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: 1546154
Sex: M
Age: 16
State: OR

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

Lab Data:

Allergies: phenergan and Zithromax

Symptom List: Dysphagia, Epiglottitis

Symptoms: Passed out and went into convulsions, woke up and couldn?t breathe well until albuterol was administered

Other Meds: None

Current Illness: None

ID: 1546155
Sex: M
Age: 51
State: NC

Vax Date: 04/13/2021
Onset Date: 04/01/2021
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: None

Symptom List: Anxiety, Dyspnoea

Symptoms: Diagnosed as Tinnitus. Ringing in both ears.

Other Meds: Omega 3 Multi Vitamin Vitamin D Metamucil Fiber Zyrtec

Current Illness: None

ID: 1546156
Sex: M
Age: 38
State: NC

Vax Date: 08/11/2021
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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Dose administered from vial that had been open for 24 hours from puncture time.

Other Meds:

Current Illness:

ID: 1546157
Sex: F
Age: 11
State: TX

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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: NO ADVERSE EVENTS REPORTED. PT IS UNDERAGE AND REPORTED TO US AS 12YO , PT IS REALLY 11YO

Other Meds:

Current Illness:

ID: 1546158
Sex: F
Age: 38
State: PA

Vax Date: 07/22/2021
Onset Date: 07/22/2021
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: Sulfa drugs, Cipro, Ceclor, shellfish, Naporsen, iodine, adhesive tape

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

Symptoms: At 11:49 am after first shot my lips itched and when I looked in the mirror my upper lip and area under my nose were swollen. My tongue and face swelled and tongue was bright red. Inside of my cheeks where bright red, throat was itching and roof of mouth itching and had hives on them. Inside of my nose and eyes itched. Then my whole upper body itched and had random red rashes on arms, especially my right arm. I had problems breathing, like my asthma, kicked in. I used my inhaler and that helped. Then my allergies kicked in and my right ear hurt from my sinuses being swollen and for a week it was like I was having a bad allergy n asthma attack. I took 2 Benadryl at night and that helped on top of my inhaler and all my allergy medicine.

Other Meds: Claritin, Montelukast, Aspirin, Flonase, Breo 25/100 , Folic Acid

Current Illness: N/A - healthy and take allergy shots once a month and no reaction to them.

ID: 1546159
Sex: F
Age: 33
State: CA

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: Vicodin, Benadryl, Valium

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

Symptoms: Patient felt lightheaded, heat going up from stomach and tightness in the throat. Called 911, vitals were checked. Patient felt better.

Other Meds: N/A

Current Illness: N/A

ID: 1546160
Sex: F
Age: 77
State: SC

Vax Date: 07/01/2021
Onset Date: 07/01/2021
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: NKDA

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Persistent weakness > 2 weeks.

Other Meds: Albuterol, Eliquis, Insulin Glargine, Gabapentin, Melatonin, Zocor, Aspirin, MULTAQ, Ferrous sulfate, Lasix, DUO-NEB, Levothyroxine, Nystatin, Probiotic, Entresto, and Anoro.

Current Illness:

ID: 1546161
Sex: F
Age: 29
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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: RPH intern administered pfizer instead of moderna for dose 2.

Other Meds:

Current Illness:

ID: 1546162
Sex: F
Age: 45
State: CA

Vax Date: 05/13/2021
Onset Date: 05/14/2021
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: percocet

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: 100* fever for 1 day, lethargy for 5 days, brain fog for approximately 1 month, increased blood sugar - immediately after and still occurring. Severe cramping and abnormal bleeding, including the cycle lasting 12-14 days, during 2 menstrual cycles following vaccine. Inflammation and pain in joints, mostly in wrists- incapacitating pain. Inflammation in joints continues sporadically in various joints.

Other Meds: n/a

Current Illness: n/a

ID: 1546163
Sex: M
Age: 50
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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Administered vaccine from vial that had been opened for 24 hours and 30 minutes since original puncture.

Other Meds:

Current Illness:

ID: 1546164
Sex: M
Age: 54
State: OR

Vax Date: 07/15/2021
Onset Date: 07/24/2021
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: Sulfur based antibiotics

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

Symptoms: A week after 1st dose, nauseated, sweats, severe runny nose, vomiting. Recurred again @3am 08/08/2021 awoke with severe runny nose, severe nausea, and sweating. Now every time I have a meal I sleep for hours and feel dopey just like I did the 1st 4 days after 1st dose. Elevated pulse, lack of energy, mild cognitive issues. Supposed to receive 2nd dose 08/12/2021 but will cancel until symptoms receed or treatment is given or recommended.

Other Meds: None

Current Illness: None

ID: 1546165
Sex: M
Age: 20
State: NY

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: SYR
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Patient fainted on the floor after 5 minutes of getting covid19 moderna vaccine. pulse and breathing were normal while he was unconscious. He woke up almost right away. He sat down on the chair and said that he didnt eat anything, we offered him orange juice. he felt better. emt was called right away and promptly arrived for assistance and evaluation. he left the store on his feet after about 10 minutes with the emt team.

Other Meds:

Current Illness:

ID: 1546166
Sex: M
Age: 60
State: OH

Vax Date: 07/23/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Patient states he can't see very well out of his left eye. Pinpoint vision. He went to the doctor and they said it was from the shot and not to get the second dose. Patient wanted me to report this because his doctor told him he wanted it reported.

Other Meds:

Current Illness:

ID: 1546167
Sex: M
Age: 19
State: CT

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: SYR
Vax Site: LA

Lab Data:

Allergies: none disclosed

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

Symptoms: Patient seemed to be doing well before, during, and immediately following vaccination. About 5 minutes after receiving the vaccine patient fell backwards in his chair and hit the ground. He lost consciousness for a few seconds. I called 911 and stayed with him until EMTs arrived. Patient had started feeling better, was able to get up, drink water etc. I followed up later in the evening and his parents informed me that he was feeling fine and did not have any additional issues.

Other Meds: unknown

Current Illness: unknown

ID: 1546168
Sex: F
Age: 40
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: 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: Vaccine administered from vial that had been punctured for 24 hours and 30 minutes.

Other Meds:

Current Illness:

ID: 1546169
Sex: F
Age: 32
State: CA

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: IM
Vax Site: LA

Lab Data:

Allergies: No

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

Symptoms: I'm 9 month postpartum and have been exclusively breastfeeding my baby. I've been always careful with lumps and never got mastitis. When I received my 1 shot of Pfizer vaccine I felt pain in my left breast immediately. In 3 hours pain got worse but I continued to latch baby on the affected breast to empty it. Next day I've developed fever 100.7 and noticed swelling of the breast tissue and redness. I contacted International Board Certified lactation consultant who advised me to go to the ER. I was admitted to the ER 2 days after I received my Pfizer shot and the ER doctor ruled out the diagnosis is the mastitis of the left breast.

Other Meds: Postnatal supplements from Ritual Inc. , Suflower lecithin

Current Illness: Perfectly healthy

ID: 1546170
Sex: M
Age: 36
State: MA

Vax Date: 08/11/2021
Onset Date: 08/11/2021
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: Chest pains occurring around 4 hours after vaccination. More acute than generalized, located on the left side of the chest, a few 3-4 fingers above & inside the left nipple. Filling this form out during the first 45-60min of symptoms, relatively acute pain has also ebbs/flows, comes in waves - eg few on, 1 off.

Other Meds:

Current Illness:

ID: 1546171
Sex: M
Age: 34
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: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Vaccine administered 7 days early. No reactions noted.

Other Meds: None noted

Current Illness: None noted

ID: 1546172
Sex: F
Age: 77
State: MO

Vax Date: 02/26/2021
Onset Date: 04/26/2021
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: epinephrine, sulfa

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: finger tingling

Other Meds: calcium, fish oil, magnesium, vit D, COQ10, vit C, zinc, green tea, red yeast rice,

Current Illness: none

ID: 1546173
Sex: M
Age: 30
State: CA

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:

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

Symptoms: no adverse event with vaccine. Intern administered pfizer instead of moderna for dose 2.

Other Meds:

Current Illness:

ID: 1546327
Sex: F
Age: 59
State: TN

Vax Date: 08/07/2021
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: Swelling in arm, neck and face. She went to walk in clinic first and was given a steroid shot. It didn't get better. She went to ER and was given several medications

Other Meds:

Current Illness:

ID: 1546328
Sex: M
Age: 57
State: NJ

Vax Date: 03/20/2021
Onset Date: 04/03/2021
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: none

Symptom List: Unevaluable event

Symptoms: evening of 3 Apr 21 woke up from sleep with sense that I could not breath; something wrong. i drove to local ER where I was admitted to ICU fo2 days, with numerous blood clots in both lungs and one on my right upper leg. I was not in any vehicle accident nor suffered any fall or injury prior to this diagnosis. I was in complete shock. No family history of blood clots.

Other Meds: indomathacin as needed

Current Illness: none

ID: 1546329
Sex: M
Age: 39
State: CA

Vax Date: 08/11/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKA

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

Symptoms: Pt. stated he had shortness of breath. Denied chest pain, dizziness. When approached pt. looked calm and showed no signs of distress. I started asking background information if patient had pmh of respiratory disease - asthma, COPD, etc. he denied and stated that it was just in his head. I verified if he had a fear of needles and last time he received a vaccine. He hasn't had a vaccines for since childhood and doesn't like needles. Offered to monitor him longer and see if he had trouble walking and talking in pharmacy. Patient states he feels fine and has already been monitoring for 20 minutes. He wanted to get fresh air and stay on hospital campus if anything changes.

Other Meds: Unknown

Current Illness:

ID: 1546330
Sex: F
Age: 31
State: NY

Vax Date: 12/30/2020
Onset Date: 06/22/2021
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 developed vertigo in June

Other Meds: Viibryd, Wellbutrin, amitryptylline, aurovela 24 fe, klonipin

Current Illness: None

ID: 1546331
Sex: F
Age: 60
State: MN

Vax Date: 01/29/2021
Onset Date: 08/07/2021
Rec V Date: 08/11/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Injection site pain, Menorrhagia

Symptoms: cold like symptoms, 2-3 days; nasal congestion, runny nose, headache, feels warm

Other Meds: Aspir-Low 81 mg; Estradiol; MedroxyProgesterone; Lipitor; Lisinopril

Current Illness: none

ID: 1546332
Sex: F
Age: 68
State: CA

Vax Date: 05/25/2021
Onset Date: 05/26/2021
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: After 2nd shot (lot# EW0183) on 05/25/2021, I had 102F fever for 2 days.

Other Meds: None

Current Illness: None

ID: 1546333
Sex: M
Age: 29
State: TX

Vax Date: 08/09/2021
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Headache, muscle aches, fatigue the next morning

Other Meds: Multivitamin

Current Illness: none

ID: 1546334
Sex: F
Age: 61
State: CA

Vax Date: 07/31/2021
Onset Date: 08/01/2021
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: RA

Lab Data:

Allergies: Polyethyleneglycol

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient received J and J vaccine July 31st around noon. Pt was waited 15 minutes and was fine when left the pharmacy. Patients symptoms started at night. Pt vomitted, had diarrhea and dehydration and numbness on the legs. Monday, pt was given 2 iv bags. Platelet count was low. Tue: pt was at ER for having dehydration, diarrhea and was given 1 iv bag of fluid. On Wed, was briefly was without symptoms, except being tired. Since then, patient continue to have dehydation, and vomitting up until the following Monday (August 9th, 2021). Pt was admitted to the ER. Oxy level dropped to around 60%. Pt was given oxygen. CT scan did not indicate any blood clot. Cardiac enzym was elevated. Scan also showed cardiac inflammation. Doctor determined patient might have experienced minor heart attack or cardiac inflammation. Pt has been transported to Cardiac clinic for further evaluation.

Other Meds: no made aware to provider

Current Illness: Healthy and fit individual

ID: 1546335
Sex: M
Age: 83
State: CO

Vax Date: 01/10/2021
Onset Date: 01/15/2021
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: RA

Lab Data:

Allergies: Codeine , sulfa , latex bandages

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

Symptoms: If possible would like to send photos of patient's/spouse's arms and fingers.

Other Meds: Long list provided upon request

Current Illness: CLL leukemia, Parkinson's

ID: 1546336
Sex: M
Age: 42
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:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Sulfas, sechlor, penicillin, vancomycin

Symptom List: Nausea

Symptoms: Recurrent tinnitus. 3 times on 8/10/21 and 5 times on 8/11/21

Other Meds: Multivitamin and vitamin d

Current Illness: None

ID: 1546337
Sex: F
Age: 36
State: MO

Vax Date: 01/29/2021
Onset Date: 07/25/2021
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: Shellfish

Symptom List: Injection site pain

Symptoms: Stomach issues, will need EGD

Other Meds: Gilenya, gildess ,mirtazapine

Current Illness:

ID: 1546338
Sex: F
Age: 51
State: PR

Vax Date: 03/26/2021
Onset Date: 04/06/2021
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: Corticosteroid

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

Symptoms: Migraine (daily headache) it's oppressive and persistent, blurry vision.

Other Meds: Ambien 10mg, Cymbalta 60mg, Neurontin 300mg

Current Illness: Osteoarthritis, Lumbar Herniated disc, Sciatic nerve, Insomnia

ID: 1546339
Sex: M
Age: 17
State: CA

Vax Date: 07/31/2021
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: none

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

Symptoms: Patient developed severe Bell's Palsy beginning approximately 8 days after 2nd dose of Pfizer COVID19 vaccination. Patient with near complete paralysis of left facial nerve. Unable to close eye.

Other Meds: none

Current Illness: none

ID: 1546340
Sex: F
Age: 12
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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: N/A

Symptom List: Tremor

Symptoms: 12 yr old received Pfizer vaccine, within 5 minutes pt lost conscious and became unresponsive with possible mild seizure. Patient received 0.15mg EpiPen -within minutes patient become more responsive. EMS arrived and transported patient to nearest hospital.

Other Meds: N/A

Current Illness: N/A

ID: 1546341
Sex: M
Age: 11
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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: dairy, soy, nuts, eggs, shellfish

Symptom List: Erythema, Pruritus

Symptoms: Patient and Guardian both verified birth date of 06/28/2009 but insurance has DOB as 06/28/2010 making patient underage for current guidelines

Other Meds: na

Current Illness: na

ID: 1546342
Sex: F
Age: 73
State: IL

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: none reported

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

Symptoms: Patient was supposed to receive Shingrex Vaccine. Instead patient received a 3rd Pfizer Covid shot in error. Patient is ok. Doctor was called.

Other Meds: none

Current Illness: none reported

ID: 1546343
Sex: F
Age: 20
State: KS

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

Lab Data:

Allergies: no

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

Symptoms: Adminstered vaccine at 5:30 pm, patient bled from injection site, mother also with client and got vaccine, client watched this writer clean blood off her arm and mother get her shot, stated at that time 5:33 pm "I feel light headed" and then her head went down and she was limp, removed her mask so she could breathe, pulse present, sweaty, turned fan on and went for a wet rag, client became conscious at 5:37 pm, reported felt some better at 5:38 pm, at 5:40 pm vomited. BP at 5:35 pm 106/80 p 87. At 5:45 BP 83/52 P 57. Gave client 2 6 oz glasses of water which she drank at 5:55 pm walked client to car accompanied by mother, reported feeling better. Advised if sx. worsen to go to ER, reports history of fainting in past.

Other Meds: no

Current Illness: no

ID: 1546344
Sex: F
Age: 66
State: NV

Vax Date: 01/07/2021
Onset Date: 01/21/2021
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: Mirphine

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Double vision inability to focus. Diagnosed ocular mysthinia Gravis

Other Meds: Calcium Fish oil Glucosamine chondrotin Tumeric

Current Illness: None

ID: 1546345
Sex: M
Age: 41
State: TX

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

Lab Data:

Allergies: None

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

Symptoms: About noon today (18 hours after dose), massive headache, fever, injection site soreness - as well as joint pain. Took Tylenol for this, seemed to help. Then approximately 9:00pm (26 hours from dose), developed dizziness and confusion, as well as shortness of breath

Other Meds: None

Current Illness: None

ID: 1546346
Sex: M
Age: 78
State: CA

Vax Date: 03/15/2021
Onset Date: 08/11/2021
Rec V Date: 08/11/2021
Hospital: Y

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: n/a

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

Symptoms: Breakthrough covid case being hospitalized for covid

Other Meds: n/a

Current Illness: n/a

ID: 1546347
Sex: M
Age: 58
State: OH

Vax Date: 03/07/2021
Onset Date: 03/31/2021
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: None

Symptom List: Pain in extremity

Symptoms: Developed A-fib and congestive heart failure, diagnosed in August 2021

Other Meds: None

Current Illness: None

ID: 1546348
Sex: F
Age: 72
State: FL

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: 2
Vax Route:
Vax Site:

Lab Data:

Allergies: NKA

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

Symptoms: 08/9/21 10PM Left arm to shoulder started to ache, increased in severity then I was unable to move left arm(felt like it was frozen in place). My arm was in a bent position. Felt very cold. Took 2 Tylenol. About 11:30PM, felt no better but decided to go to bed. Fell asleep about midnight. My husband woke me about 8AM. Was able to move arm then the remainder of the day my muscles ached. Relief with ibuprofen. 8/11 Felt fine.

Other Meds: Metoprolol, Flecanide, Spiroaldactone, Lipitor, Baby ASA, Colace, Omega, Amitriptyline

Current Illness: No

ID: 1546349
Sex: F
Age: 17
State: MD

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

Lab Data:

Allergies: Amoxicillin, Pollen, Mold, Mosquito bites

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

Symptoms: After I got vaccinated, I was fine for about five minutes. Then, my hands got all tingly and numb. My shoulders both got really hot and I sweated profusely despite being in the car driving home. When I got home, it hurt to the touch. The next day, nothing changed though the numbness disappeared. My arm had swollen up to a huge lump. It is still swollen today at the time of writing this (08/11/2021).

Other Meds: None

Current Illness: None

ID: 1546350
Sex: F
Age: 27
State: HI

Vax Date: 02/11/2021
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: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Fully vaccinated and tested positive for COVID-19. Symptoms of scratchy throat started on 8/8/21. Tested positive for COVID-19 on 8/10/21. As of 8/11/21 has symptoms of sore throat, cough, and congestion.

Other Meds:

Current Illness:

ID: 1546522
Sex: F
Age: 69
State: AZ

Vax Date: 02/12/2021
Onset Date: 02/15/2021
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: Sustiva medication-rash

Symptom List: Vomiting

Symptoms: I developed a rash which circulated around my arm. Was given medication and it went away.

Other Meds: Genvoya, Eliquis, Pravastatin, Provera, Cephalexin, B-complex, Vit D3, Calcium

Current Illness: HIV + for 26 years. DVT, Osteoperosis

ID: 1546523
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: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: The 2nd moderna vaccine was given 1 week early.

Other Meds:

Current Illness:

ID: 1546524
Sex: M
Age: 41
State: LA

Vax Date: 08/11/2021
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: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

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

Symptoms: Extreme pounding headache, swollen eyes, blood shot eyes, and dry eyes.

Other Meds: None

Current Illness: None

ID: 1546525
Sex: M
Age: 30
State: NJ

Vax Date: 08/03/2021
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: Penicillin

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Migraine headache (still current as of report). Started gradually and worsened over time.

Other Meds: Lisinopril 10mg

Current Illness:

ID: 1546526
Sex: M
Age: 49
State: IL

Vax Date: 01/01/2021
Onset Date: 01/14/2021
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: Nka

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

Symptoms: After 7 hours I developed numbness in my arm and hand as well as left back. The numbness lasted several days.

Other Meds: Vit d Fish oil Creator hCTZ aspirin

Current Illness: None

ID: 1546527
Sex: F
Age: 23
State: WA

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

Lab Data:

Allergies: none

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

Symptoms: Pt received vaccine and immediately became dizzy and fainted briefly, during this time she urinated. She stayed seated and I helped her sit back and relax. after a minute or so she became nauseous and vomited twice over the next 5 minutes. blood pressure stayed around 85/55 for the next 10 minutes before leveling at 90/55. She did not know what it usually is, she left accompanied by a friend 30 minutes after vaccine feeling better. I will follow up with her on 8/12/21

Other Meds: unknown

Current Illness: unknown

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm