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

Incidents per State

State Total
92,076
AK1,880
AL6,345
AR4,151
AS46
AZ14,991
CA66,887
CO12,550
CT8,943
DC1,795
DE2,009
FL42,724
FM4
GA17,031
GU124
HI2,580
IA4,919
ID2,892
IL22,128
IN24,197
KS5,047
KY9,111
LA5,500
MA15,718
MD13,434
ME3,351
MH8
MI20,971
MN13,585
MO10,747
MP30
MS3,198
MT2,477
NC18,051
ND1,501
NE3,109
NH3,218
NJ20,216
NM4,218
NV4,728
NY37,667
OH20,793
OK6,692
OR9,244
PA25,607
PR2,588
QM2
RI2,163
SC7,261
SD1,282
TN10,445
TX39,890
UT4,618
VA15,980
VI67
VT1,830
WA16,071
WI12,042
WV2,571
WY926
XB5
XL1
XV2

ID: 1108438
Sex: F
Age: 43
State: CA

Vax Date: 03/14/2021
Onset Date: 03/15/2021
Rec V Date: 03/17/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Site: Swelling at Injection Site-Severe, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Medium

Other Meds:

Current Illness:

ID: 1108439
Sex: M
Age: 69
State: AZ

Vax Date: 02/19/2021
Onset Date: 03/08/2021
Rec V Date: 03/17/2021
Hospital: Y

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List: Anxiety, Dyspnoea

Symptoms: Acute Embolic Stroke (Diagnostic Code I63.9)

Other Meds: Metoprolol Succinate 50mg, Irbesartan 300mg, Amlodipine Besylate 5mg

Current Illness: None

ID: 1108440
Sex: F
Age: 20
State: MI

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/17/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Escitalopram Quetiapine

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

Symptoms: Pt has been vomiting and experiencing extreme body aches, headache and SOB

Other Meds: Bupropion

Current Illness: Unknown

ID: 1108441
Sex: F
Age: 38
State: CA

Vax Date: 03/09/2021
Onset Date: 03/17/2021
Rec V Date: 03/17/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: NA

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Sore arm shortly after the vaccination. Muscle soreness in the area of the injection site, large red bumps, severe itchiness and swollen arm in the injection site (did not appear until 3/17...6 days after the initial shot).

Other Meds: NA

Current Illness: NA

ID: 1108442
Sex: M
Age: 73
State: NH

Vax Date: 03/11/2021
Onset Date: 03/11/2021
Rec V Date: 03/17/2021
Hospital: Y

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: GI intolerance to Erythromycin Seasonal allergens

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

Symptoms: Hospitalization Pleuritis with Extreme pain upon breathing. Controlled with intravenous narcotics, oral agents at discharge Intermittent Atrial fibrillation

Other Meds: Bupropion Asa Vit D Xyzal Famotidine

Current Illness: None

ID: 1108443
Sex: M
Age: 60
State: AZ

Vax Date: 03/13/2021
Onset Date: 03/14/2021
Rec V Date: 03/17/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Chills, Confusional state, Eye inflammation, Headache, Laboratory test

Symptoms: fever, chills, myalgias, SOB, increase in baseline cough. Some symptoms improving after 24 hours of onset but SOB and increase in cough still present at 72 hours post-vaccination.

Other Meds: Symbicort

Current Illness: recovering from "long-haul COVID-19"

ID: 1108444
Sex: F
Age: 22
State: NY

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/17/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Dairy, sesames, scallops, gluten

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Extreme dizziness ,tightness in chest, Stomach pain extreme fatigue, muscle pain, lightheadedness

Other Meds: Zoloft, plumacort, albuteral, Flonase, zertec, zofran

Current Illness: Had covid 1 month ago

ID: 1108445
Sex: M
Age: 54
State: TX

Vax Date: 03/16/2021
Onset Date: 03/17/2021
Rec V Date: 03/17/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Systemic: Allergic: Difficulty Breathing-Medium, Systemic: Headache-Medium

Other Meds:

Current Illness:

ID: 1108446
Sex: F
Age: 84
State: PA

Vax Date: 03/15/2021
Onset Date: 03/17/2021
Rec V Date: 03/17/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Onions, MSG (Chinese food only), sulfa.

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: She got the vaccine, she had no effects, and no reaction whatsoever. The husband had no side effects either. On 3/16/21 they were on their way to go to bed and the bedroom is upstairs and she was fine, she was in the bedroom getting ready for bed, and her husband followed 15 minutes later and when he got upstairs she was sitting in a chair next to the bed, and he noticed that when he spoke with her that she did not speak clearly back, and was very low tone, not much loudness to her speech. He didn't think much about it, and he talked with her again and noticed that she seemed to be having some difficulty talking, but he could understand what she was saying if he paid close attention. He then realized that something was wrong, and asked her how she felt and she said she felt strange. She was trying to take a pair of socks off and could not reach them. She tried to lift her leg to put one knee over the other for her to remove them and was not able to do that. He helped her take the socks off, she wanted to put some cream on her foot and was not able to do so, which is her usual routine. He put that on her foot while he was talking to her, and her speech was different than it was earlier. She was wearing a turtle neck shirt and was not able to take it off to get dressed for bed. Her husband assisted in dressing her to get ready for bed. He was thinking that she may have been having a mini-stroke. She tried to get up from the chair and was not able to get up on her own. He went to try to help her to lift her and it was hard. When she did get her bottom up off the chair she stayed in a bent position and was not able to stand up. He put her back down on the chair and tried some more times, and ultimately able to get up and he was able to get her into the bed (the chair was next to the bed). She could sit on the edge of the bed, but was not able to move her legs on her own to get into the bed. He struggled to get her in the bed and was not in a mood to talk and just leaned over on one side to try to go to sleep. He told her he was going to get the walker in the basement for her to use. He brought up the walker and put in by the bed, and informed her that it was there, and reached to see where it was in the event that she needed to use it through the night. She did get up around 3:15 this morning to use the bathroom and her husband asked if she needed assistance, and she said that she was able to get up and go to the bathroom, and moved her legs just slow and was able to use the walker. She was feeling much better at that time. She got up one more time during the night and was not in need of the walker and was back to bed. This morning when they got up at 8:00 Am and she was back to her normal self. She came down the steps and was like nothing had ever happened. They called her son who works in the hospital and he told them to call us to see if there were any other people that had the same reaction. She stated while he was giving me this information that she did not recall a lot of the events that he was telling me.

Other Meds: Temazepam, Ezetimibe, magnesium, Vitamin C, Presser vision, Losartan/HCTZ, multivitamin.

Current Illness: None.

ID: 1108448
Sex: F
Age: 65
State: ME

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/17/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Unknown

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Vaccine administered at 1145. At 1200 patient reported that her heart was racing, dizziness, lightheadedness, and throat feeling "tight." BP 110/70. Symptoms progressed. 911 Called. EpiPen administered in L thigh at 1210. 1211 BP 112/60, still complaining of "throat swelling" and lightheadedness. EMS arrived at 1213 and transported patient by ambulance to Hospital emergency department at 1217.

Other Meds: Unknown

Current Illness: None

ID: 1108449
Sex: F
Age: 49
State: FL

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 03/17/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: Within 10 minutes got blurred vision and felt like going to faint. happened 3 times during first 30 minutes happened 3 times. Felt like throat was tight when swallowing . Face started to tingle and numbness lips and tongue for about 5 minutes , Tightness in throat for 2 hours . went back to Cvs and stayed for a an hour . Felt like swelling of throat for the first night . 2 days had a sore throat , little by little went away. took 3 days to swallow normal. Called her doctor for advice on second short

Other Meds:

Current Illness:

ID: 1108450
Sex: F
Age: 66
State: IA

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 03/17/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: doxycycline, Augmentin, moxifloxicin, Cholestrymine, Cipro Xl

Symptom List: Rash, Urticaria

Symptoms: After receiving the first dose on February 12, 2021 I noticed more fatigue. I had labs on February 15th. My tacrilimus increased slightly and my CMV viral load increased. After the 2nd dose on March 12, 2021, the fatigue was slightly worse. When labs were done again on March 15th, the tacilimus increased again and Dr reduced the dosage.The CMV increased more. There were no changes to the anti-viral med. Dr was also notified but have not heard back from her.

Other Meds: acetaminophen, amlodipine, vitamin C, aspirin, Bumetanide, Tums

Current Illness: Cytomegalovirus

ID: 1108451
Sex: F
Age: 39
State: IN

Vax Date: 01/16/2021
Onset Date: 01/17/2021
Rec V Date: 03/17/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Peanuts-anaphylactic Seasonal Allergies Dilaudid related medication

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

Symptoms: The day after vaccination I had fever chills and my Lymph node in my right armpit got swollen as big as a golf ball. It was sore, the pain was constant and went down after a week and half. I had a phone consult with my doctor, No symptoms after the first dose of vaccine.

Other Meds: Low Dose birth control Singular 10mg Airduo 232-14mcg Prilosec 20mg Trazadone Lexapro 20mg Allegra 20mgs Multivitamin

Current Illness:

ID: 1108452
Sex: F
Age: 51
State: NC

Vax Date: 03/04/2021
Onset Date: 03/15/2021
Rec V Date: 03/17/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Milk

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

Symptoms: Red heated circular rash on upper arm near injection site

Other Meds: Centrum 50+ Joint Supplement Magnesium Aspirin

Current Illness: None

ID: 1108453
Sex: M
Age: 72
State: AZ

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/17/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Allergic to Sulfa, some spring allergy response to pollen

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

Symptoms: Pain at site of injection, beginning in the evening, first noticed around 8:30 pm. Upon going to bed, noted a slight headache. Upon waking around 5:30 am, noted general achiness over my body, slight headache continuing. Around 6:00 am, took Tylenol for the headache and body pain, by 11:00 am headache has gone, body achiness has largely subsided.

Other Meds: Low dose blood pressure, cholesterol

Current Illness:

ID: 1108454
Sex: F
Age: 19
State: TN

Vax Date: 03/15/2021
Onset Date: 03/17/2021
Rec V Date: 03/17/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Arugula

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

Symptoms: Sudden syncope - under one minute

Other Meds: Naproxen, Flovent

Current Illness:

ID: 1108455
Sex: F
Age: 88
State: CA

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/17/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Aspirin, Vancomycin and Wellbutrin

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

Symptoms: Pt. was vaccinated on 3/17/21 at 0924. At 0940, pt. had bounded carotid pulse and decrease level of consciousness. Pt. progressed to having no pulse and chest compressions were given for about 1 minute. Pt. was given 6L of O2 and 9-1-1 was called. Pt. regained consciousness at 0945. BP 140/90, HR 62. Ambulance arrived at 0953 and pt. was assessed by EMT. Pt.?s daughter provided pt.?s medical history. Pt. has history of passing out, atrial fibrillation and seizures. Pt. left via ambulance at 1003.

Other Meds: Magnesium, Centrum Silver Ultra Women, metoprolol tartrate, Diltiazem, Keppra, Klor-con, furosemide, Digoxin, Pravastatin, vitamin D.

Current Illness: Unknown

ID: 1108456
Sex: M
Age: 56
State: PA

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/17/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient states he "felt weird", tingly all over and extremely anxious. Patient was brought to observation for continued care. vs: P-92 r-16 b/p 174/92. Repeat b/p after 15 minutes was 124/90. Patient feeling much better. Now states he had been very anxious about receiving vaccine. B/P cuff recycled it did not measure correctly- air in cuff. Repeated and up to 170/90, patient states it went up because he was worried about the cuff. Refused to have any more vital signs. Ambulated in unit, did well. Discharged home after 30 minutes.

Other Meds: Lisinopril, Metoprol, Simbastat

Current Illness: None

ID: 1108457
Sex: F
Age: 38
State: IL

Vax Date: 03/16/2021
Onset Date: 03/17/2021
Rec V Date: 03/17/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Diarrhea, body aches, and fever.

Other Meds:

Current Illness:

ID: 1108458
Sex: F
Age: 66
State: OK

Vax Date: 03/05/2021
Onset Date: 03/07/2021
Rec V Date: 03/17/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Sulfa - wheals

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

Symptoms: 3/7/2021 at 2am woke with liquid diarrhea, nausea and vomiting, and severe headache. She took Advil once late afternoon 3/7. Headache lasted a couple of days. Vomiting lasted 24 hr. Three liquid diarrhea stools/hr for 24 hr, then liquid stools approx once every hour to hour and a half. Started Imodium on 3/9 and continued to have liquid diarrhea stools 5-6 times in 24 hours. Reports significant bloating and gas. Last Imodium dose 3/12. Diarrhea stopped 3/13. She had severe fatigue from 3/7 until 3/13.

Other Meds: Baby Aspirin daily Lipitor 20 mg daily Zenlafaxine ER 150 mg daily Metoprolol 50 mg daily Trazodone 100 mg at night

Current Illness: None

ID: 1108459
Sex: F
Age: 70
State: MA

Vax Date: 03/02/2021
Onset Date: 03/02/2021
Rec V Date: 03/17/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: tree nuts, latex

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

Symptoms: Swelling, itchiness at injection site. Muscle aches. Swelling, itchiness, subside but reappear after a few days and it is still present 2 weeks after injection

Other Meds:

Current Illness:

ID: 1108460
Sex: F
Age: 67
State: IN

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/17/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: "artificial sweetners", Avelox, azithromycin, baclofen, Bextra, Ceftin, codeine, Compazine, contrast dye, Darvocet N, Duricef, Forradil,erythromycin, Keflex, latex, lisinopril, Lorcet, NSAIDS, nuts, peanuts, penicillin, povidone iodine, Prnivil, shellfish, Skelzsin, sulfa, Toradol, Ultram, vancomycin, Vicodin, Xolair, Zestril

Symptom List: Unevaluable event

Symptoms: 67 year old female with PMH of HTN, HFpEF, history of DVT, obesity, migraines, gastroparesis, Sicca symptoms, asthma, chronic bronchitis, and GERD who presents with anaphylactic reaction s/p COVID vaccine administration. Received COVID vaccine across the street (<1 minute EMS ride) C/o itching, cough, and wheezing shortly after No respiratory distress or hypoxia en route Received IM epi (2 weeks expired) and Benadryl PTA Symptoms improving now Has extensive allergy list Review of Systems 10 point ROS completed and negative except noted in HPI above Physical Exam/Objective Vitals & Measurements last 24 hours VITAL SIGNS Temp C: 36.3 DegC Heart Rate: 87 bpm Resp Rate: 16 br/min BP #1: 139 / 59 mmHg SpO2 (%): 99 % O2 Device: Room air Height CM: 152.4 cm Ideal Body Weight: 45.5 kg General: NAD, well-nourished Eyes: No scleral icterus, EOMI HENT: Normocephalic, atraumatic, no airway edema Neck: Supple, intact range of motion Respiratory: Lungs CTAB, symmetric chest wall expansion, no wheezes, speaking in full sentences Cardiovascular: RRR, no murmur, +2 peripheral pulses Abdomen: Soft, NTTP, non-distended Musculoskeletal: No gross deformity Integumentary: Intact, warm, dry, no rashes Neurologic: A&O x 3, no focal deficits Psychiatric: Cooperative, appropriate mood and affect Medical Decision Making 67 year old female with extensive PMH including asthma, chronic bronchitis, and GERD who presents with anaphylactic reaction s/p COVID vaccine administration. Has long list of allergies. On exam, airway intact, no respiratory distress, no wheezing, speaking in full sentences, C/o subjective itching and cough that is starting back up. IV methylprednisone IV famotidine Albuterol PRN Benadryl PRN Observe Rx EpiPen upon discharge Re-Assessment Observed for >4 hours Symptoms resolved Counseled patient on EpiPen use and gave strict return precautions Has albuterol and Benadryl in her purse Has had many reactions in the past and is very familiar with how to manage them Discharge home with daughter

Other Meds: Abaloparatide, aspirin, cevimeline, cholecalciferol, clonazepam, cyanocobalamin, cyclosporine opthalmic, diltiazem, duloxetine, erenumab, famotidine, furosemide, levealbuterol, metoprolol, multivitamin, pantoprazole, potassium chloride, pra

Current Illness: see ED notes

ID: 1108461
Sex: M
Age: 51
State: IN

Vax Date: 03/15/2021
Onset Date: 03/16/2021
Rec V Date: 03/17/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Penicillin

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

Symptoms: Extreme headache, fever, nausea, leg cramps

Other Meds:

Current Illness:

ID: 1108462
Sex: F
Age: 73
State: NV

Vax Date: 02/12/2021
Onset Date: 03/12/2021
Rec V Date: 03/17/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Dilantin (Seasonal)

Symptom List: Injection site pain, Pain

Symptoms: passed out VOMITING DIDN'T TAKE TYLENOL couldn't open mouth PRESSURE TOP OF HEAD

Other Meds: citalopram 20 WG tab ferrous sulfate 325 MG tab lovastatin 40 MG tab. primidone 250 MG tab. All Day Allergy PO Aspirin 81 PO BIOTIN PO Calcium-Vitamin D3 PO cranberry PO Vitamin B Complex PO Multivitamin PO Vitamin D3 PO

Current Illness: none

ID: 1108463
Sex: M
Age:
State: NC

Vax Date: 02/15/2021
Onset Date: 02/22/2021
Rec V Date: 03/17/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: sulfa

Symptom List: Injection site pain, Menorrhagia

Symptoms: Rash on left/right arm and to lower ribs. Continues to spread to right wrist. Consulted MD and was prescribed mometasone furoate0.1%. Has helped some but hasn't cleared completely.

Other Meds:

Current Illness:

ID: 1108464
Sex: F
Age: 41
State: SC

Vax Date: 03/08/2021
Onset Date: 03/15/2021
Rec V Date: 03/17/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None

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

Symptoms: Tennis ball size (diameter) knot at injection site, very itchy and hot to the touch. Sore lymph nodes under arm, on the same arm as the injection.

Other Meds: None

Current Illness: None

ID: 1108465
Sex: F
Age: 50
State: UT

Vax Date: 03/11/2021
Onset Date: 03/12/2021
Rec V Date: 03/17/2021
Hospital: Y

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: NA

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Heart was in A-fib, blood clot formed and had a Left Posterior Parietal Stroke

Other Meds: NA

Current Illness: NA

ID: 1108466
Sex: F
Age:
State: FL

Vax Date: 03/15/2021
Onset Date: 03/15/2021
Rec V Date: 03/17/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: cheeks red, caller states this is her cousin who just texted her to say her symptoms resolved

Other Meds:

Current Illness:

ID: 1108467
Sex: F
Age: 63
State: OH

Vax Date: 03/02/2021
Onset Date: 03/09/2021
Rec V Date: 03/17/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: 4" round red circle developed on patient's left arm approximately one week after receiving vaccine

Other Meds:

Current Illness:

ID: 1108468
Sex: F
Age: 60
State: AK

Vax Date: 03/15/2021
Onset Date: 03/15/2021
Rec V Date: 03/17/2021
Hospital:

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Allergies: Perfume/ grass/ flowers

Symptom List: Nausea

Symptoms: Numbness in mouth, lips teeth, Redness in face, itching on face and head, rash across arms and chest. Joint pain, fatigue. Took Benadryl went to bed.

Other Meds: None

Current Illness: None

Date Died: 01/25/2021

ID: 1108469
Sex: F
Age: 77
State:

Vax Date: 01/06/2021
Onset Date: 01/25/2021
Rec V Date: 03/17/2021
Hospital:

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Allergies:

Symptom List: Injection site pain

Symptoms: Deceased Narrative: This was a 77 yo F with h/o HFpEF, afib (warfarin), COPD, obesity hypoventilation syndrome, OSA on BiPAP, T2DM, RA, L-sided follicular bronchitis and newly diagnosed probably malignant pulmonary process. Patient was admitted to facility 9/26-10/15 for acute on chronic hypercarbic respiratory failure with persistent O2 requirement despite treatment for CAP, COPD and CHF exacerbation. Patient then underwent high dose steroid taper per Rheum. Patient presented an overall poor state of health and was at high risk of complications with any procedures and was not a candidate for systemic therapy for a malignancy based on functional status. Patient was accepting of terminal diagnosis and transitioned to comfort measures at home.

Other Meds:

Current Illness:

Date Died: 02/23/2021

ID: 1108470
Sex: M
Age: 88
State:

Vax Date: 03/15/2021
Onset Date: 02/12/2021
Rec V Date: 03/17/2021
Hospital:

Vax Type:
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Allergies:

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

Symptoms: Pulmonary Embolism Narrative: Patient was hospitalized with acute pulmonary embolis on 2/12/2021. Was started on Eloquis and discharged on 2/15/2021, with primary diagnosis of acute PE and BLE DVT. Secondary diagnosis of acute systolic heart failure with bilateral pleural effusions. On 2/17 we got notification that patient was placed on hospital.

Other Meds:

Current Illness:

Date Died: 02/20/2021

ID: 1108471
Sex: M
Age: 76
State:

Vax Date: 02/12/2021
Onset Date: 02/20/2021
Rec V Date: 03/17/2021
Hospital:

Vax Type:
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Lab Data:

Allergies:

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

Symptoms: death Narrative: Pt received 1st moderna covid vaccine 2/12/2021 and passed away of unknown causes 2/12/2021 Pt 76 year old with AAA,HTN,CKD,COPD

Other Meds:

Current Illness:

Date Died: 03/13/2021

ID: 1108472
Sex: M
Age: 58
State:

Vax Date: 03/06/2021
Onset Date: 03/13/2021
Rec V Date: 03/17/2021
Hospital:

Vax Type:
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Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: cardiac arrest Narrative: Per medics, Patient was gardening when he stated he felt dizzy and collapsed. Wife started CPR until medics arrived. Patient arrived at the hospital after 20min of pulseless V tach and 10 min of PEA.

Other Meds:

Current Illness:

Date Died: 01/23/2021

ID: 1108475
Sex: M
Age: 78
State:

Vax Date: 01/06/2021
Onset Date: 01/23/2021
Rec V Date: 03/17/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
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Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: death Narrative: Patient received COVID vaccine # 1 on 1/6/2021, on 1/23/21 his wife reported to the facility that he passed away. Notes in database do not mention cause of death or where death occurred. There are no scanned records in database with any detail either.

Other Meds:

Current Illness:

Date Died: 02/20/2021

ID: 1108476
Sex: M
Age: 85
State:

Vax Date: 02/06/2021
Onset Date: 02/10/2021
Rec V Date: 03/17/2021
Hospital: Y

Vax Type:
Manufacturer:
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Lab Data:

Allergies:

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

Symptoms: Narrative: Dose #1 of vaccine was administered 2/6/21, per daughter's report patient became ill 3 days later (cough) and was taken to local hospital and was discharged with diagnosis of CAP, NSTEMI and acute on chronic CHF exacerbation. Discharged home on hospice where he passed away at home on 2/20/21.

Other Meds:

Current Illness:

Date Died: 01/29/2021

ID: 1108477
Sex: F
Age: 90
State:

Vax Date: 01/07/2021
Onset Date: 01/29/2021
Rec V Date: 03/17/2021
Hospital:

Vax Type:
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Allergies:

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

Symptoms: Patient died unrelated to covid vaccine Narrative: The patient had advanced Alzheimer's disease and severe dementia. Patient received the first dose of Moderna vaccine on 1/7/2021 and no adverse reaction was reported. Placed in hospice care and passed away on 1/29/2021. Cause of death not documented. No indication that death was related to COVID 19 vaccination.

Other Meds:

Current Illness:

Date Died: 02/26/2021

ID: 1108478
Sex: M
Age: 83
State:

Vax Date: 01/28/2021
Onset Date: 02/26/2021
Rec V Date: 03/17/2021
Hospital: Y

Vax Type:
Manufacturer:
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Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Death Narrative: Patient was outpatient. There was no information or document notes about reactions, underlying or active conditions between the time patient came in for the first Pfizer dose and their death.

Other Meds:

Current Illness:

ID: 1108496
Sex: U
Age:
State: VA

Vax Date: 05/28/2013
Onset Date:
Rec V Date: 03/17/2021
Hospital:

Vax Type:
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Lab Data:

Allergies:

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

Symptoms: painful rash, and drug induced hypersensitivity syndrome.; painful rash, and drug induced hypersensitivity syndrome.; This initial spontaneous report was received from a lawyer regarding a case in litigation and refers to a currently 57 or 58-year-old patient of unknown gender. No information was provided regarding concomitant medications, concurrent conditions or medical history. On or about 28-MAY-2013, the patient was inoculated with zoster vaccine live (ZOSTAVAX) for the long-term prevention of shingles and zoster-related conditions (dose, dose number, route, anatomical site of vaccination, lot # and expiration date were not provided). On an unknown date (reported as subsequently), the patient was treated by health care providers for the following injuries resulting from zoster vaccine live (ZOSTAVAX) used: painful rash and drug induced hypersensitivity syndrome (drug reaction with eosinophilia and systemic symptoms). The outcome of drug reaction with eosinophilia and systemic symptoms and rash was unknown. The causal relationship between the events and zoster vaccine live (ZOSTAVAX) was assessed as related. Upon internal review, drug reaction with eosinophilia and systemic symptoms was considered a medically significant event.

Other Meds:

Current Illness:

ID: 1108498
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 03/17/2021
Hospital:

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Allergies:

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

Symptoms: slightly sore arm; This case was reported by a consumer and described the occurrence of pain in arm in a adult patient who received Herpes zoster (Shingrix) for prophylaxis. Previously administered products included Shingrix (on an unknown date 1st dose was received refer case no US2021AMR058889). On an unknown date, the patient received the 2nd dose of Shingrix. On an unknown date, unknown after receiving Shingrix, the patient experienced pain in arm. On an unknown date, the outcome of the pain in arm was unknown. It was unknown if the reporter considered the pain in arm to be related to Shingrix. Additional details were provided as follows: Age at vaccination was not reported. The age group was not reported, but was selected adult as per vaccine indication. Six months after 1st vaccination patient had recived second dose of vaccine and had almost no side effects other than a slightly sore arm. The reporter enquired was it normal to have almost no side effect after the second shot. This case has been linked with US2021AMR058889 reported by same reporter.; Sender's Comments: US-GLAXOSMITHKLINE-US2021AMR058889:same patient - 1st dose

Other Meds:

Current Illness:

ID: 1108499
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 03/17/2021
Hospital:

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Allergies:

Symptom List: Pain in extremity

Symptoms: Suspected vaccination failure; Having it; Painful; This case was reported by a consumer via interactive digital media and described the occurrence of suspected vaccination failure in a patient who received Herpes zoster (Shingles vaccine) for prophylaxis. On an unknown date, the patient received Shingles vaccine. On an unknown date, unknown after receiving Shingles vaccine, the patient experienced vaccination failure (serious criteria GSK medically significant), shingles and pain. On an unknown date, the outcome of the vaccination failure was unknown and the outcome of the shingles and pain were not recovered/not resolved. It was unknown if the reporter considered the vaccination failure, shingles and pain to be related to Shingles vaccine. Additional details were reported as follows: The age at vaccination was not reported. The patient stated that had shot but it did not stop from having shingles now for 15 months and it was still painful. This case was considered to be a suspected vaccination failure case, as the details regarding being full vaccination schedule, laboratory confirmation for shingles and exact time to onset were unknown.

Other Meds:

Current Illness:

ID: 1108500
Sex: M
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 03/17/2021
Hospital:

Vax Type:
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Vax Name:
Lot:
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Lab Data:

Allergies:

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

Symptoms: Suspected vaccination failure; Got them; This case was reported by a consumer via interactive digital media and described the occurrence of suspected vaccination failure in a male patient who received Herpes zoster (Shingles vaccine) for prophylaxis. On an unknown date, the patient received Shingles vaccine. On an unknown date, unknown after receiving Shingles vaccine, the patient experienced vaccination failure (serious criteria GSK medically significant) and shingles. On an unknown date, the outcome of the vaccination failure and shingles were unknown. It was unknown if the reporter considered the vaccination failure and shingles to be related to Shingles vaccine. Additional details were reported as follows: The age at vaccination was not reported. The reporter's friends husband had a vaccination and still got shingles. This case was considered to be a suspected vaccination failure case, as the details regarding being full vaccination schedule, laboratory confirmation for shingles and exact time to onset were unknown.

Other Meds:

Current Illness:

ID: 1108501
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 03/17/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
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Lab Data:

Allergies:

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

Symptoms: Suspected vaccination failure; shingles; This case was reported by a consumer via interactive digital media and described the occurrence of suspected vaccination failure in a patient who received Herpes zoster (Shingles vaccine) for prophylaxis. On an unknown date, the patient received Shingles vaccine. On an unknown date, unknown after receiving Shingles vaccine, the patient experienced vaccination failure (serious criteria GSK medically significant) and shingles. On an unknown date, the outcome of the vaccination failure and shingles were unknown. It was unknown if the reporter considered the vaccination failure and shingles to be related to Shingles vaccine. Additional details were reported as follows: The age at vaccination was not reported. The patient got shingles as side effect to the shingles shot. This case was considered to be a suspected vaccination failure case, as the details regarding being full vaccination schedule, laboratory confirmation for shingles and exact time to onset were unknown.

Other Meds:

Current Illness:

ID: 1108502
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 03/17/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
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Vax Site:

Lab Data:

Allergies:

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

Symptoms: got the shingles about 2 years later/ Suspected vaccination failure; Shingles; Awful. Two trips to the E.R.; This case was reported by a consumer via interactive digital media and described the occurrence of vaccination failure in a patient who received Herpes zoster (Shingles vaccine) for prophylaxis. On an unknown date, the patient received Shingles vaccine. On an unknown date, 2 years after receiving Shingles vaccine, the patient experienced vaccination failure (serious criteria GSK medically significant), shingles and feels awful. On an unknown date, the outcome of the vaccination failure, shingles and feels awful were unknown. It was unknown if the reporter considered the vaccination failure, shingles and feels awful to be related to Shingles vaccine. Additional details were reported as follows: The age at vaccination was not reported. The patient had the shingles shot about 3 years before the date of reporting and about 2 years later the patient experienced the shingles and was awful. The patient had two trips to the emergency room (ER). This case was considered to be a suspected vaccination failure case, as the details regarding being full vaccination schedule and laboratory confirmation for shingles were unknown.

Other Meds:

Current Illness:

ID: 1108503
Sex: F
Age: 48
State: ND

Vax Date: 02/04/2021
Onset Date: 02/06/2021
Rec V Date: 03/17/2021
Hospital: Y

Vax Type:
Manufacturer:
Vax Name:
Lot:
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Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: Dehydration; Orthostatic positive with liquid watery stool/continues with liquid stool; Frequent diarrhea defined as hourly stool; A spontaneous report was received from a nurse practitioner concerning a 48-years-old female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced dehydration, frequent diarrhea defined as hourly stool, orthostatic positive with liquid watery stool/continues with liquid stool. The patient had a history of colon cancer with a colon resection. No relevant concomitant medications were reported. On 04 Feb 2021, prior to the onset of the events the patient received their first of two planned doses of mRNA-1273 (lot: not provided) for prophylaxis of COVID-19 infection. On 06 Feb 2021, the patient had frequent diarrhea defined as hourly stool. On 09 Feb 2021, she was hospitalized for 48 hours due to dehydration. She was doing fine. On 13 Feb 2021, despite the medications she was back to orthostatic positive with liquid watery stool. On 08 Mar 2021, patient continued with liquid stool. Treatment included cholestyramine, fiber, loperamide hydrochloride. The seriousness criterion for the event dehydration was hospitalization. Action taken with mRNA-1273 in response to the events was unknown. The outcome of the event of dehydration was resolved on an unknown date in Feb 2021. The outcome of the event, frequent diarrhea defined as hourly stool was considered as resolved. The outcome of the event, orthostatic positive with liquid watery stool/continues with liquid stool was not resolved. The reporter did not provide an assessment for the events dehydration, frequent diarrhea defined as hourly stool, orthostatic positive with liquid watery stool/continues with liquid stool.; Reporter's Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. Further information has been requested.

Other Meds:

Current Illness:

ID: 1108504
Sex: F
Age: 71
State:

Vax Date: 03/05/2021
Onset Date: 03/05/2021
Rec V Date: 03/17/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient was erroneously given Pfizer instead of Moderna for dose 2. Patient was contacted to notify patient and to follow-up if patient had any side effects. No side effects noted by patient during call.

Other Meds:

Current Illness:

ID: 1108505
Sex: F
Age: 70
State: FL

Vax Date: 03/04/2021
Onset Date: 03/05/2021
Rec V Date: 03/17/2021
Hospital: Y

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Flagyl

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

Symptoms: 103 temperature, loss of consciousness, low BP. Dizziness.

Other Meds: Synthyroid,Neurotin,Librax,Premarin.

Current Illness: Post concussion syndrome acute

ID: 1108506
Sex: F
Age: 48
State: IL

Vax Date: 03/16/2021
Onset Date: 03/17/2021
Rec V Date: 03/17/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Body aches and fever

Other Meds:

Current Illness:

ID: 1108507
Sex: F
Age: 60
State: IN

Vax Date: 02/17/2021
Onset Date: 02/17/2021
Rec V Date: 03/17/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
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Lab Data:

Allergies: Steriods, Augmentin, Sulfur medications.

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

Symptoms: I immediately had an increase in heart rate to 110 bpm. after getting the injection. I sat for 30 minutes instead of the 15. My heart rate still continued to stay high. I drove home and continued to monitor my heart rate. My heart rate stayed elevated for the remainder of the evening. The lowest was around 99 bpm when I retired to bed. Woke the next morning with a heart rate in the 80's. Normally my resting heart rate is around 62 bpm. Within 24 hours, my heart rate was back to normal. As of today, my heart rate is back to normal. I have a slight cough, but I believe that is due to my sinus allergies.

Other Meds: Fluticasone Proplonate Nasal spray 50 mcg 1xday/ Diltaiazem 360 mg1xday, Plaqunil 400 MG 1xday, Benicar 20 MG 1xday, Asprin 81 MG 1xday, Vitamin D3 50 mg 1xday, Vitamin C500 MG 1x day.

Current Illness: None

ID: 1108508
Sex: F
Age: 54
State: WI

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 03/17/2021
Hospital:

Vax Type:
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Lab Data:

Allergies: None reported

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

Symptoms: Janssen COVID-19 Vaccine EUA Patient received J&J COVID vaccination at 1430 on 3/10. Patient reports immediately feeling "scratchy throat and hoarse voice." Patient took 50 mg Benadryl PO, then went to urgent care where she received 10 mg dexamethasone PO and 40 mg famotidine PO. Patient reports symptomatic improvement, but continued scratchiness to throat and "voice sounding off." Patient presented to the ED and received 0.3 mg IM epinephrine. Epinephrine administered with significant symptomatic improvement. No findings of angioedema on exam. Patient breathing comfortably without signs of impending airway compromise. Patient observed for 4 hours following epinephrine administration. Hoarseness resolved. Patient discharged home.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 704,237

Page last modified: 26 October 2021 2:21am