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: 1172728
Sex: F
Age: 38
State: CA

Vax Date: 04/04/2021
Onset Date: 04/05/2021
Rec V Date: 04/06/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List:

Symptoms: Chills, fatigue, fever, body aches, headache, lower back and hip pain, diarrhea, sore arm. Started about 6 hours after injection. All symptoms except sore arm and diarrhea stopped after about 36 hours after injection. Took acetaminophen and Advil and excederin to alleviate some symptoms starting about 12 hours after injection.

Other Meds: Prenatal vitamins, probiotic, vitamin D supplement

Current Illness: None

ID: 1172729
Sex: F
Age: 25
State: IL

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/06/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Patient fainted approximately 5 minutes after vaccination. Patient regained consciousness immediately. Patient also reported cold sweats.

Other Meds:

Current Illness:

ID: 1172730
Sex: F
Age: 66
State: MI

Vax Date: 03/16/2021
Onset Date: 03/17/2021
Rec V Date: 04/06/2021
Hospital: Y

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

Lab Data:

Allergies: Penicillin

Symptom List:

Symptoms: This greatly accelerated symptoms from after first shot and sent me to ER next morning where was kept on pain med IV for 4 days and received MRI. Discharged home with pain meds, muscle relaxers, and nerve pain med.

Other Meds: Synthroid, Cytomel, Prilosec, Mobic, Tylenol XS, Flexeril, Multivitamin, Lysine, Lechitin, Leutin, Align probiotic, K2, CQ10, Fish, oil, D3, Airborne, Elderberry, Yuvafem, Xidra eye drops, Calcium, Oxycodone

Current Illness: Following first dose vaccine, developed back pain which was so severe sent me to ER. I was pushed into second dose in wheelchair as my pain stemmed from pinched nerve in back that arouse day after first shot (awoke to inflamed back and neck and during course of day must have reached for something and it pinched a nerve. But odd how didn't do anything out of normal routine that day. Anyway after questioning various doctors they all agreed that should. Get second shot. So in wheelchair I went in and sure enough as I predicted the shot exacerbated my back pain., and very next morning went to ER where I was admitted for 4 days and got MRI.

ID: 1172731
Sex: F
Age: 67
State: CA

Vax Date: 03/11/2021
Onset Date: 04/01/2021
Rec V Date: 04/06/2021
Hospital:

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

Lab Data:

Allergies: non

Symptom List:

Symptoms: Irritability, depression, anxiety, nausea, headache, fever, joint pain, muscle aches and pain, chills, electrolyte imbalance, dehydrated, low potassium and magnesium, muscle cramping in arms, hands, legs, calves, feet

Other Meds: Baby Asprin, Zyterc 10mg, Clonazepam .5/twice daily, Diazonxide 2 villa a day every 4 hours, Diclofenac Sodium topical gel to back twice daily, Cymbalta 60mg twice daily, iron 65mg twice daily, kilo-Con 20mEq pwder twice daily, Levetiraceta

Current Illness: pneumonia

ID: 1172732
Sex: F
Age: 55
State: CO

Vax Date: 04/01/2021
Onset Date: 04/02/2021
Rec V Date: 04/06/2021
Hospital:

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

Lab Data:

Allergies: Demerol (Respiratory distress and hallucination), Morphine (pt get violent), Tetracycline (rash).

Symptom List:

Symptoms: Covid Vaccine: First: 3/11/21 (lot # EN6203 - LD) Second dose: 4/1/21 (lot # EN6208 -LD) Patient received her second dose vaccine on Thursday 4/1. On Friday 4/2 she started to develop sore arm and lightheaded sensation. When she checked her blood pressure, her systolic was in the 80s. Patient was presented to ED for checkup.

Other Meds:

Current Illness:

ID: 1172733
Sex: F
Age: 49
State: MD

Vax Date: 03/06/2021
Onset Date: 03/09/2021
Rec V Date: 04/06/2021
Hospital: Y

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

Lab Data:

Allergies: Penicillin

Symptom List:

Symptoms: By March 9, I began experiencing loss of appetite, tiredness, jaundice and nausea.

Other Meds: Flonase nasal spray Vitamin D3 Multivitamin

Current Illness: N/A

ID: 1172734
Sex: F
Age: 60
State: MS

Vax Date: 03/08/2021
Onset Date: 03/08/2021
Rec V Date: 04/06/2021
Hospital:

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

Lab Data:

Allergies: Penicillin, Chlorpheniramine-Phenylephrin, Codeine, Meloxicam, Valacyclovir

Symptom List:

Symptoms: rapid Heart Beat

Other Meds: Tylenol, Pepcid, Zyrtec

Current Illness: none

ID: 1172735
Sex: F
Age: 62
State: MD

Vax Date: 03/25/2021
Onset Date: 03/26/2021
Rec V Date: 04/06/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List:

Symptoms: chills, dizziness, lightheadedness, fever, fatigue, GI distress, pain at injection site, muscle aches, joint aches, nausea, dry heves, vomiting, arm heavy at night.

Other Meds: none

Current Illness: none

ID: 1172736
Sex: F
Age: 19
State: NV

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/06/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List:

Symptoms: About 15 minutes after receiving the vaccine, teammate went to stand up and got dizzy. Pt advised to sit back down and wait a bit. RN out to assess pt and again pt was ok sitting but upon standing noted wobbly and asked to sit back down. She did complain of dizziness at this time with some slight shortness of breath. BP noted in 120's with several checks, diastolic BP noted in 70's with heart rate noted 90-110 which per pt elevated HR normal for pt. At this time she did state that she was having some cardiac workup completed and just had on that was removed on 23rd March. At this time pt was brought back to treatment floor for further evaluation with ambulation assistance by RN. Pt was placed on oxygen 2 liters. BP's remained normal in 120's and HR as well between 90-100. Each time pt felt ok and went to stand she became dizzy and noted wobbly thus asked to sit but BP's remained normal. Pt states she ate some cucumbers and another fruit prior to coming. Pt at 1230 up to restroom with noted vomiting. After vomiting pt stated she was feeling much better. BP noted 124/84 temp 98.1 with c/o of n/v but no other symptoms while in restroom. Left arm noted some patchy redness after pt was itching the arm. At this time pt was given Benadryl 25 mg 2 tablets PO. Continued to monitor pt for about 30 minutes with redness subsiding on her arm, while all vitals remained stable. At this time pt was eager to leave and head home. at 1300 BP noted at 119/73 HR at 100. All symptoms subsided and while pt was standing no wobbling noted. Dr. was phoned and notified of the event as he is the medical director. Pt was given RN number to call when she arrived home.

Other Meds: Fluoxetine, hydroxyzine, lamotrigine

Current Illness: depression, in cardiac work up currently which was not disclosed until after vaccine was given, pt just had a zion monitor which was removed on 23rd March

ID: 1172737
Sex: M
Age: 64
State: CO

Vax Date: 03/29/2021
Onset Date: 03/29/2021
Rec V Date: 04/06/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
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Lab Data:

Allergies: Lisinopril, Azythromycin, Tree Nuts, Peanuts, Soy, Eggs

Symptom List:

Symptoms: Approximately 1 hour after injection, experienced strong facial numbness which lasted about an hour. Approximately 9 hours after injection, experienced very weak and shallow-breathing.

Other Meds: Metoprolol, Acyclovir, Vitamin B-12, Vitamin C, Rhodiola Rosea, Cognium

Current Illness:

ID: 1172738
Sex: F
Age: 61
State: KY

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 04/06/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Short of breath, dizzy, nauseous, tightness in throat, tingling in upper extremities.

Other Meds:

Current Illness:

ID: 1172739
Sex: F
Age: 66
State: DE

Vax Date: 03/30/2021
Onset Date: 03/30/2021
Rec V Date: 04/06/2021
Hospital:

Vax Type:
Manufacturer:
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Lab Data:

Allergies: Bioxin Yeast, vinegar, alcohol, mushrooms and all foods of fungus Chemicals, smoke and airbourne toxins

Symptom List:

Symptoms: Tuesday March 30th 2021 Received Pfizer Dose #2 at 12:25pm resulting in injection site pain. By 3:30pm adverse symptoms began: Dizziness, lightheadedness, pain from injection site gradually radiating down left arm and into left leg, later to right side and ultimately all over body. It felt like muscle aching all over my body (run over by a truck feeling as people describe.) Bedridden ? Severe fatigue and lethargy ? Dizziness ? Lightheadedness ? Muscle aching all over body ? Chills ? Sweats Wednesday March 31st 2021 Bedridden ? All the above plus pounding throbbing migraine headache ( Contacted Dr. and although I have high BP was allowed to take Aleve, and 1 pill got rid of the headache within hours thankfully) Thursday April 1st 2021 (Bedridden and sat in chair) ? All the above from Tuesday plus severe abdominal pain doubling over with vomiting four times Friday April 2nd 2021 (feeling mildly better, able to stand to take a shower. Sat in chair most of day) ? Dizziness and light headedness persist ? Moderate fatigue and lethargy (reducing) ? Moderate body aching ? No chills and sweats ? Nerve tingling similar to when hitting funny bone in elbow but in hands and arms ? Poor cognitive abilities Saturday April 3rd 2021 (Contacted dr regarding long duration of these persisting adverse symptoms and told to overly hydrate, a prescription was called in for anti-nausea medication to take if needed. Not needed, not taken, not picked up. This may last up to two weeks!) ? Same symptoms as Friday Sunday April 4rd 2021 (Feeling better in the morning, able to bake a cake, but afterwards bedridden again for the rest of the day.) ? Severe fatigue and lethargy ? Dizziness ? Lightheadedness ? Moderate body aching ? Poor cognitive abilities in thinking, memory etc. ? Nerve tingling similar to when hitting funny bone in elbow but in hands and arms ? Minimal chills and sweats Monday April 5rd 2021 (Cancelled all plans and sat by computer.) ? Same as Sunday but with severe chills and sweats and a bonus of 3 bouts of diarrhea Tuesday April 6rd 2021 In bed all morning and sat during afternoon. (Phoned to notify both Pharmacy where I received Pfizer #1 and the Pfizer #2 and doctor?s office of persisting adverse side effects) Contacted VAERS which timed out my responses twice on line and left a message on their phone recording to contact me. Sending this by fax to Dr.'s office. ? As of 4pm same symptomatology as Sunday

Other Meds: Metoprolol Succ (Toprol XL) 1 Tablet daily 50mg Quinapril/HCTZ (Accuretic) 1 Tablet daily 20/25 Vitamins 1- Vitamin C time release 1500 2- Garlic 500 1- Selenium 50 mcg 1- Co-Q 10 100mg 1- Multivitamin 2- Calcium + D 1-Vitamin D 1-Gi

Current Illness: None

ID: 1172740
Sex: M
Age: 33
State: WA

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

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

Lab Data:

Allergies: No

Symptom List:

Symptoms: The morning of April 3, staff at the Clinic discovered a discrepancy in the preparation of Pfizer vaccine doses. It was discovered that several undiluted vaccine doses were administered. Staff accounted for all unused undiluted vaccine doses. Unfortunately, 10 undiluted vaccine doses had been administered to patients and were not able to be retrieved. This patient received one of the undiluted doses. The medical team contacted the CDC to determine the potential side effects and observation requirements of receiving an undiluted vaccine. The CDC confirmed that the recipients of the undiluted doses may experience stronger side effects and symptoms than someone who received the diluted dose (sore arm, flu-like symptoms, etc.). The site public health officer spoke with suspected recipients of the undiluted vaccine to explain potential medical side effects. The Health District will follow up to monitor their status.

Other Meds:

Current Illness:

ID: 1172741
Sex: F
Age: 18
State: TX

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/06/2021
Hospital:

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

Lab Data:

Allergies: NONE

Symptom List:

Symptoms: PT RECEIVED SHOT, SAT ON CHAIR FOR 5 MINUTES. PT STATES SHE DOESN'T FEEL GOOD AND SLOWLY FELL OUT OF HER CHAIR. I WAS ABLED TO CATCH HER IN TIME AND LAY HER DOWN ON THE GROUND. PT LOST CONSCIOUSNESS AND STOPPED BREATHING. WAS ABOUT TO PERFORM CPR BUT PT WOKE UP BY HERSELF AND ACTED NORMAL AGAIN.

Other Meds: NONE

Current Illness: NONE

ID: 1172742
Sex: M
Age: 62
State: CA

Vax Date: 04/05/2021
Onset Date: 04/05/2021
Rec V Date: 04/06/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Headache, metallic taste, tingling of tongue. BPs 148/88 (pulse 62), O2 sat 100%. BP 139/84 (pulse 64), O2 sat 100%. Benadryl 25 mg PO. Final BP 134/83 (pulse 55).

Other Meds:

Current Illness:

ID: 1172743
Sex: F
Age: 73
State: NY

Vax Date: 03/31/2021
Onset Date: 04/04/2021
Rec V Date: 04/06/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: itching and redness going down arm, naseau, headache, head fog 50mg Benadryl

Other Meds: mercapto purine 75mg

Current Illness:

ID: 1172744
Sex: M
Age: 29
State: ID

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/06/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List:

Symptoms: Patient was waiting 15 minutes after receiving the vaccine and before the 15 minutes were up, he stood up to ask a question to the staff. While walking to the counter patient fainted hitting neck on a stand as well as head on ground. Staff members came out to approach patient at which time he was conscious. He was able to identify his name/age and speak normally but reported dizziness. Emergency services were contacted and while waiting for them to arrive patient had requested to sit up and was moved slowly to chair. Emergency services evaluated patient and determined he was ok and didn't need to go to hospital and was ok to leave when comfortable.

Other Meds: none

Current Illness: none

ID: 1172745
Sex: F
Age: 74
State: NJ

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/06/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: METALLIC TASTE IN MOUTH 2-3 HOURS POST DOSE

Other Meds:

Current Illness:

ID: 1172746
Sex: M
Age: 16
State: CO

Vax Date: 03/25/2021
Onset Date: 03/25/2021
Rec V Date: 04/06/2021
Hospital:

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

Lab Data:

Allergies: None Known

Symptom List:

Symptoms: Vaccine administered to patient at inappropriate age interval per EUA. No adverse reaction was recorded.

Other Meds: None

Current Illness: None

ID: 1172747
Sex: F
Age: 35
State: FL

Vax Date: 04/04/2021
Onset Date: 04/05/2021
Rec V Date: 04/06/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List:

Symptoms: Received the shot at 11:15am on 4/4/21. Woke up at 3:30am on 4/5/21 with a fever, chills, body aches, headache and nauseous. It lasted 24hours. Woke up today 4/6/21 with a swollen lymph node in my left arm pit.

Other Meds: 20mg Lexapro & 10mg lisinopril

Current Illness: N/A

ID: 1172748
Sex: M
Age: 62
State: WA

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

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

Lab Data:

Allergies: sulpha

Symptom List:

Symptoms: I was experiencing mild tinnitus off and on prior to getting my first shot. Like three or four times a week in the afternoons and evenings. The day after I got my first shot (Moderna), the tinnitus was immediately noticeable while waking up that day and has been constant ever since. It is currently barely tolerable but I'm having second thoughts about getting the second dose. As best I can tell, there is no treatment available for tinnitus.

Other Meds: none

Current Illness: none

ID: 1172749
Sex: F
Age: 60
State: CA

Vax Date: 03/03/2021
Onset Date: 03/05/2021
Rec V Date: 04/06/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List:

Symptoms: Had steroid indfusions. Now oral steroid. MRI pending of back and head. Following up with neruology. Lab work up negative.

Other Meds: patient reported to Moderna. I did as well and was told I would receive a call back but never did. I am her clinician. The patient is concerned she may be suffering from Moderna side effects. She received her maternal aunt vaccine last We

Current Illness: No illnesses - hip replacement a few months ago

ID: 1172750
Sex: M
Age: 54
State: PA

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

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

Lab Data:

Allergies: Penicillin

Symptom List:

Symptoms: Beginning at 11:30 PM I began to experience chills. I spiked a fever throughout the night and slept very little. Beginning around 2 PM I experienced aching joints comparable to arthritis. About that time I also began to experience sinus congestion and pain Which was similar to having a significant sinus infection. By 8 AM the fever was beginning to break but the aches and sinus congestion remained, and stomach pain arose. Throughout the day, there were episodes of fever. Stomach pain resolved around noon. Congestion and aches and fever were largely resolved by 4pm, at which time two Tylenol were taken, with only occasional low fever episodes. I slept well that night and felt fine the following morning.

Other Meds: None

Current Illness: None

ID: 1172751
Sex: M
Age: 45
State: MO

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/06/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List:

Symptoms: PATIENT REPORTED STARTING TO FEEL FAINT AND BLACKED OUT FOR 30-45 SECONDS WITHIN 1-2 MINUTES AFTER RECEIVING VACCINE. HE EXPERIENCED DIAPHORESIS AND FELT HE WAS GOING TO PASS OUT. DENIED SOB, HIVES, SWELLING, STOMACH PAIN. REPORTED HE HAD NO HEALTH CONDITIONS BUT THAT THIS HAD HAPPENED TO HIM BEFORE BUT THIS WAS WORSE - SAID HE HAD NOT EATEN THAT DAY OR DRANK WATER. RPH GAVE PATIENT WATER AND LEMONADE ABOUT 2 MINUTES OR SO INTO REACTION AND PATIENT SAID HE STARTED TO FEEL BETTER AFTERWARD. 911 WAS CALLED AND PARAMEDICS RESPONDED WITH TAKING BLOOD PRESSURE AND BLOOD SUGAR - BP A LITTLE LOWER THAN AVERAGE BUT UNSURE WHAT PT TYPICALLY RAN AT. BLOOD SUGAR NORMAL AFTER DRINKING LEMONADE. PATIENT TAKEN TO ER FOR FURTHER CARE

Other Meds: PATIENT REPORTED TAKING ONLY 2 MEDICATIONS FOR BACK PAIN AT TIME OF VACCINATION, BUT COULD NOT THINK OF WHAT IT WAS NAMED. THOUGHT ONE OF THE MEDICATIONS WAS MELOXICAM, WHICH HE HAD TAKEN THAT MORNING. ENTIRE HISTORY UNKNOWN.

Current Illness: PATIENT PUT NO ON ALL QUESTIONS ON VAR, BUT UPON QUESTIONING VERBALLY, PATIENT REPORTED ONLY HEALTH CONDITION AS BACK PAIN. DENIED ALL OTHER HEALTH CONDITIONS OR ILLNESSES.

ID: 1172752
Sex: M
Age: 64
State: NY

Vax Date: 02/18/2021
Onset Date: 02/19/2021
Rec V Date: 04/06/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List:

Symptoms: Persistent pain and weakness of the arm s/p vaccination

Other Meds: Atorvastatin, Intermezzo, Trazodone, Viagra

Current Illness: None

ID: 1172753
Sex: F
Age: 33
State: NJ

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

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

Lab Data:

Allergies: Tramadol

Symptom List:

Symptoms: Rash/Hives developed 24 hours post vaccination

Other Meds: Levothyroxine

Current Illness:

ID: 1172754
Sex: F
Age: 27
State: CA

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/06/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Janssen -COVID 19- EUA 04-06-21 Adverse Event #1 Approximately 3 minutes following vaccination Pt had seizure. Personnel on scene assisted her to the ground and protected her head. No injuries from event. Pt assessed by Team 1 crew member, then turned over to ALS Medic unit.

Other Meds:

Current Illness:

ID: 1172755
Sex: F
Age: 46
State: FL

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

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

Lab Data:

Allergies: Sulpha Drugs Melatonin

Symptom List:

Symptoms: 20 mins. after receiving the vx (vaccine) I felt some dizziness. Within a few hours of that I felt very tired and developed a sore throat. I also found the slightest exertion left my chest feeling as though someone put a weight on it or the sensation when I can't hold my breath much longer. I was NOT panting for breath or feeling like and asthma attack. I was extremely cold during the night. I went to sleep at 9:30 PM Friday and slept until Saturday 4:00 PM (18.5 hours). I was very achy during that time to the extent that it was painful to be touched. I felt very weak throughout, as though I had weights attached to my limbs, that entire evening. The dizziness worsened that night to the extent that I felt I might pass out. I still had the sore throat for the entire day. I slept for 10 hours that night (Saturday). I woke Sunday and the dizziness was gone unless I bent over or got up suddenly. The sore throat and achiness were gone. I did have a headache that day. The dizziness returned in the evening and I started to experience nausea as well which made sleeping difficult (Sunday night). I only slept 3 hours, but other than being tired, I felt that I was getting more energy back and not exhausted like I'd been during the weekend. I had minimal dizziness. I did experience nausea on occasion throughout the afternoon and night. I slept 8 hours Monday night. Tuesday morning I woke up completely exhausted again. I had a raging headache. As of now (4:20 PM Tuesday) I still have bouts of dizziness. I have no energy and feel lethargic. I am experiencing a bit of tightness in my chest again when doing minimal exertion.

Other Meds: Lamictal, Fluticasone Prop spray, Atorvastatin, Duloxetine HCL, Percocet, Levothyroxine, Pregabalin, Hetlioz, Tumeric, Fish Oil, Women's Daily Vitamin, Hydroxyzine HCL (as needed), Cyclobenzaprine (as needed), Ibuprofen (as needed)

Current Illness: None

ID: 1172756
Sex: F
Age: 25
State: CA

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/06/2021
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Allergies: nkda

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Symptoms: patient was in the observation area and fainted from her chair to the floor. Observation nurses were able to arouse her immediately and transferred her from the observation area to the EMS room via wheelchair. Patient reported that she has "issues" when she gets her blood drawn bur has never passed out before. She denies chest pain, shortness of breath or nausea at this time. She was given H2O and allowed to rest on the gurney, all vitals were WNL 128/87 pulse 75 pulse ox 100%. Pt was discharged in stable condition to father who was driving her home @ 12:35pm.

Other Meds: denies

Current Illness: denies

ID: 1172757
Sex: F
Age: 58
State: CO

Vax Date: 04/05/2021
Onset Date: 04/05/2021
Rec V Date: 04/06/2021
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Allergies: Narcotics, demerol, morphine, cause nausea and pruritus. Lidocaine causes pruritus. Allergic to cream and high fat milk, mild corn allergy. Have had two previous reactions to Jelly fish stings, second was a very tiny Man-o-war which caused a severe reaction including discoloration similar tot he covid arm on my leg.

Symptom List:

Symptoms: Severe Headache and body aches started with in a few minutes and because progressively worse. Fever 102. 7, and body aches started within a few hours. 12 hours post vaccine severe chills and uncontrollable muscle tremors ( this happened with both vaccines, tremors occurred for 5.5 hours both times). Nausea started after 5 hours, vomiting of fluids started 10 hours after vaccine. Selling at the vaccine site and severe myositis, 6/10 at rest, 10/10 with any movement, unable to touch site, 4 cm swelling of Left deltoids compared to the right. Previous vaccine site was still tender 4 weeks after the vaccine, not sure how long this one will hurt, but unable to use arm or touch it without severe pain 30 hours later. Pain and shortness of breath within 5 hours of vaccine, this improved by 24 hours after vaccination, Because I have had shortness of breath that has persisted after the first vaccine I plan to do some follow up lab work with possible chest x-rays and echo with my primary care MD in the next 1-2 weeks.

Other Meds: Pre-medicated because I had a severe reaction to the first vaccine on 3/8/2021, migraine head ache for 3 days, fever,103.2, severe nausea and, chills and uncontrollable muscle tremors for 5 hours ( tremors started 12 hours post vaccine). H

Current Illness: None

ID: 1172758
Sex: F
Age: 51
State: ID

Vax Date: 03/29/2021
Onset Date: 03/29/2021
Rec V Date: 04/06/2021
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Allergies: Sulfa

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Symptoms: From Monday night to Friday - Headache, fever, chills, congestion, and fatigue On Monday night only - sore throat On Tuesday only - loss of smell and taste Ongoing - Congestion

Other Meds: Levothyroxine, D Amphetamine ER, Allegra, D3, Losartan

Current Illness: None

ID: 1172759
Sex: F
Age: 46
State: OH

Vax Date: 03/23/2021
Onset Date: 04/06/2021
Rec V Date: 04/06/2021
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Allergies: penicillin, sulfa drugs, environmental allergies, flu vaccine.

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Symptoms: 24 hours after shot tiredness, chills,fever, pain at injection site for 48 hours. Today, I woke up this morning with a light pink rash, about the size of my fist, around the injection site. I had the shot 12 days ago.

Other Meds: Prozac, nasacort

Current Illness: None

ID: 1172760
Sex: F
Age: 78
State: WA

Vax Date: 01/11/2021
Onset Date: 01/16/2021
Rec V Date: 04/06/2021
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Allergies: Gluten - hives Fluconosole ? red spots Iodine (IVP dye) - hives Penicillins - hives Doxycycline - nausea Tramadol ? nausea Zolendronic Acid ? mild congestion

Symptom List:

Symptoms: **Please note that the same adverse reaction (diarrhea) occurred after each of my two Covid -19 vaccinations. See separate VAERS form for the second incidence.** I had my first Covid-19 vaccination shot on 1/11/2021. About five days later (1/16/2021), I awoke with an episode of diarrhea. This continued for about 10 days, until 1/25/21. On most days, these episodes were first thing in the morning only (on waking), but some days had more episodes, with some in the middle of the night. I had loss of appetite but no vomiting or fever and only slight weight loss. [I had started the antibiotic Sulfamethoxazole ? TMP SS in December 2020 and wondered if this might be a cause, but I checked with my urologist and we agreed that I had likely taken it for too long for it to be an issue.] **Please note that diarrhea started again on 2/2/2021, the morning after my second Covid shot. See separate VAERS form for this incidence.**

Other Meds: Aspirin ? 81mg daily Calcium ? Magnesium ? Vitamin D: 500:500:400 daily Glucosamine ? 1000 mg daily Metoprolol succinate ? 25mg daily Omega-3 ? 2560 mg, daily Prednisone ? 2 mg, daily Simvastin (Zocor) ? 40 mg every 48 hours Bactrim ? 400-

Current Illness: Possible low grade urinary tract infection, being treated prophylactically.

ID: 1172761
Sex: F
Age: 34
State: UT

Vax Date: 03/29/2021
Onset Date: 03/29/2021
Rec V Date: 04/06/2021
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Symptoms: Vaccine that had been refrigerated for 34 days.

Other Meds:

Current Illness:

ID: 1172762
Sex: M
Age: 18
State: NJ

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/06/2021
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Allergies: no known allergies

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Symptoms: Patient described burning sensation in both ears. resolved in a few minutes.

Other Meds: unknown

Current Illness: unknown

ID: 1172763
Sex: M
Age: 57
State: WA

Vax Date: 04/03/2021
Onset Date: 04/03/2021
Rec V Date: 04/06/2021
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Allergies: no

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Symptoms: The morning of April 3, staff at the Community Vaccination Clinic discovered a discrepancy in the preparation of Pfizer vaccine doses. It was discovered that several undiluted vaccine doses were administered. Staff accounted for all unused undiluted vaccine doses. Unfortunately, 10 undiluted vaccine doses had been administered to patients and were not able to be retrieved. This patient received one of the undiluted doses. The medical team contacted the CDC to determine the potential side effects and observation requirements of receiving an undiluted vaccine. The CDC confirmed that the recipients of the undiluted doses may experience stronger side effects and symptoms than someone who received the diluted dose (sore arm, flu-like symptoms, etc.). The site public health officer spoke with suspected recipients of the undiluted vaccine to explain potential medical side effects. The Health District will follow up to monitor their status.

Other Meds:

Current Illness:

ID: 1172764
Sex: M
Age: 21
State: VA

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/06/2021
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Allergies: N/A

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Symptoms: Felt anxious about the shot and got it at 10:48, started feeling dizzy at around 10:55 during the 10 minute waiting period, then started to black out and I immediately told the nurse who's quick actions prevented me from fully fainting (laying me down and giving me food/water and elevating my legs). Blood pressure was fine she said along with O2 levels. Left around 11:25 after I felt able to. We both think this was likely related to the anxiety about getting the shot itself (I have anxiety in general so it was not paired with a mistrust or anything about the vaccine) and began fainting 7 minutes after getting the vaccine. I was anxious about any possible symptoms and needles/shots/blood draws make me feel uneasy. However, this issue was not present with the first shot.

Other Meds: 150mg Sertraline

Current Illness: N/A

ID: 1172765
Sex: M
Age: 57
State: ND

Vax Date: 03/31/2021
Onset Date: 04/01/2021
Rec V Date: 04/06/2021
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Symptoms: Patients wife states he had a vomiting episode during the night of the shot. Now is currently asymptomatic

Other Meds:

Current Illness:

ID: 1172766
Sex: F
Age: 20
State: GA

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/06/2021
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Symptoms: Pt became dizzy and nauseated after IM injection. Assisted to floor to lay down with BLEs elevated. VS as follows: BP 98/68 laying down, HR 99, sats 98% on RA, no LOC. Pt given water and snack bar, recovered within 10 mins and ambulated out of clinic in NAD

Other Meds:

Current Illness:

Date Died: 04/06/2021

ID: 1172767
Sex: M
Age: 52
State: TN

Vax Date: 03/29/2021
Onset Date: 03/31/2021
Rec V Date: 04/06/2021
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Allergies: No known allergies

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Symptoms: Patient presented 4/3 stating received Pfizer COVID-19 vaccine on Monday and began having sympoms about Wednesday. Developed fever by Thursday and cough/nausea/vomiting by Friday. Cough ongoing and feels like he should have production but is not able sputum out. The pain is chest is described as not being able to fully expand his lungs when he tries to inhale. Patient presented 4/6-DOA

Other Meds: Metformin unknown po Lisinopril 20mg po 1 tab daily

Current Illness: Unknown

ID: 1172768
Sex: F
Age: 27
State: IN

Vax Date: 04/01/2021
Onset Date: 04/02/2021
Rec V Date: 04/06/2021
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Allergies: Keflex, leaves, tetanus shots

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Symptoms: At about 12:45AM on 4/2/21 I noticed I had a fever, a headache, chills, and injection site pain. My fever broke about 5 hours later and my headache and chills went with it. The injection site pain continues even now on 4/6/21.

Other Meds: Hydrochlorothiazide 25mg/day Amlodipine 5mg/day Biotin 6,000 mcg/day

Current Illness: High blood pressure

ID: 1172769
Sex: F
Age: 47
State: CA

Vax Date: 04/05/2021
Onset Date: 04/05/2021
Rec V Date: 04/06/2021
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Symptoms: Tired, thirsty. Flushing/sweating - BP119/68 (pulse 65).

Other Meds:

Current Illness:

ID: 1172770
Sex: F
Age: 39
State: NJ

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/06/2021
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Allergies: Reports allergy to demerol

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Symptoms: 1:45 pm Post vaccination reports "feeling heart beating fast", denies any additional symptoms or complaints; medical monitoring x 30 min w/vital assessment: BP 126/88 HR 130-135 RR 14 O2 sat 99% RA; 2:15 pm rest w/po hydration and persistent tachycardia noted w/monitoring; HR 133. Transported via ambulance due to unresolved elevated HR, for further evaluation / treatment.

Other Meds: none reported

Current Illness:

ID: 1172771
Sex: F
Age: 65
State: NM

Vax Date: 03/31/2021
Onset Date: 03/31/2021
Rec V Date: 04/06/2021
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Allergies: Tegratrol, Codeine, Sulfa, Opiods, Insects

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Symptoms: 20 minutes after Pfizer 1st dose on 3/31/2021, symptoms of Bells Palsy with twitching, numbness, and tingling. As of this writing 4/6/2021 symptoms persist. Patient had only previous instance of Bells Palsy in April 2014 which completely resolved a month later with no lasting effects at that time.

Other Meds: gabapentin, mirtazapine, lamotrigine, acylcovir

Current Illness:

ID: 1172772
Sex: F
Age: 60
State: TX

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/06/2021
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Allergies: unknown

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Symptoms: The patient received Moderna Dose #1 today at our facility. Within ImmTrac, it states that patient received the Pfizer series. Dose #1 3/1/21 and Dose #2 3/28/21. I called and spoke with patient and she states that she has not received any previous COVID vaccines although all the information was correct: name, address, DOB, and phone number. Please advise on further action and if patient should received 2nd Moderna dose. Was able to reach patient at spouse's number

Other Meds: unknown

Current Illness: unknown

ID: 1172773
Sex: M
Age: 61
State: NY

Vax Date: 04/03/2021
Onset Date: 04/03/2021
Rec V Date: 04/06/2021
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Symptoms: Cough 2 days Fever 1 day Chills 1 day Dizzyness 2 days Headache 3 days Ey e Pain 3 days

Other Meds:

Current Illness:

ID: 1172774
Sex: F
Age: 31
State:

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/06/2021
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Symptoms: 4/6/2021 Patient was observed post Covid-19 immunization for 15 minutes . During the observation period, she experienced an adverse reaction with the following symptoms: urticaria. Assessment : Time of assessment 304pm. Alert and oriented and Urticaria. Actions taken: Vitals sign taken VAERS form obtained and completed by RN. VS at 304pm , BP 123/68, P- 86, O2- 99% Medications administered: - Benadryl 25 mg tab PO x 1 at 324pm by RN - Famatodine 1o mg 1 po x 1 at 304pm by RN, Loratadine 10 mg 1 po x 1 by RN at 304pm by RN. Disposition: discharged home with no further complaints, husband with patient and is patient driver. Patient instructed to follow up with PCP regarding further covid vaccines, she was provided vaccine information and discharged home. Immunizations Administered Name Date Dose VIS Date Route Pfizer COVID-19 Vaccine 4/6/2021 2:39 PM 0.3 mL 12/11/2020 Intramuscular

Other Meds:

Current Illness:

ID: 1172775
Sex: F
Age: 73
State: AZ

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 04/06/2021
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Allergies: All sulfa drugs,morphine,hydro o done,oxycodone,propoxyphene, meperidine,amlodopine

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Symptoms: Moderna COVID-19 vaccine EUA Vomiting, headache, achy all over, dizzy, weak Lasted just that evening On second vaccine, vomiting next day, very sore arm, headache, dizzy Have been feeling sick to my stomach many days lately...haven?t vomited

Other Meds: Insulin,nifedipine,rosuvastatin,Latanoprost,aspirin,vitamin C,vitamin B12,vitamin D3, magnesium, ubiquinol,zinc,tumeric

Current Illness: None

ID: 1172776
Sex: F
Age: 15
State: CO

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 04/06/2021
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Allergies: None

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Symptoms: No adverse event. Patient was too young. Parents are aware. Parent was aware of age when bringing child in for vaccine.

Other Meds: None

Current Illness: None

ID: 1172777
Sex: F
Age: 57
State: WI

Vax Date: 02/01/2020
Onset Date: 02/01/2020
Rec V Date: 04/06/2021
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Allergies: celebrex, doxycycline, indomethacin, keflex, sulfa

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Symptoms: Pt's arm/shoulder started hurting right at the time of injection and was very sore for days, pain worsened and pt lost strength and range of motion. Called pharmacy after a few weeks to inquire and pharmacy instructed pt that the sore arm was a side effect. Months passed and the pain worsened and range of motion decreased so much so that the patient was unable to reach the top of their head to wash hair. Pt made an appt with ortho (11/2/2020), ortho completed a scan, determined that this was a SIRVA injury and gave steroid injection. Patient's pain was relieved immediately and stayed improved until 4/2021, now pain is increasing again and range of motion declining again.

Other Meds: turmeric, vitamin D3, no prescriptions meds

Current Illness: none

Total 2021 VAERS Injuries: 704,237

Page last modified: 03 October 2021 5:28pm