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: 1821114
Sex: F
Age: 39
State: MI

Vax Date: 10/21/2021
Onset Date: 10/22/2021
Rec V Date: 10/27/2021
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: unfermented soy and sea sponge

Symptom List: Dysphagia, Epiglottitis

Symptoms: I was completely fine the first day after the shot and then about 34 hours later my heart started to feel like it was a baby turning about in a mother's womb, after about 20-30 minutes I became very cold and light headed and called 911 when I was very close to passing out. My heart stabilized by the time the paramedics arrived and my blood pressure slowly came back up, I then shook uncontrollably for about 45 minutes. My heart felt a little tired the following day but I was otherwise totally fine outside of that rather scary hour or so.

Other Meds: multivitamin

Current Illness: none

ID: 1821115
Sex: F
Age: 59
State: NY

Vax Date: 04/21/2021
Onset Date: 10/18/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data: Blood work 10/27/2021- waiting on results

Allergies: Yes, amoxicillin

Symptom List: Anxiety, Dyspnoea

Symptoms: About a week ago, I experienced palpitations in my heart and a weak and shaky feeling. I contacted my physician and was sent to do blood work. I am awaiting the results of that. I believe he is checking my thyroid function.

Other Meds: Yes

Current Illness: No

ID: 1821116
Sex: M
Age: 74
State: OH

Vax Date: 10/25/2021
Onset Date: 10/25/2021
Rec V Date: 10/27/2021
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: Patient came in for a booster (.25) but received full dose(.5). Patient did experience body aches, fever and chills.

Other Meds:

Current Illness:

Date Died: 10/08/2021

ID: 1821117
Sex: F
Age: 74
State: MT

Vax Date: 03/03/2021
Onset Date: 10/04/2021
Rec V Date: 10/27/2021
Hospital: Y

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: Patient diagnosed and hospitalized with COVID-19 while fully vaccinated.

Other Meds:

Current Illness:

ID: 1821118
Sex: F
Age: 65
State: AL

Vax Date: 10/25/2021
Onset Date: 10/26/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data: none

Allergies: none

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

Symptoms: Red-Itchy spots all over her body-Hives

Other Meds: Losartan; Hydrochlorothiazide; Clanazepan Vitamin D3; Vitamin B-12

Current Illness: none

ID: 1821119
Sex: M
Age: 23
State: TX

Vax Date: 09/07/2021
Onset Date: 09/07/2021
Rec V Date: 10/27/2021
Hospital:

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1821120
Sex: M
Age: 38
State: CA

Vax Date: 07/28/2013
Onset Date: 10/01/2013
Rec V Date: 10/27/2021
Hospital:

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

Lab Data: In December 2013 a colonoscopy was performed and in the colonoscopy report the diagnosis was mild, moderate, and severe pancolitis.

Allergies: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Approximately 10 weeks after I was administered Anthrax Vaccine, I began to have symptoms and experienced frequent bowel movements, frequent bloody stools, frequent abdominal pains, etc. Approximately 19 weeks after I was diagnosed with Ulcerative Colitis.

Other Meds: Multivitamin, Fish oil

Current Illness: None

ID: 1821121
Sex: M
Age: 66
State: DE

Vax Date: 02/26/2021
Onset Date: 03/29/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data: 3/29/2021--troponin concentration not elevated 3/29/2021--abnormal ECG--partial bundle branch block--a new finding

Allergies: None

Symptom List: Pharyngeal swelling

Symptoms: About a month after the second dose of the COVID19 (Moderna) I experienced rapid changes in heart rate about 15 to 20 minutes into a workout on an elliptical machine. I have been working out on an elliptical machine 3 times a week regularly for several yeato rs. After I experienced the second episode I went to the ED. History and evaluation found no elevation in troponin concentration. The ECG was abnormal; it revealed a partial bundle branch block--a new finding compared to previous ECGs. Discharge diagnosis was ventricular tachycardia with a recommendation that I see my primary care physician for further evaluation. I continued to experience similar episodes intermittently during workouts on the elliptical machine until sometime in August 2021, Since then, I have not experienced similar episodes.

Other Meds: Lisinopril 5 mg daily Aspirin 81 mg daily Fexofenadine (Allegra) 180 mg daily

Current Illness:

ID: 1821122
Sex: F
Age: 47
State: MI

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

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

Lab Data:

Allergies: Penicillins - hives

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient reported numbness / tingling (site; leg); numbness in face; increased HR, dizzy, sweat/fevers after 1st dose. 1st COVID vaccine on 1/27. She immediately had numbness/tingling of the injection site. Shortly after that her left leg had numbness and tingling. She states it progressed to her left face and neck. She states she had some minor swelling of the left leg and face. Denies swelling of her throat or breathing difficulties. She reports her face like she had gotten Novacaine. She also reports elevated heart rate, dizziness, and sweats/feverish within the first few days of getting the vaccine. She states all of her symptoms have resolved except for tingling in her left leg. She states her left leg is no longer swollen and the tingling is minimal and intermittent and vastly improved compared to last week. Denies weakness or numbness of either side of her body. Consult Visit with Allergy: History of adverse reaction to Pfizer COVID vaccine: I have seen over a dozen patients with complaints of numbness tingling. None had recurrence with the second dose. The mechanism is unclear, but think this is due to irritation from the vaccine. Angioedema can be seen after the COVID vaccines. It is the same mechanism as viral induced hives- it is from activation of the immune system and lasts several days. It is not allergy. She is not considered at increased risk of anaphylaxis and should get the second dose with no special precautions. Letter of clearance written. I do recommend cetirizine or fexofenadine pretreatment to limit angioedema (take one at least one hour prior and then BID for 3 days). Patient nervous for 2nd dose - has not received yet.

Other Meds: Multiple Vitamin (MULTIVITAMIN PO) Prenatal Vit-Fe Fumarate-FA (TRINATE) TABS Vitamin D, Ergocalciferol, 50000 UNITS CAPS

Current Illness: NA

ID: 1821123
Sex: M
Age: 28
State:

Vax Date: 09/22/2021
Onset Date: 10/25/2021
Rec V Date: 10/27/2021
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:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

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: 1821124
Sex: M
Age: 30
State: TX

Vax Date: 09/11/2021
Onset Date: 09/11/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1821125
Sex: M
Age: 74
State: NC

Vax Date: 10/25/2021
Onset Date: 10/26/2021
Rec V Date: 10/27/2021
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: penicillin

Symptom List: Rash, Urticaria

Symptoms: fever, aches all over and terrible stomach pain. They resolved after about 24 hours

Other Meds: Latuda, Klonopin, risperdal, flomax, simvastatin, modadinil, restasis, latanaprost, levothyroxin

Current Illness: none

ID: 1821126
Sex: M
Age: 56
State: NC

Vax Date: 12/23/2020
Onset Date: 01/11/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Cognitive disturbance; mental fog.

Other Meds: B-complex vitamins

Current Illness: None

ID: 1821127
Sex: F
Age: 77
State: MA

Vax Date: 10/22/2021
Onset Date:
Rec V Date: 10/27/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: The patient was found unconscious - ambulance was called and pt was hospitalized. Her BP (according to the patient) was 80/50

Other Meds:

Current Illness:

ID: 1821128
Sex: F
Age: 54
State: VA

Vax Date: 10/26/2021
Onset Date: 10/27/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data: none

Allergies: Percocet, sulfa, biaxin

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

Symptoms: Headache the day of vaccination Following morning, thought everything was fine; walked outside and suddenly felt very lightheaded and unbalanced - enough so that I momentarily completely lost my balance and hit my head on a metal bracket overhead.

Other Meds: Dilantin, Omeprazole, Hydroxychloroquine, Zyrtec, Visual Advantage Tear Support

Current Illness: none

ID: 1821129
Sex: M
Age: 42
State: TX

Vax Date: 09/09/2021
Onset Date: 09/09/2021
Rec V Date: 10/27/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1821130
Sex: F
Age: 22
State: KY

Vax Date: 03/31/2021
Onset Date: 10/23/2021
Rec V Date: 10/27/2021
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: Tested Positive for Covid

Other Meds:

Current Illness:

ID: 1821131
Sex: F
Age: 33
State: FL

Vax Date: 10/25/2021
Onset Date: 10/25/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data:

Allergies: n/a

Symptom List: Ear pain, Hypoaesthesia

Symptoms: I immediately had a metallic taste in my mouth and became lightheaded. Arm became very sore as the day went on. Metallic taste lasted about 12 hours. Stomachache and feeling generally unwell came on about 4 hours after administration. Also felt like of "out of it" and sickly. Felt better after about 12 hours. Arm was sore for about 48 hours.

Other Meds: methimazole

Current Illness: graves disease

ID: 1821132
Sex: F
Age: 33
State: OH

Vax Date: 10/24/2021
Onset Date: 10/24/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data: N/a

Allergies: Sulfa

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: 2nd dose I got red and swollen rash. Few hours later it developed a hard ball under it and got bigger. Sore to the touch. 2nd day was about a quarter in size red, swollen and hard knot under, sore to the touch. Day 3 bigger the hard area also bigger still sore to touch, slightly itchy .day 4 (10/27/21) its now 3x2 inches, slightly itchy at times, red sore to the touch and still big hard knot under it. Classified as "covid arm" it seems to continue getting bigger throughout the day and each day after. Slighly nauseous now and then.

Other Meds: N/a

Current Illness: None

ID: 1821133
Sex: F
Age: 30
State: WA

Vax Date: 10/25/2021
Onset Date: 10/26/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Severe head ache, intense joint pain throughout entire body, exhaustion. Then shortness of breath that started around 4pm and lasted until about 7pm.

Other Meds: Sertraline, birth control, spirinolactone, vitamin d, berberine, fish oil, magnesium

Current Illness: None

ID: 1821134
Sex: F
Age: 41
State: OH

Vax Date: 10/25/2021
Onset Date: 10/26/2021
Rec V Date: 10/27/2021
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: Blood work - completed 10/26 Urinalysis- completed 10/26 X-ray - completed on 10/26 Cat Scan - completed on 10/26

Allergies: Bactrim

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

Symptoms: Extremely high heart rate - 140 beats per minute at rest and high blood pressure - ended up in the ER

Other Meds: None

Current Illness: N/A

ID: 1821135
Sex: F
Age: 80
State: WV

Vax Date: 01/26/2021
Onset Date: 09/14/2021
Rec V Date: 10/27/2021
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: Patient was admitted to the hospital with Covid symptoms, pneumonia, and hypoxia after vaccination.

Other Meds:

Current Illness:

ID: 1821137
Sex: M
Age: 21
State: NJ

Vax Date: 10/15/2021
Onset Date: 10/15/2021
Rec V Date: 10/27/2021
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 Dose of Vaccine - Too Low-

Other Meds:

Current Illness:

ID: 1821138
Sex: M
Age: 73
State: IN

Vax Date: 10/25/2021
Onset Date: 10/26/2021
Rec V Date: 10/27/2021
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: Insomnia, headache, gas pain, vision loss

Other Meds: Amlodapine , metroprolol, duloxitine

Current Illness: None

Date Died: 10/20/2021

ID: 1821139
Sex: M
Age: 91
State: NJ

Vax Date: 09/25/2021
Onset Date: 10/09/2021
Rec V Date: 10/27/2021
Hospital: Y

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

Lab Data: Vaccine information: Pfizer 1st Dose: 3/6/21; 2nd Dose: 3/27/21 - administered at mass vaccination site Pfizer 3rd Dose 9/29/21 lot #301358A COVID-19 Tests: 10/9/21 - Rapid - Positive - Lab Specimen ID: 331112799 10/9/21 - PCR - Positive - Lab Specimen ID: L11301695.6000.968

Allergies: Unknown

Symptom List: Injection site pain, Menorrhagia

Symptoms: COVID-19 Vaccine Breakthrough Case: Hospitalization & Death The case tested positive for COVID and went to the emergency room and was admitted on 10/9/21. The case unfortunately passed away on 10/20/21. The individual received a monoclonal antibody infusion on 10/9/21. As part of his COVID-19 symptoms, the individual had difficulty breathing, loss of smell/taste, and a fever. The case also developed pneumonia and acute respiratory distress syndrome (ARDS).

Other Meds: Unknown

Current Illness:

ID: 1821140
Sex: M
Age: 50
State: KY

Vax Date: 05/25/2021
Onset Date: 10/22/2021
Rec V Date: 10/27/2021
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: Tested Positive for Covid

Other Meds:

Current Illness:

ID: 1821141
Sex: F
Age: 56
State: TX

Vax Date: 09/11/2021
Onset Date: 09/11/2021
Rec V Date: 10/27/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1821142
Sex: M
Age: 33
State: GA

Vax Date: 10/26/2021
Onset Date: 10/26/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data:

Allergies: Slight allergy to shrimp

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Started having intense tingles and soreness across my entire body, this progressed to feeling cold chills, and ultimately intense shaking around 10:30 pm. I went home and started to get a headache, felt nauseous, and reached a fever of 103 at one point. By 11:30pm. Took 2 500 mg Tylenol around 11. Took a 200 mg Advil around 1:00 am. Took a look warm shower and did a sponge bath to try and lower the fever. Woke up around 5 am and took two more 500mg Tylenol. Woke up at 10am temperature had returned to 97.7. Feel fatigued but I?m ok.

Other Meds: Trazadone, one a day active multivitamin,

Current Illness:

ID: 1821143
Sex: M
Age: 68
State:

Vax Date: 03/27/2021
Onset Date: 08/30/2021
Rec V Date: 10/27/2021
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:

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

Symptoms: Patient presented to the ED in town on 8/29/2021 with c/o shortness of breath and syncopal episode. He completed his COVID vaccination in February 2021. His O2 sats were 88% so he was started on oxygen and eventually required 6L of high flow. He was started on steroids and remdesivir. He was eventually on room air at rest, but still required 3L oxygen with activity. He was discharged to home with Rx to complete a 10 day course of steroids. No oxygen prescribed upon discharge.

Other Meds:

Current Illness:

ID: 1821144
Sex: M
Age: 63
State: IL

Vax Date: 10/26/2021
Onset Date: 10/26/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data:

Allergies: Erythromycin.

Symptom List: Nausea

Symptoms: Fatigue, swelling in the throat, joint pain, headaches.

Other Meds: Concerta 18mg

Current Illness: None.

ID: 1821145
Sex: F
Age: 34
State: ID

Vax Date: 10/19/2021
Onset Date: 10/21/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data: Chest x-rays came back clear, blood work came back clear as well. 10/24/21

Allergies: None

Symptom List: Injection site pain

Symptoms: I have hives and welts on my entire body, including palms of my hands, soles of my feet, in my ears, on my lips, on my eyelids, there isn't a place on my body that hasn't had hives and welts. I am having a hard time breathing. I have to use an albuterol rescue inhaler usually 4-5 times a day in order to open my airways back up.

Other Meds: None

Current Illness: None

ID: 1821146
Sex: M
Age: 49
State: GA

Vax Date: 10/25/2021
Onset Date: 10/25/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: injection site pain and soreness, Headache, joint pain all over body, Fever 100.5, stomach pain, low back pain, nausea

Other Meds: Cholesterol and BP meds

Current Illness: None

ID: 1821147
Sex: M
Age: 24
State: TX

Vax Date: 09/09/2021
Onset Date: 09/09/2021
Rec V Date: 10/27/2021
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: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1821149
Sex: M
Age: 73
State: MT

Vax Date: 07/26/2021
Onset Date: 10/04/2021
Rec V Date: 10/27/2021
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: Tremor

Symptoms: Patient diagnosed and hospitalized with COVID-19 while fully vaccinated.

Other Meds:

Current Illness:

ID: 1821150
Sex: F
Age: 30
State: DE

Vax Date: 10/26/2021
Onset Date: 10/26/2021
Rec V Date: 10/27/2021
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: Erythema, Pruritus

Symptoms: Headache, Sore arm, burning at injection site

Other Meds: Multivitamin

Current Illness: None

ID: 1821151
Sex: M
Age: 29
State: TX

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 10/27/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1821153
Sex: M
Age: 32
State: TN

Vax Date: 09/14/2021
Onset Date: 09/14/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Administration error due to non-viable vaccine dose being given

Other Meds:

Current Illness:

ID: 1821154
Sex: F
Age: 49
State: GA

Vax Date: 04/27/2021
Onset Date: 04/27/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data: X-ray- showed nothing was broken. (September 2021)

Allergies: Penicillin

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: When the shot was administered, they sterilized that area and marked where the shot would be given on my arm. The person giving the shot didn't pull the muscle up as far as they did on the first one. The shot was extremely painful when going inside my arm. My shoulder started hurting a couple hours later. After 6 hours I couldn't lift my left arm. Within 24 hours I felt the worst at that point. I was literally bedridden for 3 days. When the fever broke I felt better. The arm felt sore for about another week. If I over used my arm or moved it, that would cause my shoulder to ache until about 3 months ago. The pain has gotten worst. I went to the ER for the pain in September 2021 because I couldn't use my arm. They gave me muscles relaxants and an anti-inflammatory medication called flexeril. They told me to take ibuprofen. My range of motion is down less than 30% now. When the shot was being administered I am afraid that they had damaged something.

Other Meds: Toujeo injection Fiasp injection Ozempic injection Levothyroxine 50mcg 1xday

Current Illness: none

ID: 1821155
Sex: M
Age: 48
State: NY

Vax Date: 10/27/2021
Onset Date: 10/27/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data: ekg trijemony

Allergies: pcn

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

Symptoms: sob, chest pain,

Other Meds: none

Current Illness: none

ID: 1821156
Sex: F
Age: 31
State: MD

Vax Date: 10/13/2021
Onset Date: 10/13/2021
Rec V Date: 10/27/2021
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: Flu shot

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

Symptoms: Itch pale light-headed dizzy nose tingle migrane

Other Meds:

Current Illness:

ID: 1821157
Sex: M
Age: 60
State: FL

Vax Date: 04/15/2021
Onset Date: 07/17/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data: COVID test

Allergies: Penicillin

Symptom List: Pain in extremity

Symptoms: Had a breakthrough of COVID after being fully vaccinated. Which lead to a sinus infection. I was prescribe a Z-pack.

Other Meds: Yes, prescriptions

Current Illness: No

ID: 1821158
Sex: F
Age: 56
State: OH

Vax Date: 10/25/2021
Onset Date: 10/25/2021
Rec V Date: 10/27/2021
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 came in for a booster (.25) but received full dose(.5)

Other Meds:

Current Illness:

ID: 1821159
Sex: F
Age: 24
State: TN

Vax Date: 09/14/2021
Onset Date: 09/14/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Administration error due to a non-viable dose of vaccine administered

Other Meds:

Current Illness:

Date Died: 10/15/2021

ID: 1821160
Sex: F
Age: 72
State: MT

Vax Date: 04/09/2021
Onset Date: 10/03/2021
Rec V Date: 10/27/2021
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: Patient diagnosed and hospitalized with COVID-19 while fully vaccinated.

Other Meds:

Current Illness:

ID: 1821161
Sex: M
Age: 17
State: NY

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 10/27/2021
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: There were no symptoms.

Other Meds:

Current Illness:

ID: 1821162
Sex: M
Age: 39
State:

Vax Date: 04/27/2021
Onset Date: 05/01/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data: I did not go see a doctor. I can't afford to.

Allergies: None.

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: A week or maybe it was 2 weeks after my last Moderna Covid-19 shot, I experienced an episode of my heart fluttering or irregular heartbeat which was definitely not normal. I also was trying to catch my breath which was also not normal. I have never felt this way before. I took a nap after feeling like that because it made me really tired. I woke up feeling ok after an hour of napping. Every now and then I still feel my heart flutter randomly since I had the shot. So I'm a bit concerned. After looking up side effects, I came across news of people having similar heart symptoms after the Moderna shot, so I thought I should report it so it can be documented that it has happened to me too.

Other Meds: None.

Current Illness: None.

ID: 1821163
Sex: M
Age: 64
State: NC

Vax Date: 09/14/2021
Onset Date: 09/14/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Administration error due to a non-viable dose of vaccine being administered

Other Meds:

Current Illness:

Date Died: 10/20/2021

ID: 1821164
Sex: F
Age: 64
State: KY

Vax Date: 09/10/2021
Onset Date: 10/20/2021
Rec V Date: 10/27/2021
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: Pennicillin

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Pt.'s Sister states that after receiving the 1st dose of Phizer 09/10/2021, started experiencing symptoms 10/19/2021 pt. found unconscious on the floor, Emergency Room visit *transported suffered 3 Heart Attacks, Cardiac Arrest resulting in Death 10/20/2021.

Other Meds:

Current Illness:

ID: 1821165
Sex: M
Age:
State: IL

Vax Date:
Onset Date: 10/26/2021
Rec V Date: 10/27/2021
Hospital: Y

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

Lab Data: N/A

Allergies: Penicillin

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

Symptoms: hospitalization

Other Meds: N/A

Current Illness: N/A

ID: 1821166
Sex: F
Age: 43
State: VA

Vax Date: 10/24/2021
Onset Date: 10/25/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data: Waiting on lab results as of 10/27. Blood taken at 5pm pm on 10/26 test: CBC with differential/Platelet, Comp. Metabolic Panel (14), D-Dimer-F-plasma, Fibrinogen Antigen-LB plasma, PT and PTT, Sedimentation Rate-Westergren, ANA w/Reflex, C-Creative Protien-Quant, Creatine KinaseTotal Serum, von Willebrand Profile.

Allergies: None

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

Symptoms: Pain in both legs. Softball size bruising on both legs. Headache which would not go away with two doses of Motrin one dose of Tylenol.

Other Meds: Valacyclior, Metformin, Venlafaxine, B Complex, Vitamin D, Vitamin C

Current Illness: Herpes Simplex 1

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am