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: 1582815
Sex: F
Age:
State: NY

Vax Date:
Onset Date:
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:

Symptom List: Dysphagia, Epiglottitis

Symptoms: 1st dose. When I go the vaccine 5-10 minutes I started with a headache and nausea, they told me to sit down and I felt dizzy. When I got home, I had a severe headache and nausea and I had a high fever and called the doctor who recommended Motrin every 6 hours, the the pain did not go away and I began to vomit with nausea and permanent headache. 2nd dose, after 20 minutes I had a headache and upset stomach when I got home I had a fever and my arm and hand swelled. Then my face swelled and turned red and I had a severe headache, fever lasted 4 days (102). My face got big and red (like a monster) and around the cheekbones I had a rash . I had a lot of itching around the vaccine site. I still feel the itch and feel something under my skin. I still have fever. I'm taking Ibuprofen. The visit with the doctor was virtual.

Other Meds: Multivitamin Centrum - daily

Current Illness:

ID: 1582817
Sex: F
Age: 67
State: PA

Vax Date: 04/05/2021
Onset Date: 08/04/2021
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: Bee Venom Protein (Honey Bee)Hives / Urticaria MethadoneOther (document details in comments), Hypotension CiprofloxacinItching DicyclomineOther (document details in comments) IbuprofenRash NickelRash PenicillinsRash Tetanus Vaccines And ToxoidNausea and Vomiting

Symptom List: Anxiety, Dyspnoea

Symptoms: Cough Shortness of Breath Fatigue Muscle or body aches Headache Sore throat Congestion or running nose Registered Nurse Specialty: Oncology Progress Notes Signed Encounter Date: 8/11/2021 Patient here for Regeneron infusion. Patient tolerated infusion well and was monitored for 1 hour post. Upon discharge, patient was provided a pulse ox, thermometer, after visit summary and follow up instructions. No adverse events noted during this visit.

Other Meds: ALBUTEROL SULFATE INHL atorvastatin (LIPITOR) 40 mg tablet carvediloL (COREG) 3.125 mg tablet cholecalciferol, vitamin D3, 25 mcg (1,000 unit) capsule cyclobenzaprine (FLEXERIL) 10 mg tablet diphenhydrAMINE (BENADRYL) 25 mg tablet DULoxetin

Current Illness:

ID: 1582818
Sex: M
Age: 80
State:

Vax Date: 03/13/2021
Onset Date: 08/16/2021
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: This is a 81-year-old male with no significant past medical history. Does not take any medications at home. Patient is extremely hard to hear and poor historian as well. He reported that he came to the hospital with a chief complaint of progressive worsening generalized weakness for about 7-10 days. He reports that he is also having some worsening shortness of breath especially on exertion during this time. Vaccine date: 03/13/2021 Hospitalization date: 08/16/2021

Other Meds:

Current Illness:

ID: 1582819
Sex: M
Age: 86
State: NC

Vax Date: 03/25/2021
Onset Date: 04/07/2021
Rec V Date: 08/18/2021
Hospital: Y

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

Lab Data:

Allergies: Keflex antibiotic

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: I received a stroke on the morning of April 7, 2021 , 13 days after my second vaccine shot on March 25.

Other Meds: Lipitor, Proscar, daily multivitamins

Current Illness:

ID: 1582820
Sex: F
Age: 45
State: NJ

Vax Date: 07/13/2021
Onset Date: 07/14/2021
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: Latex, Peanuts, Tree Nuts

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

Symptoms: Right arm pain, Fatigue, Body Aches, My Rheumatoid Arthritis Symptoms which had been in remission started again: Terrible Weakness and Pain in both hands and arms, difficulty raising arms over head, joint pain all over body, swollen joints especially knuckles in hands, unable to grip with hands, leg pain, knee joint/ankle pain, increased back and neck pain - Pain symptoms worse in the morning w extreme fatigue in mid afternoon and evening. After a few weeks I went and got Prednisone from doctor, this helped alleviate some of the pain and symptoms. Still having pain - not back to where I was before I got the 1st Moderna Shot on July 13, 2021

Other Meds: Tylenol

Current Illness: None

ID: 1582821
Sex: F
Age: 58
State: GA

Vax Date: 04/27/2021
Onset Date: 04/28/2021
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: Swelling and Redness at injection site, headache, fatigue

Other Meds:

Current Illness:

ID: 1582822
Sex: F
Age: 71
State: OH

Vax Date: 07/07/2021
Onset Date: 07/15/2021
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: Percocet

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: coughing, diminished but still present Increase/spiking blood pressure, somewhat controlled now

Other Meds: Valsartin, Avastostatin, Coreg, Multiple Vitamin for women over 50,

Current Illness: none

ID: 1582823
Sex: F
Age: 56
State: CO

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

Lab Data:

Allergies: Wasp, deer flies, sulfa, codeine, iodine, benadryl and many others

Symptom List: Pharyngeal swelling

Symptoms: Was dizzy that evening after injection. Very fatigued next morning and still fatigued and sore at injection site. These side effects are not bad, just thought I should report. I was very nervous about getting this shot due to my sensitivity to medicines and other allergies, so these side effects are better than I was expecting.

Other Meds: Keppra, fluoxetine, armodafinil

Current Illness:

ID: 1582824
Sex: F
Age: 53
State: PA

Vax Date: 04/09/2021
Onset Date: 07/29/2021
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: Iodinated Contrast Media

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Chief Complaint Patient presents with ? Cough seen at pcp about 1 week - diagnosed with sinus infection. given amoxicillin. sxs not getting any better since. ? Fatigue ? Nasal Congestion

Other Meds: aspirin 81 mg tablet atorvastatin (LIPITOR) 20 mg tablet calcitriol (ROCALTROL) 0.25 mcg capsule cholecalciferol, vitamin D3, 1,000 unit tablet magnesium oxide (MAG-OX) 400 mg tablet mycophenolate sodium (MYFORTIC) 180 mg EC tablet omeprazo

Current Illness:

ID: 1582825
Sex: F
Age: 59
State: KY

Vax Date: 06/11/2021
Onset Date: 08/14/2021
Rec V Date: 08/18/2021
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: None

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Contracted COVID-19 on 08/14/2021

Other Meds: Blood Pressure Medication - Name unknown

Current Illness: None

ID: 1582826
Sex: F
Age: 50
State: SC

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: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: NKA

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

Symptoms: Severe headache, heart palpitations, Nausea, Vomiting, fever 104.2, joint pain, kidney issues, fatigue

Other Meds: Prilosec Citalopram Topamax

Current Illness: None

ID: 1582827
Sex: F
Age: 47
State: NJ

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Heart palpitations.

Other Meds: Sumatriptan; Lorazepam; Vitamins

Current Illness:

ID: 1582828
Sex: F
Age: 23
State: TN

Vax Date: 06/08/2021
Onset Date: 06/12/2021
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: potentially Amoxicillin

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

Symptoms: About 4 days after both doses of the vaccine, experiences 4-5 times a day of heart flutters, shooting pains in chest, chest tightness. Ongoing after 3 months. Had to go to urgent care and was referred to cardiology - ongoing testing occurring.

Other Meds: vitamin c, zinc, vitamin d, multi-vitamin

Current Illness: no

ID: 1582830
Sex: M
Age: 43
State: PA

Vax Date: 08/17/2021
Onset Date: 08/17/2021
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: nka

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

Symptoms: patient states the technician immunizing was removing the needle as injecting and gave the shot into the sq instead of in the muscle.

Other Meds: Enbrel, lexapro, xanax, crestor, losartan , pantoprazole and ibuprofen

Current Illness: no illness

ID: 1582831
Sex: F
Age: 43
State: CT

Vax Date: 08/16/2021
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: Pineapple, mango, salt on salted nyts

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

Symptoms: Itchy red blob on vaccine site

Other Meds: Ocrevus, vitamin d, b12, c, iron, & magn3sium

Current Illness: Na

ID: 1582832
Sex: F
Age: 36
State: FL

Vax Date: 08/06/2021
Onset Date: 08/18/2021
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: Lactose intolerant, latex allergy, seasonal allergies

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

Symptoms: Rash on left arm where shot was given but expanding beyond it. Rash red with a slightly dark red outlining the outside of the rash. Hot to the touch, slight itching but more of a burning sensation. Itching/burning sensation being mild.

Other Meds: Ibuprofen / daily multivitamin

Current Illness: N/A

ID: 1582833
Sex: M
Age: 23
State: IL

Vax Date: 04/15/2021
Onset Date: 04/23/2021
Rec V Date: 08/18/2021
Hospital: Y

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: Experienced mild chest pain and elevated heart rate in the days following the second vaccine dose. Also experienced discomfort in the heart when lying down. Received medical attention from ER department and was found to have heightened troponin levels and irregular EKG readings. Was given potassium pills to help support healthy blood flow and was prescribed a "healthy" low sodium diet during my time there. Discharged after 3 days of testing and was diagnosed with an enlarged heart and mild hypertension. During a follow-up visit with the cardiologist, he informed that symptoms aligned very well with those of pericarditis and believed that I may have experienced an overactive immune response to my second vaccine dose.

Other Meds:

Current Illness:

ID: 1582834
Sex: M
Age: 75
State: MD

Vax Date: 02/17/2021
Onset Date: 04/01/2021
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: n/a

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Grover's disease, and atopic exzema

Other Meds: 1 librium, advair, bentyl, sucralfate 2. vitamins

Current Illness: n/a

ID: 1582835
Sex: F
Age: 45
State: FL

Vax Date: 05/26/2021
Onset Date: 06/02/2021
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: I get hives from doxylamine succinate. I have food sensitivities/allergies to gluten (severe inflammation) and dairy (IBS).

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Nerve demyelination, Optic neuritis, disk edema, visual loss in both eyes, pain. Treatment ongoing through ophthalmologist and neuro ophthalmologist. It have been nearly 3 months. I still have yet to return to normal vision. Optic neuritis and disk edema still present. And as an added fun fact, I failed a work physical which led me to not having a job. Eyesight apparently is rather important is critical safety roles.

Other Meds: durezol eye drops, zinc, vitamins C D and B12, DHA, Melatonin

Current Illness: Uveitis/Iritis onset beginning of May 2021, treatment began 5/5/21 with Durazol. Literally left the eye doctor to go to vaccine site. All symptoms had resolved.

ID: 1582836
Sex: F
Age: 69
State: MA

Vax Date: 03/15/2021
Onset Date: 04/01/2021
Rec V Date: 08/18/2021
Hospital:

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

Lab Data:

Allergies: Levaquin, Sulfa, Antibiotics, Bactrim

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

Symptoms: Diarrhea with multi bowl movements several time a day, nausea, bloating, and headaches. Went to Urgent Care and ER. Diagnosed with Gastroenteritis. Later tests reveled low enzyme levels. Diagnosed with Pancreatic Insufficiency. Now taking medicine for the low enzymes. Enzyme levels at 15, normal enzyme level are near 200.

Other Meds: Efsexor XR, Wellbuprin, Singulair

Current Illness: None

ID: 1582837
Sex: F
Age: 63
State: TX

Vax Date: 05/20/2021
Onset Date: 05/20/2021
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, Naproxen

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

Symptoms: Injection was given in wrong place. It was Subcutaneous not Intramuscular. A large knot with red circle size of half dollar came up within 12 hours of injection and lasted almost 3 weeks. It was very painful to touch. Blood vessels in right eye burst and I was slightly nauseous. Nausea subsided after 2 hours. Eye returned to normal after 5 days. Knot remained for about 3 weeks but when it was gone it left an indention in my arm. Indention has been there for 3 months now.

Other Meds: None

Current Illness: None

ID: 1582838
Sex: M
Age: 22
State: TN

Vax Date: 08/17/2021
Onset Date: 08/17/2021
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: Unevaluable event

Symptoms: Headache, chills, sweating, nausea, dizziness, swollen throat, congestion, cough beginning around 9 hours after receiving the vaccine.

Other Meds:

Current Illness:

ID: 1582839
Sex: F
Age: 78
State: MD

Vax Date: 02/10/2021
Onset Date: 04/15/2021
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:

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

Symptoms: The joint in my hip was very sore. I woke up with it like that. As I tried to walk on it, the pain got really bad to the point that I couldn't step on it. I went to my PCP and we tried Tylenol (1000mg) morning and evening. That did not seem to help. Since the Tylenol wasn't working, they told me to try Voltaren. It was a topical cream that I applied 4 times a day. Eventually, I was able to walk again. I started with a cane. Now I am walking un-aided while using the cream on my hip. It is an anti-inflammatory. We have been calling it arthritis. It may just be age related. I do feel like it's important to report this just in case.

Other Meds: Amlodipine/Benazepril - 10/20mg / 1xday; Hydrochlorizide - 25mg/1xday; Pravastatin - 40mg/1xday; Aspirin - 81mg/1xday; Calcium with D3 - 600mg/1xday; Multivitamin - 1xday/Centrum Silver; Vitamin C - 1000mg/1xday; Vitamin D3 - 1000iu/1xday

Current Illness:

ID: 1582840
Sex: F
Age: 27
State: SC

Vax Date: 08/02/2021
Onset Date: 08/02/2021
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: Macrobid Morphine Thiuram Mix Gluten Dairy Eggs Gold

Symptom List: Injection site pain, Pain

Symptoms: 1. Extreme worsening of Narcolepsy symptoms - severely fatigued, excessive day-time sleepiness, very frequent cataplexy, hallucinations, night terrors, sleep paralysis 2. Breakthrough blood clots between menstrual cycle

Other Meds: Armodafinil 250mg Bupropion 150mg Zyrtec

Current Illness: None

ID: 1582841
Sex: F
Age: 43
State: MA

Vax Date: 08/03/2021
Onset Date: 08/05/2021
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: penicillin

Symptom List: Injection site pain, Menorrhagia

Symptoms: Started in left arm shooting pain, to the point where she couldn't pick up arm, then moved into neck. Pain kept traveling up to jaw, under eye and above left eye, including ear. Pain sometimes goes to back. Pt thought she was having a stroke and could barely talk. Pt went to ER on 8/12, all labs came back perfect. Was treated for muscles being inflammed, pt is recommeded to follow up with PCP, pt is to be treated with steroids.

Other Meds: none

Current Illness: covid in March 2021

ID: 1582842
Sex: F
Age: 53
State: GA

Vax Date: 04/28/2021
Onset Date: 05/30/2021
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: Percocet

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

Symptoms: One month after the second dose of Moderna, meat began tasting rotten. It steadily became worse where nearly all meat, corn, and onions taste and smell extremely rotten. Chicken and ham occasionally taste bad. I have seen my primary care physician who ran blood work to rule out vitamin D deficiency. I am now seeing an ENT who has prescribed three different nose sprays, plus a round of prednisone. Nose sprays are - saline spray (over the counter), XHance, and Azelastine. I finished the prednisone and am still using the nose sprays (one week now).

Other Meds: Levothyroxin; multi-vitamin; vitamin c; calcium

Current Illness: None

ID: 1582843
Sex: F
Age: 81
State: PA

Vax Date: 03/26/2021
Onset Date: 03/29/2021
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: no allergies

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Imbalance sensations that were mild with first shot. After 2nd shot, developed severe headaches, imbalance sensation worsened, fatigued/tiredness, voice hoarseness, and numbness on arm.

Other Meds: Pravastatin

Current Illness: none

ID: 1582844
Sex: F
Age: 12
State: AZ

Vax Date: 08/16/2021
Onset Date: 08/17/2021
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: none

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: febrile, short of breath, taken to local ER. Treated and released.

Other Meds: Cetirizine

Current Illness: none

ID: 1582845
Sex: F
Age: 79
State: MO

Vax Date: 08/16/2021
Onset Date: 08/16/2021
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: Patient described severe myalgia all over - especially in feet and legs. She said she has been stuck in bed since the afternoon of the day of vaccination. She is just now feeling up to ambulating.

Other Meds:

Current Illness:

ID: 1582846
Sex: M
Age: 59
State: MI

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

Lab Data:

Allergies: no allergies

Symptom List: Nausea

Symptoms: Staff member gave patient pfizer vaccine without diluting it. Patient waited 30 minutes and had no adverse reaction.

Other Meds: norvasc, promethazine, prilosec, prozac, zofran, imdur, metformin, gabapentin, lisinopril, crestor, and lantus

Current Illness: NA

Date Died: 08/17/2021

ID: 1582847
Sex: M
Age: 58
State: IA

Vax Date: 07/31/2021
Onset Date: 08/04/2021
Rec V Date: 08/18/2021
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: NKA

Symptom List: Injection site pain

Symptoms: Patient was a 58 year old patient. He had ESRD on HD MWF. He had previously been hospitalized 8/4/21 - 8/5/21 - diagnosed with Covid 19 during this stay - stabilized and was able to be discharged home. He deteriorated at home and was brought back to the ED via EMS 8/6/21 with ARDS secondary to Covid - 19. He was intubated and remained for the duration of his stay in the ICU. He had two code incidents 8/16/21 and 8/17/21. Upon the 3rd Code, they were unable to revive him and upon discussion with family - decision made to stop CPR and patient expired.

Other Meds: albuterol (PROVENTIL) (2.5 MG/3ML) 0.083% nebulizer solution 75 mL 3 5/23/2019 Sig: Take 3 mLs by nebulization every 4 (four) hours as needed for Wheezing. Route: Nebulization PRN Reason(s): Wheezing aspirin low dose (ASPIRIN)

Current Illness: None

ID: 1582848
Sex: F
Age: 43
State: KY

Vax Date: 08/08/2021
Onset Date: 08/09/2021
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: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Left neck pain, blood clot, arm swelling.

Other Meds: Vitamin D

Current Illness: No

ID: 1582849
Sex: F
Age: 52
State: MA

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Allergic mucositis to certain dog hair types. Seasonal allergies

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

Symptoms: In April I went to the doctor for my vertigo, and they found a blood clot in my neck in the right vain.

Other Meds: Amlodipine; Synthroid; Turmeric; Riboflavin; Magnesium; Vitamin D; Melatonin; Loratidine

Current Illness: no

Date Died: 08/12/2021

ID: 1582850
Sex: F
Age: 92
State: MS

Vax Date: 08/11/2021
Onset Date: 08/12/2021
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: Tremor

Symptoms: 8/12/21 @ 03:37 AM - PT NOTED TO HAVE EMESIS ON SHEETS AND GOWN. RESPONSIVE, VITALS STABLE, MD AND FAMILY NOTIFIED, ZOFRAN ORDERED AND GIVEN. NO DISTRESS NOTED. 8/12/21 @ 09:55 AM - PT NOTED TO BE EATING BREAKFAST. NO DISTRESS NOTED. 8/12/21 @ 8:50 PM - VOMITING, NON-RESPONSIVE, RESPIRATORY DISTRESS. 02 SATS 48-50%. AMBULANCE CALLED, PT TAKEN TO ER. 8/12/21 @ 8:58 PM - FACILITY NOTIFIED THAT RESIDENT EXPIRED.

Other Meds: ASA ATIVAN LORAZEPAM SEROQUEL ZOLOFT LASIX TRAZODONE LOPRESSOR VITANMIN D NAMENDA DIGOXIN

Current Illness: UTI ALZHEIMERS CELLULITIS ATRIAL FIB SICK SINUS SYNDROME ANXIETY MAJOR DEPRESSIVE D/O PSYCHOTIC D/O WITH DELUSIONS HTN RESTLESSNESS/AGITATION CONSTIPATION

ID: 1582851
Sex: M
Age: 52
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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Denies

Symptom List: Erythema, Pruritus

Symptoms: Individual misrepresented vaccination status to staff in order to receive third dose of Pfizer prior to CDC recommendation for booster.

Other Meds: Unknown

Current Illness: Denies

ID: 1582852
Sex: F
Age: 66
State: NY

Vax Date: 01/24/2021
Onset Date: 01/24/2021
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: penicillin, sulfa

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

Symptoms: after shot sat for 30mins and was fine and 10 later her neck was red and hot and her was covered in welts. she was taken to the ER and she couldn't breathe and was given the epipen

Other Meds: no

Current Illness: no

ID: 1582853
Sex: F
Age: 63
State: CT

Vax Date: 02/19/2021
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: NKA

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

Symptoms: Resident had vaccine prior to arrival at assisted living.

Other Meds: unknown, did not reside here then

Current Illness: unknown, did not reside here then

ID: 1582854
Sex: F
Age: 48
State: TX

Vax Date: 02/10/2021
Onset Date: 05/01/2021
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: Asthenia, Chills, Headache, Myalgia

Symptoms: I started to feel exhausted, fatigue and a fever of 99 then rose to 100. By the third day I had real bad diarrhea. About a week into feeling these symptoms I started a Z-pac. I loss my appetite and nauseated from eating for about 2 weeks.

Other Meds: Ambien; Ibuprofen

Current Illness:

ID: 1582855
Sex: F
Age: 36
State: OH

Vax Date: 08/05/2021
Onset Date: 08/11/2021
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: None

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

Symptoms: On the 5th-6th day I became incredibly fatigued. Noticed that my neck was swollen and sore. I am a nurse practitioner, therefore palpated my neck, and noted very large supraclavicular lymph node present., multiple. This was on the right side, the same side I had my shot. The next day however another supraclavicular lymph node appeared on the left side as well. Fatigue was extreme for three days.

Other Meds: Multi-vitamin

Current Illness: None

ID: 1582856
Sex: F
Age: 34
State: GA

Vax Date: 04/12/2021
Onset Date: 04/25/2021
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:

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

Symptoms: 2 days of right upper arm pain and swelling at injection site

Other Meds:

Current Illness:

ID: 1582857
Sex: F
Age: 57
State: AL

Vax Date: 05/21/2021
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: yes.

Symptom List: Pain in extremity

Symptoms: Shingles

Other Meds: compounded t3 t4 compounded hormone cream xanax

Current Illness: chronic fatigue syndrome

ID: 1582858
Sex: F
Age: 35
State: MS

Vax Date: 08/13/2021
Onset Date: 08/14/2021
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: Double vision looking upward. Double vision in R eye looking upward to the left

Other Meds: Plaquenil, methotrexate, folic acid, b12, iron, trazodone, Celebrex, flexeril

Current Illness: UTI

ID: 1582860
Sex: M
Age: 17
State: WA

Vax Date: 03/18/2021
Onset Date: 08/17/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: Patient was given Moderna on 3/18/2021 and his booster on 4/12/2021- patient was not 18 at time of vaccine administration.

Other Meds:

Current Illness:

ID: 1582861
Sex: M
Age: 73
State: NE

Vax Date: 03/17/2021
Onset Date: 03/26/2021
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: aspirin

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

Symptoms: rash and welts on rt deltoid

Other Meds: atorvastatin, vit d, avapro, lopressor, omeprazole, rapamune, prodof, ventolin,

Current Illness:

ID: 1582863
Sex: F
Age: 32
State: IA

Vax Date: 04/28/2021
Onset Date: 08/18/2021
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: Erythromycin, Mefoxin, Demerol

Symptom List: Vomiting

Symptoms: Breakthrough Covid infection. Patient received Pfizer vaccine on April 28th and May 17th, and presented with active COVID infection 8/18/2021. Symptoms first started 8/16/2021 with headache, cough, nasal congestion, bodyaches, shortness of breath. Respiratory panel positive for SARS-CoV-2 PCR.

Other Meds: Aristada

Current Illness: None

ID: 1582864
Sex: F
Age: 41
State: MA

Vax Date: 08/05/2021
Onset Date: 08/13/2021
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: Lobster

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Day #1 headache, numbness to face and injection site. Chills 1hr after injection. Day 2-5 posterior occipital headache, day 7 rash to injection site worsening, day 15 rash, red, raised hard, itchy, bulls eye in appearance.

Other Meds: Zyrtec daily, flonase, Apri birth control

Current Illness:

ID: 1582865
Sex: M
Age: 64
State: GA

Vax Date: 08/14/2021
Onset Date: 08/15/2021
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: none

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

Symptoms: Lymph nodes in left arm swollen

Other Meds: none

Current Illness: none

ID: 1582866
Sex: M
Age: 51
State: MI

Vax Date: 01/15/2021
Onset Date: 08/16/2021
Rec V Date: 08/18/2021
Hospital: Y

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: Patient was fully vaccinated. Patient has now been hospitalized on 8/16 with C19+ diagnosis. Presented with upper respiratory symptoms of distress.

Other Meds: Unknown

Current Illness: Unknown

ID: 1582867
Sex: F
Age: 47
State: SC

Vax Date: 04/13/2021
Onset Date: 04/16/2021
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:

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

Symptoms: Palpitations, Site Redness, Slight Blood Pressure Elevation

Other Meds:

Current Illness:

ID: 1582868
Sex: F
Age: 35
State: IN

Vax Date: 08/16/2021
Onset Date: 08/17/2021
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: Vitamin B12

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

Symptoms: urticaria, muscle pain in the middle of chest and arm.

Other Meds: Magnesium, Vitamin D3 and Zinc

Current Illness: General anxiety, back pain, gastritis

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm