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**
PLEASE CHECK BACK SOON
Download the files above while you wait.







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: 1785700
Sex: M
Age: 78
State: IL

Vax Date: 09/18/2021
Onset Date: 09/25/2021
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 to report.

Allergies: NSAIDS

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient received the vaccine on 9/18/21 and had nothing to report at that time in regards to adverse events or side effects. About a week after receiving the vaccine he noticed a small bump and bruising in the location of where he received the vaccine. It is not painful, hot, and there is no discomfort according to the patient. The bruising started dark purple in that one spot and has slowly started to dissipate along with the bump decreasing in size.

Other Meds: Zolpidem 10mg, Hydrochlorothiazide 12.5mg, Clopidrogel 75mg, Tamsulosin 0.4mg, Metformin 500mg, Losartan 50mg, Atorvastatin 40mg, Allopurinol 300mg, Propranolol ER 80mg.

Current Illness: None to report

ID: 1785702
Sex: F
Age: 17
State: TX

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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: none

Symptom List: Anxiety, Dyspnoea

Symptoms: 17 Y/O PATIENT GOT A PFIZER BOOSTER WHICH IS ONLY RECOMMENDED FOR 18 Y/O AND ABOVE. PATIENT CURRENTLY HAS NO ADVERSE REACTIONS OR SIDE EFFECTS. WE CONTACTED PFIZER AND PER PFIZER NO RECOMMENDATIONS RIGHT NOW BUT PFIZER SAFETY DEPARTMENT WILL CALL US BACK IF NEEDED. PFIZER INTERACTION I.D NUMBER

Other Meds: none

Current Illness: none

ID: 1785703
Sex: M
Age: 47
State: IL

Vax Date: 04/13/2021
Onset Date: 04/15/2021
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: Blood tests, MRI, CT scan

Allergies: None

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

Symptoms: After receiving my 2nd dose, I started feeling unwell. I also started hearing voices, which has never happened before. On 09/22/2021 around 6 pm, I started shaking and I fell to the ground. When I went to the ER, I was diagnosed with epileptic seizure.

Other Meds: Lisinopril; glimepiride; esomeprazole; pentoxifylline; Farxiga; simvastatin; Janumet; aspirin; levetiracetam; Keppra

Current Illness: None

ID: 1785704
Sex: F
Age: 73
State: CA

Vax Date: 09/24/2021
Onset Date: 10/03/2021
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: none

Allergies: none

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: I had an infection in my eyes that resulted in my eyes watering, runny nose, and pain in the left and right eye. The left eye was worse. I went to an urgent care on 10/8/2021. The doctor said it was an unusual eye infection, and the ducts in my eyes were plugged. I was prescribed Ofloxacin eye drops 4xday and told to wash my eyes with cotton balls.

Other Meds: Amlodipine 5mg, 1xday Hydroxychloroquine 200mg Xalatan 1xday Toprol XL Mucinex Ofloxacin 4xday

Current Illness: none

ID: 1785705
Sex: M
Age: 56
State: CO

Vax Date: 04/19/2021
Onset Date: 05/12/2021
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: LA

Lab Data: None

Allergies: No

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

Symptoms: Ringing in the ears constantly still occurring since the 2nd dose.. No history of tinnitus up to this date

Other Meds: Lisinopril

Current Illness: No

ID: 1785706
Sex: M
Age: 58
State: CO

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 10/14/2021
Hospital: Y

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: CAT scan - stroke MRI - stroke Ultrasound of heart - negative for a hole in my heart, everything looked good Bloodwork: my cholesterol was at the same level as in the past, not dangerous but at a elevated level so was prescribed medication

Allergies: None

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

Symptoms: Received the first dose of Moderna on 3/19/21 am. At approximately 3 pm, my right side went numb. Traveling at the time, we arrived at 4:30 pm and it seemed to have subsided. Waited until the next morning and went to the hospital because the symptoms came back. They did a CAT scan and confirmed I had a stroke. I was flown to another hospital where several tests were performed including MRI etc. and confirmed again that it was a stroke. Was released the following day with medication prescribed by doctors. The fact that I had gotten my first vaccine that morning, was brought up multiple times and was side stepped. They told me it wasn't likely that the vaccine is what caused it, but would not rule it out. No doctors up until today when I had follow up appt, have told me to report this event.

