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: 1238250
Sex: F
Age: 47
State:

Vax Date: 04/10/2021
Onset Date: 04/10/2021
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: LA

Lab Data:

Allergies: N/A

Symptom List: Dysphagia, Epiglottitis

Symptoms: We had an adverse reaction to a Moderna vaccine today. Someone was notified. The patient received her vaccine around 6:55 pm on Saturday 4.10.21. She had a history of allergies but no anaphylaxis, or even hives. I felt comfortable giving her the vaccine with her history. Around 7 pm, her husband came to the counter and said she was itching a lot. I brought her to the immunization room and asked if she was interested in taking Benadryl. She was so I gave her two diphenhydramine tablets, 50 mg total. After 20 minutes, she started having hives and the husband requested we give her liquid Benadryl. I provided another 25 mg in liquid at 7:20 pm and 7:30 pm. At 7:30 I also provided her hydrocortisone 1% cream over the counter to help with the itching. At 7:30 she requested to go home but I did not feel comfortable letting her go so I asked her to wait a little longer. I had her husband stay with her and at 7:55 pm I heard hoarseness in her voice. At that point I took out the epinephrine and she didn't want it, I said I had to give it to her on the account that she was getting worse and I would have to call EMS. I administered one epinephrine pen and she instantaneously was able to breath again. EMS arrived within minutes and assessed the patient. EMS confirmed that she was doing well and the medications that were provided were appropriate and kept her symptoms at bay. EMS checked her BP, HR and did an EKG and it all checked out and patient was doing well. At no point did she lose consciousness. She was asked if she wanted to go to the ER or return home and she was comfortable going home.

Other Meds: N/A

Current Illness: N/A

ID: 1238251
Sex: M
Age: 53
State: WI

Vax Date: 03/28/2021
Onset Date: 03/30/2021
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: Morphine

Symptom List: Anxiety, Dyspnoea

Symptoms: Acute bilateral pulmonary emboli without known risk factors for this condition. Onset of symptoms consistent with acute pulmonary embolism started 2 days after vaccination. Formal diagnosis made on CT chest on 4/13/2021 after worsening symptoms of shortness of breath with exertion prompted evaluation in ER

Other Meds: Valacyclovir prn

Current Illness: None

ID: 1238252
Sex: F
Age: 44
State: CT

Vax Date: 04/10/2021
Onset Date: 04/11/2021
Rec V Date: 04/21/2021
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: Approximately 2 hours after the vaccination I felt very minor side effects (headache / soreness on injection site). The next morning I felt the more intense side effects (fever of 101.1, chills, fever, extreme sweat, loss of appetite, body aches and fatigue). While the majority of the side effects have passed I still have no appetite. I am a very healthy adult that does strength training 4x a week, I typically eat and snack every 3 hours. Since the vaccination day I have no desire to eat and I am down to 2 meals (breakfast and dinner). I am also experiencing headaches and dizziness but this could be from the lack of nutrients. Because I feel dizzy I am forcing myself to eat as I almost fainted during a morning workout and had shortness of breath. This particular morning I had coffee, a protein shake and a banana prior to my workout. I have not read or seen any additional information on the loss of appetite lasting this long and I am getting concerned

Other Meds: Oral birth control pills

Current Illness: None

ID: 1238253
Sex: F
Age: 64
State: NC

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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies: penicillin, ace inhibitors

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient reports lightheadedness, burning and lump in throat. Benadryl given. symptoms improved by 2:51pm.

Other Meds:

Current Illness:

Date Died: 04/15/2021

ID: 1238254
Sex: M
Age: 85
State:

Vax Date: 02/23/2021
Onset Date: 04/15/2021
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 erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: This 85 year old male received the Covid shot on 2/23/21 and subsequently died on 4/15/21. 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: 1238255
Sex: F
Age: 74
State: MA

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

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: azithromycin, nsaids, cephalexin, cipro, sulfa

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

Symptoms: patient came in for routine physical exam on 4/12. had gotten J/J vaccine on 3/17. husband reported onset of dyspnea a few weeks prior, eg starting some time after her vaccine. worsened significantly 2-3 days prior to her physical, but she refused to go to hospital. was found to be hypoxic at her routine physical and sent by ambulance to ED, had large saddle PE requiring thrombolysis, left leg DVT. was in ICU. now home off oxygen on anticoagulation.

Other Meds: aspirin 325, atenolol, fenofibrate, atorvastatin, enalapril, sertraline, lasix

Current Illness:

ID: 1238256
Sex: F
Age: 73
State: IN

Vax Date: 03/21/2021
Onset Date: 03/21/2021
Rec V Date: 04/21/2021
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: Pyrexia, White blood cell count decreased

Symptoms: headache, fatigue & malaise since day of vaccine until cerebral hemorrhage on 4/18/21

Other Meds: amlodepine, atenolol, ativan

Current Illness: none

ID: 1238257
Sex: M
Age: 37
State: GA

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:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Patient listed NKA on intake sheet

Symptom List: Pharyngeal swelling

Symptoms: Cashier reported to the pharmacist that a patient in the post-vaccination waiting area looked red and sweaty prompting the pharmacist to check on the patient. This was approximately 5 minutes after the patient had received his vaccine. The patient had his eyes closed and reported feeling hot and tingly. Patient exhibited no signs of rash or respiratory reaction. Patient was given a cold pack for his neck and recovered after a few minutes. During a follow-up call the next day, the patient reported he had fainted at some point when his eyes were closed. After leaving the pharmacy, the patient went home and took a nap. The patient reported no further or lasting effects.

Other Meds: unknown

Current Illness: Patient listed none on intake sheet

ID: 1238258
Sex: M
Age: 54
State: GA

Vax Date: 04/12/2021
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: N/A

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: The pain that is felt is like many needle punctures on primarily the right lung, but has been felt on the left lung at times. The pain is not constant but rather at random times throughout the day. This sudden, sharp, needle-like pain was felt mostly on the following dates: Tuesday, 04/13/2021 (both lungs felt pain twice early in the morning around 1:00 AM and a few more times in the afternoon), Sunday, 04/18/2021 (pain felt twice only on right lung around 2:00 PM), Monday, 04/19/2021 (pain felt on right lung around 10:00 AM and again around 4:00 PM), and on Tuesday, 04/20/2021 (pain felt on right lung around 1:30 PM). Since Monday, 04/19/2021, a constant feeling of discomfort, tenderness, and slight burning has been felt on the right lung.

Other Meds: N/A

Current Illness: N/A

ID: 1238259
Sex: F
Age: 33
State: CA

Vax Date: 03/31/2021
Onset Date: 04/09/2021
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: NKA

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient was vaccinated with Pfizer Vaccine on 3/31/2021. Patient denies having any immediate symptoms of allergic reaction. Patient was taking phentermine diet pills for 10 days prior to receiving her first dose of the Pfizer vaccine and continued with use for 10 days following her Pfizer vaccine dose. Patient states she experienced her "throat closing up" 9 days following her first dose of the Pfizer vaccine (April 9, 2021). Patient states the swelling was severe and affected her ability to swallow. Patient did not consult with doctor following symptoms. Patient states she took Amoxicillin for 2 days following adverse event because she "thought it was an infection". Amoxicillin was not prescribed to patient. Patient states her symptoms relieved following use of amoxicillin (4/11/2021).

Other Meds:

Current Illness:

ID: 1238260
Sex: F
Age: 78
State: WI

Vax Date: 03/18/2021
Onset Date: 04/01/2021
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: Norco, ginseng, lactose intolerant, levaquin, levofloxacin, naproxen, biaxin, nitroglycerin, statins

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

Symptoms: Patient received Janssen COVID19 vaccine on 3/18/21. The week of 4/12/21, patient noted right calf pain. No swelling or redness noted. Patient was seen in MD office on 4/21/21 and mentioned pain in right calf and that it was improving. MD ordered venous US and D-dimer and both tests were completed and resulted on 4/21/21. D-dimer is positive and venous US is positive for DVT in right gastrocnemius vein. Patient will start on Eliquis 10mg twice a day for 7 days, then Eliquis 5mg twice a day for 6 months. Will have Chest CT to rule out PE on 4/22/21.

Other Meds: turmeric, Coenzyme Q10, verapamil (CALAN SR), lisinopril (ZESTRIL), , omeprazole (PRILOSEC), cholecalciferol (VITAMIN D3), fish oil-omega-3 fatty acids, aspirin 81 MG tablet, cyanocobalamin (VITAMIN B-12), CALCIUM CITRATE-VITAMIN D PO

Current Illness: none

ID: 1238261
Sex: M
Age: 43
State: GA

Vax Date: 04/14/2021
Onset Date: 04/15/2021
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:

Symptom List: Rash, Urticaria

Symptoms: generalized body aches

Other Meds:

Current Illness:

ID: 1238262
Sex: M
Age: 61
State:

Vax Date: 03/25/2021
Onset Date: 04/01/2021
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:

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

Symptoms: pt had ED visit and was hospitalized within 6 weeks of COVID vaccine

Other Meds:

Current Illness:

ID: 1238263
Sex: F
Age: 80
State: OR

Vax Date: 04/05/2021
Onset Date: 04/05/2021
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: METRONIDAZOLE, SULFAS, FLUOCINOLIDE OINTMENT, NEOMYCIN

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

Symptoms: PATIENT REPORTED RIGHT FOOT SWOLLEN FOR ABOUT 4 TO 5 DAYS. LEFT FOOT HAD "MINOR" SWELLING. THIS WAS AFTER THE SECOND COVID MODERNA SHOT. SHE ALSO HAD SWOLLEN LEG AFTER THE FIRST SHOT WHICH RESOLVED ON ITS OWN BUT PERSISTED FOR ALMOST 13 DAYS.

Other Meds:

Current Illness:

ID: 1238264
Sex: F
Age: 30
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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: CLAMMY, SWEATY, SEIZURE LIKE ACTIVITY, NAUSEA, AND VOMITING

Other Meds:

Current Illness:

ID: 1238265
Sex: F
Age: 16
State: AL

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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Patient received a dose of Moderna after leading pharmacist to believe that she was 18. No adverse events were observed.

Other Meds:

Current Illness:

ID: 1238266
Sex: F
Age: 61
State: AZ

Vax Date: 03/31/2021
Onset Date: 04/13/2021
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: Penicillin, Ancef, morphine

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

Symptoms: Shingles on right side, pelvis area

Other Meds: Doxycycline, multi vitamin, calcium supplement, probiotic

Current Illness: Sinus Infection

ID: 1238267
Sex: F
Age: 43
State: AR

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: none

Symptom List: Ear pain, Hypoaesthesia

Symptoms: achy and chills started 12 hours after shot. lasted 18 hours. 48 hours after shot began horrible neck pain that started on the right side of my neck and eventually traveled around to my whole neck. So sore and stiff I could barely function for 2 days. I am now on my 5th day of neck pain. It is better than when it started but still hurts.

Other Meds: none

Current Illness: none

Date Died: 03/21/2021

ID: 1238268
Sex: M
Age: 91
State:

Vax Date: 02/19/2021
Onset Date: 03/21/2021
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:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: This 91 year old white male received the Covid shot on 2/19/21 and subsequently died on 3/21/21. 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: 1238269
Sex: M
Age: 16
State: VA

Vax Date: 04/20/2021
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: none known

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

Symptoms: Soon after vaccination became dizzy, diaphoretic and pale w/bp 90/50

Other Meds: none known

Current Illness: none known

Date Died: 04/13/2021

ID: 1238270
Sex: M
Age: 74
State: NY

Vax Date: 03/31/2021
Onset Date: 04/10/2021
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 was already in hospital for severe COPD. While there, he was given J&J Covid-19 vaccination. Approximately 11 days after vaccination, patient developed vomiting that could not be controlled. He later developed abdominal pain that worsened and also could not be controlled. Intravenous pain killers eventually hastened his passing.

Other Meds: various pain-control medications (patient has been taking these for decades)

Current Illness:

ID: 1238271
Sex: F
Age: 29
State: CO

Vax Date: 03/23/2021
Onset Date: 03/23/2021
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: none reported

Symptom List: Unevaluable event

Symptoms: Patient received 1st dose Pfizer. She missed her 2nd dose appointment and scheduled the vaccine for an event where we were only vaccinating with Moderna. No adverse reaction reported at time of vaccine or after administration.

Other Meds: none reported

Current Illness: none reported

ID: 1238272
Sex: F
Age: 49
State: OH

Vax Date: 04/10/2021
Onset Date: 04/10/2021
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:

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

Symptoms: pain in rt arm lasted 2-3 days, Nausea (24 hr), weakness (24 hr), headache and body soreness (lasting 24 hrs).

Other Meds: Adderall XR

Current Illness: none

ID: 1238273
Sex: F
Age: 44
State: MI

Vax Date: 04/15/2021
Onset Date: 04/16/2021
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: NONE

Symptom List: Injection site pain, Pain

Symptoms: Tinnitus since shot # 2

Other Meds: Zinc, Vit C, Omega 3

Current Illness: NONE

ID: 1238274
Sex: F
Age: 19
State: IL

Vax Date: 04/18/2021
Onset Date: 04/18/2021
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: Unknown

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient experienced hypotension post vaccination; transported to hospital via ambulance.

Other Meds: Unknown

Current Illness: Unknown

ID: 1238275
Sex: M
Age: 46
State: IN

Vax Date: 04/01/2021
Onset Date: 04/14/2021
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: mildly allergic to wheat (that's a maybe: when I buy a commercially made whole wheat bread, if I eat a lot of it, then my gums swell a bit. But, when my wife makes a whole wheat bread, no allergic reactions. also, when I eat wheat gluten / seitan, no allergic reactions either).

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

Symptoms: the next day, after being vaccinated, my left shoulder muscle (deltoid), right where the vaccine was administered, I felt a bit of a discomfort. and this lasted for about 3 days. after about 3 to 4 days after being vaccinated, "all" my muscles started to ache a bit, and I felt a bit weak. that passed after maybe 3 to 4 days. about 4 to 5 days later, or about 10 days after being vaccinated, the outside of my left arm (where the vaccine was administered) felt strangely over sensitive; to a touch and temperature. for the most part that has subsided now. However, about 4 days ago (a little over 2 weeks after being vaccinated) my left arm feels a bit weird. the feeling is similar to a mildly pinched nerve. for instance, if you sit for sometime with an arm at a weird position, (maybe twisted), you can get a weird feeling, of a bit of a discomfort. not the one where your arm goes numb, but a bit "uncomfortable". but that typically goes away after a couple of minutes after you get up and start moving your arm. Well, this is the feeling now, except that it's been like that for the past 4 days or so. However, no outside reactions, no skin discoloration, etc. I spoke with a nurse, and she advised me to report this side effect, and to make appointment with my PCP if the symptom does not subside in the next few days.

Other Meds: I'm a vegan, about once per month I take B-12 vitamin tablet, also probiotics

Current Illness: none

Date Died: 04/15/2021

ID: 1238276
Sex: M
Age: 58
State:

Vax Date: 03/22/2021
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: LA

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: This 58 year old white male hospice patient received the Covid shot on 3/22/21 and died on 4/15/21. 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: 1238277
Sex: F
Age: 55
State: IN

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:
Dose Series: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: codeine, morphine

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: 9 hours after injection, symptoms began: chills, fever, fatigue, aches/pain

Other Meds: Lisinopril

Current Illness:

ID: 1238278
Sex: F
Age: 49
State: NY

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: red wine

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

Symptoms: Day 1: Fever, chills Day 2: swollen lymph nodes under armpit; dizziness

Other Meds: Synthroid (100mg)

Current Illness: n/a

ID: 1238279
Sex: F
Age: 51
State: KY

Vax Date: 04/08/2021
Onset Date: 04/14/2021
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: Penicillin

Symptom List: Nausea

Symptoms: Sever Uncontrollable Headache, Elevated and erratic blood pressure (186/101) for 7 days followed by Moderate- Bad headache with severe nausea and lightheadedness, erratic blood pressure,, still ongoing

Other Meds: Vitamin C, Vitamin D

Current Illness: None

Date Died: 04/05/2021

ID: 1238280
Sex: M
Age: 70
State: CO

Vax Date: 03/10/2021
Onset Date: 04/05/2021
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: The decedent was visiting family. There are no reported adverse effects known.

Other Meds:

Current Illness:

ID: 1238281
Sex: M
Age: 37
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: sulfa-hives Cefaclor-swelling

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

Symptoms: Patient received vaccine in right deltoid. Approximately 90 seconds later he lost consciousness. Had seizure like activity for approximately 30 seconds, then regained consciousness. BP checked and 130/90. HR initially irregular to auscultation then became steady. Strong pulse to palpation. EMS was called. Patient was given juice and crackers. Patient denies pruritis, difficulty swallowing, difficulty breathing, or facial swelling. Hx vasovagal response to vaccines in the past. No hx seizures. EMS arrived within 5 minutes and evaluated patient. Patient declined transportation to ER. He and partner waited in observation area for 30 minutes with no additional adverse effects.

Other Meds: Diazepam

Current Illness: none

ID: 1238282
Sex: F
Age: 17
State: AZ

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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Less than 24 hours after receiving first shot, my 17 year old daughter started experiencing heart palpitations. Her resting heart rate is 63. She has an Apple Watch and was able to track her rate. Highest was 123, then fluctuated between high 100s and low 110s. It lasted until Tuesday (and slowly lowered). By Wednesday morning it returned to normal. It frightened her and kept her awake at night.

Other Meds: Enbrel Methotrexate

Current Illness:

ID: 1238283
Sex: M
Age: 51
State: WI

Vax Date: 04/16/2021
Onset Date: 04/17/2021
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: All Statins, Savella, Effexor, Cymbalta, Morphine, Topamax

Symptom List: Tremor

Symptoms: Severe muscle pain and weakness in entire body, crippling-unable to walk or even stand with the assistance of a walker device. lasted 3 days - Same side effect as after 1st dose.

Other Meds: Gabapentin, Metformin, Nadolol, Lisinopril, Omeprazole, Lovaza, Fenofibrate, Diazapam, Cyclobenzaprine, Low dose Aspirin, Lutein, Vitamin D-3, Cetirizine, Mutivitamin 50+ men

Current Illness: none

ID: 1238284
Sex: M
Age: 55
State: VA

Vax Date: 03/19/2021
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: Penicillin, Keflex

Symptom List: Erythema, Pruritus

Symptoms: About 6 Days later noticed tinnitus in both ears. It may have come a little earlier. It has not gone away since the 1st shot. Very annoying.

Other Meds: Pepto Bimol, Rosuvastatin, Fluconazole

Current Illness: colonitis

ID: 1238285
Sex: F
Age: 61
State: MN

Vax Date: 12/24/2020
Onset Date: 04/15/2021
Rec V Date: 04/21/2021
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:

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

Symptoms: Tested positive for Covid

Other Meds:

Current Illness:

Date Died: 04/19/2021

ID: 1238286
Sex: M
Age: 85
State:

Vax Date: 02/16/2021
Onset Date: 02/21/2021
Rec V Date: 04/21/2021
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:

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

Symptoms: This 85 year old white male hospice patient received the Covid shot on 2/16/21 and went to the ED on 2/21/21 and was admitted on 2/22/21 with altered mental status, pneumonia, severe sepsis, bladder cancer, UTI, dementia and died on 4/19/21. 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: 1238287
Sex: F
Age: 53
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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NO ALLERGIES

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: PATIENT ALMOST FAINTED, LOW HEART RATE ON VITALS CHECK COMPLETED BY STORE MANAGER, CHEST PAIN, TINGLING SENSATION IN ARM

Other Meds: NONE PROVIDED

Current Illness: NO ILLNESSES

ID: 1238288
Sex: F
Age: 54
State: WI

Vax Date: 03/29/2021
Onset Date: 04/17/2021
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:

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

Symptoms: Client tested positive for COVID-19 on 04/17/21. Client states that they are asymptomatic. Client is being followed by a case manager with the Health Dept.

Other Meds:

Current Illness:

ID: 1238289
Sex: M
Age: 55
State: AL

Vax Date: 02/05/2021
Onset Date: 03/02/2021
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: None

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

Symptoms: Development of fever blisters (cold sores). I've had cold sore/fever blister before. For the past 30 years I would typically get ONE cold sore roughly about every 3-4 years. Typically it was an indicator I was about to experience an illness. They were VERY rare and always noted as I will not kiss my children or wife when I would get one. It would always appear in the exact same location on the upper left part of my top lip. Very minor cold sore but a cold sore none the less. My reaction to the 2nd shot was pretty strong. I had a 102F fever starting at 10PM the evening after the second vaccination. Very strong muscle contractions and joint inflammation. The fever and soreness disappeared about 36 hours later and I was fine. Fast forward a week or two (from the second shot) and I developed an unusual coldsore on my lower lip. It appeared almost immediately. I began to apply Abrevia (10% Docosanol) right away. Honestly it was a very unusual cold sore. Much larger than any cold sore I had ever had. It even caused bumps on the interior part of my lower lip. This has never happened. In the past this cold sore would be it. Then I would be free of them for an extended period. As of April 21, 2021, I've had 2 additional cold sores. This is three cold sores in a period of less then 5 weeks. My diet, exercise and lifestyle have not really changed. This is VERY odd.

Other Meds: None

Current Illness: None

ID: 1238290
Sex: M
Age: 35
State: MI

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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: cefadroxil

Symptom List: Pain in extremity

Symptoms: Vaccine given 20days after first dose. (8 days too soon) Adverse symptoms are unknown at this time and effectiveness of vaccine unknown

Other Meds: imuran, sumatriptan,

Current Illness: none

ID: 1238291
Sex: M
Age: 60
State: MO

Vax Date: 03/17/2021
Onset Date: 03/18/2021
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: Patient has had severe headache since vaccine - starting day after - "worst headache of his life". Now has loss of smell, shortness of breath and nasal drainage

Other Meds:

Current Illness:

ID: 1238292
Sex: M
Age: 34
State: NY

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: Pecans - same reaction

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

Symptoms: Received Moderna vaccine at 10:30 am on 4/21/21. within 15 minutes felt tightness in throat and "flush" from the neck up. One hour later became diaphoretic and arms swelled. The swelling to arms is similar to the reaction he has with pecan allergic reactions

Other Meds: None

Current Illness: None

ID: 1238293
Sex: F
Age: 62
State: WA

Vax Date: 04/06/2021
Onset Date: 04/15/2021
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: shellfish

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

Symptoms: "covid arm" itching, hot arm in area of vaccination, sore again days after initial soreness wore off

Other Meds: lisinopril/HCTZ

Current Illness:

ID: 1238294
Sex: F
Age: 76
State: CA

Vax Date: 03/25/2021
Onset Date: 03/29/2021
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: maybe sulfa

Symptom List: Vomiting

Symptoms: Traverse myelitis. Extremely painful neck and back in joints which moved outwards to arms and legs. Started on about day 4. Could no walk to toilet. Pain moved out from joints to muscles in arms and legs. It is improving but after 30 days! Also my tinnitis got worse. I have never had a vaccine or a flu shot in my 76 yr life.

Other Meds: vit d flaxseed oil , potassium, magesium, synthroid, cytomel, estradial, progesterone, bystolic

Current Illness: none

ID: 1238295
Sex: F
Age: 26
State: CA

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: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Allergic to Penicillin

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Cold sweat at the time of injection. A day later small fever and nausea

Other Meds:

Current Illness:

ID: 1238296
Sex: M
Age: 21
State:

Vax Date: 04/18/2021
Onset Date: 04/18/2021
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: VS: HR 78, RR 18, BO 134/72, Pulse ox 98 No PMH, PSH or NKDA. Only allergic to pollen When in observation area synopsized and hit L occipital with small lump. Positive for HA, neurologic exam (-), emesis x1. Concern for concussion. EMS called

Other Meds:

Current Illness:

ID: 1238297
Sex: M
Age: 58
State: PA

Vax Date: 04/01/2021
Onset Date: 04/01/2021
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: N/ K

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient received the Pfizer shot at a vaccination clinic set up at his workplace. He was shockingly gray and visibly weakened for two and a half days. Patient gradually regained his strength. No other reaction was observed or mentioned.

Other Meds: Kirkland?s multi vitamin, D3, zinc gummies

Current Illness: None

ID: 1238298
Sex: F
Age: 17
State: NY

Vax Date: 04/16/2021
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: RA

Lab Data:

Allergies: nuts, peanuts, environmental, dog, cat

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

Symptoms: she developed sore throat, aphtous ulcers and loss of appetite

Other Meds: zyrtec

Current Illness: none

ID: 1238299
Sex: F
Age: 64
State: PA

Vax Date: 04/13/2021
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: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Presented to the ED on 4/18/21 with tachycardia and shortness of breath. Found to have bilateral DVTs and bilateral pulmonary emboli - confirmed with imaging. As a result, was found to have obstructive shock with presumed right heart failure. She received 50mg of systemic TPA along with catheter directed thrombolysis. Remains critically ill in the ICU.

Other Meds:

Current Illness: Apparently has a recent history of cancer and is s/p multiple surgeries. Has been less mobile lately. Unfortunately, I cannot obtain any more information in regards to this.

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm