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: 1242197
Sex: F
Age: 29
State: LA

Vax Date: 04/13/2021
Onset Date: 04/13/2021
Rec V Date: 04/22/2021
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: Extreme nausea and vomiting starting same day as second injection and lasting until today (4/22/21)

Other Meds: Bupropion XL (150 mg), Alpraolam (1 mg), Essential Balance (FoxyFit), OxyFuel (Five Star Nutrition)

Current Illness: n/a

ID: 1242198
Sex: F
Age: 43
State: TX

Vax Date: 03/29/2021
Onset Date: 03/29/2021
Rec V Date: 04/22/2021
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: Tinnitus, ear and head pressure, hearing loss, constant noise in my ears.

Other Meds: Levoxyl

Current Illness:

ID: 1242199
Sex: F
Age: 27
State: KY

Vax Date: 04/02/2021
Onset Date: 04/06/2021
Rec V Date: 04/22/2021
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: Menstrual cycle started 14 days early, and lasted 15 days. Mostly a light period but completely abnormal.

Other Meds: None.

Current Illness: None.

ID: 1242200
Sex: M
Age: 63
State: TX

Vax Date: 03/11/2021
Onset Date: 03/11/2021
Rec V Date: 04/22/2021
Hospital:

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

Lab Data:

Allergies: None.

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: He got the vaccine, and when they administered it on his left shoulder it started bleeding. The younger girl put a band-aide on it, and walked off and called another girl. The other girl took over the band-aide and it was saturated with blood but stopped bleeding, but area was swollen. They then had him wait 30 minutes, and everything was fine, and instructed to put ice on it which he did. The pain seems to have not gone away yet and it's been over 30 minutes. At night he feels it more as he relaxes, it's the same pain as it was when he got the vaccine and he can also feel a little knot if he rubs it. He called employee health and they offered to do an US and gave him our information to call. This pain goes all the way past his elbow on the left side only. Sometimes he can feel it on his back, but it's mainly on the shoulder area.

Other Meds: Baby aspirin, Atorvastatin calcium, Omeprazole.

Current Illness: None.

ID: 1242201
Sex: F
Age: 44
State: NC

Vax Date: 03/25/2021
Onset Date: 03/25/2021
Rec V Date: 04/22/2021
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

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

Symptoms: Started feeling extremely tired four hours later. Developed a cough, maybe pollen related. Went home and slept for a few hours. Woke with fever and sore all over.

Other Meds: None

Current Illness: No

ID: 1242202
Sex: F
Age: 42
State: MI

Vax Date: 04/15/2021
Onset Date: 04/15/2021
Rec V Date: 04/22/2021
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: Bactrium, Novahistine, Sertraline, Midrin, Vicodin

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

Symptoms: In the first 15 minutes I started to experience a strong metallic taste in my mouth that lasted about 3 days before going away. Nausea, slight headache and fatigue.

Other Meds: Levothyroxine, Atarax 25mg

Current Illness: None

ID: 1242203
Sex: F
Age: 47
State: PA

Vax Date: 03/26/2021
Onset Date: 04/10/2021
Rec V Date: 04/22/2021
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: SOME ANTIBOTICS

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: SHINGLES STARTED AROUND 4/10/21, DX 4/12/21. PRESCRIBED VALACYCLOVIR. CURRENTLY RECOVERING.

Other Meds: EXCEDRINE/MOTRIN

Current Illness: NONE AS I KNOW

ID: 1242204
Sex: F
Age: 43
State: TX

Vax Date: 04/02/2021
Onset Date: 04/10/2021
Rec V Date: 04/22/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Pharyngeal swelling

Symptoms: Started as a little itch, scratched the itch then it swoll up about the size of 6 in X 6 in. To date I still get pains in the same area.

Other Meds: Zyrtec

Current Illness: None

Date Died: 04/03/2021

ID: 1242205
Sex: F
Age: 81
State: GA

Vax Date: 03/28/2021
Onset Date: 04/01/2021
Rec V Date: 04/22/2021
Hospital:

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

Lab Data:

Allergies: No

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: 8 days after the 2nd Pfizer shot sudden vomiting including blood and then collapse and died. No other symptoms of sickness leading up to this.

Other Meds: Not sure

Current Illness: No

ID: 1242206
Sex: F
Age: 42
State: TX

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 04/22/2021
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: Gluten, Lactose, Peppers

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Pt stated the back of her tongue, feels like it is swelling, but stated that her throat doesnt feel bad. denies SOB. At 1403, pt stated that she had a strange taste in her outh and her tongue feels tight against her teeth. at that time EMTs were paged. pt talking with EMTs reguarding medical HX and allergies. at 1440 pt is drinking water 1450 pt stated that she is ready to go home and that she is feeling better. Pt was abulatory upon leaving and walked out of the tent and drove off.

Other Meds: Synthroid 150mcg

Current Illness:

ID: 1242207
Sex: F
Age: 69
State:

Vax Date: 01/07/2021
Onset Date: 01/07/2021
Rec V Date: 04/22/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Pt called stating that her site bled when she received the vaccine. Reports bruising and redness on same day of vaccine. Site is still bruised and red after 1 week. No swelling drainage or heat at the vaccination site reported.

Other Meds:

Current Illness:

ID: 1242208
Sex: F
Age: 55
State: CA

Vax Date: 04/19/2021
Onset Date: 04/19/2021
Rec V Date: 04/22/2021
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: Fever of 100.2, chills, aches, headache for two days

Other Meds: lisinopril -hctz levothyroxine

Current Illness: none

ID: 1242209
Sex: F
Age: 51
State: IL

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

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

Lab Data:

Allergies: None

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

Symptoms: Headache, arm pain followed by body pain and joint pain, nausea, diarrhea, fatigue, tightness in chest. Took Tylenol, extra lansoprolol, and rest. Limited food intake. Drinking water

Other Meds: Metoprolal, amlodipine, triamt/hctz, lansoloprole, buspirone, dulexotine, klonopine, daily vitamin.

Current Illness: Migraine

ID: 1242210
Sex: F
Age: 46
State: KS

Vax Date: 03/29/2021
Onset Date: 04/02/2021
Rec V Date: 04/22/2021
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: none

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

Symptoms: five blood blisters in mouth (two large blisters under tongue, one large blister on inside lower lip, two small blisters on inside left cheek)

Other Meds: Cyred

Current Illness: none

ID: 1242211
Sex: F
Age: 61
State: CO

Vax Date: 04/21/2021
Onset Date: 04/21/2021
Rec V Date: 04/22/2021
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: Ibuprofen

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

Symptoms: headache, drenching night sweats, sleep paralysis, hallucinations: "entities pouring into bedroom and over bed, stuck in a deep crevasse with people trying to pull her out, earthquake"

Other Meds: xanax0.5, flexeril10, ativan0.5, percocet5-325, desyrel300 *mg

Current Illness: None

ID: 1242212
Sex: F
Age: 40
State: CA

Vax Date: 03/31/2021
Onset Date: 03/31/2021
Rec V Date: 04/22/2021
Hospital: Y

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: Nausea, vomting, palpitations starting 10 minutes after vaccine administration. Generalized Tonic Seizure 2 days after vaccine. CT head negative in ED, discharged 8 days after vaccine, presented to clinic with continued daily seizure like activity, inability to stand due to leg shaking. Exam notable for Lower extremity myoclonus. Then, admitted to hospital on 4/8. MRI brain unremarkable. EEG with potential epileptiform activity. Patient discharged on 4/10 on keppra for seizure prophylaxis, Home health physical therapy and neurology follow up.

Other Meds: escitalopram, alprazolam, odansetron

Current Illness:

ID: 1242213
Sex: M
Age: 51
State: AZ

Vax Date: 04/21/2021
Onset Date: 04/21/2021
Rec V Date: 04/22/2021
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: EYE DROPS

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

Symptoms: PATIENT WAS APPROACHED IN VEHICLE AND ASKED HOW HE WAS FEELING, HE SAID HE DIDNT FEEL WELL AND THOUGHT HE MAY OF PASSED OUT. HE WAS ASKED TO PUT HIS CAN IN PARK AND ROLL DOWN HIS WINDOWS. UPON HIM DOING SO HE PASSED OUT AND BECAME UNRESPONSIVE. BP WAS 62/30. 911 WAS CALLED. ICE PACKS WERE PLACED AROUND HIS NECK AS HE WAS CLAMMY AND PALE. HIS LIPS WERE PURPLISH AND OXYGEN WAS 91%. HE CAME TO A SECONDS LATER AND ASKED WHAT HAPPENED. HE THEN WHEN INTO WHAT LOOKED LIKE A SEIZURE THAT LASTED ABOUT 15 SECONDS.HE WAS ASKED IF HE HAD A HISTORY OF SEIZURES AND HE SAID NO. HIS BP WAS TAKEN AGAIN AND IT WAS 90/60.OXYGEN WAS AT 91%. WHEN HE PASSED OUT AGAIN, EPI WAS ADMINISTERED AND PARAMEDICS ARRIVED APPROX 1 MINUTE LATER

Other Meds: NONE INDICATED

Current Illness: NONE INDICATED

ID: 1242214
Sex: M
Age: 56
State: NC

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

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

Lab Data:

Allergies: N/A

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Approximately 20 hours after receiving the vaccine, my hands and feet became very cold, and my whole body began to shake - have chills, and my teeth began chattering. Approximately 3 hours later, I began to feel warm; my eyelids were very warm whenever I blinked. Slowly but surely I began to feel better.

Other Meds: Gabapentin 600mg, Losartan/HCTZ 100-25mg, Amitriptylin 100mg, Simvastatin 40mg, Vit. B12 5000,Super B-Complex with Electrolytes, Co Q-10 100mg, MSM 1000mg, Glucosamine Chondroitin 750-600 mg, Vit. C 500mg, Fish Oil 1000mg

Current Illness: N/A

ID: 1242215
Sex: M
Age: 48
State: NY

Vax Date: 04/05/2021
Onset Date: 04/15/2021
Rec V Date: 04/22/2021
Hospital:

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

Lab Data:

Allergies: Lactase allergy

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: rash developed after 10 days on neck, back, waist, under arms, forearms, back of knees. very itchy.

Other Meds: 5mg Amlodipine (Hypertension)

Current Illness: None

ID: 1242216
Sex: F
Age: 63
State: AL

Vax Date: 04/01/2021
Onset Date: 04/02/2021
Rec V Date: 04/22/2021
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

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

Symptoms: Fever Dry cough Aches Headache Unable to take a deep breath Throat sore Diarrhea Swollen lymph nodes

Other Meds: Amitriptyline Lamotrigine

Current Illness: None

ID: 1242217
Sex: F
Age: 53
State: NJ

Vax Date: 04/21/2021
Onset Date: 04/21/2021
Rec V Date: 04/22/2021
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: N/A

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

Symptoms: Tingling and warm/heated sensations randomly on face, head, arm and leg and some redness. This started shortly after shot and continuing even through the next day (currently) but seems to be lessoning in severity.

Other Meds: Diltiazem CD CAP 180 MG/24 HR, Levothyroxine TAB 100MCG, Eliquis TAB 5 MG., Breo 200 mcg/25 mcg, Vitamin D2 2000 IU, B12 3000 mcg, Easter-C 500 mg., Zinc chewable tablet

Current Illness: N/A

ID: 1242218
Sex: F
Age: 67
State: AZ

Vax Date: 04/20/2021
Onset Date: 04/21/2021
Rec V Date: 04/22/2021
Hospital:

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

Lab Data:

Allergies: No known allergies

Symptom List: Unevaluable event

Symptoms: Woke up at 3:00am feeling nauseous and vomited shortly after. For the next 12 hours, I had fever, chills, headaches, neck and shoulder pain, felt sore all over, and was dizzy when standing up.

Other Meds: Trazodone Gabapentin Multivitamin

Current Illness: Headaches

ID: 1242219
Sex: F
Age: 28
State: CA

Vax Date: 04/16/2021
Onset Date: 04/16/2021
Rec V Date: 04/22/2021
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: Syncope, dizziness. BPs 76/58 (pulse 70), 104/60. 720 CC water given along with crackers.

Other Meds:

Current Illness:

ID: 1242220
Sex: F
Age: 44
State: OH

Vax Date: 04/20/2021
Onset Date: 04/21/2021
Rec V Date: 04/22/2021
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: Fatigue, headache, low fever, body aches, soreness at injection site

Other Meds: None

Current Illness: None

ID: 1242221
Sex: M
Age: 38
State: PA

Vax Date: 04/22/2021
Onset Date: 04/22/2021
Rec V Date: 04/22/2021
Hospital:

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

Lab Data:

Allergies: Pt reports allergy to sulfa drug as an infant. He does not remember the incident and is not sure what reaction he had.

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient reports lightheadedness, sweating, and dizziness ~2 minutes after receiving vaccine. He reports history of similar reactions to vaccines, blood draws, etc. He denies changes in vision or hearing. He denies trouble breathing, chest pain, rash. He was transported by wheelchair to medical observation unit at 6:00pm. He was already starting to feel better on arrival to medical observation unit. He was released at 6:35 to drive himself home. He reported complete resolution of symptoms upon discharge. Vitals as follows: 6:04pm- HR- 69, BP- 112/72, SPO2- 99 6:35 (sitting)- HR- 68, BP- 110/70 6:40 (standing)- HR- 68, BP- 112/70

Other Meds: n/a

Current Illness: n/a

ID: 1242222
Sex: F
Age: 33
State: KY

Vax Date: 04/13/2021
Onset Date: 04/14/2021
Rec V Date: 04/22/2021
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: severe swelling of arm 3 inches in diameter, covid arm, migraine for 9 days, vomiting, chills, cold sweats, shortness of breath, diarrhea, dizziness, confusion,

Other Meds: venlaflaxine 150mg, b12, mono-linyah

Current Illness:

ID: 1242223
Sex: M
Age: 72
State: WA

Vax Date: 03/23/2021
Onset Date: 04/03/2021
Rec V Date: 04/22/2021
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: No

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Legs went rubbery when walking on treadmill, speaking was slow and deliberate (not slurred). Facial expression and hand grip was normal. Lasted about 1-2 minutes. About 12 hours later, difficulty walking, could not perform fine hand movements to control mouse curser, Facial expression and hand grip was normal. Lasted about 10 minutes but on way to ER at medical center. See Item 19 for more information

Other Meds: Vitamin C, Lipitor, Losartan, Multivitamin

Current Illness: None

ID: 1242224
Sex: M
Age: 46
State: ME

Vax Date: 04/22/2021
Onset Date: 04/22/2021
Rec V Date: 04/22/2021
Hospital:

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

Lab Data:

Allergies: Sulfa Drugs

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient fainted 5 minutes after receiving vaccination. EMTs attended patient. Patient recovered.

Other Meds: None

Current Illness: None

ID: 1242225
Sex: M
Age: 30
State: DC

Vax Date: 04/21/2021
Onset Date: 04/22/2021
Rec V Date: 04/22/2021
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: Codeine

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

Symptoms: Tingling and occasional electric shooting pain in right arm, usually originating in the right wrist and extending both into the right little finger and a distance upward as far as the top of the right tricep.

Other Meds: Venlafaxine

Current Illness:

ID: 1242226
Sex: M
Age: 27
State: WA

Vax Date: 04/22/2021
Onset Date: 04/22/2021
Rec V Date: 04/22/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: It was reported by the safety officer that the guest complained about feeling faint and hot 10 minutes after receiving the vaccine. EMS was called to see guest. Guest became sweaty and was offered water, which he drank. Guest was conscious and talking to the EMS. Vital signs were WNL. After a few minutes the guest stated that he was feeling better and no longer felt hot. Patient was observed for an additional 15 minutes per the suggestion of EMS. After the 30 minutes, guest continued to be without symtoms and was able to stand up with out dizziness nor lightheadedness. Able to leave on his own.

Other Meds:

Current Illness:

ID: 1242227
Sex: F
Age: 61
State: VA

Vax Date: 04/22/2021
Onset Date: 04/22/2021
Rec V Date: 04/22/2021
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 patient had a localized rash near the injection site. The patient was told to monitor the rash and report to the ED if symptoms continue or worsen.

