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: 1343645
Sex: M
Age: 69
State: PA

Vax Date: 03/07/2021
Onset Date: 03/20/2021
Rec V Date: 05/24/2021
Hospital:

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

Lab Data: none as of yet , can't afford the Co Pay

Allergies: None

Symptom List: Dysphagia, Epiglottitis

Symptoms: First dose approximately 20 days after extremely burning sensation over whole nose searing hot lasted about 25 min, Called Family Dr. He ordered Zpack antibiotics , Second dose approximately 25 days bowel habits changed lots of mucus appears to come in bowel movements

Other Meds: None

Current Illness: Bulging disc lower back

ID: 1343646
Sex: F
Age: 59
State: NY

Vax Date: 05/14/2021
Onset Date: 05/15/2021
Rec V Date: 05/24/2021
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: nka

Symptom List: Anxiety, Dyspnoea

Symptoms: pt states the next day she had a painful left arm. She had a developed a red rash on her neck. She noticed a red rash on upper part of her right chest area. After she showered she noticed another red patch of bumps in other areas on her body. It is now more like hives and itching. The rash if from her scalp to her feet. Pt will contact her PCP.

Other Meds:

Current Illness:

ID: 1343647
Sex: F
Age: 74
State: FL

Vax Date: 05/20/2021
Onset Date: 05/21/2021
Rec V Date: 05/24/2021
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: Sulfa, Old Tetanus

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

Symptoms: Dizziness, brain fog, weakness, sever indigestion, headaches (lasting more than 3 days)

Other Meds: Acyclovir, Inderal, Levothyroid

Current Illness:

ID: 1343648
Sex: F
Age:
State:

Vax Date:
Onset Date: 05/22/2021
Rec V Date: 05/24/2021
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: - threw up at 5am morning after vaccine -rash on face since 05/23 -sore arm since 05/22 -clammy morning of 05/23

Other Meds:

Current Illness:

ID: 1343649
Sex: M
Age: 65
State: PA

Vax Date: 03/15/2021
Onset Date: 05/17/2021
Rec V Date: 05/24/2021
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 scan and mri on 5/17/21

Allergies:

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

Symptoms: Stroke due to blood clot in artery at the base of the brain

Other Meds:

Current Illness:

ID: 1343650
Sex: F
Age: 33
State: NH

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 05/24/2021
Hospital:

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

Lab Data:

Allergies: Penicillin, Sulfa

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

Symptoms: Patient reported dizziness after first dose, was asked to stay for 30 minuted of observation following second dose. Patient progressed from dizziness (BP taken at this time, was normal) to nausea/dry heaving, with coughing and shortness of breath/chest tightness, which was not alleviated by her Albuterol inhaler. The contents of one Epipen was administered to the patient and she was transported to the hospital via ambulance.

Other Meds: Escitalopram, Albuterol HFA, Desloratadine

Current Illness: Seasonal allergies

ID: 1343651
Sex: M
Age: 63
State: OR

Vax Date: 05/01/2021
Onset Date: 05/01/2021
Rec V Date: 05/24/2021
Hospital:

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

Lab Data: None.

Allergies: None.

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: He got his vaccine, immediately where the needle went in he had a bruise and just stayed the same. Then a few days later he started feeling stiffness and pain in his right neck and shoulder area. He did not have any rash, fever or other symptoms. He does still have the swelling at the injection site. He has taken Aleve for the discomfort. He has not called his doctor. He is able to work, but is having the pain in the neck and the shoulder every day.

Other Meds: None

Current Illness: None.

ID: 1343652
Sex: F
Age: 66
State: PA

Vax Date: 03/16/2021
Onset Date: 05/08/2021
Rec V Date: 05/24/2021
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: Morphine Reglan Vicodan Dust

Symptom List: Pharyngeal swelling

Symptoms: I developed an itchy rash initially on my abdomen and then it spread to my arms. It looked like papular hives to me but also had fine smaller rough areas.. I did not go to my doctor's office as I am a retired nurse practitioner and this was not severe. It was minimally responsive to benedryl, clariton and topical steroid cream and it was self limiting to about 10 days then started to fade. I am reporting this because it occurred within 2 months of my second vaccine, 3/16/2021, and I was on no new medicines, had eaten no new foods and was not in contact with anything different.

Other Meds: Vitamin D Welbutrin Citrucel Miralax Tylenol

Current Illness: Out patient surgery March 2 , 2021

ID: 1343653
Sex: M
Age: 43
State: CA

Vax Date: 05/13/2021
Onset Date: 05/21/2021
Rec V Date: 05/24/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: After the first inoculation, I started having the side effects two weeks in with fever, chills and muscle pains throughout the body. I also experienced a certain mental restlessness and adrenaline rush while feeling physically tired. It went away after 3-4 days. Following the 2nd shot, I started feeling hazy and mentally restless again with physical fatigue the day after the inoculation. A week later, I had really strong stomach cramps with numbness in the entire right shoulder where I got the 2nd inoculation. Mental restlessness and physical fatigue were also common daily,

Other Meds: MAGNESIUM, B12, MELATONIN, VITAMIN B, C, ZINC, OMEGA 3 (VEGAN), BCAA, MILK THISTLE, GYMNEMA SYLVESTRE

Current Illness: NONE

ID: 1343654
Sex: F
Age: 30
State: NY

Vax Date: 05/18/2021
Onset Date: 05/18/2021
Rec V Date: 05/24/2021
Hospital:

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

Lab Data: Saw FNP 5/24/21.

Allergies: None

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Pt stated she "felt funny" then developed Hives on her Arm.

Other Meds: None

Current Illness: Chronic Obesity

ID: 1343655
Sex: F
Age: 41
State: MN

Vax Date: 05/21/2021
Onset Date: 05/22/2021
Rec V Date: 05/24/2021
Hospital:

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

Lab Data:

Allergies: codeine, strawberries, shrimp

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

Symptoms: abdominal cramping, similar to my reaction to codeine. Some itching

Other Meds: synthroid, multi-vitamins

Current Illness: none

ID: 1343656
Sex: F
Age: 54
State: OH

Vax Date: 05/15/2021
Onset Date: 05/18/2021
Rec V Date: 05/24/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data: none

Allergies: None

Symptom List: Rash, Urticaria

Symptoms: Itching began on Tuesday May 18 at 10pm on my thighs; then itching continued to back of the legs and knees with a slight swelling feeling. So much that I needed to look and see if I had gotten bit or something. I changed out of jeans and then saw my legs had developed rashes in large sections; some looked like hives, some like little red bumps, some with just read splotches. I washed my legs thinking maybe a bug or allergen and put anti itch cream on one leg to see if it would help or if I needed anything else. I went to bed shortly after and then woke at 6am (Weds. May 19) and when I changed out of pj's, noticed rashes also at the injection site; the itching continued to come and go and when it would begin to itch, the rash/bumps would appear without scratching. The rashes would continue on primarily the legs and glutes but also injection side and a little on the shoulder/back of the same side of the injection site and small rash on each ear. This continued for three days intermittently. The rashes stayed for about 1-2 hours then new ones would appear as the old ones faded. Friday, I was finally itch-free by later in the evening. I did not take any medication or apply any more anti itch cream despite the intense itching sensation. I took pictures for documentation if you need them.

Other Meds: Magnesium Citrate Blueberry Extract Zinc Vitamin C Glucosamine Chondroitin L-carnitine Collagen B-12 Probiotic Dulcolax

Current Illness: None

ID: 1343657
Sex: M
Age: 64
State: OH

Vax Date: 04/12/2021
Onset Date: 04/20/2021
Rec V Date: 05/24/2021
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: My blood pressure has been under control for 44 years. I'm not overweight. My blood pressure has been all over the place. Up to 200/100, staying in the 150s to 170s/ 90s.

Other Meds: Ditilezam 240mgs

Current Illness:

ID: 1343658
Sex: M
Age: 55
State: CT

Vax Date: 04/12/2021
Onset Date: 05/10/2021
Rec V Date: 05/24/2021
Hospital: Y

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

Lab Data:

Allergies: None

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

Symptoms: Rapid heartbeat, fatigue

Other Meds: None

Current Illness: None

ID: 1343659
Sex: M
Age: 69
State:

Vax Date: 03/01/2021
Onset Date: 03/05/2021
Rec V Date: 05/24/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Patient presented to the ED on 3/5/21, 3/11/21, and 3/23/21. Patient presented to the ED on 5/10/21 and was subsequently hospitalized within 6 weeks of receiving COVID vaccination.

Other Meds:

Current Illness:

ID: 1343660
Sex: F
Age: 30
State: NC

Vax Date: 05/23/2021
Onset Date: 05/24/2021
Rec V Date: 05/24/2021
Hospital:

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

Lab Data: Plan clinic walk-in or dermatology consult if continues or worsens.

Allergies: PCN

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

Symptoms: Injection sight swelling, small pimple sized pustules with inflamed surrounding capillaries. ?Rash? is not itchy and spreads from injection-site arm (left) across and down upper chest and breasts. Noted approximately 22 hours after second dose. No reaction to first dose, other than mild arm tenderness.

Other Meds: None

Current Illness: None

ID: 1343661
Sex: F
Age: 22
State: OH

Vax Date: 04/16/2021
Onset Date: 04/16/2021
Rec V Date: 05/24/2021
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: None

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

Symptoms: Blood pressure immediately dropped. Continued dropping. Told to go home and drink plenty of liquids and get rest. Began vomiting that evening. The vomiting, being dizzy and sleeping continued for days. Went to Urgent Care on April 20, 2021. They gave me nausea medicine and said I should expect to feel this way for about one week. The nausea medicine helped with the vomiting, but did not help with being dizzy and sleepy. Making a trip to the ER for more answers.

Other Meds: Birth control; Claritin D

Current Illness: None

ID: 1343662
Sex: F
Age: 51
State: IN

Vax Date: 04/07/2021
Onset Date: 04/09/2021
Rec V Date: 05/24/2021
Hospital:

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

Lab Data: ENT Hearing Test on 5/19/21

Allergies: None that aware of

Symptom List: Ear pain, Hypoaesthesia

Symptoms: When I received the first dose 4/7/21, I had a burning sensation go up my left arm to my face. My face felt hot and then my chest. I felt scared like I could be having something wrong but I continued on. I then got very tired. The next day I felt achy knees. Two days later I started having buzzing in my ears but didn't realize it could be a side effect. I went to a Urgent Care and was treated for a possible ear infection and given antibiotics. That did not help or cure my condition. The buzzing/ringing is on the same side/left as my injection. On 5/5/21, I went for my second injection and asked if the buzzing/ringing or being on antibiotics was a problem, they said no. The buzzing/ringing increased. I went to my regular Primary Care doctor who didn't see anything wrong. She referred me to an ENT. The ENT ran a hearing test. The hearing test seemed to come back ok but I still have the Tinnitus. The Tinnitus is worse at night and in the morning when everything is very quiet. Some days are worse than others and I have seen no improvement. I also am experiencing hot flashes. They also happened after the first shot and increased after the second. The Tinnitus is very bad at time and I want it to go away. It is like buzzing in my left ear that is always there but sometimes I can tune it out. I think it is important to report this as I have not had anyone tell me it is a possible side effect. If it is than this needs to really be investigated and studied and communicated with people. It is very disturbing as I have never had Tinnitus before. I hope and pray it goes away and there are no other side effects.

Other Meds: Vitamin D

Current Illness: None

ID: 1343663
Sex: F
Age: 40
State: AZ

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 05/24/2021
Hospital:

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

Lab Data: none

Allergies: BENADRYL: Bradycardia - asthma BUSPAR: Dizziness (Moderate to severe) - vertigo PERTUSSIS VACCINES: Other (Severe) - hx of grand mall seizures PNEUMOCOCCAL VACCINE: Other - arm swelling, redness, pain TRAMADOL: Hives (Moderate) TYLENOL: Other (Moderate to severe) - hx of non alcoholic fatty liver disease

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: about 1 hour after receiving vaccine had swelling in throat resolved on own in 15 minutes. then 7 hours later returned with difficulty swallowing and breathing. started wheezing, felt light headed and dizzy, took epi injection.

Other Meds: advair levothyroxine vit D topiramate sertraline Montelukast tumeric

Current Illness: was not sick at the time

ID: 1343664
Sex: F
Age: 46
State: IL

Vax Date: 10/27/2020
Onset Date: 10/27/2020
Rec V Date: 05/24/2021
Hospital:

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

Lab Data: Doctor visit and X ray on 2/23/21for diagnosis. Physical therapy twice a week since 2/26/21, then once a week starting May, 2021.

Allergies: N/A

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

Symptoms: Within a few hours, my shoulder/top of arm was very sore, more so than I usually experience with a flu shot. Pain started the same day, shoulder issues gradually worsened - stiffness, loss of mobility. Over the next several months, I experienced pain in my shoulder that gradually worsened and the range of motion was significantly diminished and was getting worse., which led me to make an appointment with my physician. He diagnosed me with Adhesive Capsulitis (frozen shoulder), ordered X rays to confirm and prescribed physical therapy.

Other Meds: multi-vitamin, Vitamin D, L-Lysine

Current Illness: N/A

ID: 1343665
Sex: M
Age: 18
State: CA

Vax Date: 05/17/2021
Onset Date: 05/20/2021
Rec V Date: 05/24/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Myocarditis

Other Meds: None

Current Illness: None

ID: 1343666
Sex: M
Age: 22
State: FL

Vax Date: 05/23/2021
Onset Date: 05/23/2021
Rec V Date: 05/24/2021
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: Systemic: Abdominal Pain-Severe, Systemic: Body Aches Generalized-Severe, Systemic: Chills-Severe, Systemic: Dizziness / Lightheadness-Medium, Systemic: Flushed / Sweating-Severe, Systemic: Headache-Medium, Systemic: Nausea-Severe, Systemic: Vomiting-Severe, Additional Details: AFTER RECEIVING THE VACCINE, AROUND 3PM, PT SEEMED AOX3, AFTER ABOUT 5 MINUTES, PATIENT BECAME EXTREMELY PALE AND BECAME EXTREMELY FLUSHED, AND WAS PERSPIRING. PATIENT CONCOMITTANTLY BECAME NAUSEOUS WITH ABDOMINAL PAIN, AND HEADACHE, AFTER WHICH (~5MIN) PROCEEDED TO VOMIT. PATIENT LEFT STORE AFTER ABOUT 30 MINUTES AFTER HE BEGAN TO FEEL BETTER. SPOKE WITH PT BRIEFLY THIS MORNING (5/24/2021) AND PT STATED HE IS FEELING MUCH BETTER, AND HAD NO ADDITIONAL S/Sx OF VACCINE REACTION.

Other Meds:

Current Illness:

ID: 1343667
Sex: F
Age: 43
State: NH

Vax Date: 05/21/2021
Onset Date: 05/21/2021
Rec V Date: 05/24/2021
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: N/A

Allergies: Shellfish

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

Symptoms: Bilateral Arm and Leg Urticaria- raised itchy rash

Other Meds: Fluoxetine, Advair, Singulair

Current Illness: none known

ID: 1343668
Sex: M
Age: 16
State: CO

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 05/24/2021
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: 16 year old was given a Moderna vaccine instead of a Pfizer vaccine. Based on the CDC recommendations, we had the patient return for their second dose of Moderna on 05/11/2021 even though he was out of the age range.

Other Meds:

Current Illness:

ID: 1343669
Sex: M
Age: 54
State: TX

Vax Date: 04/06/2021
Onset Date: 04/08/2021
Rec V Date: 05/24/2021
Hospital:

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

Lab Data: n/a

Allergies: Remicade, mycelex

Symptom List: Injection site pain, Menorrhagia

Symptoms: patient complains of hoarse voice, that is still present on 5/24/2021. The day after shot developed fever of 102, aches, chills.

Other Meds: ) ACYCLOVIR 800MG TAB TAKE ONE-HALF TABLET BY MOUTH ACTIVE TWICE A DAY FOR INFECTION 2) ADALIMUMAB 40MG/0.8ML INJ PEN KIT INJECT 40MG (0.8ML) ACTIVE UNDER THE SKIN EVERY WEEK FOR INFLAMMATORY BOWEL DISEASE 3)

Current Illness:

ID: 1343670
Sex: M
Age: 19
State: MO

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 05/24/2021
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: none

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

Symptoms: Patient experienced dizziness about 10 minute after injection. Laid down on floor with feet up. Given some juice since had not eaten yet for the day. Patient feeling better in about 5 minutes.

Other Meds: Flonase nasal spray

Current Illness: unknown

ID: 1343671
Sex: F
Age: 45
State: MA

Vax Date: 05/19/2021
Onset Date: 05/23/2021
Rec V Date: 05/24/2021
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: Nickle

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Rash on arms, legs, backside. Looks and feels like the start of poison ivy but the bumps are smaller and not quite as itchy. While the rashes are large, I'd call them minor as they aren't terribly disruptive. I marked item 20 as not recovered because it just showed up yesterday. I don't know how long to expect the rash to remain. This does not seem to need medical attention.

Other Meds: Combipatch

Current Illness: none

ID: 1343672
Sex: M
Age: 20
State: CO

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 05/24/2021
Hospital:

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

Lab Data: none

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Pt received his vaccine and returned to the waiting room. Within 5 minutes he slumped to the floor, he lost consciousness and had a brief seizure lasting less than 30 seconds There was a sheriff deputy in the waiting area that asked him his name, year, president and where he was. He was able to answer all questions, but was still shaking. We called 911 and EMTs were here within 2 minutes and took over. After assessing him and taking his vitals they decided to transport him to Hospital.

Other Meds: None

Current Illness: None

ID: 1343673
Sex: F
Age: 41
State: TX

Vax Date: 04/08/2021
Onset Date: 04/01/2021
Rec V Date: 05/24/2021
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: I had bloodwork and and X-ray performed.

Allergies: I am not allergic to anything.

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

Symptoms: The morning after I received the vaccine, I started having chest pressure and acid reflux. There was a hard pressure in my chest and my heart was beating weird. I started to develop a headache. I had low blood pressure a couple days later. I went to the clinic and they said I may have a blood clot. I also went to Hospital and they took some blood and did an X-ray and they told me I was fine. I was told that it may be anxiety or stress. The chest pain started to go away, but now my teeth are hurting and are sensitive. I feel that the adverse event lasted for three weeks.

Other Meds: I was taking Lovastatin 20mg, a dietary supplement coq10, 100mg and Estroven.

Current Illness: I did not have any other illnesses.

ID: 1343674
Sex: M
Age: 37
State: IA

Vax Date: 04/12/2021
Onset Date: 05/03/2021
Rec V Date: 05/24/2021
Hospital:

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

Lab Data: 5/14/21, GP ran blood panel, blood sugar was high after night of fasting, negative for diabetes. All other blood work within range.

Allergies: None

Symptom List: Nausea

Symptoms: On 4/13/2021, strong chills and mind racing followed by fatigue. Then on or about 5/3/21, onset of severe anxiety, panic attacks, raised blood pressure, buzzing in left thigh muscle, loss of appetite, frequent urination, strong urge to urinate, not able to sleep, feel on edge at all times, cannot focus, brain fog, fatigue. On 5/7 GP increased desvenlafaxine to 100 mg and prescribed lorazepam .5 to 1 mg to sleep. On 5/14, no improvement of symptoms, added buspirone 3 times a day. As of 5/24, no improvement in symptoms, muscle buzzing is worse, and hands are unsteady. Still no real appetite, constant cold sweats and headache.

Other Meds: 50mg desvenlafaxine; Zyrtec, 5-10 mg melatonin.

Current Illness: None

ID: 1343675
Sex: F
Age: 61
State: MD

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/24/2021
Hospital:

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

Lab Data:

Allergies: lithium, abilify, gabapentin, olmesartan

Symptom List: Injection site pain

Symptoms: onset within 30 minutes of severe and persistent tinnitus

Other Meds: amlodipine, duloxetine, escitalopram, dalmane, mobic, flonase, claritin, lamictal, losartan, lasix, protonix, iron, melatonin

Current Illness:

ID: 1343676
Sex: F
Age: 18
State: MN

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 05/24/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Systemic: Dizziness / Lightheadness-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: purple hands-Medium, Additional Details: Patient was very anxious prior to the moderna vaccine administration. Once given, she started feeling dizzy and faint. After about 10 minutes her hands were turning purple. She was asked if I can call 911 for help and she agreed. paramedics arrived within 5-10 min and took her in for care.

Other Meds:

Current Illness:

ID: 1343677
Sex: F
Age: 91
State:

Vax Date: 03/11/2021
Onset Date: 04/16/2021
Rec V Date: 05/24/2021
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: Patient presented to the ED and was subsequently hospitalized within 6 weeks of receiving COVID vaccination. Diagnosis was acute respiratory failure with hypoxia and acute diastolic heart failure.

Other Meds:

Current Illness:

ID: 1343678
Sex: F
Age: 14
State: AZ

Vax Date: 05/23/2021
Onset Date: 05/23/2021
Rec V Date: 05/24/2021
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: None

Symptom List: Tremor

Symptoms: Patient had episode of vasovagal syncope approximately 3 minutes after the vaccine. Pharmacist assisted dad in comforting patient. Patient was placed flat on the floor. 911 was called by technician. Patient aroused before EMS arrived on scene approximately 2 minutes after syncopal episode. Patient recovered. EMS did not take patient.

Other Meds: None

Current Illness: None

ID: 1343679
Sex: M
Age: 24
State: NC

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 05/24/2021
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 was hot and sweaty, passed out, came around and felt better over next 15-20 minutes, patient's parent contacted ems but when they arrived patient was much improved

Other Meds:

Current Illness:

ID: 1343680
Sex: F
Age: 49
State: PA

Vax Date: 05/21/2021
Onset Date: 05/23/2021
Rec V Date: 05/24/2021
Hospital:

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data:

Allergies: No

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

Symptoms: nosebleeds

Other Meds: No

Current Illness: No

ID: 1343681
Sex: F
Age: 58
State: GA

Vax Date: 04/09/2021
Onset Date: 04/12/2021
Rec V Date: 05/24/2021
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: Tetracycline (possibly) Eggs ( as a child, but no longer) Pollen Dust

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

Symptoms: I had headaches, chills (finger tips especially) and rapid heart beat. I began feeling winded going up and down stairs and/or walking. After a couple of more days, I began using an oximeter to check my pulse. The readings were 108 - 112 compared to my normal 60 - 82.

Other Meds: Vitamins

Current Illness:

ID: 1343682
Sex: F
Age: 60
State: FL

Vax Date: 05/13/2021
Onset Date: 05/13/2021
Rec V Date: 05/24/2021
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: na

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: ITP Rash (have pictures) the major concern. I had exceedingly intense pain in my hands, feet, and knees, shaking throughout the body. The more common side effects that I had were diarrhea, nausea, fever, and body pain. I know feel tingling in my toes. Several days later, I also had an event that lasted a few minutes where my right arm shook.

Other Meds: spironolactone, toprol, metformin, benedryl, famotidine, elidel cream

Current Illness: Had alergies - water eyes, nose, sneezing in days prior to shot. No fever

ID: 1343683
Sex: F
Age: 56
State: MA

Vax Date: 04/27/2021
Onset Date: 04/29/2021
Rec V Date: 05/24/2021
Hospital: Y

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

Lab Data: chest CT angiogram 5/23/21

Allergies: morphine

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

Symptoms: acute pulmonary emboli.

Other Meds: atorvastatin, metformin

Current Illness: none

ID: 1343684
Sex: F
Age: 40
State: NJ

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/24/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Blood oxygen level dropped rapidly to 86 about 30min after shot. Caused a feeling of hypoxia and slurred speech.

Other Meds: Levothyroxine Prenatal Vitamins Zyrtec

Current Illness:

ID: 1343685
Sex: M
Age: 43
State: NC

Vax Date: 05/04/2021
Onset Date: 05/04/2021
Rec V Date: 05/24/2021
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: Patient had Moderna shot for 1st dose. PT received Pfizer shot for 2nd dose

Other Meds:

Current Illness:

ID: 1343686
Sex: F
Age: 33
State: PA

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 05/24/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 2
Vax Route:
Vax Site:

Lab Data:

Allergies: NKA

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

Symptoms: Pt was vaccinated and released after 15 minutes. While walking out, she began to feel numbness in her R hand. No other symptoms reported. Pt reports that she fell 2 days ago, striking her R elbow and still has abrasion. Cap refill, sensation, and strength are intact and equal bilaterally. VSs normal. Pt released home, recommend follow up with PCP.

Other Meds: None

Current Illness: None

ID: 1343687
Sex: F
Age: 40
State: NY

Vax Date: 05/22/2021
Onset Date: 05/22/2021
Rec V Date: 05/24/2021
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 aware of

Allergies: Dilaudid Lactose and dairy

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

Symptoms: 10:38 patient experienced slight numbness of the right cheek. Obtained history, not very good at giving info about history. 10:40 took BP 132/92. Denies hx of hypertension. denies having tightness of chest or difficulty breathing. 10:48 given benedryl 50mg. 10:58 reports feeling facial swelling improving, but complains of tunnel vision similar to when she has migraines. 10:59 assessed by NP at site location. Moved to Exam room for closer observation. NP informed patient if symptoms worsen she would be transport via EMS. 11:27 BP 135/85 pulse ox 98% pulse 76. Reports no further symptoms at this time and existing ones resolved. 11:31 patient allowed to leave with NP informing patient that if any symptoms return to be seen by a doctor. Talked with patient today at 11:30, to which she informed me that her arm was swollen and he face was slightly this morning. I asked her to see a doctor. She was going to call the Clinic and see NP that saw her Saturday during the clinic

Other Meds: none

Current Illness: none

ID: 1343688
Sex: F
Age: 68
State: CA

Vax Date: 03/20/2021
Onset Date: 03/25/2021
Rec V Date: 05/24/2021
Hospital:

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

Lab Data: echo cardiogram, zio patch

Allergies: sulfa

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

Symptoms: arrhythmias

Other Meds: vitamins, metoprolol, benazepril

Current Illness:

ID: 1343689
Sex: F
Age: 17
State: IN

Vax Date: 05/16/2021
Onset Date: 05/16/2021
Rec V Date: 05/24/2021
Hospital:

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

Lab Data: X-ray, bloodwork, cat scan, echo on her heart, heart monitor.

Allergies: Penicillin

Symptom List: Vomiting

Symptoms: My child was accidentally given moderna instead of Pfizer even though she is under 18. After the mistake was made she began to have nausea and vomiting, headache and lethargic. After 6 days she began to have chest pain, rapid heartbeat and the nausea continued. We have ended up in the hospital admitted because of the tachycardia.

Other Meds:

Current Illness: None

ID: 1343690
Sex: M
Age: 72
State: TX

Vax Date: 03/12/2021
Onset Date: 03/15/2021
Rec V Date: 05/24/2021
Hospital:

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

Lab Data: laryngeal scope exam

Allergies: nkda

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: hoarse voice

Other Meds: ALLOPURINOL 300MG TAB TAKE ONE TABLET BY MOUTH EVERY DAY ACTIVE FOR GOUT ASPIRIN 81MG EC TAB TAKE ONE TABLET BY MOUTH EVERY DAY TO ACTIVE REDUCE THE RISK OF STROKE & HEART ATTACK (TAKE WITH FOOD) ATORVASTATIN CALCIUM 80MG TAB TAK

Current Illness: N/A

ID: 1343691
Sex: F
Age: 65
State: OH

Vax Date: 04/06/2021
Onset Date: 04/16/2021
Rec V Date: 05/24/2021
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: Left Foot X-ray 5/3/2021 MRI Left Foot 5/12/2021

Allergies: Allegra, polyethylene glycol

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

Symptoms: On the tenth day after the second covid vaccine, I woke up with left foot pain. No injury. Pain and difficulty walking increased on a daily basis. Sought medical help. Diagnosis of tendonitis. Had X-ray, then MRI. Results showed two tendon tears in foot. I consider these to be spontaneous. Also having pains in both arms.

Other Meds: Sodium bicarbonate, magnesium lysinate glycinate, calcium carbonate, niacinamide, omega 3, vitamin D, vitamin E

Current Illness: None

ID: 1343692
Sex: M
Age: 52
State: RI

Vax Date: 03/02/2021
Onset Date: 04/23/2021
Rec V Date: 05/24/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: CT Scan, Blockage testing, EKG

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Never had a heart issue before but ended up in Hospital on 4/23 for 5 nights on AFIB.

Other Meds: Citalapram, Multi-Vitamin, Fish Oil

Current Illness:

ID: 1343693
Sex: M
Age: 23
State: TX

Vax Date: 04/09/2021
Onset Date: 04/15/2021
Rec V Date: 05/24/2021
Hospital:

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

Lab Data:

Allergies: Peanuts

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

Symptoms: About 2 days after I received my first dose of the Pfizer vaccine, I started experiencing chest pain and muscle cramps. On day 6 I experienced it the worst, my chest tensed up and all at once my left side of my body started cramping. Most noticeable of the pain was coming from my heart. It got better as the day ended. Noticed serious muscle cramps for the week after.

Other Meds: None

Current Illness: None

ID: 1343694
Sex: F
Age: 66
State: LA

Vax Date: 02/12/2021
Onset Date: 03/30/2021
Rec V Date: 05/24/2021
Hospital: Y

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

Lab Data: Platelets 578, Neut 79.9, Lymph 9.9, potassium 2.1, chloride 97, creatinine 1.08, albumin 2.9, ast 47, alt 98, alkaline phos 237. sed rate 75, vitamin b 12 1112, ekg showed sinus tachycardia, with ischemia,

Allergies: NKDA

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

Symptoms: acute pericarditis, chest pain and fatigue

Other Meds: latisse 0.03% eye soultion Alprazolam 1 mg bid

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am