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: 1263141
Sex: F
Age: 41
State:

Vax Date: 04/27/2021
Onset Date: 04/27/2021
Rec V Date: 04/27/2021
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: Shortness of breath

Other Meds:

Current Illness:

ID: 1263142
Sex: M
Age: 28
State:

Vax Date: 04/26/2021
Onset Date: 04/26/2021
Rec V Date: 04/27/2021
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: Patient had flushing/sweating, dizziness, lightheaded, diaphoretic, lips tingling, slight blurred vision, anxious. Given water, juice, graham crackers. Symptoms improved, stable, patient released from vaccination site.

Other Meds:

Current Illness:

ID: 1263143
Sex: M
Age: 49
State: NY

Vax Date: 04/25/2021
Onset Date: 04/25/2021
Rec V Date: 04/27/2021
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: Penicillin

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

Symptoms: lightheaded

Other Meds:

Current Illness:

ID: 1263144
Sex: F
Age: 63
State:

Vax Date: 03/15/2021
Onset Date: 04/15/2021
Rec V Date: 04/27/2021
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: After the vaccine, patient reported pain from the arm radiated to left neck area and left ear. EMS at bedside.

Other Meds:

Current Illness:

ID: 1263145
Sex: M
Age: 62
State: TN

Vax Date: 04/23/2021
Onset Date: 04/23/2021
Rec V Date: 04/27/2021
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: The patient was given a first dose Phizer on 3-24-21 and inadvertently given Moderna on 4-23-21 as his second dose; The patient has been notified and he denies any s/s of side effects from the vaccine. He stated " I never knew I had them"

Other Meds:

Current Illness:

ID: 1263146
Sex: F
Age: 63
State: TX

Vax Date: 04/10/2021
Onset Date: 04/22/2021
Rec V Date: 04/27/2021
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: None

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

Symptoms: Left ear drum rupture, ringing and loss of hearing in left ear

Other Meds: Enalapril 5mg Metformin Zyrtec

Current Illness: None

ID: 1263147
Sex: F
Age: 32
State: NE

Vax Date: 04/20/2021
Onset Date: 04/21/2021
Rec V Date: 04/27/2021
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: Cefaclor

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: My filler started swelling. I also had a terrible headache and was exhausted.

Other Meds: Citalopram Lamotrigine Zolpidem Clonazepam Mirena

Current Illness: none

ID: 1263148
Sex: M
Age: 36
State: MA

Vax Date: 04/27/2021
Onset Date: 04/27/2021
Rec V Date: 04/27/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Patient described feeling anxious around needles/blood, fainted upon injection.

Other Meds:

Current Illness:

ID: 1263149
Sex: F
Age: 17
State:

Vax Date: 04/25/2021
Onset Date: 04/25/2021
Rec V Date: 04/27/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: difficult swallowing post vaccine - tightness of throat. ; Gave Epi 0.5ml at 14;18; Ambulance at 1430

Other Meds:

Current Illness:

ID: 1263150
Sex: F
Age: 41
State: MD

Vax Date: 04/09/2021
Onset Date: 04/23/2021
Rec V Date: 04/27/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: No Known Allergies

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Deep venous thrombosis at the site of vascular access line-Initially started on heparin, now switched to Rivaroxaban Thrombocytopenia-Supportive treatment and monitoring

Other Meds: Apixaban, Citalopram, Lisinopril, Lorazepam, Melatonin, KCL, Prednisone, Senna-c Completed Chemotherapy with Taxol 2 days prior.

Current Illness: Breast cancer Hypertension Rheumatoid arthritis Vascular port related clot Depression

ID: 1263151
Sex: M
Age: 64
State: MN

Vax Date: 03/18/2021
Onset Date: 04/26/2021
Rec V Date: 04/27/2021
Hospital: Y

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 was admitted to the hospital 4/26 with fatigue and dyspnea and tested positive for COVID (non ICU)

Other Meds:

Current Illness:

ID: 1263152
Sex: M
Age: 59
State: NC

Vax Date: 04/12/2021
Onset Date: 04/19/2021
Rec V Date: 04/27/2021
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: Left side facial / body numbness & tingling.

Other Meds: Novolin N, Novolin R, aspirin 81mg, Prilosec

Current Illness: None

ID: 1263153
Sex: U
Age: 59
State: FL

Vax Date: 04/07/2021
Onset Date:
Rec V Date: 04/27/2021
Hospital:

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

Lab Data:

Allergies: Allergic to opioids and all plants

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

Symptoms: Approximately 24 hours after my vaccine with Pfizer I had excruciating heart pain that felt like I was having a heart attack along with felt like my throat was closing. That reaction lasted for 4 days with no ease of the chest pain. My temperature after the 24-hour period was 102, the next day 101, the next day 100.2, and then the last day of 99.5

Other Meds: Seljan's, prednisone, lisinopril, duloxetine, trazodone,

Current Illness: None

ID: 1263154
Sex: M
Age: 40
State: MA

Vax Date: 04/12/2021
Onset Date: 04/12/2021
Rec V Date: 04/27/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: No allergies to anything

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

Symptoms: The evening of the vaccination I began experiencing tingling at the site of the shot, then this extended through the night to chest pains and tightness in the chest. That continued through the night and into the following day. The following day and lasting until present (4/27/2021) I have continued to experience tingling at night, extending to my arm and fingers, random very sharp pains in my chest, and some feeling of strong heart throbbing. This subsides during the day-time (when I'm upright versus lying down) but all of these symptoms return during the evening. These are all things I never experienced prior to the vaccine. Also, I have tested regularly for COVID-19 since my companyconducts covid-19 testing and I have not been infected with COVID-19 at any point during the past year. The continuation of these symptoms is concerning. There have been at least two instances where the sharp pains in my chest were much more intense than the other chest pains I have felt since the vaccine.

Other Meds: None

Current Illness: Not sick in over 1 year with any kind of symptoms.

ID: 1263155
Sex: F
Age: 24
State: IL

Vax Date: 03/28/2021
Onset Date: 03/28/2021
Rec V Date: 04/27/2021
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: Patient reported facial swelling and throat tightness within 1 hour after vaccination. Patient treated herself with Benadryl at home. Patient advised not to receive second dose of vaccine.

Other Meds:

Current Illness:

ID: 1263156
Sex: F
Age: 53
State: NV

Vax Date: 04/15/2021
Onset Date: 04/16/2021
Rec V Date: 04/27/2021
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, Bell Pepper and Latex

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

Symptoms: Chills, sever aching in the joints, tired, general pain

Other Meds: Verapamil, Levotheroxine, Trazodone

Current Illness: none

ID: 1263157
Sex: F
Age: 36
State: LA

Vax Date: 03/17/2021
Onset Date: 03/26/2021
Rec V Date: 04/27/2021
Hospital:

Vax Type: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: None

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

Symptoms: Though my period ended on March 6th, normally. My period started again on the 26th. It was accompanied by much more intense pain and cramping, as well as intense suicidal ideation. That period ended after a very heavy bleeding of 4 days. I got the second shot just before my 37th birthday and the very next day felt terrible. My entire body hurt in a way I have never experienced before. My feet hurt, my hips, extreme fatigue. That continues in varying severity. I started spotting again on April 19th, which continues until I started another period on April 23rd which just ended yesterday, the 26th. I am still very fatigued and have been dealing with extreme suicidal thoughts and uncontrollable crying.

Other Meds: None

Current Illness: None

ID: 1263158
Sex: M
Age: 42
State: NY

Vax Date: 04/27/2021
Onset Date: 04/27/2021
Rec V Date: 04/27/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: THE PATIENT RECEIVED JANSSEN COVID 19 VACCINE IN THE LEFT ARM. I RECOMMENDED TO SIT FOR 15 MINUTES TO OBSERVE THE PATIENT. PATIENT REQUESTED TO USE THE BATHROOM IN THE PHARMACY RIGHT AFTER VACCINE. PATIENT CAME BACK FROM THE BATHROOM SAYING THAT HE FAINTED AND FELL IN THE BATHROOM AND SLASH OPEN THE LEFT SIDE OF HIS CHEEK WAS BLEEDING A LOT AND HE FELT DIZZY AND NAUSEA. HE FAINTED THE SECOND TIME ON THE FLOOR. 911 WAS CALLED PROMPTLY. POLICE AND AMBULANCE CAME TO GO TO THE HOSPITAL.

Other Meds: NO

Current Illness:

ID: 1263159
Sex: F
Age: 53
State:

Vax Date: 03/14/2021
Onset Date: 03/14/2021
Rec V Date: 04/27/2021
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: Patient describes development of metallic taste and headache after vaccine administration . No other symptoms reported . No dizziness , sob, difficulty ambulating / standing noted . Patient sent home with ER precautions and told to follow-up with PCM.

Other Meds:

Current Illness:

ID: 1263160
Sex: F
Age: 63
State: FL

Vax Date: 04/10/2021
Onset Date: 04/10/2021
Rec V Date: 04/27/2021
Hospital:

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

Lab Data:

Allergies: Aspirin

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

Symptoms: From patient to after hours provider with c/o head and leg pain after Johnson & Johnson CVD19 vaccine. She states symptoms started 24 hours after vaccine and has not resolved. Patient advised to proceed to the nearest ER for evaluation for potential side effect due to J&J vaccine. Patient states understanding.

Other Meds: Cromolyn Sodium, Levocetirizine, Lisinopril -HCTZ, Montelukast, Omeprazole,

Current Illness:

ID: 1263161
Sex: F
Age: 53
State:

Vax Date: 04/25/2021
Onset Date: 04/25/2021
Rec V Date: 04/27/2021
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:

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

Symptoms: itchy around vaccination site.

Other Meds:

Current Illness:

ID: 1263162
Sex: F
Age: 49
State: MI

Vax Date: 04/10/2021
Onset Date: 04/23/2021
Rec V Date: 04/27/2021
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: SULFA,REGLAN

Symptom List: Unevaluable event

Symptoms: PATIENT COUDN'T WALK SINCE 23RD, 12DAYS AFTER RECEIVING VACCINE. LEFT LEG SWEELLED UP. HUSBAND TOOK HER TO EMERGENCY DR'S DID FULL STROKE PROTOCOL. PATIENT IS STILL IN ICU.

Other Meds: NONE

Current Illness: NONE

ID: 1263165
Sex: F
Age: 54
State: MI

Vax Date: 01/29/2021
Onset Date: 04/23/2021
Rec V Date: 04/27/2021
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: lisinopril -- > anaphylaxis codeine -- > anaphylaxis levofloxacin - reaction not specified orbactiv -- > hives penicillin -- > anaphylaxis morphine -- > anxiety

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

Symptoms: Received COVID-19 vaccine on 1/8/21 and 1/29/21. On 4/23/21 the patient developed chills, cough, headache, loss of taste/smell, shortness of breath, and congestion. Tested positive for COVID. Treated with monoclonal antibodies (BAM/etesevimab).

Other Meds: atorvastatin, fioricet, zyrtec, temovate cream, lofibra capsules, fluoxetine, glimepiride, hydrodiurril, keppra, levetiracetam, synthroid, lorazepam, cozaar, glucophage, singulair, omeprazole

Current Illness: none

ID: 1263166
Sex: M
Age: 29
State: CA

Vax Date: 03/21/2021
Onset Date: 03/24/2021
Rec V Date: 04/27/2021
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: Acute tinnitus in left ear a couple of days after receiving first dose of the Covid-19 Moderna Vaccine. One month later issue is not resolved.

Other Meds: None

Current Illness: None

ID: 1263167
Sex: F
Age: 71
State: TX

Vax Date: 04/22/2021
Onset Date: 04/23/2021
Rec V Date: 04/27/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Injection site pain, Menorrhagia

Symptoms: The day after the 2nd Moderna vaccine I developed 2 blisters on right ankle...they started out red, itchy, and burning & in less than 24 hours they got really inflated. 2 days later they popped by themselves & slowly started to drain. Today is day 5 after the vaccine,

Other Meds: Calcium Citrate w/D3, Coenzyme B-Complex, Core Daily 1 multi-vitamin, CQ10, Cramp Defense (magnesium malate), Omega 3, Osteo Bi-Flex, Turmeric, Vitamin D3

Current Illness: none

ID: 1263168
Sex: F
Age: 58
State: IN

Vax Date: 04/22/2021
Onset Date: 04/22/2021
Rec V Date: 04/27/2021
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: Levaquin, Keflex, sulfa

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

Symptoms: fever, chills, chest pressure, feeling like I was going to pass out, throat felt funny

Other Meds: None

Current Illness: None

ID: 1263169
Sex: M
Age: 51
State:

Vax Date: 04/25/2021
Onset Date: 04/25/2021
Rec V Date: 04/27/2021
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: chest pain. anxiety -- resolved

Other Meds:

Current Illness:

ID: 1263170
Sex: M
Age: 56
State: OR

Vax Date: 04/23/2021
Onset Date: 04/25/2021
Rec V Date: 04/27/2021
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 known

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Nausea and headache then vomiting. All began approximately 40 hours after vaccination. Treatment was rest and bland foods for 36 hours. Nausea subsided after vomiting for about 2 hours. Occasional nausea but no more vomiting for next 24 hours. Light headache continued for 36 hours.

Other Meds: nsaid, vitamin c, multi-vitamin

Current Illness: None

ID: 1263171
Sex: F
Age: 40
State: KS

Vax Date: 04/12/2021
Onset Date: 04/13/2021
Rec V Date: 04/27/2021
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: N/A

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

Symptoms: Light tension headache behind eyes, very sleepy, aches at joints (knees, lower back, elbows.

Other Meds: Tri Feymnor and Generic Claritin

Current Illness: N/A

ID: 1263172
Sex: F
Age: 49
State:

Vax Date: 04/27/2021
Onset Date: 04/27/2021
Rec V Date: 04/27/2021
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: RN attempted to administer Pfizer COVID-19 vaccine using a VanishPoint 25g 1mL needle (most likely from LOT G210308). Upon administration, vaccine "spilled" out from around the needle hub. RN confident no vaccine was actually administered, and proceeded to administer a complete dose using a separate syringe.

Other Meds:

Current Illness:

ID: 1263173
Sex: F
Age: 41
State: IN

Vax Date: 04/23/2021
Onset Date: 04/25/2021
Rec V Date: 04/27/2021
Hospital:

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

Lab Data:

Allergies: Sulfa drugs, cipro, penicillin

Symptom List: Injection site pain

Symptoms: Swollen lymph nodes above left collarbone and in left side of neck, lethargy, headache, muscle pain. Started with chills and general lack of energy within 6 hours of shot; lymph node swelling and deeper arm and shoulder pain presented 48 hours after shot and still persist at day 4.

Other Meds: None

Current Illness: None

ID: 1263174
Sex: M
Age: 60
State: MN

Vax Date: 03/31/2021
Onset Date: 04/09/2021
Rec V Date: 04/27/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Difficulty breathing due to heart pounding and could not walk more than 50 feet. Had ECHO yesterday 4/26/21, which revealed inflammation. Provider recommended waiting to do second dose for now.

Other Meds:

Current Illness:

ID: 1263175
Sex: F
Age: 28
State: CT

Vax Date: 04/23/2021
Onset Date: 04/26/2021
Rec V Date: 04/27/2021
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: n/a

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

Symptoms: patient developed a bump on the right bicep

Other Meds: n/a

Current Illness: n/a

ID: 1263176
Sex: F
Age: 68
State:

Vax Date: 03/14/2021
Onset Date: 03/14/2021
Rec V Date: 04/27/2021
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: Nausea; Pt c/o nausea 15 mins after receiving vaccine. She denied chest pain, SOB, difficulty breathing, or other complaints. Past med hx as reported by patient is carotid artery disease. Pt assessed and evaluated by NP and paramedic. Pt had mild anxiety, BP - 157/80.

Other Meds:

Current Illness:

ID: 1263177
Sex: M
Age: 82
State: LA

Vax Date: 04/14/2021
Onset Date: 04/25/2021
Rec V Date: 04/27/2021
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: 11 DAYS AFTER 2ND PFIZER SHOT PATIENT DEVELOPED SHINGLES CONFIRMED BY DR.

Other Meds:

Current Illness:

ID: 1263178
Sex: M
Age: 58
State: IL

Vax Date: 03/28/2021
Onset Date: 03/28/2021
Rec V Date: 04/27/2021
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: Patient described generalized hives within 1 hour after vaccination.

Other Meds:

Current Illness:

ID: 1263179
Sex: F
Age: 42
State: CA

Vax Date: 03/25/2021
Onset Date: 04/04/2021
Rec V Date: 04/27/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: Rash with vesicles on the feet and other parts of the body

Other Meds: Humira, Tylenol#3, Seroquel, nortriptyline

Current Illness:

ID: 1263180
Sex: M
Age: 63
State: MN

Vax Date: 03/08/2021
Onset Date: 03/13/2021
Rec V Date: 04/27/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Increase short of breadth, chest pain, & blood clog

Other Meds: None

Current Illness: Hypertension, diabetes,

ID: 1263181
Sex: F
Age: 53
State: CA

Vax Date: 04/27/2021
Onset Date: 04/27/2021
Rec V Date: 04/27/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

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

Symptoms: Pt. C/O thick tongue and throat scratchiness same as when she took Penicillin. Pt give Benedryl, IM and within 5 min stated feeling better, no more sx reported

Other Meds: Blood pressure meds

Current Illness:

ID: 1263182
Sex: F
Age: 40
State:

Vax Date: 04/25/2021
Onset Date: 04/25/2021
Rec V Date: 04/27/2021
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: weird feeling, itchy all over mostly arms. increased phelgm with throat / tongue/ swelling; anxious.

Other Meds:

Current Illness:

ID: 1263183
Sex: F
Age: 36
State: WA

Vax Date: 03/06/2021
Onset Date: 04/03/2021
Rec V Date: 04/27/2021
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: Pain in extremity

Symptoms: Four weeks after the vaccine I started to have lower abdominal pain for a 24-hour period. I am on Birth Control, Falmina and it was before the Placebo Pills Started. I passed a large clot of blood the next day and went to Urgent Care. It was sent for Pathology and it was deemed a Deciduous casting. I had a Pelvic Ultrasound the following week and it was normal. The clinic I went to for follow up was.

Other Meds: Falmina birth control

Current Illness:

ID: 1263184
Sex: F
Age: 64
State: FL

Vax Date: 04/24/2021
Onset Date: 04/25/2021
Rec V Date: 04/27/2021
Hospital:

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

Lab Data:

Allergies: Biaxin, Buspare

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

Symptoms: Rash on my left arm, looks like hives and spreading, itchy and burning

Other Meds: Meclizine, Pepcid, Prozac, Abilify, Metoprolol, Amlodipine

Current Illness: Cough

ID: 1263185
Sex: F
Age: 57
State:

Vax Date: 04/26/2021
Onset Date: 04/26/2021
Rec V Date: 04/27/2021
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: Patient had dizziness. High BP 181/95 -- > 180/98, advised to follow up with PCP. Given water. FYI had rash after first dose.

Other Meds:

Current Illness:

ID: 1263186
Sex: M
Age: 58
State: OR

Vax Date: 01/22/2021
Onset Date: 01/23/2021
Rec V Date: 04/27/2021
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: Acute onset severe muscle spasming of right semitendinosis muscles and daily muscle tremors of same muscles to date.

Other Meds: none

Current Illness: none

ID: 1263187
Sex: F
Age: 25
State: NY

Vax Date: 04/04/2021
Onset Date: 04/16/2021
Rec V Date: 04/27/2021
Hospital: Y

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

Lab Data:

Allergies: Gluten

Symptom List: Vomiting

Symptoms: Painful headache, dizziness, loss of feeling in right side, numbness in right side, drooping face, blurred vision, shortness of breath

Other Meds: Birth Control (TriSprintec)

Current Illness:

ID: 1263188
Sex: M
Age: 15
State: WI

Vax Date: 04/05/2021
Onset Date: 04/05/2021
Rec V Date: 04/27/2021
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:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Pt. arrived for dose #2 04/27/2021. We refused and informed that dose #2 can be given after 16th birthday.

Other Meds:

Current Illness:

ID: 1263189
Sex: F
Age: 30
State: WI

Vax Date: 01/31/2021
Onset Date: 04/23/2021
Rec V Date: 04/27/2021
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: compazine, oxycodone

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

Symptoms: Pt received both doses of Pfizer COVID-19 vaccine, on 1/9/2021 and 1/31/2021. Pt had symptoms of COVID and was tested through employee health on 4/23/2021. She came back positive. No hospitalization.

Other Meds: Nuvaring, ferrous sulfate, hydroxychloroquine, metformin, prednisone, prenatal vitamins, vitamin D

Current Illness:

ID: 1263190
Sex: M
Age: 68
State: CO

Vax Date: 03/25/2021
Onset Date: 04/20/2021
Rec V Date: 04/27/2021
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: Statins; Codeine

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient admitted for worsening COVID 19 symptoms (fever, hypoxia, generalized weakness, chest tightness, dyspnea, nausea, and cough). Patient tested positive for COVID 19 in 4/15/. He received courses of remdesivir and dexamthasone, Noted by attending physician, suspected patient may not have mounted sufficient immune response with vaccine due to Cellcept.

Other Meds: Cellcept; Doxazosin; Gabapentin; Effexor; Finasteride; Dapsone; Metformin

Current Illness:

ID: 1263191
Sex: F
Age: 41
State: FL

Vax Date: 04/20/2021
Onset Date: 04/27/2021
Rec V Date: 04/27/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: One week post vaccination patient has swelling and red rash in left arm where injection was given.

Other Meds: Bupropion xl 300mg

Current Illness: unknown

ID: 1263192
Sex: F
Age: 52
State: OK

Vax Date: 04/22/2021
Onset Date: 04/22/2021
Rec V Date: 04/27/2021
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: Pcn- hives

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

Symptoms: Severe body ache, itching rash, armpit swelling, breast pain, muscle pain, fever, chills, bone and joint pain.

Other Meds: fosinopril, estradiol, methocarbamol, gabapentin, buspirone, fluoexetine, folic acid, benedryl, phentermine

Current Illness: neuropathy, sjogrens, oa, degen disc, reynaulds, horners

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm