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: 1801258
Sex: F
Age: 39
State: NC

Vax Date: 04/26/2021
Onset Date: 04/27/2021
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: None

Symptom List: Dysphagia, Epiglottitis

Symptoms: Repeated events of vertigo that are still happening now 2-3 times a week, 6 months post injection

Other Meds: Synthroid

Current Illness: None

ID: 1801259
Sex: F
Age: 45
State: AZ

Vax Date: 04/03/2021
Onset Date: 05/01/2021
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:

Allergies: no

Symptom List: Anxiety, Dyspnoea

Symptoms: Always had extremely regular periods of 6-7 days, never had any breakthrough bleeding, since vaccine period was two weeks late twice and have had very long periods of up to 12 days. and breakthrough bleeding, still ongoing as of Oct 2021, I do not take any birth control or other medications containing hormones

Other Meds: Temazepam 15 mg

Current Illness: no

ID: 1801260
Sex: F
Age: 37
State: CA

Vax Date: 10/13/2021
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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Site: Bruising at Injection Site-Severe, Site: Itching at Injection Site-Severe, Site: Pain at Injection Site-Severe, Site: Redness at Injection Site-Severe, Site: Swelling at Injection Site-Severe, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Mild, Systemic: Allergic: Itch (specify: facial area, extremeties)-Severe, Systemic: Allergic: Itch Generalized-Severe, Systemic: Allergic: Rash (specify: facial area, extremeties)-Severe, Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Mild, Systemic: Body Aches Generalized-Medium, Systemic: Chills-Mild, Systemic: Confusion-Mild, Systemic: Diarrhea-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: Exhaustion / Lethargy-Mild, Systemic: Headache-Mild, Systemic: Joint Pain-Medium, Systemic: Nausea-Medium, Systemic: Numbness (specify: facial area, extremities)-Medium, Systemic: Shakiness-Medium, Systemic: Tachycardia-Medium, Systemic: Tingling (specify: facial area, extemities)-Medium, Systemic: Tinnitus-Mild, Systemic: Weakness-Medium, Additional Details: Patient states doctor recommends not to receive second dose.

Other Meds:

Current Illness:

ID: 1801261
Sex: F
Age: 64
State: NJ

Vax Date: 04/28/2021
Onset Date: 04/28/2021
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: None

Allergies: None that I know of

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: I had pretty severe swelling, redness and very hard to move my fingers and joints on both hands, I believe due to the inflammatory osteo arthritis that I have. It lasted approximately 5/6 days.

Other Meds: Medrol for (Inflammatory Osteo-arthritis) 4mg - every other day Diovan for High Blood Pressure - daily Zyrtec for year round allergies - daily

Current Illness: Just the Inflammatory Osteo-Arthritis and High Blood pressure

ID: 1801262
Sex: F
Age: 49
State: CO

Vax Date: 04/16/2021
Onset Date: 09/25/2021
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: Doctor ordered: Ultrasound to check for gall bladder issues - I did have some small gall stones but not obstructing causing.

Allergies: Losartan; Lisinopril

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

Symptoms: I had several days of bad episodes at night - that kept me up - of abdominal pain. Was unable to sleep. Nexium OTC for treatment. That helped with symptoms. I had those about 5 days. I saw my doctor on Friday. I am still having a little bit of symptoms but not like it was.

Other Meds: Amlodipine; Lexapro

Current Illness: no

ID: 1801263
Sex: F
Age: 29
State: MT

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

Allergies: Shellfish - Mollusks

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

Symptoms: Onset of symptoms occurred approximately 12 hours post vaccines. Symptoms include vomiting, nausea, extreme body aches, fever, chills, fatigue, and dizziness. Received a shot of Toradol and Zofran. Currently, at 48 hours post vaccines, nausea and vomiting are not present. Fever and chills comes and goes. Body aches have lightened in severity, (not crying due to pain anymore) but are still present. Fatigue and dizziness are still present./

Other Meds: Venlafaxine Metoprolol

Current Illness: None

ID: 1801264
Sex: M
Age: 57
State: VA

Vax Date: 04/16/2021
Onset Date: 07/01/2021
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: See item 18

Allergies: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Started having urinary issues in Jul 2021; saw PCP and was treated for UTI (Precautionary) with antibiotics. Urine sample showed RBC. Was referred by PCP to Urologist. Initial consultation with Urologist was followed by 1 tests; CT Urogram on 10/1/21 and a Cystoscopy on (10/11/15). Results showed a mass in each the bladder and right kidney. A TURBT procedure was performed on 10/15/21; the tumor was resected and biopsies were taken; pathology reported that the tumor was a T1HG. A follow-on TURBT is scheduled for early Nov 2021 along with follow on treatments and removal of the Kidney tumor. Treatment is ongoing.

Other Meds: 50+ Multivitamin Diclofenac Lisinopril 40 mg Flonase 50mcg/actuation

Current Illness: None

ID: 1801265
Sex: F
Age: 71
State: TX

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: UNK
Vax Route: IM
Vax Site: LA

Lab Data: no

Allergies: Penicillin, Robatussin and Tylenol

Symptom List: Pharyngeal swelling

Symptoms: On 10/15/2021 that night I started feeling feverish, very weak, muscle ache. Temp was 103 at the high side. I took three Motrin's and went to bed. On 10/16/2021 I woke up very sore and fatigued, so I rested and took more Motrin, no fever. On 10/17/2021 I was well besides a bit of swelling at the injection site and bit bruised.

Other Meds: I took Synthroid, Simvastatin, Vit D3, and Calcium.

Current Illness: no

ID: 1801266
Sex: M
Age: 63
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1801267
Sex: M
Age: 30
State: IL

Vax Date: 02/10/2021
Onset Date: 02/28/2021
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: None

Symptom List: Diarrhoea, Nasal congestion

Symptoms: In the morning of late February I noticed Minor swelling in my armpit lymph nodes. Early March both armpit lymph nodes were size of grapes and by the end of March they were gone. In that time frame I went to a Doctor and they sent me to a radiologist for a ultrasound and in the process of scheduling a biopsy it went back to normal. They said it was a common side effect and they ended up not doing a biopsy. My arms were also sore.

Other Meds: None

Current Illness: None

ID: 1801268
Sex: F
Age: 55
State: CA

Vax Date: 10/07/2021
Onset Date: 10/07/2021
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: Systemic: Exhaustion / Lethargy-Medium, Systemic: Tachycardia-Medium, Additional Details: patient stated she had trouble walking home and ended up needing to go to emergency room

Other Meds:

Current Illness:

ID: 1801269
Sex: F
Age: 61
State: CA

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: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data: None

Allergies: No

Symptom List: Rash, Urticaria

Symptoms: Headache followed by fever and chills.

Other Meds: Lotrel, Indapamide, ASA, Krill Oil

Current Illness: No

ID: 1801270
Sex: F
Age: 47
State: IN

Vax Date: 09/24/2021
Onset Date: 10/03/2021
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: Stress Test, CT chest, holter monitor

Allergies: PCN

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

Symptoms: On 24Sept2021, I received my 1st dose of Pfizer COVID19 vaccine in my left arm intramuscular. On 03Oct2021, 9 days after receiving my first dose, I started experiencing Premature Ventricular Contractions (PVCs). On 04Oct2021 and 05Oct2021, 10 and 11 days after receiving Pfizer first dose, I experienced chest discomfort and shortness of breath (SOB). On 05Oct2021, I went to the emergency room and was admitted for additional testing (stress test, lab draws and CT chest scan). On 06Oct2021, I was discharged. On 13Oct2021, I had an appt with a cardiologist and I am wearing a holter monitor for evaluation. I have had NO cardiac issues myself nor do I have a family history.

Other Meds: None

Current Illness: None

ID: 1801271
Sex: F
Age: 51
State: NV

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

Lab Data:

Allergies:

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

Symptoms: Systemic: Allergic: Difficulty Breathing-Severe, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Severe, Systemic: Abdominal Pain-Medium, Systemic: Body Aches Generalized-Severe, Systemic: Chest Tightness / Heaviness / Pain-Severe, Systemic: Chills-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: Fever-Severe, Systemic: Headache-Severe, Systemic: Joint Pain-Severe, Systemic: Nausea-Severe, Systemic: Weakness-Severe, Additional Details: PT CAME TO PHARMACY COMPLAINING ABOUT REACTION SHE GOTTEN AFTER VACINATION INFORM HER TO GO TO HOSPITAL OR URGENT TO GET CHECK

Other Meds:

Current Illness:

ID: 1801272
Sex: F
Age: 33
State: FL

Vax Date: 08/15/2021
Onset Date: 08/15/2021
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: Site: Itching at Injection Site-Severe, Site: Redness at Injection Site-Severe, Systemic: Allergic: Itch (specify: facial area, extremeties)-Severe, Systemic: Allergic: Itch Generalized-Severe, Systemic: Allergic: Rash (specify: facial area, extremeties)-Severe, Systemic: Allergic: Rash Generalized-Severe

Other Meds:

Current Illness:

ID: 1801273
Sex: F
Age: 67
State: GA

Vax Date: 10/09/2021
Onset Date: 10/10/2021
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: Tetnus, Liscinapril

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

Symptoms: Severe leg pain, from hip all the way down both legs. Severe spasms, getting progressively worse each day. Needs crutches or cane to walk. Severe muscle and joint pain every day. Given steroid pack with first urgent care visit. Given muscle relaxer with second urgent care visit. First given Trimadol. Side effects with Trimadol included nusea, vomitting, upset stomach, and nightmare. Felt drunk. Couldn't operate car or walk straight. Changed muscle relaxer.

Other Meds: Blood pressure medication

Current Illness: None

ID: 1801274
Sex: M
Age: 30
State: MA

Vax Date: 10/13/2021
Onset Date: 10/13/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1801275
Sex: F
Age: 77
State: MI

Vax Date: 08/12/2021
Onset Date: 10/17/2021
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: POS for covid on admisson

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: RUQ pain

Other Meds:

Current Illness:

ID: 1801276
Sex: F
Age: 31
State: CA

Vax Date: 08/29/2021
Onset Date: 10/18/2021
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: none

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Patient admitted to hospital for Elective Induction of pregnancy, diagnosed with shingles by care provider

Other Meds: Prenatal Vitamins

Current Illness: Pregnancy

ID: 1801277
Sex: F
Age: 69
State: FL

Vax Date: 12/01/2020
Onset Date: 05/21/2021
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: Serial hearing tests

Allergies: None

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

Symptoms: Sudden onset of hearing loss left ear. Occurred 4 months after 2nd dose

Other Meds: Spironolactone, lisinopril, metoprolol , letrozole, ASA

Current Illness:

ID: 1801278
Sex: F
Age: 89
State: CO

Vax Date: 01/27/2021
Onset Date: 10/12/2021
Rec V Date: 10/20/2021
Hospital: Y

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: CT scan, blood tests, blood thinners, 3 magnetic resonance resolution clips in descending colon,, IV fluids,

Allergies: Milk intolerance

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

Symptoms: Patient had several strokes on both sides of her brain, atrial fibrillation and major GI bleeds, all causing 2 trips to the hospital. She has been given 2 transfusions, as the GI bleed has made her blood count go down. She is currently is in the hospital, they are trying to get her stabilized.

Other Meds: Insulin, potassium, cranberry, narco, multivitamin, heart medication, laxatives, other things we couldn?t remember.

Current Illness: Maintaining ADL s with full assistance, but thriving, getting outside daily.

ID: 1801279
Sex: M
Age: 32
State: MO

Vax Date: 06/02/2021
Onset Date: 08/23/2021
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: unknown

Allergies: unknown

Symptom List: Unevaluable event

Symptoms: Symptom onset was 08-23-2021. Symptoms included cough, shortness of breath, sore throat, vomiting, headache, fatigue and myalgia. The case tested positive on 08/24/2021 at Medical Center. He was hospitalized from 08/24/2021 through 08/28/2021.

Other Meds: unknown

Current Illness: unknown

ID: 1801280
Sex: M
Age: 52
State: VA

Vax Date: 04/14/2021
Onset Date: 04/16/2021
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: Ultrasound on July, 2, 2021 (at VCU Health Systems) shows no evidence of lymphadenopathy by size criteria. A non-enlarged 0.6 x 1.3 cm superficial hypoechoic node in the right axilla without a prominent fatty hilum at the area of concern, possibly reactive.

Allergies: None

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

Symptoms: Palpable swelling in Right axillary accompanied by tender and swollen lymph nodes with mild pain in the upper arm, back, and right side. Palpable swelling and mild pain persist after six months with little to no change in size. No special treatment prescribed.

Other Meds: Fish Oil (675mg) Zyrtec (over the counter)

Current Illness: None

ID: 1801281
Sex: F
Age: 41
State: VA

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: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Patient began to have hives, redness and coughing. Was given 25 mg of Benadryl which initially began to help. Patient then began with more coughing and stated she felt razor blades in her throat. Was given another 25 mg of Benadryl and then evaluated in the ER, treated and released.

Other Meds: Unknown

Current Illness:

ID: 1801282
Sex: F
Age: 79
State: CA

Vax Date: 10/16/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Site: Pain at Injection Site-Mild, Site: Redness at Injection Site-Medium, Additional Details: Redness around injection site from shoulder to elbow joint

Other Meds:

Current Illness:

ID: 1801283
Sex: M
Age: 12
State: TX

Vax Date: 08/17/2021
Onset Date: 08/17/2021
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: CHILD UNDER AGED AT TIME OF VACCINE. DOB LISTED AS 06/11/2021 ON CONSENT. IMMTRAC LISTS AS 6/11/2010.

Other Meds: NOT REPORTED

Current Illness: NOT REPORTED

ID: 1801284
Sex: F
Age: 45
State: MO

Vax Date: 04/29/2021
Onset Date: 08/26/2021
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: unknown

Allergies: unknown

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Symptom Onset was 08-26-2021. Symptoms included cough, shortness of breath, sore throat, abdominal discomfort, poor appetite, nausea, diarrhea, chest pain, wheezing, headache, fatigue, myalgia, chills and dizziness. The case tested positive for Covid-19 on 08-30-2021. She was hospitalized from 8-30-2021 to 09-03-2021.

Other Meds: unknown

Current Illness: unknown

ID: 1801285
Sex: F
Age: 63
State: NC

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: RA

Lab Data: na

Allergies: na

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: The client was administered High Dose Fluad and the client is only 63. No s/sx of adverse reactions noted by client.

Other Meds: na

Current Illness: na

ID: 1801286
Sex: F
Age: 55
State: TN

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

Lab Data:

Allergies: Levaquin, latex

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

Symptoms: Horrible headache, chills, fever, nausea, diarrhea for 3-4 days about 6 hours after I got my first vaccine

Other Meds: Rizatriptan, Propanol, Advil, Benadryl, vitamins A E B+, Centrum Silver and Flaxseed oil

Current Illness:

ID: 1801287
Sex: M
Age: 43
State: AL

Vax Date: 10/06/2021
Onset Date: 10/11/2021
Rec V Date: 10/20/2021
Hospital: Y

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

Lab Data: currently in hospital

Allergies: none

Symptom List: Nausea

Symptoms: Chest pain, blood clots, new onset T cell leukemia

Other Meds: Protonix, Zinc

Current Illness: None

ID: 1801288
Sex: F
Age: 88
State: MO

Vax Date: 02/28/2021
Onset Date: 08/30/2021
Rec V Date: 10/20/2021
Hospital: Y

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

Lab Data: unknown

Allergies: unknown

Symptom List: Injection site pain

Symptoms: Symptom onset was 08-30-2021. Symptoms included cough, fatigue and myalgia. Patient tested positive for Covid-19 on 8-30-2021 (and on 9-02-2021 and 9-09-2021). She was hospitalized on 8-30-2021 through 9-4-2021 due to Covid-19 and heart rate, at Hospital.

Other Meds: unknown

Current Illness: unknown

ID: 1801289
Sex: F
Age: 13
State: NY

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: 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: Systemic: Allergic: Itch Generalized-Medium, Systemic: Allergic: Rash Generalized-Medium, Additional Details: As of time Mother called itchy rash with hives had not resolved. Being followed by pediatrician

Other Meds:

Current Illness:

ID: 1801290
Sex: F
Age: 56
State: GA

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

Lab Data: None as of yet, but will visit Primary Care Physician on 10/22/2021

Allergies: Tylenol, Aspirin, Penicillin, Bactrum (antibiotic)

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

Symptoms: Headaches, Heart fluttering, Pain in chest, shoulder/neck pain, calf bruise, pain in leg, irregular/fast heart beat all on left side, site of injection. Going to see Primary care Physician on 10/22/2021

Other Meds: Biotin, Vitamin B12, Vitamin D, Vitamin C, Multi-vitamins for Women

Current Illness: None

ID: 1801291
Sex: F
Age: 92
State: MO

Vax Date: 03/25/2021
Onset Date: 10/02/2021
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: IM
Vax Site: LA

Lab Data: unknown

Allergies: unknown

Symptom List: Tremor

Symptoms: Case had a cough for several weeks before it worsened, on 10/02/2021. Case was taken to the hospital. She was admitted on 10/02/2021 until released on 10/05/2021.

Other Meds: unknown

Current Illness: unknown

ID: 1801292
Sex: M
Age: 72
State: FL

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: Only environmental.

Symptom List: Erythema, Pruritus

Symptoms: Profound fatigue. Extreme body aches. Skin hypersensitive. Touching hair was highly irritating. Blood oxygen second day Tuesday = 86.6.

Other Meds: Too many to enter.

Current Illness: None.

ID: 1801293
Sex: F
Age: 41
State:

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

Allergies:

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

Symptoms: Patient given Pfizer COVID vaccine #2 at 0920 and at 0927 began to c/o hives and redness. Given Benadryl 25 mg PO. Began to improve, however at 0940 began to say she was having a feelin as if she had razor blades in her throat and began coughing. Given another Benadryl 25 mg PO and evaluated in ER, treated and released.

Other Meds:

Current Illness:

ID: 1801294
Sex: F
Age: 89
State: OH

Vax Date: 10/18/2021
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: LA

Lab Data: None

Allergies: Percocet

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

Symptoms: Resident very lethargic, unable to speak in full sentences. Face flush, Vitals stable beside heart rate. Very irregular heart rate.

Other Meds: Colace, Claritin, Tylenol ER, Olanzapine, Depakote

Current Illness: LUMBAGO WITH SCIATICA, LEFT SIDE, ALLERGIC RHINITIS, DEMENTIA WITH BEHAVIORAL DISTURBANCE

ID: 1801295
Sex: U
Age: 74
State: UT

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: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

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: 1801296
Sex: M
Age: 56
State: IN

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: 011J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: chills, fatigue for about 24 hours

Other Meds: Atorvastatin 10mg Multivitamin

Current Illness: None

ID: 1801297
Sex: M
Age: 66
State: MO

Vax Date: 04/05/2021
Onset Date: 09/27/2021
Rec V Date: 10/20/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Given antibiotics for Covid-19-related illness

Allergies: unknown

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

Symptoms: Symptom onset was 09-27-21. Symptoms included fever, cough, loss of smell, loss of taste, congestion, vomiting, diarrhea, headache, fatigue, chills, low blood pressure and low oxygen. Could hardly walk. Case admitted to local Hospital on 10/01/2021 through 10/06/2021.

Other Meds: unknown

Current Illness: unknown

ID: 1801298
Sex: F
Age: 46
State: AZ

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

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: Systemic: Dizziness / Lightheadness-Medium, Systemic: Hyperventilation-Mild, Systemic: Tachycardia-Medium, Systemic: Weakness-Medium, Additional Details: Patient started feeling dizzy 5 minutes after the vaccine administration. Upon checking her heart rate was in the range of 105-135 bpm. 10 minutes later paramedics came and checked patient's blood glucose, blood pressure and EKG and everything came normal. Patient said she will follow up with a doctor regarding this and went home.

Other Meds:

Current Illness:

ID: 1801300
Sex: F
Age: 30
State: NY

Vax Date: 10/14/2021
Onset Date: 10/14/2021
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: hospital My d dimer is evaluated , ct scan of chest was clear on monday night 10/18/2021 ER ask for me to follow up with my doctor

Allergies: cipro, Codine

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

Symptoms: Inflammation , bruising on my left arm and also right legs , SOB , chest pressure and pain , body aches and weakness , headache and eye pain

Other Meds: None

Current Illness: Bronchitis

ID: 1801301
Sex: F
Age: 87
State: MO

Vax Date: 03/05/2021
Onset Date: 08/30/2021
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: IM
Vax Site: LA

Lab Data: unknown

Allergies: unknown

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

Symptoms: Symptom onset was 8-30-2021. Symptoms were not reported; family member explained that it was difficult to differentiate between Covid-19 symptoms and those due to Parkinson's disease. Case tested positive for Covid-19 on 09-02-2021. She was hospitalized at from 09-02-2021 through 09-07-2021. The case had received three Covid-19 (Pfizer) vaccines, on 02/12/2021, 03/05/2021 and 08/30/2021.

Other Meds: unknown

Current Illness: unknown

ID: 1801302
Sex: F
Age: 58
State: OH

Vax Date: 07/10/2021
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: PCR + 10/18/2021

Allergies: nka

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

Symptoms: breakthrough covid + asymptomatic, hospital admission for trauma

Other Meds: albuterol

Current Illness: no

ID: 1801304
Sex: F
Age: 37
State: SC

Vax Date: 04/16/2021
Onset Date: 09/01/2021
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: Ceclor (itching)

Symptom List: Vomiting

Symptoms: No negative outcome from vaccine, but was diagnosed with Covid in September and Received monoclonal antibody treatment at an outpatient facility

Other Meds: Post-natal multivitamin (still breastfeeding infant)

Current Illness: None

ID: 1801305
Sex: F
Age: 42
State: VA

Vax Date: 10/16/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Site: Itching at Injection Site-Mild, Site: Redness at Injection Site-Mild, Site: Swelling at Injection Site-Mild, Systemic: Allergic: Itch (specify: facial area, extremeties)-Mild, Systemic: Allergic: Rash (specify: facial area, extremeties)-Mild, Systemic: pt says redness/itc started in 1 arm then went to other to hands-Mild

Other Meds:

Current Illness:

ID: 1801306
Sex: F
Age: 35
State: CT

Vax Date: 10/06/2021
Onset Date: 10/07/2021
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: BODY HURT TO TOUCH, CHILL, HEADACHE, TIRED AND NAUSEOUS

Other Meds: junel- birth control

Current Illness:

ID: 1801307
Sex: F
Age: 52
State: CA

Vax Date: 09/03/2021
Onset Date: 09/04/2021
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: COVID (rapid test) and flu tests - negative Strep test - result still not known.

Allergies: no

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Immediately, it was about 14 hours later: Body aches, chills and not feeling good. That was kind of in a cycle. I took Tylenol and it went away and I felt well enough to go to dinner (out) and about 10 pm it started again and I took some more Tylenol and it went away and the next day, I felt a little icky. Last Thursday, I had a sore throat, ear ache, body aches, fever and chills. Took a COVID and flu test and they were both negative. I went to a child and an adult care on Thursday. Saw real doctor on Monday - she did a strep test (do not have results yet). Ceftin -an antibiotic she prescribed me that I'm on now; the fever went away yesterday but I'm getting it back again today. She wants me to come back in for another COVID test and get a chest x-ray and do some bloodwork. I am going to do the chest x-ray and COVID test today. I got my flu shot on the 19th of September, 2021.

Other Meds: Infusions - every 6 weeks - Entybio; Blood pressure med; Benadryl at night sometimes to sleep

Current Illness: no

ID: 1801308
Sex: M
Age: 59
State: FL

Vax Date: 07/23/2021
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:

Allergies:

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

Symptoms: Site: Pain at Injection Site-Mild, Systemic: Swollen feet-Medium, Additional Details: Pt reports swelling on both foot occurring about a week after second shot and lasted for about 3 weeks after.

Other Meds:

Current Illness:

ID: 1801309
Sex: F
Age: 63
State: KS

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

Lab Data:

Allergies: Penicillin, codeine

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

Symptoms: Pain at injection site Pain in right arm pit

Other Meds: Advil

Current Illness: None

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am