VAERS 2021 Database www.vaers.hhs.gov

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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: 1821955
Sex: M
Age: 85
State: MA

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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: PATIENT RECEIVED FLU SHOT FOR 2ND TIME IN SEASON

Other Meds:

Current Illness:

ID: 1821956
Sex: F
Age: 65
State: CA

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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: I experienced itchiness, nausea, fatigue, muscle pain, skin sensitivity, shortness of breath and chest pressure.

Other Meds: Yes

Current Illness:

ID: 1821957
Sex: F
Age: 70
State: CA

Vax Date: 10/27/2021
Onset Date: 10/27/2021
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: N/A

Allergies:

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

Symptoms: Med Error: Patient received the 21st dose of a 20 limit Moderna Vial. Patient had left the post recovery area before the incident was caught and patient was not able to be notified.

Other Meds:

Current Illness:

ID: 1821958
Sex: F
Age: 55
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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies: Patient self reports allergies to various unknown things: breaks out in hives

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient self reported allergies to unknown things. Patient was hesitant in receiving vaccine because of fear of having allergic reaction but patient self reported that her employer is making her get the vaccine. Patient consented to receiving first dose of Pfizer and let the clinical team know about her concerns. Clinical team extended observation time to 30 mins as per protocol. Patient received vaccine at approximately 1738. Patient went to observation area and within 5 minutes patient reported itchiness, redness and hives. Hives and redness observed by clinical team. Benadryl 25mg oral given to patient with good effect. Patient reports decrease in itchiness and no hives observed.

Other Meds: Unknown

Current Illness: Unknown

ID: 1821959
Sex: M
Age: 79
State: LA

Vax Date: 09/30/2021
Onset Date: 10/01/2021
Rec V Date: 10/27/2021
Hospital: Y

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

Lab Data:

Allergies: NKDA

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

Symptoms: ALTERED MENTAL STATUS; CARDIAC EFFECTS

Other Meds:

Current Illness:

ID: 1821960
Sex: F
Age: 60
State: WI

Vax Date: 09/29/2021
Onset Date: 10/02/2021
Rec V Date: 10/27/2021
Hospital: Y

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: CTPA 10/3/21 with left pulmonary embolism.

Allergies:

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

Symptoms: Pulmonary embolish

Other Meds: Lamotrigine, albuterol, chlorthalidone

Current Illness:

ID: 1821961
Sex: F
Age: 33
State: KY

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:

Allergies: Celiacs

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Heavy, bright red bleeding at injection site over 15+ hours after the injection. Severe, sharp arm pain when the injection was administered. Bruising on right arm has been developing. Deep body aches and joint pain on legs, headache, fatigue.

Other Meds: Crestor, trinessa, spironolactone, baby aspirin, adderall, lexapro, synthryoid

Current Illness: None

ID: 1821962
Sex: F
Age: 49
State: CA

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: None.

Allergies: Pollen seasonal.

Symptom List: Pharyngeal swelling

Symptoms: Client already received 2 doses of Sputnik vaccine on 2/24/21 and 3/18/21. Client received first of Moderna series, based on CDC guidelines.

Other Meds: Rosuvastatin and Calcium

Current Illness: None

ID: 1821963
Sex: F
Age: 30
State: FL

Vax Date: 10/26/2021
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: LA

Lab Data: EKG : diffuse st depressions and biphasic T wave V4 normal troponin D dimer < 500 CXR normal CBC, BMP normal

Allergies: aspirin

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Pt presented to ER for chest pain, palpitations, shortness of breath which started within a few hours of her Pfizer covid booster given yesterday on 10/26/21. She went home took tylenol/ motrin without relief. pt reported continued pain, shortness of breath, chest pain with rest and exertion worsened with laying flat improved with sitting forward constant since a few hours post administration of the vaccine so she sought care today. no cardiac hx in patient or her family

Other Meds: oral contraceptive mood disorder medication

Current Illness: none

ID: 1821964
Sex: F
Age: 55
State: AL

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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: N/A

Allergies: N/A

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient has cerebral palsy and scoliosis. Her nurse alerted the pharmacy that the patient was hot and anxious. She used an ice pack on her neck and drank some coke.

Other Meds: N/A

Current Illness: Cough

ID: 1821965
Sex: F
Age: 55
State: FL

Vax Date: 08/31/2021
Onset Date: 09/06/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data: 9/27/2021 mammogram 10/11/2021 mammogram and ultrasound left breast

Allergies: Nka

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

Symptoms: Soon after my 2nd shot I noticed a nerve type pain in my left breast. On 9/27 my annual mammogram showed an asymmetry in my left breast requiring further testing. On 10/11 further mammogram and ultrasound of my left breast showed a cyst and an enlarged lymph node which are probably benign per the report and my gyn. Previous mammogram in September 2020 was normal. Left breast pain is still present today.

Other Meds: None

Current Illness: None

ID: 1821966
Sex: F
Age: 37
State: GA

Vax Date: 10/06/2021
Onset Date: 10/08/2021
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:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Patient reports under arm lymph nodes started swelling 2-3 days after vaccine. She went to the emergency department. The ED advised her that the swelling was due to the vaccine and would subside on its own. The swelling went away shortly after her ED visit and she is now feeling fine.

Other Meds:

Current Illness:

ID: 1821967
Sex: M
Age: 46
State: CT

Vax Date: 04/24/2021
Onset Date: 10/09/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data: no tests or labs at this point.

Allergies: none

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

Symptoms: Beginning approximately 2:00 PM I had an elevated heart rate that persisted for ~90 minutes before I sought medical attention in the emergency room. This event appears to be part of symptoms of my A-Fib diagnosis. My heart rate is typically in the 60's, however it was at a rate of approximately 120 during these 90 minutes. once under observation in the ER, the Doctor indicated that Cardioversion - I was given the choice of electrical or IV medication. I chose electrical which was prefaced by an administration of propofol. My heart rate returned to normal following the cardioversion.

Other Meds: Eliquis 2x daily 5mg Escitalopram 1x daily 10mg Trazodone 1x daily 50mg B12 supplement 1x daily 500mcg

Current Illness: Atrial Fibrillation Mild Depression Mild Sleep Apnea TIA January 2021

ID: 1821968
Sex: F
Age: 43
State: AZ

Vax Date: 02/02/2021
Onset Date: 02/03/2021
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: N/A

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

Symptoms: 12 hours later - low fever (101.5) and sore muscles and weak. I have a scar from the shot (extremely similar to scars I've seem that people who received the small pox vaccine)

Other Meds: Pristiq, Wellbutrin, Benadryl, Ativan

Current Illness: N/A

ID: 1821969
Sex: F
Age: 35
State: IL

Vax Date: 10/18/2021
Onset Date: 10/21/2021
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: None

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

Symptoms: Pain in the left arm, severe chills, severe hot flashes, burning eyes, runny noise, headache, sneezing.

Other Meds: Vita Fusion Women?s Multi Gummi Vitamins

Current Illness: None

ID: 1821970
Sex: M
Age: 50
State: KY

Vax Date: 10/14/2021
Onset Date: 10/15/2021
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: CTA 10/22/21- severe inflammation surrounding celiac artery with pseudoaneurysm 10/22- negative blood cx, CRP elevated to 20, all other markers negative CTA 10/25/22- worsening of inflammation and pseudo

Allergies: NKDA

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

Symptoms: Pt received the COVID Booster on 10/14/2021. The following day on 10/15, developed some chills and nausea. On 10/16, he developed severe abdominal pain and back pain that did not subside until he presented to hospital on 10/22. CT scan revealed severe inflammation surrounding the celiac artery with a pseudoaneurysm of the artery. Work-up including blood cultures negative for any infection. ECHO was negative for vegetation. Pt has had no recent procedures except cholecystectomy years ago. No recent dental work. Infectious disease saw the pt and stated concern for "Vaccine Immune Thrombotic Thrombocytopenia". He did not have thrombocytopenia and HIT panel negative. A repeat CT scan on hospital day hospital day 4 revealed worsening of the celiac inflammation and pseudonaneurysm. The pt ended up getting a celiac artery covered stent to address the risk fo rupture of the stent. There is no reason to explain this sudden pseudoaneurysm. These are typically seen in patient with recent infectious process or instrumentation, not spontaneous.

Other Meds: None

Current Illness: None

ID: 1821971
Sex: M
Age: 16
State: NM

Vax Date: 10/27/2021
Onset Date: 10/27/2021
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: Misread pts date of birth on consent form , parent in room did not indicate patient was minor. I believed he was 18 yo . paperwork prepared by technician indicated jansen vaccine . Gave patient the jansen vaccine and did not realize until further discussion with patient and parent after shot given date of birth was actually for 16 year old . I read a different dob, patient actual dob different. Parent and patient not concerned not upset. Discussed booster for patient should be a Pfizer dose. Told parent we would follow up with them to make sure patient doing ok and parent was ok with that.

Other Meds:

Current Illness:

ID: 1821972
Sex: M
Age: 80
State: NH

Vax Date: 03/11/2021
Onset Date: 04/23/2021
Rec V Date: 10/27/2021
Hospital: Y

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

Lab Data: See above Lumbar puncture 4/27/21 All tests performed between 4/26 and 4/30/21

Allergies: Calcium Acetylsalicylate

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Acute Inflammatory Demyelinating Polyneuropathy Hospitalized 4/26/21 with severe leg weakness/sensory loss on exam; Also developed a left sided bells palsy the week of 4/26/21 MRI T and LS spine negative;CT Brain negative; Lyme test negative, CMV,EBV,HIV negative; B12,TSH normal Lumbar Puncture-Increased CSF Protein, lymphocytic pleocytosis, oligoclonal band Treated with IV IgG infusions x 5 days -Initial partial improvement in leg strength after 1 week Gradual improvement over a few months-mostly recovered; however modest cognitive deficit remains

Other Meds: Leuprolide Singulair Atorvastatin Amlodipine Albuterol zinc Ascorbic acid

Current Illness: prostate cancer Asthma Dyslipidemia Hypertension

ID: 1821973
Sex: F
Age: 65
State: FL

Vax Date: 10/21/2021
Onset Date: 10/21/2021
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: NONE

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Patient has a 3 inch red spot that is sensitive to touch but not at injection site. The spot is 3 inches down from injection site and inside arm area. Patient has had the spot for 6 days and gets very red after hot shower.

Other Meds: N/A

Current Illness: N/A

ID: 1821974
Sex: M
Age: 70
State: CA

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: chills 11 hours later, lasting 3 hours. Body and joint aches and fatigue the day after

Other Meds: none

Current Illness: none

ID: 1821975
Sex: M
Age: 85
State: WI

Vax Date: 10/20/2021
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: 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: Sore throat and lost voice

Other Meds:

Current Illness:

ID: 1821976
Sex: U
Age:
State: NM

Vax Date:
Onset Date:
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: Unevaluable event

Symptoms: Unknown

Other Meds:

Current Illness:

ID: 1821977
Sex: F
Age: 65
State: MN

Vax Date: 10/25/2021
Onset Date: 10/27/2021
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: codeine, hydrocodone, penicillin,

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

Symptoms: rash on left arm.

Other Meds: gabapentin

Current Illness:

ID: 1821978
Sex: F
Age: 68
State: CA

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

Lab Data: None

Allergies: Anaprox

Symptom List: Injection site pain, Pain

Symptoms: Four to six hours after receiving the Covid booster in my left arm very near my acromion process I developed severe pain and could not extend my left arm outward from my body without using my other arm to support it. I have never been given an injection so high up on the shoulder! I phoned the pharmacy to complain to the pharmacist and told her I was an RN and that her technique was off. It needs to be two to three finger breadths below the acromion process. I have been using ice, ibuprofen, Voltarin topical to ease the pain. This feels like frozen shoulder.

Other Meds: Pravastatin, Atenolol

Current Illness: None

ID: 1821979
Sex: F
Age: 21
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:
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Ibeuprofin

Symptom List: Injection site pain, Menorrhagia

Symptoms: My arm became very hot and firm. I have a firm ball of tissue where the shot was administered. I also got a rash in the shape of a circle over the area where I got the shot. Very extreme fever for the first two days.

Other Meds: No

Current Illness: No

ID: 1821980
Sex: F
Age: 67
State: CA

Vax Date: 02/25/2021
Onset Date: 03/25/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data: Blood test, brain scan, chest X-ray. June 5, 2021. Results: Elevated platelets, ESR, CRP, WBC

Allergies: Sulfa, betadine

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

Symptoms: Developed headache, scalp tenderness, jaw claudication, elevated temp (101), feeling generally unwell. Went to ER, was diagnosed with Giant Cell Arteritis (autoimmune disease).

Other Meds: levothyroxine, estradiol, cephalexin, progesterone, multivitamins

Current Illness: None

ID: 1821981
Sex: F
Age: 68
State: FL

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: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies: None

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Headache first, nausea, severe shivvers for 30 minutes, joint aches lasted for 10 hours, slight fever

Other Meds: Fluoxetine, losartan, cosopt, magnesium glycinate, EmergenC vitamin

Current Illness: None

ID: 1821982
Sex: M
Age: 54
State: FL

Vax Date: 10/14/2021
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: UNK
Vax Route: IM
Vax Site: RA

Lab Data: none at this time

Allergies: unknown

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: painful, eraser sized lump appeared in neck; right side just below base of skull 2 inches from ear canal. Does not appear to be getting any larger. Still there today. Monitoring to see if it grows or moves.

Other Meds: multivitamin; flax seed oil; low dose aspirin

Current Illness: none

ID: 1821983
Sex: F
Age: 32
State: GA

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

Lab Data:

Allergies: No

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

Symptoms: 103 fever for 36 hours, headache, nausea, body aches, swollen lymph nodes in armpit for 48+ hours

Other Meds:

Current Illness: No

ID: 1821985
Sex: F
Age: 63
State: WA

Vax Date: 04/28/2021
Onset Date: 04/28/2021
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: None

Symptom List: Nausea

Symptoms: My shoulder hurt at the injection site immediately. I now have constant pain and limited range of motion.

Other Meds: None

Current Illness: None

ID: 1821986
Sex: M
Age: 40
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:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Per patient "I am about 50 hrs. removed and am still having a pretty robust reaction at the injection site: redness, hard swelling, itching, and skin is warm to the touch. Are you aware of how common this reaction is and should it be a cause for concern? The soreness has subsided a bit, but all of the aforementioned symptoms are still quite present. "

Other Meds:

Current Illness:

ID: 1821987
Sex: F
Age: 45
State: CA

Vax Date: 07/21/2021
Onset Date: 07/21/2021
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: No

Allergies: No

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

Symptoms: Burning in my arm and soreness for one week and a half in the arm of the injection site. Fatigue - what is ongoing still - extra fatigue that I never had before; and I had a headache for two days. Eczema about four weeks after the vaccine where started getting rash and the doctor said it was Eczema and I've never had that before. I went on steroids (topical) and and Oral steroid for that. It helped somewhat but it's been recurrent. I get it every month or two months now. I went to the doctor for the fatigue recently. He told me to get more rest which is not improving it. It's abnormal fatigue. I never have felt this fatigued before - even get it doing housework and working out - things I try to do every day. It's becoming more difficult to do those things. I have an appt with him in December and he said if I still have fatigue - he'll do testing then. He gave me another prescription for B12 shots which I had been taking regularly before this vaccine but now they're not helping. I also got a sinus infection (started getting it in September) and I haven't gotten a sinus infection since 2019. It was pretty severe this time. This time I had to see an ENT specialist yesterday for this because it wasn't going away. In the past, it has resolved on it's own. He told me he didn't want to give me antibiotics at first and suggested doing a nasal rinse and take Flonase to help with the congestion. I am still having the sinus infection, it has not resolved yet.

Other Meds: No

Current Illness: No

ID: 1821988
Sex: F
Age: 37
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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

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

Symptoms: Left Arm immobility, pain and generalized bruising.

Other Meds: None

Current Illness: None

ID: 1821989
Sex: F
Age: 25
State: WA

Vax Date: 10/14/2021
Onset Date: 10/14/2021
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: Tremor

Symptoms: Patient admitted she was very nervous for vaccine. Took a moment to calm down. After receiving vaccine started feeling dizzy, trouble keeping eyes open. Moved patient to a private area. Provided water and apple juice. Took BP. 94/63 mmHg. Patient requested ice packs because feeling sweaty and diaphoretic. Provided ice packs. Repeat BP 101/75 mmHg. Patient is a young healthy female, likely low baseline BP. Patient reported feeling better and departed. Likely vasovagal response due to being nervous and "insult" of needle in arm.

Other Meds:

Current Illness:

ID: 1821990
Sex: F
Age: 37
State: MN

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

Lab Data:

Allergies: Betadine and Chlorhexidine

Symptom List: Erythema, Pruritus

Symptoms: Fever, chills, joint pain, headache, fatigue, insomnia, nausea, dizziness started after I went to sleep, around 12 am and continued all night until I woke up at 9:30 am

Other Meds: Lyumjev, Tresiba, Escitalopram, Buspirone, Famotidine, Mili

Current Illness: None

ID: 1821991
Sex: M
Age: 46
State: NJ

Vax Date: 06/01/2021
Onset Date: 10/18/2021
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: PCR + for Covid on 10/18/2021 and 10/25/2021

Allergies: none known

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

Symptoms: Client received 2 doses of Covid vaccine (Pfizer) in June 2021. Developed symptoms of Covid on 10/18 - nasal congestion, fatigue, weakness, myalgia, loss of taste and smell, fever, dizziness, chest heaviness with breathing, Tested + with PCR on 10/18 and 10/25. Treated with monoclonal antibody infusion at Hospital on 10/26. Improvement in 24 hours noted. Also treated with steroids and inhaler.

Other Meds: none known

Current Illness: none known

ID: 1821992
Sex: F
Age: 31
State: OH

Vax Date: 09/13/2021
Onset Date: 09/19/2021
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: Blood work completed to rule out diabetes, kidney issues and vitamin deficiencies. All have come back normal. Vein ultrasound proved no blood clots. MRI is ordered and more blood work has been ordered to identify cause of nerve pain and tingling/numbness.

Allergies: N/A

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

Symptoms: Nerve pain in legs and feet, tingling/numbness in feet, legs, hands, arms and face. Felt foot pain at night and then left foot fell asleep for over 24 hours. began having nerve pain a few days later in legs and left foot. Went to hospital and they ordered a vein ultrasound to check for blood clots. Test came back negative. Have been referred to Pain Medicine and Neurology so far and no doctor can explain the issues I have expressed.

Other Meds: N/A

Current Illness: N/A

ID: 1821993
Sex: F
Age: 47
State: WA

Vax Date: 09/20/2021
Onset Date: 09/20/2021
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: Covid test

Allergies: Sensitivity to eggs; I bruise easily with Flomax; I itch with Lexapro

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Later that evening I started shaking and I ran a low grade fever of 99-100. I had scalp pain which was the worst and my hair is falling out and dermatology confirmed that. The shaking was horrible. I'm also getting these blood rushing feelings like my blood is too thick and it's rushing through certain veins and there's a vein on left side of head and I feel it rushing through. I have pain in leg and I take a aspirin just to be on the safe side. The scalp pain is horrendous and it hurts to touch the top of my head. The shaking stopped and that was a full week of shaking. I got Covid 3 weeks after the 2nd dose as well and tested positive on October 17, and those covid symptoms started 7 days prior to testing positive and those symptoms were fever, shaking, body aches and pains, sore throat, and an additional cough to the one I already have, a headache, and I smelled ammonia constantly and I would try to eat meat and it smelled like ammonia. After I tested positive for Covid, it was a week before my symptoms stopped. The only thing I still have is the blood rushing feeling in veins and the scalp pain. I don't know how to explain the scalp pain but my Doctor did give my fluocinonide ointment to put on my head. I had Covid previously from November 2020-January 2021.

Other Meds: Methadone; methylprednisolone; hydroxychloroquine; vitamin C; vitamin with iron; vitamin D; folic acid; vitamin B complex.

Current Illness: None

ID: 1821994
Sex: F
Age: 62
State: IN

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: SYR
Vax Site: LA

Lab Data:

Allergies: Sulfa, fentanyl

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

Symptoms: I Started to get a headache during my shift ( 6am to 14:30) . At home I became real tired and headache increased. Around 18: 00 I was so exhausted that I laid down, I got up about 45 minutes later, laid back down around 19: 30. I started to shiver and my temperature shot up ( 103.1). I was shivering so bad that my whole body was shaking. I took ibuprofen and acetaminophen to relief symptoms. Next day symptoms lasted pretty much all day. When I woke up my hands and fingers where swollen. With my first vaccination I only had a headache but second shot pretty much had the same symptoms than my booster. I did not call my physician.

Other Meds: Carvedilol 3.125, levothyroxine 75mcg, norco 10/325 ,

Current Illness: Rheumatoid arthritis, high cholesterol,

ID: 1821995
Sex: F
Age: 67
State: UT

Vax Date: 10/23/2021
Onset Date: 10/24/2021
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: Cardiac MRI showed myocarditis

Allergies:

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

Symptoms: Developed myalgias, headache, chest pain, nausea the day after the vaccine which progressed and chest pain became severe with elevated troponin. Cardiac MRI confirmed myocarditis.

Other Meds:

Current Illness:

ID: 1821996
Sex: F
Age: 69
State: VA

Vax Date: 09/22/2021
Onset Date: 10/02/2021
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: CT neck= negative

Allergies: Opiates, Phenobarbital; Singulair

Symptom List: Pain in extremity

Symptoms: Large lymph node neck swelling with left lower jaw pain. Difficulty moving neck. No fever, sinus drainage, sore throat or dental issues. Completely resolved by October 7th. PCP said it could not be due to vaccine but I read that you can have lymph node swelling anywhere after Covid vaccine. Neck CT was completely negative. Antibiotics prescribed but not taken.

Other Meds: Lumigan eye gtts; Azelastine nasal spray BID; Zyrtec, Imitrex PRN; vitamins C, D, B12; multivitamin; Valarian, Fiber, Colace, Folic acid

Current Illness:

ID: 1821997
Sex: F
Age: 61
State: ID

Vax Date: 04/15/2021
Onset Date: 04/15/2021
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: BUSPIRONE

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

Symptoms: Shoulder pain same as injection site since injection.

Other Meds: TYLENOL

Current Illness: Dental abscess

ID: 1821998
Sex: F
Age: 54
State: MT

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

Lab Data:

Allergies: NKA Except bee stings

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

Symptoms: Due to reported adverse COIV vaccine, had pt. sit on site 15: pt vistied with staff member additional 15 min, left, returned~ 10 min later c/o"numb lips and tongue" Pt had Bendadryl & took 50 mg po. Vitals stable o2 98% pulse 70, 150/80. Provided gatorade, no problem swallowing noted.Pt remained stable; sx resolved. Returned to work on site at her request.

Other Meds: Ibuprofen

Current Illness:

ID: 1821999
Sex: M
Age: 16
State: TX

Vax Date: 08/06/2021
Onset Date: 08/01/2021
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: Nerve conduction study conducted 10/7/21, which was abnormal. Patient had a sedated MRI spectroscopy and LP on 10/8 which was reassuring against infection, normal protein levels, oligoclonal bands pending, culture pending. MRI spectroscopy obtained abnormal Patient started on IVIG per neurology and received 3 days of infusions with significant improvement. Patient will follow-up with Neurology in clinic.

Allergies: Amitriptyline Hydroxyzine Hcl

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

Symptoms: * (Principal) Generalized weakness, extreme fatigue andmuscle pain Leg pain, bilateral Bilateral arm pain Pain and weakness in lower back, upper and lower extremities only. Pain and weakness appears to start at the shoulders and progress down to wrist with less hand involvement bilaterally Patient he received his first COVID vaccine just prior to symptoms onset. His symptoms worsened in early September after receiving his second dose Post-vaccine polyneuritis

Other Meds: Tylenol

Current Illness:

ID: 1822001
Sex: U
Age: 26
State: WA

Vax Date: 10/08/2021
Onset Date: 10/08/2021
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: Patient spoke foreign language with girlfriend present translating. They stated he was nervous. After receiving vaccine patient said he did not feel well. Patient was downplaying how bad he felt but girlfriend was insistent that he needed help. Moved patient to a private area. Provided apple juice and water. Instructed him to take off sweatshirt since he was hot. Patient sweaty and diaphoretic. Took BP 86/47 mmHg. More water provided. Repeat BP 95/55 mmHg. Then 105/62 mmHg. BP taken about every 5-10 mins. Patient stayed for about 30 minutes before feeling better and leaving.

Other Meds:

Current Illness:

ID: 1822002
Sex: F
Age: 67
State: IL

Vax Date: 03/10/2021
Onset Date: 04/15/2021
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: None. MD stated has seen this problem symptom reaction in others

Allergies: None

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Multi site rashes

Other Meds: Enbrel injection Metformin Benicar Atenolol Baby aspirin Jardiance Multi vitamin

Current Illness: None

ID: 1822003
Sex: F
Age: 22
State: KS

Vax Date: 10/21/2021
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:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: none

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

Symptoms: Immediate severe burning feeling and numbness in left hand. Loss of range of motion that resolved mostly on 10/26/21. Severe pain in left shoulder joint that interfered with sleep that resolved 10/25. Numbness, tingling, cold sensation in left hand have not resolved. Experiencing "flare-ups" of shoulder pain and frozen joint periodically that have not resolved. Unable to lift items more than a couple pounds with left arm, specifically cannot pick up 10 pound dog or backpack that has not resolved. Unable to grip lighter weight items for more than a few minutes and frequently dropping items. Tried alternating Tylenol and Ibuprofen, used maximum recommended daily doses with no relief. Tried using ice pack for 20 minutes on several occasions with no relief. Vaccine was injected anterior to midline and less than 1 finger width below the acromion process. May need follow up with physician or physical therapist.

Other Meds: Vienva once daily Multivitamin once daily Vitamin D 2000IU once daily

Current Illness: none

ID: 1822004
Sex: M
Age: 43
State: WA

Vax Date: 09/10/2021
Onset Date: 09/11/2021
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: Constant mild Headaches. Some severe headaches, and loss of focus.

Other Meds: None

Current Illness: None

ID: 1822005
Sex: F
Age: 44
State: MD

Vax Date: 10/07/2021
Onset Date: 10/07/2021
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: MRI

Allergies:

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

Symptoms: Patient received flu vaccine too high causing a shoulder impingement with significant pain. She is still in pain after more than 2 weeks and has received steroids, an MRI, and is going to physical therapy.

Other Meds:

Current Illness:

ID: 1822006
Sex: M
Age: 36
State: MA

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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: None yet.

Allergies: pennisilun

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

Symptoms: Within a minute of receiving the vaccine, I became lightheaded/dizzy/sweaty and almost fainted. I needed an icepack, fluids, and to put my feet up. This lasted 30 minutes, and then severe body aches, chills, fever, fatigue, cough, stuffy nose, dizzyness, nausea persist more than 24 hours later

Other Meds: multi-vitamin

Current Illness: none

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am