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: 1574503
Sex: M
Age: 53
State:

Vax Date: 02/20/2021
Onset Date: 02/21/2021
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: Nuts, grass, pollen.

Symptom List: Dysphagia, Epiglottitis

Symptoms: A headache that starts in the back of the neck on the left hand side, spreads through the front of the head. Headache is constant with temporary relief.

Other Meds:

Current Illness:

ID: 1574504
Sex: F
Age: 23
State: NY

Vax Date: 03/24/2021
Onset Date: 08/07/2021
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: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st 03/03/21dose Lot#EN6202 2nd dose 03/24/21,lot#ER8727 Diagnosed covid positive:08/08/21 Symptom onset:08/07/21 Exposure:work Symptoms:fatigue, runny nose,headache

Other Meds:

Current Illness:

ID: 1574505
Sex: F
Age: 46
State: ID

Vax Date: 08/16/2021
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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

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

Symptoms: Numbness and tingling throughout right arm and fingers by 15 minutes post vaccination. By 45 min - 1 hour post vaccination there is numbness and tingling and sensation of limited blood flow down continuing in right arm, and right side of face, and neck and into right leg. Right extremities are cooler to touch and there is diminished sensation with some right side weakness. Slight head-ache observed. Capillary refill within 2 seconds, but noted to be sower than usual. All symptoms continue to be observed up to current time of filing report and continuing to be monitored at home.

Other Meds: none

Current Illness: none

ID: 1574506
Sex: F
Age: 40
State: NY

Vax Date: 02/06/2021
Onset Date: 08/07/2021
Rec V Date: 08/16/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose 01/11/21Lot#012L20A 2nd dose 02/06/21,lot#012M20A Diagnosed covid positive:08/08/21 Symptom onset:08/07/21 Exposure: Symptoms:muscle ache,nasal congestion

Other Meds:

Current Illness:

ID: 1574507
Sex: M
Age: 42
State:

Vax Date: 01/15/2021
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:

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

Symptoms: Patient had a positive COVID test on 8/14/2021

Other Meds:

Current Illness:

ID: 1574508
Sex: F
Age: 49
State: NY

Vax Date: 02/02/2021
Onset Date: 08/05/2021
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: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose 01/12/21Lot#EL3248 2nd dose 02/02/21,lot#EN5318 Diagnosed covid positive:08/07/21 Symptom onset:08/05/21 Exposure:Home Symptoms:SOB, fatigue,ABD pain,nausea/vomiting,chills,headache,back pain,chest pain

Other Meds:

Current Illness:

ID: 1574509
Sex: M
Age: 57
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: 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 dose01/06/21 Lot#EL3248 2nd dose 01/27/21,lot#EL9262 Diagnosed covid positive:08/07/21 Symptom onset:08/03/21 Exposure: Symptoms:muscle aches, cough, runny nose, headache.

Other Meds:

Current Illness:

ID: 1574510
Sex: F
Age: 15
State: WI

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:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKDA

Symptom List: Pharyngeal swelling

Symptoms: Lightheaded and nausea within 5 minutes of vaccination. Provided hydration and something to eat. After 15 minutes she complained of difficulty breathing. Located NP and patient HR, breathing, and oxygenation was found to be within normal limits. After 30 minutes, patient was feeling well enough to go home with her mother.

Other Meds: norethindrone-ethinyl estradiol (JUNEL FE 1/20) 1 mg-20 mcg (21)/75 mg (7) per tablet

Current Illness: None noted

ID: 1574511
Sex: F
Age: 45
State: KY

Vax Date: 03/27/2021
Onset Date: 03/27/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Participant came to a Vaccine Mass Event facilitated by the Health Department on 3/27/21. 303 persons were vaccinated with J&J vaccine that day. We were notified by the Immunization Registry on 8/10/21 that the participant had records of being given the Pfizer vaccine at separate Vaccine Mass Event held on 3/21/21 and on 4/11/21.

Other Meds:

Current Illness:

ID: 1574512
Sex: F
Age: 35
State: CA

Vax Date: 08/09/2021
Onset Date: 08/10/2021
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: No

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Received shot in afternoon of Monday Aug 9th, felt fine, perhaps a little dizzy and uncoordinated later that night. Woke up the next morning with sore arm and tingling/numb fingertip in left middle finger, and parts of the peripheral fingers. Paresthesia has lasted for one week now. No weakness, but numbness and tingling have continued.

Other Meds: No

Current Illness: No

ID: 1574513
Sex: F
Age: 59
State: CA

Vax Date: 02/26/2021
Onset Date: 02/26/2021
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: codeine

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

Symptoms: Elevation of tinnitus volume, lasted two days. Began about one hour after injection. My hope is that data such as this can be used in tinnitus research. I am willing to participate in a clinical trial. Thank you.

Other Meds: Melatonin 10 mg at bedtime

Current Illness: none

ID: 1574514
Sex: M
Age: 23
State: AL

Vax Date: 05/17/2021
Onset Date: 05/17/2021
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: At the time of the first round of my Moderna vaccine, I immediately became dizzy with a headache and a sore arm. Once I left the pharmacy I developed a fever and nausea. That night I got hives. I had a fever nausea and lack of energy (Flu like symptoms) for a month making it difficult to do everyday tasks and maintain my composure at work. The second dose was the same, minus hives. I have not fully recovered from the vaccine that I took months ago. Since receiving the vaccine I have felt drained of energy and am often dizzy. The vaccine took a toll on my health, I lost a very unhealthy amount of weight over the month of flu like symptoms, had I been in worse health at the time of vaccine it may have taken longer for the flu like symptoms to leave jeopardizing my ability to pay rent. Had I been in bad health, the vaccine might have killed me. I did not see a doctor, as I cannot afford one. I should have.

Other Meds:

Current Illness:

ID: 1574515
Sex: F
Age: 60
State: CA

Vax Date: 03/13/2021
Onset Date: 03/13/2021
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: codeine

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

Symptoms: Elevation of tinnitus volume, lasted two days. Began about one hour after injection. My hope is that data such as this can be used in tinnitus research. I am willing to participate in a clinical trial. Thank you.

Other Meds: Melatonin 10 mg at bedtime

Current Illness: none

ID: 1574516
Sex: F
Age: 60
State: CA

Vax Date: 04/03/2021
Onset Date: 04/03/2021
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: codeine

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

Symptoms: Elevation of tinnitus volume, lasted two days. Began about one hour after injection. My hope is that data such as this can be used in tinnitus research. I am willing to participate in a clinical trial. Thank you.

Other Meds: Melatonin 10 mg at bedtime

Current Illness: None

ID: 1574517
Sex: M
Age: 42
State: NY

Vax Date: 07/28/2021
Onset Date: 07/30/2021
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: NONE

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

Symptoms: AFTER 2-3 DAYS OF VACCINATION, PATIENT DEVELOPED COVID ARM RASH AROUND INJECTION SITE ON LEFT ARM. SLOWLY MOVED TOWARD ELBOW. AFTER 1 WEEK, PATIENT CAME IN HAVING DARK BROWN BRUISING AROUND LEFT ELBOW ABOUT 4 INCHES IN DIAMETER (NO PAIN/TENDERNESS OR REDNESS). UPON FOLLOW-UP 4 DAYS LATER, BRUISING HAD SUBSIDED AND ELBOW RETURNED TO NORMAL.

Other Meds: NONE

Current Illness: NONE

ID: 1574518
Sex: F
Age: 54
State: NC

Vax Date: 08/16/2021
Onset Date: 08/16/2021
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 her second Pfizer COVID vaccine at 3:29 pm this afternoon. At 3:40 pm, she stated complaining of not feeling well, having a metallic taste, and having the feeling of pins and needles in her mouth. VS were taken at 3:41 with BP 169/92, HR 90, and O2 Sat of 100%. VS were taken again at 3:45 with BP 169/98, HR 86, and O2 Sat 98%. It was determined with increased BP that EMS be called to further assess patient. EMS arrived at 4:04 to assess patient. Manual BP at that time was 200/120. EMS offered to transport patient to for further evaluation, but patient refused transport and stated she wanted to go home to see if her BP would decrease some. Staff encouraged patient to have someone pick her up from the site instead of patient trying to drive herself home. Patient was discharged home in the care of her son and instructed to call 911 for any further or worsening of symptoms with verbalization of understanding and agreement.

Other Meds:

Current Illness:

ID: 1574519
Sex: F
Age: 57
State: OH

Vax Date: 08/13/2021
Onset Date: 08/14/2021
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:

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

Symptoms: The patient reported that her arm is red and swollen and warm on 8/16/21. She received her vaccine on 8/13. It was originally hard to the touch near the injection site, which has lessened.

Other Meds:

Current Illness:

ID: 1574520
Sex: F
Age: 30
State: GA

Vax Date: 08/16/2021
Onset Date: 08/16/2021
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: PT ALMOST PASSED OUT WITHIN 5 MINUTES OF RECEIVING MODERNA COVID-19 VACCINE. PER EMS SHE WAS HYPERVENTILATED DUE TO PANIC/ANXIETY ATTACKS. PT WAS FINE AFTER 15 TO 20 MINUTES. PT HAS LEFT THE FACILITY.

Other Meds:

Current Illness:

ID: 1574521
Sex: F
Age: 55
State: CA

Vax Date: 04/28/2021
Onset Date: 05/01/2021
Rec V Date: 08/16/2021
Hospital:

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

Lab Data:

Allergies: Penicillin sensitivity- caused sore joints in past

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: 1st shot April 7, 2021 - sore arm upon touch at injection site 2nd shot April 28, 2021 - sore arm at injection site. Symptoms developed next day of severe "head cold" - congestion, stuffy nose, watery eyes which resolved in a few days. Within one month noticed neck was sore just above collar bone on left side only. This has not resolved and causes great discomfort. Lymph nodes (?) do not appear enlarged. Pain is now felt along the left side of my neck as well. Pain is always present.

Other Meds: Multi vitamin

Current Illness: None

ID: 1574522
Sex: M
Age: 41
State: AL

Vax Date: 04/01/2021
Onset Date: 04/01/2021
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: Arm pain at injection site. Has become sore arm with decreased movement. Arm continues to hurt with movement or while stationary. Saw dr who did X-ray and MRI. Referred for physical therapy.

Other Meds:

Current Illness:

ID: 1574523
Sex: F
Age: 60
State: CA

Vax Date: 07/09/2021
Onset Date: 07/09/2021
Rec V Date: 08/16/2021
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: codeine

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

Symptoms: Elevation of tinnitus volume, lasted two days. Began about one hour after injection. My hope is that data such as this can be used in tinnitus research. I am willing to participate in a clinical trial. Thank you.

Other Meds: Melatonin 10 mg at bedtime

Current Illness: none

ID: 1574524
Sex: F
Age: 41
State: GA

Vax Date: 08/12/2021
Onset Date: 08/13/2021
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: Unevaluable event

Symptoms: Patient reports tingling in fingers and toes beginning the day after vaccination, off and on, mostly at night, and sore/achy feeling under chin in area of lymph nodes starting 8/16. Patient says lymph nodes are not swollen and are not painful when palpitated. No fever accompanies other symptoms. Recommended alerting PCP as to adverse events and to notify dr immediately if any nausea, vomiting, irregular heartbeat, dizziness or fainting occurs.

Other Meds:

Current Illness:

ID: 1574525
Sex: M
Age: 76
State: MN

Vax Date: 03/05/2021
Onset Date: 08/11/2021
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: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: nausea, vomiting, fever, cellulitis

Other Meds:

Current Illness:

ID: 1574527
Sex: F
Age: 61
State: CA

Vax Date: 04/15/2021
Onset Date: 06/01/2021
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: Cequa- Headache, fever, runs, nausea Codeine- headache, palpitations Bactrim- headache, itching Naproxin- slurred speech, inability to move limbs, Headache, my brain doesn?t work right. Decongestants- blood pressure goes way up Nutrasweet- swollen itchy tongue and migraine Sensitive to oranges and other citrus

Symptom List: Injection site pain, Pain

Symptoms: It's been a while since this started but my oxygen level started dropping into the 80s and I start gasping for breath bringing it up into the 90s again. It happens for sometimes just a few minutes and sometimes for hours. I went to urgent care and the doctor assumed it was asthma though it wasn't happening anymore when I got there and put me on prednizone for maybe 10 days. It stopped after about 4 days on medication and started up again a couple days after it was gone so my doctor gave me about 3 weeks of prednizone but it didn't help. The whole time I was having albuterol via nebulizer which didn't help either. About a month after the loss of breath started I had palpitations and my pulse got as high as 176 while my bp got as low as 78/50 so I went to the er only it stopped before I got there. Since then I've been to the er 4 more times. I had an angiogram and have clear arteries, I had a sleep study with no results yet, I had a pulmonary function test which I passed. They just don't know what is happening still.

Other Meds: Albuterol by nebulizer every 4-6 hours as needed Ajovy injection monthly Atarax 25mg 3x day as needed Azelastine .01% 2 squirts 2x daily Baclofen 10mg 6 x day can take more 4 severe pain Cymbalta 60mg in am Elavil 25-50mg at night Frova 1 i

Current Illness:

ID: 1574528
Sex: M
Age: 39
State: NC

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

Lab Data:

Allergies: None reported

Symptom List: Injection site pain, Menorrhagia

Symptoms: About 10 minutes after receiving the vaccine the patient came back to the pharmacy complaining of nerve pain, numbness, and tingling down his right forearm and a nerve pain and warm feeling in his thigh and lower back. When checking with the patient several hours later around 6 pm, he reported most of these symptoms were gone other than some numbness persisting in his right hand. He also reported having a temporary rash on his forearm that had since faded.

Other Meds: Unknown

Current Illness: Unknown

ID: 1574529
Sex: F
Age: 25
State: OR

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

Lab Data:

Allergies:

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

Symptoms: PT RECEIVED VACCINE AT 3 WEEKS INSTEAD OF 4 WEEKS

Other Meds:

Current Illness:

ID: 1574530
Sex: F
Age: 16
State: VA

Vax Date: 07/10/2021
Onset Date: 07/14/2021
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: Tylenol

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Vesicular rash left areola, left ear lobe, face, trunk, legs

Other Meds: No

Current Illness:

ID: 1574531
Sex: F
Age: 63
State: GA

Vax Date: 04/14/2021
Onset Date: 07/23/2021
Rec V Date: 08/16/2021
Hospital: Y

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: Patient stated she was tested because she felt weak and went to apple care who then sent her to the hospital. Patient became symptomatic on 7/21 which included congestion, sore throat, cough, fatigue, and headache. Patient stated she is only experiencing problems with hemorrhoids' today. Patient has hypertension and experienced sarcoma cancer in 2006. Patient also has arthritis.

Other Meds:

Current Illness:

ID: 1574532
Sex: F
Age: 53
State: TX

Vax Date: 08/15/2021
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: Sensitive to grains, eggs, some plants, some shellfish Sensitive to bandage or tape adhesive Sensitive to Hydrocodone

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

Symptoms: As of 8/16/21 8am. Headache, stiffness in neck and shoulders, muscle pain around injection site, difficulty raising arm. 10 am plus a little nausea - resolved with Pepcid. Felt a little better with Ibuprofen. 12pm plus a little fatigue - felt a little better with rest 3:30pm pm - plus dizziness. Headache is pretty prominent

Other Meds: Taken Day of: Armour Thyroid iodine CBD oil Taken day after: Vitamin D3 Selenium K2 Methyl Folate Armour Thyroid iodine CBD oil Co-Q10

Current Illness:

ID: 1574533
Sex: F
Age: 43
State: CT

Vax Date: 01/26/2021
Onset Date: 01/26/2021
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: Teflax

Symptom List: Nausea

Symptoms: Some brain fog and irregular period after 1st dose, dizziness from turning head. Lingered for several weeks (2-3). After second dose, 10 hours after shot, 101-degree fever, chills. Was fine the next day, normal temperature. Then developed bronchitis around February, again in July. Have had persistent asthma, became significantly worse after vaccine dose. Went to pulmonologist. Given oral steroids back in winter, 4 times in total. Steroid inhaler, nebulizer machine, inhalant steroid disc, bronchodilator, albuterol inhaler, albuterol nebulizer, BUCP used with machine on daily basis. Going for CAT Scan soon. No longer able to work because of the extent of the symptoms.

Other Meds: Antacid; Concerta

Current Illness:

ID: 1574534
Sex: F
Age: 73
State: FL

Vax Date: 05/07/2021
Onset Date: 08/12/2021
Rec V Date: 08/16/2021
Hospital: Y

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

Lab Data:

Allergies: Lobster, Crestor, Niacin, Iodine topical

Symptom List: Injection site pain

Symptoms: Fully vaccinated with a Covid-19 positive test, severe symptoms.

Other Meds: Hydralazine 25mg, Gabapentin 300mg, Aspirin 81mg, Levothyroxine 125mg, Insulin Lispro, Ezetimide 10mg, Allopurinol 300mg, Biotin 300mg, Bumex 1mg, Tresiba FlexTouch 55units, Calcium/Vitamin D Tablet, Omega-3 2 Cap

Current Illness: Diabetes mellitus, Hypercholesterolemia, Hypertension, Hypothyroidism, Neuropathy

ID: 1574535
Sex: M
Age: 24
State: CA

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

Lab Data:

Allergies: N/A

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

Symptoms: No reaction

Other Meds: N/A

Current Illness: N/A

ID: 1574536
Sex: F
Age: 50
State: TX

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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: N/A

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

Symptoms: Pt. states that after receiving the 1st dose of Phizer 08/06/2021, started experiencing symptoms 08/07/2021 of blurred vision, slight headache, and pain in the eyes. Primary visit with recommendations of Eye Doctor visit. Developed Shingles diagnosed by ER.

Other Meds: N/A

Current Illness: N/A

ID: 1574537
Sex: M
Age: 15
State: OR

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: No known Medical Allergies

Symptom List: Tremor

Symptoms: Chest Pain Developed a few days after vaccine administration.

Other Meds: None

Current Illness: None

ID: 1574538
Sex: M
Age: 33
State: CA

Vax Date: 08/16/2021
Onset Date: 08/16/2021
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: IM
Vax Site: LA

Lab Data:

Allergies: Onion and garlic

Symptom List: Erythema, Pruritus

Symptoms: Patient fell off from an armrest chair while waiting after his second Moderna shot. It happened so suddenly after about 5 minutes waiting on the chair. His left eye brown had a cut and was bleed. He was under quick care of the facility employees and then paramedics.

Other Meds: Adderall

Current Illness: No

ID: 1574539
Sex: M
Age: 60
State: CA

Vax Date: 04/17/2021
Onset Date: 05/04/2021
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: none

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

Symptoms: extreme weakness thigh muscles and joint pain in knees

Other Meds: albuterol for asthma

Current Illness: none

ID: 1574540
Sex: F
Age: 12
State: AL

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

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

Lab Data:

Allergies: no known allergies

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

Symptoms: Patient received the first vaccine on 7/25/21 and developed visual disturbances on 7/27/21. Her mother noticed her squinting and trying to use just one eye to look at something. Patient states that her right eye has double vision that started as persistent on 7/27/21, but now seems to come and go. She states if she is looking at her teacher in class, she can see two heads. She was seen in our office today for an exam and vision screening which was WNL. She has been referred today to opthalmology for a dilated eye exam.

Other Meds: Minocycline

Current Illness: none

ID: 1574541
Sex: F
Age: 50
State: CO

Vax Date: 07/29/2021
Onset Date: 07/30/2021
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: n/a

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: I have been having menstrual bleeding for 3 1/2 weeks and it will not stop. It seems to be getting worse.

Other Meds: I have been having menstrual bleeding for 3 1/2 weeks, since the vaccine.

Current Illness: n/a

ID: 1574543
Sex: F
Age: 11
State: MS

Vax Date: 08/14/2021
Onset Date: 08/14/2021
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:

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

Symptoms: No adverse reaction - The patient presented to a Community Vaccine Event with a consent form signed by a guardian. The date of birth placed on the form by the guardian was (12). When I went to enter information in MIIX, I discovered the Date of Birth of the patient was (11) which is not able to receive the vaccination.

Other Meds:

Current Illness:

ID: 1574544
Sex: M
Age: 33
State:

Vax Date: 08/12/2021
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: Fever, joint pain, headache

Other Meds: Terbinafine

Current Illness:

ID: 1574545
Sex: M
Age: 46
State: KY

Vax Date: 01/20/2021
Onset Date: 08/07/2021
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: Unknown

Symptom List: Pain in extremity

Symptoms: Pt. had both Moderna vaccines as stated. S/O of COVID was 08/07/2021.

Other Meds: Unknown

Current Illness: Unknown

ID: 1574546
Sex: M
Age: 51
State: MN

Vax Date: 05/12/2021
Onset Date: 05/12/2021
Rec V Date: 08/16/2021
Hospital:

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

Lab Data:

Allergies: no

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

Symptoms: persistent pain in left arm and his first to fingers have numbness

Other Meds: no

Current Illness: no

ID: 1574547
Sex: F
Age: 60
State: CA

Vax Date: 05/12/2021
Onset Date: 06/02/2021
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: penicillin

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

Symptoms: debilatating headaches and fatigue, began in june doctor diagnosed as migraine and has been treating. the headaches have been non stop. i have about 2 good days out of a week and 4 days that i spend in bed with severe pain.

Other Meds: lisinopril, mevacor, women's multivitamins, Claritin and Flonase

Current Illness: none

ID: 1574548
Sex: M
Age: 30
State: VA

Vax Date: 05/20/2021
Onset Date: 07/23/2021
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: IM
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Severe Headache on day of injection (5/20/2021) and then nausea, increased water intake and frequent urination (07/08/2021) then vomiting, dizziness and severe dehydration starting (07/23/2021). Hospitalized with Diabetic Ketoacidosis. Diagnosed with Type 1 Diabetes due to unknown causes. Permanent damage to pancreas unable to produce insulin; will require insulin therapy for Type 1 diabetes for life.

Other Meds: None

Current Illness: None

ID: 1574549
Sex: M
Age: 94
State: FL

Vax Date: 02/05/2021
Onset Date: 02/13/2021
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: Plavix

Symptom List: Vomiting

Symptoms: January 15th had first vaccine. The next week he was complaining with leg pain. The second vaccine was February 5th. I ended up falling February 13th. I had no factures and went to rehab. Had DVT in the right leg and put on blood thinners. I ended up with a GI bleed which required a transfusion of 3 pints of blood. They could no longer find the clot in the right leg and went back to rehab. A few days later my right leg swelled. I had a clot on my leg and two pulmonary embolisms one in each lung. A stent was placed through the clavicle bone. They performed a thrombectomy on the right leg. I was sent home and I now have a-fib problems.

Other Meds: Gabapentin; Abvent; Tylenol; Flomax

Current Illness:

ID: 1574550
Sex: M
Age: 71
State: ID

Vax Date: 08/14/2021
Onset Date: 08/14/2021
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: No Known Allergies

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient received Moderna COVID 19 vaccine for 1st dose in series on 07/19/2021. He was mistakenly given a Pfizer shot for the second dose on 08/14/2021. He did not report any adverse events or adverse reactions as of 08/16/2021.

Other Meds: Unknown

Current Illness: Unknown

ID: 1574551
Sex: M
Age: 19
State: NC

Vax Date: 08/16/2021
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:

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

Symptoms: ABOUT 1 MINUTE AFTER IMMUNIZATION, PT STATED FEELING DIZZY. PT LOST CONSCIOUSNESS, MUSCLES TIGHTED AND SPASMED, MOVE PT TO FLOOR AND HELPED HIM TO REGAIN CONSCIOUSNESS, TAKING AWHILE TO COME AROUND SO 911 CALLED AND CHECK OUT PATIENT, HAD LOW BP, TRIED TO GET UP AND GOT DIZZY AGAIN, PT STAYED ABOUT 30 MINUTES AND WAS WHEELED OUT TO CAR BY EMS, REFUSED ER VISIT.

Other Meds:

Current Illness:

ID: 1574552
Sex: F
Age: 40
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: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Advil and seasonal allergies

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Injection given up in the shoulder joint. Pain from shoulder blade down to finger tips. Spoke with doctor who wants to monitor for potential rotator cuff injury, but suspects tendon inflammation from injecting too high in the shoulder and not in the deltoid muscle.

Other Meds: Zyrtec, birth control, allergy nose spray

Current Illness: None

Date Died: 08/10/2021

ID: 1574553
Sex: F
Age: 65
State: WI

Vax Date: 03/13/2021
Onset Date: 03/15/2021
Rec V Date: 08/16/2021
Hospital: Y

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

Lab Data:

Allergies: ? Norvasc [Amlodipine Besylate] HIVES ? Oxycontin [Oxycodone] Other (See Comments) Panic attacks after long term use ? Pseudoephedrine Other (See Comments) hallucinations ? Thiazide-Type Diuretics zaroxolyn caused nausea, diarrhea, hot flush ? Adhesive (Environmental) RASH adhesive tape ? Aspirin S/p gastric bypass ? Bumetanide VOMITING ? Celebrex [Celecoxib] RASH ? Cephalosporins rash and stomach upset ? Darvocet [Propoxyphene N-Apap] itching ? Demerol ANXIETY and PRURITUS ? Erythromycin GI UPSET ? Extract Of Poison Ivy Other (See Comments) ? Hydrochlorothiazide severe gastro problems ? Hydrocodone-Acetaminophen PRURITUS ? Metaxalone VOMITING ? Metoclopramide Hcl Other (See Comments) unsure ? Milk Intolerance (Food) GI UPSET Raw milk only, ok if within foods ? Monosodium Glutamate (Food Or Med) GI UPSET sever gastro problems ? Nsaids Other (See Comments) S/p gastric bypass ? Nuvigil [Armodafinil] depression ? Opioid Analgesics PRURITUS Itching- can take Vicodan if takes Benadryl with it ? Oxycodone-Acetaminophen HIVES ? Penicillins stomach upset and rash ? Pentazocine RASH ? Poison Sumac Extract Other (See Comments) ? Skelaxin [Skelaxi

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

Symptoms: Patient has extensive history of autoimmune disorders. Received Moderna vaccine #1 on 3/13/21. Developed sore throat 3/15, progressing to oral lesions - went to urgent care on 3/22/21 and ED on 3/25/21 (diagnosed with stomatitis). Evaluated by ENT specialist 4/2/21 and diagnosed with oropharyngeal lichen planus. Was prescribed steroids. Hospitalized 4/2/21, 4/17/21, and 7/23/21 due to dehydration, malnutrition, and weakness. Patient opted for hospice care and died 8/10/21.

Other Meds: ? levothyroxine 25 MCG tablet ? B-D U/F PEN NEEDLE 31G X 5 MM Misc ? Forteo 600 MCG/2.4ML Solution Pen-injector ? midodrine (PROAMATINE) 10 MG tablet ? hydrOXYzine (ATARAX) 25 MG tablet ? metoPROLOL tartrate (LOPRESSOR) 25 MG tablet ? DULox

Current Illness: PERIPHERAL NEUROPATHY

ID: 1574554
Sex: F
Age: 78
State: MT

Vax Date: 04/07/2021
Onset Date: 04/30/2021
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: Cipro; Losartan; latex; dust; pollen

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

Symptoms: I had headaches, which I never have. I had brain fog and pressure in my head. After the second shot it got worse. It lasted until 2 weeks ago. The headaches lasted for about 2 or 3 weeks. The pressure in my head was very aggravating. I contacted the PA and she did not do anything. I took some Advil for the headaches. I went to physical therapy and to get a massage. They were working on my head to release the pressure. They said my spinal fluid was not moving. I had a chest x-ray and blood tests done and they were all clear.

Other Meds: Metoprolol; Potassium; vitamin A; B complex; B12; D; D3; zinc; garlic; vitamin K; iodine; vitamin for my eyes

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm