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: 1387914
Sex: F
Age: 39
State: PA

Vax Date: 02/05/2021
Onset Date: 05/30/2021
Rec V Date: 06/10/2021
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: No

Symptom List: Dysphagia, Epiglottitis

Symptoms: I am off birth control now for 2 weeks and no period Chonte to think of it I haven't had one since the vaccine

Other Meds: Birth control pills

Current Illness: None

ID: 1387915
Sex: M
Age: 12
State: PA

Vax Date: 06/09/2021
Onset Date: 06/10/2021
Rec V Date: 06/10/2021
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: None

Symptom List: Anxiety, Dyspnoea

Symptoms: Painful injection site later the same day. Following morning injection site very painful/sore. Headache. Fever.

Other Meds: Norditropin (Rx) multivitamin probiotics Phosphatidyl Choline

Current Illness: None

ID: 1387916
Sex: F
Age: 62
State: PA

Vax Date: 04/07/2021
Onset Date: 05/17/2021
Rec V Date: 06/10/2021
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: DOPPLER - NEGATIVE

Allergies: TOPICAL ANITBIOTIC OINTMENTS

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

Symptoms: AFTER THE FIRST INJECTION THERE WAS NO REACTION. AFTER THE SECOND INJECTION STARTING 8 HOURS AFTER THE INJECTION SHE HAD SEVERE MUSLCE WEEKNESS AND COULD NOT MOVE. SHE HAD A FEVER GREATER THAN 101 AND PIERCING PAIN IN THE HEAD AND MUSLCE ACHES THAT LASTED ABOUT 48 HOURS. SHE HAD TO CALL OFF OF WORK. ABOUT 12 DAYS AFTER THE 2ND INJECTION SHE DEVELOPED REDNESS, TENDERNESS, SWELLING IN THE LOWER LEGS. WENT TO MED EXPRESS AND A DOPPLER WAS DONE FOR BLOOD CLOT. IT WAS NEGATIVE. THEY SYMPTOMS PROGRESSED AND SHE WENT TO HER PCP. DIAGNOSED WITH CELLULITIS AND WAS PUT ON KEFLEX. UPON EXAM YESTERDAY IN OUR OFFICE IT WAS CONFIRMED THAT SHE HAS ERYTHEMA NODOSUM.

Other Meds: LEVO-T MELOXICAM VITAMIN D TRAZODONE

Current Illness: HOSHIMOTOS THYRODITIS ARTHRITIS

ID: 1387917
Sex: F
Age: 57
State: FL

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

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

Lab Data: BP 135/89, T 97.6, O2Sat 100% RA, HR 73, Blood Glucose 128.

Allergies: n/a

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient is a 57 year old female complained of light headedness, dizziness. Encouraged pt. to relax, stay calm. Water provided. Fire Rescue arrived to scene for further evaluation. Vital signs rendered. Pt. denies any pain, discomfort. Pt. refused hospitalization. Pt. recovered from adverse event at 2:06pm with no complaints of lightheadedness, dizziness and left observation via personal vehicle.

Other Meds: Medical Marijuana

Current Illness: n/a

ID: 1387918
Sex: F
Age: 79
State: MI

Vax Date: 06/09/2021
Onset Date: 06/09/2021
Rec V Date: 06/10/2021
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: Systemic: Nausea-Mild, Systemic: Shakiness-Mild

Other Meds:

Current Illness:

ID: 1387919
Sex: F
Age: 17
State: KS

Vax Date: 06/09/2021
Onset Date: 06/09/2021
Rec V Date: 06/10/2021
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: Systemic: Dizziness / Lightheadness-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Nausea-Mild, Systemic: Visual Changes/Disturbances-Mild, Additional Details: PT fainted and fell out of the chair several minutes after administration of vaccine. Pt regained conciousness immediately after fall. Suffered minor injuries to the face and knee (rug burn) and felt dizzy, lightheaded, and nauseas for at least 15 minutes before regaining complexion. PT discloses after incident that she has issues fainting with blood draw and some injections. PT rested for 45 minutes in the store before leaving. Vitals reviewed are normal before leaving the store

Other Meds:

Current Illness:

ID: 1387920
Sex: M
Age: 16
State: NE

Vax Date: 06/09/2021
Onset Date: 06/09/2021
Rec V Date: 06/10/2021
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: Pyrexia, White blood cell count decreased

Symptoms: Systemic: Fainting / Unresponsive-Mild

Other Meds:

Current Illness:

ID: 1387932
Sex: F
Age: 47
State: SC

Vax Date: 06/05/2021
Onset Date: 06/05/2021
Rec V Date: 06/10/2021
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: Site: Pain at Injection Site-Mild, Additional Details: has persistent dry cough now for several day,not going away,told pt to contact md if persists

Other Meds:

Current Illness:

ID: 1387933
Sex: F
Age: 58
State: KY

Vax Date: 02/04/2021
Onset Date: 05/03/2021
Rec V Date: 06/10/2021
Hospital:

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

Lab Data: Pelvic exam and PAP smear - 5/11/21 - normal Urine culture - 5/11/21 - normal Ultrasound Pelvis Complete, Transabd, Transvag - 5/12/21 - normal appearance, a 2cm uterine mass that is likely a fibroid

Allergies: Penicillin, Sulfa Antibiotics

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Sudden onset of extreme vaginal pain, blood in urine. Tests/exams were done but nothing unusual was found. There was no treatment. Problem resolved after about 12 days.

Other Meds: Vitamin B12, Vitamin D3, Vitamin C, Calcium

Current Illness: N/A

ID: 1387934
Sex: M
Age: 63
State: IL

Vax Date: 05/11/2021
Onset Date: 05/11/2021
Rec V Date: 06/10/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

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

Other Meds:

Current Illness:

ID: 1387935
Sex: F
Age: 45
State: MI

Vax Date: 06/02/2021
Onset Date: 06/09/2021
Rec V Date: 06/10/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Started with very swollen right shoulder, like twice the size of not larger of my left arm a few days ago. Then yesterday morning,6/9, I woke up and my right armpit hurt like swollen lymph node pain, armpit hurt all day. I can ignore the swollen shoulder it doesn't bother me just looks odd. But this morning,6/10, the armpit pain is duller but my shoulder is severely swollen, hard, hot and tingly, and very large defined red circle around the injection site.

Other Meds: None

Current Illness: None, just seasonal allergies

ID: 1387936
Sex: F
Age: 46
State: FL

Vax Date: 06/09/2021
Onset Date: 06/09/2021
Rec V Date: 06/10/2021
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. They just took my vitals but will be contacting my primary dr today.

Allergies: Sulfa, penicillin, macrobid, vitamin b sensitivity

Symptom List: Rash, Urticaria

Symptoms: Was given shot and felt fine. Then suddenly became dizzy and started blacking out and sweating profusely. Staff told me my skin was white. I was laid down and my legs were held up while they took vitals. My clothes became drenched in sweat. One nurse told me this was from anxiety. I was not remotely anxious at the time of the shot and do not have a fear of needles - I have tattoos and piercings, have had IVs and had blood drawn numerous times and have never ever had anything like this before. After an hour I could stand but barely walk for a couple hours more.

Other Meds: Flonaise, claritin

Current Illness:

ID: 1387937
Sex: F
Age: 43
State: CA

Vax Date: 06/01/2021
Onset Date: 06/06/2021
Rec V Date: 06/10/2021
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: heavy menstrual cramping and bleeding as well as severe back pain.

Other Meds:

Current Illness:

ID: 1387938
Sex: F
Age: 64
State: VA

Vax Date: 06/01/2021
Onset Date: 06/02/2021
Rec V Date: 06/10/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Site: Itching at Injection Site-Severe, Site: Pain at Injection Site-Severe, Site: Redness at Injection Site-Severe, Site: Swelling at Injection Site-Severe

Other Meds:

Current Illness:

ID: 1387939
Sex: M
Age: 16
State: AZ

Vax Date: 06/09/2021
Onset Date: 06/09/2021
Rec V Date: 06/10/2021
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: Systemic: pale-Mild, Systemic: Visual Changes/Disturbances-Medium, Systemic: Weakness-Mild, Additional Details: Pt vision went dark within a few minutes after vaccine. Pt HR 40s, O2 93%, temp 97.1 and pt looking pale. UTA BP as pt is autistic teenager and was agitated and trying to leave during visit. Pt mother present and helped calm patient. 911 called due to vision change and low heart rate. EMS arrived and pt HR back up and no longer pale. EMS reassessed pt, per pharmacy on NP return, pt/guardian refused ER transport and condition stabilized. Pt vision returned. Further EMS services declined.

Other Meds:

Current Illness:

ID: 1387940
Sex: F
Age: 44
State: PA

Vax Date: 06/09/2021
Onset Date: 06/09/2021
Rec V Date: 06/10/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Systemic: Chest Tightness / Heaviness / Pain-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Hyperventilation-Mild, Systemic: Numbness (specify: facial area, extremities)-Mild, Systemic: Tingling (specify: facial area, extemities)-Mild, Additional Details: Immediately after vaccination given, patient developed a tingling, numb and warm sensation on the right side of her face. Also felt tingling in her lips and began hyperventilating. She took 50mg of diphenhydramine. After a few minutes, tingling sensation in lips and hyperventilation resolved. After 30 minutes, patient still experiencing some facial numbness. She was still able to move the muscles in her face and no drooping was observed. Followed up 6 hours later and still having same sensation.

Other Meds:

Current Illness:

ID: 1387941
Sex: M
Age: 47
State: OH

Vax Date: 04/27/2021
Onset Date: 05/27/2021
Rec V Date: 06/10/2021
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: Several CT scans and two angiograms performed at Hospital

Allergies: None

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

Symptoms: The day after the first dose I experienced a subarachnoid hemorrhage. I was hospitalized for 10 days due to the hemorrhage.

Other Meds: Lisinopril-HCTZ 20-12.5

Current Illness: None

ID: 1387942
Sex: M
Age: 46
State: NY

Vax Date: 04/12/2021
Onset Date: 04/15/2021
Rec V Date: 06/10/2021
Hospital:

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

Lab Data: EKG 5/20; Blood Panel 5/20, Ecocardiogram 5/20, CT w. Iodine Scan 5/26; Blood Tests 5/26, 5/27, TEE 5/27

Allergies: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: 4 Days after vaccine (4/16/21), elevated heart rates while running/exercising. Max HR was 195+ for 46/yo Male. This continued during running for more 12 days (4/28/21), and seemed had resided on 4/29/21. Note: Prior to vaccine only had two runs with a max HR higher than 190, both of those were strenuous endurance events (high altitude or sprinting). 10 Days after the high heart rates, on 5/10 patient experienced another spike in heart rates, and a few. On 5/18 another high heart rate episode occurred but patient didn't see heart rate recover. Patient utilized a new smart watch to check ECG and watch diagnosed they were in AFIB. Patient visited doc / ER and while in ER came out of Afib, patient was placed on Metropol. Patient back into Afib 1 week later, admitted to hospital to undergo Cardioversion. Patient is still working with cardiologist and internist to determine next steps.

Other Meds: Turmeric MSM and Glucosamine

Current Illness: None

ID: 1387943
Sex: M
Age: 69
State: CO

Vax Date: 03/12/2021
Onset Date: 03/23/2021
Rec V Date: 06/10/2021
Hospital:

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

Lab Data: NONE

Allergies: NONE PREVIOUSLY (ONLY BEE STINGS - "ANAPHYLACTOID" TYPE)

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Took 600mg of Ibuprofen (200mg x3) orally at 7:45AM, 30 minutes later while viewing a medical webinar at my desk at home, I suddenly noticed significant itching of my entire hands which quickly became reddened and progressively swollen as the itching sensation become more generalized within 10-15 minutes. I got up from my chair to go tell my wife but as I walked a few paces, I became extremely weak with visual 'closing in' as I barely prevented myself from collapsing to the floor / losing consciousness. At the same time my tongue was now thickened and malfunctioning making my spoken words to my wife almost unintelligible - all consistent with a CLASSIC ANAPHYLAXIS REACTION. My wife helped me to the couch to recline where I carefully swallowed CHLORPHENIRAMINE 8MG, FAMOTIDINE 20MG; and 15 minutes later DIPHENHYDRAMINE 50MG (I did not have any Epinephrine available from prior 'bee sting kits'). At no time was my breathing impaired nor was there any audible wheezing or dyspnea. After ~45 minutes I was improving noticeably, and after ~2-3 hours I had made a 100% recovery with no sequelae thereafter. Although I had taken my routine morning medications several HOURS PRIOR, nevertheless, (after purchasing several vials of Epinephrine 1mg/1mL for protection in case of another reaction), after this event and over the succeeding days I re-added each of those medications separately / one-at-a-time to ensure that NONE of those was the offending agent - NO problems ensued. For obvious reasons, I have 100% AVOIDED ingesting Ibuprofen or other typical NSAIDs since this episode (although my routine single daily aspirin tablet has presented no problems). BOTTOM LINE: DESPITE HAVING USED IBUPROFEN 400MG OR 600MG PERHAPS 1-2 TIMES WEEKLY AS NEEDED FOR MUSCULOSKELETAL DISCOMFORT OVER MANY YEARS, NEVER UNTIL THIS ANAPHYLACTIC EPISODE 11 DAYS AFTER MY SECOND DOSE OF MODERNA'S COVID-19 VACCINE HAD THERE EVER BEEN ANY TYPE OF ADVERSE REACTION TO IBUPROFEN WHATSOEVER.

Other Meds: LOSARTAN 100MG; HYDROCHLOROTHIAZIDE 25MG; EZETIMIBE 10MG; SIMVISTATIN 20MG; FAMOTIDINE 20MG; VITAMIN D3 2000IU; ASPIRIN 325MG; ADULT MULTIVITAMIN; SUGAR-FREE PSYLLIUM

Current Illness: NONE

ID: 1387944
Sex: F
Age: 14
State: IL

Vax Date: 06/06/2021
Onset Date: 06/09/2021
Rec V Date: 06/10/2021
Hospital: Y

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

Lab Data: MRI of heart, blood work showing elevated troponin, echo, and ekg

Allergies: None

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

Symptoms: Myocarditis

Other Meds: None

Current Illness: None

ID: 1387945
Sex: M
Age: 18
State: MA

Vax Date: 05/24/2021
Onset Date: 06/09/2021
Rec V Date: 06/10/2021
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: X-ray Labs Cat scan Covid test

Allergies: Shellfish

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

Symptoms: Fever Sob Tachycardia Elevate d-dimer Chest pain Cough

Other Meds: None

Current Illness: None

ID: 1387946
Sex: M
Age: 20
State: MN

Vax Date: 06/05/2021
Onset Date: 06/05/2021
Rec V Date: 06/10/2021
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: Fainting / Unresponsive-Mild, Additional Details: pt passed out 1 minute after giving 0.3ml of pfizer IM to left arm......pt was seated so gently fell forward onto my legs and then laid on the floor. pt regained consiousness within 10 seconds. Mom saw a twich and insisted I call 911 to ensure he was not having a seizure, which he was not. Paramedics came and assessed vitals, which were all good and pt walked out with them and parents. I called the pt the next day to follow up and patient was fine. No other issues.

Other Meds:

Current Illness:

ID: 1387947
Sex: F
Age: 44
State: NH

Vax Date: 01/01/2021
Onset Date: 01/01/2021
Rec V Date: 06/10/2021
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. No medical history of any issues to warrant testing. Yearly physicals all normal. Blood work all normal. These side effects/adverse events have only begun post covid-19 vaccine injection. I was a perfectly healthy individual prior.

Allergies: codine (nausea)

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

Symptoms: Initial reaction (2 days post): nausea, fever, chills, sore left arm, muscle aches 1month post-present time: hip and knee pain, stabbing right ear pain, chronic fatigue

Other Meds: none

Current Illness: none

ID: 1387948
Sex: M
Age: 45
State: DE

Vax Date: 06/02/2021
Onset Date: 06/02/2021
Rec V Date: 06/10/2021
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: Site: Pain at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Systemic: Numbness (specify: facial area, extremities)-Severe, Additional Details: numbness on left side from neck to toes. did not go away for days

Other Meds:

Current Illness:

ID: 1387949
Sex: F
Age: 64
State: MA

Vax Date: 05/10/2021
Onset Date: 05/31/2021
Rec V Date: 06/10/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Systemic: Chest Tightness / Heaviness / Pain-Severe, Systemic: Diagnosed with "costochondritis" by hospital-Severe

Other Meds:

Current Illness:

ID: 1387950
Sex: F
Age: 58
State: NC

Vax Date: 05/18/2021
Onset Date: 05/18/2021
Rec V Date: 06/10/2021
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: Systemic: Allergic: Difficulty Breathing-Medium, Systemic: Chest Tightness / Heaviness / Pain-Medium, Additional Details: Pt stated that 1&1/2 hours after first dose she felt a stuffiness of the nose (nasal congestion) along with tightness of the chest which made it difficult to get in a deep breath. Symptoms persisted for 5-6 hours. Pt did not seek medical attention. Pt came for second dose 6/8/21, informed patient to seek medical attention if symptoms reoccur.

Other Meds:

Current Illness:

ID: 1387951
Sex: M
Age: 21
State: IL

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

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

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1387952
Sex: M
Age: 33
State: IL

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

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1387953
Sex: F
Age: 61
State: MA

Vax Date: 01/04/2021
Onset Date: 03/16/2021
Rec V Date: 06/10/2021
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: Percocet Dilodid

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

Symptoms: Involuntary Lip pursing "Fish Lips" about once a minute.

Other Meds: Atorvastatin Lisinopril Vitamin D Fish oil

Current Illness: NA

ID: 1387954
Sex: F
Age: 26
State: FL

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

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

Lab Data: Patient was brought to ER via wheelchair and left with out being seen.

Allergies: PCN Amoxicillin Flagyl Clindamycin

Symptom List: Nausea

Symptoms: Patient started to complain about hives and itching on torso and chest area after approximately 30 minutes post immunization.

Other Meds: Acetaminophen Ibuprofen Docusate Prenatal Vitamins

Current Illness: Unknown

ID: 1387955
Sex: F
Age: 51
State: NV

Vax Date: 05/04/2021
Onset Date: 05/18/2021
Rec V Date: 06/10/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Systemic: Exhaustion / Lethargy-Severe, Systemic: SHINGLES-Severe, Systemic: Neurological Disorder (diagnosed by MD)-Severe

Other Meds:

Current Illness:

ID: 1387956
Sex: M
Age: 57
State: TX

Vax Date: 03/10/2021
Onset Date: 05/17/2021
Rec V Date: 06/10/2021
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: Report bilateral leg heaviness mainly to the calf region and mostly of the right leg that is constant started 2.5 weeks ago. There is no bruising, or feeling of warmth of the lower extremity. He denies chest pain, leg pain, SOB, HA or blurred vision. Reports movement makes it better and inactivity makes it worst. Treatment: None , Outcome: Does not interfere with ADLs

Other Meds:

Current Illness:

ID: 1387957
Sex: F
Age: 32
State: MI

Vax Date: 05/25/2021
Onset Date: 05/28/2021
Rec V Date: 06/10/2021
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: left arm and shoulder blade pain. pain developed from mid shouderblade, down the arm and into hand. sensations and reflexes normal.

Other Meds:

Current Illness:

ID: 1387958
Sex: F
Age: 19
State: AL

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

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

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: Within 10 minutes of the vaccine, numbness and swelling started traveling up from the injection site to the left side of my neck and jaw/cheek area. By 30 minutes afterward, it had made my whole arm feel numb including my fingers. I took Tylenol and Benadryl and iced the areas. Swelling and numbness persisted for the next 3-4 hours. I was fine the next morning as far as I could tell.

Other Meds: doxycycline hyclate 100 mg, potassium gluconate 595 mg, soma-vit multivitamin

Current Illness:

ID: 1387975
Sex: M
Age: 63
State: IL

Vax Date: 05/11/2021
Onset Date: 05/11/2021
Rec V Date: 06/10/2021
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: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)

Other Meds:

Current Illness:

ID: 1387976
Sex: M
Age: 64
State: FL

Vax Date: 06/09/2021
Onset Date: 06/09/2021
Rec V Date: 06/10/2021
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: Site: Redness at Injection Site-Mild, Additional Details: About 5 min. after immunization, pt fainted, pt had pulse and breathing but high BP 180/89; paramedic were called & pt was take to ER. Per pt wife, he had history of fainting with injwection & blood tests. Also he has cardiovaculary disease and pacemaker. I recieved all these info after pt. faining; if I was informed prior; I would have recommended pt to recieve vaccination at hospital location.

Other Meds:

Current Illness:

ID: 1387977
Sex: F
Age: 13
State:

Vax Date: 06/06/2021
Onset Date: 06/08/2021
Rec V Date: 06/10/2021
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: 6/9 Summary: 13-year-old girl with JIA, chronic constipation, chronic tension-like headaches who presents with chest pain, nausea, vomiting, dizziness 1 day after receiving her second dose of her Covid vaccine. Initially seen in the ED 1 day prior to admission discharged on her lab work, chest x-ray are reassuring. Today, continues to have reassuring labs including troponin, BMP, BNP and EKG normal sinus rhythm. No evidence of JIA flare at this time. -Cardiology consult today re: chest pain -Obtain ECHO -Monitor for resolution of tachycardia -Keep on cardiorespiratory monitoring -Clears, IVF, serial abdominal exams, wean IVF as PO intake improves -Discussed with patient maintaining good hydration at home -Zofran PRN N/V -f/u orthostatic VS -Dispo: Pending resolution of chest pain/tachycardia and Cardiology clearance

Allergies:

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

Symptoms: Note- This patient did not receive the vaccine at our facility so I do not have further details on the vaccine. 13 y/o female with hx of juvenille arthritis, migraines and anxiety, here for left sided CP, palpitations, fast HR, SOB since 6/8 receiving the 2nd Covid vaccine on 6/6/21. Pt states she is also having some nausea and fatigue. Pt has not taken any medications at home for pain. Pt currently taking methotrexate but no steriods. No family hx of blood clots or blood disorders. Differential Diagnosis: Electrolyte abnormality, dehydration, arrythmia, COVID vaccine reaction, myocarditis r/t COVID vaccine. EKG NSR. negative troponin.

Other Meds:

Current Illness:

ID: 1387978
Sex: F
Age: 71
State: TX

Vax Date: 01/14/2021
Onset Date: 01/23/2021
Rec V Date: 06/10/2021
Hospital: Y

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

Lab Data: Echocardiogram, Cat Scan

Allergies: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: There was a little soreness and redness. A couple days after my heart started racing and it got worse. I went into Afiv and was hospitalized for 3 days. I had my heart shocked three times to get it into rhythm.

Other Meds: Synthroid, Blood pressure medicine

Current Illness: None

ID: 1387979
Sex: F
Age: 49
State: MA

Vax Date: 06/07/2021
Onset Date: 06/09/2021
Rec V Date: 06/10/2021
Hospital:

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

Lab Data: CBC blood test and 2 EKGs. I refused the CT scan. All tests performed 6/9/21

Allergies:

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

Symptoms: Initial nausea and lightheadedness, followed by headaches day of shot and next day. 2 days after shot incredible dizziness in the a.m. 1 hour after waking which lasted all day. Dizzy sitting and standing. Saw double vision with slight headache. Slight sweating. Not hungry. Urged to go to ER due to possible stroke; however, all tests proved stroke negative. The dr. finally admitted it was a possible vaccination side effect, which I initially told them it was most likely the cause.

Other Meds: Levothyroxine, Omeprazole

Current Illness:

ID: 1387980
Sex: F
Age: 50
State: MA

Vax Date: 06/09/2021
Onset Date: 06/09/2021
Rec V Date: 06/10/2021
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: Systemic: Dizziness / Lightheadness-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Hypotension-Medium, Systemic: Weakness-Medium

Other Meds:

Current Illness:

ID: 1387981
Sex: F
Age: 59
State: NY

Vax Date: 03/29/2021
Onset Date: 04/26/2021
Rec V Date: 06/10/2021
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: None stated.

Other Meds:

Current Illness:

Date Died: 06/04/2021

ID: 1387983
Sex: F
Age: 94
State:

Vax Date: 02/24/2021
Onset Date: 05/14/2021
Rec V Date: 06/10/2021
Hospital: Y

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: - Acute kidney failure, unspecified - Hypo-osmolality and hyponatremia

Other Meds:

Current Illness:

ID: 1387984
Sex: M
Age: 36
State: NY

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

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

Lab Data:

Allergies:

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

Symptoms: Error: Wrong Dose of Vaccine - Too Low

Other Meds:

Current Illness:

ID: 1387985
Sex: F
Age: 23
State: MA

Vax Date: 06/04/2021
Onset Date: 06/08/2021
Rec V Date: 06/10/2021
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: Gluten; Pineapple; Ammoxicillin

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

Symptoms: Fever days past; migraines 3+ days post vaccination; hives/rash on back + front on neck, arms, and legs

Other Meds: LoLoestrin; Biotin; B6; B12; D3; Fiber; Zinc

Current Illness:

ID: 1387986
Sex: M
Age: 72
State:

Vax Date: 05/02/2021
Onset Date: 06/07/2021
Rec V Date: 06/10/2021
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:

Allergies:

Symptom List: Vomiting

Symptoms: Patient presented to the ED on 6/7/21 with abdominal pain that had started earlier that day. CT abdomen, CXR, and urinalysis were done and all came back negative. Patient denied any respiratory symptoms. On physical exam, he was found to have severe swelling, erythema, and ecchymosis on his left leg extending into the upper thigh and knee. A lower extremity doppler was done and found extensive occlusive thrombosis within the left lower extremity beginning in the external iliac vein and extending into the common femoral, femoral, profunda, popliteal and visualized deep calf veins. No evidence of PE or DVT in the RLE was found. Vascular Surgery was consulted, who did not recommend any procedures, but patient was started on a heparin drip. Hematology later saw the patient and changed the heparin drip to rivaroxaban on 6/9/21. Infectious Diseases was also consulted for possible sepsis.

Other Meds:

Current Illness:

ID: 1387987
Sex: M
Age: 32
State: PA

Vax Date: 05/01/2021
Onset Date: 05/01/2021
Rec V Date: 06/10/2021
Hospital:

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

Lab Data: None

Allergies: None

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Sore at injection spot after 1st shot for about 1 hour. Sore arm from elbow to shoulder from 5 hours after 2nd shot. Continued for about 24 hours. site of injection was red and size of a quarter.

Other Meds: None

Current Illness: None

ID: 1387988
Sex: F
Age: 30
State: OH

Vax Date: 06/09/2021
Onset Date: 06/09/2021
Rec V Date: 06/10/2021
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: Systemic: Chills-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Nausea-Medium, Systemic: Shakiness-Medium

Other Meds:

Current Illness:

ID: 1387989
Sex: M
Age: 42
State: GA

Vax Date: 06/03/2021
Onset Date: 06/03/2021
Rec V Date: 06/10/2021
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: Migraine, fever, chills, muscle pain, joint pain

Other Meds:

Current Illness:

ID: 1387990
Sex: M
Age: 15
State: MI

Vax Date: 04/03/2021
Onset Date: 04/02/2021
Rec V Date: 06/10/2021
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: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: 15 year old RECEIVED MODERNA BRAND VACCINE. IT WAS REALIZED WHEN HE CAME BACK FOR 2ND DOSE.

Other Meds:

Current Illness:

ID: 1387991
Sex: F
Age: 33
State: PA

Vax Date: 04/26/2021
Onset Date: 05/24/2021
Rec V Date: 06/10/2021
Hospital:

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

Lab Data:

Allergies: mild allergies to eggs and pollen

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

Symptoms: I started to have cold symptoms for about 2 h a day after the first shot. After the second shot I felt lethargic most of the time. At the end of May, when trees started to bloom, I started to have severe allergies to pollen (I had mild alleries before) with headaches. The allergy pills I used to take before(Zyrtec) were very effective. Now they make me feel drowsy and seems they have no effect. The allergies are so bad that as soon as I get out and walk thru grass or trees, my eye get blurry and ichy as does my noes.

Other Meds: none

Current Illness: none

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am