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: 1794846
Sex: M
Age: 33
State: MS

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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: flu a/b and covid19 antigen rapid test

Allergies: none

Symptom List: Dysphagia, Epiglottitis

Symptoms: within 1 hour of receiving vaccination, he developed a cough and body aches. on 10/18/2021 he saw provider and was tested for covid19 + flu a/b and flu B is positive.

Other Meds: none

Current Illness: none

ID: 1794847
Sex: F
Age: 60
State: MD

Vax Date: 10/07/2021
Onset Date: 10/13/2021
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: Hospital ran bloodwork, urine sample and did a cat scan of head and neck

Allergies: None known.

Symptom List: Anxiety, Dyspnoea

Symptoms: Headache started on the evening of October 13th (one week after 1st dose of Pfizer. Thursday morning turned headache into migraine that was so severe meds did not work. Had projectile throw up, which has never happened before. Had to be taken to hospital by ambulance as I could not walk or hold myself up. Was treated in the ER with a cocktail of drugs to ease my pain. Received prescriptions for Ibuprofen (800mg 3 x a day), Acetaminophen 1000mg 3 x daily and cyclobenzaprine.NE 10mg 3 x a day for 10 days.

Other Meds: Lisinopril HCTZ 10-12.5 Duloxetine HCL DR 80 MG Bupropion HCL XL 300MG Omega-3 Fish Oil 17.50mg

Current Illness: I felt good at the time of vaccination.

ID: 1794848
Sex: F
Age: 45
State: VA

Vax Date: 09/14/2021
Onset Date: 09/15/2021
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:

Allergies: n/a

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

Symptoms: I developed the shingles.

Other Meds: n/a

Current Illness: n/a

ID: 1794849
Sex: M
Age: 60
State: VA

Vax Date: 04/08/2021
Onset Date: 07/01/2021
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:

Allergies: Avalox; lactose intolerance

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Ringing in both ears (high frequency whine); constant and ongoing

Other Meds: Daily: multivitamin; claritin; brimonidine tartrate 0.15%; flonase

Current Illness:

ID: 1794850
Sex: F
Age: 66
State: KY

Vax Date: 01/26/2021
Onset Date: 10/05/2021
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:

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

Symptoms: Tested Positive for Covid

Other Meds:

Current Illness:

ID: 1794851
Sex: F
Age: 51
State: TX

Vax Date: 10/16/2021
Onset Date: 10/16/2021
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:

Allergies: IV contrast, Lisinopril

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

Symptoms: Pt c/o dizzy and difficulty breathing.

Other Meds: BP medications, premarin, pregabalin

Current Illness:

ID: 1794852
Sex: F
Age: 29
State: TX

Vax Date: 04/29/2021
Onset Date: 04/29/2021
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: NONE

Allergies: NKA

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: RECEIVED FIRST DOSE MODERNA #ER8733 RECEIVED SECOND DOSE PFIZER

Other Meds: NOT REPORTED

Current Illness: POSITIVE TEST FOR COVID-19. DATE UNKNOWN

ID: 1794853
Sex: F
Age: 37
State:

Vax Date: 10/12/2021
Onset Date: 10/12/2021
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: NA

Symptom List: Pharyngeal swelling

Symptoms: Was sent to hospital, vax triggered seizures.

Other Meds: NA

Current Illness: NA

ID: 1794854
Sex: M
Age: 72
State: AR

Vax Date: 10/12/2021
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: N/A

Allergies: N/A

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Pt. states that after receiving the 1st dose of Influenza High-Dose 10/12/2021, started experiencing symptoms 10/15/2021 of itchiness towards the back of the left arm, crescent shaped with a rash weeping clear fluid, and has since scabbed over. Slight soreness (3 days) has subsided, still continuing to have mild itchiness at the back side of the left arm. No Primary visit noted.

Other Meds: N/A

Current Illness: Sinus/Allergies

Date Died: 10/09/2021

ID: 1794855
Sex: F
Age: 67
State: MO

Vax Date: 02/12/2021
Onset Date: 09/11/2021
Rec V Date: 10/18/2021
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:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: PATIENTS DEVELOPED COVID-19 PNEUMONIA ON 09/11/2021 THAT PROGRESSED TO PATIENT'S DEATH ON 10/09/2021 AFTER MANY DAYS IN HOSPITAL.

Other Meds:

Current Illness:

ID: 1794856
Sex: F
Age: 62
State: TX

Vax Date: 03/02/2021
Onset Date: 10/14/2021
Rec V Date: 10/18/2021
Hospital: Y

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

Lab Data: CBC, CMP,CXR, EKG,d-dimer

Allergies: NKA

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

Symptoms: Short of breath, patient tested positive at home, went for Regeneron infusion, low sats in office and was admitted to ER.

Other Meds: Amlodipine, Atorvastatin, Enalapril, Gabapentin, Lantus, Tramadol, Baclofen, Tessalon Perles, Ibuprofen

Current Illness:

ID: 1794857
Sex: F
Age: 52
State: MA

Vax Date: 10/13/2021
Onset Date: 10/14/2021
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:

Allergies: Seasonal

Symptom List: Rash, Urticaria

Symptoms: Large lump left side of base of neck/shoulder. Pain over clavicle on left side. Started 10/13/21. Tried Excedrin, motrin, acetaminophen for symptoms with no effect. Same side as vaccine administration. MD notified and aware, has not been seen at this time by MD.

Other Meds: Centrum silver multi-vitamin Excedrin migraine Acetaminophen Motrin

Current Illness:

ID: 1794858
Sex: F
Age: 71
State: KY

Vax Date: 03/26/2021
Onset Date: 10/09/2021
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:

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

Symptoms: Tested Positive for Covid

Other Meds:

Current Illness:

ID: 1794859
Sex: M
Age: 55
State: GA

Vax Date: 10/12/2021
Onset Date: 10/12/2021
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 yet.

Allergies: Amoxicillin

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

Symptoms: I had mild tinnitus before getting the Janssen COVID-19 Vaccine. Around 10 hours after getting the shot, I started having chills, fever and muscle aches. My tinnitus got really loud at the same time in both ears and has stayed loud. The rest of the symptoms cleared up after 48 hours. My tinnitus is still very loud and has not returned to pre-vaccine levels.

Other Meds: Rosuvastatin 10 mg once daily Aspirin 81 mg once daily Equate Complete Multivitamin once daily

Current Illness: None

ID: 1794860
Sex: U
Age:
State: MO

Vax Date: 10/01/2021
Onset Date: 10/02/2021
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: None

Allergies: Unknown

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

Symptoms: No medical treatment sought by patient. She reported experiencing some blurry vision but she was able to sit down and it then passed after approximately 1 hour.

Other Meds: Unknown

Current Illness: Unknown

ID: 1794861
Sex: M
Age: 64
State: PA

Vax Date: 09/18/2021
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:

Allergies:

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

Symptoms: Patient reports new onset of bilateral leg weakness that started immediately after getting 2nd Covid vaccine.

Other Meds:

Current Illness:

ID: 1794862
Sex: F
Age: 53
State: MI

Vax Date: 10/08/2021
Onset Date: 10/12/2021
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: EKG Chest Xray

Allergies: onions tomatoes

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

Symptoms: Chest Pain, Back Pain on left side for both pains

Other Meds: 200 mg Plaquenil 115 Levoxyl 25 Lopressor 5 mg Norvas Symbicort inhaler 2 puffs twice a day

Current Illness: non

ID: 1794863
Sex: F
Age: 31
State: NE

Vax Date: 09/27/2021
Onset Date: 09/30/2021
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:

Allergies: Phenobarbital, Mold

Symptom List: Ear pain, Hypoaesthesia

Symptoms: 31 y.o. female who presented to the emergency department for rash similar to hives, onset evening of 9/29/21. Patient has a past medical history significant for hives with fall allergies and when she had COVID-19 in October 2020. On Monday 09/27/21, patient endorses she received her second dose of the Pfizer vaccine. Over the next few days she felt fatigue and fever that was relieved with Tylenol and Aspirin. Late last night she experienced onset of an itchy and painful rash, consistent with her past experience with hives. She went to work this morning and experienced progressively worsening symptoms while walking outside. She noted shortness of breath, nausea, and her tongue feeling different, prompting this ED. In this ED, she reports nausea has resolved. Patient notes rash is tracking up the back of her neck and is also on her groin, abdomen, and bilateral arms/hands.Denies fever, cough, cold like symptoms, vomiting, diarrhea, abdominal pain, and urinary symptoms. Patient endorses with first Pfizer dose she experienced a nodule, although did not develop a rash like she is currently experiencing. Patient discharged from ED in stable condition with prescriptions for prednisone and famotidine.

Other Meds:

Current Illness:

ID: 1794864
Sex: M
Age: 50
State: MA

Vax Date: 09/27/2021
Onset Date: 09/28/2021
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:

Allergies: Penicillen, Keflex

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Severe chills, then sweating, fever and chest pain in heart area for 24 hrs. Body aches last about 72 hours. Took tylenol and drank lots of fluids

Other Meds: Bupropion 150mg daily

Current Illness: None

ID: 1794865
Sex: U
Age: 48
State: MO

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: See above: EKG, Chest x-ray and lab tests all completed on 10/13/21

Allergies: None Known

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

Symptoms: Patient reported to the ED on 10/13/21 stating symptoms of weakness, chest pain, shortness of air with exertion, body aches and chills began that morning. No issues were reported on 10/12/21. EKG was normal. Chest x-ray was normal. Lab testing CBC, Troponin, electrolytes, renal values, urine specimen and glucose were all within normal limits. She was instructed to take OTC medication for symptoms and was dismissed from the ED that same day

Other Meds: Zrytec; Flonase; Zaditor; Multi-vitamin; Junel Fe

Current Illness: None known

ID: 1794866
Sex: F
Age: 37
State: VA

Vax Date: 10/16/2021
Onset Date: 10/16/2021
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: none

Allergies: None

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

Symptoms: 7:30pm-Intense shaking hands, dizzy, tight heart (not chest, just heart), BP 173/87 45mins after onset of symptoms, weakness, BMP in the high 80's. 9:30- Neighbor who is a first responder checked me out. BP was 148/87. 30 mins later 136/68. Not clamy and eyes ok. Extremely tired that night and all of the next day. Felt like heart was fluttering/beating irregularly. 10/18- feeling significantly better.

Other Meds: None

Current Illness: none

ID: 1794867
Sex: F
Age: 66
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies: actos, atorvastatin, lisinopril, metformin

Symptom List: Unevaluable event

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

Other Meds: cholecalciferol, clonidine, cyanocobalamin, ergocalciferol, furosemide, glimepiride, lantus solostar, levothyroxine, losartan, ozempic, rosvastatin

Current Illness: leg swelling 9/13/21

ID: 1794868
Sex: F
Age: 33
State: OH

Vax Date: 10/15/2021
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies: Aspirin

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

Symptoms: Arm, shoulder and neck swelling. Body aches all over, unable to rest, low grade fever, headache and fatigue Took Aleve - little relief Benadryl- no relief

Other Meds: Metopeolol 100mg, concerta 20mg, fluoxetine 20mg.

Current Illness:

ID: 1794869
Sex: F
Age: 65
State: MA

Vax Date: 10/17/2021
Onset Date: 10/17/2021
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: Evaluated at Clinic on 10/18/21

Allergies: n/a

Symptom List: Injection site pain, Pain

Symptoms: Got HD vaccine at 12pm yesterday and notice about 4 hours later. Swollen, hot, and red arm. Put ice packs and ibuprofen

Other Meds: n/a

Current Illness: n/a

ID: 1794870
Sex: F
Age: 46
State:

Vax Date: 09/08/2021
Onset Date: 09/08/2021
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:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Anaphylaxis. Patient had immediate onset of palpitations and dizziness. 25 minutes later, developed swelling of throat, lips, tongue associated with choking on food, dyspnea, and dysarthria due to tongue swelling. Also had diffuse pruritus, erythema of face, swelling of hands and entire left arm extending downward from injection site. History is reported to me today by patient. She took Benadryl 12.5mg with which throat swelling improved. Symptoms overall persisted for a couple weeks before gradually resolving. Did not seek medical attention immediately due to distrust of emergency room care.

Other Meds:

Current Illness:

ID: 1794871
Sex: F
Age: 60
State: MI

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

Lab Data:

Allergies: none

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

Symptoms: No adverse out come. Patient only aged 60 and received fluad (only approved for 65+)

Other Meds: unknown

Current Illness: unknown

ID: 1794873
Sex: F
Age: 64
State:

Vax Date: 10/17/2021
Onset Date: 10/17/2021
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: None

Allergies: Oranges, carrots, pollens, ethromyacin, aspirin, perfumes, lilacs, jasmine, garlic, dust, molds

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Itching all over body, rash on face - took a Benedryl - this started immediately after shot. About 7 hours later, I was aching all over, had a headache, nausea, and my heart rate was odd.

Other Meds: None

Current Illness: None

ID: 1794874
Sex: F
Age: 54
State: KY

Vax Date: 05/18/2021
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: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Tested Positive for Covid

Other Meds:

Current Illness:

ID: 1794875
Sex: F
Age: 59
State: NY

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

Allergies:

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

Symptoms: Employee signed consent for flu vaccine and was administered Fluzone Quad in left upper arm. Once vaccine was administered, employee informed nurse that she received Fluzone Quad on 10/5/21. This event resulted in the employee receiving 2 doses of Fluzone Quad. No adverse reaction was reported to nurse as a result of this event.

Other Meds:

Current Illness:

ID: 1794877
Sex: M
Age: 37
State: IL

Vax Date: 10/08/2021
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: RA

Lab Data: Had MRI, chest X-ray, and EKG - all negative. CBC and chemistries negative except dehydration and hypokalemia found after and episode.

Allergies: None

Symptom List: Nausea

Symptoms: Sudden vertigo, severe sweating, and muscle weakness, fatigue after an episode. Vertigo lasts about 1-2 mins and other symptoms last 1-3 hours

Other Meds: Zoloft 75 mg daily

Current Illness: None

ID: 1794878
Sex: F
Age: 62
State: TN

Vax Date: 10/05/2021
Onset Date: 10/05/2021
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:

Symptom List: Injection site pain

Symptoms: High dose vaccine was given to 62 year old discovered after administration. No adverse affects reported by patient.

Other Meds:

Current Illness:

ID: 1794879
Sex: F
Age: 53
State: MD

Vax Date: 10/10/2021
Onset Date: 10/17/2021
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: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Full body rash that looks and feels like sunburn. Extremely itchy.

Other Meds: Welbutrin Zoloft Zebeta

Current Illness: None

ID: 1794880
Sex: F
Age: 43
State: SC

Vax Date: 03/31/2021
Onset Date: 05/01/2021
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: US Carotid Duplex Bilateral, CT Brain/Head w/o Contrast, and Electrocardiogram EKG.

Allergies: None

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

Symptoms: Heart Palpations-May 05, 2021 Tinnitus=May 11, 2021 Hearing Loss Right Ear-May 11, 2021 Spots on Brain--September 26, 2021 Paresthesia-September 28, 2021 Photophobia and Phonopobia--September 15, 2021 Neuropathy- October 2, 2021 Brain Fog- May 4, 2021 Small Vessel Disease-September 26, 2021 Headaches-April 29, 2021

Other Meds: budesonide-formoterol 80 mcg-4.5 mcg/inh inhalation aerosol and Albuterol inhaler

Current Illness:

ID: 1794881
Sex: M
Age: 16
State: FL

Vax Date: 08/02/2021
Onset Date: 08/09/2021
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: Covid test, cultures, labs.

Allergies: NKA

Symptom List: Tremor

Symptoms: Pt sent to ER for seizure.

Other Meds:

Current Illness:

ID: 1794882
Sex: F
Age: 35
State: OH

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: IM
Vax Site: LA

Lab Data: none

Allergies: tdap and flu vaccines

Symptom List: Erythema, Pruritus

Symptoms: throat itching and coughing, had to take more benadryl and eventually took prednisone. symptoms started within 20 minutes of injection. continued to take benadryl for 4 days then took prednisone for 3 days

Other Meds: benadryl due to allergies to other vaccines

Current Illness: none

ID: 1794883
Sex: F
Age: 42
State: AL

Vax Date: 06/12/2021
Onset Date: 07/24/2021
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: CTA of lung, Head and Cornary Ct of hearat and echo

Allergies: Penicilian

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

Symptoms: heart enlargement, breathing issues

Other Meds: metformin, jardiance, probiotics

Current Illness: Diabetic

ID: 1794884
Sex: F
Age: 53
State: NV

Vax Date: 06/24/2021
Onset Date: 06/24/2021
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: none

Allergies: SOME ANTIBIOTICS AND PAIN MEDICINES

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

Symptoms: numbness tingles and arm went numb. and been sick then with lupus

Other Meds: TYLENOL

Current Illness: NONE

ID: 1794885
Sex: F
Age: 46
State: FL

Vax Date: 03/24/2021
Onset Date: 03/29/2021
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: I did not have any medical tests completed.

Allergies: I am allergic to prednisone, morphine, hydrocodone family, latex, American and European Dust mites, Cats, Oak trees, Walnut Trees and Pecan Trees.

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: After receiving my vaccine, a few days later, I felt like I couldn't breathe. My sinus tissues flared up. I went to the Health ER, but they told me that I was having an anxiety attack. That was not correct. So I walked out of the ER and went to my doctors office across the highway. He gave me a prednisone shot and I felt better the next day.

Other Meds: I was taking Bupropion XL, Buspirone, Baclofen, gabapentin, misoprostol, Celexa, Omeprazole, Potassium, metolazone, Torsemide, Atorvastatin, Pramipexole, Quetiapine, Vitamin B Shots every 2 weeks, Zofran, Tamsulosin, Humira, Ventolin, Albut

Current Illness: I was not experiencing any illness at this time.

ID: 1794886
Sex: F
Age: 55
State: KY

Vax Date: 02/26/2021
Onset Date: 10/05/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Tested Positive for Covid

Other Meds:

Current Illness:

Date Died: 10/06/2021

ID: 1794887
Sex: M
Age: 74
State: KY

Vax Date: 02/18/2021
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: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: PATIENT EXPIRED ON 10/06/2021

Other Meds:

Current Illness:

ID: 1794888
Sex: F
Age: 74
State: TX

Vax Date: 04/27/2021
Onset Date: 04/27/2021
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: NKA

Symptom List: Pain in extremity

Symptoms: IMMTRAC INDICATES THIRD DOSE OF UNKNOWN COVID VACCINE ADMINISTERED, FOLLOWING 04/27/2021

Other Meds: NOT REPORTED

Current Illness: NOT REPORTED

ID: 1794889
Sex: M
Age: 40
State: MI

Vax Date: 10/09/2021
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:
Dose Series: 2
Vax Route:
Vax Site:

Lab Data:

Allergies: None

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

Symptoms: 102.8 fever, chills, Deira, Light Headed. This went on for over a week. I still feel tired and light headed all the time. 99 fever still.

Other Meds: Did not take any

Current Illness: None

ID: 1794891
Sex: M
Age: 69
State: TX

Vax Date: 09/03/2021
Onset Date: 09/17/2021
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: Latex gloves

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

Symptoms: Sore neck and shooting pain, and shoulder painl

Other Meds: Lantus ozempic hydrochlorothiazide metformin atorvastatin Lisinopril Glipizide aspirin

Current Illness: None

ID: 1794892
Sex: F
Age: 62
State: NC

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

Lab Data:

Allergies: sinusitis,

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

Symptoms: knot near collar bone, wont go away headache

Other Meds: anxiety pills, vitamin d

Current Illness:

ID: 1794893
Sex: M
Age: 67
State: FL

Vax Date: 07/28/2021
Onset Date: 08/09/2021
Rec V Date: 10/18/2021
Hospital: Y

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

Lab Data: Covid test, cxr.

Allergies: PCN

Symptom List: Vomiting

Symptoms: Pt came to ER c/o dizziness, generalized weakness, high blood pressure, epigastric pain, vomiting, dry cough, and SOB for the past 5 days.

Other Meds:

Current Illness:

ID: 1794894
Sex: F
Age: 42
State:

Vax Date: 09/09/2021
Onset Date: 10/11/2021
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: COVID-19 positive 7/27/2021

Allergies: NKDA

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient did not have a true adverse event, but I was asked by our institute to submit it through VAERS as patient received monoclonal antibodies to treat COVID 7/30/2021, then received Pfizer COVID vaccines 9/9/2021 and 10/11/2021 (within the 90 days of receiving the monoclonal antibodies).

Other Meds: Amlodipine, gabapentin, Basaglar, metformin

Current Illness: COVID-19 infection -received monoclonal antibodies- July 2021

ID: 1794895
Sex: M
Age: 57
State: ND

Vax Date: 10/01/2021
Onset Date: 10/11/2021
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: COVID swab on 10/11/2021 with negative results

Allergies: None

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

Symptoms: About a week after vaccination, Patient didn't feel good complaining of nausea and back pain. Covid swab obtained and was negative. Patient stayed home the 12-14 with back pain, fever, and fatigue. Felt a little better on the 16th but still feels under the weather.

Other Meds: Cyclobenzaprine, Ibuprofen, Tylenol, Vitamin D, Vitamin C, Multivitamin, Cholesterol Tab

Current Illness: None

ID: 1794896
Sex: F
Age: 38
State: CA

Vax Date: 10/01/2021
Onset Date: 10/17/2021
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:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Premature menstruation (7 days early) very heavy bleeding compared to normal

Other Meds:

Current Illness: Cold

ID: 1794897
Sex: F
Age: 53
State: TX

Vax Date: 10/01/2021
Onset Date: 10/01/2021
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 because I am uninsured

Allergies: None

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

Symptoms: Extreme fatigue Rheumatoid flare Heart/chest pain Headache

Other Meds: Vitamin C

Current Illness: None

ID: 1794898
Sex: F
Age: 79
State: CO

Vax Date: 09/28/2021
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: IM
Vax Site: RA

Lab Data:

Allergies: None.

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

Symptoms: Soreness at injection site, severe flu-like symptoms, weak, loss of apetite, fever of 101 for 2 days, red blotch at injection site for over 2 weeks.

Other Meds: None.

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am