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

Date Died: 09/05/2021

ID: 1801206
Sex: M
Age: 74
State: KY

Vax Date: 04/18/2021
Onset Date: 09/05/2021
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: CBC BMP 9/05,8/29,9/3,8/31, 8/30 BNP 9/3/21CHEST XRAY 9/3,9/4, 8/31, 8/25, 8/18

Allergies: UNKNOWN

Symptom List: Dysphagia, Epiglottitis

Symptoms: PT DEVELOPED COVID PNEUMONIA WITH RESPIRATORY FAILURE

Other Meds: UNKNOWN

Current Illness: RESPIRATORY FAILURE R/T COVID PNEUMONIA REQ MECH VENTILATION SEPTIC SHOCK

ID: 1801207
Sex: M
Age: 51
State:

Vax Date: 08/12/2021
Onset Date:
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:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Diarrhoea

Other Meds:

Current Illness:

ID: 1801208
Sex: F
Age: 15
State: NJ

Vax Date: 06/11/2021
Onset Date: 07/11/2021
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:

Allergies: Hazel nuts.

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

Symptoms: Loss of hair, diagnosed alopecia areata, steriod injections every month provided by healthcare professional.

Other Meds: Remicade.

Current Illness:

ID: 1801209
Sex: F
Age: 29
State: MD

Vax Date: 10/01/2021
Onset Date: 10/04/2021
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: NKA

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Recurring headache. Treated with Aleve with some relief.

Other Meds: Lo Loestrin Fe, Vitamin D 4000 units

Current Illness: None

ID: 1801210
Sex: F
Age: 45
State: CA

Vax Date: 10/12/2021
Onset Date: 10/12/2021
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: Vitals and pulse ox monitored

Allergies: Penicillin-Hives

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

Symptoms: Pruritic rash all over armpit. No SOB, No N/V 10-15 min post COVID # 3 shot. Pruritis head all over body to groin, then on feet, hives, lip swelling, tightness and chest epigastric pain. Treated with Benadryl 50 mg, Loratadine 10mg . Then pulse ox dropped to 91%. Lightheaded, dizziness, flushed hot, clammy and shaken. 14:33 138/78 95 99% 16 Benadryl 25mg 14:43 Benadryl 25mg 14:44 Loratadine 10mg 14:46 97/106 15:08 120/60 91% 58 15:35 110/90 98% 91 D/C 16:00 to home.

Other Meds: Trulicity, Simponi

Current Illness: None

ID: 1801211
Sex: F
Age: 70
State: FL

Vax Date: 10/08/2021
Onset Date: 10/08/2021
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:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1801212
Sex: M
Age: 34
State: OR

Vax Date: 10/12/2021
Onset Date: 10/12/2021
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: None

Allergies: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Description of events: Client came into clinic requesting Moderna dose 2. It was confirmed in the Epic and Alert system that client had received dose 1 and met the date criteria for the 2nd dose. The vaccinator received the requested Moderna vaccine on their vaccine table, but inadvertently administered one of their Pfizer vaccines, also on their table, instead. Vaccinator immediately realized the error, explained to the client what had happened, and brought the Moderna vaccine back to the dose drawer to report the incident. Vaccinator reviewed situation, discussed any potential risks and benefits of using two different Mrna brands of vaccine. Client reported understanding of situation, completed 15 min observati

Other Meds: Unknown

Current Illness: Unknown

ID: 1801213
Sex: F
Age: 44
State: NJ

Vax Date: 06/26/2021
Onset Date: 07/31/2021
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: ER 2 days in a row July 31, 2012 and August 1, 2021 Brain MRI and CT scan done, some types of pain killers given , August 2, 2021 Neck MRI done and EMG test done, August 6, 2021-continuing Physical Therapy, Acupuncture, Heat and Cold Therapy, Massages, Manual Therapy, Electrotherapy, Cup Therapy, Medical Taping,

Allergies: Orange the fruit and Nemoycin, PCMX, Iodopropynyl butycarbamate, phenoxyethanol

Symptom List: Pharyngeal swelling

Symptoms: Five days after 2nd dose which was on 07.23.2021 my left side went completely paralyzed waste up. Could not feel my left side arms, back, breast, fingers, hands. Had hard time breathing and pain that was unbearable. Still have no feeling in two fingers, I have a bone sticking out from under my armpit, my left breast is in pain can not even touch it, my upper left side of back is constantly cracking, have sharp pains in entire left side, tingling pins and needles all day on left side, left elbow takes 1 hour to open up in the am, stabbing in back on bi sap, triceps, and shoulder. Basically my left side is not working

Other Meds: Otezla, Vitamin B, C, D, Biotin, Cabergoline, Humira, Baclofen, Cranberry Capsules, Probiotic, Xanax

Current Illness: I have Psoriatic Arthritis, Minor Carpel Tunnel, Spongiotic Dermatitis, 8mm Pineal Cyst in brain, 7mm Brain Tumor in brain benign

ID: 1801214
Sex: M
Age: 20
State: SC

Vax Date: 10/02/2021
Onset Date: 10/03/2021
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:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: PATIENT DID NOT QUALIFY FOR A 3RD DOSE, BUT HAD NO ADVERSE REACTIONS.

Other Meds:

Current Illness:

ID: 1801215
Sex: F
Age: 76
State: NY

Vax Date: 09/24/2021
Onset Date: 09/30/2021
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: None.

Allergies: Contrast-dye and Latex.

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Dizzy, vomiting, passing out-( very deep sleep) occurred 6 days after vaccination. Vomiting ceased 4 hours later but dizziness continues to now. Dizziness when bending over.

Other Meds: Multi -vitamin; Ocuvite; Cranberry; Flax-seed; Calcium; B complex; glucosamine.

Current Illness: None.

ID: 1801216
Sex: F
Age: 76
State: MA

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: SYR
Vax Site: LA

Lab Data: none

Allergies: none

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

Symptoms: Due to the shingles, my nerve ending discomfort was still there after I got my booster the pain became worse. My doctor put me on tramadol and something else. one was for pain and one was for nerves.

Other Meds: Citalopram, Ezetimibe, Eliquis, Metoprolol , Atorvastatin, Omeprazole, flax seed, probiotic, glucosamine chondroitin,

Current Illness: shingles

ID: 1801217
Sex: F
Age: 57
State: GA

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

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

Lab Data: Audiology Test- 10/5/21 MRI- 10/18/21 Audiology Test- 10/20/21

Allergies: None

Symptom List: Rash, Urticaria

Symptoms: On 9/28/21, the patient complained of ear ringing and fatigue. After taking a nap, she complained to her daughter about the loss of hearing. She also complained about dizziness and balance issues. The daughter had reached out to PCP regarding sudden hearing loss. On 10/5/21, the patient was taken back to the PCP for a check-up. They completed a hearing test and recommended seeing ENT as her hearing was completely gone for the left side. The daughter was able to get the patient to the ENT that day. ENT performed the hearing test twice and was not sure as to how she developed sudden hearing loss. ENT prescribed Prednisone regimen to reduce the inflammation that can cause the nerve to be blocked. After 2 weeks of steroids, still no improvement. The family pushed the ENT for an MRI and the MRI scan came to be clean. The daughter took the patient to another ENT for a second opinion. That ENT also says that the flu vaccine could have triggered an inflammatory response that has led to her hearing loss. The ENT will be performing a series of steroids injecting in the patient's ear in hopes to save the hearing. But the ENT did say that if the patient's hearing has no changes after the injections, then the patient will suffer from permanent hearing loss and will need hearing aids. For the loss of balance, the ENT has also recommended for Vestibular therapy which she will have to attend weekly.

Other Meds: None

Current Illness: None

ID: 1801218
Sex: M
Age: 12
State: TX

Vax Date: 08/12/2021
Onset Date: 08/12/2021
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: NKA

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

Symptoms: POSSIBLE CHILD UNDERAGED. DOB REPORTED AS 8/8/09 ON CONSENT BUT OTHER RECORDS INDICATE ACTUAL DOB IS 8/27/2011.

Other Meds: NOT REPORTED

Current Illness: NOT REPORTED

ID: 1801220
Sex: F
Age: 59
State: IA

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: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Patient received a Pfizer Covid booster. Their first 2 vaccines were Moderna.

Other Meds:

Current Illness:

ID: 1801221
Sex: F
Age: 56
State: TX

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: 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: Patient is reporting feeling unwell, low grade fever and body aches. Still has a sore arm.

Other Meds:

Current Illness:

ID: 1801222
Sex: M
Age: 39
State: IL

Vax Date: 08/16/2021
Onset Date: 08/30/2021
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: Pending.

Allergies: NA.

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

Symptoms: Pt c/o low libido and energy for 3 months. Not exactly clear when sx started after 1st Moderna vaccine, sx were not immediate so he is not sure exactly how long after. Pt also had COVID 3 months ago and reports relatively mild sx. He was forced to get vaccine w/n 30 days. Tested pos COVID 2 Aug 2021 and 1st moderna 16 Aug 2021, 2nd 10 Sep 2021. Pt can get an erection if he tries; however, he has significant decrease in libido, which is effecting his relationship w/ his spouse. Admits to fatigue which showed up at same time and loss of pleasure in doing things. Moved to area 12 months ago. No major career changes or stress changes. Denies SI/HI. He reports he is sleeping 7-8hrs/night. Denies diplopia, myalgia, muscle weakness, numbness, paresthesia. No hematuria, urinary urgency, urinary frequency, pain w/ bowel movements, hematochezia, pain w/ ejaculation, testicular pain, testicular swelling.

Other Meds: Advair 100; Albuterol; Flovent; Tylenol; Sudafed.

Current Illness: Mild COVID diagnosed 2 Aug 2021.

ID: 1801223
Sex: F
Age: 83
State: IN

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

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

Symptoms: Patient received a 4th COVID19 vaccine in addition to the influenza vaccine on 9/9/21 at Pharmacy. Patient had already received the COVID19 booster on 6/28/21.

Other Meds:

Current Illness:

ID: 1801224
Sex: F
Age: 55
State: NY

Vax Date: 04/16/2021
Onset Date: 04/17/2021
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: blood work, echo

Allergies: ALLERGIC TO ALMOST ALL OF THE MEDICINES

Symptom List: Ear pain, Hypoaesthesia

Symptoms: I was really sick after the second dose and my whole chest was really heavy. I had to go to the urgent care and they told me to not take any pain medication since i am allergic to almost all of the medicine. I contacted my doctor and she said that a lot of people are having the same problem and told me to just be on the look and let her know if it gets worst.

Other Meds: VENASAN

Current Illness: NONE

ID: 1801225
Sex: F
Age: 63
State: FL

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

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

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

Other Meds:

Current Illness:

ID: 1801226
Sex: F
Age: 37
State: CA

Vax Date: 09/29/2021
Onset Date: 09/29/2021
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: Had EKG 9/29/2021

Allergies: n/a

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

Symptoms: Left arm became numb after the vaccine injection. Numbness all the way down the arm and left leg. Had chest pain and sharp pain, swollen lymph node in left axilla. Blood pressure also went up. Had to go to emergency room

Other Meds: n/a

Current Illness: n/a

ID: 1801227
Sex: M
Age: 72
State: KY

Vax Date: 02/06/2021
Onset Date: 10/13/2021
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: COVID19 test 10/13/21

Allergies:

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

Symptoms: Positive COVID19 test 10/13/21

Other Meds:

Current Illness:

ID: 1801228
Sex: F
Age: 55
State: NY

Vax Date: 10/11/2021
Onset Date: 10/11/2021
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: Tegretol and Dilantin cause severe itching.

Symptom List: Unevaluable event

Symptoms: Within 15 minutes of receiving Moderna vaccine, lightheadedness lasted for about 20-30 minutes. Within 2 hours left knee joint pain lasted 3-4 hours. Next morning (October 12, 2021) noticeable blood red color from mouth while brushing teeth for 2-3 minutes.

Other Meds: 2.5 mg Amlodipine, 50 mg Zinc, Calcium and D3 600 and 800 iu, Biotin 500 mcg, B complex, Cetirizine 10 mg, Vitamin C 500 mg, multivitamin, famotidine 20 mg,

Current Illness: none

ID: 1801229
Sex: F
Age: 41
State: IA

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: 1
Vax Route: IM
Vax Site: LA

Lab Data: No known needed testing

Allergies: Fish oil

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

Symptoms: Patient came into the clinic for a booster dose of vaccine (called ahead prior to coming), marked "yes" to immunocompromised, and no to at least 6 months from last dose of Pfizer vaccine. Immunization given. Per reason written on sheet patient does not qualify as immunocompromised, as reason put was smoking. No known adverse events/side effects at this time, tolerated well. Patient was notified of event, To call back with any concerns. Observed in office for 15 minutes.

Other Meds:

Current Illness:

ID: 1801230
Sex: F
Age: 26
State: FL

Vax Date: 09/29/2021
Onset Date: 10/14/2021
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: None yet

Allergies: PCN, shrimp

Symptom List: Injection site pain, Pain

Symptoms: Immediately after receiving the vaccine, I experienced severe left arm pain for a total of 3 days which was relieved only after taking Ibuprofen. About a week later, I started noticing that I would become very tired and short of breath after going up 4 flights of stairs (which I normally do several times a day during work). For the past week, I have been feeling more fatigued and short of breath. I was completely normal before receiving the vaccine and nothing has changed in my diet or daily routine.

Other Meds: None

Current Illness: None

ID: 1801231
Sex: M
Age: 31
State: IL

Vax Date: 10/18/2021
Onset Date: 10/20/2021
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: None

Symptom List: Injection site pain, Menorrhagia

Symptoms: After 2nd shot (Feb 11, 2021) had severe chest pain and was in ER, they thought it was heart burn, took a Pepcid and eventually it went away. Symptoms were racing heart, trouble breathing, extreme chest pain in waves. Recently got 3rd shot thinking would be better, around 12:30 am woke up with chest pain, and it grew to extreme levels. Treated it with a Pepcid and ibuprofen, after about 2 hours the pain eventually subsided. Didn't go to ER because I thought it was just heart burn from the last time I had it. Based on recent studies, we think it may be Myocarditis or Pericarditis which they say can be a side effect of the vaccine.

Other Meds: None

Current Illness: None

ID: 1801232
Sex: F
Age: 12
State: TX

Vax Date: 08/11/2021
Onset Date: 08/11/2021
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: NONE

Allergies: NKA

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

Symptoms: POSSIBLE UNDERAGED CHILD. CHILD DOB RECORDED ON CONSENT. DOB IN IMMUNIZATION REGISTRY LISTED.

Other Meds: NOT REPORTED

Current Illness: NOT REPORTED

ID: 1801233
Sex: F
Age: 81
State:

Vax Date: 02/13/2021
Onset Date: 10/13/2021
Rec V Date: 10/20/2021
Hospital: Y

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: Nausea, Pain in extremity, Pyrexia

Symptoms: COVID-19 pneumonia

Other Meds:

Current Illness:

ID: 1801234
Sex: M
Age: 68
State: KY

Vax Date: 03/19/2021
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: UNK
Vax Route: IM
Vax Site: RA

Lab Data: COVID19 test 10/15/2021

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Positive COVID19 test 10/15/2021

Other Meds:

Current Illness:

ID: 1801235
Sex: F
Age: 50
State: VA

Vax Date: 09/21/2021
Onset Date: 09/25/2021
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: N/A

Allergies: Beef, Pork, Prednisone, Shellfish

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

Symptoms: Pt. states that after receiving the 1st dose of Moderna 09/21/2021. started experiencing symptoms 09/25/2021 of burning in the chest and mouth, loss of taste, and abdominal cramps. Lasting 10/18/2021 with lingering burning in the night time. Received 2nd dose of Moderna 10/20/2021 and experiencing similar symptoms, will follow-up with Primary if continues.

Other Meds: N/A

Current Illness: N/A

ID: 1801236
Sex: F
Age: 62
State: MI

Vax Date: 04/08/2021
Onset Date: 10/14/2021
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: RA

Lab Data: Swabbed pos on admission 10.14.21

Allergies:

Symptom List: Nausea

Symptoms: SOB

Other Meds: Albuterol, verapamil, triaminolone, sumatriptan, sucralfate, simvastin, sertraline, prednisone, multivitamin, synthroid, albuterol, lioresal, b complex, estradiol, amitriptyline

Current Illness:

ID: 1801237
Sex: M
Age: 84
State: FL

Vax Date: 10/11/2021
Onset Date: 10/11/2021
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: Injection site pain

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

Other Meds:

Current Illness:

ID: 1801238
Sex: F
Age: 80
State: IL

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

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

Symptoms: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-

Other Meds:

Current Illness:

ID: 1801239
Sex: M
Age: 30
State: CA

Vax Date: 08/24/2021
Onset Date: 08/24/2021
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:

Allergies:

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

Symptoms: Site: Pain at Injection Site-Severe, Additional Details: patient called to report that since he received his vaccine, he cannot lift his entire arm or move it, if he does lift or move it it hurts greatly. this is located on the site where he received the injection.

Other Meds:

Current Illness:

ID: 1801241
Sex: F
Age: 59
State: PA

Vax Date: 06/03/2021
Onset Date: 06/17/2021
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:

Symptom List: Tremor

Symptoms: Arm kept getting sore and sore. She start noticing a pain in her arm which kept getting worse. She couldn't move her arm not up or down without it hurting. Now she cant do anything with her. All this is in the left arm where she rcvd her shot. And she realized that the lady who gave her the vaccine did it wrong.

Other Meds: topamax, flexeril, klonopin, robaxin, zyrtex, celexa, maxalt, dhe 10mg/cf 65mg/mtcp 10mg/diclof na 50mg, compazine

Current Illness: no

ID: 1801242
Sex: F
Age: 19
State: WV

Vax Date: 10/19/2021
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: Doxycycline

Symptom List: Erythema, Pruritus

Symptoms: Light headed, painful injection site, sore throat, sore joints

Other Meds: Escitalopram Claritin Junel f/20 Bupropion

Current Illness: Stomach bug two weeks ago

ID: 1801243
Sex: M
Age: 12
State: TX

Vax Date: 08/12/2021
Onset Date: 08/12/2021
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: NONE

Allergies: NKA

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

Symptoms: POSSIBLE UNDERAGED FOR VACCINE. CHILD DOB LISTED ON CONSENT BUT OTHER RECORD INDICATES DOB AS DIFFERENT.

Other Meds: NOT REPORTED

Current Illness: NOT REPORTED

ID: 1801244
Sex: F
Age: 43
State: FL

Vax Date: 10/19/2021
Onset Date: 10/19/2021
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: Systemic: Chest Tightness / Heaviness / Pain-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Headache-Medium, Systemic: Hypertension-Medium, Systemic: Nausea-Mild, Systemic: Numbness (specify: facial area, extremities)-Medium, Systemic: Tachycardia-Medium, Additional Details: numbness on left side of face and neck

Other Meds:

Current Illness:

ID: 1801245
Sex: F
Age: 29
State: GA

Vax Date: 09/14/2021
Onset Date: 09/18/2021
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: Evaluation

Allergies: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Shingles outbreak on right side of torso.

Other Meds: None

Current Illness: None

ID: 1801246
Sex: M
Age: 53
State: TN

Vax Date: 10/01/2021
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: All types of penicillin

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

Symptoms: Severe muscle pain throughout whole body

Other Meds: One A Day vitamin vitamin C vitamin D pantoprazole Livalo

Current Illness:

ID: 1801247
Sex: F
Age: 59
State: UT

Vax Date: 09/29/2021
Onset Date: 10/03/2021
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: none

Allergies: Food sensitivities only not Allergies. Auto immunes

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

Symptoms: After having Covid in Dec. 2019 or Feb 2020 and again possibly in Mar. 2021 with Moderate to Sever symptoms. After the first vaccination, I had more sever symptoms than either time of having Covid it's self. Dizziness, loss of balance, Fatigue, Need more sleep and naps. Overall body aches and numbing pain. Body heat and cold. Head aches. Brain Fog debilitating. Some lymph node effects. Slight recurring sore throat. Clinginess in the ears and throat. Heart clenching and racing.

Other Meds: Vit. C. Vit. D3 Wellness Formula Vit and Herbal Dates were not recognized. Wouldn't take my inputs.

Current Illness: Auto immune; Long Covid

ID: 1801248
Sex: M
Age: 64
State: MA

Vax Date: 10/01/2021
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: Made a visit to Hospital Urgent Care, visit to my primary care office and a Eco cardio exam. Echo Findings General Findings The image quality was fair (3). Left Ventricle Left ventricular cavity size is normal and the left ventricular wall thickness is increased. There is symmetric left ventricular hypertrophy. Left ventricular systolic function is normal. There are no segmental left ventricular wall motion abnormalities noted. The estimated ejection fraction is 72% (Normal 50-75%). The left ventricular ejection fraction was measured by the single dimension method. Right Ventricle The right ventricular size is normal. The right ventricular systolic function is normal. Left Atrium The left atrium is normal in size. Right Atrium The right atrium is normal in size. Aortic Valve The aortic valve is tricuspid. There is no evidence of valvular aortic stenosis. There is no evidence of aortic regurgitation by color and spectral Doppler. Mitral Valve There is no evidence of mitral valve prolapse. There is trace mitral regurgitation detected by spectral and color Doppler. Tricuspid Valve There is evidence of trace to mild tricuspid regurgitation by color and spectral Doppler. The RV systolic pressure was estimated from the peak TV regurgitant velocity (assuming an RA pressure of 10 mmHg). The estimated RV systolic pressure is 35 mmHg. Pulmonic Valve There is evidence of trace pulmonary regurgitation by color and spectral Doppler. Pericardium There is no evidence of pericardial effusion. Comparison Findings No prior studies for comparison.

Allergies: None

Symptom List: Pain in extremity

Symptoms: Felt a shock like pain in my heart and tight chest after about 2 hours. The pain is still there after almost 4 weeks. fog and occasional light pain in my forehead region, Pains along the sides of my body including my stomach area.

Other Meds: 80 MG of Omeprazole

Current Illness: Esophagitis

ID: 1801249
Sex: M
Age: 54
State: PA

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: None

Allergies: Iodine

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

Symptoms: Just after vaccination patient experienced difficulty swallowing, tingling all over body, possible throat tightening, and increased blood pressure. Pt reported to ER and was given Benadryl. Symptoms resolved.

Other Meds: None

Current Illness: None

ID: 1801250
Sex: M
Age: 33
State: MA

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

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

Symptoms: Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Severe, Systemic: Tingling (specify: facial area, extemities)-Medium, Additional Details: EMS came and treated patient. was evaluated, blood pressure was normal, blood sugar normal. Patient did not go to hospital. Stayed for 10 minutes more and then left

Other Meds:

Current Illness:

ID: 1801251
Sex: F
Age: 39
State:

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

Lab Data:

Allergies:

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

Symptoms: headache, arm pain, finger tingling/numbness,

Other Meds:

Current Illness:

ID: 1801252
Sex: M
Age: 24
State: NY

Vax Date: 10/20/2021
Onset Date: 10/20/2021
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: vital signs and cardiac monitor for 45 minutes.

Allergies:

Symptom List: Vomiting

Symptoms: client became diaphoretic shortly after getting vaccine. did not lose consciousness; slid from chair onto floor by vaccination staff, pale color. client reports this has happened before with vaccinations. client reported no fluids or food prior to getting vaccination. provided freezer pop, water and moved by wheelchair to medical tent and attended by EMS team. additional food provided, candy, juice and water. monitored with VS and cardiac monitor for 45 minutes. once recovered.

Other Meds:

Current Illness:

ID: 1801253
Sex: F
Age: 82
State: FL

Vax Date: 10/11/2021
Onset Date: 10/11/2021
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 GIVEN AFTER BEYONF USE DATE

Other Meds:

Current Illness:

ID: 1801254
Sex: M
Age: 33
State: MA

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

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

Symptoms: Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Severe, Systemic: Tingling (specify: facial area, extemities)-Severe

Other Meds:

Current Illness:

ID: 1801255
Sex: F
Age: 56
State: UT

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: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies: No known

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Pt presents with a fever up to 103.5 F., chills, body aches, joint pain, cough. These symptoms started the days after her booster. Treatment is Tylenol, Ibuprofen, hydration, rest and a short course of Prednisone.

Other Meds: Meloxicam Cyclobenzaprine

Current Illness: No known

ID: 1801256
Sex: M
Age: 84
State:

Vax Date: 02/22/2021
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: RA

Lab Data:

Allergies:

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

Symptoms: covid positive requiring oxygen in hospital

Other Meds:

Current Illness:

ID: 1801257
Sex: F
Age: 69
State: MA

Vax Date: 10/19/2021
Onset Date: 10/19/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am