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: 1814749
Sex: F
Age: 66
State: WV

Vax Date: 03/31/2021
Onset Date: 04/03/2021
Rec V Date: 10/25/2021
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: Unable to walk. Was diagnosed with Guillain-Barre syndrome by healthcare provider.

Other Meds: None.

Current Illness: None.

ID: 1814750
Sex: M
Age: 32
State: NJ

Vax Date: 10/01/2021
Onset Date: 10/02/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: ER on 10/16: EKG / Chest x-ray came back clean Int Medicine doctor on 10/22: ordered Holter monitor (scheduled for 10/28), blood work (11/1), and echocardiogram (11/9)

Allergies: pollen/ragweed

Symptom List: Anxiety, Dyspnoea

Symptoms: Heart palpitations, changes in heart rate from simple tasks (induced by activity), extreme fatigue, muscle pain/tremors, joint pain, chest tightness, stomach pain and diarrhea, random electric shocks throughout different parts of the body. Onset was gradual for these symptoms and they seem to cycle randomly.

Other Meds: none

Current Illness: none

ID: 1814751
Sex: F
Age: 41
State: WI

Vax Date: 08/19/2021
Onset Date: 08/27/2021
Rec V Date: 10/25/2021
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: EKG, MRI, MRA, Blood Work

Allergies: Shell Fish Allergy

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

Symptoms: A week after the vaccination, I started to have pressure in my left eye. They at first thought it was a sinus infection. However, by Thursday, September 3rd, I have shadowed vision. Could not see clearly. Went to Medical Center, Eye Dr, and then a Specialist. After many tests including EKG, MRI, MRA, Blood Work, etc. It was determined I had an enflamed optic nerve. All other causes were ruled out. Date of vaccination and onset of symptoms determined vaccination was the cause. Still have not regained full vision in left eye.

Other Meds: None

Current Illness: None

ID: 1814752
Sex: M
Age: 74
State: KY

Vax Date: 04/01/2021
Onset Date: 10/23/2021
Rec V Date: 10/25/2021
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: Tested Positive for Covid

Other Meds:

Current Illness:

ID: 1814753
Sex: F
Age: 62
State: TX

Vax Date: 10/04/2021
Onset Date: 10/04/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data:

Allergies: Clindamycin, aspirin, albuterol, animal dander, seafood, cigarette smoking, household cleaning products,

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

Symptoms: Skin broken out in hives and eczema. Home treatment the first 7 days . Then called Prescribed hydr-oxyzine. I did want the steroids treatment. My skin cleared up on my neck and back of neck. I still have issue on my arms with the break out. I have a second dose 10.25.21 @12:00PM.

Other Meds: No

Current Illness: Carpal tunnel and a pinched nerve do not take any medication only physical therapy. I have allergic reaction due to environmental and with some medication.

ID: 1814754
Sex: F
Age: 65
State: FL

Vax Date: 10/22/2021
Onset Date: 10/24/2021
Rec V Date: 10/25/2021
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: Feathers, codeine

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

Symptoms: Tinnitus. Blocked right ear, pressure. Eye Pressure right side. Similar to 1st dose back in March 17, Moderna. ( I filed that review with you back then ) Insomnia , I feel my thyroid level are off. Hypothyroid symptoms returning and upping my meds hoping to resolve? Phantom smells have returned more frequent now too. I skipped 2nd dose back in April due to these side effects. The ear issues resolved but still had Tinnitus, decided to get the Booster 1/2 dose thinking the side effects would be less severe? ( Had my antibodies checked at 6 months and they were still detectable, 37,

Other Meds: Levothyroxine - Hashimoto's Disease and Hypothyroidism

Current Illness: Hashimoto's Disease /Hypothyroidism, Porokeratosis, DSAP, DDD, arthritis

ID: 1814755
Sex: F
Age: 19
State: OR

Vax Date: 10/24/2021
Onset Date: 10/24/2021
Rec V Date: 10/25/2021
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: About 2 hours after the vaccine, Patient reported feeling like her body caught fire. By 8pm she was in so much pain she couldn?t move. 12 hours later, she claims she has never felt this pain before and is worse than the worst pain she?s ever felt which was her abortion.

Other Meds:

Current Illness: Had a bad cold about 2 weeks ago.

ID: 1814756
Sex: F
Age: 48
State: MT

Vax Date: 10/21/2021
Onset Date: 10/22/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data:

Allergies: exercise-induced food allergies

Symptom List: Pharyngeal swelling

Symptoms: 3 days later had clots in left calf, felt like blood pressure cuff inside of different places in lower leg cutting off feeling below and causing pressure up to hip. It was only mostly resolved by taking about 1200 FU of nattokinase twice six hours apart.

Other Meds: only taking multi-vitamins maybe

Current Illness: long-haul COVID

ID: 1814758
Sex: F
Age: 32
State: MI

Vax Date: 03/04/2021
Onset Date: 10/22/2021
Rec V Date: 10/25/2021
Hospital: Y

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

Lab Data: COVID-19 test positive on 10/22/2021

Allergies: Metformin (nausea, vomiting)

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient presented to emergency department on 10/20/2021 complaining of nausea, vomiting, and generalized pain for past 5 days. She fell down stairs, which led her to calling ambulance. She was admitted for further management. Patient found to be COVID-19 positive on 10/22/2021. Patient was discharged home on 10/24/2021.

Other Meds: glipizide (GLUCOTROL) 10 MG tablet Insulin Glargine (LANTUS SOLOSTAR) 100 UNIT/ML PEN injection naproxen (NAPROSYN) 500 mg tablet

Current Illness: None known

ID: 1814759
Sex: M
Age: 62
State: VA

Vax Date: 10/23/2021
Onset Date: 10/23/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Client for additional dose. 1st dose Janssen. Client requested Moderna additional dose. Client rec'd Moderna, 0.5ml Moderna. Client should have received 0.25ml Moderna dose. Client informed of wrong dose via telephone on 10/25/2021. Client informed that there is no evididence of harm from receiving this dose.

Other Meds: unknown

Current Illness:

Date Died: 10/25/2021

ID: 1814760
Sex: F
Age: 28
State: CA

Vax Date: 08/01/2021
Onset Date: 10/25/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: Coronary angiography EKG - Positive for ST segment elevation DDimer 1031, Trop 0.053, BNP 1431

Allergies: None

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

Symptoms: Approximately 3-5 week after 2nd dose of vaccine patient experience Myocardial Infarction. Angiography revealed diffuse thrombus in coronary arteries and enlarged heart. Pulmonary Embolism is not excluded. Patient expired during angiogram procedure

Other Meds: unknown

Current Illness: Unknown

ID: 1814761
Sex: F
Age: 74
State:

Vax Date: 10/21/2021
Onset Date: 10/21/2021
Rec V Date: 10/25/2021
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: Polyethylene glycol (taken orally) I did not have a reaction to vaccine doses 1 and 2. Biaxin Sulpha drugs

Symptom List: Rash, Urticaria

Symptoms: I was watching TV and dozing on and off, when I was jolted upright by an instantaneous and sharp pain across my upper back. I has some tightness in my chest and my breathing became a little labored. The pain was extreme and I thought maybe it was a heart attack. I called the local hospital and the person who answered the phone called the on -call doctor at my PCP's office, which is affiliated with the hospital. I was instructed to call the hospital back if I hadn't heard from the doctor within 20 minutes. The doctor called and I explained what at happened. By then the pain was slightly diminished. The doctor said she didn't know if it was related to the booster shot, and added that if it was a heart attack the pain would be constant. She said that if it got unbearable that I should come to the hospital. The pain continued to diminish, but moved from my back to the area of my right lung (front and back). It took two hours for most of the pain to subside. I did not need to go to the hospital.

Other Meds: Ibuprofen Advair inhaler Multi-vitamin Calcium and vitamin D supplement Fish oil supplement Gingko Biloba herbal supplement

Current Illness: None

ID: 1814762
Sex: M
Age: 82
State: KY

Vax Date: 03/31/2021
Onset Date: 10/18/2021
Rec V Date: 10/25/2021
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: Tested Positive for Covid

Other Meds:

Current Illness:

ID: 1814763
Sex: F
Age: 32
State: IL

Vax Date: 10/22/2021
Onset Date: 10/24/2021
Rec V Date: 10/25/2021
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: None

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

Symptoms: Patchy redness on skin below injection site. Does not itch and there are no bumps.

Other Meds: Wellbutrin 100mg qam Lexapro 5mg qam

Current Illness: None

ID: 1814764
Sex: F
Age: 59
State: WV

Vax Date: 09/15/2021
Onset Date: 09/22/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: no medical tests

Allergies: codene

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

Symptoms: I have had vertigo most of my life. It is not an inner ear issue and through intense testing i have vestibular migraines which causes the vertigo. I was put on zoloft and have not had a vertigo episode in about 5 years give or take (i do not remember the dates) about a week after taking the j and j covid vaccine, my vertigo has returned. the first sign was around 2 in the morning when i woke to use the bathroom. from then on every morning and throughout the day i am miserable. i have to be careful what i do, how i turn etc or it will set off a severe episode. my quality of life as gone down hill since receiving the vaccine. i had so many good years of waking feeling great and not having to worry about the effects of vertigo. Now i am back to where i was years ago. My dosage of zoloft has been increased to the maximum amount i can take but it is not helping. I am sorry i ever got the vaccine.

Other Meds: Bupropion 150mg 1x daily Famotidine 40mg 1xbedtime Sertaline 150mg 1x daily omeprazole 40 mg 1 x daily echinacia

Current Illness: none

ID: 1814765
Sex: F
Age: 16
State: SC

Vax Date: 10/25/2021
Onset Date: 10/25/2021
Rec V Date: 10/25/2021
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: None reported

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

Symptoms: Vaccine was given to 16 year old patient, briefly complained of dizziness, but resolved after observation.

Other Meds: None reported

Current Illness: None

ID: 1814766
Sex: M
Age: 51
State: TX

Vax Date: 10/05/2021
Onset Date: 10/06/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: Waiting results

Allergies: Penicillin

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

Symptoms: Headaches for the past several weeks, possible Bells Palsy. Getting CT scan to rule out brain bleeds

Other Meds: ASPIRIN EC 81 MG TABLET LIOTHYRONINE SOD 5 MCG TAB LOSARTAN POTASSIUM 50 MG TAB ROSUVASTATIN CALCIUM 20 MG TAB CARVEDILOL 6.25 MG TABLET NOVOLOG 100 UNIT/ML VIAL LEVOTHYROXINE 150 MCG TABLET

Current Illness: None

ID: 1814767
Sex: F
Age: 42
State: CA

Vax Date: 10/21/2021
Onset Date: 10/23/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data:

Allergies: Allergic to proteins in bee/wasp venom and severe anti-coagulant proteins in mosquito bites.

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Sore tender arm for 4 days. Headache. I started to menstruate a week early, beginning yesterday, 10/24/2021. Today, 10/25/21 I woke with severe cramping and inflammation in the area around my uterus. The cramping is causing me to miss work today which isn't normal for me.

Other Meds: Advil Dual Action, Tumeric, Cinnamon blood sugar regulator

Current Illness: None

ID: 1814768
Sex: M
Age: 28
State: MD

Vax Date: 12/24/2020
Onset Date: 03/02/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: EKG, troponins, CT scan

Allergies: N/A

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Pleuritic chest pain in middle of night, presented to ED, anti-inflammatory meds, steroids, arrhythmia

Other Meds: Fluoxetine

Current Illness: N/A

ID: 1814769
Sex: M
Age: 75
State: CT

Vax Date: 10/22/2021
Onset Date: 10/22/2021
Rec V Date: 10/25/2021
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: Sulfa

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

Symptoms: At first, no arm pain. About 4 hours later ....very fatigued, plus swollen hands ....slept for about 2 hours ...when awake ...no further symptoms. Since that afternoon real arm pain for the next two days, then gone. I am emailing these side effects because I could not get into the VSafe response system to report these side effects. Thank you.

Other Meds: None

Current Illness: None

ID: 1814770
Sex: F
Age: 61
State: TN

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

Allergies: amoxicillin; augmentin; cipro; iodine; morphine, oxycontin; shellfish

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

Symptoms: Breakthrough hospitalization for COVID19 in vaccinated patient

Other Meds: aspirin; folic acid; hydroxyzine; losartan; mobic; multivitamin; oxybutynin; prolia; propranolol; sertraline; tramadol

Current Illness:

ID: 1814771
Sex: F
Age: 14
State: WI

Vax Date: 06/08/2021
Onset Date: 06/24/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: Comprehensive Blood and LIver testing including Ultrasounds and Liver Biopsy due to hair loss and increased liver functions. Testing and Procedure dates - all 2021: July 27 July 30 Aug 13 Aug 24 Sept 7th, Oct 12 Oct 21

Allergies: None

Symptom List: Unevaluable event

Symptoms: Increased liver enzyme levels, hair loss within 2 weeks of 2nd dose. No previous familial history of autoimmune disorders Both autoimmune Hepatitis and Alopecia have been diagnosed in my daughter since her vaccinations

Other Meds: Daily Multivitamin

Current Illness: None

ID: 1814772
Sex: M
Age: 41
State: KY

Vax Date: 04/29/2021
Onset Date: 10/17/2021
Rec V Date: 10/25/2021
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: Tested Positive for Covid

Other Meds:

Current Illness:

ID: 1814773
Sex: F
Age: 41
State: IN

Vax Date: 10/22/2021
Onset Date: 10/23/2021
Rec V Date: 10/25/2021
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: None

Symptom List: Injection site pain, Pain

Symptoms: Fever, chills, body aches, joint pain all of which lasted 36 hours

Other Meds: Fluoxetine 40mg daily

Current Illness: None

ID: 1814774
Sex: M
Age: 65
State: KY

Vax Date: 03/10/2021
Onset Date: 09/11/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: Tested POSITIVE 9/13/2021

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Started running a fever, muscle aches, headache , fatigue, coughing , wheezing and shortness of breath and Congestion being other symptom not listed on the case report form.

Other Meds:

Current Illness:

ID: 1814775
Sex: M
Age: 26
State: MS

Vax Date: 10/22/2021
Onset Date: 10/22/2021
Rec V Date: 10/25/2021
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: none

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

Symptoms: 1 hour after receiving vaccination - and since this time - he has been having hot flashes (cannot cool off), generalized body aches, weakness, intermittent dizziness and nausea/vomiting.

Other Meds: none

Current Illness: none

ID: 1814776
Sex: F
Age: 48
State: WV

Vax Date: 10/07/2021
Onset Date: 10/08/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Extreme fatigue

Other Meds: Norvasc 10 mg; HCTZ 25 mg; Prilosec 20 mg; vitamin B12

Current Illness: none

ID: 1814777
Sex: F
Age: 79
State: MI

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

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

Lab Data: COVID-19 test positive on 10/22/2021

Allergies: Bactrim (rash), amoxicillin (hives)

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient presented to emergency department on 10/22/2021 with bloody, loose stool. She reported having symptoms of cough and sinus drainage about a week before presentation. She was found to be COVID-19 positive during admission screening. Patient required no supportive care for management of COVID-19 symptoms during admission.

Other Meds: acidophillus/lactobacillus (FLORANEX) chew tablet amLODIPine (NORVASC) 10 MG tablet aspirin (HALFPRIN) 81 MG tablet calcium (OSCAL) 500 MG tablet fluticasone (FLONASE) 50 MCG/ACT nasal inhaler levothyroxine (SYNTHROID) 75 MCG tablet pravaST

Current Illness: None known

ID: 1814778
Sex: M
Age: 72
State: GA

Vax Date: 10/14/2021
Onset Date: 10/14/2021
Rec V Date: 10/25/2021
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: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: Since 10/14/21 pt complains of a fluid moving around in his head when he turns over in bed

Other Meds: Lisinopril carvetolow

Current Illness:

ID: 1814779
Sex: F
Age: 48
State: WA

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: Office visit with primary care physician diagnosis with SIRVA (10/21/21)

Allergies: cucumbers, macadamia nuts, red peppers

Symptom List: Nausea

Symptoms: about 4 hours post-injection, pain began in neck and shoulder accompanied by a severe headache. A couple hours later pain radiating down arm and numbness/tingling in fingers.Next day--neck, front and back of shoulder in severe pain. Mobility and range of motion extremely limited. Pain and symptoms continuing at present.

Other Meds: oral birth control

Current Illness: none

ID: 1814780
Sex: F
Age: 62
State: OH

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: Got xray of right knee that showed advanced arthritis. PCP referred me to orthopeadic for knee replacement.

Allergies: Morphine, penicillin

Symptom List: Injection site pain

Symptoms: Severe pain in both knees, getting up and down from chair increased the pain. Left knee pain subsided in about 5-6 days. Right knee got worse. At my PCP on 10/14/2021 and she looked at knee. Got a x-ray on 10/15. Showed advanced arthritis and referred to an orthopeadic surgeon to consider a knee replacement.

Other Meds: HCTZ, K+Cl,Pantoprazole,Atorvastatin,Albuterol,Symbocort,Allopurinol,VitD2,Calcitroil,Methotrexate,Enbrel,folic acid,Gabapentin,Cymbalta,Leucovorin,Tramadol,Loratidine,Turmeric,daily multivitamin.

Current Illness: Covid 19

ID: 1814782
Sex: F
Age: 57
State: KY

Vax Date: 08/13/2021
Onset Date: 10/17/2021
Rec V Date: 10/25/2021
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: Tested Positive for Covid

Other Meds:

Current Illness:

ID: 1814783
Sex: F
Age: 47
State: MA

Vax Date: 02/16/2021
Onset Date: 05/31/2021
Rec V Date: 10/25/2021
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: none

Allergies: Penicillin Vicodin

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

Symptoms: Soreness at injection site, body aches

Other Meds: Omeprazole Probiotic

Current Illness: Shingles flare up

ID: 1814784
Sex: F
Age: 71
State: IA

Vax Date: 10/22/2021
Onset Date: 10/22/2021
Rec V Date: 10/25/2021
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: None.

Symptom List: Tremor

Symptoms: Sore arm, pain in the arm pit up to neck area, unable to use arm properly.

Other Meds: None.

Current Illness: None.

ID: 1814785
Sex: M
Age: 58
State: MA

Vax Date: 02/20/2021
Onset Date: 09/29/2021
Rec V Date: 10/25/2021
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: covid positive test on 9/29/21 chest x ray impression on 9/29/21: no acute abnormality chest x ray impression on 10/6/21: acute process, consistent with history of covid pneumonia

Allergies: aspirin, shrimp

Symptom List: Erythema, Pruritus

Symptoms: Patient tested positive for covid at urgent care then presented to ED on 9/29/21 with fatigue, chills, and cough. Patient is fully vaccinated. Patient was properly treated for covid and was discharged on 10/9/21.

Other Meds: symbicort, calcitriol, vitamin d3, diltiazem, fluticasone, loratadine, omeprazole, polyethlyene glycol, prednisone

Current Illness: N/A

ID: 1814786
Sex: F
Age: 57
State: FL

Vax Date: 10/13/2021
Onset Date: 10/13/2021
Rec V Date: 10/25/2021
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: n/a

Allergies: Codeine Sulfate

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

Symptoms: Patient received first dose of Flucelvax on 9/15/2021 along with her first COVID-19 vaccine. Flu clinic was on 10/13/2021 and patient showed up to receive flu shot while thinking the clinic was for COVID-19 second dose. I reached out to patient to inform her and addressed any concerns and or side effects that she might have experienced. Patient stated she had no side effects and that she felt fine and that she will look out for any future side complications that she might experience.

Other Meds: n/a

Current Illness: n/a

Date Died: 10/19/2021

ID: 1814787
Sex: F
Age: 89
State: TN

Vax Date: 09/14/2021
Onset Date: 10/08/2021
Rec V Date: 10/25/2021
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:

Allergies: Cephalexin and codeine

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

Symptoms: Breakthrough hospitalization of vaccinated COVID19 patient. Pt was DNR with a history of major neurocognitive disorder. Pt had acute non-ST elevation myocardial infection. Family made patient comfort care and she passed away on 10/19.

Other Meds: Cholecalciferol; DHEA; Docusate; Ferrous Sulfate; levothyroxine; nitrostat;

Current Illness:

ID: 1814788
Sex: F
Age: 78
State: MI

Vax Date: 01/18/2021
Onset Date: 09/26/2021
Rec V Date: 10/25/2021
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:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: suspected breakthrough case, hospitalization

Other Meds:

Current Illness:

ID: 1814789
Sex: M
Age: 59
State: KY

Vax Date: 08/13/2021
Onset Date: 10/21/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Tested Positive for Covid

Other Meds:

Current Illness:

ID: 1814790
Sex: F
Age: 58
State: MI

Vax Date: 10/23/2021
Onset Date: 10/24/2021
Rec V Date: 10/25/2021
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: No

Allergies: minocycline

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

Symptoms: About 12 hours after the shot I developed muscle aches, chills and sweats. The following day 10/24 I still had muscle aches and chills. This morning on 10/25 I developed a rash on my torso running across my body under my bra line. Rash isn't itchy, warm or painful. I developed these same exact symptoms with my 2nd dose of the Pfizer vaccine which I had on 3/24/21 lot#EN6199. I believe my healthcare provider reported that one, but not sure.

Other Meds: none

Current Illness: non

ID: 1814791
Sex: M
Age: 24
State: ID

Vax Date: 10/23/2021
Onset Date: 10/23/2021
Rec V Date: 10/25/2021
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: Patient was given 0.3mL of the Pfizer vaccine mixed with 1.8mL of the diluting saline. He was watched for over an hour without any SE. He was monitored overnight without SE. Since then, he reported only "sore arm" at the vaccination site. No other sequelae to report.

Other Meds:

Current Illness:

ID: 1814792
Sex: F
Age: 71
State: NJ

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

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

Lab Data:

Allergies:

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

Symptoms: PATIENT REPORTED INFLAMED LYMPH NODE

Other Meds:

Current Illness:

ID: 1814793
Sex: F
Age: 70
State: PA

Vax Date: 10/25/2021
Onset Date: 10/25/2021
Rec V Date: 10/25/2021
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: NKA

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

Symptoms: Patient was inadvertantly given 0.3 ml of undiluted Pfizer vaccine. Patient was called twice immediately after this was discovered to notify her of the error. She did not answer either call. A voicemail was left with instructions to call back ASAP with the store number and my cell phone number. I will continue to call the patient until she answers. I will tell her what adverse effects to watch for and what do if she experiences them. She will be given my cell phone number to call if she has any further questions. I will plan on checking in with her later today and several times over the next few days/weeks.

Other Meds: Unknown

Current Illness: Unknown

ID: 1814794
Sex: M
Age: 35
State: MN

Vax Date: 01/25/2021
Onset Date: 10/24/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: Test via ABBOTT ID NOW COVID-19 on 10/25/2021

Allergies:

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

Symptoms: Wife not fully vaccinated was COVID (+) 10/19 Patient was tested 10/22 results negative; developed headache Sunday night and was tested on Monday 10/25 with (+) results. Patient is a chiropractor who was fully vaccinated and will quarantine for 10 days before returning to his practice.

Other Meds:

Current Illness:

ID: 1814795
Sex: F
Age: 42
State: UT

Vax Date: 10/02/2021
Onset Date: 10/02/2021
Rec V Date: 10/25/2021
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:

Symptom List: Vomiting

Symptoms: Intense headaches/migraines for 3 weeks following the second dose.

Other Meds: Ibuprofen

Current Illness:

ID: 1814796
Sex: F
Age: 43
State: IN

Vax Date: 10/24/2021
Onset Date: 10/01/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: None

Allergies: NA

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Body aches Chills

Other Meds: Citalopram Wellbutrin

Current Illness: NA

ID: 1814797
Sex: M
Age: 54
State: ND

Vax Date: 10/16/2021
Onset Date: 10/18/2021
Rec V Date: 10/25/2021
Hospital: Y

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: Patient reports thrombocytopenia of 6500 and was hospitalized.

Other Meds:

Current Illness:

ID: 1814798
Sex: F
Age: 47
State: IN

Vax Date: 10/19/2021
Onset Date: 10/19/2021
Rec V Date: 10/25/2021
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:

Allergies: Morphine

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Bad stomach cramps

Other Meds: Amlodipine, Omeprazole and Bayer baby aspirin

Current Illness: No

ID: 1814799
Sex: F
Age: 78
State: KY

Vax Date: 03/05/2021
Onset Date: 10/20/2021
Rec V Date: 10/25/2021
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: Tested Positive for Covid

Other Meds:

Current Illness:

ID: 1814800
Sex: M
Age: 51
State: WI

Vax Date: 10/22/2021
Onset Date: 10/22/2021
Rec V Date: 10/25/2021
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: Pravastatin, Relpax, Effexor, Savella, Cymbalta, Amitryptline, Atorvostatin, Meloxicam, Topamax, Livalo

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

Symptoms: Headache. Severe, crippling muscle pain and weakness throughout entire body. Started about 11:30 pm Friday 10/22/2021 lasted until Monday 10/25/2021.

Other Meds: Omeprazole, Gabapentin, Lisinopril, Fenofibrate, Diazepam, Nadolol, Cyclobenzapr, Jardiance, Lavaza

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am