Other Meds:

Current Illness:

ID: 1242228
Sex: M
Age: 38
State: HI

Vax Date: 04/19/2021
Onset Date: 04/19/2021
Rec V Date: 04/22/2021
Hospital:

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

Lab Data:

Allergies: no

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

Symptoms: Severe fever lasting greater than 72hrs. Severe tonsil swelling lasting great than 72hrs.

Other Meds: valtrex

Current Illness: no

ID: 1242229
Sex: M
Age: 60
State:

Vax Date: 04/20/2021
Onset Date: 04/21/2021
Rec V Date: 04/22/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Strong flu-like symptoms (chills, 100?F fever, muscle aches, swollen and achy glands including testicles, and headache) that lasted for ~24 hrs beginning 13 hrs after injection and ending about 37 hrs after injection.

Other Meds: Meloxicam - 15 mg/day

Current Illness: None

ID: 1242230
Sex: F
Age: 16
State: RI

Vax Date: 04/22/2021
Onset Date: 04/22/2021
Rec V Date: 04/22/2021
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: Patient became dizzy and nauseous after vaccine. pt was assisted to wheelchair and brought to hallway for assessment. After first set of vitals pt vomits and passes out for about 30 seconds (max). Pt is woken up and reassessed. Pt is A&OX4. After second set of vitals pt states she feels better. Mom and pt decide to leave together instead of calling for a rescue.

Other Meds:

Current Illness:

ID: 1242231
Sex: F
Age: 48
State: TN

Vax Date: 04/12/2021
Onset Date: 04/18/2021
Rec V Date: 04/22/2021
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: Sulfa, penicillin, whey

Symptom List: Erythema, Pruritus

Symptoms: Rash on torso and face. Swelling in tongue and back of mouth. Headache.

Other Meds: None

Current Illness: None

ID: 1242232
Sex: M
Age: 66
State: FL

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 04/22/2021
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: Flu Syptoms

Other Meds: Lisonpril, metropolol,

Current Illness: None

ID: 1242233
Sex: M
Age: 37
State: CA

Vax Date: 03/11/2021
Onset Date: 03/26/2021
Rec V Date: 04/22/2021
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: Blood clots in the Liver and Kidney also Pulmonary Embolism. went to ER was admitted and spent 6 days there. was put on Heparin as well as antibiotics. currently on Warfarin to maintain proper blood INR numbers.

Other Meds: None

Current Illness: None

ID: 1242234
Sex: M
Age: 28
State: CA

Vax Date: 04/22/2021
Onset Date: 04/22/2021
Rec V Date: 04/22/2021
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: nka

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Fainted

Other Meds: none

Current Illness: nk

ID: 1242235
Sex: F
Age: 58
State: IL

Vax Date: 01/22/2021
Onset Date: 02/08/2021
Rec V Date: 04/22/2021
Hospital: Y

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: Pontine Stroke. Left upper extremity weakness, visiospstial deficit

Other Meds:

Current Illness:

ID: 1242236
Sex: F
Age: 53
State:

Vax Date: 01/11/2021
Onset Date: 04/11/2021
Rec V Date: 04/22/2021
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: Iodine-anaphylaxis

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

Symptoms: Shortness of breath. Chest tightness. Epi given. Albuterol

Other Meds: Wellbutrin. Clonazepam. Methadone. Trazadone.

Current Illness:

ID: 1242237
Sex: M
Age: 59
State: OK

Vax Date: 02/04/2021
Onset Date: 04/11/2021
Rec V Date: 04/22/2021
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

Symptom List: Pain in extremity

Symptoms: DVT BLOOD CLOTD

Other Meds: Xarelto, trulicity, metformin, jardiance, norco, escitaloprim

Current Illness: None

ID: 1242238
Sex: M
Age: 37
State: OH

Vax Date: 04/16/2021
Onset Date: 04/16/2021
Rec V Date: 04/22/2021
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: Pt received his vaccine at 12:57 PM and around 1PM he started feeling light headed and became sweating. Pt remained oriented x 4. Able to answer questions. Pt was laid down on his back, feet elevated higher than his head. Vitals were taken at 13:05. BP 132/80, HR 67, RR 20, T 95.5 (temporal) OxSat 96% RA. Pt stated he has had these type of episodes before. He is not taking any of the OTC medications. Ha has an allergy reaction to PCN in the past. No vaccine in the last 14 days. Pt stated he feels better @1320 pt was able to sit up and drank 100% of his water. Pt was assisted out to his car where his wife was waiting. Pt laid down in the back. Advised to call 911 if his symptoms get worse. He agreed

Other Meds:

Current Illness:

ID: 1242239
Sex: M
Age: 17
State: CA

Vax Date: 04/22/2021
Onset Date: 04/22/2021
Rec V Date: 04/22/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: Client received dose number of COVID-19 Moderna vaccine as an off label use.

Other Meds:

Current Illness:

ID: 1242240
Sex: F
Age: 62
State: CA

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 04/22/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: Patient is also a provider who was doing medical observation of vaccine clinic. She presented without her vaccine card saying she was due for her second vaccine. She was medically screened and received her second dose. When entering the second dose into the medical record, it was noted that first dose was on 3/29/2021. Second should have been given on 4/26/2021 rather than 4/20/21.

Other Meds: None

Current Illness: None

ID: 1242241
Sex: F
Age: 32
State: VA

Vax Date: 04/22/2021
Onset Date: 04/22/2021
Rec V Date: 04/22/2021
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: biaxin, augmentin

Symptom List: Vomiting

Symptoms: Within a couple minutes of the vaccination, patient said she felt like she was going to pass out. The pharmacist took her to a chair to sit down. Within a few seconds, the patient collapsed out of the chair, fell in the floor. She was out for about 15-20 seconds then came around. 911 was called immediately when patient collapsed from the chair. Patient was taken to the hospital for evaluation.

Other Meds: none known

Current Illness: none known

ID: 1242242
Sex: F
Age: 64
State: MI

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 04/22/2021
Hospital:

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

Lab Data:

Allergies: No allergies.

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: 2nd dose of Moderna given at 10:00am; felt tired a few hours later. Around 8:45pm, same day, began with non-stop chills, aches & elevated fever (under100) lasting approximately 9-10 hours. Fever was 100.2 degrees next morning. Chills subsided but aches continued another 24 hours. Used max amount of Tylenol throughout this time and for another 2-3 days. Very tired if any activity was attempted such as walking in house or trying to cook, etc. After 3-4 days felt better but a rash developed on insides of both arms that also itched. This lasted a few days, was helped a little with Benadryl oral and cream applied to rash but it went away without further medical attention.

Other Meds: Multi vitamin, hair skin & nails supplement, calcium, probiotic, vitamin D3, Lisinopril 10mg, Tylenol 500mg (as needed).

Current Illness: None

ID: 1242243
Sex: F
Age: 57
State:

Vax Date: 04/11/2021
Onset Date: 04/11/2021
Rec V Date: 04/22/2021
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: Nausea, lightheaded, shaky, some spasticity related to underlying MS

Other Meds:

Current Illness:

ID: 1242244
Sex: M
Age: 58
State: NY

Vax Date: 04/01/2021
Onset Date: 04/05/2021
Rec V Date: 04/22/2021
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: no

Symptom List: Injection site swelling, Limb discomfort

Symptoms: WHITE blotches all over body

Other Meds: Xanax, duloxetine, tadalafil, metformin, alpha-lipoic acid, Omega 3

Current Illness: had squamous cell cancer that was removed PRIOR to vaccine...hyper-immune system

ID: 1242245
Sex: M
Age: 18
State: CA

Vax Date: 04/16/2021
Onset Date: 04/16/2021
Rec V Date: 04/22/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Blurry vision, light-headed. BPs 87/62 (pulse 81), 114/82 (pulse 68). Patient was dehydrated - advised to hydrate before second vaccine dose.

Other Meds:

Current Illness:

ID: 1242246
Sex: M
Age: 54
State: TX

Vax Date: 04/16/2021
Onset Date: 04/20/2021
Rec V Date: 04/22/2021
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: Penicillin

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

Symptoms: Joint swelling in hands three days after shot. Joint swelling and pain in big toe of right foot.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm