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: 1800944
Sex: F
Age: 43
State: NY

Vax Date: 09/15/2021
Onset Date: 09/15/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: Cat-Scan 09/20/2021

Allergies: Pennicillin

Symptom List: Dysphagia, Epiglottitis

Symptoms: Pt. states that after receiving the 1st dose of Phizer 09/15/2021, started experiencing symptoms 20mins 09/15/2021 of whole left side feeling of "pens & needles" continuously, right side of the body will have the feeling of "pens & needles" randomly. Neurologist appt. 09/20/2021 (estimated) no recommendations/ more testing (Cat-Scan). Still continuing to experience symptoms. Neurologist appt. 10/20/2021

Other Meds: N/A

Current Illness: N/A

ID: 1800945
Sex: F
Age: 79
State: MN

Vax Date: 01/14/2021
Onset Date: 10/16/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: Covid PCR test completed 10/18/21

Allergies: Levofloxacin, PCN, shrimp

Symptom List: Anxiety, Dyspnoea

Symptoms: Deep cough,, runny nose, lethagy beginning 10/16/21

Other Meds: Tylenol, atrovastatin, biofreeze, Citalopram, diclofenac sodium, Eliquis, gabapentin, geri-lanta,levothyroxine, myrbetriq, omeprazole, oxybutin, miralax, senna, robafen DM, sucralfate,trazadone

Current Illness: N/A

ID: 1800946
Sex: F
Age: 35
State: TX

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 10/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: NONE

Allergies: NKA

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

Symptoms: RECEIVED FIRST DOSE AT HEB PHARMACY ON 2/26/2021. RECEIVED SECOND DOSE TOO EARLY (ONLY 14 DAYS) ON 3/12/2021. RECEIVED ADDITIONAL THIRD DOSE ON 4/9/2021.

Other Meds: NOT REPORTED

Current Illness: NOT REPORTED

ID: 1800947
Sex: M
Age: 65
State: VA

Vax Date: 06/07/2021
Onset Date: 06/15/2021
Rec V Date: 10/20/2021
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: Rash down both arms. and then went to both legs, Rash was very itchy and started to bleed.I thought it would go away but it did not.I went to my dotor on 7/27/2021 he prescribed Hyroxyzine 10mg and Triamcinolone .01%. the Rash started to go away. The rash came back on 9/20/2021 I reapplied the cream took my Hydroxyzine.which helps.Please tell this will not be permanent?

Other Meds: Centrum

Current Illness: none

ID: 1800948
Sex: F
Age: 26
State: PR

Vax Date: 08/28/2021
Onset Date: 08/28/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data:

Allergies: N/A

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

Symptoms: Female patient in the observation area reports feeling dizzy and head pain. Patient is taken to a paramedic who laid her down with legs elevated and takes her vitals. Patient tell me she suffers from vasovagal. Vitals are taken 110/60 BP Sat 98, 68P 102 Ext. Mother came to look for her.

Other Meds: N/A

Current Illness: N/A

ID: 1800949
Sex: F
Age: 43
State:

Vax Date: 04/11/2021
Onset Date: 10/19/2021
Rec V Date: 10/20/2021
Hospital: Y

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:

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

Symptoms: Breakthrough COVID case, positive for COVID on 10/19/21, symptomatic.

Other Meds:

Current Illness:

ID: 1800950
Sex: F
Age: 59
State: SC

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

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

Lab Data: ECG - normal sinus rhythm at 70 bpm.

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Following the vaccine administration, the patient became flushed. She laid down on a stretcher and complained of her heart fluttering and discomfort in the left arm, which was also the site of the injection. Patient was taken to the ED and evaluated.

Other Meds:

Current Illness:

ID: 1800951
Sex: F
Age: 67
State:

Vax Date: 02/25/2021
Onset Date: 09/01/2021
Rec V Date: 10/20/2021
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: Pharyngeal swelling

Symptoms: Patient described having extreme hair loss. Her hair came out in clumps. She already talk to her Rheumatologist about it and he said to talk to her pharmacist.

Other Meds:

Current Illness:

ID: 1800952
Sex: F
Age: 54
State: FL

Vax Date: 10/17/2021
Onset Date: 10/18/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: evaluation on 10/18/21 at Hospital.

Allergies: seasonal allergies prednisone

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient reports after receiving second shot in COVID vaccine series she developed tachycardia, HR ranging from 108-119, HTN 180s/97, and high fevers of 103. Patient states her symptoms started throughout the night after receiving the vaccine. Report she attempted to go to work, but had to leave due to her symptoms. Reports she was evaluated by Hospital and was sent home to rest, treat symptoms, and monitor HR and BP. Patient states she rested and took Tylenol for her symptoms. Reports she had a fever of 99-103 until 10/20/21. Stated on 10/20/21 her symptoms started to improve, HR 84, blood pressure 130/81. Reports she had tachycardia, hypertension, and febrile for 3 days post vaccine.

Other Meds: Mobic as needed ibuprofen as needed

Current Illness: none

ID: 1800953
Sex: M
Age: 58
State: KY

Vax Date: 04/08/2021
Onset Date: 10/14/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Tested Positive for Covid.

Other Meds:

Current Illness:

ID: 1800954
Sex: M
Age: 75
State: MN

Vax Date: 03/03/2021
Onset Date: 03/04/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data:

Allergies: Lipitor.

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

Symptoms: Seizure the day after the vaccine.

Other Meds: Plavix; Imdur; Metoprolol; Prilosec.

Current Illness: N/A.

ID: 1800955
Sex: M
Age: 60
State:

Vax Date: 04/11/2021
Onset Date: 10/19/2021
Rec V Date: 10/20/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Breakthrough COVID case, positive for COVID 10/19/21, symptomatic, ICU.

Other Meds:

Current Illness:

ID: 1800956
Sex: F
Age: 38
State: GA

Vax Date: 10/15/2021
Onset Date: 10/15/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: On 10/20/2021 I had multiple x-rays done of my shoulder and I was prescribed a steroid pack and topical anti-inflammatory as well as exercises I need to do twice a day to prevent frozen shoulder.

Allergies: IV versions of Compazine and Reglan, adhesive tape Food sensitivities to gluten, eggs, grapes and dairy

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

Symptoms: The vaccine was injected too high in my shoulder and there was a pop that I heard and felt as the needle was injected. Two hours after the shot I was experienced extreme shoulder pain (not typical arm muscle soreness). I have limited range of motion and I am unable to lift and move my arm/shoulder without pain. I am experiencing some radiation pain up my neck and down to my elbow. The pain in my shoulder joint is more on the inside and not at the injection site. I am still experiencing pain five days later and went to an orthopedic doctor who specializes in shoulder injuries. He diagnosed me with SIRVA and said that the inflammation and pain I am experiencing is caused by the improper administration of the vaccine into my bursa and not my deltoid muscle. He said that these types of injuries typically take between 6-8 weeks to heal fully.

Other Meds: Spirolactone, Ajovy, probiotic, omega, colace, DIM, HTP-5

Current Illness: N/A

ID: 1800957
Sex: F
Age: 32
State:

Vax Date: 09/22/2021
Onset Date: 09/23/2021
Rec V Date: 10/20/2021
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:

Allergies:

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

Symptoms: Chills, Lethargy, Headache - chills and headache slowly faded within 24 hours of onset of events and the lethargy lasted a few days

Other Meds:

Current Illness:

ID: 1800958
Sex: M
Age: 74
State: FL

Vax Date: 10/04/2021
Onset Date: 10/04/2021
Rec V Date: 10/20/2021
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 KNOWN

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

Symptoms: NO ADVERSE REACTION.... DRUG GIVEN AFTER BEYOND USE DATE

Other Meds: NONE KNOWN

Current Illness: NON KNOWN

ID: 1800959
Sex: M
Age: 43
State: FL

Vax Date: 05/06/2021
Onset Date: 05/20/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: x-ray ultra sound - meralgia paraesthetica 08/12/2021- COVID-19 test- positive

Allergies: no

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

Symptoms: On 05/20/2021, two weeks after the vaccination, my left leg in my thighs are feeling sharp pain, especially when I walk a lot. On 07/16/2021- the doctor did x-rays and ultrasound. They didn't see a clear pic. but they think its a nerve that is pinched. He diagnosed it as Meralgia paraesthetica. I still have the AEs I still have to go to the doctor to get more tests for my leg. On 08/12/2021- I went to pharmacy and was tested for COVID-19 and the results were positive. I was having normal flu symptoms. I lost my smell and taste, for the 1st time in my life, I had fever, runny nose, headache, muscle ache, bone ache, all that stuff, the usual flu symptoms. I had the symptoms for a week and they resolved on their own.

Other Meds: Vitamin D Vitamin C

Current Illness: no

ID: 1800961
Sex: M
Age: 25
State: AL

Vax Date: 06/04/2021
Onset Date: 09/28/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: ECHO, CBC, CMP, TROPI , CKMB, Holter Monitor, Thyroxine, FT4, Fibrin D-dimer, BNP

Allergies: None

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

Symptoms: 26 yr old Military Student pilot (previously in excellent physical condition without any underlying conditions), reports that he received in June 2021. He presented to clinic with concerns about fluttering/racing of hear, heart noticed his heart rate has felt elevated in the last 2 months. Patient reports the heart rate feels racing during the morning for approximately 2 hours , and that he feels fairly tired following the event. Patient reports that his physical training has been harder to complete due to the racing heart race, the patient feels as though he is losing his breathe more often and getting tired more quickly. Patient reports no intervention, but he did attempt to change diet and exercise. EKG demonstrated pericarditis sent for labs, ECHO and cardiology consult to rule out myocarditis.

Other Meds: None

Current Illness: None

ID: 1800962
Sex: M
Age: 23
State: VA

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

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

Lab Data:

Allergies: No known food or drug allergies

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient complained of feeling as if "everything had slowed down." Pt. became diaphoretic, and c/o feeling like his hands were tingling. Pt. was placed on the floor with legs elevated. BP was monitored and pulse. His first b/p was 66/44. Monitored over the next 30 minutes, and b/p readings were 134/89 and 115/79. Heart rate was 44 at the beginning of episode and was monitored as well. The heart rate was 72 bpm once his blood pressure had resumed to his normal range. Pt. reported that he had a history of anxiety disorders and panic attacks. Non labored breathing. Ice pack was placed on patient's forehead. Pt. declined the offer for any other follow up medical care. Pt. appeared to have had a vasovagal response from having an injection. Monitored closely for the next 30 minutes and given follow up instructions for if symptoms reappeared after leaving the site.

Other Meds: None listed or verbally given.

Current Illness: None given.

ID: 1800963
Sex: F
Age: 77
State: IL

Vax Date: 10/09/2021
Onset Date: 10/15/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: Dr. referred to Neurology. Neurology didn't schedule 1st visit with dr until jan 26 2022

Allergies: Sulfa.

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Numb fingers in left hand began on 10/15--started with fingertips, spread to entire hard to wrist. As of reporting date (10/20) numbness still present.

Other Meds: Irbesartan; Cardivelol; Atorvastatin; ultracet; lexapro; trazedone;diazepam; bentyl; calcium w/vit D; folic acid; refresh tears; imodium or pepto (as needed.)

Current Illness: Interstitial nephritis;type 2 diabetes;congestive heart failure; Sjogrens; chronic fatigue.

ID: 1800964
Sex: M
Age: 34
State: TN

Vax Date: 10/18/2021
Onset Date: 10/19/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: 7 hours after vaccination severe chills, pain, shaking, feeling cold diffuse muscle pain next day, nausea/vomiting left arm is red at injection site ~ 2 inches in diameter

Other Meds: Lisinopril 20 mg daily

Current Illness: none

ID: 1800965
Sex: F
Age: 66
State: MA

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 10/20/2021
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: Evaluation and EMG being ordered. Referral for Should specialist.

Allergies: Shellfish, Iodine

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

Symptoms: Sudden onset of Pain in the left arm immediately following Flu shot injection. Pain in lateral arm and weakness.

Other Meds: Metformin, hydrochlorothiazide, lovastatin, jardiance,

Current Illness: None

ID: 1800966
Sex: M
Age: 27
State: CO

Vax Date: 03/01/2021
Onset Date: 08/23/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: Visited doctor for the headaches and received a CT scan for any abnormalities. No abnormalities were found.

Allergies: Pork

Symptom List: Unevaluable event

Symptoms: Series of migraines and cluster headaches. Occurred in mid august and lasted until mid September. Also have experienced nausea, indigestion, and diarrhea since the administration of the vaccine.

Other Meds: Zoloft; Trazodone; Propranolol.

Current Illness:

ID: 1800967
Sex: U
Age: 71
State: FL

Vax Date: 10/05/2021
Onset Date: 10/05/2021
Rec V Date: 10/20/2021
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: NONE KNOWN

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

Symptoms: NO ADVERSE REACTION... DRUG GIVEN AFTER BEYOND USE DATE

Other Meds: NONE KNOWN

Current Illness: NON KNOWN

ID: 1800968
Sex: M
Age: 12
State: TX

Vax Date: 07/30/2021
Onset Date: 07/30/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: NOT REPORTED.

Allergies: NKA.

Symptom List: Injection site pain, Pain

Symptoms: CHILD UNDERAGED FOR VACCINE. DOB REPORTED AS 06/23/2009 ON CONSENT BUT IMMTRAC DOB IS 10/23/2010. CHILD RECEIVED SECOND PFIZER DOSE AS WELL ON 8/20/2021 (LOT#EW0177.)

Other Meds: NOT REPORTED.

Current Illness: NOT REPORTED.

ID: 1800969
Sex: M
Age: 71
State: WA

Vax Date: 10/14/2021
Onset Date: 10/14/2021
Rec V Date: 10/20/2021
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: UNKNOWN.

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient received more than the recommended number of Pfizer COVID-19 vaccine doses. In total they received four doses of the vaccine.

Other Meds: UNKNOWN.

Current Illness: UNKNOWN.

ID: 1800970
Sex: F
Age: 62
State: TX

Vax Date: 01/12/2021
Onset Date: 01/22/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: x ray, mri

Allergies: None

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

Symptoms: Patient reports that within 24 hours, she began having swelling and weakness in both lower extremities which gradually increased to both upper extremities.

Other Meds: None

Current Illness: None

ID: 1800971
Sex: F
Age: 64
State: IN

Vax Date: 10/01/2021
Onset Date: 10/18/2021
Rec V Date: 10/20/2021
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: Nka.

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Fever, chills, body ache and back pain, fatigue.

Other Meds: Celebrex; Hydrochlorothiazide; Vitamins; Mucinex; Imniprazole; Aspirin.

Current Illness: No.

ID: 1800972
Sex: F
Age: 94
State: MN

Vax Date: 01/14/2021
Onset Date: 10/16/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: Covid PCR test completed 10/18/21

Allergies: PCN

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Lethargy- awaiting orders from doctor

Other Meds: Unknown- Does med management by self

Current Illness: N/A

ID: 1800973
Sex: M
Age: 78
State: NC

Vax Date: 02/05/2021
Onset Date: 02/06/2021
Rec V Date: 10/20/2021
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: Head scan and blood work.

Allergies: Morphine

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

Symptoms: I had a nosebleed after the vaccination, and it took a long time to stop the bleeding. Headaches every night and body aches. My doctors up the high blood pressure medicine because they thought it was my blood pressure. The head scan and blood work came normal.

Other Meds: LOSARTAN

Current Illness: None

ID: 1800974
Sex: F
Age: 51
State: CO

Vax Date: 08/19/2021
Onset Date: 08/23/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: The neurologist - diagnosed me with Occipital Neuralgia - he ordered a whole bunch of blood tests; and MRI - with and without contrast. I see him November 1st to discuss everything.

Allergies: Penicillin; Sulfa drugs; Daypro; Zyban; Reglan; Compazine; Tigan; Shellfish; intolerant of dairy and gluten.

Symptom List: Nausea

Symptoms: For the last six years, I have had a tremor in my left hand and head only. It was very sporadic and would only act up a few times a year before the vaccine. Since I got my vaccine - it's now every day and a lot more pronounced then it was ever before. My Rheumatologist - due to headaches I also had, had already recommended a neurologist for me to see and I have seen him. I have also had migraines, ice pick headaches for six years and after the vaccine, the headaches became a lot more significant. Neurologist - I saw him on October 1st. I am having migraines and tension headaches (ice pick headaches) - I have some sort of headache every day now. The week after I got the vaccine - it was the ice pick headaches - it feels like someone is stabbing you with an ice pick on your head - it lasts a few seconds but comes out of the blue. Those were the first two weeks after the vaccine and now it's more the migraine and tension headaches that I get every day. My neurologist prescribed a headache medicine (Topamax) but told me if I don't like how it made me feel to stop it. I stopped taking it after a week because it made me feel like a complete zombie. My tremors are still bad and I still have the headaches every day.

Other Meds: Armour thyroid; Zyrtec; Vit B12 supplement; Plaquenil; Vit C; Vit D3; Metoprolol; Monthly I get an injection: Benlysta -June 29th and skipped July because we were traveling and had it again on August 31st

Current Illness: no

ID: 1800976
Sex: F
Age: 72
State: IN

Vax Date: 01/14/2021
Onset Date: 01/14/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: None

Allergies: I have allergic reactions to most medications, a lot of food, and airborne and injested chemicals

Symptom List: Injection site pain

Symptoms: I informed the woman who gave me the shot that i have MCS - Multiple Chemcial Sensitivities - and I had had two previous anaphalactic reactions - once to shellfish and once to preservatives on lettuce. After the shot, I was taken to the ER and monitored for 15 minutes. I didn't have a reaction, so I was excused. Thirty-forty minutes after that at home, I started to experience flu-like symptoms and extreme pain on the outside of my upper body. My upper body felt like it was burning and swelling and my chest started cramping - and my throat felt like it was closing. This lasted for one hour. Then all those symptoms moved to my lower body and that lasted for one hour. After that, the symptoms slowly subsided.

Other Meds: I have taken vitamins and herbal supplements for years

Current Illness: Multiple Chemical Sensitivities (MCS), Fibromyalgia

ID: 1800977
Sex: F
Age: 47
State: MN

Vax Date: 10/01/2020
Onset Date: 10/01/2020
Rec V Date: 10/20/2021
Hospital:

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

Lab Data:

Allergies: codiene

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

Symptoms: Intense shoulder pain, limited range of motion. Intensity lessened with time, but a year later I still do not have full range of motion and there is pain (ranging from 4-8 on a 10 point scale) daily.

Other Meds: none

Current Illness: none

ID: 1800978
Sex: M
Age: 75
State: MN

Vax Date: 04/14/2021
Onset Date: 10/19/2021
Rec V Date: 10/20/2021
Hospital: Y

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

Lab Data:

Allergies: None

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

Symptoms: Pt admitted for GI bleed, suspected lower GI bleed, which he has had previous. Routine COVID testing returned positive. Pt with no COVID symptoms, vaccinated with Moderna.

Other Meds: aspirin EC, lisinopriL, omeprazole,

Current Illness:

ID: 1800979
Sex: U
Age: 81
State: FL

Vax Date: 10/05/2021
Onset Date: 10/05/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data:

Allergies: NON KNOWN

Symptom List: Tremor

Symptoms: NO ADVERSE REACTION.... DRUG GIVEN AFTER BEYOND USE DATE

Other Meds: NONE KNOWN

Current Illness: NON KNOWN

ID: 1800980
Sex: F
Age: 60
State:

Vax Date: 10/18/2021
Onset Date: 10/18/2021
Rec V Date: 10/20/2021
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: Erythema, Pruritus

Symptoms: sore throat/neck, chills, joint pain, injection site itchy and red, heart palpitations on yesterday, lips tingling

Other Meds: inhaler, motrin

Current Illness:

ID: 1800981
Sex: F
Age: 56
State: TX

Vax Date: 08/18/2021
Onset Date: 08/18/2021
Rec V Date: 10/20/2021
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: NONE

Allergies: NKA

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

Symptoms: RECEIVED SECOND PFIZER DOSE TOO SOON. RECEIVED PFIZER FIRST DOSE ON 08/04/2021. RECEIVED THIS SECOND DOSE ON 08/18/2021.

Other Meds: NOT REPORTED

Current Illness: NOT REPORTED

ID: 1800982
Sex: M
Age: 85
State: MN

Vax Date: 04/07/2021
Onset Date: 10/18/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: 10/18/21 Covid positive on facility outbreak testing

Allergies: NKA

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

Symptoms: N/A

Other Meds: Unknown- Independent with medication management

Current Illness: None known

ID: 1800983
Sex: F
Age: 40
State: MN

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

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

Lab Data:

Allergies: NKMA

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: None

Other Meds:

Current Illness:

ID: 1800984
Sex: F
Age: 24
State: TX

Vax Date: 10/12/2021
Onset Date: 10/17/2021
Rec V Date: 10/20/2021
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: TIA, evaluated in ER. Follow up with PCP

Other Meds:

Current Illness:

ID: 1800985
Sex: F
Age: 39
State: VA

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 10/20/2021
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: I was seen 5/5/21 where I was told it was immune mediate neuropathy most likely involving all domains of motor, sensory and autonomic function. I had an abnormal QSWEAT test and tilt table test. Anhydrosis in both arm and leg sites. Postural tachycardia which fits with the criteria of postural orthostatic tachycardia (POTS). My CRP was elevated. Some of my interluekins were elevated along with my TNF. They tried treating me with a high dose steroid taper, which I could not tolerate. I went to the ER on 4/8 after incredible pain from muscle spasms, shaking, weakness and chest pain but received no answers. A neurologist has also said on 9/2/21 that it is most likely immune-mediated, small fiber and autonomic fiber neuropathy. He talked about nerve damage taking a long time to heal.

Allergies: Allergic to Penicillin and Sulfur antibiotics.

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

Symptoms: 3/10 - burning face, nasal passages and tongue. 3/11 - Fatigue. 3/12-3/13 Headache. 3/12 to current - Nausea, Loss of appetite, stomach cramps, join pain, weakness. 3/16 to current - twitching and popping under skin, muscle spasms, fasciculations, burning under skin, internal tremors and vibrations, tingling and shock feelings (almost like nerve pain) 3/17 to current - full body tremors and shaking. Rib cage and chest spasms. Heart rate and blood pressure spikes even at rest. 3/18 - Loss of bladder control (happened once more on 4/2). 4/24 to current - Petechia on arms, legs and stomach. 5/1 to current - increase in burning, aching, pinching, stinging, throbbing, numbness, tingling. As of 10/20/21 I sometimes have days where I feel a little better but symptoms come back strong at unexpected times. It is frustrating as I can no longer work. I can only walk for short distances, and sometimes not at all without severe pain and weakness. When I push myself, my symptoms flare even worse for a day or two. I love to sing in church and events, but I no longer have the strength or stamina to do so. I used to love walks around lakes, and hiking through the mountains. I have tried to walk short distances more recently, but it only makes the symptoms worse and I end up in bed for days again. This has robbed me of my career and my hobbies. I work now just to function enough to take care of my family and each day is a struggle.

Other Meds: Vitamin D3

Current Illness: None

Date Died: 10/19/2021

ID: 1800987
Sex: F
Age: 63
State: KY

Vax Date: 03/08/2021
Onset Date: 10/19/2021
Rec V Date: 10/20/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: This patient was initially seen in Emergency Department in October with a complaint of shortness of breath, cough malaise fatigue and rhinorrhea. Patient's husband did test positive for COVID-19, this patient did as well test positive during emergency department evaluation. This patient did receive COVID-19 vaccination Jansen single dose. Patient was admitted to the hospital service started on dexamethasone 10 mg q. 12 hours and 5 day course of Remdesivir. Patient also started on therapeutic Lovenox and IV antibiotic directed at acute acquired pneumonia ceftriaxone and azithromycin. 7 October pulmonary was consulted, with recommendations to continue the course of dexamethasone and Remdesivir. 10 October Pt transferred to the ICU started on noninvasive ventilation. 13 October respiratory failure with pending respiratory arrest patient was intubated placed on full mechanical ventilation. Pt then underwent proning protocol with some benefit early on. However, patient continued to be hypoxic while supine. Prone protocol was DC due to skin breakdown with persistent hypoxia as supine. Patient later developed septic shock placed on broad-spectrum antibiotics. Patient requiring pressor support to maintain map pressure above 60. Discussing patient's care with daughter, given its poor diagnosis, decision was to make patient DNR and to redirect care to comfort.

Other Meds:

Current Illness:

ID: 1800988
Sex: M
Age: 17
State:

Vax Date: 10/20/2021
Onset Date: 10/20/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data:

Allergies: NKDA

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

Symptoms: after receiving influenza, menactra and Men B vaccines, pt became light headed, clammy, sweaty and pale skinned

Other Meds:

Current Illness: none

ID: 1800989
Sex: F
Age: 82
State: FL

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

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

Lab Data: N/A

Allergies: Sulfa

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

Symptoms: Pt. states that after receiving the 2nd dose of Pneumo Polysaccharide 10/08/2021 (received the High-Dose Influenza Right arm), started experiencing symptoms 30mins after of pain in the left arm at injection site, chills, fatigue, muscle aches, and flu-like symptoms. Soreness still continuing in the left arm. No noted Primary visit/communications.

Other Meds: Valsartan, Hydrochlorothiazide, Ambien 10mg, Low-Dose Apralizone, Multi-Vitamin, Eye Vitamin, D3

Current Illness: N/A

ID: 1800990
Sex: M
Age: 60
State: NJ

Vax Date: 03/17/2021
Onset Date: 10/11/2021
Rec V Date: 10/20/2021
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: ECHO, cardiac cath, labs. all between 10/11/2021 and 10/13/2021 at outside facility.

Allergies: NKDA

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

Symptoms: Patient presented on 10/11/2021 with complaints of dyspnea x1 month. Patient is healthy with no significant underlying conditions. EKG at that time in my office was abnormal, patient sent to ER for evaluation and treatment. Found to have EF of 17%, acute systolic Heart failure with no CAD on cardiac cath. Patient discharged to home on 10/13/2021 with Life Vest and cardiac follow up.

Other Meds: ASA 81mg daily klonopin 0.5mg po qhs flonase 1 spray each nostril daily sildenafil 100mg po 1 hour prior to sexual activity

Current Illness: na

ID: 1800991
Sex: M
Age: 50
State: CT

Vax Date: 10/13/2021
Onset Date: 10/13/2021
Rec V Date: 10/20/2021
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: Penicillin, Almonds

Symptom List: Vomiting

Symptoms: The day I received the first dose 10/13/21 I developed a rash/raised skin on my upper right thigh which is still present on 10/20/21. The following days i developed chest tightness and a dry cough intermittently. On 10/18/21 i felt pain under my right eyelid which worsened at night into a visible puffing and swelling under my right eye. By 10/20/21 this area worsened and is extremely swollen/puffy causing problems with vision. Going to see Dr. at 14:00 hrs. on 10/20/21.

Other Meds: No

Current Illness: None

ID: 1800992
Sex: F
Age: 38
State: PA

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: MRI

Allergies: Seasonal Allergies

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: I experienced brain fog, itchy throat, sore arm, fever, diarrhea, headache, poor appetite, hard to concentrate and memory loss. My memory loss is so bad I had a GPA of 3.9 now I'm failing in my studies. I'm experiencing daily headaches taking me 2 hours each day to get out of bed, experienced 10 lb weight loss, going hours without eating. I have memory loss this has affected my studies and job duties as a nurse. I have seen a Neurologist and PCP running more tests (MRI) has recommended me to see another Neurologist. In my everyday, example: instead of using the coffee pot I picked up a flower vase. Another example, as a travel nurse I administer medication I thought I gave one of my patients her medication however I didn't only because the computer recognized it. This is very unsafe for me at work being a nurse I have to give patients narcotics. My grades are failing in school I have 66% now. I have an appointment on next Wed to get blood work done.

Other Meds: No

Current Illness: No

ID: 1800993
Sex: F
Age: 6
State: MN

Vax Date: 10/18/2021
Onset Date: 10/18/2021
Rec V Date: 10/20/2021
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: NKMA

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

Symptoms: NONE

Other Meds:

Current Illness:

ID: 1800994
Sex: M
Age: 87
State: MN

Vax Date: 01/14/2021
Onset Date: 10/16/2021
Rec V Date: 10/20/2021
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: 10/18/21 Covid PCR tested positive

Allergies: NKA

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Lethargy, Loss of appetite

Other Meds: Unknown- Wife manages all medications

Current Illness: None known

ID: 1800995
Sex: F
Age: 44
State: TX

Vax Date: 04/01/2021
Onset Date: 08/01/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: Echo, Stress Echo, upper GI, CT Scan

Allergies: Adhesive allergy

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

Symptoms: Developed shortness of breath, pressure in chest and chest pains.

Other Meds: Effexor, Lansoprazole, Doxycyclin, Vitamin D

Current Illness:

ID: 1800997
Sex: F
Age: 28
State: CA

Vax Date: 04/28/2021
Onset Date: 05/01/2021
Rec V Date: 10/20/2021
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:

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

Symptoms: Menstrual cycle irregularity; two periods in one month for six months

Other Meds: Lexapro

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am