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: 1549202
Sex: F
Age: 43
State: CA

Vax Date: 04/01/2021
Onset Date: 05/12/2021
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: None

Symptom List: Dysphagia, Epiglottitis

Symptoms: Irregular MenstruaL cycle. I?m not pregnant. I track my cycle with ?cycles? fertility app. My period was very regular and since my vaccine it has occurred one time and was incredibly heavy.

Other Meds: None

Current Illness: None

ID: 1549203
Sex: F
Age: 15
State: SD

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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: NKDA

Symptom List: Anxiety, Dyspnoea

Symptoms: Moderna vaccine given to patient under 18 years of age

Other Meds: None

Current Illness: None

ID: 1549204
Sex: M
Age: 19
State: CA

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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None was written on the consent form filled out by the patient

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

Symptoms: On 08/11/21 patient came to the pharmacy with his 3 other family members (total of 4 people) for COVID vaccine. Rph administered Pfizer Covid Vaccine (dose 1) to the patient in a stand-up position and soon after patient fainted on the ground. He re-gained his conciousness right away. Rph called the store director. Rph asked patient to be sitting down on the ground and measured his bloodpressure - it was read 107/68. When Rph asked patient what his normal BP was, patient or the family members did not know. No history of hypertension was listed on the consent form. Rph monitored patient for 30 minutes and instructed him to seek medical care if necessary.

Other Meds: None was written on the consent form filled out by the patient

Current Illness: None was written on the consent form filled out by the patient

ID: 1549205
Sex: F
Age: 58
State: FL

Vax Date: 08/04/2021
Onset Date: 08/11/2021
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: Amoxicillin, Sulfa, Cleocin, pitted fruit

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: About 7 days after vaccination the injection site became itchy, red, burning and a rash approximately 10x6 cm erupted. The site hurt the day after the vaccine then was fine until the symptoms started on 8/11.

Other Meds: Atenolol, Zoloft, Synthroid

Current Illness: None

ID: 1549206
Sex: M
Age: 88
State: MN

Vax Date: 01/27/2021
Onset Date: 08/11/2021
Rec V Date: 08/12/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: SNF called to report patient developed a cough, fever 100.8, and malaise today. This despite ceftriaxone and vancomyicn antibiotic therapy for his prostate abscess. He needs timely eval to include blood tests, nasal PCR, CXR, etc. Consider drug fever if no source found.

Other Meds:

Current Illness:

ID: 1549207
Sex: M
Age: 15
State: PA

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

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

Symptoms: Received Moderna vaccine under the age of 18. Had no adverse side effects.

Other Meds:

Current Illness:

Date Died: 08/10/2021

ID: 1549208
Sex: M
Age: 88
State: OH

Vax Date: 01/28/2021
Onset Date: 02/02/2021
Rec V Date: 08/12/2021
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: Iopidine, Betimol, Pilocarpine, Timilol; Timolol-Brimon-Dorzol

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: The patient suffered a myocardial infarction complicated by systolic heart failure and, over the course of 6 months led to cardiac arrest and death.

Other Meds: acetaZOLAMIDE , Aspirin, Azopt 1 % Ophthalmic Suspension, Cent

Current Illness:

ID: 1549209
Sex: F
Age: 53
State: GA

Vax Date: 06/30/2021
Onset Date: 07/18/2021
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: Penicillin Avocado Red Cherries

Symptom List: Pharyngeal swelling

Symptoms: Since the shot my left arm gets stiff and doesn't have the same mobility especially if I don't move it for a while.

Other Meds: None

Current Illness: None

ID: 1549210
Sex: F
Age: 49
State: MO

Vax Date: 04/26/2021
Onset Date: 04/28/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: After the 2nd vaccine, I had increased diarrhea. I was on the toilet about 20 times a day till early morning to 4 or 5 in the evening. I could only go on a short trip because I had to go to the bathroom about 3 or 4 times. I couldn't get off the toilet to eat or drink. I lost 20 pounds. It has continued for 3 months after 2nd vaccine. It ceased 4 or 5 weeks ago. I'm still having diarrhea but not as frequent. I have been recently diagnosed with crohn's disease. The symptoms just appeared after taking the vaccine. Maybe a year ago on lockdown I did have some of these symptoms but they were a little light. Some of my symptoms have ceased 4 or 5 weeks ago which are decreased frequent diarrhea, irritability, nausea, trouble concentrating, insomnia, intense migraines, or lingering headaches that lasted for two weeks, and sharp stabbing pains on all sides of my head. I had a rash that would appear on my hands, wrist, and forearm that would reappear every couple months off and on since about a year ago after receiving the vaccine. I had a rash on my lower abdomen once but it went away after about a day. I also had some swelling of my fingers. All of those symptoms went on full blown after 2nd vaccine. I also experienced a flush of warmness over my face. When I looked in the mirror my face would be flushed red. This happened off and on but more frequently after the vaccine. It happens about 2 or 3 times out of the week. When I was sitting on my toilet at my apartment my head was at the same level as the electrical panel to the left of me. I experienced sharps pains in the head. They would just come out of no where. I had a reading for the electrical panel and it was close to 850 volts per meter which is 8x higher than the recommended volts per meter. I have been sitting by the electrical panel for 3 months days and evenings because I had to stay on toilet due to the diarrhea. I could feel that the radiation from the electrical panel was making me ill. Once I moved out of that apartment I did start to feel a lot better. I would like to know who is responsible for me being exposed to the high radiation for long periods of time. I have been disabled because of this, and I haven't been able to work since.

Other Meds:

Current Illness:

ID: 1549211
Sex: F
Age: 39
State: KS

Vax Date: 08/03/2021
Onset Date: 08/03/2021
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: Codeine Penicillin Rosati Seroquel

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient stated that an hour after she received the vaccination she felt a pain in her lungs. She had a hard time breathing for about 6 hours. She received a bad headache. Her vision started to go in and out of vision. She is tired all the time. She is sleeping for 3 or 4 hours in the day time. She said her body hurts to walk. Her arms are sore and she is very irritated.

Other Meds: Laminthaol Trazadone 150mg @ night Meloxicam Methazole Vitamin D3 Zinc Women's supplement Rescue inhaler Advair inhaler Takes one shot once a week Orzimpic

Current Illness:

ID: 1549212
Sex: M
Age: 39
State: AR

Vax Date: 08/10/2021
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: Blurred vision

Other Meds: none

Current Illness: none

ID: 1549213
Sex: M
Age: 64
State: WI

Vax Date: 12/17/2020
Onset Date: 12/19/2020
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: Chantix

Symptom List: Rash, Urticaria

Symptoms: Patient reports loss of smell one week after receiving first Pfizer vaccination. Patient has not regained sense of smell. Patient denies COVID infection.

Other Meds:

Current Illness: None

ID: 1549214
Sex: F
Age: 13
State: SD

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: NKDA

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

Symptoms: None

Other Meds: None

Current Illness: None

ID: 1549215
Sex: M
Age: 14
State: FL

Vax Date: 05/15/2021
Onset Date: 05/18/2021
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: None

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

Symptoms: Pt has had ongoing issues with taste and smell since shortly after getting the first dose of the Pfizer vaccine on 5/15/2021. First recorded date was on 5/18/2021. Certain foods that he really enjoyed eating prior to vaccination including eggs and Goldfish crackers, smell and taste horrible.

Other Meds: Norditropin

Current Illness: MODY and GHD (growth hormone deficiency)

ID: 1549218
Sex: F
Age: 42
State: AZ

Vax Date: 01/20/2021
Onset Date: 07/07/2021
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: Unknown

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

Symptoms: Covid like symptoms started 7/4/21

Other Meds: None

Current Illness: None

ID: 1549219
Sex: F
Age: 37
State: MT

Vax Date: 12/30/2020
Onset Date: 12/31/2020
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: Unknown

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

Symptoms: Vaginal Spotting from both vaccines

Other Meds: Unknown

Current Illness: Unknown

ID: 1549220
Sex: F
Age: 12
State: PA

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

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

Symptoms: received Moderna vaccine under the age of 18. No adverse side effects.

Other Meds:

Current Illness:

ID: 1549221
Sex: M
Age: 44
State: ME

Vax Date: 08/06/2021
Onset Date: 08/06/2021
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: none

Symptom List: Ear pain, Hypoaesthesia

Symptoms: chest pain, almost passed out on 8/11, abnormal EKG, nausea, headache. Ended up in ER 8/11

Other Meds: none

Current Illness: none

ID: 1549222
Sex: M
Age: 26
State: NH

Vax Date: 08/12/2021
Onset Date: 08/12/2021
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:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Pt was given a dose drawn up greater than 12 hours, approximately 36 hrs.

Other Meds:

Current Illness:

ID: 1549223
Sex: F
Age: 71
State: CA

Vax Date: 07/23/2021
Onset Date: 07/23/2021
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: Band aids, nothing else

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

Symptoms: Shoulder pain, at least 6" x 6" plus radiating down to elbow. Constant pain, started immediately from shot. Won't stop - won't go away. It was been 3 weeks and it is not getting better.

Other Meds: Daily multi vitamin, VitD, nothing else

Current Illness: None

ID: 1549224
Sex: F
Age: 33
State: IL

Vax Date: 08/10/2021
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: 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: Chest tightness day 1 and 2. Diarrhea day 3.

Other Meds:

Current Illness:

ID: 1549225
Sex: F
Age: 58
State: TX

Vax Date: 04/23/2021
Onset Date: 04/24/2021
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: Unevaluable event

Symptoms: After the 04/23/2021 - COVID-19 Moderna shot I've had bad headaches and extremely tired.

Other Meds: Multi-Vitamin, Zinc

Current Illness: None

Date Died: 05/17/2021

ID: 1549226
Sex: M
Age: 87
State: TN

Vax Date: 02/22/2021
Onset Date: 05/17/2021
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: Unknown

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

Symptoms: Death - Symptom onset date 04/24/21 to include chills, loss of taste/smell, headache, fatigue, cough, SOB, nausea, vomiting and diarrhea.

Other Meds: Unknown

Current Illness: Unknown

ID: 1549227
Sex: F
Age: 39
State: VA

Vax Date: 12/30/2020
Onset Date: 12/30/2020
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: NKDA

Symptom List: Injection site pain, Pain

Symptoms: Symptoms: DIARRHEA, UNSPECIFIED, HEADACHE, DIZZINESS AND GIDDINESS, OTHER FATIGUE, PALPITATIONS, NAUSEA, CHEST PAIN, UNSPECIFIED. This 39yo female advised receiving her first Pfizer covid vaccine on 12/30/2020. Within 15 minutes she had a metallic taste in her mouth, and felt nauseated. She had some diarrhea so she went home. (has hx of obesity and DM). She reports 1-2 days later she felt light headed, and dizzy. Day 3 she has a headache, blurry vision with nausea and vomiting. Day 4 she had vertigo with heart racing (168bpm), chest tightness described as a pressure, with heavy legs "as if wearing ankle weights". She went to local ER (called 911 for transport). ER admitted even though had negative EKG, CE, PCR, for TTE. However when test done, it was halted immediately as her heart rate went over 182. She stated she was given a diagnosis by cardiology of POTS on discharge after further testing. She was released with meclizine for vertigo prn, and propranolol for POTS which has helped improve s/s over past several months. She uses her compression stocking and keeps herself hydrated.

Other Meds: meclizine, propranolol, metformin, Lisinopril

Current Illness: denied

ID: 1549228
Sex: M
Age: 46
State: IL

Vax Date: 06/10/2021
Onset Date: 06/30/2021
Rec V Date: 08/12/2021
Hospital: Y

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: Severe headache, projectile vomiting, incoherent, unsteady gait, stroke like symptoms, abdominal pain, bradycardia, decreased pulse ox, and severe pain.

Other Meds: Levothyroxine 200mcg Same day as vaccine received steroid injection (marCaine, lidocaine, & celestone soluspan) to left foot.

Current Illness: None

ID: 1549229
Sex: F
Age: 46
State: LA

Vax Date: 08/02/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: 8/2 Annular rash started on neck and has since moved to chest. 8/11 electric feeling in arm, swelling, heat and red

Other Meds:

Current Illness:

ID: 1549230
Sex: F
Age: 42
State: NY

Vax Date: 08/12/2021
Onset Date: 08/12/2021
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:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Received Pfizer COVID vaccine at 12:38om. At 12:53pm reported feeling heaviness in tongue. Benadryl administered at 12:56pm. reports relief of symptoms at 1:04pm.

Other Meds:

Current Illness:

ID: 1549231
Sex: M
Age: 42
State: KY

Vax Date: 07/18/2021
Onset Date: 08/10/2021
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:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: tested positive after being fully vaccinated.

Other Meds:

Current Illness:

ID: 1549233
Sex: F
Age: 84
State: OH

Vax Date: 02/11/2021
Onset Date: 08/12/2021
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: RA

Lab Data:

Allergies: TMP/Sulfa (shortness of breath), penicillins (not specified), ramipril (not specified)

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

Symptoms: Breakthrough COVID infection. Direct admit to Hospital from Medical Center. SpO2 100% on 4LNC, presented to for shortness of breath, had positive COVID test, and pneumonia noted on imaging.

Other Meds: unknown

Current Illness: unknown

ID: 1549234
Sex: F
Age: 36
State:

Vax Date: 04/29/2021
Onset Date: 07/24/2021
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:

Symptom List: Nausea

Symptoms: Patient is a 36 yo female, s/p full Pfizer COVID vaccination: dose 1 on 4/8, dose 2 on 4/29. Patient is an employee of this institution with new onset cough, muscle/body aches, and sore throat as of 7/24. Denies known exposure to COVID-19. POCT rapid test results positive on 7/24. Patient meets criteria for both bamlanivimab and casirivimab/imdevimab, however patient declines infusion.

Other Meds:

Current Illness:

ID: 1549235
Sex: F
Age: 17
State: MD

Vax Date: 05/09/2021
Onset Date: 07/21/2021
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: Pollen, cats

Symptom List: Injection site pain

Symptoms: Experienced a red dot rash approximately 2 weeks before visited pediatrician and blood work was done. The rash was diagnosed as petechaie at Pediatrics on August 7, 2021. The next day we received a call that a critical message was sent regarding my daughters platelet count. It was 5,000. We were immediately told to go to hospital where more blood work was done and confirmed a diagnosis of Immune Thrombocytopenia (ITP). We are currently being seen by the Hematology Clinic at Hospital.

Other Meds: Lexapro, Wellbutrin, Lo Lo Estrin

Current Illness: None

ID: 1549236
Sex: F
Age: 56
State: DE

Vax Date: 01/07/2021
Onset Date: 01/13/2021
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: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: One week after the first vaccine of Pfizer for COVID 19, I got two blood clots in my right calf. They didn't dissolve until 8 months after first presenting.

Other Meds: One week after the first vaccine, I was diagnosed with 2 blood clots in my right calf. I still Have one (six months after) that has not yet dissolved

Current Illness:

ID: 1549237
Sex: F
Age: 15
State: WI

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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: none

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

Symptoms: Patient stated she was not feeling well, volunteers/staff moved her into the shade, moments later she fainted. On assessment HR rate was 45, BP not obtained. Patient was pale, eyes wide open staring off into space, arms ridged contracted outward, not able to answer questions. Patients body was supported, cold compress applied to back of next. HR monitored. Continuously asking patient questions until able to respond. Thirty seconds to a minute patient started to ask what happened, her color began to come back. She was able to drink water and orange juice. Patient stated she felt tired and her legs felt heavy. Patient was monitored for thirty more minutes with no other effect. Parent was told to notify physician.

Other Meds: None

Current Illness: Patient and dad stated she had a "cold" about a week ago.

ID: 1549238
Sex: F
Age: 50
State:

Vax Date: 04/17/2021
Onset Date: 07/25/2021
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: Omnicef

Symptom List: Tremor

Symptoms: Patient is a 50 yo female s/p full Pfizer vaccination: dose 1 on 3/27 and dose 2 on 4/17. Patient presents to the ED on 7/25 with chief complaint of fatigue, cough, headache, and nausea for 1 day. She reports recent exposure to COVID-19. Rapid COVID test results positive on 7/25.

Other Meds:

Current Illness:

ID: 1549239
Sex: F
Age: 45
State: VA

Vax Date: 04/20/2021
Onset Date: 04/21/2021
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:

Symptom List: Erythema, Pruritus

Symptoms: ADVERSE EVENT(s): Arm soreness and tiredness ((As of August 12, 2021, I am still experiencing the following symptoms on and off)): difficulty breathing (chest tightness), fast heartbeat, allergies/rash, dizziness, tiredness, brain fog, increased muscle/joint pain, chills, occasion fever, headache, and unexpected hormonal/mood changes. TREATMENT: Primary care doctor visits, self-care, meditation, podcasts, mental health awareness/seminars, excercise, rest, and a new neuorology, pain management specialist - medication management and changes. OUTCOME: TBD.

Other Meds:

Current Illness:

ID: 1549240
Sex: F
Age: 54
State: TX

Vax Date: 01/16/2021
Onset Date: 01/17/2021
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: Swollen lymph node in mid lateral side of my neck. The lymph node took 4 weeks to be normal with each dose.

Other Meds: Phytolacca oil

Current Illness:

ID: 1549241
Sex: M
Age: 54
State: SC

Vax Date: 04/01/2021
Onset Date: 04/19/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: migrating nerve damage. rt leg left rt arm now left arm stays numb. left hip is numb.

Other Meds: Wellbutrin 150 mg lisinopiopril 20 mg tamsulosin .04 x 2 metoprolol 50 mg meloxicam 15 mg NP thyroid 90 mg cetirizine 10 mg D3 5000mg fish oil 5000 mg red yeast rice 2400 mg turmeric 1000 mg B12 500 mg DHEA 50 MG probiotics 150 billi

Current Illness: lyme high blood pressure low blood pressure migrating rheumatoid arthritis enlarged prostate

ID: 1549242
Sex: F
Age: 39
State:

Vax Date: 02/04/2021
Onset Date: 07/26/2021
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: Amoxicillin, sulfa antibiotics, Vicodin

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient is a 39yo female s/p full Moderna COVID vaccination: dose 1 on 1/7 and dose 2 on 2/4. Patient is physician at this institution. Exposure to COVID-19 on 7/15. Symptoms reported include cough. PCR test ordered on 7/26 resulted back positive.

Other Meds:

Current Illness:

ID: 1549243
Sex: M
Age: 60
State: KY

Vax Date: 04/09/2021
Onset Date: 08/02/2021
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:

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

Symptoms: Covid positive

Other Meds:

Current Illness:

ID: 1549245
Sex: M
Age: 31
State:

Vax Date: 02/15/2021
Onset Date: 07/27/2021
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:

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

Symptoms: Patient is 31 yo male s/p full Pfizer COVID vaccination: dose 1 on 1/25 and dose 2 on 2/15. Patient is an employee of this institution with new onset cough, headache, and congestion on 7/27. Patient reports possible COVID-19 exposure. Rapid test resulted positive on 7/27. Patient underwent casirivimab/imdevimab infusion on 7/28.

Other Meds:

Current Illness:

ID: 1549246
Sex: F
Age: 52
State: TX

Vax Date: 04/14/2021
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: Iodine, latex, avocados, cantaloupe, corn, peanuts

Symptom List: Pain in extremity

Symptoms: Pain at injection site, in able to touch muscle without pain. PsA flare up since 3weeks after 2nd shot. Flare up has been non stop. Unable to use hands on regular basis due to PsA.

Other Meds: Levothyroxine, singular, Paxil

Current Illness: None

ID: 1549247
Sex: M
Age: 62
State: FL

Vax Date: 03/20/2021
Onset Date: 07/04/2021
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: None

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

Symptoms: Pulmonary Embolism diagnosed. Blood thinners administered by sub-q abdominal injection then prescription rivaroxaban 15 mg twice per day for three weeks then 20 mg once per day indefinite

Other Meds: Metoprolol 25mg twice per day, 81 mg Aspirin, Loratadine, Multi-vitamin, Vitamin C, Vitamin D3, Zinc, esomeprazole

Current Illness: None

ID: 1549248
Sex: F
Age: 75
State: FL

Vax Date: 02/17/2021
Onset Date: 07/31/2021
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: Lortab, Vicodin

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

Symptoms: Patient experienced one week of diarrhea, abdominal pain, fatigue, and cough for 2 weeks. She came to ED on 7/31/2021 and tested positive COVID PCR. She was hospitalized on 7/31/2021. She also stated her husband is currently hospitalized for Covid. Note: patient completed the series of COVID19 Pfizer vaccines in Feb, 2021. 8/4/21: patient discharged.

Other Meds: Allopurinol, carvedilol, clopidogrel, furosemide, pregabalin,

Current Illness: defied

ID: 1549249
Sex: M
Age: 68
State:

Vax Date: 03/23/2021
Onset Date: 07/28/2021
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: Gabapentin, penicillins

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

Symptoms: Patient is 68 yo male s/p full Pfizer COVID vaccination: dose 1 on 2/16 and dose 2 on 3/23. Patient called in on 7/28 with symptoms of fever of 103, chills, and cough. PCR test results positive on 7/28. Pt received Casirivimab/Imdevimab infusion on 7/29.

Other Meds:

Current Illness:

ID: 1549250
Sex: M
Age: 67
State:

Vax Date: 03/29/2021
Onset Date: 07/28/2021
Rec V Date: 08/12/2021
Hospital: Y

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: Patient is a 68 yo male s/p full Pfizer COVID-19 vaccination: dose 1 on 3/8 and dose 2 on 3/29. PMH of multiple myeloma last treatment on 7/21/2021 with VRd, HTN, diabetes. Presents to the ED on 7/28 for fatigue, SOB, weakness, lightheadedness, fever. He had known COVID exposure on 7/23. Rapid test resulted positive and patient admitted to the hospital on 7/28. Empirically treated with cefepime + doxycycline, then ceftriaxone, then Augmentin due to immunocompromised status. Discharged from hospital on 8/2.

Other Meds:

Current Illness:

ID: 1549251
Sex: M
Age: 32
State: NY

Vax Date: 06/27/2021
Onset Date: 06/27/2021
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: None

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Neuropathy, burning in arms and legs, tingling in hands and feet, numbing in extremities, pain in heart, severe body aches that start 6 days after second dose of vaccine and is still occurring 6 weeks later.

Other Meds: None

Current Illness: None

ID: 1549252
Sex: F
Age: 33
State:

Vax Date: 02/09/2021
Onset Date: 07/28/2021
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: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: Patient is 34 yo female s/p full COVID-19 Pfizer vaccination: dose 1 on 1/19 and dose 2 on 2/9. Patient is an employee of this institution with new loss of taste/smell and congestion/runny nose. Denies known exposure to COVID-19. PCR test results positive on 7/28.

Other Meds:

Current Illness:

ID: 1549253
Sex: F
Age: 47
State: MO

Vax Date: 07/17/2021
Onset Date: 07/19/2021
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: After I received the injection I got a sore arm and 2 days later I developed a rash on my left arm and it spread all over my legs, arms, stomach. wrists. There are bumps everywhere. The rash does itch. I went to the emergency room.. They performed blood work. Gave me a steroid cream and another oral medicine. Have not gotten the oral medicine because over prior authorization is needed. They believe, but not definite, it is called Licaen Plainus.

Other Meds:

Current Illness:

ID: 1549254
Sex: F
Age: 25
State:

Vax Date: 03/25/2021
Onset Date: 07/29/2021
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:

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

Symptoms: Patient is a 25 yo female s/p full Pfizer COVID vaccination: dose 1 on 3/4 and dose 2 on 3/25. Patient is an employee at this institution and reports new onset sore throat and congestion/runny nose on 7/29. Denies known exposure to COVID-19. Rapid test results back positive on 7/29.

Other Meds:

Current Illness:

ID: 1549255
Sex: M
Age: 22
State: CO

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

Lab Data:

Allergies: NKDA

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

Symptoms: Vaccine diluted with sterile water instead of normal saline

Other Meds: Maxitroll, Benadryl, Fluticasone, Benzonatate

Current Illness: COVID symptoms

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm