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: 1244009
Sex: F
Age: 58
State: NY

Vax Date: 04/18/2021
Onset Date: 04/19/2021
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:

Symptom List: Dysphagia, Epiglottitis

Symptoms: cramp-like pain between shoulder where vaccine was injected (left) and top of neck

Other Meds:

Current Illness:

ID: 1244010
Sex: F
Age: 39
State: MD

Vax Date: 03/20/2021
Onset Date: 04/20/2021
Rec V Date: 04/22/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Anxiety, Dyspnoea

Symptoms: Experienced HSV-2 outbreak after virus having been dormant for 2.5 years, majority of which time was not under treatment with Valcyclovir. Outbreak occurred 6 days after 2nd vaccination.

Other Meds: Lexapro, Gabapentin, Lamotrigine, Adderall, Esomeprazole

Current Illness: None

ID: 1244011
Sex: M
Age: 80
State:

Vax Date: 03/29/2021
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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: ED/hosp within 6 weeks of COVID vaccine

Other Meds:

Current Illness:

ID: 1244012
Sex: F
Age: 24
State: WI

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: System failure at clinic led to client receiving wrong manufacturer as second dose. Client was informed they received Moderna 1st dose and Pfizer 2nd dose.

Other Meds:

Current Illness:

ID: 1244013
Sex: F
Age: 33
State: NY

Vax Date: 03/03/2021
Onset Date: 03/01/2021
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: None

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

Symptoms: Rash to skin fold (axilla, groin, and abdomen) began about 3/31/2021. Diagnosed with biopsy as eczema on 4/21/2021. Additional rash to extremities and trunk began about 4/5/2021 and continues to worsen. Diagnosed as PUPPPS on 4/17/2021. Currently pregnant with EDD 5/16/2021

Other Meds: Prenatal vitamin

Current Illness: None

ID: 1244014
Sex: M
Age: 71
State:

Vax Date: 04/16/2021
Onset Date: 04/17/2021
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:

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

Symptoms: weakness, couldn't walk, dehydrated, fall, ambulance brought patient to the Emergency Department.

Other Meds:

Current Illness:

ID: 1244015
Sex: M
Age: 53
State:

Vax Date: 04/21/2021
Onset Date: 04/22/2021
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:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Headache, feeling run down

Other Meds:

Current Illness:

ID: 1244016
Sex: F
Age: 59
State: IN

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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Penicillin

Symptom List: Pharyngeal swelling

Symptoms: Severe chills and nausea. Chills are gone but still haven't eaten in 3 days.

Other Meds: Losartin 50mg, atorvastatin 10mg, HCTZ50mg, levothyroxine 125mcg, calcium 500mg w/d

Current Illness: None

ID: 1244017
Sex: M
Age: 25
State: WY

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: LA

Lab Data:

Allergies: seasonal allergies

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Pt has received second dose of the Moderna series. He had completed his fifteen minutes of observation and after standing to leave, he collapsed onto the floor hitting his head at 1152. Myself,RN rushed over and began to evaluate condition. Pt was oriented x4 and stated he had become light headed after standing. Stated that his head hurt from hitting it on the floor. Began monitoring vital signs. Initial VS showed BP of 138/82, Pulse of 83, and respirations at 14. Applied oxygen per nasal cannula until we could monitor oxygen level which was found to be 96%. After continuing to talk with pt, he again passed out while still laying down. We were able to awaken him and he was still oriented x4. . Second VS at 1159 showed BP of 130/82, P 82, and 02 of 96. Pt reported his history of seizures. Continued to monitor. Third set of VS at 1204 were BP 124/78, P 78, R 12, 02 96. Police arrived at 1205 and ambulance arrived at 1209. Pt refused to be taken in by ambulance and continued to converse. We sat pt up to sitting position. At 1207, BP was 124/80, P 79, and 02 96. He was then moved up to sit in chair but after sitting there at approximately 1215, pt again passed out but was supported by the EMT. After regaining consciousness, he then agreed to be transported to hospital via ambulance.

Other Meds: Paxil

Current Illness: NA

ID: 1244018
Sex: F
Age: 60
State: AL

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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: sulfur

Symptom List: Diarrhoea, Nasal congestion

Symptoms: vaccinator gave pt Pfizer vaccine as her second dose in series. Pt received Moderna as her first dose. Spoke with overseeing physicians and advised pt that her series is now complete and not to receive a third dose. pt instructed to call with any questions.

Other Meds: unknown

Current Illness: none documented

ID: 1244019
Sex: M
Age: 31
State: IL

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: SULFA AND SULFA ANTIBIOTICS

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

Symptoms: Patient's girl friend reported he fainted and bumped his head on the floor. He fainted and was awake by the time the pharmacist came out to the aisles.

Other Meds: NONE LISTED

Current Illness: NONE REPORTED

ID: 1244020
Sex: M
Age: 54
State: IL

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: SYR
Vax Site: RA

Lab Data:

Allergies: nkda

Symptom List: Rash, Urticaria

Symptoms: Pt became dizzy and felt cold feet

Other Meds:

Current Illness: DIABETES

ID: 1244021
Sex: F
Age: 17
State: OK

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

Lab Data:

Allergies: None that we are aware of.

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

Symptoms: Patient felt light-headed about 15 minutes after shot. She stood up and fell. A gentleman caught her so she wasn't injured. She said she was hot. She said her heart wasn't racing. I took her pulse and it was normal.

Other Meds: None that we are aware of.

Current Illness: None that we are aware of.

ID: 1244022
Sex: F
Age: 43
State: NY

Vax Date: 04/10/2021
Onset Date: 04/21/2021
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:

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

Symptoms: Reports bilateral calf pain with numbness concerning for bilateral DVT. Symptoms began night of 4/21/21. Reports feeling brain fog and fatigue.

Other Meds:

Current Illness:

ID: 1244024
Sex: F
Age: 45
State: TX

Vax Date: 03/26/2021
Onset Date: 03/27/2021
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:

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

Symptoms: Pt started having PVCs, pitting edema, fatigue, arm pain, brain fog and bradycardia the day after vaccination. Symptoms persisted fo 10 days before slowly starting to improved. Still c/o feeling fatigued and foggy 3 weeks later.

Other Meds:

Current Illness:

ID: 1244025
Sex: F
Age: 87
State: MI

Vax Date: 01/08/2021
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:

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

Symptoms: Fully vaccinated patient tested Covid positive 4/20/21 using PCR test through Lab.

Other Meds:

Current Illness:

ID: 1244026
Sex: M
Age: 17
State: KS

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

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

Symptoms: It was discovered after the administration of the vaccine was given to Trenton when he was 17 years and 4 months old. He did not experience any side effects due to the vaccine other than a sore arm. After consulting the CDC Covid-19 Vaccine Administration Errors and Deviations we told the patient we would administer the 2nd dose to complete the series.

Other Meds:

Current Illness:

ID: 1244027
Sex: F
Age: 53
State: IA

Vax Date: 04/14/2021
Onset Date: 04/21/2021
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: Penicillan, sulfa drugs, savella,

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Very bad Chills ans shaking first night. Nausea day 2 and 3. Normal on day 4. Severe diarhhea days 5 and 6 along with all over body aches. Unable to eat due to nausea days 6-8, Day 7 severe nausea, body aches with uncontrollable shaking all night, Entire body of nerve in excruciating pain. Day 8 (today) Felt like I needed to go to the ER last night. Can't go to work. In bed all day with continued bouts of chills and shaking. Fever has been low grade or none during all this.

Other Meds: levothyroxine

Current Illness:

ID: 1244028
Sex: F
Age: 46
State: OR

Vax Date: 03/25/2021
Onset Date: 03/25/2021
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: No

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: First felt tingling feeling within first 24 hours after receiving the vaccine and then developed a cold sore Treated with Abreva. Took about 2 weeks to heal

Other Meds: Multivitamins

Current Illness: No

ID: 1244029
Sex: M
Age: 73
State: CO

Vax Date: 04/17/2021
Onset Date: 04/18/2021
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: NKDA/FA/Other

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

Symptoms: renal failure, LV dysfunction

Other Meds: aspirin 81 mg, lipitor 80, coreg 25mg, gabapentin 300 mg, zestoretic 20-15.5

Current Illness: HLD, HTN,CABG 2017, afib

ID: 1244030
Sex: F
Age: 24
State: VA

Vax Date: 04/16/2021
Onset Date: 04/17/2021
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: Cefzil, Sulfa, Pineapple, Coconut, Toradol, Lidocaine, Statins, Norco, Oxycodone, erythromycin, reglan, haldol, versed, bentyl, some topical adhesives, EEG glue

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

Symptoms: Woke up at 2am with severe migraine. Went back to sleep, woke at 8:30am with severe migraine and HR near 150bpm. Checked fitbit and had been tachy since 2am. Went to ER. Migraine reached 7/10 intensity, was brought down to a 5/10 with 30mL liquid tylenol and two zofran (unknown strength). Was given 1L saline at 400mL/hour. Tachycardia lasted 14hrs before we got it back under 100bpm. During ER visit felt feverish but temp was not rechecked after triage. Checked at home and was 99.1?F (high for me as I don't get fevers). This broke overnight and did not have a recurrence of tachycardia episode. Continued tylenol for 3 more days, migraine was slowly lessening. As of today I still have a headache but it does not warrant tylenol. I was treated at the ER by a Dr., who diagnosed me with a post-vaccination reaction and stated my POTS likely was why I had such a strong tachycardic response.

Other Meds: Benadryl liquid 5mL Zyrtec liquid 5mL Zofran 8mg ODT Miralax 17g Saline infusions 2L/2x week PIV Estradiol cream 1g 1x/week Albuterol inhaler as needed for allergic reaction Flovent inhaler as needed for allergic reaction Epipen as needed

Current Illness: Candida infection, recent topical allergic reaction to EEG glue

ID: 1244031
Sex: F
Age: 35
State: TX

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: LA

Lab Data:

Allergies: Sertraline

Symptom List: Unevaluable event

Symptoms: Pt Felt Anxious and reported feeling Itchy all over her body. No signs of urticaria, no S.O.B. only feeling of anxiety and an urge to scratch herself. EPFD Called out for evaluation and patient refused transport.

Other Meds: Levothyroxine

Current Illness: None

ID: 1244032
Sex: M
Age: 49
State: NY

Vax Date: 04/01/2021
Onset Date: 04/20/2021
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: Penicillin

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

Symptoms: Nauseous 24/7 ,,arm still hurts like I was stabbed,,very tired I only want to sleep,,cold then hot then cold chills,,whole body hurts and I walk very slowly now,,diarrhea started today 4/22/2021..my daughter said I have slurred speech at times since the vaccine

Other Meds: None

Current Illness: None

ID: 1244033
Sex: F
Age: 40
State: WI

Vax Date: 03/10/2021
Onset Date: 03/23/2021
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:

Symptom List: Injection site pain, Pain

Symptoms: IgA Vasculitis

Other Meds:

Current Illness:

ID: 1244034
Sex: F
Age: 29
State: FL

Vax Date: 04/21/2021
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: Allergic to cats

Symptom List: Injection site pain, Menorrhagia

Symptoms: Arm began getting sore at night. Woke up the next Morning with serious pain in my neck and shoulders and nausea. Continued throughout the day. Got the chills later in the day and fever. Tylenol helped a little but constant neck pain and headache continue

Other Meds: Zyrtec, Juice Plus Vitamins

Current Illness: None

ID: 1244035
Sex: F
Age: 30
State: VT

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

Lab Data:

Allergies:

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

Symptoms: Shortly after receiving first dose of Moderna vaccine patient experienced localized arm redness where shot had been administered. Patient remained at pharmacy for 30 min for observation. Redness did not get worse and patient was not experiencing any other symptoms that shes believed to be related to vaccine. Instructed patient to call MD if redness/rash worsened.

Other Meds:

Current Illness:

ID: 1244036
Sex: F
Age: 55
State: MI

Vax Date: 04/13/2021
Onset Date: 04/17/2021
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: Sulfa, molds, pollen

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Rash on neck and chest

Other Meds:

Current Illness:

ID: 1244038
Sex: F
Age: 37
State: AZ

Vax Date: 04/08/2021
Onset Date: 04/09/2021
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: NONE

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: SEE PREVIOUS EXPLANATION.

Other Meds: 04/09/2021 - ELECTRIC SHOCK LIKE TINGLING SENSATION IN BOTH HANDS. MOSTLY HER FINGERS. WENT AWAY AFTER A FEW HOURS. 04/12/2021- STARTED HAVING TINGLING AND NUMBNESS OF BOTH FEET. STATES IT FELT LIKE "WHEN YOU PUT ON ICY HOT CREAM ON AND T

Current Illness: NO

ID: 1244039
Sex: F
Age: 26
State: NJ

Vax Date: 04/22/2021
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: NKDA

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

Symptoms: Patient received second dose of moderna vaccine at 3:31pm on 4/22/2021, during observation patient reported to feel "dizzy" and reported heavy breathing. Felt like she would lose consciousness/fall over. While discussing her symptoms, she began to feel pain in the center of her chest and continued with feeling of being faint and difficulty breathing. Patient appeared flushed and was warm to touch which later resolved. Ambulance was called and patient decided to leave by ambulance at 4:21pm after it arrived at 4:16pm. Her husband was onsite and was notified by herself. No further incident.

Other Meds: Zoloft, olmesartan, gabapentin, albuterol

Current Illness: No acute illness

ID: 1244040
Sex: M
Age: 26
State: IL

Vax Date: 04/09/2021
Onset Date: 04/09/2021
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: Unknown

Symptom List: Nausea

Symptoms: Patient experienced numbness and stiffness of arm post vaccination, recovered and released

Other Meds: Unknown

Current Illness: Unknown

ID: 1244041
Sex: F
Age: 21
State: OR

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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Patient received second dose too early. First dose was 3/29/21, 2nd dose was given 23 days after 1st dose.

Other Meds:

Current Illness:

ID: 1244042
Sex: M
Age: 27
State:

Vax Date: 03/18/2021
Onset Date: 03/29/2021
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 known

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

Symptoms: Patient tested positive for COVID19 on 30MAR21

Other Meds: None

Current Illness: None noticed by patient

ID: 1244043
Sex: F
Age: 48
State: TX

Vax Date: 04/16/2021
Onset Date: 04/17/2021
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:

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

Symptoms: Pt had local reaction including a red hard lump and painful axillary lymphadenopathy

Other Meds:

Current Illness:

ID: 1244044
Sex: M
Age: 40
State: GA

Vax Date: 04/09/2021
Onset Date: 04/12/2021
Rec V Date: 04/22/2021
Hospital: Y

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

Lab Data:

Allergies: None

Symptom List: Tremor

Symptoms: Hemorrhagic Stroke. Admitted to Hospital on 4/12. No significant risk factors for stroke. Discharged on 4/15 and followed up with neurology department

Other Meds: Vitamin D3

Current Illness: None

ID: 1244045
Sex: F
Age: 60
State: IN

Vax Date: 03/26/2021
Onset Date: 04/08/2021
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:

Symptom List: Erythema, Pruritus

Symptoms: Lymph nodes swollen over collarbone and stiff neck on left side, after two weeks left eye is blurry and may have a swollen nerve . MRI done to be sure nothing else is causing the nerve swelling.

Other Meds:

Current Illness:

ID: 1244046
Sex: F
Age: 17
State: MD

Vax Date: 04/22/2021
Onset Date: 04/22/2021
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:

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

Symptoms: A few minutes after receiving the vaccine, the patient complained of feeling hot, flushed, and faint. She then wanted to lie down on the floor. I called an ambulance, as she refused to let me take her blood pressure. When the EMTs arrived, she was sitting up and feeling notably better. She and her mother declined going to the hospital.

Other Meds:

Current Illness:

ID: 1244048
Sex: F
Age: 46
State: IL

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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Client reports itching to upper extremities with flu shots.

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

Symptoms: 11:38am- Facial flushing noted when mask removed. Patient reports tingling and itching in the face, neck, chest, and ears. Monitored patient and talked. Patient speech is clear. She denies shortness of breath. 12:02 pm- Itching and tingling continues, 25 mg Benadryl given, continued to monitor continuously. 12:10 pm- Patient states tingling and itching is a little better and says no longer itching. 12:22 pm- patient states she is feeling a lot better. Requested to leave. Going to work 3 miles away and has friends at work she said that will keep an eye on her. Patient left at 12:24, drove self. Follow- up with client on 4/16/21 at 2:58 pm. States tingling and itching is a lot less and less than it had been in the same amount of time after the first Moderna shot.

Other Meds:

Current Illness:

ID: 1244049
Sex: F
Age: 32
State: ME

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None known

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: 20 minutes after shot became flushed in face and hot. Subsided within 15 minutes. Approx 1 hour after injection experienced elevated heart rate (above 125) when in a sitting/sedentary state. 24 hours (approx) post vaccine experienced another short episode of elevated heart rate.

Other Meds: N/A

Current Illness: None

ID: 1244050
Sex: F
Age: 47
State: NJ

Vax Date: 04/09/2021
Onset Date: 04/11/2021
Rec V Date: 04/22/2021
Hospital:

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

Lab Data:

Allergies: No

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

Symptoms: After 2 days I had face swelling. I used steroids to treat. I still have pain in my injection site 13 days later. There's a dull achy pain, as well, in my left back shoulder.

Other Meds: Vitamins: D, B, Magnesium

Current Illness: None

ID: 1244051
Sex: F
Age: 26
State: CA

Vax Date: 03/20/2021
Onset Date: 04/10/2021
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:

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

Symptoms: Rash at right side of neck, spreading over several days towards left aspect of neck.

Other Meds:

Current Illness:

ID: 1244052
Sex: F
Age: 26
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: CT contrast dye Lemon grass Metformin

Symptom List: Pain in extremity

Symptoms: Swelling of injection site with both vaccinations, red, hot, painful burning, blister like formations, Charlie horses/ cramping in arm, headache, fever

Other Meds: Mono-linyah Dicyclomine Omeprazole Levothyroxine Trazadone Venlafaxine Buspirone Magnesium oxide

Current Illness: Sinus infection

ID: 1244053
Sex: F
Age: 21
State:

Vax Date: 04/17/2021
Onset Date: 04/17/2021
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: Chills the same night of 2nd dose. Muscle pain, arm pain, headache, and mild fever of 99.6 for 2 days after vaccination treated with Tylenol. Fatigue for all 3 days.

Other Meds:

Current Illness:

ID: 1244054
Sex: F
Age: 70
State: PR

Vax Date: 03/15/2021
Onset Date: 04/07/2021
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: No

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

Symptoms: On the 19th to the 20th after the vaccination My mother had a lot of headache and on the 21st day after the second dose of the vaccine was administered she had a lot of pain in both legs for 4 days, she could hardly walk. We did not suspect it was the vaccine so she just rested and did not contact her doctor. But yesterday we saw in a news story that this symptom should be reported.

Other Meds: None

Current Illness: Under weight

ID: 1244055
Sex: F
Age: 38
State: TX

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

Lab Data:

Allergies: None known

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

Symptoms: Patient reported on form that they had a previous allergic reaction to a meningitis vaccine in the past (10+ years ago). Immunizer informed patient to stay at pharmacy for the next 30 minutes following the vaccination to be able to monitor for allergic reaction. At around minutes 20-30, we checked in on patient who said she was experiencing shortness of breath. She began administering her inhaler that she had on hand (Ventolin/albuterol), it was not having any noticeable effect. Patient reported worsening shortness of breath and reported that she felt a swelling sensation and felt that her ears were swelling. She was visibly struggling with breathing. At this time we helped her back into the immunization area for privacy. Myself (pharmacist) and the other pharmacist on duty were talking her through breathing and trying to calm her down while helping her contact a family member in the area. We administered 1 dose of epinephrine 0.3 mg after about 10-15 minutes of her experiencing a visible serious allergic reaction. Right before administering the Epinephrine we instructed a technician on staff to call EMS. Within about 5 minutes of administering epi the patient began to be able to breathe better. We kept trying to keep her calm and within 10 minutes from administering EPI the EMS had arrived and they took her outside to allow her more fresh air to determine if she needed to go to the hospital.

Other Meds: Patient had a prescription for Ventolin albuterol inhaler

Current Illness: None known

ID: 1244056
Sex: F
Age: 53
State: GA

Vax Date: 03/19/2021
Onset Date: 03/20/2021
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: None

Symptom List: Vomiting

Symptoms: 3/20/21 Fever the entire day until next morning Swollen and painful lymph node left side breast lasted 4 days.

Other Meds: Hydroxyurea 500mg Folic acid 1mg Losartan hctz daily chewable aspirin OneADay multi women D3 1000 iu Xyzal sinus tab

Current Illness: None

ID: 1244057
Sex: F
Age: 49
State: OH

Vax Date: 04/17/2021
Onset Date: 04/22/2021
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: NKDA

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient contacted office to inform us that when she received her first dose of Pfizer she bled for a couple weeks (like a menstrual cycle) and she received her 2nd dose on Saturday April 17th and started bleeding today April 22nd.

Other Meds: NKDA

Current Illness: bleeding after receiving 1st dose Pfizer

ID: 1244058
Sex: F
Age: 49
State: TN

Vax Date: 04/20/2021
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:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: none known

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

Symptoms: I experienced tachycardia that sent me to the ER. My heart rate was consistently between 120 and 135 for several hours. I discovered this around 12:30 am on 4/21 but slept for a few hours before going to the ER at around 6:30 am, when I realized my HR was still elevated. After 2 bags of IV fluids, it was just under 100, where it remained most of the day. All other tests (EKG and labs) were normal, so they released me at around 10:15 am with instructions to rest in bed. Today (4/22) it is mostly in the 90s, so it seems to be returning to normal.

Other Meds: Rosuvistatin 20 mg

Current Illness: NA

ID: 1244059
Sex: F
Age: 74
State: FL

Vax Date: 02/10/2021
Onset Date: 02/13/2021
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: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: I received the vaccine on February 10, 2021. Then I awoke with a sever pain in my lower left side, and called my doctor. After examining me, Dr. decided that I should go to local Hospital for an Ultrasound and a CT Scan.

Other Meds: Synthroid .75, vitamin D3 25mcg

Current Illness: None

ID: 1244060
Sex: M
Age: 85
State: OH

Vax Date: 04/10/2021
Onset Date: 04/13/2021
Rec V Date: 04/22/2021
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: penicillins

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

Symptoms: Patient received the vaccine on 4/10/21 and a few days later hit his leg, which subsequently became erythematous and swollen. He went to urgent care on 4/13/21 and received a prescription for doxycycline which he stopped taking prior to resolution of symptoms due to side effects from the medication. He was prescribed clindamycin, but did not start this medication. Patient had outpatient labwork this morning which revealed an elevated SCr, for which he was sent to the ED. The patient was found to have AKI with hyperkalemia, as well as left lower extremity DVT and cellulitis. Patient is being treated with heparin and linezolid, as well as Kayexalate. The patient is being admitted to the hospital for treatment.

Other Meds: tamsulosin, simvastatin, potassium chloride ER, fish oil, multivitamin, midodrine, lisinopril, furosemide, ferrous sulfate, digoxin

Current Illness:

ID: 1244061
Sex: M
Age: 54
State: MI

Vax Date: 03/29/2021
Onset Date: 04/10/2021
Rec V Date: 04/22/2021
Hospital: Y

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

Lab Data:

Allergies: Hydrocodone

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

Symptoms: Hospitalized for acute blood clot in each leg

Other Meds: Rytary, flomax, lisinopril, cialis

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm