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: 1558308
Sex: U
Age: 40
State:

Vax Date: 03/26/2021
Onset Date: 03/26/2021
Rec V Date: 08/14/2021
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: N/A - Admin deviation reporting only; no adverse event

Symptom List: Dysphagia, Epiglottitis

Symptoms: Administrative deviation only; no adverse event resulted from this deviation. Administrative deviation only; no adverse event resulted from this deviation. This patient received a mixed series of COVID-19 vaccine (one dose of Moderna and one dose of Pfizer - box #4 above reflects the date of the second dose). The decision to administer a mixed series to the patient was due to an "exceptional circumstance" stemming from the unavailability of the first vaccine product (Moderna) at the time the second dose was This patient received a mixed series of COVID-19 vaccine (one dose of Moderna and one dose of Pfizer - box #4 above reflects the date of the second dose). The decision to administer a mixed series to the patient was due to an "exceptional circumstance" stemming from the unavailability of the first vaccine product (Moderna) at the time the second dose was due. We understand that although CDC provides considerations for a mixed series in exceptional circumstances (such as a vaccine shortage, which was the case here), a mixed series is still considered an administration deviation that requires VAERS reporting. Note that the date of vaccination on this form reflects the date the patient received his/her second vaccine dose.

Other Meds: N/A - Admin deviation reporting only; no adverse event

Current Illness: N/A - Admin deviation reporting only; no adverse event

ID: 1558309
Sex: F
Age: 48
State: OR

Vax Date: 08/05/2021
Onset Date: 08/13/2021
Rec V Date: 08/14/2021
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: Peppers

Symptom List: Anxiety, Dyspnoea

Symptoms: Sudden extreme swollen lymph under jaw, side neck and base of skull, and left arm pit. Intermittent Numbness follows same path from injection to elbow through forearm to thumb. New Slight redness and heat at injection site. Mild throat irritation and drainage (I suspect from wildfire smoke, but could be related to lymph, so including.)

Other Meds: Vitamin c, vitamin d, magnesium

Current Illness: None

ID: 1558310
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/14/2021
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: My chronic migraines are out of control: lasting days and I am not being able to stop them myself. I have to go to ER. Already 4 times. Never happened before my vaccination. My preventive migraine meds are not working as well as before.

Other Meds:

Current Illness:

ID: 1558311
Sex: F
Age: 51
State: GA

Vax Date: 08/11/2021
Onset Date: 08/11/2021
Rec V Date: 08/14/2021
Hospital:

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

Lab Data:

Allergies: Nsaids

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Headache, body aches, , cramping , a 101-degree fever that lasted 24 hours. Sweating profusely, chest/lung pain, 72 hours. Chills 48 hours. Did not seek treatment

Other Meds: COQ10/Fish Oil/Esomeprazole/Vitamin D/Atenolol/Duloxetine/Buprpion/Methocarbomol/Gabapentin/Atorvastatin/Quetiapine/Trazodone/Prazosin/Hydroxyzine/Lortab/Calcium, Magnesium,Zinc

Current Illness:

ID: 1558312
Sex: F
Age: 52
State: AK

Vax Date: 07/01/2021
Onset Date: 07/01/2021
Rec V Date: 08/14/2021
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: NO MENSTRUAL CYCLE SINCE VACCINATION, LOSS OF BLADDER CONTROL AND JOINT PAIN.

Other Meds:

Current Illness:

ID: 1558313
Sex: F
Age: 76
State: CA

Vax Date: 02/25/2021
Onset Date: 03/12/2021
Rec V Date: 08/14/2021
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: Penicillin

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

Symptoms: On several occasions, severe dizzy spells, extreme vomiting, rapid increase in blood pressure. I have been to the emergency room for this on about 5 occasions. No apparent cause has been found.

Other Meds: Eliquis 5mg 2x day 5-MTHF Plus Forte Biotics Acti-Mag Plus powder Boswellia - Allergy Resource Group Calcium Lactate Catalyn GF Cardio-Plus GF - Cataplex F CoQ-Zyme100 Plus Biotics (for cholesterol) D3 5000 Hawthorn - Livaplex - Standar

Current Illness:

ID: 1558314
Sex: M
Age: 50
State: NM

Vax Date: 04/27/2021
Onset Date: 04/28/2021
Rec V Date: 08/14/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Since the day after getting the vaccine, the muscles in my upper left arm, around the site of the injection, hurt when I stretch them. It feels like a permanently pulled muscle. The effect is most noticeable first thing in morning but occurs to some degree throughout the day, every time I stretch my left arm. It's been almost four months since I received the shot, but my muscles still haven't recovered.

Other Meds: None

Current Illness: None

ID: 1558315
Sex: F
Age: 15
State: IA

Vax Date: 08/13/2021
Onset Date: 08/13/2021
Rec V Date: 08/14/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Pharyngeal swelling

Symptoms: Patient was given Modena vaccine at age 15/No adverse reaction reported to this

Other Meds: Melatonin, Depo Provera

Current Illness: none

ID: 1558316
Sex: F
Age: 41
State: CT

Vax Date: 08/12/2021
Onset Date: 08/12/2021
Rec V Date: 08/14/2021
Hospital:

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

Lab Data:

Allergies: Latex, tree nuts

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Swollen injection site with abrasions warm to touch, entire arm through to arm pit sore and Swollen, still not cleared up 48 hours later. Blood pressure climbed from 110/77 to 128/91 by 10pm day of vaccination, down back to normal by 9am next morning. Muscles aches and excessive sweating and temp 100.6 for 36 hours starting 5 hours after vaccination.

Other Meds: Junel Fe, sertraline hcl 100mg

Current Illness: None

ID: 1558317
Sex: F
Age: 78
State: FL

Vax Date: 08/12/2021
Onset Date: 08/13/2021
Rec V Date: 08/14/2021
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:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: HEADACHE, DIZZINESS, OFF BALANCE, CONSTIPATED, INCREASED BLOOD PRESSURE, EMERGENCY ROOM

Other Meds:

Current Illness:

ID: 1558318
Sex: F
Age: 66
State: VA

Vax Date: 07/29/2021
Onset Date: 07/30/2021
Rec V Date: 08/14/2021
Hospital:

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

Lab Data:

Allergies: Erythrymicin, Darvocet

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

Symptoms: Friday pain started 24 hours pain in shoulder worse than being kicked by horse and being thrown 20 feet, worse than 11 bee stings at same time, pain so bad no sleep for next two nights. crept up my are into shoulder and across my back....Finally got sleep Sunday after taking 2) 625. Tylenol, then 2 more 8 hours later. Shot triggered chronic pain.

Other Meds: Tegratol, generic. Monelukest.

Current Illness: Epilepsy, Asthma, chronic pain, chronic Fatigue, Restless legs syndrome, arthritis,

ID: 1558319
Sex: M
Age: 13
State: PA

Vax Date: 08/05/2021
Onset Date: 08/06/2021
Rec V Date: 08/14/2021
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: Heart inflammation. Headache. Chest pain. Difficulty breathing.

Other Meds: None

Current Illness: None

ID: 1558320
Sex: F
Age: 80
State:

Vax Date: 03/26/2021
Onset Date: 03/26/2021
Rec V Date: 08/14/2021
Hospital:

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

Lab Data:

Allergies: N/A - Admin deviation reporting only; no adverse event

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

Symptoms: Administrative deviation only; no adverse event resulted from this deviation. Administrative deviation only; no adverse event resulted from this deviation. This patient received a mixed series of COVID-19 vaccine (one dose of Moderna and one dose of Pfizer - box #4 above reflects the date of the second dose). The decision to administer a mixed series to the patient was due to an "exceptional circumstance" stemming from the unavailability of the first vaccine product (Moderna) at the time the second dose was This patient received a mixed series of COVID-19 vaccine (one dose of Moderna and one dose of Pfizer - box #4 above reflects the date of the second dose). The decision to administer a mixed series to the patient was due to an "exceptional circumstance" stemming from the unavailability of the first vaccine product (Moderna) at the time the second dose was due. We understand that although CDC provides considerations for a mixed series in exceptional circumstances (such as a vaccine shortage, which was the case here), a mixed series is still considered an administration deviation that requires VAERS reporting. Note that the date of vaccination on this form reflects the date the patient received his/her second vaccine dose.

Other Meds: N/A - Admin deviation reporting only; no adverse event

Current Illness: N/A - Admin deviation reporting only; no adverse event

ID: 1558322
Sex: F
Age: 25
State: GA

Vax Date: 08/13/2021
Onset Date: 08/14/2021
Rec V Date: 08/14/2021
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: The day after my vaccine I experienced normal side effects of fatigue and body aches. Later in the afternoon I also started having breathing/asthma issues. My asthma is very controlled and typically I only have flare ups with sickness. The breathing problems I have experienced are very similar to the issues I had when I was sick with Covid-19 in December of 2020.

Other Meds: One Chapter Womens Multivitamin

Current Illness: none

ID: 1558323
Sex: M
Age: 42
State: VA

Vax Date: 08/14/2021
Onset Date: 08/14/2021
Rec V Date: 08/14/2021
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: Patient became unconscious while waiting the 15-20 minute period after vaccination. His parents tried to wake him but no response. Was asked to call ambulance. While on phone with dispatcher, the parents threw water on him and he woke up. Parents said to cancel ambulance. Patient remained in pharmacy for another half hour while drinking water and eating candy. He felt back to normal and left with his parents.

Other Meds:

Current Illness:

ID: 1558324
Sex: F
Age: 33
State: TX

Vax Date: 08/07/2021
Onset Date: 08/07/2021
Rec V Date: 08/14/2021
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: ADHESIVE TAPE

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

Symptoms: Patient reports that a few hours after receiving the vaccine, she broke out in a pruritic rash on her face and forearms which is still persisting 7 days post vaccine administration. Symptoms have not improved with Claritin. Pt denies lip/tongue/throat swelling, dyspnea, chest pain, nausea, vomiting, diarrhea or any mental status changes.

Other Meds: NOVOLOG INSULIN

Current Illness:

ID: 1558325
Sex: M
Age: 12
State: CA

Vax Date: 08/14/2021
Onset Date: 08/14/2021
Rec V Date: 08/14/2021
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: Very short-term syncope, probably caused more by anxiety/stress from receiving a vaccine as patient was nervous when actually receiving a shot. Patient reported nausea and appeared to be hyperventilating right after incident occurred so mother took him to the restroom together with member of pharmacy staff. Patient returned after a few minutes reporting he was feeling much better. Was able to walk and converse freely. Kept patient for 30 minutes observation period.

Other Meds:

Current Illness:

ID: 1558326
Sex: F
Age: 18
State: NY

Vax Date: 07/26/2021
Onset Date: 07/30/2021
Rec V Date: 08/14/2021
Hospital:

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

Lab Data:

Allergies: Lactose Intolerant

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Four days after getting my first dose of the Pfizer vaccine I woke up at around 5:40 with a stabbing chest pain and difficulty breathing. This lasted for 15-20 minutes. Day five I was fine, however day 6 the pain came back around the night time like at 9:00. Days 6 and 7 I had trouble breathing at night. Lastly today, 8/14/2021 I have had pain in my upper chest near my right side for 5-10 minutes.

Other Meds:

Current Illness:

ID: 1558327
Sex: M
Age: 66
State: CA

Vax Date: 07/15/2021
Onset Date: 07/18/2021
Rec V Date: 08/14/2021
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: two days after vaccine, started getting like large red spots mostly on both legs. Very similar to a mosquito bite with a little white spot at the top. The itch very severe.

Other Meds: levothyroxine alfuzosin unison

Current Illness: none

ID: 1558328
Sex: M
Age: 54
State: TX

Vax Date: 08/14/2021
Onset Date: 08/14/2021
Rec V Date: 08/14/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Pt complained of warm feeling about 10 minutes after receiving vaccination and requested some water, pt was given an ice pack to cool off. symptom resolved after 10 minutes. Pt was monitored for another 10 minutes before discharged.

Other Meds: Ozempic, Ambien, Mirtazapine, Fluoxetine, Betamethasone cream, Invokana, Metformin

Current Illness:

Date Died: 08/10/2021

ID: 1558329
Sex: M
Age: 79
State: MS

Vax Date: 07/20/2021
Onset Date: 08/10/2021
Rec V Date: 08/14/2021
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: PCN

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

Symptoms: Patient was found dead in the yard of his residence. He laid in the yard for a couple of days before he was discovered. No further information was provided by the family. His wife lives with him in the home; however, she is disabled and unable to provide any information.

Other Meds: amLODIPine (NORVASC) 10 MG tablet aspirin 325 MG tablet Fexofenadine HCl (ALLEGRA PO) fluticasone (FLONASE) 50 MCG/ACT nasal spray IBUPROFEN PO metoprolol (TOPROL-XL) 50 MG 24 hr tablet Omega-3 Fatty Acids (FISH OIL PO)

Current Illness: Digestive Laryngopharyngeal reflux (LPR) Respiratory Chronic sinusitis

ID: 1558330
Sex: F
Age: 32
State: CA

Vax Date: 04/09/2021
Onset Date: 04/10/2021
Rec V Date: 08/14/2021
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: Unevaluable event

Symptoms: I was 35 weeks pregnant at the time of my second dose of Moderna COVID vaccine. Approximately 15 hours after receiving the vaccine, I developed a fever. Approximately 18 hours after receiving the vaccine, my water broke and I went into preterm labor (baby and I are fine).

Other Meds: Prenatal vitamin

Current Illness: None

ID: 1558331
Sex: F
Age: 41
State: MN

Vax Date: 01/27/2021
Onset Date: 01/28/2021
Rec V Date: 08/14/2021
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: none

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

Symptoms: Upon waking on 1/28/2021: Redness and hives at site injection that spread in surface area coverage over next several days; arm swelling over next several days; increased fatigue (ongoing); severe headache for 24 hours; armpit/axillary lymph node enlargement for 1-2 weeks; submandibular/neck lymphadenopathy (ongoing) that has not resolved Waited 6-8 weeks to monitor reduction in lymph nodes enlargement at neck, but it increased and I went into my heme/onc in April to have her check it out. I had an ultrasound done in April 2021 and a repeat US in August 2021 with minimal size increase or no change in size. Abnormal LFTs during both lab checks around time of ultrasounds. I was given a steroid regimen over this past week and went in for f/u labs 8/13/21.

Other Meds: 30 mg duloxetine daily, 10 mg adderall generic daily, daily multivitamin

Current Illness:

Date Died:

ID: 1558332
Sex: M
Age: 41
State: CA

Vax Date: 08/11/2021
Onset Date: 08/13/2021
Rec V Date: 08/14/2021
Hospital: Y

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: death

Other Meds:

Current Illness:

ID: 1558333
Sex: F
Age: 54
State: AZ

Vax Date: 04/08/2021
Onset Date: 04/25/2021
Rec V Date: 08/14/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Injection site pain, Menorrhagia

Symptoms: Injection given high in the deltoid area, deep. Severe pain and stiffness. Diminished motion.

Other Meds: Vitamins A, B, C, Selenium, zinc, folic acid, glucosamine

Current Illness: None

ID: 1558334
Sex: F
Age: 55
State: CA

Vax Date: 07/22/2021
Onset Date: 07/23/2021
Rec V Date: 08/14/2021
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: None

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

Symptoms: I have had severe diarrhea every single day since taking the vaccine, 3-6x daily and with abdominal pain. Have never had this problem priory

Other Meds: None

Current Illness: None

ID: 1558335
Sex: M
Age: 0
State: FL

Vax Date: 08/14/2021
Onset Date: 08/14/2021
Rec V Date: 08/14/2021
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: none reported

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: patient's family member called after couple hours after receiving the vaccine,mentioning that the patient was feeling dizzy which might be also due to his upset stomach for which he had taken immidium. Pharmacist called the patient in a few hours and patient was feeling ok.

Other Meds: none reported

Current Illness: none reported

ID: 1558336
Sex: M
Age: 34
State: TX

Vax Date: 08/10/2021
Onset Date: 08/11/2021
Rec V Date: 08/14/2021
Hospital:

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

Lab Data:

Allergies: mosquito bites

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Irritation at injection site, arm hurt, 1st day 2nd day headache, fever of 100.2, sharp stabbing pains in arms and legs, left arm elbow, other random spots extreme fatigue, muscle weakness, nausea, short of breath, day 3 & 4 , joints tight , stiff spine, neck & back charlie horse. Headache, can't sleep Treatment: taking Tylenol, drinking extra fluids, rest

Other Meds: none

Current Illness: none

ID: 1558337
Sex: M
Age: 39
State: IA

Vax Date: 08/13/2021
Onset Date: 08/13/2021
Rec V Date: 08/14/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Pain at injection site, mild fever (100F), treating with Ibprofen.

Other Meds: None

Current Illness: None

ID: 1558338
Sex: M
Age: 37
State: NC

Vax Date: 08/12/2021
Onset Date: 08/14/2021
Rec V Date: 08/14/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Nausea

Symptoms: Itchy, burning hives and rashes on left arm, armpit, upper chest and neck

Other Meds: Amlodepine Lisinopril

Current Illness: None

ID: 1558339
Sex: F
Age: 15
State: CA

Vax Date: 08/14/2021
Onset Date: 08/14/2021
Rec V Date: 08/14/2021
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: After patient got her second dose of the Pfizer vaccine, she felt light-headed and blacked out for a split -second and fell to the floor and hit her head. I put her on the side, and placed a soft cloth underneath her head and gave her a hard candy to suck on. After 5 minutes she felt better and was able to sit on the chair.

Other Meds: Montelukast 10mg : 1 tablet by mouth every day.

Current Illness: none

ID: 1558340
Sex: F
Age: 40
State: LA

Vax Date: 07/29/2021
Onset Date: 07/31/2021
Rec V Date: 08/14/2021
Hospital:

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

Lab Data:

Allergies: Nuts, penicillin, potato, mushrooms, and more (food allergies usually onset by stress)

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

Symptoms: Mild vestibular issues (the spins when turning my head) Began about 2 days after vaccination (7/29 vax date), still occurring (as of 8/14)

Other Meds: none

Current Illness: none

ID: 1558341
Sex: M
Age: 75
State: WA

Vax Date: 02/14/2021
Onset Date: 02/17/2021
Rec V Date: 08/14/2021
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: Ambien, Sulfa drugs, Zoloft, Delsym otc cough, Baclofen, Gabapentin, Diclofenac gel, Bupropion, Azelastine, Iprattropium Bromide, Mira-lax, AND Covid 19 Vaccine

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

Symptoms: Light fatigue 3 days after first shot lasting until the second shot; Incapacitating fatigue 3 hours after second shot lasting until this date of 08/14/2021 although it did lighten up over time but has not completely stopped.

Other Meds: Balzalazide, Anoro Ellipta, Omerprazole, Testosterone, Levitra, Rosuvastatin---Metamucil, Florastor Probiotics, Vitamin D, Osmolite 1.5 stomach tube feed

Current Illness:

ID: 1558343
Sex: M
Age: 17
State: AL

Vax Date: 08/14/2021
Onset Date: 08/14/2021
Rec V Date: 08/14/2021
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: Tremor

Symptoms: 1 minute after patient received the vaccine he began to seize and was unresponsive for approximately 30 seconds. We laid the patient on his back and he began to respond and said he felt light-headed. Ems arrived and checked his vitals. He was released by EMS 45 minutes later.

Other Meds: none

Current Illness: none

ID: 1558344
Sex: M
Age: 36
State: IL

Vax Date: 08/14/2021
Onset Date: 08/14/2021
Rec V Date: 08/14/2021
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: Erythema, Pruritus

Symptoms: PATIENT GOT THE FIRST DOSE OF COVID -19 MODERNA VACCINE AND CAME IN TO GET HIS SECOND DOSE OF MODERNA. PATIENT WAS GIVEN COVID - 19 PFIZER VACCINE AS THE SECOND DOSE INSTEAD.

Other Meds: NONE

Current Illness: NONE

ID: 1558345
Sex: M
Age: 23
State: OH

Vax Date: 12/31/2020
Onset Date: 05/17/2021
Rec V Date: 08/14/2021
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: Over the course of three days, had fatigue, fever of 101, sore throat, persistent cough and sneezing

Other Meds:

Current Illness:

Date Died: 07/30/2021

ID: 1558346
Sex: M
Age: 41
State: WV

Vax Date: 07/16/2021
Onset Date: 07/16/2021
Rec V Date: 08/14/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Was very tired and wanted to stay in bed from short time after receiving the vaccine. Experienced some chest pain. Was found deceased in house at night 14 days later.

Other Meds: None known

Current Illness: None

ID: 1558347
Sex: M
Age: 23
State: CA

Vax Date: 08/13/2021
Onset Date: 08/14/2021
Rec V Date: 08/14/2021
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: Penicillin, Tylenol

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Shortness of breath, dizziness, sore arm

Other Meds: Vitamin D, Ceylon Cinnamon

Current Illness:

ID: 1558348
Sex: M
Age: 41
State: OH

Vax Date: 08/14/2021
Onset Date: 08/14/2021
Rec V Date: 08/14/2021
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: none per patient

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

Symptoms: pt felt extremely dizzy and sweaty, 911 was called. and they determined it was just the anxiousness of the pt that was manifested

Other Meds: none per patient

Current Illness: none per patient

ID: 1558349
Sex: M
Age: 67
State: MO

Vax Date: 02/12/2021
Onset Date: 03/05/2021
Rec V Date: 08/14/2021
Hospital: Y

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: Unknown

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

Symptoms: On 7/17/2021, case was hospitalized due to COVID. Symptoms: Fever, muscle aches, fatigue

Other Meds: Unknown

Current Illness:

ID: 1558350
Sex: F
Age: 20
State: CT

Vax Date: 08/10/2021
Onset Date: 08/10/2021
Rec V Date: 08/14/2021
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: At present Chest Pain since 1/2 hour after vaccination now occurring 5+ days . Anxiety present over symptoms for hour after vaccination. Body aches and soreness at injection site present on 11th only. Headaches on and off still present. Insomnia in relation to chest pain.

Other Meds: none; On July 22nd I did have a hepatitis vaccine.

Current Illness: none

ID: 1558351
Sex: F
Age: 70
State: TX

Vax Date: 03/15/2021
Onset Date: 03/15/2021
Rec V Date: 08/14/2021
Hospital:

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

Lab Data:

Allergies: Tetanus and Tetracycline

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

Symptoms: Right Arm injection: Soreness at the injection site, difficulty lifting my right arm in any direction. The discomfort continued and worsened over the past 5 months with no improvement. No medication was taken such as acetaminophen or ibuprofen, for the discomfort. Reported the problem to my medical caregiver, but was told it is not unusual.

Other Meds: Levothyroxine 88mcg, vits: D, Calcium, Multi, Fish Oil. I cannot remember any other vitamins I may have taken at the time.

Current Illness: None

ID: 1558352
Sex: F
Age: 26
State: CA

Vax Date: 02/24/2021
Onset Date: 02/26/2021
Rec V Date: 08/14/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: My normally regular menstruation came 3 days earlier and I experienced heavier than usual bleeding with small clots present. This was out of the ordinary. Since then, I have noticed PMDD type symptoms such as excessive mood swings, head fog and feelings of being 'crazy'. My menstrual cycle has now become irregular, it used to be about 32 days long and now its 35-38 days long.

Other Meds: none

Current Illness: none

ID: 1558353
Sex: F
Age: 23
State: IL

Vax Date: 08/14/2021
Onset Date: 08/14/2021
Rec V Date: 08/14/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: during administration the syringe tip leaked vaccination. The needle was fully penetrated into arm and dose leaked out from the base of the syringe tip/ base i.e. where the needle screws onto the syringe base. Syringe was sealed and a single unit package with the tip and base already together but obviously it wasnt completly secured. Pt did not receive full 0.5ml dose as a result. No other incident/details to report

Other Meds: na

Current Illness: na

ID: 1558354
Sex: F
Age: 32
State: CA

Vax Date: 08/14/2021
Onset Date: 08/14/2021
Rec V Date: 08/14/2021
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: NONE AS REPORTED BY PATIENT

Symptom List: Vomiting

Symptoms: AT APPROXIMATELY 10:40 AM PATIENT REPORTED FEELING DIZZINESS AND TIGHTNESS IN THE THROAT. WHEN ASKED IF SHE WAS HAVING DIFFICULTY BREATHING, PATIENT STATED "NO.' PATINET WAS CHECKED FOR BLOOD PRESSURE AND PULSE. PATIENT WAS GIVEN DIPHENHYDRAMINE 25 MG AND PREDNISONE 10 MG. PATIENT WAS LAYING DOW FOR 10 MINUTES AND PULSE AND BLOOD PRESSURE WAS RE-CHECKED. PATIENT STATED THAT SHE WAS NOT HAVING ANYMORE TIGHTNESS OF THE CHEST NOR FEELING ANY DIZZINESS. PATIENT WAS ABLE TO LEAVE FOR HOME.

Other Meds: NONE AS REPORTED BY PATIENT

Current Illness: NONE AS REPORTED BY PATIENT

ID: 1558355
Sex: F
Age: 57
State: CA

Vax Date: 03/12/2021
Onset Date: 03/21/2021
Rec V Date: 08/14/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: night of vaccine 8:30 PM Noticed left eye and left side of mouth drooping, hard to open left eye all the way, felt exhausted, went to bed March 13hard to open left eye, face feels numb headache started on left side, sharp, odd shooting pains in head some heart pounding starts afternoon- vision blurry, unable to focus, esp. in left eye ringing in ears, very sensitive to light March 14 headache continues, shooting pains on left side of skull, not like a normal headache blurry vision in left eye, light sensitivity and ringing in ears continue heart pounding, elevated bp and pulse hot, red swollen area around injection site nerve pain on left side of body begins- feels like a line is drawn down the middle of my body, left side ?on fire? with numbness and flu-like aching, difficulty sleeping due to heart pounding, March 15 area around injection site red and swollen- nerve pain on left side worsens, left side of neck and base of skull aching, left outer knee is very painful at night 8:30 PM Noticed left eye and left side of mouth drooping, hard to open left eye March 13 hard to open left eye, face feels numb headache started on left side, sharp, odd shooting pains in head some heart pounding starts- drank electrolyte water afternoon- vision blurry, unable to focus, esp. in left eye ringing in ears, very sensitive to light March 14 headache continues, shooting pains on left side of skull, not like a normal headache blurry vision in left eye, light sensitivity and ringing in ears continue heart pounding, elevated bp and pulse hot, red swollen area around injection site nerve pain on left side of body begins- feels like a line is drawn down the middle of my body, left side ?on fire? with numbness and flu-like aching difficulty sleeping due to heart pounding March 15 area around injection site red and swollen nerve pain on left side worsens, left side of neck and base of skull aching, left outer knee is very painful at night ringing ears continues, severe vision goes back to normal, but still light sensitive, hard to work heart pounding gets worse as day goes on, bp 140/90 (very high for me) racing heart at night, night sweats, feels like menopause acid reflux at night starts around this time can?t sleep due to heart palpitations March 16-30 ringing ears continues, vision goes back to normal, but still light sensitive, hard to work heart pounding gets worse as day goes on, bp 140/90 (very high for me) racing heart at night, night sweats, feels like menopause acid reflux at night starts around this time- (has not stopped) can?t sleep April 6 -April 15 continued numbness and aching on left side of body, gradually diminishes except numbness at base of skull, weak, heart still feels ?sore?, can?t exercise much April 16- present ?gripping? feeling on heart has gradually subsided but not completely, feels painful when pulse goes up have still not returned to normal (low) level of exercise, but doing some numbness and light pain on left side has mostly subsided except at the base of the skull, and radiates at times to left side of neck and face, under left eye and up left side of head and outer ear and sometimes to heart Pain continues to appear in the outer left knee. Pain in knee wakes me up at night. This knee pain is occurs 3-4x a week.

Other Meds: vitamin C

Current Illness: none

ID: 1558356
Sex: F
Age: 71
State: MD

Vax Date: 01/27/2020
Onset Date: 02/05/2020
Rec V Date: 08/14/2021
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: Sulfa, penicillin

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

Symptoms: 9 days after first inoculation, my upper arm became red, swollen, hot -- an area about 3 x 6 inches

Other Meds: Rosuvastatin, metformin, baby aspirin, CoQ10, fish oil

Current Illness: None

ID: 1558357
Sex: M
Age: 24
State: TX

Vax Date: 05/12/2021
Onset Date: 05/18/2021
Rec V Date: 08/14/2021
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

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Developed heart pressure, vertigo, and nausea. Heart pressure lasted for days after vaccination.

Other Meds: none

Current Illness: none

ID: 1558358
Sex: M
Age: 53
State: TX

Vax Date: 08/11/2021
Onset Date: 08/11/2021
Rec V Date: 08/14/2021
Hospital:

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

Lab Data:

Allergies: Naproxen

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

Symptoms: dyspnea, chills, body pain, dizziness,, fatigue, nausea

Other Meds: Amlodipine, Symbicort

Current Illness: none

ID: 1558359
Sex: F
Age: 64
State: WA

Vax Date: 01/01/2021
Onset Date: 06/20/2021
Rec V Date: 08/14/2021
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: bee venom, tramadol

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

Symptoms: I had an outbreak of Herpes Zoster (shingles) on June 20, which resolved completely in 5 weeks. I had pain on one side of my lower back which wrapped around into my abdomen, then developed a rash. This all slowly resolved. I had received a Zostavax vaccine when I was 60. This is the first time I've had shingles. The first dose was given 1/14/21 and the second dose listed above was given on 2/2/2021.

Other Meds: estradiol vaginal cream, Vitamin D3, famotidine 20mg,

Current Illness: none

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm