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: 1793537
Sex: M
Age: 67
State: OH

Vax Date: 10/13/2021
Onset Date: 10/13/2021
Rec V Date: 10/16/2021
Hospital:

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

Lab Data:

Allergies: morphine

Symptom List: Dysphagia, Epiglottitis

Symptoms: severe flu symptoms, slowly getting better and treating OTC medicine

Other Meds: vitamins, metoprolol, and simvastatin

Current Illness: none

ID: 1793538
Sex: F
Age: 35
State: FL

Vax Date: 10/08/2021
Onset Date: 10/08/2021
Rec V Date: 10/16/2021
Hospital:

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

Lab Data: Blood work basic labs 10/10/2021 Ct scan of brain w/w/o contrast 10/10/21 EKG 10/10/2021 Chest X-ray 10/10/2021 Blood work basic labs 10/15/2021 EKG 10/15/2021

Allergies: Multiple medication and food sensitivities

Symptom List: Anxiety, Dyspnoea

Symptoms: Immediately after injection I felt my ears ringing and incredibly dizzy. I felt as though my heart rate dropped really low and as if I might pass out. The next day I experienced near black outs multiple times upon waking and had to be asleep all day. Because of the severe fatigue. The following day since I still felt strange I went to the emergency room. The symptoms of palpitations, scratchy throat, weakness, dizziness and confusion seems to wax and wane. I also had pupils that were two different sizes when in the emergency room that day. 4 days after my first emergency room visit my itching throat symptoms got worse and I woke up feeling as though my throat was closing and I couldn?t breathe. I was coughing and gagging and felt as though I was going to throw up. I called my primary care doctor and they advised me to go to the hospital. I returned again to the same hospital and the doctor confirmed it sounded like an additional allergic reaction to the vaccine. I left the hospital yesterday 10/15/2021 and today I feel like I cannot move my neck, my throat appears to have closed more and I have severe tenderness and swelling around my neck, throat, and even jaw and face area. I am truly concerned. My follow up Dr appointment is on Tuesday 10/19/2021 and it was the earliest I could be seen.

Other Meds: Yasmin, oxycodone, sertraline

Current Illness: Wolf Parkinson?s white, inappropriate sinus tachycardia, fibromyalgia, gastroparesis, arthritis and immune disorder not specified

ID: 1793539
Sex: M
Age: 59
State: FL

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 10/16/2021
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: None

Allergies: None

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

Symptoms: 1) pain @ injection site started 9 hours after shot lasted 2 days 2) sinus cold the day after shot lasted 2 days. Not sure if related. 3) hives about 1 week after shot. I had them on my arms,chest,top of feet,groin,buttocks and waist line. SECOND SHOT 1) pain @ injection site. Less then the first shot and only lasted a day. 2) hives mostly came up on my upper thighs. Not as bad as the first. They did not itch as much.

Other Meds: Vitamin A,B12,cranberry,D3,Glucosamine,Iron and Potassium

Current Illness: None

ID: 1793540
Sex: F
Age: 52
State: MA

Vax Date: 10/12/2021
Onset Date: 10/15/2021
Rec V Date: 10/16/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Low grade fever 99.7 on 10/15

Other Meds: Humalog, Lantus, Metformin (extended release), Duloxetine, Trulicity

Current Illness:

ID: 1793541
Sex: F
Age: 26
State: FL

Vax Date: 10/15/2021
Onset Date: 10/16/2021
Rec V Date: 10/16/2021
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 erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Severe migrane, full body ache, tenderness around injection site, pain at injection site, unable to move arm due to pain, cramping, PMS symptions without mensturation.

Other Meds:

Current Illness:

ID: 1793542
Sex: F
Age: 56
State: WI

Vax Date: 10/06/2021
Onset Date: 10/07/2021
Rec V Date: 10/16/2021
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: EKG

Allergies: Sulfa drugs, erythromycin, zythromycin

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

Symptoms: 10 hours after receiving both Shingrix and flu vaccines I experienced dizziness and nausea. I then fainted three times in about five minutes and fell down a flight of stairs. My pulse was 140 at that time. 8 hours after this incident I went to Urgent Care. My heart rate was 144. An EKG was normal. I followed up several days later with my PCP. My pulse stayed at or above 100 for about a week.

Other Meds: Singulair, Prempro, cyclobenzoprene, sudafed, fish oil, patonase, nasonex

Current Illness: None

ID: 1793543
Sex: F
Age: 71
State: VA

Vax Date: 10/14/2021
Onset Date: 10/15/2021
Rec V Date: 10/16/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: PATIENT STATED SHE WOKE UP THE DAY AFTER RECEIVING HER BOOSTER SHOT WITH 2 BOILS ON HER FACE AND 3 BOILS ON HER NECK. ASKED HER IF THEY ITCHED OR WAS IRRITATED AND SHE SAID NO - JUST LOOKED LIKE THEY WERE COMING TO A HEAD. ADVISED PATIENT TO SEE DOCTOR AND TO CALL THE VAERS NUMBER TO REPORT AS WELL.

Other Meds:

Current Illness:

ID: 1793545
Sex: F
Age: 71
State: IN

Vax Date: 10/14/2021
Onset Date: 10/15/2021
Rec V Date: 10/16/2021
Hospital:

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

Lab Data:

Allergies: n/a

Symptom List: Pharyngeal swelling

Symptoms: Woke up with terrible chills. Felt really fatigued and sick to my stomach with a terrible headache all day following the vaccine shot (on Friday..the shot was Thursday). This was the booster. Had a very sore arm also. After the first 2 shots, I had no symptoms. I went to bed early last night and feel much better today.

Other Meds: multivitamin

Current Illness: n/a

ID: 1793547
Sex: F
Age: 26
State: MO

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

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

Lab Data:

Allergies: Penicillin and sulfa drugs

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Flu like symptoms that are unable to be relieved with over the counter medication. Cramping and contractions as well. I am 34 weeks and due 11/27/21.

Other Meds: Singular, Wellbutrin, omeprezole, procardia, prenatal vitamin, colace, Zyrtec

Current Illness: None

ID: 1793548
Sex: F
Age: 50
State: NC

Vax Date: 10/01/2021
Onset Date: 10/08/2021
Rec V Date: 10/16/2021
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: Red food coloring Penicillin

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Very sore and tender breast started with swollen lymph nodes under one arm then the other and then both breast got sore. Hurts to not have support or roll over. Has lasted for 10 days.

Other Meds: Vitamin C Salmon Oil 3,000 mg daily

Current Illness: None

ID: 1793549
Sex: M
Age: 37
State: WA

Vax Date: 10/10/2021
Onset Date: 10/11/2021
Rec V Date: 10/16/2021
Hospital: Y

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

Lab Data: CT angiogram chest 10/13/2021 --Multifocal, predominantly linear bibasilar opacity, likely atelectasis. --Mild stranding of the left anterior chest wall/left axillary region subcutaneous tissues, as may be seen in the setting of cellulitis, with several prominent likely reactive left axillary lymph nodes. Troponin I 1.052 ng/mL (0 - 0.028 ng/mL) WBC 16.07 K/uL (4-12) Sed rate 25 mm/hr (0-15) CRP 11.7 mg.dL (0-1.0)

Allergies: Penicillin

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

Symptoms: Patient states that he received his first dose of the Moderna vaccination on October 10. The next day he began having myalgias, chills, and headache. 2 days later, he developed chest pain and shortness of breath. He had a fever to 103 deg F at home. Chest pain is described as tightness, located in the midsternal region with some radiation to the neck. He reports this is worse with bending forward. The pain has been constant. He feels as though he is unable to take a deep breath. He had COVID in 1/2021 - with positive COVID-19 test on 1/18/2021. He presented to the ED and was noted to have elevated WBC and cardiac troponin. CTA chest was negative for pulmonary embolism. He was diagnosed with acute myocarditis. There was improvement in the chest discomfort, albeit still present, at the time of discharge. Symptomatic treatment recommended.

Other Meds: dabigatran metoprolol tartrate hydrochlorothiazide testosterone cypionate

Current Illness: none

ID: 1793550
Sex: F
Age: 73
State: KS

Vax Date: 10/15/2021
Onset Date: 10/15/2021
Rec V Date: 10/16/2021
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: None known

Symptom List: Rash, Urticaria

Symptoms: I had an appointment scheduled online to get a Flu shot. The tech didn't ask my name or ask my birth date before she gave me the shot. Afterwards, she gave me a vaccination record sheet indicating she had given me the Covid 19 booster shot. I told her I was supposed to be getting a flu shot. They discovered that she had the wrong record--another person with a very similar name. Since it was a Friday afternoon, I was told to go to an urgent care or the emergency room if I had side effects. So far--the next day--I have no side affects.

Other Meds: Amlodepine 5 mg daily

Current Illness: None

ID: 1793551
Sex: F
Age: 48
State: FL

Vax Date: 10/08/2021
Onset Date: 10/15/2021
Rec V Date: 10/16/2021
Hospital:

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

Lab Data: N/A

Allergies: None

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

Symptoms: Severe headache, nausea and vomiting Drank fluids and rested in bed when wasn't vomiting

Other Meds: None

Current Illness: None

ID: 1793552
Sex: M
Age: 30
State: CA

Vax Date: 05/17/2021
Onset Date: 06/25/2021
Rec V Date: 10/16/2021
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: Blood tests 4+ times (full panel, lipids, trop, c-reactive, dimer, etc.), brain MRI, 4 chest x-rays, echo - stress and regular, 5+ ECGs, full neurological exam, cardiac MRI, CT cardiac angiogram

Allergies: None

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

Symptoms: Constant - ongoing chest pain (24 hours a day). Fatigue, headaches at base of skull, numbness in arms / legs / face, muscle aches (might just be from a reduction of physical exercise) and brain fog

Other Meds: None

Current Illness: None

ID: 1793553
Sex: M
Age: 82
State: IN

Vax Date: 10/12/2021
Onset Date: 10/14/2021
Rec V Date: 10/16/2021
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: rash on right upper arm

Other Meds: ezetimide--livalo--allopurinol--81mg aspirin---collagen peptide--ammonium lotion

Current Illness:

ID: 1793554
Sex: M
Age: 55
State:

Vax Date: 10/13/2021
Onset Date: 10/13/2021
Rec V Date: 10/16/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: ADMINISTERED DOSE FROM EXPIRED VIAL

Other Meds:

Current Illness:

ID: 1793555
Sex: F
Age: 15
State: TN

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 10/16/2021
Hospital:

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

Lab Data: none

Allergies: none

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

Symptoms: She was only 15 and flublok is only approved in 18 and above

Other Meds: unknown

Current Illness: none

ID: 1793556
Sex: M
Age: 59
State: WI

Vax Date: 10/15/2021
Onset Date: 10/15/2021
Rec V Date: 10/16/2021
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: NKA

Symptom List: Ear pain, Hypoaesthesia

Symptoms: I got extreme chills that went away after a few hours.

Other Meds: Lisinopril, Rosuvastatin, Naltrexone, Clomiphene, Glucosimane Chondroitin, Multivitamin, Low dose aspirin

Current Illness: None

ID: 1793557
Sex: M
Age: 45
State: CT

Vax Date: 09/29/2021
Onset Date: 10/01/2021
Rec V Date: 10/16/2021
Hospital:

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

Lab Data: Ct 10-16-21

Allergies: No

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Parotitis on CT and continuing at 2 weeke

Other Meds: Paxil

Current Illness: No

ID: 1793558
Sex: F
Age: 51
State: TX

Vax Date: 09/14/2021
Onset Date: 10/03/2021
Rec V Date: 10/16/2021
Hospital: Y

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

Lab Data: EKG Echocardiogram

Allergies: Levaquin

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

Symptoms: chest pains and shortnesss of breathe diagnosed with Pericarditis

Other Meds: Metformin Embrel Amlodipine Atorvastin

Current Illness: Sarcadosis DIabetes

ID: 1793559
Sex: M
Age: 13
State:

Vax Date: 10/04/2021
Onset Date: 10/05/2021
Rec V Date: 10/16/2021
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: Bloodwork Oct 11, Oct 14, ECG Oct 14

Allergies: None

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

Symptoms: Fever, chills, headache, nausea, sore muscles for first 6 days, then numbness in right arm spreading to left shoulder and neck

Other Meds: None

Current Illness: None

ID: 1793560
Sex: F
Age: 59
State: IL

Vax Date: 05/17/2021
Onset Date: 06/15/2021
Rec V Date: 10/16/2021
Hospital:

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

Lab Data: EKG, Echo Cardiogram, Stress Test - scheduled Angioplasty

Allergies: None known

Symptom List: Unevaluable event

Symptoms: Since the 2nd shot I have had racing, pounding vibrating heart and fluttering heart it has continued for months. I have never experienced this before. I have been through an EKG, Echo cardiogram, Stress test and am now scheduled for angioplasty surgery. Prior to this healthy active 59 year old no issues.

Other Meds: Estrodial 2mg, Vitamin D, Vitamin C, Multi-vitamin

Current Illness: None

ID: 1793562
Sex: F
Age: 61
State: IA

Vax Date: 10/15/2021
Onset Date: 10/15/2021
Rec V Date: 10/16/2021
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: The patient reported she felt "clammy" and noticed increased sweating. After a few minutes of sitting and deep breathing she reported numbness of her left arm and tingling in her hands. She denied diphenhydramine when offered. She denied any difficulty breathing or closing of the throat. She had no visible skin reaction. She was advised to wait 30 minutes rather than the 15 minute waiting period. We recommended she seek medical attention, but she denied and reported the tingling an numbess had gone away. After she felt better, we had her wait for 15 more minutes. She was no longer experiencing any side effects. We recommended she follow up with her primary care provider and seek medical attention if she had any other adverse events once home.

Other Meds:

Current Illness:

ID: 1793563
Sex: F
Age: 63
State: FL

Vax Date: 10/14/2021
Onset Date: 10/15/2021
Rec V Date: 10/16/2021
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: Penicillin, Kefex, simvastatin

Symptom List: Injection site pain, Pain

Symptoms: Pain at injection site. Severe headache. Vomiting after meal. IBuprofen one at onset of arm pain and headache 4:30 am One at at 1 pm One at 8 pm Table spoon of Honey to relive coughing

Other Meds: 1) ANASTROZOLE 1MG TAB TAKE ONE TABLET BY MOUTH EVERY ACTIVE DAY FOR BREAST CANCER 2) INSULIN,GLARGINE,HUMAN 100 UNIT/ML INJ INJECT 46 UNITS UNDER THE SKIN EVERY DAY FOR DIABETES. DISCARD 28 DAYS AFTER OPENING 3) SEMAGLUTIDE 0.5MG/0.375

Current Illness: None

ID: 1793564
Sex: F
Age: 42
State: WV

Vax Date: 10/12/2021
Onset Date: 10/13/2021
Rec V Date: 10/16/2021
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: None

Symptom List: Injection site pain, Menorrhagia

Symptoms: Left side lymphadenopathy Chest pain Stiff neck Headache

Other Meds: Zoloft 100mg daily Famotidine 40mg daily

Current Illness: None

ID: 1793565
Sex: F
Age: 54
State: CO

Vax Date: 10/14/2021
Onset Date: 10/16/2021
Rec V Date: 10/16/2021
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: none

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

Symptoms: Fever, RUQ ( liver pain)

Other Meds: Vitamin C, 1000mg

Current Illness: none

ID: 1793566
Sex: F
Age: 72
State: GA

Vax Date: 10/09/2021
Onset Date: 10/09/2021
Rec V Date: 10/16/2021
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: statins

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Vomiting, nausea, very sore arm, numbness in arm, redness At Injection site,, swelling and hardness at site, numbness in arm., Injection site felt hot. Still very sore and red after more than a week.

Other Meds: Calcium citrate plus, Biotin, folic acid, multivitamin and mineral, vitamin C, flaxseed, cranberry extract, vitamin D3, baby aspirin, metoprolol Succinate ER, pantry for Saul sod ER, allopurinol, Metronidazole, potassium CL, fluoxetine, Ex

Current Illness: None

ID: 1793568
Sex: M
Age: 37
State:

Vax Date: 10/05/2021
Onset Date: 10/06/2021
Rec V Date: 10/16/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Morning after I received the shot, behind my ears down to Base of back of neck had severe pain/ache. As the day progressed this pain spread to my shoulders, then full arms. My hips down my legs eventually had the same pain/aches. It is now 11 days after the injection and the pain/aches in my legs have yet to stop. I am also experiencing periodic numbness and tingling in my limbs. Lastly, I have had hot itchy hives in my armpits, groin, Intergluteal cleft, and behind my knees

Other Meds: None

Current Illness: None

ID: 1793569
Sex: F
Age: 20
State: MA

Vax Date: 10/15/2021
Onset Date: 10/15/2021
Rec V Date: 10/16/2021
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: no

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

Symptoms: Patient fainted approximately 10 minutes after receiving her vaccine. She stood up to throw away some trash and said she didn't feel well. She was caught by a nurse in the room so she had a controlled fall and didn't get hurt. She was treated by 2 nurses working at this clinic. They applied ice to her forehead, took her vitals and gave her a snack and some juice. After about 15 minutes she said she was feeling much better and left with her step mom. Her step mom said that she frequently faints when getting vaccines or other medical procedures. The patient, said it's anxiety related.

Other Meds: no

Current Illness: no

ID: 1793571
Sex: F
Age: 42
State: FL

Vax Date: 06/22/2021
Onset Date: 06/26/2021
Rec V Date: 10/16/2021
Hospital: Y

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

Lab Data: I went to local HCF in July

Allergies:

Symptom List: Nausea

Symptoms: Chest pain and rapid heartbeat

Other Meds: Nifedipine

Current Illness: High blood pressure

ID: 1793572
Sex: F
Age: 80
State: AR

Vax Date: 10/14/2021
Onset Date: 10/15/2021
Rec V Date: 10/16/2021
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: Symtom: shaking with chills at 1600 . Went to bed in winter nightgown and wool socks under heavy comforter. Woke up at 2000 with no chills. Don't remember trying to sleep. Took no medicine. No fever involved. No previous Experience with this symtom.. Realize happened after 24 hours.

Other Meds: None

Current Illness:

ID: 1793573
Sex: M
Age: 56
State: UT

Vax Date: 10/11/2021
Onset Date: 10/14/2021
Rec V Date: 10/16/2021
Hospital:

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

Lab Data: None taken

Allergies: I have had reactions in the past to tetanus shot, years ago

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

Symptoms: Thursday evening after work , I started to have headaches starting at my lower neck ( brain stem area) getting worse over the next 4 hour to the point of seeing spots, bad pain to the point of vomiting, because of the pain, head throbbing, like zI could feel my pulse pounding in my entire head, ringing in my ears.

Other Meds: None

Current Illness: None

ID: 1793574
Sex: M
Age: 75
State: NC

Vax Date: 10/13/2021
Onset Date: 10/15/2021
Rec V Date: 10/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: none

Allergies: none

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

Symptoms: After moderate swelling at the left arm injection site (within 24 hrs.), my underarm began to swell and became very painful. The lymph node (assumption) at my left arm pit stayed swollen for the next 24 hours while I maintained a moderate fever (99/100) with flu like symptoms with lethargy. Within 48 hrs. after injection I could feel an unusual sourness in my left arm extending from the inside of my arm near the injection site to the inside of my wrist (nerve ?). Today 10/16, the symptoms appear to be mitigating, but still very present and annoyingly painful at times.

Other Meds: amlodipine 5mg aspirin 81mg multivitamin

Current Illness: none

ID: 1793575
Sex: F
Age: 62
State: NY

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 10/16/2021
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 palpitations 2 hours post vaccination lasting for approximately 10 minutes lower back pain altered coordination/balance chest pain on and off

Other Meds: Pravastatin Sodium. Losartan Potassium Vitamin D2.

Current Illness: HTN

ID: 1793576
Sex: F
Age: 17
State: MN

Vax Date: 05/18/2021
Onset Date: 10/13/2021
Rec V Date: 10/16/2021
Hospital: Y

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

Lab Data: CT PR chest and abdomen 10-12-2021 echocardiogram 10-12-2021 bilat leg doppler, 10-12-2021 ct venogram 10-13-2021 d-dimer 10-12-2021

Allergies: none

Symptom List: Erythema, Pruritus

Symptoms: saddle pulmonary emboli, IVC clot

Other Meds: unknown

Current Illness: diabetes

ID: 1793578
Sex: F
Age: 77
State: FL

Vax Date: 09/29/2021
Onset Date: 09/30/2021
Rec V Date: 10/16/2021
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: CT scan, Tuesday, 10/12/2021 Office visit, GI physician Endoscopy scheduled for 11/9/2021 (on waiting list in event of a cancellation.

Allergies: Zetia, Demerol, Lamisil

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

Symptoms: Nausea, stomach pain, (not gastric irritation), fatigue, enteritis, nausea continues with difficulty eating food, weight loss, 5#.Stomach pain and abdominal bloating, now less.

Other Meds: Levothyroxine 0.75 micrograms Metoprolol Tarta 50 mgs, Crestor 10 mg Meloxicam 7.5 mgs Flexeril 5-10 mgs hs Gabapentin 400 mgs, tid Alendronate Sodium once weekly Calcium 600 mgs with Vitamin D 300 Daily multivitamin Magnesium 250 mgs COQ-1

Current Illness: None

ID: 1793579
Sex: F
Age: 67
State: AZ

Vax Date: 09/28/2021
Onset Date: 10/01/2021
Rec V Date: 10/16/2021
Hospital:

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

Lab Data: CXR, EKG, Covid test, complete blood profile.

Allergies: none

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

Symptoms: Developed severe dizzyness exacerbated with head movement. No neurological symptoms. However, did seek medical attention at ED 10/10/21 due to near syncopal episodes. All cardiac, neurological workup negative. After discharge, follow up with PC who prescribed Meclizine. Took one dose which worsened symptoms and severe lassitude. Discontinued medication after one dose.

Other Meds: Synthroid 88mcg, Vitamin D3

Current Illness: none

ID: 1793580
Sex: F
Age: 31
State: OH

Vax Date: 08/18/2021
Onset Date: 08/20/2021
Rec V Date: 10/16/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Swelling of face that affected mostly chin, ears, and eye pads. Hot to the touch and bright red. Rash at injection site for over two weeks. Lump under arm for over two weeks, painful to touch. Altered sense of smell still present after two months.

Other Meds: Chewable multivitamin

Current Illness: None

ID: 1793581
Sex: F
Age: 58
State: NY

Vax Date: 09/27/2021
Onset Date: 10/14/2021
Rec V Date: 10/16/2021
Hospital: Y

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

Lab Data: CT scan, US legs

Allergies: Codiene and Ultram

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

Symptoms: Submassive PE and DVT with other risk factors. Started on Anticoagulation and appears to be improving.

Other Meds: Suboxone, Celexa, Burpropion, Flexeril. Lasix. Trazadone

Current Illness: None

ID: 1793582
Sex: F
Age: 75
State:

Vax Date: 04/09/2021
Onset Date: 10/15/2021
Rec V Date: 10/16/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Fever and SOB

Other Meds:

Current Illness:

ID: 1793583
Sex: F
Age: 67
State: WI

Vax Date: 08/26/2021
Onset Date: 10/16/2021
Rec V Date: 10/16/2021
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: antibiotics, nut allergy

Symptom List: Pain in extremity

Symptoms: 8/26 Day of vaccine arm soreness and had flushing on body (arms and chest). 8/28 -9/5 Arm soreness at site of injection. 9/7 Scalp severe itchiness and welts like allergic reaction which i have never had before. 9/10 Still mild injection site tenderness 9/23 Still having itchiness and notice sore joints at times which never had before

Other Meds: phentermine, vita D3, quercetin, vit. C, Calcium with Vit. K2.

Current Illness: none

ID: 1793584
Sex: F
Age: 64
State: MI

Vax Date: 03/22/2021
Onset Date: 03/29/2021
Rec V Date: 10/16/2021
Hospital:

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

Lab Data: Blood Test run 10/14/2021 when getting into a long wait for a doctor's appointment

Allergies: Penicillin

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

Symptoms: Severe breakout of Rheumatoid Arthritis

Other Meds: Daily Vitamin Lorsartan

Current Illness: None

ID: 1793585
Sex: F
Age: 20
State: NM

Vax Date: 06/09/2021
Onset Date: 06/09/2021
Rec V Date: 10/16/2021
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: No allergies

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

Symptoms: In the first three hours there was pain in injection site, which disseminated to the hole upper left arm. The pain limited movement and worsened at night. After three days the pain was gone

Other Meds: Gelcupro (isotretinoine) 40 mg, oral administration

Current Illness: No presented illnesses

ID: 1793586
Sex: F
Age: 8
State: CA

Vax Date: 10/15/2021
Onset Date: 10/16/2021
Rec V Date: 10/16/2021
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: Red and swollen at site of injection, approximately 2.5in x 1in. Tylenol given for pain. Injection administration technique questionable, RN injected too low, possibly missing the deltoid. Reported this information to our primary care provider's office.

Other Meds: Tylenol

Current Illness:

ID: 1793587
Sex: F
Age: 36
State: NY

Vax Date: 09/18/2021
Onset Date: 09/25/2021
Rec V Date: 10/16/2021
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: None

Symptom List: Vomiting

Symptoms: 38 weeks pregnant at the time Developed a large red spot with an additional large red ring around it. Have several pictures available to show. Went back to get my second shot today and they didn?t feel comfortable giving me the second dose.

Other Meds: Prenatal vitamins

Current Illness: None

ID: 1793588
Sex: F
Age: 55
State: IN

Vax Date: 10/15/2021
Onset Date: 10/16/2021
Rec V Date: 10/16/2021
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: No

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Arm soreness. Fever like symptoms, body aches, weakness

Other Meds: Losartan Multivitamin

Current Illness: No

ID: 1793589
Sex: F
Age: 54
State: FL

Vax Date: 10/13/2021
Onset Date: 10/14/2021
Rec V Date: 10/16/2021
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: sulfa

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

Symptoms: fever of 101.2 chills & body aches sharp shooting / stabbing pain randomly all over body (in torso, extremity muscles and joints) tightness in chest major pain at injection site and by lungs/heart resting heartbeat of 108 bpm

Other Meds: none

Current Illness: none

ID: 1793590
Sex: F
Age: 49
State: FL

Vax Date: 08/01/2021
Onset Date: 09/26/2021
Rec V Date: 10/16/2021
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: none

Symptom List: Injection site swelling, Limb discomfort

Symptoms: I received the second dose of the vaccine on august 21, 2021. on september 26, 2021, I started my menstrual cycle and as of today, october 16, 2021 I am still bleeding. it has been 21 days with occasional cramping. I will see my gynocologist for an exam on thursday, october 21, 2021

Other Meds: lisinopril 5mg supre B complex zinc 50mg womens one a day D3 mcg milk thistle lexapro 20 mg lunesta 3 mg tizanidine 2mg

Current Illness: none

ID: 1793591
Sex: F
Age: 10
State: CA

Vax Date: 10/15/2021
Onset Date: 10/16/2021
Rec V Date: 10/16/2021
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: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: Splotchy red and swollen at site of injection, approximately 2in x 1in. Tylenol given for pain. Injection administration technique questionable, RN injected too low, possibly missing the deltoid. Reported this information to our primary care provider's office.

Other Meds: Tylenol

Current Illness:

ID: 1793592
Sex: F
Age: 45
State: OH

Vax Date: 10/10/2021
Onset Date: 10/12/2021
Rec V Date: 10/16/2021
Hospital: Y

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

Lab Data: unknown

Allergies: pillacilln, Iodine

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

Symptoms: facial paralysis causing Bell Palsy,

Other Meds: Tracrolimus,Sensipar, Metoprolol, mycophenolate,Eliquis,Amlodipine Besylate.

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am