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: 1794795
Sex: F
Age: 70
State: FL

Vax Date: 04/08/2021
Onset Date: 08/08/2021
Rec V Date: 10/18/2021
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: Labs, covid

Allergies: Keflex, levaquin, omnicef, PCN

Symptom List: Dysphagia, Epiglottitis

Symptoms: Pt came to ER c/o weakness onset 10 days prior.

Other Meds:

Current Illness:

ID: 1794796
Sex: F
Age: 31
State: MN

Vax Date: 06/10/2021
Onset Date: 06/10/2021
Rec V Date: 10/18/2021
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: No adverse effects were reported but a Janssen vaccine was administered after a completed series of Pfizer vaccine.

Other Meds:

Current Illness:

ID: 1794797
Sex: M
Age: 68
State: IA

Vax Date: 10/06/2021
Onset Date: 10/09/2021
Rec V Date: 10/18/2021
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 BUT Schedule to go to employee health today (10/18/2021)

Allergies: none

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

Symptoms: After the second Covid 19 vaccine night time headaches develops for 5 months from Jan 27th to the end of March 2021. After the third, 3rd booster vaccines on 10/06/2021 mild headaches started again but on 10/16/2021 and 10/17/2021 and today the headaches are more severe. They improve with 1000 mg of acetaminophen 4 times per day but do not completely go away.

Other Meds: Salmon Oil lutein and zeaxanthin

Current Illness: none

ID: 1794798
Sex: M
Age: 48
State: RI

Vax Date: 09/14/2021
Onset Date: 09/14/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: COVID-19 test negative.

Allergies: NKA

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: For employer vaccine compliance or termination by 10/31/21 patient received Covid19 vaccine on 9/14/21. On 9/14/21 initial symptoms of adverse reaction displayed in 4-6 hours of injection (6pm). Symptoms included tachycardia (132bpm), difficulty breathing (labored), body hives, vertigo, and severe tinnitus. Pt. treated with Epinephrine 0.3mg auto inject (self administered). Outcome of injection successful in treatment of tachycardia, DOB and hives. After several days of continued remaining symptoms Pt received urgent care consultation 9/27/2021, Pt was prescribed Hydroxychloroquine 200 mg, Azithromycin 500 mg, Dexamethasone 2 mg, Zinc 50 mg. Full recovery.

Other Meds:

Current Illness: NONE

ID: 1794799
Sex: M
Age: 58
State: KY

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

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

Lab Data:

Allergies: NKDA

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

Symptoms: NONE

Other Meds: NORVASC, ASA, LEXAPRO, FOLIC ACID, LISINOPRIL, MULTI VIATMIN, VIBRYD

Current Illness:

ID: 1794800
Sex: F
Age: 41
State: NJ

Vax Date: 10/16/2021
Onset Date: 10/17/2021
Rec V Date: 10/18/2021
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: None

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

Symptoms: Swollen underarm lymph nodes

Other Meds: None

Current Illness: None

ID: 1794801
Sex: F
Age: 58
State: IL

Vax Date: 03/09/2021
Onset Date: 03/09/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: No, My primary wanted to send me for test but I could not afford it.

Allergies: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Right after the shot my shoulder swelled up so bad I was in severe pain. I took ibuprofen. It subsided but it now is getting worse. I know something is wrong in there but, I can't afford to go get it diagnosed at an orthopedic. It become disabling, I can hardly do anything. I can't even sleep on my right side anymore.

Other Meds: Levothyroxine; Sertraline; Trulicity

Current Illness: None

ID: 1794802
Sex: M
Age: 31
State: TX

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Pharyngeal swelling

Symptoms: First evening, weak, no appetite, unable to move, fatigue for full 48 hours. Day 7 - rash, diagnosed as contact dermatitis, showed up on arms, stomach, legs, weeping wounds. Still experiencing fatigue at day 10.

Other Meds: Multi-vitamin

Current Illness: None

ID: 1794803
Sex: F
Age: 67
State: AR

Vax Date: 10/15/2021
Onset Date: 10/15/2021
Rec V Date: 10/18/2021
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: Preservatives, (Needs preservative-free ophthalmic preparations)

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient developed 4-6 inch approx. erythematous rash within 2 hours of vaccination. Swelling was significant. Symptoms persisted to 72 hours.

Other Meds: Synthroid, Glaucoma Meds

Current Illness: None

ID: 1794804
Sex: M
Age: 31
State: TX

Vax Date: 05/04/2021
Onset Date: 05/04/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: NONE

Allergies: NKA

Symptom List: Diarrhoea, Nasal congestion

Symptoms: "BECAME LIGHT HEADED AND HOT AT 10:15AM."N

Other Meds: NOT REPORTED

Current Illness: NOT REPORTED

ID: 1794805
Sex: F
Age: 33
State: FL

Vax Date: 04/08/2021
Onset Date: 08/08/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: Covid test, cxr.

Allergies: NKA

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

Symptoms: Pt came to ER c/o difficulty breathing and cough onset 3 weeks ago and gradual. Covid exposure.

Other Meds:

Current Illness:

ID: 1794806
Sex: M
Age: 37
State: FL

Vax Date: 09/01/2021
Onset Date: 09/20/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: Echo Nuclear test Stress test Mri

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Racing heart. Chest pain. squeezing. Palpitations. Unbearable back pain

Other Meds:

Current Illness:

Date Died: 10/15/2021

ID: 1794807
Sex: F
Age: 69
State: SD

Vax Date: 10/15/2021
Onset Date: 10/15/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: CXR, EKG, CMP, CBC, ABG, COVID-19 PCR, Coags

Allergies: NKA

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

Symptoms: Patient received her booster dose from Pharmacy at an unknown time on 10/15/21. Her husband reports she had been well throughout the day. At some point, the patient began to complain of left sided chest pain and then became weak and had to lay down onto the floor. She then became unresponsive and upon arrival of EMS, she was asystole. She presented to our ED and we were able to get ROSC, but then the flight crew took off, the patient went into complete arrest again and was brought back to ED where resuscitation efforts continue, but the patient was pronounced dead at 2359.

Other Meds: Loratadine 10mg daily, multivitamin, Aleve PRN

Current Illness: Unknown-- patient presented in full cardiac arrest. Husband reports the patient had been well that day.

ID: 1794808
Sex: M
Age: 85
State: KY

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 10/18/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: None

Allergies: None

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

Symptoms: Patient was given Pfizer booster shot with sterile water instead of saline solution.

Other Meds: allopurionol, aspirin, ergocalciferol, hydrochlorothiazide, metoprolol, pravastatin

Current Illness:

ID: 1794809
Sex: F
Age: 39
State: GA

Vax Date: 10/16/2021
Onset Date: 10/18/2021
Rec V Date: 10/18/2021
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: Hives at injection site, burning, itching

Other Meds:

Current Illness:

ID: 1794810
Sex: F
Age: 62
State: GA

Vax Date: 09/16/2021
Onset Date: 09/18/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: Pending appt for evaluation with Cardiologist Nov. 3,2021

Allergies: None

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

Symptoms: 2 days after 2nd dose of Moderna COVID vaccine had 2 hours of tachycardia with rates of 150-160, since then I have had irregular heart rate daily, fatigue, some shortness of breath, no specific chest pain, some days more than others and no correlation with activity, during night and day. This has been ongoing for 4 weeks, I have pending appt with Cardiologist, Nov. 3, 2021 to evaluate.

Other Meds: Levothyroxine Metformin Progesterone Estradiol Lunesta

Current Illness: None

ID: 1794811
Sex: F
Age: 38
State: NY

Vax Date: 09/27/2021
Onset Date: 09/28/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data:

Allergies: NKA

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

Symptoms: My arm was tingling and sore to the touch and when moving. The non-injection arm was also tingling. I felt dizzy and spacey, like a far away feeling, almost like a disorientation. I had a headache as well, and was extremely fatigued. I also got my period 7 days early, when my period has been on a 28 cycle for about 10 years. There are also cysts on my ovaries now.

Other Meds: Synthroid

Current Illness: None

ID: 1794812
Sex: F
Age: 13
State: MA

Vax Date: 10/01/2021
Onset Date: 10/15/2021
Rec V Date: 10/18/2021
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: None reported

Symptom List: Ear pain, Hypoaesthesia

Symptoms: immunization record with prior vaccinations was under a different last name used.

Other Meds: None reported

Current Illness: None reported

ID: 1794813
Sex: F
Age: 34
State: IL

Vax Date: 10/14/2021
Onset Date: 10/16/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: no

Allergies: no

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: 6 inch rash on right arm. Very swollen, and with a thickness to it. Feels warm and very tender.

Other Meds: no

Current Illness: no

ID: 1794814
Sex: F
Age: 32
State: NJ

Vax Date: 10/12/2021
Onset Date: 10/13/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Swollen lymph nodes near collarbone.

Other Meds:

Current Illness:

ID: 1794815
Sex: F
Age: 37
State: CO

Vax Date: 05/07/2021
Onset Date: 05/15/2021
Rec V Date: 10/18/2021
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: In process heart monitoring Waiting on heart echo

Allergies: None

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

Symptoms: Went to the hospital, a couple weeks after 2nd dose with severe chest pain, I felt like I was having a heart attack. After the hospital visit I had a follow up apppointment on August 23rd with my primary care physician due to on going chest pain. My primary care physician sent me to a specialist for heart monitoring and an echo. I was seen by Cardiologist October 13th who put me on a heart monitor and ordered an Echo. While at this appointment I explained this chest pain began after my second dose of the covid-19 vaccine. I have never had chest pain before the vaccine. He explained that he believes I could have Pericarditis possibly due to the vaccine but wasn't sure. I haven't had my echo yet because it's scheduled for November but I am currently wearing a heart monitor right now.

Other Meds: None

Current Illness: None

ID: 1794816
Sex: F
Age: 29
State: AZ

Vax Date: 10/16/2021
Onset Date: 10/16/2021
Rec V Date: 10/18/2021
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: Unevaluable event

Symptoms: Arm pain. Cannot sleep on it for two days, limited range of motion, pain radiating to elbow on second day. Swelling the size of a golf ball at injection site.

Other Meds: Kyleena IUD

Current Illness: None

ID: 1794817
Sex: M
Age: 39
State: FL

Vax Date: 02/16/2021
Onset Date: 08/08/2021
Rec V Date: 10/18/2021
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: Covid test, cxr.

Allergies: Food allergies, aspirin

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

Symptoms: Pt came to ER c/o chest and abdominal pain.

Other Meds:

Current Illness:

ID: 1794818
Sex: F
Age: 53
State: NY

Vax Date: 09/27/2021
Onset Date: 09/30/2021
Rec V Date: 10/18/2021
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: Swelling and pain of all major joints. Limited mobility, difficulty standing/walking due to swelling in knees.

Other Meds:

Current Illness:

ID: 1794819
Sex: F
Age: 12
State: GA

Vax Date: 10/14/2021
Onset Date: 10/14/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: Vitals 122/67 BP, pulse 128, resp 22, sp o2 83-86 % 0.3 mg epi-pen administered and 40 mg diphenhydramine IM given o2 at 2 L per nasal cannula Within 1-2 minutes after medications administered vital were: 123/86 BP, pulse 101, resp 20, sp 02 98% and patient stopped sneezing and SOB resolved

Allergies: NKDA; hay fever per mother

Symptom List: Injection site pain, Menorrhagia

Symptoms: Developed sneezing, tightness of throat, and tingling of the fingers about 7 minutes post vaccination. Continual sneezing, clutching of throat.

Other Meds:

Current Illness: None

ID: 1794820
Sex: M
Age: 6
State: AR

Vax Date: 10/08/2021
Onset Date: 10/08/2021
Rec V Date: 10/18/2021
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: No allergies resulting in anaphylactic reaction. Environmental

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

Symptoms: The patient received the influenza vaccine in error. He was not supposed to receive it. According to his father, Pt's arm was sore following the vaccination. He had no other side effects or negative outcomes.

Other Meds: Unknown

Current Illness: Unknown

ID: 1794821
Sex: F
Age: 51
State: DC

Vax Date: 10/04/2021
Onset Date: 10/06/2021
Rec V Date: 10/18/2021
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: Amoxicillin/penicillin

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: 36 hours after vaccination, a raised red itchy rash developed on the back of my neck about the size of my palm. 12 hours later, the itchiness started to subside. the raised bumps took about 4-5 days to completely heal and go away.

Other Meds:

Current Illness:

ID: 1794822
Sex: M
Age: 46
State: PA

Vax Date: 10/06/2021
Onset Date: 10/06/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data:

Allergies: penicillin g

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: On Oct 6th PM after vaccination started breaking out in few hives through out body. This was relieved with over the counter antihistamines. These symptoms persisted for the next few days. On the evening of Oct 8th. he started having redness and itching of hands. Took antihistamines again and applied over the counter steroid cream to hands. Went to sleep but at 2AM was woken up by severe redness and itching of hands the right slightly worse than the left. Research done on computer to diagnose self with acute onset angio edema of hands. Over the course of the next 10 hours the symptoms worsened until both hands were double in size. and unusable. Prescribed self a course of Prednisone. Took 20 mg on the 9th at 10 AM and 60 mg on the 9th at 21:00 and another 60 mg on the 10th at 21:00. During this time I also continued taking round po Benadryl and Claritin D. By the morning of the 11th the symptoms started to abate. Hands reduced swelling enough to be usable but continued redness and itching. From the 11th onwards has been continuing to take over the counter antihistamines. Also have continued to have occasional bouts of hives all over body since that time. Also starting on the 11th developed continual hemorrhoidal bleeding which never stopped. Was prescribed steroid suppositories and hemorrhoid cream to reduce the symptoms.

Other Meds: pepcid prn

Current Illness: none

ID: 1794823
Sex: F
Age: 34
State: OK

Vax Date: 09/08/2021
Onset Date: 10/03/2021
Rec V Date: 10/18/2021
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: D-dimer drawn to rule out possible blood clots. Test was normal.

Allergies: NKDA

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

Symptoms: About roughly two weeks after covid vaccination, patient's right forearm began to swell with patches of a hive-like rash. She went to an urgent care and was treated with steroids which did not help. There is no pain with the swelling. She later followed up with her PCP regarding the issues.

Other Meds: NONE

Current Illness: UNKNOWN

ID: 1794824
Sex: F
Age: 20
State: TX

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 10/18/2021
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: NKA

Symptom List: Nausea

Symptoms: RECEIVED FIRST COVID VACCINE MODERNA LOT# ER8729 ON 04/17/2021. SECOND DOSE PFIZER LOT # EW0175 ON 05/08/2021

Other Meds: NOT REPORTED

Current Illness: NOT REPORTED

ID: 1794825
Sex: F
Age: 60
State: OH

Vax Date: 01/26/2021
Onset Date: 04/19/2021
Rec V Date: 10/18/2021
Hospital: Y

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

Lab Data: I had a CT scan brain attack (no bleed), perfusion study with IV contrast which found the blood clot.

Allergies: I am allergic to sulfa.

Symptom List: Injection site pain

Symptoms: Three months after receiving my second dose, I started experiencing a bad pain in the back of my head. I experienced extreme dizziness and nausea. I had to grab the back of my head with both hands and my right side became flaccid. My husband found me a couple minutes later and called 911. I went to ER and they performed a CT scan brain attack (no bleed), then they performed another CT with IV contrast and that showed them where the blood clot was. The ER doctor called the Clinic and they sent a helicopter to get me. At the Clinic, I was taken immediately to surgery. I had an emergency Mechanical Thrombectomy to remove the clots. I was hospitalized for 4 days. On 09/03/2021 I had a loop recorder to see if I am going in and out of Atrial fibrillation.

Other Meds: I was taking one baby aspirin per day, metformin 1000 mg (2x per day), Vitamin B12 1000mcg, Losartan 50mg, and Lipitor 80mg,

Current Illness: I was not experiencing any illness.

ID: 1794826
Sex: F
Age: 39
State: TX

Vax Date: 10/14/2021
Onset Date: 10/14/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: Did not go to DR

Allergies: N/A

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

Symptoms: stiff neck on same side as shot administered large welt at injection site achy muscles migraine headache

Other Meds: N/A

Current Illness: N/A

ID: 1794827
Sex: F
Age: 19
State: IL

Vax Date: 10/16/2021
Onset Date: 10/16/2021
Rec V Date: 10/18/2021
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: Patient complained of feeling lightheaded and dizzy. Patient was laid down for 30 minutes. BP 101/59, pulse 74, respirations 16.

Other Meds:

Current Illness:

ID: 1794828
Sex: M
Age: 79
State: FL

Vax Date: 03/16/2021
Onset Date: 08/08/2021
Rec V Date: 10/18/2021
Hospital: Y

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

Lab Data: Covid test, labs, cxr.

Allergies: NKA

Symptom List: Tremor

Symptoms: Pt came to ER c/o coughing and vomiting.

Other Meds:

Current Illness:

ID: 1794829
Sex: M
Age: 18
State: NE

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 10/18/2021
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: NKA

Symptom List: Erythema, Pruritus

Symptoms: Vaccine given was expired, it had expired on 9/21/2021

Other Meds: Unknown

Current Illness: Unknown

ID: 1794830
Sex: M
Age: 65
State: PA

Vax Date: 09/09/2021
Onset Date: 09/09/2021
Rec V Date: 10/18/2021
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: One set of blood work and his white blood count is up, which they told him is some sort of infection, and they want to do another test in 2 weeks to compare them.

Allergies: Keflex.

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

Symptoms: He got his vaccine, as soon as he got it he got a stiff neck. The next day he got a headache, an then really sick to his stomach and took Pepto Bismol and went to get out of his chair on Monday following the vaccine and he fell to the ground and had excruciating pain in his left leg and back, which he has never had this problem before. He had to use a walker as his leg gave out on him, which the lower back and leg pain has continued which is down to his feet and his feet are swollen. He also has pain in his jaw on the left side. Everything is on the left side. He then got a big huge blister on his elbow, which is starting to heal up. He went to the ER twice, he went to his PCP and his endocrinologist and received steroids, muscle relaxants which did not help. He cannot recline back as the pain is excruciating and has not slept in his bed since 9/13/21. The pain is starting to subside, just a little bit, it is now a 7/10 now, but was a 10/10, and he cannot do anything as he now has to walk with a walker, which he did not need a walker before the vaccine. He had a regular appointment with his PCP today who was shocked to see the blister on his arm. He saw an orthopedist and they have him scheduled for an MRI on 10/28/21 of his spine. His endocrinologist sent him for COVID testing and also for Lyme testing and they both came back negative. The doctors that he has seen cannot figure out what or why he is having these symptoms. He feels that this is reaction to the vaccine. He did in the past had elbow and shoulder surgery on the left side 34 years ago and never had a problem, and feels that it has attacked his weak spots from previous surgeries. He has a few friends that are now in wheelchairs from the same vaccine. He also has blisters on his little finger and his ring finger on his right hand, and the doctor said that it was deep and that he had never seen one that deep. The skin has been healing and was extremely thick and that it took half of his knuckle off of that hand, which is the only thing that has happened on the right side.

Other Meds: Basaglar, Novolog, Lyrica, Rosuvastatin, Hydrochlorothiazide, Omeprazole, Valsartan, Amlodipine, Morphine sulfate 15 mg twice daily, Latanoprost.

Current Illness: None.

ID: 1794831
Sex: M
Age: 36
State: PA

Vax Date: 10/14/2021
Onset Date: 10/15/2021
Rec V Date: 10/18/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: Chills, headache, vomiting, burning with urination, dizzy spells, tremors. Onset 11 hours post injection lasting 24 hours, felt fine for a day, then very sick with hallucinations 72 hours after vaccine.

Other Meds: Maloxicam

Current Illness: None

ID: 1794832
Sex: F
Age: 49
State: ME

Vax Date: 10/15/2021
Onset Date: 10/15/2021
Rec V Date: 10/18/2021
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: Asthenia, Chills, Headache, Myalgia

Symptoms: 2 hours after receiving shot patient had severe hives and was disorientated.

Other Meds: hydrochlorothiazide, losartan, duloxetine, albuterol

Current Illness: None

ID: 1794833
Sex: F
Age: 72
State: PA

Vax Date: 02/17/2021
Onset Date: 09/24/2021
Rec V Date: 10/18/2021
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:

Allergies:

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

Symptoms: Patient developed COVID. Was admitted to hospital on 9/24/21 with cough and SOB. Tested positive for covid. Treated with decadron, oxygen, and remdesivir. Symptoms rapidly improved and patient was discharged on 9/25/21

Other Meds:

Current Illness:

ID: 1794834
Sex: F
Age: 73
State: VT

Vax Date: 10/14/2021
Onset Date: 10/15/2021
Rec V Date: 10/18/2021
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: Codeine, PCN

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

Symptoms: 5 cm x 5 cm induration surrounding injection site

Other Meds:

Current Illness: none

ID: 1794835
Sex: F
Age: 62
State: WA

Vax Date: 10/15/2021
Onset Date: 10/16/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: NA

Allergies: antibiotics - anaphylaxis and hives dairy eggs

Symptom List: Pain in extremity

Symptoms: left arm pain, headache and dizziness for 24 hours

Other Meds: celebrex and trazadone

Current Illness: no

ID: 1794836
Sex: F
Age: 41
State: IA

Vax Date: 10/11/2021
Onset Date: 10/14/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data:

Allergies: Gold, cinnamic aldehyde, ceclor

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

Symptoms: I have swollen lymph nodes on the inside of my elbows, both arms. I felt it important to note that it can happen on the opposite arm as the one that the shot was give in.

Other Meds: Bupropion

Current Illness: None

ID: 1794837
Sex: F
Age: 16
State: NC

Vax Date: 06/12/2021
Onset Date: 07/21/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: Labs- Creatinine 1.17, BUN 27, urine protein/creatinine ratio 9.18, Positive anti-DNA >=1:640.

Allergies:

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

Symptoms: Seen for joint pain in 7/21 (the joint pain started a few weeks after her second dose of the covid vaccine) -- she has now been diagnosed with lupus and glomerulonephritis -

Other Meds: albuterol sulfate HFA 90 mcg/actuation aerosol inhale Lessina 0.1 mg-20 mcg tablet

Current Illness: Asthma, Allergic rhinitis, Obesity, Acute Bronchitis,

ID: 1794838
Sex: M
Age: 72
State: FL

Vax Date: 08/02/2021
Onset Date: 08/08/2021
Rec V Date: 10/18/2021
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 test, cxr.

Allergies: NKA

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

Symptoms: Pt came to ER c/o SOB, cough.

Other Meds:

Current Illness:

ID: 1794839
Sex: F
Age: 66
State: TX

Vax Date: 10/15/2021
Onset Date: 10/16/2021
Rec V Date: 10/18/2021
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: I woke on the morning of 16 Oct with a knot at the injection site along with pronounced redness, swelling and warmth. The redness extended about 2 inches by 6 inches in my upper arm. While the symptoms are improving, they have persisted and today the area is still red, and swollen although less so) with the involved area still about 2 inches by 3 inches. It is sore to the touch, but there is no change to range of motion.

Other Meds: Daily multiple vitamin

Current Illness: none

ID: 1794840
Sex: F
Age: 88
State: KY

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 10/18/2021
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

Allergies: hydrocjolorothiazide, codeine, Demerol, lyrica, pencillins cross reactors, sulfa drugs cross reactors

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient was given Pfizer booster shot with sterile water instead of saline solution.

Other Meds: aspirin, zebeta, omeprazole, Metamucil, psyllium, rhopressa, timolol, vyzulta

Current Illness:

ID: 1794841
Sex: F
Age: 61
State: NE

Vax Date: 03/22/2021
Onset Date: 03/23/2021
Rec V Date: 10/18/2021
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: None. Reported to doctor who dismissed it as nothing. I hoped it would diminish by now, but it is not yet.

Allergies: None. A sensitivity to sunflower oil

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

Symptoms: Tinnitus -- very irritating and worse in left ear, with an extra echo almost like a higher pitch and cymbal quality.

Other Meds: Calcium, magnesium, D3 almost daily (I forget sometimes).

Current Illness: None.

ID: 1794842
Sex: M
Age: 71
State: AR

Vax Date: 02/26/2021
Onset Date: 04/25/2021
Rec V Date: 10/18/2021
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: Blood Work 04/27/2021

Allergies: N/A

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Pt. states that after receiving the 2nd dose of Moderna 02/26/2021, started experiencing symptoms 04/27/2021of drainage from the (right/possibly both) eye, drooping of the left side of the mouth. 04/27/2021 (Traveling Blurry Vision) Changes in Vision with Dizziness, Emergency Room visit; Blood Work ran (Normal), Suspected Bell's Palsy. Doctor prescribed Acyclovir antibiotics. Recommendation for Follow-Up with Primary, estimated 05/2021. Primary recommended just Observation and follow-up if persist. Symptoms lasting estimated 10 days and subsided.

Other Meds: Lisinopril 20mg x2, Matropelol 25mg x2, Amlodipine 5mg x1, Metaphorim 1000mg x2, Sivevastatin 10mg x1, Low-Dose Aspirin x1, Multi-Vitamins, Turmeric

Current Illness: Sinus/Allergies

Date Died: 10/08/2021

ID: 1794843
Sex: F
Age: 69
State: WI

Vax Date: 10/06/2021
Onset Date: 10/07/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: Rapid Step-negative Step Culture- negative

Allergies: NKDA

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

Symptoms: Pt started with chills and sore throat approximately 12 hours after receiving the vaccines. She presented to urgent care on 10/7/21 and was seen. The urgent care did a rapid strep which was negative and advised to due symptomatic treatment. They felt she was experiencing an immune response the vaccines.

Other Meds: Tylenol PRN, Acylcovir, PRN, Allopurinol daily, ASA daily, Dexamethasone daily, lorazepam prn, losartan daily, omeprazole daily, ondansetron prn, potassium, daily, sodium fluoride paste daily, bactrim 3x per week

Current Illness: IgG Kappa multiple myeloma, HTN, GERD w/ esophageal stricture, COVID Infection 10/2020,

ID: 1794845
Sex: F
Age: 51
State: OH

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: None as of October 18th 2021

Allergies: Pencillin; Seasonal Outdoor

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

Symptoms: Within about 1-2 hours I was extremely thirsty, severe headache, fatigue, lightheaded and rapid heart by 3pm I had shortness of breathe and chest pain and went home from work. On day 2 started body ache and low grade fever, on day 3 started with nausea and diarrhea as well. My blood pressure has also been sporadically elevated throughout. Went to family doctor on October 8th told me to treat diarrhea with Imodium and see if that helps thought I might be dehydrated. I felt better but still having issues with shortness of breathe and chest pain as well as not being able most normal activities (housecleaning, walking the dog, etc.) I am following up with my family doctor on October 19th.

Other Meds: Lexapro; Lisinopril/hydrochloro thiazide; doxepin HCL; IC Amlodipine Besylate, Zyrtec; multivitamin; Metformin

Current Illness: No

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am