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: 1208594
Sex: M
Age: 30
State: TX

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 04/14/2021
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: NKDA

Symptom List: Dysphagia, Epiglottitis

Symptoms: PT had some dizziness , Pt blood pressure was checked. PT felt that she was ok. I informed the PT if she started to feel worse to call 911 or her doctor.

Other Meds:

Current Illness:

ID: 1208595
Sex: M
Age: 63
State: UT

Vax Date: 04/06/2021
Onset Date: 04/07/2021
Rec V Date: 04/14/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Codeine cyclobenzaprine

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient had the COVID vaccine 5 days prior to admission, this was followed by diarrhea, body aches, intermittent shortness of breath and general feeling unwell. Most resolved but the diarrhea and intermittent respiratory distress, this worsened on day of admission (4/11/21) with decline in mental status. Nausea with no vomiting, no fever, no cough. Patient was admitted to the ICU with acute respiratory failure with hypoxia and pneumonia. Placed on BiPAP, IV fluids. Patient is currently in the ICU with diagnosis encephalopathy, bilateral aspiration pneumonia, right pleural effusion and UTI. Discussed patient with Health Department who requested patient be reported to VEARS for review.

Other Meds: unknown

Current Illness: unknown

ID: 1208596
Sex: F
Age: 49
State: NC

Vax Date: 03/31/2021
Onset Date: 04/01/2021
Rec V Date: 04/14/2021
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: none small shellfish reaction to large prawns thinking the idone, but I eat oysters, regular shrimp, with no problem.

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

Symptoms: received shot at 3pm on the 31st. next morning at 6am woke up with bad headache like a migrane with nausea which I never get. on left side of my head and into my teeth. was very tired and able to sleep off. Also had a lot of loose stools. felt better late afternoon and then headache returned and stayed with me all night and until about 10:30 next day and went away. on the 8th day I woke up with a swollen lower lip. I had also noticed during the week some dizzyness if moved my head too quickly. then on the 11th day that evening got a migrane and it went away in the afternoon and then came back the next night and did not sleep. was so strong down my left side of headand down my neck and nauseous and I threw up. I went to the doctor and he gave me a shot of toradal and a muscle relaxer which seemed to help. I never get migranes so concerned this is a continued reaction to the shot. the loose fiberous stools seemed to continue for most of the week.

Other Meds: Lexipro 5mg, multivitamin

Current Illness: none

ID: 1208597
Sex: F
Age: 20
State: CT

Vax Date: 04/11/2021
Onset Date: 04/13/2021
Rec V Date: 04/14/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies: N/A

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Headache started Sunday night, but controlled with Tylenol. Monday the headache was intermittent. Tuesday 4/12 the headache and leg craps started in the afternoon. 4/14 She was sent home from work with nausea, headache not letting up after taking Tylenol, numb hands. I called Occupational Health and they suggested having her report to Backus ED today.

Other Meds: Oral Birth control Cryselle.

Current Illness: None

ID: 1208598
Sex: M
Age: 24
State: OK

Vax Date: 03/21/2021
Onset Date: 03/22/2021
Rec V Date: 04/14/2021
Hospital:

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

Lab Data:

Allergies: NKA

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

Symptoms: 4/13 coworker received text message from mother of pt who reports that began experiencing "hives" after taking the Janssen vaccine; started on abd then spread to extremeties, back and neck Phone call to (nurse at the jail) who states she is aware of the hives and has pictures, no c/o respiratory difficulties. They have administered topical antifungal and tx for scabies thinking maybe it was related to a new blanket. Advised that due to the new reports regarding Janssen, it would be advised to have him evaluated by a physician. agreed, she will reach out to her provider for guidance. Report from mom that was taken to the ER and given a topical steroid cream only.

Other Meds: Pt is currently a resident in the jail, unknown medications at time of administration

Current Illness: Pt stated he was not ill during interview for vaccination

ID: 1208599
Sex: M
Age: 44
State: KS

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 04/14/2021
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: Penicillin

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

Symptoms: Itchy rash on legs. Appeared approximately 3 hours after vaccination.

Other Meds:

Current Illness:

ID: 1208600
Sex: F
Age: 52
State: WI

Vax Date: 03/31/2021
Onset Date: 04/14/2021
Rec V Date: 04/14/2021
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: Latex, Chlorahexadine

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient suffered from SOB 4 days after receiving injection, was diagnosed on 4/14/21 with bilateral PE's. Admitted to hospital.

Other Meds: Fluticasone, Ibuprofen, Loratadine, Flonase, Albuterol, Apple Cider vinegar Tabs, Fish Oil

Current Illness: Asthma and sinus infection at the time of vaccine

ID: 1208601
Sex: F
Age: 19
State: CA

Vax Date: 04/09/2021
Onset Date: 04/10/2021
Rec V Date: 04/14/2021
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: Dizziness, nausea, passed out, hit head, had seziure

Other Meds: None

Current Illness: None

ID: 1208602
Sex: F
Age: 26
State: FL

Vax Date: 04/11/2021
Onset Date: 04/11/2021
Rec V Date: 04/14/2021
Hospital:

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

Lab Data:

Allergies: PCN

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Rush throughout body, then passed out. Immediate recovery. Paramedics @ side. Refused transport to hospital.

Other Meds: Topimex, Birth Control

Current Illness: Migraines

ID: 1208603
Sex: F
Age: 34
State: WA

Vax Date: 04/07/2021
Onset Date: 04/08/2021
Rec V Date: 04/14/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Severe vomiting and massive swollen hot injection site with a large raised red rash on arm, spreading nearly from shoulder to elbow. Lasted for 5 days.

Other Meds: none

Current Illness: none

ID: 1208604
Sex: F
Age: 41
State: AZ

Vax Date: 04/12/2021
Onset Date: 04/13/2021
Rec V Date: 04/14/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Scratcy throat, head cold feeling, mild fever, tiredness, swollen nymph nodes in neck

Other Meds: Centrum multivitamin, vitamin D, levothyroxine

Current Illness: None

ID: 1208605
Sex: F
Age: 48
State: KY

Vax Date: 03/24/2021
Onset Date: 04/02/2021
Rec V Date: 04/14/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies: Sulfa, latex

Symptom List: Rash, Urticaria

Symptoms: Left arm swelled from injection sight to shoulder, red, hot, rash, painful, injection sight hard and dark color

Other Meds: Atenolol, lamictal, aripizaole, lisinoprole, ability, celexa, amolodipine, vitamin d, amitrypoline, hydroxzine

Current Illness: N/A

ID: 1208606
Sex: F
Age: 60
State: SD

Vax Date: 03/12/2021
Onset Date: 03/14/2021
Rec V Date: 04/14/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: I got extremely dizzy at 4:00am on Sunday after getting the shot about noon on Friday (so roughly 40 hours later.) The vertigo was so severe that I had to lay on my back and try no to move my head any direction. Getting up even to go to the bathroom resulted in nausea because of the intense dizziness. The dizziness/vertigo lasted until about 9:00am Monday morning (so nearly 30 hours.) I actually still have some residual dizziness when I move my head a certain way, but it goes away quickly and doesn't cause nausea. (I was worried I'd have a similar reaction to the second shot, but I only had some fatigue and a sore arm with the second shot.)

Other Meds: None

Current Illness: None

ID: 1208607
Sex: M
Age: 76
State: FL

Vax Date: 01/17/2021
Onset Date: 03/22/2021
Rec V Date: 04/14/2021
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: Codeine

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

Symptoms: Felt a little off the day after I received the first shot. Lost my hearing in my right ear only on March 22, 2021.

Other Meds: Centrum silver and Life extension prostate formula

Current Illness: None

ID: 1208608
Sex: M
Age: 63
State: NC

Vax Date: 04/08/2021
Onset Date: 04/12/2021
Rec V Date: 04/14/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Patient's wife called PCP's office to report possible vaccine reaction. Approximately 4 days after vaccine, patient had significantly worse neuropathy in bilateral extremities as well as sleeplessness. These are chronic conditions for the patient but per wife they were notably worse following vaccination.

Other Meds: Vitamin C, Vitamin D3, klonopin, vitamin B12, doxazosin, gabapentin, melatonin, mirtazapine, omeprazole, suvorexant

Current Illness:

ID: 1208609
Sex: F
Age: 40
State: VA

Vax Date: 04/09/2021
Onset Date: 04/10/2021
Rec V Date: 04/14/2021
Hospital:

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

Lab Data:

Allergies: penicillin

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

Symptoms: Patient started with swollen injection site 2 and 1/4 inch in diameter. Hurt to touch and hot to touch. Headache, bodyache, severe fatigue, and nausea. On April 13th blood pressure started to rise and was 160/106. Patient decided to go to the Emergency Department and was seen by Dr. She was prescribed ibuprofen, Zofran, acetaminophen. Dr concluded that all symptoms were from the Janssen vaccine.

Other Meds: fluoxetine 20mg

Current Illness:

ID: 1208610
Sex: F
Age: 67
State: IL

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 04/14/2021
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: Patient received Pfizer as second dose instead of Moderna.

Other Meds:

Current Illness:

ID: 1208611
Sex: F
Age: 40
State: GA

Vax Date: 04/10/2021
Onset Date: 04/10/2021
Rec V Date: 04/14/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Severe stomach pain, diarrhea for 48 hours, vomiting, nausea, severe headache. Also very sore arm.

Other Meds: Tylenol

Current Illness: Neurological condition

ID: 1208612
Sex: F
Age: 72
State: MA

Vax Date: 04/12/2021
Onset Date: 04/12/2021
Rec V Date: 04/14/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Headache; muscle aches; soreness at vaccination sight; ringing in ears; nausea; dizziness

Other Meds: estradiol; centrum Silver; Vitamin C 500mg

Current Illness: none

ID: 1208613
Sex: F
Age: 32
State: FL

Vax Date: 04/09/2021
Onset Date: 04/10/2021
Rec V Date: 04/14/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Pt had an red rash in her arm, bruising, fatigue, diarrhea, abdominal pain.

Other Meds:

Current Illness:

ID: 1208614
Sex: F
Age: 51
State: MA

Vax Date: 03/10/2021
Onset Date: 03/20/2021
Rec V Date: 04/14/2021
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: Sulfa

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

Symptoms: Long list of symptoms that have happened 10 days after vaccine inlcluding abdominal pain, pins and needles of skin, leg numbness and hard time navigating stairs, and tremors in hands.

Other Meds: Citalopram 20mg

Current Illness: N/A

ID: 1208615
Sex: M
Age: 22
State: CA

Vax Date: 04/13/2021
Onset Date: 04/13/2021
Rec V Date: 04/14/2021
Hospital:

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

Lab Data:

Allergies: bees, doxycycline

Symptom List: Unevaluable event

Symptoms: 1330 recevied pfizer covid vaccine, lot # EW0153 right deltoid 1345 walked to tent, due to lightheadedness, anxiety, feels itchy at throat, VSS 1352 scratchy throat, rash at throat, ENT clear , HR RR,lungs clear A&P 1355 worsening symptoms , clearing throatt, sob, wheals on neck, epinephrine 1:1000 0.5ml IM given , 02 10 L via mask, 1402 throat symptoms resolved, no sob, pulse ox 100 , VSS ENT : clear, cardio rr without murmur,lungs clear A&P diphenhydramine 50mg IM left deltoid, IV hep lick Right antecubital 1413transported via ambulance sse progress note scanned into chart

Other Meds: testosterone cypionate intramuscular oil

Current Illness:

ID: 1208616
Sex: F
Age: 27
State: WI

Vax Date: 04/07/2021
Onset Date: 04/12/2021
Rec V Date: 04/14/2021
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: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: headache, cramping by her hip, pain in her legs

Other Meds: none

Current Illness: none

ID: 1208617
Sex: F
Age: 19
State: FL

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 04/14/2021
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: none

Symptom List: Injection site pain, Pain

Symptoms: Patient was very nervous upon receiving vaccine and told immunizing tech that she had previously fainted upon donating blood. Immediately after receiving the shot, she said she felt like fainting. Her mother walked her to the observation chair for monitoring. She fainted and her mother along with two grocery associates went to hold her from falling off the chair. Two paramedics who happened to be a few feet away came to assist and took her vitals. Other medics arrived and took her to the hospital.

Other Meds: Enskyce (birth control pill)

Current Illness: previous history of syncope upon donating blood

ID: 1208619
Sex: M
Age:
State: NY

Vax Date: 03/01/2021
Onset Date: 04/14/2021
Rec V Date: 04/14/2021
Hospital:

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

Lab Data:

Allergies: Shellfish, sulfa medications

Symptom List: Injection site pain, Menorrhagia

Symptoms: Tinnitus

Other Meds:

Current Illness: None

ID: 1208620
Sex: M
Age: 23
State:

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 04/14/2021
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:

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

Symptoms: syncope for 2-3 seconds, hit head on ground. symptoms improved after laying down.

Other Meds:

Current Illness:

ID: 1208621
Sex: F
Age: 53
State: CA

Vax Date: 04/05/2021
Onset Date: 04/06/2021
Rec V Date: 04/14/2021
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:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Body aches, fever 100 deg or more, 30 hours post vaccine. Then ok for several days, normal activity. One week post 4/13/21 more symptoms: body aches, joint and muscle pain, fatigue, ear ringing, headache, fever, chills.

Other Meds:

Current Illness:

ID: 1208622
Sex: F
Age: 29
State: NC

Vax Date: 03/26/2021
Onset Date: 03/29/2021
Rec V Date: 04/14/2021
Hospital:

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

Lab Data:

Allergies: Ibuprophen

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Injection site nodule - approximately the size of a ping pong ball, no symptoms (no pain, itching, swelling or tenderness), persisting three weeks post injection.

Other Meds: Effexor, Lamictal, Sronyx.

Current Illness: n/a

ID: 1208623
Sex: F
Age: 18
State: IA

Vax Date: 04/08/2021
Onset Date: 04/09/2021
Rec V Date: 04/14/2021
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: NKDA

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

Symptoms: There was a miscommunication between the pharmacist and the nurse and the shot did not get reconstituted so patient was injected with 0.3mL of the concentrated stock solution which probably ended up being about 4-5 doses worth. She complained of a sore arm the next day and said it was moderate pain (4/10). This was the only adverse event that was reported by the patient we followed up with her on 4/14/21 and she said she had fully recovered.

Other Meds: NA

Current Illness: N/A

ID: 1208624
Sex: F
Age: 30
State: GA

Vax Date: 04/07/2021
Onset Date: 04/08/2021
Rec V Date: 04/14/2021
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: Nausea

Symptoms: right sided facial numbness

Other Meds: none

Current Illness: vertigo

ID: 1208625
Sex: F
Age: 66
State: MN

Vax Date: 03/18/2021
Onset Date: 03/21/2021
Rec V Date: 04/14/2021
Hospital: Y

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

Lab Data:

Allergies: amoxcillin contrast dye

Symptom List: Injection site pain

Symptoms: developed severe abdominal pain; multiple CT scans of abdomen, treated with abx no better, originally had diarrhea then constipation original felt to have diverticulitis labs normal sigmoidoscopy - swollen sigmoid hospitalized, symptoms resolved

Other Meds: hctz fluoxetine buproprion montelukast Breo inhaler

Current Illness: none

ID: 1208626
Sex: F
Age: 49
State: AZ

Vax Date: 03/27/2021
Onset Date: 04/04/2021
Rec V Date: 04/14/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: 7 days following the shot I had extreme fatigue, shortness of breath, GI issues, chest pain, sharp headache and extreme leg pain. Symptoms started about 6am and got increasing worse through the day. At night when I was in bed at about 6pm my legs and chest hurt so bad I couldn't take it, so that by 11pm I went to the ER. Because of where we live in and it was a hot day, I suggested that I was dehydrated and never thought about the shot or that it might be side effects. I was treated with IV fluids and paid meds, I have given chest Xrays and it was determined I had inflammation in my chest. Once my PVCs were under control (I had been in bi-Gemini) I was released with Zofran and Tramadol. I have felt extremely tired since. And I am unsure if I should contact a health care provider.

Other Meds: carvadol, levothyroxine, losartin, spironolactone, acetazolamide,

Current Illness: none

ID: 1208627
Sex: M
Age: 60
State: TX

Vax Date: 04/12/2021
Onset Date: 04/12/2021
Rec V Date: 04/14/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: This was the second shot. I didn't expect to get sick since I had been sick after the first one. Symptoms were for the first night uncontrollable shaking, vomiting & light fever (100). This is the second day and I feel tired although I slept about 20:00 hours yesterday and 12 today. Expect to recover tomorrow!

Other Meds: None

Current Illness: None

Date Died: 04/13/2021

ID: 1208628
Sex: M
Age: 67
State: VA

Vax Date: 04/09/2021
Onset Date: 04/13/2021
Rec V Date: 04/14/2021
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: Codeine, Lipitor

Symptom List: Tremor

Symptoms: It was reported by the Sheriff's Dept. that patient was found expired on 4/13/21 - sitter reported that patient went to take a nap and the sitter went to check on him and found him unresponsive and called 911; patient was DOA on arrival

Other Meds: Coreg, Furosemide, Aspirin, Fish Oil, Nitroglycerin, Nystatin topical, Lasix, Lactulose, Potassium Chloride, Omeprazole, Loratadine, Flomax, Gabapentin, Narcan, Tramadol, Zolpidem, Combivent, Imdur

Current Illness: Essential hypertension, Cardiomyopathy, Chronic viral Hepatitis C, Cirrhosis of the liver, Hypokalemia, Anxiety disorder, CHF, Gout, Ischemic heart disease, COPD, Smoker, Diabetic neuropathy, Lipid disorder, Diabetes Mellitus, Cataracts, Chronic insomnia, Radiculopathy lumbar region, GERD, Benign prostatic hyperplasia with lower urinary tract symptoms, Chronic kidney disease stage 3, Seasonal allergies, BMI 39.0-39.9

ID: 1208629
Sex: F
Age: 27
State: CA

Vax Date: 03/01/2021
Onset Date: 03/12/2021
Rec V Date: 04/14/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Erythema, Pruritus

Symptoms: I had sparkles in my vision 5 min. after getting my shot. They went away quickly, so I wasn't concerned. I had a little bit of hotness up my neck and a little itchy, but both also were quick to go away. I went home and went to bed without issue. I woke up at 4am crying and in a lot of pain all over my body. I had a crushing headache, my back, arms and legs ached down to the bone. I had a fever of 100.7, and had to call in sick from work. I took 3 ibuprofen and it didn't help stop the pain or fever. I cried myself back to sleep after wreathing in pain for 3 hours. Woke up again crying again and the pain and fever continued on. I drank 2 beers to see if that would help relax my muscles and back around 3pm and by 4pm I finally felt somewhat better, but still couldn't get up out of bed. I had to call my brother over to help me and considered asking him to take me to the hospital several times because the pain was so intense. The spot where I got my shot wasn't inflamed, or if it was I didn't notice. It did seem a little stiff. I managed to fall back asleep and by the time I woke up again the next day around 5am, I felt completely fine. Fever disappeared and the body pain was gone. It was like nothing had ever happened.

Other Meds: None

Current Illness: None

ID: 1208630
Sex: M
Age: 37
State: AZ

Vax Date: 03/31/2021
Onset Date: 03/31/2021
Rec V Date: 04/14/2021
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: None known

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

Symptoms: Patient reports that within 2 hours of receiving Janssen vaccine, started with migraine-symptoms and dizziness; he had to stay out from work the next next day due to fatigue/dizziness/headaches/myalgias. Started with shortness of breath and asthma exacerbation symptoms on 4/1/21; saw PCP, on 4/2/21 for shortness of breath and asthma/allergy-like symptoms. He also reports that since the time of his vaccine his BP has been running slightly high around 140/85 and headaches have continued off and on. He was started on Budenoside inhaler by PCP and prednisone (patient does not recall dose). Came to see me at on-site clinic on 4/13/21 for continued headaches and concerns to blood pressure elevation persistence

Other Meds: Albuterol PRN

Current Illness: None known

ID: 1208631
Sex: F
Age: 21
State: NV

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 04/14/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: After about 7 hours of receiving the vaccine I started to shiver. My body felt extremely cold even though I was in 75 degree temperature indoors. I started getting goosebumps. That lasted for about 9 hours throughout the night. I also experienced nausea for about 30 minutes at 8:45 pm. I felt like I was going to pass out within that time period too. My head was also hurting throughout the night. My body was aching through the night as well. The only reason I am not sure if I had a fever is because I did not have a thermometer. My arm was sore for 3 days and I was also sweating throughout the first night.

Other Meds:

Current Illness: No

ID: 1208632
Sex: F
Age: 33
State: GA

Vax Date: 01/04/2021
Onset Date: 01/15/2021
Rec V Date: 04/14/2021
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: NKDA

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Received first Moderna vaccine on 1/4/2021 Continued taking daily consumption of OCP No illness, infection or ABX use during this time LMP 1/15/2021 Positive HPT on 2/14/2021 Experienced episodes of early vaginal bleeding in pregnancy on x2 separate occurrences, primary care and OBGYN notified ABD pain and cramping present Monitored with hcg levels every 2 days and pelvic ultrasounds Confirmed right ectopic pregnancy 3/4/2021 Diagnosed with a non-viable pregnancy Treatment to end ectopic pregnancy with methotrexate required (other option was surgical management and I declined) Pain/trauma and emotional distress occurred Still being followed with weekly blood draws related to ectopic and methotrexate use

Other Meds: Prenatal vitamin Vitamin D Vitamin C Biotin Iron supplement Progesterone only birth control pills Synthroid

Current Illness: None

ID: 1208633
Sex: F
Age: 37
State: CO

Vax Date: 04/05/2021
Onset Date: 04/05/2021
Rec V Date: 04/14/2021
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: Shellfish

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

Symptoms: Fever, chills, body aches, tiredness for 24 hours starting from 8pm 4/5/21 to 8 pm 4/6/21

Other Meds: Ibuprofen, women?s daily probiotic garden of life, women?s daily multivitamin garden of life vitamin code, and nutrafol hair vitamin

Current Illness: None

ID: 1208634
Sex: F
Age: 62
State: TX

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 04/14/2021
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: several antibiotics, asprin

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

Symptoms: High Fever (over 101), vertigo, severe shaking, nausea, muscle and joint pain, migraine, fatigue

Other Meds: Lunesta, estrogen, restasis

Current Illness: none

ID: 1208635
Sex: F
Age: 61
State: CT

Vax Date: 03/01/2021
Onset Date: 03/19/2021
Rec V Date: 04/14/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: Stroke- hearing loss in right ear, extreme headache left temple lobe, nausea, dizziness, diarrhea, inability to move legs. Hospitalized for 5 days Continued weakness left side of the body

Other Meds: Blood thinner, heart medication, statin, aspirin

Current Illness:

ID: 1208636
Sex: M
Age: 49
State: IN

Vax Date: 04/12/2021
Onset Date: 04/13/2021
Rec V Date: 04/14/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 2
Vax Route:
Vax Site:

Lab Data:

Allergies: N/A

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

Symptoms: Headache

Other Meds: N/A

Current Illness:

ID: 1208637
Sex: F
Age: 42
State: TX

Vax Date: 04/01/2021
Onset Date: 04/09/2021
Rec V Date: 04/14/2021
Hospital:

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

Lab Data:

Allergies: Allergic to Ceclor, Codeine, Vicodin, Morphine and some sulfa

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

Symptoms: The 1st dose (on 3/3/21) caused nausea, gerd, fever of 100.4 for and body aches for 2 days, with mild headache. The 2nd dose, (on 4/8/210 I took Tylenol prior to vaccine and every 5-6 hours for over 48 hours but still ran 103 fever for two days after the injection. The reaction began with nausea, vomiting and 102 fever about 12 hours after injection and quickly rose to 103 for the next 48 hours. I had severe headache, dizziness and body aches for 3-4 days after the vaccine.

Other Meds: Levothyroxine, Oxybutiynin, Gabapentin, Omeprazole, TylenolDiclofenac

Current Illness: none

ID: 1208638
Sex: F
Age: 49
State:

Vax Date: 04/08/2021
Onset Date: 04/09/2021
Rec V Date: 04/14/2021
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: tree nuts, amoxicillian, avolox

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

Symptoms: Facial selling. Started in chin area where I had facial filler and then spread over face and neck overnight. Woke up with hives on torso, back, butt and inner thighs.

Other Meds:

Current Illness: none

ID: 1208639
Sex: F
Age: 68
State: NJ

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 04/14/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Erythromycin, fish, nuts, metrotrexosate, all fruits, okra

Symptom List: Vomiting

Symptoms: Later the day after the vaccine I developed severe chills and a really bad sore throat. I developed hives in my throat and mouth which cause hoarsness and was hurting really bad. On that Monday I visited my PCP who prescribed an antibiotic which did help and took antihistimines also. I developed a fever an was really tired and after about 3 day the symptoms subsided. My arm was really sore for about 2 days also.

Other Meds: Genivua, Farciegia, Clortmomeride, Trocevia, Decolicant, Crestor, prilia, Vit D.

Current Illness: no

ID: 1208640
Sex: F
Age: 41
State: MA

Vax Date: 04/12/2021
Onset Date: 04/12/2021
Rec V Date: 04/14/2021
Hospital:

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

Lab Data:

Allergies: No

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Burning hot sensation on tight side of chest/breast

Other Meds: None

Current Illness: None

ID: 1208641
Sex: M
Age: 75
State: MO

Vax Date: 02/26/2021
Onset Date: 03/05/2021
Rec V Date: 04/14/2021
Hospital: Y

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

Lab Data:

Allergies: NKA

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

Symptoms: 1 week after receiving the second dose of the Pfizer vaccine, started to feel short of breath with chest pain, a week later showed up to the hospital with extensive bilateral PEs and new onset A. fib. Physician can not determine the etiology behind the PEs, but cannot find any malignancy. Referred patient to pulmonology and hematology for further work-up. Physician feels that this could be an adverse reaction to the Pfizer vaccine Heparin drip for pulmonary emboli 4/8

Other Meds: glimeperide 2 mg, metformin 500 BID, metoprolol tart 50 BID, ASA 81 QD, plavix 75 mg QD, lisinopril 10 mg QD, simvastatin 40 mg QD, nitro SL prn

Current Illness:

ID: 1208642
Sex: F
Age: 61
State: MS

Vax Date: 02/24/2021
Onset Date: 02/24/2021
Rec V Date: 04/14/2021
Hospital: Y

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: Zucchini

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Diagnosed as Guillan-Barre?Syndrome

Other Meds:

Current Illness: Rheumatoid arthritis

ID: 1208643
Sex: M
Age: 40
State: TX

Vax Date: 04/12/2021
Onset Date: 04/13/2021
Rec V Date: 04/14/2021
Hospital:

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

Lab Data:

Allergies: Bee Stings

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

Symptoms: Fatigue beginning the following morning (6AM) Fever 99.9 at 6AM treated with Ibuprofen Fever 102.2 at 7PM treated with Ibuprofen Fever 102.8 at 8:30 PM Fever throughout the night accompanied with excessive sweating Consistent Body and Joint aches

Other Meds: Omeprazole

Current Illness: none

ID: 1208644
Sex: F
Age: 35
State: CA

Vax Date: 04/10/2021
Onset Date: 04/11/2021
Rec V Date: 04/14/2021
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: Minor blurred vision on the next morning and lasted about 6 hours then vision came back at late evening

Other Meds: None

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm