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: 1277985
Sex: M
Age: 33
State: IN

Vax Date: 04/29/2021
Onset Date: 04/30/2021
Rec V Date: 05/01/2021
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: Z-pak

Symptom List: Dysphagia, Epiglottitis

Symptoms: Headache, chest tightness, chills, sensitive to touch

Other Meds: Bupropion

Current Illness:

ID: 1277986
Sex: M
Age: 30
State: IN

Vax Date: 04/29/2021
Onset Date: 04/30/2021
Rec V Date: 05/01/2021
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: Amoxicillin and penicillin

Symptom List: Anxiety, Dyspnoea

Symptoms: Chills, achey, minor fever, lethargy. Symptoms lasted about 12 hrs after 1st shot and 24 hrs after 2nd shot.

Other Meds: NA

Current Illness: NA

ID: 1277987
Sex: F
Age: 57
State:

Vax Date: 04/27/2021
Onset Date: 04/28/2021
Rec V Date: 05/01/2021
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: Penicillamine Sulfamethoxazole Cipro Levaquin Keflex

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

Symptoms: Vein protruding, extreme arm pain and swelling, high fever, sensitivity to touch

Other Meds:

Current Illness:

ID: 1277988
Sex: M
Age: 76
State: FL

Vax Date: 04/17/2021
Onset Date: 04/18/2021
Rec V Date: 05/01/2021
Hospital:

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

Lab Data:

Allergies: No

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Complained arm with vaccine hurt. Went to bed. Made a large noise which woke me at around 1:30 am. I found him unresponsive with wound on his forehead. Called paramedics. Took to hospital and then to rehab.

Other Meds: Levothyroxin, amlopine, aspirin, atorvastin, carvedilol, glippizide, insulin, lactobacillus, levetiracetam, losartan, pantoprazole, spironnolactone.

Current Illness: None

ID: 1277989
Sex: M
Age: 60
State: HI

Vax Date: 02/25/2021
Onset Date: 03/03/2021
Rec V Date: 05/01/2021
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 as I know

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

Symptoms: I experienced dizziness lasting for several minutes several times on several days after I received the first dose of vaccines. It happened after several days from Feb 25, 2021. However I did not experience dizziness after taking second dose of the same vaccine type on March 18, 2021.

Other Meds: Oyster Shell Calcium Vitamin D Tablet and Ammonium Lactate Lotion

Current Illness: None other than lack of enough sleep

Date Died: 05/01/2021

ID: 1277990
Sex: F
Age: 68
State: PA

Vax Date: 04/29/2021
Onset Date: 05/01/2021
Rec V Date: 05/01/2021
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: Patient passed away, was notified by Coroner

Other Meds:

Current Illness:

ID: 1277991
Sex: F
Age: 60
State: IL

Vax Date: 05/01/2021
Onset Date: 05/01/2021
Rec V Date: 05/01/2021
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: PCN

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: C/o facial fullness, jaw/facial heaviness, dizziness, and slight speech slurring 5 mins after vaccine. No CP, SOB, dyspnea, blurry vision, HA, redness, swelling, rash noted. A&O x 4, able to speak full sentences. VS stable: 88. 97%, 144/86, BS: 116. EKG: NSR. Neuro exam normal, muscle strength intact, facial symmetry, no facial droop noted. Advised pt to transport to hospital but pt refused transport. Observed for total 45 mins.

Other Meds: None

Current Illness: None

ID: 1277992
Sex: F
Age: 37
State: IN

Vax Date: 04/29/2021
Onset Date: 04/30/2021
Rec V Date: 05/01/2021
Hospital:

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

Lab Data:

Allergies: Anything in the "mycin" family, lortabs, percocet, darvocet, and tramadol. All cause nausea and vomiting.

Symptom List: Pharyngeal swelling

Symptoms: Fever, chills, body aches, extreme fatigue, migraine, nausea, and inappetance. Lasted about 1 day, used Tylenol at home to keep fever down. By the next morning, only had slight fatigue and minor headache.

Other Meds: Dexilant

Current Illness: None

ID: 1277993
Sex: F
Age: 36
State: OH

Vax Date: 04/30/2021
Onset Date: 04/30/2021
Rec V Date: 05/01/2021
Hospital:

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

Lab Data:

Allergies: yes - has had allergic reaction to other drugs

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: about 5 minutes after receiving vaccine pt developed hives, scratchy throat, felt like throat was closing, coughing

Other Meds: synthroid, spirolactone

Current Illness: no

ID: 1277994
Sex: F
Age: 71
State:

Vax Date: 04/30/2021
Onset Date: 05/01/2021
Rec V Date: 05/01/2021
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: Headache, body aches

Other Meds:

Current Illness:

ID: 1277995
Sex: M
Age: 49
State: IN

Vax Date: 04/01/2021
Onset Date: 04/30/2021
Rec V Date: 05/01/2021
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: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: Fever 103 3hrs, 101-102 18hrs, severe muscle and joint aches. Symptoms decreasing at 48hrs.

Other Meds: Otc fish oil, vitamin D

Current Illness: None

ID: 1277996
Sex: F
Age: 62
State: DC

Vax Date: 04/28/2021
Onset Date: 04/29/2021
Rec V Date: 05/01/2021
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: Starting on Thurs. April 29th @ 4:50am I had aches all over body, headache, a slight fever 98.7 (normal is 97.3), diarrhea and nauseousness. I slept off and on throughout the day as my energy level was quite low. These symptoms continued throughout the day and into the evening. at 4:50am I began taking 2 Tylenol every 6 hours. Fri. April 30th my temperature had returned to normal and my aches and pains had to diminished slightly however I still had some diarrhea and nauseousness and my headache was constant. I continued taking Tylenol every 6 hours. My energy level was a little better but not at 100% more like 65%. Sat. May 1st my temperature is normal and I have very few aches and pains however I still have diarrhea, some nauseousness and a constant headache. I didn't take any Tylenol however my headache was too much so I took 2 Tylenol at 2pm EDT. My energy level is at 85% today. I am not too sure if my continued diarrhea, some nauseousness and a constant headache are side effects from my Wed. April 28th 2nd Pfizer vaccine shot. If my diarrhea, some nauseousness and a constant headache continue throughout the weekend I need to talk to a medical profession on what I should do.

Other Meds: Diabetes meds: Metformin 500MG ? 2 at breakfast, 1 at lunchtime, 2 at dinner Pioglitazone (Actos Generic Brand) 15mg ? 1 at breakfast Basaglar (insulin glargine rDNA origin) injection ? 6 to 8 units at bedtime Sleeping/Anxiety: Seroq

Current Illness: None

ID: 1277997
Sex: F
Age: 58
State: IN

Vax Date: 04/20/2021
Onset Date: 04/30/2021
Rec V Date: 05/01/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Fever, fatigue

Other Meds: Thyroid medication & hormones

Current Illness: None

ID: 1277998
Sex: F
Age: 55
State: TX

Vax Date: 04/29/2021
Onset Date: 04/30/2021
Rec V Date: 05/01/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Menstrual cycle very heavy bleeding and clotting. light headed

Other Meds: None

Current Illness:

ID: 1277999
Sex: F
Age: 38
State: PA

Vax Date: 05/01/2021
Onset Date: 05/01/2021
Rec V Date: 05/01/2021
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: fainted, sweating- hx: fainting at site of needles per mom

Other Meds: unknown

Current Illness:

ID: 1278000
Sex: F
Age: 26
State: NY

Vax Date: 04/27/2021
Onset Date: 04/29/2021
Rec V Date: 05/01/2021
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 amoxicillin bactrum azithromycin zithromax

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

Symptoms: Roughly 50 painless mouth blisters, all over inside of lips, cheeks, and palate. Extremely sore throat (nasopharynx) that inhibits eating, drinking, yawning, and sleeping. Went to urgent care and got a cream and gargle, but neither help my throat.

Other Meds: Combo birth control, multivitamin, magnesium

Current Illness: None

ID: 1278001
Sex: F
Age: 63
State: MI

Vax Date: 04/21/2021
Onset Date: 05/01/2021
Rec V Date: 05/01/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient's family member called the pharmacy today regarding the patient having redness at the site of the vaccination, itchy and swollen. No other associated symptoms. Will follow up with the patient on Monday. Patient took Zyrtec and will use hydrocortisone cream at the injection site area if still itchy.

Other Meds:

Current Illness:

ID: 1278002
Sex: F
Age: 25
State: GA

Vax Date: 04/30/2021
Onset Date: 05/01/2021
Rec V Date: 05/01/2021
Hospital:

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

Lab Data:

Allergies: No

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Lump in my neck on the left site. One is small from the first injection. The second lump is larger from the second injection and a tad sensitive and painful.

Other Meds: No

Current Illness: No

ID: 1278003
Sex: F
Age: 37
State: TX

Vax Date: 04/19/2021
Onset Date: 04/20/2021
Rec V Date: 05/01/2021
Hospital:

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

Lab Data:

Allergies: shrimp. mites, dust

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: constant headeach for 9 days

Other Meds: levothyroxine 85mcg

Current Illness: none

ID: 1278005
Sex: F
Age: 58
State: CA

Vax Date: 03/31/2021
Onset Date: 04/06/2021
Rec V Date: 05/01/2021
Hospital:

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

Lab Data:

Allergies: codeine

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

Symptoms: On 4/6/2021, one week after first vaccine with Moderna, extreme skin sensitivity developed (without a rash) on upper left leg, near groin. About a week later, 4/12/2021, a rash of raised, red bumps appeared at site of skin sensitivity. It was diagnosed as shingles by NP on 4/13/2021. A 7-day course of antiviral medication was prescribed. After a week of medication, the rash lessened and skin sensitivity stopped.

Other Meds: Vitamins: C, D3, Omega 3, Zinc, Selenium

Current Illness:

ID: 1278006
Sex: F
Age: 53
State: WA

Vax Date: 04/22/2021
Onset Date: 04/22/2021
Rec V Date: 05/01/2021
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: Codeine, Pollen, Mold

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

Symptoms: Patient developed severe nausea/vomiting the night of the vaccine administration, then was diagnosed with aspiration pneumonia four days later and is being treated with antibiotics.

Other Meds: Larin FE 24 (oral contraceptive) 1 daily Buproprion XL 300 mg daily

Current Illness: None

ID: 1278007
Sex: F
Age: 18
State: CA

Vax Date: 05/01/2021
Onset Date: 05/01/2021
Rec V Date: 05/01/2021
Hospital:

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

Lab Data:

Allergies: NKA

Symptom List: Unevaluable event

Symptoms: Pt is a 18 yo F. Came for 1st dose of Moderna vaccination. Pt had an episode of Vasovagal (syncoy) reaction at 10:55 about 10 minutes after being vaccinated. Episode lasted for about 4 seconds, this nurse lay her down for 5 minutes on the bed and elevated her leg, took vitals while lying down ( 107/68 72 99% RA 18), then have her sit for another 5 minutes (113/68 71 100% RA 16) water was given. Pt recovered without difficulties, ER precaution given, pt acknowledge understanding. Pt was observed for another 15 minutes, and showed no symptom, then was let go

Other Meds: Water.

Current Illness: N/A

ID: 1278008
Sex: F
Age: 60
State: CA

Vax Date: 04/15/2021
Onset Date: 04/17/2021
Rec V Date: 05/01/2021
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: None

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

Symptoms: I have been extremely and unusually fatigued since the 2nd vaccine. I was walking approx 10 -12 miles a week and now am lucky if I walk 4. I need to rest/nap constantly and have a constant headache. I have never had headaches like this prior to 2nd vaccine.

Other Meds: Enhertu IVIG Curcumin, Complex B, Vit D, Vit C, Turkey Tail mushroom extract, green tea extract, saffron, 5-Loxin, iCaps,

Current Illness: Metastatic breast cancer

ID: 1278009
Sex: M
Age: 45
State: NY

Vax Date: 04/30/2021
Onset Date: 04/30/2021
Rec V Date: 05/01/2021
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: Patient answered no at time of vaccination

Symptom List: Injection site pain, Pain

Symptoms: Patient complained of shortness of breath shortly after receiving the vaccine. After 15 minutes patient complained increased shortness of breath and requested transportation to Hospital ER. Patient left the facility with consistent V/s's but feeling much worst per Dr.'s note. Patient sent to ER by ambulance stationed on site. EMS at this facility assisted the MD and transported the patient to the ER.

Other Meds: Unknown

Current Illness: Underline condition

ID: 1278010
Sex: F
Age: 42
State: PA

Vax Date: 04/03/2021
Onset Date: 04/03/2021
Rec V Date: 05/01/2021
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 Known

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient was sitting in observation and after 5 mins patient began c/o itching of neck. Upon exam patient exhibited urtacaria of neck and chest. Patient denied any difficulty breathing or shortness of breath. LS:CTAx4, VS: 132/68, RR:16, HR:92, SPO2: 99% on room air. Patient was given Benadryl 50mg IM in Left Deltoid. Patient was reassesed at 5 mins post benadryl administration with relief of itching and urtacaria still present. Patient still denied difficulty breathing. @ 10 mins patient had complete relief of symptoms. Patient stayed additional 10 mins w/o incident. Patient instructed to follow up with physician or call 9-1-1 in case of emergency.

Other Meds: NONE

Current Illness: None

ID: 1278011
Sex: F
Age: 37
State:

Vax Date: 04/30/2021
Onset Date: 04/30/2021
Rec V Date: 05/01/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: redness to skin, slight rash near injection site, dizziness, given zyrtec 10 mg PO observed for additional 20 mins

Other Meds:

Current Illness:

ID: 1278012
Sex: F
Age: 21
State: IN

Vax Date: 04/29/2021
Onset Date: 04/30/2021
Rec V Date: 05/01/2021
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: N/A

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: The top layer of my skin came off in a quarter-sized chunk while removing the bandage from the vaccine (muscle NOT visible). Clear, yellow liquid has been leaking out of the area. I cleaned the area with an antiseptic wipe, applied a topical triple antibiotic ointment, and applied a bandage.

Other Meds: N/A

Current Illness: None

ID: 1278013
Sex: M
Age: 19
State: IN

Vax Date: 04/29/2021
Onset Date: 04/30/2021
Rec V Date: 05/01/2021
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: Extremely Soar upper arm where vaccine was injected.

Other Meds:

Current Illness:

ID: 1278014
Sex: F
Age: 60
State: CA

Vax Date: 04/29/2021
Onset Date: 04/30/2021
Rec V Date: 05/01/2021
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: Allergic to Apples/Pears

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

Symptoms: About 10 hours after 2nd dose of Pfizer COVID19 vaccine I developed a fever which spiked at about 102 couple hours later and went down to about 99-100 for about another 24 hours. Today (2 days after 2nd dose) I am feeling fine.

Other Meds: daily vitamin, vitamin, biotin supplement

Current Illness: none

ID: 1278015
Sex: M
Age: 62
State: MI

Vax Date: 05/01/2021
Onset Date: 05/01/2021
Rec V Date: 05/01/2021
Hospital:

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

Lab Data:

Allergies: PCN feldine

Symptom List: Nausea

Symptoms: headache started about 45 min after shot, laid down on couch (at home) and fell asleep (30 min +/-) when awoke tongue felt a little thick, drank water then tongue felt sore on top and "hairy", but a lot less thick. headache subsiding. tongue top still sore 4 hours later

Other Meds: multi-vitamin glucosamine/chondroitin amlodipine/besylate 5mg

Current Illness:

ID: 1278016
Sex: M
Age: 63
State: PA

Vax Date: 05/01/2021
Onset Date: 05/01/2021
Rec V Date: 05/01/2021
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, seasonal allergies

Symptom List: Injection site pain

Symptoms: pale, diaphoretic, flushed

Other Meds: Allopurinol - Gout

Current Illness: NONE

ID: 1278017
Sex: F
Age: 53
State: UT

Vax Date: 04/03/2021
Onset Date: 04/03/2021
Rec V Date: 05/01/2021
Hospital:

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

Lab Data:

Allergies: penicillin, shell fish

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

Symptoms: Rash. swelling in legs, couldn't swallow and started to have trouble breathing

Other Meds: oxycodone, and antibiotics

Current Illness: reactions to the first vaccination

ID: 1278018
Sex: F
Age: 29
State: GA

Vax Date: 04/21/2021
Onset Date: 04/23/2021
Rec V Date: 05/01/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Redness around vaccination site along with a lump at injection site started 4-23, but had gone away by 4-25, but redness and lump reappeared 4-29 along with slight itching and heat in the area of the injection site

Other Meds:

Current Illness:

Date Died: 04/21/2021

ID: 1278019
Sex: M
Age: 86
State: NY

Vax Date: 03/16/2021
Onset Date: 04/09/2021
Rec V Date: 05/01/2021
Hospital: Y

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

Lab Data:

Allergies: none

Symptom List: Tremor

Symptoms: On 4/9/2021 patient suffered from a Hemorragic Stroke on the left side of the brain making him unable to move his right leg and toes, right arm and hand, slight droop of right lip, and responding mostly in one word answers with delays at times. He was hospitalized in the am hours, sent to ER and then to Neuro ICU for 3.5 days and then moved onto a neuro floor for 1.5 days. On 4/13/2021 he was transported to an acute rehabilitation center to receive OT, PT and Speech Theraphy. On 4/19/2021 patient suffered from Ischemic Stroke on the right side of the brain, he became unresponsive. He was intubated on 4/19/2021, placed into ICU and was removed from intubation, due to poor life outcome from the 2 strokes having affected his body, on 4/21/2021.

Other Meds: Warfarin SOD 2.5 mg Tablets 1x/day at bedtime Bayer Baby Aspirin 1x/day after breakfast Metoprolol ER Succinate 25 mg 1x/day after breakfast Pravastatin 10 mg Tablets 1x/day after breakfast Tamsulosin 0.4 mg Capsules 1 before dinner Finaste

Current Illness: none

ID: 1278020
Sex: F
Age: 48
State:

Vax Date: 04/01/2021
Onset Date: 04/30/2021
Rec V Date: 05/01/2021
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: Nickle allergy

Symptom List: Erythema, Pruritus

Symptoms: After 12 hours a headache started, which continued for the next 12 hours, plus tiredness. About 28 hours after the shot also started a slight fever. All symptoms gone the 2nd morning after the shot.

Other Meds: Women multi-vitamin, magnesium, vitamin D, Vitamin B-12, Bupropion,

Current Illness: None

ID: 1278021
Sex: F
Age: 42
State: PA

Vax Date: 04/30/2021
Onset Date: 04/30/2021
Rec V Date: 05/01/2021
Hospital:

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data:

Allergies: None Known

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

Symptoms: Patient was sitting in observation and after 5 mins patient began c/o itching of neck. Upon exam patient exhibited urtacaria of neck and chest. Patient denied any difficulty breathing or shortness of breath. LS:CTAx4, VS: 132/68, RR:16, HR:92, SPO2: 99% on room air. Patient was given Benadryl 50mg IM in Left Deltoid. Patient was reassesed at 5 mins post benadryl administration with relief of itching and urtacaria still present. Patient still denied difficulty breathing. @ 10 mins patient had complete relief of symptoms. Patient stayed additional 10 mins w/o incident. Patient instructed to follow up with physician or call 9-1-1 in case of emergency. This is the correct report has wrong date of 4/3/21; i

Other Meds: NONE

Current Illness: None

ID: 1278023
Sex: F
Age: 26
State: CA

Vax Date: 04/28/2021
Onset Date: 04/28/2021
Rec V Date: 05/01/2021
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: Received her first dose Pfizer vaccine (LOT#: EW0179 EXP: 8/2021) at 0949 on 4/28/21. Patient alerted, EMT that she was feeling lightheaded and felt like she had very heavy eyes. Patient also started feeling increasing chest pain deep in sternal region. EMT alerted, PHN and another PHN. PHN's arrived on scene. PHN asked EMT to take vital signs at 0955. BP: 68/40, pulse: 61, O2:98%. Patient stated that her chest was increasingly hurting and quickly became a 10/10. Patient became ANOX1 quickly. PHN activated EMS. EMS arrived on scene at 1010. Paramedics started treatment. Patient received IV, EKG, blood/glucose test). Patient was routinely assessed by paramedics. Paramedics took the patients BP. BP: 95/50 and then 88/53. Patient left vaccination site on gurney with paramedics at 1028.

Other Meds:

Current Illness:

ID: 1278024
Sex: F
Age: 79
State: FL

Vax Date: 04/01/2021
Onset Date: 05/01/2021
Rec V Date: 05/01/2021
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: Severe arthritis flare, severe soft tissue pain whole body, unable to get out of bed or chair by myself lasting 3 weeks untill able to get on Prednisone

Other Meds: Balsalazide Fish oil Entyvio infusion Vitamin D Calcium pilll

Current Illness:

ID: 1278025
Sex: F
Age: 36
State: NY

Vax Date: 04/30/2021
Onset Date: 04/30/2021
Rec V Date: 05/01/2021
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:

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

Symptoms: headache, body chills, tiredness one day

Other Meds:

Current Illness:

ID: 1278026
Sex: F
Age: 37
State: MD

Vax Date: 04/29/2021
Onset Date: 04/30/2021
Rec V Date: 05/01/2021
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: Adhesive

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

Symptoms: Palm size redness that's hot, lightly tender to the touch, swollen, and larger in size on the 2nd day. Marked the outside of the redness to see if there is change. Heat pack and Aleve.

Other Meds: Aleve Vitamin D Magnesium

Current Illness: None

ID: 1278027
Sex: M
Age: 20
State: IN

Vax Date: 04/29/2021
Onset Date: 04/29/2021
Rec V Date: 05/01/2021
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: Fever of 100 F, whole body aches, nausea, chills, sweats, inability to sleep

Other Meds:

Current Illness:

ID: 1278028
Sex: F
Age: 54
State: MD

Vax Date: 05/01/2021
Onset Date: 05/01/2021
Rec V Date: 05/01/2021
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: C/O feeling "light headed" Pt. discharged at 14:25 on 5/1/2021 EMS-recorded by RN

Other Meds:

Current Illness:

ID: 1278029
Sex: F
Age: 42
State: IN

Vax Date: 04/29/2021
Onset Date: 04/29/2021
Rec V Date: 05/01/2021
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: Arm soreness and mild nausea set in that evening. The next day, also had muscle aches, joint aches, mild headache, chills, and very low grade fever. Took 2 ibuprofen and slept for 2.5 hrs that evening. All symptoms but arm soreness were gone in 24 hrs. No effects from 1st vaccine.

Other Meds: Syeda

Current Illness:

Date Died: 05/01/2021

ID: 1278030
Sex: M
Age: 27
State: VA

Vax Date: 04/27/2021
Onset Date: 04/30/2021
Rec V Date: 05/01/2021
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: No known food or medication allergies

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

Symptoms: 27 year old male with Down's Syndrome and no other past medical history received second COVID-19 vaccine on 4/27/2021. On 4/30/2021 began "feeling poorly" with nausea/vomiting and possible chest discomfort. Originally presented to ED on morning of 4/30 - EKG completed demonstrated diffused ST elevation. Patient was transferred to Medical Center for heart catheterization. Left heart catheterization demonstrated normal coronary arteries and LVEDP of 25. Stat ECHO demonstrated pericardial effusion and concern raised for myopericarditis. Patient subsequently transferred to a different Medical Center for higher level of care. Upon arrival to Medical Center plan was to intubate and take to cath lab for heart biopsy and PA catheter placement. However, upon intubation patient began to decompensate and subsequently developed cardiac arrest. During ACLS, VA ECMO was placed and therapeutic hypothermia was initiated. Following VA ECMO placement patient received IVIG, high dose methylprednisolone (1000 mg), anakinra 100 mg, and broad spectrum antibiotics (vancomycin and Zosyn). Despite these efforts the patient continued to have hemodynamic instability and was on high dose vasopressors (epinephrine, norepinephrine, dopamine, angiotensin II, vasopressin). Patient subsequently suffered another cardiac arrest, briefly regained pulse with high dose vasopressors, but subsequently lost pulse despite best efforts and died on 5/1/2021 at approximately 13:00.

Other Meds: None

Current Illness: None

ID: 1278031
Sex: F
Age: 29
State: UT

Vax Date: 05/01/2021
Onset Date: 05/01/2021
Rec V Date: 05/01/2021
Hospital:

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

Lab Data:

Allergies: NONE

Symptom List: Vomiting

Symptoms: A FEW MINUTES AFTER ADMIN, PATIENT STARTED FEELING BAD AND PASSED OUT 3 TIMES. I GAVE HER WATER WHICH SEEMED TO HELP BETWEEEN EACH EPISODE. HER EYES SEEMED TO ROLL BACK AND SHE TWICHED SLIGHTLY BUT CAME BACK. HER ARM DID BLEED A LITTLE SO I CLEANED AND PLACED ANOTHER BANDAGE ON HER ARM. PATIENT WAS FEELING BETTER AND SHE WENT HOME WITH HER SIGNIFICANT OTHER.

Other Meds: N/A

Current Illness: NONE

ID: 1278032
Sex: F
Age: 57
State: NY

Vax Date: 04/27/2021
Onset Date: 04/28/2021
Rec V Date: 05/01/2021
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: April-28-2021 around 9:21am woken up to nauseous headache right side joint pain left arm neck shoulder dizziness weakness heart was beating fast. Been very tired.

Other Meds: None

Current Illness: C. L. L

ID: 1278033
Sex: F
Age: 28
State: PA

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

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

Symptoms: got lightheaded , patient laid down on the floor. We observed the patient .We took vitals at 2:38 pm heart rate 80, o2 98 and BP 128/80. We asked how he was feeing and he states that he was feeling back to himself so we left him leave.

Other Meds: no

Current Illness: no

ID: 1278034
Sex: F
Age: 42
State: NC

Vax Date: 04/30/2021
Onset Date: 05/01/2021
Rec V Date: 05/01/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Painful, warm, red swollen knot at injection site.

Other Meds: Trazodone, buspirone, metaprolol, Prozac, clonazepam (as needed), vyvanse

Current Illness: None

ID: 1278035
Sex: F
Age: 32
State: CO

Vax Date: 03/28/2021
Onset Date: 03/28/2021
Rec V Date: 05/01/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

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

Symptoms: extreme fatigue, ringing in the ears, mouth ulcers, stomach pain, chronic prolonged headaches, vertigo, nausea, loss appetite, change in menstrual cycle, drop in blood placets, unable to resume normal life

Other Meds: Tylenol occasionally....

Current Illness: none

ID: 1278036
Sex: F
Age: 42
State: MN

Vax Date: 05/01/2021
Onset Date: 05/01/2021
Rec V Date: 05/01/2021
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: diflucan, dilaudid, percocet, senna, respberries

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

Symptoms: Patient received her first COVID-19 (Pfizer) dose at approximately 1100. Because she reported a history of allergies to medications and raspberries, she was asked to stay in clinic for 30 minutes following her vaccination. About 20 minutes after her vaccination, she told the RN her throat was feeling "spongy" and tight. She also reported a racing heart and feeling faint. Recommended she go down the hall to the ED and escorted her there. and got her checked into the ER. She did report worsening throat tightening upon arrival to the ED.

Other Meds: cymbalta, lamictal, ativan, ibuprofen, advair on medication list

Current Illness: none

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm