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: 1554357
Sex: M
Age: 47
State: IL

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient felt dizzy just after the vaccine administration, fainted and fell. He looked pale

Other Meds:

Current Illness:

ID: 1554358
Sex: F
Age: 17
State: ME

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

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Vaccine administered 6 hours after reconstitution...Contacted PFizer, CDC, ACIP and local epidemiologist. Physician advice was followed to consider dose give as valid and offer re-vaccination only if patient wanted. Patient was contacted and expanded the issue offered advisement from physician and offered re-vaccination if wanted. no adverse reaction s/p vaccination.

Other Meds:

Current Illness:

ID: 1554359
Sex: M
Age: 21
State:

Vax Date: 08/09/2021
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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Pt w/ allergy to Kiwi (unspecified rxn).

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

Symptoms: "Pt w/ allergy to Kiwi (unspecified rxn). PMH: Obesity Hypercholesteremia Gender dysphoria Depression Anxiety Current Medications: Testosterone 50mg IM Qweek Qvar 80mcg/act 3inh BID Albuterol 2 inh Q4hrs PRN wheezing or SOB 2mins post vaccination pt had a syncopal episode with flushing/sweating, pinched nerve pain, and dizziness. BP 138/85, HR 100, RR 16. Pt symptoms improved over 30 mins. Pt stable and released from the vaccination site @15:00."

Other Meds: Current Medications: Testosterone 50mg IM Qweek Qvar 80mcg/act 3inh BID Albuterol 2 inh Q4hrs PRN wheezing or SOB

Current Illness:

ID: 1554360
Sex: F
Age: 33
State: IN

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

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Headache, malaise, low grade fever, bilateral upper extremity weakness

Other Meds: Multivitamin, Linzess, Adderall

Current Illness: None

ID: 1554361
Sex: F
Age: 61
State:

Vax Date: 07/06/2021
Onset Date: 07/06/2021
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: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Moderna COVID-19 Vaccine EUA dose given 36 days after for refrigeration

Other Meds:

Current Illness:

ID: 1554362
Sex: F
Age: 57
State: NY

Vax Date: 07/30/2021
Onset Date: 07/30/2021
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: nkda

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

Symptoms: Reports fatigue, fever after vaccine and was out of work. Persistent dizziness and fainted on 8./11/21. Went to ED and informed it was bc of vaccine.

Other Meds: uk

Current Illness: uk

ID: 1554363
Sex: F
Age: 31
State: ME

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

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Vaccine administered 6 hours after reconstitution...Contacted PFizer, CDC, ACIP and local epidemiologist Dr. advice was followed to consider dose give as valid and offer re-vaccination only if patient wanted. Patient was contacted and expanded the issue offered advisement from Dr. and offered re-vaccination if wanted. no adverse reaction s/p vaccination.

Other Meds:

Current Illness:

ID: 1554364
Sex: M
Age: 28
State:

Vax Date: 07/23/2021
Onset Date: 07/23/2021
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:

Symptom List: Pharyngeal swelling

Symptoms: Moderna COVID-19 Vaccine EUA dose given 56 days after BUD for refrigeration

Other Meds:

Current Illness:

ID: 1554365
Sex: M
Age: 36
State: OH

Vax Date: 04/30/2021
Onset Date: 05/21/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: 1. Developed urticaria. Anytime my skin heats up -- working out, taking a shower, mowing the lawn -- I break out into a rash that covers my arms, neck, and patches on my stomach/chest. Never had any allergies or reactions to anything in my life.

Other Meds: Multivitamin

Current Illness: None

ID: 1554366
Sex: F
Age: 27
State: AZ

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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Facility called office reporting hives. Was sent to the ED for evaluation

Other Meds: unknown

Current Illness: RA, lupus Hx of seizures

ID: 1554367
Sex: F
Age: 69
State: GA

Vax Date: 01/16/2021
Onset Date: 07/20/2021
Rec V Date: 08/13/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: COVID-19 Pneumonia

Other Meds:

Current Illness:

ID: 1554368
Sex: F
Age: 34
State:

Vax Date: 04/17/2021
Onset Date: 04/18/2021
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: Sulfa - antibiotics

Symptom List: Rash, Urticaria

Symptoms: Fever, palpitations, inflamed thyroid causing hyperthyroidism , anxiety, depression, insomnia , migraines

Other Meds: None

Current Illness: None

ID: 1554369
Sex: M
Age: 51
State: MN

Vax Date: 08/11/2021
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: Symptoms began at 0900 on 8/13/21. Patient was at home and became dizzy and weak with complaints of blurred vision. Then developed occipital headache and pain behind his right eye. Was having difficulty ambulating during this event. Patient presented to the emergency department at 0930, no neurological symptoms were noted, patient only complaining of the headache at this time. Head CT was performed to rule out hemorrhage, then head CT/neck with contrast was performed. Acute vascular findings were ruled out, but incidental findings of mediastinal lymphadenopathy as well as nodular and interstitial change at the lung apices were found. Chest CTA was then performed which found mediastinal and bilateral hilar lymphadenopathy and pulmonary findings that were strongly suggestive of sarcoidosis, or possibly lymphoma but less likely. Patient was able to discharge home with diagnosis of sarcoidosis and leukopenia.

Other Meds:

Current Illness:

ID: 1554370
Sex: F
Age: 30
State: LA

Vax Date: 06/22/2021
Onset Date: 07/06/2021
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: None

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

Symptoms: My milk supply (breastfeeding) completely stopped about 1-2 weeks after the shot. I noticed my supply lowering about 3-5 days after my second shot. I also have a lot of constant pressure on my right arm where I received my first shot.

Other Meds: Pre-natal vitamins

Current Illness: None

ID: 1554371
Sex: F
Age: 23
State: ME

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

Lab Data:

Allergies:

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

Symptoms: Vaccine administered 6 hours after reconstitution...Contacted pfizer, CDC, and local epidemiologist Dr...Dr. advice was followed to consider dose give as valid and offer re-vaccination only if patient wanted. Patient was contacted and expanded the issue offered advisement from Dr. and offered re-vaccination if wanted. No adverse reaction s/p vaccination.

Other Meds:

Current Illness:

ID: 1554372
Sex: M
Age: 13
State: TX

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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKDA

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

Symptoms: Father alerted this RN to patient development of extreme fatigue after approximately 13 minutes post administration. This RN administered Zyrtec 10mg solution p.o. and manual blood pressure via right arm was 132/90, HR=81-88, O2= 98% via pulse oximeter and respiratory rate=12. Patient became more difficult to arouse, transported via wheelchair to room with reclining chair and epinephrine on site. Father report patient with NKDA, and no known history of adverse reactions to past vaccines or injection. No known medical history, other than medication for attention deficit per father. Code called by non-clinical staff member. This RN re-assessed patient and patient reported new onset of sharp chest pain to center of chest- no abnormal heart sounds auscultated at that time. Emergency response team arrived concurrently, and Pediatric MD began assessment of patient at 14:03pm. Patient began to complain of swelling to throat and new difficulty breathing. This RN administered 0.3cc Epinephrine, at 14:04pm per protocol and Pediatric MD aware. Immediate response in patient noted. Patient alert and oriented to person and place. Patient stable and transported by pediatric emergency nurse via wheelchair to the Pediatric Emergency Department for further evaluation and monitoring after administration of Epinephrine. Patient accompanied by father.

Other Meds:

Current Illness: No known per father

ID: 1554373
Sex: F
Age: 47
State: TX

Vax Date: 06/28/2021
Onset Date: 06/29/2021
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: None

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

Symptoms: July 24-25 trying to get up but did not feel strength in right hand. Unable to get up and felt dizzy. Felt right side of face felt frozen. Ambulance arrived, was able to move hand but could not stand. Told me I had a TIA and admitted to hospital for 2 days. August 9 Went back to ER and did not have a stroke but given blood thinner. Given anxiety medication because could not sleep.

Other Meds: Metformin bid, Atorvastatin

Current Illness: None

ID: 1554374
Sex: M
Age: 34
State: ME

Vax Date: 08/12/2021
Onset Date: 08/12/2021
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: Vaccine administered 6 hours after reconstitution...Contacted PFizer, CDC, ACIP and local epidemiologist Dr. advice was followed to consider dose give as valid and offer re-vaccination only if patient wanted. Patient was contacted and expanded the issue offered advisement from Dr. and offered re-vaccination if wanted. no adverse reaction s/p vaccination.

Other Meds:

Current Illness:

ID: 1554375
Sex: F
Age: 60
State: TX

Vax Date: 08/13/2021
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: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Patient states; "I feel like its going through me. All through my body up to my head." Nurse took vitals: Pulse 73, O2 95%, BP 168/96, Temp 98.0F, respiration 26. Monitored for 15 minutes, blood pressure was taken again it was 160/92. Patient recovered and left.

Other Meds:

Current Illness: None

ID: 1554376
Sex: M
Age: 62
State: WI

Vax Date: 06/01/2021
Onset Date: 08/09/2021
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: ACE inhibitors - Unknown reaction

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

Symptoms: Patient contracted COVID after being fully vaccinated.

Other Meds: Aspirin 325mg daily atorvastatin 40mg daily plavix 75mg daily losartan 50mg daily metoprolol tartrate 25mg BID nitroglycerin 0.4mg sublingual PRN for chest pain sildenafil 100mg PRN

Current Illness: None Documented

ID: 1554377
Sex: F
Age: 13
State: PR

Vax Date: 08/13/2021
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: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: I do not have any allergies

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

Symptoms: Patient reports feeling dizzy looks pale and notifies EMT staff and supervisor. VS are taken at 12:45pm BP 100/60, P52. 12:55 VS are taken BP 110/80, P68, R20/min. 1:20pm VS are taken again BP 100/70, P68/min and R16/min. Patient looks active and reports feeling better and walks away.

Other Meds: Not taking any medicine

Current Illness: I did not suffer from any disease

Date Died: 08/13/2021

ID: 1554378
Sex: M
Age: 46
State: IL

Vax Date: 08/10/2021
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: Fish

Symptom List: Unevaluable event

Symptoms: Death

Other Meds: no know home meds

Current Illness: pts live in girlfriend was dx with covid 19 on 8/3 per contact tracer documented that pt was experiencing mild sx at time of intial tracing.

ID: 1554379
Sex: F
Age: 27
State:

Vax Date: 06/07/2021
Onset Date: 06/07/2021
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:

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

Symptoms: Moderna COVID-19 Vaccine dose given 1 dayafter BUD for refrigeration

Other Meds:

Current Illness:

ID: 1554380
Sex: M
Age: 50
State: CA

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: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: N/a

Symptom List: Injection site pain, Pain

Symptoms: First Dose: Pfizer (05/04/2021) Second Dose: Moderna (08/13/2021)

Other Meds: N/a

Current Illness: N/a

ID: 1554381
Sex: F
Age: 30
State: CA

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

Lab Data:

Allergies: no allergies reported by client.

Symptom List: Injection site pain, Menorrhagia

Symptoms: Client received Janssen COVID vaccine (LOT# 201A21A, exp: 09/01/2021) at approximately 1608. Co-Lead RN, noted client EMT walk over to client who was sitting in chair near vaccination table. Co-Lead RN approached EMT and client. Per EMT, client alerted Vaccinator RPH that she was feeling lightheaded approximately 2 minutes after vaccination. Client alert and oriented to date, time, place and event. Client notes she usually feels lightheaded, hot and flushed following blood draws and injections and notes this feels similar. Client's skins were pink, warm and dry. Client assisted to zero-gravity chair. At 1613, vital signs were taken in sitting position: BP: 132/77, HR: 50, and RR10.Client reports he last ate at approximately 1100 and notes she had a salad. Client denies any other symptoms of shortness of breath, chest pain, palpitations, numbness or tingling, itchiness, or nausea. Client denies allergies to medications/foods/environment. Client denies medical history or use of medications at this time. Vital signs were taken at 1626 in seated position: BP 126/92, HR: 61, RR:12. Co-Lead RN checked in with client at 1640, and client reported he is feeling well and does not have any complaints. Co-Lead RN provided client with ER precautions and advised client to follow up with PCP . Client verbalized understanding. Client left observation area at 1641 following 30 minute observation from onset of symptoms. Client walking with a steady gait.

Other Meds: None reported by client.

Current Illness: none reported by client.

ID: 1554382
Sex: M
Age: 13
State: PR

Vax Date: 08/06/2021
Onset Date: 08/13/2021
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: No

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

Symptoms: Patient reports feeling dizzy and looks pale. Vital signs are taken at 1:30 pm B/P 100/60 68/ min, respiration 16, and dxt. 87mg/dl. Dr. is consulted and indicates the patient legs to be raised and the vitals are re-evaluated in the next 30 min. The new vital signs are taken spo2 99%, BP 100/80, pulse 82/min. Patient is discharge and walks out of the vaccination center.

Other Meds: None

Current Illness: None

ID: 1554383
Sex: F
Age: 14
State: MO

Vax Date: 08/13/2021
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: LA

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: The patient experienced light-headedness and almost fainted. She sat down on the floor and put her head between her knees. We had her sit in pharmacy area for further observation for about 30 minutes and she covered with no problems.

Other Meds:

Current Illness:

ID: 1554384
Sex: F
Age: 31
State: IN

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: RA

Lab Data:

Allergies: tramadol

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Itching all over body. No rash, bites or bumps. Only itching.

Other Meds: xyzal, flonase, magnesium

Current Illness: n/a

ID: 1554385
Sex: F
Age: 33
State:

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

Lab Data:

Allergies: N/A

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

Symptoms: "Pt w/ hx of PTSD, Panic Disorder, Obesity, Migraines, HTN, Depression. Pt is s/p bilateral salpingectomy on 12/3/20. Pt has no known allergies. 5mins post vaccination, pt c/o hives. Vitals: BP 98/67, HR 72, RR 20. Pt given Benadryl PO @14:45. Pt improved, pt stable and released from the vaccination site."

Other Meds: N/A

Current Illness:

ID: 1554386
Sex: M
Age: 29
State:

Vax Date: 06/07/2021
Onset Date: 06/07/2021
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: Nausea

Symptoms: Moderna COVID-19 Vaccine EUA dose given 1 days after BUD for refrigeration

Other Meds:

Current Illness:

ID: 1554387
Sex: F
Age: 43
State: OR

Vax Date: 08/06/2021
Onset Date: 08/06/2021
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:

Symptom List: Injection site pain

Symptoms: Patient was given her second dose of Pfizer 1 week early (Given 08/06, should have been 08/13)

Other Meds:

Current Illness:

ID: 1554388
Sex: M
Age: 13
State: TX

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: 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: Patient complained of light-headed and dizziness almost immediately after administration. Patient was asked to stay seated and remain in observation area for 15 minutes. Patient then complained of numbness and tingling of extremities and was not responding to commands or instructions. Patient never appeared to lose consciousness, however pharmacist suspected vasovagal syncope/response. EMS was dispatched and arrived in 10 minutes. Blood sugar was tested and was normal, Blood pressure was low. Patient taken to Medical Center for observation/IV fluids and released a few hours later.

Other Meds: None

Current Illness: Dehydration

ID: 1554389
Sex: F
Age: 68
State: TX

Vax Date: 01/15/2021
Onset Date: 01/29/2021
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: Sulfa drugs, clavulanic acid, tape, surgical glue

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

Symptoms: High blood pressure, strong palpitations, had to go the ER the next day because they did not stop. (1/30/2021). Later on had inflammation of blood vessels in some spots of right arm, and a skin rash. These two subsided on their own.

Other Meds: None

Current Illness: None

ID: 1554390
Sex: M
Age: 44
State: WI

Vax Date: 02/03/2021
Onset Date: 08/05/2021
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: No known allergies

Symptom List: Tremor

Symptoms: Patient contracted COVID-19 after being fully vaccinated

Other Meds: None Documented

Current Illness: None Documented

ID: 1554392
Sex: F
Age: 48
State: WA

Vax Date: 08/11/2021
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: Iodinated Diagnostic Agents

Symptom List: Erythema, Pruritus

Symptoms: Approximately 8 hours after my 2nd Moderna vaccination I began getting chilled and fatigued. That lasted for about 12 hours.

Other Meds: Levothyroxine Multivitamin Lysine Vit C Vit D

Current Illness: No

ID: 1554393
Sex: M
Age: 44
State: AZ

Vax Date: 08/10/2021
Onset Date: 08/10/2021
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: No

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

Symptoms: Anxiety, Dizziness, Inability to Sleep, Pressure in the Head, Weak legs, Numbness in hands and feet

Other Meds: Multi-vitamin, Tylenol,

Current Illness: Had a tooth removed one week prior

ID: 1554394
Sex: F
Age: 82
State: CA

Vax Date: 05/12/2021
Onset Date: 05/12/2021
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: LA

Lab Data:

Allergies: LISINOPRIL

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

Symptoms: PATIENT PASSED OUT

Other Meds: JANUMET, MOBIC, OLMESARTAN, LANTES, ESTRADIOL ,GLIPIZIDE, LEVOTHYROXIN, BISOPROL, FERROUS SULFATE, VIT D DULOXTINE, ROSUVASTIN,

Current Illness: NO ILLNESS AT TIME OF VACINE

ID: 1554395
Sex: F
Age: 27
State: TN

Vax Date: 05/03/2021
Onset Date: 06/12/2021
Rec V Date: 08/13/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Fever for four days, highest recorded temp 100? Coughing Stuffy nose Sore throat General malaise Went to urgent care and was given an antibiotic and cough medicine which finally ended the fever. Did not feel back to normal for 2 weeks. Chest congestion and coughing persisted the longest.

Other Meds: Complement+ vitamin supplement

Current Illness: None

ID: 1554396
Sex: M
Age: 47
State: IN

Vax Date: 08/11/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Diagnosed with benign paroxysmal positional vertigo. Emergency room visit after 36 hours. After 48 hours, still unable to move.

Other Meds:

Current Illness:

ID: 1554397
Sex: F
Age: 61
State: FL

Vax Date: 07/29/2021
Onset Date: 08/01/2021
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: Bell's palsy symptoms, pulling of the face, drooping of the face, pain in the neck of the arm vaccinated, headaches, dizziness and tightness in the face.

Other Meds: vitamins

Current Illness:

ID: 1554398
Sex: F
Age: 32
State: KY

Vax Date: 04/15/2021
Onset Date: 05/11/2021
Rec V Date: 08/13/2021
Hospital:

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

Lab Data:

Allergies: gluten sensitivity

Symptom List: Pain in extremity

Symptoms: menstrual changes - onset of night sweats, extremely heavy cycles, irregular spotting leading up to my period, longer cycles, trouble sleeping, increased irritability

Other Meds: magnesium

Current Illness: n/a

ID: 1554399
Sex: F
Age: 16
State: CA

Vax Date: 07/06/2021
Onset Date: 07/08/2021
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: Patient with redness surrounding site for 1 week, firm area for 2 weeks

Other Meds: none

Current Illness:

ID: 1554400
Sex: F
Age: 47
State: KY

Vax Date: 04/28/2021
Onset Date: 04/28/2021
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: Allergies to both tree and ground nuts. Allergy to demoral, Nsiads, feldene, lodine, tagament, celebrex

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

Symptoms: Arm pain, fever approx 101-102, upper respiratory, bronchitis, gastrointestinal- vomiting, diarrhea, headache, body aches, etc ... worse than flu I had in 2002/3

Other Meds: Repatha Carvedilol Amlodipine zyrtec fenofribrate lipitor trazadone B12 injections low dose aspirin plavix zetia lisinopril

Current Illness: N/A

ID: 1554401
Sex: F
Age: 46
State: SD

Vax Date: 02/08/2021
Onset Date: 02/14/2021
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: Possibly amoxicillin

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

Symptoms: Two days after an infusion, (five days after the shot), I got light jaw swelling at night and pain. It would last about a week or two. In April, they did a ten day course of dexamethasone

Other Meds: meds for RA

Current Illness: none

ID: 1554402
Sex: F
Age: 31
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: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: Generalized itchiness beginning at 0930. Took zrytec at 1145. Continued itchiness during day but lessened. Took benadryl at 2130. No itchiness next morning.

Other Meds:

Current Illness:

ID: 1554404
Sex: M
Age: 66
State: AR

Vax Date: 03/19/2021
Onset Date: 03/21/2021
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: sulfa

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: i have a rash, or red spots on legs, especially above the knee. They don't itch and still are present 5 months later. There was some rash below the knee; it cleared, but the rash on the thighs is still as prominent as it was in March. The doctor recommended a cream but i was hoping it would clear on its own which it has not. I'd send a picture if i could. Its not awful, but certainly prominent.

Other Meds: multi vitamin, vitamin b complex

Current Illness: n/a

ID: 1554405
Sex: F
Age: 53
State: FL

Vax Date: 07/29/2021
Onset Date: 08/05/2021
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: NKA

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

Symptoms: Bruising on left hand that looks like a blistered splotch appeared about 5-6 days after vaccination and then another similar but smaller spot on lip about a week after the first bruise was noticed followed 2 days later by 2 more eraser sized bruises again in the spot of the 1st bruise on hand. Saw my primary care today because I've never had any issues with bruising and these bruises aren't like any other bruise I have ever had. She has ordered blood work fasting for tomorrow but asked me if I had reported the reaction. So I am reporting this experience. Also having dizziness when lying flat and then rolling side to side or standing.

Other Meds: NONE

Current Illness: NONE

ID: 1554406
Sex: M
Age: 25
State: VA

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: IM
Vax Site: LA

Lab Data:

Allergies: None reported

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient passed out approximately 5 minutes after receiving vaccine. He became more alert after about 1 minute then passed out a second time after approximately 5 minutes. EMT arrived at this time and took over monitoring the patient.

Other Meds: None known

Current Illness: None reported

ID: 1554407
Sex: F
Age: 38
State: WA

Vax Date: 03/16/2021
Onset Date: 03/20/2021
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: RA

Lab Data:

Allergies: spirinolactin

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

Symptoms: With 4 days received an extra menstrual cycle that month along with a bloody nose. That menstrual cycle was 9 days long (normal is 4). It was incredibly heavy and not able to be contained to normal sanitary options. This has continued for all of the following months resulting in having to leave work at periods of time due to excess bleeding. Menstrual cycle has not normalized and has continued to be 9 to 14 days in length all of the subsequent months and is accompanied by dizziness, anxiety and palpitations.

Other Meds: Carvedilol Losartan Sertraline Magnesium Co-q 10 Excedrin

Current Illness: none

ID: 1554408
Sex: M
Age: 40
State: TX

Vax Date: 02/01/2021
Onset Date: 08/12/2021
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:

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

Symptoms: vaccinated with pfizer Jan-Feb 2021. Had cough, sore throat but its relieved . Now you have runny nose and congestion.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm