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: 1826260
Sex: F
Age: 80
State: PR

Vax Date: 10/28/2021
Onset Date: 10/28/2021
Rec V Date: 10/28/2021
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: Mango; Aspirin; Perfumes; Environment

Symptom List: Dysphagia, Epiglottitis

Symptoms: An 80-year-old female patient was taken to the incident observation area for her first dose of MODERNA at 4:18pm. At 4:25pm the itch began which intensified in the head, arms, legs and chest. Then, the vital signs were taken which were: 130/80mmHg, 18 resp., 50 Pulse and 92 DXT. The case was consulted with Dr., who indicated that BENADRYL 25mg be administered and that it be left under observation while the treatment progresses as required. At 4:46pm BENADRYL 25mg is administered in the upper left external buttock and Famotidine 20mg p.o. as both are H1 and H2 antihistamines for allergy relief. At 4:50pm he was administered Famotidine as H2 receptor at 4:55pm. On the other hand, at 3:22pm, the patient is offered to be transferred to a hospital and indicates that it is not necessary and that if she feels bad that she has BENADRYL not to get better, she would go to a hospital.

Other Meds: Losartan; Metoprolol

Current Illness: NO

ID: 1826261
Sex: F
Age: 47
State: WA

Vax Date: 09/18/2021
Onset Date: 09/18/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: pending

Allergies: none

Symptom List: Anxiety, Dyspnoea

Symptoms: burning sensation from toes to knees bilaterally, onset 4 hours after her second shot. Persisting at time of MD eval 10/27/2021

Other Meds: trazodone, sertraline, ibuprofen

Current Illness: none

ID: 1826262
Sex: F
Age: 49
State: CT

Vax Date: 10/28/2021
Onset Date: 10/28/2021
Rec V Date: 10/28/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Patient came in wanting to get a flu shot and was accidentally administered a shot of the Pfizer COVID 19 vaccine. The patient had received two shots prior to this one with the second being approximately 3-4 months ago.

Other Meds:

Current Illness:

ID: 1826263
Sex: M
Age: 78
State: NY

Vax Date: 10/23/2021
Onset Date: 10/23/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: none

Allergies: none

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: The patient was incorrectly given a full dose of the Moderna vaccine (0.5 milliliters) instead of the half dose (0.25 milliliters) as a booster dose. The patient was told to monitor but was having no adverse events thus far.

Other Meds:

Current Illness:

ID: 1826264
Sex: M
Age: 52
State: TX

Vax Date: 10/01/2021
Onset Date: 10/16/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: Labwork Normal. Abdominal Ultrasound Normal. No Gallstones. Upper Endoscopy Monday October 25, 2021 Revealed Gastritis.

Allergies: No Known Allergies

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

Symptoms: Epigastric Pain described as dull and achy that radiated to back. Back constant and worsened by eating. Not improved with clear liquid diet and over the counter PPI therapy. Seen in Emergency Department at health care facility on 10/19/2021 and Diagnosed with Gastritis. Abdominal Ultrasound Normal on 10/21/2021. Seen by Gastroenterology on 10/22/2021 due to persistent pain not improved with Pantoprazole and Carafate. Upper Endoscopy on Monday 10/25/2021 revealed Gastritis. Biopsies pending.

Other Meds: Loratadine 10 mg daily Montelukast 10 mg daily Metoprolol Succinate 25 mg daily Vitamin D3 5000 IU daily Biotin 2500 mcg daily Esomeprazole 20 mg daily

Current Illness: N/A

ID: 1826265
Sex: M
Age: 26
State: TX

Vax Date: 08/02/2021
Onset Date: 08/05/2021
Rec V Date: 10/28/2021
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: MRI CT scan Blood work EKG

Allergies: none

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

Symptoms: Chest pain, extreme dizziness, brain inflammation

Other Meds: none

Current Illness: none

ID: 1826266
Sex: F
Age: 70
State: AK

Vax Date: 10/12/2021
Onset Date: 10/13/2021
Rec V Date: 10/28/2021
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: Adhesive bandage, amlodipine, aspirin, bee stings, codeine, companzine spansule, demerol hcl, droperidol, erythromycin, fish, gabapentin, green pepper, inapsine, nsaids, palivizumab, robaxin, shellfish, synalgos-dc, tetracycline, tizanidine, tolectin 600

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: No issues with first 2 vaccines. 10/12 received booster. 10/13 started having symptoms. Severe chills and shaking, had to stop dialysis early. Diarrhea x2 days. Redness, hardness, swelling, heat, pain at injection site, wrapped around to backside of arm. Continued worsening until 4th day after injection. Still sensitive to the touch, but no longer red and hot for another couple of days.

Other Meds: albuterol-ipratropium, chlorhexidine mucous membrane liquid, cholecalciferol, cyanocobalamin, fluoride topical paste, glucagon, levothyroxine, metoprolol, midodrine, renal caps multivitamin, mupirocin topical, ondansetron, oxycodone, pantop

Current Illness: None

ID: 1826267
Sex: M
Age: 12
State: CA

Vax Date: 10/28/2021
Onset Date: 10/28/2021
Rec V Date: 10/28/2021
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: Pharyngeal swelling

Symptoms: THird party administered Flublok to the patient that was only supposed to get Pfizer covid vaccine. No signs and symptoms for now. Patient's mother was informed to call us if there are any side effects.

Other Meds:

Current Illness:

ID: 1826268
Sex: M
Age: 30
State: CA

Vax Date: 10/14/2021
Onset Date: 10/16/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data:

Allergies: no

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: After 15 min of sitting was walking back to work and heart started to race and become short of breathe and dizzy. 10/15/2021 urine became tea like. 10/16/2021 went to ED because heart rate became very high, began to become sweaty, numbness in legs and hand and face with a tingling sensation. 10/26/2021 episode happened again went to ED. Slight chest pain and sharpness continue even occurs in the back directly behind heart.

Other Meds: Just Nyquil for fever

Current Illness: besides blood and protein in urine

ID: 1826269
Sex: F
Age: 78
State: NY

Vax Date: 10/23/2021
Onset Date: 10/23/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: none

Allergies: none

Symptom List: Diarrhoea, Nasal congestion

Symptoms: The patient was given a full dose of the Moderna vaccine (0.5 milliliters) instead of a half dose (0.25 milliliters) as their booster dose. The patient was having no adverse events at the time, but has been told to continue to monitor their symptoms.

Other Meds:

Current Illness:

ID: 1826270
Sex: F
Age: 56
State: PA

Vax Date: 10/24/2021
Onset Date: 10/26/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: UNKNOWN. PHARMACY DISTRICT MANAGER TRIED CONTACTING THE PATIENT SEVERAL TIMES BUT HAD NO LUCK GETTING HOLD OF HER

Allergies: NO

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

Symptoms: PATIENT STATED THAT AFTER THE SHOT HER ARM WAS HURTING AND SHE WORKS AT A ORTHOPEDIC OFFICE AND WAS TOLD BY THE PHYSICIAN THAT IT IS DUE TO THE PLACE OF ADMINISTRATION

Other Meds: NOT MENTIONED

Current Illness: NO

ID: 1826272
Sex: F
Age: 54
State: MO

Vax Date: 10/28/2021
Onset Date: 10/28/2021
Rec V Date: 10/28/2021
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 tingling in arms from elbows to fingertips and legs from knees to toes that has persisted for last 7 hours. Recommended visit to urgent care facility as I could not find similar reports.

Other Meds:

Current Illness:

ID: 1826273
Sex: F
Age: 62
State: CA

Vax Date: 10/26/2021
Onset Date: 10/26/2021
Rec V Date: 10/28/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: C/o feeling sick including swelling and redness in arm, fatigue, diarrhea, low appetite, body aches Denies taking her temp but having chills Had third Covid injection 2 days ago and sx started same night as injection C/o cough and congestion

Other Meds:

Current Illness: Cardiovascular; Hypertension, unspecified type; Hyperlipidemia, unspecified hyperlipidemia type; GI and Hepatology; Gastroesophageal reflux disease, unspecified whether esophagitis present; Vitamin D deficiency; Endocrine; Hypothyroidism, unspecified type; Musculoskeletal and Integumentary Acne, unspecified acne type

ID: 1826274
Sex: F
Age: 40
State: PR

Vax Date: 09/29/2021
Onset Date: 09/30/2021
Rec V Date: 10/28/2021
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: ABG 7.747 labs totally altered.

Allergies: Crabs

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

Symptoms: Respiratory distress, asthma, fatigue, asthma, tiredness, chronic hypertension 145/110.

Other Meds: Vitamin C; SINGULAIR; ZYRTEC

Current Illness: Lack of menstruation; Asthma; Hypertension; Fatigue; Muscle pains; Mood changes

ID: 1826275
Sex: F
Age: 38
State: TX

Vax Date: 10/25/2021
Onset Date: 10/26/2021
Rec V Date: 10/28/2021
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: Codeine

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

Symptoms: Fever, lethargy, cold chills, achy muscles started on 2nd day and still present today (4th day) post shot

Other Meds: Lexapro, Ritalin, Multivitamin, Probiotics

Current Illness: n/a

ID: 1826276
Sex: M
Age: 26
State: OK

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/28/2021
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:

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

Symptoms: pt was really cold and shivering. got better after 5 to 7 minutes

Other Meds:

Current Illness:

ID: 1826277
Sex: M
Age: 84
State: OH

Vax Date: 04/17/2021
Onset Date: 10/14/2021
Rec V Date: 10/28/2021
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: 10/28/21 Hemoglobin: 10.2; hematocrit: 32.3 INR: 2.2 (on warfarin for AFib) D-dimer: 1.17 Potassium: 3.6 Chest X-ray: pulmonary infiltrates CT PE: No evidence of pulmonary embolism; bilateral pulmonary ground glass opacities; small pleural effusions

Allergies: donepezil, atorvastatin, gabapentin, metoprolol succinate, verapamil

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

Symptoms: Patient became ill approximately 2 weeks prior to presentation to the ED. Initial symptoms were cough and fatigue. Patient presented to ED with complaints of hemoptysis and shortness of breath. Patient tested positive for COVID-19 on 10/20/21 as an outpatient. Patient has received a fluid bolus and will be admitted to the hospital.

Other Meds: Warfarin, vitamin B12, levothyroxine, irbesartan, Norco, amlodipine

Current Illness:

ID: 1826278
Sex: F
Age: 71
State: MN

Vax Date: 09/29/2021
Onset Date: 10/07/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: None done

Allergies: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Started with itchy rash at nap of neck then had itchy rash to inside of elbows,then itchy rash to upper outer thighs then to both buttocks and upper and lower back.

Other Meds: Lisinoprel,hydrochlorothorizide,vit d,calcium, magnesium,immune booster, vit c, probiotic, apple cider vinegar

Current Illness: None

ID: 1826279
Sex: F
Age: 41
State: TN

Vax Date: 10/27/2021
Onset Date: 10/28/2021
Rec V Date: 10/28/2021
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: Patient was given fluarix vaccine in the left arm deltoid region on 10/27/21 she comes back on 10/28/21 to say the front part of her arm was swollen and red and warm to touch and she believes she was given the vaccine in that area.

Other Meds:

Current Illness:

ID: 1826280
Sex: F
Age: 36
State: WA

Vax Date: 10/28/2021
Onset Date: 10/28/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: n/a

Allergies: n/a

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

Symptoms: No adverse reaction. Pt's series completion date was checked after vaccine administration. Pt had second dose of series in July....so she wasn't do for a booster. AKA booster was administered before 6 month

Other Meds: n/a

Current Illness: n/a

ID: 1826281
Sex: M
Age: 38
State: PR

Vax Date: 10/28/2021
Onset Date: 10/28/2021
Rec V Date: 10/28/2021
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: Crustacean

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

Symptoms: Male patient 38 years old was in area of observation waiting 30 minutes after getting MODERNA (0.25ml) and reports feeling dizzy and head pain. Patient was taken to area of observation and treatment, he was evaluated and refers having strong head pain, dizziness and blurry vision. Vital signs were taken: 80dxt, 98 saturation and clear lungs on auscultation, no edema, no itchiness, and no rash. 140/80 mmHg and 16 resp. Later another MODERNA dose was administered 0.25ml since he mentioned having HIV. Later after administering second dose 0.25ml the head nurse noticed the patient was having the same reaction as the first dose. At 6:30pm patient refers feeling better and was offered to go to the hospital but he said it was not necessary. Vitals were taken again 120/80mmHg, 16 respirations, 80 dxt, 98 r/a, 82 pulse. At 7:22pm patient refers feeling better. The case was consulted with Dr.

Other Meds: N/A

Current Illness: N/A

ID: 1826282
Sex: M
Age: 54
State: AL

Vax Date: 04/16/2021
Onset Date: 04/19/2021
Rec V Date: 10/28/2021
Hospital: Y

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

Lab Data: Can send or you can request my records. too many too list.

Allergies: n/a

Symptom List: Unevaluable event

Symptoms: Leg paralysis that started in the toes and over a couple of days progressed up both legs into the thigh. Was admitted to the ER where I was given a LP to check for GBS. I was then told that I had Guillian Barre Syndrome and that I should undergo IVIG Treatments . I was admitted to a room from the ER and was given IVIG for 5 days. After day 3-4 the paralysis started to reverse and 90% of the feeling in my legs came back. I still have numbness and little control of my left foot, knee and ankle. The right leg is back to normal. I have been unable to walk without wearing a PHAT brace. I am back to work on light duty permanently. Also have Bladder issues since the GBS, and some neuro issues.

Other Meds: Prednisone, Relafen, Pravastatin, lisinopril

Current Illness: stomach flu/salmonella

ID: 1826283
Sex: M
Age: 61
State: OR

Vax Date: 10/26/2021
Onset Date: 10/26/2021
Rec V Date: 10/28/2021
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: none

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

Symptoms: extreme soreness at injection site, redness and hard surrounding injection site 2 inch diameter. moderate grade fever (100.8 F) for 12 hours, insomnia and strange dreams when I was able to sleep. muscle aches in left arm and abdomen, light-headed feeling

Other Meds: Simvastatin, Lisinopril

Current Illness: none

ID: 1826284
Sex: M
Age: 23
State: GA

Vax Date: 10/28/2021
Onset Date: 10/28/2021
Rec V Date: 10/28/2021
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 LOST CONSCIOUSNESS( AKA BLACKED OUT) AND SLUMPED OVER FOR ABOUT 1 SECOND, THEN REGAINED CONSCIOUSNESS. HE REMAINED IN THE STORE FOR ABOUT 30 MINUTES AND DID NOT EXHIBIT ANY FURTHER SIDE EFFECTS.

Other Meds:

Current Illness:

ID: 1826285
Sex: M
Age: 47
State: CA

Vax Date: 08/14/2021
Onset Date: 08/18/2021
Rec V Date: 10/28/2021
Hospital: Y

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

Lab Data: comprehensive labs , d dimer , echo

Allergies: none

Symptom List: Injection site pain, Menorrhagia

Symptoms: chest pain / palpitations

Other Meds: none

Current Illness: none

ID: 1826286
Sex: M
Age: 32
State: NY

Vax Date: 10/28/2021
Onset Date: 10/28/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: tachycardia

Other Meds:

Current Illness:

ID: 1826287
Sex: F
Age: 33
State: OK

Vax Date: 10/09/2021
Onset Date: 10/23/2021
Rec V Date: 10/28/2021
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: NA

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Heavy and prolonged beyond normal (6+ days) menstruation. This happened after my first two rounds with the Pfizer vaccine for 2-3 months post vaccination, and is occurring again after the booster.

Other Meds: Hydroxychloroquine, buspirone, naltrexone, women?s daily multivitamin, Flonase, Zyrtec, Calcium/Magnesium/Zinc, Vitamin D3, Melatonin, Naproxen Sodium

Current Illness: NA

ID: 1826288
Sex: M
Age: 70
State: TX

Vax Date: 09/29/2021
Onset Date: 10/11/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: 10/14/2021 Dr. observed swollen-feverish left leg during examination as a results was then referred to imagery facility for doppler/mri. Blood clot confirmed in lower left leg. Blood thinners started on 10/14/2021

Allergies: Aspirin

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: On 10/11/2021 awoke in morning with discomfort in left leg with swelling and feverish in lower leg.With no previous problems not sure for the cause. When awoke again on 10/12/2021 experiencing same symptoms so contacted doctor to schedule appointment. Able to schedule appointment for on 10/14/2021 at which time symptoms were noted by doctor and in addition to examining leg doctor felt it necessary to send me to obtain a doppler/mri of left leg where a blood clot was found in the lower leg area. After imagining completed was immediately sent back to doctor offices where it was verified the results of test was positive for a blood clot. Was started on blood thinners for blood clot, steroid pak for swelling and antibiotics for fever in leg.

Other Meds: metformin, allopurinol ,hydrochlorothiazide ,amlodipine besylate, zertec, famotidine, montelukast, multivitamin, B-12 dissolvable tablet, D-3, Fibercon, Tumeric, Cinnamon, Omega 3-6-9.

Current Illness: none

ID: 1826289
Sex: F
Age: 68
State: NY

Vax Date: 10/26/2021
Onset Date: 10/28/2021
Rec V Date: 10/28/2021
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: No tests performed as of yet. I was interviewed by PCP and her staff. I have an appointment to come in tomorrow.

Allergies: Penicillin, Duracef and Tea Tree Oil

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

Symptoms: Egg Sized Lump on left arm, which is arm I was vaccinated. Lump is soft, numb and hot to touch. It closer to the elbow but the needle was injected into my upper arm. Even though the lump is numb my arm feels tingly, also when I clench my right hand into a fist it feels tender. They day after vaccine I slept most of the day and since yesterday I have diarrhea. I don't know if it has anything to do with it but after my second dose on 02/11/2021, about a week after the vaccine I got covid arm. I had a very large inflamed, hot, itchy rash on the left arm which was also the arm I got the second dose.

Other Meds: Atorvastatin, Vitamin D, Atenelol, Nifedipine, Multi Vitamin

Current Illness: None

ID: 1826291
Sex: M
Age: 4
State: OH

Vax Date: 10/28/2021
Onset Date:
Rec V Date: 10/28/2021
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: went to give pt shot and as soon as needle hit skin, arm flailed and did not adminster due to inability to calm child. child received non of the vaccine.

Other Meds:

Current Illness:

ID: 1826292
Sex: F
Age: 53
State: AL

Vax Date: 10/27/2021
Onset Date: 10/28/2021
Rec V Date: 10/28/2021
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: Injection site pain

Symptoms: 101 fever, UTI-like symptoms, ringing in ears, body aches, numb/tingling feet moving up legs, swelling near armpits, headache

Other Meds: Venlafaxin xr Locating Levothyroxin

Current Illness: Sinus infection

ID: 1826293
Sex: M
Age: 55
State: OH

Vax Date: 02/28/2021
Onset Date: 02/28/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: None

Allergies: None

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

Symptoms: Pain high in shoulder from the first day, eventually reduced range of motion treated by physical therapy with only partial success (range of motion partly restored, pain still constant).

Other Meds: None

Current Illness: None

ID: 1826294
Sex: F
Age: 24
State: WA

Vax Date: 10/26/2021
Onset Date: 10/26/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: Bloodwork - 10/27/2021

Allergies: Morphine, penicillin, hydrocodone

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

Symptoms: Nausea and headache appeared immediately. Began vomiting + diarrhea within 2 hours of injection time. After being unable to keep food/fluids down over 24 hours, was instructed to go to ER.

Other Meds:

Current Illness:

ID: 1826295
Sex: M
Age: 17
State: TN

Vax Date: 10/28/2021
Onset Date: 10/28/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: na

Allergies: no known allergies

Symptom List: Tremor

Symptoms: Wrong vaccine given; no symptoms post injection

Other Meds: Zyrtec

Current Illness: n/a

ID: 1826296
Sex: F
Age: 51
State: CA

Vax Date: 09/23/2021
Onset Date: 09/28/2021
Rec V Date: 10/28/2021
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: Allergic: Penicillin, Humera Causes inflammation: Wheat, gluten, sugar, salt, dairy

Symptom List: Erythema, Pruritus

Symptoms: The first few days following the injection I had mild headaches, brain fog and injection site pain. On September 28th I began getting tension headaches that came on anytime day or night. Usually taking one 500 mg Tylenol did the trick and the headaches slowly subsided. But about 50% of the time, I needed 2 to 3 500 mg Tylenol per day. Slowly the headaches began lessening and it has now been 3 days without any headaches. During my worst headaches, my brain also felt headache pain. It was awful. I also had brief pain in my back as well. I also felt chills at times and my right ear hurt as well at times.

Other Meds: Celebrex Folic Acid NAC

Current Illness: Rheumatoid Arthritis

ID: 1826297
Sex: M
Age: 34
State: WA

Vax Date: 10/21/2021
Onset Date: 10/22/2021
Rec V Date: 10/28/2021
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: None

Allergies: None aware of

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

Symptoms: 18 hours in - nausea. Lasted 3 days after. 24 hours in - woke up in middle of night with racing heart. 3 days in - arm pain at site. Still going on 6 days in - full body aches. Still going on.

Other Meds: Inhaler, allergy medicibe

Current Illness: None

ID: 1826298
Sex: F
Age: 70
State: OH

Vax Date: 10/26/2021
Onset Date: 10/26/2021
Rec V Date: 10/28/2021
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: NKA

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

Symptoms: PT HAD BEEN MISTAKEN AND ASKED FOR A FLUZONE HD ON 10.26.2021 BUT DID NOT REMEMBER THAT SHE ALREADY HAD THE SAME VACCINE ADMINISTERED ON 09/21/2021. NO ADVERSE REACTIONS/EFFECTS REPORTED BY PATIENT. MD CONTACTED AND NOTED IN PATIENT CHART.

Other Meds: N/A

Current Illness: NONE

ID: 1826299
Sex: M
Age: 20
State: GA

Vax Date: 10/28/2021
Onset Date: 10/28/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: N/A

Allergies: Sulfa drugs

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: 2-4 minutes after administration, began feeling very hot, with sweating. Vision blurred, hearing started to fade, and eventually fainted. Was fine nearly 10 minutes later. Was unconscious for about 10 seconds.

Other Meds: OTC melatonin supplements, daily before bed.

Current Illness: N/A

ID: 1826300
Sex: M
Age: 67
State: CO

Vax Date: 10/25/2021
Onset Date: 10/25/2021
Rec V Date: 10/28/2021
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:

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

Symptoms: Required a booster dose and was administered a full dose (.5ml) Moderna vaccine. He was notified of the error and denied any side effects at that time. He was advised to call the health department with any questions or concerns.

Other Meds:

Current Illness:

ID: 1826301
Sex: M
Age: 70
State: NY

Vax Date: 02/25/2021
Onset Date: 03/01/2021
Rec V Date: 10/28/2021
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: Used Holter monitor in March, 2021 which verified Afib. Heart doctor prescribed Eliquis.

Allergies: Dairy

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

Symptoms: About 1 week after second dose began having attacks of Atrial Fibrillation. Occured various times of the day. Mostly heart racing and irregular heart beats.

Other Meds: Plavix Imdur Metoprolol Lipitor Zetia Lisinopril

Current Illness:

ID: 1826302
Sex: F
Age: 81
State: IL

Vax Date: 10/28/2021
Onset Date: 10/28/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: N/A

Allergies: Information on record

Symptom List: Pain in extremity

Symptoms: Patients received second dose of Moderna 6/9/21. Booster injection given today was too early per CDC guidelines.

Other Meds: Information on record

Current Illness: None

ID: 1826303
Sex: M
Age: 71
State: CA

Vax Date: 10/25/2021
Onset Date: 10/26/2021
Rec V Date: 10/28/2021
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: The 2nd Day I had swelling that was kind of large and today 10-28-2021, I broke out in a huge rash where the injection site was and intense itching started to accrue.

Other Meds: Micardis 80 mg for Hypertension

Current Illness: None

ID: 1826304
Sex: F
Age: 38
State: CA

Vax Date: 04/08/2021
Onset Date: 05/12/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: I was seen at Kaiser for the second miscarriage

Allergies: NA

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

Symptoms: I had a miscarriage within 2 weeks of receiving the second dose. I was likely was "pregnant" at the time of vaccine, dose 2. 1st miscarriage was 5/12/21 (4.5 weeks pregnant) 2nd miscarriage was 7/16/21 (8 weeks pregnant)

Other Meds: prenatal vitamin

Current Illness: NA

ID: 1826305
Sex: F
Age: 53
State: CA

Vax Date: 10/26/2021
Onset Date: 10/28/2021
Rec V Date: 10/28/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: Cervical lymphadenopathy

Other Meds:

Current Illness:

ID: 1826306
Sex: F
Age: 3
State: CO

Vax Date: 10/28/2021
Onset Date: 10/28/2021
Rec V Date: 10/28/2021
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: NKDA

Symptom List: Vomiting

Symptoms: Patient received her flu shot and was fine immediately after administration. A few minutes later, when she was standing with her parents, there was a loud crash and she fell and hit her chin on the floor. Gave a cold compress, she looked pale and was crying. After they left the pharmacy, someone else who saw patient fall said she swayed and had looked dizzy.

Other Meds:

Current Illness:

ID: 1826307
Sex: F
Age: 63
State: SC

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

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

Lab Data: CBC, CMP

Allergies: Penicillin and Sulfa- Hives

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Fevers, chills, nausea, and vomiting

Other Meds: acetaminophen (generic for TYLENOL) 500mg tablet albuterol HFA (PROVENTIL HFA) 108 (90 BASE)mcg/act inhaler amLODIPine (generic for NORVASC) 5mg tablet aspirin 81mg EC tablet atorvastatin (generic for LIPITOR) 80mg tablet carvedilol (generi

Current Illness:

ID: 1826308
Sex: M
Age: 29
State:

Vax Date: 10/22/2021
Onset Date: 10/27/2021
Rec V Date: 10/28/2021
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: Headache, fatigue begginning several hours after the injection around 6:00 pm lasting until the next morning

Other Meds:

Current Illness: Cold

ID: 1826309
Sex: F
Age: 29
State: WA

Vax Date: 10/07/2021
Onset Date: 10/08/2021
Rec V Date: 10/28/2021
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 yet?went to urgent care but they could not do an MRI or draw blood?waiting to be seen by Primary Care

Allergies: Penicillin

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Friday morning, October 8th I woke up with a fever over 102? and normal flu symptoms. I had excruciating back pain and assumed it was due to the fever. The fever broke roughly 48hrs later but it has now been three full weeks and my lower back pain (that I have never experienced before) is still excruciating.

Other Meds: Levothyroxine 0.125 Birth control (Gianvi) Multivitamin B12 Fish Oil Probiotic

Current Illness: N/A

ID: 1826310
Sex: F
Age: 28
State: FL

Vax Date: 10/26/2021
Onset Date: 10/27/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data:

Allergies: Bactrim, ciprofloxacin

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

Symptoms: large, 12cm x 10 cm, axillary swelling, mass, painful

Other Meds: Loestrin FE, HCTZ, paroxetine, Ativan

Current Illness: None

ID: 1826311
Sex: M
Age: 45
State: PA

Vax Date: 10/01/2021
Onset Date: 10/04/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: Cardiologist only ordered a TSH blood test on 10/11/2021, drawn on 10/12/2021

Allergies: None

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

Symptoms: Palpitations, fluttering, shortness of breath for 7 days

Other Meds: None

Current Illness: None

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am