Other Meds: Losartan

Current Illness: None

ID: 1785707
Sex: M
Age: 37
State: NY

Vax Date: 05/22/2021
Onset Date: 05/22/2021
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: unknown

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient received Moderna vaccination previously at another facility. Vaccine brands were mixed.

Other Meds: unknown

Current Illness:

ID: 1785708
Sex: F
Age: 38
State: AZ

Vax Date: 02/04/2021
Onset Date: 09/27/2021
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: LA

Lab Data: Positive PCR Covid-19 test.

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Complaint of elevated temperature, headache and runny nose/congestion.

Other Meds:

Current Illness:

ID: 1785709
Sex: F
Age: 59
State: OK

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: LA

Lab Data: None

Allergies: Penicillin--hives; tetanus immune globulin--hives

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: PFIZER COVID-19 VACCINE EUA: The patient received an appropriately timed Pfizer/BioNTech COVID-19 vaccine dose. However, after the dose was administered and was to be documented, the presence of historical data indicating the patient had also received a Janssen COVID-19 vaccine dose previously was noted. The patient's vaccine history indicated she received the Janssen dose then subsequently received the Pfizer/BioNTech primary series.

Other Meds:

Current Illness:

ID: 1785710
Sex: F
Age: 60
State: CA

Vax Date: 04/28/2021
Onset Date: 05/13/2021
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: Dermatologist took a skin punch biopsy on August 26th. First potential diagnosis was granuloma annulare. After biopsy results, reported on 9/2/2021, determined may more likely be SCLE (subcutaneous lupus or something like that). Says is sun-sensitive, autoimmune condition. suggested that it can arise from medications, including bupropion which I take and less likely lamogitrine. I had mentioned that the timing was that it started as a small itchy lesion (became weepy at first) within several weeks or less of 2nd vaccination. I have been on these two medications for more than 2 years. My prescribing psychiatrist recommended reporting the event and condition. But dermatologist does not think there is a relationship. Who knows?

Allergies: sulfanomide antibiotics

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Small itchy patch of skin on face that continued to grow in ring like pattern on face. Went to dermatologist in August after it continued to grow and get more red.

Other Meds: Bupropion, Oxycarbepin, Lamogitrin, Lithium, Levothyroxine, Metropolol Succinate

Current Illness: Bi-polar, hypertension, hypothyroidism, mitral reguritation

ID: 1785711
Sex: M
Age: 12
State: KS

Vax Date: 10/06/2021
Onset Date: 10/06/2021
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: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: 2nd Pfizer Covid vaccination was given one week early. Foster Mom notified patient did not have any ill side effects. Notified patients PCP with no new orders.

Other Meds:

Current Illness:

ID: 1785712
Sex: F
Age: 44
State: VA

Vax Date: 04/08/2021
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: MRI confirmation in June

Allergies: mild peanut allergy

Symptom List: Rash, Urticaria

Symptoms: Developed increasing right shoulder pain with decreasing mobility in late April. By EOM May, I'd lost a large degree of mobility in my right shoulder and was pursuing phsyical therapy. Eventually went for imaging and was diagnosed with frozen shoulder

Other Meds: Iron, advil, magnesium, vit c

Current Illness: n/a

ID: 1785713
Sex: F
Age: 65
State: CA

Vax Date: 04/07/2021
Onset Date: 08/17/2021
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: Three chest x-rays, blood tests, COVID tests, all ordered by the doctor

Allergies: Airborne allergy haven't pinpointed the cause hives with it; Allegra

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

Symptoms: I started getting a major headache. That lasted a couple of days. The second day, I started sweating profusely at night. I had to change my shirt three or four times a night. I had a temperature of 103. I had no congestion. I didn't have any phlegm. It was mainly the headache the and profuse sweating and then I started getting a little achy. That lasted about three days. The fourth day, I went to take a COVID test negative result. I called my personal doctor and told him my symptoms. He thought I might have had COVID. I went to retake the test by his request the following day, it came back negative again. After that, I went to see the doctor about two days after the second test. I was feeling crummy still. He looked at me and he sent me for a chest x-ray and gave me antibiotics, not sure what the antibiotic was. And I took the antibiotic for 10 days. And chest x-ray came back and he said he wanted me to take another one before he told me what was wrong. And he did blood tests, too. I took the second chest x-ray about five days into the antibiotic regimen and by then I had started feeling better. Took the second chest x-ray and two days later, he told me I had a minor case of pneumonia. He said my blood test showed a high, it was reading high that I had a real bad infection. I think about a week and 1/2 later after the antibiotic regimen, I started feeling a lot better. My sweats had almost diminished. My temperature came down to 98 degrees. It took about two weeks where I started feeling a lot better but I wasn't 100% still. I went to the doctor about three weeks after it all started. I told him I felt a lot better and everything seemed normal. I went for a third chest x-ray. He said my chest was fine and to go ahead and finish the regimen of antibiotics. I was good about a month later.

Other Meds: Irbesartan; atorvastatin; omeprazole; Allegra; omega 3 fish oil; multivitamin

Current Illness: No

ID: 1785714
Sex: M
Age: 36
State: AL

Vax Date: 04/24/2021
Onset Date: 09/15/2021
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: 9-15-21: CT Scan negative for Stroke

Allergies: N/A

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

Symptoms: Bell?s Palsy to the right side of face. Numb tongue right sided Facial paralysis on right side Symptoms still going.

Other Meds: N/A

Current Illness: N/A

ID: 1785715
Sex: F
Age: 56
State: NC

Vax Date: 04/08/2021
Onset Date: 09/30/2021
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: 2 Covid test both positive

Allergies: None

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

Symptoms: I had a sore throat that gradually that got worse and worse. I had a little bit of stuffiness, runny nose. I got an at home covid test and was shocked when it came back positive on Oct 1 and on Monday the October 4th I looked into getting a monoclonal antibody treatment on the October on the 6th then the next day felt worse, I had a horrible headache and a fever that did not respond to tylenol and within 24 hours I started improving. I still have congestion and drainage in my throat. I have tested negative now with a home test.

Other Meds: Injection Repatha; Lexapro; Zetia; Benicar; omega 3; COQ10; vit D3; aspirin

Current Illness: None

ID: 1785716
Sex: M
Age: 65
State: WI

Vax Date: 05/13/2021
Onset Date: 10/13/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data: POS COVID 19 TEST 10/13/21

Allergies: DUST MITE, SMOKED FOODS

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

Symptoms: BREAKTHROUGH COVID INFECTION

Other Meds: ALBUTEROL, PREDNISONE, ADVAIR, ELIQUIS, BUMEX, FERROUS SULFATE, CRESTOR, CYANOCOBALAMIN, METOPROLOL, MULTIVITAMIN, KDUR,FLOMAX

Current Illness: NONE NOTED

ID: 1785717
Sex: F
Age: 62
State: CA

Vax Date: 10/14/2021
Onset Date: 10/14/2021
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: 10/14/2021 - stroke evaluation negative, EKG - normal sinus rhythm, 12 lead EKG normal sinus, blood pressure check

Allergies: nka

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

Symptoms: @1246 patient extremities moving uncontrollably at vaccination table while seated. Patient reported not feeling well. Clerk called for NP & observation nurse and they approached patient. EMS followed. @1249 NP and EMS assessed patient. Patient reported weakness of legs and general weakness. Hx of uncontrollable shaking occurs on first and second vaccine administration. No pallor, no SOB, no fever, no chills, no diaphoresis, no reports of dizziness, no lightheadedness, no chest pain at present, denies swelling of throat, no pain at present. Medical history of stomach ulcers and thyroid nodules. No hx of anxiety. Medications: Lasix for water retention, sulfa drug, Lipitor. Reports taking 2 tylenol before coming. sp02 100 HR 98 BP 118/77 HR 91. @1253 shaking subsides momentarily , reports chest pain, w/ history of costochondritis @1256 EKG assessment by EMS, NP evaluated, patient with normal sinus rhythm @1259 patient still seated, sp02 100%, POD Director called 911 @1300 stroke eval, no facial drooping, strength in hands despite shaking, EMS did 12 lead EKG with normal sinus rhythm. Patient eyes closed able to speak and converse. @1300 chest pain 9/10, uncontrollable moving comes and goes, pain does not spread, bp 122/81 HR 95 @1304 sp02 100%, supplemental o2 provided on 2L by EMS, patient reports pain feels like stabbing on external chest, reports experiences chronic pain of chest, eyes closed and reports eyelids feel heavy, was able to open eyes on request @1309 uncontrollable movements present, paramedics arrived, NP endorsed care to paramedics and was taken to the Hospital.

Other Meds:

Current Illness:

ID: 1785718
Sex: F
Age: 65
State: VA

Vax Date: 10/07/2021
Onset Date: 10/08/2021
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: None

Allergies: Kiwi fruit and seasonal allergies

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Loud high pitch ringing in ears.

Other Meds: Calcium, vitamin D, fish oil, Allegra, Flonase

Current Illness:

ID: 1785719
Sex: F
Age: 61
State: IL

Vax Date: 10/11/2021
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: N/a

Allergies: Penicillin

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Very painful arm. Swelling and heat at injection site. Painful through the arm and down the top part of body under armpit. I have been taking Tylenol. Did not go to dr. I was told I should report.

Other Meds: Prilosec Zovirax Prozac Amlodipine Multi vitamins

Current Illness:

ID: 1785720
Sex: M
Age: 25
State: VA

Vax Date: 09/28/2021
Onset Date: 10/05/2021
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: none

Allergies: cefzil

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

Symptoms: left sided tingling of arm and leg

Other Meds: none

Current Illness: none

ID: 1785721
Sex: M
Age: 57
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: None medically indicated at this time.

Allergies: NKMA

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

Symptoms: Pt was administered the Janssen COVID vaccine today on 10/14/2021. The vaccine expired on 10/2/2021.

Other Meds: Duaklir Pressair, cephalexin 500 mg, Symbicort, PorAir HFA, Chlorthalidone 25mg, albuterol sulfate

Current Illness: none reported

ID: 1785722
Sex: M
Age: 35
State: CA

Vax Date: 10/04/2021
Onset Date: 10/04/2021
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: None stated.

Other Meds: Patient came in to office on 10/04/21 told the MA that he had received dose of moderna a report was ran thru cair using correct dob and name nothing came up a couple hours later patient brought covid vaccine card and it had the 1st dose of

Current Illness:

ID: 1785723
Sex: M
Age: 18
State: CA

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: LA

Lab Data:

Allergies: Penicillin

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

Symptoms: Immediately after the vaccine administration, patient complained of being lightheaded. About 30 seconds to 1 minute afterwards, patient had a syncope (fainting) episode while he was sitting on the chair. The episode lasted for about 10 to 20 seconds and patient regained consciousness. EMTs arrived and took vitals. Everything checked out to be normal. Patient was let go after a total of 30 minutes of observation. Patient stated this is not the first time this happened to him. A year ago, the same thing happen when he went for a blood draw. He also stated that he was a little nervous before the vaccine administration and that he is a little bit scared of needles.

Other Meds: Per patient, he is not on any medications.

Current Illness: Per patient, none.

ID: 1785724
Sex: F
Age: 15
State: MN

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

Lab Data: none

Allergies: amoxicillin

Symptom List: Injection site pain, Pain

Symptoms: patient had syncopal episode. She has had similar/same issues with previous injections.

Other Meds: Acetaminophen, vitamin D, fluoxetine 10mg, hydroxyzine 25mg, melatonin 2.5mg

Current Illness: Nothing in pt chart

ID: 1785725
Sex: F
Age: 52
State: MA

Vax Date: 09/14/2021
Onset Date: 09/23/2021
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: Eye and physical exam

Allergies: None known

Symptom List: Injection site pain, Menorrhagia

Symptoms: Eye twitching started day 8 and is continuing an has been 3 weeks so far. High eye pressure to be seen in 30 days for follow-up

Other Meds: Topical for rosacea, multi-vitamin, advil

Current Illness: none

ID: 1785726
Sex: F
Age: 17
State: AZ

Vax Date: 04/01/2021
Onset Date: 10/14/2021
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:

Allergies:

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

Symptoms: ABNORMALLY LONG MENSES

Other Meds:

Current Illness:

ID: 1785727
Sex: F
Age: 15
State: CO

Vax Date: 09/23/2021
Onset Date: 09/23/2021
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: Dose given under the age of 18

Other Meds:

Current Illness:

ID: 1785728
Sex: F
Age: 30
State: CA

Vax Date: 10/01/2021
Onset Date: 10/02/2021
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: nonne

Allergies: none

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: 17 hours after vaccination, tiredness, body aches, fever, chills lasted for approximately 36 hours. 5 days after vaccination, rash on both arms, chest, and legs. Lasted for approximately 12 hours.

Other Meds: none

Current Illness: none

ID: 1785729
Sex: F
Age: 25
State: AZ

Vax Date: 03/29/2021
Onset Date: 09/24/2021
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: Positive home Covid-19 test

Allergies:

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

Symptoms: Complaint of elevated temperature, sore/scratchy throat, headache, runny nose/congestion, and nausea/vomiting.

Other Meds:

Current Illness:

ID: 1785730
Sex: M
Age: 64
State: FL

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: RA

Lab Data:

Allergies: latex

Symptom List: Nausea

Symptoms: Muscle Pain, mild fever

Other Meds:

Current Illness:

ID: 1785731
Sex: F
Age: 40
State: TX

Vax Date: 04/09/2021
Onset Date: 08/01/2021
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: LA

Lab Data: none

Allergies: lactose intolerance

Symptom List: Injection site pain

Symptoms: Depression/anxiety, treated unsuccessfully with Lexapro, currently trying Wellbutrin 75 mg 1x daily, some improvement PS I wasn't sure if item 15 was about the place I got the vaccine or the place I got treatment for the adverse event, it was the latter, I got the vaccine in a vacant parking lot, no idea the address

Other Meds: Rx: Gabapentin 300 mg up to 4x daily OTC: Vitamin D supp 2,000 IU 1x daily, Cetirizine 10 mg 1x daily

Current Illness: no acute illnesses

ID: 1785732
Sex: F
Age: 63
State: AZ

Vax Date: 01/23/2021
Onset Date: 09/28/2021
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: Positive PCR Covid-19 test.

Allergies:

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

Symptoms: Complaint of cough, headache, runny nose/congestion, and myalgia.

Other Meds:

Current Illness:

ID: 1785733
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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Sulfa, adhesives, morphine

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

Symptoms: Hives after second dose. Started the morning after the second shot. One week later they are getting worse and persisting. From the bottom of my feet, trunk, legs, and back.

Other Meds: None

Current Illness: None

ID: 1785734
Sex: F
Age: 54
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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: Gave patient Fluad, patient is not +65 years of age. Informed patient about encounter, patient reported no ADR when phone called happened.

Other Meds:

Current Illness:

ID: 1785735
Sex: F
Age: 33
State: SC

Vax Date: 04/07/2021
Onset Date: 09/09/2021
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: Azithromycin

Symptom List: Erythema, Pruritus

Symptoms: I had the delivery of my first child. During the delivery I was fine at first, but then I experienced an uterine inversion. I had to have an emergency surgery. My baby was 7 lbs. 14 oz. During the pregnancy I had no complications. I was prescribed pain killers after the surgery. I also had a mastitis and endometriosis infection. I was prescribed antibiotics for that.

Other Meds: Prenatal Vitamins

Current Illness: none

ID: 1785736
Sex: F
Age: 70
State: PA

Vax Date: 03/05/2021
Onset Date: 10/06/2021
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: I had my flu shot the day before my booster.

Allergies: Bactrim, epinephrine.

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

Symptoms: Fever that was 3.5 higher than my normal temperature, severe headache that lasted for 5 days, extreme weakness, fatigue, nausea, no appetite. Could not do any of my normal chores, or exercise. My doctor had me take an 800mg of Motrin and that did nothing with the severe headache. Very bad chills. I had the two other Pfizer vaccines and just had a normal reaction. This was the booster. My arm hurt where the injection was, but that did not concern me. I was like this for a full week. I am still weak and very easily fatigued.

Other Meds: Cardio-Levodopa, Xanax, Lipitor, Aspirin, Lasix, B12, D, Folic Acid, Metamucil, Sennakot S.

Current Illness: None

ID: 1785737
Sex: M
Age: 36
State: GA

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

Lab Data:

Allergies: N/A

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

Symptoms: Severe dizziness Headaches Heart palpitations

Other Meds: Lisinopril Protonix Lexapro

Current Illness:

ID: 1785738
Sex: M
Age: 62
State: CA

Vax Date: 03/08/2021
Onset Date: 04/01/2021
Rec V Date: 10/14/2021
Hospital:

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

Lab Data: EKG

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Heart arrhythmia (on going), fatigue.

Other Meds:

Current Illness:

ID: 1785739
Sex: M
Age: 53
State: VA

Vax Date: 05/09/2021
Onset Date: 05/23/2021
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: Got blood work and all normal. No anomalies.

Allergies: None

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

Symptoms: Left side if head and face become numb for about 4 weeks. Sore throat that lasted 5 weeks but doctor could not see redness in my throat. Tested for strep and other issues and doctor couldn't find anything wrong. Ears started ringing and still ring 8 or 9 times per day.

Other Meds: None

Current Illness: None

ID: 1785740
Sex: M
Age: 36
State: MA

Vax Date: 10/12/2021
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: none

Allergies: none

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

Symptoms: Pt states he started to feel fatigue, lightheaded, mild headache on 10/13/2021. Pt reports symptoms are improving.

Other Meds: none

Current Illness: none

ID: 1785741
Sex: F
Age: 43
State: TX

Vax Date: 10/11/2021
Onset Date:
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: amoxicillin, azithromycin

Symptom List: Pain in extremity

Symptoms: constant numbness, tingling on the left side (arm, hand leg) and intermittent numbness and tingling on the right side

Other Meds: multivitamin

Current Illness: none

ID: 1785742
Sex: M
Age: 74
State: NY

Vax Date: 03/05/2021
Onset Date: 03/06/2021
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: CBC, Comprehensive Metabolic panel, C Reactive Protein Plasma, Sedimentation Rate Erythrocyte, Thyroid Stimulating Hormone, Urine culture screening , Urine Dipstick Chemistry.

Allergies: NKDA

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

Symptoms: started with sore throat, developed entire body rash, then blistering and finally complete peeling of all skin.

Other Meds: amlodipine, metoprolol succinate, olmesartan, potassium chloride, pulmicort inhalation, torsemide, multi vitamin, glucosamine- chondroitin

Current Illness: none

ID: 1785743
Sex: M
Age: 44
State: NC

Vax Date: 09/11/2021
Onset Date: 09/11/2021
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: Hospitalized 4 days Cultures CT Chest.Abd pelvis Ct neck CTA chest Echocardiogram

Allergies: codeine

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

Symptoms: FEVER SEPSIS TACYCARDIA HYPOXIA UNKNOWN ETIOLOGY

Other Meds: crestor cosentyx rythmol indur

Current Illness: tooth infection

ID: 1785744
Sex: M
Age: 29
State: TN

Vax Date: 09/15/2021
Onset Date: 09/15/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: bloody nose, coughing blood, bloody bowel movements, lots of bleeding problems, everything lasted 1 month, left arm pain with bloodclot still there

Other Meds:

Current Illness:

ID: 1785745
Sex: F
Age: 34
State: IL

Vax Date: 08/09/2021
Onset Date: 10/13/2021
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: Patient received Pfizer Booster only 2 months after series completion. Patient didn't express any adverse reactions while waiting her 15 minutes after her vaccination. Discussed with provider, no additional recommendations. Left message on voicemail to inform patient.

Other Meds:

Current Illness:

ID: 1785746
Sex: F
Age: 46
State: GA

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: SYR
Vax Site: LA

Lab Data:

Allergies: none reported to pharmacy

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: After vaccine administration the patient started bleeding profusely and swelling occurred at injection site. The patient's arm was elevated and pressure was applied which stopped the bleeding. A cold compress was applied to swelling at injection site for 15 mins and patient was observed by pharmacy staff. After 15 minutes, the swelling had gone down, there was no further bleeding and the patient was sent home.

Other Meds: Ferralet

Current Illness: none reported to pharmacy

ID: 1785747
Sex: M
Age: 53
State: CA

Vax Date: 09/28/2021
Onset Date: 09/30/2021
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: Dr. visit to review bump on roof of mouth and continued dizziness and balance issues on Oct 1, 2021. Dr. examined and advised to give it a few more days.

Allergies: None

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

Symptoms: 2 days after small bump on roof of mouth. Very tender and painful for 6-7 days. Continued dizzy and balance issues. No injection site soreness but 5 days post injection shoulder joint in injection arm incredibly sore for 6+ days

Other Meds: Vitamin D

Current Illness: None

ID: 1785748
Sex: F
Age: 59
State: IL

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

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient presented to the pharmacy and was picking up scripts that she stated was for ceellulitis

Other Meds:

Current Illness:

ID: 1785749
Sex: F
Age: 69
State: OH

Vax Date: 04/09/2021
Onset Date: 04/09/2021
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: RA

Lab Data: Not applicable

Allergies: Sulphur, Motofen, Cantil, Relafen, Disalcid, Flagyl, Celexa, and Zofran Seafood, Coffee, Corn, Chocolate, Baker's Brewer's Yeast, Oats, and Barley

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

Symptoms: I have been experiencing Head Trimmers on a daily basis since receiving the vaccine. I went to see my PCP and was referred to a Neurologist who examined me and diagnosed with Primary Head Trimmers that are not associated with Parkinson's disease on 06/18/2021. Since then the Head Trimmers are more prevalent along with causing my hands to shake..

Other Meds: I took my daily medications: Synthroid 50mcg, Flonase 50mcg, Azelastine HCL 137mcg, Protonix 40mg, Tagamet 400mg, Gabapentin 300mg, Singular 10mg, Tylenol 500mg, Claritin, Fee Oil, Vitamin D-3, Magnesium, and Promethazine HCL Syrup 6.25mg.

Current Illness: No

ID: 1785750
Sex: F
Age: 69
State: IN

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: Pt has swollen lymph nodes. Told her to monitor and call if it gets worse. She usually takes aleve and told her it would be okay to take that. Explained to patient this is a common reaction but watch out for fever or redness or signs of infection. Told her it should go down in a few more days. Patient had no complaints of severe allergic reaction or breathing difficulty.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am