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: 1268018
Sex: M
Age: 54
State: MA

Vax Date: 04/26/2021
Onset Date: 04/26/2021
Rec V Date: 04/28/2021
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: percoset

Symptom List: Dysphagia, Epiglottitis

Symptoms: continuous spasming across middle back to left kidney area, groin area, random spasming in abdomen area, lower chest; no treatment as of yet

Other Meds: Prasugrel, metroprolol, fluoxetine, atorvastatin, aripiprazole

Current Illness: Root canal, shingles (speculative)

Date Died: 04/27/2021

ID: 1268019
Sex: F
Age: 83
State:

Vax Date: 02/26/2021
Onset Date: 04/22/2021
Rec V Date: 04/28/2021
Hospital: Y

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: This 83 year old female received the vaccine on 2/26/21 and went to the ED on 4/22/21 and was admitted with Thrombocytopenia, acute renal failure, fall with subdural hematoma, clavicle fracture, anemia, head injury, anascara, hyperkalemia and died on 4/27/2021. Please refer to the other details submitted within this report and contact the person who submitted this report via email for additional follow up details and investigation.

Other Meds:

Current Illness:

ID: 1268021
Sex: F
Age: 26
State: MN

Vax Date: 01/28/2021
Onset Date: 02/18/2021
Rec V Date: 04/28/2021
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: Squash

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

Symptoms: Covid positive resulted on 2/19/2021, collected on 2/18/2021

Other Meds: clindamycin (CLINDAGEL) 1 % gel 60 g 8/10/2020 8/10/2021 Sig: Apply to underarms twice daily. diclofenac sodium (VOLTAREN) 75 mg EC tablet 20 tablet 3/11/2021 3/21/2021 Sig: Take 1 tablet (75 mg total) by mouth 2 (two) times a day as

Current Illness: Headache-reported 1/6/2021

ID: 1268022
Sex: U
Age: 16
State:

Vax Date: 04/07/2021
Onset Date: 04/07/2021
Rec V Date: 04/28/2021
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: Patient was under the age of 18 years when vaccinated

Other Meds:

Current Illness:

ID: 1268023
Sex: F
Age: 26
State: OH

Vax Date: 04/24/2021
Onset Date: 04/26/2021
Rec V Date: 04/28/2021
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: The vaccine gave me body aches, a fever, and then it triggered an outbreak of genital herpes that I had previously never been diagnosed with until now.

Other Meds: None

Current Illness: None

ID: 1268024
Sex: F
Age: 58
State: MO

Vax Date: 04/21/2021
Onset Date: 04/22/2021
Rec V Date: 04/28/2021
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: Penicillin, carrots, oatmeal, cod

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

Symptoms: Patient reported feeling "quievering" on right side of face a few minutes after receiving 2nd dose of Moderna. Patient said symptoms lasted about 10 minutes then went away. She was monitored for a full 30 minutes before leaving with her companion without further incident.

Other Meds: Armour thyroid, hydrochlorothiazide; Montelukast, Goody powder (like Excedrin Migraine except it's an orange-flavored powder), magnesium oxide 400 mg, glucosamine chondroitin, fish oil, vitamin D3

Current Illness: None

ID: 1268025
Sex: F
Age: 56
State: MI

Vax Date: 04/28/2021
Onset Date: 04/28/2021
Rec V Date: 04/28/2021
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: unknown

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: We received a call to the call center that the patient Right eye was swelling closed. Patient did not speak with medical personnel and did not respond to phone call attempt. Patient was advised to seek assistance at the Emergency Room.

Other Meds: unknown

Current Illness: unknown

ID: 1268026
Sex: F
Age:
State: FL

Vax Date: 04/22/2021
Onset Date: 04/24/2021
Rec V Date: 04/28/2021
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: Hives/rash appeared and has been getting worse; not itchy, a little sore, mildly swollen, mildly red. It's Inside the elbow and inside L arm toward the wrist and toward armpit, all along the inner arm, Describes them as red uneven and crusty in appearance adv that this type of rash is not likely related to the shot given placement on the opposite arm but concerned for medical issues (ex I'm concerned for shingles possibly, given placement and description of the rash), would adv FU with a HCP first thing in the morning. Provided phone number for follow up if anything worsens tonight and PCC will check back in the morning 4/27-patient calling back, states her symptoms have improved . caller had mentioned that she was so lethargic for a few days, sx have subsided

Other Meds: Benadryl, tramadol PRN, levothyroxine, quetiapine, duloxetine 60 and 30 mg, tizanidine, metformin, propranolol, prochlorperizine, gabapentin, trazodone, clonazepam

Current Illness:

ID: 1268027
Sex: M
Age: 32
State: IN

Vax Date: 04/26/2021
Onset Date: 04/28/2021
Rec V Date: 04/28/2021
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: Nausea and vomiting

Other Meds: Zoloft

Current Illness:

ID: 1268028
Sex: M
Age: 25
State: IL

Vax Date: 04/28/2021
Onset Date: 04/28/2021
Rec V Date: 04/28/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Diarrhoea, Nasal congestion

Symptoms: We had a patient today that passed out after his covid vaccine. It was his 2nd covid immunization. He got his immunization at the pharmacy in the booth and then he sat down in one of the waiting chairs at the end of the cough and cold aisle. While he was sitting down, he began to feel unwell, he then got up off his chair and then was approaching the drop off window (he was going to let us know he didn't feel well) at that time he then passed out. He fell into the privacy screen of the imz booth. He did fall into the booth which did break some of his fall. He also knocked off one of the frames that we had on the wall, and then I think it fell on his nose. He did get a cut nose and he also bit his lip or mouth because his mouth was bleeding also. He reported that his nose did hurt, and he will have a prominent bruise on his nose. We did provide him with a couple of ice packs and a bottle of water. The patient (25 years old) and his mother both stated that he has passed out in the past when he has been around needles. He stated that he got to thinking about getting the shot and the needle going into his arm and that is when he started to feel unwell.

Other Meds: none

Current Illness: n/a

ID: 1268029
Sex: F
Age: 69
State: WI

Vax Date: 04/09/2021
Onset Date: 04/23/2021
Rec V Date: 04/28/2021
Hospital:

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

Lab Data:

Allergies: NKA, just sensitivities to things (gets upset stomach).

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

Symptoms: CLIENT REPORTS THAT 4-5 DAYS AGO SHE STARTED HAVING EXTREME FATIGUE, AND RIGHT NECK, SHOULDER, PAIN THAT IS POUNDING AND REQUIRES TYLENOL PO Q 3 HOURS. ICE HELPS A LITTLE BUT ONCE MEDICATION WEARS OFF SHE HAD SEVERE PAIN IN THESE AREAS. IT STOPS AT THE LOCATION OF THE SHOT ON HER RIGHT SIDE/ARM.

Other Meds: Tylenol and Tums

Current Illness: none reported

ID: 1268030
Sex: M
Age: 24
State: MA

Vax Date: 04/28/2021
Onset Date: 04/28/2021
Rec V Date: 04/28/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: syncopal episode

Other Meds:

Current Illness:

ID: 1268031
Sex: M
Age: 48
State:

Vax Date: 04/25/2021
Onset Date: 04/28/2021
Rec V Date: 04/28/2021
Hospital:

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

Lab Data:

Allergies: azithromycin

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

Symptoms: generalized rash Dx: Delayed Hypersensitivity Reaction Clobetasol 0.05% cream, Benadryl 50 mg PO q6h

Other Meds: Descovy, Tivicay

Current Illness:

ID: 1268032
Sex: F
Age: 66
State: CO

Vax Date: 03/21/2021
Onset Date: 03/21/2021
Rec V Date: 04/28/2021
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: Fever, severe chills, severe aching, head pain, ear pain, vomiting, dizzy For about 12 hours then continued ear and head pain and dizzy for another 12 hours Arm very sore for about 7-10 days

Other Meds:

Current Illness:

ID: 1268033
Sex: F
Age: 31
State: IL

Vax Date: 04/27/2021
Onset Date: 04/27/2021
Rec V Date: 04/28/2021
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: Unknown

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

Symptoms: Patient experienced lightheadedness post vaccination, recovered and released

Other Meds: Unknown

Current Illness: Unknown

ID: 1268034
Sex: F
Age: 26
State: MA

Vax Date: 04/05/2021
Onset Date: 04/07/2021
Rec V Date: 04/28/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Ever since I got the COVID vaccine I have been having blurry wavy vision that makes my head hurt. My first dose was 4/5 and second was recently on 4/26. It has happened 4 times since the beginning of the month. It starts off with waves and blurs and then gives me a massive migraine. I cant see straight when this happens and get bad brain fog. I have to chug water and take 800+ mg tablets of migraine relief to make it better, but it takes a good 2 hours to feel any better at all. I have NEVER had this issue before or have a history of migraines.

Other Meds: Birth Control

Current Illness: none

ID: 1268035
Sex: F
Age: 37
State:

Vax Date: 04/28/2021
Onset Date: 04/28/2021
Rec V Date: 04/28/2021
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: Reglan (akathesia) Nuts (GI) Latex (rash)

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

Symptoms: Patient recevied Pfizer vaccine and shortly after noticed her throat was scratchy and felt tight. She was given 50 mg of benadryl PO with no relief. Was administered 0.3 mg of epineiphrine IM and called 911. EMS shortly arrived and transferred patient to nearest ED. Symptoms prior to leaving in stretcher were: diaphoresis, chest pressure, throat closing sensation, scratchy throat, "I don't feel right".

Other Meds: Lisinopril 10 mg daily

Current Illness: UTI

ID: 1268036
Sex: F
Age: 51
State: GA

Vax Date: 04/26/2021
Onset Date: 04/27/2021
Rec V Date: 04/28/2021
Hospital:

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

Lab Data:

Allergies: Ibuprofen

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Hives/chills

Other Meds: Singular Flonase Azelastine Zyrtec Oeste oven patch Multi vitamin

Current Illness: No

ID: 1268037
Sex: F
Age: 16
State: LA

Vax Date: 03/27/2021
Onset Date: 04/28/2021
Rec V Date: 04/28/2021
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 received the 1st Moderna vaccine. She is only 16 years old. This was discovered when patient presented for the 2nd Moderna vaccine.

Other Meds:

Current Illness:

Date Died: 03/17/2021

ID: 1268038
Sex: M
Age: 81
State: OR

Vax Date: 03/16/2021
Onset Date: 03/17/2021
Rec V Date: 04/28/2021
Hospital:

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

Lab Data:

Allergies: No known food or drug allergies

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

Symptoms: Fiance reports 24 hrs after receiving the COVID-19 J&J vaccine pt passed away

Other Meds: Aspirin, atorvastatin, donepezil, ezetimibe, furosemide, levothyroxine, lisinopril, metoprolol, sildenafil, warfarin

Current Illness: Hypothyroidism, iron deficiency anemia, BPH, chronic systolic heart failure, hx of ischemic cardiomyopathy, hypercholesterolemia, hypertension, memory impairment, ED, s/p CABGx4, poor compliance with medication, prostate cancer

Date Died: 04/24/2021

ID: 1268039
Sex: M
Age: 73
State:

Vax Date: 04/23/2021
Onset Date: 04/24/2021
Rec V Date: 04/28/2021
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: This 73 year old white male received the 2nd Covid shot on 4/23 and died on 04/24/21. Please refer to the other details submitted within this report and contact the person who submitted this report via email for additional follow up details and investigation.

Other Meds:

Current Illness:

ID: 1268040
Sex: F
Age: 34
State: CO

Vax Date: 04/17/2021
Onset Date: 04/23/2021
Rec V Date: 04/28/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Unevaluable event

Symptoms: round one was just extreme exhaustion for about 2 weeks which lifted the day before round 2 shot; round two was given on April 17. By April 23, I woke up with hives all around my mouth. Thinking it was contact dermititis, I evaluated anything and everything, hydrocortisone, etc. Nothing worked and it became painful and started to spread. My skin is swollen and cracked. Went to see the dr who confirmed side effect from vaccine

Other Meds: Adderall

Current Illness: N/A

ID: 1268041
Sex: F
Age: 52
State: OR

Vax Date: 04/07/2021
Onset Date: 04/08/2021
Rec V Date: 04/28/2021
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: Tetracycline

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

Symptoms: 24 hours after the vaccine, began getting stomachaches and nausea for the next 5 days. The following Wednesday, my blood pressure started to spike to 140 and 150 over 90+. Contacted primary after that. I was put on Prednisone for 5 days in case of an infection. Primary ran blood tests on me and: Blood work from 4/16/2021 Note to Patient: your MCV continues to be high but this is improving, continue wiht B12 supplements Note to Patient: essentially normal, we will keep a watch on your liver function but this can also be elevated with nausea and vomiting Blood work from 3/26/2021 Note to Patient: your labs show possible vitamin Deficiency. We have order additional blood work to be done to see if your B12 or folate are low, this can be seen with frequent use of omeprazole. Once we have the results of your additional labs we can decide on medication changes.

Other Meds: Famotidine 40 Mg Tablet Montelukast 10 Mg Tablet Estradiol 0.0375 Mg/24 Hr Semiweekly Transdermal Patch Gralise 600 Mg Tablet,extended Release Omeprazole 20 Mg Capsule,delayed Release Medroxyprogesterone 2.5 Mg Tablet Carvedilol 12.5 Mg Tab

Current Illness: Sinuses acting up

ID: 1268042
Sex: F
Age: 64
State: WI

Vax Date: 04/01/2021
Onset Date: 04/02/2021
Rec V Date: 04/28/2021
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: many antibiotics both IV and oral

Symptom List: Injection site pain, Pain

Symptoms: Woke up out of a sound sleep with severe headache ,nausea and vomiting. Location of headache:Frontal, top of head, behind eyes. Severe pain. Different than her usual migraines. Had a brain bleed in 2013 so is familiar with how that felt and this felt very different per patient. Tylenol was taken and did help but not much . Constant thing. Had severe headache for 1 week. Dissipated and continues with it today. When had headache she was in bed . Only up to do her husbands medication. Was told to contact her PCP on 04/13/2021. Never had pain like this prior. She took BP 04/14/21 and was 119/65. Waiting for MD call back.

Other Meds: lobatilol,ditropan, tylenol,ativan,phenergan PRN

Current Illness: nothing

ID: 1268043
Sex: F
Age: 43
State:

Vax Date: 04/26/2021
Onset Date: 04/26/2021
Rec V Date: 04/28/2021
Hospital:

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

Lab Data:

Allergies: Second dose of COVID-19 Pfizer vaccinationOn 4/26/21 Swollen face, swollen throat around 9:15 PM that followed with high-grade fevers , body aches, chills around 9-12 hours after receiving vaccine at 3:15 . First dose of COVID-19 vaccination Pfizer 4/04/21- low grade fever 12 hours after vaccination

Symptom List: Injection site pain, Menorrhagia

Symptoms: Still swollen, taking Benadryl, Tylenol. Fatigued and achy but feeling better 48 hours after initial vaccination

Other Meds: Xanax, Adderall and trazodone

Current Illness: Between vaccines I had an extremely heavy Menstrual cycle

Date Died: 04/21/2021

ID: 1268044
Sex: M
Age: 68
State: TN

Vax Date: 04/21/2021
Onset Date: 04/21/2021
Rec V Date: 04/28/2021
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: Hydralazine and Betadine

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

Symptoms: Clinic was informed that patient patient went unresponsive at home at 2pm on 4/21/21 and patient expired.

Other Meds:

Current Illness:

ID: 1268045
Sex: F
Age: 60
State: CA

Vax Date: 04/28/2021
Onset Date: 04/28/2021
Rec V Date: 04/28/2021
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: Unknown

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient reported feeling "quievering" on right side of face a few minutes after receiving 2nd dose of Moderna. Patient said symptoms lasted about 10 minutes then went away. She was monitored for a full 30 minutes before leaving with her companion without further incident.

Other Meds: Unknown

Current Illness: Unknown

ID: 1268046
Sex: F
Age:
State: FL

Vax Date: 04/16/2021
Onset Date: 04/24/2021
Rec V Date: 04/28/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Abd. pain, nausea started last pm. No vomiting.

Other Meds: Elavil 50 mg Levothyroxine 100 mg

Current Illness:

ID: 1268047
Sex: M
Age: 64
State: IA

Vax Date: 04/26/2021
Onset Date: 04/26/2021
Rec V Date: 04/28/2021
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: bacitracin, codeine, polymyxin B

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

Symptoms: Received 2nd dose of Moderna on 04/16/2021 and was seen in the clinic on 04/26/2021 for a rash that developed on 04/24/2021. Rash was noted as small erythematous papules on both arms, between fingers and legs, and the right side of the neck. Rash was severely itchy. Was diagnosed with scabies and given Permethin cream.

Other Meds: Trulance, Vitamin D3, Culturelle, carafate, zyrtez, MVI, APAP, Benadryl

Current Illness: None

ID: 1268048
Sex: M
Age: 65
State: NY

Vax Date: 03/31/2021
Onset Date: 04/23/2021
Rec V Date: 04/28/2021
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: vancomycin

Symptom List: Nausea

Symptoms: Pt received his 2nd covid 19 vaccination on 3/31. Presents on 4/26 with 3 days of nausea, vomiting, diarrhea, fever, chills. admitted with severe sepsis and gram negative bacteremia of unknown etiology. being treated with ivf , zosyn and supportive care

Other Meds: asa, Plavix, gabapentin, imdur, lantus, Lisinopril, metoprolol, protonix, crestor, ambien prn

Current Illness: None

Date Died: 04/26/2021

ID: 1268049
Sex: M
Age: 86
State:

Vax Date: 02/26/2021
Onset Date: 03/26/2021
Rec V Date: 04/28/2021
Hospital: Y

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: Fall Death

Other Meds:

Current Illness:

ID: 1268050
Sex: F
Age: 36
State: IL

Vax Date: 04/27/2021
Onset Date: 04/27/2021
Rec V Date: 04/28/2021
Hospital:

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

Lab Data:

Allergies: Unknown

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

Symptoms: Patient experienced anxiety post vaccination, recovered and released

Other Meds: Unknown

Current Illness: Unknown

ID: 1268051
Sex: M
Age: 46
State: MI

Vax Date: 04/22/2021
Onset Date: 04/22/2021
Rec V Date: 04/28/2021
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: Sulfa

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

Symptoms: I received my second Pfizer COVID vaccine shot at 11:00 am. The first 12 hours after everything was normal and fine. I ate dinner and got ready for bed. But then, starting 12 hours after my shot, starting at 11:00 pm, I began to have severe chills and total body shakes. I was curled up into a ball under blanket, both freezing cold and profusely sweating. My breathing was very fast and I couldn't slow it down. My stomach was very upset and I was unable to eat anything. At 3:30 am, I got a severe Migraine which lasted until 6:00 am. I continued to feel very ill the whole rest of the day. Finally, around 9:00 am some 34 hours after syptoms began, they left me.

Other Meds: Buprenorphine 8 mg, Xanax 1 mg, Prazosin 4 mg, Remeron 30 mg, Pantoprazole 40 mg, Lisinopril-HCTZ 20-25 mg, Clonidine 0.1 mg 2 per day, Atenolol 50 mg 2 per day, Testosterone shot every 2 weeks (last dose April 19, 2021).

Current Illness: Abscess with septicemia diagnosed March 16. Treated with: 1) Clindamycin 450 mg every 6 hours from March 16 to March 26. 2) Moxifloxacin 400 mg 1 per day from March 16 to March 29. 3) Rocephin shot March 16 and again on March 18.

ID: 1268052
Sex: M
Age: 41
State: OH

Vax Date: 04/23/2021
Onset Date: 04/24/2021
Rec V Date: 04/28/2021
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 experienced symptoms consistent with vaso-vagal syncope approximately 5 minutes after injection: palor, diaphoresis, dizziness. Patient recovered within 30 minutes with rest and water.

Other Meds:

Current Illness:

ID: 1268053
Sex: F
Age: 64
State: IN

Vax Date: 04/26/2021
Onset Date: 04/26/2021
Rec V Date: 04/28/2021
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: Metformin/Glucophage, Naproxen

Symptom List: Erythema, Pruritus

Symptoms: Painful Diarrhea

Other Meds: Irbesartan HCTZ, Calcium +D, Azathioprine, Atorvastatin, Cetrizine, Pantoprazole Sod, Melsalamine, Labetalol, Diltiazim, Aspirin, Acetaminophen +Codine, Fluticasone Propionate, Valsartan/Hyrochlorothiazide, Multi Vitamin, Eye Vitamin

Current Illness: None

ID: 1268054
Sex: F
Age: 46
State: FL

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/28/2021
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: Sulfa drugs, tetracycline, tramadol

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

Symptoms: Fever up to 103 F, intense fatigue, dizziness, vivid dreams, joint pain, body aches, bone pain (especially in the long bones of the leg), waves of nausea, diarrhea, loss of appetite, and severe headache/pain when I moved my eyes. This lasted for 2 weeks.

Other Meds: Fioricet, Xanax, valerian root, probiotics

Current Illness: N/A

ID: 1268055
Sex: F
Age: 54
State: KY

Vax Date: 03/10/2021
Onset Date: 03/24/2021
Rec V Date: 04/28/2021
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: nka

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

Symptoms: I began having a burning and tingling sensation around my ribcage on my right side. I attributed it to possible swollen lymph nodes as the result of the vaccine. I had tenderness there for about a week. It started getting better and on my right side in my waist area, I had a sensation on my skin with no visible rash or anything, but it felt like my skin was burning and tingling. I thought maybe I was getting shingles, but never broke out. The same pain then went to my inside upper arms, both of them and then it spread into my armpits. and down both my sides. At times, the sensation was across the top of my chest. There is no rash, there is no visible inflammation and my skin doesn't feel warm to the touch although it is burning and tingling to me. It has been going on now for weeks. I have taken naproxen to see if it was some kind of inflammation as an immune response and it has helped on some days but not on others. I feel stupid to make a Dr appointment because there is nothing to see, but the painful sensation is real. It feels like a really bad sunburn.

Other Meds: none

Current Illness: no

ID: 1268056
Sex: F
Age: 17
State: NJ

Vax Date: 04/28/2021
Onset Date: 04/28/2021
Rec V Date: 04/28/2021
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: n/a

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient fainted after vaccine administration.

Other Meds: n/a

Current Illness: n/a

ID: 1268057
Sex: M
Age: 39
State: WA

Vax Date: 04/27/2021
Onset Date: 04/27/2021
Rec V Date: 04/28/2021
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: Shellfish

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

Symptoms: Tinnitus, joint pain, muscle pain, migraines , left arm expressly sore

Other Meds: Trazadone, vyvanse, buspirone, amlodipine, escitalopram, telmisartan

Current Illness:

ID: 1268058
Sex: M
Age: 56
State: GA

Vax Date: 04/27/2021
Onset Date: 04/27/2021
Rec V Date: 04/28/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

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

Symptoms: Approximately 4 hours after receiving the first dose of covid vaccine, patient reported muscle pain in his thighs and a low grade fever was noted 100.8F. Patient was brought down to infirmary for close observation and treatment of symptoms.

Other Meds: none

Current Illness: none

ID: 1268059
Sex: F
Age: 48
State: WA

Vax Date: 04/12/2021
Onset Date: 04/12/2021
Rec V Date: 04/28/2021
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 antibiotics, gluten intolerance

Symptom List: Pain in extremity

Symptoms: Increase in volume of existing tinnitus. This started soon after the shot and has continued for 16 days and counting.

Other Meds: Melatonin

Current Illness:

ID: 1268060
Sex: F
Age: 75
State: FL

Vax Date: 03/27/2021
Onset Date: 03/27/2021
Rec V Date: 04/28/2021
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: 4/25-headaches, nausea, vertigo, bouts of memory loss. Nausea has resolved. Patient planning on making appointment with physician sometime this week. Advised for patient to stay hydrated.

Other Meds: Synthroid

Current Illness: low b/p, hypothyroidism

ID: 1268061
Sex: M
Age: 31
State: VA

Vax Date: 04/26/2021
Onset Date: 04/26/2021
Rec V Date: 04/28/2021
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: Fatigue directly after the shot, developing into chills at 11pm that evening. Injection site soreness. Woke up at 7am (8 hours later) with a low-grade fever (~99-100F), dizziness, nausea, and a terrible headache. Took an Aleve to help. Symptoms mostly went away by 11pm that evening (16 hours later, 48 hours from injection time). All symptoms besides minor muscle aches were gone by the follow morning.

Other Meds: Roman testosterone support multi-vitamin, containing vitamin D3, zinc, magnesium, ashwagandha, maca, and copper

Current Illness:

ID: 1268062
Sex: M
Age: 47
State: NY

Vax Date: 03/19/2021
Onset Date: 04/01/2021
Rec V Date: 04/28/2021
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: Extreme fatigue, confusion/"brain fog," and chest tightness which have mostly subsided. Tinnitus: Loud ringing in ears has not stopped.

Other Meds: None

Current Illness: None

ID: 1268063
Sex: F
Age: 30
State: IL

Vax Date: 02/11/2021
Onset Date: 03/06/2021
Rec V Date: 04/28/2021
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: n/a

Symptom List: Vomiting

Symptoms: My period is late and changed after my 1st dosage of Moderna. It seems like I am now irregular. I am waiting for my period to come on now but no signs as of yet. When I did have a period in the beginning of April, it appeared as if I was spotting for days - 1 week and no cramps.

Other Meds: n/a

Current Illness: n/a

Date Died: 04/25/2021

ID: 1268064
Sex: F
Age: 76
State:

Vax Date: 03/19/2021
Onset Date: 04/25/2021
Rec V Date: 04/28/2021
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: This 76 year old female received the 2nd Covid shot on 3/19/21 and died on 4/25/21. Please refer to the other details submitted within this report and contact the person who submitted this report via email for additional follow up details and investigation.

Other Meds:

Current Illness:

ID: 1268065
Sex: F
Age: 16
State: WA

Vax Date: 04/28/2021
Onset Date: 04/28/2021
Rec V Date: 04/28/2021
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: unknown

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

Symptoms: 16 y/o female c/o upper left quadrant, abdominal px. Pt's mom states that she has a history of anxiety and abdominal px on lower right quadrant, from a previous cist. Px does not radiate and changes with inspiration. Vitals - BP 108/70, HR 66, RR 20. Mom wants pt seen at the hospital. Pt transported to hospital via medical transportation.

Other Meds: unknown

Current Illness:

ID: 1268066
Sex: F
Age: 41
State: SD

Vax Date: 04/26/2021
Onset Date: 04/27/2021
Rec V Date: 04/28/2021
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:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: R11.14 Bilious vomiting IV fluids were given

Other Meds:

Current Illness:

ID: 1268067
Sex: F
Age: 60
State: TX

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 04/28/2021
Hospital:

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

Lab Data:

Allergies: iodine

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

Symptoms: Extremely confused and agitated. Vision was reduced significantly. Not able to understand or comprehend simple tasks. This went on for 3 days.

Other Meds: prenatal vitamin, folic acid, Levetiracetam (750mg)

Current Illness:

ID: 1268068
Sex: M
Age: 28
State: NY

Vax Date: 04/28/2021
Onset Date: 04/28/2021
Rec V Date: 04/28/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Dizziness immediately after vaccination, resolved enough to report to the observation room, became syncopal right after arriving in obsevation. Had brief loss of consciousness, recovered fully in treatment area

Other Meds: unknown

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm