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: 1590919
Sex: F
Age: 65
State: OH

Vax Date: 07/09/2021
Onset Date: 07/20/2021
Rec V Date: 08/20/2021
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: Dysesthesia; numbness in feet; Severe foot pain in both feet/ both feet started aching and the severity increased/both my feet became extremely painful; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (Severe foot pain in both feet/ both feet started aching and the severity increased/both my feet became extremely painful), DYSAESTHESIA (Dysesthesia) and HYPOAESTHESIA (numbness in feet) in a 65-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 033C21A) for COVID-19 vaccination. Family history included Peripheral neuropathy (Patient had hereditary peripheral neuropathy. Has worsened over past 5 years) since 2000. Concurrent medical conditions included Drug allergy (allergy to sulpha). Concomitant products included ROSUVASTATIN from 13-Apr-2021 to an unknown date for High cholesterol, ESTRADIOL from 13-Apr-2021 to an unknown date for Hormone replacement therapy, MAGNESIUM CITRATE, CYANOCOBALAMIN (B 12) and MENTHOL (SUPER LYSINE+) for Supplementation therapy. On 09-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) .5 milliliter once. On 20-Jul-2021, the patient experienced PAIN IN EXTREMITY (Severe foot pain in both feet/ both feet started aching and the severity increased/both my feet became extremely painful). 20-Jul-2021, the patient experienced HYPOAESTHESIA (numbness in feet). On 23-Jul-2021, the patient experienced DYSAESTHESIA (Dysesthesia). The patient was treated with PARACETAMOL (TYLENOL) for Foot pain, at a dose of 1 dosage form and GABAPENTIN (oral) for Dysesthesia, at a dose of 100 milligram three times a day. On 23-Jul-2021, PAIN IN EXTREMITY (Severe foot pain in both feet/ both feet started aching and the severity increased/both my feet became extremely painful) and HYPOAESTHESIA (numbness in feet) had resolved with sequelae. At the time of the report, DYSAESTHESIA (Dysesthesia) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. On 20-Jul-2021, It was stated that both feet became extremely painful from 10 am to 5 pm, next day same thing, only pain much wrose lasted from 10 am to 6 pm. On 22-Jul-2021, again pain came in the morning and lasted until 6pm. Took Tylenol to help with aching feet. Pain was severe On 23-Jul-2021, Patient went to neurologist he describe it as dysaesthesia and prescribed with gabapectin 100 mg tid by oral route, at that point patient had only taken one gabapectin and the foot pain was over by 23-Jul-2021 of most pain. The patient had been left with more numbness in feet as such. Most recent FOLLOW-UP information incorporated above includes: On 21-Jul-2021: Follow up received and contain Non significant information. On 09-Aug-2021: Significant follow-up information included race, ethnicity, medical history, concomitant and treatment medication were added, outcome of the event pain in extremity was updated and new events were added.

Other Meds: ROSUVASTATIN; ESTRADIOL; MAGNESIUM CITRATE; B 12; SUPER LYSINE+

Current Illness: Drug allergy (allergy to sulpha); Peripheral neuropathy (Patient had hereditary peripheral neuropathy. Has worsened over past 5 years)

ID: 1590932
Sex: M
Age: 17
State: MA

Vax Date: 08/17/2021
Onset Date: 08/17/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Shakiness-Medium

Other Meds:

Current Illness:

ID: 1590933
Sex: F
Age: 39
State: TN

Vax Date: 04/26/2021
Onset Date: 05/01/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Constant leg pain/cramps in night or early morning. Mostly calf pain in both legs.

Other Meds: CBD OIL

Current Illness:

ID: 1590934
Sex: F
Age: 43
State: PA

Vax Date: 08/06/2021
Onset Date: 08/17/2021
Rec V Date: 08/20/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Systemic: Allergic: Itch (specify: facial area, extremeties)-Severe

Other Meds:

Current Illness:

ID: 1590935
Sex: M
Age: 69
State: OH

Vax Date: 05/26/2021
Onset Date: 06/04/2021
Rec V Date: 08/20/2021
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 erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: I started having light headedness and dizzyness around the 4th of June, As of to day (August 20,20210 I am still having these adverse effects. I was put on Predisone for 12 days 10 mgs 66,55,44,33,22,11 All I have heard is that these events just take time to leave the body. There are days when the dizzyness is dibilitating. Please help me

Other Meds: none

Current Illness: none

ID: 1590936
Sex: F
Age: 32
State: IL

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 08/20/2021
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: Systemic: tingling of tongue and dry mouth-Medium, Systemic: Tingling (specify: facial area, extemities)-Mild, Additional Details: tingling of tongue dry patch in mouth

Other Meds:

Current Illness:

ID: 1590937
Sex: M
Age: 29
State: VT

Vax Date: 05/01/2021
Onset Date: 08/18/2021
Rec V Date: 08/20/2021
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: Cecile (rash as infant).

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: I have been experiencing symptoms of myocarditis or pericarditis?a feeling that my heart is fluttering, flushed, or murmuring and a general chest feeling of calm fatigue. I have never experienced these before. My partner and I have both been experiencing symptoms of some immune response to an infection or virus. Both of us have been experiencing: runny nose, some sinus pressure, mild sneezing, and sore throat. But I believe neither of us has experience fever or coughing. She is experiencing none of the chest/heart symptoms, only I am. Is it possible that I am related to other cases tying COVID-19 mRna vaccines in young men to heart inflammation? I am otherwise a very healthy individual. BMI is around 22.4. Diet vegetarian. Moderate/low sugar and salt intake.

Other Meds: Magnesium; Fish Oil; and Vitamin D supplements.

Current Illness: None.

ID: 1590938
Sex: M
Age: 33
State: DC

Vax Date: 07/19/2021
Onset Date: 07/21/2021
Rec V Date: 08/20/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Pharyngeal swelling

Symptoms: Heart flutter starting day after vaccination at 11am and ending 3 days after vaccination. Flutter was intermittent and would begin early in the day, usually morning. I did not seek medical attention.

Other Meds: None, multivitamin

Current Illness: None

ID: 1590939
Sex: M
Age: 27
State: GA

Vax Date: 08/17/2021
Onset Date: 08/17/2021
Rec V Date: 08/20/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Systemic: Fainting / Unresponsive-Mild, Systemic: Hypotension-Medium, Additional Details: Patient experienced syncope and fell face down onto the floor at the rx dept area. After vaccinating, i advised patient to have a seat on the chair for 15 minutes, but after 5 minutes, patient stood up and moved to the pick up line in the rx dept. and at that time, he fell face down onto the floor. I had him to ly down with both legs elevated for 30 minutes and he was back to nor mal. I asked and he stated he didn't have any cut on the lips or any broken teeth. patient is on Chlotharlidone 25mg

Other Meds:

Current Illness:

ID: 1590940
Sex: M
Age: 23
State: NJ

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

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

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Error: Booster Given Too Early-

Other Meds:

Current Illness:

ID: 1590941
Sex: F
Age: 12
State: MN

Vax Date: 08/18/2021
Onset Date: 08/18/2021
Rec V Date: 08/20/2021
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: Site: Bruising at Injection Site-Mild, Site: Itching at Injection Site-Mild, Site: Pain at Injection Site-Mild, Site: Redness at Injection Site-Mild, Site: Swelling at Injection Site-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Hypotension-Mild

Other Meds:

Current Illness:

ID: 1590942
Sex: F
Age: 37
State: AZ

Vax Date: 12/22/2020
Onset Date: 01/01/2021
Rec V Date: 08/20/2021
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: Hydrocodone, latex

Symptom List: Rash, Urticaria

Symptoms: Irregular menstrual cycle, miscarriage

Other Meds: Compounded thyroid medication

Current Illness:

ID: 1590943
Sex: F
Age: 29
State: LA

Vax Date: 08/03/2021
Onset Date: 08/09/2021
Rec V Date: 08/20/2021
Hospital:

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

Lab Data:

Allergies: Amoxicillin and shrimp

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

Symptoms: Started with major fatigue and muscle aches. Two days later I started running a fever with random mild headaches. I then started having facial congestion and a sore throat, and developed a cough and feeling of aches in the chest. I tested for COVID and was negative. On August 14 I lost my taste (I had not completely gained my taste after being sick last year) As of today (August 20) I am still having a fever, one of my tonsils is swollen, I am still congested, and am still experiencing fatigue and muscle aches, along with a cough and a sore chest. I have been tested for COVID three times and every time was negative.

Other Meds: Wellbutrin, lamictal, multivitamin,

Current Illness: None

ID: 1590944
Sex: M
Age: 36
State: CT

Vax Date: 08/12/2021
Onset Date: 08/12/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Error: Booster Given Too Early.

Other Meds:

Current Illness:

ID: 1590945
Sex: F
Age: 47
State: MD

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 08/20/2021
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: Systemic: Allergic: Difficulty Breathing-Mild, Systemic: Visual Changes/Disturbances-Mild, Systemic: Weakness-Mild

Other Meds:

Current Illness:

ID: 1590946
Sex: F
Age: 37
State: AZ

Vax Date: 01/12/2021
Onset Date: 01/01/2021
Rec V Date: 08/20/2021
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: Hydrocodone, latex

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

Symptoms: Irregular menstrual cycles, miscarriage

Other Meds: Compounded thyroid medication

Current Illness:

ID: 1590947
Sex: F
Age: 57
State: FL

Vax Date: 07/27/2021
Onset Date: 07/28/2021
Rec V Date: 08/20/2021
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: Site: Pain at Injection Site-Mild, Systemic: chest pain-Severe, Systemic: Tingling (specify: facial area, extemities)-Medium, Additional Details: Patient states after shot she had pain in her chest and pain

Other Meds:

Current Illness:

ID: 1590948
Sex: M
Age: 61
State: RI

Vax Date: 03/01/2021
Onset Date: 04/15/2021
Rec V Date: 08/20/2021
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: Tinnitus

Other Meds: Simistatin .5 mg

Current Illness: N/a

ID: 1590949
Sex: F
Age: 27
State: OH

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 08/20/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1590950
Sex: F
Age: 15
State: FL

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

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

Lab Data:

Allergies: none per mother

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

Symptoms: Complaint of dizziness. Skin noted warm and clammy to touch. Onsite emergency response team notified at 3:40 pm. Alert, oriented and responsive to all stimuli. Emergency team arrived at 3:43 pm. Vital signs: pulse 61, O2Sat 97% on room air and blood sugar 113. 3:50 pm Vital signs: 94/58, pulse 62 and O2Sat 98% on room air. 3:56 pm transferred to ambulance via stretcher for transport to for medical evaluation. Client accompanied by her mother, . When transfer from observation, client was alert, oriented and communicating with emergency team. Transferred at 3:56 pm.

Other Meds: none per mother

Current Illness: none per mother

ID: 1590951
Sex: F
Age: 45
State: NC

Vax Date: 02/22/2021
Onset Date: 03/01/2021
Rec V Date: 08/20/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: None stated.

Other Meds:

Current Illness:

ID: 1590952
Sex: M
Age: 45
State: NY

Vax Date: 07/04/2021
Onset Date: 07/11/2021
Rec V Date: 08/20/2021
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: Systemic: Pt developed (2) 1cm bumps on left elbow 1 week after 1st shot. Developed small 1cm lump on left should after 2nd dose-Medium, Additional Details: Pt developed (2) 1cm bumps on left elbow 1 week after 1st shot in left arm. Developed small 1cm lump on left should after 2nd dose shot in left arm.

Other Meds:

Current Illness:

ID: 1590953
Sex: M
Age: 30
State: IN

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 08/20/2021
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: Systemic: Fainting / Unresponsive-Severe, Additional Details: After receiving vaccination during the waiting period, the patient got up to walk down the aisle and started feeling faint. He sat down then fainted. Pharmacist rushed to him. He was alert and oriented. Pulse was strong. He was alerted to the date, his name, and location. Clinic nurse came and evaluated. We called an ambulance to be careful. His bp at that time was 100/58. He continued to be monitored by EMT on arrivial. He did indicate he has passed out after vaccination in the past

Other Meds:

Current Illness:

ID: 1590954
Sex: M
Age: 14
State: PA

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 08/20/2021
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: Systemic: he said his chest felt hot but no pain or issues with his heart-Mild, Additional Details: The hotness in his chest was there, and then it wasn't, then came back again. I told his mom to keep an eye on him and make sure it didn't get worse and if his heart started to be affected to get him to the dr. I took his temperature and it was the same as before I gave the shot. The hotness started a few minutes after receiving the shot. Still felt a bit hot he said before they left the store.

Other Meds:

Current Illness:

ID: 1590955
Sex: M
Age: 46
State: LA

Vax Date: 07/28/2021
Onset Date: 07/29/2021
Rec V Date: 08/20/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Injection site pain, Menorrhagia

Symptoms: Joint and body aches 36 hours after injection. Lasting 18 hours.

Other Meds: none

Current Illness: none

ID: 1590956
Sex: M
Age: 25
State: OK

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 08/20/2021
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: Systemic: Fainting / Unresponsive-Mild, Additional Details: Pt moved to chair after vaccination and fell forward about 10 minutes after his shot, hit his head on the floor and cut his forehead. paramedics came and evaluated him and he decided to go home rather than seek medical care.

Other Meds:

Current Illness:

ID: 1590957
Sex: F
Age: 19
State: MI

Vax Date: 08/03/2021
Onset Date: 08/03/2021
Rec V Date: 08/20/2021
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: Systemic: Abdominal Pain-Medium, Systemic: Fever-Medium, Systemic: Headache-Severe, Systemic: Nausea-Severe

Other Meds:

Current Illness:

ID: 1590958
Sex: M
Age: 75
State: KY

Vax Date: 04/01/2021
Onset Date: 08/12/2021
Rec V Date: 08/20/2021
Hospital:

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

Lab Data:

Allergies: Unknown

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Upon Disease Investigation 8/19/21 - case reported symptom onset of 8/12/21 which included fever, runny nose, headache, fatigue, cough and nausea.

Other Meds: Unknown

Current Illness: Unknown

ID: 1590959
Sex: F
Age: 41
State: VA

Vax Date: 08/18/2021
Onset Date: 08/18/2021
Rec V Date: 08/20/2021
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: Headache, hot flashes, aching body, chest pain, flu like, leg cramps,

Other Meds: Celexa and amitriptyline

Current Illness:

ID: 1590960
Sex: M
Age: 68
State: IL

Vax Date: 03/31/2021
Onset Date: 08/11/2021
Rec V Date: 08/20/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: Hospital admission 7 days after symptom onset. Patient-reported symptoms include weakness, poor appetite, body aches, fever, cough, shortness of breath.

Other Meds:

Current Illness:

ID: 1590961
Sex: F
Age: 53
State: PA

Vax Date: 08/16/2021
Onset Date: 08/18/2021
Rec V Date: 08/20/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Site: Itching at Injection Site-Mild, Site: Pain at Injection Site-Mild, Site: Redness at Injection Site-Mild, Site: Swelling at Injection Site-Mild, Additional Details: Patient presented at pharmacy 8/19/21 after receiving 2nd dose Pfizer Vaccine on 8/16/21. Patient stated she experienced expected side effects up to 24 hours after vaccination (discomfort at injection site, fatigue, body ache.) and symptoms resolved. Approximately 48-72 hours after vaccination, patient developed new arm tenderness that developed into redness, mild swelling and itching. Recommended oral diphenhydramine with PCP follow-up.

Other Meds:

Current Illness:

ID: 1590962
Sex: M
Age: 52
State: PA

Vax Date: 05/01/2021
Onset Date: 05/05/2021
Rec V Date: 08/20/2021
Hospital:

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

Lab Data:

Allergies: shellfish, penicillin

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

Symptoms: sleep loss, joint pain, rash, brain fog, low o2 levels (normally 94-98 since 82-92), activated Epstein Barr Virus, severe allergy symptions (runny nose, chest congestion)

Other Meds: omeprazole 40mg

Current Illness: none

ID: 1590963
Sex: M
Age: 12
State: FL

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 08/20/2021
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: none per dad

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

Symptoms: Complaint of nausea and vomited x1. Dad stated, "he is nervous." 10:42 am medics activated. Client complexion noted to be pink, he was alert and having conversation with dad. Stated client he felt better. 10:46 am medics arrived, had conversation with dad. Noted to be ambulatory, alert, exited.

Other Meds: none per dad

Current Illness: none per dad

ID: 1590964
Sex: F
Age: 24
State: MA

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 08/20/2021
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: Systemic: Fainting / Unresponsive-Severe, Systemic: Seizure-Severe

Other Meds:

Current Illness:

ID: 1590965
Sex: F
Age: 33
State: MD

Vax Date: 04/14/2021
Onset Date: 05/10/2021
Rec V Date: 08/20/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Erythema, Pruritus

Symptoms: May 2021 - symptoms include chills, body aches, fever (102 at highest), nausea, vomiting, diarrhea for one-two days followed by a mucusy cough and shortness of breath for an extended period of time (4-6 weeks). Body aches and fever continued every couple of days for almost a month. Tested negative for COVID. Was diagnosed with "pneumonia" and prescribed LevoFLAXacin which seemed to help the symptoms go away. I felt better and almost back to normal for a month until the symptoms showed up again, end of July 2021. Symptoms were the same as mentioned above for one-two days followed by a mucusy cough and shortness of breath, this time with elevated heart rate (resting rate 120-140) with low sat (85-90) particularly

Other Meds: Prenatal vitamins

Current Illness: None

ID: 1590966
Sex: F
Age: 38
State: GA

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 08/20/2021
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: Systemic: Dizziness / Lightheadness-Mild

Other Meds:

Current Illness:

ID: 1590967
Sex: M
Age: 14
State: TX

Vax Date: 08/05/2021
Onset Date: 08/19/2021
Rec V Date: 08/20/2021
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: Systemic: Allergic: Difficulty Breathing-Medium, Additional Details: mother reported that son was allergic to an ingredient in the vaccine and that he was not feeling well and was having difficulty breathing. vaccine was administered on 08/05/21 and incident was reported on 08/09/21. mother stated son was taken to see the doctor

Other Meds:

Current Illness:

ID: 1590968
Sex: F
Age: 39
State: MI

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 08/20/2021
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: NA

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: EXTREME DIZZYNESS, AND BRAIN FOG, JITERY/SHAKEY, COULDNT LIFT UP HEAD FIRST DAY AFTER 6 HRS GETTING 2ND SHOT

Other Meds: PHENTERMINE, TALTZ, BIRTH CONTROL

Current Illness: NA

ID: 1590969
Sex: F
Age: 47
State: TX

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 08/20/2021
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: Iodine, shellfish

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

Symptoms: Metallic taste in mouth within minutes of receiving dose

Other Meds: Vitamin C, multivitamin

Current Illness:

ID: 1590970
Sex: F
Age: 26
State: IA

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 08/20/2021
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: Site: Redness at Injection Site-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: Flushed / Sweating-Mild, Additional Details: Administed vaccine, pt stated she felt she would pass out. I told her to take a couple of deep inhalations. I took her temp 95.5F She laid on the floor said she was starting to feel better, got up and sat in chair. Afew minutes later said she felt faint again and laid on floor. I call 911, she said she did not want to see any responders, said she was going home, got up and left. would not wait for card, did not want any treatment -just left . I called and cancelled the 911 call

Other Meds:

Current Illness:

ID: 1590972
Sex: M
Age: 15
State: NV

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 08/20/2021
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: Pain in extremity

Symptoms: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild

Other Meds:

Current Illness:

ID: 1590973
Sex: F
Age: 39
State: MO

Vax Date: 12/21/2020
Onset Date: 01/01/2021
Rec V Date: 08/20/2021
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: Abnormal menstruation then diagnosed with premature menopause in May 2021

Other Meds: Da Vinci Hair Effects Vitamin D3 + K2 (5000 iu daily)

Current Illness: None

ID: 1590974
Sex: F
Age: 50
State: IN

Vax Date: 01/15/2021
Onset Date: 01/18/2021
Rec V Date: 08/20/2021
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: Sulfa

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

Symptoms: After approximately about 15 minutes my left arm where the injection sight was my arm was in intense pain,felt like my injection sight was tearing my muscle apart the pain was intense I then took Tylenol when I got back to work it was still painful. About three days later the pain subsided slightly. I then noticed I couldn?t move my arm behind my back to scratch it without extreme pain, when I would sleep and try to stretch my arm out I would get a sharp pain. I can?t reach in my refrigerator without pain, I can?t sleep without pain, I can?t exercise without pain. I?m now in physical therapy due to this and their diagnosis is that my arm is froze.

Other Meds: Vitamin D Urasadal Biotin Flintstone vitamin

Current Illness: None

ID: 1590975
Sex: F
Age: 78
State: WA

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 08/20/2021
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: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-

Other Meds:

Current Illness:

ID: 1590976
Sex: M
Age: 24
State: AZ

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 08/20/2021
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: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium

Other Meds:

Current Illness:

ID: 1590977
Sex: F
Age: 71
State: KY

Vax Date: 04/01/2021
Onset Date: 04/01/2021
Rec V Date: 08/20/2021
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: Unknown

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Upon Disease Investigation date of 8/19/2021 case had received both doses of the Moderna vaccine and reported the following symptom onset of 8/14/2021; subjective fever, chills, runny nose, new olfactory disorders, headache, cough and nausea. Still symptomatic.

Other Meds: Unknown

Current Illness: Unknown

ID: 1590978
Sex: F
Age: 29
State: TX

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

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

Lab Data:

Allergies:

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

Symptoms: Systemic: Allergic: Itch (specify: facial area, extremities)-Medium, Systemic: Allergic: Itch Generalized-Medium, Additional Details: patient complained of itchiness on her neck, arm and back a few minutes after getting the shot. RPH on duty gave her two dose. RPH observed her for 30 minutes, to make sure her condition doesn't get worse. She seems to be feeling ok, so we let her leave the pharmacy after 30 minutes. We counselled her to go to the ER if she feels any difficulty breathing or severe allergic reaction of itchiness worsens. RPH followed up with patient 2 hours afterwards and patient itchiness had resolved.

Other Meds:

Current Illness:

ID: 1590979
Sex: M
Age: 50
State: VA

Vax Date: 06/30/2021
Onset Date: 08/13/2021
Rec V Date: 08/20/2021
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:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: This patPient received 3 vaccine doses. Pfizer on 6/30 and 7/21. He received Moderna on 8/13

Other Meds:

Current Illness:

ID: 1590980
Sex: F
Age: 77
State: MI

Vax Date: 02/17/2021
Onset Date: 08/17/2021
Rec V Date: 08/20/2021
Hospital: Y

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

Lab Data:

Allergies: divalproex sodium penicillins

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

Symptoms: Pt admitted with breakthrough case of COVID on 8/18/2021

Other Meds: aspirin 81mg PO qday clopidogrel 75mg qday Cortef 5mg PO bid insulin aspart 100 units/mL per scale SQ QIDAC bedtime isosorbide mononitrate 30mg PO qAM lexapro 10mg PO qday lipitor 40mg PO at bedtime lisinopril 10mg PO qday meclizine 25mg PR

Current Illness:

ID: 1590981
Sex: M
Age: 73
State: NJ

Vax Date: 08/18/2021
Onset Date: 08/18/2021
Rec V Date: 08/20/2021
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: Penicillin

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

Symptoms: Lightheadedness, Nausea, Headache, Body Pains, Sore arm

Other Meds: Tacrolimus 1mg (2X/day), Protonix 40mg (1X/day), Aspirin 81mg (1X/day), Terazosin 5mg (1X/day), Lipitor 20mg (1X/day), Viread 300mg (1X/day)

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm