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: 1582441
Sex: M
Age: 78
State: CA

Vax Date: 08/18/2021
Onset Date: 08/18/2021
Rec V Date: 08/18/2021
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: unknown

Symptom List: Dysphagia, Epiglottitis

Symptoms: 1243- Patient?s wife approaches RN stating her husband (patient) is feeling dizzy. RN approaches patient. NP and EMT are notified. Patient states this is his 3rd dose with Pfizer. (attestation letter was signed) 1244- NP, POD Lead, 4 nurses, EMT, and patient wife are at patient?s side. Patient is laid down on a sheet on the ground with his lower extremities elevated onto a chair. EMTs are attaching monitor to patient. NP is assessing patient. He has a h/x of intermittent elevated BP, fibromyalgia, elevated cholesterol, and pre diabetes. Patient states his SBP baseline is in the 130?s. Pt takes Crestor and Cymbalta at home. Patient states he feels ?shaky? and states his last meal was at 0800 this morning. Patient?s hands are cold to touch. Patient denies headache, chest pain, blurred vision, or SOB. NP requests BS reading. 1246- RN collects blood glucose sample. BP: 151/86, P:67, O2: 99%, BS:111 Patient states he has a h/x of elevated BP. He verbalizes he is ?slightly shaky.? Patient is given cookies and Gatorade. 1250- patient states he is feeling better and he is assisted to a sitting position in the chair. He has cold hands. Denies numbness, diaphoresis is not present, denies dizziness, denies chest pain, denies SOB. 1300- denies lightheadedness, vision changes, patient is warm to touch. 1303- patient is still sitting in chair BP: 153/85, P:58, O2: 99. 1306- patient states he feels an intermittent heaviness after taking Cymbalta 30mg this morning and sitting in the same position for long periods of time triggers his fibromyalgia symptoms. 1310- Patient states he was taking metoprolol a couple months ago but his physician stopped the medication because his BP was too low. NP advises patient to follow up with primary care physician about elevated BP. 1314- Patient states he ?feels okay, ready to go home? Patient is advised to eat when he gets home. Patient is alert, and ambulates safely to car with wife and escorted by RN.

Other Meds: Crestor, Cymbalta

Current Illness: intermittent elevated blood pressure

ID: 1582442
Sex: F
Age: 57
State: MA

Vax Date: 04/01/2021
Onset Date: 05/01/2021
Rec V Date: 08/18/2021
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: None

Symptom List: Anxiety, Dyspnoea

Symptoms: 104+ fever Day 1, 103 Fever Day 2 and Day 3, 102 Fever Day 4, 101 Fever Day 5. Extremely shaking from Hour 8 to 24 hour mark. Blinding headache and Tachycardia first 24 hours. Rest Heart Rate took at least 30 days to get back to 65bpm. 30 days! Felt shortness of breath and overall fatigue. Legit the most seriously sick I've ever been in my entire life. I tool Tylenol and Aleve to lower fever for that full 5 days and could barely move. I hydrated fully and constantly throughout. I am reporting because I am extremely pro vaccine - but also extremely hesitant to get a booster without drawing titres first to measure my level of antibodies after 8 months. I felt like I could have had an acute cardiac event for those first few days (I have bad genetics when it comes to cardiac markers and family history). I had tachycardia within 8 hours after the 2nd dose/shot (and didn't realize it until weeks later and noticed on my wearable biometric device). And as I said, it took a full month for my heart to actually get back to its baseline after 2nd dose. I should note that I had really no side effects after the first dose at all. Just a slightly sore arm. But that second dose? I just didn't go to ER because I didn't think they would do more than give me Tylenol and IV. I hydrated and took Tylenol (but wasn't entirely sure I was going to live, in complete seriousness). I've never been even close to that sick before in my life. So, super hesitant about these boosters. And want direction for patients like me who had severe (rare) side effects. I believe a booster could kill me.

Other Meds: Toprol XL 100mg qd Tramadol HCL 50mg tablet 3x a day L-thyroxine (synthroid) Tabs100 mcg (9 tabs week) Atorvastatin Tabs 10 mg qd Cyclobenzaprine Hcl Tabs 10 mg qd (at hs)

Current Illness: None

ID: 1582443
Sex: F
Age: 61
State: MI

Vax Date: 01/15/2021
Onset Date: 02/05/2021
Rec V Date: 08/18/2021
Hospital: Y

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: On 2/5/2021 I went to my doctor and they said I had developed a heart murmur. The on 05/03/2021 I had to get heart surgery. Then 3 months later on 08/03/2021 I had a stroke. I just got out of the hospital.

Other Meds: Blood Pressure medication

Current Illness:

ID: 1582444
Sex: F
Age: 47
State: OH

Vax Date: 05/21/2021
Onset Date: 06/16/2021
Rec V Date: 08/18/2021
Hospital:

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

Lab Data:

Allergies: tetracycline, bactrim, lamictal, fluorescein, tegretol

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: 1. Superior branch retinal vein occlusion diagnosed 6/24/2021 - initial symptoms of right eye blurriness/haziness started one week prior. No treatment required at this time, retinal specialist is following. 2. Hashimoto's Thyroiditis diagnosed 8/18/2021. Palpitations severe enough for an ED visit on 8/8/2021, follow up labwork concluded diagnosis. No treatment at this time. Endocrinology appointment is pending.

Other Meds: Naproxen PRN, D3 25mcg daily

Current Illness: none

ID: 1582445
Sex: F
Age: 29
State: MN

Vax Date: 05/18/2021
Onset Date: 08/15/2021
Rec V Date: 08/18/2021
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: Dose 1 4/14/2021 Pfizer EW0169 pt has covid 19

Other Meds:

Current Illness:

ID: 1582446
Sex: F
Age: 23
State: NJ

Vax Date: 08/12/2021
Onset Date: 08/17/2021
Rec V Date: 08/18/2021
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: I had a seizure after getting the depo shot on 08/17/2021 and my Vaccine on 08/12/2021. I've never had seizures before so my primary doctor thought it best I follow up with this

Other Meds: Depo Birth Control Shot & Methylprednisolone 4MG

Current Illness:

ID: 1582447
Sex: F
Age: 36
State: TX

Vax Date: 08/15/2021
Onset Date: 08/16/2021
Rec V Date: 08/18/2021
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

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Swollen arm, pain in injection site, unable to move arm, high heart rate, difficulty breathing, body aches, dizziness, muscle tightness then falling over, double vision

Other Meds: Propranolol, lamotrigine, motillium, fluoxetine, zofran, aripprazole, forteo, remicade

Current Illness: None

ID: 1582448
Sex: F
Age: 32
State: MN

Vax Date: 01/14/2021
Onset Date: 08/13/2021
Rec V Date: 08/18/2021
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: pt currently has covid 19

Other Meds:

Current Illness:

ID: 1582449
Sex: F
Age: 59
State: AR

Vax Date: 08/10/2021
Onset Date: 08/10/2021
Rec V Date: 08/18/2021
Hospital:

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

Lab Data:

Allergies: Benadryl. Ultram, Sulfa, Flagyl, chicken, robaxin,

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Called and said that since getting the first vaccine yesterday, she has been having a tingling in her lip and then in the night she woke up with a terrible headache and also now she is coughing terribly. She also reported that she has swelling in both cheeks and vision changes.

Other Meds: Topiramate, Tylenol w/codiene, Lyrica. Kumigan solution, Restatis, Oxygen, Mobix, Celexa, Provera, Clondidine, buspirone, meclizine, cetirizine, proair inhaler, minipressm omeprazeol. norvasc, diclofenac sodium, Wellbutrin SR,

Current Illness:

ID: 1582450
Sex: M
Age: 63
State: GA

Vax Date: 07/03/2021
Onset Date: 07/19/2021
Rec V Date: 08/18/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Codeine

Symptom List: Diarrhoea, Nasal congestion

Symptoms: On 07/03/2021 Patient was administered a Johnson & Johnson Covid-19 sot in his right arm at 12:43p.m. Everything went well as far as the shot went,but as time went on 07/19/2021 he was waken at 5:30 a.m. a bad case of acid reflux which he had awhile ago but not since he was taking prebiotics and probiotics which helped but not this time it came with a vengeance. He was vomiting and had a fever. He did take some Omeprazole that morning which it stop for a while but the moment he went to eat some food it started all over again the vomiting and the fever was back higher then before. By Wednesday 07/28/2021 it was better bad so we went over to a Medical Center they then took a Coivd-19 Test which was negative. They did ran a battery of blood work on him but after waiting for five long hours to be seen by a doctor he was extremely cold in the waiting area and he was in great pain sitting on the uncomfortable chairs we went home. The following day we went over to urgent care and once again the PA give him another Covid-!9 test which was once again negative The PA suggested we go over to a Hospital. The next day we went over there was tested again and was negative again They checked him in but they never found the Covid-19 after being poked and stuck soo many times he was really not feeling good and they did know that he had a inflamed and infected gallbladder which the infection traveled through his blood stream Which was very dangerous for him however it appeared that they were taking his blood every two hours which became very unbearable for him and he wanted to go home. I went to pick him up at 3:00 a.m. One of the call me to convince to still in the hospital but he refused. So the next day we went over to another Hospital, Their was when he tested postive all because his gallbladder was very inflamed and infected due to the vaccine and he also has a blood clot thats on top of his liver.Now he has to wear a colonscopy bag until they can remove his gallbladder which is about four weeks . He has to wear the bag to drain any infection . They have him taking A blood thinner Drug which was $645.93 which we can't afford.

Other Meds: Mutliple vitamin, prebiotics and probiotics.

Current Illness: N/A

ID: 1582451
Sex: F
Age: 76
State: GA

Vax Date: 02/25/2021
Onset Date: 07/25/2021
Rec V Date: 08/18/2021
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:

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

Symptoms: Hospitalized

Other Meds:

Current Illness:

ID: 1582452
Sex: F
Age: 43
State: MA

Vax Date: 04/20/2021
Onset Date: 08/05/2021
Rec V Date: 08/18/2021
Hospital: Y

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: The patient is a 43-year-old female, who presented to the hospital because of acute onset of lower abdominal pain. Aymptomatic for covid 19.

Other Meds:

Current Illness:

ID: 1582453
Sex: F
Age: 51
State: PR

Vax Date: 03/26/2021
Onset Date: 04/01/2021
Rec V Date: 08/18/2021
Hospital:

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

Lab Data:

Allergies: No

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

Symptoms: HAIR LOST. ALOPLESIA. 3 CIRCLE SPOTS

Other Meds: Multivitamins

Current Illness: None

ID: 1582454
Sex: F
Age: 41
State: OH

Vax Date: 05/27/2021
Onset Date: 05/28/2021
Rec V Date: 08/18/2021
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: Medication allergies: IV dye, succinylcholine, morphine, vicodin, Tdap

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

Symptoms: My pregnancy history: gravita 2, para 1. I was 36wks 2days pregnant on 05/27/2021. Estimated date of delivery: 06/22/2021. Delivery date was; Birth weight 6lb 14oz. Adverse event: Constant excruciating pain deep in right shoulder. Pain and heaviness in upper forearm, inner and outer elbow, and lower forearm. Numbness in thumb, pointer fingers and pinky/ring fingers. Range of motion is severely limited. Unable to reach behind me. Pain when reaching, pushing, pulling, almost any movement. Unable to hold my daughter in my right arm after she was born. Extreme difficulty breastfeeding on right side. Difficulty pumping due to pain. Unable to perform my normal daily functions. Currently seeing my family doctor, physical therapy, taking oral steroids, ibuprofen, ES Tylenol, using ice/heat, BioFreeze, rest, home exercises provided by PT, ultrasound therapy, chiropractic care, physio tape, massage, and now have an appointment with an orthopedist for continued care.

Other Meds: Protonix, pepcid, cymbalta, requip, singulair, albuterol inhaler, dulera inhaler, vit B12 , vit D with calcium, biotin, prenatal vitamin, tums

Current Illness: None

ID: 1582455
Sex: F
Age: 23
State: OH

Vax Date: 08/10/2021
Onset Date: 08/18/2021
Rec V Date: 08/18/2021
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: Major localized swelling at injection site, right upper arm, near the shoulder, eight days after receiving the vaccine. Swelling, bruising, and red inflammation at and around injection site. Arm/Shoulder is warm to the touch.

Other Meds: Birth control

Current Illness: None

ID: 1582456
Sex: F
Age: 71
State: CA

Vax Date: 02/21/2021
Onset Date: 02/21/2021
Rec V Date: 08/18/2021
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

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

Symptoms: Day of vaccine - slight dizziness that went away during the day Some time after I noticed that I would wake up with a racing, pounding heart rate.

Other Meds: Iron, Vitamin B 12, Vitamin B complex

Current Illness: None

ID: 1582457
Sex: M
Age: 43
State: MN

Vax Date: 04/01/2021
Onset Date: 08/13/2021
Rec V Date: 08/18/2021
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: currently has covid 19

Other Meds:

Current Illness:

ID: 1582458
Sex: F
Age: 43
State: NV

Vax Date: 08/01/2021
Onset Date: 08/03/2021
Rec V Date: 08/18/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Started bleeding on August 3rd somedays heavy bleeding occurred this was not the normal period, and was not close to time for cycle . I am still experiencing bleeding.

Other Meds: None

Current Illness: N/A

ID: 1582459
Sex: M
Age: 45
State: NY

Vax Date: 08/01/2021
Onset Date: 08/01/2021
Rec V Date: 08/18/2021
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: pain on left shoulder, weakness in knees

Other Meds: metformin, lipizod

Current Illness:

ID: 1582460
Sex: M
Age: 69
State: MN

Vax Date: 02/26/2021
Onset Date: 08/17/2021
Rec V Date: 08/18/2021
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: shortness of breath, chest pain, abnormal EKG, elevated troponin, epigastric pain, left lower quadrant abdominal pain, nausea

Other Meds:

Current Illness:

ID: 1582461
Sex: F
Age: 58
State: TX

Vax Date: 02/06/2021
Onset Date: 02/06/2021
Rec V Date: 08/18/2021
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: penicillin, codeine, sulfa drugs

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

Symptoms: Inadvertent subcutaneous injection below deltoid, Pain in shoulder, swollen glands, muscle weakness and pain, unable to lift arm and activate scapula. Diagnosed SIRVA. I have had several months of physical therapy to regain strength in my left shoulder. I have had improvement but not 100% normal (90%).

Other Meds: estradiol patch

Current Illness: none

ID: 1582462
Sex: F
Age: 21
State: TX

Vax Date: 08/10/2021
Onset Date: 08/11/2021
Rec V Date: 08/18/2021
Hospital:

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

Lab Data:

Allergies: Codiene

Symptom List: Unevaluable event

Symptoms: Day 1 after injection-numbness of left arm for 1 day Day 7 after injection-runny/stuffy nose, chest congestion, headache, numbness of left arm returned

Other Meds: Zinc-day of shot vitamin C -Emergen C-after shot 8 days Mucinex Cold and Flu-after shot 8 days

Current Illness: none

ID: 1582463
Sex: F
Age: 40
State: MS

Vax Date: 07/01/2021
Onset Date: 07/01/2021
Rec V Date: 08/18/2021
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: Burning from injection that subsided within 10 minutes, very sore upper arm pain for 3-4days, knee joint pain with burning sensation started 24 hours after injection and still present. Calf pain 6 days after and is intermittent. Mild fever 24 hours after subsided within 12 hours.

Other Meds: None

Current Illness: None

ID: 1582465
Sex: F
Age: 20
State: WA

Vax Date: 08/18/2021
Onset Date: 08/18/2021
Rec V Date: 08/18/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Message taken by other staff and passed on to this RN: "Patient called and states that she got her COVID vaccine today and is now on her way to indigo urgent care due to her lips swelling and hives under her eyes. "

Other Meds:

Current Illness:

ID: 1582466
Sex: F
Age: 53
State: MD

Vax Date: 03/15/2021
Onset Date: 03/15/2021
Rec V Date: 08/18/2021
Hospital:

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

Lab Data:

Allergies: Shortly after vaccine my throat began to swell. It felt like my throat was closing. It didn?t last for long.

Symptom List: Injection site pain, Menorrhagia

Symptoms: Shortly after I received the shot. I would estimate 20-39 minutes my throat began to swell. It felt like it was slightly closing. It didn?t last long. It was not too severe, I went back to let the pharmacist know what had occurred. She asked if I stayed the fifteen minutes . I think I waited I think 10-12 minutes and keft. As I said it didn?t seem to last long and I told that to the pharmacist. She immediately told me I could not receive the second dose. I reported this to my primary Dr and she agreed I shouldn?t get the second dose unless I?m a hospital setting.

Other Meds: None

Current Illness: Non

ID: 1582467
Sex: F
Age: 22
State: MN

Vax Date: 04/20/2021
Onset Date: 08/13/2021
Rec V Date: 08/18/2021
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: Dose 1 Moderna 03/23/2021 lot 044A21A currently has covid 19

Other Meds:

Current Illness:

ID: 1582468
Sex: M
Age: 51
State: GA

Vax Date: 01/30/2021
Onset Date: 01/30/2021
Rec V Date: 08/18/2021
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: Penicillin

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Shortness of breath, febrile, chills, hives & swelling over 100% of body

Other Meds: Triumec, Zertec

Current Illness: None

ID: 1582469
Sex: F
Age: 71
State: NY

Vax Date: 08/04/2021
Onset Date: 08/06/2021
Rec V Date: 08/18/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Heaviness in chest, rapid and slow heart beats. Heart beat may be fluttery at times. Happens for increments of time - not steadily feeling the same symptoms. She described 4 hours on and then off for most of the rest of the day. No swelling of feet/ankles/hands. No fatigue other than that the first day after the shot. No abnormal injection site reaction.

Other Meds:

Current Illness:

ID: 1582470
Sex: M
Age: 82
State: MN

Vax Date: 03/04/2021
Onset Date: 08/13/2021
Rec V Date: 08/18/2021
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: Dose 1 Moderna 2/5/2021 016M2oA currently has covid 19

Other Meds:

Current Illness:

ID: 1582471
Sex: F
Age: 47
State: NY

Vax Date: 08/15/2021
Onset Date: 08/16/2021
Rec V Date: 08/18/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Nausea

Symptoms: 12 hours after vaccine- chills and body aches relief with Tylenol 15 hours after vaccine - fatigue, slept on and off for over 24 hours, alternating Tylenol and Advil when awake for body aches 36 hours after vaccine - nausea and fatigue 72 hours after vaccine - slight fever 99.5 orally and fatigue, nausea and food aversions

Other Meds: Lexapro

Current Illness: None

ID: 1582472
Sex: M
Age: 66
State: FL

Vax Date: 02/23/2021
Onset Date: 03/23/2021
Rec V Date: 08/18/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

Symptom List: Injection site pain

Symptoms: Joint soreness and unrelenting tendinitis in multiple locations.

Other Meds: Atorvastatin 40 mg; Valsartan 325 mg

Current Illness: None

ID: 1582474
Sex: M
Age: 59
State: MN

Vax Date: 04/09/2021
Onset Date: 08/13/2021
Rec V Date: 08/18/2021
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 induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Dose 1 moderna 03/12/2021 031A21aA lot Currently has Covid 19

Other Meds:

Current Illness:

ID: 1582475
Sex: F
Age: 55
State: MO

Vax Date: 08/18/2021
Onset Date: 08/18/2021
Rec V Date: 08/18/2021
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: egg, carafate. citalopram, amox, ozempic

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

Symptoms: Patient complaint of swelling in throat and difficulty breathing after 1st dose of moderna

Other Meds: n/a

Current Illness:

ID: 1582476
Sex: F
Age: 81
State: KY

Vax Date: 03/29/2021
Onset Date: 08/15/2021
Rec V Date: 08/18/2021
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: Tremor

Symptoms: Tested positive for covid-19 after being fully vaccinated.

Other Meds:

Current Illness:

ID: 1582477
Sex: F
Age: 74
State: UT

Vax Date: 02/15/2021
Onset Date: 04/09/2021
Rec V Date: 08/18/2021
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; Diovan; Amoxicillin; Motrin; Lortab; Iodine; adhesive tape

Symptom List: Erythema, Pruritus

Symptoms: I woke up and my lip was quite swollen, and I had some hives. I went to urgent care, and they thought it might have been a reaction to medication. They put me on steroids or antibiotics I do not remember, and it seem to help somewhat. I continued to get it, so I went to my PCP and explained my symptoms. She put me on antihistamine, Allegra in the morning and Zyrtec at night. At least I don't itch but I am still getting the hives. When I went to see an allergist, I was told to stop taking the antihistamine for 3 days and I got swells, it was horrible. They did a urine analysis for UTI and the results where I did have a UTI. As soon as I saw her on the next 3 days, I took an antihistamine and it helped but I am still having hives.

Other Meds: Alendronate sodium tablet; Aspirin; Metformin; Amlodipine; Triamterene; Oxybutynin

Current Illness: None

ID: 1582478
Sex: F
Age: 60
State: TN

Vax Date: 08/14/2021
Onset Date: 08/15/2021
Rec V Date: 08/18/2021
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: pcn cephalexin

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

Symptoms: fever, chills, body aches, headache, sore arm 24 hrs after vaccine 2 days after vaccine, swollen arm at vaccine site with red splotches, 3rd day, red circular rash, hot to the touch

Other Meds: lisinopril lovastatin prempro tresibia fiasp

Current Illness:

ID: 1582479
Sex: F
Age: 29
State: CA

Vax Date: 08/09/2021
Onset Date: 08/01/2021
Rec V Date: 08/18/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: 8 day after vaccination got Lump on injection site hot to touch very painful and itchy now day 9 have under arm pain on injected arm and brown vaginal bleeding

Other Meds:

Current Illness:

ID: 1582480
Sex: M
Age: 38
State: TX

Vax Date: 08/14/2021
Onset Date: 08/14/2021
Rec V Date: 08/18/2021
Hospital:

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

Lab Data:

Allergies: None that I know of.

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: My left eye began twitching about 2 hours after the vaccination and continued on and off for two days. This has never happened to me and was very bizarre. I couldn?t think clearly for around two days, especially the first day, and my hand dexterity was very poor on the first day. I couldn?t type well or do normal motor functions on the phone or computer. I was also extremely tired for around 1 day could barely keep my eyes open, starting a few hours after the vaccine. I also had moderate pain in my lower right stomach although that has largely subsided after 4 days. I had moderate pain in my arm that went away after 2-3 days. I also had intermittent chest pain. I never recall having any reactions to any vaccines before other than pain in the arm. This was very very different. If I had known I would have this reaction, especially with whatever was happening with my brain and chest, I definitely would not have received the vaccine.

Other Meds: None

Current Illness: Nothing noticeable maybe a minor cold in weeks prior.

ID: 1582481
Sex: M
Age: 31
State: CA

Vax Date: 02/05/2021
Onset Date: 04/28/2021
Rec V Date: 08/18/2021
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: No

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

Symptoms: Heart palpitations. Constant. Lead to anxiety and difficulty focusing and sleeping

Other Meds: Singular Qvar

Current Illness: No

ID: 1582482
Sex: F
Age: 48
State: TX

Vax Date: 08/18/2021
Onset Date: 08/18/2021
Rec V Date: 08/18/2021
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: no

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

Symptoms: Dizzy and lightheaded

Other Meds: no

Current Illness: no

ID: 1582483
Sex: F
Age: 12
State: LA

Vax Date: 08/13/2021
Onset Date: 08/13/2021
Rec V Date: 08/18/2021
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 known

Symptom List: Pain in extremity

Symptoms: School Nurse obtained consent from the child's mother to give 2nd dose of vaccine to the child at school on 8/13/2021. The mother came to Hospital on 8/11/2021 to get her 2nd dose for herself & also got the child's 2nd dose that day. The school nurses were not notified that the child received the 2nd dose on 8/11/2021 & the child did not tell them that she had already had her 2nd shot. This resulted in a 3rd dose given to the child on 8/13/2021. The mother of the child did speak to the school nurse after the event and the child did not have any adverse reaction at that time.

Other Meds: Unknown

Current Illness: Unknown

ID: 1582484
Sex: F
Age: 51
State: GA

Vax Date: 04/02/2021
Onset Date: 04/01/2021
Rec V Date: 08/18/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: About 2 weeks after my second dose I began having ear trouble in my left ear. Loss of hearing, ringing, blocked Eustachian tube, etc. I have never before had problems with my ear (s). I made 2 trips to urgent care was given antibiotics and steroid oral and doses by shot. No improvement with meds. Referred to local ENT for ongoing issues and hearing loss with left ear.

Other Meds: None

Current Illness: None

ID: 1582485
Sex: M
Age: 62
State: NY

Vax Date: 08/18/2021
Onset Date: 08/18/2021
Rec V Date: 08/18/2021
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: NKDA

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

Symptoms: No adverse event occurred for the patient. The patient received an initial dose of Moderna COVID vaccination at a local Pharmacy in July and came to Pharmacy for their 2nd dose. The patient stated he delayed receiving the vaccination because he was out of the country. After completing the vaccination the patient approached the vaccination area again to inform me that he had already received the Janssen vaccine back in April. He purposefully did not disclose this information to either pharmacy in order to receive the Moderna vaccination series.

Other Meds: Unknown

Current Illness: None

ID: 1582486
Sex: F
Age: 74
State: NJ

Vax Date: 01/29/2021
Onset Date: 02/26/2021
Rec V Date: 08/18/2021
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: sulfur, codeine

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

Symptoms: burning tongue and loss of taste since second vaccination.

Other Meds: Zetia 1/day , Lisinopril 10 mgs, 2/day Diltiazem ER 180 mgs 1/day Esetimbe 10 mg 1/d multi vitamins 2/day, Lutin, anti cramp, cranberry, fish oil

Current Illness: spinal stenosis followed by Epidural in May 2021

ID: 1582487
Sex: F
Age: 34
State:

Vax Date: 08/16/2021
Onset Date: 08/16/2021
Rec V Date: 08/18/2021
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:

Symptom List: Vomiting

Symptoms: Slight lip swelling noted 5 min after vaccine adm. Doctor informed, rec'd advise to have pt transfer to urgent care. Pt in stable condition, no respiratory distress.

Other Meds:

Current Illness:

ID: 1582488
Sex: F
Age: 41
State: PA

Vax Date: 04/06/2021
Onset Date: 04/13/2021
Rec V Date: 08/18/2021
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: Sulfa meds, eggs, B/W pepper; mild allergies- tomato, wheat/ gluten, rye, baker's and brewer's yeast, safflower oil.

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: High B12 levels, per blood test

Other Meds: Magnesium malate, maca root

Current Illness: None

ID: 1582489
Sex: F
Age: 91
State: CT

Vax Date: 03/20/2021
Onset Date: 03/20/2021
Rec V Date: 08/18/2021
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: None

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

Symptoms: 5 hours after getting the vaccine I had a stroke. 5 hours after the vaccine, she had a stroke, she was taken to the hospital. She was hospitalized for 3 days. She came out with left hand and left foot paralyzed. She could not eat on her own. She had therapy as treatment, 5 days after leaving the hospital we had to take her back again because she was dehydrated and malnourished, because she could not feed herself. Days later they sent her back home by ambulance telling us that there was nothing more to do for her. The hospital was not willing to place a gastric tube on a 91 year old. On May 2nd she was dying at home, so we decided to take her to Hospital, she came in on the verge of going into coma. They restored her with fluids, and she stayed for ten days, while they checked if she was eligible to place a gastric tube. They finally decided she was eligible for the gastric tube, she was discharged the next day. At this time of her life, she depends on a gastric tube, she also suffers from a lot of pain in her left hand and left foot both left hand and foot are weak. She needs 2 people to help her 24 hours per day.

Other Meds: Lisinopril 20 Mg

Current Illness: Pharyngitis

ID: 1582490
Sex: F
Age: 49
State: OH

Vax Date: 08/14/2021
Onset Date: 08/16/2021
Rec V Date: 08/18/2021
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: Pain/Swelling side of Left Breast Pain and Swelling left underarm / pit area Low-Grade fever, no higher then 100.1

Other Meds: Seizure Med Allergy pill Synthroid pill

Current Illness: No

ID: 1582491
Sex: F
Age: 39
State: OK

Vax Date: 08/11/2021
Onset Date: 08/18/2021
Rec V Date: 08/18/2021
Hospital:

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

Lab Data:

Allergies: unknown

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

Symptoms: Patient states that something didn't feel quite right when she received the shot, that her arm felt weird and the shot hurt a lot. She said that her arm stayed warm and she noticed over the next few days that a hard spot was forming where the vaccine was given and has progressively gotten larger and warmer. She believes she has been running a fever off and on, and she has radiating pain across her back down to her kidney area. I was able to palpate a warm hard area on her right arm that was about 1.5 inches in diameter. She states that ibuprofen or aleve help with the pain, but that her cleaning job in environmental services, chores like mopping cause worsening of her symptoms and even cause her arm/shoulder to freeze up.

Other Meds: unknown

Current Illness: none

ID: 1582492
Sex: M
Age: 53
State: NC

Vax Date: 08/18/2021
Onset Date: 08/18/2021
Rec V Date: 08/18/2021
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: Patient presented to pharmacy for second vaccine Pfizer. Patient is a MD. Patient stated he had had first dose only greater than 4 months ago and needed second dose. Patient confirmed on vaccine consent form that he had only received 1 dose of Pfizer. After vaccine was given, pharmacy determined via system profile that patient had in fact already received second dose of Pfizer.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm