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: 1553989
Sex: F
Age: 71
State: FL

Vax Date: 01/09/2021
Onset Date: 07/18/2021
Rec V Date: 08/13/2021
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: penicillin, codeine, sulfa (Septra)

Symptom List: Dysphagia, Epiglottitis

Symptoms: Developed fever of 99 to 101 for 8 days; muscle aches, upper back pain, cough

Other Meds: Levothyroxine .50 mcg and .75 mcg., Lexapro 20 mg.; calcium w/magnesium and zinc suuplement; b12 supplement; vitamin c; vitamin D3

Current Illness: Just Hypothyroid/Hashimoto's autoimmune

ID: 1553990
Sex: F
Age: 61
State: CT

Vax Date: 01/12/2021
Onset Date: 08/08/2021
Rec V Date: 08/13/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Unknown

Other Meds:

Current Illness:

ID: 1553991
Sex: F
Age: 44
State:

Vax Date: 08/02/2021
Onset Date: 08/03/2021
Rec V Date: 08/13/2021
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: Random skin itching, no whelps or visible signs of rash. Itching in one spot which is migratory.

Other Meds: multivit, calcium

Current Illness: none

ID: 1553992
Sex: F
Age: 52
State:

Vax Date: 07/09/2021
Onset Date: 07/11/2021
Rec V Date: 08/13/2021
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: Patient was admitted for heart attack

Other Meds:

Current Illness:

ID: 1553993
Sex: F
Age: 88
State:

Vax Date: 03/09/2021
Onset Date: 08/11/2021
Rec V Date: 08/13/2021
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: Presented to the ED on 8/11/2021 for painful back mass. She did not have any covid symptoms but tested positive. No prior positive test results for COVID-19 documented.

Other Meds:

Current Illness:

ID: 1553994
Sex: M
Age: 29
State:

Vax Date: 08/08/2021
Onset Date: 08/08/2021
Rec V Date: 08/13/2021
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: "5mins post vaccination, pt c/o left leg numbness. Pt was at a hospital earlier that morning (8am) for anxiety, not overnight. No medication given during visit. Per pt, he was told that he was dehydrated. Vitals: @10:15 BP 174/64, HR 79, RR 16 -- > @10:24 138/67, 71, 16, 100% RA. Pt stable and released from the vaccination site. PMH: Asthma and Anxiety Medications: albuterol 2inh Q4hrs PRN wheezing Sertraline 100mp PO Daily"

Other Meds: Medications: albuterol 2inh Q4hrs PRN wheezing Sertraline 100mp PO Daily

Current Illness: "hospital visit" for anxiety/dehydration the morning of vaccination

ID: 1553995
Sex: F
Age: 19
State: TX

Vax Date: 04/01/2021
Onset Date:
Rec V Date: 08/13/2021
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: Pyrexia, White blood cell count decreased

Symptoms: Vaccinated with Pfizer in April 2021. Experiencing only loss of sense of smell and some cold.

Other Meds:

Current Illness:

ID: 1553996
Sex: F
Age: 54
State: PR

Vax Date: 04/28/2021
Onset Date: 05/10/2021
Rec V Date: 08/13/2021
Hospital:

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

Lab Data:

Allergies: Sulfa

Symptom List: Pharyngeal swelling

Symptoms: After my second shot, during the month of May, I had a medical appointment with my gynecologist and I showed him the strange white patch I recently discovered under my left breast. He looked at it and said I had to go the dermatologist to have it checked. I got an appointment and went to the dermatologist on June 29, 2021. They had a biopsy done on the patch and it came back consistent with vitiligo.

Other Meds: Lovaza Xarelto 20 mg Synthroid .88

Current Illness:

ID: 1553997
Sex: M
Age: 48
State: NY

Vax Date: 08/13/2021
Onset Date: 08/13/2021
Rec V Date: 08/13/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: graves disease ...hyperthyroidism..rapid weight loss ..sweating profisely..rapid heart beat ...went to er and admitted to hospital with afib

Other Meds: lipitor 10 mg..hydrocodone 10 mg..enalapril 5 mg

Current Illness: herniated disc L5 S1

ID: 1553998
Sex: F
Age: 65
State: MI

Vax Date: 02/08/2021
Onset Date: 03/01/2021
Rec V Date: 08/13/2021
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: effinefrin

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Pain and soreness in right breast, enlarged breast, In 2017 I had breast cancer. Stage 0 and a Lumpectomy operation was performed.

Other Meds: Simvastatin, Ramipril, Potassium Chloride, Metformin, HydroChlorothiazide, omeprazole

Current Illness: None

ID: 1553999
Sex: M
Age: 15
State: GA

Vax Date: 08/01/2021
Onset Date: 08/11/2021
Rec V Date: 08/13/2021
Hospital:

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

Lab Data:

Allergies: NKDA

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

Symptoms: PATIENT FAINTED. RECOVERED IMMEDIATELY. EMT WAS CALLED AND ALL VITALS WERE TAKEN. PATIENT'S MOTHER REFUSED ER VISIT. MOTHER AND PATIENT WALKED OUT OF STORE WITHOUT ANY FURTHER INCIDENT.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1554000
Sex: F
Age: 37
State: MN

Vax Date: 08/12/2021
Onset Date: 08/12/2021
Rec V Date: 08/13/2021
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: IV contrast dye (hives), sulfa antibiotics (hives), Wellbutrin (hives)

Symptom List: Rash, Urticaria

Symptoms: Fever, chills, sore arm at injection site, and intense body aches starting 12 hours after injection. Treated with acetaminophen.

Other Meds: Prenatal vitamin, calcium, vitamin D, DHA, probiotic

Current Illness: None

ID: 1554001
Sex: F
Age: 15
State: IL

Vax Date: 08/12/2021
Onset Date: 08/13/2021
Rec V Date: 08/13/2021
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: improper storage and handing of vaccine

Other Meds:

Current Illness:

ID: 1554002
Sex: M
Age: 28
State: TN

Vax Date: 08/13/2021
Onset Date: 08/13/2021
Rec V Date: 08/13/2021
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: NKA

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

Symptoms: pt had a syncopal episode 5 minutes after dose administered. Pt states he has had similar episodes before d/t needles, blood, etc. Pt did not fall, pt recovered quickly.

Other Meds: unknown

Current Illness: none

ID: 1554003
Sex: M
Age: 67
State: DC

Vax Date: 08/06/2021
Onset Date: 08/07/2021
Rec V Date: 08/13/2021
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: metformin

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

Symptoms: Patient had a hemorrhagic conversion of a traumatic brain injury and a right pontine infarct 24 hours after administration of the vaccine

Other Meds: amlodipine chlorthalidone keppra

Current Illness: Patient has traumatic brain injury

ID: 1554004
Sex: F
Age: 44
State: MA

Vax Date: 04/24/2021
Onset Date: 05/05/2021
Rec V Date: 08/13/2021
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: Pine nuts, erythromycin

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

Symptoms: Nipple discharge less than 2 weeks after second dose.

Other Meds: Multi vitamin, b complex, omega fish oil, vitamins d and c, elderberry, probiotics

Current Illness: None

ID: 1554005
Sex: F
Age: 30
State: GA

Vax Date: 04/08/2021
Onset Date: 07/10/2021
Rec V Date: 08/13/2021
Hospital: Y

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: Was tested on 07/10/2021 at medical clinic. Rode in private car. Ended up getting admitted to Hospital on 07/12/2021

Other Meds:

Current Illness:

ID: 1554006
Sex: F
Age: 25
State: NY

Vax Date: 07/31/2021
Onset Date: 08/01/2021
Rec V Date: 08/13/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient stated that the second day after receiving she received the normal symptoms and then she started twitching. patient stated the twitching is constant and has not stopped and it happens all over her body.

Other Meds:

Current Illness:

ID: 1554007
Sex: M
Age: 12
State: IL

Vax Date: 08/12/2021
Onset Date: 08/13/2021
Rec V Date: 08/13/2021
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: dose administered after improper temp storage. No outcome reported as of now

Other Meds:

Current Illness:

ID: 1554008
Sex: M
Age: 59
State: CA

Vax Date: 08/11/2021
Onset Date: 08/12/2021
Rec V Date: 08/13/2021
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 known

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

Symptoms: Hives oner body and swelling of upper lip and face

Other Meds: none

Current Illness: none

ID: 1554009
Sex: F
Age: 38
State: KY

Vax Date: 04/14/2021
Onset Date: 08/09/2021
Rec V Date: 08/13/2021
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: Patient received both doses of vaccine. last dose 4/14/21 developed symptoms 8/8/2021 and tested + for COVID on 8/10/2021

Other Meds:

Current Illness:

ID: 1554010
Sex: M
Age: 54
State: IL

Vax Date: 08/12/2021
Onset Date: 08/13/2021
Rec V Date: 08/13/2021
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: improper storage and handing of vaccine

Other Meds:

Current Illness:

ID: 1554011
Sex: F
Age: 28
State: TX

Vax Date: 08/03/2021
Onset Date: 08/03/2021
Rec V Date: 08/13/2021
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: Lidocaine, bananas, kiwis, grass, pollen

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

Symptoms: Redness, swelling-recovered post 5 days. sustained constant headache since injection

Other Meds: Ibuprofen

Current Illness:

ID: 1554012
Sex: F
Age: 90
State:

Vax Date: 02/25/2021
Onset Date: 08/12/2021
Rec V Date: 08/13/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Presented to the ED for evaluation of cough for the last two weeks. Denies loss of taste or smell, abdominal pain, chest pain, or diarrhea. Reports feeling nauseated but no episodes of emesis. No prior COVID infections.

Other Meds:

Current Illness:

Date Died: 08/09/2021

ID: 1554013
Sex: F
Age: 69
State:

Vax Date: 06/18/2021
Onset Date: 08/09/2021
Rec V Date: 08/13/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient died on August 9, 2021.

Other Meds:

Current Illness:

ID: 1554014
Sex: F
Age: 54
State: NV

Vax Date: 08/04/2021
Onset Date: 08/07/2021
Rec V Date: 08/13/2021
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: NSAIDS, Asprin and Sulfa

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

Symptoms: Leading up to August 7th I had general aches and pains, tiredness, nausea, and right underarm lymph node enlarged. Later in the morning of the 7th, I had urinary tract pain when urinating. The urine was a dark yellow and very cloudy with a horrible smell and when I wiped there were a couple of small specks of blood. I had planned on going to the Emergency Room, however, I was able to control the pain and clear the issue with lots of fluids. On August 8th I awoke with chills and drenched in sweat. From that point on all symptoms stopped except for some minor urinary tract pain which subsided on August 10th.

Other Meds: Lyrica, Methocarbamol, Oxycodone, Flecainide, Methimazole, Estradiol Patch, Cholestyramine, Proair

Current Illness: Graves Disease, Hyperthyroidism, Hypercalcemia, Hypovitaminosis D, Alergic Asthma

ID: 1554015
Sex: M
Age: 58
State: MO

Vax Date: 05/03/2021
Onset Date: 05/03/2021
Rec V Date: 08/13/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: The first shot, I had a stinging in my left arm. I felt lightheaded, I had a fever, muscle aches all over my body. I felt like I got hit by a train. With the second shot, I felt it going into my shoulder and then up into my brain, it was a tingling feeling in my brain. It felt like the dye with a heart cath. I had the chills. I am completely drained of energy. I have been having trouble breathing. I went to the ER July 5th. I thought I as having a stoke. I was losing the left side body function. They did a CT scan. They found a blood clot. They did blood work also. I also aspirated with apple sauce. They also found gallstone in my duct. The neurologist told me to go somewhere else with better equipment for further testing. I have an appointment Monday with my doctor about my gallstones. The hospital started me on Eliquis to help with the blood clot.

Other Meds: Metoprolol tare, Alprazolam, Tramadol Hcl, Clopidogrel, levothyroxine Pantoprazole, Simvastatin, Losartan, Vitamin B-12, Vitamin D-3, fish oil, Zyrtec

Current Illness:

ID: 1554016
Sex: F
Age: 55
State: MO

Vax Date: 03/25/2021
Onset Date: 03/25/2021
Rec V Date: 08/13/2021
Hospital:

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

Lab Data:

Allergies: Shell Fish & Bee Stings

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: -First 4 days after the vaccine, I had a severe headache that wouldn't go away. -I've had a debilitating headache daily ever since. I've been taking Excederin or Advil a couple of times a day to be able to function. Note: In my entire life, I had previous to the vaccine only experienced a headache twice. -A month after the vaccine, (April 2021), I could feel a dump & divet in the front part of my head, which continues to expand this date. I now have a dent that is expanding to my forehead. -In late June, I experienced a type of shoulder paralysis. Nothing that I did contributed to this. - A day later, I sought out a Chiropractor and she was able to get it where I could move it, but the pain was still there and now in my back shoulder blade area going up my neck. This is the first time I had experienced anything like this. -I went back a second time and she took x-rays. On my third visit, she said that the x-rays showed a tumor in my upper right arm. At that point, she was concerned about treating this without additional information. She recommended that I see my Physician. I do not have Healthcare and don't have a Physician. -I've been back a number of times, just to get a little relief. -The headaches have gotten much worse with little relief and the divet is now a dent in my head, expanding to my forehead. The tumor in my arm seems to be getting more pronounced.

Other Meds: None

Current Illness: None

ID: 1554017
Sex: F
Age: 70
State: IL

Vax Date: 08/12/2021
Onset Date: 08/13/2021
Rec V Date: 08/13/2021
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: dose administered after improper temp storage. No outcome reported as of now

Other Meds:

Current Illness:

ID: 1554018
Sex: F
Age: 36
State: SC

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

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

Lab Data:

Allergies: N/A

Symptom List: Nausea

Symptoms: Within minutes of injection: numbness, weakness, tightness of left wrist. Mostly resolved. Within hours of injection: chest tightness/heaviness. Mostly resolved. Morning post-injection: TMJ or tightness/pain in jaw. Persistent still.

Other Meds: Birth control. Blood pressure medication. Vitamins: C, B6, B12, D, Milk Thistle, Tumeric, Chromium Piccolinate, Probiotic, Collagen.

Current Illness: N/A

ID: 1554019
Sex: F
Age: 17
State: CA

Vax Date: 08/11/2021
Onset Date: 08/11/2021
Rec V Date: 08/13/2021
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: Injection site pain

Symptoms: I took my 17 year old daughter to the pharmacy for her HEP B shot - and she was ACCIDENTIALLY injected with the Moderna COVID vaccine, WHICH WAS INTENDED FOR ANOTHER PATIENT. This error took place because the pharmacists 'wanted to save time' by bringing syringes for 2 patients into the consultation room. NOTE: She was already fully vaccinated with the Pfizer vaccine. This was an UNAUTHORIZED 3rd vaccine for which I did not give consent. My daughter has been ill with vaccine side effects for 3 days. These have included: fever, loss of appetite, nausea, extreme fatigue, muscle pain, joint pain, skin painful to the touch. chills, sore throat, headache. swollen, painful lymph nodes and general malaise. She has also experienced severe anxiety and distress, as have we, as parents.

Other Meds: none

Current Illness: none

ID: 1554020
Sex: F
Age: 19
State: TX

Vax Date: 05/31/2021
Onset Date: 06/20/2021
Rec V Date: 08/13/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: When seen for a well visit - Patient reports that she feels like she has had some dizzy spells at times and fainted once at school (not with exercise) - she currently says that she gets fatigued a lot more easily and has palpitations with exercise now - this has been going on for a few weeks; Will have some chest tightness and pain when it happens, but she feels fine right now. This started a few weeks after her last COVID vaccine dose, which was received elsewhere. She has never had asthma issues and did not need an inhaler except when she had bronchitis in the past. This is happening during inside workouts.

Other Meds: none

Current Illness: none known

ID: 1554021
Sex: F
Age: 27
State: MN

Vax Date: 01/07/2021
Onset Date: 08/12/2021
Rec V Date: 08/13/2021
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: PATIENT WAS TESTED ON 8/12/21 AND TESTED POSITIVE TO COVID

Other Meds:

Current Illness:

ID: 1554022
Sex: F
Age: 62
State:

Vax Date: 01/29/2021
Onset Date: 01/29/2021
Rec V Date: 08/13/2021
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: Ketorolac/toradol Cipro Colonocopy prep

Symptom List: Tremor

Symptoms: Immediate numbness in arm given ( Within 1-2 minutes)like pins and needles lightheadedness( pretty quickly) extreme thirst( within 20-30 minutes) tiny blood spot on backs of hands and forearms( within 45-60 minutes) tingling ( kind of like pins and needles) in lips and red eyes After I noticed tiny red spots on hands and ask doctor about , they said they were not there when monitoring BP etc.. They then gave me 2 shots at their office . I believe one benedryl type and one steroid type. Kept me at there office and monitored how I was felling for about 2 hours.

Other Meds: Vitamin d3 Vitamin c vitamin B12

Current Illness:

ID: 1554023
Sex: F
Age: 18
State: MN

Vax Date: 08/11/2021
Onset Date: 08/11/2021
Rec V Date: 08/13/2021
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: Erythema, Pruritus

Symptoms: Patient received expired dose of Moderna.

Other Meds: No

Current Illness: Unknown

ID: 1554024
Sex: M
Age: 14
State: IL

Vax Date: 08/12/2021
Onset Date: 08/13/2021
Rec V Date: 08/13/2021
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: dose administered after improper temp storage. No outcome reported as of now

Other Meds:

Current Illness:

ID: 1554025
Sex: M
Age: 43
State: IL

Vax Date: 08/12/2021
Onset Date: 08/13/2021
Rec V Date: 08/13/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: improper storage and handing of vaccine

Other Meds:

Current Illness:

ID: 1554026
Sex: F
Age: 41
State: IL

Vax Date: 08/12/2021
Onset Date: 08/13/2021
Rec V Date: 08/13/2021
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: dose administered after improper temp storage. No outcome reported as of now

Other Meds:

Current Illness:

ID: 1554027
Sex: F
Age: 79
State: CT

Vax Date: 02/11/2021
Onset Date: 02/16/2021
Rec V Date: 08/13/2021
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: no

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

Symptoms: Apr 13 th - 5 days later I was swimming, I had a high heart rate which stayed high 110. Went to doctor on 15 APr 2021 .6 days after vaccine.

Other Meds: Levothyroxine, lotomax ,comigan, latanoprost, miratex -0.25 milligram

Current Illness: no

ID: 1554028
Sex: F
Age: 44
State: IL

Vax Date: 08/12/2021
Onset Date: 08/13/2021
Rec V Date: 08/13/2021
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: improper storage and handing of vaccine

Other Meds:

Current Illness:

ID: 1554030
Sex: F
Age: 17
State: GA

Vax Date: 08/13/2021
Onset Date: 08/13/2021
Rec V Date: 08/13/2021
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: Pain in extremity

Symptoms: Patient passed out after receiving vaccine within about 5 minutes, face became pale and then became pink again, blood pressure dropped and came back up again, last blood pressure reading was low. Patient was in and out but was responsive when EMT arrived. The symptoms took place over a course of about 15 minutes.

Other Meds: None

Current Illness: None aware of

ID: 1554031
Sex: F
Age: 40
State: CA

Vax Date: 07/31/2021
Onset Date: 08/06/2021
Rec V Date: 08/13/2021
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: Full body and face rash, pain on my left arm and bicep. Developed a cold sore that has not begun to heal for 4 days. Red sores and tenderness inside of mouth and outer lips. Tired, foggy mind, cold/flu like symptoms, fever and sore throat that have not gotten better after 14 days of injection and left eye twitch.

Other Meds: None

Current Illness: None

ID: 1554032
Sex: M
Age: 62
State: IL

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

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

Lab Data:

Allergies:

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

Symptoms: improper storage and handing of vaccine

Other Meds:

Current Illness:

ID: 1554033
Sex: F
Age: 17
State: WI

Vax Date: 08/12/2021
Onset Date: 08/12/2021
Rec V Date: 08/13/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: Upon checking in to our vaccinatin clinic on 8/12/21 with parent, this 17 year old was looked up in the database to discover that a Moderna Vaccine was entered in by pharmacy with an administration date of 1/29/2021. Parent and patient denied receiving this Moderna vaccine and presented to our clinic to receive a Pfizer vaccine. Clinic staff took the work of the parent that the child did not receive the Moderna vaccine and there must have been an entry error, so Pfizer dose 1 was administered. On 8/13/21 writer called pharmacist and confirmed the patient did receive a Moderna vaccine on 1/29/2021 at their pharmacy.

Other Meds: unknown

Current Illness: unknown

ID: 1554034
Sex: M
Age: 31
State: NY

Vax Date: 07/08/2021
Onset Date: 07/08/2021
Rec V Date: 08/13/2021
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: NO

Symptom List: Vomiting

Symptoms: We administered the Johnson and Johnson COVID vaccine to a 31 year old male, we instructed him to remain in the store for at least 15 minutes. A few minutes after receiving the vaccine the gentleman got up, walked a little and did a few squats in order to look at some items on the shelf, he ended up passing out a few moments later. We administered the EpiPen and 30 seconds later he was conscious again. We called 911 and an ambulance showed up within 5 minutes of him receiving the EpiPen. Although the patient seemed to be okay, we advised him to go to the hospital for a check up anyway and he walked out with the EMT technicians.

Other Meds: NO

Current Illness: NO

ID: 1554035
Sex: F
Age: 19
State: IL

Vax Date: 08/12/2021
Onset Date: 08/13/2021
Rec V Date: 08/13/2021
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: dose administered after improper temp storage. No outcome reported as of now

Other Meds:

Current Illness:

ID: 1554036
Sex: F
Age: 49
State: NY

Vax Date: 03/05/2021
Onset Date: 03/06/2021
Rec V Date: 08/13/2021
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: no

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

Symptoms: Chills Flu symptoms Fever Tested positive for COVID on July 11, 2021 Since testing positive I've been coughing , my oxygen level has been hoovering around 90, severe fever. I had to go to doctor and was given a nebulizer. My symptoms lasted 4 weeks even now I'm struggling to breathe. Doctor wanted me to see if I can get a booster shot.

Other Meds: no

Current Illness: no

ID: 1554037
Sex: F
Age: 76
State: MN

Vax Date: 03/05/2021
Onset Date: 08/11/2021
Rec V Date: 08/13/2021
Hospital: Y

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: Headache, confusion, hypomagnesemia, cerebral amyloid angiopathy, expressive aphasia, hypertension, increasing frequency of seizure activity, acute encephalopathy, paranoia, hallucinations, brain atrophy,

Other Meds:

Current Illness:

ID: 1554038
Sex: F
Age: 15
State: IL

Vax Date: 08/12/2021
Onset Date: 08/13/2021
Rec V Date: 08/13/2021
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: improper storage and handing of vaccine

Other Meds:

Current Illness:

ID: 1554039
Sex: F
Age: 22
State: CA

Vax Date: 04/19/2021
Onset Date: 04/19/2021
Rec V Date: 08/13/2021
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: Keflex, prednisone

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

Symptoms: the evening of the second injection I started bleeding and it wasn't my period cycle and it didn't stop also followed migraine headaches and bouts of high blood pressure 190/100 or better, still occurring

Other Meds: Travera birth control pills

Current Illness: poly cystic ovarian syndrome (PCOS)

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm