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: 1268384
Sex: F
Age: 56
State: RI

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: LA

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Systemic: Allergic: Itch (specify: facial area, extremeties)-Mild, Systemic: Itching/tingling in facial area. The same happened during first dose.-Mild, Additional Details: Post vaccine, patient experienced itching in facial area/tongue. No difficulty breathing. Diphenhydramine 25 mg x1 given with patient's consent. She was observed for approximately 45 minutes post-vaccine, and was walked to her car after. She feels comfortable to drive home, as she lives 10 minutes away and was feeling better. She was counseled and given instructions for appropriate measures (911) if necessary.

Other Meds:

Current Illness:

ID: 1268385
Sex: M
Age: 34
State: MI

Vax Date: 04/22/2021
Onset Date: 04/25/2021
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: Penicillins

Symptom List: Anxiety, Dyspnoea

Symptoms: 34 YO male patient with no past medical history presents with sudden stroke-like symptoms including right sided arm and leg weakness, numbness, slurred speech and facial droop. Symptoms lasted for roughly 45 minutes. Suspected CVA. MRI done in hospital was found to be consistent with microinfarcts in the left hemisphere of the brain, mostly along the cortical ribbon with a single lesion in the left parasagittal/lateral pons. Full neuro and cardio workup is currently being done. ECHO w/ bubble study was weakly positive and plans are for TEE today. Otherwise, no exact cause identified and few risk factors. Found out that the patent was taking no medications prior and had no past medical history and was otherwise a 34 YO healthy male, who received their first dose of Moderna COVID-19 vaccine on 4/22. 3 days later the patient had this event. The timing of everything makes me report this as the potential is there that this is a vaccine ADE and plausible reason for this thrombotic event.

Other Meds: Patient has no PMH and on no medications at home according to EMR

Current Illness: none

ID: 1268386
Sex: F
Age: 64
State: MN

Vax Date: 04/27/2021
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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Na

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

Symptoms: Chills, fever, headache, pulse over 100, aches, fatigue.

Other Meds: Chorlathadone Potassium Zinc Cough syrup

Current Illness: Covid 19, diagnosed March 28, 2021

ID: 1268387
Sex: F
Age: 79
State: SC

Vax Date: 03/30/2021
Onset Date: 04/23/2021
Rec V Date: 04/28/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Bilateral dural sinus and jugular vein thromboses. Has viridans streptococcal bacteremia. Thrombosis may be infected. Patient also tested positive for SARS-CoV2 4/23/2021. Being treated with antibiotics, Eliquis. Not thrombocytopenic. HIT studies pending.

Other Meds:

Current Illness:

ID: 1268388
Sex: M
Age: 82
State: MA

Vax Date: 03/02/2021
Onset Date: 04/06/2021
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: in april 2021 i suddenly came down with pain in legs and arms went to urgent care the symptons are that of polymyaliga and now on prednisone

Other Meds: metforman for diabetes

Current Illness: none

ID: 1268389
Sex: M
Age: 67
State: WI

Vax Date: 04/27/2021
Onset Date: 04/27/2021
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:

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

Symptoms: Client received Janssen vaccine after already completing 2 dose Moderna series

Other Meds:

Current Illness:

ID: 1268390
Sex: F
Age: 20
State:

Vax Date: 04/15/2021
Onset Date: 04/20/2021
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:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Left arm rash within minutes of receiving vaccine. Then resolved. Headache, dizziness, difficulty concentrating, difficulty focusing vision, right ear pain-intermittent. Shortness of breath-improved with albuterol inhaler. History of asthma.

Other Meds:

Current Illness:

ID: 1268391
Sex: M
Age: 57
State: TN

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

Lab Data:

Allergies: none

Symptom List: Pharyngeal swelling

Symptoms: Blood pressure dropped from around 135/80 to 116/66 for several hours Tuesday afternoon. Today it is back to where it has been. Last night I woke at 2am with a 101.8 fever. (I'm normally 107.8) Today soreness at site of injection, Muscle aches, Slight fever, and shortness of breath.

Other Meds: protonix

Current Illness: Elavated Blood Perssure

ID: 1268392
Sex: M
Age: 44
State: KS

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: N/A

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Itchy rash at injection site

Other Meds: Sertraline, omeriprizole, lisinipril, fish oil, maylox

Current Illness: Had a common cold a few weeks earlier

ID: 1268393
Sex: M
Age: 24
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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Mild

Other Meds:

Current Illness:

ID: 1268394
Sex: F
Age: 73
State: NC

Vax Date: 03/17/2021
Onset Date: 04/20/2021
Rec V Date: 04/28/2021
Hospital: Y

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

Lab Data:

Allergies: demerol avacado

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

Symptoms: Bilateral PE, currently hospitalized, day 5 of inpatient status

Other Meds: bumetanide gabapentin lantus humalog losartan pantoprazole pravastatin venlafaxine

Current Illness:

ID: 1268395
Sex: F
Age: 54
State: PA

Vax Date: 04/09/2021
Onset Date: 04/13/2021
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: SULFA, FLUOROQUINOLONES

Symptom List: Rash, Urticaria

Symptoms: RED SPOTS ON THE LEGS BELOW THE KNEE

Other Meds:

Current Illness:

ID: 1268396
Sex: F
Age: 80
State: TX

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: hydralazine, penicillin

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

Symptoms: Patient received second dose of pfizer at facility unit on 4/27/2021. It was found that day a card in the patient's bag that she has received the moderna vaccine also from her PCP. Her 1st dose of Moderna was 3/17/1 1st dose pfizer 4/6/21, 2nd dose moderna 3/17/21 and 2nd dose pfizer 4/27/21. She is not exhibiting any adverse reactions at this time.

Other Meds: atorvastatin, bupropion, coreg, plavic, levothyroxine, folic acid, meclizone, singular,clonazepam,nitroglycerin, namzaric

Current Illness: n/a

ID: 1268398
Sex: F
Age: 37
State:

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: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Approximately 10 minutes after receiving Pfizer COVID vaccine pt c/o itching of face and arm at injection site. Pt was medicated with Benadryl 50 mg po and taken to ED stat. Pt was registered and report given to ED triage nurse, Note: Patient was in vaccine clinic getting 1st pfizer vaccine. Patient states that 10 minutes after vaccine, face and injection site began itching. No facial/tongue/lip swelling. No hives. Denies shortness of breath. Speaking in clear complete sentences. Managing secretions. AxOx4. Pt had first dose of Covid vaccine at 1210 and developed itching at injection site and face. Pt given benadryl by staff at vaccine clinic and itching resolved. No throat or tongue swelling.

Other Meds:

Current Illness:

ID: 1268400
Sex: F
Age: 35
State: NJ

Vax Date: 04/21/2021
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: Methylisothiazolinone 2-Hydroxy-4-Methoxy-Benzophenone Glutaral Methylchloroisothiazinoline

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

Symptoms: Itchy rash about 3 inches in diameter at injection site and swelling, only appeared one week post shot.

Other Meds: None

Current Illness: None

ID: 1268401
Sex: M
Age: 17
State: TN

Vax Date: 04/24/2021
Onset Date: 04/24/2021
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:

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

Symptoms: Error: Incorrect Reconstitution

Other Meds:

Current Illness:

ID: 1268402
Sex: F
Age: 21
State: UT

Vax Date: 04/22/2021
Onset Date: 04/22/2021
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: none

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

Symptoms: The vaccine was given a week too soon. Their first dose was 4-1-2021 so their second dose should have been given later.

Other Meds: unknown

Current Illness: none

ID: 1268403
Sex: F
Age: 24
State:

Vax Date: 04/22/2021
Onset Date: 04/22/2021
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: NONE

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Client was very petite and approximately 5' 1" tall. Client stated that immediately after receiving vaccine (Covid--19 Pfizer) she had a strange taste in her mouth. When she got to the observation tent, client was feeling sick to stomach. Nurse escorted her to bathroom where she started vomiting. Client given water.

Other Meds: NONE

Current Illness: NONE

ID: 1268404
Sex: F
Age: 38
State: MO

Vax Date: 04/27/2021
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: Headache Swollen, tender lymph node under left armpit

Other Meds:

Current Illness:

ID: 1268406
Sex: F
Age: 46
State: OH

Vax Date: 04/28/2021
Onset Date: 04/28/2021
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: Sumac latex tetnus

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

Symptoms: Left upper back shooting pain and swelling.

Other Meds: Ashwagandha requip combivent inhaler omniprozole

Current Illness: None

ID: 1268407
Sex: F
Age: 5
State:

Vax Date: 09/09/2020
Onset Date: 12/10/2020
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: no

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

Symptoms: Eyes fixed and does not react, it happens frequently.

Other Meds: no

Current Illness: Swelling, redness, fever, malaise, irritability.

ID: 1268408
Sex: F
Age: 48
State: TN

Vax Date: 04/24/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: Error: Incorrect Reconstitution

Other Meds:

Current Illness:

ID: 1268409
Sex: F
Age: 44
State: IN

Vax Date: 04/26/2021
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Penicillin

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

Symptoms: Fever of 101, chills, body aches, tired, arm pain. Fever last for about 10 hours, felt better by early morning on April 28th.

Other Meds: Birth control pills

Current Illness: None

ID: 1268410
Sex: M
Age: 51
State: MO

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

Symptom List: Injection site pain, Pain

Symptoms: Error: Second Vaccine given on 21st Day rather than on 28th Day. No adverse event

Other Meds: Unknown

Current Illness: NKI

ID: 1268411
Sex: M
Age: 50
State: CA

Vax Date: 04/23/2021
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: Unknown

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient received 0.3ml of Moderna vaccine rather than 0.5ml. Kept patient in observation for over 30 minutes. Spoke with patient about error however, does not recommend revaccinating since patient got over half the dose. No signs or symptoms observed.

Other Meds: Unknown

Current Illness: Unknown

ID: 1268412
Sex: F
Age: 25
State: CO

Vax Date: 04/08/2021
Onset Date: 04/08/2021
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: None reported

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

Symptoms: patient presented to urgent care reporting intermittent hives, rash, and itching on lower back and arms since vaccination. Using hydrocortisone cream and fexofenadine that temporarily improve symptoms. Patient denies respiratory and neurologic symptoms. Vital signs all within normal ranges. Patient advised to use oral diphenhydramine and manage at home.

Other Meds: Loestrin, spironolactone

Current Illness: None reported

ID: 1268414
Sex: F
Age: 25
State: VA

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

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Nausea, vomiting, lethargy, body aches

Other Meds: OrthoEvra birth control patch

Current Illness:

ID: 1268415
Sex: M
Age: 35
State: DC

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

Lab Data:

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient arrived to check in for appointment with his wife. Patient does not speak English so his wife translated and shared that the patient wasn't feeling well due to allergies to the pollen and wasn't sure if he could take the shot. I checked the patient's temperature and it was 98.7F. I asked the patient what his symptoms were. Patient reported mucus draining causing irritation to the back of his throat. I recommended OTC nasal spray for the post-nasal drip. I asked if patient had any history of allergic reaction to any vaccine, fainting, or history of seizures and patient denied. I stated patient was in the clear to take the shot if he was comfortable. Patient said okay. Pharmacist administered the shot and patient and his wife were seating in our waiting area to wait 20 min. After 10 min, patient's wife screams that her husband is not feeling well. Pharmacist rushes to the patient and sees his body shaking in the seat and asks a customer to lay him on the ground. Customer calls 911. Seizing lasted less than a minute. I approach the scene and immediately lay the patient to his side. Patient is conscious and breathing. Patient denied chest paint, headache, or tingling sensation in hands and feet. Patient vitals were checked. Paramedics arrive and did a full check up and everything was within normal limits. Patient openly reported he had not eaten all day and has history of fainting after shot due to anxiety of needles. Paramedics encouraged patient to seek medical attention, but patient denied. Patient was given water and a banana and went home.

Other Meds: None

Current Illness: None

ID: 1268416
Sex: M
Age: 25
State: FL

Vax Date: 04/24/2021
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:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Error: Incorrect Reconstitution

Other Meds:

Current Illness:

ID: 1268417
Sex: F
Age: 55
State: NJ

Vax Date: 04/12/2021
Onset Date: 04/16/2021
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: NKDA or food allergies

Symptom List: Nausea

Symptoms: 4 to 5 days after receiving vaccine, she noticed rash under left arm extending to deltoid area to elbow, itchy red. Used cortisone cream to help with itch. next morning she noticed her left lip was swollen, numbness on left upper lip and swollen face. Only lasted for around 24 hours. Notified Dr and hasn't heard much from them. Was advised to speak with Dr in regards to it and getting approval for 2nd dose. She feels better today and never seeked care for this.

Other Meds: synthroid, calcium

Current Illness: no recent illness. Did have Covid-19 in October of 2020

ID: 1268418
Sex: F
Age: 92
State: IL

Vax Date: 03/24/2021
Onset Date: 03/24/2021
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: Injection site pain

Symptoms: Patient received a 3rd COVID vaccine in error on 3/24/21. Patient received this 3rd vaccine at an extended-care facility. No adverse events have been noted.

Other Meds:

Current Illness:

ID: 1268419
Sex: F
Age: 58
State: WI

Vax Date: 04/15/2021
Onset Date: 04/18/2021
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

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

Symptoms: Large red patch on arm at injection site. About 3x6 in size. Flat not raised. Warm to touch. Mild itch. Resolved after 3 days.

Other Meds: Thyroid NP 120 GR; LDN ( low dose naltrexone) 4.5 mg for Hashimoto's Disease

Current Illness: None

ID: 1268420
Sex: F
Age: 42
State: IN

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: RA

Lab Data:

Allergies: yes

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

Symptoms: Patient reported lightheadedness, minor throat swelling, "foggy" feeling. Reported some dizziness. Advised patient to lay down and monitored them. Offered snacks and drinks. Patient reported feeling better after an hour and left on own will with no symptoms.

Other Meds: unknown

Current Illness: unknown

ID: 1268421
Sex: F
Age: 53
State: FL

Vax Date: 04/23/2021
Onset Date: 04/23/2021
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: None

Symptom List: Tremor

Symptoms: Fatigue, fever, nausea, headache. Fatigue started about 4 hours after shot. Got out of bed the next morning with a 100.4 fever and nausea. Headache may have been due to caffeine withdrawal (no coffee due to nausea). Symptoms lasted the entire day. Woke up feeling fine on the 25th (headache went away after a cup of coffee!!).

Other Meds: Fish oil, glucosamine/chondroitin, black seed oil, milk thistle

Current Illness: None

ID: 1268422
Sex: F
Age: 70
State: CA

Vax Date: 02/13/2021
Onset Date: 02/13/2021
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: PENICILLIN, SULFA, ERYTHROMYACIN, VANCOMYACIN, GENTAMYACIN, STRAWBERRIES

Symptom List: Erythema, Pruritus

Symptoms: AFTER ABOUT 15, 20 MINUTES FROM RECEIVING THE VACCINE, i STARTED HAVING A HEAVY FEELING IN MY CHEST, THE HEART AREA. AT THE SAME TIME I WAS FLUSHED, MY FACE BECAME QUITE RED AND i WASN'T FEELING GOOD. i KNEW SOMETHING WASN'T RIGHT AND BECAUSE OF MY EART PROBLEMS, i ASKED THE NURSE TO TAKE MY BP. SHE DID. iT WAS ELEVATED, BUT i DON'T REMEMBER THE VALUES ANYMORE. MY PULSE WAS 40. the NURSE WAS WORRIED AND TOOK THE MEASURES AGAIN, NO CHANGE. tHEY KEPT US WAITING FOR 40 MINUTES. IN TIME I STARTED FEEING BETTER AND i WAS ALLOWED TO GO HOME. mY HUSBAND WAS WITH ME, SO i DIDN'T HAVE TO DRIVE THE 35 MILES HOME, WHICH WAS GOOD. at HOME i FELT ok, BUT THE NEXT DAY MY RIGHT ARM WAS VERY SORE.THAT LASTED A COUPLE OF DAYS. WHEN WE WENT BACK TO THE I TAKE THE SECOND SHOT? WHAT ABOUT ANY BOOSTER SHOTS? CAN I TAKE THAT? CAN I SWITCH TO ANOTHER VACCINE, MODERNA? I'M NOT COMFORTABLE WITH THE J&J VACCINE I HAVE TRIED TO FIND ANSWERS TO MY QUESTIONS ONLINE, BUT APPARENTLY MY REACTION TO PFIZER IS NOT A COMMON ONE AS I COULDN'T FIND ANY INFORMATION RELATED TO THAT.

Other Meds: VITAMINS A, C, E, Q10, PROPRANOL (5G/DAY) i TOOK THIS AT 7 AM THE DAY OF VACCINATION

Current Illness: NONE

ID: 1268423
Sex: F
Age: 25
State: TN

Vax Date: 04/24/2021
Onset Date: 04/24/2021
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:

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

Symptoms: Error: Incorrect Reconstitution

Other Meds:

Current Illness:

Date Died: 04/26/2021

ID: 1268424
Sex: F
Age: 47
State: WI

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: 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: The decedent was found in her bedroom by her daughter. Medical history only includes previous blood clots. Decedent has been complaining of coughing and shortness of breath the past few days. There is no history of drug use. The decedent had a foam cone when found.

Other Meds:

Current Illness:

ID: 1268427
Sex: F
Age: 48
State: PA

Vax Date: 04/13/2021
Onset Date: 04/14/2021
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: none

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient reported experiencing Left side face/arm/hand numbness on 4/14/21 the day after receiving Moderna Covid Vaccine #2. She presented to a local hospital ER but work up did not find anything wrong. She stated on 4/28/21 that she still experiences numbness and it crosses to right side.

Other Meds: unknown

Current Illness: none

ID: 1268428
Sex: F
Age: 53
State: TX

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: SYR
Vax Site: LA

Lab Data:

Allergies: ALLERGIES: SULFA (SULFONAMIDES) | TETRACYCLINE ANALOGUES

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

Symptoms: Pt did not voice she received Vaccine (Janssen) in county jail (04/08/21) prior to coming to Prison. pt was asked if she had a vaciine within the past 14 days and she denied. Pt received Mondera vaccine @ 1222 and a few minutes after voiced tightness in her throat @1228, at this time the pt inmate voiced she received the Janssen injction. Pt. was administered epinephrine 0.3mg IM as ordered by unit MD, approx. 30 seconds after injection pt. voiced issue had resolved - pt was sent to local ER via 911 call/ ambulance.

Other Meds: LITHIUM CARBONATE 300MG CAP Rx ID: 30232609 1 CAPS ORAL TWICE DAILY FOR 30 DAYS. NEW SAF P INTAKE MEDICATION. AMLODIPINE 5MG TABLET Rx ID: 30254364 KOP 1 TABS ORAL EVERY MORNING FOR 30 DAYS. FLOVENT HFA 110MCG INH 120PF Rx ID: 30232615 KOP

Current Illness: Asthma HTN Seizures Hep -C

ID: 1268429
Sex: F
Age: 17
State:

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

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

Symptoms: Pt received Pfizer COVID vaccine, was walking with father next to her, felt faint, and father eased her to the floor, no head or body injury. Positive pallor and diaphoresis noted, legs elevated and pt color improved with pt now alert and oriented. Assisted to upright position, onto stretcher, given 1 small bottle water po, BP: 108/68, HR: 87, RR: 16 nonlabored, SaO2: 100% on RA. Pt currently has menses. 1023: drank 1 apple juice, feeling better. 1038: BP: 94/53, HR: 64, RR: 16 nonlabored, Sa02: 100% on RA. Sat upright on stretcher, legs dangling. 1044: BP 91/58, HR: 70, RR: 16 nonlabored, SaO2: 100% on RA, feeling well, drank 2 apple juice cups, standing up. 1049: standing up BP: 84/46, HR: 62, RR: 16 nonlabored, SaO2: 100% on RA. 1100: Pt feeling well, no c/o, escorted to front door of hospital, father at side. Pt aware to drink fluids today and especially during menses. Pt is also a dancer and practices every day. Discussed hydration needs prior to discharge from vaccine clinic. Pt aware to discuss vasovagal response from this injection at next visit so pt can lay down.

Other Meds:

Current Illness:

ID: 1268430
Sex: M
Age: 38
State: FL

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

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: PATIENT RECEIVED A PFIZER COVID-19 VACCINE THAT WAS LEFT OUTSIDE OVER NIGHT PASSED THE 6 HOURS EXPIRATION DATE. NO ADVERSE EFFECTS REPORTED

Other Meds:

Current Illness:

ID: 1268431
Sex: F
Age: 85
State: NC

Vax Date: 02/10/2021
Onset Date: 02/28/2021
Rec V Date: 04/28/2021
Hospital: Y

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

Lab Data:

Allergies: NKA

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

Symptoms: Pt awoke on 02/28/2021 with increased lower extremity edema went to Urgent care had CXR and was told to increase Lasix to 40 mg daily for 4 days. Swelling became worse over next 2 days and patient became short of breath and on 03/02/2021 she went to Hospital and had a CT scan of chest which showed a pulmonary embolus and a bilateral lower extremity ultrasound which showed a right femoral DVT and popliteal occlusive thrombus and a posterior tibial and peroneal vein occlusive thrombus. She was started on Lovenox and admitted to the hospital . she was discharged on 03/05/2021 and had a right femoral thrombectomy as an outpatient on 03/ 08 2021 with complete resolution . She was discharged home on Lovenox and later switched to Eliqus. She is home and doing well at time ofreport.

Other Meds: Metformin 1000 mg daily, Lasix 20 mg daily , Losartan 100 mg daily

Current Illness:

ID: 1268432
Sex: F
Age: 26
State: ID

Vax Date: 03/31/2021
Onset Date: 03/31/2021
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: none known

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

Symptoms: Patient experienced vertigo and nausea after returning home following receiving the vaccine. Arm swelled noticeably and stayed swollen for 14 days. Three days after the vaccine administration she developed a large bump on the back of her head, which her doctor told her was a swollen lymph node. She experienced nausea for up to 9 days after receiving the vaccine.. She currently is being evaluated for a rheumatoid condition due to chronic joint pain, which she has had for an unspecified time prior to receiving the vaccine. According to the patient her doctor considers this an immune reaction to the shot, possibly related to an overactive immune condition. Today, 29 days after receiving the vaccine the patient says she has recovered completely but her doctor recommends she not receive the second shot.

Other Meds: none known

Current Illness: none reported

ID: 1268433
Sex: F
Age: 33
State: TX

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: Nope

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

Symptoms: Fever, chills...body aches...nerve pains all after 8 or 830pm monday ...and all day tuesday....

Other Meds:

Current Illness: None

ID: 1268434
Sex: F
Age: 53
State: PA

Vax Date: 04/11/2021
Onset Date: 04/14/2021
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:

Symptom List: Vomiting

Symptoms: HIVES ALL OVER HER BODY

Other Meds:

Current Illness:

ID: 1268435
Sex: F
Age: 20
State: WI

Vax Date: 04/20/2021
Onset Date: 04/20/2021
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: none

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: headache started 1 hour after shot persistent x 8 days no history headaches

Other Meds: none

Current Illness: none

ID: 1268436
Sex: F
Age: 24
State: FL

Vax Date: 04/14/2021
Onset Date: 04/14/2021
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: N/A

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

Symptoms: - Pain in palm of left hand immediately after receiving the injection - Left shoulder/trap pain starting a few hours after injection that continued throughout the night. Couldn?t sleep on left side. Full pain by left shoulder blade too. Symptoms lasted for about a day or two. - On eighth day after the injection I noticed stinging pain in the palm of my left hand, and also pain in my left elbow going down to center of my palm, pinky finger, and ring finger. Fingers/hand felt weak like I couldn?t grasp anything. Elbow felt like I hit my ?funny bone? with shooting pain down by forearm. Upper shoulder felt okay.

Other Meds:

Current Illness: N/A

ID: 1268437
Sex: F
Age: 59
State: TN

Vax Date: 04/24/2021
Onset Date: 04/24/2021
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: Error: Incorrect Reconstitution

Other Meds:

Current Illness:

ID: 1268438
Sex: F
Age: 41
State: GA

Vax Date: 04/20/2021
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: RA

Lab Data:

Allergies: No known allergies

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

Symptoms: Bright red, firm irritated area on right arm around injection site. Approximately 2 x 2 1/2?.

Other Meds: Multivitamin Vitamin B Creon Welchol Vitamin D Ibuprofen Started doxycycline on 4/21 for eyelid irritation/infection that began on 4/1

Current Illness: Eyelid irritation/possible infection

ID: 1268439
Sex: F
Age: 24
State: NH

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: none listed

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

Symptoms: Pt received first dose of Covid-19 vaccine 03/26/2021. Pt returned 4/28/21 to get second Covid shot. Approximately 10 minutes later pt states not feeling well, feeling dizzy. RPH took blood pressure using automatic blood pressure machine. After erroring out, got a reading of 80/58, pulse 45. Pt was given a soda at her request as she stated thought her blood sugar might be low. Went to repeat bp monitor approximately 5 minutes later with error (erratic reading). 911 was called.

Other Meds: oral contraceptive (couldn't remember name), Claritin OTC

Current Illness: None listed

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm