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: 1549146
Sex: F
Age: 59
State: CA

Vax Date: 05/19/2021
Onset Date: 06/08/2021
Rec V Date: 08/12/2021
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: Sulpha

Symptom List: Dysphagia, Epiglottitis

Symptoms: Vocal paralysis for 3 months now

Other Meds: 40mg citalopram 900mg oxcarbazepine

Current Illness: None

ID: 1549147
Sex: M
Age: 30
State: TN

Vax Date: 08/12/2021
Onset Date: 08/12/2021
Rec V Date: 08/12/2021
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 known

Symptom List: Anxiety, Dyspnoea

Symptoms: Pt presented to pharmacy for his shot appointment (as required by his employer). Less than one minute post injection, patient turned to leave store and collapsed. He basically leaned right as right side of head impacted wall. As he was falling, he rotated a bit and the back of his head hit lower wall - actually damaging the sheetrock. Patient had lost control of all motor functions, became unconscious as his eyes dilated and rolled back in his head, and he was moaning. Looked very much like an epileptic event. 911 was called while patient was unconscious. Approximately 1 minute later patient recovered enough to be oriented x3, unaware of what had happened. He was then able to sit up, but pale and sweaty even though building is cool. Fire and EMT arrived on scene in less than 5 minutes from call and proceeded to evaluate patient according to their protocols. Pt declined several offers to go to hospital or clinic. Post evaluation Pt was provided cold water at their suggestion.

Other Meds: None known

Current Illness: None known

ID: 1549148
Sex: M
Age: 51
State: SD

Vax Date: 08/02/2021
Onset Date: 08/02/2021
Rec V Date: 08/12/2021
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: NONE

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

Symptoms: FEVER STARTED AS LOW GRADE 1 HOUR AFTER INJECTION. ELEVATED TO A HIGH OF 103.7f AT 3 HOURS AFTER. TREATED WITH ADVIL AND ASPRIN. LEFT AND RIGHT HAND JOINT PAIN INTERMITTENT, AND PERSISTS TO CURRENT. TREATMENT HAS NOT BEEN SOUGHT AS IT HAS NOT BEEN NEEDED.

Other Meds: TESTOSTERONE, MULTIVITAM

Current Illness: NONE

ID: 1549150
Sex: F
Age: 57
State: MD

Vax Date: 08/12/2020
Onset Date: 08/12/2021
Rec V Date: 08/12/2021
Hospital:

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

Lab Data:

Allergies: Macrobid, cephalosporins, Advil

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient started to develop nausea and a headache about 10 minutes after vaccination. About 15-20 minutes after vaccination, she complained of shortness of breath and difficulty swallowing. 0.3mg epi administer and patient sent to the hospital.

Other Meds: vitamin d

Current Illness: none

ID: 1549152
Sex: M
Age: 44
State: FL

Vax Date: 07/22/2021
Onset Date: 07/23/2021
Rec V Date: 08/12/2021
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: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Pt. states that after receiving the 2nd dose of Moderna 07/22/2021, started experiencing symptoms 07/23/2021 of Pericardial, Myocardial, Heart Palpations, and vascular constrictions in both arms. Pain lasting 2 weeks with minor pains still continuing. No Primary visit noted.

Other Meds: N/A

Current Illness: N/A

ID: 1549153
Sex: F
Age: 67
State:

Vax Date: 02/01/2021
Onset Date:
Rec V Date: 08/12/2021
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: Swollen lymph nodes, pain at injection site, suffered a stroke.

Other Meds: None.

Current Illness:

ID: 1549154
Sex: M
Age: 40
State: TN

Vax Date: 07/01/2021
Onset Date: 08/08/2021
Rec V Date: 08/12/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Fever of 102, sore throat, inability to swallow, ear pain (left), headaches, flu-like aches

Other Meds: None

Current Illness: None

ID: 1549155
Sex: M
Age: 63
State: TX

Vax Date: 06/16/2021
Onset Date: 06/18/2021
Rec V Date: 08/12/2021
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

Symptom List: Pharyngeal swelling

Symptoms: Shortness of breath heart palpitations a fib

Other Meds: Advair 250/50 Singular 10mil Tramadol 50 mil

Current Illness: Asthma

ID: 1549156
Sex: F
Age: 45
State: TX

Vax Date: 02/10/2021
Onset Date: 03/02/2021
Rec V Date: 08/12/2021
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: 3/4/21- experienced skipped heartbeats which later found out are pre-ventricular contractions (PVC) that preceded chest pain with shortness of breath that would last between 2-3 minutes. Went to my PCP and ER and no one could tell me what was happening. Occurred from 3/2/2021 -7/16/21. I?m a pharmacist who counsels and administers all covid vaccines and when VIS was updated to include myocarditis/ pericarditis and symptoms,, as I was counseling a patient it dawned on me that those were my symptoms. My doctors could not find anything but I began treatment for pericarditis on my own,. On 7/14/21 I started taking ibuprofen 600mg three times a day for 14 days . I have not had any episodes since 7/16/21.

Other Meds: Singular Advair Spironolactone- for hair loss Adderall Pristiq Wellbutrin

Current Illness: None

ID: 1549157
Sex: M
Age: 57
State: IL

Vax Date: 04/07/2021
Onset Date: 06/01/2021
Rec V Date: 08/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None known. Came down with Guillain-Barre syndrome the one time I got the influenza vaccine. Put me in the hospital for a week. Fully recovered.

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Heart arrhythmia occurring several weeks after second dose. Can't say that it is due to the vaccine. Occasional feel of irregular or fast heart beats. Have had EKG, Holter Monitor and Echocardiogram. Results of Holter below. Symptoms have settled but occur on occasion.

Other Meds: allopurinol 300 MG / 1 daily losartan Potassium 50 MG / 1 daily pantoprazole 40 MG / 1 daily Triamcinolone Acetonide 55 MCG/ACT Aero / 2 sprays daily PROBIOTIC-10 OR / 1 daily

Current Illness: None.

ID: 1549158
Sex: F
Age: 16
State: NJ

Vax Date: 08/11/2021
Onset Date: 08/11/2021
Rec V Date: 08/12/2021
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: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: PT STATES FEVER, BODY ACHES, SOB, LOCALIZED RASH 3 HOURS AFTER RECEIVING VACCINES--SEEN IN ED

Other Meds: NONE

Current Illness: NONE

ID: 1549159
Sex: F
Age: 62
State: NY

Vax Date: 01/29/2021
Onset Date: 03/01/2021
Rec V Date: 08/12/2021
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: NKDA

Symptom List: Rash, Urticaria

Symptoms: I began to have finger joint pain and inflammation. Mostly my index and middle fingers would become achy, red and warm to touch. It would switch back and forth from my right hand to my left. Only occurring on one hand at a time. It was intermittent symptoms with no symptoms at times. One evening my fingers on my right hand began to ache within several minutes the aching moved to my hand with more intensity. Then moved into my right wrist that was very painful and continued for about 2 hours then totally stopped abruptly. All these symptoms lasted over a span of 2 months. Since then I?ve had some intermittent minor finger joint aching.

Other Meds: None

Current Illness: None

ID: 1549160
Sex: F
Age: 54
State: OH

Vax Date: 08/09/2021
Onset Date: 08/11/2021
Rec V Date: 08/12/2021
Hospital:

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

Lab Data:

Allergies: NSAIDS

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

Symptoms: Patient called on 8/12/21 saying she had a reaction to her 2nd COVID19 Pfizer vaccine given on 8/9/21. She said she started to notice yesterday (8/11/21) a rash like spot under the injection site. She described it as red, hard, sore, and hot to touch. It is still there today (8/12/21) and she called to tell us.

Other Meds: ESTRADIOL, PROGESTERONE,

Current Illness:

ID: 1549161
Sex: F
Age: 53
State: WI

Vax Date: 05/08/2021
Onset Date: 07/01/2021
Rec V Date: 08/12/2021
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:

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

Symptoms: Pain in left leg, difficulty walking. Stent clogging

Other Meds: Blood pressure, cholesterol, anti depression, baby aspirin, multivitamin

Current Illness:

ID: 1549162
Sex: F
Age: 64
State: WV

Vax Date: 02/13/2021
Onset Date: 02/13/2021
Rec V Date: 08/12/2021
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: norvasc - penicillin - ibuprofen - ampicillin and similar drugs

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

Symptoms: Approximately 1 hour after getting my second vaccine I began feeling tingling and numbness on the right side of my face. The next morning my right eye was irritated. I thought I had some allergy irritant affecting it. My eye continued to get worse through the week as the eye swelling got worse, the eye was itching/burning and was developing small spots on the eyelid. I contacted Dr's office and was told it was a shingles like virus. She put me on an antiviral medication for 2 weeks. The eye cleared up to a point, but I have had ongoing issues with it. I have repeated the antiviral medication again recently with some of the same symptoms. However, this week, I am having new issues with my right eye. It is having pain constantly, pressure behind my eye, burning, itching and pain in my temple and below my eye. I went back to Dr. 8-11-21 at which time she preformed eye scans, vision test and blood work. I was informed by her this morning I could possibly have Giant Cell Arteritis. More tests to follow next week to recheck. She also said my cataract has grown that she did not see before.

Other Meds: METFORMIN HCL ER MAGNESIUM OXIDE VITIMAN D3 ELIQUIS LANSOPRAZOLE ATENOLOL CHLORTHAL LEVOTHYROXINE GLIMEPIRIDE KLOR-CON M20 GABAPENTIN Albuterol sulfate hfa Symbicort Tylonal

Current Illness: high blood pressure - type 2 diabetes - thyroid issues - asthma - afib - GERD

ID: 1549163
Sex: F
Age: 67
State: VA

Vax Date: 08/12/2021
Onset Date: 08/12/2021
Rec V Date: 08/12/2021
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: BEES, SEASONAL ALLERGIES

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

Symptoms: 20-25 MIN AFTER VACCINE GIVEN, CLIENT BEGAN TO FEEL FLUSHED, BODY TINGLING, ITCHY, AND THROAT "TICKLING". VITALS WERE MONITORED FOR 30 MIN AND BENEDRYL GIVEN AT 11:22 AM. CLIENT BEGAN TO FEEL BETTER AND LEFT THE HEALTH DEPT AT 1145 WITH DAUGHTER. CLIENT WAS GOING HOME AND DAUGHTER WOULD BE WITH HER AT HOME TODAY.

Other Meds: NA

Current Illness: NA

ID: 1549164
Sex: F
Age: 15
State: NY

Vax Date: 07/09/2021
Onset Date: 08/03/2021
Rec V Date: 08/12/2021
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: None

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

Symptoms: Pt developed bruising about 3 weeks after vaccination

Other Meds:

Current Illness:

ID: 1549165
Sex: F
Age: 40
State: VI

Vax Date: 07/16/2021
Onset Date: 07/19/2021
Rec V Date: 08/12/2021
Hospital:

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

Lab Data:

Allergies: Bactrum

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Appoximately 3 days after first dose, noticed heart arrhythmia, especially upon first waking in morning and moving into vertical position, during yoga when body goes from horizontal to vertical positions. Cannot walk up a flight of stairs or exercise without my heart going out of rhythm. Episodes last about 20 minutes. My blood pressure machine picked up the arrhythmia. When I went to urgent care to see if it was safe to take second dose, Doctor performed EKG which was normal, but referred me to a cardiologist, and said I should take my second dose. I am still having daily arrhythmia's. Side effect two. Sharp shooting pains up my neck into my head, subsides after a few seconds, but is very painful when happening. Started a week after 1st dose and has not subsided. Happens up to 30 times a day.

Other Meds: none

Current Illness: none

ID: 1549166
Sex: F
Age: 82
State: WI

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

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

Lab Data:

Allergies: Aleve

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Itching from the 2nd dose, Nausea from the 1st dose. Since recovered from the nausea. Not recovered from the itching.

Other Meds: Terazosin, Hydrochloroeh, Metoprolol, Levophyroxine, Famotidine, Super B Complex

Current Illness: None

ID: 1549167
Sex: F
Age: 60
State: WA

Vax Date: 03/01/2021
Onset Date: 03/05/2021
Rec V Date: 08/12/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: 2 weeks after 2nd shot I experienced arm pain from the elbow down for about a week until the pain changed to pain at the injection site followed by pain radiating down my entire right arm. Pain type changed from a more general pain type to a "pins & needles" tingly pain that radiated down my arm. Tingly nerve type pain. Pain was intense & primarily occurring when my arm was bent at a right angle. Did not see physician. Symptoms lasted 3 weeks & then faded away. Have not had any issues with this pain until now. On 8/10 the lower arm pain came back briefly followed by slight tingly nerve pain. I've been having slight nerve pain for a couple days so far. I also am having cold symptoms now with runny nose, headache, sore throat. Wondering if this could be Covid Delta virus & its brought back some mild symptoms from the vaccination last year.

Other Meds: none

Current Illness: none

ID: 1549168
Sex: F
Age: 62
State: MA

Vax Date: 04/01/2021
Onset Date: 04/29/2021
Rec V Date: 08/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Severe muscular pain and stiffness in legs, arms, hands and neck. Has been occurring (in 2021): ? From late-April onward in legs. ? From mid-May onward in arms and legs. ? From late-May onward in neck, hands, arms and legs. Occurs after being sedentary: ? Especially severe in legs, arms, hands and neck upon waking each morning. ? Also severe in legs upon rising from being seated throughout each day.

Other Meds: Metoprolol, Lisinopril and Hydrochlorothiazide C, Calcium and D3

Current Illness: Mastitis

ID: 1549169
Sex: F
Age: 12
State: TX

Vax Date: 08/12/2021
Onset Date: 08/12/2021
Rec V Date: 08/12/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: The site became red immediately. After about 5 min the site became warm to the touch and had some swelling, there was a slight rash developing in the lower part of her left arm with in 10 min. Patient declined feeling pain or sick or any swelling of the throat. Patient given 25mg of Benadryl orally and observed for another 10 min and was escorted home by her mother.

Other Meds:

Current Illness:

ID: 1549171
Sex: F
Age: 55
State: CO

Vax Date: 02/23/2021
Onset Date: 03/01/2021
Rec V Date: 08/12/2021
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: Shellfish; narcotics (intolerance)

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

Symptoms: Tinnitus

Other Meds: None

Current Illness: None

ID: 1549172
Sex: M
Age: 17
State: KS

Vax Date: 08/10/2021
Onset Date: 08/10/2021
Rec V Date: 08/12/2021
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: NKA

Symptom List: Injection site pain, Pain

Symptoms: 8/10/21 1700-arm hurt, didn't feel well while at work 8/10/21 Late Evening and into the night, did not recall exact time-diaphoretic, Facial swelling, headache Morning 8/11/21-facial swelling still present, but had gone down, feet and hands itching, lethargic. Pt made mother aware of symptoms, she called clinic at approx. 0930 we had him come into clinic for 1000 appt. Patient was examined and administered a dose of Depo Medrol. 8/12/21 spoke with patients mother 1115. Pt woke mother up early complaining that his "bones hurt". His arm is still swollen, but he had noted a rash starting in different areas all over his body, still complains of hands itching. Mother gave him Tylenol and antihistamine around 0630. Patient did go into work. His mother said he is suppose to check in with her during his lunch.

Other Meds:

Current Illness: NONE

ID: 1549173
Sex: M
Age: 62
State: OK

Vax Date: 03/28/2021
Onset Date: 08/11/2021
Rec V Date: 08/12/2021
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: PT VERBALLY STATES HE RECEIVED PRIME AND BOOSTER DOSE OF MODERNA COVID 19 IN DALLAS WITH LAST DOSE ADMINSITERED ON OR ABOUT 03-28-2021. PT TESTED POSITIVE FOR COVID 19 DISEASE 08-11-2021 PCR AND IgG POSITIVE.

Other Meds:

Current Illness:

ID: 1549174
Sex: F
Age: 17
State: TN

Vax Date: 08/07/2021
Onset Date: 08/08/2021
Rec V Date: 08/12/2021
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: Dairy

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

Symptoms: Vomiting, drop in blood pressure, almost passing out

Other Meds: Seysara, propranolol, omeprazole, multivitamin, pre and probiotics

Current Illness: None

ID: 1549175
Sex: F
Age: 33
State: AL

Vax Date: 05/28/2021
Onset Date: 05/29/2021
Rec V Date: 08/12/2021
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: Cephalosporins

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: The vaccine caused me to go into DKA (Diabetic Ketoacidosis). I had to go into ICU. The doctors said that I was less than 24 hours away from DYING!!

Other Meds: Novolog Ramipril ? 2.5MG Larin FE ? 1.5 ProAir inhaler Generic allergy pill ? 10MG Buspirone ? 10MG Lamotrigine ? 200MG Gabapentin ? 600MG Generic nose spray ? 50MCG Mirtazapine ? 15MG Venlafaxine ER ? 75MG

Current Illness: No

ID: 1549176
Sex: F
Age: 48
State: TN

Vax Date: 06/12/2021
Onset Date: 06/13/2021
Rec V Date: 08/12/2021
Hospital:

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

Lab Data:

Allergies: Lactose allergy

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Was not feeling well within 12 hours. Started feeling run down, just physically sick. Within the next few hours was having shortness of breath. Within less than 48 hours of the 2nd vaccine, went to Urgent Care. They did some basic tests and then said that I should go and be checked out at the ER due to the shortness of breath concerns. I went to the ER and they did a series of labs and tests. I told them that I had the 2nd vaccine on the 12th and that's when I started having additional symptoms. They did a CT scan and some lab work. They sent me home 5 hours later saying that the tests and labs showed a UTI and shortness of breath but only gave an antibiotic. The only reason I ended up in urgent care and the ER was due to my reaction to the vaccine.

Other Meds: Propranalol 40 mg 1x a day

Current Illness: none

ID: 1549177
Sex: M
Age: 30
State: KY

Vax Date: 05/19/2021
Onset Date: 08/10/2021
Rec V Date: 08/12/2021
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:

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

Symptoms: - No symptoms

Other Meds:

Current Illness:

ID: 1549178
Sex: F
Age: 37
State:

Vax Date: 08/09/2021
Onset Date: 08/09/2021
Rec V Date: 08/12/2021
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: 6-8 hours after receiving vaccination body began twitching, began to subside after a couple of hours. Twitching has reoccurred.

Other Meds: None.

Current Illness: None.

ID: 1549179
Sex: M
Age: 14
State: PA

Vax Date: 06/30/2021
Onset Date: 07/03/2021
Rec V Date: 08/12/2021
Hospital:

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

Lab Data:

Allergies: No

Symptom List: Injection site pain

Symptoms: 3 days after 2nd vaccine my son had stabbing chest pain. We was transported by ambulance from a local ER to hospital with high traponin levels. He was diagnosed with Myocarditis from the vaccine.

Other Meds: Zertek

Current Illness:

ID: 1549180
Sex: M
Age: 25
State: UT

Vax Date: 08/11/2021
Onset Date: 08/11/2021
Rec V Date: 08/12/2021
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 meds

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

Symptoms: Cramping on left side of chest, irregular, rapid heart beat. Muscle soreness, fever, shortness of breath. No treatment

Other Meds:

Current Illness:

ID: 1549181
Sex: M
Age: 17
State: NJ

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: My son and I received his vaccination card and when we got home (after the pharmacy was closed for the night) we realized that the pharmacy had marked his card as receiving the Janssen COVID Vaccine and not the Pfizer as scheduled and confirmed upon arrival. Needless to say, we both barely slept all night not knowing what shot my son had actually received. I went first thing this morning to the pharmacy and spoke with the pharmacist on duty (not the same pharmacist that administered the shot the night prior) and she was very appologetic and corrected the situation and corrected my son's vaccination card. This never should have happened and I would like a governmental explanation as to how they are SO sure that my son ACTUALLY received the right injection. Thank you very much.

Other Meds:

Current Illness:

ID: 1549182
Sex: F
Age: 74
State: MO

Vax Date: 02/17/2021
Onset Date: 02/17/2021
Rec V Date: 08/12/2021
Hospital: Y

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

Lab Data:

Allergies: penicillin, sulfur

Symptom List: Tremor

Symptoms: Within 15 minutes of injection, I started getting a racing heart with strong palpitations and blood pressure and heart rate went up. I let staff know I was not feeling well. They escorted me into another room and took my vitals. Blood pressure and heart rate were high. I had nitro pill so I took one, and it went down a little but still high. The staff called 911. They wanted to escort me to Hospital but I felt a little better so my husband drove me to another Hospital because they have my records and my heart dr is there.

Other Meds: diltiazem 180 mg, LArgine 1000 mg, nitro patch, 81 mg aspirin, pantolozole 40 mg, isosorbide monitrate 60 mg, atorvastin 40 mg, clopidogrel 75 mg, melatonin 5 mg, tylenol pm 500 mg

Current Illness: none

ID: 1549183
Sex: F
Age: 73
State: WV

Vax Date: 04/09/2021
Onset Date: 04/10/2021
Rec V Date: 08/12/2021
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:

Symptom List: Erythema, Pruritus

Symptoms: Patient had swelling and redness that encompassed entire arm. Went to emergency room. During visit was discovered that she was having heart damage. According to the patient the doctor told her it was from the vaccine.

Other Meds:

Current Illness:

Date Died:

ID: 1549185
Sex: M
Age: 86
State: TN

Vax Date: 04/20/2021
Onset Date: 08/09/2021
Rec V Date: 08/12/2021
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: FULLY VACCINTED CASE DECEASED 8/9/21

Other Meds:

Current Illness:

ID: 1549186
Sex: F
Age: 49
State: NM

Vax Date: 08/11/2021
Onset Date: 08/12/2021
Rec V Date: 08/12/2021
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: Fluconazole, clarithromycin, sulfa

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

Symptoms: Muscle aches, joint pain, chest pain, fatigue, weakness in legs. Calcium channel blocker needed for chest pain

Other Meds: Ivermectin, azithromycin, malarone, nystatin, vitamins C, D3, zinc, potassium, magnesium, multivitamin, monolaurin, liposomal glutathione, sacro B, probiotics

Current Illness: Lyme disease, babesiosis, coronary vasospasm

ID: 1549187
Sex: F
Age: 46
State: CA

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

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

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient complained of tingling of lips, RN walked patient over to urgent care for further evaluation.

Other Meds:

Current Illness:

ID: 1549189
Sex: F
Age: 47
State: IL

Vax Date: 04/01/2021
Onset Date: 04/15/2021
Rec V Date: 08/12/2021
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: Mushrooms

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

Symptoms: After dose 1 ( got both doses), I started experiencing shortness of breath when exercising and doing simple tasks that I normally do without a problem. I have had issues with exercise induced asthma that the inhaler helps with but this time the shortness of breath was worse, inhaler hasn't helped and breathing issue sometimes appears when I have not exercised. Had a PFT test (non-running) took 2 sample inhalers and singular-didn't help so discontinued. Saw PCP and we are awaiting exercise PFT test. Breathing issue still with me. Saw ENT for taste issue. Still ongoing with him. I have 30+ foods that taste like the smell of spoiled milk or cleaning solution. My smell is also off as many things such as my perfume, lotion, etc. smell rancid. I am taking alpha lipoic acid, zinc and doing flonase to help with these issues. No change so far. I did have COVID in September of 2020 and lost my taste and smell for over a month. While the taste came back fine, my smell never came back 100%. I also had breathing issues in which I had to get medication from my doctor to help me with. It seems after my vaccine, it's brought my shortness of breath symptom back and messed up my taste.

Other Meds: Fish oil, Vitamin D, lamoTRIgine 100 mg, buPROPion HCL 150 mg, Breo Ellipta 200-25 mcg/dose, multivitamin w/iron & 9 mg iron-400 mcg tab

Current Illness: None

ID: 1549190
Sex: F
Age: 55
State: VA

Vax Date: 06/04/2021
Onset Date: 06/07/2021
Rec V Date: 08/12/2021
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: latex, ancef, sulfur drugs, nuts, tomatoes,

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

Symptoms: mouth and right eye twitching constantly, head feels funny, numbness in shoulder

Other Meds:

Current Illness:

ID: 1549191
Sex: F
Age: 31
State: SC

Vax Date: 08/06/2021
Onset Date: 08/11/2021
Rec V Date: 08/12/2021
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 & Morphine Allergy

Symptom List: Pain in extremity

Symptoms: Immediately following treatment, I suffered severe intense arm pain which after 4 hours, my entire arm was stiff and a large egg sized know appeared. On day six, the know turned red and became itchy with a rash. The following day, the size of the rash is very large and has spread over night and the knot is still present. For the first three days following the vaccine, I suffered severe exhaustion but other than these issues, no other side effects occurred.

Other Meds: None

Current Illness: None

ID: 1549192
Sex: F
Age: 34
State: PA

Vax Date: 08/05/2021
Onset Date: 08/05/2021
Rec V Date: 08/12/2021
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: Pt complained of dizziness approximately 5 minutes after injection. Patient laid down and was given a cool towel for her forehead. Symptoms resolved 10 min later.

Other Meds:

Current Illness:

ID: 1549194
Sex: M
Age: 76
State: KY

Vax Date: 02/02/2021
Onset Date: 08/09/2021
Rec V Date: 08/12/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: Received COVID vaccine 01/12/2021 and 02/02/2021 Tested positive for COVID 19 08/09/2021 Asymptomatic

Other Meds: B/P med Seizure med

Current Illness: N/A

ID: 1549195
Sex: M
Age: 58
State: MI

Vax Date: 04/29/2021
Onset Date: 08/11/2021
Rec V Date: 08/12/2021
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:

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

Symptoms: patient presented with shortness of breath, and tested positive for COVID-19

Other Meds:

Current Illness:

ID: 1549196
Sex: M
Age: 28
State: NC

Vax Date: 07/15/2021
Onset Date: 07/15/2021
Rec V Date: 08/12/2021
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: unknown/unknowable

Symptom List: Vomiting

Symptoms: Upon documentation of second dose in our state covid vaccination portal, it was shown that the patient had received his first dose on a day inconsistent with the date on the card he presented, and only 5 days prior to this administration. Recent analysis of the state vaccine portal now shows that he has received additional doses of both the Pfizer and the Janssen vaccines at multiple other locations.

Other Meds: unknown/unknowable

Current Illness: unknown/unknowable

ID: 1549197
Sex: F
Age: 55
State: VA

Vax Date: 06/26/2021
Onset Date: 06/26/2021
Rec V Date: 08/12/2021
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: latex, ancef, sulfur drugs, nuts, tomatoes,

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: mouth, eye twitching-shoulder numb, arm and hand twitching, rt side body twitching, muscle spasms

Other Meds:

Current Illness:

ID: 1549198
Sex: M
Age: 21
State: CO

Vax Date: 08/11/2021
Onset Date: 08/11/2021
Rec V Date: 08/12/2021
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: Patient given Janssen vaccine at 12:05pm. At 12:10, patient became diaphoretic, lightheaded, and lost all color in face. We lowered patient to ground slowly, laid him flat on the carpet, and elevated feet on chair. Patient passed out. Checked vitals at 12:10pm. BP 110/72, O2 96, Pulse 62, RR 16. Patient regained consciousness and was confused/had no recollection about what had occurred. Assumed blood sugar was also low in combination with the low blood pressure, so I administered two glucose tablets and had the patient drink some apple juice. Checked vitals again at 12:20pm. BP 115/90, O2 92, Pulse 62, RR 14. BP increased and patient expressed that he was no longer lightheaded and felt much better. Checked vitals again at 12:30pm. BP 120/87, O2 96, Pulse 70, RR 14. Since the patient's BP and O2 levels increased to normal, I had him call someone to pick him up so he wouldn't have to drive home. I slowly assisted the patient to get up from the floor. Made sure he was stable enough to walk, was no longer lightheaded or symptomatic and that his color had returned in his face. I assisted him to the car and explained to his roommate what had occurred and the interventions we had done, including administering two glucose tablets and apple juice. Told patient to take it easy for the day and get some rest. Documented in the patient's chart the adverse reaction to the Janssen vaccine. Also documented on Emergency flow sheet. VAERS report completed.

Other Meds: NONE

Current Illness: NONE

ID: 1549199
Sex: F
Age: 57
State: OK

Vax Date: 08/12/2021
Onset Date: 08/12/2021
Rec V Date: 08/12/2021
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: Client was given Moderna for 1st dose on July 14th 2021. Client was inadvertently given Pfizer for second dose after client reported verbally and written that client was given pfizer for first dose. Upon looking in OSSISS noted client was given moderna for first dose. No adverse affects noted at this time. Informed client of incident and notified to monitor any symptoms. notify PCP or Health dept if needed.

Other Meds:

Current Illness:

ID: 1549200
Sex: M
Age: 21
State: MA

Vax Date: 07/21/2021
Onset Date: 08/04/2021
Rec V Date: 08/12/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

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

Symptoms: Pt.'s Mother states that after receiving the 1st dose of Moderna 07/21/2021, started experiencing symptoms 08/04/2021 of hives throughout the body (chest-legs), itchiness lasting 2 weeks still continuing through the feet. Urgent Care visit 08/07/2021 prescribed Prednisone.

Other Meds: N/A

Current Illness: N/A

ID: 1549201
Sex: M
Age: 14
State: FL

Vax Date: 07/24/2021
Onset Date: 07/25/2021
Rec V Date: 08/12/2021
Hospital: Y

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

Lab Data:

Allergies: Bacitracin; Neomycin

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

Symptoms: 14 year old male with no significant past medical history received second COVID vaccine on 7/24/2021. On 7/25/2021, he woke up with flu-like symptoms including malaise, tactile fever and intermittent chest pain that escalated over the next 24 hours to the point that he needed to go to the emergency dept. Pain was alleviated with ibuprofen and tylenol. Troponin was found to be elevated in the ED so he was admitted to pediatric cardiac at Health facility. Chest pain described as left-sided midsternal. EKG normal and ECHO showed trace physiologic tricuspid and pulmonic insufficiency. Troponin once admitted was 0.52, then 0.36. Admitted on 7/26 at 12:05 and discharged on 7/29. To F/U with cardiology.

Other Meds: Ibuprofen and acetaminophen

Current Illness: None documented

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm