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**
PLEASE CHECK BACK SOON
Download the files above while you wait.






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: 1554461
Sex: F
Age: 65
State: CA

Vax Date: 02/13/2021
Onset Date: 03/15/2021
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 Sulpha

Symptom List: Dysphagia, Epiglottitis

Symptoms: Bells Palsey Left side of face paralyzed for 3 to 4 weeks

Other Meds: B HRT Calcium Vit D

Current Illness: None

ID: 1554462
Sex: F
Age: 40
State: NC

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

Lab Data:

Allergies: norco

Symptom List: Anxiety, Dyspnoea

Symptoms: Migraine, facial numbness, dizziness, ear pain, chest pain, panic attach

Other Meds: none

Current Illness: none

ID: 1554463
Sex: F
Age: 30
State: PA

Vax Date: 04/01/2021
Onset Date:
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:

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

Symptoms: Vaccinated with Pfizer in April 2021. Has no symptoms. Had covid in the end of January and bigining of February. Does not feel like sick at all. Discussed plan of care and treatment. Pt got reinfested with covid.

Other Meds:

Current Illness:

ID: 1554464
Sex: M
Age: 76
State: CA

Vax Date: 01/31/2021
Onset Date: 03/11/2021
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: Allergies against penicillin and and other "illins"

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: No adverse effects after the first or after the second injection on 02/28/2021 at the same place. 2nd injection lot #013A21A March 11 in the morning I noted that my left hand was swollen. The swelling went away during the day, but returned the next morning. There have not been any changes to this. At times the swelling is more severe than on other days. There is no numbness in my fingers.

Other Meds: Tamsulosin .4mg, Valacyclovir HCL 500mg, Ibandronate Sodium 150mg (once a month), Calciaum Citrate, CoQ10 100mg, Mature Multi Vitamin, Vitamin C 1,000mg, Vitamin D3 5,999IU, Immuplex, Aspirin 81mg. All but Inbandronate one per day

Current Illness: none

ID: 1554465
Sex: M
Age: 70
State: TN

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 erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Patient received the vaccine at 9:40 am on 08/11/2021. That evening, he experienced some shortness of breath when lying down to go to sleep. He has the same experience the following evening. He thought it was anxiety, so he took a valium. He did sleep a little better, but he still felt like it was difficult to take a deep breath. He returned to Clinic on 08/13/2021 for evaluation and advice. At his visit, it was discovered that his heart rate was 150-160 bpm. He was referred to hospital.

Other Meds: takes a blood pressure medication, but he does not know the name

Current Illness: none

ID: 1554466
Sex: F
Age: 43
State: TX

Vax Date: 03/11/2021
Onset Date: 04/15/2021
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: Bactrim Cinnamon

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

Symptoms: Fatigue, headache ,fever,

Other Meds: Pantoprazole, Montelukast, Pataday, topiramate, Amitriptyline, calcium +d3,super B-complex,Glucosamine chondroition, Miralax, benifiber, Famotidine, Ondansetron, Tizanidine, Ubrelvy, Rizatriptan, Sumatriptan

Current Illness: None

ID: 1554467
Sex: F
Age: 33
State: FL

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

Lab Data:

Allergies: Cactus, peptobismol

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: The night I got the shot I felt mostly fine, I started getting a headache about an hour later, otherwise good until about 5am. I work nights so I?m normally good staying up. Then I started feeling drained and getting body aches. By the time I got home from work it was worse. I started feeling dizzy and went to lay down. I spiked a high fever but was able to get it down at home with Tylenol and ice and staying hydrated. This cycle continued until yesterday afternoon when my fever finally broke. Then last night I started hallucinating. I was aware that I was hallucinating but couldn?t make it stop for what felt like at least an hour. I kept seeing lights that I knew weren?t really there and felt like the lights were talking to each other and also became paranoid that if I turned to look directly at the source of the lights some unknown terrible thing would happen. I have never had hallucinations before. I?ve had panic attacks before but this was very different. I knew it wasn?t really but I couldn?t stop seeing it and I was definitely awake, but too afraid to even move. Once it stopped I felt ok. I haven?t had

Other Meds: Gabapentin, amlodopine, hydrochlorothiazide, Robaxin, Celebrex, iron supplements, progesterone

Current Illness: None

ID: 1554468
Sex: M
Age: 38
State:

Vax Date: 04/30/2021
Onset Date: 04/30/2021
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: Pharyngeal swelling

Symptoms: Pt with 2nd pfizer vaccine on 30 Apr, (1st dose on 09 apr), reported to clinic to see PCM on 05 may with approximately 7 dizzispells per day and near syncope episodes + fatigue for nearly a week. Orthostatics were check and normal. PCM referred pt to neurology. Neuro perfromed a series of EEGs. Neuro referred pt for polypharmacy eval due to multiple meds associated with sx + cardiology. Both cardio and neuro believe sx most likely associated with med regimen as results of tests were insignificant of findings. Pt came to see myself on 25 Jun where we d/c'd lyrica (lose dose of 25mg daily daily since 11 Mar 2021 and tizanidine taking since jul 2020). Pt first noted resolutions of sx on 07 jul. but on 22 jul pt notes dizzispells still present but every other day. Made one more adjustment with alfuzosin, which pt started on 25 May, changed to tamsulosin, without change to sx. Medicinal wise, the covid 19 pfizer vaccine is the only other medication introduced around the pt reported sx. Pt states that i was the only provider who inquired about vaccinations around the time that sx started and encounters with other provides, vaccination was not inquired about.

Other Meds: pregabalin 25mg once daily, tramadol 50mg every 6 hrs prn, lidocaine 5% patch daily prn, tizanidine 2mg every 8 hrs prn, vitamin d2 50,000 IU weekly, Ibuprofen 800mg TID prn, pantoprazole 20mg po daily

Current Illness: bph, chronic pain, Low back pain, spondylolithesis, PTSD, chronic migraines

ID: 1554469
Sex: F
Age: 34
State: AZ

Vax Date: 08/10/2021
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: no

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Redness, Body Aches, Nausea, tired, arm pain around injection site. Next day: arm war to the touch, redness, unable to raise arm, arm pain. Took Tylenol 500 mg (2times), Swollen under armpit, PCP said it was a bacterial infection.

Other Meds: Cephalexin 500 mg 1 cap every 8 hours Bactrim DS 800 mg-160 mg 1 twice a day PRN Melatonin 20 mg Omega 3 Oral Twice a day Omeprazole 20 mg 1 cap twice a day Trazodone 50 mg 1 tab QHS

Current Illness: No

ID: 1554470
Sex: F
Age: 23
State: CA

Vax Date: 02/12/2021
Onset Date: 02/15/2021
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: Amoxicillin

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Adult blaschkitis. Cluster of raised pink papules on collarbone area. Untreatable. Had it for 6 months. Itchy at times and scaly appearance.

Other Meds: Vyvanse, Zoloft

Current Illness: None

ID: 1554471
Sex: F
Age: 53
State:

Vax Date: 08/07/2021
Onset Date: 08/12/2021
Rec V Date: 08/13/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: new onset nausea, vomiting, diarrhea, and flushed feeling

Other Meds:

Current Illness:

ID: 1554472
Sex: F
Age: 52
State: IL

Vax Date: 08/10/2021
Onset Date: 08/10/2021
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: None

Symptom List: Rash, Urticaria

Symptoms: 1.) Diarrhea starting around 5 for evening 2.) Fever began around midnight and hit 101 at 3:00. Advil reduced fever 3.) Lethargy 4.) I started by period 3 days later the exactly like I did 3 weeks prior on my shot on 7/13 which lasted for 10 days after not having it for 7 months as hitting menopause and have an IUD. 5.)Racing heart off and on similar to when I had the Covid Virus in Feb 2020

Other Meds: IUD

Current Illness: None

ID: 1554473
Sex: F
Age: 51
State: CA

Vax Date: 02/07/2021
Onset Date: 05/01/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Follow up report to original: I have had really odd insect bites all over my torso, arm and actually my whole body. I don't know if it is related to shingles or what. I have noticed them the last two months. They itch. We've had terminator/exterminator come out spray. We have done flea bombs and insect bombs, but I still noticed the "bites" mostly on torso front and back. Sometimes on arms, legs etc. I use a topical spray for itching and pain. In May, I noticed that I had feeling of being very overwhelmed. I felt disorganized. It was hard for me to be motivated to exercise or eat right. I am more irritable and yelling more. I have been using THC edibles in the evenings when I'm not working or the weekend. I am currently looking for a psychiatrist to oversee the medication management. The edibles seem to help I'm much less reactive and I have a longer "fuse" not as emotional or irritable. I have been to a doctor and a private therapist.

Other Meds: Wellbutrin; Zoloft

Current Illness: No

ID: 1554474
Sex: F
Age: 73
State: WI

Vax Date: 08/04/2021
Onset Date: 08/04/2021
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: clonidine - sleepy

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

Symptoms: Patient attended Shingrix vaccination clinic and received Shingrix vaccine. Upon entry into records, it was noted that patient already completed the series in 2019.

Other Meds: Multiple vitamin, Preservision aeds 2, omeprazole, metoprolol ER, fish oil, lisinopril/HCTZ, amlodipine, atorvastatin, cinnamon, vitamin B-6, vitamin D-3, oxybutynin, aspirin

Current Illness: NA

ID: 1554475
Sex: M
Age: 75
State: MD

Vax Date: 03/10/2021
Onset Date: 03/13/2021
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: None

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

Symptoms: 3 days after 2nd dose of Moderna, experience tinnitus (3/13/21). Unrelenting x months. No other neurological findings. Tinnitus confirmed, had canceling audio waves technology in clinic rendering relief. Return of symptoms when left clinic. Aug 2021: 15d course of methylprednisolone yielded complete relief. Now 1 wk after cessation, return of lower grade tinnitus, that is intermittent.

Other Meds: ASPIRIN 81 MG EC TABLET Take by mouth. BUPROPION (WELLBUTRIN SR) 100 MG 12 HR TABLET TAKE ONE TABLET BY MOUTH TWICE A DAY DARUNAVIR ETHANOLATE (PREZISTA) 600 MG TABLET Take 1 tablet (600 mg per dose) by mouth 2 (two) times daily

Current Illness: None

ID: 1554477
Sex: F
Age: 40
State:

Vax Date: 08/01/2021
Onset Date: 08/01/2021
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: None

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

Symptoms: Swollen lymph nodes; pain radiating down arm injected, shoulder area & chest; pain and itchiness at injection site; sharp fleeting pains throughout body; chills; twitching eye; fatigue; headache

Other Meds: None

Current Illness: None

ID: 1554478
Sex: M
Age: 36
State: TX

Vax Date: 02/01/2021
Onset Date:
Rec V Date: 08/13/2021
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: emailed / vaccinated with pfizer in Feb 2021. Feels congestion only.

Other Meds:

Current Illness:

ID: 1554479
Sex: F
Age: 72
State: GA

Vax Date: 08/02/2021
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: Sulfa and lexapro

Symptom List: Ear pain, Hypoaesthesia

Symptoms: 3x5 cm erythematous and mildly indurated area at site of injection

Other Meds:

Current Illness:

ID: 1554480
Sex: M
Age: 72
State: KY

Vax Date: 08/13/2021
Onset Date: 08/14/2021
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 SAID THAT HE GOT A SMALL RASH ON BOTH ARMS STARTING THE DAY AFTER HIS SHOT. IT DID NOT APPEAR TO BE VACCINE RELATED TO ME BUT FELT THAT I SHOULD REPORT IT. SEEMED MORE LIKE CONTACT DERMATITIS. PATIENT SAID THAT HE IS OUTSIDE A LOT BUT THAT IS WAS NOT POISON IVY BUT IT LOOKED SIMILIAR TO ME. THE RASH HAD IMPROVED AND WAS ALMOST GONE WHEN HE CAME IN. HE SAID HE DIDN'T KNOW IF IT WAS RELATED BUT THOUGHT HE SHOULD SHARE IT.

Other Meds: NONE

Current Illness: NONE

ID: 1554481
Sex: F
Age: 64
State: GA

Vax Date: 01/28/2021
Onset Date: 07/21/2021
Rec V Date: 08/13/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: COVID PNEUMONIA LEAD TO HOSPITALIZATION

Other Meds:

Current Illness:

ID: 1554482
Sex: M
Age: 55
State: WA

Vax Date: 04/02/2021
Onset Date: 04/09/2021
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: Bell's Palsu

Other Meds:

Current Illness:

ID: 1554483
Sex: M
Age: 30
State: GA

Vax Date: 06/08/2021
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: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: Patient stated that a few days ago the top of his mouth started feeling smooth like he was losing feeling. On 8/12/2021 he stated that it was hard for him to open his mouth. On 8/13/2021 his eyes were swollen and hard to open. He also could not feel the left side of his mouth. He said he could feel the muscle on his right side but not the left. He thought he was having a stroke. He went to the hospital, and they did a CT SCAN. The doctor diagnosed him with a ceria paisley.

Other Meds:

Current Illness:

ID: 1554484
Sex: F
Age: 48
State: TX

Vax Date: 04/01/2021
Onset Date:
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: Vaccinated with Moderna in April 2021. Has no symptoms.

Other Meds:

Current Illness:

ID: 1554485
Sex: F
Age: 61
State: WA

Vax Date: 04/02/2021
Onset Date: 04/08/2021
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: Bell's Palsy

Other Meds:

Current Illness:

ID: 1554486
Sex: F
Age: 11
State: NM

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: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient is under the age of 12.

Other Meds:

Current Illness:

ID: 1554487
Sex: F
Age: 29
State: WA

Vax Date: 07/02/2021
Onset Date: 07/07/2021
Rec V Date: 08/13/2021
Hospital: Y

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 true allergies, but severe reactions to gluten, oats, soy, and dairy, and bad reactions to eggs, garlic, onion, cane sugar, nightshades, and most fruits and vegetables.

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

Symptoms: Within a week from second shot, started having significant trouble breathing and higher heart rate than usual. Drs tried treating it as asthma initially as I and mild asthma in the past (but have never even had a full-blown asthma attack), but relief was only just enough that I was able to sleep without waking up not being able to breathe. After asthma medications proved to not help enough over the course of a week with a new management medication (Flovent), I tried Prednisone as my pulmonologist suggested. That also didn't help. I was struggling to breathe and my heart rate was consistently over 120 bpm, so I went to the ER. After a lot of testing and being admitted for two nights at the hospital, eventually I was diagnosed with POTS. Although I've had symptoms of it before, and suspected I might have it, I had never come close to having so much trouble breathing before and my heart rate was higher than normal (over 120 just sitting up partially) even though it's fairly common for my heart rate to be over 100 with very little activity. After the diagnosis of POTS I have been following instructions to treat at home, but even with treatment for a week and a half so far (compression stockings and a lot of fluids and electrolytes), although my breathing i snuck better when I'm completely still, even walking up and down stairs slowly makes it hard to catch my breath. At this time it's unclear whether this is a permanent change in my condition or a temporary one. Also worth noting is that we had a major heat wave around the time of my second vaccine shot and I may have been more dehydrated than normal and hotter, which could have exacerbated the POTS symptoms, but heat and dehydration have never put me in this state before.

Other Meds: Testosterone cypionate, Albuterol, Low Dose Naltrexone, Hemp CBD, Vitamin D3

Current Illness: Fibromyalgia and Asthma. Suspected POTS and EDS - hypermobile type.

ID: 1554488
Sex: M
Age: 65
State: CA

Vax Date: 02/11/2021
Onset Date: 08/04/2021
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: 8/13, Patient called to ER and stated that Sx, chills since 8/1. The last day worked was 7/23. Son was point of contact. Vaccinated.

Other Meds:

Current Illness:

ID: 1554489
Sex: F
Age: 54
State: WY

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: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Client received a 3rd dose of Moderna intentionally, on consent form denied having been vaccinated previously.

Other Meds:

Current Illness:

ID: 1554490
Sex: F
Age: 51
State: CA

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: RA

Lab Data:

Allergies: Food allergy, unknown, anaphylaxis Tape-rash Donnatol-vomit

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

Symptoms: Patient developed allergic reaction to vaccine within 8 minutes. Patient c/o of lighheadedness was given Zyrtec at 8:51 a.m. VS at 8:55 were BP 142/84, P 68 and O2 99%. Patient c/o redness in face and throat and Benadryl 25 mg IM at 8:58 a.m. Dexamethasone 4mg given IM at 8:59 a.m. Patient c/o throat tightening. EpiPen administered at 9:01 a.m. VS B/P 129/76, P 77, 02 100%. 9:11 BP 129/77, P 80, S02 100%. 9:17 BP 107/66, P72, )2 98%.

Other Meds: Riboflavin 400 mg every day Albuterol Inhaler prn Miralax daily Tylenol prn Ibuprophen prn

Current Illness: None

ID: 1554491
Sex: M
Age: 35
State: WA

Vax Date: 06/05/2021
Onset Date: 06/10/2021
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: Bell's palsy

Other Meds:

Current Illness:

ID: 1554492
Sex: F
Age: 54
State: AR

Vax Date: 07/30/2021
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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: N/A

Symptom List: Injection site pain

Symptoms: Severe red and swollen arm, her pcp recommended for her to not get the second shot.

Other Meds: N/A

Current Illness: N/A

ID: 1554493
Sex: F
Age: 34
State: MA

Vax Date: 03/18/2021
Onset Date: 04/10/2021
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: No

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

Symptoms: My first dose it was during my baby conception, I didn?t know that. The second dose I felt tired and very sick. After that I discovered that I was pregnant. During my pregnancy I had headache every day for almost 4 months and I also throwed up almost everyday. Between my 3 to 4 months we discovered evidence of Down syndrome. On 14 to 15 weeks we had the confirmation. I am afraid that the vaccine applied during the conception might be related to this event.

Other Meds: Sertraline

Current Illness: No

ID: 1554495
Sex: F
Age: 48
State: MA

Vax Date: 05/03/2021
Onset Date: 07/26/2021
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: penicillin, latex, oral allergy syndrome

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

Symptoms: Tested positive for COVID-19 on July 26, 3 months after the 2nd shot

Other Meds: nothing

Current Illness: none

ID: 1554496
Sex: M
Age: 47
State: WI

Vax Date: 08/05/2021
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's girlfriend called pharmacy 8/13. She said patient got Moderna 8/5/21. That evening, he had a sore arm. Over the weekend, he then could not raise his arm and could not move wrist or fingers. He took Ibuprofen with some relief. However, today he is in excruciating pain. She said he cannot even put a shirt on. He was advised to seek medical attention

Other Meds: none aware of

Current Illness: none known

ID: 1554497
Sex: F
Age: 51
State: AL

Vax Date: 08/05/2021
Onset Date: 08/05/2021
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: unknown

Symptom List: Erythema, Pruritus

Symptoms: after receiving vaccine, approximately 15 minutes later, patient had a panic episode, pt was short of breath, but able to breath with no signs of anaphylaxis. EMS was called by daughter and pharmacist were notified. Patient was able to walk to stretcher and left in ambulance.

Other Meds: unknown

Current Illness: unknown

ID: 1554498
Sex: F
Age: 29
State: MA

Vax Date: 07/22/2021
Onset Date: 07/25/2021
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: Woke up Sunday morning and couldn't use left leg. Went to the ER, had imaging done on the left leg and was diagnosed with DVT with multiple small clots. Prescribed Eliquis for 6 months. Was called by CDC via using the V-Safe daily check in and asked to complete this form.

Other Meds:

Current Illness:

ID: 1554499
Sex: F
Age: 24
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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKA

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

Symptoms: @1328 Post vaccination, patient started complaining of nausea. Emesis bag provided. Pt vomited about 300ml of food bolus. Pt stated that she usually vomits when she's on her period and she is currently menstruating. Pt has a follow up visit with PMD on Aug 26th. Cooling measures provided. Effective. @1335 Pt is feeling better. Able to tolerate PO intake. VS 137/90 67RN 100%RA 18RR. Pt came in with husband and is confident of going home. ED precautions provided and encourage to message PMD about incident. Dr. made aware.

Other Meds: Famotidine, Simethicone

Current Illness: None

ID: 1554501
Sex: M
Age: 0
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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none known

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: PATIENT FAINTED

Other Meds: none known

Current Illness: none known

ID: 1554502
Sex: F
Age: 47
State: ID

Vax Date: 05/04/2021
Onset Date: 07/29/2021
Rec V Date: 08/13/2021
Hospital:

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

Lab Data:

Allergies: Sofia, antibiotics, latex, sermonize

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

Symptoms: I started having symptoms on July 25th. I had trouble eating and swelling. My face started to droop. I thought it was a stroke. I went to the ER. They treatment me four hours. They did a CT scan and blood test. I had migraines. I was diagnosed with Bell palsy.

Other Meds: levothyroxine, Paroxetine, Veracomile

Current Illness:

ID: 1554503
Sex: F
Age: 24
State:

Vax Date: 08/03/2021
Onset Date: 08/10/2021
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: mice

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

Symptoms: Localized swelling, erythema, tenderness at injection site

Other Meds: none

Current Illness: none

ID: 1554505
Sex: M
Age: 67
State: MN

Vax Date: 08/04/2021
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: Pain in extremity

Symptoms: 2 inch red lump at injection site noted 9 days after inject. Unsure of when reaction started

Other Meds:

Current Illness:

ID: 1554506
Sex: M
Age: 69
State: MO

Vax Date: 02/26/2021
Onset Date: 07/31/2021
Rec V Date: 08/13/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 2
Vax Route:
Vax Site:

Lab Data:

Allergies: unknown

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

Symptoms: 2nd dose on 2/26/2021. Then admitted to hospital on 7/31/2021. Currently still in hospital in regular nursing floor. Unable to reach family for status update

Other Meds: unknown

Current Illness: unknown

ID: 1554507
Sex: F
Age: 64
State: NY

Vax Date: 01/29/2021
Onset Date: 03/04/2021
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: I am allergic to Penicillin, Tetracycline, and Sulphur based drugs.

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

Symptoms: I experienced soreness at the injection site. During my regular annual physical in February 4, 2021 and it showed that two particular liver enzymes showed AST 791 and ALT 1319 which made my PCP's become concerned because the range was higher than it should be. I had subsequent blood work showed that the enzymes were still to high AST756 and ALT 1413. I was sent to see a specialist for follow up and was diagnosed with Autoimmune Hepatitis. I was given prescription medications Prednisone (has since been replaced with Budesonide as of 8/10/2021) and Azathioprine until further notice. My diagnosis is now a lifetime condition of Autoimmune Hepatitis.

Other Meds: I took my normal medications Hydroxyzine along with supplements: Vitamin D, Magnesium, Biotin, Ibuprofen, Melatonin.

Current Illness: No

ID: 1554508
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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKA

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

Symptoms: Patient received vaccine and then said she did not feel well. Within minutes she became unresponsive and starting having jerking movements indicating a seizure. Her eyes became blank and then seemed to roll back into her head. At that point it did not appear that the patient had a pulse. I laid her on the floor to start CPR and she then became responsive before CPR was administered. We had called the paramedics and they arrived and found the patients vital signs to be normal.

Other Meds: Unkown

Current Illness: No

ID: 1554509
Sex: F
Age: 71
State: OR

Vax Date: 03/29/2021
Onset Date: 04/12/2021
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: antibiotics

Symptom List: Vomiting

Symptoms: uti, flu like symptoms

Other Meds: femotadine, alprazalam,

Current Illness:

ID: 1554510
Sex: M
Age: 27
State: WY

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

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Extraneous dose, not realized until entered in database, had a Janssen 03/17/2021. On consent form ct denied ever having a COVID vaccine previously. Attempted to call ct twice to assess how he did, no answer, unable to leave a message.

Other Meds:

Current Illness:

ID: 1554511
Sex: M
Age: 67
State: FL

Vax Date: 07/08/2021
Onset Date: 07/09/2021
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: RA

Lab Data:

Allergies:

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

Symptoms: patient states 10 hours after receiving second moderna he experienced difficulty breathing and ended up at the hospital intubated for 9 days

Other Meds: unknown

Current Illness:

ID: 1554512
Sex: M
Age: 38
State: CA

Vax Date: 02/05/2021
Onset Date: 03/22/2021
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: Penicillin

Symptom List: Injection site swelling, Limb discomfort

Symptoms: 3-22-21 developed DVT in left leg. Eliquis perscribed. 5-2-21 ultrasound shows second DVT left leg, 5-10-21. Labs show increase in ALT liver enzymes of 500+. Bilirubin 5 and ANA positive. 7-12-21 ALT at 1112 bilirubin 5. ESR 36. 7-22-21 ALT 1299. Diagnosed with AIH. Possible LUPUS. No prior indications for either. Put on 40 mg of prednisone.

Other Meds: None

Current Illness: None

ID: 1554513
Sex: F
Age: 20
State: NY

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

Lab Data:

Allergies: Penicillin

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

Symptoms: Swollen, red, itchy, painful rash around injection site. 2 inches in diameter.

Other Meds: Probiotic, ashwagandha root

Current Illness:

ID: 1554514
Sex: F
Age: 22
State: NH

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: RA

Lab Data:

Allergies: nka

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

Symptoms: Patient experieced dizziness and fainting after receiving the vaccine. She continued to pass out and regain consciousness repeatedly over a half hour or so. She experienced sweating, chills, tingling in extremities, and loss of hearing. She was evaluated by EMS and cleared to go home.

Other Meds: none

Current Illness: none

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm