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: 1821167
Sex: M
Age: 75
State:

Vax Date: 01/01/2021
Onset Date: 09/23/2021
Rec V Date: 10/27/2021
Hospital: Y

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

Lab Data: Rapid COVID test (10/6/2021) = positive

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Approximately 9/23/21 or 9/24/21 this patient started becoming ill with headache, cough, shortness of breath, temp 104, and fatigue. On 9/2721 the patient had a positive Covid test done at the health department. On 9/30/21 the patient continued to decline so he went to emergency department, while in the ER he had a chest x-ray labs and steroids and was discharged home to manage symptoms. On 10/6/2021, he went to his primary care provider and he was noted to be hypoxic with oxygen saturation anywhere between 85 to 90% on room air. The patient was sent to the emergency room for further evaluation and he continued to be hypoxic upon presentation requiring oxygen to keep his oxygen saturations greater than 90%. He eventually required up to 55L of heated high flow. He also received dexamethasone x 10 days and baricitinib x 14 days. He was discharged home on 5L of oxygen and a prednisone taper.

Other Meds:

Current Illness:

ID: 1821169
Sex: F
Age: 64
State: MI

Vax Date: 10/12/2021
Onset Date: 10/13/2021
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: VITAMIN B12 IRON +TIBC CBC WITH DIFFERENTIAL FERRITIN TSH SEDIMENTATION RATE, AUTOMATED ANA PROTIME-INR APTT VON WILLEBRAND DISEASE PROF

Allergies: None

Symptom List: Anxiety, Dyspnoea

Symptoms: Burst blood vessel in right big toe the day following booster vaccine. Bruising spread to second toe. Doctor described the event as a paroxysmal hematoma.

Other Meds: Edarbi, Rosuvastatin, Omega #, Calcium + D, Multivitamin, Co-Q-10, Biotin

Current Illness: None

ID: 1821170
Sex: F
Age: 26
State:

Vax Date: 10/04/2021
Onset Date: 10/21/2021
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: Negative pregnancy tests

Allergies: None

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

Symptoms: Missed mensuration without pregnancy

Other Meds: None

Current Illness: None

ID: 1821171
Sex: F
Age: 88
State: WV

Vax Date: 02/20/2021
Onset Date: 10/07/2021
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 admitted to hospital with covid symptoms and hypoxia after receiving vaccination.

Other Meds:

Current Illness:

ID: 1821172
Sex: F
Age: 30
State: OK

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

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1821173
Sex: M
Age: 79
State: TX

Vax Date: 09/06/2021
Onset Date: 09/06/2021
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: 1821174
Sex: M
Age: 68
State: AZ

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

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient was given .5ml of booster instead of .25ml

Other Meds: None

Current Illness: None

ID: 1821175
Sex: F
Age: 18
State: GA

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

Lab Data: N/A

Allergies: NKDA

Symptom List: Pharyngeal swelling

Symptoms: Patient experience dizziness and eventual syncope around 10-15 minutes after receiving 2nd dose of Pfizer COVID-19 vaccine. Patient came to after a few seconds and experienced usual post syncope symptoms (lightheadedness, cold sweats, body soreness, etc). Patient sat in pharmacy for approximately 30 minutes post event and sipped on orange juice and water while eating a few crackers. Patient was able to walk to car under her own power with her family and went home. Pharmacy will follow up with patient later today to check for any other symptoms.

Other Meds: None that we are aware of

Current Illness: None that we are aware of

ID: 1821176
Sex: M
Age: 17
State: NY

Vax Date: 04/10/2021
Onset Date: 04/10/2021
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:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: There were no symptoms.

Other Meds:

Current Illness:

ID: 1821177
Sex: F
Age: 69
State: MT

Vax Date: 01/06/2021
Onset Date: 10/01/2021
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: Patient diagnosed and hospitalized with COVID-19 while fully vaccinated.

Other Meds:

Current Illness:

ID: 1821178
Sex: M
Age: 20
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:
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: 1821179
Sex: M
Age: 45
State: MA

Vax Date: 04/12/2021
Onset Date: 08/05/2021
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: X-Rays and Exam by Doctor - treatment by an x-ray guided cortisone injection (Appears to have resolved by pain (Sept. and October treatment dates)

Allergies: n/a

Symptom List: Rash, Urticaria

Symptoms: About 4 months after my 1st Covid Vaccination, and 3 months after my 2nd Vaccine, I developed "Frozen Shoulder" in my left arm. I had both Covid vaccines in my upper left arm. I am a Type 1 Diabetic, and I know that Diabetics are more likely to develop "Frozen Shoulder" but I thought I should report this to the CDC because I've read online that those infected with Covid also appear to be more likely to develop "Frozen Shoulder"

Other Meds: Propecia, Humalog Insulin (Type 1 Diabetic), Simvastatin, Baby Asprin

Current Illness: n/a

ID: 1821180
Sex: F
Age: 57
State: VA

Vax Date: 03/24/2021
Onset Date: 04/15/2021
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- yet

Allergies: No

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

Symptoms: Immediately had an unusual sensation on left side behind left ear. Since that time continuing AND increasing? I have had tinnitus ( ear ringing ) bilaterally. I have never had an occasion experience of ear ringing for more than 15 seconds and very rarely at all ( lifetime) Likewise I have some noticed hearing defects as noticed by those around me. I fully thought this tinnitus would subside over time but it has only increased its frequency and duration.

Other Meds: None

Current Illness: None

ID: 1821181
Sex: F
Age: 45
State: TX

Vax Date: 10/24/2021
Onset Date: 10/24/2021
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: SYR
Vax Site: LA

Lab Data: N/A

Allergies: Allergies: PCN, some latex Adverse reaction to ZPak

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

Symptoms: After Moderna Covid vaccine injection #2 sick for 2 days, including Tinnitus in right ear and vertigo, intermittent headaches. Also for 3 days had a burning rash in left arm from injection site down to wrist skin "appeared scaly in red form", but was not, resolved after 72 hrs. Have had the other symptoms ever since. Following Moderna booster on 10-24/21, increased Tinnitus, vertigo and injection site remains a 4?3 inch square of inflamed, red raised skin incredibly painful to the touch.

Other Meds: N/A

Current Illness: N/A

ID: 1821182
Sex: F
Age: 27
State: AZ

Vax Date: 09/03/2021
Onset Date: 09/03/2021
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1821183
Sex: F
Age: 75
State: CO

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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies: Penicillin

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

Symptoms: Initially, extreme fatigue, followed by muscle soreness and fever (102.4) and continued fatigue/soreness. Lasted for more than 36 hours and disappeared as suddenly as it arrived.

Other Meds: lisinopril multiple vitamin zinc ibuprofen

Current Illness: None

Date Died: 10/22/2021

ID: 1821184
Sex: M
Age: 79
State: KY

Vax Date: 06/21/2021
Onset Date: 10/22/2021
Rec V Date: 10/27/2021
Hospital: Y

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: Pt died after testing positive for COVID-19 on 10/4/2021

Other Meds:

Current Illness:

ID: 1821185
Sex: F
Age: 45
State: CA

Vax Date: 10/22/2021
Onset Date: 10/22/2021
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: No

Allergies: Penicillin

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Right after injection I got dizzy, chest and throat got tight. The next day I had fever, numbness and tingling in right arm.

Other Meds: Vitamins

Current Illness: No

ID: 1821188
Sex: F
Age: 66
State: OH

Vax Date: 09/24/2021
Onset Date: 09/25/2021
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: blood tests

Allergies: NO

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: upset stomach , sore arm , hot arm , itchy arm , serve body aches , and spike in blood pressure.

Other Meds: NO

Current Illness: no

ID: 1821189
Sex: M
Age: 16
State: NY

Vax Date: 04/06/2021
Onset Date: 04/06/2021
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:

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

Symptoms: There were no symptoms.

Other Meds:

Current Illness:

ID: 1821190
Sex: M
Age: 91
State: MT

Vax Date: 02/22/2021
Onset Date: 10/01/2021
Rec V Date: 10/27/2021
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:

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

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

Other Meds:

Current Illness:

ID: 1821192
Sex: M
Age: 71
State: WV

Vax Date: 04/02/2021
Onset Date: 10/12/2021
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 admitted to hospital with covid symptoms and shortness of breath after vaccination.

Other Meds:

Current Illness:

ID: 1821193
Sex: F
Age: 63
State: NC

Vax Date: 03/26/2021
Onset Date: 05/10/2021
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: Sulfa Levaquin

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

Symptoms: Psoriasis flare - scalp Psoriasis flare - white spots on lower legs

Other Meds: Otezla Cosentyx Singulair

Current Illness:

ID: 1821194
Sex: M
Age: 70
State: KY

Vax Date: 03/01/2021
Onset Date: 10/17/2021
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:

Symptom List: Injection site pain, Pain

Symptoms: Tested Positive for Covid

Other Meds:

Current Illness:

ID: 1821195
Sex: F
Age: 17
State: NY

Vax Date: 04/10/2021
Onset Date: 04/10/2021
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: Injection site pain, Menorrhagia

Symptoms: There were no symptoms.

Other Meds:

Current Illness:

ID: 1821196
Sex: F
Age: 66
State: CA

Vax Date: 01/06/2021
Onset Date: 05/15/2021
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: no

Allergies: Kiwi fruit a lot of grasses food sensitivity nitrofurantoin

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

Symptoms: On 05/15/2021- my heart rate would go up to 150 bpm and subside. That would happen periodically. It did not happen every day but it happened frequently. For no reason, I would be sitting , without exertion, and it would go up. My resting heart rate is 65. I did not do any thing about it because it did not last long enough. Initially it was occurring like daily. Shortly it gradually declined in frequency. It has not happened but once in the past month. Unknown, if my AEs have recovered because it happened yesterday, very briefly and it hasn't happened for a while.

Other Meds: multiple vitamins vitamin D calcium magnesium periodically Claritin- not often

Current Illness: no

ID: 1821197
Sex: F
Age: 58
State: MT

Vax Date: 03/31/2021
Onset Date: 10/01/2021
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: LA

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

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

Other Meds:

Current Illness:

ID: 1821198
Sex: F
Age: 64
State: GA

Vax Date: 09/23/2021
Onset Date: 09/23/2021
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:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: As described by the patient in her words, a hard/raised red knot (between the size of a dime and nickel) formed almost immediately at the injection site. After approx. 10 days, the spot became irritated and infected/developed pus. The patient treated it with a medicated cream given to her by her husband who she says is a physician-assistant. After 3 weeks, it started to heal and scab over. When the patient came back to the office for her second dose, a small scar was still visible. The patient reported that she experienced no other adverse side effects. She received her second dose in the same left arm a few inches above the original site and was informed to call our office if she had any similar or other reaction.

Other Meds:

Current Illness:

ID: 1821199
Sex: F
Age: 26
State: PA

Vax Date: 10/04/2021
Onset Date: 10/04/2021
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: Bees

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

Symptoms: 26 year old patient given high dose influenza vaccine recommended for 65 years and older.

Other Meds: lamotrigine 100 mg tablet (lamotrigine); cetirizine 10 mg tablet; Flonase Allergy Relief 50 mcg/actuation spray; hydroxyzine HCl 25 mg tablet (hydroxyzine hcl); Ventolin HFA 90 mcg/actuation HFA aerosol inhaler; Zafemy 150-35 mcg/24 hr patc

Current Illness: n/a

ID: 1821200
Sex: F
Age: 91
State: KY

Vax Date: 10/27/2021
Onset Date: 10/27/2021
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: AST 2013, ALT 664, alkaline phosphatase 2009, total bilirubin 1.4 CT indicated inflammation/distended gallbladder

Allergies: None listed in record from hospital

Symptom List: Nausea

Symptoms: This patient experienced severe epigastric pain in the evening on the same day she received her Pfizer booster. She presented to the emergency department. Lab results showed elevated liver enzymes (see below). CT scan indicated gallbladder was distended and there was inflammation; impression: acute cholecystitis. The patient had no gallstones. The PCP for this patient said the patient's LFTs were within normal limits at time of last bloodwork, and less than 24 hours after presenting to the ED the patient's liver enzymes were trending down. The PCP felt that this may be an adverse reaction to the booster due to 1. the short period of time between administration of booster and onset of symptoms, 2. no gallstones or other apparent reason for inflammation and elevated liver enzymes, 3. the transient nature of the symptoms.

Other Meds: No regular medications, takes daily vitamin

Current Illness: none

ID: 1821201
Sex: F
Age: 70
State: VA

Vax Date: 10/18/2021
Onset Date: 10/19/2021
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: None

Allergies: Codeine, Doxycycline, amoxicillin

Symptom List: Injection site pain

Symptoms: Fever, rash on neck within 24 hours, itching, light sensitivity at area of rash, fatigue, diarrhea, nausea, headache, chills, sore ankles, weight loss. Rash spreading within 48 hours to breasts, arms, wrist, leg, and buttocks. Treatment with dermatologist- steroid cream to address rash, treatment with general practitioner- prescription strength antihistamine. Restricted diet. Outcomes- 9 days after shot still have rash, fatigue, and intermittent nausea and headaches.

Other Meds: Vitamin D, Vitamin C, Calcium, Zyrtec,

Current Illness: None

ID: 1821202
Sex: M
Age: 16
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:
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: There were no symptoms.

Other Meds:

Current Illness:

ID: 1821204
Sex: M
Age: 64
State: IN

Vax Date: 10/13/2021
Onset Date: 10/20/2021
Rec V Date: 10/27/2021
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: Oct 21 2021 MRI, carotid ultrasound, EKG,Chest X-ray, blood tests. Oct 22 2021 heart ultrasound.

Allergies:

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

Symptoms: Stroke ct scan Oct 20 2021

Other Meds: 40 mg simvastatin

Current Illness:

ID: 1821205
Sex: F
Age: 93
State: MT

Vax Date: 04/07/2021
Onset Date: 09/18/2021
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: 1821206
Sex: M
Age: 57
State: TX

Vax Date: 09/08/2021
Onset Date: 09/08/2021
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: Pfizer vaccine

Symptom List: Erythema, Pruritus

Symptoms: Started breaking out with a rash and bumps the day after all aver most of my body lasted about a week itching badly

Other Meds:

Current Illness:

ID: 1821207
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: 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: There were no symptoms.

Other Meds:

Current Illness:

ID: 1821208
Sex: F
Age: 66
State: TX

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: 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: Severe chills starting 10:30 pm on 10/26/21 continuing until 9am 10/27/21. 1:30 am 10/27/21 got up , extreme dizziness and passed out on floor. Went back to bed, still chilled with leg and foot cramps.

Other Meds:

Current Illness:

ID: 1821209
Sex: M
Age: 72
State: KY

Vax Date: 04/02/2021
Onset Date: 10/18/2021
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: Asthenia, Chills, Headache, Myalgia

Symptoms: Tested Positive for Covid

Other Meds:

Current Illness:

ID: 1821210
Sex: M
Age: 52
State: AZ

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

Allergies: none

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

Symptoms: Patient was given .5ml of moderna instead of the .25ml Patient complained of fever, chills, malaise.

Other Meds: none

Current Illness: none

ID: 1821211
Sex: M
Age: 15
State: PA

Vax Date: 09/20/2021
Onset Date: 10/05/2021
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: Did covid and flu tests on 10/05 negative results Covid, flu and blood, urine and Lyme disease tests on 10/12 Back to er on 10/19 for dehydration did blood work given Zofran To Dr on 10/20 given prescriptions and faxed insurance company for medical approval to go to a pediatric gastroenterologist. Today 10/26 no word from insurance still can not keep liquids or food down

Allergies: None

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

Symptoms: Headache, nausea, vomiting, diarrhea, chills, since 10/05/2021 he has lost 20lbs because he can not keep food or liquids down. Has been to er for iv fluids due to dehydration

Other Meds: None

Current Illness: None

ID: 1821212
Sex: F
Age: 23
State: VA

Vax Date: 05/19/2021
Onset Date: 05/30/2021
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: 5/30/21 Troponin I peak 3.79 5/31/2021 Echo Summary * Left ventricular systolic function is normal with an ejection fraction by Biplane Method of Discs of 60 %. * Normal right ventricular systolic function. * There is mild posteriorly directed mitral regurgitation. * There is mild tricuspid regurgitation. * No pulmonary hypertension with estimated right ventricular systolic pressure of 26 mmHg. * No valvular vegetations visualized. * No prior study is available for comparison. 5/30/21 Cardiac MRI 1. Myopericarditis with patchy abnormal delayed enhancement, myocardial edema of the basal walls, and patchy areas of pericardial thickening/enhancement consistent with pericarditis. 2. Normal biventricular size and function.

Allergies: None

Symptom List: Pain in extremity

Symptoms: Patient admitted with myopericarditis to Hospital 11 days after vaccination. Started having pleuritic chest pains the day after vaccination.

Other Meds: ACETAMINOPHEN (TYLENOL) 325 MG TABLET Take 650 mg by mouth daily as needed for Pain IRON-VITAMIN C (VITRON C) 65-125 MG TAB Take 1 tablet by mouth daily RIMEGEPANT SULFATE (NURTEC) 75 MG TABLET DISPERSIBLE Take 75 mg by mouth once as need

Current Illness: ? Anemia ? Heavy menses ? Lupus anticoagulant disorder ? Pulmonary embolism 11/2019

ID: 1821213
Sex: M
Age: 60
State:

Vax Date: 10/14/2021
Onset Date: 10/14/2021
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: Fever, shortness off breath, heart palpitations, significant pain at the injection site. Effects lasted 36-48 hours and were evident after both vaccinations. I am retired military and have received many shots most people will never receive, including the full Anthrax series and Plague, but I have never had this kind of a reaction from any vaccine.

Other Meds: Atorvastatin

Current Illness:

Date Died: 10/04/2021

ID: 1821214
Sex: F
Age: 48
State: SD

Vax Date: 02/22/2021
Onset Date: 09/18/2021
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: PCR positive COVID-19 test on 09/18/2021, despite being fully vaccinated.

Allergies: Documented allergies to amoxicillin, dextran sulfate, nitrofurantoin, ibuprofen, penicillin

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

Symptoms: This is a breakthrough case of COVID-19 that resulted in death. The individual was vaccinated with the Pfizer product on 02/01/2021 and 02/22/2021. The individual tested positive via PCR for COVID-19 on 09/18/2021 and was admitted to the hospital on that same day. The individual reported COVID-19 symptoms of fatigue, weakness, cough, shortness of breath, fever, chills, nausea, vomiting, diarrhea, and feeling lightheaded. They were hospitalized until their death on 10/04/2021. Death Certificate details are as follows: Part I Cause of Death A: Acute Respiratory Distress Syndrome B: COVID 19 Pneumonia Part II Other Significant Conditions: Viral Sepsis, Shock, Immunosuppression, Acute Kidney Failure ON Chronic Kidney Disease, Hospital Acquired Pneumonia The patient was considered to be immunosuppressed at the time of death, due to medication use; the person was a kidney transplant recipient.

Other Meds:

Current Illness:

ID: 1821215
Sex: F
Age: 53
State: TX

Vax Date: 09/24/2021
Onset Date: 09/30/2021
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: Had blood work done. Swollen lymph nodes with no infection. I?m going to a dermatologist to have a punch biopsy done to see if I?m allergic to something that was in the COVID medication.

Allergies: None known

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

Symptoms: Approximately 7 days after receiving my 3rd dose I began breaking out in migrating rashes all over my body. This has been going on for weeks and doesn?t seem to be getting better. I?ve had blood work done and also show swollen lymph nodes but no infection. I?m having a punch biopsy this week to see if I?m allergic to PEG. Not sure what is causing this but it all started after shot. All medications I listed I?ve been taking for the past 6months with no issues.

Other Meds: Bystolic 5mg Vitamin B+ (B complex) L-methyl folate 10mg Sermorelin daily injections .2cc Cyanocobalamin (B-12) injections .5 cc once weekly ProOmega 1 daily (650 EPA/450 DHA) Magnesium Orotate (500 mg) once daily Vitamin C+ (w/Zinc L-

Current Illness: None

ID: 1821216
Sex: M
Age: 39
State: NY

Vax Date: 10/06/2021
Onset Date: 10/14/2021
Rec V Date: 10/27/2021
Hospital: Y

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

Lab Data: Full battery of stroke tests, blood work, genetic tests, cardiograms, etc. The only abnormal finding was Protein S and Protein C activity. Antigen levels were normal, but activity and function were out of reference frame. PROTEIN S ACTIVITY ? Final result ?10/19/2021 6:48 AM ? Component Value Ref Range Performed At Pathologist Signature PROTEIN S ACTIVITY 49 77 ? 143 % PROTEIN C FUNCTION ? Final result ?10/19/2021 6:48 AM ? Component Value Ref Range Performed At Pathologist Signature PROTEIN C FUNCTIONAL 28 70 ? 130 %

Allergies: potential cipro allergy

Symptom List: Vomiting

Symptoms: Patient is a 39 y.o. male with PMHx significant for recently diagnosed HTN, who presented to hospital on 10/14 with sudden onset monocular vision loss in right eye s/p intra?arterial tPA injection into right ophthalmic artery. MRI showed subacute/acute small infarction in right frontal corona radiata. TEE does show potential fibroelastoma on MV leaflet but otherwise workup without obvious cause of CRAO. ?neck vessels patent?. TTE ?10/15/2021? normal left ventricular size normal left ventricular systolic function; ejection fraction ?2D? = 63% normal left ventricular diastolic function normal right ventricular size normal right ventricular function no evidence for valvular aortic stenosis minimal valvular mitral regurgitation inadequate tricuspid regurgitation to assess right ventricular systolic pressure no evidence for interatrial shunt; agitated saline contrast performed: no evidence of intracardiac or intrapulmonary shunt, color Doppler performed: no flow demonstrated no evidence for pericardial effusion Etiology: Undetermined at this time. No significant atherosclerosis. Concern for embolic origin. Vision in right eye has returned to about 95%, but some level of permanent retina damage due to the oclusion.

Other Meds: lisinopril, methylprednisolone, meloxicam

Current Illness: Lower back pain,

ID: 1821217
Sex: M
Age: 76
State: MT

Vax Date: 03/19/2021
Onset Date: 09/29/2021
Rec V Date: 10/27/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

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

Other Meds:

Current Illness:

ID: 1821218
Sex: F
Age: 43
State: TX

Vax Date: 10/24/2021
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: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Fever, chills, muscle/joint pain, headache, nausea (flu-like symptoms). Started late on 10/24/21 and lasted until midmorning on 10/26/21.

Other Meds: levothyroxine, duloxetine, acetaminophen, loratadine

Current Illness:

ID: 1821219
Sex: F
Age: 34
State: FL

Vax Date: 10/21/2021
Onset Date: 10/24/2021
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: IM
Vax Site: LA

Lab Data: CPK level peaked at 25K, declined to 5K after fluid resuscitation Autoimmune markers negative, including anti-jo1, ANA, p-anca,c-anca MRIs negative for acute abnormalities

Allergies: none

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Rhabdomyolysis, myositis, stock and glove lower extremities (other causes ruled out, autoimmune and viral tests resulted) Given fluids and antibiotics Resolved after fluid resuscitation

Other Meds: Adderall

Current Illness: ADHD

ID: 1821220
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:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: There were no symptoms.

Other Meds:

Current Illness:

ID: 1821221
Sex: M
Age: 85
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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: none

Allergies: penicillin lisinopril unknown food (>30 years ago)

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

Symptoms: Redness, pruritus Improved next day, but still present First two injections were Moderna; only adverse reaction was pain at vaccination site

Other Meds: gabapentin multivitamin baby aspirin Elequis calcium/vitamin D supplement mesalamine cardidilol dioxin atorvastatin

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am