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**
PLEASE CHECK BACK SOON
Download the files above while you wait.






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: 1229899
Sex: M
Age: 91
State: HI

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 04/19/2021
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:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient Received Moderna vaccine 2/11/2021, 3/11/2021, and 4.14.2021- 3 doses instead of 2

Other Meds:

Current Illness:

ID: 1229900
Sex: F
Age: 64
State: CA

Vax Date: 03/29/2021
Onset Date: 04/08/2021
Rec V Date: 04/19/2021
Hospital:

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

Lab Data:

Allergies: allergic to sulpha antibiotics

Symptom List: Anxiety, Dyspnoea

Symptoms: 6 days after the first dose, I experienced morning vertigo to the extent that I had to hold on to walls. After 12 days, that passed. 8 days after the second dose (April 8), I had vertigo when I bent over or turned my head while lying in bed especially on my back and fatigue that made me unable to walk more than 1/2 hour. The vertigo got a little better around April 19, but the fatigue remains significant

Other Meds: vitamin B, D, zinc

Current Illness: none

ID: 1229901
Sex: F
Age: 39
State: CO

Vax Date: 04/08/2021
Onset Date: 04/17/2021
Rec V Date: 04/19/2021
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

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

Symptoms: rash on right arm developed after several days.

Other Meds: brio

Current Illness: none

ID: 1229902
Sex: F
Age: 17
State:

Vax Date: 04/17/2021
Onset Date: 04/17/2021
Rec V Date: 04/19/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Pt complained of Shortness of breath and chest tightness that started just a few minutes after vaccine administration. Pt has history of asthma. Exam done within normal limits. Pt given 2 puffs of albuterol. Symptoms remain mild after 45 min of observation. Pt discharged home with precautions.

Other Meds:

Current Illness:

ID: 1229903
Sex: F
Age: 65
State: PA

Vax Date: 04/16/2021
Onset Date: 04/17/2021
Rec V Date: 04/19/2021
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 erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Red rashes itching all over body hands chest stumoch leg swsollen face with red rashes bumps.

Other Meds: none

Current Illness: none

ID: 1229904
Sex: F
Age: 48
State: CO

Vax Date: 04/13/2021
Onset Date: 04/13/2021
Rec V Date: 04/19/2021
Hospital:

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Called to see pt as rapid repsonse appx 1 hour after receiving first Moderna vaccine. Pt endorsed dizziness, generalized weakness, dyspnea at rest, generalized CP. Pt reported sx felt like previous asthma attacks. No anginal equivalents, other respiratory s/sx. No localizing neurologic c/o. Reports SMBG at home recently "all lower than 200". BG level of pt was 302. Upon entering exam room pt noted to be pale with pulse in 110s. No increased effort of breathing, oximetry high 90s on RA, BP wnl. Exam per above. EKG performed after all vitals and glucose obtained and was normal. Checked VS every 5 minutes x 2 with decrease of HR to normal range. Pt subjectively felt better at this time, had regained normal color, and 15 minutes later requested going home.

Other Meds:

Current Illness:

ID: 1229905
Sex: F
Age: 51
State: NJ

Vax Date: 03/23/2021
Onset Date: 03/23/2021
Rec V Date: 04/19/2021
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: certain anesthesia - I take longer to come out of

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: 3/23 & 3/24 - Sore arm 3/23 & 3/24 - Severe diarrhea which did make me weak 3/23 - 3/26 -My Sjogrens Syndrome had a flare but I previously never had such dry hands and dry legs. - I did have fatigue 4/1 & 4/2 - I had COVID arm -> I can share a picture of my left arm 4/9 thru 4/11 - Bulging temple on my left side just above my left eye appeared -- I took aspirin from 4/9 thru 4/12 to reduce chance of a blood clot -- This never happened like this in my life before and I had no headache and I was not dehydrated -- I can share a picture of the temple by my eye. I did feel fatigue. 4/7 thru 4/17 - The left side of my upper lip twitched for about a minute; it usually occurred in the morning when I woke up. 3/23 thru 4/17 - My Sjogrens Syndrome dry eye inflammation and dryness increased in my left eye but has since gone back to pre-vaccine limited dryness

Other Meds: multi vitamin iron pill

Current Illness: Sjogrens Syndrome - it mainly effected my eyes..dry eye I had been to the Doctor and had bloodwork prior to taking the vaccine and my Sjogren's levels were low I had low iron due to pre-menopause and heavy bleeding due to small uterine fibroids and ovarian cysts

ID: 1229906
Sex: F
Age: 23
State:

Vax Date: 04/19/2021
Onset Date: 04/19/2021
Rec V Date: 04/19/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Pt c/c of feeling dizzy. Pt appeared to be passing out. Pt sat back on the chair and unable to respond to question and looked very pale and diaphoretic. Pt was moved to the cot and had her lay down. Few minutes pt felt better and able to say her name. EMT assessed the patient and felt much better

Other Meds:

Current Illness:

ID: 1229907
Sex: F
Age: 25
State: NJ

Vax Date: 04/05/2021
Onset Date: 04/01/2021
Rec V Date: 04/19/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Mild tinnitus that has shown up a few times. Each time it comes it stops shortly after.

Other Meds: None

Current Illness: None

ID: 1229908
Sex: F
Age: 59
State: LA

Vax Date: 04/17/2021
Onset Date: 04/17/2021
Rec V Date: 04/19/2021
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:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: mRNA mixed series delivered - Pfizer on 3/24/21 and Moderna on 4/17/21

Other Meds:

Current Illness:

ID: 1229909
Sex: M
Age: 54
State: IA

Vax Date: 04/07/2021
Onset Date: 04/08/2021
Rec V Date: 04/19/2021
Hospital:

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

Lab Data:

Allergies: NKA

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

Symptoms: Pt experienced SOB the day after he received his covid 19 vaccine. He continues to have SOB.

Other Meds: atenolol, fiber supplement, fluoxetine, naproxen, omeprazole, probiotic, quetiapine fumarate, simvastatin and tamsulosin

Current Illness: None

ID: 1229910
Sex: F
Age: 57
State: MN

Vax Date: 04/19/2021
Onset Date: 04/19/2021
Rec V Date: 04/19/2021
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: See next page

Symptom List: Rash, Urticaria

Symptoms: Patient told check-in staff that she had pre-medicated for anxiety prior to coming for first COVID-19 vaccine. Prior to vaccine, patient told vaccinator she was anxious. She shared that she had a history of laryngospasm triggered by some smells. Vaccinator approached writer asking if arm could be cleansed with soap and water prior to vaccination instead of alcohol wipe although patient stated she felt she would be ok with alcohol wipe being used. Writer advised that vaccine site was not equipped with supplies to cleanse arm in that fashion. Advised vaccinator to offer additional mask to patient to cover hers to prevent odors and to turn head while arm being cleansed. (continued on next page)

Other Meds: See next page

Current Illness: unknown

ID: 1229911
Sex: F
Age: 59
State: UT

Vax Date: 03/26/2021
Onset Date: 03/26/2021
Rec V Date: 04/19/2021
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 reported

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

Symptoms: Vaccine mixed with incorrect diluent (sterile water instead of normal saline). Pt informed of error and offered revaccination. Pt reports sore arm with onset about 5 days after vaccination that lasted about 15 days.

Other Meds: clonazepam, citalopram, levothyroxine

Current Illness: none reported

ID: 1229912
Sex: M
Age: 50
State: CA

Vax Date: 04/13/2021
Onset Date: 04/13/2021
Rec V Date: 04/19/2021
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: No known Allergies

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

Symptoms: Shortness of Breath with cough , generalized weakness, left rib pain radiating to upper back pain (sharp in nature)

Other Meds: unknown

Current Illness: Unknown

ID: 1229913
Sex: M
Age: 49
State: MI

Vax Date: 04/15/2021
Onset Date: 04/15/2021
Rec V Date: 04/19/2021
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: NKDA

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

Symptoms: Breakdown in communication with SNF. Patient received vaccination series back in January and February.. Patient was screened and consented to vaccine series. After 4th vaccine was given it was found that patient received the series twice. No reactions to eoth the 3rd or 4th dose. Serial numbers are:3rd dose- 007B21A 4th dose- 0043B21A.

Other Meds:

Current Illness:

ID: 1229914
Sex: F
Age: 27
State: IA

Vax Date: 04/03/2021
Onset Date: 04/06/2021
Rec V Date: 04/19/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: April 6, 2021 - Intermittent blurry/spotty vision for about 10 minutes. Once vision returned to normal, felt nauseated and emesis x1 then migraine around right eye for approximately 4 hours. April 8, 2021 - Sudden onset of blurry/spotty vision for approximately 20 minutes. Once vision returned to normal, had migraine around right eye for approximately 4 hours. April 13, 2021 - Same symptoms as 4/8/2021

Other Meds: None

Current Illness: None

ID: 1229915
Sex: M
Age: 53
State: PA

Vax Date: 04/16/2021
Onset Date: 04/17/2021
Rec V Date: 04/19/2021
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: Ringing in both ears

Other Meds: Multi vitamin, zinc

Current Illness:

ID: 1229916
Sex: F
Age: 79
State: VA

Vax Date: 04/16/2021
Onset Date: 04/19/2021
Rec V Date: 04/19/2021
Hospital:

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

Lab Data:

Allergies: iodine

Symptom List: Ear pain, Hypoaesthesia

Symptoms: swollen lymph node under left jaw

Other Meds: synthroid .88mcg, losartan, centrum silver, vitamin d

Current Illness:

Date Died: 04/06/2021

ID: 1229917
Sex: M
Age: 69
State: CA

Vax Date: 03/25/2021
Onset Date: 04/02/2021
Rec V Date: 04/19/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: 4/3/21 at 0052 during Q15 rounds the patient was found laying awake on the floor next to his bed. He denied falling. Vitals showed BP 95/57, Temp 96, O2 sat 77%. He was evaluated and transferred to an acute care hospital with cardiac specialty. He was found to have elevated triponin and chest x-ray showed lung infiltrates; COVID test was negative. Diagnosis was MI and pnuemonia. He received a right coronary artery stent. The patient was intubated on full ventilation support. On 4/4/21 the patient went into cardiac arrest 3 times and was resuscitated. On 4/5/21 his condition declined and he went into cardiac arrest again and was resuscitated around noon. The patient died in acute care on 4/7/21 at 0608.

Other Meds: aripiprazole 400mg IMQ4 weeks (last dose 3/24/21), cholecalciferol 25mcg daily, fluphenazine 5mg daily

Current Illness:

ID: 1229918
Sex: M
Age: 61
State: MS

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

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

Lab Data:

Allergies: shell fish

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

Symptoms: 4/1/2021 Shivers/Shakes at about 10pm, Fever was high 102+, after midnight began vomiting for along period and until empty. Chills continued with fever thru the night. 04/02/2021: The next day had severe headache and fever all day. Went to bed at 10pm and woke the next day feeling much better. 04/03/2021 Weak all day but headach was gone. Had some shortness of breath for almost a week.

Other Meds: cialas 20mg, , vitamins ( vit D, Zinc, Vit. B , Fish Oil, Vit. C, )

Current Illness: none

ID: 1229919
Sex: F
Age: 31
State: CA

Vax Date: 04/15/2021
Onset Date: 04/15/2021
Rec V Date: 04/19/2021
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: None

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

Symptoms: Day 1 - Sore arm resolved 4 days after Day 2: Itchy rash, still ongoing 4 days after. Headache, body ache, skin sensitivity, lasting one day.

Other Meds: None

Current Illness: None

ID: 1229920
Sex: F
Age: 46
State: MI

Vax Date: 01/13/2021
Onset Date: 04/16/2021
Rec V Date: 04/19/2021
Hospital:

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

Lab Data:

Allergies: reglan - tachycardia

Symptom List: Unevaluable event

Symptoms: Received Pfizer COVID vaccine 12/23/20 and 1/13/2021. On 4/16/2021 developed body aches, cough, headache, nasal congestion, and sore throat. Tested positive for COVID.

Other Meds: excedrin migraine, lipitor, xcopri, lamictal, synthroid, zestril

Current Illness: none

ID: 1229921
Sex: F
Age: 60
State: CA

Vax Date: 04/09/2021
Onset Date: 04/11/2021
Rec V Date: 04/19/2021
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: Hay, Horses, Cats

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

Symptoms: 2 days after shot I felt unable to get deep breaths, slight pressure in chest and feeling of shortness of breath. 3rd day cough developed, and continued for 6 days, now is improved but still slight cough and not quite normal

Other Meds: None

Current Illness: None

ID: 1229922
Sex: M
Age: 23
State:

Vax Date: 04/19/2021
Onset Date: 04/19/2021
Rec V Date: 04/19/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Pt reports left arm weakness and numbness, chest pain/tightness, and overall does not feel well. does not take any medications

Other Meds:

Current Illness:

ID: 1229923
Sex: M
Age: 27
State: TX

Vax Date: 03/18/2021
Onset Date: 03/22/2021
Rec V Date: 04/19/2021
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: Injection site pain, Menorrhagia

Symptoms: Patient started feeling unwell on 03/22/2021 and went to the E.R. Patient was diagnosed with Bells Palsy.

Other Meds: None

Current Illness: None

ID: 1229924
Sex: F
Age: 32
State: AZ

Vax Date: 04/18/2021
Onset Date: 04/18/2021
Rec V Date: 04/19/2021
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: N/A

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

Symptoms: First 12hrs no major symptoms, just light fatigue and a minor headache. About 16hrs post vaccination, started experiencing body aches, chills, and a fever of 101.3. Very intense headache that still hasn't gone away about 34hrs in. Severe arm pain/soreness in vaccinated arm starting about 4hrs post shot.

Other Meds: Atenolol; Ortho-tricyclen; Ajovy; Botox for migraines Magnesium, Biotin, Vitamin B Complex

Current Illness: None

ID: 1229925
Sex: F
Age: 41
State: NM

Vax Date: 04/19/2021
Onset Date: 04/19/2021
Rec V Date: 04/19/2021
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: n/a

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient Fainted 2-3 minutes after receiving vaccine while in observation waiting area. Blood pressure was really low at 84/50. We monitored patient for 20 minutes more, had her put feet up, cool pack on chest, gave a cool water to drink, and checked BP 3 times. Patient was fine after initial fainting. She was walked to her vehicle and did get home safely

Other Meds: n/a

Current Illness: none

ID: 1229926
Sex: M
Age: 52
State: IL

Vax Date: 04/19/2021
Onset Date: 04/19/2021
Rec V Date: 04/19/2021
Hospital:

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

Lab Data:

Allergies: NKA

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Dizziness, lightheadedness

Other Meds: Bisoprolol

Current Illness: None

ID: 1229927
Sex: M
Age: 41
State: VA

Vax Date: 04/14/2021
Onset Date: 04/17/2021
Rec V Date: 04/19/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Ringing in my ear

Other Meds: None

Current Illness: None

ID: 1229928
Sex: F
Age: 21
State: IL

Vax Date: 04/10/2021
Onset Date: 04/10/2021
Rec V Date: 04/19/2021
Hospital:

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

Lab Data:

Allergies: unknown

Symptom List: Nausea

Symptoms: We are reporting that the patient did not truthfully complete the vaccine consent form. Patient did indeed receive a prior COVID vaccination on 2/4/21 as a Moderna. She completed the form as not having received a prior dose. She received a Pfizer COVID vaccine on 4/10/21.

Other Meds: unknown

Current Illness: unknown

ID: 1229929
Sex: M
Age: 24
State: CA

Vax Date: 04/07/2021
Onset Date: 04/07/2021
Rec V Date: 04/19/2021
Hospital: Y

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

Lab Data:

Allergies: None that are known

Symptom List: Injection site pain

Symptoms: First few days had chills, extreme sweating, nausea, and then ended up in hospital with irritation and inflammation of heart lining and walls.

Other Meds: Truvada

Current Illness: None that are known

ID: 1229930
Sex: F
Age: 40
State: GA

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

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

Lab Data:

Allergies: Shrimp

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

Symptoms: Blood pressure 50/40 heart beat 50 fever body spasms eye spasms diarrhea short breath lot headaches skin burning when showering skin very dry and swollen

Other Meds: Just Tylenol and my heart pills

Current Illness: No

ID: 1229931
Sex: M
Age: 41
State: NE

Vax Date: 04/01/2021
Onset Date: 04/16/2021
Rec V Date: 04/19/2021
Hospital: Y

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

Lab Data:

Allergies: NKA

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

Symptoms: Reporting per Moderna COVID-19 requirements n/v/d abdominal pain, elevated white count: appendicitis

Other Meds: None

Current Illness: none

ID: 1229932
Sex: M
Age: 69
State: MI

Vax Date: 04/15/2021
Onset Date: 04/16/2021
Rec V Date: 04/19/2021
Hospital:

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

Lab Data:

Allergies: none reported

Symptom List: Tremor

Symptoms: PC to patient after receiving vm that he was feeling "deathly ill" following his vaccination. He states that he really didn't do anything for a couple days and his mental capabilities were affected. He states he received his vaccination thurs and fri morning he called his friend to have him check on him every couple hours since he just didn't feel right. His friend told him by 2pm that he had a hard time having a conversation with him as he was only able to get out a few words and they didn't make sense. He had shaking, vomiting, weakness, fatigue, staggered when he walked and really doesn't have much memory of friday. He states his friend called the walk in clinic to see if he should go in and was told those were just normal side effects. Patient believes he had covid in the past month as he had altered taste and his friend had covid and was hospitalized with similar sx. He states his sense of taste is back to the saltiness that it was when he had covid. He reports that still on day 4 post vaccine, he doesn't feel he is mentally at baseline and is struggling to pull words out. He plans to make an appointment to see his physician today.

Other Meds: seroquel,losartan 100mg, norvasc 5mg, hydrochlorothyazide 50mg, creatine, collagen, branched chain amino acids, CLA supplement

Current Illness: COVID-19 likely

ID: 1229933
Sex: F
Age: 62
State: LA

Vax Date: 04/07/2021
Onset Date: 04/17/2021
Rec V Date: 04/19/2021
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: PCN, Cephalexin, erythromycin, azithromycin, clarithromycin

Symptom List: Erythema, Pruritus

Symptoms: Pt had reaction to Left arm 7 days after administration of Covid vaccine, 6x4x6 redness and swelling at injection site.

Other Meds:

Current Illness: None reported

ID: 1229934
Sex: M
Age: 31
State: IL

Vax Date: 03/23/2021
Onset Date: 04/18/2021
Rec V Date: 04/19/2021
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

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

Symptoms: occlusive DVT involving left lower extremity extending from the left common femoral vein through the femoral vein and popliteal vein: Patient noticed L groin pain when getting up after resting after a bike ride. Pain significantly worsened overnight and leg more red than right leg on exam with tenderness of groin. Venous duplex showed extensive left lower extremity DVT. Patient sent to ER for further evaluation and treatment. Patient denied any shortness of breath or chest pain. pulse ox 98%, pulse 88 bpm.

Other Meds: none

Current Illness: none

ID: 1229935
Sex: M
Age: 20
State: CA

Vax Date: 04/15/2021
Onset Date: 04/17/2021
Rec V Date: 04/19/2021
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: None

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

Symptoms: . He received his second Moderna vaccine on 04/15th. He did have localized pain in his arm and the following day, had some headache and neck stiffness. Yesterday evening around 5 o' clock he developed left chest pain that has persisted. It has waxed and waned, but not disappeared. It reached an intensity of 7/10 prompting him to get a ride to the emergency room for evaluation. He was found to have myocarditis, with troponin elevation to 37 ng/mL, and globally reduced ejection fraction 45%. His care is ongoing.

Other Meds: None

Current Illness: None

ID: 1229936
Sex: F
Age: 22
State: IN

Vax Date: 04/17/2021
Onset Date: 04/18/2021
Rec V Date: 04/19/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Fainted, nauseous, light headedness, fever, chills, weakness, exhaustion.

Other Meds: Zinc

Current Illness: Covid

ID: 1229937
Sex: F
Age: 35
State: DE

Vax Date: 02/08/2021
Onset Date: 02/25/2021
Rec V Date: 04/19/2021
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: No

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

Symptoms: A little over 2 weeks following my first vaccine i started to have numbness and tingling in my legs that spread to my arms. I made an appointment with my primary care physician who recommended i follow up with a neurologist. I scheduled a neurologist appointment for a month later but went to the ER three times with symptoms worsening feeling weak and like I was going to pass out. I was initially told by my primary care physician and ER physician that this was not a side effect of the vaccine so i received my second dose. My heartrates have not been able to be controlled since going up to the 190's when i stand.

Other Meds: Prenatal, Birth Control

Current Illness: No

ID: 1229938
Sex: M
Age: 38
State: NV

Vax Date: 03/12/2021
Onset Date: 03/24/2021
Rec V Date: 04/19/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Tiny red spots on the skin (petechiae), on legs. Cant afford treatment.

Other Meds: None

Current Illness: None

ID: 1229939
Sex: M
Age: 48
State: WA

Vax Date: 04/07/2021
Onset Date: 04/12/2021
Rec V Date: 04/19/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Pain in extremity

Symptoms: DVT diagnosed 7 days after vaccine. Pt does have hx of DVT in past and was dx'd with COVID by NAAT at same time. Otherwise no risk factors.

Other Meds: tesosterone cypionate 200mg/ml every 2 weeks nuvigil 200mg daily red yeast rice extract omeprazole 20mg

Current Illness: Pt developed COVID 19 five days after vaccine.

ID: 1229940
Sex: F
Age: 48
State: NC

Vax Date: 03/29/2021
Onset Date: 03/29/2021
Rec V Date: 04/19/2021
Hospital:

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

Lab Data:

Allergies: Augmentin - allergic reaction one time, rash

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

Symptoms: 3-4 hours - Flu like symptoms, body aches 12-14 hours - severe nausea and seizure

Other Meds: Shaklee Menopaise Balance Complex Shaklee Herb-lax

Current Illness: None

ID: 1229941
Sex: M
Age: 37
State: FL

Vax Date: 04/19/2021
Onset Date: 04/19/2021
Rec V Date: 04/19/2021
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: PCN

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

Symptoms: 37-year-old male, with past medical history of Pre-Diabetes, Hypercholesterolemia, Thyroid nodules, Kidney stones and Insomnia, who presents with left arm numbness post vaccination administration. Patient states that the numbness began at the vaccination site and traveled down to his left hand. Patient denies radiation of numbness to the left neck and/or face. This is the patients second vaccination that was received in the Left deltoid. Patient denies previous reaction to vaccination number 1 or to other vaccinations in the past. The NP and paramedics at patient side. Patient with equal strength and pulses to bilateral upper extremities. Stroke Scale negative. Patients initial vitals ( 145/99 BP, 98% RA, 99 HR, Resp 12, glucose 116), repeat vitals (134/84 BP, 100% RA, 81 HR) and (136/93 BP, 99%, 81 HR, Resp 10), (130/94 BP, 99% RA, 80 Pulse on discharge. EKG with NSR. Patient was monitored by the NP and Paramedic for 30 mins with resolution of symptoms. Patient denies numbness, weakness, tingling of the left upper extremity, chest pain, difficulty breathing or throat discomfort. Patient was cleared to be discharged home. Patient aware to follow up if symptoms persist or worsen.

Other Meds: Benicar

Current Illness:

ID: 1229942
Sex: F
Age: 48
State: CO

Vax Date: 03/29/2021
Onset Date: 04/09/2021
Rec V Date: 04/19/2021
Hospital:

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

Lab Data:

Allergies: no

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

Symptoms: Sudden onset severe joint pains - shoulders and hips - 24 hours/day minimal relief of symptoms with ibuprofen. ongoing. crp 39. very similar presentation to PMR except for the sudden onset

Other Meds: fluticasone ibuprofen

Current Illness: no no

ID: 1229944
Sex: M
Age: 21
State: IL

Vax Date: 04/10/2021
Onset Date: 04/16/2021
Rec V Date: 04/19/2021
Hospital: Y

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

Lab Data:

Allergies: Penicillin - unknown rxn

Symptom List: Vomiting

Symptoms: 21 y.o. male with no significant PMHx who received the Johnson and Johnson vaccine 4/10/21 found to have extensive LLE DVT (extending above inguinal ligament). Pt was transferred to OSF for catheter directed thrombolysis. He was given 10 mg Eliquis prior to transfer. Pt reports acute onset of LLE pain the evening of 4/16 with progressive pain over the weekend and development of LLE edema/redness 4/18. Left leg mildly more edematous than right. Foot pink/warm, sensorimotor intact. No skin discoloration. Pt denies recent surgery, prolonged immobility or known family history of clotting disorders.

Other Meds: none

Current Illness: none

ID: 1229945
Sex: F
Age: 38
State: NJ

Vax Date: 04/10/2021
Onset Date: 04/13/2021
Rec V Date: 04/19/2021
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: Seasonal allergies only.

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: 3 days after receiving my 2nd Moderna vaccine I went into anaphylaxis. My throat felt like it was closing, tongue swelled up and could barely speak. My hands swelled and very extremely itchy. I developed hives all over my upper body including my head. This has Never happened before.

Other Meds: Lexapro, YAZ, Metformin, Zyrtec

Current Illness: No

ID: 1229946
Sex: F
Age: 27
State: WA

Vax Date: 04/03/2021
Onset Date: 04/03/2021
Rec V Date: 04/19/2021
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: No known allergies, mild lactose intolerance

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

Symptoms: I had a 104 degree fever from Saturday through Tuesday afternoon Very tired, nauseous Bad headache

Other Meds: None, I do not take medications

Current Illness: None

ID: 1229947
Sex: F
Age: 31
State: KY

Vax Date: 03/18/2021
Onset Date: 03/19/2021
Rec V Date: 04/19/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: bupropion-hives, levofloxacin-hives, lansoprazole-hives, omeprazole-hives, adhesive-rash

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Hives that come and go. She reports the day after vaccine when her cloths touch or she scratches her face she develops welts

Other Meds: Glargine insulin, Lispro insulin, Mirena IUD, cetirizine 10 mg

Current Illness: none

ID: 1229948
Sex: F
Age: 33
State: SC

Vax Date: 04/02/2021
Onset Date: 04/10/2021
Rec V Date: 04/19/2021
Hospital:

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

Lab Data:

Allergies: Ceclor, Codeine, Dimetapp

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

Symptoms: The day after the vaccine developed a fine, red itchy rash on both arms and back. Rash went away after 24 hours of it starting. 8 days after the vaccine, developed a raised, hive-like, itchy, sore, warm-to-touch rash over Left upper arm. Rash lasted 24-48 hours.

Other Meds: mini-pill (oral birth control), prenatal vitamin

Current Illness: No

ID: 1229949
Sex: F
Age: 57
State: CA

Vax Date: 04/11/2021
Onset Date: 04/12/2021
Rec V Date: 04/19/2021
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: NO KNOWN ALLERGY

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

Symptoms: patient had headache and pain at injection site , went to PCP and ER checked up they did ultra sound and cat scan on her head . The result is no head trauma. Instead patient report has Urinary tract infection

Other Meds: NO INFORMTION

Current Illness: NONE

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm