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: 1574350
Sex: M
Age: 42
State: NY

Vax Date: 02/06/2021
Onset Date: 08/01/2021
Rec V Date: 08/16/2021
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: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose Moderna,Lot#012L20A 2nd dose Moderna,lot#012M20A Diagnosed covid positive:08/04/21 Symptom onset:07/31/21 Exposure:community Symptoms:Fatigue, congestion,runny nose,sinus congestion.

Other Meds:

Current Illness:

ID: 1574351
Sex: U
Age: 39
State:

Vax Date: 06/19/2021
Onset Date: 06/19/2021
Rec V Date: 08/16/2021
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: Pt has history of hypertension, did not take BP meds this morning and missed all meals. BP and O2 checked and EMS contacted. Departed with EMS.

Other Meds:

Current Illness:

ID: 1574352
Sex: F
Age: 42
State: NY

Vax Date: 04/09/2021
Onset Date: 08/04/2021
Rec V Date: 08/16/2021
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: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose 04/09/21Lot#205A21A Diagnosed covid positive: Symptom onset:08/04/21 Exposure:08/04/21 Symptoms:Home

Other Meds:

Current Illness:

ID: 1574353
Sex: F
Age: 49
State: FL

Vax Date: 04/27/2021
Onset Date: 04/28/2021
Rec V Date: 08/16/2021
Hospital:

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

Lab Data:

Allergies: Codeine; amoxicillin

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: About a day after the vaccine, had a sun-burn like rash for about 1 week, went away on it's on. Resembled a rug burn.

Other Meds: Hydroxychloroquine; Losartan

Current Illness: N/A

ID: 1574354
Sex: F
Age: 72
State: DC

Vax Date: 05/19/2021
Onset Date: 05/20/2021
Rec V Date: 08/16/2021
Hospital:

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

Lab Data:

Allergies: Ampicillan Erythromycin Anesthesia Eye drops Ciproxloxacian Metronadaxole

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

Symptoms: Difficulty breathing, injections was red with a big bump and a rash formed around it, tiredness, weakness, rash traveled from injection site to shoulders and scalp

Other Meds: Synthroid 175mcg (once daily)

Current Illness: Lymphedema Sleep Apnea Carbon Dioxide on Lungs

ID: 1574355
Sex: F
Age: 58
State:

Vax Date: 08/02/2021
Onset Date: 08/02/2021
Rec V Date: 08/16/2021
Hospital:

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Patient obtained 1st dose Pfizer vaccine at 0915am. As per patient, she is to be monitored 45min to 1hour, instructed by her allergy doctor. At 10:36, medical alert was called. Patient was complaining of Headache and dizziness. Pain level of headache was a 9. 1037 BP 158*/68 HR 82 SAT 99%. Patient alert and oriented. 1042am BP 156/77 HR 74 Pain level 6. At 1046 BP 148/80 HR 77. Patient stated her headache was better. Patient left with her friend who was scheduled to pick her up. End time is 1047am.

Other Meds:

Current Illness:

ID: 1574356
Sex: M
Age: 40
State: NY

Vax Date: 03/08/2021
Onset Date: 08/05/2021
Rec V Date: 08/16/2021
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: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose 02/14/21Lot#EM9810 2nd dose03/08/21,lot#EN6206 Diagnosed covid positive:08/05/21 Symptom onset:08/03/21 Exposure:Home Symptoms:Fever, cough, fatigue, muscle aches,sore throat,chills,runny nose,headache.

Other Meds:

Current Illness:

ID: 1574357
Sex: F
Age: 65
State: FL

Vax Date: 02/03/2021
Onset Date: 07/13/2021
Rec V Date: 08/16/2021
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: COVID-19 infection

Other Meds:

Current Illness:

ID: 1574358
Sex: F
Age: 56
State: PA

Vax Date: 01/19/2021
Onset Date: 08/14/2021
Rec V Date: 08/16/2021
Hospital:

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

Lab Data:

Allergies: Bacitracin Mycinette [Cetylpyridinium-benzocaine] Neomycin Sulfate Polymyxin B AmlodipineRash

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Cough Nasal Congestion Headache

Other Meds: irbesartan (AVAPRO) 150 mg tablet levothyroxine (SYNTHROID) 50 mcg tablet lisinopriL (ZESTRIL) 10 mg tablet multiple vitamins (DAILY MULTI-VITAMIN) tablet tablet omeprazole (PriLOSEC) 20 mg capsule simvastatin (ZOCOR) 20 mg tablet SUMAtript

Current Illness: None

ID: 1574359
Sex: M
Age: 46
State:

Vax Date: 08/15/2021
Onset Date: 08/16/2021
Rec V Date: 08/16/2021
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: Patient completed Pfizer COVID vaccine series by different vendor on 3/7/2021 and 3/28/2021. Patient then received 3rd dose of Pfizer by us as documented on this report on 8/15/2021.

Other Meds:

Current Illness:

ID: 1574360
Sex: F
Age: 38
State: NC

Vax Date: 08/13/2021
Onset Date: 08/14/2021
Rec V Date: 08/16/2021
Hospital:

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

Lab Data:

Allergies: Vancomycin Droperidol

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

Symptoms: Pea sized lump at injection site.

Other Meds: Omeprazole Adderall Prozac

Current Illness: None

ID: 1574361
Sex: F
Age: 43
State: NY

Vax Date: 01/27/2021
Onset Date: 08/03/2021
Rec V Date: 08/16/2021
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:

Symptom List: Rash, Urticaria

Symptoms: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose 01/07/21Lot#EL3248 2nd dose 01/27/21,lot#EL9262 Diagnosed covid positive:08/05/21 Symptom onset:08/02/21 Exposure: Symptoms:Cough, loss of smell, scratchy throat,runny nose, loss of smell.

Other Meds:

Current Illness:

ID: 1574362
Sex: M
Age: 32
State: NY

Vax Date: 04/13/2021
Onset Date: 08/03/2021
Rec V Date: 08/16/2021
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: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose 03/23/21Lot#ER8727 2nd dose 04/13/21,lot#EW0150 Diagnosed covid positive:08/05/21 Symptom onset:08/03/21 Exposure:community Symptoms:fatigue,runny nose,sore throat,headache.

Other Meds:

Current Illness:

ID: 1574363
Sex: F
Age: 29
State: NY

Vax Date: 01/27/2021
Onset Date: 08/03/2021
Rec V Date: 08/16/2021
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:

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

Symptoms: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose 01/06/21 Lot#EL3248 2nd dose 01/27/21,lot#EL9262 Diagnosed covid positive:08/05/21 Symptom onset:08/03/21 Exposure:community Symptoms:cough, fatigue,muscle aches, chills,headache

Other Meds:

Current Illness:

ID: 1574364
Sex: U
Age: 21
State:

Vax Date: 05/22/2021
Onset Date: 05/22/2021
Rec V Date: 08/16/2021
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 fell to the ground at approximately 11:33. Vital signs assessed. Ems contacted and transported patient out of center.

Other Meds:

Current Illness:

ID: 1574365
Sex: F
Age: 20
State:

Vax Date: 07/29/2021
Onset Date: 07/29/2021
Rec V Date: 08/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Patient received 1st dose Pfizer vaccine in the outpatient pharmacy by nurse. 5 min after vaccine, patient felt faint and was nauseated. Medical alert called by outpatient pharmacy. Patient laid across the bench and feet were elevated. 1st BP 11:31 was 91/45 HR 72 sat 100%. Patient was alert but stated her head felt warm. Unable to get a glucose reading. 2nd BP 1133am 94/46 HR 77 SAT 100%. Patient was sitting and stated her heart felt like it was racing. Last BP 1138am 93/66 HR 74. Patient transported via wheelchair to the ED by ED nurse. Accompanied by mother.

Other Meds:

Current Illness:

ID: 1574366
Sex: F
Age: 36
State: PA

Vax Date: 04/25/2021
Onset Date: 04/25/2021
Rec V Date: 08/16/2021
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: Benadryl

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

Symptoms: 10 minutes after vaccination, pt experienced shortness of breath and a racing heart beat. Pt gave her own Epi-Pen into her left thigh. Oxygen applied. Pt transported to ED. given IV fluids & symptoms resolved, discharged to home.

Other Meds:

Current Illness:

ID: 1574367
Sex: F
Age: 50
State: CA

Vax Date: 08/05/2021
Onset Date: 08/06/2021
Rec V Date: 08/16/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient reported Rapid or abnormal heart beats ever since she got the vaccine and been feeling uncomfortable. The episodes are random.

Other Meds: none reported but History shows Methocarbomol 500 mg tablet

Current Illness: None reported

ID: 1574368
Sex: M
Age: 76
State: PA

Vax Date: 02/27/2021
Onset Date: 08/02/2021
Rec V Date: 08/16/2021
Hospital: Y

Vax Type: PNC13
Manufacturer: PFIZER\WYETH
Vax Name: PNEUMO (PREVNAR13)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: Iodinated Contrast MediaHives / Urticaria, Rash Venom-honey BeeAnaphylaxis, Swelling AtomoxetineHives / Urticaria, Itching, Rash IohexolHives / Urticaria Quinidine-quinine Analogues (Cinchona Alkaloids)Other (document details in comments) Amoxicillin-pot ClavulanateItching

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: ED to Hosp-Admission Current 8/2/2021 - present (14 days) the Hospital Chief Complaint Patient presents with ? Shortness of Breath Sepsis secondary to pneumonia, presenting with tachypnea and leukocytosis and acute kidney injury Community-acquired pneumonia versus COVID-19 pneumonia ?Admit to medical service

Other Meds: apixaban (ELIQUIS) 5 mg tablet aspirin 81 mg chewable tablet bumetanide (BUMEX) 1 mg tablet ELIQUIS 2.5 mg tablet hydrALAZINE (APRESOLINE) 10 mg tablet isosorbide mononitrate (IMDUR) 30 mg 24 hr tablet levothyroxine (SYNTHROID) 100 mcg tabl

Current Illness:

ID: 1574369
Sex: F
Age: 52
State: FL

Vax Date: 01/25/2021
Onset Date: 07/26/2021
Rec V Date: 08/16/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: covid-19 infection

Other Meds:

Current Illness:

ID: 1574370
Sex: M
Age:
State: KY

Vax Date: 11/01/1963
Onset Date: 04/01/2021
Rec V Date: 08/16/2021
Hospital: Y

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: Acute hypoxemic respiratory failure d/t COVID19/sepsis d/t pneumonia requiring ICU admission

Other Meds:

Current Illness:

ID: 1574371
Sex: M
Age: 42
State: CT

Vax Date: 06/29/2021
Onset Date: 07/01/2021
Rec V Date: 08/16/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Unevaluable event

Symptoms: Abnormal cardiovascular response during exercise for 45 days post injection - elevated heart rate, reduced lung capacity - unable to safely exercise. 100 degree fever for 2 days post infection. Unusual / rare fungal eye infection also occured 3 weeks post-infection, but this could be a coincidence.

Other Meds: none

Current Illness: none

ID: 1574372
Sex: F
Age: 62
State: PA

Vax Date: 03/13/2021
Onset Date: 07/01/2021
Rec V Date: 08/16/2021
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: Purple bruises lasting weeks and then itching and turning into a rash that hurts doesn?t go away with cortisone cream and last for weeks

Other Meds: None

Current Illness: None

ID: 1574373
Sex: F
Age: 38
State: PA

Vax Date: 01/21/2021
Onset Date: 08/09/2021
Rec V Date: 08/16/2021
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: Amoxicillin-pot ClavulanateOther (document details in comments)

Symptom List: Injection site pain, Pain

Symptoms: Fever or Chills Fatigue Muscle or body aches Headache Sore throat Congestion or running nose

Other Meds: FLUoxetine (PROzac) 40 mg capsule levonorgestrel (MIRENA) 20 mcg/24 hr (5 years) IUD SUMAtriptan (IMITREX) 50 mg tablet(Expired) topiramate (TOPAMAX) 100 mg tablet

Current Illness: Headache

ID: 1574374
Sex: M
Age: 25
State:

Vax Date: 06/10/2021
Onset Date: 06/10/2021
Rec V Date: 08/16/2021
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: After patient received his 1st dose COVID vaccine, patient came to the door where nurse was stationed. Patient stated he felt like he was having a seizure and his head was hurting. Nurse notified Pharmacy Technician and a medical alert was called. Nurse assisted him to the chair. Patient said he felt like his eyes were heavy and head was hurting. Patient was assisted to lay on the bench. We called 911 for fire rescue, at that moment ER nurse arrived with a wheelchair. Patient was transported to wheelchair and sent to the ER Nurse and accompanied by employee, security and patient's father.

Other Meds:

Current Illness:

ID: 1574375
Sex: F
Age: 78
State: TN

Vax Date: 02/24/2021
Onset Date: 08/10/2021
Rec V Date: 08/16/2021
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: Amoxicillin

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

Symptoms: Pt was admitted on 8/10/21 for severe hypoglycemia due to a medication prescribed as an outpatient. She was tested for FluA and SARS CoV-2 AG on admission and was found to be positive for both. She denied SOB, cough or fever at admission. She also denied headache, head congestion or sore throat. She reported dizziness with positional changes and diarrhea. She was monitored for 2 days without any change in respiratory status. She was discharged on 8/13.

Other Meds: Allopurinol 100mg po daily; aspirin 81mg po daily; calcitriol 0.25mcg po daily; hydroxychloroquine 200mg po BID; furosemide 20mg po BID; leflunomide 20mg po daily; simvastatin 40mg po at bedtime

Current Illness: unknown

ID: 1574376
Sex: M
Age: 23
State:

Vax Date: 07/13/2021
Onset Date: 07/13/2021
Rec V Date: 08/16/2021
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: Patient became diaphoretic. Blood pressure 82/54.

Other Meds:

Current Illness:

ID: 1574377
Sex: F
Age: 52
State: NC

Vax Date: 08/12/2021
Onset Date: 08/12/2021
Rec V Date: 08/16/2021
Hospital:

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

Lab Data:

Allergies: Nickel Shellfish Soy Sulfa Taltz autoinjector Darvocet Hydrocodone Iodine Proxyphene Napsylate Gadavist Humira

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient received PFIZER COVID vaccine #1 at approximately 11:30AM. Developed symptoms (coughing, shortness of breath at 11:55AM. 12:02PM placed in exam room, O2 applied HR: 121 Pulse Ox: 99% 12:03PM continued coughing, difficulty swallowing, EpiPen administered right thigh. HR: 123 Pulse Ox: 100% 12:06PM 50mg Benadryl administered R deltoid BP 146/100 12:07PM BP 178/116 HR 110 Pulse Ox 99% 12:10PM HR 107 Pulse Ox 99% 12:11PM BP 149/96 HR 105% EMS called, patient transported to medical facility

Other Meds: Aspirin 81mg PO QD Bupropion 75mg PO BID Cetirizine 10mg PO QD Cholecalciferol 5,000units PO QAM Furosemide 40mg PO PRN Multivitamin QD Phentermine 37.5mg PO QD Enbrel 50mg SQ Aleve 2 tablets PO QD

Current Illness: None

ID: 1574378
Sex: F
Age: 59
State: FL

Vax Date: 07/30/2021
Onset Date: 08/15/2021
Rec V Date: 08/16/2021
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: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: Pt received Pfizer vaccine x1. Admitted into the hospital for COVID on 8/16/21. Pt is currently being treated with remdesivir and dexamethasone.

Other Meds:

Current Illness:

ID: 1574379
Sex: M
Age: 23
State: UT

Vax Date: 02/01/2021
Onset Date: 02/01/2021
Rec V Date: 08/16/2021
Hospital:

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

Lab Data:

Allergies: Environmental allergies

Symptom List: Nausea

Symptoms: Itching all over, dizziness, tightening of throat increase heart rate, panic attacks, tendinitis, headache, shaking of right leg, and fatigue.

Other Meds: Zyrtec

Current Illness:

ID: 1574380
Sex: F
Age: 42
State: CA

Vax Date: 07/09/2021
Onset Date: 07/12/2021
Rec V Date: 08/16/2021
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: Tingling of lower legs

Other Meds:

Current Illness:

ID: 1574381
Sex: M
Age: 30
State:

Vax Date: 05/28/2021
Onset Date: 05/29/2021
Rec V Date: 08/16/2021
Hospital:

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

Lab Data:

Allergies: Erythromycin, pediazole

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

Symptoms: Felt hot and cold. Couldn't sleep well waking up every few hours. Vomited after trying to eat breakfast around 9:30am. Feet were numb and tingly. All symptoms went away by 12:45-1pm except the numb and tingly feet. That lasted a few days and then went away for about a week. Came back and lasted for 3 months. Finally going away now.

Other Meds: Multivitamin, zyrtec

Current Illness: None

ID: 1574382
Sex: M
Age: 63
State: OK

Vax Date: 08/09/2021
Onset Date: 08/12/2021
Rec V Date: 08/16/2021
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: Plavix

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

Symptoms: Headache, runny nose, congestion, cough, body aches, fatigue. Scratch throat and cough started 3 days after receiving shot, runny nose, congestion, body aches and fatigue started 5 days after shot.

Other Meds: Metformin, novolog, treshiba, ropinorole, ranolazine, prasugrel, sacubitril-valsartan, Jardiance

Current Illness: None

ID: 1574383
Sex: M
Age: 70
State: NY

Vax Date: 03/04/2021
Onset Date: 03/22/2021
Rec V Date: 08/16/2021
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: ACE Inhibitors

Symptom List: Tremor

Symptoms: Initial and enduring alteration of smell. Loss at times or smelling odors that are not in my immediate environment. Very bothersome and distracting. Second filing of this abnormality/side effect

Other Meds: BP meds, cholesterol meds, aspirin, vitamin D,C,magnesium

Current Illness: None

ID: 1574384
Sex: F
Age: 54
State: SC

Vax Date: 03/17/2021
Onset Date: 03/19/2021
Rec V Date: 08/16/2021
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: N/A

Symptom List: Erythema, Pruritus

Symptoms: Pt. states that after receiving the 1st dose Moderna of 03/17/2021, started experiencing symptoms 03/19/2021 of tingling in the right side with pressure. Continuing with nerve pain throughout the back of the neck. ER visit 03/24/2021, Cat-Scan preformed but no outcome.

Other Meds: N/A

Current Illness: N/A

ID: 1574385
Sex: F
Age: 23
State: PA

Vax Date: 04/28/2021
Onset Date: 04/28/2021
Rec V Date: 08/16/2021
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: Pt became lightheaded, dizzy and fell from chair in post vaccine observation area. No injury from fall, BP 75/38, Pt states has happened before with blood work and while getting a body piercing. Transported to ED, given hydration and food, Discharged to home. She did receive 2nd vaccination on 05/18/2021 without incident

Other Meds:

Current Illness:

ID: 1574386
Sex: F
Age: 33
State: TX

Vax Date: 05/24/2021
Onset Date: 05/25/2021
Rec V Date: 08/16/2021
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: Gluten intolerance

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

Symptoms: 0900 5/25/21: Suddenly started sweating profusely, nausea, tachypnea, chills, neuropathy in all extremities, and vision blacked out about 10-15 times in a row. After about 15 minutes, I was able to get back to bed. Temperature was 97.4 F at this time. This was the most concerning grouping of adverse symptoms after receiving the Moderna vaccine. PCP and cardiologist agree that this was a circulatory issue. Ever since, my tachycardia and shortness of breath have worsened. Heart rate was up to 120's with Long Covid prior to vaccine and was improving. Now up to 160's post-vaccine, hypotensive, and unable to work.

Other Meds: Lo Loestrin Fe

Current Illness: None

ID: 1574387
Sex: M
Age: 56
State: FL

Vax Date: 01/25/2021
Onset Date: 07/27/2021
Rec V Date: 08/16/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: covid-19 infection

Other Meds:

Current Illness:

ID: 1574388
Sex: F
Age: 70
State: PA

Vax Date: 03/10/2021
Onset Date: 07/28/2021
Rec V Date: 08/16/2021
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: DigoxinShortness of breath / Dyspnea OtherHives / Urticaria, Other (document details in comments) Influenza Virus Vaccines CodeineNausea and Vomiting LisinoprilCoughing Pneumococcal VaccineOther (document details in comments)

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

Symptoms: Fever, cough, diarrhea, sore throat, headache, and vomiting. Low BP 76/54, exertional dyspena

Other Meds: albuterol HFA (PROVENTIL;VENTOLIN) 90 mcg/actuation inhaler aspirin 81 mg tablet atorvastatin (LIPITOR) 20 mg tablet cholecalciferol, vitamin D3, 2,000 unit capsule clopidogreL (PLAVIX) 75 mg tablet furosemide (LASIX) 20 mg tablet metoprolo

Current Illness:

ID: 1574389
Sex: F
Age: 50
State: MN

Vax Date: 02/08/2021
Onset Date: 08/13/2021
Rec V Date: 08/16/2021
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: COVID positive >14 days post vaccine series

Other Meds:

Current Illness:

ID: 1574390
Sex: F
Age: 71
State: TN

Vax Date: 08/04/2021
Onset Date: 08/04/2021
Rec V Date: 08/16/2021
Hospital:

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

Lab Data:

Allergies: Sulfa.

Symptom List: Pain in extremity

Symptoms: Severe reaction all over the body started on 08/05th and lasted till Saturday. Patient has a swollen lips .

Other Meds: none

Current Illness: none

ID: 1574391
Sex: M
Age: 64
State: KY

Vax Date: 07/01/2021
Onset Date: 08/01/2021
Rec V Date: 08/16/2021
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:

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

Symptoms: Acute hypoxic respiratory failure due to COVID-19 pneumonia requiring ICU admission.

Other Meds:

Current Illness:

ID: 1574392
Sex: M
Age: 38
State: NC

Vax Date: 08/11/2021
Onset Date: 08/11/2021
Rec V Date: 08/16/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: Patient indicated that he wished to receive the vaccine and denied having received a previous Covid vaccine. Staff utilized the state covid vaccine management system to identify inmates who may have already received a Covid vaccine; this inmate may have been added to list after checks were completed. The patient received the Janssen Covid vaccine; vaccine administration was entered into the Covid vaccine management system and at that time it was found that the patient had received Covid vaccine, Moderna, at another correctional institute on 3/25/21. The nursing director was notified on 8/13/21 and was advised to monitor inmate for vaccine reactions.

Other Meds: unknown

Current Illness: none

ID: 1574393
Sex: F
Age: 41
State: NH

Vax Date: 08/06/2021
Onset Date: 08/07/2021
Rec V Date: 08/16/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: Vaginal bleeding started 24hrs after vaccine. Menstruation bleeding started prematurely by at least 2 weeks, my period was not due and yet it started the next day of the vaccine. I was not having anymore stress than usual, the only factor was the covid shot. This has never happened to me before, my periods are regular. I had bleeding from the abnormal menstruation for 5 days and the amount was a little less to about the same I usually have of bleeding. Did have craming. The period ended in its own. No other un8sual symptoms. I did have fever, aches, headache as expected and told to watch for the next day of vaccine. **the side effect of early bleeding and menstruation was not told to me as possible side effect and I was taken by surprise.

Other Meds: Multi vitamin

Current Illness: None

ID: 1574394
Sex: F
Age: 48
State: OK

Vax Date: 08/13/2021
Onset Date: 08/13/2021
Rec V Date: 08/16/2021
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: Penicillin, Codeine, Benadril,

Symptom List: Vomiting

Symptoms: Red, Swollen area with fever and has a burning sensation. Stings to the touch and has progressively gotten worse each day. It started out less than an inch in diameter a few hours after then initial does and is now close to 3 inches in diameter on day 4.

Other Meds: None

Current Illness: Unknown

ID: 1574395
Sex: M
Age: 59
State: AZ

Vax Date: 04/12/2021
Onset Date: 08/16/2021
Rec V Date: 08/16/2021
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: Patient was fully vaccinated with pfizer covid vaccine. Received the doses on 3/22/21 and 4/12/21. Patient subsequently tested positive for covid infection on 8/16/21.

Other Meds:

Current Illness:

ID: 1574396
Sex: F
Age: 41
State: TX

Vax Date: 08/09/2021
Onset Date: 08/16/2021
Rec V Date: 08/16/2021
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 drugs

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

Symptoms: Injection site is hot to touch and raised, about a quarter sized.

Other Meds: Allergra Dovato FLO (supplement for menstrual symptoms) Tylenol

Current Illness: Allergy symptoms and had been carrying for my son who was strep positive

ID: 1574397
Sex: F
Age: 13
State: CO

Vax Date: 05/19/2021
Onset Date: 06/01/2021
Rec V Date: 08/16/2021
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: No

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Vaginal spotting starting 2 weeks after 1st covid vaccine. Regular periods prior to vaccination. Spotting has persisted to the present. No regular period since the time of 1st covid vaccine.

Other Meds: Unknown

Current Illness: Unknown

ID: 1574398
Sex: M
Age: 51
State: PA

Vax Date: 01/21/2021
Onset Date: 08/05/2021
Rec V Date: 08/16/2021
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 on File

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

Symptoms: Sore throat COVID exposure

Other Meds: None

Current Illness: None

ID: 1574399
Sex: F
Age: 30
State: FL

Vax Date: 03/20/2021
Onset Date: 07/23/2021
Rec V Date: 08/16/2021
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: covid-19 infection

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm