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: 1343997
Sex: F
Age: 40
State: TX

Vax Date: 05/12/2021
Onset Date: 05/16/2021
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:

Allergies: nkda

Symptom List: Dysphagia, Epiglottitis

Symptoms: After first covid shot (L arm), got a little bit of chest pain, went away 9 days after, got a large whelp on L deltoid, eventually went away Had 2nd shot 5/12/2021 (R arm), next day had some malaise "completely what I expected" The Sunday after, had pain on R FA and veins were larger/darker than normal Some ankle pain Repeat on chest pain again Would be worse after deep breathe or laying down, other times no apparent rhyme or reason

Other Meds: Albuterol inhaler

Current Illness: NA

ID: 1343998
Sex: F
Age:
State: TX

Vax Date:
Onset Date: 05/21/2021
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: none

Allergies: zythromycin (z-pack), phenobarbitol

Symptom List: Anxiety, Dyspnoea

Symptoms: 05/21 intermittent breathing issues - full breath hard to take and caused a cough. happened once every few hours lasted through 05/23 05/22 started feeling warm - low grade temp 98.9 around 4pm only lasted about 4 hours 05/22 body aches around 6pm - lasted until 05/23 am 05/23 fatigue - could not fully wake up. even when up eyes were heavy and felt like closing. 05/24 nausea in the morning. included vomitting. brief dizziness when went back to bed 05/22 - 05/23 diarrhea 05/22 - present. injection site sore / upper arm hurts 05/24 - midday - muscular pain around midsection - hurts when taking deep breath or twisting 05/22 - 05/23 chills 05/21 - 05/24 just not feeling good

Other Meds: multi-vitamin, Farxiga, B-complex, Dexilant, mirapex, L-lysine,

Current Illness:

ID: 1343999
Sex: F
Age: 59
State: ME

Vax Date: 04/29/2021
Onset Date: 04/29/2021
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:

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

Symptoms: chest tighened on first dose, history of cardiomyopathy, second dose has same feeling, does not feel like angina

Other Meds:

Current Illness:

ID: 1344000
Sex: F
Age: 85
State: MN

Vax Date: 04/08/2021
Onset Date: 04/27/2021
Rec V Date: 05/24/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient was hospitalized within 6 weeks of receiving COVID vaccination. Diagnosis was stenosis of left carotid artery.

Other Meds:

Current Illness:

ID: 1344001
Sex: M
Age: 39
State: IN

Vax Date: 05/21/2021
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 erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Symptoms consistent with a mild case of bell's palsy. Numbness and tingling in left side of face from chin to cheekbone. No drooping in mouth or eye

Other Meds:

Current Illness:

ID: 1344002
Sex: M
Age: 61
State: WI

Vax Date: 05/20/2021
Onset Date: 05/20/2021
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:

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

Symptoms: Patient began sweating and feeling lightheaded shortly after vaccination at approximately 1125. Patient then fainted in his chair and was initially non-responsive to the nurse. At this time I called 911. The nurse administered a single epi pen in patient's quad and he woke up. The nurse then took patient's vitals at 1138: BP - 109/73; P-84; SPO2-99%; T-97.4; R-16. Patient stating he was still feeling dizzy and fatigued. The paramedics arrived and took patient to hospital for continued evaluation. I called patient later in the afternoon and he had already been discharged and was at home resting and feeling better.

Other Meds:

Current Illness:

ID: 1344003
Sex: M
Age: 64
State: MI

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

Lab Data: None noted

Allergies: No known allergy

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: patient received expired vaccine (refrigerator 31 days, expired 1 day from storage date)

Other Meds: None noted

Current Illness: None noted

ID: 1344004
Sex: M
Age: 21
State:

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

Lab Data:

Allergies: Pt w/ hx of allergy to penicillins - swelling that required hospitalization.

Symptom List: Pharyngeal swelling

Symptoms: Pt w/ hx of allergy to penicillins - swelling that required hospitalization. Pt presents w/ facial rash/hives, dizziness. p/t c/o tingling/numbness BLA LE, RUE. BP 164/92, HR 116, RR 16 -- > 160/94, 116, 16. 911 called and the patient was taken to the Emergency Room ~30mins post vaccination.

Other Meds:

Current Illness:

ID: 1344005
Sex: F
Age: 70
State: TN

Vax Date: 05/19/2021
Onset Date: 05/20/2021
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: NONE

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient comes into pharmacy on 05/24/21 with 2inch by 2 inch bruise on left deltoid muscle at injection site. She states the bruise appeared the next day after the vaccine and has gotten bigger in size. She reports little bit of headache that didn't last long . Her had arm soreness for 3 days but now it doesn't hurt and she has no need to seek medical attention.

Other Meds: ASPIRIN, glimiperide, tizanidine, hydrocodone/apap, atorvastatin and benazapril

Current Illness: NONE, goes to therapy for hip

ID: 1344006
Sex: M
Age: 60
State: NJ

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

Lab Data: none

Allergies: none

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Arm sore, tooth fillings hurting, general body ache.

Other Meds: none

Current Illness: none

ID: 1344007
Sex: M
Age: 42
State: CT

Vax Date: 05/06/2021
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: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Penicillin, Bactrim, Keflex, soribtol,

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

Symptoms: Initially, my injection site was sore and then became itchy. After I woke up the next day I was extremely itchy all over my body. It began at my neck and proceeded to travel all down my body. It felt as if I had a horrible case of poison ivy. My PCP gave me two rounds of prednisone and also had me take allegra and Pepcid AC. , Thr full-body itchy became very painful and I am left with hundreds of little sores and scratches all over me. I am now almost 20 days from the first shot and on a daily basis I have 2-3 painful itchy hot spots. My doctor recommended that I do not get the second shot.I am so angry I put this unapproved poison in my body.

Other Meds: Allegra, multivitamin, topical CBD

Current Illness:

ID: 1344008
Sex: F
Age: 48
State: LA

Vax Date: 04/08/2021
Onset Date: 05/14/2021
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:

Allergies: Codine

Symptom List: Rash, Urticaria

Symptoms: Antibiotics, steroids, rest

Other Meds: amitriptyline, Spironolactone, multi-vitamin, vitamin C, calcium plusD supplement, SAM-E, B12

Current Illness: Sinus Infection 4/6/2021 Upper Respiratory Infection 5/14/2021

ID: 1344009
Sex: M
Age: 25
State: AZ

Vax Date: 05/02/2021
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: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Lost vision, lost ability to move, collapsed on floor, one side of body regained movement, dizziness, chest pain

Other Meds:

Current Illness:

ID: 1344010
Sex: F
Age: 57
State: TX

Vax Date: 03/11/2021
Onset Date: 03/12/2021
Rec V Date: 05/24/2021
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: None

Allergies: Preservatives like Sodium Benzoate, Latex

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

Symptoms: My arm was in uncomfortable pain, sore, tender, and swollen for a week. The next day I started feeling hot but it was not a fever, my head started hurting and I was just feeling blah. I called the County Hotline and they said that they have heard that before. I felt like I was getting the flu, but it never turned into the flu. I was very fatigued and out of sorts for about a week and then everything went away.

Other Meds: Yes

Current Illness: COVID-19

ID: 1344011
Sex: F
Age: 65
State: KS

Vax Date: 03/19/2021
Onset Date: 03/28/2021
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: None she is aware of.

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

Symptoms: Intense upper stomach / upper back pain began on 3/28/21. Went to ER. Was held for emergency gallbladder removal surgery. Doctor said bad inflammation seen inside the abdomen area during surgery. Gall stone removed size of golf ball and gallbladder removed as well.

Other Meds: Vitamin D

Current Illness: No

ID: 1344012
Sex: F
Age: 44
State: NY

Vax Date: 05/15/2021
Onset Date: 05/23/2021
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: I went to my primary care Dr who prescribed an antibiotic

Allergies: Phenergan

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

Symptoms: Itchy, red, hot and swollen at injection site

Other Meds: None

Current Illness: No

ID: 1344013
Sex: F
Age: 21
State: IL

Vax Date: 05/10/2021
Onset Date: 05/10/2021
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: I have yet to have an appointment with my doctor, but if asked, I will update the situation to those who request it.

Allergies: Lamb

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

Symptoms: The first symptom I experienced was a high grade fever that reached 103.5 degrees Fahrenheit. The fever lasted from 2:00pm on May 10th (the day it was administered) until 2:00 am on a May 11th (the early hours of the day after it was administered). Some weakness, as well as muscular soreness in the left arm persisted in the insuring days. The reason why I chose to report my experience is because something that I thought was abnormal happened. On the evening of May 15th, as I was putting on my pajamas, I noticed an irregular mass in my left breast. As I examined it further, I realized that this mass was not there previously and warning shots fired off in my head, immediately. I immediately asked my grandmother to do another examination of my breast, and she confirmed my suspicion that there was a foreign mass located above my nipple in my left breast. It was difficult for me to closely monitor this mass as it was difficult for me to think about it as it triggered emotional distress. I asked my mom to do an examination and she also noted the mass. A little more than a week later, I noticed that the mass shrunk. Since everyone in my family was on edge for nearly a week suspecting that a 21 year old female in their family could possibly have breast cancer, this caused my family to consult my grandmother?s doctor, and have her assistant contact me about what could potentially be happening. Her assistant spoke to me over the phone and communicated that it is important for me to have the mass formally examined and for me to receive a mammogram. She also mentioned that many women who have received the vaccine also noticed irregular lumps in their breasts after receiving the vaccine. I want women in my age range to be aware that they might notice lumps in their breasts after the vaccine and not to experience the same emotional distress of thinking that they have breast cancer when it could be inflammation occurring in their lymph nodes as a result of being administered the Covid vaccine.

Other Meds: Loloestrin Fe

Current Illness: Infrequent migraines

ID: 1344014
Sex: F
Age: 22
State: PA

Vax Date: 05/21/2021
Onset Date: 05/22/2021
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: N/A

Allergies: Amoxicillin

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Moderna COVID-19 Vaccine EUA Around 4am on 5/22 I developed a mild fever. Got up around 7am 5/22 and took my temperature (99.8). I walked down my stairs to make toast and around 7:20 am I fainted in my kitchen. I had eaten and drank plenty of water the night before, so I don't think I was dehydrated or hypoglycemic. No other fainting events the rest of the day but I was extremely dizzy and nauseous.

Other Meds: Had an abscess on my finger (started antibiotics on evening of May 16th) (sulfamethexoazole trimethoprim)

Current Illness: Cellulitis and abcess on right middle finger

ID: 1344015
Sex: F
Age: 66
State: MO

Vax Date: 05/24/2021
Onset Date: 05/24/2021
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: N/A

Allergies: Thiomersal

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Five minutes after administering the patient's second COVID-19 vaccine (Moderna), the patient claimed her throat was getting itchy and tight. She described the feeling as what happens to her when she has an allergic reaction to thiomersal - no history of anaphylaxis; anaphylaxis did not occur this time. Patient was asked if she'd like a dose of Benadryl to help with the reaction, she replied yes, and the patient was given 25mg of Benadryl liquid. Patient waited 20 minutes after the Benadryl dose until symptoms went away. She was called later in the day and reported she was feeling much better and had no issues when she left the pharmacy.

Other Meds: Unknown

Current Illness: Unknown; replied "none" on immunization form.

ID: 1344016
Sex: F
Age: 26
State: CA

Vax Date: 05/24/2021
Onset Date: 05/24/2021
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:

Allergies: some allergies to pineapple or other foods. No anaphylactic reactions to anything.

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

Symptoms: After about 25 minutes patient came back into pharmacy to report tingling and numbness in right arm. There was a palpable, large, red rash on right arm as well. Patient also complained about itchy top of throat. About 10:15am patient was injected with 50mg of diphenhydramine at site of injection. Pt's blood pressure was normal 148/98 at 10:00am and 147/90 at 10:03am. Patient felt much better in 10 minutes and 90% of rash went away. Patient's husband drove patient home around 10:45am.

Other Meds:

Current Illness:

ID: 1344017
Sex: M
Age: 27
State: NY

Vax Date: 05/12/2021
Onset Date: 05/12/2021
Rec V Date: 05/24/2021
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: held a clinic back in March and again in May 12. Patient came to both clinics and received J&J. Second clinic was not aware that he already received a dose

Other Meds:

Current Illness:

ID: 1344018
Sex: F
Age: 34
State: MI

Vax Date: 05/20/2021
Onset Date: 05/20/2021
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: cardiomegaly, splenomegaly, hepatomegaly

Allergies: none

Symptom List: Unevaluable event

Symptoms: rapid heart rate, shortness of breath, nausea and vomiting

Other Meds: pristiq, zyrtec

Current Illness: none

ID: 1344019
Sex: M
Age: 35
State: TX

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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

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

Symptoms: after receiving the vaccine patient was feeling nausea and light-headed and he fainted on the floor 5 minutes after the vaccine administration

Other Meds: n/a

Current Illness:

ID: 1344020
Sex: F
Age: 50
State: FL

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

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: had bakers cyst burst and had 3 blood clots

Other Meds:

Current Illness:

ID: 1344021
Sex: M
Age: 56
State: NC

Vax Date: 04/08/2021
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:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: PATIENT IS COMPLAINING OF RIGHT ARM PAIN. SAYS THAT THE DR HAS DETERMINED THAT HE HAS A TEAR IN HIS RIGHT ROTATOR CUFF

Other Meds:

Current Illness:

ID: 1344022
Sex: F
Age: 69
State:

Vax Date: 04/14/2021
Onset Date: 05/15/2021
Rec V Date: 05/24/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Patient presented to the ED and was subsequently hospitalized with acute metabolic encephalopathy.

Other Meds:

Current Illness:

ID: 1344023
Sex: F
Age: 55
State: MN

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

Lab Data:

Allergies: No

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: I spoke with my cardiologist and my primary about my uncontrolled blood pressure. So we could take measures to help with that. They both said unlikely from vaccine. I just know the my blood pressure was under control until my first shot of the vaccine

Other Meds: Carvedilol Lisinopril Adderall Oxybutynin Escitalopram Glucosamine Low dose aspirin

Current Illness: High blood pressure Cardiomyopathy Anxiety Depression

ID: 1344024
Sex: F
Age: 3
State: TN

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: No known allergies

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Havrix vaccine given too soon after 1st dose.

Other Meds: Unknown

Current Illness: unknown

ID: 1344025
Sex: F
Age: 34
State: OR

Vax Date: 05/19/2021
Onset Date: 05/19/2021
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:

Allergies: Opiates Sulfa Cipro Cyldamyacin Visible light ( solar urticaria)

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

Symptoms: Moderna. Injection 2. Fever. Cough. Gagging. Muscle aches. Chills. Confusion. Fatigue. Weakness. Soreness at injection site. Symptoms still persisting 6 days later.

Other Meds: Propranolol Hydroxychoroquine Wellbutrin Zyrtec Pepcid Topi ram ate Cyclobenzprine

Current Illness:

ID: 1344026
Sex: M
Age: 12
State: WA

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: RA

Lab Data:

Allergies: Allergy to shell-fish/seafood. Hives as a reaction

Symptom List: Nausea

Symptoms: Patient was immunized with Pfizer vaccine as a minor with consent from mother. Patient had no issues initially with vaccine. Following 15 minutes after administration, patient noted flank pain and both sides of abdomen and also labored breathing. We called a code white in the store had management as well as pharmacist offer ambulance to patient and also monitored the patient. Mother and son left AMA and went to call patient's doctor.

Other Meds:

Current Illness:

ID: 1344027
Sex: F
Age: 28
State: TX

Vax Date: 05/12/2021
Onset Date: 05/18/2021
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: Sulfa

Symptom List: Injection site pain

Symptoms: Rash under right breast appeared on May 18th. Right side of body became sore on May 21st. Went to urgent care in May 22nd and was diagnosed with shingles. Currently taking Valtrex to treat.

Other Meds: N/A

Current Illness: None

ID: 1344028
Sex: F
Age: 24
State:

Vax Date: 04/25/2021
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:

Allergies:

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

Symptoms: Extremely heavy period and painful menstrual cramps that are not eased by over the counter medication.

Other Meds:

Current Illness:

ID: 1344029
Sex: M
Age: 16
State: DC

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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Patient walked in to receive Covid-19 vaccine. We informed him that we have two vaccines Pfizer and Janssen, and that Janssen was for 18 and up. We asked him how old he was. He said he was 18 and wanted the Janssen vaccine.

Other Meds:

Current Illness:

ID: 1344030
Sex: M
Age: 41
State:

Vax Date: 02/17/2021
Onset Date: 02/17/2021
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.

Allergies: None

Symptom List: Tremor

Symptoms: Sever chills, headache, extreme fatigue, sore arm, worse migraine ever suffered and never had a migraine before, nausea, exhaustion. All of these lasted 48 hours and the migraine did not occur until 72 hours later.

Other Meds: None

Current Illness: None

ID: 1344031
Sex: F
Age: 32
State: AZ

Vax Date: 05/01/2021
Onset Date: 05/18/2021
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: N/A

Symptom List: Erythema, Pruritus

Symptoms: Itching, swelling, many hives all over body.

Other Meds: N/A

Current Illness: N/A

ID: 1344033
Sex: M
Age: 52
State: NC

Vax Date: 05/17/2021
Onset Date: 05/01/2021
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:

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

Symptoms: Patient came back to pharmacy on 5/24 to report he came from the MD office and was told he had an infection at the site of injection and it was red and scabbed and about the size of a quarter.

Other Meds:

Current Illness:

ID: 1344034
Sex: F
Age: 38
State: ME

Vax Date: 04/29/2021
Onset Date: 04/29/2021
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:

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

Symptoms: vasovagal to past shots, dizzy but recovered

Other Meds:

Current Illness:

ID: 1344035
Sex: F
Age: 45
State: LA

Vax Date: 01/27/2021
Onset Date: 01/27/2021
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: Covid-19 antibody test- negative blood work Weekly Covid 19 test

Allergies: penicillin- anaphylaxis reaction

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: 1 hour later, participant got a headache, pain in arm and at injection site and felt achy. She took Tylenol and laid down to sleep. Woke up with flu like symptoms and right arm started to swell and the underarm had a big knot. The injection site was huge, hot and red. Participant went to the doctor the next day and the doctor took measurements. No medications prescribed. Participant continued to take Tylenol and Motrin. About 2 weeks after the vaccine, participant lost taste and smell. About 3 weeks after the 2nd dose, participant developed a pain under the right breast to the arm pit. Participant was diagnosed with Shingles and prescribed Valtrex for treatment. Currently, participant symptoms have all resolved except for shortness of breath.

Other Meds: Amlodpine 10mg once a day for blood pressure Metoprolol 200mg 1/2 tablet daily for blood pressure Flexeril 10mg twice a day for muscle relaxer Motrin 200mg OTC as needed Ambien 10mg at bedtime for sleep

Current Illness: none

ID: 1344036
Sex: F
Age: 70
State: VT

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

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

Lab Data: None

Allergies: Many medication allergies including resulting anaphylaxis

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

Symptoms: It seems I experienced every listed side effect, save for fatigue. That included fever, muscle aches, brain fog, nausea, gastrointestinal distress

Other Meds: Vitamin C, Vitamin D3, Calcium, Magnesium, Zinc, Multivitamin, Mucinex

Current Illness: None

ID: 1344037
Sex: U
Age: 64
State: AZ

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: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None.

Allergies: Penicillin VK

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

Symptoms: She got her vaccine, within 10-15 minutes she was talking to her sister and she put her hands out and she had not read any reactions. She stretched out her arms in front of her and noticed that the middle fingers on the left hand was twitching. Then a little bit later there was a muscular contraction in the middle of her left thigh, midway between her hip and knee on the anterior side. Was an intermittent muscular contraction on the same side she got the shot. The twitching back and forth of her finger was 1/4 of he way. She googled it and saw that it may be related to the vaccine. Friday, it continued twitching back and forth like a metronome. If she stretches her forearms out prone the ring finger, middle finger and especially the middle finger. Saturday the symptoms were still there but not as much. The thigh symptoms continued for about 2 hours. She walked from her sisters house which is about 1/2 block and it disappeared. The finger issues are more long-term and some numbness in the hand itself. Her right hand at times this weekend had jiggling fingers, but the left is the worse. It is intermittent movement and slight 1/8" movement on those 3 fingers still. There is a general numbness in the fingers as well, not 100% like it's supposed to feel This is going through the entire left arm and down into the hand. It is not as constant that it was on Friday, getting better and just intermittent right now. She has not contacted her doctor yet, but states that she will. She noticed a clumsiness and a sense of unsteadiness with her walking and felt safe doing so. She may have gotten COVD in Feb/March 2020, said she had almost every symptom from COVID and had lost her sense of smell, slight diarrhea, sore throat, runny dose, temp of 100.3. She still has some loss of sense of taste. She was told at one time that she had markers for Sjogren's.

Other Meds: None.

Current Illness: None.

ID: 1344038
Sex: F
Age: 43
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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Pain in extremity

Symptoms: Expired Vaccine given, no adverse event occured. contacted patient about matter.

Other Meds: None

Current Illness:

ID: 1344039
Sex: M
Age: 13
State: VA

Vax Date: 05/22/2021
Onset Date: 05/22/2021
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: 911 called .Patient transferred to Er /Hosp per mom's request

Allergies: NKDA

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

Symptoms: 13year old hispanic male who collapsed 5-10 minutes following first dose of Pfizer injection. Patient caught by MRC volunteer and sat on a chair.Patient able to verbal ID name,calm ,dusky.Pulse ox 60% ,Heart Rate 100.Patient laid down with lower extremity upward.BP 100/74 pulse ox increased to 96%.Heart rate down to 70's.Calm ,pale .

Other Meds: NONE

Current Illness: NONE

ID: 1344040
Sex: F
Age: 54
State: CA

Vax Date: 04/02/2021
Onset Date: 05/07/2021
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

Allergies: unknown

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

Symptoms: Inadvertently received a 3rd dose of of the COVID 19 vaccine.

Other Meds: unknown

Current Illness: unnknown

ID: 1344041
Sex: F
Age: 44
State: MI

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

Lab Data: No tests have been performed. I did contact CVS on Monday 5/24, they told me to contact my Doctor which I did and to inform the CDC by filling out this form. My Doctor instructed me to contact him in the next couple of days to update him on my condition unless things get worse then I am to call his office immediately and he will see me that day.

Allergies: None.

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

Symptoms: About 3.5 hours after the injection on May 18th my right leg became slightly numb and tingling (pins and needles kind of feeling). By the next morning my leg was ok. Then on Sunday, May 23rd my right leg began to tingle and go numb again. Then the next morning (5/24) my leg was still numb/tingling and both my hands had a tingling sensation as well.

Other Meds: Propranolol 20 mg taken twice daily Tapazole 2.5 mg taken every other day Doxycycline 100 mg Vitamin D3 Vitamin E Biotin

Current Illness: None.

ID: 1344042
Sex: M
Age: 28
State: UT

Vax Date: 04/07/2021
Onset Date: 04/10/2021
Rec V Date: 05/24/2021
Hospital: Y

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

Lab Data: Troponin levels in blood. First test was around 0.8 and then they went up to about 1.8 later than night and then after NSAIDs helped the troponin levels started to decline. I was tested for viruses and fungal culprits of myocarditis. I did not have any positive results for known myocarditis inducers. I was negative for COVID-19 as well. I had COVID-19 in October of 2020

Allergies:

Symptom List: Vomiting

Symptoms: I woke up with pain in the chest and numb left arm three days after the first Moderna shot. I went to the ER. I had an Irregular EKG and Elevated Troponin levels. I was held at the hospital for 34 hours. I was prescribed colchocine and ibuprofen and pantaprazole to reduce swelling in my heart and pericardium. I have been not excercising and been going to a cardiologist.

Other Meds:

Current Illness:

ID: 1344043
Sex: M
Age: 34
State: ME

Vax Date: 04/29/2021
Onset Date: 04/29/2021
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:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: dizzy, light headed, past med history of panic attacks

Other Meds:

Current Illness:

ID: 1344044
Sex: M
Age: 54
State: VA

Vax Date: 04/12/2021
Onset Date: 04/20/2021
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:

Allergies: No

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

Symptoms: Severe pain in left knee after few days of second vaccine shot. Slight pain started in right knee - pain while walking or standing for a long period of time

Other Meds: Blood pressure and blood thinner medications

Current Illness: No

ID: 1344045
Sex: M
Age: 38
State: WI

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

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Nausea and fever for 3 hours, pain at injection site for 5 days

Other Meds: Turmeric/curcumin, Natrol ImmuneBoost

Current Illness:

ID: 1344046
Sex: F
Age: 33
State: TX

Vax Date: 03/22/2021
Onset Date: 04/05/2021
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: RA

Lab Data: EMG and NCV confirmed neuropathic injury. MRI brain and spinal cord were normal. CSF was normal. Metabolic panel, CBC, RPR were normal.

Allergies: none

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

Symptoms: Diffuse paresthesias due to acute axonal polyneuropathy

Other Meds: none

Current Illness: cirrhosis

ID: 1344047
Sex: F
Age: 66
State: MA

Vax Date: 05/19/2021
Onset Date: 05/19/2021
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: MR brain without any new/acute findings to explain seizure. EEG initially with frequent seizure activity, improved s/p levetiracetam and lacosamide.

Allergies:

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

Symptoms: Patient developed generalized tonic clonic seizure several hours after Pfizer vaccine.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am