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: 1788201
Sex: F
Age: 31
State: LA

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

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

Lab Data: Auto-Immune Panel- CBC Various other test Upper GI series-Low motility CT Scan

Allergies: Codeine

Symptom List: Dysphagia, Epiglottitis

Symptoms: Later that evening after the vaccine I started feeling really tired with no other symptoms. But in mid-May I noticed my appetite diminishing resulting in many times I didn't even eat. I was really tired resulting in many times of me getting off work and being in bed about 5pm and sleeping until 5am most days and this went on and progressed for several days and developed severe fatigue causing me to be super tired and just want to sleep. I began getting severely nauseous when I did try to eat d/t the fact that I wasn't eating. And this went on for days. 6/15 I went off food completely because I had no appetite and could not eat for 1 weeks. On 6/25 I went to the ER because the symptoms were so bad and I had lost about 5 pounds by then and was given IV fluids for dehydration and took various test and monitored and I was released. Still after another week of not being able to eat and severe fatigue I went back to the ER and was admitted on 6/30 to Our Hospital for 2 days. While admitted I was so malnourished and severely dehydrated I was given IV fluids and Reglan via the IV to help my digestive tract work better. My condition was stabilized and was discharged. I still cannot eat much so I am having to drink Ensure to get my nutrients. If I eat too much it gets stuck in my small intestines and to date I can barely function because I cant eat and have little energy. I have a drug they state I need but I cant afford to get it. In Mid-July a CBC was done and one of the auto-immune indicators were a little elevated so an auto-immune panel has been drawn and I am currently awaiting my results.

Other Meds: no

Current Illness: no

ID: 1788202
Sex: F
Age: 55
State: ID

Vax Date: 03/12/2021
Onset Date: 10/03/2021
Rec V Date: 10/15/2021
Hospital:

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

Lab Data: 10/04/2021 positive SARS-COV-2 by PCR 10/12/2021 negative SARS-COV-2 by PCR

Allergies: Penicillin

Symptom List: Anxiety, Dyspnoea

Symptoms: Headaches, cough, extreme tiredness, congestion in head and chest for 5 days

Other Meds: None

Current Illness: Stuffy nose

ID: 1788203
Sex: M
Age: 40
State: PA

Vax Date: 05/03/2021
Onset Date: 05/31/2021
Rec V Date: 10/15/2021
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:

Allergies: Ibuprofen

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

Symptoms: Insomnia and trouble staying asleep. Falling asleep initially is fine.

Other Meds: Singulair Zyrtec vitamin D zinc magnesium fish oil creatine

Current Illness:

ID: 1788204
Sex: M
Age: 38
State: VA

Vax Date: 10/04/2021
Onset Date: 10/05/2021
Rec V Date: 10/15/2021
Hospital:

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

Lab Data: No

Allergies: Insects

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: I had a seizure, lost my motor coordination, fever, chills, headache, fatigue, joint swollen. On day 2 to present any physical activity my chest feel really tight and I feel lightheaded.

Other Meds: Vertex; Fish oil; Ambien

Current Illness: No

ID: 1788205
Sex: F
Age: 58
State: MI

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 10/15/2021
Hospital:

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

Lab Data: EKG - slight difference; Stress test - inconclusive.

Allergies: Tetanus; Bactrim

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

Symptoms: About 15 minutes after getting the shot I got a metallic taste in my mouth. That metallic taste lasted almost 6 weeks. It comes back sporadically, and when it comes back it lasts between one day and a week. The lymph node under my left arm swelled to larger than a softball. I couldn't put my arm down. And that started on 4/21. And it took 2 weeks for the swelling to go down under my arm. And occasionally and sporadically, it'll slightly swell, hurt for a day, and then go away. I had swelling ? of the way across my chest. The swelling was significant. It was approx. 2 inches high. Husband said it looked like I had 3 breasts. That lasted for 2 and a half weeks also. With the swelling came a lot of chest pressure, and I still have chest pressure occasionally now, which caused me to go to my cardiologist. I will say at the time, we had a lot of COVID in my area so I didn't go to the hospital because I was scared to. But it took a while to get into the doctor, so my doctor did not see the complete swelling but there was still some there. When I went to my cardiologist (I go every 6 months) and he does an EKG. This time there was a slight minimal difference in my EKG. A stress test didn't show anything, but there is a slight glitch in my heart beat. My EKG prior to the vaccine was 2 weeks prior, so since the pressure and everything started after the vaccine, that's why I'm relating the heart pressure and everything to the vaccine and the swelling and everything that I had. During all of this, I took aspirin and Benadryl. Since I couldn't get to any doctor. My doctor has told me that her professional advice was not to get the second dose of the vaccine for the risk of anaphylaxis.

Other Meds: Lisinopril

Current Illness: N/A

ID: 1788206
Sex: M
Age: 34
State: FL

Vax Date: 10/15/2021
Onset Date: 10/15/2021
Rec V Date: 10/15/2021
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

Allergies: Penicillin - childhood allergy

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

Symptoms: Patient passed out for about 30 seconds 2 minutes after getting the vaccine. Patient is coherent and back to normal after regaining consciousness.

Other Meds: None

Current Illness: None

ID: 1788207
Sex: M
Age: 56
State: MA

Vax Date: 06/16/2021
Onset Date: 06/16/2021
Rec V Date: 10/15/2021
Hospital:

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

Lab Data:

Allergies: Amoxicillin

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Chest Pains - heart area - lasted several months

Other Meds: None

Current Illness: None

ID: 1788208
Sex: F
Age: 49
State: SC

Vax Date: 07/23/2021
Onset Date: 07/24/2021
Rec V Date: 10/15/2021
Hospital:

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

Lab Data: When i came back to work on Monday 7/26/21 , i immediately went to my gyn and she called an order to mammography for a mammogram, and i had just had a mammogram the month before and the results were fine. They did another mammogram and an ultrasound and saw the inflammation and called it Mondor's disease. I took ibuprofen and rubbed voltaren cream which helps relive inflammation

Allergies: fresh water fish, fresh tomatoes, bananas, latex

Symptom List: Pharyngeal swelling

Symptoms: I was vaccinated on Friday 7/23/21 and on Saturday 7/24/21 I woke up and there was a red knot under my left breast and a raised line from the knot down to my ribcage, which looked like a vein and it was well recognized, and a little sensitive but not painful. The knot was also itchy.

Other Meds: multivitamin, elderberry chewable, b12, triamcinolone topical ointment for eczema

Current Illness: none

ID: 1788209
Sex: M
Age: 17
State: OR

Vax Date: 05/01/2021
Onset Date: 10/14/2021
Rec V Date: 10/15/2021
Hospital:

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

Lab Data:

Allergies: Environmental Allergies Gluten & Lactose Intolerance

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Experienced urticaria and symptoms similar to dermatographism. Plan: order COVID test due to fever. Benadryl at night, Zyrtec during the day. Cortisone cream on rash. Providing Prednisone 10mg for severe urticaria. Advised to seek further medical care if feeling any swelling/tingling around mouth.

Other Meds: Albuterol Sulfate HFA 90 mcg Inhaler - per needed Azelastine 0.05% Eye Drops - per needed Fluticasone Propionate 50 mcg Nasal Spray - per needed Zyrtec - per needed Multivitamin Omega 3 Trimcinolnone Acetonide 0.5% Topical Ointment

Current Illness:

ID: 1788210
Sex: F
Age: 62
State: TX

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 10/15/2021
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: penicilan

Symptom List: Diarrhoea, Nasal congestion

Symptoms: vertigo, sick headache, fever, fatigue, and stiffness in left arm

Other Meds: farmerthyroid

Current Illness:

ID: 1788211
Sex: M
Age: 59
State: HI

Vax Date: 07/01/2021
Onset Date: 09/16/2021
Rec V Date: 10/15/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: COVID hospitalization after full vaccination.

Other Meds:

Current Illness:

ID: 1788212
Sex: F
Age: 45
State: NY

Vax Date: 10/15/2021
Onset Date: 10/15/2021
Rec V Date: 10/15/2021
Hospital:

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

Lab Data:

Allergies: anesthestics for dental treatment

Symptom List: Rash, Urticaria

Symptoms: During patient's 15 minute wait time after vaccination, patient reported to have some numbness in right arm and leg. Patient also said that they felt some tightness in chest. Patient was breathing and said can breath. Patient requested that we call 911 and we did. EMS came and asked if patient wanted to go to hospital. Patient requested to go.

Other Meds: No

Current Illness: no

ID: 1788213
Sex: M
Age: 72
State: FL

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

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

Lab Data:

Allergies: ramipril, flunisolide

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

Symptoms: Situation: Moderna COVID-19 Vaccine Dose 2 administered too soon Background/Risk Factors: Patient scheduled for dose 1 of COVID Vaccine on 9/13/21. Unclear how patient had second dose appointment scheduled on 10/6/21. For unknown reason (not documented in chart) patient received second dose early. Assessment: Vaccinator must look at vaccine record card or CPRS to ensure appropriate timeframe between first and second dose. Response/interventions: Patient notified that dose administered too soon. Per CDC guidance, doses inadvertently administered earlier than the grace period should not be repeated.

Other Meds: amlodipine, atenolol, atorvastatin, furosemide, gabapentin, lidocaine, losartan, omeprazole

Current Illness: none

ID: 1788214
Sex: F
Age: 56
State: MA

Vax Date: 08/28/2021
Onset Date: 09/01/2021
Rec V Date: 10/15/2021
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: Had cardiac monitor on at the time ( zio patch)

Allergies: None

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

Symptoms: 6 beat run on VTach

Other Meds:

Current Illness: None

ID: 1788215
Sex: M
Age: 79
State: ID

Vax Date: 03/17/2021
Onset Date: 03/23/2021
Rec V Date: 10/15/2021
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: none

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

Symptoms: consistent chills (always cold) upset stomach(always slight upset) consistent mild headaches, hard time focusing on any project, consistent muscle aches, very difficult to motivate myself on anything, extreme anger issues over minor things, depression, all of these are ongoing and seems to be getting more severe

Other Meds: Losartan, Vit B complex

Current Illness: none

ID: 1788216
Sex: F
Age: 46
State: AR

Vax Date: 09/21/2021
Onset Date: 10/01/2021
Rec V Date: 10/15/2021
Hospital:

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

Lab Data: On 10/9/21, patient went to local urgent care, informed them of her symptoms and that she had received her first dose of Pfizer on 9/21/21. Urgent care diagnosed patient with bronchitis and sent her home on antibiotics.

Allergies:

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

Symptoms: Patient got the Pfizer vaccine dose 1 on 9/21/21. On 10/1/21, she started having shortness of breath. As time went on her oxygen sats dropped in the 70s . This lasted for several days. As days went by, patient experienced increased shortness of breath, confusion, disorientation, increased sleepiness, inability to stay awake, tremors in upper extremities and memory impairment. On 10/8/21, while at work. It was noticed by patients co-workers, that she couldnt stay awake, that her speech was somewhat slurred. She was sent home. On 10/9/21, Patient went to local urgent care, informed them of her symptoms and that she had received her first dose of Pfizer on 9/21/21. Urgent care diagnosed patient with bronchitis and sent her home on antibiotics.

Other Meds:

Current Illness:

ID: 1788217
Sex: M
Age: 75
State: IL

Vax Date: 10/15/2021
Onset Date: 10/14/2021
Rec V Date: 10/15/2021
Hospital: Y

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

Lab Data: N/A

Allergies: None

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

Symptoms: hospitalization 10/14/2021

Other Meds: N/A

Current Illness: N/A

ID: 1788218
Sex: M
Age: 60
State: WI

Vax Date: 04/30/2021
Onset Date: 10/12/2021
Rec V Date: 10/15/2021
Hospital: Y

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

Lab Data: COVID-19 PCR NP swab positive 10/7/21 Chest Xray 10/12/21 Subtle mid and lower lung zone patchy opacities favoring multifocal infectious/inflammatory process including Covid related pneumonia.

Allergies: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient completed COVID-19 Moderna vaccine series on 4/30/21. Patient was admitted to reporting hospital on 10/12/21 with shortness of breath needing high flow 30L of 02. Patient originally tested positive on 10/7/21 after attending a funeral where lots of other people tested positive. Chest xray shows patchy opacities favoring COVID pneumonia. Patient is still admitted at this time.

Other Meds: Aspirin 81mg, Lipitor 40mg, chlorthalidone 25mg, doxazosin 2mg, tulicity 1.5mg, gabapentin 300mg, glyburide 5mg, lisinopril 40mg, metformin 1000mg, multi-vitamin, naproxen sodium 220 mg

Current Illness: diabetes mellitus type 2, essential hypertension, hyperlipidemia, OSA

ID: 1788219
Sex: M
Age: 61
State: FL

Vax Date: 04/17/2021
Onset Date: 08/10/2021
Rec V Date: 10/15/2021
Hospital: Y

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

Lab Data:

Allergies: No Known Allergies

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Admission to chospital with COVID-19 diagnosis on admission

Other Meds:

Current Illness:

ID: 1788220
Sex: M
Age: 48
State: HI

Vax Date: 08/14/2021
Onset Date: 09/24/2021
Rec V Date: 10/15/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: COVID hospitalization after full vaccination.

Other Meds:

Current Illness:

ID: 1788221
Sex: M
Age: 65
State: WI

Vax Date: 03/09/2021
Onset Date: 10/08/2021
Rec V Date: 10/15/2021
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: None Documented

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

Symptoms: Patient contracted COVID after being fully vaccinated cough, chills, diarrhea, loss of taste, loss of smell, sore throat.

Other Meds: None Documented

Current Illness: None Documented

ID: 1788222
Sex: F
Age: 30
State: MD

Vax Date: 03/03/2021
Onset Date: 09/29/2021
Rec V Date: 10/15/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: Patient presents to the ED with abdominal pain, fatigue, worsening jaundice, anxiety, tremulousness and shortness of breath. Patient was also found to be COVID positive. She was admitted for management of acute metabolic encephalopathy, acute on chronic liver failure, hyponatremia, hypokalemia, large ascites, acute on chronic pancreatitis. She was discharged 16 days later in stable condition.

Other Meds:

Current Illness:

ID: 1788223
Sex: M
Age: 39
State:

Vax Date: 02/02/2021
Onset Date: 02/02/2021
Rec V Date: 10/15/2021
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: possible increase in seizure activity since getting the second Covid vaccine. reports having fatigue and memory loss (short term and difficulty recalling details) after having 2nd vaccine. Hx of nocturnal seizures. Employee reports saw Neurologist (2/12/12)- reports advised that employee should be off work all next week. States having EEG and blood work done. States symptoms slightly. As noted after second Covid shot on 2/2, he had "41 events" on CPAP that night then had low grade fevers, chills, and headache for a few days which resolved but had continued fatigue, incoordination, and memory loss, forgot "things I knew before the vaccine". improving.

Other Meds:

Current Illness:

ID: 1788224
Sex: F
Age: 23
State: VA

Vax Date: 10/15/2021
Onset Date: 10/15/2021
Rec V Date: 10/15/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: unknown. taken to hospital

Allergies: Avacado, Bananas, Latex

Symptom List: Injection site pain, Pain

Symptoms: Approximately 30 seconds after I gave patient her flu shot, she started seeing spots and very faint. She went down on the floor and pulled my pant leg. I turned and saw her on the floor and yelled at the techs to call emergency services. I bent down to talk to patient and she told me she had an Epi-pen in her bag and wanted me to give it to her. I administered it in her left thigh. I stayed down on the floor just talking to her until the paramedics arrived. She never lost consciousness and was talking/laughing with me. When the paramedics arrived, they took her vitals and all were within normal range. However, she still felt weak and when the paramedics asked if she wanted to go to the hospital she said yes. They did need to put her on a stretcher

Other Meds: Celexa 40mg daily Junel FE 1.5/30 i tablet daily

Current Illness: Unknown

ID: 1788225
Sex: M
Age: 85
State: SD

Vax Date: 10/15/2021
Onset Date: 10/15/2021
Rec V Date: 10/15/2021
Hospital:

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

Lab Data: None.

Allergies: Codeine (shortness of breath and anxiety)

Symptom List: Injection site pain, Menorrhagia

Symptoms: Today, 10/15/21 at 0955, a gentleman, patient, came in for his Pfizer Booster. On the schedule under notes, it lists Pfizer booster - 2nd dose given at facility, he was checked in and brought to a bay for vaccination. On his card his first dose was given by facility on and only listed a LOT number (We verified in system, and therefore wrote ?Moderna? on the card for 1st dose) as no manufacturer was listed. In our system there was NO immunization record of any COVID-19 Vaccination, patient reported he had his vaccines elsewhere. The second dose did have the sticker on the card. After the vaccinator vaccinated patient, it was then discovered. The vaccinator notified our charge nurse immediately and then provider on site (CNP) was notified. Charge nurse did check the website which had NO immunizations for COVID-19, except ours that was given today 10/15/21 (written as 10/11/21 ? for accountability purposes, the vaccinator, charge nurse and myself did not notice the vaccinator wrote 10/11/21 as the date, and therefore, did not correct it before patient left). After vaccines were verified through the system, they were appropriately updated in patients chart.

Other Meds: Tylenol 650 mg every 6 hours as needed Vitamin C 500 mg daily Aspirin 81 mg daily Cetirizine 10 mg daily Pepcid 20 mg daily Flonase nasal spray, 2 sprays daily to each nostril Hydrochlorothiazide 25 mg daily Metoprolol 25 mg daily (XL) M

Current Illness: Patient denies.

ID: 1788226
Sex: M
Age: 70
State: FL

Vax Date: 04/15/2021
Onset Date: 05/20/2021
Rec V Date: 10/15/2021
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: Multiple tests performed 5/22,23,24/2021

Allergies: none

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

Symptoms: 4 days of tachycardia resulting in cardioversion required 5/24/21. Sinus rhythm restored 5/24

Other Meds: HCTZ, atorvastatin

Current Illness: none

ID: 1788227
Sex: F
Age: 30
State: TX

Vax Date: 09/20/2021
Onset Date: 09/27/2021
Rec V Date: 10/15/2021
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: Hives starting on the right forearm and proceeded to other parts. Excessive bruising on the left forearm and proceeded to other parts.

Other Meds: Levothyroxine 0.175mg (175mcg) Tabs Oysco 500/D Tablets

Current Illness:

ID: 1788228
Sex: F
Age: 34
State: HI

Vax Date: 03/01/2021
Onset Date: 09/26/2021
Rec V Date: 10/15/2021
Hospital: Y

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: COVID hospitalization after full vaccination.

Other Meds:

Current Illness:

ID: 1788229
Sex: F
Age: 49
State: CA

Vax Date: 10/01/2021
Onset Date: 10/04/2021
Rec V Date: 10/15/2021
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: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: Significant rash all overy the body

Other Meds:

Current Illness:

ID: 1788230
Sex: M
Age: 28
State: WI

Vax Date: 03/31/2021
Onset Date: 10/06/2021
Rec V Date: 10/15/2021
Hospital:

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

Lab Data:

Allergies: Clindamycin - Rash

Symptom List: Nausea

Symptoms: Patient contracted COVID after being fully vaccinated Cough, runny nose, cough, congestion, loss of taste.

Other Meds: Fluoxetine 40mg daily

Current Illness: None Documented

ID: 1788231
Sex: M
Age: 50
State: NC

Vax Date: 10/15/2021
Onset Date: 10/15/2021
Rec V Date: 10/15/2021
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: NONE

Symptom List: Injection site pain

Symptoms: LOT NUMBER EXPIRED ON 10/8/2021 WITHOUT PRIOR KNOWLEDGE. VACCINE GIVEN ON 10/15/2021, NO ADVERSE REACTION NOTED.

Other Meds: NONE

Current Illness: NONE

ID: 1788232
Sex: M
Age: 54
State: IL

Vax Date: 09/30/2021
Onset Date: 10/07/2021
Rec V Date: 10/15/2021
Hospital:

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

Lab Data: no laboratory tests. Clinical observation on 9/9 and 9/10

Allergies: ibuprofen, penicillin

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

Symptoms: Trigeminal neuralgia began 9/7, shingles diagnosis 9/10

Other Meds: none

Current Illness: none

ID: 1788233
Sex: M
Age: 57
State: MT

Vax Date: 10/15/2021
Onset Date: 10/15/2021
Rec V Date: 10/15/2021
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:

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

Symptoms: I was given the first dose of Pfizer vaccine on 9/17/2021 and today the nurse screwed up and gave me an Moderna instead? My face is really flushed I am feeling hot flashes and my arm is getting sore I?m really freaked out my heart rate is elevated I?m not sure whether that?s because I?m scared that they gave me the wrong vaccine or whether it?s an adverse reaction

Other Meds:

Current Illness: COVID on 10-1-2021

ID: 1788234
Sex: F
Age: 27
State: OR

Vax Date: 09/13/2021
Onset Date: 09/14/2021
Rec V Date: 10/15/2021
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: N/A

Symptom List: Tremor

Symptoms: Chills, Headache, Soreness at Injection Site

Other Meds: N/A

Current Illness: N/A

ID: 1788235
Sex: M
Age: 87
State: CA

Vax Date: 01/31/2021
Onset Date: 09/28/2021
Rec V Date: 10/15/2021
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: 88-year-old woman with significant past medical history of COPD/asthma, pulmonary hypertension, atrial fibrillation on Coumadin, coronary artery disease and prediabetes presents on transfer from Hospital for Covid pneumonia. Patient had been previously vaccinated and contracted Covid from her daughter. Started developing fevers and chills with cough and progressive shortness of breath. Went to Hospital today where she was found to have Covid pneumonia with acute hypoxemic respiratory failure. While at hospital patient fell and a CT scan of the head was obtained which was negative for bleed. Patient was placed on 4 L of oxygen with improvement in her oxygen saturation. Patient currently feels comfortable without shortness of breath on 4 L of oxygen by nasal cannula. Denies chest pain, nausea vomiting, diarrhea, abdominal pain.

Other Meds:

Current Illness:

ID: 1788236
Sex: M
Age: 86
State: HI

Vax Date: 05/01/2021
Onset Date: 09/26/2021
Rec V Date: 10/15/2021
Hospital: Y

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:

Allergies:

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

Symptoms: COVID hospitalization after full vaccination.

Other Meds:

Current Illness:

ID: 1788237
Sex: F
Age: 73
State: CT

Vax Date: 10/01/2021
Onset Date: 10/09/2021
Rec V Date: 10/15/2021
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: morphine, penicillin, foreldehyde, peanuts, perfumes, harsh detergents,

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

Symptoms: 3-4 bouts of nasty diarrhea the past 3 days, intermittent chills, swelling of lymph nodes, temp 99.1-99.5...

Other Meds:

Current Illness: psoriasis

ID: 1788238
Sex: M
Age: 68
State: MO

Vax Date: 10/12/2021
Onset Date: 10/12/2021
Rec V Date: 10/15/2021
Hospital:

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

Lab Data: hypoglycemia shortness of breath focal motor weakness

Allergies: levaquin sudafed ampicillan sulfa drugs

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Recieved shot at 11am weakness in right leg at 2pm started chiils no fever blood sugar fell rapidly to low in 50s by 4pm blood pressure escalated to 197 over 91 nauseated pain in right leg continued called 911

Other Meds: aspirin oxycodone amiodarone atorvastin carvedilol clopidogrel docusate iron furosemide hydralazine insulin novolog tresiba isosorbide mononitrate levothyroxine losartan tamsulosin anoro inhaler vitamins zinc

Current Illness: open wound on right foot with skin grafts

ID: 1788239
Sex: F
Age: 39
State: MO

Vax Date: 09/21/2021
Onset Date: 09/21/2021
Rec V Date: 10/15/2021
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: none

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

Symptoms: 3rd year in a row that I had an ulcerative colitis flare-up (blood in stool, loose stool) within a day or two of getting the flu shot.

Other Meds: Humira

Current Illness: none

ID: 1788240
Sex: F
Age: 70
State: NY

Vax Date: 09/29/2021
Onset Date: 10/04/2021
Rec V Date: 10/15/2021
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: Had an ultrasound of my right thigh and upper calf (they explained that an ultrasound can't be done on the lower calf as the blood vessels aren't large enough). Comments from the Doctor's Office Ultrasound negative for a blood clot. Symptoms likely musculoskeletal and will resolve over time. Study Result Impression No sonographic evidence of deep vein thrombosis in the right lower extremity. Urgency: Routine. This is a routine medical imaging report. Recommendation: No specific imaging recommendation.

Allergies: Sensitivity to morphine, fluticasone propionate, augmentin, latex, adhesive

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

Symptoms: On Day 5 I started having localized pain in my right calf, similar to a knot in my muscle. On Day 6 the pain had moved to a new location in my right calf. Again on Day 8 and 9, the pain moved. Day 10 was a similar location to Day 8. On Day 11 my calf was so sore (felt bruised) that I couldn't rest my leg on the recliner. Day 12 started the cycle all over again, so I went to the doctor.

Other Meds: Latanoprost 0.005%, levothyroxine 100 mcg, simvastatin 40 mg, lisinopril 5 mg, CoSopt .2 ml, Multi vitamin, fish oil 1000 mg, vitamin D 2000, flaxseed 1000 mg, calcium

Current Illness:

ID: 1788241
Sex: M
Age: 21
State:

Vax Date: 10/06/2021
Onset Date: 10/11/2021
Rec V Date: 10/15/2021
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: Right buttock and right leg (upper and lower) shingles lesions onset after 5 days of vaccine, condition remains.

Other Meds: None

Current Illness: None

ID: 1788242
Sex: M
Age: 58
State: NC

Vax Date: 10/15/2021
Onset Date: 10/15/2021
Rec V Date: 10/15/2021
Hospital:

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

Lab Data: NONE

Allergies: NONE

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

Symptoms: PATIENT GIVEN COVID VACCINE AFTER EXPIRATION WITHOUT PRIOR KNOWLEDGE OF EXPIRATION DATE: EXPIRED ON 10/8/2021 AND GOVEN ON 10/15/2021

Other Meds: NONE

Current Illness:

ID: 1788243
Sex: F
Age: 61
State: CA

Vax Date: 04/02/2021
Onset Date: 04/05/2021
Rec V Date: 10/15/2021
Hospital:

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

Lab Data: blood tests, physical neuro exam

Allergies:

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

Symptoms: nocturnal, bilateral paresthesia (has happened to both feet/legs, hands?whichever is lowest if on the side, or hand if in a bent position on back). Also persistent severe knee and foot joint subluxation.

Other Meds: multivitamins, fish oils, Levothyroxine

Current Illness:

Date Died: 10/11/2021

ID: 1788244
Sex: M
Age: 64
State: MI

Vax Date: 05/06/2021
Onset Date: 10/11/2021
Rec V Date: 10/15/2021
Hospital:

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

Lab Data: COVID "detected" test on 10/04/2021.

Allergies: Sorafenib, Penicillins, Zosyn (bata lactams), Vancomycin, amlodipine.

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

Symptoms: Fully vaccinated patient admitting through ED for COVID who subsequently died from COVID. Provider discharge note "65 YO male with AML requiring BMT and subsequent GVHD admitted with hypoxia due to covid pneumonia. Patient developed respiratory failure with hypoxia requiring HFNC and BiPAP support. Eventually transitioned to comfort care with progression of disease despite aggressive treatment. Patient passed today comfortably with family at bedside at 856AM."

Other Meds: Acyclovir, elavil, norvasc, ammonium lactate 12% lotion, aspirin, lipitor, zithromax, calcium carbonate, plavix, diflucan, atarax, lidocaine, pisinopril, TOPROL XL, remeron, dulera, singulair, prednisolone eye drops, prednisone tablets, lyr

Current Illness:

ID: 1788245
Sex: F
Age: 18
State: IA

Vax Date: 10/15/2021
Onset Date: 10/15/2021
Rec V Date: 10/15/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: none

Allergies: Amoxicillin

Symptom List: Vomiting

Symptoms: Patient received Moderna on 10/13/2021 after having Pfizer on 09/13/2021. Patient was notified. No c/o side effects reported by patient when this nurse spoke to her on 10/14/2021. Patient was notified on 10/14/2021 that she is considered fully vaccinated per CDC response via e mail.

Other Meds: Clindamycin OCP Hydroxyzine

Current Illness: None aware of

ID: 1788246
Sex: F
Age: 58
State: IA

Vax Date: 10/15/2021
Onset Date: 10/15/2021
Rec V Date: 10/15/2021
Hospital:

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

Lab Data: none known yet

Allergies: NKDA

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: RN administered two Pfizer vaccinations instead of one third dose and one Shingrix. After finding out patient got two doses of Pfizer (one in each arm) we all elected not to administer the Shingrix.

Other Meds: glipizide, one touch, fenofibrate, zolpidem, duloxetine, metoprolol, trajenta, atorvastatin

Current Illness: unknown

ID: 1788247
Sex: M
Age: 39
State: CA

Vax Date: 10/09/2021
Onset Date: 10/10/2021
Rec V Date: 10/15/2021
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: Pt received his 2nd Pfizer shot on Saturday October 9th, 2021. On Sunday October 10, 2021 he began to have swelling on the face, his upper lip became completely swollen at 5P.M and he became very week for the rest of the day. On Monday, October 11, he continued to feel weak and have more swelling around his eyes.

Other Meds:

Current Illness: Had facial swelling and hives with his first Pfizer vaccine on 9/8/21.

ID: 1788249
Sex: F
Age: 53
State: PA

Vax Date: 10/12/2021
Onset Date: 10/13/2021
Rec V Date: 10/15/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: none

Allergies: Strawberries, Vicodin, Tylenol c Codeine

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient woke up at 0430 with hives/welts all over trunk and legs. She took 100mg of Benedry and sypmtoms resolved slowly over the next 12 hours

Other Meds: Ethosuximide, Valerean Root

Current Illness:

ID: 1788250
Sex: M
Age: 20
State: VA

Vax Date: 04/08/2021
Onset Date: 07/01/2021
Rec V Date: 10/15/2021
Hospital:

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

Lab Data: Bloodwork - Negative for Celiac Biopsy showed Positive for Celiac

Allergies: no

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

Symptoms: After the 2nd dose had fever 102 and last for about one day. I had constipation for a long time , over the summer the symptoms , getting full very quickly and nausea and bothered me most. Not every meal but just more frequent in Jul2021 and saw the doctor mid August2021 biopsy positive for celiac , bloodwork was negative. endoscopy and biopsy came back positive for celiac.

Other Meds: Vitamin D. Miralax

Current Illness: no

ID: 1788251
Sex: M
Age: 30
State: NE

Vax Date: 09/15/2021
Onset Date: 09/17/2021
Rec V Date: 10/15/2021
Hospital:

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

Lab Data: currently seeking help.

Allergies: none

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

Symptoms: Severe right testicle pain and pressure and swelling after first dose. Middle right testicle pain and pressure after second dose. headache, drowsiness, chills and cold sweats after second dose.

Other Meds: Tylenol, melatonin, vit d3

Current Illness: no

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am