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: 1591573
Sex: F
Age: 54
State: NY

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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Idiopathic Urticaria

Symptom List: Dysphagia, Epiglottitis

Symptoms: Hives from head to toe, fever, chills, diarrhea, vomiting, migraine, tongue swelling, sore muscles, dizziness and very fatigued. On Saturday signs of Pericarditis returned and therefore I began taking the prescribed medication from prior episode (colchicine). Missed 2 days of work (Friday and Monday). Had to utilize epi pen, and also took regular doses of Benedryl. Could not eat or drink for three days. A week later and the headache is still slightly there and hives are slowly diminishing.

Other Meds: daily morning prescriptions: Nifedipine, hydroxyzine. daily evening prescriptions: Fluoxetine, lev0cetirizine

Current Illness:

ID: 1591574
Sex: F
Age: 58
State: CT

Vax Date: 01/30/2021
Onset Date: 07/21/2021
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: none

Symptom List: Anxiety, Dyspnoea

Symptoms: No adverse reactions to initial shot other than sore arm, 2nd shot has low fever (99.8), aches, tired, not hungry, Currently experiencing Shingles (7 months later) but was told to report it.

Other Meds: Metformin, synthroid, atorvastatin, liothytonine, escitalopram

Current Illness: none

ID: 1591575
Sex: M
Age: 46
State:

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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: "14mins post vaccination pt c/o dizziness, hot flashes/feeling warm. NO other new/abnormal sxs. Vitals @10:02 BP 135/90, HR 68 O2 Sat 100%. Pt was monitored an additional 10 mins, given fluids. Pt verbalized improvement to sxs. Given ok to be released from clinic. A&Ox4. Pt stable and released from vaccination site. ED precautions given. PMH significant for Asthma, Allergic Rhinitis, GERD, gallbladder disease, fatty liver, and diverticulosis. Pt had a recent visit to the ED 7/19 for acute on chronic abdominal pain. Current Medications: No active prescriptions for this patient."

Other Meds: Current Medications: No active prescriptions for this patient.

Current Illness: Pt had a recent visit to the ED 7/19 for acute on chronic abdominal pain.

ID: 1591576
Sex: M
Age: 30
State: CA

Vax Date: 01/29/2021
Onset Date: 02/26/2021
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: NKA

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient had a positive COVID-19 test on 8/19/2021 after being fully vaccinated with Moderna Vaccine.

Other Meds: Unknown

Current Illness: Unknown

ID: 1591577
Sex: F
Age: 44
State: GA

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: Lisinopril

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

Symptoms: Patient administered 0.3ml of Pfizer vaccine that was diluted with only 0.8ml diluant.

Other Meds: ergocalciferol Jardiance Methocarbamol Linzess Zyrtec Valtrex Vitamin B12 Biotin Atorvastatin Calcium Sumatriptan Succinate Gabapentin Fluticasone Propionate amlodipine Besylate hydrochlorothiazide metformin Januvia Ozempic

Current Illness: Other fatigue, localized swelling mass and lump of neck, low back pain, essential hypertension, TM, excessive daytime sleepiness, Vit D Deficiency

ID: 1591578
Sex: F
Age: 33
State: WA

Vax Date: 08/20/2021
Onset Date: 08/20/2021
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: PT RECIEVED THE FIRST DOSE ON 8/5/21 THEN THE 2ND DOSE ON 8/20/21. IT IS MODERNA AND SHOULD HAVE BEEN 28 DAYS

Other Meds:

Current Illness:

ID: 1591580
Sex: F
Age: 23
State: CA

Vax Date: 08/12/2021
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: Pyrexia, White blood cell count decreased

Symptoms: Began feeling heart pounding and what felt like mild shock waves traveling down neck. Persisted for about 5 or 10 minutes, subsided temporarily, but has reoccurred approximately twice each day since then (about 1 week). Usually occurs around 9:00 am and around 5:00 pm, and while resting or light physical activity. I also feel my heart begin to pound heavily at other times throughout the day (frequently, usually lasting for 5 or 10 minutes). These more frequent occurrences are not accompanied by the sensation of electric shock waves. I can still breathe normally. I have not had this experience prior to the Covid vaccine.

Other Meds:

Current Illness:

ID: 1591581
Sex: F
Age: 63
State: NJ

Vax Date: 07/05/2021
Onset Date: 07/06/2021
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: Patient is a new resident who was admitted to our facility on 8/11/21 after a hospitalization for a stroke. Per her records, she received the first dose of the Pfizer COVID vaccine on 7/5/21 and had a CVA on 7/6/21 (she has a prior history of CVA's also)

Other Meds: Amiodarone HCL 200mg daily, Fluoxetine HCL 20mg BID, Insulin NPH 8 units Q 8 hours, Losartan K 12.5mg daily, ASA 81mg, Furosemide 20mg daily, Atorvastatin 40mg daily, TrazadoneHCL 100mg at bedtime, Carvedilol 3/125mg BID

Current Illness: History of prior CVA's, Diabetes Mellitus type 2, Hyperlipidemia, Anxiety, Hypertension, ASHD, Heart Failure, Aphasia, Dyphagia, Hemiplegia and Hemiparesis, Neuromuscular Dysfunction of the Bladder, Difficulty Walking, and Urinary Retention

ID: 1591582
Sex: F
Age: 44
State: CO

Vax Date: 07/27/2021
Onset Date: 07/28/2021
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: Patient stated that immediately started to swell up and turn red around injection site. Patient stated that she received a migraine the next day. She experience Vertigo. Within 14 days patient has been to the ER 3 times. She experienced delusional spell when she didn't know who any of her family members was. She has been experiencing emotional episodes. She had serve fatigue.

Other Meds:

Current Illness: Dry Cough

ID: 1591583
Sex: M
Age: 36
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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: No known allergies.

Symptom List: Diarrhoea, Nasal congestion

Symptoms: At approximately 2:43 PM patient slipped off of chair in observation area of clinic and fell face-down unconscious. As patient was turned over, it was noted that he seemed to be experiencing a seizure. Seizure activity lasted for approximately 3 seconds. Upon resolution of the seizure activity, patient began to regain consciousness, alert but not oriented at first. Vital signs were conducted, blood pressure 163/83, pulse regular 62 beats per minute. EMS notified. Patient complained of head pain (occipital region) and was diaphoretic. No apparent trauma to head noted, full extraocular movement. Patient began to regain more consciousness. EMS arrived on scene @ approximately 3 PM. EMS further evaluated patient. Repeat vital signs, blood pressure 147/80, pulse 60 beats per minute, respiratory rate 18 breaths per minute, oxygen saturation within normal limits. EMS also performed an EKG which was found to be normal. Patient refused any further treatment and signed AMA (against medical advice). Ultimately patient was going to be transported home by a fellow co-worker.

Other Meds: None

Current Illness: None

ID: 1591584
Sex: M
Age: 48
State: KY

Vax Date: 04/15/2021
Onset Date: 08/14/2021
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: Runny Nose, Congestion, and Sneezing

Other Meds:

Current Illness:

ID: 1591585
Sex: M
Age: 56
State: IL

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: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: dizzy, lightheaded, diarrhea, no appetite, fever, chills, coughing

Other Meds:

Current Illness:

ID: 1591586
Sex: M
Age: 64
State: MI

Vax Date: 04/03/2021
Onset Date: 08/16/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Came in for cholangitis

Other Meds: Prilosec, zofran, prinivil,

Current Illness:

ID: 1591587
Sex: F
Age: 65
State: NC

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: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: lidocaine

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

Symptoms: Syncope

Other Meds: Nortriptylin 10mg Amlodipine 10 mg Benazapril/HCTZ 20-25 Vitamin D3 1.25mg

Current Illness: none

ID: 1591588
Sex: F
Age: 29
State: OR

Vax Date: 04/09/2021
Onset Date: 04/09/2021
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: Right after getting the shot I felt like my left side of my throat was closing. The next day I woke up and my right eye was bloodshot and itchy. Two days after the shot I got a rash on my right forearm.

Other Meds: None

Current Illness: None

ID: 1591589
Sex: M
Age: 13
State: MT

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: IM
Vax Site: LA

Lab Data:

Allergies: N/A

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

Symptoms: Unauthorized age group. No adverse reaction at this time.

Other Meds:

Current Illness:

ID: 1591590
Sex: F
Age: 24
State: MN

Vax Date: 08/12/2021
Onset Date: 08/12/2021
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: Tramadol Ketorolac Nickel Adhesive Ciprofloxacin Lorazepam Codeine

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

Symptoms: Got my vaccine on 8/12/21 felt fine after then roughly 3 hours after started feeling very sick. I was told it would last 1-3 days. It is now 8/20/21 I have had a migraine since given the vaccine. I have chronic migraines and I had not had one in months. I have been puking, very tired, dizzy, not able to eat much. I have not been feeling myself. I have been confused and super slow to do things. I have had diarrhea and sweats. I have had these symptoms since 3 hours after getting the vaccine on 8/12/21

Other Meds: Sumatriptan 8/11/21 Tylenol 8/12/21 Travatan Z 98/11/21 Rizatriptan 8/11/21 Omerprazole 8/11/21 Medroxyprogestrone Metformin

Current Illness:

ID: 1591591
Sex: F
Age: 89
State: MO

Vax Date: 02/26/2021
Onset Date: 08/06/2021
Rec V Date: 08/20/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: patient admitted to 08/06/2021 to 08/12/2021. Patient was not interviewed. Unknown if hospitalization was due to or related to COVID. Attempted to call case two times but no return phone call.

Other Meds:

Current Illness:

ID: 1591592
Sex: M
Age: 85
State: WI

Vax Date: 03/11/2021
Onset Date: 07/30/2021
Rec V Date: 08/20/2021
Hospital: Y

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

Lab Data:

Allergies: ace inhibitors, atorvastatin, celebrex, metoprolol, rosuvastatin, zetia

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: 7/28/2021 Started to feel weak, diaphoretic, sore throat, lightheaded. 7/30/2021 presented to ED with continued cough, sore throat and R leg pain. Had been out of town on trip two weeks prior. Tested Covid-19 positive 7/30/2021. Due to immunocompromised status, did not qualify for remdesivir, decadron or tocilizumb. Placed on prophylactic heparin and given fluids and placed on O2. Was hypotensive and Benicar and HCTZ were held. Discharged 8/1/2021 in improved condition, without supplemental oxygen, with the following dx: hypotension, AKI, Covid-19. Submitter does not have access to any further hospitalization information. If further follow up information is required, please contact the hospital.

Other Meds: unknown

Current Illness: unknown

ID: 1591593
Sex: M
Age: 19
State: IL

Vax Date: 08/13/2021
Onset Date: 08/17/2021
Rec V Date: 08/20/2021
Hospital: Y

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

Lab Data:

Allergies: none known

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

Symptoms: Chest pain, shortness of breath. Patient presented to the ER for evaluation of symptoms. Noted to have tachycardia upon arrival

Other Meds:

Current Illness: none known

ID: 1591594
Sex: F
Age: 60
State: IL

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: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Valium, Codeine

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

Symptoms: Patient was having perspiration and tightness in the chest, eventually began to have numbness and tingling in the throat and face

Other Meds:

Current Illness:

ID: 1591595
Sex: F
Age: 66
State: TX

Vax Date: 07/22/2021
Onset Date: 07/22/2021
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 Known

Symptom List: Unevaluable event

Symptoms: Developed Bumps on right inner leg above knee joint evening of 1st dose, (7/22/21)PM. Blisters form, (7/23/21)AM. Went to an urgent care facility on 7/24 where I wasa diagnosed with a Bullous Disorder Unspecified Returned 7/29/29 and was diagnosed with Shingles and prescribed Vacacylovir Side Note: I have never been diagnosed with Chicken Pox!

Other Meds: Complete Women 50+ Multivitamin Multi Mineral Supplement

Current Illness: None

ID: 1591596
Sex: M
Age: 50
State: TX

Vax Date: 02/01/2021
Onset Date: 02/01/2021
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: Lactose intolerance Latex

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

Symptoms: Extreme Tremors and twitching Gait difficulty Headaches Fatigue Diagnosed as Functional Neurological Disorder by Dr. I missed a lot of work and considered suicide since I'm the provider for my family. I have been to lots of doctors and therapy. I have a lot more good days now but I still have bad days like today.

Other Meds: Fluticosone Viagara Vitamin D

Current Illness: Essential tremor IBS

ID: 1591598
Sex: F
Age: 51
State:

Vax Date: 01/21/2021
Onset Date: 08/17/2021
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 has Covid

Other Meds:

Current Illness:

ID: 1591599
Sex: F
Age: 72
State: NC

Vax Date: 02/09/2021
Onset Date: 02/14/2021
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: NKA

Symptom List: Injection site pain, Menorrhagia

Symptoms: I had a piece of a peppermint patty and I started feeling sick. I started sweating profusely, I had chills and I was short of breath. I thought I had diarrhea because my stomach was hurting really bad.

Other Meds: No medications at the time of vaccination.

Current Illness: No illnesses at the time of vaccination.

ID: 1591600
Sex: F
Age: 56
State: MD

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

Lab Data:

Allergies: OPOIDS IV CONTRAST DYE

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

Symptoms: SAID TONGUE FELT COLD. SMALL RED, ITCHY RASH COVERING BOTH FEET AND PROGRESSING UP BOTH ANKLES. LARGE HIVES ON FOREHEAD. CHEST TIGHTNESS. HIVES LATER APPEARED ON NECK, CHEST AND STOMACH. PATIENT WENT TO EMERGENCY DEPARTMENT. WAS TREATED AND RELEASED

Other Meds: NOT REVEALED TO US

Current Illness: UNKNOWN

ID: 1591601
Sex: M
Age: 12
State:

Vax Date: 08/05/2021
Onset Date: 08/08/2021
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: none

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Vasculitis in fingertips and toes. The fleshy part of his fingertips got red/purple as well as his big toe. Has been over a week and has not resovled.

Other Meds: tylenol

Current Illness: none

ID: 1591603
Sex: F
Age: 84
State: CA

Vax Date: 01/28/2021
Onset Date: 02/02/2021
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: sulfa antibiotics theophylline cipro dust

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: fever Dizziness, difficulty breathing, out of breath / very low energy loss of audible voice

Other Meds: Losartan Amlodipine Metoprolol

Current Illness: irregular heart beat

ID: 1591604
Sex: F
Age: 40
State: TX

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: N/A

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

Symptoms: Swollen, tender lymph nodes under left armpit. Arm rash 4 inches surrounding injection site on arm. Tender injection site. All symptoms occurring 48 hours after injection and persisting through the time of this report.

Other Meds: Cimzia (biologic)

Current Illness: N/A

ID: 1591605
Sex: M
Age: 38
State: WV

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: RA

Lab Data:

Allergies: nkda

Symptom List: Nausea

Symptoms: Patient stated that he immediately felt light headed, but said he suffered from anxiety and was feeling a little anxious before the shot. We watched him, gave him water and he seemed fine around 30 minutes after incident and left.

Other Meds: n/a

Current Illness: patient stated he had anxiety and blood pressure issues

ID: 1591606
Sex: M
Age: 39
State: VA

Vax Date: 04/14/2021
Onset Date: 06/26/2021
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: none

Symptom List: Injection site pain

Symptoms: General malaise at beginning , mixed reports from doctors, By end of week one was admitted to ICU for heart failure, blood clotting following remainder of organs were failing. First admitted to hospital, after 6 days flown to another hospital, were he is still

Other Meds: none

Current Illness: none

ID: 1591607
Sex: M
Age: 61
State: FL

Vax Date: 07/29/2021
Onset Date: 08/07/2021
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 induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Shortness of breath. Anxiety. Both to the point I went to the ER

Other Meds: None

Current Illness: None

Date Died: 08/19/2021

ID: 1591608
Sex: M
Age: 76
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

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

Symptoms: This is the case of a 76 year old with a history of DM, high cholesterol, and a recent humeral bone infection. The decedent had his PORT removed today after his bone infection appeared to be healed. The decedent did not smoke cigarettes, did not drink alcohol, did not use illicit drugs, did not have depression, and did not have any COVID symptoms. Today the decedent appeared in high spirits after he received his booster/third shot of Moderna. He received it on 8/19/21 at the Pharmacy at 1300 hours. This evening the decedent was with his wife when he told her all of a sudden he felt sick. He started toward the bathroom when she reported hearing a noise from him that "she has never heard before". She heard the decedent collapse and called 911. EMS started ALS and EMS took over. They continued for minutes but he could not be resuscitated and was pronounced on scene. EMS confirmed all of the medications were in order, no concerns of foul play, or any other unnatural death. Jurisdiction is assumed due to vaccination shot within 48 hours. Previous vaccinations received included Moderna on 2/14/21, lot #015M20A, Second shot 3/14/21 lot #044A21A

Other Meds: TBD

Current Illness: Humeral bone infection

ID: 1591609
Sex: M
Age: 30
State: GA

Vax Date: 08/07/2021
Onset Date: 08/07/2021
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: allergic to Cefzil and doxycyclene

Symptom List: Tremor

Symptoms: Within 10 minutes of receiving the vaccine, I experienced chest tightness/discomfort. These symptoms worsened over the first day (Saturday August 7) and persisted through August 9. I was not able to do any strenuous physical activity. Today is August 20 and the symptoms have lessened significantly but I still have a noticeable discomfort in my chest and am still short of breath to the point where I avoid strenuous activity. The chest discomfort affects my ability to get to sleep at night.

Other Meds: one a day men's multivitamin, vitamin D

Current Illness: None

ID: 1591611
Sex: F
Age: 33
State: LA

Vax Date: 07/18/2021
Onset Date: 07/18/2021
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: Ciproflaxacin and Codeine

Symptom List: Erythema, Pruritus

Symptoms: My arm, hands, neck, and back all became tight, irritated, in pain, stiff, and sometimes numb/tingling. I heard some tightness and pain was usual after the first few days - but it has been over a month and I am still in incredible pain and I have limited range of motion. I am unable to carry and hold things in my hand. To hold a piece of paper hurts my hand/arm. My whole arm still feels inflamed; it hurts down my back and even up to my left ear. I went to the pharmacy where I received my vaccination, they DID NOT record my adverse reaction nor the length of time. They did not notate it at all. The head pharmacist simply told me to go to the doctor. The doctor I went to also did not report my symptoms to the CDC or Department of Health. How are people to know that there are complications if no one is recording/reporting them? Or if they are not obligated to do so? I am having to report my own adverse symptoms. At the doctor, they told me of patients having swollen lymph nodes and breast pain for weeks following. I am sure they did not report these complications. At the doctors office, the doctor first prescribed me prednisolone and ibuprofen. I received very little relief. They then tried steroid and anti inflammatory injections & prescribed me flexeril. I received some relief but the problem is still ongoing. It has been over a month of me being in pain. I went to the doctor yesterday, and they prescribed me Nabumetone & Gabapentin. I am also to take physical therapy. All of this is costly and is costing me money as I have private insurance and have a high deductible. On the referral to physical therapy, the doctor wrote: "33yo female presents left arm arthralgia, limited ROM with stiffness and muscle spasms." Yet even this description does not sum up the problems and pain that I have received. My ear, shoulder, arm, hands, fingers, and back are all in pain, feel inflamed, and can hardly withstand me touching things. I have not been able to be without medication. I have been a very healthy person and now I feel disabled by the COVID Vaccine.

Other Meds: Aurovela - Hormonal Birth Control

Current Illness: None

ID: 1591612
Sex: M
Age: 57
State: LA

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: NKA

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

Symptoms: The patient misinformed medical staff upon arriving claiming he had not be vaccinated yet and requested to be given J&J. Upon entering the patient information to system it was discovered he had already received both doses of Pfizer.

Other Meds: J&J COVID-19 Vaccine

Current Illness: None known

ID: 1591613
Sex: F
Age: 46
State:

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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: unknown

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

Symptoms: "15mins post vaccination pt c/o chest pain ""pinching"" 2/10, non-radiating. No other new/abnormal sxs. Vitals @9:57 BP 112/72, HR 90, O2Sat 100%. Pt given fluids and monitored until the pt was given the ok to be released from clinic. Pt verbalized ok to leave. ED precautions given. Pt left w/ steady gait. A&Ox4.

Other Meds: unknown

Current Illness:

ID: 1591615
Sex: F
Age: 70
State: IL

Vax Date: 02/13/2021
Onset Date: 02/27/2021
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: narcotics, H2 blockers, pneumococal vaccine #1

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: February 27th -- 2 weeks after vaccine number 2, I awoke at 2 am shaking with chills, a fever of 103, shortness of breath, high heart rate, low oxygen saturation rate, coughing and a feeling of heaviness on my chest. Later in the day, my primary care physician's on-call doctor told me to call 911 and go to the ER, assuming this must be COVID. Hospital ER diagnosed pneumonia but I didn't believe it. March 17th, I visited my primary care physician after drawing blood in the lab, doing another chest X-ray and an echocardiogram. March 18th, the echocardiogram report filed showed reduction in ejection fraction to about 30-35 percent (from what had been a normal 55 to 60% before the vaccines). Cardiology started a beta blocker drug and I was referred on to pulmonology and gastroenterology for additional testing. May 9th, the exact same symptoms occurred at around 2 am, which necessitated another visit to the ER, again with the same pneumonia diagnosis. Still don't believe I had pneumonia but did go through two rounds of two different antibiotics each. Just had my 2nd echo a few weeks ago and the ejection fraction is up to 40, but cardiologist doesn't "like the way the heart" looks. All of these medical visits and explorations are in an effort to truly understand what has happened to my body -- I am slow and sluggish, can't walk more than 4 blocks without being winded, and of course am staying alone in my high-rise apartment most of the time. I still believe this is vaccine related myocarditis.

Other Meds: atorvastatin 40 mg 1/day; fluticasone propionate 50 mcg, 1/day both nostrils; lisinopril 5 mg 1/day; omega-3 fatty acids fish oil 1,000 mg 1/day; omeprazole 20 mg 2/day; proventil HFA 90 mcg as needed; rifaxim 200 mg, 1/day; metoprolol 25

Current Illness: GERD, asthma, PT for left rotator cuff soreness

ID: 1591616
Sex: M
Age: 12
State:

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:

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

Symptoms: Pfizer vaccine was mixed incorrectly with less than 1.8 mL's being added to the vial therefore vaccine was more concentrated with 0.3 mL given. No adverse events noted.

Other Meds:

Current Illness:

ID: 1591619
Sex: F
Age: 21
State: LA

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: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKA

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

Symptoms: Red, warm, raised area to direct injection site measuring 5.6 cm width by 4 cm height

Other Meds: Unknown

Current Illness: Unknown

Date Died: 08/18/2021

ID: 1591620
Sex: M
Age: 81
State: TN

Vax Date: 02/08/2021
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: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: Patient had covid vaccine x 2. Last dose on 2/8/21. Admitted to Hospital on 08/15/2021 with covid symptoms. Positive COVID specimen on 8/15/2021. Patient expired at hospital on 8/18/2021.

Other Meds:

Current Illness:

ID: 1591621
Sex: F
Age: 33
State: CA

Vax Date: 02/12/2021
Onset Date: 02/21/2021
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: Ten days after the second dose of the vaccine I had a panic attack and my doctor needed to prescribe additional medication. I was feeling very anxious for about 48 hours, and it was not like anything I had before. My menstrual cycle was very unusual for about 3 months. I was having spotting before my period and then it would last longer than normal. Then I would get another period before it was due.

Other Meds: Wellbutrin, Buspar.

Current Illness:

ID: 1591622
Sex: M
Age: 11
State: MO

Vax Date: 08/19/2021
Onset Date:
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: no

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

Symptoms: none gave vaccine to soon

Other Meds: none

Current Illness: none

ID: 1591623
Sex: M
Age: 23
State: NY

Vax Date: 07/22/2021
Onset Date: 07/23/2021
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: Patient stated that he has a sharp pain in his arm that he has had since he taken the vaccine. The pain in his left shoulder is very severe. Her can not rest. He stated that he has also lost his ability to concentrate. Patient was at the hospital in the ER when he called to make report. 08/20/21.

Other Meds:

Current Illness:

ID: 1591624
Sex: F
Age: 39
State: UT

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: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

Symptom List: Vomiting

Symptoms: I lost consciousness, had a seizure and stopped breathing. My husband had to administer rescue breathing to get me to start breathing again.

Other Meds: Women?s multivitamin

Current Illness: None

ID: 1591625
Sex: F
Age: 59
State: AZ

Vax Date: 04/10/2021
Onset Date: 05/29/2021
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: GI irritation with Erythromycin

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: I developed a strong flutter under my sternum, cough and eventually lightheadedness. Went to ER and was kept overnight, released on medication the next day.

Other Meds: naproxyn 550 once per day, multi vitamen, calcium, Cosamin DS, vaginal estrodiol, Vit D3, B1

Current Illness: none

ID: 1591626
Sex: M
Age: 16
State: NY

Vax Date: 08/18/2021
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: Site: Swelling at Injection Site-Mild, Systemic: Chills-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: Fever-Severe, Systemic: no appetite-Severe, Systemic: Weakness-Severe

Other Meds:

Current Illness:

ID: 1591627
Sex: F
Age: 69
State: GA

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: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Codeine

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient administered 0.3ml of Pfizer, that was diluted with 0.8ml diluent

Other Meds: Gabapentin, wellbutrin, atorvastatin

Current Illness: unknown

ID: 1591628
Sex: F
Age: 60
State: DC

Vax Date: 05/01/2021
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: RA

Lab Data:

Allergies:

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

Symptoms: First dose administered on 05/01/21 excess 42 days no adverse effect noted

Other Meds:

Current Illness:

ID: 1591629
Sex: M
Age: 60
State: AL

Vax Date: 06/14/2021
Onset Date: 06/15/2021
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: None

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

Symptoms: The next day he started feeling bad. That Thursday he started feeling dizzy felt that way for two days. Sunday he started to feeling better and has since been diagnosed with Vertigo. Feels as though the earth is moving all day until he falls asleep. Unable to talk for long periods of time.

Other Meds: None

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm