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: 1801049
Sex: F
Age: 47
State: IL

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

Allergies: Shrimp and reaction to morphine

Symptom List: Dysphagia, Epiglottitis

Symptoms: Sore arm facial flushing muscle pain joint pain nausea diarrhea vomiting fatigue

Other Meds: Synthroid

Current Illness: No

ID: 1801050
Sex: F
Age: 72
State: AZ

Vax Date: 03/10/2021
Onset Date: 03/11/2021
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: X-rays, PT multiple appointments April through July

Allergies: Sulfa

Symptom List: Anxiety, Dyspnoea

Symptoms: Redness, soreness, edema to elbow. Additionally pain in back, hips, legs, neck, shoulder and left thumb

Other Meds: Propranolol 10 mg BID, aspirin 81 mg daily, azalastine nasal spray PRN

Current Illness: None

ID: 1801051
Sex: F
Age: 49
State: KY

Vax Date: 02/23/2021
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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: COVID19 test 10/05/2021.

Allergies:

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

Symptoms: Positive COVID19 test 10/05/2021.

Other Meds:

Current Illness:

ID: 1801052
Sex: M
Age: 93
State: TN

Vax Date: 05/27/2021
Onset Date: 10/13/2021
Rec V Date: 10/20/2021
Hospital: Y

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

Lab Data: 10/12/21 COVID-19 ANTIGEN TESTING DONE AT HOLSTON HELTH AND REHABILITATION CENTER = POSITIVE

Allergies: no known medication allergies

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: 10/13/21 PATIENT SEEN IN THE ER WITH KONWN COVID 19 ILLNESS. REPORTEDLY RECEIVED REGENERON AND DECADRON TREATMENT. PATIENT WITH LOW BP . ADMITTED TO INPATIENT HOSPITAL WITH COVID 19 PNEUMONIA, ACUTE RESP FAILURE DUE TO COVID 19, SPETIC SHOCK, ACUTE KIDNEY INJURY.10/19/21 PATIENT AND FAMILY WOULD LIKE TO NOT HAVE ANY FURTHER INTERVENTION AND WOULD LIKE TO TRNSITION BACK TO CONSERVATIVE TREATMENT MEASURES. ANY ADDITIONAL INFORMATION REGARDING THE OUTCOME SHOULD BE DIRECTED TO REHAB FACILITY. NOTE: NO VACCINE LOT NUMBER WAS ENTERED INTO THE DATABASE. so not able to provide that information .

Other Meds: unknown

Current Illness: unknown

ID: 1801053
Sex: F
Age: 39
State: AK

Vax Date: 09/28/2021
Onset Date: 10/01/2021
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: LA

Lab Data: Patient did not seek medical attention for this episode and did not feel it necessary to have any testing done. Episode was discovered at her 2nd dose appointment. Pt declines vitals signs stating issue has resolved. Pt still wanted to get 2nd dose since she was not sure if the 2 events are related.

Allergies: Unknown Anaphylactic reaction as a child, required epipen, but has not happened since. No other known allergies.

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

Symptoms: Patient stated that she had an episode of palpitations that woke her from sleep. She said that this occurred over 2-3 minutes in the middle of the night while she was sleeping. Pt denies having chest pain, dizziness, SOB, or other cardiac symptoms. Pt denies increased caffeine use or performing activities that may increase HR or cause chest discomfort. Pt stated that after episode, she went back to bed and it has not happened again. She did not seek out advise from PCP or vaccine-administering clinic. Pt denies any cardiac symptoms on day of 2nd dose. Pt requested to have 2nd dose.

Other Meds: Metformin, glimepiride

Current Illness: N/A

ID: 1801054
Sex: M
Age: 36
State: MD

Vax Date: 10/14/2021
Onset Date: 10/15/2021
Rec V Date: 10/20/2021
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: I havent had any tests related to my side effects.

Allergies: My only known allergies are to cashew nuts.

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

Symptoms: My initial symptoms were extreme fatigue, body chills, body aches, body fever occurring around 10pm on 10/14/2021 which lasted through 6am on 10/15/2021 at which time the fatigue, chills, aches, and fever subsided and I first noticed the loose stool. I have had loose stools since 10/15/2021 through today 10/20/2021 accompanied with a slight nausea, and stomach discomfort. I feel a general discomfort (difficult to explain) but its stemming from my stomach and radiating outwardly. The loose stools are most noticeable in the morning and evening but I have also had loose stools mid day.

Other Meds: dietary supplements: cinnamon chromium berberine Equate: multivitamin Liver health supplement Hydroxycut

Current Illness: I had no known illnesses at the time of vaccination including up to one month prior.

ID: 1801055
Sex: M
Age: 51
State: IN

Vax Date: 10/12/2021
Onset Date: 10/13/2021
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

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Headaches for two or three days

Other Meds: Multi vitamin, gabapentin, atorvastatin calcium

Current Illness:

ID: 1801056
Sex: M
Age: 73
State: CA

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

Allergies: none

Symptom List: Pharyngeal swelling

Symptoms: patient was rushed to the hospital .and was diagnosed wit TIA. patient was put on 80 mg of lipitor and 75 mg of plavis and 81 mg aspirin.

Other Meds: atorvastatin 40 mg once daily -atenolol 25 mg once daily

Current Illness: none

ID: 1801057
Sex: F
Age: 16
State: CA

Vax Date: 04/24/2021
Onset Date: 04/25/2021
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: None

Allergies: Shellfish

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: 16 hours after administration, my child experienced sudden onset of menstrual bleeding; 7 days before her normal predicted cycle start day. Now 6 months later she has not had a normal menstrual cycle. Her cycles are coming as soon as every two weeks now. She also had rough skin patches appear all over her body within days of the vaccine

Other Meds: None

Current Illness: None

ID: 1801058
Sex: F
Age: 64
State: CO

Vax Date: 04/14/2021
Onset Date: 04/17/2021
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: Excessive itching and tingling on right arm and it took months to heal any cut or bruise

Other Meds: flueotine

Current Illness:

ID: 1801059
Sex: F
Age: 71
State: IN

Vax Date: 10/01/2021
Onset Date: 10/02/2021
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:

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

Symptoms: No immediate events apparent. Patient self reports difficulty breathing and blood in sputum

Other Meds:

Current Illness:

ID: 1801060
Sex: F
Age: 63
State: KS

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: SYR
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: pt received fluzone HD and based on age should have received fluarix quadrivalent

Other Meds:

Current Illness:

ID: 1801061
Sex: F
Age: 98
State: MN

Vax Date: 01/14/2021
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: Covid PCR test completed on 10/18/21

Allergies: Clindamycin, Diltiazem, Sulfa, Augmentin

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

Symptoms: Tested covid positive on facility outbreak testing

Other Meds: Unknown- Son manages and she self administers

Current Illness: N/A

ID: 1801062
Sex: F
Age: 12
State: TX

Vax Date: 08/05/2021
Onset Date: 08/05/2021
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: NONE

Allergies: NKA

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

Symptoms: UNDERAGED CHILD. 11 YEARS OLD. DOB LISTED ON CONSENT. IMMUNIZATION REGISTRY LISTS AS DIFFERENT.

Other Meds: NOT REPORTED

Current Illness: NOT REPORTED

ID: 1801063
Sex: M
Age: 61
State: NY

Vax Date: 04/12/2021
Onset Date: 04/12/2021
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: X-ray-right lung shrunk, hand

Allergies: rosuvastatin calcium, statin, hmg, coa

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

Symptoms: A couple hours after the vaccine I developed a high fever about 101.7 fever and shakes and was extremely cold which went on about a week. After that week my body seemed very weak causing me to see my Cardiologist and my TSH level was extremely high. I was referred to my Thyroid Dr who did another test and see the TSH level was still extremely high. I was then referred to a Rheumatologist and who advised I have Sjogren's Syndrome and prescribed me Hydroxythloroquine 200mg to help with the pain. 5/12 about 1:30am the joint pain and fever begin coming back again and took 2 Tylenol to help with the pain. The pain is has now gotten a little better and is now about a 7 but the pain keeps coming back, the fever keeps coming back and I continue to feel down each day and I have to take Tylenols daily to help with the pain, but after 1hr after I take the Tylenol I go into a massive sweat and my body gets soaking wet. An X-Ray of my the right side of my lung was done and noticed the right side lung is now almost about 30cm smaller than my left lung and a CT Scan has been ordered 11/7 to check that further.

Other Meds: Tylenol

Current Illness: no

ID: 1801064
Sex: F
Age: 62
State: WA

Vax Date: 09/01/2021
Onset Date: 10/08/2021
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: none

Allergies: codeine, oysters

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

Symptoms: On the evening of 10/8/21, I noticed a tender, mobile lump posterior upper thigh, 1-2 cm diameter. The nurse practitioner examined it on 10/13/21 and suspected it is a benign reactive lymph node. Did not think it was related to malignancy.

Other Meds: Padcev, estradiol, melatonin, vitamins C & D & B-coomplex, lysine, probiotic, Ca/Mg/Zn, berberine, nettle, neem, milk thistle Received flu vaccine approximately 9/29/21

Current Illness:

ID: 1801065
Sex: F
Age: 49
State: NY

Vax Date: 10/19/2021
Onset Date: 10/20/2021
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:

Allergies: None

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

Symptoms: Fever of 101, malaise, bitter taste in mouth, pain on the injection site of the arm

Other Meds: None

Current Illness: None

ID: 1801066
Sex: M
Age: 49
State: IA

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

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Severe constant headache, muscle pains throughout body.

Other Meds: Famotodine, gabapentin, breo ellipta, albuterol

Current Illness: None

ID: 1801067
Sex: F
Age: 29
State: IA

Vax Date: 10/11/2021
Onset Date: 10/12/2021
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: Pregnancy Test- negative

Allergies: none

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: After receiving the vaccine at 1:15PM, I woke up that night around 1AM with moderate to severe pelvic pain. I assumed it was cramping because I was expecting my period. I took ibuprofen so that resolved the pain. Since then I intermittently had very mild pain in my pelvic area and lower back. I still haven't had my menstrual cycle yet. The day after receiving the vaccine, 2 or 3 days later, I had some pain radiating from both my armpits to the side of my breast. It was worse in the left. I am breastfeeding. I feel like I have had some engorged spots in my breast but I didn't feel anything. I feel like I did have some swollen lymph nodes in my armpits as well. I have taken multiple pregnancy test since then and they are all negative.

Other Meds: Prenatal

Current Illness: none

ID: 1801068
Sex: M
Age:
State: FL

Vax Date: 10/06/2021
Onset Date: 10/06/2021
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:

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

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

Other Meds:

Current Illness:

ID: 1801069
Sex: M
Age: 23
State: KY

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: 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: Heavy Headache 1055, Left hand cramp 1120, numbness of the face 1130

Other Meds:

Current Illness:

ID: 1801070
Sex: M
Age: 65
State: NM

Vax Date: 08/19/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data: None.

Allergies: Steroids; opioids.

Symptom List: Unevaluable event

Symptoms: Have a history of periodic rectal bleeding (blood clots) since 2008 - every six weeks has rectal bleeding. Three weeks after vaccine, hives at vaccine site. Four weeks after vaccination, had arm/neck vein swelling, and increase in episodes of rectal bleeding with pain.

Other Meds: Medical cannabis; No e-mail - alternative phone is 505 818 7664.

Current Illness: History of rectal bleeding since 2008.

ID: 1801071
Sex: F
Age: 32
State: MN

Vax Date: 04/13/2021
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:

Allergies: Bactrim, shell fish

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

Symptoms: Symptoms started on 10/18/21: cough, chest tightness, fever, headache, earache, body aches.

Other Meds: Zyrtec; prednisone Keflex, Aleve, Zofran

Current Illness: none

ID: 1801072
Sex: M
Age: 68
State: NC

Vax Date: 08/16/2021
Onset Date: 08/25/2021
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: Negative COVID test 09/02/21. Chest Specialist visit with 6 minute walk test and other studies on 09/30/21, all normal. Negative sleep study 10/04/21.

Allergies: Penicillins

Symptom List: Injection site pain, Pain

Symptoms: A week after 3rd shot, I felt short of breath. I checked with an oximeter and my pulse oxygen was 75 (dangerously low). After it remained lower than 93 for 24 hours, I contacted my Primary Care Physician and made an appointment to get tested for COVID and check the hypoxia. I was referred for a sleep study to rule out sleep apnea causing daytime oxygen desaturations. The COVID test was negative. During the wait for the sleep study my oxygen saturation continued to stay 89-93. All my life, it has been 98-99 (high normal range). The study revealed no treatment for sleep apnea needed as there was negligible apnea, hypopnea, etc. My oxygen levels have resumed 98-99 consistently after about 7 weeks since the 3rd shot. There is no other explanation or personal medical history to explain this.

Other Meds: Plaquinil (for Rheumatoid Arthritis ) and Levothyroxine.

Current Illness:

ID: 1801073
Sex: F
Age:
State: FL

Vax Date: 10/06/2021
Onset Date: 10/06/2021
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:

Symptom List: Injection site pain, Menorrhagia

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

Other Meds:

Current Illness:

ID: 1801074
Sex: M
Age: 57
State: IA

Vax Date: 10/12/2021
Onset Date: 10/13/2021
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: I had a Flu shot in the morning, and the pneumonia, Shringrix and 3rd Pfizer Covid shot in the afternoon.

Allergies:

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

Symptoms: Temperatures for three days over 103 degrees. Terrible headache on the first day

Other Meds: Humalog, Lantis, Statin

Current Illness:

ID: 1801075
Sex: F
Age: 58
State: CA

Vax Date: 04/17/2021
Onset Date: 04/18/2021
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: I have CBC; they have checked for metals; they have checked the ANA - it's elevated - that never showed up high before but now it has; and I've a lot of testing - through different doctors. Urgent Care for sinus pain and thinking I had COVID again - but it's just my allergies and immune system stuff.

Allergies: Penicillin; Entex; Keflex; Septra; Vibramycin; Sulfa; Benadryl; Iodine; Lidocaine; Dimetapp; Contrast of most kinds; Axiid; Compazine; Reglan; Zofran; Maxalt; Latex; Peanuts; Imitrex; Mangoes; Strawberries, cantaloupe, Honeydew

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: When I had COVID, I had issues with my bladder and my left thigh. (I had COVID in July 2020 and then again December of 2020). After the vaccine, I felt the same issues but they were worsened and intensified. My sedimentation rate won't go down. Doctor can't get it down. I do feel all the inflammation all throughout my body. The doctor tried to give me Prednisone - high doses. But I couldn't take it - it made me really sick. Had to stop that the Prednisone after a few days and she had wanted to do it for a month. I struggle with brain fog and memory ever since I had COVID - the whole thing - I am not sure if the vaccine made it worse - the vaccines sure didn't help. I get very forgetful and confused - I forget how to get home. I don't have dementia and Alzheimer's. I just get very lost for a few minutes in my brain. I try to read and it's just frustrating. My grandson is four - he has a 20 piece kids puzzle and I could not for the life of me do that puzzle and I'm a puzzle person. I was crying - due to the inability to do a child's puzzle. I love to color and I find it very difficult to sit down and color. I have go see a Urologist to see what is going on with my bladder. I have to go see an OB doctor because I have had severe pelvic pain as well. All of this is after the vaccine. I had a hysterectomy when I was 30 - 28 years ago and but I need to see on OB/GYN.

Other Meds: Gabapentin; Gabapentin; Nexium; Warfarin; Synthroid; Xopenex; Aller-Tec; Fluticasone Propionate; Nortek - 75 mg; Vit B12; Vit C; Glucosamine Chondroitin; Chelated Magnesium; CoQ10; Sugar free gummies - Fiber-well

Current Illness: No

ID: 1801077
Sex: M
Age: 65
State: NC

Vax Date: 05/15/2021
Onset Date: 05/17/2021
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: MRI brain, ct brain, CTA h&n, echo, LE dopplers, echo, D-Dimer 190 - 500 NG/ML FEU 1,240 High

Allergies: none

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Got Covid virus in February, Mild trouble with smell, sinus congestion. Was not hospitalized Then received COVID vaccinations #1 May 15th, on May 17th started having left groin pain. Set to the ER and was found to have arthritis in his bilateral hips? Nothing else revealed pain source. Saw Dr. - June 1st who gave him a hip injection. apparently ortho didn't know if arthritis was really the cause of pain He was taking some pain medications which were not helping. #2 Covid shot 6/4/21 July 6th got another hip injection. Did feel some minor relief, but not fully resolved. In June/ early July, he started having language trouble , " acting funny " per wife, having a lot of " frustration with his words" . PCP ordered CT brain. 7/16- CT scan Subacute infarcts involving the left frontal lobe/insula and left occipital lobe which subacute would date back 2-3 weeks surrounding the timeline of the second vaccine. MRI brain on 9/2/2021 confirmed the infarcts in the bilateral MCA and PCA territories. D-Dimer was taken

Other Meds:

Current Illness:

ID: 1801078
Sex: F
Age: 0
State: IL

Vax Date: 01/22/1950
Onset Date: 10/15/2021
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: none

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

Symptoms: low heart rate, lightheaded

Other Meds: ezetimibe 10mg tabs levothyroxine sodium 88mcg oral tabs 81mg baby aspririn coq-10 200mg amino-d-tox

Current Illness: none

ID: 1801079
Sex: F
Age: 50
State: IA

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:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: NONE

Symptom List: Nausea

Symptoms: Began to feel itchy all over about 15 minutes after injection. Patient reported that "it feels like when I work in the garden too long". No other symptoms of anaphylaxis so treated with 25mg Benadryl, water, rest & observation for 30 more minutes. Itchiness resolved and patient was comfortable going home with additional info regarding when to seek additional care if needed.

Other Meds:

Current Illness:

ID: 1801080
Sex: M
Age: 30
State: SD

Vax Date: 09/29/2021
Onset Date: 09/30/2021
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: EKG

Allergies:

Symptom List: Injection site pain

Symptoms: Ongoing Pericarditis (chest tightness during exercise, fatigue, muscle soreness)

Other Meds: Omeprazole, b-12, fluticasone,

Current Illness:

ID: 1801081
Sex: F
Age: 42
State: TX

Vax Date: 10/18/2021
Onset Date: 10/19/2021
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: Dairy and egg allergy

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

Symptoms: swollen/painful left arm pit swollen/painful left side of arm pit/side of chest left shoulder and collar bone hurt (not injection site)

Other Meds: Synthroid, Vitamin D, Magnesium, Ibuprofen,

Current Illness:

ID: 1801083
Sex: F
Age: 59
State: MD

Vax Date: 10/15/2021
Onset Date: 10/16/2021
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: RA

Lab Data: None

Allergies: Allergic to contrast dye

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

Symptoms: Headache, low grade fever, body aches. Did not have any side effects with the first or second dose I received from Pfizer vaccine in Jan. 2021 and February 2021, Only the 3rd shot. Symptoms' lasted approx. 24 hrs.

Other Meds: Zoloft, Rosuvastatin , Metoprolol, Multivitamin, Vitamin D3, Omega 3

Current Illness: No

ID: 1801084
Sex: M
Age: 59
State: ID

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: N/A.

Allergies: Penicillian

Symptom List: Tremor

Symptoms: Familial tremors typically only cause mild hand or leg shaking. Diagnosed with tremors and associated anxiety 5 years ago. After each vaccination shot, the tremors increased to the extent that walking and talking were difficult. Tremor-induced anxiety reduced ability to think. Severe tremors lasted about 12 hours followed by 18 hours of no energy. Normal tremors and energy returned 48 hours after injection. Did not seek medical help.

Other Meds: Levothyroxin

Current Illness:

ID: 1801085
Sex: F
Age: 43
State: TX

Vax Date: 10/18/2021
Onset Date: 10/19/2021
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: none.

Symptom List: Erythema, Pruritus

Symptoms: Patient experience fever, weakness, congestion, cough, fatigue, and soreness to L arm. Started 16 hours after vaccinated, and continue to 48 hours, with worsening fatigue, and weakness.

Other Meds: none.

Current Illness: none.

ID: 1801086
Sex: F
Age: 27
State: CT

Vax Date: 04/11/2021
Onset Date: 04/12/2021
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: EKG and other heart exams came back "fine" according to my doctors. Blood exams have come back normal as well, according to doctors. I visited the hospital in May

Allergies: N/a

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

Symptoms: I have been experiencing trouble breathing, chest tightness, and "pop corn" like popping feelings in my chest as well as fast heart rate and pain in my right arm. It's hard to breath when this occurs. I began feeling this after receiving the J&J vaccine in April 2021 and it has not stopped. It occurs randomly every couple days, sometimes everyday. The discomfort/pain lasts for several hours sometimes and feels worse when I lay down on my back. I've had to sleep on my side to avoid inducing the chest tightness. I had never experienced this before getting the COVID-19 vaccine.

Other Meds: Martazapam /Venlafaxine

Current Illness:

ID: 1801087
Sex: M
Age: 67
State: NC

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

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

Symptoms: NO ADVERSE REACTION TO 3RD DOSE.

Other Meds:

Current Illness:

ID: 1801088
Sex: F
Age: 15
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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: N/A

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient reports itching in the area of his left arm. He is moved to the back area with a paramedic for evaluation and several maps of outbreaks started to appear in the back area, abdominal area, red and swollen arms, vitals are taken.

Other Meds: N/A

Current Illness: N/A

ID: 1801089
Sex: M
Age: 26
State: MN

Vax Date: 04/16/2021
Onset Date: 05/17/2021
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: Fever, loss of sense of taste and smell

Other Meds:

Current Illness:

ID: 1801090
Sex: F
Age: 42
State: UT

Vax Date: 09/21/2021
Onset Date: 09/21/2021
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:

Allergies:

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

Symptoms: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1801091
Sex: F
Age: 53
State: VA

Vax Date: 10/14/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data: none to date

Allergies: shrimp, bacitracin oint

Symptom List: Pain in extremity

Symptoms: Day 1 post vaccination of booster : Fatigue , chills Day 2 post vaccination of booster : lymph swelling under armpit about 3 inches in diameter , some itching started irritating Day 6 post vaccination of booster : lymph swelling under armpit about 1 1/2 inch in diameter still some irritation, will try Benadryl and call on call nurse for more instructions

Other Meds: prilosec 20 mg, culturelle probiotic, maxzide 25 mg

Current Illness: graves disease

ID: 1801092
Sex: F
Age: 44
State: VA

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

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

Symptoms: As soon as I received my second dose of my Pfeizer shot I felt like an electric current run through my left arm where I received the vaccine. I also experienced blurry vision up to 20 mins later. And a week later I still feel a little tired.

Other Meds: NA

Current Illness: NA

ID: 1801093
Sex: M
Age: 28
State: MD

Vax Date: 09/29/2021
Onset Date: 10/01/2021
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: none at this time

Allergies: no known allergies

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

Symptoms: linear urticaria intermittent for last 2+ weeks

Other Meds: none

Current Illness: none

ID: 1801094
Sex: M
Age: 27
State: KY

Vax Date: 04/14/2021
Onset Date: 10/02/2021
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: COVID19 test 10/2/2021

Allergies:

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

Symptoms: Positive COVID19 test 10/2/2021

Other Meds:

Current Illness:

Date Died: 09/11/2021

ID: 1801095
Sex: F
Age: 75
State:

Vax Date: 02/01/2021
Onset Date: 08/27/2021
Rec V Date: 10/20/2021
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:

Allergies:

Symptom List: Vomiting

Symptoms: pt presented in acute respiratory failure with hypoxia, tested positive for COVID; respiratory status worsened and pt intubated with mechanical ventilation; condition continued to decline; pt was extubated and died in the hospital

Other Meds:

Current Illness:

ID: 1801096
Sex: M
Age: 54
State: FL

Vax Date: 10/06/2021
Onset Date: 10/06/2021
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:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

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

Other Meds:

Current Illness:

ID: 1801097
Sex: F
Age: 56
State: TX

Vax Date: 04/16/2021
Onset Date: 08/01/2021
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: Rapid Covid Test

Allergies: none

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

Symptoms: Breakthrough COVID- August 2021; sore throat, headache, fatigue; tested at urgent care-- 2-3 days of not feeling well, quarantined for 10 days feel fine now

Other Meds: none

Current Illness: none

ID: 1801098
Sex: F
Age: 73
State: FL

Vax Date: 02/04/2021
Onset Date: 02/10/2021
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: X-ray on 08/24/2021 MRI on 10/01/2021

Allergies: Codeine, Cipro

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Since receiving the shot, I?ve had pain in my upper arm. It has gotten significantly worse, now affecting my shoulder. MRI diagnosed it as tendinitis of the rotator cuff.

Other Meds: Levothyroxine, Olmesartan, Hydroxyzine, Calcium, One-a-Day vitamin, Miralax

Current Illness: None

ID: 1801099
Sex: F
Age: 58
State: FL

Vax Date: 10/14/2021
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: RA

Lab Data: blood work and EKG

Allergies: NONE

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

Symptoms: The next morning of my vaccination i had a lymph node and pain in my shot arm. i had chest tightness. After noon i took my pulse and it was really strong. I was worried and went to the urgent care and they gave me Tylenol and did an ekg and the pulse was down to 90. The doctor feel my pulse skip twice. My temperature was really high when i left the house. When i went home from the urgent care i felt much better my fever was down and my pulse was better as well. I went to bed but the fever was back so i had to get over the counter medication. Couple of days later i had hives.

Other Meds: LISINPORIL, ATORVASTATIN, VITAMIN D3, MAGNISIUM,

Current Illness: NONE

ID: 1801100
Sex: F
Age: 13
State: TX

Vax Date: 08/09/2021
Onset Date: 08/09/2021
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: NONE

Allergies: NKA

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

Symptoms: UNDERAGED CHILD. DOB ON CONSENT REPORTED AS DATE. CHILD DOB IN SYSTEM IS OTHER DATE. UNKNOWN IF CHILD RECEIVED SECOND PFIZER DOSE.

Other Meds: NOT REPORTED

Current Illness: NOT REPORTED

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am