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: 1821430
Sex: M
Age: 51
State: MO

Vax Date: 10/05/2021
Onset Date: 10/05/2021
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: Penicillin

Symptom List: Dysphagia, Epiglottitis

Symptoms: Fatigue, vomiting, swollen left eye and then turned to a black eye for 10+ days

Other Meds: Adzenys

Current Illness:

Date Died:

ID: 1821431
Sex: F
Age: 58
State: KY

Vax Date: 09/26/2021
Onset Date: 10/05/2021
Rec V Date: 10/27/2021
Hospital: Y

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

Lab Data: Chest XR 10/25, 10/24x2, 10/21x2, 10/20, 10/19x2, 10/18, 10/5 Chest CT 10/11, 10/5 Lower Extremity US 10/7 CT Abd 10/24 CT Head 10/24 Renal US 10/22

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Admitted 10/5/21 to Hospital. Intubated 10/19. Discharge Dx: Acute hypoxic hypercarbic respiratory failure due to COVID PNA, COVID PNA with ARDS, AKI d/t ATN, pneumomidiastinum, uremic bleed, aspiration and neumococcal PNA, acute thrombocytopenia, liver cirrhosis. Changed to comfort care and terminally extubated 10/25/21

Other Meds:

Current Illness:

ID: 1821432
Sex: F
Age: 61
State: AZ

Vax Date: 03/10/2021
Onset Date: 06/28/2021
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: none

Allergies: penicillin Crab protine

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

Symptoms: approximately 3 months after I received the 2nd Moderna vaccine my hair began to fall out in clumps. It was think hair and now is thin. I continue to loose about 3 clumps a day.

Other Meds: Levothyroxine 125 mcg Liothyronine sod 5 mcg

Current Illness: none

ID: 1821433
Sex: M
Age: 73
State: PA

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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient came in for a Moderna booster (.25) but received full dose(.5)

Other Meds:

Current Illness:

ID: 1821434
Sex: F
Age: 25
State: KY

Vax Date: 07/21/2021
Onset Date: 09/02/2021
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: Positive Covid 19 test 09/02/2021

Allergies:

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

Symptoms: Fever

Other Meds:

Current Illness:

ID: 1821435
Sex: F
Age: 13
State: VA

Vax Date: 09/19/2021
Onset Date: 09/20/2021
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: No additional testing was conducted outside of an ophthalmological exam.

Allergies: Sulfa, seasonal

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

Symptoms: Patient described constant blurred vision and palinopsia in her left eye only. This began one day after receiving her first vaccine dose and lasted approximately 4 weeks, resolving around 10/23/2021. Today when I saw her she reported no issues, perfect acuity in both eyes, and no clinical signs of an adverse event. She reported no additional symptoms or health concerns. I believe she also received a flu shot some time after the initial covid vaccine; her PCP advised she wait longer before receiving the second covid vaccine given the recent flu shot. As of 10/27/21 she has not had the second dose.

Other Meds: Ritalin, Claritin, Flovent, Symbicort, Albuterol

Current Illness: none according to pt

ID: 1821436
Sex: M
Age: 40
State: WI

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: IM
Vax Site: LA

Lab Data: none

Allergies: unknown

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient wanted J&J and we think that he was given Pfizer. When we went to count inventory, it was off after him, leaving an extra J&J and one less Pfizer;

Other Meds: unknown

Current Illness: unknown

ID: 1821437
Sex: F
Age: 47
State: WA

Vax Date: 09/01/2021
Onset Date: 09/01/2021
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:

Allergies: none

Symptom List: Pharyngeal swelling

Symptoms: Severe and at time debilitating insomnia: significant delayed sleep onset latency (2+hrs), nighttime awakening, and inability to return to sleep (3-4hrs to fall back to sleep). Contributing to profound lethargy and exhaustion.

Other Meds: Wellbutrin, Synthroid, and Tylenol PRN

Current Illness: None

ID: 1821438
Sex: F
Age: 64
State: TX

Vax Date: 03/01/2021
Onset Date: 03/01/2021
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: no

Allergies: Topical iodine, kiwi, nickel

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: 03/01/2021 at around 8:00 pm it started with a headache, chills fever. On 03/05/2021 I still had the headache, and began having GI symptoms with diareahha and vomiting at the same time, along with abdominal pains, bleeding during diareahha , that lasted a day and half.

Other Meds: I was taking Syrelto, Triamterene, Levothyroxine, Liothyronine, Versa care, Monologues, Pagesterone, Methylate.

Current Illness: no

ID: 1821439
Sex: F
Age: 47
State: NJ

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

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

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Error: Wrong Dose of Vaccine - Too Low-

Other Meds:

Current Illness:

ID: 1821440
Sex: M
Age: 41
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:
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Unusual and excessive gum bleeding.

Other Meds:

Current Illness:

ID: 1821441
Sex: F
Age: 26
State: OH

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: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data: No

Allergies: No

Symptom List: Rash, Urticaria

Symptoms: First day of my shot I got sorriness at the injection site. Then felt tired some first day coming home. Around 12:03 on October 25th Then the 26th I felt low fever with chills and fatigue. Wanted to sleep. On October 27th, 2021 Still feel some fatigue. In the morning

Other Meds: No

Current Illness: No

ID: 1821442
Sex: F
Age: 75
State: KS

Vax Date: 08/12/2021
Onset Date: 08/22/2021
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: CT chest, abd, pelvis Echocardiogram Pericardiocentesis

Allergies: Reaction: Palpitations Medium Side Effect/Adverse Event 1/8/2016 Past Updates Cardio Tea Influenza Virus Vaccines Influenza Virus Vaccines Fatigue, Myalgia Not Specified 6/18/2015 Penicillins Penicillins Not specified, Other (See Comments) Not Specified 6/18/2015 Past Updates breathing issues as child, Adverse Reaction Sulfa (Sulfonamide Antibiotics) Sulfa (Sulfonamide Antibiotics) Hives, Not specified, Other (See Comments) Not Specified 6/18/2015 Past Updates breathing issues as child, Adverse Reaction

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

Symptoms: Aug 12 2021: Received Johnson and Johnson Vaccine Aug 16: Her husband was diagnosed with COVID, she did not develop symptoms and was not tested for COVID Late Aug/Early Sep: began to develop dizzy/lightheaded that was a real change for her 10/18/21: Progressive chest fullness when returning from trip to lake with family and friends, presented to ER, diagnosed with pericarditis, begun on colchicine and ASA 650 BID 10/20/21: Progressive epigastric abd discomfort, poor appetite, called our office, recommended to down titrate ASA dose to 325, which she did 10/20-10/25/21: Progressive chest fullness, epigastric discomfort, poor appetite, emesis, difficulty being flat in bed 10/24-25 CT C/A/P and ECG: Pericardial effusion Atrial flutter/fibrillation is newly diagnosed

Other Meds: ACETAMINOPHEN (TYLENOL EXTRA STRENGTH ORAL) Take 1,000 mg by mouth daily. ? acyclovir (ZOVIRAX) 200 MG capsule TAKE 1 CAPSULE BY MOUTH TWO TIMES DAILY 180 capsule 3 ? APPLE CIDER VINEGAR ORAL Take by mouth nightly. ? aspirin 81 MG E

Current Illness: None

ID: 1821443
Sex: F
Age: 52
State: NY

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: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1821444
Sex: M
Age: 53
State:

Vax Date: 04/26/2021
Onset Date: 10/15/2021
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: COVID 20Oct2021. BP normal. Oxygen normal.

Allergies: Gluten sensitivity

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

Symptoms: I had a funny feeling in my throat and severe fever and chills and body aches for 3 days. 20Oct2021 developed a deep cough for 3 days. 23oct2021 it started go away. 20Oct2021 lost taste and smell 22 or 23 oct2021 regained them both.

Other Meds: N/A

Current Illness: NO

ID: 1821445
Sex: F
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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: none

Allergies: unknown

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

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

Other Meds: unknown

Current Illness: none

ID: 1821446
Sex: F
Age: 13
State: KY

Vax Date: 10/25/2021
Onset Date: 10/25/2021
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: None

Allergies: None

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

Symptoms: Pt was given Pfizer vaccine that had BUD of 10/21/2021.

Other Meds: None

Current Illness: None

ID: 1821447
Sex: F
Age: 55
State: KY

Vax Date: 02/26/2021
Onset Date: 10/18/2021
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:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Covid positive contact unknown

Other Meds:

Current Illness:

ID: 1821448
Sex: F
Age: 71
State: NJ

Vax Date: 10/22/2021
Onset Date: 10/22/2021
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:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Error: Wrong Dose of Vaccine - Too Low-

Other Meds:

Current Illness:

ID: 1821449
Sex: F
Age: 48
State: WA

Vax Date: 10/04/2021
Onset Date: 10/08/2021
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: SWOLLEN/ TENDER BREAST AND/OR LYMPH NODES

Other Meds:

Current Illness:

ID: 1821450
Sex: F
Age: 63
State: VT

Vax Date: 04/21/2021
Onset Date: 08/19/2021
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: MRI, CT scans, multiple bood drawsl August 19 and 20 and 21. September 4and5

Allergies: Codiene, Dilaudid, Clindamycin, Neomycin, Prednisone, Protonix

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

Symptoms: Stroke on right side from foot to top of head. Iv medication to embolyze the clot(s) given with 2 days in hospital. generalized weakness for about a week after. 2 weeks later experienced a mild heart attack and was hsopitalized for night and day

Other Meds: Synthroid. multivita min, B-6, B-12, fish oil, curcumin, folic acid and D-3

Current Illness: Occulo-pharyngeal muscular dystrophy, Paroxysmal supraventricular tachycardia

ID: 1821451
Sex: F
Age: 84
State: CA

Vax Date: 10/21/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Cozaar, HcTz, Hydralazine, Lisinopril, Metoprolol, Nifedipine, Xanax, Tetracycline, Chorthalidone,

Symptom List: Unevaluable event

Symptoms: Patient became hypertensive and was experiencing right scapular pain. Hypertension did not resolve with rest. Patient was sent to emergency room via ambulance for further evaluation

Other Meds: Synthriod, Catapres, Neurotin, Apresline, Aldactone, Ventolin, Alvesco,

Current Illness:

ID: 1821452
Sex: M
Age: 75
State: NJ

Vax Date: 10/22/2021
Onset Date: 10/22/2021
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: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1821453
Sex: M
Age: 66
State: OH

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: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Patient came in for a Moderna booster (.25) but received full dose(.5)

Other Meds:

Current Illness:

ID: 1821454
Sex: F
Age: 72
State: IL

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: SYR
Vax Site: LA

Lab Data:

Allergies: Iodine, erythromycin, seafood

Symptom List: Injection site pain, Menorrhagia

Symptoms: Broke out into severe hives all over the body including face arms legs, back, stomach, heart Palpitations high blood pressure, nausea

Other Meds: bupropion, clonazepam, estradiol, lisinopril metformin, rosuvastatin, synthroid12 , omeprazole dr, B12, aspirin 81, Cramp Defence(magnesium)

Current Illness: None

ID: 1821455
Sex: M
Age: 24
State: FL

Vax Date: 09/04/2021
Onset Date: 10/12/2021
Rec V Date: 10/27/2021
Hospital: Y

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

Lab Data: See above summary.

Allergies: No known allergies

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

Symptoms: Severe thrombocytopenia - Patient developed altered mental status and hypotension. Patient was emergently endotracheally intubated due to acute hypoxic respiratory failure. MTP was initiated and patient was transfused 4 units packed red blood cells, 1 unit cryoprecipitate, 2 units platelets and patient was started on tranexamic acid every 8 hours 800 mg due to life-threatening coagulopathy. Patient was found to have life-threatening acute blood loss anemia with hemoglobin 2.3\hematocrit 7. Patient received transfusion of blood products. Due to life-threatening hypotension and hemorrhagic shock patient required IV norepinephrine drip/vasopressin drip/and sodium bicarb drip due to profound metabolic acidosis with lactic acid 21.5. Echocardiogram was done on 9/18/2021 which showed EF 60/64%. On 9/27 he remained sedated, orally intubated on mechanical ventilation. Had an episode of melena. Transfused 6 units PRBCs 2 units platelets 2 units FFP 2 units cryoprecipitate overnight. On 9/28 Hematology recommended plasmapheresis. Patient had persistent melena and continued on IV PPI. 10/1 Patient initiated on dialysis on 9/30 due to volume overload and severely elevated phosphorus. Patient continued to have critically low platelet level and severe anemia. Platelets and PRBCs transfused. 10/2 Patient underwent plasmapheresis and HD, both of which he tolerated well. Patient had severe anemia requiring 2u PRBC and persistently thrombocytopenic requiring platelet transfusion. Patient extubated 10/3. IVIG started 10/5 per Hematology. Transfused 1u platelets, ordered 2u pRBCs for worsening anemia. He received 1 unit PRBCs and 1 unit platelets overnight for hemoglobin of 6.5 and platelet of 3 10/10. On 10/12 patient had repeat BM biopsy with IR. Dexamethasone suppression test unsuccessful due to improper timing of lab collection. Patient received 1 unit pRBCs for hgb 6.2. Ophthalmology consulted for vitreous hemorrhage, rec reconsult in 2 weeks if unimproved, OP follow up. Transferred out of ICU 10/13. Heme/onc following getting scheduled transfusions. Intermittently requiring prbc transfusion as well. Surg onc consulted. S/p splenectomy 10/22. Hematology managing of Nplate and continuing cyclosporin, and continuing transfusion of platelets. Undergoing splenectomy vaccination with plt transfusions per hematology. Patient is still inpatient.

Other Meds: None

Current Illness: None

ID: 1821456
Sex: F
Age: 34
State: KS

Vax Date: 10/16/2021
Onset Date: 10/16/2021
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: CBC with auto differential, collected 10/25/2021 SEdimentation Rate, collected 10/25/2021 TSH (reflex if T4 abnormal), collected 10/25/2021 Lipid panel, collected 10/25/2021 CMP, collected 10/25/2021 All lab panels were within normal limits. Doctor prescribed rogaine and recommended to follow up with dermatologist.

Allergies: No known allergies to medications or foods.

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: About 8 hours after my second dose of COVID-19 vaccine I began having chills which progressed into more significant rigors (shivering, feeling cold, copious sweating), insomnia, fatigue, nausea, and fever of 101.3F around 11:30pm on 10/16/2021. Those symptoms lasted for roughly 14hrs. I again noticed temporary loss/changes in my smell and taste that lasted roughly 48hrs. I followed up with the public health office and the physician (the site where I had received my vaccine). Within 5 days of receiving my second dose I noticed my hair loss that I had been experiencing since my first dose of COVID-19 vaccine began worsening. I again followed up with the public health office and the physician and then sought care from my primary health care provider. At which time she drew lab work and conducted a physical assessment.

Other Meds: Meloxicam 15mg once daily, women's multivitamin (smarty pants brand), nature's way women's probiotic.

Current Illness: No know illnesses at the time of vaccination or one month prior.

ID: 1821457
Sex: M
Age: 58
State: TN

Vax Date: 10/20/2021
Onset Date: 10/20/2021
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: Sulfa

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: describes normal signs and symptoms post influenza vaccine However, additional symptom reported "his wife noticed he "wobbled" and did not walk straight the night of receiving the vaccine that day.

Other Meds:

Current Illness:

ID: 1821458
Sex: M
Age: 30
State: NY

Vax Date: 10/14/2021
Onset Date: 10/20/2021
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: Have an appointment with my primary care who suggested this may be due to nerve inflammation. I am currently taking vitamin D and claritin

Allergies:

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

Symptoms: Pins and needles started in my legs approx 1 week after vaccine Since then over the second week, they have progressed to my upper body, arms, legs and face I have also experienced burning sensations and numbness in my feet and legs Both pinkies are number and tingling most of the time

Other Meds:

Current Illness:

ID: 1821459
Sex: F
Age: 93
State: NJ

Vax Date: 10/22/2021
Onset Date: 10/22/2021
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: Nausea

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1821460
Sex: M
Age: 51
State: MN

Vax Date: 08/24/2021
Onset Date: 08/25/2021
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: Medical provider can provide if needed. Patient is reporting the adverse reaction.

Allergies: NA

Symptom List: Injection site pain

Symptoms: Blood pressure prior to vaccine was 135/80, day after patient checked his blood pressure and it was 200/150. Currently working with healthcare facility to reduce blood pressure. EKG and blood work have been done to eliminate any other causes to the increase of the blood pressure

Other Meds: Irbesartan mesalamine omeprazole

Current Illness:

ID: 1821461
Sex: F
Age: 81
State: MO

Vax Date: 09/29/2021
Onset Date: 10/18/2021
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: Lab Results 10/26 CBC WBC: 7.94 K/mcL WBC: 8.7 K/mcL WBC: 10.29 K/mcL Hgb: 5.6 Gm/dL Critical Hgb: 3.6 Gm/dL Critical Hgb: 4.5 Gm/dL Critical Hct: 18.5 % Critical Hct: 12.7 % Critical Hct: 15.3 % Critical Platelet: 267 K/mcL Platelet: 257 K/mcL Platelet: 312 K/mcL Chemistries Sodium Level: 145 mmol/L Sodium Level: 143 mmol/L Potassium Level: 3.3 mmol/L Low Potassium Level: 3.3 mmol/L Low Chloride: 110 mmol/L Chloride: 107 mmol/L CO2: 23 mmol/L Low CO2: 22 mmol/L Low BUN: 23.2 mg/dL High BUN: 25.7 mg/dL High Creatinine: 1 mg/dL Creatinine: 1.1 mg/dL Glucose Level: 107 mg/dL High Glucose Level: 119 mg/dL High

Allergies: PCN

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

Symptoms: On ~10/18 patient began to show signs of being short of breath when doing any activity. She also felt dizzy and light headed. She has had melena over the last few days. Her O2 saturation was low at PCP appointment 10/25 and she was sent to ER. She has been found to have auto immune hemolytic anemia.

Other Meds: Lisinopril, HCTZ, Omega 3 fish oil

Current Illness: HTN

Date Died: 09/13/2021

ID: 1821462
Sex: F
Age: 90
State:

Vax Date: 02/15/2021
Onset Date: 08/27/2021
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:

Allergies:

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

Symptoms: pt tested positive in nursing home for COVID; hx of dementia, HTN; brought to hospital due to worsening respiratory failure; dx with COVID pneumonia, AKI; made a DNR/DNI; comfort care measures; pt's condition declined and she expired in the hospital

Other Meds:

Current Illness:

ID: 1821463
Sex: F
Age: 71
State: NJ

Vax Date: 10/22/2021
Onset Date: 10/22/2021
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: Tremor

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1821464
Sex: F
Age: 78
State: MO

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:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: patient says her arm is red, sore and hot to touch for the last 2 days

Other Meds:

Current Illness:

ID: 1821465
Sex: M
Age: 37
State: IN

Vax Date: 10/05/2021
Onset Date: 10/06/2021
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: Blood work, stool studies, CT scan

Allergies: None

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

Symptoms: I had the expected headache and sore arm. Later that night I began developing diarrhea which then became bloody. After 3 weeks of work up, I have been diagnosed with Ulcerative Colitis

Other Meds: None

Current Illness: None

ID: 1821466
Sex: F
Age: 77
State: CA

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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: N?A

Allergies: Cipro

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

Symptoms: Severe arm pain, total body pain, headache, fatigue,. mild chills Have recovered somewhat but not totally

Other Meds: Budesonide, Sertraline, Triamterine, Advair At 9:00 AM

Current Illness: N/A

ID: 1821467
Sex: F
Age: 48
State: PA

Vax Date: 10/25/2021
Onset Date: 10/27/2021
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: None

Allergies: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Broke out in a raised red rash on both arms and chest and trunk

Other Meds: Lisinopril 20 mg

Current Illness: Possible shingles?

ID: 1821468
Sex: F
Age: 82
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: unknown

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

Symptoms: Patient was given .5ml of moderna instead of .25ml Patient complained of local reaction at the injection site.

Other Meds: Unknown

Current Illness: None

ID: 1821469
Sex: M
Age: 76
State: FL

Vax Date: 10/07/2021
Onset Date: 10/08/2021
Rec V Date: 10/27/2021
Hospital: Y

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: Pleae contact physician and/or Hospital for this information.

Allergies: Dusts, pollens, molds.

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

Symptoms: The day afte receiving my third (booster) dose of the Pfizer vaccince, I suffered a stroke.

Other Meds: Sirlimus, Mycophenolic acid, Diltiazem CD, Colesevelam HDC, Omega-3 ethyl estr capsules,Ezetimibe, Folbee PLus, Ketoconazole cream, Fenofrbrate, Glimepiride, Insulin, Aspirin 81 mg, Sodium bicarbonate tabs, Multivitamins, Omeprazole, Benadr

Current Illness: Hypertension, Diabetes,

ID: 1821470
Sex: F
Age: 63
State: NJ

Vax Date: 10/22/2021
Onset Date: 10/22/2021
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: Pain in extremity

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1821471
Sex: F
Age: 47
State: PA

Vax Date: 10/08/2021
Onset Date: 10/11/2021
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: None

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

Symptoms: Since being vaccinated, I have had extreme trouble breathing. I get short of breath quickly doing mundane activities. It is getting progressively worse and I am scheduling an appointment to see my doctor. I had an episode last night where I could not stop coughing and took almost an hour to catch my breath so I could speak.

Other Meds: N/A

Current Illness: None

ID: 1821472
Sex: F
Age: 70
State: OH

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Patient came in for a Moderna booster (.25) but received full dose(.5)

Other Meds:

Current Illness:

ID: 1821473
Sex: M
Age: 17
State: TX

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

Lab Data: None

Allergies: NKA

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

Symptoms: No adverse Effects

Other Meds: N/A

Current Illness: NONE

ID: 1821474
Sex: M
Age: 71
State: NJ

Vax Date: 10/22/2021
Onset Date: 10/22/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1821475
Sex: M
Age: 52
State: MN

Vax Date: 10/19/2021
Onset Date: 10/24/2021
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:

Allergies: Midrin

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Siezure..5min duration

Other Meds: Metformin, oxycodone, acyclovir

Current Illness: Multiple sclerosis, diabetes

ID: 1821476
Sex: M
Age: 67
State: MN

Vax Date: 03/27/2021
Onset Date: 10/26/2021
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: 10/26/2021 SARS Coronavirus-2, PCR detected

Allergies:

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

Symptoms: Pt developed s/s of COVID, presented to the ED and tested positive for COVID

Other Meds:

Current Illness:

ID: 1821477
Sex: M
Age: 16
State: KY

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: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Pt was given Pfizer vaccine that had BUD of 10/21/2021.

Other Meds: None

Current Illness: None

ID: 1821478
Sex: F
Age: 68
State: UT

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: RA

Lab Data:

Allergies: Sulfa drugs (rash). Adhesives

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

Symptoms: Strong metallic taste in mouth lasting 16 hours

Other Meds: Lamictal, Bupropion, Mirapex, Levothyroxine, vitamin D3, biotin, zinc

Current Illness: None

ID: 1821479
Sex: M
Age: 6
State: TX

Vax Date: 10/19/2021
Onset Date: 10/20/2021
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: Sonogram, soft tissue and knee; Bloodwork

Allergies: peanut - completely avoids; egg - tolerates baked eggs; Followed by allergist

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

Symptoms: Given flu vaccine in office on Tuesday. By Wednesday, developed swelling and redness of right leg from thigh to knee. Had normal labs and sono of right knee. Treated with benadryl and motrin. Resolved without further sequelae.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am