VAERS 2021 Database www.vaers.hhs.gov

Main Page | All 2021 Deaths | Videos
VAERS Updated: 10/01/2021
** VAERS DATABASE Last updated: October 1, 2021**
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Manufacturers

Total Manufacturer
187,133MODERNA
33,878JANSSEN
2,321PFIZER\BIONTECH
1,091GLAXOSMITHKLINE BIOLOGICALS
983UNKNOWN MANUFACTURER
363MERCK & CO. INC.
229SEQIRUS, INC.
45DYNAVAX TECHNOLOGIES CORPORATION
41NOVARTIS VACCINES AND DIAGNOSTICS
29SANOFI PASTEUR
18EMERGENT BIOSOLUTIONS
8PAXVAX
7TEVA PHARMACEUTICALS
4PFIZER\WYETH
3BERNA BIOTECH, LTD.
2SMITHKLINE BEECHAM
2INTERCELL AG
2PROTEIN SCIENCES CORPORATION
1CSL LIMITED

Incidents per State

State Total
77,548
AK1,869
AL5,581
AR3,688
AS47
AZ14,288
CA61,984
CO11,665
CT8,149
DC1,663
DE1,807
FL37,749
FM5
GA15,058
GU120
HI2,453
IA4,625
ID2,692
IL20,334
IN24,007
KS4,615
KY7,696
LA4,887
MA14,654
MD12,514
ME3,129
MH11
MI18,739
MN12,528
MO9,710
MP29
MS2,790
MT2,375
NC16,368
ND1,356
NE2,880
NH3,100
NJ17,634
NM3,916
NV4,239
NY34,355
OH19,081
OK6,195
OR8,636
PA23,083
PR2,370
QM2
RI2,088
SC6,411
SD1,212
TN9,131
TX35,174
UT4,273
VA14,937
VI64
VT1,676
WA14,909
WI11,259
WV2,388
WY861
XB5
XL1
XV2

ID: 1544676
Sex: F
Age: 35
State: GA

Vax Date: 05/20/2021
Onset Date: 06/01/2021
Rec V Date: 08/11/2021
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: N/A

Symptom List: Dysphagia, Epiglottitis

Symptoms: changes in menstrual cycle to include, but not limited to: -heavier flow -long duration of cycle -painful cramps

Other Meds: N/A

Current Illness: N/A

ID: 1544677
Sex: M
Age: 33
State: IN

Vax Date: 08/09/2021
Onset Date: 08/09/2021
Rec V Date: 08/11/2021
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: Possible Seratonin reaction

Symptom List: Anxiety, Dyspnoea

Symptoms: Fever of 102 F, chills, insomnia, excessive urination resolved by 24 hours after injection. Excessive urination treated by hydration with electrolytes. Moderate headache resolved around 36 hours after injection, treated with Ibuprofen at 24 hour mark.

Other Meds: None

Current Illness: None

ID: 1544678
Sex: F
Age: 14
State: NC

Vax Date: 08/08/2021
Onset Date: 08/08/2021
Rec V Date: 08/11/2021
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: Error: Incorrect Reconstitution-

Other Meds:

Current Illness:

ID: 1544679
Sex: M
Age: 69
State: KY

Vax Date: 03/02/2021
Onset Date: 07/26/2021
Rec V Date: 08/11/2021
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: Tested Positive for Covid

Other Meds:

Current Illness:

ID: 1544680
Sex: F
Age: 19
State: NC

Vax Date: 08/08/2021
Onset Date: 08/08/2021
Rec V Date: 08/11/2021
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: Error: Incorrect Reconstitution-

Other Meds:

Current Illness:

ID: 1544681
Sex: M
Age: 29
State: IN

Vax Date: 08/10/2021
Onset Date: 08/10/2021
Rec V Date: 08/11/2021
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: Morphine

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

Symptoms: Non severe allergic reaction rash on left ankle, dull chest pain, numbness of hands feet and top of head, joint pain in left knee (2011 arthroscopic release on left knee, healed and recovered), nausea, diarrhea, arm pain, very thick nasal mucus and coughing, all symptoms have happened within 24 hours of administered vaccine.

Other Meds: None

Current Illness: None

ID: 1544682
Sex: M
Age: 46
State: NY

Vax Date: 08/02/2021
Onset Date: 08/03/2021
Rec V Date: 08/11/2021
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: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Sever pain in arm. Next day aches, severe pain left side. Lymph node in armpit was bigger than a golf ball. The enlarged node lasted 4 days. Chills would not stop for 3 days.

Other Meds: Buproprion

Current Illness: None

ID: 1544683
Sex: F
Age: 73
State: KY

Vax Date: 02/12/2021
Onset Date: 08/04/2021
Rec V Date: 08/11/2021
Hospital:

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

Lab Data:

Allergies: Unknown

Symptom List: Pharyngeal swelling

Symptoms: As of date of Disease Investigation case still had ongoing symptoms with onset 8/4/21 and included Rigors, Muscle aches, runny nose, sore throat, fatigue, cough, nausea, ear pain and hot flashes

Other Meds: Unknown

Current Illness: Unknown

ID: 1544684
Sex: F
Age: 37
State: NC

Vax Date: 08/08/2021
Onset Date: 08/08/2021
Rec V Date: 08/11/2021
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: Incorrect Reconstitution-

Other Meds:

Current Illness:

ID: 1544685
Sex: F
Age: 70
State: CA

Vax Date: 08/10/2021
Onset Date: 08/10/2021
Rec V Date: 08/11/2021
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: Booster Given Too Late-

Other Meds:

Current Illness:

ID: 1544686
Sex: F
Age: 36
State: NC

Vax Date: 08/09/2021
Onset Date: 08/10/2021
Rec V Date: 08/11/2021
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 allergy - causes hives in genital area

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

Symptoms: Subjective and objective fever with temp up to 102. Chills. Localized skin reaction over injection site - 4 cm circle of erythema.

Other Meds: fluticasone nasal spray

Current Illness:

ID: 1544687
Sex: M
Age: 15
State: NC

Vax Date: 08/08/2021
Onset Date: 08/08/2021
Rec V Date: 08/11/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Error: Incorrect Reconstitution-

Other Meds:

Current Illness:

ID: 1544688
Sex: F
Age: 73
State: KY

Vax Date: 03/01/2021
Onset Date: 08/04/2021
Rec V Date: 08/11/2021
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: Tested Positive for Covid

Other Meds: Tested Positive for Covid

Current Illness:

ID: 1544689
Sex: F
Age: 39
State: IN

Vax Date: 08/01/2021
Onset Date: 08/10/2021
Rec V Date: 08/11/2021
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: Augmenton

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

Symptoms: Woke up day after shot feeling sick and woosey. Headache that continued to get worse all day. Felt kind of out of it. Light headed. Tired. I was hot so hot. Husband said I had fever and was a bit delusional but I don't remember for sure. I just know I felt awful. He wanted to take me to doctor or hospital but I declined and wanted to sleep it off. The next day I feel fine.

Other Meds: Suboxone

Current Illness: None

ID: 1544690
Sex: F
Age: 37
State: MI

Vax Date: 07/29/2021
Onset Date: 08/04/2021
Rec V Date: 08/11/2021
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: Nubaine and Tetracycline intolerance GI related

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

Symptoms: Developed SOB on 8/2/2021. COVID-19 testing negative. Was seen at urgent care on 8/4/21 for SOB and cough given albuterol inhaler and steroid, Presented to ED on 8/6/2021. She had wheezing on physical exam and an elevated D-dimer. She was diagnosed with pneumonitis and discharge home

Other Meds: Chlothalidone 25mg daily Allopurinol 300 mg daily potassium citrate

Current Illness: none

ID: 1544691
Sex: F
Age: 33
State: FL

Vax Date: 07/14/2021
Onset Date: 07/14/2021
Rec V Date: 08/11/2021
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: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-

Other Meds:

Current Illness:

ID: 1544692
Sex: M
Age: 16
State: NC

Vax Date: 08/08/2021
Onset Date: 08/08/2021
Rec V Date: 08/11/2021
Hospital:

Vax Type: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies:

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

Symptoms: Error: Incorrect Reconstitution-

Other Meds:

Current Illness:

ID: 1544693
Sex: M
Age: 19
State: CA

Vax Date: 08/08/2021
Onset Date: 08/08/2021
Rec V Date: 08/11/2021
Hospital:

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

Lab Data:

Allergies: Patient denied allergies

Symptom List: Ear pain, Hypoaesthesia

Symptoms: 14:27: Pt in chair flagged RN over. Reported feeling extremely nauseated. pale and sweating, thready pulse present . BP 140/78, HR 120. A+O x3 Upon questioning Pt mentioned that he did not eat today. 14:30 Water was provided and fruit gummies (15g sugar) . Patient presented 2 projectile emesis. 14:30 EMS was called. Patient wanted to leave home, but team was able to ask him to seat on the floor. 14:38 blood sugar =96 per medics after 15g of sugar. 14:45 Pt did not want to get checked at hospital. EMS left Observed patient for 15 more minutes. 15:00 Pt left facility accompanied by uncle stable and oriented. Called pt by phone to check on him and mentioned feeling OK

Other Meds: Patient denied any meds

Current Illness: patient denied any illness

ID: 1544694
Sex: M
Age: 73
State: KY

Vax Date: 02/11/2021
Onset Date: 08/07/2021
Rec V Date: 08/11/2021
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: Tested Positive for Covid

Other Meds:

Current Illness:

ID: 1544695
Sex: M
Age: 46
State: IL

Vax Date: 08/10/2021
Onset Date: 08/10/2021
Rec V Date: 08/11/2021
Hospital:

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

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1544848
Sex: F
Age: 21
State: TX

Vax Date: 08/05/2021
Onset Date: 08/10/2021
Rec V Date: 08/11/2021
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: none

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

Symptoms: mild right sided Bells Palsy

Other Meds: none

Current Illness: none

ID: 1544849
Sex: M
Age: 12
State: NC

Vax Date: 08/08/2021
Onset Date: 08/08/2021
Rec V Date: 08/11/2021
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: Error: Incorrect Reconstitution-

Other Meds:

Current Illness:

ID: 1544850
Sex: M
Age: 72
State: CA

Vax Date: 02/25/2021
Onset Date: 02/26/2021
Rec V Date: 08/11/2021
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: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: After getting first vaccination I felt pressure in my head. The clinic tested me and I had experienced a stroke but the clinic was not sure when the stroke occurred. This month I have been to the emergency room twice with atrial Fibrillation. My cardiologist is recommending heart surgery.

Other Meds: Amlodipine

Current Illness: High blood Pressure

ID: 1544851
Sex: F
Age: 19
State: GA

Vax Date: 08/09/2021
Onset Date: 08/11/2021
Rec V Date: 08/11/2021
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: None

Symptom List: Injection site pain, Pain

Symptoms: A couple hours after the second dose I felt chest pain and heart palpitations, which were slightly mitigated over time after taking ibuprofen. (I also had chest pain and palpitations after the first dose, which lasted over a week before lessening--I did not take ibuprofen after the first dose.) Early today I noticed pain and tenderness on the left side of my neck around a swollen lump--I'm guessing it is a swollen lymph node. My left armpit also feels tender, especially when I move it.

Other Meds: None

Current Illness:

ID: 1544852
Sex: M
Age: 17
State: NC

Vax Date: 08/08/2021
Onset Date: 08/08/2021
Rec V Date: 08/11/2021
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: Incorrect Reconstitution-

Other Meds:

Current Illness:

ID: 1544854
Sex: F
Age: 13
State: OK

Vax Date: 08/08/2021
Onset Date: 08/08/2021
Rec V Date: 08/11/2021
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: Error: Incorrect Reconstitution-

Other Meds:

Current Illness:

ID: 1544855
Sex: F
Age: 53
State: VA

Vax Date: 07/30/2021
Onset Date: 08/01/2021
Rec V Date: 08/11/2021
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: Latex (rash), Vicodin (hives), Tysabri (anemia), Copaxone (unknown), flu vaccine (reports anaphylaxis)

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: MS relapse (fatigue, vision problems, intractable headache). Prolonged redness and soreness at site of injection (>2 wk out).

Other Meds: ergocalciferol 50,000 IU daily; levothyroxine 125 mcg daily; topiramate 50 mg twice daily; Allegra 180 mg daily; nortriptyline 50 mg at night; Excedrin Migraine as needed; Tylenol 500 mg as needed

Current Illness: None

ID: 1544856
Sex: M
Age: 20
State: TX

Vax Date: 08/10/2021
Onset Date: 08/10/2021
Rec V Date: 08/11/2021
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: Systemic: Seizure-Severe, Systemic: Shakiness-Severe, Additional Details: patient had severe seizure few minutes after vaccine which lasted for about a minute and was bleeeding from the mouth. mucus also were coming out from the mouth . no breathing problems, called and EMS came and took him to the hospital

Other Meds:

Current Illness:

ID: 1544857
Sex: F
Age: 15
State: PA

Vax Date: 08/06/2021
Onset Date: 08/08/2021
Rec V Date: 08/11/2021
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: none

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

Symptoms: Administered vaccine to 15 year old unknowingly, patient reported passing out two days following the vaccination. Patient got the vaccine on Friday and reports loss of hearing and vision blacking out the Sunday after getting the vaccine. After questioning, the patient said she had very little to eat the day before passing out and nothing the day she passed out. After drinking a soda, her blood sugar was found to be 100 so EMT assumed she passed out due to low blood sugar unrelated to vaccination. No other further adverse events/symptoms

Other Meds:

Current Illness:

ID: 1544858
Sex: M
Age: 69
State: IN

Vax Date: 07/29/2021
Onset Date: 07/30/2021
Rec V Date: 08/11/2021
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: Extreme fatigue the day after shot, slept most of the day.. Felt like shingles was starting (had shingles before). Rash over both arms, both legs, right side of torso (different from shingles that had had previously) with a lot of itching. Started as individual red spots on skin, went to red bumps, then a larger rash. Still has it on 8/11/21, hasn't improved yet. Using Benadryl for itching.

Other Meds:

Current Illness:

ID: 1544859
Sex: F
Age: 50
State: IA

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 08/11/2021
Hospital:

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

Lab Data:

Allergies: Clindamyacin

Symptom List: Injection site pain

Symptoms: Within 15 minutes of receiving the Moderna vaccine, my lips started to tingle but no swelling occurred. Within the hour, the middle of my right shoulder (near my clavicle) up the side of my neck became very tight. The left side of my face, from the top of my cheek bone down to the corner of my lip, had a numb sensation with a feeling of electrical impulses going through it. I alerted the County Health nurse on site who gave me the vaccine and she called her office and I called my regular physician. I was told to take Benadryl. The tingling in the lips went away, but I have experienced the same numbness/electrical impulse sensation on the left side of my face everyday since receiving the vaccine. I reached out to the local Public Health last week and they advised me to contact my regular physician to let him know and to fill out the VAERS form.

Other Meds: None

Current Illness: None

ID: 1544860
Sex: M
Age: 21
State: AL

Vax Date: 08/10/2021
Onset Date: 08/10/2021
Rec V Date: 08/11/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Additional Details: Patient fainted approximately 5 minutes after vaccination and was unresponsive for approximately 10-15 seconds. EMTs were called and continued care. Patient was alert and oriented when taken by EMTs.

Other Meds:

Current Illness:

ID: 1544861
Sex: F
Age: 20
State:

Vax Date: 04/11/2021
Onset Date: 04/12/2021
Rec V Date: 08/11/2021
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: headache and fever persisted for 4 days after vaccination. NSAIDs helped some but still had symptoms

Other Meds: lexapro, tri-previfem, spironolactone

Current Illness:

ID: 1544862
Sex: F
Age: 86
State: MI

Vax Date: 05/25/2021
Onset Date: 08/10/2021
Rec V Date: 08/11/2021
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:

Allergies:

Symptom List: Tremor

Symptoms: suspect COVID vaccine breakthrough

Other Meds:

Current Illness:

ID: 1544863
Sex: M
Age: 41
State: KY

Vax Date: 01/13/2021
Onset Date: 07/23/2021
Rec V Date: 08/11/2021
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: Unknown

Symptom List: Erythema, Pruritus

Symptoms: As of Disease Investigation date 7/27/21 Case reported onset of symptoms as 7/23/21 which included runny nose, muscle aches, headache, sore throat, loss of smell and fatigue.

Other Meds: Unknown

Current Illness: Unknown

ID: 1544864
Sex: M
Age: 36
State: CA

Vax Date: 08/01/2021
Onset Date: 08/01/2021
Rec V Date: 08/11/2021
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: Error: Shoulder Joint Injury (prolonged pain, tingling, etc.)-

Other Meds:

Current Illness:

ID: 1544865
Sex: F
Age: 15
State: NV

Vax Date: 04/25/2021
Onset Date: 04/25/2021
Rec V Date: 08/11/2021
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: Patient Too Young for Vaccine Administered-

Other Meds:

Current Illness:

ID: 1544866
Sex: M
Age: 38
State: OK

Vax Date: 08/10/2021
Onset Date: 08/10/2021
Rec V Date: 08/11/2021
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: Asthenia, Chills, Headache, Myalgia

Symptoms: Systemic: Fainting / Unresponsive-Medium, Additional Details: patient passed out from getting shot. he stated he always does due to anxiety with needles. he was up and feeling fine after a couple of minutes

Other Meds:

Current Illness:

ID: 1544867
Sex: M
Age: 72
State: MI

Vax Date: 03/25/2021
Onset Date: 08/09/2021
Rec V Date: 08/11/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Suspect COVID vaccine breakthrough case

Other Meds:

Current Illness:

ID: 1544868
Sex: F
Age: 54
State: KY

Vax Date: 02/01/2021
Onset Date: 08/02/2021
Rec V Date: 08/11/2021
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: Tested Positive for Covid

Other Meds:

Current Illness:

ID: 1544869
Sex: M
Age: 56
State: KY

Vax Date: 07/24/2021
Onset Date: 07/30/2021
Rec V Date: 08/11/2021
Hospital:

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

Lab Data:

Allergies: Unknown

Symptom List: Pain in extremity

Symptoms: As of disease investigation date of 8/2/21 case reported onset of symptoms as 7/30/21 which included fever, muscle aches, runny nose, new olfactory disorders, fatigue, cough, wheezing, shortness of breath, abdominal pain and diarrhea.

Other Meds: Unknown

Current Illness: Unknown

ID: 1544870
Sex: F
Age: 64
State: IN

Vax Date: 07/08/2021
Onset Date: 07/08/2021
Rec V Date: 08/11/2021
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: Headache for several hours. Increased joint/muscle pain. Left arm started locking down (like a frozen shoulder - have had a frozen shoulder before), couldn't raise more than 90 degrees (went away after 2 days). Slight pain at injection site (only when touched). Fatigue for a couple of days.

Other Meds:

Current Illness:

ID: 1544871
Sex: M
Age: 54
State: NC

Vax Date: 08/08/2021
Onset Date: 08/08/2021
Rec V Date: 08/11/2021
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: Incorrect Reconstitution-

Other Meds:

Current Illness:

ID: 1544872
Sex: F
Age: 51
State: GA

Vax Date: 07/09/2021
Onset Date: 07/09/2021
Rec V Date: 08/11/2021
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: Site: Swelling at Injection Site-Severe, Systemic: Body Aches Generalized-Severe

Other Meds:

Current Illness:

ID: 1544873
Sex: M
Age: 15
State: CA

Vax Date: 08/07/2021
Onset Date: 08/07/2021
Rec V Date: 08/11/2021
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: mom and pt denied

Symptom List: Vomiting

Symptoms: Pt received dose No.1 Pfizer vaccine at 9:10 in left arm. Stood up immediately after injection, felt dizzy then stepped back and either tripped off or fainted and fell on left side. Did not lose consciousness, sat up then moved to chair. 9:15 am BP checked after fall 138/78. Water was offered. 15 mins check Pt is sitting up, denies dizziness, no nausea 30 mins check Pt sitting up denies dizzines, nausesa "feels fine" Walked to car with mom Mother admitted patient has previously fainted with previous vaccinations. Mother did not disclose this prior to vaccine administration nor during registration

Other Meds: mom and pt denied

Current Illness: N/A

ID: 1544874
Sex: F
Age: 27
State: KY

Vax Date: 03/31/2021
Onset Date: 08/06/2021
Rec V Date: 08/11/2021
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: Tested Positive for Covid

Other Meds:

Current Illness:

ID: 1544875
Sex: M
Age: 61
State: MI

Vax Date: 01/18/2021
Onset Date: 08/10/2021
Rec V Date: 08/11/2021
Hospital: Y

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: Suspect COVID vaccine breakthrough case Pfizer dose 1 on 1/18/21 and dose 2 on 2/8/21

Other Meds:

Current Illness:

ID: 1544876
Sex: M
Age: 12
State: MD

Vax Date: 08/08/2021
Onset Date: 08/09/2021
Rec V Date: 08/11/2021
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: No

Symptom List: Injection site swelling, Limb discomfort

Symptoms: After first dose, only pain at injection site, mild headache. After second dose, severe headache that lasted 48 hours, body aches during first 24 hours. Treated with 100mg Motrin every 8 hours.

Other Meds: No

Current Illness: Ear infections at the beginning of July. Completed antibiotics 7/16/21.

ID: 1544877
Sex: F
Age: 31
State: KY

Vax Date: 07/25/2021
Onset Date: 07/30/2021
Rec V Date: 08/11/2021
Hospital:

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

Lab Data:

Allergies: Unknown

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

Symptoms: As of disease investigation date of 8/3/21 case reported onset of symptoms on 7/30/21 which included Fever, subjective fever, chills, muscle aches, runny nose, sore throat, fatigue, cough and nausea

Other Meds: Unknown

Current Illness: Unknown

ID: 1544878
Sex: F
Age: 41
State: PA

Vax Date: 05/06/2021
Onset Date: 05/19/2021
Rec V Date: 08/11/2021
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: None

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

Symptoms: Very heavy period with cramps and clots. This is not normal. This happened 2 cycles in a row. Third cycle had less cramps but was heavy and with clots.

Other Meds: None

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm