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: 1237888
Sex: F
Age: 42
State:

Vax Date: 02/26/2021
Onset Date: 03/25/2021
Rec V Date: 04/21/2021
Hospital: Y

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: pt hospitalized within 6 weeks of COVID vaccine

Other Meds:

Current Illness:

ID: 1237889
Sex: F
Age: 20
State:

Vax Date: 04/21/2021
Onset Date: 04/21/2021
Rec V Date: 04/21/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Chest tightness, sweating

Other Meds:

Current Illness:

Date Died: 04/09/2021

ID: 1237890
Sex: F
Age: 93
State:

Vax Date: 01/20/2021
Onset Date: 03/13/2021
Rec V Date: 04/21/2021
Hospital: Y

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:

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

Symptoms: This 93 year old white female hospice patient received the Covid shot on 1/20/2021 and went to the ED on 3/12 for COPD exacerbation, shortness of breath and extremity weakness. She returned to the ED on 3/13/21 and was admitted for generalized weakness and dehydration. The patient subsequently died on 4/13/21. Please refer to the other details submitted within this report and contact the person who submitted this report via email for additional follow up details and investigation.

Other Meds:

Current Illness:

ID: 1237891
Sex: F
Age: 34
State: CA

Vax Date: 04/21/2021
Onset Date: 04/21/2021
Rec V Date: 04/21/2021
Hospital:

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

Lab Data:

Allergies: none stated

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: 2nd dose provided outside of recommended 2nd dose time frame. 1st dose Pfizer provided on 01/16/2021, client claimed to have contracted COVID-19 and is now asymptomatic, 2nd shot of the series provided as per CDC/Pfizer recommendation

Other Meds: none stated

Current Illness: none stated

ID: 1237892
Sex: F
Age: 35
State: AL

Vax Date: 03/27/2021
Onset Date: 04/17/2021
Rec V Date: 04/21/2021
Hospital:

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

Lab Data:

Allergies: sulfa drugs

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

Symptoms: Irregular Menstrual cycle I have had a regular menstrual cycle since 11 years old. I received the second Moderna shot on March 27. I was on my period/cycle on my shot date- March 27, 2021.. I starts very light bleeding on Saturday April 17th- the bleeding has increased and is very heavy today (4/21). I have symptoms of my normal cycles but the symptoms seem more painful/intense- stomach ache, fatigue, and cramps.

Other Meds: Prescriptions: On second shot- 3/27/21 Lexapro On first shot-2/27/21 Paxil and minocyline

Current Illness: none

ID: 1237893
Sex: U
Age: 48
State:

Vax Date: 04/15/2021
Onset Date: 04/15/2021
Rec V Date: 04/21/2021
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: wheezing and "throat fullness" has many allergies took her albuterol(2 puffs) and 50 mg Benadryl declines epi-pen and ER transport tongue and lips are WNL, lungs clear upper airway wheezing improved

Other Meds:

Current Illness:

ID: 1237894
Sex: M
Age: 45
State: OR

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 04/21/2021
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:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient received a Pfizer second dose vaccine and the first vaccine was moderna. Patient had no symptoms and BP was 114/78 and 15 minutes later was 110/72. pulse was 70 and 15 minutes later 72. patient was kept for 45 minutes to monitor

Other Meds:

Current Illness:

ID: 1237895
Sex: F
Age: 71
State: IL

Vax Date: 03/10/2021
Onset Date: 03/17/2021
Rec V Date: 04/21/2021
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: About a week or 2 weeks later I had ringing in my left ear. It has not resolved I still have it. I went to my doctor they sent me to a ear specialist. They did a hearing test and they seen I had some lot of hearing on my left arm.

Other Meds: calcium omega 3 b12 pantoprazole 40mg atorbastin 10mg

Current Illness:

ID: 1237896
Sex: M
Age: 43
State: ND

Vax Date: 04/08/2021
Onset Date: 04/17/2021
Rec V Date: 04/21/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Warm red rash around injection site, approximately 2 inch wide by 3 inch long. Appeared on the 17th and was gone approximately one day later. Returned on 4/21/21. Benadryl given by spouse.

Other Meds: None

Current Illness: None

ID: 1237897
Sex: M
Age: 16
State: NE

Vax Date: 04/20/2021
Onset Date: 04/21/2021
Rec V Date: 04/21/2021
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 known

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Pt came in for Covid vaccine and was administered Moderna. Pt age is 16 years and 3 months so too young. Pt was observed for 15 minutes with no noted side effects.

Other Meds: None known

Current Illness: not known

ID: 1237898
Sex: M
Age: 33
State: CO

Vax Date: 04/21/2021
Onset Date: 04/21/2021
Rec V Date: 04/21/2021
Hospital:

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

Lab Data:

Allergies: CECLOR/ SULFA DRUGS

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

Symptoms: 5 MINUTES POST INJECTION : TONGUE STARTS TINGLING . SWEELING GLANDS IN THROAT . TOOK DIPHENYDRAMINE 10MINUTES LATER : BP 143/90 - THROAT STILL SWOLLEN - ARM TINGLING MBUT TONGUE IS BETTER

Other Meds: MULTI VITAMINS- CLARITIN -

Current Illness: EAR INFECTION

ID: 1237899
Sex: F
Age: 54
State: PA

Vax Date: 03/23/2021
Onset Date: 03/31/2021
Rec V Date: 04/21/2021
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: None

Symptom List: Rash, Urticaria

Symptoms: On Day 8, post vaccine, the injection site became very red, hot and itchy. It was the size of a baseball. Systemically, I developed an intense headache, stomach ache and generally feeling of being unwell..... chills, muscle aches, etc. This lasted for about 12 hrs.

Other Meds: Melatonin

Current Illness: None

ID: 1237900
Sex: F
Age: 60
State:

Vax Date: 04/16/2021
Onset Date: 04/18/2021
Rec V Date: 04/21/2021
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: unknown

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

Symptoms: vaccine 4/16 and afib 4/18 resulting in hospitalization

Other Meds: unknown

Current Illness: unknown

ID: 1237901
Sex: F
Age: 76
State: TX

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 04/21/2021
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: unknown

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

Symptoms: patient had covid shot given to her at drive up. she states immediately she started having a headache, labored breathing, tongue swelling and burning in her chest along with being flushed. the physician on site gave her benadryl and epinephrine, and she was then driven to another ED where she was given IV steroids. she states the vaccine adverse event was not reported by any of the facilities that took care of her that day. she also has had flu like symptoms since she got her shot and she is still recovering.

Other Meds: unknown

Current Illness: none

ID: 1237902
Sex: M
Age: 66
State:

Vax Date: 03/19/2021
Onset Date: 04/01/2021
Rec V Date: 04/21/2021
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: IVP dye

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

Symptoms: Headache and new uncontrolled hypertension where BP was previously controlled. New sinusitis infection. Otitis media. Now on antibiotics and flonase

Other Meds: ASA, Metoprolol, Procardia, CoQ10, Clopidegrel, Losartan, Rosuvastatin, Viagra, Vit D

Current Illness: No illnesses. Had pfizer covid #1 3 weeks prior

ID: 1237903
Sex: F
Age: 58
State: VA

Vax Date: 04/19/2021
Onset Date: 04/19/2021
Rec V Date: 04/21/2021
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:

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

Symptoms: Site: Pain at Injection Site-Mild, Additional Details: Patient reported bleeding and pain at injection site

Other Meds:

Current Illness:

ID: 1237904
Sex: M
Age: 81
State: IN

Vax Date: 01/19/2021
Onset Date: 04/09/2021
Rec V Date: 04/21/2021
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: NONE

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

Symptoms: APRIL 9 EVENING LUMP IN RIGHT LEG, PAIN TENDERNESS AND REDNESS, SITE IS HOT AS WELL. SWELLED OUT, RUNS 2 INCHES, RIGHT ON INNER PART OF LEG, BELOW KNEE LEVEL, HAS HAD 2 NEW KNEE IMPLANTS ON RIGHT LEG.

Other Meds: LISINOPRIL 20 MG TRIMINITINE BABY ASPIRIN 81 MG ALLPURINOL

Current Illness: NO

ID: 1237905
Sex: F
Age: 44
State: FL

Vax Date: 04/15/2021
Onset Date: 04/15/2021
Rec V Date: 04/21/2021
Hospital:

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

Lab Data:

Allergies: PCN, Eloquis

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Tingling at injection site, nauseous and did not eat breakfast. 108/62, HR 72, O2Sat 99% 9:30am Patient left at 9:30am, stated that she is feeling better.

Other Meds: n/a

Current Illness: n/a

ID: 1237906
Sex: F
Age: 30
State: IL

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

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

Lab Data:

Allergies: Unknown

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Patient became light headed and tachycardic post vaccination, transported to hospital via ambulance

Other Meds: Unknown

Current Illness: Unknown

ID: 1237907
Sex: F
Age: 34
State: NY

Vax Date: 04/01/2021
Onset Date: 04/20/2021
Rec V Date: 04/21/2021
Hospital:

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

Lab Data:

Allergies: N/A

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

Symptoms: I felt dizzy and got hot and my legs started shaking. I had a seizure for about a minute and then collapsed to the floor and fainted for a few seconds. I hit my knee mildly but not my head.

Other Meds: Topamax Trazadone

Current Illness: Bi-Polar Disorder

ID: 1237908
Sex: F
Age: 84
State: CA

Vax Date: 04/19/2021
Onset Date: 04/19/2021
Rec V Date: 04/21/2021
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: Patient received Pfizer first dose and inadvertently was administered Moderna for second dose.

Other Meds: Medications Ibrutinib (Imbruvica) 420 mg Oral Tab Ferrous Sulfate 325 mg (65 mg iron) Oral Tab Allopurinol (ZYLOPRIM) 100 mg Oral Tab Acetaminophen (TYLENOL) 325 mg Oral Tab Aspirin (ASPIR-LOW) 81 mg Oral TBEC DR Tab

Current Illness:

ID: 1237909
Sex: U
Age: 28
State:

Vax Date: 04/13/2021
Onset Date: 04/13/2021
Rec V Date: 04/21/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: dizzy and visual changes loss of consciousness, came to after 2 min BP 80/40 HR 70 ETOH abuse stayed in recliner for 10 min and felt better, a friend came to pick him up

Other Meds:

Current Illness:

ID: 1237910
Sex: F
Age: 49
State: NY

Vax Date: 04/19/2021
Onset Date: 04/20/2021
Rec V Date: 04/21/2021
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: Allergy to shellfish

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

Symptoms: Fever Chills Body aches Migraines

Other Meds: None

Current Illness: None

ID: 1237911
Sex: F
Age: 34
State: CA

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 04/21/2021
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: I received the vaccine at 10:30 am at pharmacy at 10:30 am. I started feeling constriction in my throat, numbness/heaviness on the right side of my face (eyelid, cheek) and lips and mild difficulty breathing around 11 am. I contacted the nurse helpline and facility after and was advised to go to an ER. I went in t the ER where I was kept under observation for approximately 4 hours. There was crookedness and drift on the right side of my face/arm observed. A CT scan was performed to rule out clots. The final diagnosis says I have Peripheral Neuropathy. The swelling on the face and tingling has reduced but not completely gone. The constriction in the throat is better.

Other Meds:

Current Illness:

ID: 1237912
Sex: F
Age: 66
State: PA

Vax Date: 04/08/2021
Onset Date: 04/11/2021
Rec V Date: 04/21/2021
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: I developed Shingles 3 days after my 2nd Moderna vaccine. Thigh became numb and had intense hip pain starting 4/11/21. Had a previously scheduled doctor's visit on 4/12/21. He thought I may have pinched/compressed a in my hip. Gave me Gabapentin for the pain. The next day, April 13, 2021, the rash started to appear across my lower back, hip area and lower front of my body. He gave me a prescription for 7 days of Valacylcovir which is ending today. Still have pain, so I'm still taking the Gabapentin

Other Meds: Metoprolol, Pravastatin, Vitamin D, Zinc and a Multiple Vitamin

Current Illness: None

ID: 1237913
Sex: F
Age: 53
State: CA

Vax Date: 04/04/2021
Onset Date: 04/10/2021
Rec V Date: 04/21/2021
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: Site: Itching at Injection Site-Severe, Systemic: Allergic: Itch Generalized-Severe, Systemic: Allergic: Rash (specify: facial area, extremities)-Severe, Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Severe, Systemic: Tingling (specify: facial area, extremities)-Medium

Other Meds:

Current Illness:

ID: 1237914
Sex: F
Age: 85
State: CA

Vax Date: 04/13/2021
Onset Date: 04/13/2021
Rec V Date: 04/21/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: When pt came home all joints muscle, back started hurting, seamed to keep getting worst after she had gotten some muscle relaxers and pain pills, Day 3 mom couldn't walk and was found on the floor, diff breathing and very week, EMS was called and taken to hospital for 3nights,

Other Meds:

Current Illness:

ID: 1237915
Sex: F
Age: 70
State:

Vax Date: 03/24/2021
Onset Date: 04/04/2021
Rec V Date: 04/21/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: pt hospitalized within 6 weeks of COVID vaccine

Other Meds:

Current Illness:

ID: 1237916
Sex: M
Age: 61
State: NE

Vax Date: 04/19/2021
Onset Date: 04/19/2021
Rec V Date: 04/21/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Pt was administered Pfizer on 03/29/2021 and Moderna on 04/19/2021.

Other Meds:

Current Illness:

ID: 1237917
Sex: M
Age: 63
State: SC

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

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: Systemic: Blood Disorder (diagnosed by MD)-Severe, Additional Details: PATIENT DEVELOPED BLISTERS AND SORES IN MOUTH APPROXIMATELY 1 WEEK AFTER RECEIVING VACCINATION. WENT TO PRIMARY CARE DOCTOR WHO DID BLOOD WORK WHICH SHOWED A PLATELET LEVEL UNDER 2000. PATIENT WAS HOSPITALIZED AND GIVEN STEROIDS BUT HAS SINCE RECOVERED.

Other Meds:

Current Illness:

ID: 1237918
Sex: M
Age: 44
State: WA

Vax Date: 03/24/2021
Onset Date: 04/17/2021
Rec V Date: 04/21/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Shingles, right side sacral region, scrotum.

Other Meds: Multivitamin, rogaine topical

Current Illness:

ID: 1237919
Sex: F
Age: 76
State: TX

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 04/21/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: after 3 minutes of getting shot, patient developed headache, labored breathing, tongue swelling, burning sensation in the chest, and was flushed. she was at a drive through administration facility run by Hospital Systems. she was given benadryl and epinephrine and then was driven to the ED, where she was given IV steroids. she also developed flu like symptoms which she is still having now.

Other Meds:

Current Illness:

ID: 1237920
Sex: F
Age: 25
State: KY

Vax Date: 03/31/2021
Onset Date: 04/01/2021
Rec V Date: 04/21/2021
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: PCN

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

Symptoms: Blood in urine and back pain

Other Meds: Nuva Ring

Current Illness: None

ID: 1237921
Sex: U
Age: 58
State:

Vax Date: 04/13/2021
Onset Date: 04/13/2021
Rec V Date: 04/21/2021
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:

Symptom List: Tremor

Symptoms: lightheaded, dizzy, room spinning 110/64 P 64 improving with water and juice

Other Meds:

Current Illness:

ID: 1237922
Sex: F
Age: 17
State: PA

Vax Date: 04/21/2021
Onset Date:
Rec V Date: 04/21/2021
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: none

Other Meds: none

Current Illness: none

Date Died: 04/19/2021

ID: 1237923
Sex: M
Age: 85
State:

Vax Date: 02/19/2021
Onset Date: 04/05/2021
Rec V Date: 04/21/2021
Hospital: Y

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:

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

Symptoms: This 85 year old white male received the vaccine on 2/19/21 and went to the ED on 4/05 and was admitted with generalized weakness, hyponatremia, fever and elevated bilirubin. On 04/16/21, he went to the ED and was admitted to the hospital on 4/17 with poor appetite and hospital admission dx of ketonuria, leukocytosis, renal insufficiency, elevated troponin, hematuria, generalized weakness and died on 4/19/2021. Please refer to the other details submitted within this report and contact the person who submitted this report via email for additional follow up details and investigation.

Other Meds:

Current Illness:

ID: 1237924
Sex: F
Age: 25
State: MI

Vax Date: 04/14/2021
Onset Date: 04/20/2021
Rec V Date: 04/21/2021
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: Penicillin & Mango

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

Symptoms: Large round itchy and irritated/painful lump at injection

Other Meds: N/A

Current Illness: N/A

ID: 1237925
Sex: F
Age: 72
State:

Vax Date: 01/29/2021
Onset Date: 03/22/2021
Rec V Date: 04/21/2021
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:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient developed type 1 diabetes after her second vaccination

Other Meds:

Current Illness:

ID: 1237926
Sex: F
Age: 40
State:

Vax Date: 04/20/2021
Onset Date: 04/21/2021
Rec V Date: 04/21/2021
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: Penicillin, gluten, dairy, nightshades, legumes

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

Symptoms: Tingling and numbness on right side of face and neck.

Other Meds:

Current Illness:

ID: 1237927
Sex: F
Age: 34
State:

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 04/21/2021
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: Contrast CT dye, stone fruit, propylene glycol, formaldehyde, fragrances, nickel, trees, weeds, mold, dust mites, dogs, cats, elastic

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

Symptoms: This was the second dose. In the first dose I had mild throat and tongue swelling (airways remained fully viable) and an itchy throat. For the second, I prophylactically treated with six allergy and asthma medicines I already use in various ways after consulting with two friends who are doctors. My reaction was either the same or slightly better on the throat swelling front with this second dose, but a bit worse on the throat itchiness front. The throat swelling mostly went away after an hour and the throat itchiness lasted about two hours.

Other Meds: Birth control, Crestor, Claritin, Flonase, montelukast, albuterol, Allegra, Benadryl, vitamin D3.

Current Illness:

ID: 1237928
Sex: M
Age: 51
State: VA

Vax Date: 04/17/2021
Onset Date: 04/17/2021
Rec V Date: 04/21/2021
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: Pain in extremity

Symptoms: Immediate raised area at the injection site. This raised lump went down within the next 30 minutes.

Other Meds: No

Current Illness: no

ID: 1237929
Sex: U
Age: 17
State:

Vax Date: 04/15/2021
Onset Date: 04/15/2021
Rec V Date: 04/21/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: lightheaded, dizzy, nauseaous vomited 4x felt better didn't eat in the morning ate crackers and drank juice and felt better left after 30 min mother drove him home

Other Meds:

Current Illness:

ID: 1237930
Sex: F
Age: 62
State: NE

Vax Date: 04/21/2021
Onset Date: 04/21/2021
Rec V Date: 04/21/2021
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: Penicillins

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

Symptoms: Pt received Moderna Covid vaccine on 3/24/2021 and then received Pfizer Covid vaccine on 4/21/21. This was 4 weeks apart but the same vaccine was not given for the second dose.

Other Meds: Trazadone 50mg and Hydroxyzine 50mg

Current Illness: none known

ID: 1237931
Sex: F
Age: 16
State: TN

Vax Date: 03/26/2021
Onset Date: 03/26/2021
Rec V Date: 04/21/2021
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: NKDA

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

Symptoms: Patient was 16 years old when given Moderna vaccine. No reports of any adverse effects; as of today (4/20/21).

Other Meds: NONE

Current Illness: NONE

ID: 1237932
Sex: M
Age: 31
State: AZ

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 04/21/2021
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: None

Symptom List: Vomiting

Symptoms: Administration error: Patient inadvertently given Moderna vaccine for second dose on 4/20/2021 after receiving 1st dose Pfizer vaccine on 3/30/2021 resulting in mixed dose vaccination series. Patient tolerated vaccination well with no adverse events.

Other Meds: None

Current Illness: None

ID: 1237933
Sex: F
Age: 63
State: MI

Vax Date: 04/17/2021
Onset Date: 04/18/2021
Rec V Date: 04/21/2021
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: Sulfa

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Redness, swelling and warm to the touch (no pain) below injection site on left arm. Iced several times/day the 18th, 19th, and 20th. Marked improvement April 21, 2021.

Other Meds: vit B12, Vit D, Multi Vit, Fish oil

Current Illness:

ID: 1237934
Sex: F
Age: 68
State: NJ

Vax Date: 04/15/2021
Onset Date: 04/15/2021
Rec V Date: 04/21/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: dizziness

Other Meds:

Current Illness:

ID: 1237935
Sex: F
Age: 62
State: TX

Vax Date: 04/02/2021
Onset Date: 04/12/2021
Rec V Date: 04/21/2021
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: Unknown

Symptom List: Injection site swelling, Limb discomfort

Symptoms: My first dose was administered on Mar. 5th, 2021. On March 18th, 2021 I had a spontaneous anaphylactic reaction requiring the use of Benadryl and an inhaler. 40 minutes after second injection (Apr. 2nd, 2021) my face became bright red - which is usually the beginnings of an allergic or non-tolerant reaction to something to which I've come in contact. A Benadryl dose resolved this reaction within 20 minutes. On April 10th I had a spontaneous anaphylactic reaction requiring the use of Benadryl. 12 Days after second dose I noticed my tongue feeling raw and started feeling a UTI beginning. By 14 days after second dose I had approximately 14 pea sized lumps on the back and back sides of my tongue, the gums of my teeth were very swollen and sore. The roots of my teeth ached terribly, chewing was very difficult. My ears were both very itchy deep within. I was seen my my physician on April 20th, 2021 and diagnosed with Candida Overgrowth.

Other Meds: Unknown

Current Illness: None

ID: 1237936
Sex: F
Age: 46
State: CO

Vax Date: 04/08/2021
Onset Date: 04/13/2021
Rec V Date: 04/21/2021
Hospital:

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

Lab Data:

Allergies: sulfa

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

Symptoms: Blood clot in right arm , SOB, CHEST PAIN, arm pain,

Other Meds: tylenol 650 mg

Current Illness: N/A

ID: 1237937
Sex: M
Age: 72
State: NV

Vax Date: 04/15/2021
Onset Date: 04/17/2021
Rec V Date: 04/21/2021
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: Slight allergy to peanuts and some legumes

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

Symptoms: April 16 low energy, laid low April 17 Morning: Low energy. Afternoon: Very chilled. No appetite. Nausea. Brain fog and fatigue. Evening: Threw up 2-3 times. Sick to stomach. Neck ache. Chilled. Finally warmed up with heating pad and many blankets. Restless sleep. April 18 Coughing, low energy, low stamina and weak. April 19 Felt much better

Other Meds: Taken daily each AM, 1 tablet: 81mg Aspirin Eye Supplement Natural Factors Lutein Supplement Standard Process Iplex Supplement Now Beta Glucan Supplement Now 1000mg Cod Liver Oil Supplement Taken daily, liquid supplement: 10 drops Nutribi

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm