A HUMIDIFIER. TREATMENTS SEEM TO BE WORKING AND SYMPTOMS ARE ALMOST CLEARED UP. Hx of problems with allergies, and congestion.

Other Meds: Montelukast; FLONASE; ZYRTEC; PROLIA; calcium; multivitamin; probiotic with prebiotics

Current Illness: Seasonal allergies

ID: 1785583
Sex: M
Age: 23
State: TN

Vax Date: 04/11/2021
Onset Date: 05/05/2021
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: Brain MRI w/ and w/out contra - negative Brain EEG - negative for epilepsy blood tests

Allergies: none

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

Symptoms: Seizure while 2 days after receiving the second dose of the vaccine. -Siezed, lost consciousness, and was hospitalized 2 days after as I was driving while I had the seziure. NO HISTORY OF SEZIURES

Other Meds: Adderall Whey Protein Finasteride

Current Illness: none

ID: 1785584
Sex: M
Age: 60
State: TX

Vax Date: 05/28/2021
Onset Date: 05/28/2021
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: None

Allergies: Not Reported

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

Symptoms: Second dose administered too early: Received second dose only 17 days after first dose, not 21. (Pfizer).

Other Meds: Not Reported

Current Illness: Not Reported

ID: 1785585
Sex: F
Age: 75
State: TX

Vax Date: 09/24/2021
Onset Date: 09/30/2021
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: all different kinds of blood work/ standard procedure for people who have auto immune disease, but we caught it fast.

Allergies: no

Symptom List: Vomiting

Symptoms: On 09/30/2021, Friday, my legs broke out in a purpura. On the following Tuesday, I went to see a rheumatologist. He prescribed an immediate introduction of prednisone 60 mg for 5 days, 40 mg for 5 days, then 20 mg for 2 weeks, then reduced by 2.5 mg every 2 weeks until reaching 0. I have taken all the doses of 60 mg, I am taking the dosage of 40 mg, and on Saturday I start the 20 mg for 2 weeks. I will be done taking this medication on 02/05/2022. My autoimmune disease was in remission since 2011. 2 weeks after the 3rd dose of Pfizer it flared it up. I am not attributing this to the vaccine. I am just reporting my experience.

Other Meds: Eliquis 5 mg bd azelastine .1% nasal solution Celebrex 100 mg bd vitamin D-3 1800 units od Lasix 20 mg Metoprolol succinate 25 mg od multivitamin potassium chloride 20 meq ER aciphex 20 mg

Current Illness: no

ID: 1785586
Sex: M
Age: 71
State: NY

Vax Date: 03/07/2021
Onset Date: 03/09/2021
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: I had blood work done.

Allergies: I am allergic to Bactrim.

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Two nights after receiving my vaccine, I experienced severe hives from my stomach to my upper legs. I went to ER and was given an IV with antihistamines. This cleared the hives and I was sent home and told to take Benadryl. I have not had any other episodes since.

Other Meds: I was taking Lipitor 10mg per day.

Current Illness: I was not experiencing any illness.

ID: 1785587
Sex: F
Age: 20
State:

Vax Date: 10/07/2021
Onset Date: 10/12/2021
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: none

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

Symptoms: Patient received Moderna dose 1 on 10/7/21, noted an itchy rash on face and neck that began on 10/12/21. She treated with 1 dose of 10 mg loratadine OTC and rash has not returned.

Other Meds: n/a

Current Illness: none

ID: 1785588
Sex: F
Age: 33
State: NY

Vax Date: 02/27/2021
Onset Date: 02/27/2021
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: N/A

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: The day (2/27/2021) I got the first dose of the Moderna Vaccine my left ear started feeling congested/clogged. I thought it would go away. Months later my left ear was still feeling congested; It started hurting and I would intermittently hear "swooshing" sounds, as if I had wind or water in my ear. I went to the doctor months later (9/2021) and was told I had a chronic ear infection and was prescribed 2 weeks of antibiotics. My ear continues to feel clogged w/ water sounds and I will need to go seek care from a ear specialist for further evaluation.

Other Meds: OTC women's vitamins

Current Illness: None

ID: 1785589
Sex: F
Age: 50
State: AR

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

Lab Data:

Allergies: Amitriptyline

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

Symptoms: Patient came in for her first dose and was given a dose that was kept at 41 F and was to be discarded but was given to the patient after the 6 hour mark. called Pfizer. Pfizer conducted additional physical and chemical stability studies which have shown that the vaccine maintains all of its measured quality attributes when the diluted vaccine is stored in the vial at 2 c to 30 c for up to a cumulative period of 24 hours , 6 hours labled time at 8c to 25 c described in the prescribing information +additional 18 hours excursion time at 8 c to 30 c in the vial only.

Other Meds: none

Current Illness: HTN, HYPOTHYROIDISM, DEPRESSION, NEUROPATHY

ID: 1785590
Sex: M
Age: 57
State: KY

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

Lab Data:

Allergies: Fish iodine

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

Symptoms: Pain in knees. some swelling, and pain in lower legs. States MD ruled out blood clots

Other Meds: actos, glimepiride, gardience, libteroxin, omperazole, aspirin, losartan, amipine, potassium, metropzole, carbamazeime, ducalax, simtcione, loperamide, fiber, imodium

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am