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: 1591521
Sex: M
Age: 39
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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

Symptom List: Dysphagia, Epiglottitis

Symptoms: Called to scene, 2 staff members, including obs RN assisting pt - pt unconscious upon arrival, pale, cool, clammy skin, pupils dilated, HRR, regular RR. Assisted staff to lay patient supine on floor. Pt still unconscious, but no other changes. In less than 2 minutes supine, pt with sudden change in consciousness - face red, muscles tense, jerked away. Appeared seizure-like momentarily, RR called. Pt then resumed consciousness, confused initially, but then awareness resumed as RR team arrived. 911 also called by another staff member. VSS - BP 121/71, HR 58, SpO2 99%. Stable once sitting upright. RR team assessed, paramedics on scene. Determine pt stable and able to dismiss teams without further intervention. Pt stayed in observation for an additional 40 minutes until recovered. Had one bout of emesis, but reported feeling better after. Given Gatorade and snacks to consume once nausea improved. Escorted to first floor where pt had friends waiting. Encouraged to rest and rehydrate until fully recovered.

Other Meds: pt reported having smoked some marijuana earlier in the day

Current Illness: none

ID: 1591522
Sex: F
Age: 49
State: NY

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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: pollen dust pet hair

Symptom List: Anxiety, Dyspnoea

Symptoms: Immediately dizzy lightheaded, loss of balance, arm is swollen, face is swollen, fever over 101, breathing issues, urine inconstancy, fainted, shaking, chills, sweating diahreah naseau rash

Other Meds: multivitamin

Current Illness: none

ID: 1591523
Sex: F
Age: 73
State: MN

Vax Date: 05/17/2021
Onset Date: 08/20/2021
Rec V Date: 08/20/2021
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: COVID infection breakthrough

Other Meds:

Current Illness:

ID: 1591524
Sex: F
Age: 12
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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: The vaccine doses were administered with diluent volume greater than 1.8ml and syringe containing air bubbles.

Other Meds:

Current Illness:

ID: 1591525
Sex: F
Age: 27
State: CO

Vax Date: 08/16/2021
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: Penicillin

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

Symptoms: I had common side effects, until Thursday. Thursday morning, I woke up and my arm hurt, but I figured that was common, until I got to work and the RNs in my clinic said that my entire upper arm was red, swollen, and bruised looking and there were white looking bumps that were raised. They were very concerned. They told me to go home and take benadryl right away, and if it continued to spread or did not get better, I needed to go to urgent care. After taking benadryl, the swelling and bruising went away, but it remained red. Today, Friday, 8/20, I now have these little white looking spots on my right arm, and it is now also red, but not swollen or bruised looking. I was told to keep an eye on both arms for swelling/bruising, and if it happens again in either arm, or if any part of either arm gets hot in either way, to go immediately to urgent care. I was instructed to report this as it is not a common side effect.

Other Meds: Citalopram, Phentermine, Topiramate

Current Illness: N/a

ID: 1591526
Sex: M
Age: 19
State: AR

Vax Date: 08/17/2021
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: Red rashes, itchy feeling

Other Meds:

Current Illness:

ID: 1591527
Sex: F
Age: 69
State: GA

Vax Date: 02/14/2021
Onset Date: 04/10/2021
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: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: I have no idea if this is connected to the vaccine. Approximately 2 months after the second dose I started getting extremely short of breath on exertion. Walking uphill, walking upstairs, or carrying something left me really short of breath and weak. In mid-May I went to my local hospital thinking I was having a heart attack as I walked up stairs and got short of breath, weak and sweaty. They referred me to a Pulmonologist thinking it was a lung problem.

Other Meds: Simvastatin, Bupropion, Meloxicam

Current Illness: NOne

Date Died: 07/30/2021

ID: 1591528
Sex: F
Age: 84
State: FL

Vax Date: 03/01/2021
Onset Date: 07/25/2021
Rec V Date: 08/20/2021
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: Pharyngeal swelling

Symptoms: covid symptoms beginning on 7/25/21

Other Meds:

Current Illness:

ID: 1591529
Sex: M
Age: 29
State: MA

Vax Date: 08/20/2021
Onset Date: 08/20/2021
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: not known

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient received the vaccine and was asked to take a sit for 15 minutes. Approximately 10 mins later his girlfriend approached us stating he felt dizzy. When I got to him, he was becoming pale. I called 911, and returned to the patient who was in and count of consciousness. Myself and a second pharmacist assisted him to the floor and checked is blood pressure and awaited EMT's to arrive. The fire department and EMT's assessed the patient who was now feeling better and he refused to be transported to the hospital.. He left the pharmacy with his girlfriend.

Other Meds: not known

Current Illness: not known

ID: 1591530
Sex: F
Age: 38
State: MA

Vax Date: 08/20/2021
Onset Date: 08/20/2021
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: none listed

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient received the vaccine at 9:30am. Approximately 10 minutes after receiving the vaccine she notified us that she was feeling hot and dizzy, and she may pass out. I gave her a cool pack to put on her back, she was sitting down, and breathing heavy. She stated that she was feeling very nervous and has a history of panic attacks. She slumped into her chair and started shaking, her head fell backwards. I held her head up , kept her head to the side, and removed her mask for air. Her entire body shook, including her legs. She came to about a minute later, and was very calm. She knew she had passed out, and that EMT's were en route. The EMT suggested that she may have had a vasovagal reaction, and was not convinced it was a seizure. She did not go to the hospital , but she did have a friend pick her up and drive her to her primary care.

Other Meds: None

Current Illness: none

ID: 1591531
Sex: F
Age: 38
State: OR

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: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Vaccine was administered after BUD (beyond use time) time.

Other Meds:

Current Illness:

ID: 1591532
Sex: F
Age: 71
State: SC

Vax Date: 02/11/2021
Onset Date: 07/01/2021
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: I am allergic to penicillin and nsaids.

Symptom List: Rash, Urticaria

Symptoms: Last month I went for an appointment with my gastroenterologist, Dr., for a colonoscopy. He performed a CT scan with contrast to see if he could notice any other possibilities causing the pain in my stomach. My colonoscopy came back normal with a polyp found and removed. My CT scan showed that I had a cyst, about 9cm in size, on one of my ovaries. I was ordered to see a GYN. I had my appointment with Dr. where she performed a pelvic exam and a pap smear. Both exams came back normal. I was ordered to have an ultrasound completed. When I did, they noticed 2 dark spots on the back of my uterus. Dr. took a biopsy of the spots and I'm still waiting for the results. Regardless of what the results are, I'm going to have a hysterectomy performed on me. If the biopsy shows cancer, I will have an oncologist perform the surgery, if it is not cancer, Dr. will perform the surgery.

Other Meds: Potassium; a multivitamin; calcium; simvastatin; and once every five weeks, I get a shot in my eye because of my macular degeneration.

Current Illness: I did not have any illness at the time.

ID: 1591533
Sex: M
Age: 11
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Patient received Pfizer vaccine to early Parent reported he was 12 years old but has 16 days to his birthday.

Other Meds: Covid Pfizer Vaccine

Current Illness: None

ID: 1591534
Sex: F
Age: 31
State: NY

Vax Date: 03/24/2021
Onset Date: 05/18/2021
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: patient came to my office complaining of fainting, dizziness and swollen lymph nodes

Other Meds:

Current Illness:

ID: 1591535
Sex: F
Age: 39
State: CA

Vax Date: 08/13/2021
Onset Date: 08/14/2021
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: The evening after 2nd dose I had horrible body aches to where I could not walk, fever102, unbearable headache , nausea, profuse sweating. As of now over a week later, my fever is down to 99 but I still experiencing debilitating body aches and fatigue along with uncontrollable sweating. I?m very scared

Other Meds:

Current Illness:

ID: 1591536
Sex: M
Age: 13
State: OR

Vax Date: 08/18/2021
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: No known allergies

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

Symptoms: 8/19/21 @ 1654 in the afternoon, call received from parent that child was at the emergency department of Hospital. Had a reaction to vaccine or medication prior to arrival. Reported patient had a bad seizure. Pt advised to discontinue guanfacine, see primary care provider, and neurology follow up. Discharged home.

Other Meds: Guanfacine 1 Mg nightly, Lactulose 10 gm/15 mL BID, Polyethylene glycol powder q 12 days.

Current Illness: No illnesses

ID: 1591537
Sex: F
Age: 34
State: FL

Vax Date: 08/09/2021
Onset Date: 08/13/2021
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: none

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

Symptoms: tingling sensation in my lower leg - in the shin area about 5/6 inches up from the where the leg forms into the foot. It is predominantly my left leg but impacts both legs. Severe headaches, some dizziness not able to focus on a image. general brain fog.

Other Meds: ibuprofen, Elderberry

Current Illness: none

Date Died: 08/16/2021

ID: 1591538
Sex: M
Age: 58
State: TN

Vax Date: 03/25/2021
Onset Date: 07/30/2021
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: Aspirin, hydrochlorothiazide and penicillins

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Pt was admitted on 7/30/21 for SARS-CoV-2 and remained hospitalized until 8/16/2021 when he expired.

Other Meds: Amantadine; amlodipine; gabapentin; haloperidol; Humalog; Levemir; levetiracetam; omeprazole; rosuvastatin; warfarin

Current Illness: unknown

Date Died: 05/26/2021

ID: 1591539
Sex: F
Age: 94
State: GA

Vax Date: 01/07/2021
Onset Date: 05/12/2021
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: PMHx of Alzehimer ds, CVA and dysphagia , HTN presented w/ AMS per Ag Rhods, Per EMS tachypnic & placed oxygen for comfort, on arrival to ED, alert but tachypnic and diaphoretic, 3 L NC oxygen. Patient is admitted with Sepsis 2/2 urosepsis vs osteomyelitis of the left forefoot + AKI + Abbot positive COVID PNA patient's son decided his mother should not get surgical intervention and he relayed she wouldn't want aggressive treatment and placed patient on hospice through SNF Death: CARDIAC ARREST, END STAGE ALZHEIMER'S DISEASE, DEMENTIA, SEPSIS

Other Meds:

Current Illness:

ID: 1591540
Sex: M
Age: 85
State: MN

Vax Date: 02/26/2021
Onset Date: 08/18/2021
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: Pencillins, Novocain

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

Symptoms: Patient received his 2nd Moderna vaccine on 02/26/2021. He had a Covid-19 test done on 08/18/2021 prior to an appointment he had scheduled with respiratory therapy. Tested positive for Covid-19 on 08/18/2021, he is asymptomatic. Patient had Monoclonal antibody therapy on 01/19/2021 due to testing positive for Covid-19 on 01/18/2021. Patient then received his first dose of Moderna on 01/29/2021, which was not the recommended 90 days after received antibody therapy. A phone call was made to the Department of Health in regards to this and they recommended that the patient be revaccinated for Covid-19 once his quarantine from this positive is over.

Other Meds: Lopressor, Proscar, Neurontin, Pepcid, aspirin, Prilosec, Naprosyn, Lupron, Calcium, Lipitor, Hytrin, Hydrodiuril

Current Illness:

ID: 1591541
Sex: F
Age: 30
State: AZ

Vax Date: 07/13/2021
Onset Date: 07/13/2021
Rec V Date: 08/20/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Severe cold sweats that lasted 10 plus days. Had to change clothes constantly throughout the day and night and was extremely uncomfortable especially when air conditioning would turn on. Sweating was so bad that my entire bed and pillow would be wet and hair would be wet. It lasted like this for 10 days but continued on an off for almost 3 weeks. Injection site extremely tender for 14 days and still is slightly tender if touched in the spot where injected 40 days later.

Other Meds: Methadone

Current Illness:

ID: 1591542
Sex: F
Age: 29
State: IL

Vax Date: 07/23/2021
Onset Date: 08/08/2021
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: Penicillin

Symptom List: Unevaluable event

Symptoms: Menstrual cycle began early and has lasted more than 2 weeks which is unusual compared to 1 week menses usually experienced

Other Meds: Sprintec Vitamin B12

Current Illness:

ID: 1591543
Sex: F
Age: 52
State: FL

Vax Date: 08/20/2021
Onset Date: 08/20/2021
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: morphine, codeine, darvocet

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

Symptoms: Pt. observed hyperventilating after vaccine. per daughter she has anxiety issues. Pt. is alert and oriented and refused emergency care. Pt. recovered on her own. She is alert and oriented. No distress noted at this time.

Other Meds: multivitamin, asa 81mg

Current Illness:

ID: 1591544
Sex: M
Age: 21
State: MS

Vax Date: 08/20/2021
Onset Date: 08/20/2021
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: Patient arrived at the pharmacy to receive a second dose of Moderna COVID19 vaccine and received a Pfizer dose instead. There has been no adverse event since receiving the vaccine, and the patient was okay when leaving the pharmacy after the required wait time (15-30 minutes).

Other Meds:

Current Illness:

Date Died: 08/20/2021

ID: 1591545
Sex: M
Age: 66
State: AR

Vax Date: 03/09/2021
Onset Date: 08/15/2021
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: Ibuprofen, Peanut oil

Symptom List: Injection site pain, Menorrhagia

Symptoms: Pt was hospitalized with covid 8/15 and died 8/20

Other Meds: Unknown

Current Illness: Unknown

ID: 1591546
Sex: M
Age: 58
State: KY

Vax Date: 08/20/2021
Onset Date: 08/20/2021
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: nka

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

Symptoms: Patient received his first dose of the Moderna vaccine on the morning of 8/20/21. The patient had told me he was nervous about needles. Approximately 15 minutes later, the patient passed out in the floor. A code white was called as I went to the patient. He was sweaty, but responsive. He told me he had not eaten yet today and that he had taken his blood pressure medicine right before leaving the house. I was told the patient takes medication for his blood pressure and that he is prediabetic. I gave him a water and some candy, he did not want either. We offered other things, such as juice, and the patient declined. I checked his blood pressure. His blood pressure was low, but he continued being responsive, and he did not want me to call EMS. The person he was with had a 30 minute wait post-vaccine, so I agreed to wait and recheck his blood pressure. I rechecked his blood pressure 5 minutes later, and it was going back up. They still had time left, so I told him I would check his blood pressure again before they left. When I went to check his blood pressure for a third time, approximately 30 minutes after the vaccine, the patient tensed up and was unresponsive for about 10-15 seconds. He threw his head back, made a few noises, and seemed to have more a seizure this time instead of passing out. I was able to keep him from falling out of his chair (he refused to stay in the floor). I had my techs call another code white and 911. EMS responded. Patient was once again coherent, he did not want to go to the ER, and was responsive enough that EMS could not force him to go. We did finally convince the patient to go with EMS to be checked further. I will be following up later in the day with the patient.

Other Meds: Lisinopril (per patient)

Current Illness: no known

ID: 1591547
Sex: M
Age: 91
State: MI

Vax Date: 02/08/2021
Onset Date: 08/15/2021
Rec V Date: 08/20/2021
Hospital: Y

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 known allergies

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Pateint started with symptoms on 8/15/2021. he reported loose stools, low grade temp, cough and a runny nose. he tested positive in the emergency room on 8/17/2021. He has needed as much as 10 liters of high flow oxygen. Currently he is on 8 liter of high flow nasal cannula. he has been given remdesivir, dexamethsone, biricitinib, budesonide neb, DouNeb tx and albuterol inhaloer as needed.

Other Meds: unknown not given at this facility

Current Illness: unknown not given at this facilty

ID: 1591549
Sex: M
Age: 49
State: WI

Vax Date: 05/12/2021
Onset Date: 05/28/2021
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: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Experienced temporary loss of vision in left eye ( transient ischemic attack). No other known symptoms. Had full eye exam with no abnormalities. Had normal echo with ultrasound on heart and arteries three months later.

Other Meds: Pravastatin 10mg

Current Illness: None

ID: 1591550
Sex: M
Age: 34
State: GA

Vax Date: 08/19/2021
Onset Date: 08/20/2021
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: NKA

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

Symptoms: Pfizer improperly diluted with only 0.8ml diluent. Nurse gave 0.3ml of the vaccine mixutre.

Other Meds: butalbital-APAP-caffiene 50-325-40, PO PRN Q4 Norvasc 5mg, 1 tab PO QD

Current Illness: UNKNOWN

ID: 1591551
Sex: M
Age: 20
State: OH

Vax Date: 08/10/2021
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: IM
Vax Site: RA

Lab Data:

Allergies: Allergic to penicilin

Symptom List: Nausea

Symptoms: Rashes and swelling on the right hand. Feel itchy and a bit painful

Other Meds: None

Current Illness: None

Date Died: 08/19/2021

ID: 1591552
Sex: M
Age: 56
State: MN

Vax Date: 04/02/2021
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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Vancomycin

Symptom List: Injection site pain

Symptoms: Patient passed away on 08/19/2021

Other Meds: albuterol, Kenalog, Klor-Con, Aldactone, Desyrel, Zoloft, Prilosec, Glucophage, Zaroxolyn, Mag-Ox, Crestor, Prinivil, Bumex, aspirin, Zyrtec

Current Illness:

ID: 1591553
Sex: F
Age: 41
State: NY

Vax Date: 02/26/2021
Onset Date: 02/26/2021
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: Allergic to sulfa drugs, metronidazole, cipro. Suspected allergy to polysorbate (previous reaction to injectable medication with polysorbate).

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

Symptoms: I was monitored for anaphylaxis for 1 hour (because of previous allergies) but was ok during that time. About 6 hours afterwards I began to develop very strong symptoms- headache, fever, dizziness, elevated heart rate. By the following day the symptoms were not manageable- heart rate was 180 when lying down, unable to balance well enough to walk to the bathroom, unable to reduce heart rate. I went to the ED at hospital, was given steroids and observed for several hours until my condition was considered stable. I had previously been exposed to Covid and was under treatment for long term symptoms including dysautonomia and MCAS. The vaccine increased my dysautonomia and MCAS symptoms to much more than they had ever been prior. Prior to the vaccine I did have light-headness and some dizziness, as well as heart palpitations but was never unable to walk and had never had a heart rate that high at rest. I was told that the vaccine might help with long-covid symptoms, but in my case it made symptoms much worse. Steroids greatly reduced the symptoms, but it took about 4 weeks to return to my pre-vaccine health status.

Other Meds: zyrtec, pepcid, multivitamin

Current Illness: Long-covid (PASC) and MCAS

ID: 1591554
Sex: F
Age: 58
State: MI

Vax Date: 01/15/2021
Onset Date: 08/15/2021
Rec V Date: 08/20/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Admitted for weakness 8/15/2021

Other Meds: Lipiotor, plavix, propanediol, lexapro, synthroid, prinzide, metformin, multivitamin

Current Illness:

ID: 1591555
Sex: M
Age: 30
State: LA

Vax Date: 08/14/2021
Onset Date: 08/15/2021
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: Unknown

Symptom List: Tremor

Symptoms: The second day after being administered the vaccine, my right arm began to have throbbing pain from the front on my right shoulder down to the bottom of the front of my bicep. This was accompanied by swelling are deep pain. It felt almost as if my arm was having the circulation cut off. The following day my right hand, fingers, forearm began to have a numbing/pins and needle type feeling. This has still not subsided and I 6 days post vaccine. Along with the arm issue, on the second day after the vaccine; I began to have a hive/rash breakout on the sides of my upper legs and buttocks. This is extremely sore and moderately itchy. This has not subsided 6 days post vaccine.

Other Meds: None

Current Illness: None

ID: 1591556
Sex: M
Age: 12
State: TX

Vax Date: 06/18/2021
Onset Date: 06/22/2021
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 that we know of

Symptom List: Erythema, Pruritus

Symptoms: hard to breathe, chest pain, chest tightness.

Other Meds: None

Current Illness: None

ID: 1591557
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: 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: NA

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

Symptoms: Son received vaccine at 2pm. At 10-11pm, he felt a rash on back of his head. He also had a tender lymph node directly below rash. Rash was blisters on back of skull. On 8/20/21, his neck tender with movement and has several enlarged lymph nodes right neck. He was taken to doctor and diagnosed with Shingles outbreak and prescribed antiviral medication.

Other Meds: Albuterol as needed, Flovent

Current Illness: Seasonal allergies

ID: 1591558
Sex: M
Age: 47
State:

Vax Date: 12/23/2020
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:

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

Symptoms: EE RECEIVED BOTH PFIZER COVID-19 VACCINE DOSES AND TESTED POSITIVE TO COVID ON 8/19/21

Other Meds:

Current Illness:

ID: 1591559
Sex: F
Age: 61
State: MI

Vax Date: 04/06/2021
Onset Date: 08/18/2021
Rec V Date: 08/20/2021
Hospital: Y

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

Lab Data:

Allergies: Lasix Metformin Sulfa Pine oil Buspar Penicillin

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: After her recent discharge from the hospital on 8/4, pt started feeling fatigued, with poor energy, worsening dry cough and shortness of breath. Pt received a message from the Health Department that she had been exposed to COVID. Pt is fully vaccinated from April.

Other Meds: Norco 5/325 q4hours as needed Eliquis 4mg twice a day Lyrica 150 twice a day amitriptyline 100mg twice a day sertraline 100mg at bedtime Spiriva Trulicity 1.5 every week Lantus 20 units twice daily Humalog 10 units before meals Victoza 1.8

Current Illness:

ID: 1591560
Sex: M
Age: 10
State: MD

Vax Date: 06/09/2021
Onset Date: 08/20/2021
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:

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

Symptoms: No adverse results - patient was 10 yrs old at time of vaccine, administration error

Other Meds:

Current Illness:

ID: 1591561
Sex: F
Age: 50
State: PR

Vax Date: 08/20/2021
Onset Date: 08/20/2021
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: Fioricet, tagamet

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

Symptoms: Patient returned to the pharmacy 2 hours after vaccination. Patient with symptoms of an allergic reaction. Presenting the following: numbing of face, chills, pain in the arm, respiratory distress, swollen arms and neck, trembling. Epi Pen and Benadryl administered by RPH. Patient stable. Ambulance came and took her to the hospital. At the moment awaiting status.

Other Meds: None

Current Illness: None

ID: 1591562
Sex: F
Age: 21
State: MS

Vax Date: 08/20/2021
Onset Date: 08/20/2021
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: Patient arrived at the pharmacy to receive a second dose of Moderna COVID19 vaccine and received a Pfizer dose instead. There has been no adverse event since receiving the vaccine, and the patient was okay when leaving the pharmacy after the required wait time (15-30 minutes).

Other Meds:

Current Illness:

Date Died: 08/18/2021

ID: 1591564
Sex: M
Age: 59
State: TN

Vax Date: 03/04/2021
Onset Date: 08/07/2021
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:

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

Symptoms: Case received second covid vaccine on 03/04/2021. Hospital on 8/7/21 with respiratory distress . Positive COVID lab on 8/7/21. Case expired at hospital on 8/18/2021.

Other Meds:

Current Illness:

ID: 1591565
Sex: F
Age: 64
State: TN

Vax Date: 04/27/2021
Onset Date: 08/09/2021
Rec V Date: 08/20/2021
Hospital: Y

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: presents with progressively worsening shortness of breath, very aggressive cough, subjective fevers on the background of her COVID-19 Treated w/ Roceph, Zith, Vit E 1200 iu daily, vit D weekly, po thiamine

Other Meds:

Current Illness:

ID: 1591566
Sex: F
Age: 63
State: VA

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

Lab Data:

Allergies: Penicillin allergy, gluten sensitivity, undiagnosed chemical sensitivity

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

Symptoms: Initially, flush and some minor sensitivity response (feeling like I was getting sick) In the evening, about 8 hours post injection, Fever, chills, cold shakes and muscle spasms Next day: headache, fever, muscle spasms - couldn?t lift head off pillow and had to sleep until the following morning ? except for the most incredible muscle spasms. Spasms continued 3rd day? large muscles, small muscles ? legs, abdomen, fingers, toes, back.

Other Meds: Armour

Current Illness: None; very healthy

ID: 1591567
Sex: M
Age: 62
State: TN

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

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: Admitted on 8/4/21 for Bilateral COVID Pnemonia superimposed with aspiration pneumonia

Other Meds: Chlorodiazepoxide; donepezil; gabapentin; oxybutynin ER; pravastatin; trazodone; vimpat

Current Illness: NKDA

ID: 1591568
Sex: F
Age: 18
State: NY

Vax Date: 04/11/2021
Onset Date: 08/20/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Latex

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient has had chest pain, Dyspnea and headaches since receiving COVID vaccination. States that sx's increased after 2nd dose

Other Meds: none

Current Illness: none

ID: 1591569
Sex: F
Age: 35
State: OH

Vax Date: 08/17/2021
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: Shellfish

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

Symptoms: Started experiencing what felt like a heart flutter frequently throughout the day following the vaccine. I continued to monitor it and could feel my heart pounding while doing low effort activities (working at my desk, watching tv) along with walking and other activity all throughout the day. After three days of this continuing and experiencing a fluttering feeling/heartbeat in my throat regularly, I went to urgent care (on Friday - three days post injection). Blood pressure was high for me at 132/80. ECG was run and came back normal indicating no heart arrhythmia. Heat palpitations were diagnosed.

Other Meds: None

Current Illness: None

ID: 1591570
Sex: F
Age: 30
State: TX

Vax Date: 05/12/2021
Onset Date: 05/29/2021
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: no

Symptom List: Injection site swelling, Limb discomfort

Symptoms: 05/12/2021 after the vaccine, I had chills, feverish, headaches, tired. Then on 05/28/2021 I noticed raised bumps, and they were itchy and they were on my face. I sent my PCP pictures, he was booked and I didn't see him till 07/24/2021. My PCP, gave me a blood test, and urine test. He was checking for thyroid and protein in the urine and he did an annual check up . My PCP looked at my bumps, at that time he said everything looked normal. I started experiencing bumps more often on my face and at one time my whole face was hot, like a sunburn and I felt like my throat was closing, like it was hard to swallow. My PCP referred me to an allergist because of my symptoms. I went to see allergist doctor on 08/10/2021, he did a blood test, an ANA test and check for allergies and autoimmune diseases. The ANA test results were that I was positive for an autoimmune disease. I have a follow up today, 08/20/2021 to go over the test results. And my symptoms have gotten worse, I don't have the allergy bumps any more but I have been tingling all over my body, and last week 08/12/2021, suddenly my arms and legs went numb. I couldn't feel when I was touched on my arms and legs. It eventually went away. But on Monday, 08/16/2021, the tingling has returned nonstop, and it feels like needles and it actually hurts. If it tingles on my forehead, I can't concentrate. If it tingles on my legs, I feel I can't walk, like my legs are not as strong. Where ever it tingles I just can't function as well. At night, I tingle to where I can't sleep. I have also been experiencing nausea and dizziness, and constipation and diarrhea. I feel like my lymph nodes under my jaw get swollen on and off throughout the day.

Other Meds: birth control- aurovela fe

Current Illness: no

ID: 1591571
Sex: M
Age: 42
State: AL

Vax Date: 08/11/2021
Onset Date: 08/11/2021
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: RA

Lab Data:

Allergies: None

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

Symptoms: Upon laying in bed for sleep, heart began pounding with what seemed to be irregular heartbeat. Lasted approximately an hour. Woke in the night with numbness in left arm and hand. After moving and flexing arm and hand, numbness began to deteriorate, and normal feeling began to come back. Symptoms seemed to have subsided by the next morning.

Other Meds: Multi-Vitamin; Super Lysine Vitamins

Current Illness: None

ID: 1591572
Sex: M
Age: 29
State: IN

Vax Date: 04/04/2021
Onset Date: 04/06/2021
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:

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

Symptoms: Tinnitus

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm