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: 1797993
Sex: M
Age: 47
State: KY

Vax Date: 03/10/2021
Onset Date: 10/09/2021
Rec V Date: 10/19/2021
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:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Covid positive contact unknown

Other Meds:

Current Illness:

ID: 1797994
Sex: M
Age: 26
State:

Vax Date: 10/05/2021
Onset Date: 10/05/2021
Rec V Date: 10/19/2021
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: 1ST DOSE MODERNA, PFIZER GIVEN IN ERROR

Other Meds:

Current Illness:

ID: 1797995
Sex: F
Age: 73
State: NC

Vax Date: 10/17/2021
Onset Date: 10/18/2021
Rec V Date: 10/19/2021
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:

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

Symptoms: Headache, lightheadedness, disoriented, sore at injection site, achy

Other Meds:

Current Illness:

ID: 1797996
Sex: M
Age: 50
State: PA

Vax Date: 10/18/2021
Onset Date: 10/18/2021
Rec V Date: 10/19/2021
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: Within a minute post-injection, felt warmth over the body-more in upper torse, then chest/neck/arm muscle tightness and discomfort, tingling, some sweating on forehead. Within 10 minutes the feelings dissipated and by 20 minutes post-injection completely gone, felt normal. Later that evening, still felt normal with minimal soreness at injection site

Other Meds: Protonix

Current Illness: None

Date Died: 08/08/2021

ID: 1797997
Sex: M
Age: 44
State: PA

Vax Date: 04/14/2021
Onset Date: 04/24/2021
Rec V Date: 10/19/2021
Hospital: Y

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

Lab Data: Brain MRI, CT angiogram, IR angiogram, EEG, EKG, labs April- July 2021.

Allergies: none

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

Symptoms: Within 2 weeks of initial vaccine dose the patient developed new-onset acute neurologic symptoms resulting in a diagnosis of cerebral thrombosis with ICH and vasogenic edema. He underwent several outpatient, ER and inpatient evaluations (in the system, except for final hospitalization at Hospital); he continued to clinically deterioriate and died on August 8, 2021.

Other Meds: none

Current Illness: none

ID: 1797998
Sex: F
Age: 49
State: MI

Vax Date: 03/18/2021
Onset Date: 03/22/2021
Rec V Date: 10/19/2021
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: ECHOCARDIOGRAM AND HEART CT SCAN

Allergies: MACROBID - ANTIBIOTIC FOOD - GLUTEN , SHELLFISH

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

Symptoms: DIZZY - ABOUT 4 DAYS AFTER VACCINE. I STILL FEEL DIZZY FROM TIME-TO-TIME 7 MONTHS LATER FAST HEART RATE FOR AWHILE. I RECEIVED A RESTING ECHOCARDIOGRAM ABOUT 8 DAYS AFTER VACCINE AND MY LEFT BUNDLE CONDITION WAS WORSE. CARDIOLOGIST PRESCIBED LISINOPRIL FOR 6 MONTHS AND MY RECENT ECHO IN LATE AUGUST WAS NORMAL LEFT BUNDLE

Other Meds: SYNTHROID MULTI-VITAMIN

Current Illness: URINARY TRACT INFECTION NAUSEA - LOSS OF APPETITE

ID: 1797999
Sex: F
Age: 42
State: OH

Vax Date: 09/07/2021
Onset Date: 09/21/2021
Rec V Date: 10/19/2021
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 states that she has had a menstrual cycle every 2 weeks since receiving the vaccine.

Other Meds:

Current Illness:

ID: 1798000
Sex: F
Age: 59
State: AZ

Vax Date: 10/09/2021
Onset Date: 10/10/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data: Audiology Test

Allergies: None

Symptom List: Pharyngeal swelling

Symptoms: Ears ringing, headache, and swelling behind the ear very painful.

Other Meds: None

Current Illness: None

ID: 1798001
Sex: M
Age: 77
State:

Vax Date: 10/18/2021
Onset Date: 10/18/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient was administered a full bottle of 6 doses by the immunizing pharmacist on 10/18/21. As of 10/19/21 the patient was contacted and was not reporting any symptoms other than a sore arm at the site of injection.

Other Meds:

Current Illness:

ID: 1798002
Sex: F
Age: 59
State: NE

Vax Date: 09/03/2021
Onset Date: 09/10/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data: blood work, A1C

Allergies: none

Symptom List: Diarrhoea, Nasal congestion

Symptoms: i have been diagnosed with the diabetes and it is really weird because I haven't had it before. Now I am on a diabetes medicine and it was after the second dose. I was really sleepy after the second dose. After the second dose my chest where my port was placed decreased.

Other Meds: TESTER CHLORIDE, ASTERZOLE, FUROFEMIDE, METFORMIN, LISIPRONIL, VITAMIN CALCIUM CITRIC D3, BLANTIS

Current Illness: none

ID: 1798003
Sex: F
Age: 84
State: NJ

Vax Date: 10/17/2021
Onset Date: 10/18/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data: n/a

Allergies: Penicillin

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

Symptoms: next day itching, swelling and redness over injection site and upper arm

Other Meds: n/a

Current Illness: none

ID: 1798005
Sex: F
Age: 41
State: NY

Vax Date: 05/21/2021
Onset Date: 05/25/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data: Intravaginal ultrasound showed no issues. Ferritin level is low (9 ng/ML)

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Changes in menstrual cycle. After 1st shot, period started 4 days later (5/25), which was a week early and last longer than usual (7 days vs 3-4 days normally). Next month (June) my period never happened (I am not pregnant and I had not skipped a period in 14 years). My next period didn?t start until 7/24 and lasted longer than usual again (12 days). My next period started on 9/1 and lasted longer than usual again (15 days). My most recent period started on 9/30 and still has not stopped (so going on 20 days of bleeding now).

Other Meds: Levothyroxine

Current Illness: None

ID: 1798006
Sex: M
Age: 41
State: AK

Vax Date: 01/29/2021
Onset Date: 02/04/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data: CRP, High Sensitive 100.00 mg/L

Allergies: None

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

Symptoms: A week after receiving the first shot I started getting "attacks" where I woke up at 5 am unable to breathe, with rigors. My whole body hurt. I would be extremely lethargic afterward for a day or 2. A week after receiving the shot I had an attack during the day, triggered by drinking half a beer and I went to the ER. I started having trouble breathing, my heart was pounding and my face and neck started turning red.

Other Meds: None

Current Illness: None

ID: 1798007
Sex: M
Age: 62
State: VA

Vax Date: 04/09/2021
Onset Date: 08/29/2021
Rec V Date: 10/19/2021
Hospital: Y

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

Lab Data: They ran a CAT scan and saw something on the brain. They ran a 2nd cat scan and gave me a MRI of my brain. Ultrasounds of my heart and said that my heart was good. An hour later and all the symptoms subsided.

Allergies: None

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

Symptoms: On August 29th I was sitting eating my lunch and took my medication for the day someone came to my door and I was trying to get up and answer the door and a weakness came to me and I couldn't stand up and kept falling onto my sofa and my right arm was very weak. And I finally got to the door and my friend said I didn't look right. when I was talking to her my speech was slurred and my face got droopy. I could barely stand up and she had to hold me up and another neighbor came over and helped me to the car because I couldn't even move my feet. They put me in the car and took me to the emergency room. They put me into trauma one. When I got to the hospital they kept telling me I was going in and out of strokes. This lasted for an hour and then the symptoms went away. From what I read about side effects is what I went through. I stayed in the hospital overnight and ran tests and diagnosed me with a TIA. They told me I had no permanent damage. I'm really concerned about the booster shot because I don't know what reaction I will have. Doctors said the rivaroxaban 20mg blood thinner kicked in and prevented me from going into a major stroke. I went back to the hospital on Sept 2nd, the weakness came back and my speech was slurred and they ran more tests and told me it was due to dehydration.

Other Meds: Diltiazem; glipizide; hydralazine; lisinopril; metformin; rivaroxaban; azelastine; Tums; pantoprazole

Current Illness: None

ID: 1798008
Sex: M
Age: 78
State: SC

Vax Date: 09/28/2021
Onset Date: 09/29/2021
Rec V Date: 10/19/2021
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: UNABLE TO REACH PATIENT NO KNOWN ADVERSE REACTION AFTER 3RD DOSE.

Other Meds:

Current Illness:

ID: 1798009
Sex: F
Age: 50
State: AR

Vax Date: 05/05/2021
Onset Date: 08/10/2021
Rec V Date: 10/19/2021
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: sulfa

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

Symptoms: Peripheral Neuropathy...It began with tingling in my feet in August 2021 then progressed over the next month to my arms, legs and torso. In addition to tingling, it began to feel like pin pricks and burning and has become somewhat painful...peripheral neuropathy. It is constant without relief by changing positions, clothes worn or ibuprofen taken to relieve pain.

Other Meds: multi vitamin Valtrex

Current Illness: none

ID: 1798010
Sex: F
Age: 78
State: OR

Vax Date: 05/05/2021
Onset Date: 06/14/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data: CT done weeks later (07/04/21) showed small left basal ganglia lacunar infarct

Allergies: amoxicillin, epinephrine

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

Symptoms: expressive aphasia, word finding difficulty

Other Meds: Vit. D, vitamin K2, Calcium, aspirin, Vit. C, tylenol

Current Illness: none

ID: 1798011
Sex: F
Age: 63
State: GA

Vax Date: 10/06/2021
Onset Date: 10/15/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data:

Allergies: NUTS, APPLES, ENVIRONMENTAL

Symptom List: Ear pain, Hypoaesthesia

Symptoms: SEVERE REDNESS AND BLISTERING TO HER SKIN THAT STARTED ON HER SHOULDERS AND HAS NOW SPREAD TO ENTIRE TORSO FRONT AND BACK.

Other Meds: NONE

Current Illness: NONE

ID: 1798012
Sex: F
Age: 66
State:

Vax Date: 08/31/2021
Onset Date: 10/16/2021
Rec V Date: 10/19/2021
Hospital: Y

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

Lab Data: MRI and CT of brain, ECHO

Allergies: sulfa, codeine, meperidine

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Pt presented to ED with right sided headache then vision loss in L eye and shaky legs. Diagnosed with CVA.

Other Meds: citalopram, meloxicam, omeprazole, sumatriptan, verapamil, Vit D, Vit B12, latanoprost eye drops

Current Illness:

ID: 1798013
Sex: M
Age: 41
State: ID

Vax Date: 09/18/2021
Onset Date: 10/12/2021
Rec V Date: 10/19/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: The patient began to feel ill and have episodes of frequent urination, increased thirst and nausea shortly after his 2nd dose of the Pfizer vaccine. On October 12th the patient presented to the Emergency Department and was admitted to the ICU for DKA and a new diagnosis of Type 1 diabetes.

Other Meds:

Current Illness:

ID: 1798014
Sex: F
Age: 41
State: NY

Vax Date: 10/18/2021
Onset Date: 10/19/2021
Rec V Date: 10/19/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Bad headache

Other Meds: None

Current Illness:

ID: 1798015
Sex: F
Age: 69
State: MT

Vax Date: 10/14/2021
Onset Date: 10/15/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data: CXR

Allergies: Methamizole

Symptom List: Unevaluable event

Symptoms: Diarrhea and "Coughing like Crazy"

Other Meds: Albuterol INH, Trintellix, Lyrica, Protonix, Ditropan, Synthroid, Femara, Prinivil, Mobic, Baclofen, Prolia, Gabapentin, Elavil, Lipitor

Current Illness: Breast CA

ID: 1798016
Sex: F
Age: 36
State:

Vax Date: 10/12/2021
Onset Date: 10/12/2021
Rec V Date: 10/19/2021
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: 1st Pfizer vaccination administered at 11:27 am. At 11:47 patient reports nausea, SOB, lightheadedness, scratchy throat. History of asthma. Symptoms similar to those experienced after PPSV23 and Tdap vaccines. patient denies swelling of tongue, mouth, or throat. Brought patient inside to lay on stretcher, legs elevated. patient face flushed, diaphoretic, eyes tearing. BP 130/87, HR 83, O2Sat 98% RA, RR 22. 11:48 Dr at bedside. 11:52 Albuterol MDI 2 puffs INH with spacer administered. 11:54 BP 122/82, HR 83, O2Sat 99% RA, RR 18. patient reports SOB subsided. 11:59 BP 120/52, HR 82, O2Sat 100% RA, RR 18. 12:07 BP 118/75, HR 75, O2Sat 100% RA, RR 18. Facial flushing, sweating, tearing subsided. 12:15 BP 118/71, HR 76, O2 Sat 100% RA, RR 16. 12:16 Patient sitting at edge of bed 12:21 BP 129/74, HR 77, O2Sat 100% RA, RR 16. 12:28 BP 124/66, HR 76, O2Sat 100 % RA, RR 16. patient states nausea and lightheadedness improving. patient reports history of vertigo, low blood pressure that causes dizziness/lightheadedness. 12:45 BP 109/71, HR 78, O2Sat 100% RA, RR 16. Lightheadedness and nausea improving. 12:56 patient reports lightheadedness and nausea improving, close to baseline. Advised patient to remain in clinic until symptoms subside, patient verbalized understanding, states she is safe drive. Reviewed with patient to call 911 with SOB, chest pain, dizziness, verbalized understanding and again stated she was safe to drive.

Other Meds:

Current Illness:

ID: 1798018
Sex: F
Age: 83
State: TX

Vax Date: 10/19/2021
Onset Date: 10/19/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Patient did not have any immediate onset of symptoms or signs of symptoms.

Other Meds:

Current Illness:

ID: 1798019
Sex: M
Age: 25
State:

Vax Date: 09/16/2021
Onset Date: 09/16/2021
Rec V Date: 10/19/2021
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: No adverse effects reported

Other Meds:

Current Illness:

ID: 1798020
Sex: F
Age: 38
State: WA

Vax Date: 10/04/2021
Onset Date: 10/13/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data: Negative right arm venous ultrasound on 10/15 for DVT or superficial clots. Normal CBC, ferritin, and CMP on 10/18.

Allergies: Niacin- flushing; zinc- GI distress

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

Symptoms: Dx with phlebitis of the right arm, starting on morning 10/13, starting with dark line and pulling sensation in ventral right arm. 10/14 noted tenderness at elbow, then progression of lines past elbow to forearm that eve. Sought virtual care on 10/14 AM. Started on 325mg aspirin and 400mg ibuprofen TID, heat, and compression as helpful. No hand or arm edema noted. Follow up on 10/18, bruising resolving, more on forearm, mild localized swelling near ecchymosis. Subjective arm fatigue. Normal radial pulses and cap refill. Plan to continue aspirin for full 7 days, monitor for resolution as symptoms seem to be improving. Continue to keep differential open if other sx occur. Did have stomach pain and 1 episode of diarrhea 10/14- assume food related d/t also in family member. Also stomach pain only 10/16- suspect NSAID related. d/c ibuprofen 10/17. None since. Context -2nd Moderna on 10/4 and flu shot on 9/29 in the right arm. No hx of prior DVT, prior clotting event, or phlebitis.

Other Meds: none

Current Illness: Reaction to Moderna COVID vaccine #1- 9/6/21- significant left axillary tenderness x 6 days, left arm and leg paresthesia/heaviness

ID: 1798021
Sex: F
Age: 70
State: CA

Vax Date: 04/13/2021
Onset Date: 04/13/2021
Rec V Date: 10/19/2021
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: LDH-350ul, Normal range is 81- 234ul

Allergies: None

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Mild typical symptoms happened 15mins after the shot-Patient felt a sense of a pulse inside their head- felt pressure their head. Sore arm the next day, lasted for a few days. Actual Symptoms began 7 months after the shot. October 1st - got flu shot- PVC disc appeared on right arm. Aches and Pain- 6:30pm bruising. Distorted vision -lasted 2mins. Blurry vision still exist. Day 2 after vaccine, i got a one sided headache- happens around the back of the head, body ache, Burning tongue Got ill for almost a week. In august 2021, I got shingles at the back of my ear.

Other Meds: Adderall xr dosage - 220 mg tablets every morning -Prescription Tylenol - 325 Hydrocodone -5mg mg Prescription Vitamin B12 Supplements -1000 MCG Vitamin D- Supplement B-3 2000 N acetylcysteine - 600mg citicoline 250mg DHA-400mg excedrin-d

Current Illness: None

ID: 1798022
Sex: M
Age: 24
State: IA

Vax Date: 10/06/2021
Onset Date: 10/06/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data: None

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: No adverse event noted. Vaccine given outside of EUA

Other Meds:

Current Illness:

ID: 1798023
Sex: F
Age: 70
State: CA

Vax Date: 04/15/2021
Onset Date: 06/01/2021
Rec V Date: 10/19/2021
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: stool sample- 05/2021- normal urine sample 05/2021- normal blood work 05/2021- normal

Allergies: sulfa medicines

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

Symptoms: In May, I experienced diarrhea that lasted about a month. I went to my doctor and they did a bunch of tests that all came back normal. There was no diagnosis. Luckily, that subsided. End of June, I noticed behind my right ear I had a bald spot. Then I noticed a bald spot on the top of my head, I went to the dermatologist and she did hormone injections in the bald spots. A month later she did more hormone injections. She prescribed additional experimental meds but I do not take them. I am now balding all over my head. I was diagnosed with Alopecia Areata.

Other Meds: none

Current Illness: none

ID: 1798024
Sex: M
Age: 15
State: NY

Vax Date: 10/15/2021
Onset Date: 10/01/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Nausea

Symptoms: Janssen vaccine was given to a minor, patient was 15 years old at the time of vaccination. Patient was evaluated and the mother was notified. Patient left the facility stable.

Other Meds: N/A

Current Illness: N/A

ID: 1798025
Sex: F
Age: 74
State: MI

Vax Date: 03/05/2021
Onset Date: 10/18/2021
Rec V Date: 10/19/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Patient Covid + on 10/18/2021 at Hospital and vaccinated with Pfizer vaccine with 1st dose on 02/12/2021 and 2nd dose on 03/05/2021. Per ED Note: This 75-year-old female with history of hypothyroidism and Covid diagnosed 2 weeks ago presents to the emergency department complaint of persistent diarrhea. Patient states the vomiting has stopped but the diarrhea has persisted loose and watery. She denies any hematochezia or melena. Patient states she is currently taking antibiotics started by her PCP for the diarrhea. She cannot tell me what the name of the antibiotic is. Patient complains of some shortness of breath but denies any fever. No prior lung problems.

Other Meds:

Current Illness:

ID: 1798026
Sex: F
Age: 51
State: NV

Vax Date: 10/15/2021
Onset Date: 10/18/2021
Rec V Date: 10/19/2021
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: Unknown

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

Symptoms: Red Swollen Itchy area at and around injection site

Other Meds: Unknown

Current Illness: Unknown

ID: 1798027
Sex: F
Age: 57
State: MD

Vax Date: 10/12/2021
Onset Date: 10/14/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data: EKG at Urgent Care 10/15/2021. EKG, CXR, & Cardiac enzymes in ED 10/15/2021. PCP eval 10/18/2021.

Allergies: Percocet (itching)

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

Symptoms: 10/13/2021 chills, headache; 10/14/2021 severe neck pain and stiffness, chest discomfort with intermittent palpitations lasting for hours, generalized itching, fatigue; 10/15/2021 localized itching below site itching.

Other Meds: Benadryl prn, ibuprofen prn taken upon onset of symptoms, but not prior to.

Current Illness: Chronic lower back pain.

ID: 1798029
Sex: F
Age: 33
State: GA

Vax Date: 09/09/2021
Onset Date: 10/13/2021
Rec V Date: 10/19/2021
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 10/1/2021- negative - prescribed antibiotics and inhaler Urgent care visit 10/13/2021- prescribed steroid shot, oral steroids, antibiotics, inhaler

Allergies: Kale/walnuts

Symptom List: Tremor

Symptoms: Ongoing facial symptoms carried over from first dose of vaccine (blisters, sensitive swollen face , swollen eye and flaking skin in patches) most recently had a resting heart rate of 100-117 along with severely swollen left eye and re-emergence of mouth sores. (10/13/21) this caused me to seek medical attention once again. Had already finished one dose of antibiotics. Currently received a steroid shot, taking oral steroids, and another round of antibiotics. I am also an avid exerciser, but can no longer exercise without an inhaler. This is only recently.

Other Meds: 200mg spironolactone + daily vitamins

Current Illness: None

ID: 1798031
Sex: F
Age: 72
State: MI

Vax Date: 03/06/2021
Onset Date: 10/11/2021
Rec V Date: 10/19/2021
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: SARS-COV-2 by NAA, micro detected SARs

Allergies: Penicillins, Sulfa Antibiotics, Aspirin, Biaxin, Sulindac, Zantac

Symptom List: Erythema, Pruritus

Symptoms: Pt presented to the ED on 10/17/2021 with complaints of nasal congestion, sore throat, nausea, vomiting, diarrhea, cough, fever, and SOB. Her symptoms progressively worsened over the past week. Pt was tested for COVID-19, which resulted positive on 10/17/21.

Other Meds: Prinvil, Flonase

Current Illness:

ID: 1798032
Sex: M
Age: 40
State: CA

Vax Date: 10/18/2021
Onset Date: 10/18/2021
Rec V Date: 10/19/2021
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: N/A

Allergies:

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

Symptoms: Patient received second dose of vaccination and fainted a couple of minutes after receiving the vaccination. Patient sat down and rested for about fifteen to twenty minutes and felt fine.

Other Meds: It is unknown what medications or dietary supplements the patient was taking at the time of the vaccination.

Current Illness:

ID: 1798033
Sex: F
Age: 71
State: IA

Vax Date: 10/06/2021
Onset Date: 10/06/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: No adverse event noted. Vaccine given outside of EUA

Other Meds:

Current Illness:

ID: 1798034
Sex: M
Age: 51
State: NC

Vax Date: 05/21/2021
Onset Date: 05/23/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data: Visited physician 05/28/2021 after adverse event

Allergies: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: 1st dose - no issue other then excessive thirst, slight dehydration 2nd dose - 15 hours post injection, fever developed lasting approx. 5 hours. The following day a rash developed on left leg only from thigh just above knee, including calf to ankle.

Other Meds: 150mg Buproprion

Current Illness: None

ID: 1798035
Sex: F
Age: 82
State: FL

Vax Date: 10/15/2021
Onset Date: 10/19/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data: EKG and oxygen levels and usual tests

Allergies: Bactria, cortisone and aspirin

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

Symptoms: At 9::00pm I felt chilled ,and achy and went to bed because I started to shake U.N. controllably. I took Tylenol at about 10:00pm and in about10 minutes the shaking stopped. Soon after I was able to take off extra pjs and covers. When I went to the bathroom at sometime around 7:00 am I felt hungry as I stood up and fainted. I fell on my back and was out for less than a minute. I was checked out by paramedics. My blood pressure was 119/49. They told me to drink Gatorade and water from being dehydrated. I had already started drinking before this. They got me in bed. I ate, rested and got through the day.feeling stronger. The next day felt stronger and stronger.

Other Meds: Coq10, calcium, multiple, magnesium,vit. c montelukast, Flonase loratadine, simvastin, b12,D3, omeprazole, chlorthalidone

Current Illness: None

ID: 1798036
Sex: F
Age: 21
State: WI

Vax Date: 09/21/2021
Onset Date: 09/22/2021
Rec V Date: 10/19/2021
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: elevated D dimer, elevated troponin levels, various labs and cardiac echo, ekg's. Further labs completed at follow up appointment with primary care physician and upcoming visit with cardiologist.

Allergies: amoxicillin, cats

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

Symptoms: Starting the night of the vaccine, flu like symptoms began (extreme body aches, severe neck/back pain, fatigue, elevated temp), which then progressed into chest pain, chest tightness, shortness of breath. Went to hospital on day four due to continued chest pain, tightness and shortness of breath and was then admitted due to elevated troponin levels and continued symptoms. Seen by cardiologist and diagnosed with myocarditis and pericarditis. Was started on nsaids (ibuprofen) and colchicine. Discharged later the next day and to follow up with primary care doctor and cardiologist. The symptoms continued for well past a week after leaving hospital.

Other Meds: vitamin D

Current Illness: none

ID: 1798037
Sex: F
Age: 50
State: VA

Vax Date: 10/16/2021
Onset Date: 10/17/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data:

Allergies: Sesame Seeds, pumpkin seeds, poppy seeds and wool

Symptom List: Pain in extremity

Symptoms: Severe numbness and tingling in both hands for a couple of hours along with shortness of breath beginning the day after I received the vaccine.

Other Meds: Lexapro, Levothyroxine, Vitamin C (500Mg) , Bi Yan Pian. One a Day Multi Vitamin

Current Illness:

ID: 1798038
Sex: M
Age: 58
State: OH

Vax Date: 02/24/2021
Onset Date: 10/07/2021
Rec V Date: 10/19/2021
Hospital: Y

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

Lab Data: CT scan w/contrast, compression test

Allergies: phenargan, lyrica

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

Symptoms: Blood clot in right femarol artery with stent, now PT/INR is staying too low for therapeutic range for aortic valve

Other Meds: coumidan, flecainade, januvia, jardiance, metformin, glipizide, cardizem, aspirin, maxide

Current Illness:

ID: 1798039
Sex: M
Age: 73
State: AR

Vax Date: 01/20/2021
Onset Date: 10/10/2021
Rec V Date: 10/19/2021
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:

Allergies:

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

Symptoms: Pt Admitted on 10/10/2021: co illness x 5-6 days with shortness of breath and increasing weakness. negative home covid test 3 days ago. arrives tachypneic, in RD, with O2 54% on RA. history per pt son. History of Present Illness: Patient is a 74-year-old male presents to the ER complaining of shortness of breath which started 5-6 days ago. He took an in-home COVID test 3 days ago was negative. He tells me had 2 doses of earlier this year and had the pfizer booster 9-30-21. In the ED tested positive for COVID. In triage, patient's room air O2 sat was 54% on room. He denies any fever chills or any known lung disease. He says he is a nonsmoker takes no medications and has no cough past medical problems that he aware of. Discussed with him code status at this point he would want to be full code. History limited by patient's hers shortness of breath despite high-flow oxygen. Pt is current in-patient.

Other Meds:

Current Illness:

ID: 1798040
Sex: F
Age: 68
State: PA

Vax Date: 10/18/2021
Onset Date: 10/18/2021
Rec V Date: 10/19/2021
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: bactrim, sulfa drugs, tetracycline, omeprazole

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

Symptoms: Face got very warm, hands felt cool, slightly dizzy, a weird feeling.. I was in a store and took a Zrytec as it is what I had with me. Called my spouse to come and drive me. By the time I got home, approximately 1/2 hour to 45 min. later, I was starting to feel better.

Other Meds: acetaminophen 4 hours prior

Current Illness: none

ID: 1798041
Sex: F
Age: 34
State: OH

Vax Date: 07/02/2021
Onset Date: 07/03/2021
Rec V Date: 10/19/2021
Hospital:

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

Lab Data:

Allergies: n/a

Symptom List: Vomiting

Symptoms: Delayed menstrual cycle by 10 days. Previously very regular, even after multiple live births. Still has not returned to normal.

Other Meds: lovenox

Current Illness: n/a

ID: 1798042
Sex: F
Age: 29
State: KY

Vax Date: 10/08/2021
Onset Date: 10/19/2021
Rec V Date: 10/19/2021
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: No known

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient called to say she believe vaccin was administered too high on her arm. It was administered in inverted triangle in the appropriate area but she said she still has pain after 11 days and her doctor agreed it was administered too higher on the arm.

Other Meds: Unknown

Current Illness: No know

ID: 1798043
Sex: M
Age: 26
State: VA

Vax Date: 07/26/2021
Onset Date: 08/02/2021
Rec V Date: 10/19/2021
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: Didn't take any test. Talked to Dr later about it.

Allergies: None

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

Symptoms: Had heart and chest pains for 3-4 days about a week after vaccine. Pain got even worst when I laid down in bed or was horizontal. No other covid related symptoms

Other Meds: 20 MG lisinopril daily

Current Illness: None

ID: 1798044
Sex: F
Age: 71
State: FL

Vax Date: 04/15/2021
Onset Date: 05/20/2021
Rec V Date: 10/19/2021
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: XRAYS 6/20/2021 INCONCLUSIVE MRI 7/282021 INCONCLUSIVE MRI 9/22/2021 INCONCLUSIVE EMG 9/30/2021 NO PERMANENT DAMAGE TO NERVES

Allergies: SULFA

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Moderna COVID-19 Vaccine EUA

Other Meds: FLUOXITINE MULTIVITAMIN ZYRTEK CALCIUM

Current Illness: NONE

ID: 1798046
Sex: M
Age: 75
State: IL

Vax Date: 03/09/2021
Onset Date: 10/17/2021
Rec V Date: 10/19/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: hospitalization of a fully vaccinated person

Other Meds:

Current Illness:

ID: 1798047
Sex: M
Age: 74
State: AZ

Vax Date: 08/31/2021
Onset Date: 09/01/2021
Rec V Date: 10/19/2021
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 known

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

Symptoms: Significant general joint/muscle pain--lasted @24 hours

Other Meds: Atorvastatin 20mg 1X; Metoprolol Succ ER 25mg 2X;Buproprion SR 2X;Celecoxib 200mg 1X;Gabapentin 600mg 1x;Tamsulosin Hydrochloride .4 Mg 1X;Immune Globulin Hyqvia 25 gm SQ;Amitiza 24Mcg;Buprenorphine Transdermal 15 mcg/hr;Oxycoode Hydrochlo

Current Illness: None Known

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am