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: 1789138
Sex: F
Age: 41
State: MI

Vax Date: 06/20/2021
Onset Date: 07/01/2021
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: LA

Lab Data: None.

Allergies: Porphyria

Symptom List: Dysphagia, Epiglottitis

Symptoms: Keep getting flutters in my heart. It feels like my body is out of control when it happens.

Other Meds: NOVOAPRID; VITMAIN D

Current Illness:

ID: 1789139
Sex: F
Age: 70
State: OH

Vax Date: 09/29/2021
Onset Date: 09/29/2021
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:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: received expired dose of pfizer. patient had a sore arm. recommended to repeat dose

Other Meds:

Current Illness:

ID: 1789140
Sex: M
Age: 87
State: MN

Vax Date: 01/27/2021
Onset Date: 10/13/2021
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: none

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

Symptoms: He has mild chonnic cough and diarrhea which has not changed. No other infectious symptoms. started 10/13/21 comes in for a COVID test after his son was tested positive for COVID 2 days ago.

Other Meds: simvastatin; Qvar; Flurometholone suspension; prednisolone

Current Illness: none

ID: 1789141
Sex: M
Age: 71
State: OH

Vax Date: 09/29/2021
Onset Date: 09/29/2021
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:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: received expired dose of vaccine. patient had a sore arm. recommended to repeat

Other Meds:

Current Illness:

ID: 1789143
Sex: F
Age: 33
State: CA

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: IM
Vax Site: LA

Lab Data: None

Allergies: None

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

Symptoms: After the pharmacist administered the Pfizer vaccine, the patient showed the card and administering pharmacist found that the first dose was Moderna. Talked to the patient, apologized and informed the patient about the error and told to contact the pharmacy for any question or any side effects may experience. Patient had no adverse effects, but advise to seek medical attention if needed. Patient has no primary physician.

Other Meds: None

Current Illness: None

ID: 1789144
Sex: F
Age: 60
State: CT

Vax Date: 09/12/2021
Onset Date: 09/13/2021
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:

Allergies: PENICILLIN

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

Symptoms: Awakened at 10 am, incredibly itching hands, then hives up to elbows, hands and arms swollen, lip swollen, face swollen, and throat discomfort. When it first started I took BENADRYL, but it got much worse. I got out my EPIPEN (bee allergy) and went to ED. There they put in an IV and gave me BENADRYL and PREDNISONE. I went home with a prescription for PREDNISONE. The hospital report says adverse drug reaction, allergic reaction, anaphylactoid response.

Other Meds: VITAMIN C; ALLEGRA; ROSUVASTATAN; BELBUCA; PREGABLIN; IRON; XANAX; MULTIVITAMIN; TRINTELLIX; DEXILANT; ESZOPICLONE; MAGNESIUM

Current Illness:

ID: 1789145
Sex: M
Age: 68
State: CA

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: LA

Lab Data: none

Allergies: none

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: after patient received dose, he said, that he had actually gotten the flu shot the month prior. monitored pt for 15 minutes, no adverse effects. checked STC/ONE no record of any other flu shot since 2016. possibly had 2 flu shots.

Other Meds: n/a

Current Illness: none

ID: 1789146
Sex: M
Age: 27
State: FL

Vax Date: 08/06/2021
Onset Date: 08/07/2021
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: Pharyngeal swelling

Symptoms: Patient broken out in open sore lesions on his face and head that turned into scabs for 2-3 days following administration of the vaccine. He also reported having itchy lower extremities for 2-3 days following administration of the vaccine.

Other Meds: None

Current Illness: None

ID: 1789147
Sex: F
Age: 83
State: OH

Vax Date: 09/28/2021
Onset Date: 09/28/2021
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:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: received expired dose of vaccine. had a sore arm and took tylenol to resolve side effects. recommended to repeat vaccine

Other Meds:

Current Illness:

ID: 1789148
Sex: F
Age: 57
State: WA

Vax Date: 01/06/2021
Onset Date: 10/12/2021
Rec V Date: 10/15/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: COVID status positive on 10/13/21.

Allergies: nkda

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient received Pfizer COVID vaccine on 12/18/20 and 1/6/21. On 10/13/21, patient was admitted to our facility for DKA and COVID-19 pneumonia. As of today (10/15/21), patient is still in HCF.

Other Meds: empagliflozin, levothyroxine, metformin, pregabalin

Current Illness:

ID: 1789149
Sex: F
Age: 68
State: OH

Vax Date: 09/28/2021
Onset Date: 09/28/2021
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:

Allergies:

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

Symptoms: received expired dose of vaccine. could not contact patient. left 2 voicemails.

Other Meds:

Current Illness:

ID: 1789150
Sex: F
Age: 85
State: MN

Vax Date: 01/27/2021
Onset Date: 10/13/2021
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: lipitor; crestor; prevacid; lisinopril

Symptom List: Rash, Urticaria

Symptoms: Patient has been having 2-3 loose stools for 4 days and ocassional cough but no fever, sore throat or SOB. starting on 10/13/21 her son was tested positive for COVID 2 days ago. Husband tested positive 10/15/21

Other Meds: Amiodarone HCl 200 MG Tablet 1 tablet Orally Once a day Losartan Potassium 50 MG Tablet 1 tablet Orally two times a day hydroCHLOROthiazide 12.5 MG Capsule 1 tablet in the morning Orally once a day Warfarin Sodium 2.5 MG Tablet 1 t

Current Illness: none

ID: 1789151
Sex: F
Age: 53
State: NY

Vax Date: 10/07/2021
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: None

Allergies: Not disclosed

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

Symptoms: Vaccine administration error. The patient received Moderna for her first two doses. Should not have been given Pfizer as her third. No adverse side effects reported by patient.

Other Meds: Not disclosed

Current Illness: not disclosed

ID: 1789152
Sex: F
Age: 23
State: OH

Vax Date: 09/30/2021
Onset Date: 09/30/2021
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: EKG - 1 Oct 21; Chest x-ray - 1 Oct 21; EKG - 5 Oct 21; EKG - 7 Oct 21; Chest x-ray - 7 Oct 21; Basic metabolic panel - 7 Oct 21; D-Dimer - 7 Oct 21; CBC w/Diff - 7 Oct 21; Troponin I - 7 Oct 21; All tests came back normal.

Allergies: Codeine; Certain laundry detergents

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

Symptoms: Developed headache, sore throat, exhaustion, and chills around 1700 on 30 Sep 21. Developed severe chest pain, extreme difficulty breathe, and was in and out of consciousness around 2200 on 30 Sep 21 until around 0230 on 1 Oct 21. The current diagnosis is costochondritis.

Other Meds: FLONASE; CLARITIN; VITAMIN B; VITAMIN C; VITAMIN D

Current Illness: None

ID: 1789153
Sex: F
Age: 49
State: NY

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

Allergies: not-disclosed

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

Symptoms: Vaccine administration error. The patient received moderna as her first dose on 05/14/2021. The patient was given Pfizer as a 2nd dose on 09/28/21. Mixed MRNA vaccines.

Other Meds: Not-disclosed

Current Illness: not-disclosed

ID: 1789154
Sex: F
Age: 55
State: CA

Vax Date: 03/04/2021
Onset Date: 03/13/2021
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: None.

Allergies: Gluten

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

Symptoms: Intermittent band-like, but sharp chest pain mostly when lying supine, with deeper inspirations, palpation, and applied pressure.

Other Meds: STELARA, Maxide, Rosuvastatin, Singular, Pantoprazol, Multivitamin, Vitamin D3, Viactiv, Iron, Fish Oil, Vitamin Supplements

Current Illness: None

Date Died: 10/14/2021

ID: 1789155
Sex: M
Age: 94
State: FL

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

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

Lab Data: NA

Allergies: NKA

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

Symptoms: Pfizer booster dose given Wednesday 10/13/21 on 10/14/21 patient was not feeling well unsteady gait, Nausea, Vomit, poor appetite, shivering. 7pm patient was unresponsive with poor vitals, emergency service transported the patient and CPR initiated. Patient pronounced deceased around 750pm.

Other Meds: Vitamin B 1000mcg, Glipazide 5mg, amlodipine besylate 5mg, Aricept 10mg, allopurinol 10mg, Simvastatin 20mg, Sertraline 50mg, Quetiapine 50mg, Pioglitazone HCl Tablet 30 MG, Omeprazole Tablet Delayed Release 20 MG, Neurontin Capsule 300 MG

Current Illness: none

ID: 1789156
Sex: F
Age: 60
State: LA

Vax Date: 09/04/2021
Onset Date: 09/01/2021
Rec V Date: 10/15/2021
Hospital:

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

Lab Data: 10/12/2021 Chest X-Ray was clear 10/12/2021 EKG was normal 10/12/2021 hgb critically low

Allergies: Sulphur

Symptom List: Ear pain, Hypoaesthesia

Symptoms: A few days after the 2nd dose I was fatigued. As days went by it worsened as well as being short of breathe and my heart was racing. It was to the point that I could not walk down 8 stairs without feeling dizzy. I went to Doctors Urgent Care on 10/12/2021 they did EKG / Chest X-Ray and Blood work. My hemoglobin level was 6.8. I was immediately referred to the emergency room. The emergency room repeated the same test with almost identical results at this point my hgb was 6.7. They ruled out internal bleeding. I required a blood transfusion (2 pints) I had a complete annual check up on April 6, 2021 and my hgb level was 12.9

Other Meds: Celexa / Buspar

Current Illness: None

ID: 1789157
Sex: M
Age: 75
State: WI

Vax Date: 10/14/2021
Onset Date: 10/14/2021
Rec V Date: 10/15/2021
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: The patient came in for his booster dose on 10/14/21. Database did not show any doses as the patient had received his first two doses in another state. When the technician asked if he was here for his booster dose, the patient stated yes and that it had been at least 6 months since he got his second dose. The patient did not have his vaccine record card on him. The technician then gave him the sticker with the lot#, date, and pharmacy information to update his vaccine record card at home. When the pharmacist went to give him the vaccine and asked if he was here for the Pfizer booster, he said yes. The next day, the patient's wife came in to get her booster dose. Upon looking at her vaccine record card, we saw that the patient's wife had received Moderna in another state, and denied her the Pfizer booster, stating that mixing manufacturers had not been approved by the CDC yet. The patient's wife then got upset, stating that her husband had received the Pfizer booster the previous day, despite also getting Moderna in another state with her. That was when the error was found. No adverse events were reported as of yet.

Other Meds:

Current Illness:

ID: 1789158
Sex: F
Age: 66
State: MN

Vax Date: 03/11/2021
Onset Date: 10/13/2021
Rec V Date: 10/15/2021
Hospital:

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

Lab Data:

Allergies: penicillin

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

Symptoms: Received 3rd Pfizer booster on 10/11/21; exposure at work, tested positive on 10/14/21, asymptomatic

Other Meds: Humira; Methotrexate; Folic acid; Prednisone

Current Illness: none

ID: 1789159
Sex: F
Age: 64
State: TX

Vax Date: 10/14/2021
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: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Extreme diarrhea that commenced 8 hours after injection. OTC antidiarrheal treatments were not effective. Explosive and liquid diarrhea episodes every 4-6 hours. No appetite and abdominal aches.

Other Meds: None

Current Illness: None

ID: 1789160
Sex: M
Age: 24
State: IN

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: IM
Vax Site: LA

Lab Data:

Allergies: NONE

Symptom List: Unevaluable event

Symptoms: PT FELT LIGHT HEADED AND STATED THEY HAD TUNNEL VISION. PT LAYED HIMSELF ON THE FLOOR WITH HIS FEET ELEVATED ON A BENCH. PHARMACIST GAVE HIM WATER AND TOOK HIS BP, WHICH WAS LOW. AFTER ABOUT 10 MIN PT FELT BETTER AND SAT UP. PT REMAINED FOR ABOUT 15 MORE MIN AND THEN LEFT NOT NEEDING FURTHER ASSISTANCE.

Other Meds: NONE

Current Illness: NONE

ID: 1789161
Sex: M
Age: 37
State: SC

Vax Date: 10/14/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies: Most nsaids

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

Symptoms: Fever, nausea, diarrhea, body aches, and fatigue.

Other Meds: None

Current Illness: None

ID: 1789163
Sex: M
Age: 47
State: CA

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:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: patient came in for flu shot and received a pfizer shot accidently. patient had already received his two moderna shots in march. patient was also given the flu shot

Other Meds: Vaccination was given at a clinic, no medication history provided

Current Illness:

ID: 1789164
Sex: F
Age: 38
State: NJ

Vax Date: 03/26/2021
Onset Date: 03/26/2021
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: EKG.

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Severe heart palpitations.

Other Meds: Verapimil

Current Illness: None

ID: 1789165
Sex: F
Age: 70
State: OH

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

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

Lab Data: not we were informed of

Allergies:

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

Symptoms: pt woke up to high fever and swollen hands and feet

Other Meds:

Current Illness:

ID: 1789166
Sex: F
Age: 39
State: DC

Vax Date: 09/03/2021
Onset Date: 09/04/2021
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: LA

Lab Data: Waiting on results-. On 9/27/21 - AM cortisol, saliva test for cortisol, -EBV, IgG and IgM. CMV, Chlamydia pneumoniae IgG. - DHEA, Estradiol, progesterone. 10/12/21 - not sure what the name is, full hormonal testing for gyno.

Allergies: None

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: The day after the vaccine i notice my body look puffy, bloated, and within 2 weeks, I had put on 5lbs (nothing changed, I work out a lot and eat healthily. This has never happened). I have now gone up two full clothing sizes and symptoms are NOT improving at all. I accidentally got the vaccine a month early, and thought i was getting a 1/2 dose but had a full 3rd dose. I was very fatigued for about a week, but that was expected.

Other Meds: WELLBUTRIN, ADDERALL, XANAX, SPIRONOLACTONE

Current Illness: SIBO (small intestinal bacteria overgrowth)

ID: 1789167
Sex: M
Age: 31
State: CA

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: RA

Lab Data: None

Allergies: nuts

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Ten minutes after getting the vaccine on the left deltoid, patient became unconscious for about 2 mins. Patient was seated in the pharmacy observation area and while he was unconscious had a very short seizure with head movement and arm movement (arm rotated clockwise and fully locked in an open position). Patient gained consciousness in 2 mins after which looked pale, clammy and had a little bit of chest tightness. After continuing to wait and rest for about another 20 mins, patient felt okay and was ready to leave. Paramedics were called initially but patient refused their service since he felt better.

Other Meds: unknown

Current Illness: None

ID: 1789168
Sex: F
Age: 66
State:

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: 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: Received third dose Pfizer vaccine at 16:45 in the left arm. Lot# 3045BA. Patient was directed to observation area. At 16:55 lightheaded, metallic taste, and dry mouth. Patient skin was warm and dry. Patient respirations were not tachypneic or dyspneic. Reported that she hadn't anything to eat since breakfast. HR: 78 BP: 130/80 RR: 16 O2Sat%: 99 17:00 ? Had a cup of water which seemed to help, dry mouth, and metallic taste going away. Declined EMS. 17:06 ?Feeling much better but still slightly lightheaded. Patient ate some food that she had brought with her in her purse. HR: 64 BP: 110/72 RR: 16 O2Sat%: 97 17:10 ?Feeling better and slowly got up without any lightheadedness and wanted to go home. Declined calling anyone to come to get her. Stated that she was fine to drive. 17:15 - Care Practitioner educated on home discharge/adverse reaction instructions and escorted attendee to her car. Patient was steady on her feet and denied any dizziness/lightheadedness.

Other Meds:

Current Illness:

ID: 1789170
Sex: F
Age: 62
State: CO

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: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: Patient stated she was having heartburn and right armpit soreness/pain about 3 to 4 minutes after injection. She waited about 15 minutes and the heartburn went away but she is still having armpit pain. It is staying the same, not getting better or worse.

Other Meds:

Current Illness:

ID: 1789171
Sex: F
Age: 63
State: NY

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:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data: Exam of ears.

Allergies: Sulfa, Codeine, Latex, Egg, Dairy, Soy, Gluten, multiple chemical and food sensitivities, contrast medium

Symptom List: Injection site pain

Symptoms: Within 3 minutes of jab, both ears felt very warm and immediately felt clogged. I also noted some bumps on roof of mouth, no sob, and left after 1/2hour with ears still feeling clogged. Symptoms persisted, no nasal d/c. On 10/4 had extreme positional vertigo, Slept, took MECLINZINE, and felt off next several days with dizziness. On 10/11 had Nurse practitioner checked ear, saw fluid, tried antihistamine, recheck by provider 10/12 and 14, diagnosed with otitis media, started on ANCEF. Ear still very clogged.

Other Meds: None

Current Illness: None

ID: 1789172
Sex: M
Age: 66
State: TX

Vax Date: 03/10/2021
Onset Date: 04/08/2021
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:

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

Symptoms: Reynaud's Syndrome.

Other Meds: METFORMIN; GEMFIBROZIL; TESTOSTERONE

Current Illness:

ID: 1789173
Sex: F
Age: 37
State: TX

Vax Date: 09/30/2021
Onset Date: 10/13/2021
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: Menorrhagia

Other Meds:

Current Illness:

ID: 1789310
Sex: M
Age: 17
State: CA

Vax Date: 05/14/2021
Onset Date: 06/28/2021
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: None.

Allergies: None

Symptom List: Tremor

Symptoms: Heart racing, fluttering, and chest pain.

Other Meds: Vyvanse

Current Illness: None

ID: 1789311
Sex: F
Age: 23
State: NJ

Vax Date: 10/03/2021
Onset Date: 10/03/2021
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: These would need to be obtained from the ER visit.

Allergies: Patient has many allergies to food, pollen and animals per patient statement

Symptom List: Erythema, Pruritus

Symptoms: Patient noted mouth and throat itching about 5 minutes after vaccination. Patient took 2 25mg benadryl about 15 after vaccination. Patient left pharmacy and later noted chest pain and nausea. These symptoms were severe enough to cause patient to go to the ER where they ruled out a pulmonary embolism. Patient was prescribed and oral steroid per patient statement.

Other Meds: Unknown

Current Illness: none

ID: 1789312
Sex: F
Age: 36
State: KY

Vax Date: 09/01/2021
Onset Date: 09/15/2021
Rec V Date: 10/15/2021
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: Full lab panels to check hormone levels to find possible alternate cause of two skipped periods.

Allergies: None

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

Symptoms: This patient since the second covid vaccine on sept 1st 2021 has now skipped two periods with no previous issues before taking the covid vaccine.

Other Meds: PROZAC

Current Illness: None

ID: 1789313
Sex: F
Age: 40
State: MD

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

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

Symptoms: Patient received pfizer COVID-19 vaccine instead of flu vaccine at an offsite COVID/flu clinic.

Other Meds:

Current Illness:

ID: 1789314
Sex: F
Age: 12
State: AL

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: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient sat for 15 mins. While her and her mom were checking out at the register, she got really dizzy. We brought her a chair and she sat down and had cold chills and began sweating. After another 10-15 mins she began to feel a little better but still felt weak.

Other Meds:

Current Illness:

ID: 1789315
Sex: F
Age: 64
State: MO

Vax Date: 09/01/2021
Onset Date: 09/04/2021
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: Required ER visit for IVF on 09/12/21. Symptoms started to improve with diet change, increase fluid intake, OTC meds. Consulted GI physician on 9/21/21 and recommended colonoscopy. 9/30/21: colonoscopy with biopsies.

Allergies: Erythromycin, Influenza vaccine, Reclast

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

Symptoms: Dose #1: 8/11/21; lot#FA7484 Dose#2: 9/1/21; lot #FC3184 After dose #1 started to have diarrhea. After Dose #2 diarrhea worsen - daily and watery with abdominal cramping and occasional bleeding, also nausea. Required ER visit for IVF on 09/12/21.

Other Meds: VITAMIN D; VITAMIN B-2; FAMOTIDINE; ASPIRIN; MULTIVITAMIN

Current Illness: None

ID: 1789316
Sex: M
Age: 28
State: CA

Vax Date: 09/29/2021
Onset Date: 09/30/2021
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:

Allergies: None

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

Symptoms: Chest pain. Left side of chest sore when I move. Awareness of chest sensation when lying in bed and turning or changing position. I've had anxiety before and this was different. This was specific sensation of the heart. I could also feel it when I was straining.

Other Meds: None

Current Illness: None

ID: 1789317
Sex: F
Age: 44
State: MN

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

Lab Data: Covid test done 10-14-21 and was negative.

Allergies: None

Symptom List: Pain in extremity

Symptoms: Bright red rash at injection site approximately 5 inches in length and 2.5 inches wide with hives located near injection site, fever of 100.6 degrees for 50 hours post injection. Severe body aches and chills for 48 hours, extreme fatigue for 48 hours, headaches for 48 hours, nausea, and loss of appetite for 48 hours. Red rash, hives, and itching at injection site still present at 72 hours post injection. Body aches 72 hours post injection. BENADRYL, IBUPROFEN, and TYLENOL for treatment.

Other Meds: DULOXETINE; CYCLOBENZAPRINE; GABAPENTIN

Current Illness: None

ID: 1789318
Sex: F
Age: 41
State: CA

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: N/A

Allergies: Pencillin; Ibuprofen

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

Symptoms: 10 min after #2 dose of Pfizer covid 19 vaccine client c/o "hives" and "itchiness" to bilateral, posterior thighs. Clients bilat thighs noted w/ redness and hives. Denies shortness of breath, throat tightness or any other respiratory problems. Vaccine injection site to left arm WNL. Client medicated w/ Benadryl 25mg po at 1810. Monitored x 40 minutes; VSS. Instructed to take an additional Benadryl 25 mg at home if s/s return and call Dr or go to ER. In addition, instructed to notify PCP of incident. Discharged to home w/partner in stable condition; redness/hives resolved. VSS.

Other Meds:

Current Illness: N/A

ID: 1789319
Sex: F
Age: 39
State: MO

Vax Date: 10/13/2021
Onset Date: 10/13/2021
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: Morphine

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

Symptoms: Since receiving my flu vaccine two days ago i've had extremely vivid nightmares with three episodes of sleep paralysis. I also keep experiencing strong phosphene visual patterns as if I have experienced pressure around my eyes during these sleep paralysis episodes and wake up feeling as if i'm struggling to get enough oxygen when I do. I have some of the more common symptoms going on. A very bad two day long migraine so far, aches, stiffness, and fatigue, as well. I do not know how serious a side effect one is supposed to report, but I cannot find much about repeat sleep paralysis episodes from the flu vaccine so I figured I would report it just to be on the safe side.

Other Meds: Omeprazole OTC, Women's Daily multivitamin

Current Illness:

ID: 1789320
Sex: M
Age: 26
State: FL

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

Lab Data:

Allergies:

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

Symptoms: PATIENT GOT LIGHT HEADED AND DIZZY, WAS HAVING COLD SWEATS. HE WAS INSTRUCTED TO LAY ON GROUND WITH FEET ELEVATED AFTER TAKING A FEW SIPS OF WATER. AFTER ABOUT 3 MINS HE WAS BACK TO FEELING NORMAL. IN THE MEANTIME THE AMBULANCE CAME, HE SAID HE DID NOT WANT TO GO TO THE HOSPITAL. HE WAS OBSERVED FOR 20 MINUTES FOLLOWING EPISODE WITH NO FURTHER ISSUES

Other Meds:

Current Illness:

ID: 1789321
Sex: F
Age: 64
State: CA

Vax Date: 03/23/2021
Onset Date: 08/13/2021
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: 8-11-21 Negative 8-18-21 Positive 8-30-21 Negative

Allergies: Cephlexin, Attenol

Symptom List: Vomiting

Symptoms: Cold like symptoms - mild dry cough, loss of smell (for weeks), loss of taste (3 days), diarrhea, blurred vision, and tired. Urgent care gave me antibiotics and cough medicine. Took antibiotics, but not the cough medicine. Also wanted me to take Vitamin C, Zinc, and Vitamin D. Zinc made me barf. Did over the counter Nighttime cough medicine - worked fine.

Other Meds: LISINOPRIL, SYNTHROID; FUROSEMIND; ATORVASTATAN; SERTRALINE; CARBEDILOL; METHOCARBAMOL; ASPIRIN; CALTRATE; VITAMIN D3; PEPSIDE

Current Illness: None

ID: 1789322
Sex: F
Age: 13
State: FL

Vax Date: 10/02/2021
Onset Date: 10/03/2021
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/went to ER and received steroid/Benadryl

Allergies: None

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Rash on face and trunk

Other Meds: None

Current Illness: None

ID: 1789323
Sex: F
Age: 72
State: SC

Vax Date: 02/01/2021
Onset Date: 02/04/2021
Rec V Date: 10/15/2021
Hospital: Y

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

Lab Data: MRI , EKG, Physical Therapy

Allergies: Red Dye Asprin

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

Symptoms: Nerve damage; experincing chronic pain in neck, shoulders, arms: lower and upper extremities

Other Meds: Linezz for constipation Zetec -D for seasonal allegies

Current Illness: IBS

ID: 1789324
Sex: F
Age: 40
State: FL

Vax Date: 10/14/2021
Onset Date: 10/15/2021
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:

Allergies: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Limon nodes under arm really swollen.

Other Meds: Albuterol

Current Illness: None

ID: 1789325
Sex: M
Age: 40
State: IL

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: IM
Vax Site: RA

Lab Data: None.

Allergies: Unknown

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

Symptoms: Patient said he received Janssen vaccine (10/15/21) and soon felt short of breath, so he took his inhaler. He became lightheaded. During my assessment at 1:45 PM he only had complaints of feeling lightheaded. His skin was not cool or clammy. He was jittery. No wheezing audible, no cough noted. No diaphoresis. He was talking in complete sentences. Denied trouble swallowing, lip swelling, and throat tightness. Pulse 71, SpO2 95%. Drinking water sitting in front of air-conditioning fan. Continued to monitor. At 2:00 PM, patient reports he is feeling better. Advised home to rest and not to return to work. At 2:13 PM, Brandon still feels jittery, but not lightheaded, no SOB, no tongue swelling or trouble swallowing, no dizziness. Will be going home. EMS was not contacted.

Other Meds: Albuterol Inhaler

Current Illness: None known

ID: 1789326
Sex: F
Age: 50
State: NC

Vax Date: 10/10/2021
Onset Date: 10/11/2021
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: On Monday, 10/11/2021, around 7:30 pm, I went to see the doctor, and she gave me the diagnosis of shingles. I started the treatment with Acyclovir 1000 mg for seven days.

Allergies: no

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

Symptoms: On Monday, 10/11/2021 day after taking a vaccine, I started feeling pain in the left armpit. At night around 2:00 am, when I turned to sleep over my left side, the pain bothered me, then I realized a hard mass on my back on the left side; I looked at the mirror it was painful with red blisters.

Other Meds: Levothyroxine 100 mg

Current Illness: no

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am