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: 1578217
Sex: M
Age: 80
State: KY

Vax Date: 02/11/2021
Onset Date: 08/02/2021
Rec V Date: 08/17/2021
Hospital: Y

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: Admitted 8/2-8/6 Moderna on 2/11/21 and 3/12/21. Positive on 8/3

Other Meds:

Current Illness:

ID: 1578218
Sex: F
Age: 12
State: PA

Vax Date: 08/03/2021
Onset Date: 08/03/2021
Rec V Date: 08/17/2021
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: UNKNOWN

Symptom List: Anxiety, Dyspnoea

Symptoms: 1ST DOSE MODERNA VACCINE GIVEN TO 12 YEAR OLD FEMALE ON 8/3/2021. NO NEGATIVE OUTCOME TO PATIENT AS PER GRANDMOTHER. NOTICED THE ERROR ON 8/17/2021 WHEN SUBMITTING VACCINE FORM. CALL PLACED TO GRANDMOTHER NOTIFIED AND SHE REPORTS THE CHILD IS FINE AND NO ISSUES AFTER THE VACCCINE. SHE REPORTED THAT HER GRANDAUGHTER'S FRIENDS ALSO RECEIVED THIS VACCINE AT ANOTHER CLINIC AND THIS WAS HER PREFERRED VACCINE.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1578219
Sex: M
Age: 38
State: NY

Vax Date: 08/06/2021
Onset Date: 08/13/2021
Rec V Date: 08/17/2021
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: Reaction to mri contrast

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

Symptoms: Uncontrollable shaking for hours. I continue to feel lightheaded and shaky

Other Meds: Amlodipene, gout medication

Current Illness: None

ID: 1578220
Sex: F
Age: 44
State: MN

Vax Date: 07/23/2021
Onset Date: 07/23/2021
Rec V Date: 08/17/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient claimed that she did not have a previous Covid vaccination when she came in. We administered Pfizer vaccination on 7/23/21. We were unable to locate vaccine records at the time of vaccination and went by patient's word that this was a first covid vaccination. However, when pulling records for second dose, we did find the report and noticed that she had received the Johnson and Johnson vaccination on 3/5/21. We did not administer her second Pfizer vaccination.

Other Meds: Unknown

Current Illness: None

ID: 1578222
Sex: F
Age: 66
State: ME

Vax Date: 08/12/2021
Onset Date: 08/12/2021
Rec V Date: 08/17/2021
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 reported

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

Symptoms: It was discovered after administering the vaccine to the patient (discovered at approximately 4PM---Unsure of exact time) that the vial had been opened on 8/11/21 and was due to "time out" and be thrown away at 6PM on 8/11/21. Vaccine was given at 1:25PM on 8/12/21 The patient has suffered no unusual side effects at this point State CDC was consulted and recommended that patient return and be re-vaccinated, as dose thought to be ineffective

Other Meds: None known

Current Illness: None known

ID: 1578224
Sex: M
Age: 78
State: KY

Vax Date: 01/22/2021
Onset Date: 08/04/2021
Rec V Date: 08/17/2021
Hospital: Y

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: Moderna on 1/22 and 2/18. Positive on 8/5 admitted 8/4-8/10

Other Meds:

Current Illness:

ID: 1578225
Sex: M
Age: 68
State: WA

Vax Date: 02/10/2021
Onset Date: 02/13/2021
Rec V Date: 08/17/2021
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: Vertigo started on the 13th of Feb. and then the morning of the 14th I had Vertigo and extremely high Blood Pressure (202 over 96). I went to the ER. I had bilateral hernia surgery April 2nd and since then I have not been myself. Severe lower back pain, some lower abdominal pain, loss of weight(20 lbs). Chest X-ray showed possible "air trapping disease" and Nuclear Bone Scan (head to toe) showed only arthritic aging. A blood test on Aug. 4th showed Sed Rate 25 mm/Hr, SGOT/AST 45 IU/L, Alk Phos 275 IU/L, SGPT/ALT 126 IU/L. A:G Ratio .9

Other Meds: Valacyclovir 500 mg once daily, Atorvastatin 10 mg once daily, Pantoprazole 40 mg once daily, Melatonin 1 mg two tablets as needed, Advill or Tylenol as needed for pain.

Current Illness:

ID: 1578226
Sex: M
Age: 75
State: PA

Vax Date: 02/07/2021
Onset Date: 08/02/2021
Rec V Date: 08/17/2021
Hospital:

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

Lab Data:

Allergies: NKA

Symptom List: Pharyngeal swelling

Symptoms: Exposure to COVID-19 virus / ASYMPTOMATIC COVID-19 virus infection Dx Medication Infusion Reason for Visit Progress Notes Encounter Date: 8/6/2021 ? ? Signed Patient is here for MAB Infusion O2 sats > or = 90% Signs of potential reaction reviewed with patient. Pt wife who is also Covid pos stayed with pt due to his dementia Tolerated IV start and MAB infusion without complication. Pt has access to pulse oximeter and thermometer for home monitoring Discharge instructions reviewed. Patient denies any questions

Other Meds: cholecalciferol, vitamin D3, (VITAMIN D3 ORAL) coenzyme Q10 (CO Q10) 100 mg capsule donepeziL (ARICEPT) 10 mg tablet finasteride (PROSCAR) 5 mg tablet hydroCHLOROthiazide (HYDRODIURIL) 25 mg tablet memantine (NAMENDA) 10 mg tablet multiple

Current Illness:

ID: 1578227
Sex: F
Age: 44
State: VA

Vax Date: 01/21/2021
Onset Date: 08/11/2021
Rec V Date: 08/17/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: On Aug 11, 2021, I was taken to an ER for pain on my right side. After my scan, the ER Dr and radiologist said I had severe appendicitis and removed my appendix that afternoon.

Other Meds: many

Current Illness: none

ID: 1578228
Sex: F
Age: 43
State: PA

Vax Date: 08/13/2021
Onset Date: 08/13/2021
Rec V Date: 08/17/2021
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: Asprin, E-myacin, Steroids, Lexapro, MSG

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Extreme fatigue, extreme join paint, dizziness, headache, swollen lymph node in armpit of right arm, diarrhea, nausea, fever, tremors, painful vagina/clitoris Took Extra Strength Tylenol for 2 days. Symptoms lasted 4 days with lessening strength. As of writing this, the swollen lymph node and painful clitoris still continue.

Other Meds: Omeprazole, Venlafaxine, Colestipol HCL, Centrum Slver for Women, Calcium 600mg + D3 10mcg

Current Illness: None

ID: 1578229
Sex: F
Age: 82
State: MN

Vax Date: 08/16/2021
Onset Date: 08/16/2021
Rec V Date: 08/17/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient stopped at the pharmacy and said she is having a rash that worsened around 2am then she went to her doctor this morning who told the patient to buy Benadryl OTC. Patient requested the pharmacy report the rash to VARES.

Other Meds:

Current Illness:

ID: 1578230
Sex: F
Age: 39
State: AL

Vax Date: 08/11/2021
Onset Date: 08/16/2021
Rec V Date: 08/17/2021
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: NKDA

Symptom List: Rash, Urticaria

Symptoms: swelling of the right arm pit, swollen lymph nodes of R arm and R breast. Tender to touch and painful when R arm is down

Other Meds: Losartan/HCTZ 100/12.5mg 1 tab daily

Current Illness: n/a

ID: 1578231
Sex: F
Age: 26
State: CA

Vax Date: 07/28/2021
Onset Date: 08/14/2021
Rec V Date: 08/17/2021
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: First pregnancy, Est. Due Date April 11th At time of injection, patient felt rush in lower abdomen/uterus Pregnancy symptoms diminished over the next few days after injection Miscarriage began on August 14, confirmed by physician on 8/16/21. Pregnancy loss

Other Meds:

Current Illness:

ID: 1578232
Sex: F
Age: 55
State: PA

Vax Date: 08/15/2021
Onset Date: 08/15/2021
Rec V Date: 08/17/2021
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: Approximately one hour after receiving the Pfizer vaccine in the left arm, I experienced left sided facial numbness that lasted all day. On the second day after receiving the vaccine, I noticed a rash on my chest.

Other Meds: None

Current Illness: N/AN/A

ID: 1578233
Sex: M
Age: 74
State: IN

Vax Date: 03/03/2021
Onset Date: 08/13/2021
Rec V Date: 08/17/2021
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: The patient received the Pfizer COVID-19 vaccine on 2/10/21 and 3/3/21, so was fully vaccinated when he tested positive for COVID-19 on 8/13/21.

Other Meds:

Current Illness:

ID: 1578234
Sex: F
Age: 53
State: VI

Vax Date: 08/13/2021
Onset Date: 08/13/2021
Rec V Date: 08/17/2021
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: Penicillin and environmental allergies

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

Symptoms: 1st Dose: Injections site pain, tenderness and swelling by the afternoon; slight light-headed/dizziness in the evening into the next day. Took two dose of Tylenol on the second day for the pain in the arm. The light-headed/dizziness was gone by the fourth day. 2nd Dose: Injection site swelling tenderness and body ache by the afternoon; fever, intense head ache, dizziness, light sensitivity eye pain vision impaired, lost of appetite lethargic state of not feeling well lasted for three days after the injection. Symptoms were treated with Tylenol every 4-hours, intake as much water, bush tea and home-made fish and onion soups that I could and slept/rest. On the third day the fever subsided about midday, but the headaches, eye sensitivity, lost of appetite, and lethargy continued, which continued to be treated with Tylenol, bush tea and soup. By the fourth day the head aches subsided, appetite still light, slight light-headed, some diarrhea and tenderness at the injection site continues. Symptoms were treated with bush tea and rest. Body achy feeling, eye sensitivity are not apparent.

Other Meds: Standard Process Immune System Health Pack (Vegetarian) and Cod Liver Oil dietary supplements.

Current Illness: None known

ID: 1578235
Sex: M
Age: 66
State: PA

Vax Date: 02/22/2021
Onset Date: 08/01/2021
Rec V Date: 08/17/2021
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: NKA

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

Symptoms: Chief Complaint Patient presents with ? Sinus Problem x 1 week. cough, ear pain, headache, fatigue, loss of appetite Suspected COVID-19 virus infection URI, acute

Other Meds: meloxicam (MOBIC) 15 mg tablet predniSONE (DELTASONE) 20 mg tablet

Current Illness:

ID: 1578236
Sex: F
Age: 41
State: KY

Vax Date: 08/13/2021
Onset Date: 08/14/2021
Rec V Date: 08/17/2021
Hospital:

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

Lab Data:

Allergies: Penicillin erythromycin kelflex

Symptom List: Ear pain, Hypoaesthesia

Symptoms: I had my injection Friday 8/13 at 10:45. The next morning I woke up at 7:00 am my arm was very sore. I had blisters in the roof of my mouth. Extreme allergy symptoms itchy watery eyes sneezing and itchy skin and face .The next morning Sunday I woke up at 8:30 am my arm was still very sore but had a large red spot where I received the injection. The sores in my mouth we still present but a little worse. Same allergy symptoms.Monday my injection spot was gone but very itchy. Same allergy symptoms. The blisters in my mouth were now popped and just sores . My tongue is slightly swollen but very sore . No open sores or blisters on my tongue. Started salt water rinse in mouth. My allergy symptoms went away Monday afternoon.Tuesday mouth sores still present and tongue sore and now sore throat. Still using salt water rinse. No allergy symptoms and my arm no longer sore or itchy.

Other Meds: Zyrtec Flonase lo-estrogen valtrex

Current Illness:

ID: 1578237
Sex: F
Age: 28
State: MI

Vax Date: 07/27/2021
Onset Date: 07/27/2021
Rec V Date: 08/17/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: temperature excursion - vaccine stored too long in freezer temperatures

Other Meds:

Current Illness:

ID: 1578238
Sex: F
Age: 41
State: KY

Vax Date: 02/05/2021
Onset Date: 08/06/2021
Rec V Date: 08/17/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Moderna on 2/5 and 3/9. Positive on around Aug 1 admitted 8/6-8/13

Other Meds:

Current Illness:

ID: 1578239
Sex: F
Age: 23
State: CO

Vax Date: 08/16/2021
Onset Date: 08/17/2021
Rec V Date: 08/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Headache, body ache, soreness, lethargic

Other Meds: Valacyclovir

Current Illness:

ID: 1578240
Sex: M
Age: 56
State: KY

Vax Date: 03/26/2021
Onset Date: 04/23/2021
Rec V Date: 08/17/2021
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: na

Other Meds: none

Current Illness: none

ID: 1578241
Sex: M
Age: 77
State: GA

Vax Date: 02/09/2021
Onset Date: 02/09/2021
Rec V Date: 08/17/2021
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: All statins

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

Symptoms: On 02/09/2021 just felt weak and very tired, I stayed in bed for 15 hours. July 18th I began having symptoms of covid, on July 20th and was tested for Covid and on the 21st of July it was positive. My symptoms lasted for 3 weeks, the first two days fever of 101.

Other Meds: I was taking allopurinol; hydroxychloroquine; losartan; amlodipine; gabapentin; omeprazole; RUTUXAN (infusions are every 6 months- 2 weeks apart)

Current Illness: No

ID: 1578242
Sex: F
Age: 57
State: CO

Vax Date: 07/23/2021
Onset Date: 07/24/2021
Rec V Date: 08/17/2021
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: Cat scan IV contrast dye, Keflex, Vicodin, mango

Symptom List: Injection site pain, Pain

Symptoms: Fever 102.6 for 30 hours, severe headache, weakness, nausea, diarrhea, arm pain with weakness, dizziness, severe body aches. Felt better within 72 hours

Other Meds: Viville Dot patch, Baby Aspirin 81mg, Pepcid AC, Zinc 50mg, Multi Vitamin, Vitamin D 5000 iu, Losartan 25mg

Current Illness: Long Haul Covid , initial covid 2/20/2021

ID: 1578243
Sex: F
Age: 43
State: OH

Vax Date: 05/19/2021
Onset Date: 05/22/2021
Rec V Date: 08/17/2021
Hospital: Y

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

Lab Data:

Allergies: Blueberry, seasonal allergies.

Symptom List: Injection site pain, Menorrhagia

Symptoms: Jaundice, high liver enzymes, fatigue, tea colored urine. Stomach pain

Other Meds: Wellbutrin, Claritin, ibuprofen.

Current Illness: None

ID: 1578244
Sex: M
Age: 13
State: CA

Vax Date: 08/13/2021
Onset Date: 08/15/2021
Rec V Date: 08/17/2021
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:

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

Symptoms: Fever with Tmax 101.6F starting approximately 6hours after vaccination. On 8/15/2021, developed chest pain. Presented to ED where found to have elevated troponin (17.8) and EKG with ST segment changes, consistent with myopericarditis. Normal cardiac function at this time. Treating with NSAIDs.

Other Meds:

Current Illness:

Date Died: 08/13/2021

ID: 1578245
Sex: F
Age: 68
State: KY

Vax Date: 03/09/2021
Onset Date: 08/05/2021
Rec V Date: 08/17/2021
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: Pfizer on 3/9 and 3/30. Positive on 8/6 8/5-8/13 admitted

Other Meds:

Current Illness:

ID: 1578246
Sex: F
Age: 81
State: TN

Vax Date: 03/24/2021
Onset Date: 08/08/2021
Rec V Date: 08/17/2021
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: Lovenox sulfa drugs (rash)

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: 82-year-old female with history of hypertension, chronic kidney disease, hyperlipidemia, chronic congestive heart failure. For the past week has had increased weakness fatigue and near syncope. Patient came to the ER with O2 sat in the 80s. Patient was also complaining of nausea with dry heaves and vomiting.Patient has been overly lethargic per family. Patient's work-up 3.6, H&H 15 and 46, platelets 91, sodium 135, potassium 3.8, BUN 22, creatinine 1.05, troponin VI 28, lactic acid 0.8, pro-Cal 0.15. + covid 19

Other Meds: aspirin 325 mg oral tablet, 325 mg/ 1 tab(s), Oral, Daily carvedilol, 6.25 mg, Oral, BID Colcrys, 0.6 mg, Oral, Daily furosemide, 20 mg, Oral, Daily pantoprazole, 40, Oral, Daily simvastatin, 10 mg, Oral, Daily at Bedtime Synthroid, 2

Current Illness: Unknown

ID: 1578247
Sex: M
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/17/2021
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: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: shoulder pain, likely rotator cuff tendonitis

Other Meds:

Current Illness:

ID: 1578248
Sex: F
Age: 52
State: OK

Vax Date: 02/26/2021
Onset Date: 02/27/2021
Rec V Date: 08/17/2021
Hospital:

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

Lab Data:

Allergies: Compazine Zofran

Symptom List: Nausea

Symptoms: Patient stated that she had the normal side effects. She also had non controllable movements. She had abnormal posturing that lasted for about five hours.

Other Meds: Lisinopril Methopenalone

Current Illness:

ID: 1578249
Sex: F
Age: 57
State: CO

Vax Date: 08/13/2021
Onset Date: 08/14/2021
Rec V Date: 08/17/2021
Hospital:

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

Lab Data:

Allergies: Cat scan IV contrast dye, Keflex, Vicodin, mango

Symptom List: Injection site pain

Symptoms: Fever 102 for 24 hours, severe neck and shoulder pain, headache, increased shortness of breath, arm pain and weakness, stomach ache.

Other Meds: VIville Dot patch, Baby Aspirin 81mg, Pepcid AC, losartan 25mg, multi vitamin, Vitamin D 5000 iu, Zinc 50mg

Current Illness: Long Haul Covid new onset hypertension

ID: 1578250
Sex: F
Age: 39
State: TX

Vax Date: 03/31/2021
Onset Date: 04/05/2021
Rec V Date: 08/17/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Since shortly after my first vaccine I have had digestive issues (intense stomach cramping that left me debilitated). I also experienced consistent adrenal surges each day while working.

Other Meds: None

Current Illness: None

ID: 1578251
Sex: F
Age: 75
State: DE

Vax Date: 02/05/2021
Onset Date: 02/27/2021
Rec V Date: 08/17/2021
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: Latex; sulfa drugs; codeine drugs; penicillin.

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

Symptoms: During the night I was shivering and left after a few hours for 12 hours. On 7 March 2021 later I woke up and had pain in legs and arms and was worst for 6 weeks. It became extreme painful. Rash across my midriff. Till today the rash is still there not as severe now. 15 March 2021 saw the doctor. No test was done. I started taking a steroid on 8 April 2021. Saw the rheumatologist 16 April 2021. I see her every 6 weeks. I am on steroids now.

Other Meds: Levothyroxine; atenolol; zinc; vitamin D3; multivitamins

Current Illness: No

ID: 1578252
Sex: F
Age: 43
State: CA

Vax Date: 05/14/2021
Onset Date: 05/15/2021
Rec V Date: 08/17/2021
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: Amoxicillin, nickel

Symptom List: Tremor

Symptoms: Headaches started after the second Pfizer vaccine. The headaches are on both sides of the back of my head and go up to the top of my head. I have had them daily now since the second dose . I had the shot in may and it is now august. I also recently had an autoimmune test come back positive. I think this shot triggered an immune response.

Other Meds: Levothyroxine 50mcg

Current Illness: Underactive thyroid

ID: 1578253
Sex: F
Age: 69
State: NJ

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 08/17/2021
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: Erythema, Pruritus

Symptoms: Per office note: 5/12/2021 She had COVID vaccine Mar 19, 2021 and since then has pain in left arm, triceps area. She can lift her arm now but there is some tenderness in the upper arm and occ forearm.

Other Meds: Omega 3 1000mg capsules Calcium + vitamin D table Vitamin C 500 mg tablet daily Glucosamine Vitamine B12 Vitamin E 40 mg 1 capsule orraly daily Melatonin 3 mg tablet at bedtime Prn Levothyroxine 25 mcgtg table one daily every am Hydrocor

Current Illness: No known

Date Died: 08/16/2021

ID: 1578254
Sex: F
Age: 84
State: KY

Vax Date: 01/04/2021
Onset Date: 08/06/2021
Rec V Date: 08/17/2021
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: Pfizer on 1/4 and 1/26. Positive on 8/7 8-6/8-16 admitted

Other Meds:

Current Illness:

ID: 1578255
Sex: F
Age: 53
State: MI

Vax Date: 03/06/2021
Onset Date: 08/12/2021
Rec V Date: 08/17/2021
Hospital: Y

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

Symptoms: Per patient, she was vaccinated at an outside facility on 3/6/2021 and 4/3/2021 both with Moderna COVID-19 vaccines. Patient recently returned from another locale visiting her daughter who was COVID positive. Patient did home COVID tests twice on 8/12/21 and were both positive. Patient presented to hospital on 8/16/2021 where another COVID test was performed on 8/16/2021 and was also positive.

Other Meds:

Current Illness:

ID: 1578256
Sex: F
Age: 59
State: CA

Vax Date: 04/02/2021
Onset Date: 04/06/2021
Rec V Date: 08/17/2021
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: Iron

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: A large red welt formed on my upper left arm, around the injection site. It was very itchy for a couple of days. I treated it with Hydrocortisone and Benadryl Spray. After couple of days the itchy subsided to a mild itch and the welt shrank in size. After about a week the itch was gone and the welt became a discoloration. The discoloration eventually faded away.

Other Meds: Synthroid, Multi-vitamin, Vitamin C, Vitamin B-12, Vitamin D, Vitamin E, Red Yeast.

Current Illness: None

ID: 1578257
Sex: M
Age: 46
State: OH

Vax Date: 01/25/2021
Onset Date: 01/26/2021
Rec V Date: 08/17/2021
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: penicillin (rash)

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

Symptoms: severe lower back pain beginning 24 hours after dose #2. The pain was so bad for 48 hours that I was unable to get out of bed, even to use the bathroom, despite high doses of Tylenol and Motrin. I called off work the first day and worked from my bed the second. The pain gradually subsided over the next week but did not disappear for months. I have a history of mild lower back pain that had rarely flared up after very specific causes (known strains, long car rides) but there was no such precipitating event this time.

Other Meds: famotidine

Current Illness: none

ID: 1578258
Sex: M
Age: 49
State: IN

Vax Date: 04/22/2021
Onset Date: 08/13/2021
Rec V Date: 08/17/2021
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: Patient received the Pfizer COVID-19 vaccine on 4/1/21 and 4/22/21, so was fully vaccinated when he tested positive for COVID-19 on 8/13/21.

Other Meds:

Current Illness:

ID: 1578259
Sex: M
Age: 51
State: MI

Vax Date: 04/17/2021
Onset Date: 04/29/2021
Rec V Date: 08/17/2021
Hospital:

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

Lab Data:

Allergies: Iodine Morphine Demerol

Symptom List: Pain in extremity

Symptoms: Lightheadedness Large Reduction of high frequency hearing Edema in left foot Chest flutters Mass in left breast

Other Meds: Atorvastatin 10mg once daily Olmesartan Medoxomil 2x 5mg (10mg total) once daily

Current Illness: None

ID: 1578260
Sex: M
Age: 87
State: KY

Vax Date: 06/10/2021
Onset Date: 08/08/2021
Rec V Date: 08/17/2021
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: Janssen on 6/10. Positive on 8/8 admitted 8/8-8/9

Other Meds:

Current Illness:

ID: 1578261
Sex: M
Age: 77
State: WA

Vax Date: 08/16/2021
Onset Date: 08/16/2021
Rec V Date: 08/17/2021
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: Diclofenac (rash)

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

Symptoms: Mildly sore arm at injection site

Other Meds: Atorvastatin 40mg daily; Methotrexate 17.5mg weekly; Folic Acid 1mg daily; Xarelto 20mg daily; Multivitamin daily;

Current Illness: Sciatica right hip/leg

ID: 1578262
Sex: F
Age: 48
State:

Vax Date: 04/21/2021
Onset Date: 04/21/2021
Rec V Date: 08/17/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: Immediate sharp pain in left neck and shoulder area. Have had a swollen lymph node in armpit since first shot. The pain in neck and arm occurred immediately when jab of 2nd shot given April 21st. Have experienced increased pain in under arm lymph nodes and in July the shoulder pain became excruciating. I made appointment with PCP who ordered ultrasound of armpit and mammogram. My chiropractor ordered a shoulder x-ray which I had on July 19th, structure looks good. Am scheduled for the ultrasound/mammogram Aug 25th. Left shoulder continues to throb and ache as well as armpit pain.

Other Meds:

Current Illness:

ID: 1578263
Sex: F
Age: 56
State: CA

Vax Date: 07/16/2021
Onset Date: 07/01/2021
Rec V Date: 08/17/2021
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: Sulfa and melons

Symptom List: Vomiting

Symptoms: tongue numbness and tingling still present

Other Meds: None

Current Illness: none

ID: 1578264
Sex: F
Age: 67
State:

Vax Date: 08/09/2021
Onset Date: 08/10/2021
Rec V Date: 08/17/2021
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: whole right side of body was hot as fire and couldnt move that side few minutes

Other Meds: trozidone, adorol, trintellix, zyrtec allergy, flonaze, gabapintin, lorazapan, lamotrigine, sleep aid, ib profen, tramadol

Current Illness:

ID: 1578265
Sex: F
Age: 54
State: KY

Vax Date: 01/07/2021
Onset Date: 08/09/2021
Rec V Date: 08/17/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Moderna on 1/7 and 2/4. Positive on 8/3 admitted 8/9-8/17

Other Meds:

Current Illness:

ID: 1578266
Sex: M
Age: 22
State: WA

Vax Date: 07/30/2021
Onset Date: 08/02/2021
Rec V Date: 08/17/2021
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: I?ve had a hard time breathing since the Tuesday after. Developed a bad headache this week, and wake up with sharp head pains. I also have aches around my body.

Other Meds: None

Current Illness: None

ID: 1578267
Sex: F
Age: 56
State: DE

Vax Date: 08/11/2021
Onset Date: 08/11/2021
Rec V Date: 08/17/2021
Hospital:

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

Lab Data:

Allergies: bactrim flagyl latex wool ppd

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

Symptoms: numbness of lips, cough- fever chills, severe body aches pain, numbness in legs on right side , muscle weakness, difficulty walking, right sided facial numbness, headache, parasthesia, chest tightness

Other Meds: levothyroxine asteline glucosamine condrotion

Current Illness: sinus/allergies congestion

ID: 1578268
Sex: F
Age: 16
State: TX

Vax Date: 07/08/2020
Onset Date: 08/06/2020
Rec V Date: 08/17/2021
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: none known

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

Symptoms: Abdominal pain - severe after 1 month

Other Meds: LEVONorgestrel/ethinyl estridiol cyclobenzaprine 5 mg multivitamins OTC

Current Illness: muscle spasms (back)

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm