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: 1545243
Sex: F
Age: 15
State: NY

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

Symptom List: Dysphagia, Epiglottitis

Symptoms: Error: Patient Too Young for Vaccine Administered-

Other Meds:

Current Illness:

ID: 1545244
Sex: F
Age: 65
State: KY

Vax Date: 03/04/2021
Onset Date: 08/02/2021
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:

Symptom List: Anxiety, Dyspnoea

Symptoms: Covid

Other Meds:

Current Illness:

ID: 1545245
Sex: M
Age: 65
State: MD

Vax Date: 07/22/2021
Onset Date: 07/22/2021
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: PATIENT PREVIOUSLY RECEIVED JANSSEN VACCINE IN FEBRUARY. NO SYMPTOMS PRESENTED AFTER ADMINISTRATION

Other Meds:

Current Illness:

ID: 1545246
Sex: F
Age: 66
State: MI

Vax Date: 07/21/2021
Onset Date: 07/21/2021
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: Poison Ivy, wasp stings

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Severe arm pain, rash and raised bumps on neck, chest and face. Itching

Other Meds: Acidophlis, CholestOff, Citrical, Centrum daily vitamin

Current Illness: None

ID: 1545247
Sex: F
Age: 36
State: CA

Vax Date: 08/11/2021
Onset Date: 08/11/2021
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: none

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

Symptoms: Patient reports tinkling in her front and back and jaw tightness with pressure pushing her jaw to the side. She also heard a "pop" sound in her head. After about 45 minutes she reported feeling better but still had some symptoms.

Other Meds:

Current Illness:

ID: 1545248
Sex: F
Age: 38
State: IN

Vax Date: 07/21/2021
Onset Date: 07/23/2021
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: None

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

Symptoms: Patient complains of arm/forearm/wrist and finger pain since vaccination. Described as shooting pain. Does not have any issues at the site of injection.

Other Meds: Wellbutrin, Clonazepam

Current Illness:

ID: 1545249
Sex: M
Age: 70
State: NY

Vax Date: 04/09/2021
Onset Date: 04/10/2021
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: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Could not move legs or stand the next morning after the vaccine. Had to be taken out in a stretcher and has not returned home since then. It's been four months.

Other Meds: Copaxone 40mg (3 times a week) Calcium

Current Illness: Multiple Sclerosis Osteoporosis Acid Reflux

ID: 1545250
Sex: M
Age: 42
State: CO

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Patient was given an expired dose.

Other Meds:

Current Illness:

ID: 1545251
Sex: M
Age: 36
State: FL

Vax Date: 07/26/2021
Onset Date: 08/09/2021
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: None

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Chest pain in the left side of the body and toward the outer pec.. I had a hard time taking a deep breath pain around the longue when coughing

Other Meds: Thyroid medecine

Current Illness: None

ID: 1545252
Sex: F
Age: 44
State: NC

Vax Date: 08/06/2021
Onset Date: 08/07/2021
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: Site: Redness at Injection Site-Medium, Systemic: Allergic: Rash (specify: facial area, extremeties)-Severe, Systemic: Allergic: Rash Generalized-Severe, Systemic: Body Aches Generalized-Severe, Systemic: Fever-Medium

Other Meds:

Current Illness:

ID: 1545253
Sex: M
Age: 17
State: FL

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: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: PATIENT IS 17 YEARS OLD AND RECEIVED THE MODERNA VACCINE. PHARMACIST DID NOT REALIZE PATIENT WAS UNDER 18 YEARS OF AGE. FATHER OF PATIENT WAS CONTACTED. BOTH FATHER AND PATIENT ARE AWARE IS STILL WOULD LIKE TO RECEIVE THE 2ND DOSE.

Other Meds:

Current Illness:

ID: 1545254
Sex: M
Age: 49
State: AR

Vax Date: 05/01/2021
Onset Date: 08/05/2021
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: SYR
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Pt admitted on 8/5/2021 after transferred from ER. He was dx with covid with worsening symptoms. History is extremely difficult to obtain from this per individual as he is extremely difficult to understand but I think he was originally diagnosed with COVID last week. He has prescriptions for Decadron, ivermectin, and hydroxychloroquine from an emergency room physician on 07/29/2021. He reports that he was actually in the emergency room on Wednesday 07/28/2021. It is extremely difficult to tell when the patient 1st began having symptoms. Pt discharged on 8/10/2021.

Other Meds:

Current Illness:

ID: 1545255
Sex: F
Age: 43
State: NY

Vax Date: 07/16/2021
Onset Date: 07/17/2021
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: Ampiciline

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

Symptoms: The next day, the swelling and itching on the injection site appeared, and it has already disappeared by now. However, the pain on my shoulder has not gone away, and it's getting worse. Many around me told me that they had pain right after inoculation, so I did not even think the pain would be a problem in the beginning. The pain started around the arm, shoulder to the neck, only on the left side, the side I received an injection. Now I cannot extend my arm without feeling pain. When I bend over, the whole left side shoulder through my fingers get tingling, and eventually feel numb. I have to quickly move my body straight back up. I cannot do many of the certain activities that I used to be able to do.

Other Meds:

Current Illness: None

ID: 1545256
Sex: M
Age: 72
State: OR

Vax Date: 03/01/2021
Onset Date: 03/05/2021
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: peanuts and fish

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

Symptoms: rash on legs developed after first injection followed by full body rash after the second injection

Other Meds:

Current Illness:

ID: 1545257
Sex: M
Age: 49
State: AR

Vax Date: 05/01/2021
Onset Date: 08/05/2021
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: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Pt admitted on 8/5/2021 after transfer. He was dx with covid with worsening symptoms. History is extremely difficult to obtain from this per individual as he is extremely difficult to understand but I think he was originally diagnosed with COVID last week. He has prescriptions for Decadron, ivermectin, and hydroxychloroquine from an emergency room physician on 07/29/2021. He reports that he was actually in the emergency room on Wednesday 07/28/2021. It is extremely difficult to tell when the patient 1st began having symptoms. Pt discharged on 8/10/2021.

Other Meds:

Current Illness:

ID: 1545258
Sex: M
Age: 82
State: FL

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

Lab Data:

Allergies: Heparin (angioedema); Aspirin related medications (abdominal pain)

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

Symptoms: For unknown reason (not documented in chart) patient received the first Pfizer COVID-19 Vaccine dose on 07/28/21 and the second dose of Pfizer COVID-19 Vaccine on 08/10/21 which is earlier than 21 days and outside of the 4-day grace period. There were no adverse events associated with administration of the vaccine. Per CDC guidance, doses inadvertently administered earlier than the grace period should not be repeated.

Other Meds: Not applicable. Dose administered too soon and medications at time of vaccination not necessary

Current Illness: Not applicable - reporting error of dose given too soon

ID: 1545259
Sex: M
Age: 59
State: IL

Vax Date: 05/04/2021
Onset Date: 05/04/2021
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: N/A

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

Symptoms: Pt reports to pharmacy with continued pain in left arm after receiving Moderna dose number 2. Painful to raise arm above head. Believes it is getting better but arm still hurts when moving. Does not hurt to touch.

Other Meds: N/A

Current Illness: None

ID: 1545260
Sex: M
Age: 29
State: FL

Vax Date: 08/03/2021
Onset Date: 08/11/2021
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: n/a

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Woke up with slight arm pain and armpit soreness. Armpit feels like a pulled muscle when arm lifted above head

Other Meds: n/a

Current Illness: n/a

ID: 1545261
Sex: F
Age: 41
State: MI

Vax Date: 05/21/2021
Onset Date: 07/03/2021
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: No

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Left socket eye pain, absent menstrual cycle over 60 days as of todays date. Left ovarian pain.

Other Meds: Multivitamin

Current Illness: None

ID: 1545262
Sex: F
Age: 37
State: MO

Vax Date: 01/29/2021
Onset Date: 03/12/2021
Rec V Date: 08/11/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Baby had several rare congenital anomalies 1.) Cri du chat syndrome 2.) large deletion in chromosome 5 3.) congenital diaphragmatic hernia Conception happened 14 days after 2nd Covid shot and these types of anomalies happen in the cell division portion of gestation or the early stages of gestation. There is a 1 in 50,000 chance of getting Cri Du Chat and a 1 in 2500 chance of getting Congenital Diaphragmatic Hernia. There is an even rarer chance of getting both.

Other Meds: Prenatal vitamins

Current Illness:

ID: 1545263
Sex: M
Age: 25
State: NH

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: 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: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Medium

Other Meds:

Current Illness:

ID: 1545264
Sex: M
Age: 29
State: AL

Vax Date: 08/10/2021
Onset Date: 08/11/2021
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: no

Symptom List: Unevaluable event

Symptoms: next day after receiving the vaccine he took the bandaid off and it off skin off each end of the bandaid it was hot and had pus

Other Meds: no

Current Illness: no

ID: 1545265
Sex: M
Age: 28
State: TX

Vax Date: 02/10/2021
Onset Date: 04/15/2021
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: Eggs, Nuts, Wheat, Gluten

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

Symptoms: After 60 Days of receiving 1 Dose of Moderna, I suffered from persistent headaches from April 2021 through June. After having headaches, it leads to having trouble breathing at night before I selpt. I then suffered a panic attack in the month of June 2021. My whole body got extremely hot and had an increase in breathing. My lymph nodes started having stabbing pains around my neck and arm pits. I went to the ER to get examined due to an increase in pain under my neck on my lympnodes. ER said after doing a MRI of my neck and X-Rays of my chest that I was fine and sent me home. I then carried on and visited with my Doctor back at home and tryed to follow up with her after event. I expressed my symptoms of stabbing feeling in chest and increase of issues or swelling in my head. She scheduled me for post covid longhaulers and I am currently seeking medical treatment or evaluations on case.

Other Meds: Vitamin D3: 5000IU's Daily Zinc: 50 Mg Daily Vitamin C: 500Mg Daily Vitamin B3: 1000Mg daily

Current Illness: Sleep Apnea, Bilateral Hand numbness, Low Testosterone

ID: 1545266
Sex: M
Age: 80
State: PA

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: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

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

Other Meds:

Current Illness:

ID: 1545267
Sex: F
Age: 36
State: CO

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:
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient was given an expired dose.

Other Meds:

Current Illness:

ID: 1545268
Sex: M
Age: 36
State: IL

Vax Date: 08/11/2021
Onset Date: 08/11/2021
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: None

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

Symptoms: Shortly after receiving the vaccine, patient fainted while sitting in a chair during the 15 minute observation period. He slowly slid off of the chair and landed beneath the chair. EMS was immediately alerted and I went to his aid. He quickly came to and was responsive. EMS arrived and evaluated him and he was released with family members about one-half hour after the event.

Other Meds: Unknown

Current Illness: None

ID: 1545269
Sex: M
Age: 80
State: PA

Vax Date: 08/09/2021
Onset Date: 08/09/2021
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:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Error: Booster Given Too Early-

Other Meds:

Current Illness:

ID: 1545270
Sex: F
Age: 13
State: PR

Vax Date: 08/01/2021
Onset Date: 08/06/2021
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: Faint.

Other Meds:

Current Illness:

ID: 1545271
Sex: F
Age: 49
State: IL

Vax Date: 08/05/2021
Onset Date: 08/06/2021
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: NKA

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

Symptoms: By 1am on 8/6/21, severe chills, body aches, fatigue, abdominal pain, nausea, severe vomiting, muscle aches, bitter/metallic taste, and anorexia for 24 hours. Currently still having metallic taste in mouth, anorexia, and fatigue.

Other Meds: Multivitamin

Current Illness: None

ID: 1545272
Sex: M
Age: 62
State: NH

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

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

Lab Data:

Allergies: Alkaseltzer Gold, Chlorpheniramine, Heparin (HIT in 2011), hydrocodone, moxifloxacin, Nitroglycerin

Symptom List: Nausea

Symptoms: Presented to the hospital in obvious congestive heart failure, complaining of sternal pain after a car accident 3 7 days before the vaccine dose.

Other Meds: Multiple, including Bumex, insulin for DM, Buprenorphine, Toprol XL, Glipizide, tizanidine, Eliquis

Current Illness: congestive heart failure exacerbation

ID: 1545273
Sex: F
Age: 61
State: ME

Vax Date: 03/13/2021
Onset Date: 05/04/2021
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: None Known

Symptom List: Injection site pain

Symptoms: About four weeks after my second Covid shot I noticed random muscle soreness throughout my body. When touching these muscles, it felt like there was a very bad bruise and hurt badly for about 30 seconds. Still sore th the touch afterwards, but made worse by pressing on them. Mostly upper arms (inner and outer), under my arms (armpits and sides of chest), upper legs and buttocks. Extreme muscle cramping in legs (calves and shins). Shooting pain in arches of feet. Severe numbness and tingling in right foot (some in left). Muscle weakness in legs. Blurry vision started end of May. Comes and goes. The worse of the symptoms were throughout June and early July. They are abating some in August, but persist some. Swollen glands in right neck under ear and on collar bone on left side. Please note that first vaccine was 3/13/21 and second was 4/3/21. Symptoms started early May, 2021

Other Meds: Dali y Multivitamin, Keppra, Calcium, Latanoprost eye drops

Current Illness: None

ID: 1545275
Sex: M
Age: 14
State: CA

Vax Date: 07/28/2021
Onset Date: 07/31/2021
Rec V Date: 08/11/2021
Hospital: Y

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

Lab Data:

Allergies: nka

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

Symptoms: 14y/o M received his 2nd dose of Pfizer COVID vaccine on 7/28 and started to complain of chest pain on 7/30. Pain worsened to 8/10 and he was seen in the ED that evening with an ECG suggestive of acute myopericarditis and positive troponin of 7.81. He was admitted for likely post-covid vaccine myopericarditis. His was initially treated with ibuprofen overnight with no complains of chest pain the following morning 7/31, and continued to be asymptomatic throughout the rest of his hospital course. Troponin on 7/31 AM was up to 15.81. An echo was completed and showed normal cardiac size and function without pericardial effusion. He was acutely treated with IVIG continuously for for 9 hours, and Ibuprofen q8 hour for a total of 4 days. Troponin was trended daily with gradual improvement to 1.36 on morning of discharge. A repeat echo was performed that was normal. Given that a repeat troponin level on 8/3 PM was 0.76, he was deemed to be stable for discharge by Pediatric Cardiology. He will need to be restricted from strenuous activities with no competitive sports or physical education for 3 months per cardiology. Pediatric Cardiology will continue to follow him as an outpatient, monitoring him 2-day post-discharge troponin level and will perform an exercise stress test in 3 months. Discharged on 7 more days of Motrin TID w meals

Other Meds: None

Current Illness: None

Date Died: 08/10/2021

ID: 1545276
Sex: M
Age: 95
State: CA

Vax Date: 08/06/2021
Onset Date: 08/08/2021
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: NKDA

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

Symptoms: Resident noted with loss of appetite on 8/8/21 and resident expired on 8/10/21

Other Meds: Acetaminophen, Aricept, Megestrol Acetate Suspension, Mirtazaine, Multivitamin-Mineral tab, Namenda, Polyethylene Glycol, Prostat Liquid

Current Illness: PROTEIN-CALORIE MALNUTRITION, DEMENTIA, HYPERTENSION

ID: 1545277
Sex: M
Age: 11
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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKDA

Symptom List: Tremor

Symptoms: Patient father and patient came to pharmacy on August 7,2021 to receive 1st dose Pfizer - When pharmacist asked Patient father and patient son- verified birthday as written on consent form. After completion of vaccine, RPH processed paperwork and was a billing issue. Called insurance to verify discrepancy as to why bulling information stated "missing birthdate". Insurance verified on file birthdate for patient was in fact different then written on consent form. Tried to called patient multiple times to confirm and no response.

Other Meds: NKDA

Current Illness: N/A

ID: 1545278
Sex: M
Age: 11
State: MN

Vax Date: 08/05/2021
Onset Date: 08/05/2021
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: Erythema, Pruritus

Symptoms: Error: Patient Too Young for Vaccine Administered-

Other Meds:

Current Illness:

ID: 1545279
Sex: M
Age: 22
State: TX

Vax Date: 12/15/2020
Onset Date: 12/20/2020
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: no

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

Symptoms: extreme, constant chest pain at rest for 30-60 mins

Other Meds: no

Current Illness: none

ID: 1545280
Sex: F
Age: 74
State: SC

Vax Date: 03/26/2021
Onset Date: 04/26/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: Psorasis flared up on my upper arms and back. Went to dermatologist on 7/12/2021. She prescribed a cream and is prescribing Cosentyx.

Other Meds: Atorvastatin 40mg, Multivitamin, Fish Oil, Calicum, B12, C, D, Low dose asiprin

Current Illness: None

ID: 1545281
Sex: F
Age: 33
State: OH

Vax Date: 07/21/2021
Onset Date: 07/21/2021
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: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: No menstrual cycle in the past month.

Other Meds: None

Current Illness: None

ID: 1545282
Sex: F
Age: 83
State: NJ

Vax Date: 05/03/2021
Onset Date: 05/04/2021
Rec V Date: 08/11/2021
Hospital:

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

Lab Data:

Allergies: penicillin,percocet, citrus

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

Symptoms: the day after the second shot I could not walk,wound up in hospital for a week lots of tests then rehab at for two weeks then home ot and pt still ongoing

Other Meds: amlopine,breo ellipta,fish oil,irbestan,lamotrine,latanopost,levothroxine,restasis,simvastatin,vit d,multyivitamin

Current Illness: below+

ID: 1545283
Sex: F
Age: 29
State: KY

Vax Date: 01/08/2021
Onset Date: 08/09/2021
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: 1545284
Sex: F
Age: 43
State: NC

Vax Date: 08/06/2021
Onset Date: 08/07/2021
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: Penicillin Iodine

Symptom List: Pain in extremity

Symptoms: The side effect that hit the hardest was the muscle/joint aches. I also had a mild fever for the following 2 days. The injection site was also very sore after the second dose. The muscle/joint pain was mostly in my legs and feet.

Other Meds: Liletta IUD

Current Illness:

ID: 1545285
Sex: M
Age: 15
State: CO

Vax Date: 08/07/2021
Onset Date: 08/07/2021
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: Patient was given an expired dose.

Other Meds:

Current Illness:

ID: 1545286
Sex: M
Age: 72
State:

Vax Date: 02/24/2021
Onset Date: 08/06/2021
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: cough, sore throat, loss of taste

Other Meds:

Current Illness:

ID: 1545287
Sex: F
Age: 47
State: GA

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

Lab Data:

Allergies:

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

Symptoms: Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Medium, Additional Details: Patient complained of slurred speech after vaccine administration, upon checking vitals an increase in blood pressure was noticed. EMS was called. Patient chose to go with EMS to Emergancy Room to be monitored. RPH followed up with patients sister and they confirmed that hospital staff is keeping her in the hospital overnight for observations.

Other Meds:

Current Illness:

ID: 1545288
Sex: F
Age: 55
State: TX

Vax Date: 07/17/2021
Onset Date: 07/27/2021
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: None

Symptom List: Vomiting

Symptoms: Huge itchy red latch, I have photos, with bumps and very hot arm. It felt like there was a very warm compress under my skin.

Other Meds: Thyroid medicine - Levothyroxine 100 mg T3- thyroid medicine -Liothyronine 10mg Heartburn medicine - Omeprazole 40mg

Current Illness: None

ID: 1545289
Sex: F
Age: 18
State: FL

Vax Date: 07/30/2021
Onset Date: 07/30/2021
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: Unsure checked vars

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: unkown patient stated she was fine was crying and called her mom.

Other Meds: unknown

Current Illness: None

ID: 1545290
Sex: M
Age: 40
State: VA

Vax Date: 07/28/2021
Onset Date: 08/06/2021
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: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: Heart became very discomfortable, there would be a series of events where it felt extremely discomfortable then went away. Then later that evening, Friday August 6 it came back and my heart was extremely discomfortable. On August 11th my breathing seems to not be normal either. For the August 6th event I was traveling out of state and was unable to visit my doctor, considered going to an emergency room but in the evening the pain went away so I did not go to one.

Other Meds: Lisinopril & allopurnal

Current Illness: none

ID: 1545291
Sex: F
Age: 69
State: HI

Vax Date: 04/17/2021
Onset Date: 08/08/2021
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:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: + Covid

Other Meds: dextroamphetamine, alvexco, dicyclomine, citalopram, melatonin

Current Illness: none

ID: 1545292
Sex: F
Age: 39
State: IN

Vax Date: 03/05/2021
Onset Date: 03/26/2021
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: Latex Azithromycin Gold

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

Symptoms: Full body itching, rash (moving around my body) - still to this day. Trying to track down whether it is due to the vaccine, a current medication prescribed, or random Eczema occurrence.

Other Meds: Humalog insulin Losartan

Current Illness:

ID: 1545293
Sex: M
Age: 53
State: ME

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: 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: 636,615

Page last modified: 03 October 2021 5:28pm