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: 1818880
Sex: F
Age: 64
State: MD

Vax Date: 04/10/2021
Onset Date: 04/17/2021
Rec V Date: 10/26/2021
Hospital:

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

Lab Data: Urgent Care 6/2/21 Unspecified otitis externa, bilateral. The suggested that I see a specialist. I went to family doctors on 6/5/21 Dr. tested and examined my ears and could find no apparent cause for the tinnitus. The ENT Care 06/14/21. Comprehensive hearing test, Tympanometry all negative for anything apparently wrong with my ears.

Allergies: shellfish, iodine, penicillin, codeine

Symptom List: Dysphagia, Epiglottitis

Symptoms: I have ringing in both ears that started after the vaccine. Never had it before. The ringing became constant on May 28, 2021. I went to urgent, my family doctor and any ear specialist. All could find to reason for the ringing and could offer no relief. It is now almost November 2021 and the ringing is still constant. I have trouble falling to sleep and hearing because the ringing and buzzing can be loud at times. The ringing wakes me up when I'm trying to sleep.

Other Meds: Eye Drops, Flonase Spray for seasonal allergies.

Current Illness: None.

ID: 1818881
Sex: F
Age: 63
State: KY

Vax Date: 09/26/2021
Onset Date: 10/10/2021
Rec V Date: 10/26/2021
Hospital:

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

Lab Data: C-diff toxin was negative urine culture negative blood tests: C-Reactive protein- High - .86mg/dl Anion gap - High - 15.1 mmol/L Monocyte, Absolute - High - .91 10*3/mm3

Allergies: Amoxicillian, Bactrim

Symptom List: Anxiety, Dyspnoea

Symptoms: I had a flu shot on 9/24. Onset of diarrhea began 2 weeks following Pfzier booster shot. Has been continuous ever since 10/10/21 with a mild case 2-4 soft stools per day. I have not had normal stools since 10/10.

Other Meds: Atorvastatin, Vitamin D, D-Mannose, Zyrtec

Current Illness: None

ID: 1818882
Sex: F
Age: 41
State: AK

Vax Date: 10/01/2021
Onset Date: 10/05/2021
Rec V Date: 10/26/2021
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: I had my regular lab work on before my booster shoot, 09/17/2021 and I haven't had labs done since then. Everything came back normal except epstein-barr Virus panel.

Allergies: I'm allergic Cipro and coffee

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

Symptoms: The first event happen after the second dose, I had joint pain all over my body and it came all of the sudden and they did labs for viral that came back abnormally high.

Other Meds: Estradiol, Testosterone, Progesterone, L-tyrosine Glutathione, pregnenolone,

Current Illness: N/A

ID: 1818884
Sex: F
Age: 16
State: CO

Vax Date: 04/28/2021
Onset Date: 04/30/2021
Rec V Date: 10/26/2021
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

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: I got swollen multiple lymph note (5/6) under armpit size of marble. Also large swollen lymph note size of tennis ball under collar bone was painful, didn't get smaller. Was prescribed: oxycodone 5mg -May 7th,=one pill , May 9th=two pills, Prednisone 50mg-3days, 25mg-2days. May 14th for 5days.

Other Meds: Tazarotene Cream .1% apply 1xday

Current Illness: None

ID: 1818885
Sex: F
Age: 57
State: MA

Vax Date: 10/09/2021
Onset Date: 10/09/2021
Rec V Date: 10/26/2021
Hospital:

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

Lab Data: PATIENT STATES SHE HAS SEEN HER MD FOR THIS

Allergies: NOT KNOWN

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

Symptoms: PER PATIENT SHE HAS BEEN HAVING CHILLS, FEELING FEVERISH BUT NO ACTUAL RAISED TEMPERATURE, DIARRHEA, HIGH BLOOD PRESSURE .

Other Meds: FLU SHOT ON 9/1/2021

Current Illness: NOT KNOWN

ID: 1818887
Sex: F
Age: 66
State: IA

Vax Date: 09/30/2021
Onset Date: 10/18/2021
Rec V Date: 10/26/2021
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: CT scan 10/21/21 Lab work 10/21/21

Allergies: propranolol

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

Symptoms: Nothing till around the 20th of October, then a headache that did not go away, then on thenight of 20th vomiting, headache reached migrain status, left side of face of my face went numb all the way to the bridge of my nose and ear burning and throbbing. When that happened, went to the ER.

Other Meds: Lisinopril amlodipine omeprazole asprin atorvastatin

Current Illness: Severe cold

ID: 1818888
Sex: F
Age: 65
State: GA

Vax Date: 09/10/2021
Onset Date: 09/11/2021
Rec V Date: 10/26/2021
Hospital:

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

Lab Data: I decided to get a Holter monitor around the second vaccine, to make check if i was having issue with my tachycardia . I used watch to also monitor my increased heart rate.

Allergies: Asprin, coffee msg and sage

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: The following day or two I had an increased on my Tachycardia and 7 days after you notice an inflammation on my arm.

Other Meds: Same prescriptions as dose 1

Current Illness: None

ID: 1818889
Sex: M
Age: 79
State: FL

Vax Date: 10/23/2021
Onset Date: 10/24/2021
Rec V Date: 10/26/2021
Hospital:

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

Lab Data: None

Allergies: None

Symptom List: Pharyngeal swelling

Symptoms: rash in upper arm area. Bump the size of maybe 40% baseball has moved from muscle to crook of arm. Article on "Ccovid arm" leads me to believe this is the reaction. Reporting for informational purposes.

Other Meds:

Current Illness:

ID: 1818890
Sex: F
Age: 71
State: OR

Vax Date: 08/16/2021
Onset Date: 10/04/2021
Rec V Date: 10/26/2021
Hospital:

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

Lab Data: I went to my doctor on Monday, Oct 25, 2021 and he said yes its a rash gave me a prescription for prednison. I have been taking benryl for the itchness.

Allergies: none

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: My face, neck and arms broke out in a itchy, swollen, sightly red warm rash. Its been 3 weeks and I still have it.

Other Meds: Blood pressure meds - lisinopril 40mg PreserVision ey vitamins Vitaimin D Vitaimin C

Current Illness: cold virus 1 month before

ID: 1818891
Sex: F
Age: 38
State: MO

Vax Date: 06/05/2021
Onset Date: 06/18/2021
Rec V Date: 10/26/2021
Hospital: Y

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

Lab Data: N/A

Allergies: N/A

Symptom List: Diarrhoea, Nasal congestion

Symptoms: 2 weeks after receiving the vaccine I started to have problems breathing. Started in the after noon on a Friday and I was wheezing like it was asthma. I have never had an issue with asthma or diagnosed with it. I woke up at 2 am and could not breath at all. Ended up calling an ambulance. They administered 2 breathing treatments on the way to the hospital. I had mentioned I had the vaccine 2 weeks to the day and they just ignored it. It is now 4 months later and am still having breathing issues and have to use an inhaler on the regular now.

Other Meds: N/A

Current Illness: N/A

ID: 1818892
Sex: F
Age: 47
State: WI

Vax Date: 10/18/2021
Onset Date: 10/20/2021
Rec V Date: 10/26/2021
Hospital:

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

Lab Data:

Allergies: Compazine Macrodantind

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

Symptoms: I am on the Depot shot and have not gotten my period in over 3 years. 48 hours of getting the COVID vaccine I had a very heavy menstrual cycle with cramps that lasted 1 week.

Other Meds: Cymbalta 60mg daily Trazadone 150mg daily Klonopin 0.5mg PRN Metoprolol 25mg daily

Current Illness:

ID: 1818893
Sex: M
Age: 34
State: OK

Vax Date: 04/12/2021
Onset Date: 05/18/2021
Rec V Date: 10/26/2021
Hospital: Y

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

Lab Data: MRI Brain, CT Brain, Lumbar puncture, Xray, routine labs

Allergies: none

Symptom List: Rash, Urticaria

Symptoms: Symptoms started 1 week prior to hospitalization. He was admitted to the Hospital May 23 or 24th with suspected alcohol withdrawl symptoms but upon routine testing all results came back negative for alcohol or drugs. From there the hospitalist ordered numereous testings of the brain. MRI could not rule out a stoke but could not verify. treated him for GBS since symptoms started 4 weeks after the covid shot was given. He remained in the hospital for 3 months and was moved to a nursing home. He is still unable to stand or put much weight on his legs. He has been handicapped since May.

Other Meds: unknown

Current Illness: none

ID: 1818895
Sex: M
Age: 23
State: UT

Vax Date: 10/25/2021
Onset Date: 10/26/2021
Rec V Date: 10/26/2021
Hospital:

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

Lab Data: N/A

Allergies: N/a

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

Symptoms: High fever (unknown temperature) severe chills. Severe sweating. Extreme muscle aches. Extreme joint aches (spine, back of knees especially). Headache for over 18 hours. Eye pain. Swelling feeling in the eyes.

Other Meds: Dupixent. Testosterone. Hcg.

Current Illness: None

ID: 1818896
Sex: M
Age: 45
State: TN

Vax Date: 08/11/2021
Onset Date: 08/11/2021
Rec V Date: 10/26/2021
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: No -

Allergies: No

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

Symptoms: Little Sore pain in the shot area for up to eight weeks - mostly off and on- Noticeable the most pain on week 6. Side-note, did-not use any gyms or any other physical labor of the arms for work activities.

Other Meds: Insulin

Current Illness: No

ID: 1818897
Sex: F
Age: 13
State: LA

Vax Date: 08/18/2021
Onset Date: 08/20/2021
Rec V Date: 10/26/2021
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: Chest X-ray 8/21 to 8/23, blood work8/21-8/23, and echo of the heart 8/21

Allergies: Shell fish, dust mites, and fire ants

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

Symptoms: Patient presented chest pain on 8/20/2021. On 8/21/2021 she was diagnosed with myocarditis. She was then hospitalized for three days. She received I igiv infusion durning her hospital stay.

Other Meds: Strattera 60mg and paroxetine 10mg

Current Illness: No

ID: 1818898
Sex: M
Age: 29
State: TX

Vax Date: 07/12/2021
Onset Date: 07/12/2021
Rec V Date: 10/26/2021
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 recorded

Allergies: no known allergies per patient

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

Symptoms: Patient described pain after 1st vaccine, and stated numbness and tingling and still complains of tingling sensation in affected arm. The 2 doses were given on left arm,

Other Meds: patient states none on record

Current Illness: patient states none on record

ID: 1818899
Sex: M
Age: 42
State: NC

Vax Date: 10/14/2021
Onset Date: 10/16/2021
Rec V Date: 10/26/2021
Hospital:

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

Lab Data: Not applicable

Allergies: No

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

Symptoms: I experienced a blackout while eating at a restaurant and was not respondent to his wife (jaw/neck tighten up). EMT responded and was able to get his blood pressure back up from 111/72 (low side of normal) and said that orange juice that he took stabilized his glucose. They wanted me to go to the hospital but I declined since I didn't pass out. I was advised that if the symptoms came back to go to the hospital ( blood pressure was taken and it was a back to normal).

Other Meds: I took my normal medications for diabetes: Metformin, Januvia, Glimepiride, and Ramipril

Current Illness: No

ID: 1818900
Sex: M
Age: 68
State:

Vax Date: 10/23/2021
Onset Date: 10/23/2021
Rec V Date: 10/26/2021
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: No unusual ADR notified at this time. It had to be half (0.25ml) of the original dose for booster, but was given full dose (0.5ml) that are usually given to the patient.

Other Meds:

Current Illness:

ID: 1818902
Sex: F
Age: 24
State: AZ

Vax Date: 08/02/2021
Onset Date: 08/20/2021
Rec V Date: 10/26/2021
Hospital:

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

Lab Data: none

Allergies: none

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: The three menstrual cycles following the vaccination were highly abnormal; irregular dates; with cycles beginning much closer together at a higher frequency. Much heavier blood loss than is typical, and extreme pain, in the back, hips and legs causing loss of consciousness, on one occasion. In the period of time following the vaccination no changes in birth control, sexual partners, diet or stress level occurred. These symptoms have persisted for three months.

Other Meds: none

Current Illness: none

ID: 1818903
Sex: M
Age: 72
State:

Vax Date: 10/23/2021
Onset Date: 10/23/2021
Rec V Date: 10/26/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: No unusual ADR notified at this time. It had to be half of the original dose for booster, but was given full dose that are usually given to the immunocompromised patient.

Other Meds:

Current Illness:

ID: 1818904
Sex: F
Age: 71
State: VA

Vax Date: 10/14/2021
Onset Date: 10/17/2021
Rec V Date: 10/26/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Unknown

Allergies: Dorzolamide

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

Symptoms: I spoke with patient via phone on 10/26/21. Patient called to inform us that after her COVID vaccine on 10/14/21, she experienced two small rashes on her neck and face the morning after her vaccination. She treated these with rubbing alcohol and they were resolved. Further, the patient reported wheezing, breathing problems and a slight fever (98.8) beginning 3-4 days after her vaccination. Her symptoms have persisted. She denies COPD, emphysema, and asthma. I asked her to call her primary care provider and make an appointment. I will plan on checking on her on Thursday 10/28/21 via phone.

Other Meds: Unknown

Current Illness: Unknown

ID: 1818905
Sex: F
Age: 70
State:

Vax Date: 10/23/2021
Onset Date: 10/23/2021
Rec V Date: 10/26/2021
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: Unevaluable event

Symptoms: It had to be half (0.25ml) of the original dose for booster, but was given full dose (0.5ml) that are usually given to the immunocompromised patient. Followed up with the patient. No unusual ADR notified at this time.

Other Meds:

Current Illness:

ID: 1818906
Sex: F
Age: 46
State: WI

Vax Date: 04/22/2021
Onset Date: 10/02/2021
Rec V Date: 10/26/2021
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: Labs for my liver and kidneys, Everything came back normal.

Allergies: N/A

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

Symptoms: I was feeling okay until I started feeling pain on my left side underneath part of my ribs, the pain continue through the week. A week later I went to urgent care and got Labs done and everything came back okay, I went back to my provided the next day bc the pain was awful. Labs were check my liver and kidney and results were normal. They were not concern at all.

Other Meds: I was taking propranolol daily for Migraine of 20MG I am taking 3 per day.

Current Illness: N/A

ID: 1818907
Sex: M
Age: 64
State:

Vax Date: 10/23/2021
Onset Date: 10/23/2021
Rec V Date: 10/26/2021
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: It had to be half (0.25ml) of the original dose for booster, but was given full dose (0.5ml) that are usually given to the immunocompromised patient. Followed up with the patient. No unusual ADR notified at this time.

Other Meds:

Current Illness:

ID: 1818908
Sex: F
Age: 64
State:

Vax Date: 10/23/2021
Onset Date: 10/23/2021
Rec V Date: 10/26/2021
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: It had to be half (0.25ml) of the original dose for booster, but was given full dose (0.5ml) that are usually given to the immunocompromised patient. Followed up with the patient. No unusual ADR notified at this time.

Other Meds:

Current Illness:

ID: 1818909
Sex: F
Age: 40
State: CO

Vax Date: 04/24/2021
Onset Date: 05/15/2021
Rec V Date: 10/26/2021
Hospital:

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

Lab Data: They did an x-ray that was clear

Allergies: Elderberry

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

Symptoms: Tennis elbow in my right arm. I saw the doctor a month ago for it. I have an arm band I wear now that doesn't really help. I am still experiencing of the tennis elbow. I do some stretching. It is my right arm and I am supposed to rest it.

Other Meds: No

Current Illness: No

ID: 1818910
Sex: F
Age: 74
State: CA

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/26/2021
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: NONE

Allergies: Tylenol- Rash NSAIDS- Rash & Itching

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Immediate onset of swelling pain pruritis at the injection site; continued to well for 72 hours.

Other Meds: hydrochlorothiazide 25mg

Current Illness: None

ID: 1818911
Sex: F
Age: 76
State:

Vax Date: 10/23/2021
Onset Date: 10/23/2021
Rec V Date: 10/26/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: It had to be half (0.25ml) of the original dose for booster, but was given full dose (0.5ml) that are usually given to the immunocompromised patient. Followed up with the patient. No unusual ADR notified at this time.

Other Meds:

Current Illness:

ID: 1818912
Sex: F
Age: 78
State: AZ

Vax Date: 03/20/2021
Onset Date: 10/20/2021
Rec V Date: 10/26/2021
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: See above

Allergies: None

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

Symptoms: During routine lab tests drawn on 10/22/2021 I was found to have a platelet count of 139x10E3/ul (Normal being 150-450 x10E3/ul.) One year earlier they were 162 x 10E3 within normal range. I have never had a low platelet count previously. I am wondering if thrombocytopenia might be a possible side effect of an mRNA Covid Vaccine?

Other Meds: Atenolol 25 mg Lisinopril 40 mg Pravastatin 20 mg Sertraline 25 mg Multivitamin, Calcium suppliment, Vitamin D, Areds Plus

Current Illness:

ID: 1818913
Sex: M
Age: 59
State: VA

Vax Date: 04/30/2021
Onset Date: 05/01/2021
Rec V Date: 10/26/2021
Hospital:

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

Lab Data: none

Allergies: None

Symptom List: Nausea

Symptoms: Prolonged congestion in nasal passages, head and ears, causing a nasal echoing when talking and loose, excessive phlem/sputum; only relieved with doses of sudafed, but symptoms began the next day after the second dose was received. Symptoms continue and are only relieved with Sudafed.

Other Meds: Lipitor, Eliquis, Vasotec, daily multivitamin, Calcitrate, CoQ10

Current Illness: none

ID: 1818915
Sex: F
Age: 64
State: AZ

Vax Date: 04/21/2021
Onset Date: 05/01/2021
Rec V Date: 10/26/2021
Hospital:

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

Lab Data: I met with my Dr. via telehealth visit in September regarding the tremor. I have another appt in November to see if more tests are needed.

Allergies: Medications: PCN, Sulfa, Keflex, TAO, Ceclor, HCTZ, Biaxin, Codeine, Demerol, Zofran. Food: Spinach, banana, cucumber, melons, tree nuts, dates, jicama, some hot peppers.

Symptom List: Injection site pain

Symptoms: Sore arm first two days that radiated into my left shoulder and neck with tingling in my fingers at times. Since April the tingling has increased noticing muscle weakness in hand where I would drop things. Since September this has increased to a tremor when I reach for things or try to grip things. Also having trouble typing on the computer.

Other Meds: Zyrtec, ProAir, QVar, Tirosint, Vivelle Dot, Vitamin D, Multi-vitamin.

Current Illness: No other illness at that time.

ID: 1818916
Sex: M
Age: 67
State: NY

Vax Date: 10/25/2021
Onset Date: 10/25/2021
Rec V Date: 10/26/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

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

Symptoms: Feverish, Fatigue, Loss of Appetite, General Malaise

Other Meds: Plavix, enalapril, Xanax, ranexa, Lasix, Vitamin D, Flomax, Topral XL, Aspirin, Hydrocodone, Humulin, Atorvastatin

Current Illness:

ID: 1818917
Sex: F
Age: 49
State:

Vax Date: 10/13/2021
Onset Date: 10/13/2021
Rec V Date: 10/26/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Migratory Joint Pain for 2 weeks; Paresthesia for 2 weeks.

Other Meds:

Current Illness:

ID: 1818918
Sex: M
Age: 46
State: ID

Vax Date: 08/30/2021
Onset Date: 09/05/2021
Rec V Date: 10/26/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: MRI and MRA to rule out stroke Sept. 9th. All images clear. Hearing and balance tests conducted on Oct. 19th. Impairment in right ear diagnosed. Appointment with ear specialist on Oct. 27th to determine next steps.

Allergies: None

Symptom List: Tremor

Symptoms: Extreme Dizziness/Vertigo. Sudden onset Sunday night, felt like bed was rocking and room was spinning. Motion sickness, vomiting, exhibited sings of stroke. Called 911 EMTs felt like it was not a stroke, but cautioned me to watch for symptoms. In New York at time of event, returned home in wheelchair Monday. Met with primary care doctor's office Tuesday, given Meclizine 25mg and a steroid. Otherwise healthy, no case of COVID or any other sickness in several years. Currently still dizzy 7 weeks later although much better than before.

Other Meds: Multi-Vitamins, Fish Oil, Vitamin C, Vitamin D

Current Illness: None

ID: 1818919
Sex: F
Age: 79
State: VA

Vax Date: 10/22/2021
Onset Date: 10/24/2021
Rec V Date: 10/26/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Patient stated that she awoke in the middle of the night on 10/24 with night sweats. She then developed a fever of 99.7 with a headache and extreme joint pain. 10/25/2021 brought a little relief but still low grade fever. Today (10/26) she is still weak and shaky. She is still having extreme joint pain and a headache as well.

Other Meds:

Current Illness:

ID: 1818920
Sex: F
Age: 25
State: IN

Vax Date: 10/08/2021
Onset Date: 10/09/2021
Rec V Date: 10/26/2021
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: Flagyl and clindamycin

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

Symptoms: Lost taste and smell (still don?t have it back) headache, sore throat, exhaustion, body aches

Other Meds: Nuvaring and probiotics

Current Illness: N/A

ID: 1818921
Sex: M
Age: 75
State: WA

Vax Date: 10/22/2021
Onset Date: 10/23/2021
Rec V Date: 10/26/2021
Hospital:

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

Lab Data: NONE. I can provide smart device screen-shots for the temperature spike, the severe insomnia, and the elevated resting heart rate on request.

Allergies: Cat dander

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

Symptoms: - I'm a professional scientist and am reporting this only to help other scientists. NO intervention needed; in fact if I knew I would have these same symptoms again (I had the same reaction to Moderna #2), I would still have gotten the vaccine. I am CERTAIN I am now protected from Covid-19. Unusual side effects (my wife had none of these for ANY of the Moderna shots): - Temperature the following day spiked 4 degrees F (normal 97.2 but it went to 101.1F), - Severe insomnia (smart device gave me a "Zero" Sleep Score), - My resting heart rate, normally 57 - 60, rose sharply to 66. Four days later it is only starting to come down (65). I've been getting good sleep the past two nights, so the increase in resting heart rate does not correlate with sleep.

Other Meds: Tamsulosin, Lipitor, Doxycycline, Trospium

Current Illness: NONE

ID: 1818922
Sex: F
Age: 63
State: AZ

Vax Date: 10/05/2021
Onset Date: 10/05/2021
Rec V Date: 10/26/2021
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: unknown

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Individual went to immunization clinic and requested the Moderna vaccine booster. At the time EUA had not been approved for the third dose (booster) and the amount 0.5ML. Employee

Other Meds: unknown

Current Illness: none

ID: 1818923
Sex: F
Age: 25
State: NY

Vax Date: 10/07/2021
Onset Date: 10/11/2021
Rec V Date: 10/26/2021
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: No

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

Symptoms: Period came 5 days early and has lasted since 10/11 without stopping so far.

Other Meds: Tri Femynor

Current Illness: No

ID: 1818924
Sex: F
Age: 83
State: TN

Vax Date: 10/25/2021
Onset Date: 10/25/2021
Rec V Date: 10/26/2021
Hospital:

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

Lab Data:

Allergies: No know allergies

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

Symptoms: Patient fainted after her third covid Pfizer vaccine. She became alert after several minutes. She drank some water and applied cold wet paper towels to her neck. After several minutes of being alert she was not able to answer questions consistently. At that time we called the ambulance. The paramedics arrived and Patient was feeling much better and was consistently able to answer questions. Patient did not require attention from the paramedics.

Other Meds: Hydrocortisone 20 mg twice a day

Current Illness:

ID: 1818925
Sex: F
Age: 44
State: IA

Vax Date: 08/25/2021
Onset Date: 08/26/2021
Rec V Date: 10/26/2021
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: Severe headache for 3-4 days. . High fever of 102-104 for 72 hours not relieved my OTC meds.

Other Meds: Zyrtec

Current Illness:

ID: 1818926
Sex: F
Age: 47
State: NY

Vax Date: 10/25/2021
Onset Date: 10/25/2021
Rec V Date: 10/26/2021
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: Shortly after vaccine administration patient reported that her tongue felt tingly and that her face felt hot and flushed - upon examination her face was starting to look red, her pulse was steady at 77, and her tongue appeared normal (not engorged or swollen). She sat resting, after another 10 minutes her face had become more red and her lips started to redden, with minimal swelling. She reported no wheezing or chest tightness, besides some anxious breathing. She sat resting for approx 40 minutes total, and with time her baseline face color returned and she reported feeling a little better, though with still some tingling. She went home and took a benadryl. Upon followup today, she ended up calling her physician, who recommended benadryl until her symptoms cleared completely. She reported some tingling earlier today but by this evening was feeling better.

Other Meds:

Current Illness:

ID: 1818927
Sex: F
Age: 56
State: IL

Vax Date: 10/26/2021
Onset Date: 10/26/2021
Rec V Date: 10/26/2021
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: latex

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

Symptoms: Patient experienced itching. Patient received 5ml diphenhydramine liquid from pharmacist on duty.

Other Meds: Bisoprolol/hctz 5-6.25mg and Estriadiol 0.1mg vaginal cream

Current Illness: None

ID: 1819155
Sex: F
Age: 40
State: GA

Vax Date: 10/25/2021
Onset Date: 10/26/2021
Rec V Date: 10/26/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: L under eye swelling and pain

Other Meds: Zoloft Progesterone Probiotic

Current Illness: None

ID: 1819156
Sex: F
Age: 12
State:

Vax Date: 10/06/2021
Onset Date: 10/06/2021
Rec V Date: 10/26/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: none

Allergies: none

Symptom List: Vomiting

Symptoms: blistering, swelling of lips, itchy throat, fever occurred within 6 hours and self resolve.

Other Meds: None

Current Illness: none

ID: 1819157
Sex: F
Age: 55
State: MI

Vax Date: 10/22/2021
Onset Date: 10/22/2021
Rec V Date: 10/26/2021
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: Sulfa, adhesives, some narcotics

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Nausea at first then tingling of the entire inside of the mouth that lasted over 48 hours (previous severe allergic reaction to Sulfa started the same way, but progressed to itching of the mouth then severe swelling of the inside of the mouth and lips). Just had the precursor of tingling this time.

Other Meds:

Current Illness:

ID: 1819158
Sex: F
Age: 65
State: FL

Vax Date: 10/23/2021
Onset Date: 10/24/2021
Rec V Date: 10/26/2021
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: UNKOWN

Allergies: UNKNOWN

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

Symptoms: PATIENT DEVELOPED BLISTERS ON THE INJECT LEFT ARM AND THE SKIN STARTED PEELING

Other Meds:

Current Illness: UNKNOWN

ID: 1819159
Sex: F
Age: 44
State: NM

Vax Date: 10/05/2021
Onset Date: 10/05/2021
Rec V Date: 10/26/2021
Hospital:

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

Lab Data: None

Allergies: NKDA

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Employee went to immunization clinic and requested Moderna Booster vaccine before EUA had been approved and the full dose.

Other Meds: Unknown

Current Illness: None

ID: 1819160
Sex: F
Age: 31
State: CA

Vax Date: 10/12/2021
Onset Date: 10/21/2021
Rec V Date: 10/26/2021
Hospital:

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

Lab Data:

Allergies: N/A

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

Symptoms: Dizziness lasting hours at a time on multiple days since injection. Nausea at times as well.

Other Meds: Prenatal vitamins

Current Illness: N/A

ID: 1819161
Sex: M
Age: 42
State: OR

Vax Date: 10/16/2021
Onset Date: 10/17/2021
Rec V Date: 10/26/2021
Hospital:

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

Lab Data: CTA completed 10/25/2021 after a positive D-dimer. Significant for PE.

Allergies: NKDA

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

Symptoms: Patient developed subsequent substernal chest pain. He does have history of Myocardiatis/Pericarditis, for this reason when I saw him on 10/25/2021 I referred him to the ER for evaluation of chest pain. He was diagnosed with Pulmonary Embolism.

Other Meds: APAP, Allopurinol, Ibuprofen, Omeprazole, Trazodone

Current Illness: Gout, GERD

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am