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: 1545554
Sex: F
Age: 88
State: KY

Vax Date: 02/25/2021
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: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Tested Positive for Covid

Other Meds:

Current Illness:

ID: 1545555
Sex: M
Age: 29
State: WA

Vax Date: 05/06/2021
Onset Date: 05/06/2021
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: UNKNOWN

Symptom List: Anxiety, Dyspnoea

Symptoms: PATIENT RECEIVED MORE THAN THE RECOMMENDED DOSES OF THE COVID-19 VACCINE. JANSSEN WAS ADMINISTERED ON 4/12/2021 AND PFIZER WAS ADMINISTERED ON 4/15/2021 AND 5/6/2021. OUTCOME, SYMPTOMS, AND TREATMENT UNKNOWN.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1545556
Sex: F
Age: 56
State: WV

Vax Date: 04/02/2021
Onset Date: 04/12/2021
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: Seasonal allergies Gentimycin Pseudoephedrine Solumedrol

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

Symptoms: On or about day 10, COVID arm appeared as well as the appearance of a wart on the inside of my R foot near the ankle. (At age 5, I?d had a plantar wart removed from the bottom of the same foot.) I know that I was not in an environment to pick up anything as I live with my elderly father and am meticulous about what I do and where I go. It began with the same type of insistent itching as COVID arm. COVID arm disappeared around day day 17 post 1st injection. I am still dealing with the remnants of the wart. The wart has been treated with Cantharidin first followed by Imiquimod cream, which I am still currently using. So far, it has been nearly 3 mos of treatment.

Other Meds: Amlodipine Tramadol Tizanidine Naproxen Extra strength hair, skin, & nails plus biotin Omega 3 Vitamin D Vitamin E

Current Illness: None

ID: 1545557
Sex: M
Age: 76
State: FL

Vax Date: 04/29/2021
Onset Date: 08/07/2021
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: pt is admitted to the hospital with covid 19 symptoms post vaccination.

Other Meds:

Current Illness:

ID: 1545559
Sex: F
Age: 15
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: No reported allergies

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

Symptoms: There were no reported adverse signs or symptoms. The vaccine that was administered was expired by 10 days (7/31/21).

Other Meds: No reported meds being taken

Current Illness: No reported illnesses at the time of vaccination or one month prior

ID: 1545560
Sex: M
Age: 15
State: TX

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

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

Symptoms: Immunizing technician came out of the vaccination room to inform me (pharmacist) that patient stated he was not feeling well right after the vaccine. As we walked to the room, we heard a falling sound and came rushing. Patient was on the floor, sitting with Dad on his side. Dad stated he fell. Patient was conscious and alert but looked pale. He sat on the floor for 5 minutes then moved to a chair with Dad's help. He passed out again about 5 minutes later for only a few seconds. Dad stated patient usually had these reactions after blood drawn. Patient was alert and oriented after 30 minutes observation. They stayed for more than an hour before leaving the pharmacy.

Other Meds: N/a

Current Illness: n/a

ID: 1545561
Sex: F
Age: 40
State: KY

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

Lab Data:

Allergies: na

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: The vaccine given was expired. This vaccine was drawn up yesterday 8/10/21 morning and the vaccine was given more than 24 hours after it was reconstituted.

Other Meds: na

Current Illness: na

ID: 1545562
Sex: M
Age: 65
State:

Vax Date: 01/26/2021
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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Patient was vaccinated on 1/05/2021 and 1/26/2021 with Pfizer vaccine. He then became symptomatic on 8/09 and tested positive for COVID-19 on 8/10

Other Meds:

Current Illness:

ID: 1545563
Sex: F
Age: 43
State: NC

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: beef, bovine complex, galactose-alpha-1,3-galactose, naproxen sodium, mammal meats, pork, adhesive tape, silicones, sulfacetamide sodium, ampicillin, clarithromycin, sulfa

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Approximately 25 minutes after administration, patient reported itching all over, lightheadedness, and "feeling bad". This progressed to include chest tightness. Rapid response was activated. VS were taken. PE was performed and notable for lip swelling, diffuse skin redness, and diaphoresis. Lungs were CTAB. One dose of Epi 0.3 mg IM was given with improvement in symptoms within 2 minutes. VS repeated with improvement. Rapid response team arrived and patient was transferred to in-house ER.

Other Meds: unknown

Current Illness: no

ID: 1545564
Sex: F
Age: 52
State: CO

Vax Date: 05/05/2021
Onset Date: 05/06/2021
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: Fever, dehydration, muscle aches, terrible exhaustion (could not get out of bed), loss of appetite, headache

Other Meds:

Current Illness:

ID: 1545565
Sex: F
Age: 47
State: GA

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: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: After receiving the Pfizer vaccine, the patient was vomiting and placed on her side. She also had a seizure about 20 minutes after receiving the vaccine the vaccine.

Other Meds:

Current Illness: Pelvic Mass, Light Breathing

ID: 1545566
Sex: F
Age: 87
State:

Vax Date: 02/26/2021
Onset Date: 06/16/2021
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: none

Symptom List: Rash, Urticaria

Symptoms: shortness of breath progressively over the course of 3 1/2 months getting worse to the point at which the patient could not walk more than 10 feet without being winded and needing to sit down. Was hospitalized due to the shortness of breath which got worse two times in the hospital and was treated with steroids, breathing treatments every 4 hours, antibiotics and heparin. Patient was in the hospital for 7 days and released on oral steroids for 6 weeks.

Other Meds: Amlodipine, Blood pressure, Afib medicine, Elaquis, probiotics, zinc, vitamin C and D

Current Illness: none

ID: 1545567
Sex: F
Age: 33
State: OH

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: Metronidzol oral

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

Symptoms: Pt reported itching sensation 1 hour after getting her injection. The itching sensation is on her chest (front and back), arms, hands and both legs. Pt called her PCP and left a message to his nurse. PCP will return her call. Pt stated she will take Benadryl at home.

Other Meds: Multivitamins, Vit. D, Iron

Current Illness: NA

ID: 1545568
Sex: F
Age: 34
State: NE

Vax Date: 07/28/2021
Onset Date: 07/28/2021
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: None

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

Symptoms: A couple minutes after the vaccine injection, patient complained of nausea and dizziness. She then proceeded to tell pharmacy staff that she has difficulty breathing and feels like she is going to black out. Pharmacist administered Epipen to patient and called 911.

Other Meds: Unknown

Current Illness: Unknown

ID: 1545569
Sex: F
Age: 23
State: TX

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

Lab Data:

Allergies: none

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

Symptoms: Patient got vaccine around 10:06AM reporting minor dizziness regarding to the 1st dose. Around 5 minutes into the next wait period, patient was found sitting on the floor eating snacks. When asked why, patient states that she felt very dizziness to the point of not being able to drive home during the wait period. Patient did report similar conditions after giving blood and not eating (patient reports not eating anything prior to vaccination). Possibly this adverse event could be just the patient not eating, but I'm reporting it just in case.

Other Meds: no prescriptions; everything else unknown

Current Illness: none

ID: 1545570
Sex: F
Age: 64
State: NV

Vax Date: 07/21/2021
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:

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

Symptoms: PATIENT HAS SUBSEQUENT SWELLING, REDNESS, PAIN ACROSS THE DELTOID OF INJECTION ARM (RIGHT) THAT WRAPPED AROUND ARM. THIS LASTED FOR APPROXIMATELY A WEEK BEFORE SUBSIDING.

Other Meds:

Current Illness:

ID: 1545571
Sex: F
Age: 50
State: VA

Vax Date: 07/16/2021
Onset Date: 07/16/2021
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: *Patient scheduled by facility for 1 dose COVID vaccine.*Client give Moderna dose on 07-16-21.*Later review showed that client had received Janssen vaccine on 06/10/2021.*Inadvertent dose

Other Meds:

Current Illness:

ID: 1545572
Sex: F
Age: 15
State: CA

Vax Date: 08/11/2021
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: pt denied

Symptom List: Ear pain, Hypoaesthesia

Symptoms: 11:23- Pt father approached RN to check on his daughter. Pt reports blurred vision, feeling dizzy, and feels "everything closing in." RN identifies pallor and diaphoresis and calls for NP and EMT over radio. POD leader and RN assist to lay the patient to the ground with lower extremities elevated on the chair. 11:24-NP and EMT arrive at the scene. NP assesses pt medical h/x, medications, previous meals, current symptoms, menstrual cycle, etc. Pt denies SOB, chest pain, nausea. Pt reports blurry vision and light headedness. Presents with a flat affect. Mental health staff are informed and arrive at scene to speak to father. B/P- 102/62, O2- 94, P- 99. Pt is still on the floor. (Present staff: NP, 2 EMT, POD leader, 3 Observation RNs, safety officer, mental health employees, father. ) 11:30 - diaphoresis and blurry vision is resolved. 11:36- pt is assisted to a sitting position on the floor and denies any abnormal symptoms. BP- 11/3, P- 95, O2- 94%. Pt is warm to touch. Team continues to monitor and pt continues to drink gatorade. 11:41- pt is assisted to chair denies abnormal symptoms. BP- 107/62, P- 98, O2- 98%. NP plans to discharge patient if she continues to feel well. 11:54- NP assesses pt and she reports feeling lightheaded. Pt is assisted to a lying position on the floor with feet elevated on the chair. BP- 106/64. NP notifies team to contact 911 for further assessment. 11:57- Blood glucose reading 137. 12: 10 EMTS arrive and NP endorsed pt care to EMTs, other EMTs assessing and taking report. 12:15- pt is assisted to a sitting position BP- 113/68, P- 94, patient is advised to seek further assessment in the ED 12:24- patient signs AMA form

Other Meds: allergy medication OTC

Current Illness: h/x of panic attacks in crowds

ID: 1545573
Sex: F
Age: 11
State: UT

Vax Date: 08/10/2021
Onset Date: 08/10/2021
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: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Patient was accidentally given Trumenba instead of Tdap. She is under the age recommendation for administration of Trumenba to a health individual - though it is approved to be given as young as age 10 for those with risk factors.

Other Meds: None

Current Illness: None

ID: 1545575
Sex: F
Age: 86
State: KY

Vax Date: 08/11/2021
Onset Date: 08/11/2021
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: na

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

Symptoms: Patient had a covid vaccine today at 1:45 pm and it was discovered at 4:45pm that the vaccine given was expired. It was reconstituted yesterday 8/10/2021 at 9:50 am.

Other Meds: na

Current Illness: na

ID: 1545576
Sex: F
Age: 74
State: SC

Vax Date: 02/16/2021
Onset Date: 02/17/2021
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: Penicilin Sulfa zpack steroids cipro dairy

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

Symptoms: Severe diareah Weight loss Stomache cramps

Other Meds: Synthroid 50 mg 5/days/wk, 75 g 2/days/wk Antibiodic Vit. B12 1000mg Vit. D 1000 mg Gavascon asprin 81 mg

Current Illness:

ID: 1545577
Sex: F
Age: 45
State: OH

Vax Date: 04/16/2021
Onset Date: 04/18/2021
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: N/A

Symptom List: Unevaluable event

Symptoms: After my second shot, my menstrual cycle shortened to 18 days, from start of cycle to the beginning of the next cycle. My periods were heavier and much more painful than they had been. This lasted for 3 months (4 cycles). This past cycle seems to have returned back to relatively normal.

Other Meds:

Current Illness:

ID: 1545578
Sex: M
Age: 40
State: MA

Vax Date: 04/18/2021
Onset Date: 07/21/2021
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: LA

Lab Data:

Allergies:

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

Symptoms: Minor illnesses several times after 2nd vaccine then developed shingles mid July 2021 (3 months after 2nd shot). Shingles quickly turned into viral meningitis with varicella zoster virus by PCR found in spinal tap. Staff were concerned about immune system as is very unusual for a healthy person with normal immune system to develop meningitis with varicella zoster virus. Someone also noted though that they had another case of it just a few weeks prior. It may not have been related to covid vaccine but it seemed worth reporting in case there is a link.

Other Meds: metFORMIN ER 500 MG 24, loratadine 10 mg, vitamin D

Current Illness: Sick almost monthly since getting vaccinated. Had cold or other virus in May and again in June (not covid - 1 year old child also was sick and tested negative for covid and flu) then Shingles mid-July 2021.

ID: 1545579
Sex: M
Age: 30
State:

Vax Date: 04/23/2021
Onset Date: 05/24/2021
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: I had a kidney stone. I had pain and had to go to the ER on July 7th. This is the first time I have ever had a kidney stone.

Other Meds: XYZAL; rogina

Current Illness: None

ID: 1545581
Sex: F
Age: 65
State: MO

Vax Date: 04/27/2021
Onset Date: 07/01/2021
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: none

Symptom List: Injection site pain, Menorrhagia

Symptoms: On July 1 2021, I had a headache, dry cough, low energy and fever of 101.7. On, July 4th I went to the urgent care because my fever got up to 102, 4 days with the fever. At the urgent care I was given a covid test that was negative. My lungs were clear. I was diagnosed with an acute upper respiratory infection. I took OTC Mucinex and was prescribed a prednisone pack and something for my cough. The cough lasted 3-4 weeks.

Other Meds: Omeprazole, Losartan, Simvastatin

Current Illness: no

ID: 1545582
Sex: F
Age: 24
State: WA

Vax Date: 05/22/2021
Onset Date: 05/22/2021
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: UNKNOWN

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

Symptoms: PATIENT RECEIVED MORE THAN THE RECOMMENDED DOSES OF COVID-19 VACCINE. PFIZER WAS ADMINISTERED 1/15/2021, THEN THE MODERNA SERIES WAS ADMINISTERED ON 4/24/2021 AND 5/22/2021.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1545583
Sex: M
Age: 31
State: VA

Vax Date: 07/16/2021
Onset Date: 07/16/2021
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: Patient scheduled by facility for 1 dose COVID vaccine.*Client give Moderna dose on 07-16-21.*Later review showed that client had received Jansenn vaccine on 06/10/2021.*Inadvertant dose

Other Meds:

Current Illness:

ID: 1545584
Sex: F
Age: 90
State: NJ

Vax Date: 02/05/2021
Onset Date: 03/10/2021
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: tinnitus both ears, hearing loss, petechiae all over skin, lowered platelet counts after vaccination

Other Meds: Carvedilol, allopurinol, hydralazine, Lipitor, metformin.

Current Illness: None

ID: 1545585
Sex: M
Age: 52
State: CA

Vax Date: 08/02/2021
Onset Date: 08/05/2021
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: PCN

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

Symptoms: 3 days Post 2nd Pfizer shot gallbladder area and stomach became painful. Contacted clinic, received a call from nurse, I explained symptoms, nurse told me essentially to wait it out and if it gets worse go to the ER. Here we are 9 days later and pain is still there sometime an 8 on pain level at night.

Other Meds: None

Current Illness: None

ID: 1545586
Sex: M
Age: 62
State: AZ

Vax Date: 02/08/2021
Onset Date: 06/01/2021
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: None.

Symptom List: Nausea

Symptoms: I have developed severe tinnitus and inflammation of the Eustachian tube

Other Meds: Tadalafil, 5 mg ? PRN Sotalol, 80 mg ? 2X per day Carvedilol, 25 mg ? 2X per day Losartan, 50 mg, 2X per day Finasteride, 1 mg, 1X per day Testosterone Cypionate 100 mg/mL intramuscular solution, 1X per week Anastrozole, 1 mg, 2X per

Current Illness: None

ID: 1545587
Sex: F
Age: 72
State: FL

Vax Date: 02/23/2021
Onset Date: 08/03/2021
Rec V Date: 08/11/2021
Hospital: Y

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

Lab Data:

Allergies: NKDA

Symptom List: Injection site pain

Symptoms: Patient required hospitalization due to breakthrough infection. She received Pfizer vaccine (2nd dose in series) on 02/23/21. Patient hospitalized from 08/03/21 - 08/09/21. Below is copied from discharge summary: Hospital course: had a ground level fall. Found to have a traumatic pneumothorax. A chest tube was placed. She worked on respiratory treatments. Past medical history significant for COPD and Covid positive. Chest tube fell out 8/5. No pneumothorax remained. she worked on pulmonary exercise and worked with therapy. Discharge to home with HHPT.

Other Meds: Breztri Aerosphere 160-9-4.8 MCG/ACT Aero Generic drug: Budeson-Glycopyrrol-Formoterol 2 inhalations, Inhalation, 2 TIMES DAILY metOLazone 10 MG Tabs Commonly known as: ZAROXOLYN 10 mg, Oral, DAILY morphine 30 MG Tbcr Commonly known

Current Illness:

ID: 1545588
Sex: M
Age: 36
State: PA

Vax Date: 01/02/2021
Onset Date: 01/17/2021
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: NA

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

Symptoms: Started with burning, prickling and weakness in Both legs and arms and progressed to burning pain, prickling sensation, weakness in Both arms, legs and pin in legs, arms and torso. Doctor informed that I have small finer neuropathy. I had no symptoms prior to receiving vaccine.

Other Meds: Amlodopine and Amitriptyline

Current Illness: None

Date Died: 07/28/2021

ID: 1545589
Sex: F
Age: 77
State: TN

Vax Date: 02/06/2021
Onset Date: 07/28/2021
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: RA

Lab Data:

Allergies: Bee stings, morphine, Opiates

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

Symptoms: Pt admitted to hospital on 7/25/21 with shortness of breath, which turned out to be positive for Covid-19. Pulmonology was consulted and patient was started on dexamethasone, remdesivir, baricitinib, as well as Tocilizumab. Started on vapotherm O2 with Fi02 of 100 %. Despite aggressive measures patient condition deteriorated. Family made patient a do not resuscitate, and patient expired on 7/28/21.

Other Meds: Unknown. Medication on hospital admission. pravastatin 0.5 tab Daily pantoprazole 40 mg Daily Singulair 10mg Q PM losartan -hydrochlorothiazide 100 mg-12.5 mg Daily ropinirole 0.5 mg Daily Metoprolol 50 mg ext release Daily Cardizem 120 mg

Current Illness: Unknown

ID: 1545590
Sex: M
Age: 41
State: CO

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: Patient came in with elderly family member asking for COVID vaccine. Filled out the paperwork and spoke about potential side effects and the 15min wait. He stated an understanding. Moderna Vaccine was administered to Left deltoid. Patient waited his 15mintues no reaction. After patient left and this RN was putting immunization it was discovered that he had already received his 3 doses series. Called patient to confirm. He stated he knew it was his 3 vaccine and he wanted a booster and did not tell this RN because he knew he would not be able to get it if he did. Explained the risks and that it is not studied or FDA approved and that adverse effects may not be known. Advised him to contact 911 or his PCP for adverse reactions.

Other Meds:

Current Illness:

ID: 1545591
Sex: F
Age: 46
State: VA

Vax Date: 05/28/2021
Onset Date: 06/04/2021
Rec V Date: 08/11/2021
Hospital: Y

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

Lab Data:

Allergies: none

Symptom List: Erythema, Pruritus

Symptoms: I experience a stroke on June 4, 2021 which was 7 days after I received the second dose of the Pfizer vaccine. I've completed all follow up tests with a hematologist, cardiologist, neurologist, and vascular surgeon which were all inconclusive for why I had the stroke. I had received an IV after my first vaccine dose for a routine procedure and developed a clot in my right arm where I had the IV. It was determined to not be in a deep vein. A follow up trans-esophageal echocardiogram determined I clearly don't have a hole in my heart.

Other Meds: Trazodone 50mg - once per day Citalopram 20mg - one and a half per day Hydroxyzine Hcl 25mg - once every other day Nortrel 1/35 Tablets 28 - once per day

Current Illness: none

ID: 1545592
Sex: F
Age: 34
State: MN

Vax Date: 08/11/2021
Onset Date: 08/11/2021
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: Patient described chest "tightness" and felt she was getting warm about 15 minutes after the vaccine. She was given water, and felt that she was "feeling less warm" after about 5 minutes (20 minutes after vaccine), but was still experiencing chest tightness. The clinic staff was informed, and they took over care of the patient. They did an EKG which was normal, and thought the chest pain was not cardiac related.

Other Meds:

Current Illness:

ID: 1545593
Sex: F
Age: 55
State: OH

Vax Date: 08/02/2021
Onset Date: 08/05/2021
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: Penicillin, Neosporin, adhesives, MRI Contrast fluid, Peanuts, Cats. Digestive upset to gluten, dairy protein, coconut and soy.

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

Symptoms: 12 minutes after eating typical breakfast foods (egg, homemade muffin), began to have rapid onset of: Red, hot, itchy rash on face, ears, knuckles; nausea and stomach pain, hearing sounded like in a box, vision got blurry and bright (not dark like fainting). Began to have trouble speaking, and was losing motor abilities. Took quick dissolve Allegra tablets (2), Benadryl children's chewables (2), and 2 X 20 mg Famitodine tablets. Was about to use epipen when vision started to clear. Vision and hearing cleared over 10 -15 minutes. Rash resolved around 20 minutes. Stomach felt bad the rest of the day. Had a milder, skin only reaction after breakfast the following day, and again 6 days later (face, ears, knuckles, elbows, knees).

Other Meds: Thyroid NP, .75 grain 2X daily, Xiidra eyedrops 2X daily, Biest (80/20) 3/Progesterone 135/Testosterone 2.5MG/ML Cream - 10 clicks (1 ML) AM and PM, Low Dose Naltrexone - 4.5 mg at bedtime, Pure Encapsulations twice daily multivitamin, 12.5

Current Illness: None

ID: 1545594
Sex: F
Age: 12
State: MI

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Pt fainted while sitting on the chair few seconds after the shot was administered. the fainting lasted few seconds then she came back fully aware of what just happened. she stayed in the room to be monitored then she vomited but felt better after. she was doing fine when she left. she was on the room a total of 40 minutes.

Other Meds: N/A

Current Illness: none

ID: 1545595
Sex: M
Age: 11
State: MO

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

Lab Data:

Allergies: Unknown

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

Symptoms: The consent form that was filled out by the guardian was misread where the date of birth was filled in. It was misread as 08/20/2008 and not the correct 08/20/2009 that it should have been. During counseling before the vaccination that Pfizer was approved for 12 years old and older but the guardian never disclosed that the child was 10 days younger than 12. The pharmacy discovered the error upon entering the information.

Other Meds: Unknown

Current Illness: Unknown

ID: 1545596
Sex: M
Age: 15
State: CO

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

Lab Data:

Allergies: Tree nut, Sumatriptan

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

Symptoms: Diluent mixed with sterile water instead of normal saline

Other Meds: Albuterol, Epi pen

Current Illness: N/A

ID: 1545597
Sex: M
Age: 39
State: MO

Vax Date: 04/20/2021
Onset Date: 04/21/2021
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: Pain in extremity

Symptoms: Slight fever. Swollen lymph node in armpit/pectoral section. Large and tender to touch for 3-5 days following second shot. Appeared on injection side (right side)

Other Meds: Whey Protein, Creatine

Current Illness:

ID: 1545598
Sex: F
Age: 56
State: NY

Vax Date: 08/09/2021
Onset Date: 08/11/2021
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: avocado, tree nuts, meloms

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

Symptoms: I broke out in a blotchy rash near the injection site two days after the injection. Arm has been sore since the injection but the blotches don't itch. I have taken an NSAID for the pain.

Other Meds: HRT, vitamin D

Current Illness:

ID: 1545599
Sex: F
Age: 38
State: VA

Vax Date: 05/01/2021
Onset Date: 06/18/2021
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: Sulfa drugs

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

Symptoms: Periods have gotten longer and heavier. Getting them every 2 weeks and they last for 20 days.

Other Meds: Allegra-D

Current Illness: None

ID: 1545600
Sex: F
Age: 43
State: PA

Vax Date: 08/04/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: Patient reported gastrointestinal paints and loose stool. Sore lump on collar bone area.

Other Meds:

Current Illness:

ID: 1545601
Sex: M
Age: 76
State: FL

Vax Date: 03/10/2021
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:

Symptom List: Vomiting

Symptoms: Pt admitted to the hospital for COVID 19 symptoms post vaccination.

Other Meds:

Current Illness:

ID: 1545602
Sex: F
Age: 39
State: KY

Vax Date: 06/17/2021
Onset Date: 06/17/2021
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: Hydrocodone

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: About 3 hours after vaccine (4:30pm) my pulse elevated past 100 even though I was doing nothing but laying around. I started getting stabbing chest pain that took my breath. I went to the hospital and my bp was 135/95 which is high for me. My venous blood gas deficit was high. My ekg showed an ST abnormality. They sent me home due to being immune compromised and home was better. I made it until Saturday morning then almost passed out and went back to the ER. Had another abnormal EKG and my bp was low this time at 85/60. My pulse is staying up with palpitations.

Other Meds: Cymbalta, mirapex, topamax, prevacid, iron, vitamin D 50,000 IU

Current Illness: none

ID: 1545604
Sex: F
Age: 65
State: NV

Vax Date: 02/23/2021
Onset Date: 03/02/2021
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: sensitivity to doxycycline, seasonal allergies like pollen, grass, trees, mold

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

Symptoms: 03/02/2021 the injection site had like a little nodule inside and it was quite tender 03/06/2021 right shoulder was very sore and by 03/09/2021 it was hurting a lot and my upper ribs were all affected by the right, I was really sore, and it felt like my vertebrae were out of place, I could not stand up straight and could not move my arm to touch my nose or tuck in a shirt. I could not get my head up because my upper back hurt so much. When I would stand up straight my shoulder would hurt. My back was very stiff. I did not go to the doctor. After getting the second dose on 03/25/2021 I had fever and chills for like a day. Then, on 04/07/2021 something was tender on my left armpit, then on 04/09/2021 I went to urgent care because I had a big, swollen, painful lymph node in my left armpit. They did not do any medical tests, they just told me to go to my PCP. They just palpated the lump on my armpit. On 05/07/2021 I had fever, chills, painful skin, and on 05/21/2021 I had fever, painful skin, chills and the right shoulder pain was worse. On 05/29/2021 I had a fever and was too sick to attend a birthday party. I saw my PCP on 06/29/2021. I have been throwing up off and on like 5 times since the first vaccine. But I think I have thrown up before. I was concerned about my gallbladder so my PCP did an ultrasound on 07/15/2021. About 06/23/2021 I was able to stand up straight. Since the second shot both my armpits have been very tender to touch and just last week they stopped hurting. Worst on the right. I still have symptoms from the first dose, I can move my arm, I have limited ROM, my pectoral muscle is super tight and tender.

Other Meds: Estradiol patch (Estradiol transdermal system) , I have been on it for 28 years, multi vitamin, vitamin C, zinc, fish oil

Current Illness: None

ID: 1545605
Sex: M
Age: 81
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: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: booster dose due to previous 2 doses of Pfizer shows Zero antibodies in his system

Other Meds:

Current Illness:

ID: 1545606
Sex: M
Age: 66
State: FL

Vax Date: 02/10/2021
Onset Date: 08/02/2021
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: NKDA

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

Symptoms: Patient required hospitalization due to breakthrough infection. He received Pfizer vaccine (2nd dose in series) on 02/10/21. Hospitalized from 08/02/21 -08/06/21. Below is copied from discharge summary: Case of 67 yo male w progressive SOB and cough, admitted due to hypoxemic resp failure secondary to COVID 19 PNA.

Other Meds: amoxicillin (AMOXIL) 500 MG Oral Capsule Take 1 capsule by mouth 3 times daily for 10 days. 5/6/21 5/16/21 azithromycin (ZITHROMAX) 250 MG Oral Tablet Take 2 tablets (500 mg) on Day 1, followed by 1 tablet (250 mg) once daily on Days 2

Current Illness:

ID: 1545607
Sex: M
Age: 62
State: PA

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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Unknown

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

Symptoms: Pt woke up at 1am with headache, joint pain, sore arm, mild swelling at injection site, fever 101 degrees; Reported to pharmacy at 9am, symptoms had not resolved at all. Advised to treat symptoms with acetaminophen/NSAIDS as necessary

Other Meds: Baclofen, cymbalta, lorazepam, gabapentin, lisinopril, oxycodone, dorzolamide-timolol ophth drops

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm