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: 1591785
Sex: F
Age: 43
State: NY

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

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

Lab Data:

Allergies: Sulfa Drugs

Symptom List: Dysphagia, Epiglottitis

Symptoms: I had no symptoms within the first 24 hours of the vaccine. The joint pain started about a day or two after the vaccine. It was intermediate and the lack of range of motion was about 2 weeks after the vaccine. I went the doctor July 26th, and they prescribed physical therapy. I have not had my first appointment for physical therapy yet.

Other Meds: Allegra

Current Illness:

ID: 1591786
Sex: M
Age: 17
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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Pt was given both doses of covid vaccine but did not have adverse reactions in office. pt waited 30mins for possible side effects.

Other Meds:

Current Illness:

ID: 1591787
Sex: F
Age: 68
State:

Vax Date: 05/26/2021
Onset Date: 07/19/2021
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: Ibuprofen

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

Symptoms: DVT of leg, hematoma, anticoagulation, drainage of hematoma

Other Meds:

Current Illness:

ID: 1591788
Sex: M
Age: 54
State: IA

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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient was given the wrong 2nd dose covid vaccine. Patient received 1st Covid vaccine on 7/23/2021 of the Moderna. On 8/20/2021 the patient was administered the 2nd covid vaccine, Pfizer. Patient was monitored for 20 mins with no adverse reaction.

Other Meds:

Current Illness:

ID: 1591789
Sex: F
Age: 21
State: GA

Vax Date: 08/19/2021
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: Allergic to seasonal allergies, pets, fruits

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

Symptoms: Ringing in ears; tinnitus

Other Meds: N/a

Current Illness: N/a

ID: 1591790
Sex: M
Age: 65
State: TX

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: After vaccine patient felt nausea, anxious, and light headed. Vitals were taken: BP 170/92, pulse 60, O2 98%, temp 98.0, respiration 24. Provided water and advised to take deep breaths. Monitored for 15 minutes Patient stated he felt better. Advised if he encountered symptoms' again call emergency services. He was cleared.

Other Meds:

Current Illness:

ID: 1591791
Sex: M
Age: 79
State: CT

Vax Date: 03/29/2021
Onset Date: 05/04/2021
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: no

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: muscle and joint pain

Other Meds:

Current Illness: none

ID: 1591792
Sex: F
Age: 30
State: FL

Vax Date: 07/26/2021
Onset Date: 08/02/2021
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: LA

Lab Data:

Allergies: No

Symptom List: Pharyngeal swelling

Symptoms: Received vaccine 07/26/2021 Right arm . The next day my upper right side of Chest felt almost swollen/ stiff, no physical pain. On roughly 08/02/2021, I noticed that the feeling of my upper right side of chest felt almost swollen/stiff again, but this time, above my collarbone the area was sensitive to the touch. In addition, upon feeling around the area, I noticed a small bump were my vein/ tendon is. I researched and found that others experienced similar cases with the Pfizer shot. I did not seek medical attention as the tenderness and swollen feeling went away after about 5 days. I have received my second dose today, 8/20/2021 and was told to report my Adverse reaction to the first dose.

Other Meds: Nature's Bounty: Women's Multivitamin Gummies

Current Illness: No

ID: 1591793
Sex: M
Age: 30
State: LA

Vax Date: 04/03/2021
Onset Date: 04/07/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: I took the Pfizer vaccine on the morning of April 3, 2021. Four days later, I woke up and the left side of my face was numb. I contacted my primary care doctor and was directed to go to the ER due to medical concerns. After the doctor examined me, I was diagnosed with Bell's Palsy. I was prescribed prednisone 20 MG Tablets that I took 3 tabs daily for 7 days, then 2 tabs for 4 days, then 1 tab for 4 days then 1/2 tab for 4 days then stop. I also took 1 valacyclovir 1000MG tablet by mouth 3 times daily for 7 days. After completing the medication, I recovered 100%.

Other Meds: none

Current Illness: none

ID: 1591794
Sex: F
Age: 102
State: ME

Vax Date: 05/18/2021
Onset Date: 05/19/2021
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: ANTIBIOTICS; BLOOD PRESSURE MEDICINES; PENICLIN; SOME IV MEDICINES; LAVACINE; DYCYCLINE; THERAMAPILE; HYPERSOCKIN; VALSATAN; DOXAXINE; COZA; VENADINE; PHELAX; ARTIFICAL SWEETNESS

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Severe muscle pain in her hands and her arm and was very painful in her neck. When the pain started we saw the doctor and they said she had PMR and they put her on phenazone. When she was off pentanone the pain came back. She got fatigue and it's still going.

Other Meds: BLOOD PRESSURE MEDICINE; PHOLOPHINE

Current Illness: NONE

ID: 1591795
Sex: F
Age: 67
State: FL

Vax Date: 02/23/2021
Onset Date: 07/23/2021
Rec V Date: 08/20/2021
Hospital: Y

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

Lab Data:

Allergies: NKDA

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

Symptoms: 8/9/21: Patient presents with generalized weakness, acute symptomatic anemia Per patient, she tested positive for COVID-19 3 weeks ago, and reports having completing her COVID-19 vaccines in January and February. Of note, patient was previously vaccinated with Pfizer COVID-19 Vaccine, last dose in February 2021. Pt was sent to ED by her GynOncologist due to a low hemoglobin count and requests for a blood transfusion. 8/10/2021: Patient discharged home 1. Stage IV poorly differentiated uterine carcinoma with squamous differentiation with worsening abdominal pelvic lymphadenopathy and New left pelvocaliectasis and ureterectasis concerning for distal ureteral obstruction or stricture possibly secondary to compression from the adjacent soft tissue nodularity in the lower pelvis 6/2021. 2. Acute deep venous thrombosis noted in the left common femoral vein, superficial venous thrombosis noted at the sapheno-femoral junction on Eliquis 5mg BID 10/2020. 3. Caris: MSI high, TMB high, PTEN path variant, PDL1 negative 10/15/2021.

Other Meds: acetaminophen prn, apixaban, docusate prn, fluticasone nasal, lisinopril, metoprolol, montelukast, MVI, pravastatin

Current Illness: n/a

ID: 1591796
Sex: M
Age: 78
State: GA

Vax Date: 02/14/2021
Onset Date: 03/24/2021
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: SYR
Vax Site: RA

Lab Data:

Allergies: Aleve; cipro; levothyroxine

Symptom List: Rash, Urticaria

Symptoms: I had fever, confusion, stomach pain, and unable to walk. Went to ER and diagnosed with Colitis. Administered to intensive care for three days. IV antibiotics and followed up with oral antibiotics when released. The symptoms have resolved about 2 weeks later.

Other Meds: Multivitamin; CoQ10; probiotic; baby aspirin; valsartan; levaterecum (Cepra); lamictal; Plavix; Protonix; Thyroid MP natural pig thyroid; cimetidine; hydralazine; escitalopram (Lexapro); oxybutynin; vit D

Current Illness: No

ID: 1591798
Sex: F
Age: 66
State: DE

Vax Date: 02/17/2021
Onset Date: 02/18/2021
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: LA

Lab Data:

Allergies: Penicillin; Sulfa; Clyndamiacyn

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

Symptoms: 02/18/2021 I had a light red rash on my left arm below the injection site. It lasted three days.

Other Meds: I take a BP medication called Losartan; Multivitamin

Current Illness: No

ID: 1591799
Sex: F
Age: 34
State: CO

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

Lab Data:

Allergies:

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

Symptoms: Itchy, trouble staying asleep, headache. I am also breastfeeding my 10mth old son and he struggled to fall asleep and stay asleep for 48 hours following my vaccine.

Other Meds: Prenatal vitamins, fiber, probiotic, collagen

Current Illness:

ID: 1591800
Sex: F
Age: 64
State: MI

Vax Date: 07/23/2021
Onset Date: 07/23/2021
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: N/A

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

Symptoms: 5 minutes after receiving the vaccine I developed shortness of breath, wheezing, tachycardia, GI symptoms, and later followed by generalized hives.

Other Meds: Synthroid 0.125 mcg/daily

Current Illness: N/A

ID: 1591801
Sex: M
Age: 16
State: AK

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: No known allergies to meds, foods, or environmental.

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

Symptoms: Pfizer Vaccine bottle was expired after June 30, 2021. No adverse reactions observed or reported.

Other Meds: None

Current Illness: None

ID: 1591802
Sex: F
Age: 37
State: PA

Vax Date: 08/13/2021
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:

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

Symptoms: I received the vaccine at 3:30 pm, at my job. I went home and later that event around 8:30 pm, I became severely fatigued, weak, tingling in both my legs and a severe headache. Those symptoms have lasted since receiving the vaccination. I developed chest pain and shortness of breath on the 18th of August. I was seen in the emergency room on the 19th and had blood work done. D-dimer test came back elevated and a Ct scan was done on my chest only. No pulmonary clots were been found. Symptoms are still present. I take Tylenol for the headache which offers temporary relief.

Other Meds:

Current Illness:

ID: 1591803
Sex: F
Age: 80
State:

Vax Date: 08/16/2021
Onset Date: 08/16/2021
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:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Pt received a dose of this, instead of Moderna, which she received the previous 2 doses

Other Meds:

Current Illness:

ID: 1591804
Sex: M
Age: 69
State: FL

Vax Date: 03/17/2021
Onset Date: 08/06/2021
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: mango, PCN

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: 8/3/2021: Patient admitted with increased abdominal distention, shortness of breath and decompensated CHF secondary to dietary indiscretion and medication noncompliance. Patient also has elevated troponin secondary to demand ischemia with a baseline heart failure. 8/6/2021: Patient tested COVID positive; on RA. Had rinus of NSVT 10 and 5 beats. Awaiting temporary HD cath placement. Of note, patient was vaccinated with the Moderna COVID-19 vaccine, last dose administered March 2021. 8/16/2021: Patient still admitted at the time of this report submission

Other Meds: unknown

Current Illness: n/a

ID: 1591805
Sex: F
Age: 74
State: MN

Vax Date: 02/18/2021
Onset Date: 02/19/2021
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: No, migraines for certain food - soy sauce

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

Symptoms: My symphons were lightly sore arm and took the two Tylenol on the same day and the pain went away 2 -3days. The other was extra fatigue for about one off and on.

Other Meds: Levothyroxine; citalopram; acetaminophen; multivitamin; vitamin C; calcium with D; biotin

Current Illness: Maybe a migraine

ID: 1591806
Sex: M
Age: 53
State: KY

Vax Date: 04/15/2021
Onset Date: 08/17/2021
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: Tested positive for COVID19 on 8/17/2021

Other Meds:

Current Illness:

ID: 1591807
Sex: M
Age: 55
State: CA

Vax Date: 02/12/2021
Onset Date: 07/15/2021
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: Wheat

Symptom List: Unevaluable event

Symptoms: Elevated blood pressure, Tinnitus; I was prescribed medication for the blood pressure. Also, I will be seeing a ENT doctor soon. My blood pressure has improved with the medicine, but the ringing in my ear has continued.

Other Meds: Viibryd; Lisinopril; Rosuvastatin; Pantoprazole; Fenofibrate; Gabapentin; Coq10

Current Illness:

ID: 1591808
Sex: M
Age: 90
State: FL

Vax Date: 02/04/2021
Onset Date: 07/24/2021
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:

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

Symptoms: Hospitalization 7/24/21-8/6/21

Other Meds:

Current Illness:

ID: 1591809
Sex: F
Age: 47
State: IN

Vax Date: 02/17/2021
Onset Date: 03/01/2021
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: penicillan

Symptom List: Injection site pain, Pain

Symptoms: I have limited mobility and deep inflammation in both of my shoulders. I saw my Dr., who then, referred me to a physical therapist to try and regain some mobility.

Other Meds: none

Current Illness: none

ID: 1591810
Sex: F
Age:
State: MN

Vax Date:
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:

Symptom List: Injection site pain, Menorrhagia

Symptoms: None stated.

Other Meds:

Current Illness:

ID: 1591811
Sex: M
Age: 71
State: MI

Vax Date: 02/17/2021
Onset Date: 04/01/2021
Rec V Date: 08/20/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: irregular heart rhythm was first diagnosed by ECG in Doctors office 8/19/2021 - low BP, high Pulse has been happening on and off and was first noted the first week of June 2021 - before that I had felt strange but just put it off to being overly tired because of some remodeling work I was doing in the house starting 1st week of March. Looking back it was the same time frame that I received the Covid vaccine, 1st shot 2/17/21, 2nd shot 3/10/21. Who knows?

Other Meds: Atorvastatin 80 MG Tab 1 a day (Lipitor) COQ-10 100MG over the counter Chlorthalidone 25 MG tab 1 a day

Current Illness: none

ID: 1591812
Sex: F
Age: 24
State: TN

Vax Date: 08/09/2021
Onset Date: 08/09/2021
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: I have had a headache every single day since the shot. It?s manageable but it?s annoying and will start hurting real bad right before I go to bed. Only way it will stop is if I will take 4 ibuprofen. I can?t take that many every single day.

Other Meds: Birth control

Current Illness: None

ID: 1591813
Sex: F
Age: 62
State: MO

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: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: PATIENT CAME BACK ON 8/20/21 AFTER RECEVING COVID-19 VACCINE ON 8/17/2021. SHE HAS A RED, WARM, FIRM WELT ON LEFT ARM IN THE TRICEPS AREA. SHE REPORTS IT IS WHERE THE VACCINE WAS GIVEN.

Other Meds:

Current Illness:

ID: 1591814
Sex: M
Age: 17
State: MI

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: RA

Lab Data:

Allergies:

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

Symptoms: No adverse event, this was an administration error. Patient was given Janssen vaccine at age 17. Patient and guardian were counseled and told that currently Janssen is only approved for age 18 and up. Patient was monitored for 15 minutes with no adverse events.

Other Meds:

Current Illness:

ID: 1591815
Sex: M
Age: 57
State: CA

Vax Date: 03/21/2021
Onset Date: 08/13/2021
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: nka

Symptom List: Nausea

Symptoms: 58M with HLD, PreDM, Due to culture (declines blood products), OA of both knees s/p knee arthroplasty who presented with cough, fever, sweats, and SOB. COVID Pneumonia/Acute hypoxemic Respiratory failure - symptom onset on 8/6. COVID positive on 8/9/21. Last fever 8/13/21 in ED. Received J&J vaccine 3/21/21. D-dimer remains >4. CRP improving. Chest CT on 8/13 negative for PE. - FiO2 down to 1L NC, cont to wean as tolerated - cont decadron 6mg daily for up to 10 days (8/13 - ) or until no longer hypoxic - completed 5 day course of remdesivir (8/13 - 17) - cont pepcid for GI prophylaxis - cont to trend inflammatory markers - continue isolation in hospital Insomnia - slept well - cont melatonin 9 mg QHS - cont trazodone 25mg qHS OSA (?) - - cont CPAP q HS as tolerated - will need sleep study outpatient PreDM - BS's Ok will dc ISS

Other Meds: Unknown

Current Illness: None

ID: 1591816
Sex: M
Age: 38
State: TX

Vax Date: 05/18/2021
Onset Date: 06/01/2021
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: Within a week or two weeks after getting my vaccine, on my left sinus I grew a mass that was about half an inch in diameter. That caused complete blockage in my sinus track. I was unable to breathe and had an infection show up. The mass was removed July 26th by a Dr. On August 6, we found out it was classified as a small blue cell malignant tumor. I am going to MD at the end of the month on August 31st to undergo further tests and treatment. This tumor is extremely rare. I am the 4th person that they have found this tumor on. The mass was sent to a diagnostics lab. One of the tumors came out on it's own and I nearly bled out so I went to the ER. They were able to get the bleeding to stop.

Other Meds:

Current Illness:

ID: 1591817
Sex: F
Age: 33
State: CA

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: Bactrim

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

Symptoms: Pt received vaccine and roughly 2 minutes later began to experience hot flashes, nausea, sweaty palms, and shortness of breath. She alerted pharmacy personnel who assessed patient for anaphylaxis. Pt was A&O x4, able to relay her name, age, where she was, and the year. Slightly altered mental state, slow to understand questions and maintain eye contact but could track when asked and answered all questions correctly. Pt was able to take breaths and shallow breathing lasted less than 60 seconds. RPh opted not to administer epipen, though one was readily available. Pt was assisted by 3 individuals to a shaded spot out of the sun, and ambulated without issue. Emergency response team was called to assess. Pt symptoms began to dissipate within minutes, mostly gone by the time EMS arrived. BG was 109, BP 127/77 sitting and standing, HR 86, EKG was normal. Pt refused transport to hospital and was observed for 30 more minutes until she drove home. Verbalized having a husband and son at home to keep an eye on her and that if symptoms returned she would seek emergent assistance. No history of fainting or allergic reaction in the past to vaccine or medication besides bactrim.

Other Meds: Hydrocortisone

Current Illness:

ID: 1591818
Sex: F
Age: 60
State: AL

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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: na

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

Symptoms: 16 hours later 8/19 extreme chills , fatigue, body aches everywhere and fever up to 102.5 that would not reduce. 8/20 low grade fever . and body aches I went back to Pharmacy 8/20 at 11 am and talked to pharmacist who said this was normal. Missed 1.5 days of work

Other Meds: vitamins

Current Illness: 48 hour summer cold 1.5 weeks before

ID: 1591819
Sex: F
Age: 53
State: FL

Vax Date: 01/11/2021
Onset Date: 08/03/2021
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: NKDA

Symptom List: Tremor

Symptoms: 8/8/2021: Pt presents with SOB, COVID +. States she was out of town with her fiance and had a known COVID exposure so she got tested outpatient and ended up testing positive with her fiance on 08/3/2021. Reports having symptoms of a cough, nausea, diarrhea, fevers (reaching 103 that she states have been better), chills, myalgias, decreased appetite and headaches. Reports having generalized fatigue and intermittent shortness of breath over the last several days but she SOB started worsening last night with worsening fatigue/weakness this morning. Reports her oxygen saturations at rest were ranging from 90-91% at home and would drop in the 80s with activity or coughing spells. She states she currently has

Other Meds: unknown

Current Illness: n/a

ID: 1591821
Sex: M
Age: 32
State: FL

Vax Date: 02/17/2021
Onset Date: 07/28/2021
Rec V Date: 08/20/2021
Hospital: Y

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: Erythema, Pruritus

Symptoms: Did not received second dose. Hospitalization 07/28/21-08/03/21. Received Remdesivir 7/29-8/2 and dexamethasone 6 mg IV daily 7/29-8/3

Other Meds:

Current Illness:

ID: 1591823
Sex: F
Age: 34
State: KY

Vax Date: 04/01/2021
Onset Date: 08/10/2021
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: unknown

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

Symptoms: None

Other Meds: unknown

Current Illness: unknown

ID: 1591825
Sex: F
Age: 87
State: FL

Vax Date: 04/08/2021
Onset Date: 08/05/2021
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: LA

Lab Data:

Allergies: NKDA

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

Symptoms: 8/5/2021: CC: Congested and headache. Patient states when she woke up this morning she was having tremendous difficulty swallowing and noted that she was unable to speak. When she tried to speak she states her low words were all slurred and garbled. She did complain of mild dizziness. A CT scan of the brain showed old lacunar infarct in the right thalamus, and noted chronic right sphenoid sinusitis suspicious for mycetoma. There is no 12 lead EKG for review. Her BP was 209/94 on admission. Patient stated she did not take her antihypertensive medications this morning. She was treated with intravenous hydralazine and labetalol. The patient also states she has been having a nonproductive cough. Patient tested positive for COVID-19 on 8/5/2021 following admission. Of note, patient previously received Pfizer COVID-19 vaccine, last dose in April 2021. 8/7/2021: Patient discharged home

Other Meds: apixaban, ASA, atorvastatin, carvedilol, cefuroxine, dicyclomine prn, difluprednate opthalmic 0.05%, ofloxacin opthalmic 0.3%, ondansetron prn, oxycodone-acetaminophen prn, pioglitazone, travoprost opthalmic 0.004%

Current Illness: accidental fall/left shoulder fracture, nausea/diarrhea

ID: 1591826
Sex: M
Age: 41
State: TX

Vax Date: 03/15/2021
Onset Date: 06/30/2021
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: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Joint pain and sensation of febrile. I was an avid runner prior and now cannot due to bilateral ankle pain for past 3 months. I am currently undergoing physical therapy and work up for possible autoimmune condition.

Other Meds: Zyrtec

Current Illness: None

ID: 1591827
Sex: M
Age: 66
State: TN

Vax Date: 01/02/2021
Onset Date: 06/01/2021
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: Reports shingles in June 2021 after receiving COVID vaccine in Jan and Feb

Other Meds:

Current Illness:

ID: 1591828
Sex: M
Age: 73
State: PA

Vax Date: 03/01/2021
Onset Date: 06/01/2021
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: none

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

Symptoms: very tired. noticeable about 3 months after vaccination and seems to be getting worse. now 6 months after second shot and i am extremely tired daily, needing to take a nap in the afternoon.

Other Meds: tikosyn, metoprolol, lisinoprol, inspra, eliquis

Current Illness: none

ID: 1591829
Sex: F
Age: 62
State: NY

Vax Date: 07/24/2021
Onset Date: 07/01/2021
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: Pain in extremity

Symptoms: Big bruises on legs and on arms. Dizziness when turning head or looking up. Hard time standing when dizzy. Fatigue even after getting full night's sleep.

Other Meds: None

Current Illness: None

ID: 1591830
Sex: F
Age: 66
State: MO

Vax Date: 02/12/2021
Onset Date: 02/12/2021
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: shellfish and sulfur

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

Symptoms: Flu-like symptoms and pneumonia.

Other Meds: Thyroid Medication

Current Illness:

Date Died: 07/30/2021

ID: 1591831
Sex: M
Age: 83
State: FL

Vax Date: 02/01/2021
Onset Date: 07/10/2021
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: NKA

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

Symptoms: SOB, fever

Other Meds:

Current Illness:

ID: 1591832
Sex: F
Age: 73
State: NY

Vax Date: 02/16/2021
Onset Date: 03/12/2021
Rec V Date: 08/20/2021
Hospital:

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

Lab Data:

Allergies: Lariam, doxycycline

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

Symptoms: I had swelling of left ankle beginning early to mid-March; I monitored this; it got worse, and I was sent for a doppler sonogram on April 21, 2021. A DVT was identified, and I was put on Xarelto for 4 weeks; the clot is gone. It was determined that the DVT was unprovoked, and there is no explanation for why it occurred.

Other Meds: hydrochlorothiazide 12.5 mg; Klot-Con M20; Vitamin Dc 25 mcg; Centrum silver

Current Illness:

ID: 1591833
Sex: F
Age: 42
State: FL

Vax Date: 05/04/2021
Onset Date: 08/01/2021
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: Hospitalization 08/01/21-08/04/21

Other Meds:

Current Illness:

ID: 1591834
Sex: F
Age: 60
State: FL

Vax Date: 03/15/2021
Onset Date: 07/24/2021
Rec V Date: 08/20/2021
Hospital: Y

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

Lab Data:

Allergies: darvocet, lyric, sensitivity to codeine

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: 8/6/21: Pt s/p BOLT who presents via 911 due to generalized weakness. Pt reports that she went to the bathroom today and she lowered herself to the ground and then could not get up so she called 911. EMS reports that the was hypotensive with systolics in the 80s. Onset: 1 day. Presents to ED with COVID-19 as of 7/24/2021. Pt was just dc on 7/29 and treated for COVID-19 pneumonia with 5 day course of Remdesivir, Dexamethasone, and monoclonal Ab. Rapid response 8/9 for Afib RVR and worsening hypoxia. Of note, pt received Moderna COVID vaccine, last admin March 2021 8/16/2021: Pt still admitted at the time of this report submission (last admission+current= total 16 days hospitalized due to current COVID infection)

Other Meds: acyclovir, atorvastatin, atovaquone, azithromycin,

Current Illness: n/a

ID: 1591835
Sex: M
Age: 14
State: LA

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: RA

Lab Data:

Allergies: none

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

Symptoms: The patient's guardian requested Moderna for the underage patient. The patient was given the Moderna vaccine; however, the patient is not of age to receive the Moderna vaccine. The pharmacist administering the shot was aware of the age and that Moderna is 18 and older; however, still administered the shot by mistake. The patient's legal guardian was notified of the mistake as soon as the error was caught by the pharmacist that gave the shot.

Other Meds: none

Current Illness: The incident just occurred this morning. There are no reported illnesses at the moment that have been reported to the facility.

ID: 1591836
Sex: F
Age: 34
State: CA

Vax Date: 02/12/2021
Onset Date: 02/13/2021
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: gold and nickel

Symptom List: Injection site swelling, Limb discomfort

Symptoms: SHOOTING PAIN IN MY NECK AND HEADACHE AND THE NEXT DAY I HAD CHILLS AND THE PAIN WAS KIND OF WORST. And the pain with my periods is really bad. I am getting lysergic and can't move and just lay down with the heat pad to keep it better. the doctors found some lumps on my ovaries and now the doctors are giving me birth control pill

Other Meds: paxcill

Current Illness: none

ID: 1591837
Sex: F
Age: 18
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: RA

Lab Data:

Allergies: None

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

Symptoms: Hives appeared all over patient's body and some "tightness" in throat. Symptoms started the afternoon of 8/17/21, after receiving the second dose of the Pfizer COVID-19 vaccine at Tthe Vaccination Center. Patient given a steroid injection Depo 80mg mixed with Celestone 6mg- IM in our office on 08/18/21. Patient also prescribed Pepcid AC (famotidine) tablet 20 mg, Take 1 tablet by mouth three times a day and hydroxyzine HCl (hydroxyzine hcl) tablet 25 mg, Take 1 tablet by mouth three times a day.

Other Meds: None

Current Illness: None

ID: 1591838
Sex: M
Age: 12
State: AK

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

Lab Data:

Allergies: None

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

Symptoms: No adverse event observed or reported by patient. Vaccine was expired after June 30. 2021.

Other Meds: None

Current Illness: No

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm