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: 1459465
Sex: F
Age: 63
State: CT

Vax Date: 03/15/2021
Onset Date: 03/30/2021
Rec V Date: 07/09/2021
Hospital:

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

Lab Data: I have had all kinds of blood work EKGs and I measure my blood pressure every day. I have seen a cardiologist, a nephrologist, and an endocrinologist.

Allergies: Amoxicillin

Symptom List: Dysphagia, Epiglottitis

Symptoms: Two weeks after the vaccine I had a sudden and extreme elevation in blood pressure. My blood pressure is always been perfect. It has come down but it is Taken 2 or 3 months for it to come down.

Other Meds: Vitamins and minerals

Current Illness: No

ID: 1459466
Sex: F
Age: 16
State: CA

Vax Date: 03/31/2021
Onset Date: 03/31/2021
Rec V Date: 07/09/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Error: Patient Too Young for Vaccine Administered-

Other Meds:

Current Illness:

ID: 1459467
Sex: M
Age: 32
State: MN

Vax Date: 04/29/2021
Onset Date: 05/16/2021
Rec V Date: 07/09/2021
Hospital: Y

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: ED/Hospitalization within 6 weeks of receiving COVID vaccination.

Other Meds:

Current Illness:

ID: 1459468
Sex: F
Age: 17
State: AZ

Vax Date: 06/21/2021
Onset Date: 06/21/2021
Rec V Date: 07/09/2021
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: Error: Patient Too Young for Vaccine Administered-

Other Meds:

Current Illness:

ID: 1459469
Sex: M
Age: 50
State: FL

Vax Date: 02/17/2021
Onset Date: 02/18/2021
Rec V Date: 07/09/2021
Hospital:

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

Lab Data: Tilt table test, EKG, halter heart monitor.

Allergies: Penicillin

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

Symptoms: Vasovagyl Syncope

Other Meds: Day meds Fluoxetine 40mg Donepezil 10mg Armodafinil 125 mg Pyridoxine B6 50mg Cyanocobalamin B12 1000mg Vitamin D3 2000 IU Folic Acid 1mg Milk thistle Fludrocortisone .1mg 2x daily Night meds Prazosin 2mg Clonezapam 3 mg Melatonin 10mg B

Current Illness:

ID: 1459470
Sex: M
Age: 23
State: AR

Vax Date: 07/08/2021
Onset Date: 07/08/2021
Rec V Date: 07/09/2021
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: None

Allergies:

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

Symptoms: None

Other Meds:

Current Illness:

ID: 1459471
Sex: M
Age: 62
State: MA

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 07/09/2021
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: penicillan, oxycontin, seafood

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: got second shot in left arm. To this day in a lot of pain. Cannot even lift half gallon of milk.

Other Meds: lisinopril, nifedeprine, excedrin migraine

Current Illness:

ID: 1459472
Sex: M
Age: 39
State: NE

Vax Date: 07/05/2021
Onset Date: 07/05/2021
Rec V Date: 07/09/2021
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: Swelling at Injection Site-Medium, Systemic: Abdominal Pain-Mild, Systemic: Body Aches Generalized-Mild, Systemic: Chills-Mild, Systemic: Fever-Mild, Systemic: Headache-Mild, Systemic: Joint Pain-Mild, Systemic: Nausea-Medium, Systemic: Tingling (specify: facial area, extemities)-Mild, Systemic: Weakness-Mild

Other Meds:

Current Illness:

ID: 1459473
Sex: M
Age: 14
State: NY

Vax Date: 03/29/2021
Onset Date: 03/29/2021
Rec V Date: 07/09/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Error: Patient Too Young for Vaccine Administered-

Other Meds:

Current Illness:

ID: 1459474
Sex: M
Age: 49
State: VA

Vax Date: 07/03/2021
Onset Date: 07/07/2021
Rec V Date: 07/09/2021
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: None

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Developed rash on the tops of both feet. Small blisters, painful. Treating with calamine lotion and foot powder. So far the rash appears to be clearing on it's own.

Other Meds: Allopurinol, Men's One a Day, Prilosec, Lisinopril

Current Illness: None

ID: 1459475
Sex: F
Age: 30
State:

Vax Date: 03/02/2021
Onset Date: 03/02/2021
Rec V Date: 07/09/2021
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: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: ED visits/Hospitalization within 6 weeks of receiving COVID vaccination. Admission 3/14, presently admitted. Second dose received 6/4.

Other Meds:

Current Illness:

ID: 1459476
Sex: M
Age: 30
State:

Vax Date: 06/28/2021
Onset Date: 06/29/2021
Rec V Date: 07/09/2021
Hospital:

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

Lab Data: N/a hoping this goes away

Allergies: None

Symptom List: Rash, Urticaria

Symptoms: Shortness of breath couldn?t breath, heart stressed. Symptoms have gotten better after one week, but still slightly present ten days after second dose.

Other Meds: None

Current Illness: None

ID: 1459477
Sex: F
Age: 36
State: CA

Vax Date: 07/08/2021
Onset Date: 07/08/2021
Rec V Date: 07/09/2021
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: Systemic: Dizziness / Lightheadness-Mild, Systemic: pt experienced dizziness and lost of hearing - husband administered epipen-Mild, Additional Details: immediately after the vaccine was administered, pt experienced dizziness and loss of hearing. husband administered pt 1 epipen and pt started to feel better. paramedics were called to the scene. they evaluated pt and vitals were wnl, breathing was wnl. pt was taken to er by ambulance. pt was conscious the entire time.

Other Meds:

Current Illness:

Date Died: 06/14/2021

ID: 1459478
Sex: F
Age: 88
State:

Vax Date: 01/16/2021
Onset Date: 06/14/2021
Rec V Date: 07/09/2021
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: Positive COVID-19 test on 06/08/2021

Allergies: Unknown

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

Symptoms: Died of COVID-19 illness on 06/14/2021 Immediate Cause of Death: Acute respiratory distress syndrome with respiratory failure Due To or as a Consequence Of: COVID-19 infection Interval between Onset & Death: 4 days COD listed as ACUTE RESPIRATORY DISTRESS SYNDROME WITH RESPIRATORY FAILURE INTERVAL BETWEEN ONSET & DEATH and COVID-19 INFECTION INTERVAL BETWEEN ONSET & DEATH

Other Meds: Unknown

Current Illness: Unknown

ID: 1459479
Sex: M
Age: 17
State: NY

Vax Date: 07/08/2021
Onset Date: 07/08/2021
Rec V Date: 07/09/2021
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: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Nausea-Medium, Systemic: Shakiness-Mild, Systemic: Tingling (specify: facial area, extemities)-Medium, Systemic: Weakness-Medium, Additional Details: After recieving the pfizer covid-19 vaccine, Patient briefly passed out while sitting down less than 5 minutes after the vaccine. Subsequently his mother screamed out for help, I ran over took his pulse, which was present but slightly faint, and almost used the epipen but he came back to consciousness before it was injected. Upon inital observation when I came over the patient was very pale and sweaty. We called 911 and shortly thereafter the medics took him to emergency room.

Other Meds:

Current Illness:

ID: 1459480
Sex: M
Age: 46
State: CA

Vax Date: 07/07/2021
Onset Date: 07/07/2021
Rec V Date: 07/09/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1459481
Sex: F
Age: 29
State: MN

Vax Date: 04/28/2021
Onset Date: 06/01/2021
Rec V Date: 07/09/2021
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:

Allergies:

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

Symptoms: Hospitalization within 6 weeks of receiving COVID vaccination.

Other Meds:

Current Illness:

ID: 1459482
Sex: F
Age: 47
State: SC

Vax Date: 07/07/2021
Onset Date: 07/08/2021
Rec V Date: 07/09/2021
Hospital:

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

Lab Data: None

Allergies: Sulfur, dye, plastic, toradol, nsaids,

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Large lump on left arm in less than 12 hours after injection, hurt to breathe, Pain everywhere, lot of pain in sides of waist and around to the back, pain in chest

Other Meds: Antibiotic, vitamins, sertraline, lamitrogine, linzess, trazadone, diazepam

Current Illness: Ear infection, blood clot disorder

ID: 1459483
Sex: M
Age: 17
State: TX

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 07/09/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Error: Patient Too Young for Vaccine Administered-

Other Meds:

Current Illness:

ID: 1459484
Sex: F
Age: 36
State: WI

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

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

Lab Data: Normal urine blood work on 7/7/21 Negative COVID 19 test on 7/7/21

Allergies: Reaction to cephflexin and Compazine

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

Symptoms: Injection site pain Fever Nausea Diarrhea Body aches Mild asthma symptoms

Other Meds: Propranolol Singular Zyrtec

Current Illness: Runny nose

ID: 1459485
Sex: F
Age: 19
State: FL

Vax Date: 07/06/2021
Onset Date: 07/06/2021
Rec V Date: 07/09/2021
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: Systemic: Confusion-Mild, Systemic: Fainting / Unresponsive-Severe, Systemic: Seizure-Mild

Other Meds:

Current Illness:

ID: 1459486
Sex: M
Age: 78
State: NY

Vax Date: 03/26/2021
Onset Date: 06/11/2021
Rec V Date: 07/09/2021
Hospital: Y

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

Lab Data: 6/15/21 Clinical History: PLEURAL EFFUSION, NOS SPECIMEN: PLEURAL FLUID FINAL INTERPRETATION: SUSPICIOUS FOR ADENOCARCINOMA. Scant atypical cells are noted on the cytology and cell block. Immunohistochemical stains demonstrate that the atypical cells are positive for CK7 and BerEp4, while negative for CDX-2, calretinin, TTF-1, and CK20. CT chest: 6/21/21 IMPRESSION: Significant airspace disease involving the right lower lobe diffusely and partially involving the right middle lobe. Underlying COPD. Small right pleural effusion CEA 14.5

Allergies: Ether, pollen

Symptom List: Unevaluable event

Symptoms: Patient is a 78-year-old white male who was vaccinated with Pfizer Covid 19 vaccines on 3/5 and 3/26/21 with a known history of chronic respiratory failure and COPD secondary to a work related injury that occurred in the 1980s followed by a compensation/pulmonary physician as well as obesity and diastolic chf, hx atrial fib, who presented to the emergency room on 6/26/21 with a chief complaint of shortness of breath with copious amounts of thick yellowish secretions. Patient was recently admitted and discharged at hospital on 6/11 for pneumonia and a pleural effusion. It was determined during that admission that he had malignant cells in the fluid consistent with adenocarcinoma and chose to not work this up any further and foregone any treatment. He returned back to the hospital with continued shortness of breath, weakness and poor p.o. intake despite using the nebulizer at home. There was no fever no hemoptysis chest pain or pleuritic pain. Imaging again reveals significant airspace disease involving the right lower lobe diffusely and partially involving the right middle lobe on CAT scan with a small right pleural effusion seen. He had a CT of the abdomen and pelvis which was negative for any malignant spread. Patient was also seen by oncology who discussed further work-up, prognosis with the patient and felt that overall he was too ill to pursue any further work-up or treatment at this time and recommended hospice/palliative care. He was discharged home on hospice care with a terminal prognosis on 7/1/21

Other Meds: Eliquis, cardizem, torsemide

Current Illness: hospitalized at another hospital on 6/11/21 for pneumonia/r sided parapneumonic pleural effusion s/p thorocentesis. cytology positive for adenocardinoma.

ID: 1459487
Sex: M
Age: 20
State: CA

Vax Date: 07/07/2021
Onset Date: 07/07/2021
Rec V Date: 07/09/2021
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: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1459488
Sex: M
Age: 12
State: IN

Vax Date: 07/08/2021
Onset Date: 07/09/2021
Rec V Date: 07/09/2021
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: Incorrect dose of COVID vaccine administered

Other Meds:

Current Illness:

ID: 1459489
Sex: F
Age: 15
State: CA

Vax Date: 07/07/2021
Onset Date: 07/07/2021
Rec V Date: 07/09/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1459642
Sex: F
Age: 62
State: IN

Vax Date: 03/18/2021
Onset Date: 05/20/2021
Rec V Date: 07/09/2021
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: blood draw on 5-20-21 platelets 12,000 multiple blood draws platelets as low as 7,000 blood draws ongoing weekly stool sample 6-30-21 negative for h pylori

Allergies: moraphine tylenol with codeine

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

Symptoms: severe fatigue, fever chills within 24 hrs lasting 2 days after second dose fatigue, bruises, petechiae after second vaccine diagnosed with ITP on 5-20-21

Other Meds: Synthroid 125 mg Vitamin D3 5000 BTU Amlodipine 2.5 mg hydrochlorothiazide

Current Illness: none

ID: 1459643
Sex: F
Age: 31
State: CA

Vax Date: 07/07/2021
Onset Date: 07/07/2021
Rec V Date: 07/09/2021
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: 1459644
Sex: F
Age: 17
State: CA

Vax Date: 07/07/2021
Onset Date: 07/07/2021
Rec V Date: 07/09/2021
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: 1459645
Sex: M
Age: 59
State: NC

Vax Date: 03/17/2021
Onset Date: 03/18/2021
Rec V Date: 07/09/2021
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: none Doctor prescribed steroid cream. After several weeks doctor prescribed anti fungal oral medication and cream.

Allergies: Codeine

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

Symptoms: Blisters and severe rash on arms and legs, itchy, red and white. After second dose, rash spread to chest and under arms.

Other Meds: Lisinopril, Atorvastatin Calcium, Fish Oil, Lethicin, Vitamin D, Zinc, Potassium, Magnesium, Tumeric

Current Illness: None

ID: 1459646
Sex: M
Age: 14
State: NY

Vax Date: 05/03/2021
Onset Date: 05/03/2021
Rec V Date: 07/09/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: Error: Patient Too Young for Vaccine Administered-

Other Meds:

Current Illness:

ID: 1459647
Sex: M
Age: 58
State: NY

Vax Date: 01/25/2021
Onset Date: 01/25/2021
Rec V Date: 07/09/2021
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: Injection site soreness persists six months after vaccine.

Other Meds:

Current Illness:

ID: 1459648
Sex: F
Age:
State: NY

Vax Date: 07/02/2021
Onset Date: 07/09/2021
Rec V Date: 07/09/2021
Hospital:

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

Lab Data: WBC 15.0 ALT 55 AST 123 NA low at 113, felt to be related to HCTZ use

Allergies: NKDA

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

Symptoms: Admitted from ED on 7/8/21 with c/o nausea, diarrhea, body aches, headache, SOB, malaise, diffuse muscle cramps. Headache on L side worsening. Also c/o heartburn

Other Meds: Metoprolol lisinopril-HCTZ

Current Illness: None identified

ID: 1459649
Sex: M
Age: 47
State: WY

Vax Date: 05/01/2021
Onset Date: 05/08/2021
Rec V Date: 07/09/2021
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: Benadryl

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

Symptoms: Mild tinnitus has become much more severe with occasional earaches. Still ongoing 2 months after first vaccine.

Other Meds: None

Current Illness: None

ID: 1459650
Sex: M
Age: 12
State: IN

Vax Date: 07/08/2021
Onset Date: 07/08/2021
Rec V Date: 07/09/2021
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: Incorrect dose of Covid-19 vaccine administered

Other Meds:

Current Illness:

ID: 1459651
Sex: F
Age: 17
State: CA

Vax Date: 07/07/2021
Onset Date: 07/07/2021
Rec V Date: 07/09/2021
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: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1459652
Sex: F
Age: 33
State: NY

Vax Date: 07/08/2021
Onset Date: 07/08/2021
Rec V Date: 07/09/2021
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: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild

Other Meds:

Current Illness:

ID: 1459653
Sex: F
Age: 30
State: CA

Vax Date: 07/07/2021
Onset Date: 07/07/2021
Rec V Date: 07/09/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1459654
Sex: F
Age: 44
State: WA

Vax Date: 04/19/2021
Onset Date: 04/19/2021
Rec V Date: 07/09/2021
Hospital:

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

Lab Data: Blood pressure and pulse taken at home and at doctor?s office.

Allergies: Alcohol (consumed or inhaled vapor), Biaxin, morphine, NSAIDS.

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Initially, some dizziness, racing heart and shortness of breath within half an hour of shot. We thought it could be because of my alcohol sensitivity, which causes similar feelings when inhaled. Nurses said I could try getting fresh air. I stood outside for 15 minutes and started to feel better, except for the racing heart beat. I went home. A few hours later, the racing heart beat came back and was worse. I had mild chest pain, an itching arm and was sweating. I called a help line and was told that can happen sometimes and that it was okay to take Tylenol now, so I did. The next day my heart was racing worse. I used a blood pressure cuff and checked my pulse rate. My BP was 181/90, which is high for me, especially on the linsopril. My pulse rate was 101 BPM. I also developed a fever and a painful and itchy rash on my arm. When I called the advice line they said that was still within non-emergency range. It went on like this for two weeks. When I saw a doctor for something else, I mentioned all of it and they said I may be allergic to the shot. I was given prednisone for symptoms related to Lupus and my swollen arm. I was told I could get the second shot a f little later than originally planned. However, even with prednisone and a pulse rate back down to 88 (high for me), I continue to have chest pains off and on. The swollen arm with a weird rash lasted for 5 weeks. I have to have a scan with contrast dye to monitor my brain tumor and insurance won?t approve them doing both at once, so still trying to schedule a look at my heart.

Other Meds: Lisinoprril, multi vitamins, Gabapentin.

Current Illness: Lupus, brain tumor.

ID: 1459655
Sex: M
Age: 17
State: NY

Vax Date: 07/08/2021
Onset Date: 07/08/2021
Rec V Date: 07/09/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Systemic: Dizziness / Lightheadness-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Shakiness-Medium, Systemic: Weakness-Medium

Other Meds:

Current Illness:

ID: 1459656
Sex: M
Age: 30
State: CA

Vax Date: 07/07/2021
Onset Date: 07/07/2021
Rec V Date: 07/09/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1459657
Sex: F
Age: 14
State: IN

Vax Date: 07/08/2021
Onset Date: 07/08/2021
Rec V Date: 07/09/2021
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: After vaccination, patient stood up and walked around the room. She started bouncing and acting a little nervous. I asked if she was feeling light headed woozy, she said a little bit. I sat her back in the chair. After about 30 seconds she fell sideways to the arm of the chair then slouched forward. I caught her before she went all the way to the floor and leaned her back into the chair, she then seized for approximately 3-5 seconds. Grandpa (legal guardian) was in the room and helped me get her to the floor where she came out for a few seconds and opened her eyes for 5-10 seconds passed out again then seized again for 3-5 seconds. She then woke up on the floor and was alert and looking around. She was very pale, I elevated her feet for a while and had her lay on the floor for 7-10 minutes. I then had her sit up on the floor and provided a bottle of water and put cold compress on the back of her neck. She stayed seated on the floor for about 5-7 minutes before I had her move to the chair to sit again with back against the back of the chair. She continued to sit there sipping water and talking for 7 minutes or so. Learned at this point that patient had not eaten breakfast and has passed out after a vaccination in the past (had not marked on the intake form). After 7 minutes or so, had the patient try to stand. She said her legs were wobbly, so I had her sit back down for several more minutes. Her coloring was much better at this point. After another several minutes we tried standing again and she felt better at that point. Had her just stand in the room for about 3 minutes before walking to the waiting room. Had her then sit in the waiting room for 5 minutes then she walked out with grandpa. They were going to get breakfast. Grandpa was going to call MD to discuss the events and follow up as necessary as well as to discuss plan going forward concerning the second dose.

Other Meds: unknown

Current Illness: none known

ID: 1459658
Sex: M
Age: 42
State: CA

Vax Date: 07/03/2021
Onset Date: 07/05/2021
Rec V Date: 07/09/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Site: Pain at Injection Site-Mild, Site: Swelling at Injection Site-Medium, Systemic: Chest Tightness / Heaviness / Pain-Mild, Systemic: Shakiness-Mild, Systemic: Tachycardia-Mild, Additional Details: patient describes shakiness, anxiety, swelling under and around arm, and pain. Reports taking 600 mg ibuprofen on tues and wed (600 mg po bid on Tues and Wed) "went away a bit and came back a little bit"

Other Meds:

Current Illness:

ID: 1459659
Sex: M
Age: 15
State: IN

Vax Date: 07/08/2021
Onset Date: 07/08/2021
Rec V Date: 07/09/2021
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: Incorrect dose of Covid-19 dose administered

Other Meds:

Current Illness:

ID: 1459660
Sex: M
Age: 17
State: IN

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 07/09/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Error: Patient Too Young for Vaccine Administered-

Other Meds:

Current Illness:

ID: 1459661
Sex: F
Age: 45
State: CA

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

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

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1459663
Sex: M
Age: 17
State: MA

Vax Date: 04/12/2021
Onset Date: 04/12/2021
Rec V Date: 07/09/2021
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: Error: Patient Too Young for Vaccine Administered-

Other Meds:

Current Illness:

ID: 1459664
Sex: F
Age: 14
State: MD

Vax Date: 07/08/2021
Onset Date: 07/08/2021
Rec V Date: 07/09/2021
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: EXPIRED VACCINES GIVEN 6/8/2021

Allergies: N/A

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

Symptoms: I received a call from the a representative at the Pharmacy stating that the had given an EXPIRED Vaccine to my daughter. He wanted us to come back into the store and get another shot. I was so unset. I need minute to get my self together. He went on to say that i could bring her back in 6/8/2021 the same day of the expired vaccine was given. However, he would recommend that I give it a day or two before bringing her back in. Also, while on the call he did apologize and said that the best thing he could is offer me a GIFT CARD!!. I felt to say that to a parent who?s daughter was just given an expired vaccines was totally unprofessional and insulting.

Other Meds: N/A

Current Illness: N/A

ID: 1459665
Sex: M
Age: 53
State: CA

Vax Date: 07/06/2021
Onset Date: 07/06/2021
Rec V Date: 07/09/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1459666
Sex: F
Age: 51
State: NC

Vax Date: 01/06/2021
Onset Date: 01/20/2021
Rec V Date: 07/09/2021
Hospital:

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

Lab Data: N/a.

Allergies: N/a

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

Symptoms: I had abdominal pain and diarrhea about two weeks post vaccination. The abdominal pain lasted maybe three days or so. The diarrhea lasted about 3-4 days as well actually. I was also a little fatigued, and that's all I can remember right now. I was self-medicating and did leave work one of the days, I went home sick. I still occasionally have abdominal pain. I contacted the doctor but received no medications or care.

Other Meds: Medication for diarrhea (unknown name); Vitamin D; Synthroid Thyroxine; Ferrous Sulfate Iron supplement; Amitriptyline

Current Illness: N/a

ID: 1459667
Sex: F
Age: 22
State: CA

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

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am