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: 1807570
Sex: F
Age: 45
State: FL

Vax Date: 10/13/2021
Onset Date: 10/16/2021
Rec V Date: 10/22/2021
Hospital:

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

Lab Data: N/A

Allergies: N/A

Symptom List: Dysphagia, Epiglottitis

Symptoms: Right Supraclavicular Lymphadenopathy

Other Meds: Toprol XL, Yaz

Current Illness: N/A

ID: 1807571
Sex: F
Age: 34
State: NC

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

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

Lab Data: None.

Allergies: PCN, E-Mycin

Symptom List: Anxiety, Dyspnoea

Symptoms: Today is 10 days post my first vaccine injection. For the first 3 days, my arm was red, tender-to-the-touch, swollen and warm. After 3 days, those symptoms dissapated completely. This morning, I woke up with a red, raised bump that is tender-to-the-touch and warm. It feels like I just got another injection, but I did not.

Other Meds: Vacepa, Vyvanse, Zoloft, Yaz, Buspar, Bio-Clense, Pro-Bio, Motrin PRN, Multi-Vitamin

Current Illness: None

ID: 1807572
Sex: M
Age: 25
State: GA

Vax Date: 10/04/2021
Onset Date: 10/04/2021
Rec V Date: 10/22/2021
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: Systemic: stuffy nose for 1 week then altered taste/smell-Mild, Additional Details: Patient reports a stuffy nose that last 1 week after the vaccine then had alterned taste and smell since the congestion resolved. He reports everything having a chemical smell or taste.

Other Meds:

Current Illness:

ID: 1807573
Sex: M
Age: 51
State: NJ

Vax Date: 10/21/2021
Onset Date: 10/21/2021
Rec V Date: 10/22/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1807574
Sex: F
Age: 51
State: SC

Vax Date: 10/20/2021
Onset Date: 10/20/2021
Rec V Date: 10/22/2021
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 erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Systemic: Body Aches Generalized-Medium, Systemic: Lymph Node Swelling-Mild, Additional Details: Pt called pharmacy after experiencing pain and redness at injection site. Described a knot on her arm with some pain radiating up into neck. Will call back if not relieved by IBU or ice, or if noticable spreading of discoloration.

Other Meds:

Current Illness:

ID: 1807575
Sex: M
Age: 49
State: FL

Vax Date: 10/19/2021
Onset Date: 10/19/2021
Rec V Date: 10/22/2021
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: bactrim, bell peppers

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

Symptoms: Slight fever, pain around injection site in arm, fatigue, tightness in chest, difficulty taking deep breaths, throat partially closing.

Other Meds: salagen, synthroid

Current Illness: none

ID: 1807576
Sex: F
Age: 70
State: RI

Vax Date: 08/20/2021
Onset Date: 08/20/2021
Rec V Date: 10/22/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Error: Wrong Patient (documentation in EMR)-

Other Meds:

Current Illness:

ID: 1807577
Sex: F
Age: 57
State: MN

Vax Date: 10/18/2021
Onset Date: 10/18/2021
Rec V Date: 10/22/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Error: Wrong Dose of Vaccine - Too High.

Other Meds:

Current Illness:

ID: 1807578
Sex: M
Age: 41
State: CA

Vax Date: 10/21/2021
Onset Date: 10/21/2021
Rec V Date: 10/22/2021
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: Wrong Dose of Vaccine - Too High-

Other Meds:

Current Illness:

ID: 1807579
Sex: F
Age: 45
State: MD

Vax Date: 10/15/2021
Onset Date: 10/16/2021
Rec V Date: 10/22/2021
Hospital:

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

Lab Data: EKG blood work no results on blood work yet EKG fine groin pain not recovered

Allergies: None

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Heart palpitations begin within 24 hours and lasted about 24 hours aspirin was taken... Within 48 hours joint pain in my groin unable to walk normally and put pressure on my leg. My provider gave an EKG it turned out normal on that following Tuesday she thought I pulled something but I only rested the day after the vaccine because of the heart palpitations...no exercise or nothing was done to pull anything...I am still having groin pain a week later.

Other Meds: None

Current Illness: None

ID: 1807580
Sex: F
Age: 25
State:

Vax Date: 10/20/2021
Onset Date: 10/21/2021
Rec V Date: 10/22/2021
Hospital:

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

Lab Data:

Allergies: No allergies

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

Symptoms: Received first injection 09/21, had heavy cycle the next day and spotting for one week after. Had second injection on 10/21 and had chills, body aches, and headache. Started heavier than usual menstrual cycle the next day, bleeding through a pad every hour and a half, continued til today (2 days after injection).

Other Meds: Prenatal vitamins

Current Illness: None

ID: 1807581
Sex: F
Age: 46
State: MN

Vax Date: 10/21/2021
Onset Date: 10/21/2021
Rec V Date: 10/22/2021
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: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-

Other Meds:

Current Illness:

ID: 1807582
Sex: F
Age: 77
State: OH

Vax Date: 10/21/2021
Onset Date: 10/21/2021
Rec V Date: 10/22/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Error: Incorrect Reconstitution-

Other Meds:

Current Illness:

ID: 1807583
Sex: F
Age: 52
State: NY

Vax Date: 10/14/2021
Onset Date: 10/14/2021
Rec V Date: 10/22/2021
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: Doppler studies were negative for DVT

Allergies: none mentioned

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

Symptoms: soreness and pain at injection site that worsened in left arm upper back and left axilla lymphadenopathy

Other Meds: none mentioned

Current Illness: none

ID: 1807584
Sex: F
Age: 40
State: OH

Vax Date: 10/21/2021
Onset Date: 10/21/2021
Rec V Date: 10/22/2021
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: Error: Incorrect Reconstitution-

Other Meds:

Current Illness:

ID: 1807585
Sex: F
Age: 72
State: PA

Vax Date: 10/21/2021
Onset Date: 10/21/2021
Rec V Date: 10/22/2021
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: Keflex Boniva

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

Symptoms: 1/ 2 booster dose.Strong Headache, throbbing eardrums, chills, vomiting (just once),sore arm, weakness and body aches , no sleep, still feel lousy

Other Meds: None

Current Illness: None

ID: 1807586
Sex: F
Age: 44
State: OH

Vax Date: 10/21/2021
Onset Date: 10/21/2021
Rec V Date: 10/22/2021
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: Incorrect Reconstitution-

Other Meds:

Current Illness:

ID: 1807587
Sex: F
Age: 76
State: CT

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

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

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

Other Meds:

Current Illness:

ID: 1807588
Sex: M
Age: 82
State: CT

Vax Date: 10/20/2021
Onset Date: 10/20/2021
Rec V Date: 10/22/2021
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: Error: Booster Given Too Early-

Other Meds:

Current Illness:

ID: 1807589
Sex: F
Age: 60
State: NY

Vax Date: 10/20/2021
Onset Date: 10/21/2021
Rec V Date: 10/22/2021
Hospital:

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

Lab Data: none

Allergies: bee stings

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

Symptoms: There is an enlarged area under left arm. Area of swelling is approximately 8 cm in diameter. I first noticed the enlargement at 3:00 pm 10/21/2021. This morning at 8:00 am on 10/22/2021 the area of swelling has gotten even larger. Pain down the left arm persists.

Other Meds: none

Current Illness: none

Date Died: 10/02/2021

ID: 1807590
Sex: F
Age: 68
State: KY

Vax Date: 08/15/2021
Onset Date: 09/05/2021
Rec V Date: 10/22/2021
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: COVID PCR confirmed positive on 9/5/21

Allergies: lisinopril - angioedema, swelling

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

Symptoms: Patient is a 68 y.o. female with PMHX of COPD, afib on eliquis, DM2, HTN, HLD, chronic anemia, HFpEF, OSA presented to ED on 8/5 with complaints of worsening SOA x4 days with associated fever, cough, dizziness. Constitutional: Positive for diaphoresis, fatigue and fever. HENT: Positive for congestion. Respiratory: Positive for cough, chest tightness and shortness of breath. Hospital Course: Upon admission, patient required escalating oxygen requirements and was admitted to the ICU. She was intubated on 9/8 due to worsening hypoxia. She was treated with 10 days of IV dex and an empiric course of antibiotics with 2 days of Vanc and 7 days of Cefepime. CT PE was obtained which showed no PE. Her course was complicated by mucus plugging on 9/10 requiring bronchoscopy. She was found to have aspergillus at that time and started on voriconazole for a 6week course. She was unable to be weaned from the vent and tracheostomy was performed on 9/27 by ENT. She also experienced Afib RVR during her hospitalization which required beta-blockade, diltiazem gtt, and amiodarone. On 10/1, she underwent bronchoscopy for BAL sample as concern for new VAP. That night, her O2 saturations decreased to the mid 80s sustaining. She also became hypotensive, requiring vasopressors. Patient is DNR/DNI and passed away on 10/02

Other Meds: gabapentin loperamide silvar sulfadiazine cream acetaminophen albuterol apixaban atorvastatin vitamin B complex chloraseptic lozenge breo ellipta bupropion XL citalolopram lomotil duloxetine furosemide insulin aspart insulin glargine magn

Current Illness: N/A

ID: 1807591
Sex: M
Age: 76
State:

Vax Date: 02/08/2021
Onset Date: 10/05/2021
Rec V Date: 10/22/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: breakthrough COVID1-19 case

Other Meds:

Current Illness:

ID: 1807592
Sex: F
Age: 88
State: MA

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

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

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1807593
Sex: M
Age: 49
State: IN

Vax Date: 02/03/2021
Onset Date: 08/25/2021
Rec V Date: 10/22/2021
Hospital:

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

Lab Data: CT angio upper extremity left arm with and without IV contrast. Medications administered: Iopamidol (ISOVUE-370) at 3:15 pm on October 21, 2021. Morphine (2:38 pm and 5:20 pm) on October 21, 2021.

Allergies: Penicillin.

Symptom List: Injection site pain, Pain

Symptoms: Numbness and soreness in my left arm (sight of injection); lasting for months. In August, I began experiencing symptoms similar to thrombosis with thrombocytopenia syndrome, and blood clots. On October 10, I developed a clot in the tip of my left ring finger, after extreme pain in my entire left arm. On October 21, I went to the emergency room.

Other Meds: None.

Current Illness: None.

ID: 1807594
Sex: M
Age: 65
State:

Vax Date: 09/08/2021
Onset Date: 09/08/2021
Rec V Date: 10/22/2021
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: Patient received a second dose of Janssen against recommendations

Other Meds:

Current Illness:

ID: 1807739
Sex: F
Age: 89
State: NH

Vax Date: 10/21/2021
Onset Date: 10/21/2021
Rec V Date: 10/22/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient presented at a mobile clinic, an assisted living facility where she lives. She Informed the vaccination team that she wanted to get a Covid booster shot and filled out a consent form. After the dose was administered, it was discovered that she had just received her 2nd dose in the series one week previously at another clinic. The 3rd booster dose was given too soon after the 2nd dose. As of today, no adverse events have been witnessed after this administration error.

Other Meds:

Current Illness:

ID: 1807740
Sex: M
Age: 58
State: WV

Vax Date: 10/12/2021
Onset Date: 10/14/2021
Rec V Date: 10/22/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Hives all over the body, itchy and loss of sleep. Zyrtec and cortisone creams did not help. Ended up with steroids and a antibiotic,

Other Meds: Lexapro, Cymbalta

Current Illness:

ID: 1807741
Sex: F
Age: 47
State: PA

Vax Date: 10/13/2021
Onset Date: 10/13/2021
Rec V Date: 10/22/2021
Hospital:

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

Lab Data: none

Allergies: none

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: rapid heart rate for two days after; difficulty sleeping. Kidneys ached afterwards. Also felt my organs in my front lower portion of body ache as well. Everything subsided by that Friday 10/15.

Other Meds: multi-vitamin, D3 supplement, fish oil, vitamin C, Gaia Adrenal support

Current Illness: none

ID: 1807742
Sex: F
Age: 41
State: VA

Vax Date: 06/14/2021
Onset Date: 06/16/2021
Rec V Date: 10/22/2021
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: NOne- I was perfectly healthy

Allergies: None

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

Symptoms: I began having painful- heavy clot like periods every other week about 3 days after i received my first injection. The injection site also became magnetic. I could put a refrigerator magnet on my arm and it would connect.

Other Meds: Prozac daily clozapam as needed

Current Illness: NONE

ID: 1807743
Sex: F
Age: 30
State: TN

Vax Date: 10/18/2021
Onset Date: 10/20/2021
Rec V Date: 10/22/2021
Hospital:

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

Lab Data:

Allergies: Codeine, penicillin, doxycycline, bactrim

Symptom List: Nausea

Symptoms: I have the Nexplanon implant and have not had a period since I had it. Two days after my second dose of the Covid vaccine I am now having a full period.

Other Meds:

Current Illness:

ID: 1807744
Sex: F
Age: 79
State: MI

Vax Date: 02/18/2021
Onset Date: 10/21/2021
Rec V Date: 10/22/2021
Hospital: Y

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

Lab Data:

Allergies: nka

Symptom List: Injection site pain

Symptoms: Pt hospitalized for shortness of breath, and heart failure. Pt developed a fever and mental status change while hospitalized and was tested for COVID which came back positive. Pt admitted on 10/15 and tested on 10/21/21. Pt currently hospitalized on 3L o2.

Other Meds: Metformin, plavix, eliquis, cozaar, pantoprazole, ropinirole, glipizide, amiodarone, budesonide-formorterol, albuterol.

Current Illness:

ID: 1807745
Sex: F
Age: 40
State: CT

Vax Date: 09/29/2021
Onset Date: 10/12/2021
Rec V Date: 10/22/2021
Hospital:

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

Lab Data: Treadmill stress test; MRI stress test

Allergies: none

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

Symptoms: Was originally scheduled for a treadmill stress test due to chest pain that began PRIOR to receiving the 3rd dose. That test resulted in an abnormal stress echocardiogram. Chest pain was different after test, and since the results were abnormal, they sent me for a stress MRI, which also yielded abnormal results.

Other Meds: prenatal vitamins, vitamin d, probiotic, biotin

Current Illness: possible acid reflux

ID: 1807746
Sex: F
Age: 73
State:

Vax Date: 05/19/2021
Onset Date: 10/15/2021
Rec V Date: 10/22/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series

Other Meds:

Current Illness:

ID: 1807747
Sex: F
Age: 53
State: VA

Vax Date: 10/21/2021
Onset Date: 10/21/2021
Rec V Date: 10/22/2021
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: On 21 October 2021, 53 year old female received 2nd dose of pfizer. Pt started having symptoms of itchiness around the local area after waiting for 15 minutes. Pt received 1st dose 28 September 2021 and states this happened when she received her first dosed. Pt was transported to ER. Pt did not receive EPI.

Other Meds:

Current Illness:

ID: 1807748
Sex: M
Age: 44
State:

Vax Date: 02/11/2021
Onset Date: 10/14/2021
Rec V Date: 10/22/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series

Other Meds:

Current Illness:

ID: 1807749
Sex: M
Age: 81
State: NC

Vax Date: 10/14/2021
Onset Date: 10/14/2021
Rec V Date: 10/22/2021
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: Administration Error, patient received 1/2 dose instead of full dose for 3rd dose

Other Meds:

Current Illness:

ID: 1807750
Sex: M
Age: 36
State: MN

Vax Date: 10/18/2021
Onset Date: 10/19/2021
Rec V Date: 10/22/2021
Hospital:

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

Lab Data: Na

Allergies: None

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

Symptoms: Right axillary lymphadenopathy (still ongoing) with ongoing edema of right axilla, flank and abdomen (ongoing). Seems to be slowly improving.

Other Meds: None

Current Illness: None

ID: 1807752
Sex: F
Age: 68
State: NC

Vax Date: 10/14/2021
Onset Date: 10/14/2021
Rec V Date: 10/22/2021
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: patient received 1/2 dose instead of full dose for 3rd dose

Other Meds:

Current Illness:

ID: 1807754
Sex: M
Age: 70
State:

Vax Date: 08/23/2021
Onset Date: 10/15/2021
Rec V Date: 10/22/2021
Hospital: Y

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: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series

Other Meds:

Current Illness:

ID: 1807755
Sex: F
Age: 53
State: FL

Vax Date: 08/12/2021
Onset Date: 09/12/2021
Rec V Date: 10/22/2021
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 at time of evaluation

Allergies: Aspirin, Venofer, Sulfa

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

Symptoms: 1 month after vaccine started w/pain at injection site, radiating down arm. Weakness and pain to left hand/wrist w/swelling. Weakness affecting grip and function.

Other Meds: Amlodipine, Losartan, Pantoprazole, Carvedilol and fioricet

Current Illness: N/A

ID: 1807756
Sex: M
Age: 85
State: CA

Vax Date: 10/14/2021
Onset Date: 10/19/2021
Rec V Date: 10/22/2021
Hospital:

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

Lab Data: I had Telephone consultation with my Doctor substitute on Oct.20 at 5:00PM But I did not raise my high blood pressure might be VAERS.

Allergies: Peniciline

Symptom List: Pain in extremity

Symptoms: My blood pressure went up 155/67 on Oct. 19, 210/69 on Oct 20, 210/69, Oct. 21 184/74 and continue high until now.

Other Meds: Lisinopril 20mg Amlodipine 5mg

Current Illness: High Blood Pressure, Diabetic, kidney problem

ID: 1807757
Sex: F
Age: 49
State: MA

Vax Date: 10/08/2021
Onset Date: 10/15/2021
Rec V Date: 10/22/2021
Hospital:

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

Lab Data:

Allergies: NKDA, dust/dust mite allergies

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

Symptoms: One week after having Pfizer Booster dose #3 on 10-8-2021, administered in Right hip IM by my request I developed small patch of vesicular sensitive lesions on right flank consistent appearance and location of Shingles/zoster. At age 49 somewhat unusual/young. Visual diagnosis as commonly done confirmatory immediately upon arising on 10-15-2021 by myself as practicing NP and colleague physician/internist on site with me when rash identified. Next day more classic vesicular features seen - photos taken. Saturday though so no culture done and not deemed necessary. Minimal pain, immediately started Antiviral therapy highly effective- contained the rash without escalation of lesions or symptoms. Today is one week out and seems contained/resolving.

Other Meds: Saxenda, Melatonin, NAC, vitamin D3, B12

Current Illness: none

ID: 1807758
Sex: M
Age: 19
State: DE

Vax Date: 10/19/2021
Onset Date: 10/19/2021
Rec V Date: 10/22/2021
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

Allergies: none

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

Symptoms: Patient is a 19 year old military personnel; on 09/24/2021 received his first dose of Covid-Pfizer at our clinic, on 10/19/2021 the patient went to a local to finish his covid vaccine series. On 10/21/2021 the patient brought his vaccine records to be updated in the immunization tracking system. I noticed that the patient records stated that he received Moderna instead of Pfizer for his second dose. Patient states he felt body aches after receiving his second shot.

Other Meds: unk

Current Illness: unk

ID: 1807759
Sex: M
Age: 82
State:

Vax Date: 06/02/2021
Onset Date: 10/15/2021
Rec V Date: 10/22/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Admitted to Hospital on Date of Adverse Event for treatment of Covid-19 Positive following completion of Covid Vaccine Series

Other Meds:

Current Illness:

ID: 1807760
Sex: F
Age: 46
State: DC

Vax Date: 04/07/2021
Onset Date: 04/07/2021
Rec V Date: 10/22/2021
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: None

Symptom List: Vomiting

Symptoms: General Malaise, Lightheadedness, Sleepy, Extended Throbbing Upper Left Arm, Excruciating Upper Left Arm Pain, Limited Left Arm and Shoulder Mobility

Other Meds: Solimo Adult Multivitamin Gummie, Solimo Vitamin D3 Gummie, Low Dose Aspirin

Current Illness: None

ID: 1807761
Sex: M
Age: 49
State: OR

Vax Date: 04/05/2021
Onset Date: 04/06/2021
Rec V Date: 10/22/2021
Hospital:

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

Lab Data: Went to emergency room, they ran several tests checking for clots in my brain and lungs with a CT scan with and without contrast dye and found no clots. They had no explanation for what was happening to me.

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Within 24 hours of the 2nd shot I had a fever that lasted 9 days of 103?, severe joint pain that lasted 17 days, I have had a constant headache behind and above my eyes that has not gone away since getting the second vaccine shot, tightness of the chest that comes and goes, I have had blurred vision especially in low light making it really hard to see, eyes have had a really hard time focusing in low light situations and I can no longer drive at night without lights blinding me, making lights look like bright stars. I am tired all the time and have no energy since getting the second vaccine shot.

Other Meds: ibuprofen, oxycodone,methocarbamol

Current Illness: none

ID: 1807762
Sex: M
Age: 55
State: GA

Vax Date: 10/21/2021
Onset Date: 10/22/2021
Rec V Date: 10/22/2021
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: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: headache, light headed, body ache, chills

Other Meds: None

Current Illness: None

ID: 1807763
Sex: F
Age: 67
State:

Vax Date: 04/06/2021
Onset Date: 10/15/2021
Rec V Date: 10/22/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series

Other Meds:

Current Illness:

ID: 1807764
Sex: F
Age: 46
State: FL

Vax Date: 10/01/2021
Onset Date: 10/03/2021
Rec V Date: 10/22/2021
Hospital:

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

Lab Data:

Allergies: Shellfish, iodine

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

Symptoms: 9 of 10 pain in my jaw and under tongue and extreme swelling in my mouth lasting one week, tongue swelling, swelling of glands in mouth and jaw thereafter; diarrhea, anal swelling sensitivity and itching ongoing and mouth and continued mouth and jaw pain

Other Meds: None

Current Illness: None

ID: 1807765
Sex: F
Age: 24
State: MD

Vax Date: 08/03/2021
Onset Date: 08/04/2021
Rec V Date: 10/22/2021
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: 1. 12 hours after receiving vaccine I showed all symptoms of COVID 19 (I could not move) 2. I also began bleeding (menstrual) still have not stopped to this day.

Other Meds: none

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am